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ANADOLU PSIKIYATRI DERGISI-ANATOLIAN JOURNAL OF PSYCHIATRY Volume: 15 Issue: 3 Pages: 238-247 DOI: 10.5455/apd.39829 Published:SEP 2014 Document Type:Article Categories / Classification Research Areas:Psychiatry Web of Science Categories:Psychiatry Document Information Language:Turkish Accessing Number: WOS:000340477600008 ISSN: 1302-6631 Other Information IDS Number: AN3HP, Amaç: Bu çalışmanın amacı, psikiyatrik ayaktan hasta popülasyonunda Gece Yeme Sendromunun (GYS) şiddetini ölçmek için kullanılan Gece Yeme Anketinin (GYA) Türkçe sürümünün geçerlilik ve güvenilirliğini değerlendirmektir. Yöntem: GYA’nın Türkçe sürümünün faktör yapısı, iç tutarlılığı ve geçerliliği incelenmiştir. İlk olarak GYA’nın Türkçeye çevirisinin ardından İngilizceye tekrar çeviri yapılmıştır. Düzeltme ve semantik uyarlama sonrası anketin anlaşılabilirliği değerlendirilmiştir. GYS tanısı psikiyatrik görüşme yapılarak konulmuştur. GYA 433 hastaya, iki hafta sonra yapılan tekrar testi ise 141 hastaya uygulanmıştır. Sonuçlar: Cronbach alfa katsayısı 0.69 bulunan anket yeterli iç tutarlılık göstermektedir. Test-tekrar test toplam puanları arasındaki intraclass korelasyon katsayısı 0.96 olarak bulunmuştur. Psikiyatrik değerlendirme sonucunda 97 hastada GYS saptanmıştır. ROC eğrisi altında kalan alan 0.90 olarak bulunmuştur. GYA puanında 18 değeri sınır değer olarak kabul edildiğinde duyarlılık %90.7, seçicilik %73.8 olarak saptanmıştır. GYA’nın doğrulayıcı faktör analizinde orijinal ankete benzer şekilde dört faktörlü yapı elde edilmiştir. Tartışma: Bu çalışmaya göre GYA’nın Türkçe sürümünün geçerli bir test olduğu, iyi tanısal özellik gösterdiği ve iç tutarlılığının yüksek olduğu söylenebilir. Anahtar Kelimeler: Gece Yeme Sendromu, Gece Yeme Anketi, geçerlilik, güvenilirlik Objective: The purpose of this study was to evaluate the reliability and validity of Turkish version of the Night Eating Questionnaire (NEQ) in psychiatric outpatient population as a measure of severity of the Night Eating Syndrome (NES). Methods: We examined the factor structure, internal consistency and validity of the NEQ in Turkish. First, we translated NEQ into Turkish; and then back-translation into English; correction and semantic adaptation and assessment of the understanding of the questionnaire. We made the diagnosis of NES according to psychiatric examination. We administered the NEQ in 433 patients and the re-test in 141 participants two weeks later. Result: The instrument showed satisfactory internal consistency with an overall Cronbach α of 0.69. Intraclass correlation for the test re-test total score was 0.96. The ninety seven patients had NES with psychiatric examination. The area under ROC curve defined as 0,904. For cut-off point of 18 in NEQ both sensitivity and specificity were 90.7% and 73.8%. The confirmatory factor analysis of the NEQ yielded a similar four factor solution as the original scale. Conclusions: We found that Turkish version of NEQ is valid and has well diagnostically performance, and high internal consistency. Key words: Night Eating Syndrome, Night Eating Questionnaire, validity, reliability

Ankarali, Handan Camdeviren/0000-0002-3613-0523 WOS: 000343833100055 PubMed: 25227835 Background: A cytologic reading of a Papanicolaou ( pap) smear followed, if the result is positive, by a colposcopic search for abnormal cells is the most common screening method for cervical cancer used worldwide. We aimed to present the correlation of smear and colposcopic findings with 6- to 12-month follow-up results and related factors in women who underwent colposcopy in Turkey. Materials and Methods: The study population consisted of women who attended the gynecology department and were referred for colposcopic evaluation in 2011-2012. A total of 232 women between ages 17 and 68 years were included. Colposcopy indications were ASCUS and higher lesions at cervical smear, macroscopic suspicious lesions, post-coital bleeding history with suspicious smear, and repeated cervical inflammation. All patients were recalled for 6- to 12-month follow-ups. Results: The most common colposcopy indication was ASCUS, and the most common biopsy result was inflammation. Nearly half of the patients returned for the control 6-month follow-up, and almost 20% of patients for a 1-year follow up. Conclusions: Colposcopic biopsy is an effective method in indicated patients but is not sufficient in itself if awareness of the subject is not raised in the population. One of the most important aims of cancer screening programs should be enabling patients in developing countries to take responsibility. Patients must be encouraged to apply to the hospital for better disease control.

saltan, asuman O/0000-0003-0546-2610; Ankarali, Handan Camdeviren/0000-0002-3613-0523 WOS: 000341190200007 PubMed: 25108749 Objective: The purpose of this study was to evaluate the short-term effects of classic massage (CM) and connective tissue massage (CTM) on pressure pain threshold and muscle relaxation response in women with chronic neck pain. Methods: Participants included 45 female volunteers (ages between 25 and 45 years) presenting to the Koroglu State Hospital Neurosurgery Polyclinic who had experienced neck pain for 3 to 6 months. The volunteers were randomly assigned to 2 groups (CM or CTM to the thoracic spine and the neck). Each treatment was carried out for 1 session. Outcome measures were obtained before and after treatment, which included pressure pain threshold that was measured with an algometer and muscle relaxation response that was evaluated with electromyography biofeedback (EMG-BF). Results: Pressure pain threshold of the sternocleidomastoid muscle was significantly different for the CM (P < .05) group. The EMG-BF values were significantly different for the CTM group (P < .05). Comparing the results of CM and CTM, EMG-BF averages favored the CTM group (P < .05). Conclusion: For the group of women with chronic neck pain that were included in this study, 1 treatment of CTM demonstrated relaxation responses and 1 treatment of CM demonstrated pain reduction.

Background: The etiopathogenesis of prostate cancer (PC) is still not clear, but hormonal, genetic, and environmental factors are thought to play a role in the tumor pathogenesis. Astrocyte elevated gene-1(AEG-1) as a novel transmembrane protein is predominantly located in the perinuclear region and endoplasmic reticulum. It has been found that AEG-1 upregulation increases the invasive ability of glioma and prostate cancer. Basic fibroblast growth factor (bFGF), matrix metalloproteinase-9 (MMP-9), cyclooxygenases-2 (COX-2), and adenomatous polyposis coli (APC) are very important in tumor progression as well. Materials and Methods: This study included 97 radical prostatectomy specimens. IHC stains for bFGF, MMP-9, COX-2, APC, and AEG-1 were performed on the tissue microarray using standard procedures. For each patient, the age, Gleason score, tumor volume, lymphovascular invasion, lymph node metastasis, surgical margin, and the invasion of vesiculoseminalis areas were assessed. Analyses were performed using the statistical PASW (ver. 18). Results: Statistically significant positive relationships were found MMP-9 and COX-2 (r = 0.242 and P = 0.017), between MMP-9 and APC (r = 0.207 and P = 0.043), and between bFGF and AEG-1 (r = 0.295 and P = 0.004). However, the relationships between age and staining results and tumor volume and staining results were not found to be significant. Although a positive correlation was found between the Gleason score and tumor volume and the Gleason score and age (r = 0.415 and P = 0.0001; r = 0.246 and P = 0.015, respectively), we did not find a statistically significant relationship between other stains and other prognostic parameters (lymphovascular invasion, lymph node metastasis, surgical margin, or vesiculoseminalis invasion). Conclusion:The relationships we found between MMP-9 and COX-2, between MMP-9, and APC and between bFGF and AEG-1 as independent prognostic parameters could be helpful in the development of new therapeutic procedures.Keywords: Adenomatous polyposis coli, astrocyte elevated gene‑1, basic fibroblast growth factor, cyclooxygenases‑2, matrix metalloproteinase‑9, prognostic parameters, prostate adenocarcinomasNigerian Journal of Clinical Practice • Oct-Dec 2013 • Vol 16 • Issue 4

BACKGROUND: Paraplegia due to ischemia/reperfusion (I/R) injury of the spinal cord is a devastating and undesired complication of thoraco-abdominal aortic surgery. Unidentified clots cause a variety of thromboembolic events and deteriorate the severity of ischemia. We investigated the effect of the degree of anticoagulation on spinal cord I/R injury and whether heparin is protective against I/R injury beside its anticoagulant properties. MATERIALS AND METHODS: Twenty-eight rats were randomly assigned to four groups (n=7 per group) as G1 (no aortic occlusion and heparin administration), G2 (45 min aortic occlusion; no heparin administration), G3 (45 min aortic occlusion; 400 IU/kg heparin to keep activated clotting time (ACT) level around 200 sec), and G4 (45 min aortic occlusion; 800 IU/kg heparin to keep ACT level around 600 sec). After neurologic evaluation at the 48th hour of reperfusion, lumbar spinal cords were removed for histopathologic evaluation and immunohistochemical staining for HSP70 (heat shock protein 70), interleukin-6 and myeloperoxidase (MPO). RESULTS: The Motor Deficit Index (MDI) scores were lowest in G1 group (p < 0.05) and the MDI scores of G3 and G4 were significantly lower than G2 group (p < 0.05).The neuronal degeneration in G3 was significantly lower than the other groups, respectively (p = 0.03). Histopathological evaluation showed no significant intergroup differences in terms of the degree of edema and inflammatory response. There was no statistically significant difference found among the groups in terms of HSP70 staining, IL-6 staining or the degree of MPO staining. CONCLUSIONS: Protection of spinal cord from I/R injury requires a multimodal management. We should not miss out the importance of adequate anticoagulation in thoraco-abdominal surgical procedures. Furthermore, the recently discovered anti-inflammatory property of glycosaminoglycans, including heparin, deserves to be investigated.

