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BackgroundMobile health (mhealth) technology presents an opportunity to address many unique challenges refugee populations face when accessing healthcare. A robust body of evidence supports the use of mobile phone-based reminder platforms to increase timely and comprehensive access to health services. Yet, there is a dearth of research in their development for displaced populations, as well as refugee perspectives in design processes to improve effective adoptions of mhealth interventions.ObjectiveThis study aimed to explore healthcare barriers faced by Syrian refugee women in Turkey, and their perceptions of a maternal-child health mobile application designed to provide antenatal care and vaccine services. These findings guided development of a framework for enhancing acceptability of mobile health applications specific to refugee end-users.MethodsSyrian refugee women who were pregnant or had at least one child under the age of 2 years old at the time of recruitment (n = 14) participated in semi-structured in-depth interviews. Participants had the opportunity to directly interact with an operational maternal-child health mobile application during the interview. Using a grounded theory approach, we identified critical factors and qualities mhealth developers should consider when developing user-friendly applications for refugees.ResultsIt was observed that a refugee's perception of the mobile health application's usability was heavily influenced by past healthcare experiences and the contextual challenges they face while accessing healthcare. The in-depth interviews with refugee end-users identified that data security, offline capability, clear-user directions, and data retrievability were critical qualities to build into mobile health applications. Among the features included in the maternal-child health application, participants most valued the childhood vaccination reminder and health information features. Furthermore, the application's multi-lingual modes (Arabic, Turkish, and English) strengthened the application's usability among Syrian refugee populations living in Turkey.ConclusionsThe inclusion of refugee perceptions in mhealth applications offers unique developer insights for building more inclusive and effective tools for vulnerable populations. Basic upfront discussions of the mobile application's health goals and its personal value to the user may improve their long-term use. Further prospective research is needed on retention and use of mobile health applications for refugee women and other displaced populations.

Iodine has long been recognized as an essential micronutrient for maternal thyroid function, as well as fetal growth and development during pregnancy. The current study aimed to evaluate thyroid hormone status, urinary iodine concentration (UIC), thyroid volume, and nodularity in pregnant women, throughout trimesters, in a borderline iodine sufficient, urban area with mandatory table salt iodization. Two-hundred-sixty-five pregnant women ranging from 17 to 45 years participated in this prospective longitudinal study. Thyroid function tests, thyroid volume, nodule growth, and UIC were recorded throughout the first, second, and third trimesters with no intervention. Median UIC was 96, 78, and 60 µg/L in the first, second, and third trimester of pregnancy, respectively (p

Background/aim: COVID-19 has now become a global pandemic. Understanding the routes of transmission is vital in the mitigation and suppression of the disease. Istanbul has become one of the disease's epicenters. This study aims to describe the first COVID-19 case and contact tracing efforts around it in Istanbul. Materials and methods: The descriptive study was conducted in Istanbul, Turkey. The first COVID-19 cases and those associated with them were investigated with contact tracing, and primary and secondary cases were described. Results: The source case was an individual who returned to Turkey from international travel at the beginning of March and tested PCR (­). The index case is the brother of the source case and is considered the first PCR (+) case diagnosed in Istanbul. Contact tracing revealed 23 PCR (+) cases, 14 of which resulted in hospitalization and three deaths. Conclusions: This study described cases of the first COVID-19 cluster in Istanbul. Moreover, contact tracing was used in this first cluster. This contributed to contact tracing algorithms in Turkey.

We examine the typologies of workplaces for sex workers in Dnipro, Ukraine as part of the larger Dynamics Study, which explores the influence of conflict on sex work. We conducted a cross-sectional survey with 560 women from September 2017 to October 2018. The results of our study demonstrate a diverse sex work environment with heterogeneity across workplace typologies in terms of remuneration, workload, and safety. Women working in higher prestige typologies earned a higher hourly wage, however client volume also varied which resulted in comparable monthly earnings from sex work across almost all workplace types. While sex workers in Dnipro earn a higher monthly wage than the city mean, they also report experiencing high rates of violence and a lack of personal safety at work. Sex workers in all workplaces, with the exception of those working in art clubs, experienced physical and sexual violence perpetrated by law enforcement officers and sex partners. By understanding more about sex work workplaces, programmes may be better tailored to meet the needs of sex workers and respond to changing work environments due to ongoing conflict and COVID-19 pandemic.

Pelvic inflammatory disease (PID) is a syndrome that causes substantial morbidity, including chronic pelvic pain, to women globally. While limited data are available from low- and middle-income countries, national databases from the United States and Europe suggest that PID incidence may be decreasing but the rate of decrease may differ by the etiologic cause. Recent studies of women with PID have reported that fewer than half of women receiving a diagnosis of PID have gonococcal or chlamydial infection, while Mycoplasma genitalium, respiratory pathogens, and the constellation of bacteria associated with bacterial vaginosis may account for a substantial fraction of PID cases. The clinical diagnosis of PID is nonspecific, creating an urgent need to develop noninvasive tests to diagnose PID. Advances in serologic testing for Chlamydia trachomatis and Neisseria gonorrhoeae could advance epidemiologic studies, while the development of vaccines against these sexually transmitted pathogens could affect incident PID and associated morbidity.

The COVID-19 pandemic has created an urgent need for robust, scalable monitoring tools supporting stratification of high-risk patients. This research aims to develop and validate prediction models, using the UK Biobank, to estimate COVID-19 mortality risk in confirmed cases. From the 11,245 participants testing positive for COVID-19, we develop a data-driven random forest classification model with excellent performance (AUC: 0.91), using baseline characteristics, pre-existing conditions, symptoms, and vital signs, such that the score could dynamically assess mortality risk with disease deterioration. We also identify several significant novel predictors of COVID-19 mortality with equivalent or greater predictive value than established high-risk comorbidities, such as detailed anthropometrics and prior acute kidney failure, urinary tract infection, and pneumonias. The model design and feature selection enables utility in outpatient settings. Possible applications include supporting individual-level risk profiling and monitoring disease progression across patients with COVID-19 at-scale, especially in hospital-at-home settings.

