Reflectance confocal microscopy as a useful diagnostic tool for monitoring of skin containing vascularized composite allograft rejection: A preliminary study on rats.

Vascularized composite allografts can undergo immune-mediated rejection, and skin biopsies are needed for monitoring of the transplant. However it is an invasive method, and requires processing time and pathological assessment. The purpose of this study is to use a new noninvasive monitoring method of the reflectance confocal microscopy (RCM) to determine severity of the allograft rejection on rats. Five groin flap allotransplantation were performed between 10 male Sprague-Dawley rats. Immunosuppressive therapy with cyclosporine A was given to the recipients during 10 days after surgery and was ended at the 10th postoperative days to allow acute transplant rejection. Following cessation of CsA, concomitant RCM evaluation and skin biopsy was performed every other day from each animal until total rejection of the allograft. Complete rejection of the allograft took nearly about 10 days and 4 or 5 RCM evaluation and skin biopsy was performed from each rat during this period. A total of 17 specimens were evaluated. A scoring system was developed based on the RCM findings. Skin biopsies were evaluated according to the Banff 2007 working classification criteria. RCM evaluation revealed epidermal irregularity and collagen destruction, however mild perivascular inflammation and degeneration of the basal epidermal layer were observed in early and late rejection period respectively with histopathologic evaluation. High correlation was found between the RCM scores and histopathologic grading. The RCM may be the useful tool to reduce the need for skin biopsy for monitoring of the skin containing vascularized composite allograft.

Correlation between the residual ridge height and the perforation limit of sinus membrane in crestal sinus elevation.

OBJECTIVES: The residual alveolar bone height at the implant recipient site plays a key role in determination of the risk of sinus membrane perforation during crestal sinus elevation. In this study, we aimed to determine the correlation between residual ridge height and perforation limit of sinus membrane and to examine the safety range for the sinus membrane continuity in crestal sinus elevation. Formalin-fixed cadavers were used for the experiment to observe outcomes. METHOD AND MATERIALS: Crestal sinus elevations were performed on 14 preserved human cadavers' heads. Residual ridge heights were measured using a bone caliper. The physiodispenser was preset to 30 Ncm and sinus floors were elevated by a concave sinus screw with diameter of 4 mm until sinus membrane perforation occurred. The perforations were identified either as Class I or Class II and the portion of the concave sinus screw in the sinus was measured each time using a ruler. Spearman's correlation coefficient was calculated to show the relation between the residual ridge heights and the membrane elevations at the time of perforation of the sinus membranes. RESULTS: In general, the perforation limit of sinus membrane after elevation was higher with greater residual ridge height. A statistically significant correlation was found between residual ridge heights and perforations of the sinus membrane (r = 0.620, P < .001). CONCLUSION: Although it is not always possible to extrapolate results from cadavers to an in vitro clinical setting, it could be considered to have clinical significance. Our findings suggest that higher subsinusoidal elevation may be achieved when the residual ridge bone height increases. The conclusions of this study should be verified with studies of more rigorous design.

Clinical study on the closure of extraction wounds of partially soft tissue-impacted mandibular third molars.

OBJECTIVE: When a mandibular third molar is partially impacted in the soft tissue, it must be determined whether the extraction wound should be left partially open or completely closed. We hypothesize that a blood clot preserving a surgical wound with easily cleanable surfaces by primary closure and drain application would postoperatively minimize dry socket and/or alveolitis development. METHOD AND MATERIALS: Twenty patients requiring bilateral extraction of partially soft tissue-impacted mandibular third molars in a vertical position were included in the study. The existence of dry sockets, alveolitis, pain, facial swelling, and trismus were evaluated on the second, fifth, and seventh days of the postoperative period. RESULTS: On the second day, pain, trismus, and swelling were higher in the drained group; however, pain reduced progressively in the drained group over time. There were no cases of dry sockets or alveolitis except for a single patient on the seventh day in the drained group over the 7-day study period. On the other hand, in the secondary closure group, the number of dry sockets was 8 (40%) on the second day. The number of alveolitis was 10 (50%) on the fifth day and 4 (20%) on the seventh day. CONCLUSION: Closed healing by drain insertion after removal of partially soft tissue-impacted third molars produces less frequent postoperative dry sockets and/or alveolitis development than occurs with open healing of the surgical wound. In cases with a risk of alveolitis development (lack of oral hygiene, immunocompromised patients, etc), it can be avoided with the "kiddle effect" and related undesired complications by implementing closed healing with drain insertion.

Serum lactate dehydrogenase levels significantly correlate with radiological extent of disease and spirometric values in patients with silicosis due to denim sandblasting.

