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The aim of this study was to investigate all-cause mortality rates and related factors in patients with different levels of eosinophilia. This retrospective cohort study was conducted between January 2020 and December 2022 in the Internal Medicine Department of Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkiye. A total of 161 patients with eosinophilia (at least 3 times) were included and divided into groups with absolute eosinophil counts of 500-999/µL (mild), 1000-1500/µL (moderate), and >1500/µL (severe). The mean age of patients was 65.67 ± 16.64 years at the time of admission, and 45 patients (57.8%) were male. The rates of mortality, oncological disease, and organ involvement were significantly higher in the severe group (P < .05). Increased serum total immunoglobulin E and vitamin B12, hematocrit value, eosinophil-to-lymphocyte ratio, and leukocyte were observed in eosinophilic patients. Decreased lymphocyte count, hemoglobin and hematocrit values were higher in deceased patients than in survivors (P < .05). Increased eosinophil-to-lymphocyte ratio, C-reactive protein, vitamin B12, and lactate dehydrogenase (LDH) activity were observed in participants who died compared to those who survived (P < .05). Multivariable logistic regression revealed that advanced age and higher LDH activity were independently associated with greater mortality risk while receiving non-steroid anti-inflammatory drugs or proton-pump inhibitors were associated with reduced mortality risk (P < .05). Advanced age and increased LDH activity were independently associated with greater risk for mortality, whereas absolute eosinophil counts was not. Considering the literature on this topic, our results show the need for further clinical and fundamental research to understand the role of eosinophils in human disease., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Land use and land cover (LULC) change analysis of the construction site and its surroundings of the Akkuyu Nuclear Power Plant project in southern Turkey was undertaken in this case study, which was supported by remotely sensed Landsat 8 image composites. The composite images compiled in 2017 and 2021 were prepared on the Google Earth Engine platform. The Random Forest algorithm was used as the classifier model. A high classification performance was obtained for both images (kappa > 0.88, overall accuracy > 90%). After the classification process, LULC maps for both years were generated, and statistical calculations for the LULC change were computed for both the entire study area (15 × 25 km) and a buffer zone with a radius of 1 km around the power plant. In the whole study area, artificial surfaces significantly increased (78.46%), whereas forests (- 8.31%) and barren lands experienced a considerable decrease (- 6.11%). In the 1 km buffer, artificial surfaces predominantly increased (113.94%), while forests and barren lands decreased dramatically (- 69.13% and - 74.28%, respectively). The agricultural areas in the study area were changed into other LULC classes: 9.1% to artificial surfaces, 27.6% to barren lands, and 21.7% to forest. The rise in the area of artificial surfaces was especially noticeable within the 1 km buffer zone: construction activities converted 36.1% of agricultural fields, 54.1% of forests, and 23.2% of barren lands into artificial surfaces. The filling activities on the seashore resulted in a loss of water bodies of up to 26.5%. The study provides an overview of how the LULC classes have evolved on the construction site and in the region. In the end, the study discusses how the current land use preferences in the region contradict the issues and concerns mentioned in the existing body of literature., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: As a result of technological developments in healthcare services, telemedicine is becoming widespread. We aimed to determine the effect of COVID-19 on Turkish medical oncologists' opinions of telemedicine through a survey., Methods: This study was conducted using an online questionnaire linked to an invitation e-mail sent to the members of the Turkish Medical Oncology Association mailing group between May and July 2020., Results: Of the 110 (73 males and 37 females) medical oncologists who answered the questionnaire, the average age was 43.9 ± 7.29 (range: 31-64) years, and the majority of the respondents were academics. The most commonly used telemedicine method was store and forward (69.7%). Telemedicine use during clinical visits and multidisciplinary councils increased significantly during the COVID-19 pandemic (p < 0.001 in both cases)., Conclusion: The use of telemedicine increased during the COVID-19 pandemic, and the pandemic has led oncologists to view telemedicine more positively., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Novel mutations have been emerging in the genome of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2); consequently, the evolving of more virulent and treatment resistance strains have the potential to increase transmissibility and mortality rates. The characterization of full-length SARS-CoV-2 genomes is critical for understanding the origin and transmission pathways of the virus, as well as identifying mutations that affect the transmissibility and pathogenicity of the virus. We present an analysis of the mutation pattern and clade distribution of full-length SARS-CoV-2 genome sequences obtained from specimens tested at Gazi University Medical Virology Laboratory. Viral RNA was extracted from nasopharyngeal specimens. Next-generation sequencing libraries were prepared and sequenced on Illumina iSeq 100 platform. Raw sequencing data were processed to obtain full-length genome sequences and variant calling was performed to analyze amino acid changes. Clade distribution was determined to understand the phylogenetic background in relation to global data. A total of 293 distinct mutations were identified, of which 152 missense, 124 synonymous, 12 noncoding, and 5 deletions. The most frequent mutations were P323L (nsp12), D614G (ORF2/S), and 2421C>T (5'-untranslated region) found simultaneously in all sequences. Novel mutations were found in nsp12 (V111A, H133R, Y453C, M626K) and ORF2/S (R995G, V1068L). Nine different Pangolin lineages were detected. The most frequently assigned lineage was B.1.1 (17 sequences), followed by B.1 (7 sequences) and B.1.1.36 (3 sequences). Sequence information is essential for revealing genomic diversity. Mutations might have significant functional implications and analysis of these mutations provides valuable information for therapeutic and vaccine development studies. Our findings point to the introduction of the virus into Turkey through various sources and the subsequent spread of several key variants., (© 2021 Wiley Periodicals LLC.)

