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Purpose: The aim of this study was to investigate the screen time of preschool children in relation to their parents’ screen-use habits and family functions. Materials and Methods: We included 198 parents whose children were attending a kindergarten in Sarıçam district of Adana. Data were collected using a questionnaire and the Family Assessment Scale. Screen times were calculated by adding up the time spent in front of tablets, TV, mobile phones, and computers. Results: The screen times were >2 h in 57.6% children on weekdays and in 76.3% on weekends, and screen times increased as age increased. Further, 88.9% parents indicated that they had family rules about screen use, 62.6% stated that their children were in front of the screen while eating, and 44.4% said their children had a screen of their own, whereas 90.9% told that they had not received any recommendations regarding screen use from family physicians or pediatricians. Low education level of parents, lack of family rules on screen use, children having their own screens, and having received no recommendations from doctors regarding screen use were noted to increase the screen times of children. There was a relationship between the screen times of children and that of parents as well as between screen times of children on weekdays and the communication subscale of family functions. Conclusion: From the results of the study, individual and institutional initiatives are recommended for family physicians and pediatricians who have many contacts with this age group to turn it into an opportunity and have a more active role in advising parents regarding screen use

Background Despite the accumulated evidence suggesting the positive aspects of using group visits in obesity, the number of qualitative studies that examine why and how the effects occur at an individual level is limited. Objectives This qualitative study aimed to explore the experiences and perspectives of women who participated in group visits and had different weight loss outcomes in the programme. Method Purposive maximum variation sampling was performed. Data collection and analysis were performed iteratively, and the data saturation method was used as a guideline for sample size. All participants who completed the group visits were approached, and finally, 20 individuals were included in the study. Semi-structured in-depth interviews were audio-recorded, transcribed verbatim, and analysed thematically using a phenomenological approach. Results The mean age of the individuals was 38.5 ± 9.8 years, the education level ranged from incomplete-high school to university degree, and the weight changes were between +4.1% and −17.1%. Two main themes emerged from the thematic analysis revealing barriers: weight stigma (two sub-themes: internal and external stigma) and traumatic life events (three sub-themes: ‘loss of relatives,’ ‘childhood traumas,’ and ‘conflicting intimate partner relationships’). Conclusion Considering the barriers to weight loss efforts in this study, these issues need to be explicitly investigated before and during the group visits in addition to weight loss practices and behavioural changes.

The objective of this study is to assess the prognostic effects of T ranscatheter aortic valve replacement (TAVR) on the patients with different degrees of left ventricular systolic (LVS) function and severe symptomatic aortic stenosis. Also examines the prognostic association of LV remodelling after TAVR.Patients stratified into four subgroups with respect to baseline LV ejection fraction (LVEF) (LVEF25%, LVEF 25%-40%, LVEF 41%-49% and LVEF ≥ 50%). We compared the baseline characteristics and temporal changes in echocardiographic parameters of the patients after TAVR, and determined all-cause mortality (ACM) in a follow-up period of mean 20.7 ± 15.8 months (up to 84). There were 495 patients at 8 centres. ACM was similar in all groups (28.1%, 29.5%, 22.5% and 24.1% respectively;This study shows that TAVR is beneficial in the whole range of LVS function, irrespective of the baseline EF. Early recovery in LVEF after TAVR is critical for survival, however, it seems to be more eye catching in the patients with advanced heart failure with reduced EF.

Objective: Fabry disease (FD) is a progressive, X-linked inherited disorder of glycosphingolipid metabolism which arises due to deficient or absent activity of lysosomal α-galactosidase A (α-Gal A). This may be associated with increased left ventricular (LV) wall thickness and may mimic the morphological features of hypertrophic cardiomyopathy. The purpose of this study was to define the ratio of occurrence of FD to the manifestation of unexplained left ventricular hypertrophy (LVH). Methods: We studied a prospectively assembled a consecutive cohort of 190 patients with unexplained LVH on echocardiography. The criterion for LVH diagnosis was a maximum LV wall thickness of 13 mm or greater. All patients were tested for mutations in the GLA gene. Results: The majority of patients were male (n=119, 63%) and the mean patient age was 47.2+-15 years. In 190 patients diagnosed with LVH, we identified 2 patients (1.05%) with documented GLA mutations [c.427G>A (p.A143T)(p.Ala143Thr)] and [c.937G>T (p.D313Y)(p.Asp313Tyr)]. After the family screening, 3 additional patients with FD were identified in 2 families, including 5 individuals who are now receiving enzyme replacement therapy. Conclusion: We identified 2 index patients with FD and unexplained LVH. Cardiologists should, therefore, be aware of FD in cases of unexplained LVH. Family screening is crucial for the earlier identification of unaffected new patients who may benefit from enzyme replacement therapy.

