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A 45-year-old male patient was admitted to our emergency department complaining of fatigue, headache, mild confusion, nausea, and vomiting. He had had Type 2 diabetes mellitus for 10 years that was managed with insulin injections. Two days before the onset of symptoms, he had consumed the natural herb Chenopodium polyspermum to regulate his blood glucose levels. Upon examination, he was found to be experiencing tenderness in the upper left abdominal area, icteric sclera, and pallor conjunctivas. Laboratory tests revealed that he was anemic and had increased levels of indirect bilirubin, lactic dehydrogenase, and creatinine in blood. Direct and indirect Coombs tests were negative, and fragmented erythrocytes were observed in peripheral blood smears. The best supportive care was provided, and therapeutic plasma exchange (TPE) treatments were administered. TPE was performed five times and hemolytic findings improved. The patient then developed chronic renal failure and was transferred to the dialysis program and discharged. In this article, we present a case with hemolytic and renal toxicity induced by the ingestion of Chenopodium polyspermum that was managed with TPE and hemodialysis. J. Clin. Apheresis 27:278-281, 2012. © 2012 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Abstract Background Training of infectious disease (ID) specialists is structured on classical clinical microbiology training in Turkey and ID specialists work as clinical microbiologists at the same time. Hence, this study aimed to determine the clinical skills and knowledge required by clinical microbiologists. Methods A cross-sectional study was carried out between June 1, 2010 and September 15, 2010 in 32 ID departments in Turkey. Only patients hospitalized and followed up in the ID departments between January-June 2010 who required consultation with other disciplines were included. Results A total of 605 patients undergoing 1343 consultations were included, with pulmonology, neurology, cardiology, gastroenterology, nephrology, dermatology, haematology, and endocrinology being the most frequent consultation specialties. The consultation patterns were quite similar and were not affected by either the nature of infections or the critical clinical status of ID patients. Conclusions The results of our study show that certain internal medicine subdisciplines such as pulmonology, neurology and dermatology appear to be the principal clinical requisites in the training of ID specialists, rather than internal medicine as a whole.

Phenomenon: Physician immigration from other countries is increasing as developed countries continue to be desirable destinations for physicians; however, the determinants of Turkish physicians' migration decisions are still unclear. Despite its wide coverage in the media and among physicians in Türkiye, and being the subject of much debate, there is insufficient data to justify this attention. With this study, we aimed to investigate the tendency of senior medical students in Türkiye to pursue their professional careers abroad and its related factors. Approach: This cross-sectional study involved 9881 senior medical students from 39 different medical schools in Türkiye in 2022. Besides participants' migration decision, we evaluated the push and pull factors related to working, social environment and lifestyle in Türkiye and abroad, medical school education inadequacy, and personal insufficiencies, as well as the socioeconomic variables that may affect the decision to migrate abroad. The analyses were carried out with a participation rate of at least 50%. Findings: Of the medical students, 70.7% had emigration intentions. Approximately 60% of those want to stay abroad permanently, and 61.5% of them took initiatives such as learning a foreign language abroad (54.5%) and taking relevant exams (18.9%). Those who wanted to work in the field of Research & Development were 1.37 (95% CI: 1.22-1.54) times more likely to emigrate. The push factor that was related to emigration intention was the "working conditions in the country" (OR: 1.89, 95% CI: 1.56-2.28) whereas the "social environment/lifestyle abroad" was the mere pull factor for the tendency of emigration (OR: 1.73, 95% CI: 1.45-2.06). In addition, the quality problem in medical schools also had a significant impact on students' decisions (OR: 2.20, 95% CI: 1.83-2.65). Insights: Although the percentage of those who want to emigrate "definitely" was at the same level as in the other developing countries, the tendency to migrate "permanently" was higher in Türkiye. Improving working conditions in the country and increasing the quality of medical faculties seem vital in preventing the migration of physicians.