Background: The Syrian crisis, which started in March 2011, has resulted in the displacement of 6.3 million refugees predominantly to neighboring countries in addition to the internal displacement of 6.2 million people. Turkey is the country hosting the largest number of refugees in the world with 3.6 million Syrian refugees 46 % of which are under 18 years old., Objective: The purpose of this article is to conduct a narrative review and analyze the vulnerabilities of refugee children in Turkey from the lens of the Sustainable Development Goals (SDG), more specifically SDG Goal 3: Good Health and Wellbeing, with a specific focus on Syrian refugee children. Moreover, this article explores the actions taken to prevent and mitigate issues that arise from these vulnerabilities., Method: This narrative review article collected data from various primary and secondary sources on the Turkish refugee framework including national and international legislation, governmental and non-governmental data and reports, and scientific papers., Results: Syrian refugee children in Turkey are facing a variety of risks in terms of their health and wellbeing including communicable and non-communicable diseases, post-traumatic stress disorder, depression, family violence, child labor, and child marriage. The measures taken for prevention and response by governmental and non-governmental entities are multilateral and aim to address issues from multiple perspectives including medical, psychosocial, child protection, and legal., Conclusions: The interventions and restructuring of the health system in Turkey contribute to the SDG number 3 for refugee children. The existence of a legal system which enables refugee access to health, protection, and other social services is key to achieve this goal. However, the existing system could be improved especially through solidifying the legal basis and centralizing the implementation for child and refugee protection. The engagement of all stakeholders to improve the health and wellbeing of refugee children remains vital., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Aims: The aim of the present study was to evaluate umbilical cord N-terminal procollagen of type l collagen (P1NP) and beta C-terminal telopeptide (βCTX) levels in term pregnancies with vitamin D deficiency., Materials and Methods: Ninety-two pregnant women between 19 and 35-years-old who delivered at term gestational age were included in the study and divided into deficient ( n  = 32), insufficient ( n  = 30), and normal (control) vitamin D levels ( n  = 30)., Results: Maternal demographic characteristics and biochemical parameters were similar among groups. The mean umbilical cord P1NP level was 221.4 (211.7-231.0, 95%CI) pg/mL in the vitamin D deficiency group, 282.5 (271.2-293.8, 95%CI) pg/mL in the vitamin D insufficiency group, and 280.9 (270.9-290.8, 95%CI) pg/mL in the control group and significantly lower in vitamin D deficiency group than others ( p  < .001). Umbilical cord P1NP level was similar in the vitamin D insufficiency group and control group ( p  = .971). The mean umbilical cord βCTX level was 5530, 9 (5511.5-5550.3, 95%CI) pg/mL in the vitamin D deficiency group, 5516.3 (5498.4-5534.2, 95%CI) pg/mL in the vitamin D insufficiency group, and 5510 (5491.4-5528.5, 95%CI) pg/mL in the control group, which was statistically similar among the groups ( p =  .251)., Conclusion: Our results indicated that vitamin D deficiency during pregnancy affects fetal bone osteoblast activity.

