Search

Objective: Growth curves are important tools for assessing the growth and development of children in the target population by age. Measuring head circumference (HC) in infants is an important tool in monitoring infant health and brain development. The aims of this study are to construct current 0-2-year-old HC growth curves and percentiles and compare the methods used in the construction of growth curves for HC measurements by gender. Materials and Methods: The study is a retrospective research that includes the HC measurements of a total of 2832 (n = 1438 girls, n = 1394 boys) children examined between 2018 and 2021 in Başkent University hospital, Ankara. Lambda-Mu-Sigma, LMSP, and LMST methods based on Box-Cox Cole and Green (BCCG), Box-Cox power exponential (BCPE), and Box-Cox t (BCT) distributions respectively, and quantile regression (QR) method were used to construct the fitted growth curves. Model performances were evaluated using the generalized Akaike information criterion. The analyses were conducted using R 4.1.2 version. Results: According to the LMS and QR methods, percentile values of HC measurements by gender were calculated and the results were compared. Smoothed HC growth curves were constructed and compared for both methods by gender. The present study, Neyzi et al study, and World Health Organization (WHO) standards were compared for the third, 50th and 97th percentiles of HC. Conclusion: This study showed that the third-97th HC percentiles calculated by LMS and QR methods are very close to each other. Additionally, this study showed that the HC percentiles of Turkish children were slightly different compared to WHO standards.

Background: It is important to monitor the development of infants and children during their growth period. Various anthropometric parameters of children are measured at regular intervals after birth, and their general health and nutrition and physiological needs are assessed based on these measurements. Aims: To construct the current body mass index (BMI) percentiles and compare them with the literature reports and World Health Organisation (WHO) data. Study Design: Cross-sectional study. Methods: This study is a cross-sectional research on 1,345 boys and 1,364 girls of age ranging from 0 to 24 months; their BMIs were measured at the Başkent University Hospital from January 2018-December 2021. The BMI growth curves for either gender were constructed according to the LMS method by using RefCurv 0.4.2. software. The “gamlss” package was employed for the selection of model parameters in fitting the BMI growth curves, and the model performance was evaluated with reference to the generalized Akaike information criterion (GAIC). Results: According to gender, smoothed BMI growth curves were constructed in the 3rd-97th percentiles. The model adequacy of the fitted growth curves was evaluated with the worm plot. The fit of the BMI model to the data was found to be sufficient, with 95% of the BMI values occurring between two elliptic curves. Conclusion: The study shows a slight increase in BMI percentile values obtained by gender compared to WHO standards.

Metachromatic leukodystrophy (MLD) is a glycosphingolipid storage disease caused by deficiency of the lysosomal enzyme arylsulfatase A (ASA) or its activator protein saposin B. MLD can affect all age groups in severity varying from a severe fatal form to milder adult onset forms. Diagnosis is usually made by measuring leukocyte ASA activity. However, this test can give false negative or false positive laboratory results due to pseudodeficiency of ASA and saposin B deficiency, respectively. Therefore, we aimed to evaluate patients with suspected MLD in a Turkish population by comprehensive clinical, biochemical, radiological, and genetic analyses for molecular and phenotypic characterization. We analyzed 28 suspected MLD patients and 41 relatives from 24 families. ASA activity was found to be decreased in 21 of 28 patients. Sixteen patients were diagnosed as MLD (11 late infantile, 2 juvenile and 3 adult types), 2 MSD, 2 pseudodeficiency (PD) and the remaining 8 patients were diagnosed as having other leukodystrophies. Enzyme analysis showed that the age of onset of MLD did not correlate with residual ASA activity. Sequence analysis showed 11 mutations in ARSA, of which 4 were novel (p.Trp195GlyfsTer5, p.Gly298Asp, p.Arg301Leu, and p.Gly311Asp), and 2 mutations in SUMF1 causing multiple sulfatase deficiency, and confirmed the diagnosis of MLD in 2 presymptomatic relatives. All individuals with confirmed mutations had low ASA activity and urinary sulfatide excretion. Intra- and inter-familial variability was high for the same ARSA missense genotypes, indicating the contribution of other factors to disease expression. Imaging findings were evaluated through a modified brain MRI scoring system which indicated patients with protein-truncating mutations had more severe MRI findings and late-infantile disease onset. MRI findings were not specific for the diagnosis. Anti-sulfatide IgM was similar to control subjects, and IgG, elevated in multiple sulfatase deficiency. In conclusion, the knowledge on the biochemical, clinical and genetic basis of MLD was expanded, a modified diagnostic laboratory algorithm for MLD based on integrated evaluation of ASA activity, urinary sulfatide excretion and genetic tests was devised.