Purpose: Previous researches suggest that determining the factors affecting the marital satisfaction would help the treatment team in achieving goals in the infertility treatment process. This study aims to examine marital satisfaction in infertile couples together with the sociodemographic, marital, and social support characteristics affecting the marital satisfaction. Materials and Methods: This study was conducted with 138 married couples receiving treatment for infertility in a public hospital located in the capital of Turkey. Results: According to the findings of the study, 86.2% of men and 82.6% of women have serious problems with marital satisfaction. Marital satisfaction scores of men are significantly lower than women. It is manifested that marital satisfaction increases as the couples get older; it decreases as the education level and monthly income amount of the couples increase and also it is lower among women living in extended families. Conclusion: Conducting future interventions by taking these factors into account shall help the treatment., Amaç: İnfertilite tedavisi sürecindeki hedeflere ulaşmada evlilik doyumunu etkileyen faktörlerin belirlenmesinin tedavi ekibine yardımcı olacağı bildirilmiştir. Bu çalışmada, infertilite tedavisi gören çiftlerin evlilik doyumlarının ve bunu etkileyen sosyodemografik, evlilik ve sosyal destek özelliklerinin incelenmesi amaçlanmıştır.Gereç ve Yöntem: Bu çalışma, Türkiye’nin başkentinde, bir devlet hastanesinde infertilite nedeniyle tedavi gören 138 evli çift ile yapılmıştır.Bulgular: Araştırma bulgularına göre, erkeklerin %86,2’sinin, kadınların ise %82,6’sının evlilik doyumuyla ilgili çok ciddi problemleri olduğu saptanmıştır. Erkeklerin evlilik doyumu puanları kadınlara göre anlamlı olarak daha düşüktür. Çiftlerin yaşı arttıkça evlilik doyumunun arttığı; öğrenim düzeyi ve gelir düzeyi yükseldikçe evlilik doyumunun azaldığı, geniş ailede yaşayan kadınların evlilik doyumunun düşük olduğu belirlenmiştir.Sonuç: Yapılacak girişimlerde, evlilik doyumu ile ilişkili olduğu saptanan bu faktörlerin dikkate alınması tedaviye yardımcı olabilir.

There are studies in the literature showing the clinical importance of fragmented QRS (fQRS) in many systemic diseases. In this study, we aimed to investigate the frequency and prognostic value of fQRS on electrocardiogram (ECG) in patients with acute ischemic stroke.We prospectively enrolled 241 patients with acute ischemic stroke between January 2018 and January 2020. ST depression and elevation, QRS duration, PR interval, RR interval, QTc interval, QTc dispersion (QTcd), T negativity, Q wave, and fQRS were evaluated on ECG. Brain computed tomography (CT) and diffusion magnetic resonance imaging (MRI) images were obtained in the acute period and the National Institute of Health Stroke Scale (NIHSS) score was calculated for each patient. Patients were followed up for a period of two years.The 241 patients comprised 121 (50.2%) men and 120 (49.8%) women with a mean age of 67.52 ± 13.00 years. In Cox regression analysis, age, NIHSS, QTcd, and fQRS were found to be independent predictors of mortality (age, hazard ratio [HR]: 1.063, p 0.001; NIHSS, HR: 1.116, p = 0.006; QTcd, HR: 1.029, p = 0.042; fQRS, HR: 2.048, p = 0.037). Two-year mortality was higher in patients with fQRS than in patients without fQRS (31% vs. 9%, p = 0.001).The fQRS is associated with poor prognosis in patients with acute ischemic stroke.

Aim: Research is ongoing to discover biomarkers that can be used to monitor disease progression and predict prognosis in peripheral artery disease (PAD). Ischemia-modified albumin (IMA) is known to predict the risk for PAD. The aim of this study was to investigate whether serum IMA levels were associated with PAD lesions and ankle-brachial index (ABI) values, and to determine the accuracy of IMA levels in predicting PAD prognosis. Material and Method: Seventy-three patients with PAD who applied to our hospital between July and September 2018 were included in the study. The lesion levels of patients with an ankle-brachial index (ABI) value lower than or equal to 0.9 were determined by computed tomography angiography (CTA). Patients were grouped according to their lesion levels and Fontaine classification. Serum IMA concentrations were measured and compared with regard to lesion levels and ABI values. Results: Sixty-five of the patients (89%) were male. The mean age of the patients was 62.2 ± 8.8 (43–77) years. The mean serum IMA level was 25.9 ± 26.7 (10–218) ng/ml. Serum IMA levels were found to be lower in patients with bilateral iliac artery lesions (p = 0.040). There was no statistically significant relationship between other parameters and serum IMA levels (p >0.05 for all). Conclusion: There is a need for biomarkers that can predict lesion level and prognosis in patients with PAD. Although no statistically significant relationship was found between lesion level and serum IMA concentrations in this study, further studies involving a higher number of patients may provide more informative data on this subject.