BACKGROUND: The aim of the present study was to investigate serum lactate dehydrogenase (LD) levels in patients with silicosis due to denim sandblasting (SDDS) and also to investigate possible correlations between serum LD levels and the degree of radiological extent of disease (RED) and pulmonary function tests. METHODS: Forty-four males with SDDS and 32 healthy male subjects were included in the study. Patients and healthy controls were compared for serum LD levels. Correlations between serum LD levels, RED and spirometric values were investigated. RESULTS: Patients with SDDS had significantly higher serum LD levels than healthy controls. Patients with complicated SDDS had significantly higher serum LD levels than patients with simple SDDS. Significant correlations were found between serum LD levels and RED values. Significant correlations were found between serum LD levels and spirometric parameters. CONCLUSIONS: High serum LD levels might be considered as a marker of pulmonary parenchymal involvement in patients with SDDS. This study also suggests that the increase in serum LD levels might be closely related to the degree of pulmonary involvement in SDDS patients.

The demonstration of the number, course, and the location of nutrient artery canals of the femur by multidetector computed tomography.

PURPOSE: The aim of this study was to evaluate the number, course, width and location of nutrient artery canals of the femur by using multidetector computed tomography (MDCT). METHODS: Sixty-six adult (35 right and 31 left) dry femurs were included in this study and scanned by MDCT. Nutrient artery canals were evaluated on the multi-planar reformatted and volume rendered images which were reproduced on the basis of axial images. RESULTS: The median value of nutrient artery canals was two (minimum 1 and maximum 6). We determined that there was a negative correlation between the number of nutrient canals and the canal diameters. The outer ostia of the nutrient artery canals were most frequently located at the middle third segment of femoral diaphysis (65%). While the vast majority of the canals were showing upward courses (95%), only a few canals were having transverse (3%) or downward (2%) courses. Most encountered location of outer ostia of the canals according to linea aspera was the medial lip of the linea aspera (44%). Various variations were demonstrated in the number, course, and location of nutrient artery canals using MDCT. CONCLUSIONS: In conclusion, the knowledge of the topographic features of the nutrient artery canals may be useful in various clinical implications such as bone grafting or radiologic evaluation for the fracture lines.

Predictors of coping in a group of Turkish patients with physical disability.

AIM AND OBJECTIVE: To describe coping strategies used and determine the influence of demographic/health-related variables and perceived social support to the prediction of coping strategies in patients with physical disabilities. BACKGROUND: The period of psychosocial adaptation following a physical disability is very stressful. The use of effective coping strategies may be helpful in adapting to disability. However, no information is available about the coping strategies used by Turkish patients with physical disability. DESIGN: The study was designed as a cross-sectional survey. The data were obtained from 51 patients with physical disability in a rehabilitation centre in Ankara, Turkey between May 2004-September 2005. METHODS: Data were collected using a questionnaire form, the Multidimensional Scale of Perceived Social Support and the Coping Strategy Indicator. Descriptive statistics, reliability analysis, Mann-Whitney U tests, Kruskal-Wallis test, chi-square test, Pearson's correlation coefficients and stepwise multivariate regression analysis were conducted. RESULTS: The most frequently used coping strategy was problem-solving, followed by avoidance coping and seeking social support. Significant predictors of overall coping strategies were age, financial status, the caregiver's presence and perceived social support, after controlling for specific variables. CONCLUSIONS: This study demonstrated that patients who were older and had a caregiver were more likely to use problem-solving strategy. Seeking social support was more common among patients who had a caregiver and those with more perceived support from friends, whereas patients who had financial difficulties used more avoidance coping. RELEVANCE TO CLINICAL PRACTICE: Better understanding the coping strategies used by individuals with physical disabilities and factors affecting coping is provide interventions that reduce the stress and support their adaptation. Nurses should be aware of the factors that affect to coping strategies used to deal with stress.

Evaluation of the current disease severity scores in paediatric FMF: is it necessary to develop a new one?