Exposure to electromagnetic fields causes a variety of health problems in living systems. We investigated EMF pollution in Şanlıurfa city center and also investigated anxiety-depression symptoms in individuals (18-40 years old) exposed to this pollution. For this purpose, electric field and magnetic field measurements were taken at Electricity Distribution Center and 44 substations (for each transformer), at 0 points, 1 meter away, 2 meters away and the house/office closest to the transformer. The experimental group was individuals living in electricity distribution center residences and individuals living near transformers ( n  = 55). The control group was selected from individuals who lived outside the city center of Şanlıurfa, did not have transformers or high transmission lines near their homes, and did not have any chronic diseases that could cause stress ( n  = 50). Anxiety and depression symptoms of the groups were measured using the Beck Anxiety Inventory Scale (BAI) and Beck Depression Inventory Scale (BDI). The relationship between EMF pollution and anxiety-depression was evaluated statistically. Maximum MF and EF values were recorded as 0.22 mT and 65.9 kV/m, respectively. All measured MF values were below standards, but EF values were above standards at some points. In conclusion, there is no statistically convincing evidence of a relationship between EMF exposure and anxiety-depression ( p  > 0.05). This result shows that there may be more meaningful results in places with higher EMF levels. We interpreted the fact that exposure to electromagnetic fields does not cause anxiety and depression in individuals, as the measured values are below the limit values.

Objectives: Determination of the attitudes of individuals toward sexually transmitted infections (STIs) can also help identify barriers to health service-seeking behavior. Hence, this study aimed to develop a scale for determining the attitudes of individuals toward sexually transmitted diseases., Study Design: This was a methodological study. The Health Belief Model (HBM) framework was used to elucidate the perceptions and interpretations of illnesses among individuals. After reviewing the relevant literature, an item pool was created to include 4 dimensions (perceived susceptibility (A), perceived severity (B), perceived benefit (C), and perceived barriers and self-efficacy (D)) about sexually transmitted diseases from the perspective of HBM. Exploratory factor analysis was conducted to evaluate the construct validity of the scale. Moreover, confirmatory factor analysis was used to examine the suitability of the items in terms of factor structures., Results: The final version of the scale comprised 19 items and 4 subdimensions. The first subdimension of the scale accounted for 20.11% of the total variance, whereas the second, third, and fourth subdimensions accounted for 17.83%, 12.50%, and 8.75% of the total variance, respectively. Collectively, these four subdimensions accounted for 59.19% of the total variance. The Cronbach's alpha reliability coefficient of the scale was found to be 0.74., Conclusions: Briefly, the present study led to the development of a novel assessment tool, Attitude Toward Sexually Transmitted Infections Scale. Higher scores on the scale indicated higher likelihood of taking action for a possible STI treatment according to the HBM approach., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Purpose: The purpose of this study is to examine the prevalence of bullying among high school students, its associated factors, and the effects of engaging in bullying behaviors on mental health., Materials and Methods: This cross-sectional study was conducted between 2021 and 2022 in the province with the highest population of children in the Southeast Anatolia region of Turkey. The data of the study were collected using the Sociodemographic Characteristics Questionnaire prepared by the researchers, Olweus Bully/Victim Questionnaire (OBVQ), and Depression Anxiety Stress Scale 42 (DASS-42)., Results: Of the 880 students who participated in the study, 34.2% reported being a victim of bullying and 13.9% reported bullied someone. Regression analysis revealed that overweight/obesity was a risk factor for both victims and bullies. On the other hand, male gender and alcohol consumption were significantly associated with bullying. Scores for depression, anxiety, and stress were significantly higher in both the victim and the bullying groups compared to students who did not fall into this cycle., Conclusions: The present findings suggest that bullying in school creates problems not only for the bullying victims but also for the bullies. Health professionals assessing youth should be aware of the characteristics of young people who may be involved in bullying.

Despite the fact that COVID-19 vaccines serve as an important tool for protection against COVID-19 infection, in individuals aged above 65 years, as well as the entire community, there are significant problems associated with getting vaccinated. The aim of this study is to determine the effect of perceptions and attitudes toward the COVID-19 epidemic in individuals over the age of 65 living in Şanlıurfa, Turkey in 2021, on the situation of having COVID-19 vaccination. The study is designed as a case-control type of research. The study population was comprised of individuals aged 65 years and above located in Şanlıurfa, Turkey. The Case Group consisted of individuals, who rejected the COVID-19 vaccination and the Control Group consisted of individuals who have received the vaccine. The individuals recruited in the Case and Control Groups were selected by means of the snowball sampling method. The study included a total of 240 individuals including 120 in the Case Group and 120 in the Control Group. Rate of vaccine rejection was higher in individuals who believed that the media exaggerated the pandemic, the disease had low contagiousness, the pandemic was a conspiracy, the environmental pollution had no role in the disease, the domestic measures taken against the epidemic were inadequate, the personal hygiene could not protect from disease, and who did not believe that the disease was inevitable [p < 0.05]. Governments have a lot of responsibilities in providing accurate information about vaccination to people and increasing confidence in the health system.

