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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.

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.

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.

Objective: Osteoporosis (OP) which is a global health problem can be prevented or the development of the disease can be delayed. To educate individuals at risk and to intervene in a timely manner will provide significant reduction in morbidity and mortality caused by OP. Possible interventions in the age group of developed OP are important to determine. Therefore, in this study, it was aimed to determine information, attitudes and behaviors levels on osteoporosis at young women. Materials and Methods: This study was carried out among 18-35 years old females who attended to outpatient clinics of Dışkapı Yıldırım Beyazıt Training and Research Hospital Family Medicine Clinic. A questionnaire was used to assess knowledge, beliefs, and practices towards OP. The questionnaire to assess practices related to OP included questions on positive and negative behaviors towards OP. The positive behaviors assessed were dietary calcium intake, physical activity and exposure to sun. The negative behavior assessed was on smoking status. Results: A total of 218 women (mean age= 26.2±5.6 years) were enrolled in the study. The median score of knowledge about OP was 40, out of a total score of 100. Knowledge scores were lower than the median in 138 (63.3%) and were higher than the median in 80 (36.7%) of the participants. In the group who had high knowledge score than median (n=80); 24 (30%) were smokers, 8 (10%) were not exposed to the sun for at least 10 minutes a day and 45 (56.2%) of the participants did not achieve the recommended daily allowances for calcium and 64 (80%) were not engaged in the recommended exercises in type and duration. Conclusion: Awareness for OP is low in young women and practices towards preventing OP are inadequate. Thus, preventive measures are required in order to encourage OP-preventive life style especially before reaching peak bone mass.

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.

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.

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

The posterior part of the hypothalamus plays a vital role in the homeostatic processes of the internal environment, including blood pressure and heart rate regulation, by means of γ-aminobutyric acid (GABA)ergic and glutamatergic neurotransmission. In this study we measured the extracellular levels of GABA and L-glutamic acid in the dorsomedial hypothalamic nucleus (DMH) and posterior hypothalamus (PH), following intracerebroventricular (i.c.v.) administration of bicuculline, a GABAA-receptor antagonist, in genetic absence epileptic rats from Strasbourg (GAERS), where heart rate, blood pressure, and EEG recordings were also collected simultaneously. The i.c.v. injection of bicuculline (0.3 nmol) produced no response in nonepileptic Wistar rats but caused an increase in mean arterial pressure in GAERS (P

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.

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.

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.

Objective: In recent years, there has been increasing focus on thyroid function in pediatric obese patients. Our aims were to investigate whether there is an association between serum thyroid-stimulating hormone (TSH) within the normal range and body mass index (BMI), and to determine if TSH levels correlate with metabolic risk factors in children. Methods: A retrospective cross-sectional analysis was carried out on 528 euthyroid, age- and sex-matched lean, overweight, or obese children. Anthropometric indices, blood pressure, fasting blood glucose, hepatic enzymes, lipid profiles, TSH, free triiodothyronine (fT3), and free thyroxine (fT4) were assessed from medical records and compared among groups. Subjects with known presence of diabetes, using medications altering blood pressure and glucose or lipid metabolism, with TSH levels >97.5 or Results: Hypertension, dyslipidemia, and elevated levels of hepatic enzymes were found to be more common in overweight and obese children (p Conclusion: Our findings suggest that obese children have higher serum TSH and fT3 levels even within the normal range, and that an increase in TSH is associated with dyslipidemia and higher systolic blood pressure. It remains to be seen whether TSH might serve as a potential marker of metabolic risk factors in obese pediatric patients.

BACKGROUND We investigated the seroprevalence of human brucellosis and risk factors in a village in Eastern Anatolia, Turkey, where a brucellosis outbreak among cattle had recently occurred. PATIENTS AND METHODS All 501 inhabitants enrolled were screened with the Rose Bengal Test and were asked to fill out a questionnaire to determine the signs and symptoms of brucellosis and the risk factors. Patients' laboratory findings and clinical responses were also evaluated. RESULTS The Rose Bengal Test was positive in 44 persons. In comparison of age groups, fever (20.2%), arthralgia (19.2%) and weight loss (8.4%) were frequently seen in children (p

