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Aim: Healthcare professionals will set an example to society with their behaviors about Traditional and Complementary Medicine usage. We aimed to investigate and compare the knowledge and attitudes of society and physicians about Traditional and Complementary Medicine to create an infrastructure for medical training. Methods: In this cross-sectional descriptive study "Turkish Version of Complementary, Alternative and Conventional Medicine Attitude Scale" was used for data collection. Results: A total of 392 physicians and 438 citizens participated in the study. Among all participants, 36.9% had used a Traditional and Complementary Medicine method before and the most used method was phytotherapy. There was a significant difference between groups in terms of the level of knowledge. Surprisingly no significant difference was found between physicians and the public in the "Dissatisfaction with Modern Medicine" subgroup. Conclusion: Although there were differences in the level of knowledge between the public and physicians, it was seen that the behavioral patterns were similar to each other. This situation suggests that physicians are also influenced by the society they live in, rather than scientific data, in their decisions about Traditional and Complementary Medicine. Being as a role model to the public, physicians are responsible for providing evidence-based answers to questions about Traditional and Complementary Medicine and should receive adequate training about methods. Keywords: complementary medicine, therapeutic use, evidence-based practice, knowledge, physicians

Aim: This study aims to research the association of metabolic syndrome components with anthropometric measurements like arm circumference, neck circumference, hip circumference, waist-hip ratio, and waist-to-height ratio, which are applied rarely. Methods: This cross-sectional study was conducted with 292 patients in November-December 2019. The arm circumference, neck circumference, waist circumference, hip circumference, waist-hip ratio, waist-to-height ratio, and body mass index measurements of the patients were made. Glucose, high-density lipoprotein, low-density lipoprotein, systolic, and diastolic blood pressure measurements were also recorded. The association between metabolic syndrome components and anthropometric measurements was analyzed. Results: Metabolic syndrome is diagnosed in 32.8% of the participants. According to body mass index, 18.6% of the patients were normal, 34.2% were overweight, and 47.2% were obese. There was a significant difference between the patients with and without metabolic syndrome in terms of laboratory parameters, blood pressure values, and anthropometric measurements. In the diagnosis of metabolic syndrome, optimal cut-off values for arm circumference, neck circumference, hip circumference, waist-hip ratio, and waist-to-height ratio were determined as 31.75 (AUC=0.703), 34.85 (AUC=0.763), 113.75 (AUC=0.757), 0.90 (AUC=0.701), 0.61 (AUC=0.769) for females while they were 35.75 (AUC=0.573), 39.75 (AUC=0.795), 111.5 (AUC=0.607), 0.96 (AUC=0.888), 0.61 (AUC=0.888) for males respectively. Conclusion: A significant correlation was detected between arm circumference, neck circumference, hip circumference, waist-hip ratio, and waist-to-height ratio, and metabolic syndrome components. However, low-density lipoprotein was not correlated with neck circumference and high-density lipoprotein with waist-to-height ratio. Keywords: metabolic syndrome, anthropometric measurement, body mass index, obesity, lipid profile

Objectives: Anti-osteoporotic drugs (AOD) are essential for secondary prevention of osteoporotic fracture (OF) in patients with established osteoporosis. However, data about AOD utilization rates are scarce among patients with OF. This study was therefore aimed at determining the AOD utilization rates among those particularly vulnerable patients. Materials and Methods: This cross-sectional study followed the medical records of patients with OF starting from their first OF diagnosis date. Each patient’s preventive osteoporosis treatments (vitamin D, calcium+vitamin D) and AOD utilization rate were recorded for a 12-month period following OF diagnosis. Results: A total of 210 patients (168 females, mean age: 67.8±11.9 years; 42 males, mean age 62.4±16.1 years) were enrolled in the study. Of these, 65.7% (n=138) did not use any medication for primary protection against osteoporosis before OF diagnosis. The ratio of patients not using any type of medication for secondary prevention after OF increased from 26.5% to 51% during a 12-month period. In addition, by one year following diagnosis, AOD usage rate had decreased from 62.3% to 41.3%. Conclusion: The AOD usage rates for secondary prevention of OF were insufficient, and cessation rates were high. Identification of factors associated with decreased AOD utility rates will provide important information for guiding patient follow-up in order to reduce the occurrence of OF.

Introduction. In this study we aimed to determine whether a difference in complications between smok­ers and non-smokers exists in type 2 diabetes mellitus (T2DM) and to evaluate if there is a correlation between microvascular complications and Fagerstrom test score. Material and methods. Patients with T2DM who at­tended the family medicine outpatient clinics were enrolled in the study. Smokers and non-smokers were compared according to their metabolic outcomes and presence of microvasculer complications. The level of smoking addiction was determined by Fagerstrom Test for Nicotine Dependence. Results. Fasting blood glucose (FBG), low-density lipoprotein, systolic and diastolic blood pressures were found to be higher in smokers. The presence of neuropathy was significantly higher in smokers. The presence of retinopathy rate increased with increasing level of smoking addiction. The nicotine dependence test score were found to be positively correlated with HbA1c and FBG levels whereas, negatively correlated with body mass index among smokers. Conclusions. Assessing the cigarette smoking status of diabetic patients at the initial clinic visit and indicating the importance of smoking cessation should be the essential part of diabetes follow up program.