Objectives: Population growth is an important public health problem with economic, social, cultural and political consequences. The aim of the study was to determine the reproductive behaviour and perspectives on fertility of women in Sanliurfa, the city with the highest fertility rate in Turkey., Methods: The quantitative dimension of the study was carried out using a mixed methods approach in which 300 women were interviewed and a questionnaire was completed; the qualitative dimension was carried out through in-depth individual interviews with 14 women, using a semi-structured interview form. Analysis of the qualitative data was done using a content analysis technique., Results: The median number of children was three (range 0-10). Women with no or a low level of education tended to have a greater number of children. Preference for a particular sex of child was one reason behind the higher number of children. These two factors were main causes of an increased number of children. Women with no or a low level of education (odds ratio [OR] 9.1) and women who expressed a preference for a male child (OR 5.9) had more children compared with other women. Participants regarded a male child as more valuable than a female child and that having many children strengthened the family. Parents regarded their sons as insurance for their old age. Having an induced abortion was perceived as a sin., Conclusion: The results showed that cultural norms and values significantly affected fertility rates.

Introduction: Interventional endoscopic procedures, such as endoscopic retrograde cholangiopancreatography (ERCP), often require sedation during the procedure. The most commonly used drugs for this purpose are midazolam and propofol, which are used as sedative and hypnotic agents with minimal analgesic potential., Aim: To compare the analgesic sedative effects of midazolam-propofol and dexmedetomidine-propofol combinations and their influence on hemodynamic and respiratory variables in patients undergoing ERCP., Material and Methods: Forty adult patients aged 20-78 and undergoing ERCP were randomized to two groups. Patients were premedicated with midazolam (0.05 mg/kg 10 min before the procedure) in group M and with dexmedetomidine (1 μg/kg for 10 min) in group D. Propofol was used for maintenance. The sedation level was monitored using the bispectral index (BIS) to maintain a score between 70 and 80. Hemodynamic and respiratory variables, recovery time and adverse events were recorded., Results: The hemodynamic and respiratory variables were similar in both groups. Total propofol consumption was significantly lower in the dexmedetomidine group (208.5 ±80.0 vs. 154.5 ±66.7 mg; p = 0.011). The recovery period was shorter in group D (time to achieve the Aldrete score 9 was 9.4 ±2.1 vs. 6.6 ±1.1 min; p < 0.001). Changes in hemodynamic and respiratory variables and adverse events were not different between the two groups., Conclusions: We found a shorter recovery time and comparable sedative and adverse effects with the dexmedetomidine-propofol combination compared with the midazolam-propofol combination. Dexmedetomidine in combination with propofol may be a safe and useful alternative for sedation for ERCP patients., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2020 Fundacja Videochirurgii.)

The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology present a list of key performance measures for endoscopy services. We recommend that these performance measures be adopted by all endoscopy services across Europe. The measures include those related to the leadership, organization, and delivery of the service, as well as those associated with the patient journey. Each measure includes a recommendation for a minimum and target standard for endoscopy services to achieve. We recommend that all stakeholders in endoscopy take note of these ESGE endoscopy services performance measures to accelerate their adoption and implementation. Stakeholders include patients and their advocacy groups; service leaders; staff, including endoscopists; professional societies; payers; and regulators.