BackgroundThe thoracic or thoracoabdominal aortic aneurysm surgery may cause spinal cord ischemia because of aortic cross-clamping and may result in severe postoperative complications caused by spinal cord injury. Ischemia/reperfusion injury may directly or indirectly be responsible for these complications. In this study we sought to determine whether combination of iloprost and montelukast can reduce the ischemia/reperfusion injury of spinal cord in a rat model.MethodsMedulla spinalis tissue concentrations of interleukin-6 (IL-6), myeloperoxidase (MPO) and heat shock protein 70 (HSP-70) were determined in 3 groups of Spraque Dawley rats: control group (operation with cross clamping and intraperitoneal administration of 0.9% saline, n = 7), sham group (operation without cross clamping, n = 7), and study group (operation with cross-clamping and intraperitoneal administration of iloprost (25 ng/kg) and montelukast (1 mg/kg), n = 7). The abdominal aorta was clamped for 45 minutes, with a proximal (just below the left renal artery) and a distal (just above the aortic bifurcation) clip in control and study groups. Hindlimb motor functions were evaluated at 6, 12, 24, and 48 hours using the Motor Deficit Index score. All rats were sacrificed 48 hours after the procedure and spinal cord tissue levels of myeloperoxidase, interleukin-6, and heat shock protein (HSP-70) were evaluated as markers of oxidative stress and inflammation. Histopathological analyses of spinal cord were also performed.ResultsThe tissue level of HSP-70 was found to be similar among the 3 groups, however, MPO was highest and IL-6 receptor level was lowest in the control group (p = 0.007 and p = 0.005; respectively). In histopathological examination, there was no significant difference among the groups with respect to the neuronal cell degeneration, edema, or inflammation, but vascular congestion was found to be significantly more prominent in the control group than in the sham or in the study group (p = 0.05). Motor deficit index scores at 24 and 48 hours after ischemia were significantly lower in the study group than in the control group.ConclusionThis study suggests that combined use of iloprost and montelukast may reduce ischemic damage in transient spinal cord ischemia and may provide better neurological outcome.

Ankarali, Handan Camdeviren/0000-0002-3613-0523 WOS: 000319357200002 PubMed: 22926528 Although Parkinson's disease (PD) and essential tremor (ET) are distinct clinical disorders, their coexistence can sometimes cause diagnostic problems. In this study, we conducted detailed investigations of patients with both ET and PD (ET-PD) and compared their clinical and cognitive profiles with those of patients with only ET or only PD. This study examined three groups of patients: the first group had ET-PD concomitantly (n = 9); the second group had only ET (n = 9); the third group had only PD (n = 10). The groups were compared in terms of demographic characteristics, clinical features, and cognitive functions. With the exception of positive family histories, which were more common in ET-PD than in PD patients, we found no differences among the groups with respect to demographic characteristics (p = 0.044). PD-only patients had more akinetic-rigid type Parkinsonism (p = 0.016), and their levodopa response was better than that of ET-PD patients (p = 0.017). Patients with ET-PD obtained significantly lower scores than those with pure ET on several cognitive tests, suggesting a prominent frontal-type cognitive dysfunction. In conclusion ET-PD patients differed from PD patients, showing more frequent familial tremor histories and lower levodopa responsiveness. This patient population also demonstrated more severe cognitive impairments than pure-ET patients. This result suggests that ET-PD patients are a subset of ET patients with more widespread neurodegeneration, which may indicate the presence of a syndrome that includes overlap between ET and PD.

barlas, ibrahim omer/0000-0002-2645-4487; Ankarali, Handan Camdeviren/0000-0002-3613-0523; Erdal, Mehmet Emin/0000-0002-6191-2930; Sahin, Gunsah/0000-0002-4215-6957 WOS: 000322120400017 PubMed: 23392773 To investigate the associations between Fas and FasL gene polymorphisms and susceptibility to knee osteoarthritis. Genomic DNA was obtained from 146 patients with knee osteoarthritis and 102 healthy controls. Genotype distributions and allelic frequencies of four polymorphisms of Fas (-670 G > A rs1800682, -1377 G > A rs2234767) and FasL (IVS2nt-124 A > G rs5030772, -844 T > C rs763110) genes were compared between the groups. Thereafter, this association was investigated between patients and controls of the same sex. There were significant differences between patients with knee osteoarthritis and controls regarding the genotype distributions and allelic frequencies of Fas-1377 G > A polymorphism (P = 0.0001 and P = 0.005, respectively). The Fas-1377 GG genotype and G allele were significantly more frequent in patients with knee osteoarthritis than in controls. Genotype distributions and allelic frequencies of Fas-670 G > A, FasL-844 T > C, and FasL IVS2nt-124 A > G polymorphisms did not differ between the groups (P > 0.05). However, there were no significant differences between patients and controls of the same sex (P > 0.05). These findings suggest that the Fas-1377 G > A polymorphism in the Fas gene related with apoptosis may contribute to susceptibility to knee osteoarthritis in the Turkish population. There is a need for further studies to evaluate the role of apoptosis in large cohorts.

Objective: Although a variety of anesthetic medicines are used intrathecally, experimental neurotoxic studies on these drugs are not sufficient. In our study, we used immunocytochemical examination to assess the neurotoxic potential of ketamine and different doses of ropivacaine administered intrathecally. Material and Methods: Thirty rabbits were divided into five groups which were inserted spinal catheters under anesthesia. Each group received in a volume of 0.3 ml, as follows: the R0.2 group received 0.2% ropivacaine, the R0.75 group received 0.75% ropivacaine, the R1 group received 1.0% ropivacaine, the K group received preservative-free S (+) ketamine and the C group received 0.9% NaCl. The onset and duration of action were recorded by using Motor Dysfunction Index (MDI). Rabbits were observed for five days and then euthanasized. After catheters were removed, brains and spinal tissue samples were evaluated by light microscopy and immunocytochemical examination. Results: The longest onset of action was observed in the K group. Among the ropivacaine groups, the onset of action diminished and the duration of action extended with an increase in dose significantly. There was axonal degeneration in the R1 group, but this finding not reach significance. In the ketamine group, significant neuronal degeneration and reduction in number of neurons in the brain sections were observed. In the 1% ropivacaine group, a relative increase in neurofilament intensity was detected using immunocytochemical assessments in the medulla spinalis and brain sections. Conclusion: The intrathecal applications of 1% ropivacaine and ketamine can induce neurotoxic damage, despite a lack of observed functional neurologic deficits. © 2013 by Türkiye Klinikleri.

Ankarali, Handan Camdeviren/0000-0002-3613-0523; barlas, ibrahim omer/0000-0002-2645-4487; Sahin, Gunsah/0000-0002-4215-6957; Erdal, Mehmet Emin/0000-0002-6191-2930 WOS: 000324824500025 PubMed: 23749041 To investigate associations of the Fas and FasL genes polymorphisms with rheumatoid arthritis (RA). One hundred patients with RA and age-, sex- and ethnically matched 101 controls were included. Four polymorphisms of Fas (-670 A > G rs1800682, -1377 G > A rs2234767) and FasL (IVS2nt-124 A > G rs5030772, -844 T > C rs763110) genes were typed from genomic DNA. Genotype distributions and allelic frequencies were compared between patients and control subjects. After the history and clinical examination of patients with RA, in terms of pain, fatigue and general health status were evaluated by visual analogue scale. Thereafter, erythrocyte sedimentation rate, C-reactive protein, blood count and rheumatoid factor levels were measured. The Disease Activity Score-28, Health Assessment Questionnaire and modified Sharp score were used to evaluate the disease activity, functional disability and radiological damage, and their relationships with the Fas and FasL gene polymorphisms were investigated. In patients with RA, CT and TT genotypes of FasL-844, polymorphism were twofold and 4.8-fold higher, and AA genotype of FasL IVS2nt-124 polymorphism was 3.4-fold higher than the control group (respectively, p = 0.05, p = 0.002, p = 0.039). T allele of FasL-844 polymorphism was more frequent in patients than controls (respectively, 52.5 vs. 41.4 %, p = 0.027). Any association was not detected between Fas (-670 A > G, -1377 G > A) and FasL (-844 T > C, IVS2nt-124 A > G) gene polymorphisms with the disease activity scores, functional disability and radiological damage. However, the Fas-670 A > G polymorphism was associated with drug therapy (p = 0.049). The distribution of GG genotype was higher compared to GA or AA genotypes in patients using triple disease-modifying antirheumatic drug therapy (71.4, 14.3 and 14.3 %, respectively). These findings suggest that the -844 T > C and IVS2nt-124 A > G polymorphisms in the FasL gene related with apoptosis may increase genetic susceptibility to RA in a Turkish population. In addition, the Fas-670 A > G gene polymorphism may be associated with disease progression. There is a need for further studies to clarify the genetic role of apoptosis in RA.