Neonatal vaccination against hepatitis B virus (HBV) infection was launched in 1998 in Turkey. The aim was to evaluate the persistence of seroprotection after HBV vaccination in order to determine the necessity of a single booster dose in 2- to 12-year-old children. This study was conducted retrospectively using hospital records of the children aged 2–12 years old who attended the pediatric outpatient clinics of Diskapi Training and Research Hospital, Ankara, Turkey between January 2010 and June 2011. Children who had received three doses of HBV vaccination in their infancy were included. A total of 530 children enrolled into the study, and 352 (66.4 %) of them had protective antibody to hepatitis surface antigens (anti-HBs) titer greater than 10 mIU/ml. The proportions of children with low, intermediate, and high anti-HB titers are different for those under 3 years of age. The majority were in the intermediate category. Those aged 4–10 years and 11 or older represented two-thirds of the children with high titers (p = 0.000). None of the children had chronic HBV infection. Unprotected children responded well after receiving the booster dose. The mean anti-HB concentration after the booster dose was more than 200 times higher than the mean antibody concentration before (p

Summary The present study discusses the clinical features and treatment outcomes during an outbreak caused by multidrug resistant (MDR) Salmonella typhi isolates from Van, Turkey. Of the 867 typhoid fever patients from the same village, 154 (17.8%) were hospitalised. A total of 42 (27.3%) cultures were positive. All S. typhi isolates were resistant to chloramphenicol, ampicillin and co-trimoxazole. Ceftriaxone was the most commonly used antibiotic (89%). It was found that the time-to-fever defervescence and the length of the hospital stay were greater for patients who were treated by ciprofloxacin than ceftriaxone ( P

Background The aims of this study were to determine the antimicrobial susceptibility patterns of urinary isolates from community acquired acute uncomplicated urinary tract infections (uUTI) and to evaluate which antibiotics were empirically prescribed in the outpatient management of uUTI. Methods Among the patients which were admitted to outpatient clinics of Ankara University Medical Faculty, Ibni-Sina Hospital during 2005-2006, a total of 429 women between the age of 18 and 65 years old who were clinically diagnosed with uUTI and to whom prescribed empirical antibiotics were enrolled in this prospective observational study. Patients' demographical data, urine culture results, resistance rates to antimicrobial agents and prescribed empiric antimicrobial therapy were analyzed. Results Totally 390 (90.9%) patients among all study population were requested for urine culture by their physicians. 150 (38.5%) of these urine cultures were positive. The most common isolated uropathogen was Escherichia coli (E. coli) (71.3%). The variations of uropathogens according to age and menopause status were not significantly different. The resistance rates of E. coli isolates for ampicillin, ampicillin-sulbactam, amoxicillin-clavulonate, cefuroxime, ceftriaxone, fluoroquinolones (FQ), co-trimoxazole (TMP-SMX) and gentamicin were 55.1%, 32.7%, 32.7%, 23.4%, 15.9%, 25.2%, 41.1%, 6.1% respectively. FQ were the most common prescribed antibiotics (77.9%) (P < 0.001), followed by TMP-SMX (10.7%), fosfomycin (9.2%), nitrofurantoin (2.1%). Treatment durations were statistically longer than the recommended 3-day course (P < 0.001). Conclusion Empirical use of FQ in uUTI should be discouraged because of increased antimicrobial resistance rates.

WOS:000334615100001 PubMed: 24669818 Background: Asymmetric dimethylarginine (ADMA), the main endogenous inhibitor of nitric oxide synthase, is considered to be associated with endothelial dysfunction. High ADMA levels have been shown to be related with disorders causing vascular inflammation such as hypertension, hypercholesterolemia, atherosclerosis, chronic heart failure, stroke and sepsis. Cutaneous anthrax (CA) is a serious infectious disease which may cause vasculitis. The aim of the study was to investigate the serum ADMA levels in patients with CA. Methods: A total of 35 serum samples of the patients with CA and 18 control sera were tested for ADMA levels using ADMA ELISA kit (Immunodiagnostik AG, Bensheim, Germany). Results: ADMA levels were found to be significantly higher in the patients group than the controls (p < 0.001). In addition, ADMA levels were found to be positively associated with sedimentation rates (R = 0.413; p = 0.026), and inversely associated with international normalized ratio (INR) levels (R = -0.46; p = 0.011). A cut-off value of 0.475 of ADMA had a sensitivity of 74.3%, specificity of 77.8%, and accuracy of 75.5% in the diagnosis of CA. Conclusion: Although the exact mechanism still remains unclear, ADMA levels could be related to immune activation in CA. In addition, these data might suggest the higher ADMA levels in patients could be due to the perivascular inflammation and vasculitis in CA.