The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology present a list of key performance measures for endoscopy services. We recommend that these performance measures be adopted by all endoscopy services across Europe. The measures include those related to the leadership, organization, and delivery of the service, as well as those associated with the patient journey. Each measure includes a recommendation for a minimum and target standard for endoscopy services to achieve. We recommend that all stakeholders in endoscopy take note of these ESGE endoscopy services performance measures to accelerate their adoption and implementation. Stakeholders include patients and their advocacy groups; service leaders; staff, including endoscopists; professional societies; payers; and regulators., Competing Interests: C. Bennett owns and works for Systematic Research Ltd., and received a consultancy fee from ESGE to provide scientific, technical, and methodological expertise for the present project (2014 – 2018). R. Bisschops has received: speaker’s fees from Covidien (2009 – 2014) and Fujifilm (2013); speaker’s fee and hands-on training sponsorship from Olympus Europe (2013 – 2014); speaker’s fee and research support from Pentax Europe; and an editorial fee from Georg Thieme Verlag as co-editor of Endoscopy. M. Bretthauer receives fees for being a member of the Norwegian government CRC screening advisory group (2012 to present) and receives funds from the American College of Physicians for editorial work for Annals of Internal Medicine. T. de Lange is a National Endoscopy Board’s member of the Norwegian Gastroenterology Association. M. Dinis-Ribeiro receives funds from Georg Thieme Verlag for editorial work for Endoscopy. M. Kaminski receives speakers and teaching fees and travel support from Olympus Erbe. C. Senore’s department received PillCAM2 Colon devices from Medtronics to conduct a comparative study (2014 – 2017); along with C. Belissario and S. Minozzi, he also received consultancy fees from ESGE to provide methodological expertise (PICOs evaluation, literature searches, and evidence summaries) for the present project (2014 – 2017). R. Valori is a director of AnderVal Ltd., a company providing endoscopy skills training (2015 to present). O. S. Balfaqih, G. Cortas, M. de Pater, D. Domagk, P. Eisendrath, P. Falt, C. Hassan, I. Koruk, A. Ono, C. J. Rees, N. Rustemović, M. Rutter, E. Schoon, C. Spada, and A. Veitch have no competing interests., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background and Study Aims: Apoptosis represents a well-known mechanism of cell death involved in most chronic liver injuries. Our aim was to investigate the serum fragment level of cytokeratin 18 (CK18), M30, in asymptomatic hepatitis B virus (HBV) carriers and patients with chronic hepatitis B (CHB) and to evaluate the relationship between serum M30 levels and the severity of hepatic injury., Patients and Methods: Asymptomatic HBV carriers (n=169), patients with CHB (n=100), and healthy control subjects (n=43) were enrolled in the study. Serum CK18 (M30) levels were analysed in all subjects. Liver biopsy for histopathological assessment was performed in asymptomatic HBV carriers and in patients with CHB infection., Results: Serum CK18 (M30) levels were significantly higher in asymptomatic HBV carriers (198.77±77.62U/L) than in healthy control subjects (146.92±40.18U/L). Patients with CHB (283.02±147.45U/L) had significantly higher CK18 (M30) levels than asymptomatic HBV carriers (p=0.001). The diagnostic efficacy of CK18 (M30) levels in distinguishing patients with HBeAg-negative CHB from asymptomatic HBV carriers was found to be moderate (c-statistics: 0.695), and the diagnostic cut-off value of CK18 (M30) was 262U/L (specificity: 85%, sensitivity: 48%, positive likelihood ratio: 3.35, and negative likelihood ratio: 0.60). There was a positive correlation between serum CK18 (M30) levels and histological activity index scores in asymptomatic HBV carriers and patients with CHB., Conclusions: Serum CK18 (M30) levels may be a valuable indicator in distinguishing asymptomatic HBV carriers from patients with HBeAg-negative CHB when considered together with ALT and HBV-DNA levels., (Copyright © 2017 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.)

Seasonal farmworkers are one of the groups that should be examined in terms of family planning method because low socio-economic levels, limited accommodation, and living conditions in agricultural areas can restrict workers' access to information and health services. The study was carried out to determine the effect of working environment in agriculture on female seasonal workers' choice of family planning method. This cross-sectional study was performed on 300 women. It was found that the working and living conditions in the agricultural sector forced women to change their family planning method.

Aim: Food allergy is a common problem in children and adults. The aim of this study was to determine the frequency of cow's milk and egg allergy based on skin prick test and oral food challenge results, Methods: We recruited 614 children aged 1 month-2 years in from different areas of Sanliurfa. An interview was conducted with each parents and family demographic, and prenatal-antenatal-postnatal information was recorded, then skin prick test was applied to the children for egg white, egg yolk and cow's milk. Cases that are required, sIgE levels for cow's milk, egg white and egg yolk were measured and food challenge tests were applied., Results: Cow's milk and egg allergy was determined in 1 case (0.16%) and 8 cases (1.30%) respectively from the results of the tests applied. Six cases (0.97%) were accepted as sensitive to egg white and egg yolk. Within the factors which were questioned, (only the egg allergy evaluation was made without the cow's milk allergy case) of those with parental consanguinity was determined at a statistically significantly high level (OR=5.8, 95% CI: 1.2-27.2, P=0.01)., Conclusion: The prevalence of cow's milk allergy in Sanliurfa is the lowest reported prevalence rate to date in children under 2 years of age. When infants develop a food allergy, this takes the form of egg allergy. Within the several factors evaluated to explain this situation, a significant relationship was determined only with parental consanguinity. However, as reported above, to date there is no genetic or epidemiological study to explain this situation.