Neonatal brain injury is a significant reason of neurodevelopmental abnormalities and long-term neurological impairments. Hypoxic-ischemic encephalopathy and preterm brain injury, including intraventricular hemorrhage are the most common grounds of brain injury for full-term and preterm neonates. The prevalence of hypoxic ischemic encephalopathy varies globally, ranging from 1 to 3.5/1000 live births in high-resource countries and 26/1000 in low-resource countries. Preterm birth's global incidence is 15 million, a significant reason for infant mortality and morbidity, permanent neurologic problems, and the associated social and economic burden. The widespread neurodevelopmental effects of neonatal brain injury could have an unfavorable impact on a variety of aspects of cognitive, linguistic, behavioral, sensory, and motor functions. Brain injury occurs via various mechanisms, including energy deprivation, excitatory amino acids, mitochondrial dysfunction, reactive oxygen species, and inflammation giving rise to different forms of cell death. The contribution of microglial activity in neonatal brain injury has widely been underlined by focusing on cell death mechanisms since the neuronal death pathways during their development are distinct from those in the adult brain. Iron accumulation and lipid peroxidation cause a relatively novel type of regulated cell death called ferroptosis. Neonates generally have biochemical iron inequalities, and their antioxidant potential is highly restricted, implying that ferroptosis may be significant in pathologic conditions. Moreover, inhaled nitric oxide therapy in infants may lead to microglial inflammation via ferroptosis and neuronal injury in the developing brain. This review article aims to summarize the studies that investigated the association between neonatal brain injury and iron metabolism, with a particular emphasis on the microglial activity and its application to the inhibition of neonatal brain injury.

Despite evidence that acculturation hassles (such as discrimination and language hassles) relate to poorer adjustment for adolescents of immigrant descent, we know less about the psychological processes underlying these associations. In this study, we test whether reduced psychological needs satisfaction in terms of a lower sense of belonging, autonomy, and competence, mediates the associations of acculturation hassles with psychological distress and academic adjustment. Our sample included 439 seventh graders from 15 schools in Germany (51% female, Mage = 12.4 years, SD = .73). Results revealed that adolescents who experienced greater discrimination and language hassles showed a lower sense of belonging with classmates and subsequently, greater psychological distress. Those who experienced greater language hassles also exhibited a lower sense of perceived competence, and ultimately poorer academic adjustment. We conclude that self-determination theory (SDT) provides an important framework to explain key processes underlying the links between acculturation hassles with psychological distress and academic (mal-)adjustment. Strengthening belonging and competence among adolescents of immigrant descent may enhance their well-being in the face of acculturation hassles.

Background: Our aim was to detect the role of radiological abdominal fat parameters by tomography and stone density by plain X-ray on extracorporeal Shock Wave Lithotripsy (SWL) stone-free rate. Methods: The patients who had undergone SWL for a single opaque renal stone < 2 cm in diameter and proximal ureteric stone < 1 cm in diameter were collected retrospectively. The characteristics of patients and stones were recorded. The stone attitude, HU, abdominal fat parameters, paraperirenal fat area, perirenal infiltration and severity of hydronephrosis with pre-treatment Non- Contrast Computed Tomography (NCCT) and stone density with radiography were evaluated by a radiologist. Four weeks after the last SWL; all patients were evaluated by plain X-ray and categorized as Stone Free (SF) and Residual Fragment (RF) group. Results: 51 patients with renal stones and 88 patients with proximal ureteral stones were included in the study. 24 (47%) and 63 (71%) patients were classified as SFfor renal and ureteral stones respectively. Only stone size was an independent predictor for stone-free rates after SWL for renal and proximal ureteral stones on multivariate analysis. The Receiver Operating Characteristic (ROC) curves for renal calculi revealed that creatinine level, stone size, stone attitude, Houns-Field Unit (HU) and Skin-to-Stone Distance (SSD) were the predictive factors for the SWL outcome (p< 0.05). The ROC curve for ureteral calculi demonstrated that HU, stone size and attitude were the predictive factors (p< 0.05). Conclusion: All abdominal fat parameters and the stone density were not related to SWL failure. A large follow-up with more patients is essential to confirm the role of radiological parameters on the outcome of SWL.

The aim of this study is to demonstrate the validity and reliability of the Categorical and Dimensional Psychometric Properties of the Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD) after its translation to the Turkish.The study was carried out with 102 volunteers from two university hospitals. The SCID interview was conducted by two experienced psychiatrists who interchanged positions as interviewer and observer; and completed the research forms without discussing the patient. The diagnostic agreement between the interviewers and the Kappa coefficient were calculated. Divergent and convergent validity analyses were carried out for diagnostic validity and the scores obtained from the self-report form as well as the dimensional evaluation scores were used in the statistical analyses.The group mean age for volunteers was 39.6±11.6 years and 66.7% consisted of females. The Kappa values for personality categories were 0.79 for avoidant personality structure, 0.64 for dependent personality structure, 0.81 for obsessive-compulsive personality structure, 0.76 for paranoid personality structure, 0.49 for schizotypal personality structure, 0.90 for histrionic personality structure, 0.66 for narcissistic personality structure, 0.89 for borderline personality structure and 0.71 for antisocial personality structure. Dimensional evaluation showed significant correlation with the diagnostic agreement between the interviewers and also with the scores of the self-report forms completed by the participants.The results demosntrated that the Turkish version of the Structured Clinical Interview for DSM-5 Personality Disorders (SCID- 5-PD-CV-TR) is valid and reliable.

BACKGROUND Culturally diverse schools contribute to adolescents' intergroup relations. Complex and inclusive social identities are mechanisms that can explain the link between structural school cultural diversity (i.e., proportion of students of immigrant descent and the number of different ethnic groups) and positive intergroup relations. We expected that similar mechanisms might be at play linking cultural diversity approaches in schools with adolescents' intergroup relations. AIM We examined the link between two sub-dimensions of cultural diversity approaches (i.e., equal treatment; heritage and intercultural learning) and adolescents' prosocial intentions and behaviour towards refugee youth. Then, we explored the mediating role of identity inclusiveness (i.e., perceived similarity of the self with others). SAMPLE AND METHODS We sampled culturally diverse eighth grade adolescents from 54 classrooms in Berlin (N = 503, Mage = 13.76 years, 50.6% female). Surveys measured perceived cultural diversity norms, adolescents' perceived identity inclusiveness with refugee youth, prosocial intentions to support refugee youth, and willingness to donate to a project for refugee youth. RESULTS Multilevel models revealed that adolescents' perception of heritage and intercultural learning predicted adolescents' prosocial intentions towards refugee youth, but not their willingness to donate. Equal treatment was not a significant predictor of adolescents' prosocial intentions towards refugee youth, or their willingness to donate. Identity inclusiveness did not mediate the relation between cultural diversity approaches and prosocial intentions. However, identity inclusiveness did positively relate adolescents' prosocial intentions and willingness to donate. CONCLUSIONS We conclude that culturally diverse schools that engage in heritage and intercultural learning might help to promote positive relations between local and refugee youth in schools and society. Fostering inclusive identities may enhance local adolescent's prosocial intention and behaviour.

