The Relationship between CHA2DS2-VASc Score and Reperfusion Success in Elective Percutaneous Saphenous Vein Graft Interventions

Abstract Background Patients with degenerated saphenous vein grafts (SVG) have a higher risk of developing no-reflow. The CHA2DS2-VASc score was established as a no-reflow predictor in patients with acute coronary syndrome (ACS). Objectives In our study, we aimed to assess the association between CHA2DS2-VASc score and no-reflow after the procedure and short-term mortality in patients with SVG who underwent elective percutaneous coronary intervention (PCI). Methods Our retrospective study comprised 118 patients who were divided into two groups according to the occurrence of the no-reflow phenomenon. The groups were compared on the basis of demographic characteristics, angiographic parameters, CHA2DS2-VASc scores, and outcome. A logistic regression analysis was additionally performed to determine the predictors of no-reflow. A p value of < 0.05 was considered statistically significant. Results Mean age of the participants was 66.4 ± 9.2 years, and 25.4% of them were female. Apart from the history of diabetes (p = 0.032), demographic data, blood parameters, ejection fraction, total stent length and diameter, medication use, median CHA2DS2-VASc score, and adverse cardiac events did not differ between the groups. In univariate logistic regression analysis, the presence of diabetes and stent length appeared to be associated with no-reflow, but not in multivariate analysis. The median CHA2DS2-VASc score was higher in non-survivors at 1-year follow-up (4.5 versus 3, p = 0.047). Conclusions In our study, we did not observe a significant relationship between no-reflow and CHA2DS2-VASc score. Larger studies are needed to reveal the indicators of improved post-intervention reperfusion in elective SVG PCI.

Comparison of pain levels developed during intramuscular injections to laterofemoral and ventrogluteal regions in children: a randomized controlled study

SUMMARY OBJECTIVE: The aim of this study was to compare the levels of pain developed during intramuscular injections to the laterofemoral and ventrogluteal regions in children. METHODS: The study population consisted of all children aged between 7 and 12 years who presented to the pediatric emergency clinic of a hospital. The sample consisted of 62 children who met the inclusion criteria and agreed to participate in the study, and the children were randomly assigned to each group (laterofemoral n=31, ventrogluteal n=31). "Buzzy" and "deep breathing" were applied to children in both groups to relieve pain during the procedure. The data were obtained using an Information Form, a visual analog scale, and the Facial Pain Scale-Revised. RESULTS: It was determined that the children in the ventrogluteal group during the intramuscular injections had lower visual analog scale and faces pain scale-revised scores immediately after the procedure compared with the vastus lateralis group, that is, they experienced less pain, and the difference between the two groups was significant (p<0.001). CONCLUSION: In children, it is recommended to choose the less painful ventrogluteal region for intramuscular injection and to inform health professionals about it.

A new hematologic predictor of major adverse events after cardiac surgery: red cell distribution width to lymphocyte ratio

Background@#The perioperative risk factors that cause severe morbidity and prolongation of postoperative hospital stay after cardiac surgery should be determined. Various scores have been used to predict morbidity and mortality. Preoperative blood counts are considered potential biomarkers of inflammation and oxidative stress. Inflammatory and immune imbalances may have a significant impact on postoperative adverse events. The present study aimed to investigate the association and potential predictive properties of red cell distribution width/ lymphocyte ratio (RLR) for major adverse events in adult patients who underwent coronary surgery with cardiopulmonary bypass. @*Methods@#After approval from the ethics committee, pre- and post-operative data of 700 patients were obtained from the electronic database of the hospital, intra- and post-operative anesthesia, and intensive care unit follow-up charts. We performed a stepwise multiple logistic regression analysis to investigate the association of RLR with major adverse events in adult patients who underwent coronary surgery with cardiopulmonary bypass. @*Results@#Among 700 patients, 47 (6.7%) had major adverse events after surgery. Multivariate logistic regression analysis showed that age (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.03–1.12; P < 0.001), mean platelet volume (OR, 1.49; 95% CI, 1.07–2.06; P = 0.017), and RLR (OR, 1.21; 95% CI, 1.02–1.43; P = 0.026) were significantly associated with major adverse events. @*Conclusions@#RLR indicates the balance between inflammatory and immune responses. Therefore, it can be used to predict adverse events following coronary surgery.

Predictors of 3-month mortality with muscle ultrasound and palliative prognostic tools among patients admitted to palliative care units

Background/Aims@#Prognostic factors are an important issue in progressive and life-limiting diseases. This study evaluate 3-month mortality in patients admitted to the palliative care unit (PCU). @*Methods@#In this study, the patient’s demographics, comorbidities, nutritional status, and laboratory values were recorded. The palliative performance scale (PPS), the palliative prognostic index (PPI), and the palliative prognostic (PaP) score were calculated. The rectus femoris (RF) cross-sectional area (CSA), RF muscle thickness, gastrocnemius (GC) medialis muscle thickness, pennation angle and fascicle length of the GC were measured by ultrasound for survival prediction. @*Results@#A total of 88 patients enrolled during the study period, with a mean age of 73.6 ± 13.3 years and a 3-month mortality rate of 59.1%. The findings of a multivariable Cox proportional hazards regression model based on age, gender, C-reactive protein level and Nutrition Risk Screening 2002 scores as covariates revealed the PPI and the PaP score to be significant predictors of 3-month mortality. In addition, in the unadjusted Cox proportional hazard regression analysis, the CSA of the RF muscle was also found to be a significant predictor of 3-month mortality. @*Conclusions@#Findings revealed that the combined use of the CSA of the RF, the PPI, and the PaP score are reliable predictors of mortality in patients admitted to the PCU.