OBJECTIVES: Modified adult disease severity scoring systems are being used for childhood FMF. We aim to test the clinical consistency of two common severity scoring systems and to evaluate the correlation of scores with the type of FMF mutations in paediatric FMF patients since certain mutations are prone to severe disease. METHODS: Two hundred and fifty-eight children with FMF were cross-sectionally studied. Assessment of the disease severity was performed by using the modified scoring systems of Mor et al. and Pras et al. Genetic analysis was performed using PCR and restriction endonuclease digestion methods for the presence of 15 FMF gene mutations. FMF mutations were grouped into three based on well-known genotypic-phenotypic associations. Correlation between the mutation groups and the severity scoring systems was assessed. The consistency of the severity scoring systems was evaluated. RESULTS: The results of two scoring systems were not statistically consistent with each other (κ = 0.171). This inconsistency persisted even in a more homogeneous subgroup of patients with only homozygote mutations of M694V, M680I and M694I (κ = 0.125). There was no correlation between the mutation groups and either of the scoring systems (P = 0.002, r = 0,196 for scoring systems of Mor et al.; P = 0.009, r = 0.162 for Pras et al.). CONCLUSIONS: The inconsistency of the two scoring systems and lack of correlation between the scoring systems and mutation groups raises concerns about the reliability of these scoring systems in children. There is a need to develop a scoring system in children based on a prospective registry.

[The relationship between antibiotic resistance and virulence factors in urinary Enterococcus isolates]. / Üriner Enterokok Izolatlarinin Antibiyotik Direnci ile Virülans Faktörleri Arasindaki Iliski.

Increasing multidrug resistance in nosocomial Enterococcus strains from all over the world recently enhances the need for further investigation of enterococci, especially their virulence factors. There are still many lacking parts about virulence factors of clinical enterococcus isolates. In this study, it was aimed to investigate the antibiotic resistance and the presence of potential virulence factors of 91 Enterococcus strains (59 E.faecalis, 31 E.faecium and 1 E.gallinarum) isolated from urine cultures of inpatients between January 2008-June 2010 in our hospital and also to evaluate whether a correlation existed between antibiotic resistance and potential virulence factors. The genes which encoded virulence factors of enterococci; aggregation substance (AS), enterococcal surface protein (ESP) and hyaluronidase (HYL) (asa1, esp, hyl respectively) were studied by molecular methods and haemolysin production and gelatinase activity were studied by phenotypic methods. Vancomycin resistant strains were checked for the presence of vanA and vanB genes. Eight (25.8%) E.faecium isolates were found glycopeptide resistant. In seven of these isolates resistance type was vanA and in one it was neither vanA nor vanB. High-level gentamicin and high-level streptomycin resistance rates were 74.2% and 61.3% in E.faecium strains and were 22% ve 27.1% in E.faecalis strains, respectively. Beta-lactamase production and linezolid resistance were not detected in any of the strains. E.faecium isolates were more resistant (p< 0.001-0.013) than E.faecalis isolates to all tested antibiotics except tetracycline, minocycline, doxycycline and streptogramin (p< 0.001). hyl gene positivity (p< 0.001) was found higher in E.faecium isolates whereas esp (p= 0.003) and asa1 (p< 0.001) gene positivity, haemolysin production (p=0.014) and gelatinase activity (p= 0.029) were higher in E.faecalis isolates. AS and ESP were the most frequent virulence factors, with the rates of 26.7% and 25.6%, respectively. There were 32 (35.6%) strains without any of the investigated virulence factors. We have also detected that asa1 gene positive E.faecalis isolates were more resistant to ciprofloxacin (p= 0.001), norfloxacin (p= 0.006) and levofloxacin (p= 0.001) than asa1 gene negative isolates; esp gene positive E.faecalis isolates were more resistant to doxycycline (p= 0.043) than esp gene negative isolates and hyl gene positive E.faecium isolates were more resistant to nitrofurantoine (p= 0.011) than hyl gene negative isolates. This was the first clinical sample originated study, investigating the corelation between antibiotic resistance and virulence factors in urinary Enterococcus isolates in Turkey.

Subgingival Epstein-Barr and cytomegalovirus occurrence in pregnancy gingivitis.

BACKGROUND: Although recent studies focused on the role of human herpesviruses in various types of periodontal disease, there was a lack of information in these reports regarding the role of pregnancy gingivitis. The aim of this study is to determine the correlation between pregnancy and the subgingival virus presence and their relationship with clinical parameters. METHODS: Seventy pregnant and 40 non-pregnant women were examined for gingival and plaque indices, bleeding on probing (BOP), and clinical probing depths (PDs) from the whole dentition. Subgingival plaque samples were obtained from sites showing signs of gingivitis and healthy sites. The polymerase chain reaction methodology was used to detect cytomegalovirus (CMV) and Epstein-Barr virus (EBV) from plaque samples. RESULTS: Our results show that gingivitis lesions in 27 (38.6%) and 10 (14.3%) pregnant patients were positive for EBV and CMV, respectively. In the non-pregnant group, EBV and CMV were detected in six (15%) and eight (20%) lesions, respectively. A statistically significant difference (P <0.01) was found between the subgingival occurrence of EBV in the two groups. In gingivitis sites, clinical PDs were affected by gestation (P <0.001) and the occurrence of EBV (P <0.001). In healthy sites, clinical PDs were affected by gestation (P <0.05), and BOP was affected by the occurrence of CMV and EBV (P <0.001). CONCLUSION: Our data indicate that pregnancy increased the risk of the presence of subgingival EBV in pregnant women by 3.647 times more than in non-pregnant women.