The study aimed to determine the prevalence of consanguinity among pregnant women, its effect on reproductive behavior and the uptake of prenatal screening. The sample consisted of 842 pregnant women recruited to a prospective cohort study conducted in twenty-three cities from different regions in Turkey between June 2017 and March 2018. Of the women, 17.7% (n = 149) were in consanguineous marriages. The consanguineous couples were younger at the time of their marriages than non-consanguineous couples, and 49% of the consanguineous marriages were arranged. The educational levels of both spouses in consanguineous marriages were lower than those in non-consanguineous marriages. There was a statistically significant difference in the prevalence of the pregnant women having a prenatal screening test between women in consanguineous marriages (53%) and those in non-consanguineous marriages (78.2%). There were no statistically significant differences between the two groups in terms of having health problems during pregnancy, the number of pregnancies, abortions and/or stillbirths, the week of delivery and the birthweight of the baby. Healthcare providers play a key role in eliciting whether or not pregnant couples are consanguineous, providing a tailored risk assessment, education, and counseling about screening and diagnostic tests for early diagnosis and management of the fetus, explaining the testing process and possible outcomes, and helping couples make informed decisions regarding their reproductive options or pregnancy management., (© 2020 National Society of Genetic Counselors.)

Inter-individual variations in the genes encoding xenobiotic-metabolizing enzymes have been reported to alter susceptibility to various diseases involving hematological disorders. The purpose of this case-control study was to investigate the relationship between CYP2D6*4 and GSTP1 Ile105Val polymorphisms and the risk of developing BCR-ABL1 negative myeloproliferative neoplasms (MPN). PCR-RFLP was used for genotyping single nucleotide polymorphisms (SNP) in CYP2D6 and GSTP1 in 139 patients with MPN and 126 controls. There was a significantly increased risk for developing BCR-ABL1 negative MPN for the group bearing the CYP2D6*4 variant allele (X 2 : 4.487; OR 1.738; 95% CI 1.040-2.904; p = 0.034). The platelet count was higher in CYP2D6*4 allele carriers (p = 0.047). There was no association between the GSTP1 Ile105Val polymorphism and the risk of developing MPNs. MPN patients bearing the GSTP1 Ile105Val variant allele had a higher prevalence of bleeding complications (X 2 : 7.510; OR 4.635; 95% CI 1.466-14.650; p = 0.006). Our study provides new data that the CYP2D6*4 polymorphism may be associated with an increased risk to develop MPNs while the GSTP1 Ile105Val polymorphism does not show such an association. To our knowledge, the current study is the first to investigate the relationship between CYP2D6*4 and GSTP1 Ile105Val polymorphisms and the risk of developing MPNs in the Turkish population. Further studies with more patients and controls are needed to support our data.

Introduction: In literature, it is well documented that migration is associated with adverse perinatal outcomes in many countries over the world. But in Turkey, health care providers and obstetricians had to face the effects of migration for the first time after civil war in Syria. Hence, this situation motivated us to conduct the current research in Turkey. Also we aimed to evaluate the effect of immigration on adverse perinatal outcomes, comparing the obstetric results of a native population and an immigrant population, and focusing on relevant indicators of perinatal health., Methods: Information from the hospital database of pregnant women who had vaginal or cesarean delivery was evaluated. The patients were divided into two groups, native women and immigrant women, according to their ethnic origin. Adverse perinatal outcomes were compared between groups using multivariate regression models. Adjusted odds ratio (aOR) and 95% confidence interval (CI) were calculated., Results: A total of 6311 patients were evaluated, of which 4271 were classified as native and 2040 were classified as immigrants. Mean hemoglobin level before delivery was significantly lower in the immigrant group. Preterm delivery (aOR: 1.41; 95% CI: 1.19-1.65), stillbirth (aOR: 1.88; 95% CI: 1.09-3.23), red blood cell transfusion requirement (aOR: 3.12; 95% CI: 2.02-3.98), unplanned birth rates before hospital arrival (aOR: 2.25; 95% CI: 1.53-3.31), and postpartum infection rates (aOR:2.12; 95% CI: 1.48-3.08) were significantly increased in the immigrant group compared with native group, even considering adjustment for potential confounders., Conclusion: The immigration may be an important and independent risk factor for some adverse maternal and neonatal outcomes., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2019 Ilknur Col Madendag et al.)