Background the inflammasome modulates the release of key proinflammatory cytokines associated with periodontal disease pathogenesis. the aim of this study was to evaluate the expression of proteins that regulate the inflammasome, namely pyrin domain-only proteins (POPs), caspase activation recruitment domain (CARD)-only proteins, and tripartite motif-containing (TRIM) proteins, in periodontal diseases. Methods A total of 68 participants (34 males and 34 females) were divided into four groups, including periodontal health (H), gingivitis (G), chronic periodontitis (CP), and aggressive periodontitis (AgP) based on clinical parameters. Gingival tissue samples were obtained from all participants for reverse transcription polymerase chain reaction (RT-PCR)-based gene expression analyses of molecules that regulate the inflammasome, including apoptosis-associated speck-like protein (ASC) containing CARD, caspase-1, interleukin-1 beta (IL-1 beta), interleukin-18 (IL-18), nucleotide-binding domain, leucine rich family (NLR) pyrin domain containing 3 (NLRP3), NLR family pyrin domain containing 2 (NLRP2), AIM2 (absent in melanoma 2), POP1, POP2, CARD16, CARD18, TRIM16, and TRIM20 by RT-PCR. Results NLRP3 and IL-1 beta were upregulated in the G, CP, and AgP groups compared with group H (P < 0.05). AIM2 was downregulated in the CP group compared with the H, G, and AgP groups (P < 0.05). TRIM20, TRIM16, and CARD18 were downregulated in the G, CP, and AgP groups compared with the H group (P < 0.05). POP1 and POP2 were downregulated in the CP and AgP, and AgP and G groups, respectively (P < 0.05). Conclusion Active periodontal disease may result in downregulation of inflammasome regulators that may increase the activity of NLRP3 and IL-1 beta in periodontal disease., Scientific and Technological Research Council of Turkey (TUBITAK), Ankara, TurkeyTurkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK), This study was not supported by any financial organization. the corresponding author of this study (Kubra Aral) was supported with a scholarship by the Scientific and Technological Research Council of Turkey (TUBITAK), Ankara, Turkey. the authors report no conflicts of interest related to this study.

Objective: To evaluate whether antenatal magnesium sulphate (MgSO4) exposure has a neuroprotective effect against hearing impairment in premature newborns. Material and Methods: Retrospective cohort study was performed with prematurely (

BACKGROUND: This study examined condom use and sexually transmitted infection (STI) testing among unmarried, non-cohabiting women and men who had multiple past-year partnerships or perceived their partner’s involvement in another sexual relationship. METHODS: We identified 5868 and 5330 unmarried, non-cohabiting sexually active women and men aged 15 to 44 years using National Survey of Family Growth data for 2011 to 2017. To measure multiple partnerships, we created 4 dichotomous variables that included both past-year number of opposite-sex sex partners (1, 2 or more) and perceived partner nonmonogamy (PPNM) (yes, no). Results were stratified by relationship type at last sex (“steady” vs “casual”). RESULTS: Overall, 39.4% of women and 48.3% of men reported multiple partnerships and 23.4% and 24.0% reported PPNM. Lower condom use was seen for women and men who had 2 or more partners in the past year and PPNM than those with only 1 partner and no PPNM (women, 28.5%; 95% confidence interval [CI], 24.1–32.9 vs 39.3%; 95% CI, 36.6–41.9) (men, 37.7%; 33.5–41.8 vs 54.9%; 51.9–57.9). STI testing was higher for groups with PPNM. Men with a steady sex partner had higher prevalence of past-year STI testing if they reported PPNM than not (adjusted prevalence ratio, 2.00; 95% CI, 1.63–2.45). CONCLUSIONS: Screening practices that include a standardized sexual risk assessment could identify those with multiple sex partners or PPNM and improve linkage to STI services. Availability of point-of-care tests and expedited partner therapy could provide targeted strategies that prioritize rapid diagnosis and effective partner treatment which may prevent further STI spread.

This prospective case-control study aimed to investigate the role of omentin, an anti-inflammatory adipokine in early pregnancy losses. The study comprised 47 women with spontaneous miscarriage at a gestational age of 8-12 weeks and 36 healthy pregnant women, matched for age, body mass index and gestational age, gravdity and parity. A significant negative correlation was determined between plasma omentin concentrations and body weight (

Cohen syndrome (CS) is a rare genetic disorder due to mutations in VPS13B gene. Among various clinical and biological features, CS patients suffer from inconsistent neutropenia, which is associated with recurrent but minor infections. We demonstrate here that this neutropenia results from an exaggerate rate of neutrophil apoptosis. Besides this increased cell death, which occurs in the absence of any endoplasmic reticulum stress or defect in neutrophil elastase (ELANE) expression or localization, all neutrophil functions appeared to be normal. We showed a disorganization of the Golgi apparatus in CS neutrophils precursors, that correlates with an altered glycosylation of ICAM-1 in these cells, as evidenced by a migration shift of the protein. Furthermore, a striking decrease in the expression of SERPINB1 gene, which encodes a critical component of neutrophil survival, was detected in CS neutrophils. These abnormalities may account for the excessive apoptosis of neutrophils leading to neutropenia in CS. KEY MESSAGES: Cohen syndrome patients' neutrophils display normal morphology and functions. Cohen syndrome patients' neutrophils have an increased rate of spontaneous apoptosis compared to healthy donors' neutrophils. No ER stress or defective ELA2 expression or glycosylation was observed in Cohen syndrome patients' neutrophils. SerpinB1 expression is significantly decreased in Cohen syndrome neutrophils as well as in VPS13B-deficient cells.

Background Heterosexual anal and oral sex are related to the acquisition and transmission of sexually transmitted diseases (STDs). As common reportable STDs (chlamydia, gonorrhea, and syphilis) in the United States are increasing, it is important to understand recent oral and anal sexual behaviors. Methods We examined the prevalence and correlates of heterosexual anal and oral sex, associated condom use, and having multiple partners among men and women aged 15 to 44 years. Results Approximately one third of women and men had ever engaged in anal sex, including 11% of adolescents (15-19 years). Most women and men had ever received or given oral sex (at >75%). Six percent and 7% of women and men, respectively, used a condom at last oral sex compared with 20% and 30% who used a condom at last anal sex. Having multiple sex partners in the past year was most common among adolescents, never or formerly married persons, and those who had a nonmonogamous partner. Less than 10% reported multiple anal sex partners in the past year. A substantial minority had multiple oral or anal sex partners; black women and men had the highest reports of oral sex partners by race/ethnicity. Conclusions Anal and oral sex are common sexual practices. Given the low rates of condom use during these behaviors, it is important that recommendations for sexual risk assessments are followed. Tailored messaging regarding risk for STD and human immunodeficiency virus acquisition during oral and anal sex may benefit adolescents, singles, and divorced individuals. Future discussions regarding the benefits of extragenital STD testing for heterosexuals may be useful.