Objective : Although cervical cancer is common, because of the presence of pre-invasive lesions and due to the fact that the cervix is an easily accessible organ, it is an appropriate disease for early diagnosis, prevention, treatment and even eradication. We aimed to evaluate the results of HPV-DNA screening program in women between the ages of 30-65 in a primary care setting and to make recommendations for preventable risk factors. Method: In this cross-sectional descriptive study we evaluated the records of 716 women 30-65 years old who scanned for HPV between 2014-2016 in a primary health care center. In the evaluation of data obtained, descriptive statistical methods and chi square test were used. Results: The average age of women included in the study was 44,11 ± 9,25, 97.1% were married; the age of first sexual intercourse was minimum 13 maximum 34 (mean 19,76 ± 3,67). Of women 20,81% smoked in various amounts, and 26,68% of them used hormonal contraceptives for varying periods of time. HPV-DNA (+) was found in 19 (2.65%) of the women. Of these, 7 (1%) were HPV-16. Conclusion: In our study, however the positive rate of HPV-DNA is lower than the studies done in Turkey and abroad, the high-risk HPV genotype-16 ratio was higher. We concluded that HPV vaccination, condom use and regular gynecological examination rates are inadequate in women which we included in our study and this may be due to economic reasons as well as socio-cultural factors.

Aim: The aim of this study is to reveal the knowledge, attitude and behaviors of the university students about Hepatitis A, Hepatitis B and Hepatitis C. Methods: This study was done among 1048 students from different faculties of five different universities in Ankara, was carried out between October 2012 and July 2013. A questionnaire was prepared by the authors by rewieving the literature and the participants were asked to fill this questionnaire. Knowledge level of participants was scored from 1 to 5 out of 100 according to the answers given about Hepatitis A, B and C. Results: When the average points of knowledge about hepatitis A, B and C is considered, it is seen that the knowledge points of males according to females and the knowledge points of the students who study in medical faculties according to the other faculties are higher. Participants were found to have a risky attitude with respect to the spread of Hepatitis A, B and C infections. While males had more risky behaviors, it was seen that there was no significant difference between the students of medical faculties according to other faculties. Conclusion: Despite advances in technology and health, Hepatitis A, B and C infections continue to be an important public health problem today. This study showed that even university students, whose education and intellectual levels are considered to be high according to society, have low level of knowledge about viral hepatitis and exhibit risky attitudes and behaviors, necessity of individual and social education. The most effective way to protect against these diseases is to increase the knowledge and awareness levels of the society and prevent the transmission of these diseases. Keywords: hepatitis, knowledge, attitude, behavior, vaccines

Aim: Night Eating Syndrome is thought to pose a risk for the development of cardiovascular system, endocrinological and psychiatric diseases. The aim of our study was to investigate the frequency of night-eating syndrome and risk factors related to night eating syndrome. Methods: This cross-sectional, descriptive study was carried out among 525 people who admitted to the Family Medicine Clinic of a tertiary hospital between 01 October and 30 November 2018. The night-eating questionnaire was applied to the partcipants using face-to-face interview. Persons with a psychiatric disorder, who have a history of chronic medication or disease, who have alcohol and drug addiction and who are working on the night shift were excluded from the study. p values < 0.05 were considered as statistically significant. Results: Fifty-one (9.7%) of the 525 patients admitted to our clinic met the criteria of Night Eating Syndrome. In our study, there were statistically significant difference between night eating syndrome and non-night eating syndrome groups with respect to smoking status and body mass index. Conclusion: Night eating syndrome is a hidden public health problem which is related to cardiovascular system diseases, diabetes mellitus and psychiatric disorders besides obesity. Because of the presence of serious health problems associated with night eating syndrome, it is very important to determine night eating syndrome in primary care.

Aim: Whether a specialization training program achieves its objectives or not is decided by showing that the graduates of the program have gained the expected knowledge, skills and behaviors. The measurement tools used in this decision require some specific knowledge and skills. The aim of this study was to analyze the questions asked in an examination and to investigate the suitability of the assistants and the education program in terms of educational sciences. Methods: Responses of Family Medicine residents to a multiple-choice test that consists of 50 items, conducted throughout the country. The questions were analyzed in terms of the connection with the educational objectives, the degree of difficulty, separation and distraction power. Results: Of the 150 questions asked, 20 were not found in the learning objectives. In the analysis of difficulties, 105 of the questions were easy and very easy questions; on the other hand, in the analysis of distraction, 27 out of 150 questions are sufficient for discriminating; in terms of distractors, all the distractors of the 19 problems were found to be functional. Conclusion: The examination is not suitable for the evaluation of both the residents and the program, because it is based on knowledge measurement by multiple choice quiz method, not being competency based, the questions are not included in the learning objectives, the disaggregation of the questions are weak, and the distractors are not working in a large majority. In order to avoid these situations, it would be appropriate for the family medicine trainers to undergo a training including the role and importance of measurement and assessment in education before taking the authority of assistant and program evaluation.