Amaç: Bu çalışmada, Adana’daki aile hekimlerine kayıtlı gebelerin prekonsepsiyonel bakım durumlarının risk taraması ve danışmanlık boyutları açısından değerlendirilmesi amaçlanmıştır. Yöntem: Örneklemi Adana ili merkez ilçelerinden rastgele seçilen 20 aile sağlığı merkezinden çalışmaya katılmaya onay veren 48 aile hekimine kayıtlı gebelerden çalışmayı kabul edenler (n=250) oluşturdu. Araştırmada sosyodemografik verileri ve prekonsepsiyonel durumu değerlendiren tarafımızca oluşturulan bir anket formu kullanıldı. Bulgular: Çalışmaya katılan gebelerin yaş ortalaması 27,8±5,6 yıldı. Gebelerin %2,8’i 18 yaş ve altı, %12,8’i 35 yaş ve üzeri olup riskli gruba girmekteydi. Katılımcıların % 6,8’i birinci dereceden akraba evliliği olduğunu, % 8,4’ü kronik bir hastalığının olduğunu % 10,8’i sigara kullandığını, % 4,8’i sürekli kullandığı ilaçlar olduğunu, % 3,6’sı reçetesiz ilaç kullandığını bildirdi. Gebelerin % 5,2’sinin erken doğum, % 2,4’ünün üçten fazla düşük, % 3,2’sinin önceki gebeliklerinde gebeliğini tehlikeye sokacak hastalık öyküsü bulunmaktaydı. Gebelerin %10,8’sinin gebeliği planlı değildi ve % 8,9’unun gebelik aralığı 24 aydan kısa, % 27,4’ünün gebelik aralığı 60 aydan uzundu. Gebe kalmadan önce danışmanlık hizmeti aldığını belirten gebelerden; %35,4’ü aile hekiminden, %29,5’i kadın doğum uzmanından, % 27,5’i ebeden/ hemşireden, % 7,6’sı da diğer sağlık çalışanlarından danışmanlık aldığını belirtmişti. Danışmanlık alınan konular sırasıyla beslenme (%22,0), vitamin kullanımı (%20), ilaç kullanımı (%13,4), aşılama (%12,6), egzersiz (%9,5), akraba evliliği (%6,3), sigara, alkol, madde kullanımı (%6), kronik hastalıklar ((%5,6), genetik hastalıklar (%2,4), diğer (%2,2) şeklinde belirlenmiştir. Sonuç: Katılımcıların yaş, obstetrik öykü, kronik hastalık, ilaç kullanımı gibi konularda riskleri bulunmakla birlikte sadece onda birinin gebeliği planlı değildir. Çoğu, gebelik öncesinde aile hekimlerinden, kadın doğum uzmanlarından ve ebe/hemşirelerden farklı konularda danışmanlık almışlardır., Aim: The aim of this study was to evaluate the preconception care related to risk screening and counseling for the pregnant women registered to the family physicians in Adana. Method: The study sample consisted of 250 pregnant women who were registered to 48 family physicians at 20 randomly selected family health centers in the central districts of the province of Adana and agreed to participate in the study. A questionnaire form created by the authors was used to evaluate sociodemographic data and preconceptional status. Results: The mean age of the pregnant women was 27.8 ±5.6 years. The participants who were 18 or younger (2.8%) and those who were 35 or older (12.8%) were considered as the risk group. Of the participants, 6.8% declared that they had close-kin marriage, 8.4% had a chronic disease, 10.8% smoked, 4.8% had prescription medication, and 3.6% used non-prescription medication. Of the pregnant women, 5.2% had a history of preterm birth, 2.4% had more than three miscarriages, and 3.2% had a history of a disease that could endanger pregnancy in previous pregnancies. Pregnancy was not planned for 10.8% of the pregnant women; the inter-pregnancy interval was shorter than 24 months in 8.9% and longed than 60 months in 27.4%. Of those who indicated that they had received counseling services before getting pregnant, 35.4% were counseled by a family physician, 29.5% by an obstetrician/gynecologist, 27.5% by a nurse/midwife, 7.6% by other healthcare personnel. The subjects about which they had received counseling were nutrition (22.0%), vitamin use (20%), medication use (13.4%), vaccination (12.6%), exercise (9.5%), consanguineous marriage (6.3%), smoking, alcohol, or substance use (6%), chronic diseases (5.6%), genetic diseases (2.4%), and other issues (2.2%). Conclusion: Only one-tenth of pregnancies were not planned even though participating pregnant women had risk factors such as age, obstetric history, chronic disease, and medication use. Most of them had received counselling on different topics from a family physician, obstetrician/gynecologist, or nurse/midwife before pregnancy.