Background: There are limited data on the long-term outcomes of COVID-19 from different parts of the world. Aims: To determine risk factors of 90-day mortality in critically ill patients in Turkish intensive care units (ICUs), with respiratory failure. Study design: Retrospective, observational cohort. Methods: Patients with laboratory-confirmed COVID-19 and who had been followed up in the ICUs with respiratory failure for more than 24 hours were included in the study. Their demographics, clinical characteristics, laboratory variables, treatment protocols, and survival data were recorded. Results: A total of 421 patients were included. The median age was 67 (IQR: 57-76) years, and 251 patients (59.6%) were men. The 90-day mortality rate was 55.1%. The factors independently associated with 90-day mortality were invasive mechanical ventilation (IMV) (HR 4.09 [95% CI: [2.20-7.63], P2 mmol/L (2.78 [1.93-4.01], P= 60 years (2.45 [1.48-4.06)], P= 600 mL/day (1.68 [1.21-2.34], P=.002), PaO2/FiO(2) ratio of = 1 (1.42 [1.00-2.02], P=.050). Conclusion: Long-term mortality was high in critically ill patients with COVID-19 hospitalized in intensive care units in Turkey. Invasive mechanical ventilation, lactate level, age, cardiac arrhythmia, vasopressor therapy, positive fluid balance, severe hypoxemia and ECOG score were the independent risk factors for 90-day mortality. WOS:000700853600007 2-s2.0-85115428262 PubMed: 34558415

AimCOVID-19 clinical presentation is heterogeneous, ranging from asymptomatic to severe cases. While there are a number of early publications relating to risk factors for COVID-19 infection, low sample size and heterogeneity in study design impacted consolidation of early findings. There is a pressing need to identify the factors which predispose patients to severe cases of COVID-19. For rapid and widespread risk stratification, these factors should be easily obtainable, inexpensive, and avoid invasive clinical procedures. The aim of our study is to fill this knowledge gap by systematically mapping all the available evidence on the association of various clinical, demographic, and lifestyle variables with the risk of specific adverse outcomes in patients with COVID-19.MethodsThe systematic review was conducted using standardized methodology, searching two electronic databases (PubMed and SCOPUS) for relevant literature published between 1stJanuary 2020 and 9thJuly 2020. Included studies reported characteristics of patients with COVID-19 while reporting outcomes relating to disease severity. In the case of sufficient comparable data, meta-analyses were conducted to estimate risk of each variable.ResultsSeventy-six studies were identified, with a total of 17,860,001 patients across 14 countries. The studies were highly heterogeneous in terms of the sample under study, outcomes, and risk measures reported. A large number of risk factors were presented for COVID-19. Commonly reported variables for adverse outcome from COVID-19 comprised patient characteristics, including age >75 (OR: 2.65, 95% CI: 1.81–3.90), male sex (OR: 2.05, 95% CI: 1.39–3.04) and severe obesity (OR: 2.57, 95% CI: 1.31–5.05). Active cancer (OR: 1.46, 95% CI: 1.04–2.04) was associated with increased risk of severe outcome. A number of common symptoms and vital measures (respiratory rate and SpO2) also suggested elevated risk profiles.ConclusionsBased on the findings of this study, a range of easily assessed parameters are valuable to predict elevated risk of severe illness and mortality as a result of COVID-19, including patient characteristics and detailed comorbidities, alongside the novel inclusion of real-time symptoms and vital measurements.

Background/aim Altered iron metabolism is one of the pathophysiological mechanisms occurring during hypoxic injuries in the central nervous system. Proper homeostasis of cellular iron is regulated by iron import, storage, and export proteins that prevent excess iron overload or iron starvation in cells. Therapeutic hypothermia is an approved treatment for hypoxic ischemia in newborns, but the underlying molecular mechanism is still unknown. We studied the effects of hypoxia, preceded with preconditioning, on the iron homeostasis of glial cells, known as a major actor in the inflammatory process during perinatal brain injury. Materials and methods Primary microglia and astrocytes in culture were exposed to 12 h of hypoxia with or without mild hypothermic preconditioning. The mRNA expression was assessed using qPCR. Iron accumulation was visualized via modified Perl’s histochemistry. Cytokine levels in cell cultures were measured using ELISA. Results Hypothermic preconditioning enhanced microglial viability, which previously was decreased in both cell types due to hypoxia. Hypoxia increased iron accumulation in the mixed glial cells and in ferritin expression in both microglia and astrocytes. Hypotermic preconditioning decreased the elevated ferritin-light chain expression significantly in microglia. Iron importer proteins, DMT1 and TfR1, both increased their mRNA expression after hypoxia, and hypothermic preconditioning continued to support the elevation of DMT1 in both glial cell types. Ferroportin expression increased as a survival factor of the glial cell following hypoxia. Hypothermic preconditioning supported this increase in both cell types and was especially significant in astrocytes. IL-10 levels were prominently increased in cell culture after hypothermic preconditioning. Conclusion The data suggest that hypothermic preconditioning affects cellular iron homeostasis by regulating the storage and transfer proteins of iron. Regulation of the cellular iron traffic may prevent glial cells from experiencing the detrimental effects of hypoxia-related inflammation.

Objectives Despite a growing HIV threat, there is no definition and characterisation of key populations (KPs), who could be the major drivers of the epidemic in Turkey. We used programmatic mapping to identify locations where KPs congregate, estimate their numbers and understand their operational dynamics to develop appropriate HIV programme implementation strategies. Methods Female and transgender sex workers (FSWs and TGSWs), and men who have sex with men (MSM) were studied in Istanbul and Ankara. Within each district, hot spots were identified by interviewing key informants and a crude spot list in each district was developed. The spot validation process was led by KP members who facilitated spot access and interviews of KPs associated with that spot. Final estimates were derived by aggregating the estimated number of KPs at all spots, which was adjusted for the proportion of KPs who visit multiple spots, and for the proportion of KPs who do not visit spots. Results FSWs were the largest KP identified in Istanbul with an estimate of 30 447 (5.8/1000 women), followed by 15 780 TGSWs (2.9/1000 men) and 11 656 MSM (2.1/1000). The corresponding numbers in Ankara were 9945 FSWs (5.2/1000 women), 1770 TGSWs (1/1000 men) and 5018 MSM (2.5/1000 men). Each KP had unique typologies based on the way they find and interact with sex partners. MSM were mostly hidden and a higher proportion operated through internet and phone-based applications. Night time was the peak time with Friday, Saturday and Sunday being the peak days of activity in both Istanbul and Ankara. Conclusions This study has highlighted the presence of a substantial number of FSWs, TGSW and MSM in Istanbul and Ankara. The information obtained from this study can be used to set priorities for resource allocation and provide HIV prevention services where coverage could be the highest., Gilead Sciences, This project was funded by a non-conditional grant from Gilead Sciences.