Background: The aim of this study was to investigate the relationship between depression and healthy lifestyle behaviors of patients with a history of transplant., Methods: This was a descriptive study. The study was conducted on 110 patients who received organ transplant and attended a university hospital in Istanbul, Turkey. Data were collected using a patient information form, the Beck Depression Inventory, and the Healthy Lifestyle Behaviors Scale-II., Results: The mean age of the patients in years ± SD was 45.8 ± 12.35; 60.9% of them were men; and the mean body mass index (kg/m 2 ) was 26.9 ± 4.84. There was a statistically significant difference between nutrition subscale and body mass index. A statistically significant difference was found between the total score of healthy lifestyle behaviors, nutrition, and interpersonal relationships subdimension with education status. There was a statistically significant difference between health responsibility, nutrition, and interpersonal relationships subdimension with marital status. There was a statistically significant difference between health responsibility subdimension and income status. A statistically significant difference was found between nutrition, spiritual growth, interpersonal relationships, stress management subdimension with living alone or living with someone. There was a statistically significant difference between depression scores and elapsed time after transplantation. There was a significant moderate negative correlation between depression and healthy lifestyle behaviors scores., Conclusion: According to results of this study, healthy lifestyle behaviors of patients with a history of organ transplant were affected by factors such as body mass index, education status, income status, and marital status. Depression levels decreased as healthy lifestyle behaviors improved for the patients of organ of the transplant., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Purpose: The aim was to determine the prevalence and risk factors of postpartum depression, and changes over time from pregnancy to postpartum period., Design and Methods: A prospective cohort study was conducted in 23 cities in Turkey, with 497 pregnant women., Findings: Of women, 13.5% had a high level of depressive symptoms during pregnancy and 4.8% during the postpartum period. Significant relationships emerged between total Edinburgh Postnatal Depression Scale score and mean age of participants and their husbands, duration of marriage, parity, and history of receiving professional psychological support., Practice Implications: Family planning education could be an important intervention to prevent depression in young couples., (© 2018 Wiley Periodicals, Inc.)

Brucellosis in pregnant women is reported to be associated with obstetric complications (OCs), and adequate data for human brucellosis during pregnancy are largely lacking. We performed this multicenter retrospective cross-sectional study to evaluate the epidemiology, clinical course, treatment responses, and outcomes of brucellosis among pregnant women. The study period comprised a 14-year period from January 2002 to December 2015. All consecutive pregnant women diagnosed with brucellosis in 23 participating hospitals were included. Epidemiological, clinical, laboratory, therapeutic, and outcome data along with the assessment data of the neonate were collected using a standardized questionnaire. Data of 242 patients were analyzed. The OC rate was 14.0% (34/242) in the cohort. Of the 242 women, 219 (90.5%) delivered at term, 3 (1.2%) had preterm delivery, 15 (6.2%) aborted, and 5 (2.1%) had intrauterine fetal demise. Seventeen (7.0%) of the newborns were considered as low birth weight. Spontaneous abortion (6.1%) was the commonest complication. There were no maternal or neonatal deaths and pertinent sequelae or complications were not detected in the newborns. Splenomegaly (p = 0.019), nausea and/or vomiting (p < 0.001), vaginal bleeding (p < 0.001), anemia (blood hemoglobin < 11 g/dL; p < 0.001), high level of serum aspartate aminotransferase (> 41 IU/L; p = 0.025), oligohydramnios on ultrasonography (p = 0.0002), history of taking medication other than Brucella treatment during pregnancy (p = 0.027), and Brucella bacteremia (p = 0.029) were the significant factors associated with OCs. We recommend that pregnant women with OC or with fever should be investigated for brucellosis if they live in or have traveled to an endemic area.

This study evaluated how genetic literacy of pregnant women in Turkey affects their use of prenatal screening and diagnostic tests. As a descriptive cross-sectional study, a Participant Identification Form and the Genetic literacy and Comprehension Measure (GLAC) were used to collect data. The sample of study consisted of 189 pregnant women who made regular antenatal care visits in Giresun, Turkey. The mean age was 29.5 ± 5.9 years and mean gestational week was 34.9 ± 5.09. Of the women, 76.7% had undergone prenatal screening tests, and 85.5% of them had learned about the tests from their doctors. The mean GLAC score of familiarity was 3.67 ± 1.78 (out of seven), and the genetic concepts answered correctly were 5.30 ± 1.79 (out of eight). No statistically significant relationship emerged between the women's genetic literacy and their use of prenatal screening or diagnostic tests. However, relationships were statistically significant between the genetic literacy of the women and the educational levels of the women themselves or their spouses, consanguineous marital status, parity, and use of folic acid supplements. Primiparous women who were highly educated, had a highly educated spouse, were not in consanguineous marriages, and had taken folic acid supplements during pregnancy were more literate in genetics. There is a need for more educational opportunities in order for women to increase their familiarity with genetic terms. Educating women will improve their understanding of genetics-related health services and increase their awareness of genetic diseases, which will allow them to take the appropriate actions for primary prevention., (© 2019 National Society of Genetic Counselors.)