A 62-year-old man with high fever, general fatigue, and history of transient ischemic attack was transferred to our cardiology clinic with high clinic suspicious of endocarditis. He had a history of mitral ring annuloplasty and coronary artery bypass grafting operation before many years ago and reoperation for aortic dissection as Bentall procedure about 3 months ago. Blood tests showed leukocytosis with massive elevation of C-reactive protein, modest elevation of troponin, marked elevation of International Normalized Ratio, mild anemia, and hypoalbuminemia. Transesophageal echocardiogram (TEE) revealed a 4-mm × 15-mm round mobile mass originating from the anterior part of the mitral annular ring. In addition, there were a sac surrounding aortic graft and surrounding aneurismal aorta suggests a separation of graft because of possible aortic perivalvular abscess. There was blood flow into the sac and extensive thrombus with mobile component was seen in it. Blood cultures were positive for Streptococcus pneumoniae . Vancomycin, gentamicin, and rifampicin were chosen as antibiotic regimen. Early surgery planned for endocarditis and drained abscess cavity. However, the patient was persistently refused the third heart surgery operation. Repeat TEE showed the absence of vegetation on mitral valve and evident shrinkage of thrombus. Chest X-ray showed large left pleural effusion. Computed tomography with contrast enhancement confirmed this finding and revealed that contrast leak to the periaortic area and spreading a path under pulmonary artery to adjacent of the anterior wall of left ventricle. Thoracentesis was performed. Fistula to left pleura was suspected but not clearly confirmed. At 6 weeks of hospitalization, he clinically deteriorated. Due to confusional state, informed consent was obtained from attending relatives. The patient was transferred to the operating room. Cardiopulmonary resuscitation was initiated and thoracotomy was performed. Dehiscence of the aortic valve was seen. Infected tissues were extracted and repair with new prosthesis aortic valve was performed. Despite all resuscitation efforts, the patient died.

Giriş: Obezite, Dünya Sağlık Örgütü ve diğer bir çok uzmanlık alanı tarafından “sağlık için risk oluşturacak şekilde anormal ya daaşırı yağ birikimi” olarak tanımlanmaktadır. Obezitenin etiyolojisinde birçok kompleks mekanizma yer almaktadır. Obezite,etiyolojisine benzer biçimde biyopsikososyal kültürel ve varoluşsal çok çeşitli rahatsızlıklara yol açmaktadır. Hem etiyolojisinde hemde sonuçlarındaki bu karmaşık yapı nedeniyle obezitenin tedavisi bireye özgü olmalıdır. Ancak birinci basamaktaki günlük hastabaşvurularındaki yoğunluk nedeniyle bu pek mümkün olamamaktadır. Bu çalışmada, birinci basamakta obezite yönetimi içinkullanılmış olan grup görüşmeleri (GG) yönteminin incelenmesi amaçlanmıştır. Yöntem: Çalışma niceliksel ve niteliksel araştırmayöntemlerinin bir arada kullanıldığı bir çalışma olarak planlandı. Araştırmanın nicel bölümünde araştırmacılar tarafından oluşturulan11 soruluk değerlendirme formu kullanıldı. Beşli Likert puanları ortalama ve standart sapma olarak hesaplandı. Nicel verilerindeğerlendirilmesinin ardından GG’leri daha detaylı incelemek ve ortaya çıkan neden-nasıl sorularına yanıt aramak amacıyla yarıyapılandırılmış derinlemesine görüşmeler yapıldı. Nitel çalışmanın yapılandırılması ve raporlanması aşamasında ise NitelikselAraştırmayı Raporlamak için Konsolide Kriterler Kılavuzu (COREQ-Consolidated Criteria for Reporting Qualitative Research)kullanıldı. Bulgular: Çalışmanın nicel kısmında yaş ortalaması 37,6±10,3 bulundu. Bu yanıtlar arasında en yüksek puanı (iyi/çok iyiderece) alan maddeler, katılımcıların beslenme ve egzersizin önemini kavramaya yönelik yanıtlarına aitti. Nitel kısmında; 1) olumluetkiler 2) olumsuz etkiler 3) sürdürülebilen sağlıklı yaşam tarzı değişiklikleri 4) motivasyonları 5) GG ile ilgili önerileri, olmak üzerebeş temaya ulaşıldı. Sonuç: GG, obezitenin yönetiminde, aile hekimliği disiplinin ilkeleri doğrultusunda uygulanabilir ve buçalışmada belirlenen iyileştirmelerle daha etkili hale getirilebilir., Introduction: Obesity is defined as abnormal or excessive fat accumulation, which poses a risk to health by the World HealthOrganization and many other areas of expertise. There are many complex mechanisms in the etiology of obesity. Obesity, like itsetiology, causes diverse biopsychosocial cultural and existential disorders. Because of this complexity in both the etiology and theoutcomes, the treatment of obesity should be customized. However, this is not possible due to the high number of daily patient log inthe primary care. The aim of this study was to investigate the group visits (GV) used for obesity management in primary care.Method: The study was planned as a combination of quantitative and qualitative research methods. In the quantitative part of thestudy, an 11-item evaluation form was used. The five-point Likert scores were calculated as mean and standard deviation. Followingthe evaluation of quantitative data, semi-structured in-depth interviews were conducted in order to examine the GV in more detail andto find answers to the why and how questions. COREQ-Consolidated Criteria for Reporting Qualitative Research was used in thestructuring and reporting phase of the qualitative study. Results: The mean age of the study was 37.6 ± 10.3 years. Among theseresponses, items with the highest score (good / very good) were the participants' responses to understanding the importance ofnutrition and exercise. In the qualitative part; 1) positive effects 2) negative effects 3) sustained healthy lifestyle changes 4)motivations 5) suggestions for GV, five themes were reached. Conclusion: GV can be applied in the management of obesity in linewith the principles of family medicine discipline and can be made more effective with the improvements determined in this study.