Management of renin-angiotensin-aldosterone inhibitors and other antihypertensives and their clinical effects on pre-anesthesia blood pressure

Blood pressure fluctuations appear more significant in patients with poorly controlled hypertension and are known to be associated with adverse perioperative morbidity. In the present study, we aimed to determine the effects of antihypertensive drug treatment strategies on preanesthetic operating room blood pressure measurements. Methods: A total of 717 patients participated in our study; 383 patients who were normotensive based on baseline measurements and not under antihypertensive therapy were excluded from the analysis. The remaining 334 patients were divided into six groups according to the antihypertensive drug treatment. These six groups were examined in terms of preoperative baseline and pre-anesthesia blood pressure measurements. Results: As a result of the study, it was observed that 24% of patients had high blood pressure precluding surgery, and patients using renin-angiotensin-aldosterone system inhibitors (RAASI) had higher pre-anesthesia systolic blood pressure than patients using other antihypertensive drugs. Patients who received beta-blockers were also observed to have the lowest pre-anesthesia systolic blood pressure, diastolic blood pressure, and mean blood pressure, compared to others. Conclusions: Recently, whether RAASI should be continued preoperatively remains controversial. Our study shows that RAASI cannot provide optimal pre-anesthesia blood pressure and lead to an increase in the number of postponed surgeries, probably due to withdrawal of medication before the operation. Therefore, the preoperative discontinuation of RAASI should be reevaluated in future studies.

Oxytocin and Vasopressin Levels and Related Factors in Adolescents with Social Phobia and Other Anxiety Disorders

Objective@#This study aimed to determine whether a difference exists in plasma oxytocin and vasopressin levels among social anxiety disorder, other anxiety disorders, and healthy control groups in adolescents. The relationship between several psychiatric variables (i.e., state and trait anxiety, social anxiety, childhood trauma, and behavioral inhibition) and oxytocin or vasopressin levels were also investigated in adolescents with anxiety disorders. @*Methods@#The study included three groups of adolescents: social anxiety disorder (n = 29), those with other anxiety disorders (n = 27), and the control group (n = 28). The participants filled out self-report scales to determine various psychological variables. Oxytocin and vasopressin levels were determined from the blood samples of the participants. @*Results@#The oxytocin levels did not show a significant difference between the social anxiety disorder group and the other anxiety disorders group. However, the oxytocin levels were significantly higher in the social anxiety disorder and other anxiety disorders groups than in the control group. The vasopressin levels did not show a significant difference among the groups. According to the hierarchical regression analysis, the state and trait anxiety levels predicted oxytocin in opposite directions. Oxytocin showed positive and negative relationship with trait and state anxiety respectively. No predictive factors were found for the vasopressin levels. @*Conclusion@#We found that the oxytocin levels of adolescents with social anxiety disorder were not different from those of adolescents with other anxiety disorders. Further studies can improve our knowledge of the relationship among anxiety disorders and oxytocin or vasopressin.

Effect of internal carotid artery aberrations on the distance between styloid process and carotid artery / Efecto de las variaciones de la arteria carótida interna en la distancia entre el proceso estiloides y la arteria carótida

SUMMARY: The objective of this study was to evaluate the role of the variations of carotid artery course on the relationship between styloid process (SP) and internal carotid artery (ICA). Carotid CT angiography scans of 170 patients were retrospectively evaluated. The variability of the course of ICA were classified. The length and medial angulation of the SP were measured on coronal 3D images. On axial images, the shortest distance between the bone edge of the SP and ICA were measured. The distance between SP and ICA among the course patterns of carotid artery were compared statistically. In the comparison of distances between SP and ICA with respect to the course of ICA, the difference between straight and curving (p <0.001) was statistically significant. Curving caused the separation of ICA and SP. The highest and the shortest distance was at the curving and coiling group, respectively. We found that SP-ICA distance has a positive and negative correlation with SP angle (p<0.001) and SP length (p<0.001), respectively. The course of ICA is one of the major determinants affecting the relationship of ICA and SP. The curving pattern of ICA has a tendency to increase the distance between SP and ICA.

RESUMEN: El objetivo de este estudio fue evaluar el rol de las variaciones que tiene el curso de la arteria carótida en la relación entre el proceso estiloides (PE) y la arteria carótida interna (ACI). Se evaluaron retrospectivamente angiografías por tomografía computarizada carotídea de 170 pacientes. Se clasificó la variabilidad del curso de ACI. Se midieron en imágenes coronales y en 3D la longitud y la angulación medial del PE. En las imágenes axiales, se midió la distancia más corta entre el margen del PE y la ACI. Se comparó estadísticamente la distancia entre PE y la ACI entre los patrones de trayecto de la arteria carótida. La comparación de las distancias entre PE y la ACI respecto al curso de ACI, fue estadísticamente significativa, siendo la diferencia entre arterias recta y curva (p <0,001). La arteria curva provocó la separación de la ACI y del PE. Las mayores y menores distancias estaban en el grupo de arterias curvas y enrolladas, respectivamente. La distancia PE-ACI tiene una correlación positiva y negativa con el ángulo PE (p <0,001) y la longitud del PE (p <0,001), respectivamente. El curso de la arteria carótida interna es uno de los principales determinantes que afectan la relación con el proceso estiloides. El patrón de curva de la ACI tiende a aumentar la distancia entre PE y la propia arteria arteria.