Background: Nausea and vomiting occur 50-90% during the first trimester of pregnancy. However, patients with hyperemesis gravidarum (HG) may be hospitalized at an incidence rate of 0.8-2% before the 20th week of gestational age. The symptoms generally start during the 5-6th gestational weeks, reaching the highest degree during the 9th week, and decline after the 16-20th weeks of gestation. Clinical findings are proportional to the severity of the disease and severe HG is characterized with dehydration, electrolyte imbalance, and nutritional deficiency as a result of vomiting., Methods: The study population consisted of two groups of pregnant volunteers at 5-12 weeks of gestation: a severe HG group and a control group. The HG severity was scored using the Pregnancy-Unique Quantification of Emesis (and nausea) (PUQE).The serum levels of the maternal Ca, parathyroid hormone (PTH), Na, K, blood urea nitrogen(BUN), creatinine, vitamin D(25OHD3), and the maternal urine NTx levels were compared between the groups., Results: In total, 40 volunteers were enrolled in this study: 20 healthy pregnant volunteers and 20 with severe HG. There were no statistically significant differences between the maternal characteristics. The first trimester weight loss of ≥5 kg was significantly higher in the severe HG group (p < 0.001), while the control group had a significantly higher sunlight exposure ratio than the severe HG group (p = 0.021). The urine NTx levels were significantly higher in the severe HG group (39.22 ± 11.68NTx/Cre) than in the control group(32.89 ± 8.33NTx/Cre) (p = 0.028).The serum Ca, PTH, Na, K, BUN, and creatinine levels were similar between the groups (p = 0.738, p = 0.886, p = 0.841, p = 0.957, p = 0.892, and p = 0.824, respectively). In the severe HG group, the serum 25OHD 3 levels were significantly lower than in the control group (p < 0.001)., Conclusions: The data from this study indicated that severe HG is associated with increased urine NTx levels. However, large-scale studies are required to understand the clinical significance of this finding, as well as the long-term consequences of elevated urine NTx levels and the underlying mechanisms., Trial Registration: NCT02862496 Date of registration: 21/07/2016.

Background/aim: The Neuropsychiatric Inventory-Clinician (NPI-C) scale is one of the best-known scales for evaluating the behavioral and psychological symptoms of dementia. This study aimed to assess the reliability and validity of the Turkish version of the NPI-C scale in patients with Alzheimer disease (AD)., Materials and Methods: The NPI-C scale was administered to 125 patients with AD. For reliability, both Cronbach's α and interrater reliability were analyzed. The Behavioral Pathology in Alzheimer's Disease (BEHAVE-AD) scale was applied for validity and, in addition, the Mini Mental State Examination (MMSE), Instrumental Activities of Daily Living (IADL) scale, and Disability Assessment of Dementia (DAD) scale were completed., Results: The Turkish version of the NPI-C scale showed high internal consistency (Cronbach's α = 0.75) and mostly good interrater reliability. Assessments of validity showed that the NPI-C and corresponding BEHAVE-AD domains were found to be significantly correlated, between 0.925 and 0.195. Moreover, the correlations between NPI-C and MMSE were significant for all domains except the dysphoria, anxiety, and elation/euphoria domains. When we conducted a correlation analysis of NPI-C with IADL, all domains were statistically significantly correlated except aggression, anxiety, elation/euphoria, and dysphoria., Conclusion: The Turkish version of the NPI-C scale was found to be a reliable and valid instrument to assess neuropsychiatric symptoms in Turkish elderly subjects with AD.

Objective: This study aimed to determine the relationship between red cell distribution width (RDW) and mortality in patients that received a partial hip prosthesis., Methods: The study included 316 patients (183 female and 133 male) that underwent surgery due to hip fracture and were followed up for ≥1 year. Mean age of the male and female patients was 77.50 years (range; 65-95) and 78.23 years (range; 65-100), respectively. The relationship between the RDW level at the time of presentation and mortality was evaluated., Results: There was a significant relationship between mortality, and age (median age for man 77.50 and for woman 78.23) trochanteric fracture, and a high RDW level (>14.5%). In patients with these 3 characteristics the mortality rate was 2.8-fold higher than in the other patients., Conclusion: RDW is a parameter measured via routine blood testing. We think that RDW measurement should be used in the planning of the treatment of hip fractures and in scoring systems used to estimate post-operative mortality.