Objective: This study aimed to investigate the use of the Least Median Squares (LMS) regression and nonparametric quantile regression model comparatively to describe children?s weight growth. Material and Methods: Two different models were used to obtain the percentile curves to identify the weight growth in girls. The first model was obtained by LMS regression, which is a member of the family of nonlinear parametric quantile regression. In addition, in this model percentile curves used to define growth were generated using the Box-Cox transformation and the cubic spline. The second model was obtained by nonparametric quantile regression that did not require the assumption of a normal distribution for construction of percentile curves. This method is a flexible approach, as well as being computationally simple. The weight values obtained from 1771 healthy girls aged between 6 and 14 years were used in both methods. The data were collected from the cross-sectional study conducted in schools in Düzce city. Results: The distributions of weight measurements according to ages revealed that there were deviations from normality at some ages, there were deviated values in the tail regions of the distribution, and the variances changed according to ages. Using both methods, growth curves were constructed separately for each age group. Predicted values of the LMS and the non-parametric quantile regression models were similar for each age. In addition, the error sum of squares derived from non-parametric quantile regression was lower than that derived from LMS regression for each percentile curve. Moreover, the estimations obtained from both methods were highly correlated with the estimation values of the province İstanbul, which was considered the reference. Conclusion: When the assumptions about the distribution and variances of the data are violated and these assumptions cannot be achieved with the transformation, nonparametric quantile regression method gives more reliable results for the creation of percentile curves. © 2013 by Türkiye Klinikleri.

Background/Aims: This study aimed to evaluate the severity of obesity and its impact on achieving target blood pressure and metabolic derangement in obese individuals. Methods: This cross-sectional and population-based study was conducted between January and December 2012. A total of 1837 consecutive obese patients admitted to our outpatient clinic were enrolled. The anthropometric and blood pressure measurements, bioelectrical impedance fat analysis, blood sample analysis, impaired glucose status, metabolic syndrome, and insulin resistance of 1265 obese patients were compared between groups of patients separated by severity of obesity. Results: Only approximately one-third of patients with previous hypertension achieved normal blood pressure. In addition, the majority of patients without previous hypertension had higher blood pressure at the end of the study compared with baseline. The percent of patients with an impaired fasting blood glucose ≥100 mg/dL was 38.5%. The frequency of impaired glucose tolerance was 39.1% in the patients who underwent OGTT Body mass index (BMI) was associated with impaired blood glucose, hypertension, insulin resistance, and the development of metabolic syndrome. The incidences of metabolic syndrome, insulin resistance, impaired glucose tolerance, and uncontrolled blood pressure were significantly different between groups of differing obesity severity (ppp=0.041, and pConclusion: The severity of obesity was associated with the failure to achieve target blood pressure and metabolic syndrome. Based on our data, blood pressure and metabolic parameters in obese patients should be monitored frequently and treated with caution.

Ankarali, Handan Camdeviren/0000-0002-3613-0523 WOS: 000327752700003 Objective: To investigate the influence of patient's socio-demographic features on patient's satisfaction with primary health care (PHC) services in the Turkish population Design: Cross-sectional and population-based study Settings: Forty-five family health centers from 15 cities throughout Turkey Subjects: One thousand two hundred and ten patients were randomly selected. The self-administered study survey was applied. Main Outcome Measures: Association between patients' sociodemographic features and patient satisfaction with primary care settings Results: The mean age of subjects was 37.4 +/- 14.7 years. When mean total score for incisions of sociodemographic features was evaluated, it was observed that the patient satisfaction level was high in female than male patients, married than unmarried patients, patients with high income than low income, in employed and unemployed than officers (p = 0.028, p = 0.043, p = 0.001, and p = 0.006, respectively). The patients with high income level had significantly higher level of satisfaction than those with low income in all domains of patient satisfaction. Female patients were more satisfied with communication, medical care, and support and information domains. Married patients were more satisfied with communication and medical care. The officers were less satisfied than other status of occupation. The patients with university level of education were more satisfied than those with middle and high school level of education. Conclusion: Income level, marital and occupational status of patient's sociodemographic features had significant influence on satisfaction levels in the Turkish population

Background: The Islamic University Habib Medical School in Uganda (IUIU), in collaboration with Doctors Worldwide (DWW) from Turkey, organized a surgical camp in April 2014. In this camp, different types of hernia repair, among other general surgical procedures were conducted. The target population was the population within the Gombe hospital serving districts. Methods: The defined area for the surgical camp was Butambala and neighboring districts including Mpigi; Gomba, Mityana, and parts of Wakiso district. The IUIU team and Gombe hospital team were respectful to the sensitivities of the community, district and government officials. The surgical team composed of 4 surgeons (three from DWW-Turkey and one from Uganda), 3 Anesthesiologists, (two from DWW-Turkey and one from Uganda), 2 nurses and 2 intern doctor, (one from DWW-Turkey and one from Uganda). Results: The total number of patients operated was 115; however the total number of operations performed was 130. One hundred and fourteen operations were different types of hernia repair. The ages of hernia patients ranged between 1 and 80 years (mean±SD is 27.46±24.55). Hemoglobin values ranged between 9.2 and 17 (mean±SD is 12.5±1.48). Only two (1.8%) of 114 hernia patients had positive results on HIV serology. Sixteen patients underwent circumcision. Of those, only two (12.5%) patients had positive results on HIV serology. Conclusion: Hernia is a common surgical problem in all age groups. It is more common in men. In addition to the operations conducted, the need for surgery for 187 patients was detected. This condition shows that the hernia operation is commonly accepted as a negligible condition. Keywords: Global surgery; Provincial; Hernia; World Wide Doctors; Uganda

Ankarali, Handan Camdeviren/0000-0002-3613-0523 WOS: 000315283500001 PubMed: 23151309 Background: Ischemia/reperfusion (I/R) injury is harmful to the cardiovascular system and is responsible for the inflammatory response and multiple organ dysfunctions. In this study we investigated the effect of activated clotting time level on the aortic cross-clamping triggers a systemic inflammatory response and it effects to lungs and heart. Methods: End organ concentrations of interleukin-6 (IL-6), myeloperoxidase (MPO) and heat shock protein 70 (HSP-70) were determined in four groups of Spraque Dawley rats: ischemic control (operation with cross clamping received IP of 0.9% saline at 2 ml/kg n=7) Sham (operation without cross clamping, n=7), heparin (ACT level about 200), High dose heparin (ACT level up to 600) The infrarenal aorta was clamped for 45 minutes by a mini cross clamp approximately 1cm below the renal artery and 1cm iliac bifurcation in all groups without sham group. Heparin was given intraperitoneal (IP) before the procedure. All rats were sacrificed 48 h later. In a second experiment, the effects of I/R on remote organs (lungs and heart) were harvested for analysis. We evaluated tissue levels of myeloperoxidase, interleukin-6, and heat shock protein (HSP-70) were analyzed as markers oxidative stress and inflammation. Histological analyses of the organs were performed. Results: The lungs paranchymal MPO and HSP-70 levels significantly decreased (p0.05) in heparinized and high dose heparinized groups when compared to ischemic control group. Histopathological evaluation as edema, cell degeneration, inflammation statistically significantly decreased in both group heparinized and high dose heparinized compared with ischemic control group (p

To determine the utility of mast cell numbers and microvascular density (MVD) in evaluating acinar type of prostatic adenocarcinoma (PCa), and to ascertain a relationship between the number of mast cells with prognostic parameters (larger tumor volume, high Gleason score, lymphovascular, perineural, seminal vesicles invasion, metastatic lymph node).The study comprised 97 radical prostatectomy specimens. The paraffin sections were stained with anti-CD31, anti- CD34 and Toluidine Blue. The numbers of positive staining of cells and microvessels in 10 high-power fields were counted systematically.A statistically significant relationship was found between MVDn and number of MC (r=0.218 and p=0. 032). There was no correlation between age and MC and MVD (p=0.406 and p=0.671, respectively).A correlation between mast cell number and microvascular density cannot depend on tumor angiogenesis or this relationship can be an independent parameter. More comprehensive studies could reveal relationship with prognostic parameters.

Maternal milk plays an important role in the development of late-onset breast milk jaundice (BMJ), possibly due to the unique characteristics of breast milk. The aim of this study was to investigate whether there is a relation between cytokine concentrations in the milk of nursing mothers and BMJ.Breast milk samples were collected from breast-feeding mothers of healthy full-term neonates, 40 with BMJ and 40 without jaundice. Milk samples were taken between the second and the fourth postpartum week. The concentrations of interleukin (IL)-1 β, IL-6, IL-8, IL-10, and tumor necrosis factor-α were measured by flow cytometric bead array.There were significant differences between the study groups in terms of IL-1 β concentrations (P= 0.013). Not statistically significant but similar trends were also seen for IL-10 (P= 0.067) and tumor necrosis factor-α (P= 0.053) concentrations. However, no significant differences were noted in IL-6 (P= 0.174) and IL-8 (P= 0.285) concentrations.IL-1 β concentration seems to be increased in milk of mothers whose infants had BMJ. Although the effect of these cytokines on BMJ is unknown, it may cause prolonged jaundice via hepatic uptake, hepatic excretion, conjugation and intestinal absorption.