Morphometric analysis of calcaneal (heel) spurs in ancient and modern Anatolian populations / Análisis morfométrico de los espolones calcáneos en poblaciones de Anatolia antiguas y modernas

SUMMARY: Heel spurs are the bony protrusion seen especially on the dorsal and plantar face of the calcaneus bone at the attachment site of the muscles. It was aimed herein to obtain data about the life styles, daily lives, and especially the socioeconomic structures of modern and ancient Anatolian populations by evaluating the prevalence, location, age, and gender differences of heel spurs on the calcaneus and comparing these findings between the populations. Herein, the 251 calcaneus bones of 137 skeletons, which had been previously analyzed paleodemographically and dated to the Middle Ages, and 68 calcaneus bones belonging to a modern population, whose gender was unknown but lived in Anatolia, were examined in terms of heel spurs. In the current study, the presence of dorsal, plantar, or both dorsal/plantar heel spurs on these in 251 calcaneus bones was 43.9 %, 11.1 %, and 10.3 %, respectively. The presence of dorsal, plantar, or both dorsal/plantar heel spurs was determined as 22 %, 3 %, and 1.5 %, respectively, among the 68 calcaneus bones belonging to the modern population. When a comparison was made of the current study with studies in the literature on modern and prehistoric populations, a higher prevalence of heel spurs was found in prehistoric samples than in modern populations. It is our belief that this situation may have derived from the heavy labor force, environmental, or sociocultural differences in ancient Anatolian populations, insufficiency of vital materials due to inadequate industrial conditions, and the solution of anatomical disruption. In addition, the findings determined herein will guide the development of future and industrial studies on the foot and foot structure.

RESUMEN: Los espolones del talón son la protuberancia ósea que se ve especialmente en la cara dorsal y plantar del hueso calcáneo en el sitio de inserción de los músculos. El objetivo de este trabajo consistió en obtener datos sobre los estilos de vida, la vida cotidiana y, especialmente, las características socioeconómicas de las poblaciones anatolias modernas y antiguas mediante la evaluación de la prevalencia, la ubicación, la edad y las diferencias de sexo de los espolones calcáneos y comparar estos hallazgos entre los poblaciones. La muestra consistió en 251 calcáneos correspondientes a 137 esqueletos, que habían sido previamente analizados paleodemográficamente y fechados en la Edad Media; también se incluyeron 68 calcáneos pertenecientes a una población moderna de Anatolia, sin distinción de sexo. De la muestra de 251 calcáneos, se encontraron espolones calcáneos dorsales, plantares y dorsales/plantares, en el 43,9%, 11,1 % y 10,3 %, respectivamente. La presencia de espolones calcáneos dorsales, plantares y dorsales/plantares se determinó en el 22%, 3% y 1,5%, respectivamente, entre los 68 calcáneos pertenecientes a la población moderna. Cuando se realizó una comparación del estudio actual con la literatu- ra sobre poblaciones modernas y prehistóricas, se encontró una mayor prevalencia de espolones calcáneos en muestras prehistóricas que en poblaciones modernas. Creemos que esta situación puede haberse derivado a la gran fuerza de trabajo, y las diferencias ambientales o socioculturales en las antiguas poblaciones de Anatolia, la insuficiencia de materiales vitales debido a las condiciones industriales inadecuadas produjo la alteración anatómica. Además, los hallazgos aquí determinados guiarán el desarrollo de estudios futuros e industriales sobre la estructura del pie.

Internalized Stigma in Pediatric Psoriasis: A Comparative Multicenter Study

Background@#Internalized stigma, adoption of negative attitudes and stereotypes of the society regarding persons’ illness, has not been studied previously in pediatric psoriasis patients. @*Objective@#We aimed to investigate the internalized stigma in pediatric psoriasis patients and to determine differences according to factors affecting internalized stigma compared to adult psoriasis patients. @*Methods@#This multicenter,cross-sectional, comparative study included 125 pediatric (55 female, 70 male; mean age±standard deviation [SD], 14.59±2.87 years) and 1,235 adult psoriasis patients (577 female, 658 male; mean age±SD, 43.3±13.7 years). Psoriasis Internalized Stigma Scale (PISS), Dermatology Life Quality Index (DLQI), Perceived Health Status (PHS), and the General Health Questionnaire (GHQ)-12 were the scales used in the study. @*Results@#The mean PISS was 58.48±14.9 in pediatric group. When PISS subscales of groups were compared, the pediatric group had significantly higher stigma resistance (p=0.01) whereas adult group had higher scores of alienation (p=0.01) and stereotype endorsement (p=0.04). There was a strong correlation between mean values of PISS and DLQI (r=0.423, p=0.001). High internalized stigma scores had no relation to either the severity or localization of disease in pediatric group. However, poor PHS (p=0.007) and low-income levels (p=0.03) in both groups, and body mass index (r=0.181, p=0.04) in the pediatric group were related to high PISS scores. @*Conclusion@#Internalized stigma in pediatric patients is as high as adults and is related to poor quality of life, general health, and psychological illnesses. Unlike adults, internalized stigma was mainly determined by psoriasis per se, rather than disease severity or involvement of visible body parts, genitalia or folds.