Objective: We aimed to determine the frequency, type, and etiology of infections and the risk factors for infections and mortality in hospitalized cancer patients. Materials and Methods: We prospectively enrolled adult cancer patients hospitalized in the internal medicine wards of a tertiary care academic center between January and August 2004. Patients were followed during their hospitalization periods for neutropenia, infections, culture results, and mortality. Results: We followed 473 cancer patients with 818 hospitalization episodes and 384 infection episodes in total. Seventy-nine percent of the infections were nosocomial, and febrile neutropenia (FN) was observed in 196 (51%) of the infection episodes. Bacteremia was found in 29% of FN episodes and in 8% of nonneutropenic patients. Gram-positive bacteria were the leading cause of bacteremia in both neutropenic and nonneutropenic cases (70% and 58%, respectively). Presence of an indwelling central catheter increased bacteremia risk by 3-fold. The overall mortality rate was 17%, whereas 34% of the patients with bloodstream infections died. Presence of bacteremia and advanced disease stage increased overall mortality by 6.1-fold and 3.7-fold, respectively. Conclusion: Nearly half of the cancer patients developed an infection during their hospital stays, with gram-positive bacteria being the predominant etiologic microorganisms. This demonstrates the changing trends in infections considering that, until 2004, gramnegative bacteria were the most predominant microorganisms among cancer patients in our institute.

Background: Several methods are available to evaluate the performance of the tests when the purpose of the diagnostic test is to discriminate between two possible disease states. However multi-class diagnostic problems frequently appear in many areas of medical science. Hence, there is a need for methods which will enable us to characterize the accuracy of diagnostic tests when there are more than two possible disease states. Aims: To show that two information theory measures, information content (IC) and proportional reduction in diagnostic uncertainty (PRDU), can be used for the evaluation of the performance of diagnostic tests for multi-class diagnostic problems that may appear in different areas of medical science. Study Design: Diagnostic accuracy study. Methods: Sixty freshly extracted permanent human molar and premolar teeth suspected to have occlusal caries lesions were selected for the study and were assessed by two experienced examiners. Each examiner performed two evaluations. Histological examination was used as the gold standard. The scores of the histological examination were defined as sound (n=11), enamel caries (n=22) and dentin caries (n=27). Diagnostic performance of i) visual inspection, ii) radiography, iii) laser fluorescence (LF) and iv) micro-computed tomography (M-CT) caries detection methods was evaluated by calculating IC and PRDU. Results: Micro-computed tomography examination was the best method among the diagnostic techniques for the diagnosis of occlusal caries in terms of both IC and PRDU. M-CT examination supplied the maximum diagnostic information about the diagnosis of occlusal caries in the first (IC: 1.056; p

The objective of this meta-analysis was to determine with cross-sectional and cohort trails whether the use of pacifier increases the risk of early weaning from exclusive breastfeeding before six months of age or cessation of breastfeeding from any breastfeeding before 24 months of age. Additionally, the effect of the age for starting pacifier use on breastfeeding duration was analyzed in the cohort trails. The Medline database was searched (1980 to 2006) with "breastfeed, breastfeeding, or breast feed" and "pacifier, dummy, or soother" as individual keywords. Only human studies published in English were included. Unpublished data were not sought. Twelve trials with weaning from exclusive breastfeeding and 19 trials with cessation of any breastfeeding were included in the meta-analysis. The meta-analysis was performed with Stata 6.0 statistical package. Summary risk ratio for early weaning before six months of age in exclusive breastfeeding trails was 2.016 (95% CI: 1.619-2.511) for pacifier users compared with nonusers in studies with univariate analysis and 1.792 (95% CI: 1.452-2.212) in studies with multivariate analysis. Similarly, pacifier usage compared with nonusers reduced the duration of any breastfeeding in both univariate (2.760, 95% CI: 2.083-3.657) and multivariate trials (1.952, 95% CI: 1.662-2.293). The use of pacifiers was associated with shortened duration of exclusive and of any breastfeeding. Given the increase in the benefits with duration of breastfeeding, parents should be informed of the link between pacifier use and shortened breastfeeding duration in order to help them make informed decisions about their children's care.