Diabetes mellitus (DM) is a chronic disease requiring continuous monitoring and treatment. Self-monitoring of blood glucose (SMBG) is frequently recommended. The purpose of the study was to evaluate effectiveness of SMBG on metabolic control in Turkish patients with type 2 DM.The cross-sectional study enrolled type 2 diabetic patients without insulin regimen. The participants were assigned to three groups according to status of SMBG: group 1- regular, group 2 - irregular and group 3 - never SMBG implementation.A total of 349 patients were enrolled. There was no significant difference in mean fasting and post-prandial blood glucose, lipid profile values between the groups. The number of patients with high education level in group 1 was higher than groups 2 and 3 (p = 0.001). HbA1c level was higher in groups 2 and 3 than group 1, but not significantly (p = 0.285). Mean spot urinary albumin- creatinine ratio (ACR) in group 1 is significantly lower than in groups 2 and 3 (p = 0.008 and p = 0.044, respectively), but no significant difference was observed between group 2 and 3 (p = 0.473).The study indicated that regular use of SMBG was not superior to irregular/never use of SMBG on glycemic control, but it seemed to be good intervention for prevention of diabetic nephropathy. We suggestively offered that SMBG should be recommended for patients with a high education level to meet the goal of its use, and it should be incorporated into self-management with effective educational intervention.

Amaç: Kardiyak otonomik işlevler klinik uygulamada kalp hızı toparlanma (KHT) indeksi ile dolaylı yoldan ölçülebilir. Bu çalışmada sistemik enflamatuvar bir hastalık olan psoriasisli bireylerde KHT indeksininin araştırılması amaçlandı. Çalışma planı: Çalışmaya 39 psoriasis hastası (18 kadın, ort. yaş 4815 yıl) ve 40 sağlıklı birey (18 kadın, ort. yaş 449 yıl) kontrol grubu olarak alındı. Psoriasisin ciddiyeti psoriasis bölge ve ciddiyet indeksine (PASİ) göre hesaplandı. Çalışmaya alınan hastaların hiçbirinin PASİ skoru 50 değildi. Tüm katılımcılara Bruce protokolü kullanılarak tredmil egzersiz testi uygulandı. Bulgular: Temel klinik ve demografik özelliklerine göre, her iki grup yaş, beden kütle indeksi, açlık kan şekeri ve kolesterol düzeyleri benzerdi. İki grup arasında sistolik veya diyastolik kan basıncı veya istirahat kalp hızlarında anlamlı bir fark gözlenmedi. Tüm hastalar ve kontrol grubu katılımcıları sinüs ritmine ve dinlenmede normal 12 derivasyonlu EKG sonucuna sahipti. Tüm katılımcılar ritim anormallikleri, iskemik değişiklikler veya diğer komplikasyonlar olmadan yorgunluk ile egzersiz testini tamamladı. Egzersiz stres testi sırasında maksimal kalp hızı ve metabolik eşdeğere ulaşma psoriasis ve kontrol grubunda benzer bulundu (sırasıyla; 16316 ve 17016, p0.07; 9.80.9 ve 10.11.0, p0.24). Birinci, üçüncü ve beşinci dakikadaki KHT indeksleri psoriasisli hastalar ile kontrol grubunda benzerdi (sırasıyla, KHT1: 3012, 3218, p0.71; KHT3: 5713, 6417, p0.10; KHT5: 6415, 6816, p0.46). Sonuç: Otonomik sinir sisteminin bir göstergesi olan ve egzersiz testi ile ölçülen KHT indeksi hafif orta derece hastalığa sahip psoriasisli bireylerle etkilenmemiştir. Objectives: In clinical practice, autonomic functions are indirectly investigated with heart rate recovery (HRR) index measurements. Our aim was to evaluate the HRR index in patients with psoriasis, which is a systemic inflammatory disease. Study design: The study population included 39 psoriasis patients (18 female, mean age 48±15 years) and 40 control group (18 female, mean age 44±9 years) healthy individuals. The severity of psoriasis was calculated using the psoriasis area and severity index (PASI). None of the study patients had a PASI score >50. All of the participants underwent treadmill exercise testing using the Bruce protocol.Results: According to basic clinical and demographic characteristics, both groups were similar with regard to age, body mass index, and fasting glucose and cholesterol levels. No significant differences were observed in the systolic or diastolic blood pressures or resting heart rates between the two groups. All patients and control-group participants had sinus rhythm and normal 12-lead ECG results at rest. All subjects completed the exercise tests to exhaustion without rhythm abnormalities, ischemic changes, or other complications. The maximal heart rate and metabolic equivalents achieved during the exercise stress test (EST) were similar in the psoriasis and control group (163±16 vs. 170±16, p0.07; 9.8±0.9 vs. 10.1±1.0, p0.24, respectively). The 1st, 3rd, and 5th minute HRR indices of patients with psoriasis were similar to those of the control group (HRR1: 30±12, 32±18, p0.71; HRR3: 57±13, 64±17, p0.10; HRR5: 64±15, 68±16, p0.46, respectively). Conclusion: The HRR index, which is calculated by an EST and associated with autonomic nervous system function, is not effected in mild to moderate psoriasis patients.

Behçet's disease, a systemic vasculitis, can cause varying degrees of activity limitation, fatigue and quality of life impairment. To date, there have been no studies regarding sleep disturbance and its relationship with fatigue and life quality in Behçet's disease. We aimed to evaluate sleep disorders and polysomnographic parameters, and to determine their relationship with fatigue and quality of life in Behçet's disease. Fifty-one patients with Behçet's disease without any neurological involvement were interviewed regarding sleep disorders. Twenty-one subjects with no sleep complaints were included as the control group. Sleep-related complaints were evaluated in a face-to-face interview. Sleep quality, excessive daytime sleepiness, fatigue, depression, anxiety, disease activity/severity, and quality of life questionnaires and an overnight polysomnography were performed. Prevalences of restless legs syndrome (35.3%) and obstructive sleep apnea syndrome with/without other sleep disorders (32.5%) were higher than in the control group and the general population. Fatigue was higher in patients with restless legs syndrome and obstructive sleep apnea syndrome, and in those with lower minimum oxygen saturation; hence, only patients with restless legs syndrome had quality of life impairment. Sleep efficiency index and sleep continuity index were lower, and wake after sleep onset, respiratory disturbance index and apnea-hypopnea index were higher than in controls (P0.01). Neither sleep disorders nor polysomnographic parameters were related to disease activity and severity. In conclusion, it is important to question sleep disorder followed by a polysomnography, if necessary, in order to improve quality of life and fatigue in Behçet's disease.

WOS: 000208870100794, …

Ankarali, Handan Camdeviren/0000-0002-3613-0523 WOS: 000296301900010 PubMed: 21640465 Objective: Diagnosis of prelabour rupture of membranes (PROM) may be challenging. Conventional diagnostic methods such as speculum examination, ferning pattern, and pH detection are not satisfactorily accurate. Two relatively new, commercially available rapid bedside immunoassay strip tests, for placental alpha microglobulin-1 (PAMG-1) and insulin-like growth factor binding protein-1 (ILGFBP-1), are alleged to be more accurate. We compared the diagnostic efficacy of PAMG-1 and ILGFBP-1 immunoassay tests and combined conventional clinical diagnostic methods in PROM. Study design: 167 pregnant women with signs and/or symptoms of PROM were prospectively evaluated with a combination of conventional clinical tests including speculum examination, nitrazine, ferning pattern, and pooling, in addition to PAMG-1 and ILGFBP-1 immunoassays. Differences in sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the diagnostic methods were compared. Results: Although the PAMG-1 assay was more accurate, the PAMG-1 immunoassay, ILGFBP-1 immunoassay, and combined conventional clinical diagnosis were, in fact, all highly accurate with no significant difference in sensitivity, specificity, PPV, NPV, or accuracy. Conclusion: Both rapid bedside strip tests may be used in clinical practice with similar efficacy in diagnosing PROM, particularly as a backup when diagnosis is still in doubt following a combination of conventional diagnostic methods. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

Ankarali, Handan Camdeviren/0000-0002-3613-0523; WOS: 000286399400001 Parricide which is defined as the murder of one's parents is a rare event. We describe a consecutive series of adolescent parricide offenders referred to the Council of Forensic Medicine for medico-legal evaluation. Majority of the adolescent parricide offenders were male with a frequency of 79.5%. Age of the offenders ranged from 12 to 18 years old with a median age of 15.13. The majority of the victims were the fathers of the offenders (27; 69.2%). Firearms and cutting devices were the most frequently used weapons. The history of abuse in the family as a motive for the murder was detected in 51.2% of the offenders. The major abuse type was physical abuse. There was no history of psychiatric disorders in the majority of the offenders (37; 94.9%). After the medico-legal evaluation of the adolescent parricide offenders in the Council of Forensic Medicine, psychiatric disorder was diagnosed only in 4 offenders. Schizophrenia was the final diagnosis in 3 cases and paranoid disorder (otherwise unclassified) in only 1 offender. Our study confirmed the frequency of mental illness among adolescent parricide offenders to be very low when compared to adult offenders. Adolescent parricide offenders differ from the other perpetrators particularly in terms of motives of the murder and psychiatric illnesses. Abuse in the family seems to play an important role in these murders. Therefore, it is extremely important that individuals in the legal, criminal justice, social work, psychology, educational and other professional communities be more conscious and informed of child maltreatment and family violence and more research is essential in understanding and preventing adolescent parricide offenders.

ObjectiveRisperidone is an atypical antipsychotic agent, despite its many advantages and widespread use, there is increasing attention to the adverse effects associated with long-term exposure to this drug.We aimed to investigate the changes in the liver function tests (LFTs) associated with one year risperidone treatment in children and adolescents.MethodsOne hundred youths who treated with risperidone more than one year were included in the study. For this study, patients’ baseline and follow-up weight and hepatobiliary function tests including alanine aminotransferases(ALT) and aspartat aminotransferases (AST), gamma gluatamyl transerase (GGT), alkaline phosphatase (ALP) and serum bilirubin levels were measured baseline, after the treatment period of six months and one year.ResultsAsymptomatic liver function test abnormalities mostly ALP elevation was found in subjects treated with risperidone. The mean levels of liver enzymes and billuribin of the patients were significantly higher after one year of treatment than the baseline. Also the mean levels of liver enzymes and billuribin of the patients were significantly higher after one year of treatment than the six months. There was significant association between changes in weight, risperidone dose and liver enzymes and billuribin levels.ConclusionsThese findings suggest that risperidone treatment in the long term commonly leads to liver function changes however it rarely may induce a serious hepatic toxicity at therapeutic doses in children and adolescents.