Background/aim: In regions such as Sanliurfa, Turkey, where the fertility rate is high, suitable health policies to easily and successfully treat urinary incontinence (UI) are needed. This study was conducted to determine the prevalence and risk factors for UI among women in the region., Materials and Methods: The participants in this cross-sectional study were selected by using 30 cluster sampling methods. A total of 300 women in the age group of 15-49 years were contacted to participate., Results: The prevalence of UI was 39.3% among women in this sample but only 8.0% actually received treatment. The logistic regression analysis showed that UI risk is increased 1.8 times by chronic diseases, 2.7 times by menopause, 3.4 times by uterine prolapse, and 9.12 times by cystocele., Conclusion: UI is a common health problem among the women in the study region; however, these women do not actively seek treatment for this problem.

The hepatotoxicity cases due to herbal medical products have been increased in recent years. Teucrium polium (TP) (mountain germander) is one of the most popular species of the Lamiaceae family and is commonly used for increasing breast milk formation and for relieving gastrointestinal complaints in the last months of pregnancy and postpartum periods. Here are presented 3 cases of serious hepatotoxicity due to TP. Three female patients aged 33, 31, and 37 years were admitted to clinic with jaundice and serious elevated liver enzymes for a period of 2 years. The patients were using TP for approximately 40 days to 3 months. Two of the 3 used TP during their previous pregnancies and were monitored for similar complaints by another center. After discontinuation of TP and supportive care, the liver function tests were decreased to normal limits within 3 months in all 3 patients. In addition to the potential hepatotoxic effect of TP, physiological changes in the postpartum period may increase the severity of hepatotoxicity. TP should be considered in differential diagnosis in patients presenting similar history and complaints, where it is used commonly.

The adhesion molecules play a major role in inflammation as well as in neoplastic diseases. The aim of this study is to evaluate the expressions of the adhesion molecules, intercellular adhesion molecule 1 (ICAM-1), ICAM-2, and ICAM-3, in Barrett's esophagus, recognized as a premalign lesion for esophageal cancer and related to inflammation. Eighteen patients with Barrett's esophagus according to endoscopy and 25 volunteers without Barrett's esophagus disease were included in the study. Tissue samples were supplied by biopsy and used for both gene expression and immunohistochemical analysis. The significance of the differences between the two groups was assessed by Student's t test. The ICAM-1 expression level was fivefold higher in the patient group compared with that of the control. There was an increase in the serum level of ICAM-1 in patients compared to that of the controls, but this increase was not significant. ICAM-2 levels were also increased in the patient group, but it was not significant. There was no difference between controls and patients in ICAM-3 levels. Significantly higher levels of ICAM-1 gene expression make us think that ICAM-1 may play an important role in Barrett's esophagus. We think that more studies, with larger patient groups and preferably detailed histopathological and clinical evaluations, are needed to explain the severity of ICAM-1, ICAM-2, and ICAM-3 molecules in Barrett's esophagus.

Background & Aims: Both unsedated transoral endoscopy (TOE) and sedated TOE have some drawbacks in clinical practice. Unsedated transnasal endoscopy (TNE) has been suggested as an alternative to both methods. This study aimed to determine the advantages of TNE in patients who have previously undergone unsedated conventional TOE., Methods: Patients who had received an unsedated TOE in the last 12 months and were scheduled for a second upper endoscopy were included. They were randomized to undergo either unsedated TOE, using a standard endoscope, or unsedated TNE, using an ultrathin endoscope. Post-procedure, patients were asked to complete a questionnaire to assess pain, discomfort and acceptability of the procedure, and to compare the current procedure with their previous unsedated TOE. Endoscope insertion rate, procedure duration, and side-effects were recorded., Results: Each group included 50 patients. With the exception of nasal pain, the tolerability and acceptance were significantly greater in the unsedated TNE group. Significantly more TNE patients (82%) found the current endoscopic procedure to be better than their previous TOE when compared with patients who had received a second TOE (12%). A repeat procedure was significantly more acceptable for TNE patients when compared to the TOE group (68% vs.16%). The duration of endoscopy was significantly shorter in TOE than in TNE (p<0.05). Endoscope insertion failed in 4% and mild epistaxis was observed in 4% of TNE patients., Conclusion: Unsedated TNE was better tolerated in endoscopy experienced patients when compared with unsedated TOE. The majority of patients found TNE more acceptable and preferable to TOE, suggesting that TNE should become a more common practice in clinics when applicable.