Free and liposome form of gallic acid improves calvarial bone wound healing in Wistar rats

Objective: To evaluate the effect of free and liposome form of gallic acid on bone regeneration in critical defects in Wistar rats. Methods: Thirty-two female Wistar rats were divided into four study groups: group 1, negative control; group 2, positive control; group 3, gallic acid powder; group 4, gallic acid liposome. A critical-sized defect was created in all rats. Groups 2 to 4 had xenograft, autograft and membrane placement while negative control rats did not receive any treatment. The defect area was sutured and rats were kept alive for 30 d. At the end of the study, a bone specimen including the defect area was removed from calvaria. All specimens were evaluated under the stereomicroscope, then underwent histological analysis. Inflammatory cell counts, osteoblast, osteoclast counts, receptor activator of nuclear factor κ-B (RANKL), osteoprotegerin (OPG), runt-related transcription factor 2 (Runx2), bone morphogenetic protein-2 (BMP-2), and alkaline phosphatase were determined. Results: The biggest unhealed defect area was observed in the negative control group and the smallest was observed in the gallic acid liposome group. There were no differences between the positive control group vs. the gallic acid powder group and the gallic acid powder group vs. the gallic acid liposome group. The severity of inflammation was the highest in the negative control group and the lowest in the gallic acid liposome group with significant differences between the groups. All groups had similar osteoblast counts while osteoclast counts were the highest in the positive control group. Gallic acid groups had a lower number of osteoclasts compared with the positive control group. Runx2 and alkaline phosphatase levels were similar in the groups while OPG and BMP-2 levels exhibited a significant increase compared with the negative control group and the positive control group. RANKL was similar in the negative control group, the positive control group, and the gallic acid powder groups but decreased in the gallic acid liposome group. Conclusions: Gallic acid powder and liposome significantly improve bone regeneration in Wistar rats with calvarial defects. The improvement in healing is evident with decreased inflammation and RANKL expressions and increased OPG and BMP-2 expressions.

Study on factors affecting mortality in nonagenarian patients in orthopaedic surgery

Background: With medicine advancing, population is aging in the world. We encounter elderly patients in operating rooms more often. In this study, the aim was to investigate mortality and morbidity rates of patients 90 years of age or older within 1 year from the date of operation due to fractures.Methods: The study was performed retrospectively in the 3rd stage health institution. All patients that had fracture operation in the operating rooms of the orthopaedics department between 2011 and 2017 and that were 90 years or older on the day of operation were included in the study. Patients who were operated twice were excluded from the study.Results: Around 83 patients of which were included in the study. The mean age of the patients was 92.89±2.84. In-hospital mortality rate was 8.4%. The mortality rate within 3 months from the operation was 18.1%, 25.3% within 1 year, and 61.4% within 5 years or above. Author found that the mean survival period for the total of the surviving patients was 23.87±18.96 months. Author found that there was a meaningful causation between morbidity developing post-operation and in-hospital mortality, 3-month mortality, and 1-year mortality (p<0.05).Conclusions: Author think that it was important to recognize the fact that despite being more vulnerable, patients 90 years of age or older have a significant life expectancy post-hospital discharge. Author think that post-operation acute morbidity affects mortality rates and it was important to avoid factors that may cause acute morbidity in patients 90 years of age and older.

The effect of colchicine on alveolar bone loss in ligature-induced periodontitis

Abstract Colchicine is widely used in the treatment of several inflammatory diseases due to its anti-inflammatory effect, but effects on bone metabolism are unclear. The aim of this study was to evaluate the effects of systemically-administered colchicine on healthy periodontium and experimentally-induced periodontitis. In total, 42 male Wistar rats were included in this study. A non-ligated group constituting the negative control group (Control, C, n = 6) and a ligature-only group forming the positive control group (LO, n = 12) were created separately. Twelve rats were treated with 0.4 mg/kg colchicine and another 12 with 1 mg/kg colchicine. In the colchicine-administered groups, right mandibles constituted the ligated groups (1 mgC-L or 0.4 mgC-L) and left mandibles formed the corresponding non-ligated controls (1mgC or 0.4mgC). Silk ligatures were placed at the gingival margin of the lower first molars. The animals were euthanized at different time-points of healing (11 or 30 days). Alveolar bone loss was clinically measured and TRAP+ osteoclasts, osteoblastic activity, and MMP-1 expression were examined histologically. There was no increase in alveolar bone loss with either colchicine dose in healthy periodontium (p > 0.05) and the highest level of alveolar bone loss, TRAP+ osteoclast number, and MMP-1 expression were measured in the LO group (p < 0.05). The 0.4 mgC-L group showed less alveolar bone loss at 11 days (p < 0.05), but greater loss at 30 days. The 1 mgC-L group showed higher osteoblast number than the other ligated groups (p < 0.05) at both time-points. In summary, colchicine did not increase alveolar bone loss in healthy periodontium and also may tend to reduce periodontitis progression. However, further extensive study is necessary to understand the mechanism of colchicine action on alveolar bone loss in periodontitis.