The aim of this study was to evaluate the prevalence of anemia and other vitamin deficiencies among elderly home care patients and to evaluate the causes of anemia and effect of malnutrition as a contributing factor. Anemia was defined according to the World Health Organization. Hemogram, serum iron, iron binding capacity, ferritin and transferrin saturation values, serum vitamin B12, folic acid and vitamin D levels were evaluated. It was tried to differentiate as absolute iron deficiency anemia, anemia of chronic disease, anemia of unknown cause and vitamin B12 deficiency anemia. Malnutrition was evaluated by Mini Nutritional Assessment test. Total of 472 patients (mean age 81,4±7,4 years) were included in the study. Anemia was detected in 179 (%37,9) patients, 22,7% of males and 45,5 % of female. Prevalence of iron deficiency anemia, vitamin B12, folic acid and vitamin D deficiencies were found 43%, 46%, 19% and 91% respectively. 22,8% of all patients were malnourished, 17,5% were under malnutrition risk. In patients with anemia 16,2% chronic disease anemia and 37,4% unknown anemia were detected. With or without malnutrition, iron deficiency anemia, vitamin B12 deficiency and vitamin D deficiency were common in the home care elderly patients.

Background Hypertension is an early finding of autosomal dominant polycystic kidney disease (ADPKD) and is related to different mechanisms. Cyst expansion related renin secretion or early endothelial dysfunctions are some of these hypotheses. Different course of hypertension in ADPKD preoccupies that relatives of ADPKD patients may also be under risk for this underlying mechanisms. In this study, we aimed to find blood pressure response problems to exercise as an initial vascular problem in unaffected relatives of hypertensive ADPKD patients. Methods The cross-sectional study included 24 unaffected relatives (siblings and children) of ADPKD patients and 30 healthy controls that performed a cycle ergometer test. Additionally, as a marker for endothelial function, nitric oxide (NO) and asymmetric dimethylarginine (ADMA) levels at baseline and post exercise were measured. Results Systolic blood pressure (SBP) and diastolic blood pressure (DBP) increases were similar in both groups during the 1st, 3rd, and 6th min of exercise. During the exercise recovery phase SBP decreased in both groups; however, in the relatives of ADPKD patients DBP remained high at the end of the 6th min, suggesting impaired capacity for exercise-induced vasodilatation. Baseline NO and ADMA, and 1-min NO and ADMA were similar in both groups. Conclusion Abnormal blood pressure response to exercise stress was observed in unaffected normotensive relatives. The observed abnormal DBP response pattern to exercise suggests that arterial vascular responses might be already altered in unaffected relatives of hypertensive ADPKD patients; however, long-term clinical trials are needed to clarify the significance of these findings.

Susceptibility of the homecare patient to vaccine preventable infections and their complications is high. Hospitalization of this patient group increases costs to the healthcare system. Therefore vaccination services are of great importance for protecting these patients from complications and hospitalization. We aimed to determine vaccination status of the patients receiving home care services from a tertiary hospital in Turkey and to reveal their vaccination needs. This cross sectional study was carried out in the Division of Home Care Services of Dışkapı Yıldırım Beyazıt Training and Research Hospital in Ankara Turkey. A questionnaire Comprised of 15 questions were administered through face to face with 336 patients and their care givers. The data obtained was analyzed with descriptive statistical methods and chi-squared test was used for comparison of proportions. A total of 86.3% of the patients and 22.6% of the caregivers were older than age 65. Approximately 45% of the patients were receiving home care due to primary neurological diagnosis such as Dementia, Parkinson's disease and Cerebrovascular Accident. In addition, 78% of the patients had at least 1 additional diagnosis other than their primary diagnosis. Although immunization indications were present among all patients included in the study and at least 22% of the care providers, only 15.2% of patients and 11.3% of care providers had been recommended to receive vaccination. Among those who had been recommended to get vaccinated, 74% of patients and 77% of care givers had been administered the recommended vaccine. This finding implied that both groups were responsive to the advice for vaccination. Moreover, since the patients receiving home care are already followed-up by a healthcare team, thus these patients can be vaccinated with very little additional logistic support.