Childhood sexual abuse is a growing concern throughout the world, although the legal sequelae of this phenomenon are frequently neglected. We aimed to reveal and compare the attitudes of judiciary and junior clerks toward sexually abused children that might contribute to these sequelae. We divided 302 study participants into two groups of judiciary members and junior clerks. All the participants were asked to anonymously complete a questionnaire about stigmatization, including questions assessing social distance, dangerousness and skillfulness. In their responses, 51.2% of the judiciary and 64.0% of the junior clerks displayed a negative attitude toward "asking a childhood sexual abuse (CSA) survivor to supervise their child for few hours" (p=0.029). When asked "What would you think if your child wanted to marry a CSA survivor?" 76.5% of the judiciary and 84.1% of the junior clerks were opposed to the idea (p=0.095). Interestingly, significantly more judiciary than junior clerks believed that a "CSA survivor can control his/her rage" (p=0.001), and significantly more of the junior clerks did not believe that "CSA survivors do not behave impulsively" (p=0.034). Both groups of legal professionals in this study appear to distance themselves from or have negative thoughts about CSA survivors, particularly when the issue involves their own children and/or social situations. Along with other factors, these negative assumptions might also contribute to lower prosecution rates and retestifying procedures., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objectives: Placement of multiple nephrostomy tubes is the standard practice after completion of multitract percutaneous nephrolithotomy (PCNL) to reduce hemorrhage and urinary extravasation.We compared the outcomes among tubeless, single nephrostomy drainage and multiple nephrostomy drainage tubes following PCNL requiring multiple tracts., Methods: We retrospectively analyzed the data of 115 patients who underwent PCNL using multiple (two or more) access tracts. Patients were categorized into three groups: one nephrostomy tube for each tract (group 1, n = 43); single nephrostomy tube placement (group 2, n = 51), and no nephrostomy drainage with antegrade placement of a double-J stent (group 3, n = 21)., Results: The three groups had comparable demographic data. The differences in operative times, average hemoglobin decrease and complication rates for the three groups were not statistically significant. The average hospital stay in the tubeless group (mean 2.1 days) was significantly shorter than that in group 1 (4.2 days) and group 2 (3.5 days). The postoperative analgesic requirement was significantly higher in group 1 compared to group 2 (p < 0.05) and group 3 (p < 0.001). Stones were completely cleared in 83.7, 84.3 and 85.7% of patients, which increased to 90.7, 92.1, and 95.2% with adjunctive therapies in groups 1, 2 and 3, respectively., Conclusions: Single or no nephrostomy drainage following multitract PCNL offers the potential advantages of decreased postoperative analgesic requirement, and hospital stay without increasing the complications., (Copyright © 2011 S. Karger AG, Basel.)

Introduction: Rib fractures are the most common type of injury associated with trauma to the thorax. In this study, we investigated whether morbidity and mortality rates increased in correlation with the number of fractured ribs., Materials and Methods: Data from 214 patients with rib fractures who applied or were referred to our clinic between January 2007 and December 2008 were retrospectively evaluated. The patients were allocated into three groups according to the number of fractures: 1) patients with an isolated rib fracture (RF1) (n = 50, 23.4%), 2) patients with two rib fractures (RF2) (n = 53, 24.8%), and 3) patients with more than two rib fractures (RF3) (n = 111, 51.9%). The patients were evaluated and compared according to the number of rib fractures, mean age, associated chest injuries (hemothorax, pneumothorax, and/or pulmonary contusion), and co-existing injuries to other systems., Findings: The mean age of the patients was 51.5 years. The distribution of associated chest injuries was 30% in group RF1, 24.6% in group RF2, and 75.6% in group RF3 (p<0.05). Co-existing injuries to other systems were 24% in group RF1, 23.2% in group RF2, and 52.6% in group RF3 (p<0.05). Two patients (4%) in group RF1, 2 patients (3.8%) in group RF2, and 5 patients (4.5%) in group RF3 (total n = 9; 4.2%) died., Conclusion: Patients with any number of rib fractures should be carefully screened for co-existing injuries in other body systems and hospitalized to receive proper treatment.

Background: An imbalance between the lipid peroxidation process and antioxidative protection is associated with the pathophysiology of coronary artery disease (CAD). The authors aimed to determine the relationship between the contributors of antioxidant protection, such as paraoxonase-1 (PON1) activity, albumin, vitamin C and ceruloplasmin (CP) levels, and lipid peroxidation indicators., Methods: In the present study, the activity of PON1 was measured, together with serum concentrations of a variety of lipid constituents, albumin, vitamin C and CP levels, and lipid peroxidation indicators (conjugated dienes [CDs] and thiobarbituric acid-reactive substances [TBARS]). Data were gathered from 26 nondiabetic, angiographically proven, Turkish CAD patients and 26 healthy controls living in the Antalya region (Turkey)., Results: CAD patients had significantly lower PON1 activity, high-density lipoprotein cholesterol, vitamin C and albumin concentrations, and higher CP, CD and TBARS concentrations than the controls. In the entire study population (n=52), serum CP levels were positively correlated with TBARS and CD levels, and negatively correlated with albumin and vitamin C levels, as well as with PON1 activity. On multiple logistic regression analysis, risk factors associated with CAD included high CP and low albumin levels., Conclusions: CAD patients and controls were matched for age and sex, and high CP and low albumin levels were found to be independent risk factors for CAD. The present data gathered from the study group living in the Antalya region verifies that in CAD patients, CP impairs the oxidant-antioxidant balance in favour of the oxidants.