Synaptic protein -synuclein (-SYN) modulates neurotransmission in a complex and poorly understood manner and aggregates in the cytoplasm of degenerating neurons in Parkinsons disease. Here, we report that -SYN present in dopaminergic nigral afferents is essential for the normal cycling and maintenance of neural stem cells (NSCs) in the brain subependymal zone of adult male and female mice. We also showthat premature senescence of adult NSCs into non-neurogenic astrocytes in mice lacking-SYN resemblesthe effects of dopaminergic fiber degeneration resulting from chronic exposure to 1-methyl-4-phenyl-1,2,3,6-tetra-hydropyridine or intranigral inoculation of aggregated toxic -SYN. Interestingly, NSC loss in -SYN-deficient mice can be prevented by viral delivery of human -SYN into their sustantia nigra or by treatment with L-DOPA, suggesting that -SYN regulates dopamine availability to NSCs. Our data indicatethat-SYN, presentin dopaminergic nerveterminals supplyingthe subependymal zone, acts as a niche componentto sustainthe neurogenic potential of adult NSCs and identify -SYN and DA as potential targets to ameliorate neurogenic defects in the aging and diseased brain., This work was supported by Ministerio de Economía y Competitividad Spanish Grants SAF2014-54581 and SAF2016-77541 and Instituto de Salud Carlos III (PI12/02574, PI13/01390, Centro de Investigacio´n Biome´dica en Red de Enfermedades Neurodegenerativas, Centro de Investigacio´n Biome´dica en Red de Salud Mental and RETIC Tercel)toM.V.,J.J.T-A., A.B., and I.F;Junta de Andalucía(Proyectos de Excelencia)toJ.J.T-A.; Generalitat Valenciana (Programa Prometeo) to I.F.; European Regional Development Fund; and European Union (E.U.) to A.B. R.S.-C. and G.B. received Spanish Ministerio de Educación FPU predoctoral fellowships. Work in the I.F. laboratory is supported by Fundacio´n Botín-Banco Santander.

To investigate the relationship between the intensity of neuropathic pain and the severity of osteopenia in type 2 diabetic patients with painful diabetic peripheral neuropathy (painful DPN).In 220 patients with type 2 diabetes included in the screening, the presence of neuropathic pain was evaluated using the Douleur Neuropathique 4 Questions (DN4) scoring system. One hundred forty-five patients with painful DPN were identified and included in the study. Socio-demographic and laboratory evaluations were made and bone mineral density (BMD) of these patients was evaluated by the dual-energy x-ray absorptiometry (DEXA) method.There was a significant correlation between the neuropathic pain score and the total T scores of the lumbar spine and femur in patients with painful DPN. According to the regression analysis (standard coefficients), the DN4 score (0.498); the level of vitamin D (- 0.246) and the female sex (0.236) for the lumbar spine region; age (0.387); DN4 score (0.261); and vitamin D level (- 0.155) for the femur region were independently influencing factors on the development of osteoporosis. When osteoporosis (T score ≤ - 2.5) of the lumbar spine was analyzed by binary logistic regression, the risk of osteoporosis in women was 4.4 times higher, and the risk increased with increasing DN4 score.The increase of neuropathic symptoms in patients with DPN is an effective and important factor in the development of diabetic osteopenia.

Problem Receptive anal intercourse (RAI) is more efficient than receptive vaginal intercourse (RVI) at transmitting HIV, but its contribution to heterosexually acquired HIV infections among at-risk women in the USA is unclear. Method of study We analysed sexual behaviour data from surveys of 9152 low-income heterosexual women living in 20 cities with high rates of HIV conducted in 2010 and 2013 as part of US National HIV Behavioral Surveillance. We estimated RAI prevalence (past-year RAI) and RAI fraction (fraction of all sex acts (RVI and RAI) at the last sexual episode that were RAI among those reporting past-year RAI) overall and by key demographic characteristics. These results and HIV incidence were used to calibrate a risk equation model to estimate the population attributable fraction of new HIV infections due to RAI (PAFRAI ) accounting for uncertainty in parameter assumptions. Results Receptive anal intercourse prevalence (overall: 32%, city range: 19%-60%) and RAI fraction (overall: 27%, city range: 18%-34%) were high overall and across cities, and positively associated with exchange sex. RAI accounted for an estimated 41% (uncertainty range: 18%-55%) of new infections overall (city range: 21%-57%). Variability in PAFRAI estimates was most influenced by uncertainty in the estimate of the per-act increased risk of RAI relative to RVI and the number of sex acts. Conclusion Receptive anal intercourse may contribute disproportionately to new heterosexually acquired HIV infections among at-risk low-income women in the USA, meaning that tools to prevent HIV transmission during RAI are warranted. The number of RVI and RAI acts should also be collected to monitor heterosexually acquired HIV infections.

Mycotoxins are defined as fungi that have negative effects on human health. The immune system of the organism is affected by mycotoxins first, and developmental problems, systemic diseases and death can be observed. Although this damage is important for all individuals, due to immaturity of the developmental areas, weak immune system and vulnerability against external factors, it can seriously affect children both in the pre- and in the postpartum period. It is aimed to examine the effects of mycotoxins on child development, which is also very important in the study, together with the studies conducted. In the research, a document analysis method was used to determine the effects of mycotoxins on children. The articles examining the effects of mycotoxins and mycotoxins on children were searched from Google Scholar between 2002 and 2020, accessible books were examined and the results of these studies were discussed as a whole. As a result of the encounter of the fetus with mycotoxins in the womb, the rate of low birth weight babies increases. At the same time, growth retardation, congenital anomalies and neural tube defects are encountered in the fetus. In infancy, mycotoxins cause developmental retardation, damage to the immune system, health problems, especially gastrointestinal problems, and cognitive development problems. As a result of encountering mycotoxins in childhood and adolescence, developmental delays, cognitive and neurological problems, and academic failures can be seen.