Background : Primary health care is the first point of entrance into the health care system for individuals and families who are seeking health care and a holistic approach to their health problems. The systematic evaluations of care is a mean to improve quality of primary health care. Patient satisfaction scales are one of these evaluation methods. The aim of this study was to translate and adapt the SPOSPCP to Turkish and examine its validity and reliability. Materials and Methods: This study was conducted among 920 patients, who applied to a family health center in Ankara, Turkey in 2015. The scale was translated to Turkish by a panel of reviewers. Confirmatory factor analysis was used in the study. The validity of the scale was determined by the validity coefficient and the reliability by alpha internal consistency coefficient. Results: The Cronbach’s alpha of the scale was 0.96. There was a high correlation between the scores of the scale and EUROPEP. The scale was considered to be reliable and valid. Conclusion: The Turkish version of SPOSPCP can be applied to healthy Turkish population and is a proper questionnaire to evaluate satisfaction levels of patients about the primary health care physicians. Giris: Birincil saglik bakimi, saglik problemlerine holistik bir yaklasim ve cozum arayan kisi ve ailelerin saglik sistemine ilk giris noktasidir. Bu bakimin kalitesinin arttirilmasinin bir yolu sistematik bir sekilde arastirilmasidir. Bu arastirmayi yapmanin bir yolu ise hasta memnuniyeti olcekleridir. Bu calismanin amaci Scale of Patient Overall Satisfaction with Primary Care Physicians isimli olcegin Turkce’ye tercume edilmesi ve gecerlik ve guvenilirliginin test edilmesidir. Gerec ve Yontem: Bu calisma 2015 yilinda Ankara’da bir aile sagligi merkezine basvuran 920 kiside yapilistir. Olcek olusturulan bir juri tarafindan Turkceye cevrilmistir. Calismada dogrulayici faktor analizi kullanilmistir. Olcegin gecerliligi “gecerlilik katsayisi” ve guvenilirligi de “Cronbach alfa guvenilirlik katsayisi” ile degerlendirilmistir. Bulgular : Calismamizda Cronbach alfa guvenilirlik katsayisini 0,96 olarak bulduk. Gecerlilik ve guvenilirligi test edilen olcekle benzer bir olcek olan EUROPEP olcegi sonuclari arasinda yuksek duzeyde korelasyon saptanmistir. Bu nedenle SPOSPCP olceginin Turkce cevirisinin gecerli ve guvenilir oldugu kabul edilmistir. Sonuc: “Hastalarin Birinci Basamak Hekimlerinde Genel Memnuniyet Olcegi” 18-75 yas arasi Turk populasyonunun Aile Hekimlerinden memnuniyetini degerlendirmek icin uygun bir ankettir.

Proton pump inhibitors are the commonly prescribed drugs for acid-related disorders. However, many of those prescriptions are inappropriate in inpatient and outpatient settings according to the recommended guidelines. Many studies have been conducted in inpatient clinics, but data about the appropriateness of proton pump inhibitor prescribing in outpatient clinics are scarce. Therefore, the aim of this study was to determine inappropriate proton pump inhibitor prescribing rates among patients admitted to a tertiary hospital family medicine outpatient clinic. A total of 259 patients (median age = 59 years; 72.6% women) were enrolled into the study and 35.9% of them had no proper indications to utilize proton pump inhibitors. Inappropriate proton pump inhibitor usage rate was significantly higher in patients older than 60 years compared with their younger counterparts (62.4% vs. 37.6%; p = .001). The most frequent reason to use a proton pump inhibitor with nonapproved indications was polypharmacy (41.9%). Despite endoscopic evaluation, 41.9% of the patients received a proton pump inhibitor without an approved indication. A significant proportion of nonindicated prescriptions were a consequence of continued prescribing without re-evaluating patients in outpatient clinics. Consideration of proton pump inhibitor indications according to the guidelines in every admission may prevent inappropriate prescriptions.

BackgroundThere is a strong association between chronic kidney disease (CKD) and cardiovascular events. Increased arrhythmia risk in kidney disease is one of the main predominant factors in increased mortality and sudden cardiac death. To estimate this risk, noninvasive measurement of repolarization abnormalities including QT interval and its heart rate-corrected value (QTc) with surface ECG, are commonly used parameters in clinical practice. The aim of this study is to examine the effect of CKD-related problems – mainly acidosis – on QT intervals.Methods30 patients with stage 3–5 CKD whose serum bicarbonate concentrations below 20 mmol/L were included in the study. Alkali therapy with oral sodium bicarbonate was used to maintain the serum bicarbonate concentration in the normal range. At the beginning all patients had sinus rhythm on surface ECG records. Kidney function tests including serum urea, serum creatinine, uric acid, blood gas analysis, and electrolytes were analyzed at the beginning and at the end of alkali treatment. All patients underwent 12 lead-ECGs, recorded simultaneously. One cardiologist examined the ECGs manually in terms of QT intervals, corrected for heart rate (QTc), QT dispersion (QTd) and corrected QT dispersion (QTcd).ResultsThere were statistically significant differences in QT intervals, QTc, QTd and QTcd before and after sodium bicarbonate treatment. The correlation analyses revealed that there were significant negative correlations in pretreatment ECGs of patients between QTd and QTcd with blood pH level. Multivariate analyses between biochemical parameters and QTd-QTcd intervals have revealed that pH was related to QTd and QTc.ConclusionsThis study demonstrated that QT intervals on surface ECG are decreased after treatment of acidosis in CKD. Further studies are needed to show whether increased QT intervals cause ventricular arrhythmias in CKD.

Background Brucellosis produces a variety of non-specific hematological abnormalities. The aim of the present study was to evaluate the hematological findings in childhood brucellosis. Methods Medical records of children with brucellosis admitted to a tertiary hospital in a 1 year period, were analyzed retrospectively. Results Sixty-nine patients (mean age, 14.5 ± 3.3 years) were diagnosed with brucellosis. The most common hematological finding was thrombocytopenia (n = 11, 15.9%). Thrombocytosis was detected in five patients (7.3%), leukopenia in four (5.8%), anemia in three (4.3%), and bicytopenia in three (4.3%). None of the patients had pancytopenia. Blood culture was positive for Brucella spp. in 41 patients (59.4%). Among those patients with positive blood culture, six (14.6%) had serum agglutination test titer ≤1/80. Platelet (PLT) count was significantly lower in the bacteremia-positive group. The OR (95%CI) of bacteremia for PLT cut-off 200 000/mm3 was 0.148 (95%CI: 0.031–0.718) and relative risk was 1.718 (95%CI: 1.244–2.372; P = 0.010). Conclusions Brucellosis should be kept in mind in the differential diagnosis of isolated thrombocytopenia in pediatric patients from endemic areas.