The Effect on Pain of Buzzy® and ShotBlocker® during the Administration of Intramuscular Injections to Children: A Randomized Controlled Trial

PURPOSE: To investigate the effect of Buzzy® and ShotBlocker® on reducing pain induced by intramuscular penicillin injections in children. METHODS: This was a randomized controlled study. A total of 150 Turkish children aged 7~12 years who presented to our pediatric emergency clinic and met the inclusion criteria were recruited. The children were randomly assigned to each group (control=50, Buzzy®=50, ShotBlocker®=50). Data were collected using an information form, the State-Trait Anxiety Inventory for Children, Visual Analog Scale, and Faces Pain Scale-Revised. RESULTS: The children in the control group had significantly higher pain scores during the penicillin injection than the children in the ShotBlocker® and Buzzy® groups. The children in the Buzzy® group had significantly less pain than the children in both the ShotBlocker® and control groups (p<.001). CONCLUSION: Buzzy® was more effective compared with ShotBlocker® in this study.

Which method to use for surgical ablation of atrial fibrillation performed concomitantly with mitral valve surgery: radiofrequency ablation versus cryoablation

Abstract Objective: The effects of energy source on the maintenance of sinus rhythm and the contribution of demographic characteristics to the case selection in patients submitted to ablation performed concurrently with mitral valve surgery were analyzed. Methods: Cryothermal (n=42; 43.8%) and radiofrequency (n=54; 56.3%) energy were employed in 96 patients submitted to mitral valve replacement and Cox maze IV procedure. Patients were called for control visits between 15 days and 12 months after discharge. The causal relationship between recurrence of atrial fibrillation and factors such as left atrial diameter, C-reactive protein, hypertension, left ventricular ejection fraction, chronic obstructive pulmonary disease, and body mass index was determined. Results: Maintenance rates of the sinus rhythm with radiofrequency and cryoablation were 97.6% and 96.3%, respectively, in the first postoperative month, whereas at the 12th postoperative month were 88.1% and 83.3%. No significant difference was found between groups in relation to the energy source. Sensitivity and specificity for left atrial diameter with a cut-off value of 50.5 mm were 85.7% and 70.7%, respectively. Sensitivity and specificity for C-reactive protein with a cut-off value of 12 mg/dL on the 15th postoperative day were 83.3% and 88.9%, respectively. The effect of body mass index on atrial fibrillation recurrence was 3.2 times. Sensitivity and specificity for left ventricular ejection fraction 37% cut-off value were 96.3% and 11.4%, respectively. Atrial fibrillation in hypertensive cases was 5.3 times more. In patients with chronic obstructive pulmonary disease, recurrence of atrial fibrillation was 40%. The causal relation between recurrence of atrial fibrillation and the studied factors was established. Conclusion: Demographic characteristics have a significant impact on ablation efficiency, while the type of energy source does not.

Obstetric outcomes among syrian refugees: A comparative study at a tertiary care Maternity Hospital in Turkey

Abstract Objective The aim of this study was to analyze and compare obstetric and neonatal outcomes between Syrian refugees and ethnic Turkish women. Methods Retrospective, observational study. A total of 576 Syrian refugees and 576 ethnic Turkish women were included in this study, which was conducted between January 2015 and December 2015 at a tertiary maternity training hospital in Ankara, Turkey. The demographic characteristics, obstetric and neonatal outcomes were compared. The primary outcomes were pregnancy outcomes and cesarean rates between the groups Results The mean age was significantly lower in the refugee group (p< 0.001). Mean gravidity, proportion of adolescent pregnancies, proportion of pregnant women aged 12 to 19 years, and number of pregnancies at < 18 years were significantly higher among the refugee women (p< 0.001). Rates of antenatal follow-up, double testing, triple testing, gestational diabetes mellitus (GDM) screening, and iron replacement therapy were significantly lower in the refugee group (p< 0.001). The primary Cesarean section rate was significantly lower in the refugee group (p= 0.034). Pregnancies in the refugee group were more complicated, with higher rates of preterm delivery (< 37 weeks), preterm premature rupture of membranes (PPROM), and low birth weight (< 2,500 g) when compared with the control group (4.2% versus 0.7%, p< 0.001; 1.6% versus 0.2%, p= 0.011; and 12% versus 5.8%, p< 0.001, respectively). Low education level (odds ratio [OR] = 1.7, 95% confidence interval [CI] = 0.5-0.1), and weight gain during pregnancy (OR = 1.7, 95% CI = 0.5-0.1) were found to be significant indicators for preterm birth/PPROM and low birthweight. Conclusion Syrian refugees had increased risks of certain adverse obstetric outcomes, including preterm delivery, PPROM, lower birth weight, and anemia. Several factors may influence these findings; thus, refugee women would benefit from more targeted care during pregnancy and childbirth.

Is preoperative clopidogrel resistance a predictor of bleeding and risks in patients undergoing emergency cabg surgery?