Surgical experiences are often stressful for children and their parents. This study aimed to determine the effect of a group game intervention on the preoperative anxiety levels of 94 parent-child dyads who were awaiting elective minor surgery at a pediatric surgery clinic. The experimental group intervention included routine preoperative preparation and a group (ie, child, parent, and researcher) game. After the parent dressed the child for surgery, a research team member assessed the child's and parent's anxiety levels using the Facial Affective Scale and Visual Facial Anxiety Scale, respectively. Before the child was transferred to the OR, the research team member reassessed both anxiety levels. When compared to the control group, the results showed that children and parents involved in facilitated group play experienced significantly decreased anxiety levels (P < .001).

Mother-to-child transmission of HIV (MTCT) accounts for a significant proportion of new HIV infections in Peru. The purpose of this case–control study was to examine maternal and infant factors associated with MTCT in Peru from 2015 to 2016. For each biologically confirmed case infant, we randomly selected four birth year- and birth hospital-matched controls from five hospitals in Lima-Callao. Maternal and infant information were gathered from medical records. Simple conditional logistic regression was utilized to examine possible maternal and infant characteristics associated with MTCT. The rate of MTCT was 6.9% in 2015 and 2.7% in 2016. A total of 63 matched controls were identified for 18 cases. Protective factors included higher number of prenatal visits (odds ratio [OR]: 0.72; 95% confidence interval [CI]: 0.55–0.94, p = 0.012) and having more children (OR: 0.10, 95% CI: 0.01–0.79, p = 0.029). Risk factors included later maternal diagnosis (OR: 1.19; 95% CI: 1.06–1.34; p = 0.001) and greater viral load at the time of maternal diagnosis (OR: 1.05; 95% CI: 1.01–1.10; p = 0.022). Our study highlights the importance of targeting early and continued prenatal care as specific areas to target to prevent gaps in the HIV treatment cascade for pregnant HIV-infected women. These strategies can ensure early screening and initiation of antiretroviral therapy to reduce MTCT rates.

The intersection of digital health platforms and refugee health in the context of the novel 2019 coronavirus disease (COVID-19) has not yet been explored. We discuss the ability of a novel mobile health (mhealth) platform to be effectively adapted to improve health access for vulnerable displaced populations. In a preliminary analysis of 200 Syrian refugee women, we found positive user feedback and uptake of an mhealth application to increase access to preventive maternal and child health services for Syrian refugees under temporary protection in Turkey. Rapid adaptation of this application was successfully implemented during a global pandemic state to perform symptomatic assessment, disseminate health education, and bolster national prevention efforts. We propose that mhealth interventions can provide an innovative, cost-effective, and user-friendly approach to access the dynamic needs of refugees and other displaced populations, particularly during an emerging infectious disease outbreak.

Hallucinations characterize schizophrenia, with approximately 59% of patients reporting auditory hallucinations and 27% reporting visual hallucinations. Prior neuroimaging studies suggest that hallucinations are linked to disrupted communication across distributed (sensory, salience-monitoring and subcortical) networks. Yet, our understanding of the neurophysiological mechanisms that underlie auditory and visual hallucinations in schizophrenia remains limited. This study integrates two resting-state functional magnetic resonance imaging (fMRI) analysis methods – amplitudes of low-frequency fluctuations (ALFF) and functional network connectivity (FNC) – to explore the hypotheses that (1) abnormal FNC between salience and sensory (visual/auditory) networks underlies hallucinations in schizophrenia, and (2) disrupted hippocampal oscillations (as measured by hippocampal ALFF) beget changes in FNC linked to hallucinations. Our first hypothesis was supported by the finding that schizophrenia patients reporting hallucinations have higher FNC between the salience network and an associative auditory network relative to healthy controls. Hippocampal ALFF was negatively associated with FNC between primary auditory cortex and the salience network in healthy subjects, but was positively associated with FNC between these networks in patients reporting hallucinations. These findings provide indirect support favoring our second hypothesis. We suggest future studies integrate fMRI with electroencephalogram (EEG) and/or magnetoencephalogram (MEG) methods to directly probe the temporal relation between altered hippocampal oscillations and changes in cross-network functional communication.

Background The association of subacute thyroiditis (SAT) and papillary thyroid carcinoma is a rare finding. In this study, we aimed to investigate the prevalence of differentiated thyroid cancer in a cohort of patients followed with the diagnosis of SAT. Patients and methods We retrospectively screened medical records of Endocrinology and Metabolism outpatient clinic in the past 20 years for patients with SAT. Patients with nodules and suspicious ultrasonography findings who underwent fine needle aspiration biopsy (FNAB) and operated due to malignancy risk were identified. Results We identified 137 (100 females, 37 males) patients with reliable records to confirm the diagnosis of SAT. The mean age of female patients was 41.1 ± 9.1 (range, 20–64) and of male patients was 43.0 ± 9.3 (range, 20–65). One or more FNAB was performed in 23 of the patients (16.8%) at the beginning and/or during the follow-up period when needed. Seven patients with suspicious FNAB findings were operated, and histopathological examination of the nodules confirmed the diagnosis of papillary thyroid carcinoma in 6 patients (4.4%). Conclusions Our observations suggesting a relatively higher prevalence of thyroid cancer in a small series of SAT patients warrant further studies to identify the real frequency of differentiated thyroid cancer and its association with inflammatory pathogenesis of SAT. This finding is compatible with the trend of increased thyroid cancer incidence all over the world. A repeat ultrasonography after resolution of clinical and inflammatory findings, and FNAB should be recommended to all patients with suspicious nodules.

BACKGROUND: The association between county-level social capital indices (SCIs) and the three most commonly reported sexually transmitted infections (STIs) in the United States is lacking. In this study, we determined and examined the association between two recently developed county-level SCIs (i.e., Penn State social capital index [PSSCI] vs. United States Congress social capital index [USCSCI]) and the three most commonly reported bacterial STIs (chlamydia, gonorrhea and syphilis) using spatial and non-spatial regression techniques. METHODS: We assembled and analyzed multi-year (2012–2016) cross-sectional data on STIs and two SCIs (PSSCI vs. USCSCI) on counties in all 48 contiguous states. We explored two non-spatial regression models (univariate and multiple generalized linear models) and three spatial regression models (spatial lag model, spatial error model and the spatial autoregressive moving average model) for comparison. RESULTS: Without exception, all the SCIs were negatively associated with all three STI morbidity. A one-unit increase in the SCIs were associated with at least 9% (p

Objective: We investigated the effect of prenatal exposure to smart phone radiation and the protective effect of omega-3 on ovarian reserve of offspring. Methods: 24 pregnant Wistar albino rats were divided into four groups. Group-I received neither radiofrequency (RF) radiation nor omega-3, group-II received RF, group-III received RF radiation and 300 mg omega-3 and group-IV received RF radiation and 600 mg Omega-3 till birth. At 42 days, bilateral oophorectomy was performed on all female offspring for follicle count and immunohistochemical staining (GDF9, FOXO1 and TUNEL). Results: Group-II had significantly lower mean number of primordial (p = 0.006), secondary follicles(p = 0.003) and a higher atresia score. Group-III variables were comparable with group-I variables. Group-IV had statistically higher median number of atretic follicles than group-I (p = 0.023). Conclusions: Ovarian reserve of offspring diminished with RF exposure during pregnancy. Omega-3 supplementation during pregnancy may reduce the potential premature ovarian failure.