Objectives:Epidemiological studies have revealed an association between higher totalperipheral white blood cells (WBC) count and Type 2 Diabetes Mellitus (T2DM).However, the association has not been systematically investigated. The aim ofthis study was to compare peripheral leukocyte count and biochemical testresults in diabetic and non–diabetic patients.Materials and Methods: The study wasconducted among the patients had been followed by Family Medicine OutpatientClinics of Dışkapı Yıldırım Beyazıt Training and Research Hospital between02.02.2015-30.09.2015. Patients anthropometric measurements, complete bloodcell count and biochemical tests’ results were recorded and these values werecompared between two groups (T2DM(+) and T2DM(-)).Results: A total of 286 patients(mean age: 58.7±10.5 years) were enrolled. There were no differences in age andsex distribution between T2DM(+) (n=108) and T2DM (-) (n=178) groups. InT2DM(+) group, leukocyte count was found to be higher than T2DM(-) group (7.73× 103/ml; 7.17 × 103/ml; p=0.001). Waist circumference, body mass index,fasting blood glucose, alanine amino transferase and triglycerides levels werealso found to significantly higher in T2DM(+) group. Conversly, high densitylipoprotein and low-density lipoprotein levels were found to be significantlylower in T2DM(+) group. Conclusion: Leukocyte count, evenwithin normal range, was higher in T2DM patients compared to non-diabeticindividuals. Our results support the role of chronic inflammation in T2DM.There is a need for comprehensive studies to explain the role of inflammationin diabetes., Amaç: Epidemiyolojikaraştırmalar periferik kandaki lökosit sayısı ile Tip 2 Diyabetes Mellitus(T2DM) arasında ilişki bulunduğunu göstermesine rağmen bu ilişki sistematikolarak incelenmemiştir. Bu çalışmada, T2DM tanısı olan hastaların (T2DM(+))lökosit sayımı ve biyokimya tetkik sonuçlarının diyabeti olmayan hastaların(T2DM(-)) sonuçlarıyla karşılaştırılması amaçlanmıştır.Materyal ve Metot: Çalışmaya;02.02.2015-30.09.2015 tarihleri arasında Dışkapı Yıldırım Beyazıt Eğitim veAraştırma Hastanesi Aile Hekimliği Poliklinikleri’ne başvuran hastalaralınmıştır. Hastaların antropometrik ölçümleri, tam kan sayımı ve biyokimyasaltestlerinin sonuçları kaydedilmiştir ve bu değerler T2DM(+) ile T2DM(-)grupları arasında karşılaştırılmıştır.Bulgular: Çalışmaya dâhiledilen 286 hastanın yaş ortalaması 58,7±10,5 yıl olarak saptandı. T2DM(+)(n=108) ve T2DM(-) (n=178) gruplarının yaş ve cinsiyet dağılımları arasındafark yoktu. T2DM(+) grubun ortalama lökosit sayısının T2DM(-) grubundan yüksekolduğu saptandı (7,73 × 103/ml; 7,17 × 103/ml; p=0,001). T2DM(+) grubun belçevresi, vücut kitle indeksi (VKİ), açlık kan şekeri (AKŞ), alaninaminotransferaz (ALT) ve trigliserid değerleri T2DM(-) grubuna göre anlamlıolarak yüksek olduğu, düşük yoğunluklu kolesterol (LDL) ve yüksek yoğunluklukolesterol (HDL) değerlerinin ise anlamlı olarak daha düşük olduğubulundu. Sonuç: Lökosit sayısı normalsınırlar içerisinde dahi T2DM hastalarında diyabeti olmayan bireylerden dahayüksektir. Bizim sonuçlarımız kronik inflamasyonun Tip 2 diyabetteki rolünüdesteklemektedir. İnflamasyonun diyabetteki rolünü açıklayacak daha kapsamlıçalışmalara ihtiyaç vardır.

Family caregivers of patient in long-term care facilities often have high rates of stress, burden and psychological illness. A descriptive study was carried out with 63 caregivers. Caregivers were asked to complete a demographic questionnaire, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Short form 36 (SF-36), which measures health related quality of life (QoL). The majority of caregivers were female (79.4%), and most often the daughter of the patient in long-term care (47.6%). The mean BDI score of the sample was 18.8, and the mean BAI score was 20.0. Almost all the mean scores referring to the QoL were decreased (lower than 50), with the exception of mental health. On the SF-36 questionnaire, the lowest scores were observed on the role-emotional, role-physical, social functioning and vitality scales of the SF-36.