Effect of nail polish and henna on oxygen saturation determined by pulse oximetry in healthy young adult females.

OBJECTIVE: The purpose of this study was to determine the effect of different colour nail polishes and henna on the measurement of oxygen saturation and the differences among the measurements of three pulse oximetry devices. MATERIAL AND METHODS: 33 healthy females with a mean age of 19±1.0 years and no complaints or known disease were included into the study. All the participants applied henna to one of their fingers a day before the study. Just before the study, one finger was left empty as control and the other fingers were dyed using various colours of nail polish (red, blue, beige, purple, brown, white, pink, green, colourless polish, light blue, light green and yellow). There were more than eight colour nail polishes and some fingers were used for the other colours after being completely cleaned. The same brand nail polishes were used for the study. Oxygen saturation measurements were done using three different pulse oximetry devices (device I, II, III) from the control, different colour nail polished and henna applied fingers. The measurements of different devices, different colour nail polishes, henna and control were statistically compared. RESULTS: The mean saturations obtained from blue, beige, purple and white nail polished fingers were significantly lower than those of control and the other coloured fingers. In addition, the mean measurement of device II was significantly lower than those of other devices. CONCLUSION: The results suggest that blue, beige, purple and white nail polished fingers might cause pulse oximetry devices to make incorrect measurements.

Health Belief Model Scale for Cervical Cancer and Pap Smear Test: psychometric testing.

AIM: This study is a report of the development and psychometric testing of the Health Belief Model Scale for Cervical Cancer and the Pap Smear Test. BACKGROUND: While the Champion Health Belief Model scales have been tested extensively for breast cancer and screening for this, evaluation of these scales in explaining the beliefs of women with regard to cervical cancer and the Pap Smear Test has only received limited attention. METHODS: This methodological research was carried out in Turkey in 2007. The data were collected with 237 randomly selected women who met the criteria for inclusion and agreed to participate in this study. The Champion Health Belief Model scales were translated into Turkish, adapted for cervical cancer, validated by professional experts, translated back into English and pilot-tested. FINDINGS: Factor analysis yielded five factors: Pap smear benefits and health motivation, Pap smear barriers, seriousness, susceptibility and health motivation. Cronbach's alpha reliability coefficients for the five subscales ranged from 0·62 to 0·86, and test-retest reliability coefficients ranged from 0·79 to 0·87 for the subscales. CONCLUSION: The Health Belief Model Scale for Cervical Cancer and the Pap Smear Test was found to be a valid and reliable tool in assessing the women's health beliefs. Understanding the beliefs of women in respect of cervical cancer and the Pap Smear Test will help healthcare professionals to develop more effective cervical cancer screening programmes.

Outcomes of vitreoretinal surgery in patients with closed-globe injury.

PURPOSE: To evaluate the clinical features, visual outcomes, and prognostic factors in patients who underwent vitreoretinal surgery after closed-globe injury. METHODS: Retrospective review of patients with closed-globe injuries who underwent vitreoretinal surgery between January 2003 and December 2007. RESULTS: The study cohort included 46 eyes from 46 patients who underwent vitreoretinal surgery for posterior segment injury. Retinal detachment was the most frequent indication for the surgery, in 33 eyes (72%). After surgery, final visual acuity of 20/400 or better was achieved in 35 eyes (76%), while 11 eyes (24%) had visual acuity less than 20/400 (poor visual outcome). The most frequent reason for poor outcome was proliferative vitreoretinopathy (PVR) (6 eyes), followed by macular complications (3 eyes) and optic atrophy (2 eyes). Two cases with PVR became phthisical following repeated vitreoretinal procedures and also lost light perception. Prognostic factors associated with poor outcomes included delayed presentation, presenting visual acuity of less than 20/400, the presence of initial macular detachment, and the need for additional surgical intervention (p<0.05). No statistical difference was found in final visual acuity between eyes with or without retinal detachment (p>0.05). Also, the presence of damage to the anterior segment was not significantly associated with poor visual outcome (p>0.05). CONCLUSIONS: In patients with posterior segment pathology caused by closed-globe trauma, retinal detachment was the most common reason for vitreoretinal surgery and PVR was the main cause of surgical failure. The poor visual outcomes associated with delayed presentation suggest that patients need to be referred for further management.