Background/aims: Drug-induced liver injury (DILI) is common worldwide and has a potentially fatal outcome. It accounts for more than half of the cases of acute liver failure in the United States. Herb-induced liver injury (HILI) is a less documented condition but a growing problem. We present here the clinical characteristics and outcome of patients with drug- and herb-induced liver injury from our center., Materials and Methods: In this 4-year retrospective study, 82 patients in whom there was a causal or highly probable relationship between herbal medicine or drug use and liver disease are presented., Results: The mean age of patients was 43.1±14.8 years; sexual distribution was 53 females and 29 males. The major cause of hepatotoxicity was drugs (87.8%), with herbal medicine accounting for 12.2%. The leading causative agents were nonsteroidal anti-inflammatory drugs (NSAIDs) (23.1%), followed by antibiotics (19.5%). The pattern of hepatotoxicity was hepatocellular in 35 patients (42.6%), mixed in 28 (34.1%), and cholestatic in 19 patients (23.1%). Teucrium polium (known popularly as felty germander), which is a traditionally used herbal medicine of the Labiatae family in our region, was the most common cause of herb-induced liver injury and responsible in 7 of 10 herbal hepatotoxic cases. Acute liver failure developed in 3 patients (two patients related with flurbiprofen and diclofenac and one patient due to an isoniazid-rifampicin combination)., Conclusion: Antibiotics and NSAIDs were the most common etiologic agents for drug-induced liver injury. Surprisingly, herbs follow these groups of drugs and must be questioned more carefully.

We described the serological prevalence of West Nile Virus (WNV) antibodies among the human population in a historical and strategic region of Turkey. A serologic survey was conducted based on suspected cases in April, 2009, in the Mesopotamia region of Turkey, in the villages that were located alongside the Zergan River. All the sera were tested by enzyme-linked immunosorbent assay ELISA (Euroimmune™), and the positive samples were tested by immunofluorescent assay (IFA; Euroimmune™). As confirmation, neutralizing antibodies against WNV were tested by microneutralization assay (MNTA). In total, 307 individuals were included. The MNTA test was found to be positive among 52 individuals out of 307 (17%). In multivariate analysis, age >50 [odds ratio (OR)=5.2, confidence interval (CI) 2.76-9.97, p<0.001) and being in an occupational risk group (OR=2.02, CI 1.02-4.04, p=0.044) were found to be the risk factors for WNV seropositivity with the MNTA test. The physicians in the region should be aware of the risk of WNV infection and should be alerted to detect the clinical cases.

The mechanisms responsible for the malignant transformation in Barrett's esophagus (BE) are still poorly understood. The authors have evaluated the role of Rho-kinase (ROCK1 and ROCK2) expressions in patients with BE. All patients underwent upper gastrointestinal system endoscopy, which was confirmed histologically. Real-time PCR revealed no marked change in gene expressions of ROCK1 and ROCK2 at mRNA levels in BE when compared to controls. Immunohistochemical and western blot analyses showed no change in ROCK1 and ROCK2 protein expressions in BE. This study demonstrates that Rho-kinase gene and protein expressions are not modified in BE.

Maternal and child health is affected by exposure to unhealthy living and working conditions, by increased exposure to health hazards, and by poor utilization of primary healthcare services. The objective of this operational study was to implement mobile primary healthcare services (MPHS) for migratory seasonal farmworkers. This study, conducted in Şanlıurfa, Turkey, between March 2008 and April 2009, examined multiple stages of MPHS implementation in both a permanent settlement (336 children aged 5 and under; 580 women of reproductive age) and a working settlement (85 living units; 217 children and 257 women). The stages included: (1) identifying the problem, (2) identifying a potential solution and a quasi-experimental study to evaluate the effect of intervention, (3) utilizing and disseminating results to stakeholders, and (4) implementing sustainable MPHS county-wide. Rates of selected outcome measures, including full childhood and tetanus vaccination, phenylketonuria screening, and safer usage of pesticides, iodine salt, and sanitary toilet facilities, increased significantly following the intervention in both the permanent and temporary settlements (P < 0.05). The majority of cases of anemia (children: 16.6%, women: 17.8%) and parasitic infections (55.4%) were treated. The study results indicate that MPHS are necessary to ensure healthcare access for migratory farmworkers and to establish a stronger public health infrastructure for this risk group.