Objective: To define serum decorin (sDEC) levels in healthy pregnants and in patients with preterm labor (PTL), and to introduce possible role of sDEC in predicting the risk for preterm birth (PTB). Materials and methods: Thirty-one women with diagnosis of PTL between 24th to 32nd weeks of pregnancy were compared with 44 healthy pregnants in this prospective case–control study. Maternal blood sDEC and uterine cervical length (CL) measurements were conducted at referral. Results: Median sDEC level was significantly decreased in PTL group (p = 0.013). Median CL was significantly shorter in PTL group (p

Background Persons with prior sexually transmitted infections (STIs) are at high risk for reinfection. No recent studies have examined frequency with which persons are diagnosed and reported with multiple bacterial STIs over time. Methods We conducted a retrospective, of confirmed syphilis, gonorrhea, and chlamydial infections reported to Massachusetts state surveillance system within a 2-year period, 28 July 2014-27 July 2016. Results Among Massachusetts population aged 13-65 years (4847510), 49142 (1.0%) were reported with ≥1 STIs; 6999 (14.2% of those with ≥1 STI) had ≥2 STIs, accounting for 27.7% of STIs. Of cases with ≥5 or more STIs (high-volume repeaters), 118 (74%) were men and 42 (26%) were women. Men spanned the age spectrum and were predominantly non-Hispanic white; 87% reported same-sex contacts. Women were younger, predominantly nonwhite, and without known same-sex contacts. Women were reinfected with gonorrhea and chlamydia or chlamydia alone; none had syphilis or human immunodeficiency virus (HIV) infection. All men with syphilis also had gonorrhea and/or chlamydia; 35% were diagnosed with HIV before, during, or within 10 months after study period. The majority (56%) of high-volume repeaters were seen at more than 1 care site/system. Conclusions In Massachusetts, a large proportion of bacterial STIs are reported from a small subpopulation, many of whom have repeated infections and are likely to have higher impact on STI and HIV rates. Public health can play a crucial role in reaching high-volume repeaters whose STI histories may be hidden from clinicians due to fragmented care.

We used the US national survey data to examine sexual behavior by pregnancy status and found that, overall, pregnant women did not differ from nonpregnant women in penile-anal sex and associated condom use. Compared with nonpregnant women, pregnant women had lower or similar reports of other sexual behaviors.

Objective: The objective of this study is to investigate maternal serum and neonatal umbilical cord asymmetric dimethylarginine (ADMA) levels in prediction of perinatal prognosis in pregnancies with preeclampsia (PE) and fetal intrauterine growth retardation (IUGR) accompanying PE (PE+IUGR).Methods: Maternal serum ADMA (msADMA) and neonatal umbilical cord ADMA (ucADMA) levels were studied from 34 patients with PE, 25 patients with PE+IUGR, and 30 healthy pregnant controls in this prospective case-control study. Umbilical artery Doppler indices of fetuses, birth weights, Apgar scores, umbilical artery pH measurements of neonates, and admissions to neonatal intensive care unit (NICU) were recorded.Results: Median msADMA was significantly higher in PE and PE+IUGR groups (p=0.024 and p=0.011, respectively), and ucADMA was significantly higher in PE and PE+IUGR groups than the control group (p=0.029 and p=0.018, respectively). Median msADMA and ucADMA levels were significantly higher in the PE+IUGR group than the PE group (p=0.019 and 0.021, respectively). ucADMA levels did not correlate with fetal umbilical arterial blood flow neither in the PE nor in the PE+IUGR group (p=0.518 and p=0.892, respectively). None was related with neonatal umbilical artery pH or NICU admission rates.Conclusions: msADMA and ucADMA correlated with severity of PE. msADMA and ucADMA failed to predict perinatal outcome in patients with PE and PE+IUGR.

Oral–facial–digital syndromes (OFDS) gather rare genetic disorders characterised by facial, oral and digital abnormalities associated with a wide range of additional features (polycystic kidney disease, cerebral malformations and several others) to delineate a growing list of OFDS subtypes. The most frequent, OFD type I, is caused by a heterozygous mutation in theOFD1gene encoding a centrosomal protein. The wide clinical heterogeneity of OFDS suggests the involvement of other ciliary genes. For 15 years, we have aimed to identify the molecular bases of OFDS. This effort has been greatly helped by the recent development of whole-exome sequencing (WES). Here, we present all our published and unpublished results for WES in 24 cases with OFDS. We identified causal variants in five new genes (C2CD3,TMEM107,INTU,KIAA0753andIFT57) and related the clinical spectrum of four genes in other ciliopathies (C5orf42,TMEM138,TMEM231andWDPCP) to OFDS. Mutations were also detected in two genes previously implicated in OFDS. Functional studies revealed the involvement of centriole elongation, transition zone and intraflagellar transport defects in OFDS, thus characterising three ciliary protein modules: the complex KIAA0753-FOPNL-OFD1, a regulator of centriole elongation; the Meckel-Gruber syndrome module, a major component of the transition zone; and the CPLANE complex necessary for IFT-A assembly. OFDS now appear to be a distinct subgroup of ciliopathies with wide heterogeneity, which makes the initial classification obsolete. A clinical classification restricted to the three frequent/well-delineated subtypes could be proposed, and for patients who do not fit one of these three main subtypes, a further classification could be based on the genotype.