In this research, we aimed to evaluate the accordance of radiologic study results with each other and with surgical findings with regard to presence and/or absence of intussusception. One hundred and seventy-nine patients treated for intussusception between 1993 and 2003 inclusive were retrospectively reviewed to compare results of initial ultrasonography, colonography, followup ultrasonography after conservative management (reduction with barium enema and/or air insufflation) and surgical findings to determine their accordance within each other with regard to diagnosis of intussusception. Results of initial ultrasonography were not in accordance with results of colonography. There was accordance between conservative management and follow-up ultrasonography results. Conservative management results were not in accordance with surgical findings. There was no accordance between followup ultrasonography results and surgical findings. Discordance of radiologic examination results with each other and with surgical findings indicates that intussusception is still a clinical diagnosis and clinical parameters deserve more importance in surgical decision-making. Radiologic examinations should be considered as complementary studies, not as definitive discriminators of childhood intussusception to achieve appropriate diagnosis and treatment.

While planning medical care, health care workers must consider the body temperature changes as measured by the mothers on most occasions. We evaluated the reliability of three different temperature measurement methods when they were used by the mothers by comparing with the measurements taken by the pediatrician. In this prospective study, body temperatures of 50 healthy newborns during their 2nd day of life were measured by mothers and one physician with mercury-in-glass (MG), digital mercury (DM) and infrared tympanic membrane thermometers (ITMT). Measurements by the mothers and the physician were correlated for the three different methods. The effects of the educational level of the mothers and the presence of children at home on the reliability and the number of differences > or = 0.5 degrees C were also evaluated for each of the methods. In comparing the measurements by the mothers and the pediatrician, correlation coefficient was 0.12 in MG thermometer readings, 0.23 in DM thermometer readings and 0.78 in ITMT readings, meaning that tympanic measurements by the mothers and the pediatricians were more correlated (p < 0.0001). The means and ranges of absolute differences of MG, DM, and tympanic thermometer measurements were 0.43 +/- 0.42, 0-1.7; 0.36 +/- 0.45, 0-2.2; and 0.13 +/- 0.12, 0-0.7 degrees C, respectively. The number of measurements with an absolute difference > or = 0.5 degrees C was 17 in MG readings, 11 in DM readings, and 1 in ITMT readings, The educational level of the mothers and the presence of children at home had no effect on the correlations. The intraclass coefficient for the three sets of measurements by the pediatricians was 0.91. Body temperature measurements in newborn babies as taken by their mothers were more correlated with the readings by the pediatricians when the ITMT was used. Tympanic thermometers seem to be useful for the mothers of any educational level and are independent of having experience with a previous child. The ease of use and short calibration time for reading are also advantageous for these thermometers.

Helicobacter pylori (H. pylori) is a common cause of gastritis in both children and adults, and its incidence increases every year. The aims of this study were to evaluate the histopathologic features of H. pylori gastritis and to compare immunohistochemical with histochemical [hematoxylin-eosin (HE) and Giemsa] staining of gastric biopsy specimens for the detection of H. pylori infection from urea breath test (UBT) (-) and UBT (+) children. Seventy-eight gastric biopsies from pediatric patients who were administered UBT were included in this study. Gastric biopsy specimens were evaluated histopathologically and graded according to the Sydney system. HE, Giemsa and immunohistochemical staining was performed for the identification of H. pylori. The frequency of H. pylori gastritis was higher in the antrum than corpus. All biopsies with H. pylori colonization showed chronic inflammation with activity. By using immunohistochemical method, coccoid forms of H. pylori and spiral bacteria with low density were observed easily. With histochemical staining, 1/10 (10%) UBT (-) biopsies were H. pylori (+), while with immunohistochemical staining, 3 of the biopsies from UBT (-) patients were found to be H. pylori (+). Biopsies from 65 of 78 (83.3%) UBT (+) patients were H. pylori (+) with histochemical staining, but only 53 of these biopsies were found to be H. pylori (+) immunohistochemically. We conclude that immunohistochemical staining is more specific than histochemical staining and UBT for the detection of H. pylori infection.

Systemic immune-inflammation index (SII), which is a good predictive marker for coronary artery disease, can be calculated by using platelet, neutrophil, and lymphocyte counts. The no-reflow occurrence can also be predicted using the SII. The aim of this study is to reveal the uncertainty of SII for diagnosing ST-elevation myocardial infarction (STEMI) patients who were admitted for primary percutaneous coronary intervention (PCI) for the no-reflow phenomenon. A total of 510 consecutive acute (STEMI) patients with primary PCI were reviewed and included retrospectively. For diagnostic tests which are not a gold standard, there is always an overlap between the results of patients with and without a certain disease. In the literature, for quantitative diagnostic tests where the diagnosis is not certain, two approaches have been proposed, named “grey zone” and “uncertain interval”. The uncertain area of the SII, which is given the general term “gray zone” in this article, was constructed and its results were compared with the “grey zone” and “uncertain interval” approaches. The lower and upper limits of the gray zone were found to be 611.504–1790.827 and 1186.576–1565.088 for the grey zone and uncertain interval approaches, respectively. A higher number of patients inside the gray zone and higher performance outside the gray zone were found for the grey zone approach. One should be aware of the differences between the two approaches when making a decision. The patients who were in this gray zone should be observed carefully for detection of the no-reflow phenomenon.