Brucella endocarditis (BE) is a rare but life-threatening complication of human brucellosis. The aim of this study was to investigate the course of BE along with the therapeutic interrelations. A total of 53 patients with BE hospitalised in 19 health institutions between 2006 and 2011 were included in the Gulhane study. Diagnosis of brucellosis was established by either isolation of Brucella sp. or the presence of antibodies, and the definition of endocarditis was made according to Duke's criteria. There were four treatment groups: ceftriaxone combined with oral antibiotics (Group 1); aminoglycosides combined with oral antibiotics (Group 2); oral antibiotic combinations (Group 3); and aminoglycoside plus ceftriaxone combined with an oral antibiotic (Group 4). Involvement rates of the aortic, mitral and tricuspid valves were 49.1%, 43.4% and 5.7%, respectively. Thirty-two patients (60.4%) had an underlying cardiac valvular problem, including previous prosthetic valve replacement (n=18). Medical treatment was provided to 32 patients (60.4%), whilst concordant medical and surgical approaches were provided to 21 patients (39.6%). Mortality in Group 1 was 15% (3/20), whilst in Group 2 it was 5.3% (1/19). In Group 3, 25.0% (3/12) of the cases died, whereas none of the cases in Group 4 died. In conclusion, mortality increased 47-fold with pericardial effusion and 25-fold due to congestive heart failure that developed after BE. Although mortality was lower in the aminoglycoside-containing arm (Groups 2 and 4), statistical analysis could not be performed owing to the small number of patients., (Copyright © 2012 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.)

Objective: To assess the in vivo hemostatic effect of a folkloric medicinal plant extract., Subjects and Methods: Wistar rats were randomized into four groups of seven. Group 1, a control group, received no pretreatment and was irrigated with saline. Group 2 received no pretreatment and was irrigated with the plant extract. Group 3, a control group, received pretreatment with heparin and was irrigated with saline. Group 4 received pretreatment with heparin and was irrigated with the plant extract. A standardized skin-bleeding model was created using full-thickness skin defects on the Wistar rats' dorsal skin. To control bleeding, compressive dressings were placed after inserting 1 mL of the plant extract or saline into the bleeding area. Hemostasis time and amount of nasal bleeding were measured in all groups to compare the treatments without and with the plant extract., Results: Without heparin pretreatment, the folkloric medicinal plant extract shortened the hemostasis time by 1.29 minute and reduced the amount of bleeding by 0.63 g. With heparin pretreatment, the plant extract shortened the hemostasis time by 2.29 minutes and reduced the amount of bleeding by 0.70 g., Conclusion: The medicinal plant extract irrigation was more effective than saline irrigation for treating hemorrhagic skin defects in animals using a compressive dressing with or without heparin pretreatment., (© 2012 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.)

Background and Aim:   The assessment and treatment of advanced gastrointestinal (GI) strictures, which are defined as the inability to pass through the strictured segment with standard endoscopes, might require radiological work-up, repeated endoscopies and surgery. The aim of the present study was to assess the role of ultrathin endoscopy (UTE) for the evaluation and treatment of advanced GI strictures., Methods:   Patients in whom an initial diagnostic upper or lower endoscopy attempt was incomplete because of a tight stricture underwent a second procedure with a UTE (5.9 mm diameter) in the same session. An interventional endoscopic therapy was also carried out according to the etiology and nature of the stricture using the same UTE. Diagnostic and therapeutic outcomes were recorded and followed up prospectively. The study was conducted in a tertiary endoscopy center., Results:   During a one and half year study period, 62 patients (51 at upper and 11 at lower endoscopy) were detected with advanced GI stricture among 8456 diagnostic upper and 3815 lower endoscopy patients. A complete endoscopic examination was successful with UTE in 40 (78%) patients with upper and in nine patients (82%) with lower GI strictures. An interventional procedure was also carried out in 16 patients with the assistance of UTE., Conclusion:   UTE is a useful tool for the evaluation of patients with advanced GI strictures. It provides a complete diagnostic endoscopy in most patients and gives an opportunity for therapeutic endoscopic procedures., (© 2011 The Authors. Digestive Endoscopy © 2011 Japan Gastroenterological Endoscopy Society.)