WOS: 000293921600006, PubMed ID: 22121930, Objective. To determine the changes in liver function tests after long-term risperidone treatment in a child and adolescent population. Methods. Weight, alanine aminotransferase, aspartate aminotransferase, gamma glutamyl transpeptidase, alkaline phosphatase and serum bilirubin of the patients were assessed in pre-treatment period, and at the sixth and 12th months of treatment. One hundred children and adolescents (aged between 3 and 18 years) were enrolled to the study. Results. Liver enzyme and bilirubin levels are higher than normal in 21.0% of the patients without clinical symptoms. No cases of hepatic failure or jaundice were seen. Only in an 8-year-old boy were there ALT level increases up to three-fold and AST level increases up to two-fold. After discontinuation of the risperidone treatment, enzyme levels were normalized in this patient. Alkaline phosphatase, alanine and aspartate aminotransferases were the most frequently increased enzymes. Conclusion. In this study, after long-term risperidone treatment of children and adolescents there was no evidence of clinically significant increases of liver enzymes and bilirubin levels. These results indicate that risperidone treatment may rarely cause serious liver enzyme increases, and may commonly cause clinically insignificant changes in liver function tests.

Some studies have found elevated alexithymia among patients with chronic pain, but the correlations between alexithymia and the severity of pain, depression, and anxiety among migraine patients are unclear. The aims of the present study were to investigate whether individuals suffering from episodic migraine (EM) differ from those with chronic migraine (CM) in regards to depression, anxiety, and alexithymia measures and to investigate the association of alexithymia with the results of depression and anxiety test inventories and illness characteristics.A total of 165 subjects with EM and 135 subjects with CM were studied. The Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and Toronto Alexithymia Scale (TAS) were administered to all subjects. The correlation between alexithymia and sociodemographic variables, family history of migraine and illness characteristics (pain severity, frequency of episode, duration of illness) were evaluated.Compared with EM patients, the CM patients had significantly higher scores on measures of depression but not alexithymia and anxiety. There was a positive correlation between TAS scores and age and education in both migraine groups, but there was no correlation between TAS scores and other demographic variables. Depression and anxiety were significantly correlated with alexithymia in both migraine groups.Our results indicate that CM patients are considerably more depressive than EM patients. In this study, depression and anxiety were significantly correlated with alexithymia in both migraine groups. Our results demonstrate a positive association between depression, anxiety, and alexithymia in migraine patients.

The reasons of post-stroke infections are still incompletely understood. Bacterial translocation (BT), the passage of viable microbes across an even anatomically intact intestinal barrier, has been described in many critical illnesses. To date, it has not been studied as a source of infection in an animal stroke model. To address this, a permanent left middle cerebral artery occlusion (MCAO) model in rats was used. After 24, 48, and 72 hours (h), sham and experimental groups were sacrificed and samples were taken for BT. Similarity between bacteria detected in tissues (blood, mesenteric lymph node, liver, spleen, and lung) and intestinal microflora was shown with phenotypic methods and antibiotyping. Possible ileum tissue injuries were shown by histopathologic examination (including morphometric analysis). Although there was no bacterial proliferation in the sham groups, 55.5%, 45.4%, and 30% bacterial proliferation was detected in MCAO groups at postoperative hour 24, 48, and 72, respectively. In MCAO groups the bacterial proliferation in tissues and ileum tissue injury scores were higher over time compared to sham groups (p0.05). Our findings support the view that stroke, itself leads to mucosal damage and bacterial translocation (Tab. 5, Fig. 2, Ref. 27).

To determine the incidence, risk factors, and appropriateness of differing guidelines in developed nations for screening for retinopathy of prematurity (ROP) in a single nursery in a large urban city in southern Turkey.The records of 260 premature infants born ≤34 weeks in a single tertiary unit were retrospectively reviewed for ROP risk factors and diagnosis. Applicability of UK and US criteria were assessed by the use of receiver operating characteristic curves.ROP of any stage was present in 60 infants (23%); ROP requiring treatment was seen in 30 (11.5%). Univariate analysis showed a significant relationship among the following factors: gestational age, birth weight, total duration of supplemental oxygen, duration of mechanical ventilation, respiratory distress syndrome, anemia, and intraventricular hemorrhage (p0.0001). Multiple logistic regression analysis showed gestational age (p = 0.039), birth weight (p = 0.05), respiratory distress syndrome (p = 0.05), and anemia (p = 0.004) as independent predictors of ROP requiring treatment. Area under curve for gestational age alone for diagnosing stage 2 or greater ROP was 0.824 ± 0.03 (p = 0.0001) and for birth weight alone was 0.808 ± 0.03 (p = 0.0001). UK screening criteria detected all stage 2 and greater ROP; US screening criteria missed 2 infants with stage 2 ROP but detected all treatment-requiring disease. Adoption of these screening criteria would have reduced unnecessary examinations by either 21% (UK) or 37% (US).UK and US criteria improved the detection accuracy for ROP requiring treatment in Turkey and should be studied for other developing nations.

Objective: Empirical beta-lactam monotherapy has become the standard therapy in febrile neutropenia. The aim of this study was to compare the efficacy and safety of piperacillin-tazobactam versus carbapenem therapy with or without amikacin in adult patients with febrile neutropenia. Methods: In this prospective, open, single-center study, 127 episodes were randomized to receive either piperacillin-tazobactam (4 × 4.5 g IV/day) or carbapenem [meropenem (3 × 1 g IV/day) or imipenem (4 × 500 mg IV/day)] with or without amikacin (1 g IV/day). Doses were adjusted according to renal function. Clinical response was determined during and at completion of therapy. Results: One hundred and twenty episodes were assessable for efficacy (59 piperacillin-tazobactam, 61 carbapenem). Mean duration of treatment was 14.8 ± 9.6 days in the piperacillin-tazobactam group and 14.7 ± 8.8 days in the carbapenem group (P> 0.05). Mean days of fever resolution were 5.97 and 4.48 days for piperacillin-tazobactam and carbapenem groups, respectively (P> 0.05). Similar rates of success without modification were found in the piperacillin-tazobactam (87.9%) and in the carbapenem groups (75.4%; P > 0.05). Fungal infection occurrence rates were 30.5 and 18% in piperacillin-tazobactam and carbapenem groups, respectively (P = 0.05). Antibiotic modification rates were 30.5 and 13.1% (P = 0.02) and the addition of glycopeptides to empirical antibiotic regimens rates were 15.3 and 44.3% for piperacillin-tazobactam and carbapenem groups, respectively (P = 0.001). The rude mortality rates were 14% (6/43) and 29.3% (12/41) in piperacillin-tazobactam and carbapenem groups, respectively (P = 0.08). Conclusions: The effect of empirical regimen of piperacillin-tazobactam regimen is equivalent to carbapenem in adult febrile neutropenic patients. © The Author (2010). Published by Oxford University Press. All rights reserved.

We investigated the effect of ebselen relative to nimodipine in an animal model of subarachnoid hemorrhage. Thirty Wistar albino rats were divided into 5 groups: G1, no intervention; G2, sham surgery without subarachnoid hemorrhage (SAH); G3, SAH only; G4, SAN plus nimodipine treatment; G5, SAN plus ebselen treatment. For G2 animals, physiological saline (0.9% NaCl) was injected into the cisterna magna. For G3, G4 and G5 animals, SAH was induced by injecting autologous non-heparinized blood into the cisterna magna. One hour after injection, G4 animals received nimodipine at 6-hour intervals and G5 animals received ebselen twice a day for 48 hours. After treatment, brain tissue and blood samples were taken for biochemical and histopathological examination. Mean malonyldialdehyde concentration was significantly higher in G3 than in G1 (p < 0.0001), G2 (p = 0.01), G4 (p = 0.002) and G5 (p = 0.014), and significantly higher in G5 than in Cl (p = 0.013). Mean superoxide dismutase activity was significantly lower in G4 than in both Cl (p = 0.025) and G2 (p = 0.02). Mean wall thickness was significantly greater in G3 than in Cl (p < 0.0001), G2 (p = 0.01), G4 (p < 0.0001) and G5 (p < 0.0001). Mean wall thickness was also significantly greater in both Cl and G2 than in G4 (p < 0.0014 and p < 0.0001) and G5 (p < 0.0001 and p < 0.0001). Mean luminal diameter of the basilar artery was significantly smaller in G3 than in G2 (p = 0.02), G4 (p < 0.018) and G5 (p < 0.001). Our results confirm that ebselen may have neuroprotective effects by acting to prevent vasospasm. (C) 2009 Elsevier Ltd. All rights reserved.