Abstract Objective: The aims of this study were to determine whether the detection of preoperative clopidogrel resistance in patients undergoing cardiac surgery while using clopidogrel could play a guiding role in the prediction of postoperative excessive bleeding, transfusion requirements, and risks and to provide clinically significant data. Methods: Two hundred and twenty-two patients [median age: 59.4 (38-83) years; 38 females] undergoing emergency and elective coronary artery bypass graft (CABG) surgeries in our clinic were evaluated prospectively. Patients with multiple systemic diseases, other than diabetes mellitus (DM) and hypertension (HT), were excluded. Patients receiving clopidogrel were also evaluated for clopidogrel resistance and grouped according to the results of this test. Assessments of platelet functions were performed by multiplate impedance aggregometry method and adenosine diphosphate test. Results: The use of postoperative fresh blood replacement and platelet transfusion was higher in patients receiving clopidogrel than in those not receiving it (P=0.001, P=0.018). DM, HT, myocardial infarction, and the number of presentation to the emergency room were significantly higher in patients receiving clopidogrel than in those not receiving it (P<0.05). No significant difference was determined between patients with and without clopidogrel resistance regarding the amount of bleeding during and after surgery, erythrocyte suspension and fresh-frozen plasma transfusion rates, preoperative troponin values, ejection fraction values, and length of hospital stays (P>0.05). Conclusion: We think that resistance studies in patients receiving clopidogrel before cardiac surgery are not efficient to predict bleeding and bleeding-related complications in patients undergoing emergency and elective CABG surgeries.

Netrin 1 and Alpha-Methyl Acylcoenzim-A Racemase in diagnosis of prostate cancer / Netrina 1 y Alfa Metil-Acil coenzima-A Racemasa para el diagnóstico de cáncer de próstata

Abstract Objectives: To investigate serum and urine levels of Alpha-methylacyl-CoA-racemase (AMACR) and Netrin 1 in patients with and without prostate cancer and to determine whether these markers could be used as alternatives in diagnosis of prostate cancer instead of serum prostate specific antigen (PSA) levels. Methods: One hundred and seventy five patients between 45-75 years to whom transrectal ultrasound guided biopsies were performed for abnormal serum PSA levels or digital rectal examinations were included. The levels of AMACR and Netrin 1 levels of blood and urine samples of 5 mL those were taken prior to biopsies were measured. . Results: The mean age of the patients was 62.7 ±6.4 years. Prostate cancer was detected in 40 patients (22.8%) while 135 of them (77.2%) were diagnosed as benign prostate hyperplasia (BPH). In BPH group, serum and urine levels of AMACR and Netrin 1 were 13.4 ±16.9 ng/mL; 7.1 ±3.4 ng/mL; 164.1±46 pg/mL and 19.5 ±5.0 pg/mL respectively. The levels of serum and urine levels of AMACR and Netrin 1 were 10.2 ±9.8 ng/mL; 6.8 ±2.5 ng/mL; 159.1 ±44.1 pg/mL and 20.1 ±5.3 pg/mL respectively in prostate cancer group. There was no statistically significant difference or correlation between these two groups serum and urine AMACR and Netrin 1 results Conclusions: Serum and urine levels of AMACR and Netrin 1 were not found to be alternatives for serum PSA levels in the diagnosis of prostate cancer in this study.

Resumen Objetivos: Investigar los niveles de alfa-metil acilcoenzima-A y Netrina 1 en pacientes con y sin cáncer de próstata y determinar si estos marcadores pueden ser usados como una alternativa en el diagnóstico de cáncer de próstata en lugar del antígeno prostático específico en suero (PSA). Métodos: Fueron incluidos 175 pacientes entre 45-75 años, a quienes se les realizó una biopsia de próstata guiada por ultrasonido por presentar un nivel anormal de PSA en el suero o un tacto rectal. Se tomó una muestra de 5 mL de sangre y orina para medir los niveles de alfa-metil acilcoenzima-A y Netrina 1. Estos niveles se midieron antes del análisis de la biopsia. Resultados: La edad media de los pacientes fue de 62.7±6.4 años. Se detectó cander en 40 pacientes (22.8%), mientras que a 135 de ellos (77.2%) se les diagnóstico una hiperplasia benigna de próstata (HBP). En el grupo HBP los niveles en suero y orina de alfa-metil acilcoenzima-A y Netrina 1 fueron 13.4 ±16.9 ng/mL; 7.1 ±3.4 ng/mL; 164.1 ±46 pg/mL y 19.5 ±5.0 pg/mL respectivamente. En el grupo con cáncer de próstata los niveles en suero y orina de alfa-metil acilcoenzima-A y Netrina 1 fueron 10.2 ±9.8 ng/mL; 6.8 ±2.5 ng/mL; 159.1 ±44.1 pg/mL y 20.1 ±5.3 pg/mL respectivamente. No hubo una diferencia significativa o una correlación entre los niveles de alfa-metil acilcoenzima-A y Netrina 1 en suero y orina al comparar estos dos grupos de pacientes. Conclusiones: Los niveles de alfa-metil acilcoenzima-A y Netrina 1 en suero y orina no son una alternativa para reemplazar el PSA en suero para el diagnóstico de cáncer de próstata.