Objective: In this study, it was aimed to compare the isolation frequency of some water-borne disease causing microorganisms in pediatric patients before and after Van earthquake in order to determine the potential impact of earthquake on those selected infectious diseases. Methods: The laboratory test results of Adenovirus, Rotavirus, Hepatitis A virus (HAV), Giardia intestinalis and E.histolytica/dispar which were requested from 0-14 years old children, during six months before and six months after Van earthquake which took place on 23 October 2011, were retrospectively reviewed. Results: Adenovirus, Rotavirus, Anti HAV IgM and E.histolytica/dispar showed reduction in the isolation frequency rate during the six months period after the earthquake compared with the same period of previous year. The reduction rates in the isolation frequencies of Rotavirus and E.histolytica/dispar were found to be statistically significant (p

Low serum 25-hydroxyvitamin D3 (25(OH)D) levels have been associated with insulin resistance and cardiovascular diseases. The influences of gender, puberty and adiposity on vitamin D status and the relationship between 25(OH)D and cardiometabolic risk factors in obese and non-obese children were studied. A retrospective analysis was carried out on 168 Turkish children during late winter. Age, gender, puberty, body mass index (BMI), 25(OH)D levels and cardiometabolic risk factors including lipid profiles, high-sensitivity C-reactive protein and insulin resistance index calculated by homeostasis model assessment (HOMA-IR) were evaluated. The median age of the study population was 11 (4–16) years, and 102 children (60.7 %) were prepubertal. Overall, 98.2 % of patients had 25(OH)D levels lower than 20 ng/mL (median 10.0 (4.0–21.3) ng/mL). The 25(OH)D levels did not correlate with BMI. However, an inverse correlation was seen between serum 25(OH)D and HOMA-IR (rho = −0.656, p = 0.006) and insulin (rho = −0.715, p = 0.002) in pubertal obese subjects. Female gender and puberty were all negatively associated with 25(OH)D. Conclusion: The association between vitamin D status and BMI is complex, and it does not seem to be altered by mild obesity. In addition, potential influence of puberty should be kept in mind while assessing the relationship between serum 25(OH)D and cardiometabolic risk factors.

Interest in childhood metabolic syndrome (MetS) has increased substantially due to the increasing prevalence of childhood obesity on a global scale. Early recognition of MetS is critical in order to delay the development of cardiovascular disease (CVD). In this study, we evaluated the relationship between complete blood count (CBC) parameters and MetS among pre-pubertal children which may provide evidence in support of using low cost, readily available clinical haematological parameters for the detection of MetS. A retrospective analysis was carried out on 330 (125 lean vs. 205 overweight) Turkish pre-pubertal children who attend to a paediatric outpatient clinic. Age, gender, puberty, body mass index, CBC parameters, cardiometabolic risk factors including lipid profiles, high sensitive serum reactive protein (hsCRP) and insulin resistance index calculated by homeostasis model assessment (HOMA-IR) were evaluated and compared among lean, overweight children and children with MetS. The mean age of the study population was 7.4 ± 1.9 years. In both gender, the mean values of mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH) and mean corpuscular haemoglobin concentration (MCHC) were significantly lower and red blood cell (RBC), platelet (PLT) counts were significantly higher in overweight children. Overall, 8.4% (n = 28) of patients met the criteria of MetS. Children with MetS had higher levels of PLT and lower levels of mean platelet volume (MPV). Of all the haematological parameters analysed, PLT was positively, whereas MPV was negatively correlated with MetS in girls. In addition, MPV was inversely correlated with fasting blood glucose, HOMA-IR, low density lipoprotein-cholesterol (LDL-C) and low density lipoprotein-cholesterol/high density lipoprotein-cholesterol (LDL-C/HDL-C) ratio in girls after adjusting for confounding factors. The risk analyses of MetS in terms of MPV quartiles showed that the adjusted OR (95% CI) for the lowest vs. the highest quartile was 7.71 (1.45-40.89) in girls. These data might suggest that MPV could be another feature of MetS in pre-pubertal girls and might be used as a surrogate marker for MetS in clinical settings.

The risk of infection in burns is well-known. In recent decades, the antimicrobial resistance of bacteria isolated from burn patients has increased. For this reason, a retrospective study was conducted at Van Training and Research Hospital to analyze the bacterial isolates from the wounds of patients admitted to the Burn Unit and to determine the susceptibility patterns of the commonly cultured organisms over a 3-year period, January 2009 to December 2011. A total of 250 microorganisms were isolated from burn wounds of 179 patients. Our results revealed that the most frequent isolate was Acinetobacter baumannii (23.6%), Pseudomonas aeruginosa (12%), Staphylococcus aureus (11.2%), Escherichia coli (10%) respectively. Multidrug-resistance has emerged as an important concern in our burn unit. Tigecycline, and colistin were found to be the most active drugs against Acinetobacter baumannii. Carbapenems and amikacin, were found to be the most active drugs against other gram negative bacteria. Vancomycin and linezolid were active against gram positive bacteria. Aggressive infection control measures should be applied to limit the emergence and spread of multidrug-resistant pathogens.