Aim: In studies in the field of medicine, necessity to examine the relations between data sets composed of categorical variable groups is widely encountered. In this study, it was aimed to examine nonlinear canonical correlation analysis (OVERALS) method, which allows examination of relations among K number of categorical variable sets and structural similarities of the data set, and to discuss usefulness of the method in more comprehensive data sets obtained from studies carried out in the field of medicine in terms of practice and interpretation. Materials and methods: OVERALS method was applied to a part of data set obtained from a study carried out with diarrhea patients. In the study, 10 variables were divided into 3 groups, namely anamnesis, symptoms, and laboratory tests. In order to examine similarities and relationships among these 3 variable groups, OVERALS method was used and results were expressed with graphical presentations. Results: It was observed that OVERALS analysis allows more detailed presentation of data structure and relations among variable sets. Conclusions: OVERALS analysis proved to be a quite useful method in graphical expression and interpretation of data structure, revealing similarities and relational structures among multi-dimensional categorical variable sets, which are used often in the field of medicine and their comprehensive interpretation. © TÜBİTAK.

Objectives: To write a new macro programme for the use of the non-parametric 3-D Receiver Operating Characteristic (ROC) surface method in the discrimination of three or more groups, to study the usefulness of electroencephalography (EEG) frequency in the diagnosis of Alzheimer type dementia (AD), non-Alzheimer type dementia (NAD) and healthy subjects, and to determine cut-off values of EEG frequency. Patients and Methods: The mean EEG frequencies in the left fontal region EEG records of subjects in the present study were calculated and the ROC surface method was used in discrimination of the groups. Results: The volume under the ROC surface was calculated as 0.464±0.150. Accuracy of the mean frequency in differentiation of groups was statistically significant (p=0.024). 8 Hz was found to be convenient for differentiation of AD from NAD patients and 10 Hz for the differentiation of NAD patients and healthy subjects. The sensitivity was 87.5% for Alzheimer's dementia diagnosis and total accuracy was 65% using this cut-off pair. Conclusion: We suggest that the mean EEG frequency may be used only as a pre-diagnostic tool for the differential diagnosis of these groups. Amaç: İlk olarak en az üç grubun ayırıcı tanısını yapmak için kullanılabilecek parametrik olmayan ROC yüzeyi metodunun yaygınlaşmasını sağlamak için yeni bir makro programı yazmayı; ikinci olarak bu metotla Alzheimer tipi demans (AD), non-Alzheimer tipi demans (NAD) ve sağlıklı bireylerin ayırıcı tanısında ortalama EEG frekansının kullanılabilirliğini araştırmayı ve üçüncü olarak ortalama EEG frekansına ait cut-off değerleri belirlemeyi amaçladık. Hastalar ve Yöntemler: Çalışmadaki bireylerin sol frontal bölgesinden kaydedilen EEG örneklerinin ortalama frekansı hesaplanmış ve ROC yüzeyi metodu ile grupların ayırımı planlanmıştır. Bulgular: Ortalama EEG frekansına göre ROC yüzeyi altındaki hacim 0.464, bootstrap standart sapması ise 0.150 olarak hesaplanmıştır. Grupları ayırmada ortalama frekansın başarısı istatistiksel olarak anlamlı bulunmuştur (Z=1.99 ve p=0.024). Muhtemel bütün değerler arasından en uygun cutoff değerleri sensitivite ve spesifite değerlerine göre belirlenmiştir. Alzheimer tipi demans hastalarını bireylerinden en iyi ayıran değer 8 Hz iken NAD bireylerini sağlıklı bireylerden en iyi ayıran değer 10 Hz olarak belirlenmiştir. Bu cut-off çiftinin kullanılması ile AD tanısı için sensitivite %87.5 ve toplam doğru tanı başarısı %65 olarak bulunmuştur. Sonuç: Bulgularımıza dayanarak ortalama EEG frekansının AD diğer demanslılar ve sağlıklı bireylerden ayırmada bir ön tanı aracı olarak kullanılabileceğini önerebiliriz., Amaç: İlk olarak en az üç grubun ayırıcı tanısını yapmak için kullanılabilecek parametrik olmayan ROC yüzeyi metodunun yaygınlaşmasını sağlamak için yeni bir makro programı yazmayı; ikinci olarak bu metotla Alzheimer tipi demans (AD), non-Alzheimer tipi demans (NAD) ve sağlıklı bireylerin ayırıcı tanısında ortalama EEG frekansının kullanılabilirliğini araştırmayı ve üçüncü olarak ortalama EEG frekansına ait cut-off değerleri belirlemeyi amaçladık. Hastalar ve Yöntemler: Çalışmadaki bireylerin sol frontal bölgesinden kaydedilen EEG örneklerinin ortalama frekansı hesaplanmış ve ROC yüzeyi metodu ile grupların ayırımı planlanmıştır. Bulgular: Ortalama EEG frekansına göre ROC yüzeyi altındaki hacim 0.464, bootstrap standart sapması ise 0.150 olarak hesaplanmıştır. Grupları ayırmada ortalama frekansın başarısı istatistiksel olarak anlamlı bulunmuştur (Z=1.99 ve p=0.024). Muhtemel bütün değerler arasından en uygun cutoff değerleri sensitivite ve spesifite değerlerine göre belirlenmiştir. Alzheimer tipi demans hastalarını bireylerinden en iyi ayıran değer 8 Hz iken NAD bireylerini sağlıklı bireylerden en iyi ayıran değer 10 Hz olarak belirlenmiştir. Bu cut-off çiftinin kullanılması ile AD tanısı için sensitivite %87.5 ve toplam doğru tanı başarısı %65 olarak bulunmuştur. Sonuç: Bulgularımıza dayanarak ortalama EEG frekansının AD diğer demanslılar ve sağlıklı bireylerden ayırmada bir ön tanı aracı olarak kullanılabileceğini önerebiliriz.

Background: Determination of the relationships between disease and psychological status in ankylosing spondylitis (AS) is needed for clinical assessment and management, as well as selection and monitoring of AS patients for biological therapy. Objective: The study aimed to describe associations between self-reported health status and psychological factors in AS patients and to compare the Symptom Checklist 90-Revised (SCL-90-R) profiles of the AS patients and the control subjects. Methods: Disease status was determined through the Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), and the Bath AS Metrology Index (BASMI). Psychological status was measured using the SCL-90-R. Results: BASDAI and BASFI scores correlated with somatization, anxiety, obsessive-compulsive, depression, and hostility subscales of SCL-90-R (P ? 0.05). BASFI scores were significantly correlated with interpersonal sensitivity and phobic anxiety subscales of SCL-90-R (P < 0.05), whereas no correlation was observed between BASDAI and interpersonal sensitivity and phobic anxiety subscales. BASMI scores were significantly correlated with somatization and interpersonal sensitivity subscales (P < 0.05). After age and sex adjustments, a statistically significant difference was determined between the somatization scores of the AS patients and control subjects (P = 0.005). Conclusion: AS is a chronic disease, which causes deformities and workforce decline. This, in turn, might lead to psychological distress. There is a need to assess the mood of patients with AS. Completion of self-report assessment tools are potentially confounded by reporting biases that result from psychological factors. Some patients may overreport symptoms or disability because of a tendency to somatize. Thus, during interpretation of these tools, psychological status should be taken into account especially deciding the treatment regimen including biologic therapies. Copyright © 2010 by Lippincott Williams & Wilkins.

Objectives: The aim of this study was to compare the Friedewald Formula with direct homogeneous low density lipoprotein cholesterol (LDL-C) assay for the detection of LDL-C levels. Methods: Fasting serum samples were obtained for lipid analysis from 1001 patients. Total cholesterol (TC) and triglyceride (TG) levels were measured with enzymatic methods and the measurements of high density lipoprotein cholesterol (HDL-C) and LDL-C levels were detected using direct methods. Results: The mean levels of serum TC, TG, HDL-C and LDL-C were detected with in the reference range. The LDL-C estimated by the Friedewald formula was significantly correlated (P < 0.01) with the direct method but there was a negative bias among them. Conclusion: Laboratories cannot use direct method as a substitute for Friedewald formula because direct method has not been standardized in large populations and increase cholesterol assay costs. © 2008 Elsevier Ireland Ltd. All rights reserved.

WOS: 000273847700006, PubMed: 20000875, Background: Treatment options for seborrheic dermatitis are numerous, including both topical and systemic agents (e.g. topical corticosteroids, oral antifungals, and psoralen plus UVA). However, long-term use of topical corticosteroids may lead to adverse effects. Pimecrolimus 1% cream is an effective and well tolerated treatment for seborrheic dermatitis. Objective: To explore the efficacy of pimecrolimus 1% cream for the treatment of seborrheic dermatitis lesions resistant to conventional treatments. Methods: Sixteen patients with resistant seborrheic dermatitis of the face applied pimecrolimus 1% cream twice daily for 2 weeks. The lesions were assessed clinically and the severity of the signs were assessed using a 4-point score. Additionally, the scores of all affected regions (paranasal, forehead, and eyebrows) were evaluated separately to assess whether different results would be obtained in different regions of the face. Also, patients completed self-assessments on a 100 mm Visual Analogue Scale (VAS) at each visit. Results: Statistically significant reductions in the scores of all parameters were observed at day 7 and day 14 of the study. There were no significant differences between the responses on the three regions of the face. No adverse effects were reported except for temporary pruritus immediately after the application of pimecrolimus 1% cream in one patient. Conclusion: Although the interpretation of efficacy was limited by the open-label, non-controlled study design and the small number of patients, this trial suggests that pimecrolimus 1% cream may be a successful treatment choice for patients with resistant seborrheic dermatitis of the face.