Amac: Bu calismanin amaci; diyabetli ve saglikli bireylerin sosyal sorun cozme becerilerinin karsilastirilmasi, diyabetli hastalarin sosyal sorun cozme tarzlarinin/yonelimlerinin yasam kaliteleri ve HbA1c duzeyleri ile iliskisinin incelenmesidir. Gerec ve Yontem: Endokrinoloji Poliklinigine basvuran Tip 2 Diabetes Mellitus tanili hastalardan dahil etme kriterlerini karsilayan 90 hasta ile benzer sosyodemografik ozelliklerde 90 saglikli bireye sosyodemografik bilgi formu, Sosyal Sorun Cozme Envanteri Kisa Formu, Dunya Saglik Orgutu Yasam Kalitesi Anketi Kisa Formu uygulandi. Diyabet hastalarinin son 3 ay icindeki HbA1c olcum degerleri kullanildi. Glisemik kontrolde hedef deger HbA1c≤7 olarak belirlendi. Bulgular: Diyabet hastalarinin islevsel sorun cozme puanlari saglikli bireylerden anlamli olarak daha yuksek; yasam kalitesinin bedensel ve cevresel alan puanlari ise anlamli olarak daha dusuktu. Kadin, calismayan, hastaligi ile ilgili egitim almayan diyabet hastalarinin islevsel olmayan sorun cozme puanlari anlamli olarak daha yuksek bulundu. HbA1c degeri ≤7 olan diyabetlilerin soruna olumlu yaklasim puanlari daha yuksekti. Korelasyon analizlerinde diyabetlilerin islevsel sorun cozme tarzlari ile yasam kalitesinin bedensel, ruhsal ve cevre alani arasinda pozitif yonde, HbA1c arasinda ise negatif yonde iliski saptandi. Sonuc: Diyabetli hastalarin sosyal sorun cozme becerilerinin degerlendirilmesi, gereksinimleri dogrultusunda girisimlerde bulunulmasi yasam kalitesinin ve klinik sonuclarin iyilestirilmesine katki saglayabilir.

40 years old female with prosthesis aortic valve had developed shortness of breath and consulted to our clinic on the first postpartum day. Her dyspnea was worsened at the last week. She had a history of Bentall operation before 16 years ago, and had a bi-leaflet mechanical prosthetic valve. After detection of pregnancy, her warfarin treatment had switched to enoxaparine 6000 IU subcutaneously for twice a day, continued throughout the pregnancy. Her weight was 62 kg. She did not have any blood test for factor Xa. On physical examination, she has orthopnea, tachypnea (24/min), tachycardia (128 bpm) and hypotension (85/55 mmHg). Electrocardiogram was uneventful with sinus tachycardia of 128 bpm with normal axis. Echocardiography revealed normal left ventricle size with left ventricle hypertrophy, ejection fraction of 60%, reduced motion of prosthetic-valve leaflets and an obstructing mass between the struts. Doppler ultrasonography showed that prosthetic aortic valve has a pressure gradient of 104/59 mmHg. These findings were consistent with prosthetic thrombosis. Moderate aortic regurgitation into the left ventricle was also detected. Transesophageal echocardiography showed 1.4 × 2.3 cm thrombotic material located over leaflets and adjacent to the posterior aortic wall. It was restricting the valve motion. The patient underwent emergency operation immediately. The thrombotic material over mechanical valve was extracted and there was no pathology seen on mechanical valve, graft repaired primarily. Postoperative recovery was fine. No bacteria were detected both direct microscopy and culture.