Role of calcium-sensing receptor, Galectin-3, Cyclin D1, and Ki-67 immunohistochemistry to favor in the diagnosis of parathyroid carcinoma

Background: As histopathological findings of parathyroid carcinoma are not certain, the diagnosis of tumors with degenerative changes may be difficult. In these cases, immunohistochemical markers are beneficial. We aimed to research the acceptability of calcium-sensing receptor (CaSR), Galactin-3, Cyclin D1, and Ki-67 as helpful markers in parathyroid tumors in cases which are difficult to diagnose. Materials and Methods: Those cases who had been diagnosed with atypical parathyroid adenoma and parathyroid carcinoma between 2010 and 2015 were reevaluated. ?mmunohistochemical markers were applied to this cases. Results: About 21 cases were parathyroid adenoma, 14 were atypical adenoma, and 10 cases were parathyroid carcinoma. According to the immunohistochemical results, global loss of CaSR staining was seen in 50% (5/10) of the patients with carcinoma while there was no loss of staining in those with parathyroid adenoma (P = 0,001). Global loss of CaSR staining was found in only one out of 14 cases with atypical adenoma. The expression of Galactin-3 was found to be positive in 40% (4/10) of carcinoma cases, 71.4% (10/14) of those with atypical adenoma, and 14.3% (3/21) of those with adenoma (P = 0,002). Cyclin D1 expression was determined to be positive in 70% (7/10) of patients with carcinoma, 71.4% (10/14) of atypical adenoma cases, and 23.8% (5/21) of those with adenoma. The Ki-67 proliferation index was seen to be above 5% in 50% (5/10) of carcinoma cases and 35,7% (5/14) of those with atypical adenoma. Conclusion: In these studies, it has been emphasized that the global loss of CaSR staining was used as a negative marker in the diagnosis of carcinoma. In this study, we have also confirmed that the global loss of CaSR staining is a useful marker to determine potential increased malignancy.

The relationship of finger length ratios (2D: 4D) with quantitative, verbal talent and anthropometric parameters / La relación de las proporciones de la longitud del dedo (2D: 4D) con el parámetro cuantitativo, talento verbal y parámetros antropométricos

SUMMARY: The aim of this study were to investigate the relationship between 2D:4D finger length ratios (the ratio of the second finger length to the fourth finger length) of students from verbal and quantitative weighted fields, and to determine the correlation of these ratios with some anthropometric measurements. For this purpose; hand length, hand width, lengths of second and fourth finger and waist, hip and neck circumferences were taken from totally 398 (199 female, 199 male) students aged 17-25 years by using millimetric callipers and non-elastic standard measuring tape. Demographic data were also taken. Moreover, Body Mass Index (BMI) and 2D:4D finger length ratios of the study group were also calculated. When we investigated the 2D:4D ratios for right, left and dominant hands among verbal and quantitative talented individuals in female students, there were statistically significant differences for right and dominant hand (p=0.032; p=0.042, respectively). On the other hand, there was no difference for left hand in female participants (p>0.05). Furthermore, there were positive correlations with 2D:4D and weight (r=0.38, p<0.001), BMI (r=0.34, p=0.01) of the male students in verballyweighted field and with hip and waist circumferences in male students in quantitatively-weighted field (r=0.30; p=0.002; r=0.41, p<0.001). In male students in quantitatively-weighted fields, there was a weak and positive correlation with 2D:4D finger length ratios and neck circumferences on the left hand, and this relationship was statistically significant (r=0.21; p=0.032). And also, there were no statistically significant correlations between anthropometric measurements and 2D:4D ratios among the female students in quantitatively weighted field. Whereas there were positive correlations with 2D:4D finger length ratios and waist circumference in female students in verbally weighted field (r=0.24, p=0.018). We believe that the data obtained in this study will be a guide for career planning goals of persons according to their quantitative and verbal talents.

RESUMEN: El objetivo de este estudio consistió en investigar la relación entre índices de longitud del dedo (2D:4D) (es decir, la relación de la longitud del segundo dedo a la cuarta longitud del dedo) de los estudiantes de campos ponderados verbales y cuantitativos, para determinar la correlación de estas proporciones con algunas medidas antropométricas. Para este propósito, se consideraron las siguientes mediciones: longitud de la mano, ancho de la mano, circunferencia del segundo y cuarto dedo y circunferencia de cintura, cadera y cuello. Se examinaron 398 estudiantes (199 mujeres, 199 hombres) de 17-25 años de edad, usando pinzas milimétricas y cinta métrica estándar no elástica. También se tomaron datos demográficos. Además, se calcularon las proporciones de índice de masa corporal (IMC) y 2D:4D del grupo de estudio. Cuando investigamos las proporciones 2D:4D para manos derechas, izquierdas y dominantes entre individuos talentosos verbales y cuantitativos en mujeres, hubo diferencias estadísticamente significativas para la mano derecha y dominante (p = 0,032, p = 0,042, respectivamente). Por otro lado, no hubo diferencia para la mano izquierda en las mujeres (p> 0.05). Además, hubo correlaciones positivas con 2D:4D y peso (r = 0,38, p <0,001), IMC (r = 0,34, p = 0,01) de los hombres en el campo verbalmente ponderado y con circunferencias de cadera y cintura en hombres en campo ponderado cuantitativamente (r = 0,30, p = 0,002; r = 0.41, p <0,001). En los hombres, en campos cuantitativamente ponderados, hubo una correlación débil y positiva en 2D, relaciones de longitud de dedo 4D y circunferencias de cuello en la mano izquierda, y esta relación fue estadísticamente significativa (r = 0,21, p = 0,032). También, no hubo correlaciones estadísticamente significativas entre las medidas antropométricas y las proporciones 2D:4D entre las estudiantes en el campo cuantitativamente ponderado. Mientras que hubo correlaciones positivas con 2D:4D, índices de longitud del dedo y circunferencia de la cintura en las mujeres en el campo ponderado verbalmente (r = 0,24, p = 0,018). Creemos que los datos obtenidos en este estudio serán una guía para los objetivos de planificación de carrera de las personas de acuerdo con sus talentos cuantitativos y verbales.