Homocysteine, a sulfur-containing amino acid, is an intermediate during the conversion of methionine to cysteine. Homocysteine can cause vascular injury and atherosclerotic plaque instability. In addition, homocysteine may be directly correlated with hyperlipidemia and lipoprotein(a) and inversely with high-density lipoprotein cholesterol. However, the results regarding the association of homocysteine level with subtypes of stroke and traditional risk factors for stroke have been inconsistent, perhaps due to ethnic differences. The aim of this study was to evaluate the role of serum homocysteine levels in Turkish patients diagnosed with atherosclerotic stroke and those with cardioembolic stroke. We measured homocysteine levels, traditional risk factors for stroke (hypertension, diabetes mellitus, and smoking) and lipoprotein(a) levels in 103 patients with large-vessel atherosclerotic stroke, 37 patients with cardioembolic stroke, and 37 controls with normal cranial magnetic resonance imaging. Only hypertension was found to be a risk factor in all patient groups (p = 0.001). Hyperhomocysteinemia (homocysteine level ? 15.90 µmol/L) was more common in patients with large-vessel atherosclerotic stroke and cardioembolic stroke (p = 0.0435 and p = 0.007, respectively); nevertheless, it was found to be a risk factor only in patients with cardioembolic stroke (p = 0.023; odds ratio (OR): 5.745). Furthermore, in the patients with large-vessel atherosclerotic stroke, hyperhomocysteinemia was positively correlated with the lipoprotein(a) level (r = 0.227, p = 0.035). In conclusion, hyperhomocysteinemia is common in patients with large-vessel atherosclerotic stroke and cardioembolic stroke. More importantly, hyperhomocysteinemia is an independent risk factor only for cardioembolic stroke in the Turkish population. © 2009 Tohoku University Medical Press.

Tigecycline seems to be a promising agent for treatment of resistant Acinetobacter baumannii infections, however approved criteria for susceptibility testing are still lacking. The aim of this study was to evaluate tigecycline activity against multidrug resistant A. baumannii clinical isolates, as well as susceptibility testing methods and disk diffusion (DD) breakpoints. Reference broth microdilution (BMD), Etest and DD methods were used. MIC50 and MIC90 by the reference method were 1 and 8 µg/ml, respectively. Applying the breakpoints for Enterobactericeae, 85.7% of the isolates were sensitive to tigecycline. The Etest resulted in lower susceptibility rates (63.7%). Essential agreement between Etest and BMD was 75.8%. 21.9% of the strains were susceptible by BMD and intermediate by Etest. Provisional DD breakpoints ?19/?14 mm produced unacceptable minor errors while adjustment to ?17/?13 mm yielded the best results. In conclusion, resistance was not rare against our MDR A. baumannii isolates although tigecycline had not been used previously. Breakpoints ?17/?13 mm may be preferred for DD. We suggest caution with intermediate results by Etest. © E.S.I.F.T. srl.

Background. There are various treatment options available for rosacea, depending on the subtype, but treatment is still generally unsatisfactory. Some reports have indicated beneficial effects of topical pimecrolimus. Aim. To compare the efficacy and safety of pimecrolimus 1% cream and metronidazole 1% cream in the treatment of patients with papulopustular rosacea (PR). Methods. A group of 49 patients with PR was investigated in this single-centre, randomized, open-label study. Patients were randomly assigned treatment with either pimecrolimus 1% cream or metronidazole 1% cream for 12 weeks. Response was evaluated by the inflammatory lesion count, the severity of facial erythema and telangiectasia, Physician's Global Assessment (PGA), and safety and tolerability at baseline and at weeks 3, 6, 9 and 12. Results. In total, 48 patients completed the study. Both treatments were very effective in the treatment of PR. There were no significant differences between the treatments in inflammatory lesion counts, overall erythema severity scores and PGA evaluated from baseline to week 12 (P > 0.05). Neither treatment produced any clinically relevant improvement in telangiectasia. Conclusion. Pimecrolimus cream is no more efficacious than metronidazole cream in the treatment of PR. © 2009 British Association of Dermatologists.

Background Increasing reports of carbapenem resistant Acinetobacter baumannii infections are of serious concern. Reliable susceptibility testing results remains a critical issue for the clinical outcome. Automated systems are increasingly used for species identification and susceptibility testing. This study was organized to evaluate the accuracies of three widely used automated susceptibility testing methods for testing the imipenem susceptibilities of A. baumannii isolates, by comparing to the validated test methods. Methods Selected 112 clinical isolates of A. baumanii collected between January 2003 and May 2006 were tested to confirm imipenem susceptibility results. Strains were tested against imipenem by the reference broth microdilution (BMD), disk diffusion (DD), Etest, BD Phoenix, MicroScan WalkAway and Vitek 2 automated systems. Data were analysed by comparing the results from each test method to those produced by the reference BMD test. Results MicroScan performed true identification of all A. baumannii strains while Vitek 2 unidentified one strain, Phoenix unidentified two strains and misidentified two strains. Eighty seven of the strains (78%) were resistant to imipenem by BMD. Etest, Vitek 2 and BD Phoenix produced acceptable error rates when tested against imipenem. Etest showed the best performance with only two minor errors (1.8%). Vitek 2 produced eight minor errors(7.2%). BD Phoenix produced three major errors (2.8%). DD produced two very major errors (1.8%) (slightly higher (0.3%) than the acceptable limit) and three major errors (2.7%). MicroScan showed the worst performance in susceptibility testing with unacceptable error rates; 28 very major (25%) and 50 minor errors (44.6%). Conclusion Reporting errors for A. baumannii against imipenem do exist in susceptibility testing systems. We suggest clinical laboratories using MicroScan system for routine use should consider using a second, independent antimicrobial susceptibility testing method to validate imipenem susceptibility. Etest, whereever available, may be used as an easy method to confirm imipenem susceptibility.

Annual Congress on Turkish National Surgery -- MAY, 2008 -- Antalya, TURKEY, WOS: 000268575000024, PubMed: 19578821, Simvastatin is a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor commonly known as a cholesterol-lowering drug with additional pleiotropic effects. Also, it is demonstrated that it prevents postoperative peritoneal adhesions in rat. This study was designed to assess its effects on the healing process of colonic anastomosis. Thirty-two male Wistar albino rats were randomized into two groups and subjected to colonic anastomosis. The study group was treated with simvastatin and the control group received only tap water instead. The rats were killed 3 and 7 days postoperatively. Wound complications, intra-abdominal abscesses, and anastomotic leaks and stenosis were recorded. Four types of assessment were performed: bursting pressure, hydroxyproline content, histopathology, and biochemical analysis. Compared to the control group, simvastatin-treated rats displayed a higher bursting pressure (p < 0.001) and anastomotic hydroxyproline content (p < 0.05). Simvastatin treatment leads to a significant decrease in malondealdehyde levels (p < 0.05) and increase in paraoxonase activity (p < 0.001) at both time points. Histopathological analysis revealed that simvastatin administration leads to a better anastomotic healing in terms of reepithelialization, decreased granuloma formation, reduced ischemic necrosis, and inflammatory infiltration to muscle layer. Clinically relevant doses of simvastatin do not have a negative impact on colonic anastomosis but improve intestinal wound healing in rats.

In researches where two or more groups are desired to be compared, observational and randomized experiments are very frequently used. As the subjects are randomly assigned to the groups in randomized experiments, balance is provided in observed/unobserved covariates of subjects in different groups. As the subjects cannot be randomly distributed into groups in observational studies, balance of observed/unobserved covariates between groups is not provided. This situation causes a biased estimate of the treatment effect. In this research, it is focused on different matching methods in observational studies and elimination of observed covariate effects confounding in the group effect, and these methods are examined comparatively. For this purpose, the effect of depression in 300 migraine patients, obtained from an observational study, on State continuous anxiety scale scores is taken and compared with the five different matching methods. Sensitivity of results is examined and it is researched whether the effect of treatment contains any bias. When results are examined, it is seen that matching methods produce similar results due to the overlap of propensity distribution in groups, high and balanced number of subjects in groups and covariates being not so many in number. The effects of unobserved covariates do not change the effect of treatment significantly. In conclusion, it is seen that, in the estimation of group effect in observational studies, it is possible to eliminate the effects of observed covariates using matching methods and matching quality of matching methods based on the propensity score is high. © 2007 Elsevier Ltd. All rights reserved.

Ankarali, Seyit/0000-0003-3752-0846; Ankarali, Handan Camdeviren/0000-0002-3613-0523 WOS: 000270857000015 PubMed: 18657004 It has been shown that nitric oxide (NO) increases aggression in male mice, whereas it decreases aggression in lactating female mice and prairie voles. It is also known that aggression can be exhibited at different levels in rodent species, strain or subtypes. The aims of this study were to investigate the proportion of aggressiveness in Wistar rats, the effect of intraperitoneally administered nonspecific nitric oxide synthase (NOS) inhibitor L-NAME (N-G-nitro L-arginine methyl ester) on maternal aggression towards female intruders, and whether these effects are due to NO production or not. Rats were given saline intraperitoneally on the postpartum Day 2 and aggression levels were recorded. The same rats were given 60 mg/kg L-NAME or D-NAME (N-G-nitro D-arginine methyl ester) on the postpartum Day 3 and their effects on aggression levels were compared to saline. While L-NAME administration did not cause any differences in the total number of aggressive behavior, aggression duration and aggression intensity, it reduced the proportion of animals showing aggressive behavior. In addition, the latency of the first aggression was significantly increased by L-NAME. In the D-NAME group, however, no significant change was found. Our results have shown that L-NAME reduces maternal aggression towards female intruders in Wistar rats through inhibition of NO production. These results suggest that the role of NO in offensive and defensive maternal aggression shares neural mechanisms.