Aim Current literature lacks a definitive threshold of idiopathic premature ventricular complex (PVC) burden for predicting cardiomyopathy (CMP). The main objective of the present study was to evaluate relationship between the PVC burden and left ventricular ejection fraction (LVEF). Method This multicenter, cross‐sectional study included 341 consecutive patients with more than 1,000 idiopathic PVC in 24 hr of Holter monitoring admitted to the cardiology clinics between January 2019 and May 2019 in the nineteen different centers. The primary outcome was the LVEF measured during the echocardiographic examination. Result Overall, the median age was 50 (38–60) and 139 (49.4%) were female. Percentage of median PVC burden was 9% (IQR: 4%–17.4%). Median LVEF was found 60% (55–65). We used proportional odds logistic regression method to examine the relationship between continuous LVEF and candidate predictors. Increase in PVC burden (%) (regression coefficient (RE) −0.644 and 95% CI −1.063, –0.225, p

Aim: The aim of this study is to implement a structured stress management program to the family medicine residents and to evaluate the impact of this upon the residents’ perceived stress, level of burnout, health behaviors and problem solving skills. Methods: The sample of the study which was planned as self-controlled experimental design constituted the family medicine residents majoring in family medicine (n=26) at our faculty, at the time when the study was conducted. Residents were given psycho education, related to stress management and social problem solving, one hour per week for eight weeks. They completed the following scales at the beginning, at the end of the educational program (month two) and the follow-up period (month 6): Perceived Stress Scale, Maslach Burnout Inventory (emotional exhaustion, depersonalization and personal accomplishment), Healthy Lifestyle Behaviors Scale-II (nutrition, physical activity, stress management, interpersonal relationships, spirituality, healthy responsibility) and Social Problem Solving Inventory (orientation, resolution, total). Besides, a questionnaire which was developed by us and which evaluated the training was performed when the training ended. Results: Of the participants 65.4% were female. The mean age was 29.8 ± 3.0 years. There were significant changes in all mean scores (p

Genetic factors and hypofibrinolytic state may contribute to the likelihood of developing in myocardial infarction (MI) in young women rather than traditional risk factors. High plasminogen-activator inhibitor-1 ( PAI-1 ) level and PAI-1 gene polymorphism have been shown to be associated with thrombotic events such as myocardial infarction, deep venous thrombosis, and stroke. We determined 4G / 4G polymorphism in a 34-year-old female patient with subacute anterior myocardial infarction and coronary thrombus in left anterior descending artery on coronary angiogram.

PubMedID: 29402785 Objective: Lifestyle modification requires extensive information sharing and counseling. However, one-on-one primary care consultations are lacking to cover all necessary components due to time constraints. This preliminary study aims to investigate the feasibility and effects of lifestyle-changing intervention by family physician-led group visits (GVs) on weight management in overweight and obese women. Methods: 60 volunteers fulfilling the inclusion criteria were enrolled. Baseline and 6th month assessments consisted of anthropometric measurements, SF-36 Health Survey, blood variables, exercise test, and resting metabolic rate. Weight maintenance was controlled at the 12th month. Results: Although weight loss among participants varied, the mean body weights were significantly decreased by 8.2% in full-attenders (n = 30). A significant increase in HDL-cholesterol and decreases in heart rate and blood pressure were found. SF-36 summary scales were significantly improved. Weight change was moderately correlated with exercise duration, compliance to diet, and baseline mental component score. It was determined that 62.5% of the participants either lost or maintained body weight at the 12th month. Conclusion: Significant weight loss and quality of life improvement was achieved in this pilot study. GVs may be a promising alternative to primary care consultations for obesity management; however, the high dropout level and diverse outcomes need further assessment. © 2018 The Author(s). Published by S. Karger GmbH, Freiburg. Firat University Scientific Research Projects Management Unit The research team would like to thank all participants for their valuable contributions and sharing and would also express their gratitude to Betül Karateke for her nursing services throughout the study. The intervention part of this work was supported by the Çukurova University Scientific Research Project with the grant number TF ????LTP ???

Yontem: ‹c hastal›klar› (‹H), cocuk sal›¤› ve hastal›klar› (CSH), ka- d›n hastal›klar› ve doum (KHD), genel cerrahi (GC), ilkyard›m ve acil (‹YA), psikiyatri (PS) ve aile hekimlii (AH) anabilim dallar›nda cal›flan toplam 125 asistan›n 99'u (%79.2) cal›flmaya kat›ld›. De- mografik ozelliklerini, uzmanl›k eitimi ve oncesi sureclerini, sa¤- l›k durumlar›n› ve sosyal yaflamlar›n› sorgulayan bir anket uygulan- d›. Bulgular: AH asistanlar›n›n yafl ortalamas›, CSH ve KHD asistanla- r›n›n yafl ortalamas›na gore daha yuksekti (p