Extrinsic and intrinsic pathways of apoptosis are involved in generalized aggressive periodontitis (GAgP). The aim of this study was to evaluate 6-month clinical outcomes relative to apoptosis of one-stage full-mouth disinfection (OSFMD) and systemic antibiotics (SA) in the treatment of GAgP.Twenty-six patients with GAgP were included in this prospective follow-up intervention study. Gingival crevicular fluid (GCF) was collected from patients at baseline and 3 and 6 months after periodontal therapy, which consisted of OSFMD and SA (amoxicillin and metronidazole, 500 mg each for 7 days). The levels of p53, caspase-3, TNF-α, TRAIL, IL-1β, and IL-10 in GCF were measured via ELISA.Periodontal parameters were improved at 3 and 6 months compared to baseline (p 0.05). p53 was decreased up to 6 months (p 0.05). TRAIL, TNF-α, and IL-10 were similar at baseline and 3 and 6 months. Caspase-3 and IL-1β were decreased at 3 months (p 0.05), but similar at 6 months compared to baseline (p 0.05).Although OSFMD plus SA improves clinical periodontal parameters up to 6 months, this treatment protocol differentially regulates the apoptosis markers caspase-3 at 3 months and p53 at 6 months without influencing TRAIL in GCF.

High GH and IGF I levels increase tubular phosphate reabsorption in patients with acromegaly. We aimed to investigate the utility of serum phosphorus levels as an indicator for predicting chance of remission in acromegaly patients. Fifty-one patients (n: 51; F: 24, M: 27) with diagnosis of acromegaly were included in the study. Plasma IGF-1, Phosphorus (P) and nadir GH levels on oral glucose tolerance test (OGTT) at the time of diagnosis were analysed retrospectively. Patients were classified into two groups according to their plasma P levels; P ≤ 4.5 mg/dl (Group-1, n: 23, 45.1%), P > 4.5 mg/dl (Group-2, n: 28, 54.9%). Two groups were compared according to remission status; remission (n: 27) and non-remission (n: 24). Remission was defined with absence of clinical symptoms, normal plasma IGF-1 (adjusted for age and gender) and GH levels (

Objective The purpose of the current analysis is to examine subgroup differences in the distribution of opposite-sex sex partners in the United States across an approximate 10-year period to identify patterns that may inform sexually transmitted infection research and prevention. Methods Data were drawn from the 2002 and 2011-2013 National Survey of Family Growth, a US probability-based household survey focusing on sexual and reproductive health. The measures included in this analysis were lifetime opposite-sex sex partners and opposite-sex sex partners in the past year. Analyses were conducted separately for men and women. All analyses were conducted in R and R-studio with the "survey" package, focusing on medians, the 80th, and 95th quartile. Results In 2002, there were significant differences between men and women in median number of lifetime sex partners with men reporting more lifetime partners. However, in the 2011-2013 data, these differences are no longer significant. Still, the findings suggest that the top 20% and top 5% of men are reporting significantly more lifetime partners than their female counterparts. In comparison, partners in the past year remain relatively unchanged for both men and women. Conclusions These findings suggest that there were important changes in the distribution of sex partners between 2002 and 2011-2013 that have implications for sexually transmitted infection prevention. Median lifetime partners are no longer different for women and men: however, the distribution of lifetime partners among men is becoming even more skewed.

ObjectivesWithin the context of rising rates of reportable STIs in the USA, we used national survey data to examine temporal trends in high-risk factors that indicate need for STI/HIV preventive services among key subpopulations with disproportionate STI rates.MethodsWe used data from the 2002 (n=12 571), 2006–2010 (n=22 682) and 2011–2015 (n=20 621) National Survey of Family Growth (NSFG). NSFG is a national probability survey of 15–44 year olds living in US households. We examined STI risk factors among sexually active men who have sex with men (MSM) and Hispanic, non-Hispanic black, 15–19 year old, 20–24 year old, and 25–29 year old women who have sex with men (WSM) and men who have sex with women (MSW). Risk behaviours included: received money or drugs for sex, gave money or drugs for sex, partner who injected drugs, partner who has HIV, non-monogamous partner (WSM, MSW only) and male partner who had sex with other men (WSM only). Endorsement of any of these behaviours was recoded into a composite variable focusing on factors indicating increased STI risk (yes/no). We used chi-squares and logistic regression (calculating predicted marginals to estimate adjusted prevalence ratios (aPRs)) to examine STI risk factors over time among the key subpopulations.ResultsFrom 2002 to 2011–2015, reported STI risk factors did not change or declined over time among key subpopulations in the USA. In adjusted analyses comparing 2002 to 2011–2015, we identified significant declines among WSM: Hispanics (aPR=0.84 (0.68–1.04), non-Hispanic blacks (aPR=0.69 (0.58–0.82), adolescents (aPR=0.71 (0.55–0.91) and 25–29 year olds (aPR=0.76 (0.58–0.98); among MSW: Hispanics (aPR=0.53 (0.40–0.70), non-Hispanic blacks (aPR=0.74 (0.59–0.94) and adolescents (aPR=0.63 (0.49–0.82); and among MSM (aPR=0.53 (0.34–0.84).ConclusionsWhile reported STIs have increased, STI risk factors among key subpopulations were stable or declined. Condom use related to these risk factors, sexual mixing patterns and STI testing should be examined.

Our objective was to evaluate preoperative and postoperative serum fetuin-A levels in female patients with primary hyperparathyroidism (PHPT) and search for the relationship with parathyroid hormone (PTH) and vitamin D (25OHD). Although a role for fetuin-A is suggested in regulating bone mineralization, its function has not been completely defined.In this cross-sectional study, 43 female patients with PHPT and 30 healthy women were recruited as the control group. We evaluated 73 women because we had only women patients with PHPT. Of the 43 patients, 10 symptomatic and 23 asymptomatic patients were surgically treated, whereas 10 patients were not operated. In all 43 patients, 25OHD, PTH, fetuin-A levels, and bone mineral densitometry were evaluated. The biochemical parameters of 33 operated patients were reevaluated at the postoperative sixth week.Fetuin-A levels of the patients with PHPT were significantly higher than that in the controls (56.6 ± 13.8 vs. 42.6 ± 20.7 ng/mL; P = 0.010). Fetuin-A levels of the operated patients were higher than nonoperated group. Furthermore, serum fetuin-A levels of the nonoperated patients were not different from those of controls. After parathyroidectomy, fetuin-A (41.5 ± 25.2 vs. 56.4 ± 13.7 ng/mL; P = 0.003), PTH [80.0 (51.5-137.5) vs. 211.0 (151.5-278.5) pg/mL; P0.001], and calcium (9.2 ± 0.7 vs. 10.7 ± 0.8 mg/dL; P0.001) values were found to be decreased significantly.In this study, fetuin-A levels of patients with PHPT were higher than those of the controls and significantly decreased after parathyroidectomy compared with the preoperative levels. Fetuin-A levels could be a beneficial marker to determine the changes in bone metabolism of the patients with PHPT and to detect the patients suitable for surgery.