Evaluation of the elbow carrying angle in healthy individuals / Evaluación del ángulo de desplazamiento del codo en individuos sanos

SUMMARY: Carrying angle, or cubital angle defined as the acute angle formed by the median axis of the arm when forearm is in fully extended and supinated position. This angle changes with skelatal growth and maturity. This study was aimed to investigate the correlation of carrying angle with bi-acromial diameter and bi-acromial diameter/bi-trochanteric diameter in our healthy young adult population. This was a cross-sectional study that included 400 (204 male, 196 female) young adult students selected from Çukurova University aged between 18-25 years (mean±standard deviation of females: 20.11±2.05 years; mean±standard deviation of males: 20.45±1.82 years) which originated from different cities in Turkey. After recording demographic data, carrying angle, forearm length, arm length, bi-trochanteric diameter and bi-acromial diameter were measured by using nonelastic tape measure, pelvimeter and manuel goniometer. In addition, body mass index and bi-acromial diameter/bi-trochanteric diameter were calculated for each participants. The mean values of body height and weight were in following respectively for both genders: 178.53±6.40 cm (male), 163.88±5.73 cm (female); 74.89±10.81 kg (male), 57.56±8.61 kg (female). Whereas on dominant arm this angle was as in males 9.77°±2.82° and 13.94°±3.97° in females. The mean value of the carrying angle on nondominant arm in males was 9.85°±2.95° and 14.03°±4.08° in females. The mean carrying angle was 9.81°±2.82° in males and 13.99°±3.97° in females. There are linear relationship between the carrying angle and height (r=-0.474, p<0.001, bi-acromial diameter (r=-0.490, p<0.001), bi-acromial diameter/bi-trochanteric diameter (r=-0.449, p<0.001), forearm length (r=-0.366, p<0.001) and arm length (r=-0.273, p<0.001). We believe that the reference values of carrying angle will help the clinician in the management of elbow displacements, fractures, prosthetic design and diagnosis of epicondylar diseases.

RESUMEN: Se estudió el ángulo de sustentación o ángulo cubital definido como el ángulo agudo formado por el eje mediano del brazo al estar en posición completamente extendido y supinado el antebrazo. Este ángulo cambia con el crecimiento esquelético y la madurez. El objetivo de este estudio fue investigar la correlación del ángulo con el diámetro biacromial y el diámetro bi-acromial / diámetro bi-trocantérico en una población adulta joven y sana. Se realizó un estudio transversal que incluyó 400 (204 hombres, 196 mujeres) estudiantes adultos jóvenes seleccionados de la Universidad de Çukurova con edades comprendidas entre 18-25 años (media ± desviación estándar de las mujeres: 20,11 ± 2,05 años; media ± desviación estándar de los hombres: 20,45 ± 1,82 años) que se originaron en diferentes ciudades de Turquía. Después de registrar los datos demográficos, el ángulo de desplazamiento, la longitud del antebrazo, la longitud del brazo, el diámetro bi-trocantérico y el diámetro biacromial se midieron utilizando cinta métrica no elástica, pelvímetro y goniómetro manual. Además, se calcularon el índice de masa corporal y el diámetro bi-acromial / diámetro bi-trocantérico para cada participante. Los valores medios de la altura y el peso corporal fueron respectivamente para ambos sexos: 178,53 ± 6,40 cm (masculino), 163,88 ± 5,73 cm (femenino); 74,89 ± 10,81 kg (masculino), 57,56 ± 8,61 kg (femenino). Mientras que en el brazo dominante este ángulo fue como en los hombres 9,77° ± 2,82° y 13,94° ± 3,97° en las mujeres. El valor medio del ángulo de transporte en el brazo no dominante en los hombres fue de 9,85° ± 2,95° y de 14,03° ± 4,08° en las mujeres. El ángulo medio de desplazamiento fue de 9,81° ± 2,82° en hombres y 13,99 ° ± 3,97 ° en mujeres. Hay una relación lineal entre el ángulo de desplazamiento y la altura (r = -0,474, p <0,001, diámetro bi-acromial (r = -0,490, p <0,001), diámetro biacromial / diámetro bi-trocantérico (r = -0,449, p <0,001), longitud del antebrazo (r = -0,366, p <0,001) y longitud del brazo (r = -0,273, p <0,001). Creemos que los valores de referencia del ángulo de carga ayudarán al clínico en el manejo de los desplazamientos del codo, las fracturas, el diseño protésico y el diagnóstico de enfermedades epicondilares.