Objective: The aim of this study is to determine the age and sex distribution and the nature of aspirated foreign bodies (FBs). We also compared Turban Pins (TP) with other FBs and discussed the extracting techniques., Methods: From 1987 through 2006, 414 patients were managed and the records of the patients were retrospectively reviewed., Results: Girls (56%) were influenced much more than the boys (44%). The median age was 4, however median age for girls and boys were 11 and 2, respectively. The 50% of the foreign body aspiration (FBA) were observed in the first years of life. There was also a great tendency to occur in the adolescent age group (32%), especially for girls. The most commonly aspirated foreign body was Turban pin (TP) (n=121) among 332 foreign bodies. FBs were successfully removed by rigid bronchoscopy in 94% of the patients. In patients who had a negative history (n=49), bronchoscopy was performed according to clinical suspicion, and it revealed foreign bodies in 41%. Thoracotomy was performed in eight (2.4%) patients. We had no mortality., Conclusions: These cases showed us that the type and age groups of FBA varies according to cultural conditions. We found that TP aspiration has different characteristics and it deserves a special attention. Suspicion is an important indication for bronchoscopy. We prefer rigid bronchoscopy because success rate is satisfactory.

Aim: We investigated specific aetiology and different therapeutic approaches in patients with empyema in a General Thoracic Surgery Clinic., Material and Methods: Charts of 139 patients admitted with empyema, between January 1998 and March 2005 were retrospectively reviewed. Although not completely comparable, patients were divided into two groups; Paediatric (n = 71) and adult (n = 68) cases. In addition to demographic characteristics, treatment options, complications and clinical outcomes were investigated according to the specific group., Results: The mean age was 5.6 years (4 mo - 17 y) for paediatric patients and 49.6 years (20-81 y) for adult patients. Overall, 65% of the patients (n = 91) were male. All paediatric cases had parapneumonic empyema, while 63% of the adult cases had parapneumonic and 23.5% had postoperative empyema. Of the paediatric cases, 50% received fibrinolytic treatment in addition to tube thoracostomy and 35% had decortication. In adults, 42% had tube thoracostomy and fibrinolytic treatment, and decortication was required in 9% only. Thoracomyoplasty was performed in 12% of the patients (n = 8). We had no mortality in paediatric patients, however mortality rate was 8% in the adult group. Morbidity, consisted mostly of prolonged air leakage and impaired lung expansion., Conclusion: Early decortication and fibrinolytic treatment are sufficient for paediatric patients, while a variety of techniques including open drainage, rib resection and thoracomyoplasty are required in adult patients with empyema.

To adapt the Western Ontario Rotator Cuff (WORC) index for use in Turkey and to investigate its reliability and validity; the Turkish version of the WORC was developed according to the guidelines in the literature. Seventy-two patients with rotator cuff disease were administered the questionnaire and were also evaluated by using the University of California Los Angeles (UCLA) shoulder rating scale, Constant score, and Short Form (SF)-36 to test validity. The WORC questionnaire was repeated in 35 patients after a mean interval of 2.9 days (range 2-7 days) to evaluate test-retest reliability. Cronbach's alpha was calculated as 0.92 for the total questionnaire. The intraclass correlation coefficients were very high and ranged between 0.96 and 0.98 for each section. There was a significant negative correlation between the Turkish version of WORC and UCLA (r = -0.598, P < 0.01), Constant score (r = -0.630, P < 0.01), and all subscales of SF-36 (P < 0.01). The Turkish version of the WORC index is a reliable and valid instrument for use in clinical trials in patients with rotator cuff disorders.