PubMedID: 26281344 Background/aim: To examine the relationship between socio demographic and pregnancy features and fetal health locus of control (FHLC) in a sample of pregnant Turkish women. Materials and methods: The study was conducted with 256 pregnant women. Data were collected by demographic questionnaire and the FHLC Scale consisting of 3 components: 1) Internality Scale (FHLC-I), 2) Powerful Others Scale (FHLC-P), and 3) Chances Scale (FHLC-C). Results: The age of marriage was found to have a positive relation with FHLC-I (r = 0.141) and a negative relation with FHLC-C (r = –0.145) (P < 0.05). The age of first pregnancy was found to have a positive relation with FHLC-I (r = 0.127). Those who have a low educational level (r = –0.258) and income (r = –0.149), who are unemployed (r = –2.839), whose number of pregnancies is high (r = 0.152), who get pregnant unplanned (r = 3.839), and who come to their first prenatal examination late (r = –0.142) have a significantly high score of FHLC-C (P

Hypertension is common in renal transplant recipients (RTRs). Ambulatory blood pressure (BP) monitoring (ABPM) is important in diagnosing hypertension and diurnal BP variation. The authors set out to compare office BP and ABPM measurements to determine diurnal pattern and to evaluate echocardiographic findings in RTRs. ABPM and office BP measurements were compared in 87 RTRs. Echocardiographic evaluation was performed for each patient. The correlations between office and 24-hour ABPM were 0.275 for mean systolic BP (P=.011) and 0.260 for mean diastolic BP (P=.017). Only 36.8% had concordant hypertension between office BP and ABPM, with a masked hypertension rate of 16.1% and white-coat effect rate of 24.1%. Circadian BP patterns showed a higher proportion of nondippers (67.8%). Left ventricular mass index was increased in 21.8% of all recipients. There was a significant but weak correlation between office BP and ABPM.

Background The quality of life in patients with diabetes is reduced and emotional coping with the disease has great impact on patient well-being. Objectives The aim of this study was to assess the psychological well-being and treatment satisfaction in patients with type 2 diabetes mellitus in primary care. Study Design and Setting Patients (n = 112) with type 2 diabetes mellitus diagnosis for at least six months were enrolled. The Well-Being Questionnaire-22 and the Diabetes Treatment Satisfaction Questionnaire were used. Physical examination and laboratory investigations were performed. Results The rates of the achieved targets were 32.1% for hemoglobin A1c, 62.5% for cholesterol and 20.5% for blood pressure. The mean scores for the general well-being, depression, anxiety, positive well-being and energy were 44.40 ± 13.23 (range = 16-62), 12.65 ± 3.80 (range = 5-18), 10.57 ± 4.47 (range = 1-18), 12.00 ± 4.01 (range = 2-18), and 9.16 ± 2.47 (range = 2-12), respectively. The mean scores for the treatment satisfaction, perception for hyperglycemia and perception for hypoglycemia were 22.37 ± 9.53 (range = 0.00-36.00), 1.71 ± 1.59 (range = 0-6), and 0.51 ± 0.98 (range = 0-6), respectively. There were significant associations between the depression score and the educational status, compliance to diet and physical exercise, and diabetic complications; between the anxiety score and the educational status, glycemic control, compliance to diet and physical exercise; between the energy score and the educational status, compliance to physical exercise, and diabetic complications; between the positive well-being score and the educational status, compliance to diet and physical exercise, complications and type of treatment; between the general well-being score and the educational status, compliance for diet and physical exercise, and complications. Treatment satisfaction was significantly associated to the educational status, glycemic control and compliance to diet and physical exercise. A significant correlation was found between the treatment satisfaction and the well-being. Conclusions Individualized care of patients with diabetes should consider improving the quality of life. Psychosocial support should be provided to the patients with type 2 diabetes and the negative effects of psychopathological conditions on the metabolic control should be lessened.

Introduction: Penile fracture has been reported with sexual intercourse, masturbation, rolling over or falling on to the erect penis. Classically the history is with a sudden snap, pain, detumescence and a hematoma of the penis with deformity. Immediate surgical treatment is recommended. The patients may delay the admission due to fear and embarrassment or the condition may usually be underreported. Case presentation: A 32-year-old man presented to primary care complaining of discoloration of penis without any significant history or symptom. Physical examination revealed swollen, ecchymotic, and deviated circumcised penis. Conclusion: Although frequent and common diseases represent the majority of daily work, the primary care physician should be alert for possible unexpected history or symptom of a rare and often serious condition. © 2009 Ozcan and Akpinar; licensee Cases Network Ltd.

Brain tumors may present with multiple psychiatric symptoms such as mania, depression, psychotic symptoms. A 58-year-old woman with type 2 diabetes mellitus, hypertension, and hyperlipidemia admitted for diabetes control. She had depressive symptoms. Her neurologic examination and laboratory tests were normal. She was diagnosed as having depression and was given antidepressants. After 5 weeks, she was found unconscious in her house and was admitted to Emergency Department. Neuroimaging revealed a brain tumor in the left frontoparietal lobe. It is important for clinicians to be aware of that in rare cases, brain tumors can be neurologically silent and only present with psychiatric symptoms. Copyright © 2008 by Lippincott Williams & Wilkins.