Purpose: Anal fissure (AF) is a common perianal condition in children. Although adult patients with AF have been treated successfully using diltiazem, it has not been studied in children. The present randomized, prospective, double-blind study assessed the response, side effects, and recurrence of diltiazem., Methods: Ninety-three children with AF were randomly divided into three groups. Each group received topical ointment. Group GTN received 0.2% glyceryl trinitrate, group L received 10% lidocaine, and group D received 2% diltiazem ointment., Results: Eighty-two patients completed the 12-month study. At the end of the first 8-week course, the healing rate in group D was significantly higher than that of the other groups (p < 0.0001, χ (2) = 19.82). Nonresponders received a second course of the same treatment. Group D showed significantly higher healing rates than the other groups (p < 0.05, χ (2) = 7.227) at the end of the second 8-week course. The group D recurrence rate was significantly different than that of the other groups (p < 0. 002, χ (2) = 12.79)., Conclusion: Diltiazem application is effective and safe for the treatment of AF in children, and has a low recurrence rate. The smooth dose-concentration curve causes minimal side effects.

Background/aims: Acute pancreatitis is well defined as pancreatic inflammation due to the activation of pancreatic enzymes secondary to several etiological factors. In the majority of patients, the clinical symptoms are self-limited, but it can also cause tissue necrosis and severe organ failures. In experimental animal models, it has been shown that wide apoptotic cell death is related to a clinically mild presentation of acute pancreatitis. Cytokeratin 18, a cytoskeletal protein, is shown to be related with apoptosis. In this study, we aimed to show the relation between serum cytokeratin 18 and the clinical presentation of acute pancreatitis in humans., Materials and Methods: A total of 54 acute pancreatitis patients were enrolled into the study. Patients were classified as mild or severe pancreatitis according to Ranson's criteria. There were 36 (66.7%) patients in the mild pancreatitis group (score < 6), and 18 (33.3%) patients in the severe pancreatitis group (score ≥ 6). During the first admission, blood samples were obtained for serum cytokeratin 18 levels., Results: Cytokeratin 18 levels in the mild pancreatitis group were significantly higher than in the severe pancreatitis group (271.2 ± 45.5 vs. 152.6 ± 38.2 IU/L; p < 0.001). There was a negative correlation between the disease activity score (Ranson score) and the serum cytokeratin 18 levels (p < 0.001; r = -0.724)., Conclusions: This first human study suggests that cytokeratin 18 (marker of apoptosis) might be a serological predictive marker for acute pancreatitis for disease activity.

A total of 38 children (49 hips) were retrospectively investigated to assess the efficacy and safety of one-stage treatment of developmental dysplasia of the hip (DDH) in untreated children from two to five years of age. Our method consisted of open reduction, Salter innominate osteotomy, femoral shortening and derotation osteotomy. The patients were distributed into two groups according to the age at which they were operated: Group I included 19 patients aged < 3 years (24 hips) and Group II included 19 patients aged > or = 3 years (25 hips). Mean follow-up was 5.08 years for Group I and 5.76 years for group II. Clinical and radiological assessment at final followup showed that the outcome was not significantly different between the two groups. Furthermore, after this follow-up period, the rates of avascular necrosis were similar. Children with DDH between two and five years of age were treated successfully with one-stage treatment.

Aim: Cascade stomach (CS) is a deformity of stomach, capable of leading dyspepsia, and its actual incidence is unknown. We investigated its frequency and performed a preliminary study to determine endoscopic diagnostic criteria., Material and Methods: One thousand four hundred and seventy-five consecutive patients were enrolled to this study. A criteria for CS in endoscopy was defined as follow: A fundal pouch after cardia, difficulty in passage from fundus to corpus and/or requiring a manoeuvre, an angulation separating fundus-corpus. Cases having all three criteria were considered as complete CS (CCS) only the third one as borderline CS (BCS)., Results: CS was diagnosed endoscopically in 33 (2.5%) and radiologically in 32 (2.4%) of patients with dyspepsia. Among endoscopically diagnosed CS patients, CCS was found to be present in 17 and BCS was found to be in 16 patients. Patients in whom CS was diagnosed endoscopically, radiological examination revealed CCS in 18 patients, BCS in 14 patients, and 1 patient with normal findings were detected. There were no significant differences between these two groups (P=0.559)., Conclusion: CS can be presented with various upper abdominal symptoms, and it can easily be diagnosed when endoscopic criteria are considered., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)