Breast-cancer-related lymphedema (BCRL) is a common complication of breast cancer treatment. Informing patients about BCRL can contribute to decrease their risk of developing the condition or prevent it from progressing further. In order to educate patients about BCRL effectively, clinical knowledge of clinicians must be adequate. In study, we aimed to reflect BCRL knowledge and attitude of Turkish primary care physicians (PCPs). This questionnaire-based study was conducted by face-to-face interview method. The participants included actively working PCPs from all parts of Turkey. The questionnaire elicited data on physicians’ demographics, the BCRL knowledge, self-reported BCRL knowledge, referral patterns, and education. A total of 314 PCPs with a mean age of 36.9 % ± 8.1 years (mean ± standard deviation) were included in the study. Median BCRL knowledge score of all study group was 15 (11–18) [median (25–75 % range)]. PCPs who received education about BCRL during their medical faculty and/or residency periods had significantly higher knowledge scores (p = 0.005). Of PCPs, 94.9 % indicated to make a BCRL referral for a breast cancer patient. Among them, 55 % preferred to make a referral to a general surgeon, 28.2 % to an oncologist, and 16.8 % to a physical medicine and rehabilitation specialist. Assessment of factors related with BCRL should be part of routine evaluation of patients with breast cancer in primary care. Education of PCPs about BCRL is warranted in order to improve the BCRL care.

Background: It is important to identify and immunize susceptible healthcare workers to prevent and control hospital infections. Our aim was to evaluate the specific antibodies against the measles, mumps, and rubella viruses and the varicella zoster virus among healthcare workers in a tertiary-care hospital. Patients and Methods: A total of 284 healthcare workers (89 men and 195 women; mean age, 33.5 ± 11 years), including 111 nurses, 87 physicians, 34 laboratory technicians, and 52 members of the housekeeping staff, of Van Training and Research Hospital were enrolled in this study. Antibodies were detected with an enzyme-linked immunosorbent assay. Results: The numbers of workers with serological susceptibility to mumps, measles, rubella, or chicken pox were 26 (9.2%), 18 (6.3%), 7 (2.5%), and 5 (1.8%), respectively. Although the difference was not statistical significant, the rate of seroprevalence of antibodies was lowest for measles (90.8%; p>0.05). Susceptibility to measles, mumps, and rubella, and chicken pox was more prevalent among young healthcare workers (p

Purpose: Brucellosis is a worldwide zoonotic disease and still constitutes a major public health problem. In the study we claimed to identify Brucella species from clinical samples of patients with active brucellosis from Van region of Eastern Anatolia and to determine in vitro antimicrobial susceptibilities of these strains to commonly used anti-Brucella agents and a possible new alternative tigecycline. Materials and Methods: A total of 56 Brucella isolates were enrolled the study and the identification of the isolates were based on conventional methods. In vitro activities of an-timicrobials were evaluated by the E test method. Results: All isolates were identified as B. melitensis. MIC90 values of doxycycline, strepto-mycin, rifampin, trimethoprim-sulfamethoxazole and tigecycline were 0.064 mg/L, 1 mg/L, 2 mg/L, 0.125 mg/L and 0.094 mg/L, respectively. Tigecycline had low MIC50 and MIC90 values against all B. melitensis strains; the highest MIC observed was 0.25 ?g/mL. Conclusion: Our data suggest that tigecycline can be a therapeutic alternative option for the treatment of brucellosis. © Ivyspring International Publisher.

[Purpose] Osteoporosis is an inflammatory disease, and platelets play a critical role in bone remodeling. Mean platelet volume has been shown to be influenced by inflammation. Our aim was to evaluate the relationship between mean platelet volume and bone mineral density in postmenopausal women. [Subjects and Methods] The records of female patients who had been referred to a tertiary hospital for bone mineral density analysis were retrospectively reviewed. [Results] A total of 175 patients (mean age: 61.3 ± 9.0 years) were enrolled. Overall, 72% (126/175) of patients met the criteria for osteoporosis. Mean platelet volume was found to be inversely correlated with body mass index. There was a significant positive correlation between mean platelet volume and femoral neck bone mineral density in our normal weight osteoporotic group, whereas there was a significant negative correlation in our overweight-obese osteoporotic group. The negative correlation between mean platelet volume and femoral neck bone mineral density in the overweight-obese osteoporotic group persisted after adjustment for confounding factors. Multivariate analyses revealed that mean platelet volume was significantly associated with femoral neck bone mineral density in osteoporotic patients in both our normal weight and overweight-obese groups. [Conclusion] Regardless of mechanisms, mean platelet volume might be used as a biomarker for osteoporosis in clinical settings.

Brucellosis produces a variety of non-specific hematological abnormalities. The aim of the present study was to evaluate the hematological findings in childhood brucellosis.Medical records of children with brucellosis admitted to a tertiary hospital in a 1 year period, were analyzed retrospectively.Sixty-nine patients (mean age, 14.5 ± 3.3 years) were diagnosed with brucellosis. The most common hematological finding was thrombocytopenia (n = 11, 15.9%). Thrombocytosis was detected in five patients (7.3%), leukopenia in four (5.8%), anemia in three (4.3%), and bicytopenia in three (4.3%). None of the patients had pancytopenia. Blood culture was positive for Brucella spp. in 41 patients (59.4%). Among those patients with positive blood culture, six (14.6%) had serum agglutination test titer ≤1/80. Platelet (PLT) count was significantly lower in the bacteremia-positive group. The OR (95%CI) of bacteremia for PLT cut-off 200,000/mm(3) was 0.148 (95%CI: 0.031-0.718) and relative risk was 1.718 (95%CI: 1.244-2.372; P = 0.010).Brucellosis should be kept in mind in the differential diagnosis of isolated thrombocytopenia in pediatric patients from endemic areas.