Introduction: Urinary Incontinence (UI) in pregnancy is more than a disease; it is a social problem that necessitates special care and management. The exact rationales and biological facts behind urinary incontinence during pregnancy are unclear and multivariate. Aim: This pilot study was designed to examine the direct effect of gestational factors (e.g., physical and metabolic/hormonal) on the presence of Gestational Urinary Incontinence (GUI), in nulliparous pregnant women. Materials and Methods: This was a questionnaire-based study comprising of 61 nulliparous pregnant woman who had not experienced any Urinary Incontinence (UI) before their pregnancies. Patients were examined during their pregnancies within the framework of the antenatal care program continued at the Division of Perinatology, Hacettepe University, Ankara, Turkey, between January 2015 and December 2016. A ‘urinary incontinence questionnaire’ was used three times during different periods of gestation (11–14, ~24 and ~37 gestational weeks) for each patient. Statistical analysis was performed using the SPSS software version 20.0. The Chi-Square test or Fisher’s-exact test was used to compare proportions in groups. Results: The prevalence of total urinary incontinence (stress urinary incontinence, urge urinary incontinence and mixed urinary incontinence) in nulliparous pregnant women was 4.9% (n=3), 9.8% (n=6) and 26.2% (n=16) at 11–14, ~24 and ~37 gestational weeks, respectively. Stress urinary incontinence was found to be 3.3% (n=2), 6.6% (n=4) and 16.4% (n=10) at 11–14, ~24 and ~37 gestational weeks, respectively. Urge urinary incontinence frequency was found to be 1.6% (n=1), 3.3% (n=2), 6.6% (n=4), and mixed urinary incontinence frequency was 0% (n=0), 0% (n=0), 3.3% (n=2) at 11–14, ~24 and ~37 gestational weeks, respectively. Maternal age, birth weight of the neonate and gestational age at birth had no statistically significant effect on GUI. Conclusion: Urinary incontinence is an important issue during pregnancy and related symptoms are more common in third trimester.

OBJECTIVE: To determine β2-microglobulin levels in amniotic fluid during the course of second trimester. STUDY DESIGN: One hundred patient’s amniotic fluid β2-microglobulin levels had been evaluated retrospectively (March-October 2009). The most common amniocentesis indication was advanced maternal age (33.3%). Others were; high risk result for triple test (18.5%), high risk result for double test (6.48%), ventriculomegaly (5.55%), obstetric history for fetus with down syndrome (4.62%), the presence of soft markers on ultrasound (13.8%), others (17.8%). Patients average gravida was 2.66 (range: 1-6), parity was 0.75 (range: 0-3), abortion was 0.65 (range: 0-3). RESULTS: All patients were at second trimester and the average gestational week was 17.7 (range 15- 22). Patients were divided into four groups (15th, 16th, 17-18th and 19-20th gestational weeks). We have demonstrated that amniotic fluid β2-microglobulin levels are increased progressively throughout the second trimester. We have specified normal β2-microglobulin values of each gestational week/period in order to be used in clinical practice. CONCLUSION: We have demonstrated that amnionic fluid β2-microglobulin levels are increased progressively throughout the second trimester.

OBJECTIVE: To validate the usability of “Beksaç Obstetrics Index” (BOI/BOIp) in the evaluation of different high risk pregnancy groups. STUDY DESIGN: This study is consisted of 3 groups of patients; 1) Pregnancies without MTHFR polymorphisms (n=65), 2) Pregnancies with methylenetetrahydrofolate reductase (MTHFR; homozygous or compound heterozygous) polymorphisms (n=140), 3) Pregnancies with “autoimmune antibody positivity” without any other type of hereditary thrombophilia (Anti-dsDNA, anti-phospholipid Ig G/M, anti-cardiolipin Ig G/M, ASMA, APA, ENA, anti-mitochondrial antibodies) (n=76). In this study, BOI which is (number of child +π/10)/Gravida is used in order to demonstrate the risk levels/scale of different high risk pregnancy groups. RESULTS: The mean BOIp (±SD) values are 0,41±0,22; 0,29±0,21; and 0,40±0,23 for Control, MTHFR and Autoimmune groups respectively. We have demonstrated statistically significantly decreased BOIp level in MTHFR group compared to the other groups (p:0,002). CONCLUSION: We have demonstrated that BOI/BOIp can be used in the assessment of risk levels of different high risk pregnancy groups.