WOS: 000266280200006, PubMed: 19466656, Introduction: 2-octyl-cyanoacrylate may be a good alternative in ischemic colon anastomosis without impairment of tissue perfusion. Methods: Forty male Wistar albino rats were randomized into four experimental groups (n = 10 in each group). In group 1 (control), a well-perfused left colonic segment was transected, and free ends were anastomosed by propylene sutures. In groups 2, 3, and 4, the animals underwent a standardized surgical procedure to induce ischemic left colon anastomosis. In group 2, an end-to-end anastomosis was created using six interrupted 6-0 polypropylene sutures between ischemic edges. In group 3, after approximating the mesenteric and antimesenteric edges of the anastomosis with two 6-0 polypropylene sutures, 2-octyl-cyanoacrylate was applied between the edges. In group 4, anastomosis was created by the same technique as described in group 2, and additionally 2-octyl-cyanoacrylate was applied on suture line. Rats were killed on day 4 following operation. Anastomotic integrity, intraperitoneal adhesion scores, anastomotic bursting pressures, and tissue hydroxyproline levels were recorded. Histopathological examination of the anastomosis was also performed. Results: There were no statistically significant differences among groups with respect to anastomotic integrity (p =.142). The mean bursting pressure values were 81.1 23.83, 43.3 26.06, 15.8 11.3, and 17.6 18.02 in groups 1, 2, 3, and 4, respectively. There were no statistically significant differences among groups 2, 3, and 4 with respect to tissue hydroxyproline levels and bursting pressure levels. The highest adhesion scores were observed in groups 3 and 4. Discussion: 2-octyl cyanoacrylate does not have additional advantages in the healing of experimental ischemic colon anastomosis.

WOS: 000266280200008, PubMed: 19466658, Introduction: Hemorrhage is a leading cause of death after trauma. It is also the major cause of operating room deaths among patients who undergo liver surgery. Various techniques and materials have been attempted to manage bleeding, but a standard method has not been defined yet. We studied the hemostatic effects of Ankaferd Blood Stopper on liver injury in comparison with regenerated oxidized cellulose. Materials and Methods: Thirty Wistar albino rats underwent partial hepatic laceration by scissors. The animals were randomized to the treatment of resected surface with either Ankaferd Blood Stopper (ABS, n = 11) or regenerated oxidized cellulose (Surgicel, n = 9), or were left untreated (controls, n = 10). All the animals were resuscitated with lactated Ringer's solution at 3.3 ml/min/kg to a mean arterial pressure (MAP) of 100 mmHg. Survival time, total blood loss, resuscitation volume, and MAP were recorded for 30 min or until death. The rats that were alive at the end of 30 min were sacrificed with blood withdrawal from catheters. Results: Rats in the ABS and Surgicel groups survived significantly longer than rats in the control group (p =.0001). There were no significant differences between the ABS and the Surgicel groups in survival (p =.91). Application of ABS and Surgicel was associated with a significant reduction in blood loss compared to controls (p =.008), with no significant differences between active treatment groups (p =.74). The resuscitation volume was not different. Conclusions: ABS is as effective as Surgicel in achieving hemostasis following partial liver excision in an experimental rat model.

WOS: 000270209000023, PubMed: 19745716, In this study, we developed a novel experimental model to evaluate muscular action on bone formation and remodeling by the help of Botulinum toxin-A (BTX). Forty-nine 15-day-old mate Wistar rats were put into 4 groups randomly. Group I was the control group. BTX 0.4 IU (0.05 mL) was injected into the right masseter muscle in group 2 and into right temporalis muscle in group 3. The same volume of sterile saline was given into the both above-mentioned muscles in group 4. At the end of the fourth month, all animals were killed. Histology and weight of the masseter and temporalis muscles were studied. Thirty different osteometric measurements were also taken from skulls. Significant atrophy in BTX injected muscles was observed in groups 2 and 3. In group 4 (saline injection), only few osteometric measurements were significantly reduced, indicating the effect of the injection itself. Both groups 2 and 3 have apparent decrease in nasal bone, premaxilla, maxilla, and zygomatic dimensions on the injected side. When masseter group was compared with control and saline groups, no significant difference was found in skull base dimensions and mandibular length. In contrast, temporal group has also shown significant decrease in skull base dimensions. Our conclusions are as follows: (1) With this model, it is possible to study muscular action on bone formation and modeling without any surgical intervention, that is, by avoiding surgical artifacts, such as scar and contracture; (2) denervation of the skeletal muscles with BTX during the growing phase does effect bone development in a negative way; (3) pediatric use of the BTX deserves reevaluation under the light of these findings.

Background and purpose: Stroke is a heterogeneous multifactorial disease. Hence, a large number of candidate genes are involved in stroke pathophysiology, such as blood pressure regulation and atherosclerosis. Although angiotensin-converting enzyme insertion/deletion (ACE I/D) polymorphism is considered to have a role in hypertension, coronary artery disease, and myocardial infarction, its relationship with cerebrovascular disease and hypertension in stroke in different ethnic populations is still inconsistent. Methods: ACE I/D polymorphism, detected by polymerase chain reaction (PCR), was studied in 97 patients with large-vessel and 60 patients with small-vessel atherosclerotic stroke (44 asymptomatic, 16 symptomatic lacunes) and 85 healthy subjects with normal brain imaging. The demographic data, lipid profile and risk factors of patients and controls were obtained retrospectively. Results: ACE genotypes were in Hardy-Weinberg equilibrium in both patients and controls. Prevalences of DD, ID and II genotype were 41%, 40%, and 19%, respectively, in the stroke group. Differences in ACE I/D polymorphism distribution were statistically insignificant between the groups. This lack of association between stroke and ACE I/D polymorphism did not change in the presence of traditional risk factors (hypertension, diabetes mellitus, smoking, and dyslipidemia). Although hypertension was significantly more common in the patient groups, ACE I/D polymorphism showed no effect on hypertension risk. This lack of association also did not change according to groups or in the presence of diabetes mellitus, male gender or smoking. Conclusion: ACE I/D polymorphism did not predict the risk of stroke or hypertension in our population living in the western Black Sea region of Turkey. © 2009 Elsevier B.V. All rights reserved., 106S235-SBAG-HD-158, Most of the controls were taken from another study sponsored by the Scientific and Technological Research Council of Turkey (STRCT) (no. 106S235-SBAG-HD-158). Hence, we wish to thank STRCT.

The aim of this study was to screen infertile men for HFE H63D mutation in correlation with clinical characteristics of infertile men (sperm concentration, sperm motility, morphology, testicular volume, Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH) and total Testosterone levels) and find out if the HFE H63D mutation has an effect on male infertility. After excluding hormonal treatment, any scrotal pathology, having any systemic diseases such as diabetes mellitus, sickle cell anemia and microdeletions of the Y chromosome, a total of 148 infertile men with age range between 17 and 52-years-old (average age 29.6 ± 7.2) were enrolled into the study. Our analysis indicates that the mean FSH levels are significantly higher (6.3 ± 4.6 mIU/ml, P = 0.03), whereas sperm motility is significantly lower (36.6 ± 28.1%, P = 0.01) in the infertile men with the HFE H63D mutation compared with subjects lacking this mutation. Comparison of allele frequencies of the infertile men with Ts < 50% versus the infertile men with Ts > 50% revealed a significant difference as expected (P = 0.001, OR = 0.14, %95 CI = 0.04-0.44). Comparison of allele frequencies of infertile men with abnormal sperm motility versus infertile men with normal sperm motility revealed a highly significant difference (P = 0.005, OR = 3.11, %95 CI = 1.41-6.86). Thus, the HFE H63D mutation seems to be an important risk factor for impaired sperm motility and is clinically associated with male infertility. © 2008 Springer Science+Business Media B.V., KÜ AF 03/08.01.03, Acknowledgments This work was supported by Kirikkale University Research Found (KÜ AF 03/08.01.03). We thank the infertility patients who made this analysis possible.

Aim: To investigate whether bioactive and free sex steroids are associated with bone mineral density (BMD) and bone turnover markers in middle aged men. Material and Methods: One hundred and fifteen out of 165 volunteers aged 35-65 years presenting to our outpatient clinic were included in the study. Serum albumin, total testosterone (T), total estradiol (E2), SHBG, osteocalcin (OC) and C-terminal telopeptide (CTx) levels were measured. Free and bioactive sex steroids, free androgen index (FAI) and free estrogen index (FEI) were calculated. BMD in the lumbar spine and the hip was measured in all participants and effects of sex steroids on BMD and bone turnover markers were investigated. Results: The mean age and the mean body mass index (BMI) in all participants were 52.4±7.8 years and 26.1±3.4 kg/m2 respectively. There was no significant difference in sex hormone levels and bone turnover markers between the individuals with osteoporosis and osteopenia and the individuals with normal BMD (p>0.05). There was a significant relation between age and FAI (r=-0.23, p=0.01), but there was no significant relation between age and bioactive and free sex steroids, FEI and SHBG. However, there was a positive correlation between BMI and bioactive E2 (r=0.35, p:0001), free E2 (r=0.29, p:0.002) and FEI (r=0.39, p=0.0001). After an adjustment for variables effective on BMD was made; no relation was found between BMD measures from the lumbar spine and the hip and serum bioactive sex steroids, free sex steroids, FAI, FEI and SHBG (p>0.05). However, there was a weak positive relation between serum bioactive T, FEI and OC, CTx levels (p=0.05). Conclusion: We think that bioactive and free sex steroids are not independent variables effective on BMD in the spine and the hip in middle aged men and that further studies are needed to elucidate the pathophysiology of idiopathic male osteoporosis.