PubMedID: 18622949 Aim: In this epidemiological report, we assessed the prevalence of osteopenia and osteoporosis (OP) in postmenopausal Turkish women and the relationship between body mass index (BMI), and some nutritional factors (habitual tea, coffee, tobacco, and milk product consumption) with OP. Methods: This multicenter study was done in postmenopausal women residing in five big cities, in four different regions of Turkey between August and November 2005. An inclusion criterion was being in the postmenopausal period for at least 12 months. A semi-structured questionnaire was completed by face-to-face interview, consisting of closed- and open-ended questions about demographic characteristics, nutritional status, and habits with two or more choices as possible responses. Bone mineral density (BMD) measurements were performed with a MetriScan® Densitometer (Alara Inc., Ca, USA). Results: Seven hundred twenty-four women were included in the study. The mean age was 57.6 ± 9.6 years, and mean age at natural menopause was 46.4 ± 5.6 years. Of the participants, 51% were illiterate. According to WHO classification; 42.5% were normal in terms of BMD, 27.2% had osteopenia, and 30.2% had OP. Women with high education levels had better T-scores (p = 0.019). Increase in BMI also had a positive effect on T-scores (p < 0.0001). A linear correlation was found between age (r= -0.386, p < 0.0001), BMI (r = -0.175, p < 0.0001), and education (r = -0.317, p < 0.0001), with T-scores. The T-scores of women who consumed tea on a regular basis were found to be higher than non-consumers (-1.51 ± 1.68 vs. -1.09 ± 1.66; p = 0.070) [when smokers, those who received hormonal therapy (HT), and those > 65 years were excluded]. Conclusion: OP was determined in 1/3 of the women. Advanced age (> 65) and being illiterate were negative factors, while high education levels, being overweight, and being treated with HT had a positive effects on BMD. Habitual tea drinking also may have a positive effect on BMD. However, tea drinking was not found to be a statistically significant factor in the present study. © Hogrefe & Huber Publishers.

OP-043 MicroRNAs (miRNAs) are small, endogenous and non-coding RNAs that are 21-25 nucleotides in length. Recent studies have demonstrated the role of miRNAs as potential biomarkers in various disorders. The aim of this study was to investigate the diagnostic importance of miRNAs in congestive

Health promotion is boosting individual’s well-being. Physicians who give counselling in health promotion can affect individuals’ health behaviours and enhance their well-being. However, it has been indicated that it becomes more difficult for physicians to offer reliable advice to patients if they do not comply with those pieces of advice themselves. Therefore, it is significant for physicians at first to evaluate their knowledge, attitude and behaviours in this subject, to identify their needs and increase their sophistication. In this paper, the concept of health promotion and the role of the family physicians were discussed.

Purpose: Vitronectin (VN) is a novel plasma glycoprotein which regulates processes such as platelet adhesion, aggregation and clotting. VN's presence has been demonstrated in atherosclerotic plaques. The aim of this study is to investigate serum VN levels and to determine their relation to the severity of coronary artery disease (CAD) in patients with acute coronary syndromes (ACS). Methods: 30 ST segment elevation acute myocardial infarction (STEMI), 32 non-ST segment elevation ACS (NSTEACS) patients and 18 healthy control cases were enrolled. VN serum level was measured once in each patient on admission for ACS, using ELISA. Coronary angiography was performed and CAD severity was evaluated using number of coronary arteries with critical stenosis, as well as the Gensini score. Appropriate statistical methods were utilized as necessary and p values less than 0.05 were considered to be statistically significant. Results: VN levels were higher in ACS patients (7.00±11.94 μg/ml in STEMI, 7.72±18.02 μg/ml in NSTEACS vs. 1.81±2.22 μg/ml in controls, p=0.001). VN's cut-off value was 1.59 μg/ml in the diagnosis of ACS with a sensitivity of 64% and specificity of 83% using ROC analysis (p=0.004). VN levels >1.59 μg/ml had a positive predictive value of 93%. The patients were divided into quartiles according to their VN levels. When upper two quartiles were compared to the lower quartiles, patients with higher VN levels had more extensive CAD determined by number of coronary arteries involved (p=0.016, Figure 1). A positive correlation was found between Gensini score and VN levels in the NSTEACS group (p=0.013). ![Figure][1] Figure 1. The relationship between the severity of cardiovascular disease vitronection levels. LMCA, left main coronary artery. Conclusions: VN levels are increased in patients with ACS and higher levels are associated with CAD severity. [1]: pending:yes