Cholestasis contributes to the genesis of fatigue through several mechanisms. Among these mechanisms, affected serotonergic neurotransmission is important in the pathogenesis of central fatigue. Previously, elevated levels of 5-hydroxyindole acetic acid (5-HIAA), the metabolite of 5-hydroxytryptamine (5-HT) and increased 5-HT(2) receptor density were demonstrated in the anterior hypothalamus and in the hippocampus of bile duct resected rats (BDR), respectively. The aim of this paper is to demonstrate evoked 5-HT release in selected brain regions like anterior hypothalamus and hippocampal CA1 regions of cholestatic rats using BDR rats as an experimental model for cholestasis. In this study, we analyzed the K+ evoked 5-HT and its metabolite 5-HIAA levels by using HPLC with electrochemical detection in the microdialysis samples collected from anterior hypothalamic and hippocampal CA1 regions of sham-operated and BDR rats (n = 6). The ratios of [5-HIAA] to [5-HT] following perfusion with 100 mM K+ artificial cerebrospinal fluid was used for the comparison of the evoked release of 5-HT. Locomotor activity was used to assess the signs of cholestasis associated fatigue in the BDR rats. The vertical and horizontal activity counts within 15 min were found to be decreased in the BDR rats compared to sham-operated rats (p < 0.05). Besides, the number of fecal boli (an index of emotionality) was also significantly fewer in the cholestatic rats (p < 0.05). No significant difference between the sham-operated and the BDR rats was detected in the basal 5-HT and 5-HIAA levels of anterior hypothalamus. K+ stimulation yielded a more profound increase in the [5-HIAA]/[5-HT] in the BDR rats (p < 0.05). The basal levels of 5-HT in CA1 region of the BDR rats was found to be lower than that of sham-operated group (p < 0.05), but no significant difference was observed in terms of evoked 5-HT release in both sham-operated and BDR rats. These findings imply the presence of affected serotonergic system in cholestasis.

Montelukast is a leukotriene receptor antagonist that is effective in the treatment of allergic rhinitis and asthma. We report a rare case of a 31-year-old woman with a history of allergic rhinitis and moderate persistent asthma, who experienced severe bruising on her lower extremities after starting montelukast treatment. Clinicians should be aware of the possibility of unusual bruising during montelukast therapy, and in those patients montelukast should be discontinued.

Unilateral absence of the pulmonary artery (UAPA) or pulmonary artery agenesis is a rare congenital disorder presenting with a wide spectrum of symptoms. UAPA is usually associated with cardiac anomalies and surgically treated in childhood. We report a rare case of a 50-year-old woman who was diagnosed with left pulmonary artery agenesis without any other cardiac anomalies. Clinicians should be aware of the possibility of undiagnosed cases of UAPA in patients through a chest radiograph that suggests the diagnosis. Confirmation of the diagnosis and anatomic details can be discerned by CT scanning.

Our aim was to compare the clinical, radiological and prognostic features of spontaneous spondylodiscitis secondary to tuberculosis (TS) and brucellosis (BS). This prospective study involved 41 patients diagnosed with spondylodiscitis. Of these, 18 (43.1%) had BS and 23 (56.1%) had TS. The mean age of TS patients was 52 ± 13.43 years and older than BS patients ( P < 0.001). A prolonged clinical course of the disease, constitutional symptoms, lymphocytosis, increased erythrocyte sedimentation rate (ESR), presence of posterior vertebrae lesions and psoas abscesses were significantly more frequent in the TS group. There are significant clinical, biological and radiological differences between TS and BS. These differences permit a presumptive aetiological diagnosis and orient the initial empirical medical treatment while awaiting a final microbiological diagnosis.

ObjectiveRecent studies have reported an increasing prevalence of childhood hypertension. Obesity is probably the most important risk factor. The relationship between hypertension and BMI in children has not been studied in Ankara, which is the second largest city in Turkey.DesignCross-sectional study analysing direct data on height, weight and blood pressure of students.SettingPopulation-based study in Ankara, the capital city of Turkey.SubjectsIn three schools, 2826 students aged 7–12 years.ResultsThe overall prevalence of hypertension was 7·9 %. Among the 222 hypertensive children, 124 (56 %) were boys and ninety-eight (44 %) were girls (P=0·40). In the whole group, 3·6 % had only systolic hypertension, 0·7 % had only diastolic hypertension and 3·5 % had both systolic and diastolic hypertension. The prevalences of overweight and obesity were both 13·9 %. BMI was significantly correlated with blood pressure (PPConclusionsHypertension was more common than has been reported in other studies. Blood pressure measurement should be routine and frequent in children, especially obese children.