Approximately 30% of patients with stage II/III colorectal cancer develop recurrence following surgery. How individual regulation of host mediated anti-tumor cytotoxicity is modified by the killer-cell immunoglobulin-like receptor (KIRs) genotype is essential for prediction of outcome. We analyzed the frequency of KIR and KIR ligand Human Leukocyte Antigen Class I genotypes, and their effects on recurrence and disease-free survival (DFS). Out of randomly selected 87 colorectal cancer patients who underwent R0 resection operations between 2005 and 2008, 29 patients whose cancers progressed within a median five-year follow-up period were compared with 58 patients with no recurrence within the same time period. Recurrent cases shared similar tumor stages with non-recurrent cases, but had different localizations. We used DNA isolated from pathological archival lymphoid and tumor tissues for KIR and KIR ligand (HLA-C, group C1, group C2, and HLA-A-Bw4) genotyping. Among cases with recurrence, KIR2DL1 (inhibitory KIR) and A-Bw4 (ligand for inhibitory KIR3DL1) were observed more frequently (p=0.017 and p=0.024); and KIR2DS2 and KIR2DS3 (both activating KIRs) were observed less frequently (p=0.005 and p=0.043). Similarly, in the non-recurrent group, inhibitory KIR-ligand combinations 2DL1-C2 and 2DL3-C1 were less frequent, while the activating combination 2DS2-C1 was more frequent. The lack of KIR2DL1, 2DL1-C2, and 2DL3-C1 improved disease-free survival (DFS) (100% vs. 62.3%, p=0.05; 93.8% vs. 60.0%, p=0.035; 73.6% vs. 55.9%, p=0.07). The presence of KIR2DS2, 2DS3, and 2DS2-C1 improved DFS (77.8% vs. 48.5%, p=0.01; 79.4% vs. 58.5%, p=0.003; 76.9% vs. 51.4%, p=0.023). KIR2DS3 reduced the risk of recurrence (HR=0.263, 95% CI = 0.080-0.863, p=0.028). The number of activating KIRs are correlated strongly with DFS, none/ one/ two KIR : 54/77/98 months (p=0.004). In conclusion the inheritance of increasing numbers of activating KIRs and lack of inhibitory KIRs, independent of tumor localization or stage, is associated with long-term DFS.

Biostatistics which is the application of statistics in the field of health and biology; provides powerful tools for creating questions, designing studies, developing measurements, and analyzing data and has an important place in determining the efficacy and safety of products such as drugs and vaccines. The impact of statistical sciences on medical and biological sciences has increased rapidly during the last few decades. Clinicians need to understand statistics well enough to follow up and evaluate empirical studies that provide an evidence base for clinical practice. Recent advances in biomedical research have created both new challenges and opportunities for statisticians and data scientists. Big data analytics, precision medicine, artificial intelligence, causal inference, and other new research resources inspire data scientists to develop modern statistical methods and innovative inference procedures. Therefore new philosophies such as causal models and prediction, new models such as graphical chain models and random effects models, faster computers and new clever algorithms for integration and maximization are needed. Without adequate investment in biostatistics, all medical research is at a significant risk of “drowning in data, but starving for knowledge”.

Background: In order to determine the presence or absence of a certain disease, multiple diagnostic tests may be necessary. Performance of these tests can be sequentially evaluated. Aims: The aim of the study is to determine the contribution of the test in each step, in reducing diagnostic uncertainty when multiple tests are sequentially used for the diagnosis. Study Design: Diagnostic accuracy study Methods: Radiographs of seventy-three patients of the Department of Dento-Maxillofacial Radiology of Hacettepe University Faculty of Dentistry were assessed. Panoramic (PAN), full mouth intraoral (FM), and bitewing (BW) radiographs were used for the diagnosis of proximal caries in the maxillary and mandibular molar regions. Diagnostic performance of radiography was sequentially evaluated by using the reduction in diagnostic uncertainty. Results: FM provided maximum diagnostic information for ruling in potential in the maxillary and mandibular molar regions in the first step. FM provided more diagnostic information than BW radiographs for ruling in the mandibular region in the second step. In the mandibular region, BW radiographs provided more diagnostic information than FM for ruling out in the first step. Conclusion: The presented method in this study provides the clinicians with a solution for the decision of the sequential selection of diagnostic tests for the correct diagnosis of the presence or absence of a certain disease.