Few studies on the benign joint hypermobility syndrome suggest a tendency toward osteopenia, but there are conflicting results. We assessed bone mineral density in pre-menopausal women with hypermobility. Twenty-five consecutive Caucasian women diagnosed with benign hypermobility syndrome by Beighton score and 23 age- and sex-matched controls were included in the study. Age, menarch age, number of pregnancies, duration of lactation, physical activity and calcium intake were questioned according to European Vertebral Osteoporosis Study Group (EVOS) form. All subjects were pre-menopausal and none of them were on treatment with any drugs effecting bone metabolism or had any other systemic disease. No statistically significant difference was found for body mass index, menarch age, number of pregnancies, duration of lactation, calcium intake, calcium score and physical activity score between the two groups. Total femoral and trochanteric bone mineral density and t and z scores were significantly lower in hypermobile patients compared to the control group. Ward's triangle and femoral neck z scores were also found to be significantly low in hypermobile patients (p<0.05). Significant negative correlations were found between the Beighton scores and trochanteric BMD, t and z scores (r=-0.29, r=-0.30, and r=-0.32) in hypermobility patients. Low bone mass was more frequently found among subjects with hypermobility (p=0.03). Hypermobility was found to increase the risk for low bone mass by 1.8 times (95% confidence interval 1.01-3.38). Our study suggests that pre-menopausal women with joint hypermobility have lower bone mineral density when compared to the controls and hypermobility increases the risk for low bone mass.

Background/aims: We aimed to investigate the prevalence of intestinal metaplasia in the cardia of a patient group with high incidence of Helicobacter pylori infection presenting for elective upper endoscopy. We also re-evaluated the relation between intestinal metaplasia in the cardia and gastroesophageal reflux disease, smoking, alcohol history, H. pylori infection, Barrett's esophagus and intestinal metaplasia elsewhere in the stomach., Methodology: Sixty patients presenting for elective upper endoscopy were included in this study. Prior to undergoing endoscopy each patient was questioned with regard to the clinical indication and symptoms including heartburn, regurgitation, and dysphagia. In addition, a smoking and alcohol history were recorded. Endoscopic biopsies: 1) one from the midantrum on the lesser curvature, 2) one from the incisura angularis, 3) one from the mid-corpus on the lesser curvature, 4) one from the columnar side of the squamocolumnar junction, 5) one from the squamous side of the squamocolumnar junction, 6) one from 2 cm distal to the esophagogastric junction, 7) one from across the squamocolumnar junction. Slides were stained using a combination of hematoxylin-eosin with Alcian blue at pH 2.5 for intestinal metaplasia. Each specimen was examined for the presence of H. pylori., Results: The prevalence of H. pylori infection was 63%. Prevalence of the H. pylori infection was significantly lower in the patients with intestinal metaplasia of the cardia than in the patients without intestinal metaplasia of the cardia (P = 0.025). There was a positive correlation between the age of the patients and having intestinal metaplasia of the cardia (r = 0.286, P = 0.008). There was no relationship between intestinal metaplasia of the cardia and pyrozis, regurgitation, dysphagia, history of alcohol and smoking esophagitis determined by endoscopy or histopathology, sex, intestinal metaplasia elsewhere in the stomach (P > 0.05)., Conclusions: The incidence of the intestinal metaplasia of the gastric cardia in Turkey is less than that of western countries. Intestinal metaplasia of the gastric cardia negatively correlates with H. pylori infection. And there was no relationship between gastric cardia intestinal metaplasia and reflux disease. Further investigations are needed for determining the premalign lesion and etiologic factors for cancer of the gastric cardia.

Background: Bronchiectasis is usually caused by pulmonary infections and bronchial obstruction. It is still a serious problem in developing countries as our country. We reviewed the morbidity and mortality rates and outcome of surgical treatment for bronchiectasis., Patients and Methods: Between 1990 and 2000, 166 patients (92 female and 74 male patients) underwent pulmonary resection for bronchiectasis. The mean age was 34.1 years (range, 7-70 years). Mean duration of symptoms was 5.7 years., Results: Symptoms were copious amount of purulent sputum in 135 patients, expectoration of foul-smelling sputum in 109, hemoptysis in 35 and cough in all patients. The indication for pulmonary resection was failure of medical therapy in 158 patients, massive hemoptysis in five and lung abscess in three. The disease was bilateral in six patients and mainly confined to the lower lobe in 127. One hundred and twenty patients had a lobectomy, 13 had a pneumonectomy, 21 had a segmentectomy and a combination of these approaches in 18. Operative morbidity and mortality were seen in 18 (10.5%) and in three (1.7%) patients, respectively. Follow-up was complete in 148 patients with a mean of 4.2 years. Overall, 111 patients were asymptomatic after surgical treatment, symptoms were improved in 31, and unchanged or worse in six., Conclusions: Surgical treatment of bronchiectasis is more effective in patient with localized disease. It is satisfactory with acceptable ratio of morbidity and mortality.