Anatomic survey of arachnoid foveolae and the clinical correlation to cranial bone grafting.

INTRODUCTION: When performing in situ harvesting of cranial bone grafts, there is a risk of entering the pericranial-intracranial venous system, either directly or indirectly through the arachnoid foveolae. The aims of this study were to investigate the size and location of arachnoid foveolae and to provide an anatomic road map to prevent penetrating these structures. METHODS: Three hundred dry skulls were selected from the Hamann-Todd osteological collection (Cleveland, OH); skulls were collected between 1912 and 1938. Our study skulls were limited to whites or African American adults. Exclusion criteria included children (<18 y), ethnic groups other than African Americans and whites, skulls demonstrating fracture or craniofacial abnormalities, or any skull whose age, ethnicity, and sex could not be confirmed. From the 300 skulls in the collection, 200 met the criteria and were included in our review. The mean age of these 200 individuals was 43.86 years, with a male-to-female proportion of 100:100, and a white-to-African American proportion of 144:56. A 500-W candescent light was used to transilluminate the arachnoid foveola, and digital photographs with scale were obtained. The location and diameters of foveolae for arachnoid granulations relative to the coronal and sagittal suture were measured. CONCLUSIONS: Approximately 90% of major arachnoid foveolae are located within 2.5 cm of the coronal and 1.5 cm of the sagittal suture for the left and right parietal bones. Major arachnoid foveolae are located at closer distances to the superior sagittal suture and the coronal suture in the right and left parietal bone than minor foveolae. The results of this study imply that potential complications can be minimized by avoiding these areas and by harvesting in situ bone grafts from the absolute and relative safe zones described in this study.

Vascular endothelial growth factor, basic fibroblast growth factor, insulin-like growth factor-I and platelet-derived growth factor levels in human milk of mothers with term and preterm neonates.

Human milk is a complex biological fluid. It contains many nutrients, anti-infectious and biologically active substance. Human milk also contains many angiogenic polypeptides. We have determined four of these: Vascular endothelial growth factor (VEGF), basic fibroblast growth factor (b-FGF), insulin-like growth factor- I (IGF-I) and platelet-derived growth factor (PDGF). The aim of this study was to compare the concentrations of VEGF, b-FGF, IGF-I and PDGF in human milk collected from mothers with preterm and term neonates. Human milk samples were collected from 29 mothers of preterm (<37 weeks) and from 29 mothers of term (38>weeks) infants at days 3, 7 and 28 postpartum. Milk samples were analyzed for VEGF, b-FGF and PDGF by enzyme-linked immunosorbent assay and IGF-I was measured by radioimmunoassay method. Human milk levels of VEGF, IGF-I and b-FGF were significantly higher (p<0.001). Furthermore, within-preterm group concentrations of VEGF, IGF-I and PDGF significantly differed during postpartum days 3-7-28 (p<0.001, p<0.05, p<0.001, respectively), but did not do so for b-FGF concentrations. In term groups, concentrations of IGF-I and VEGF significantly differed (p<0.05, p<0.001, respectively), but did not do so for concentrations of b-FGF and PDGF. This is the first report of simultaneous measurements of four major angiogenic factors in human milk collected from mothers with preterm and term. Our results suggest that three of four angiogenic factors, VEGF, b-FGF and IGF-I, are higher concentration in human milk which collected from preterm mothers than those of terms.

Comparison of the effects of inhalation, epidural, spinal, and combined anesthesia techniques on rat cremaster muscle flap microcirculation.

BACKGROUND: This experimental study was designed to investigate and compare the effects of different anesthesia techniques on rat cremaster muscle flap microcirculation. METHODS: Fifty male Sprague-Dawley rats (130-150 g body weight) were divided into five experimental groups containing ten animals each. Group I, group II, and group III were designated as inhalation, epidural, and spinal anesthesia groups, respectively. Group IV was designated as a combination group for inhalation and epidural anesthesia. Group V was a combination group of inhalation and spinal anesthesia. RESULTS: Group III and group V showed significant increases in the number of rolling and sticking leucocytes and in RBC volume (peripheral stasis) when compared with group I. Blood flow and velocity significantly increased without peripheral stasis in groups II and IV when compared with group I. Although there was no statistically significant difference in the numbers of rolling, sticking, and transmigrating leucocytes or in functional capillary perfusion, group IV had better flow hemodynamics in the peripheral microcirculation when compared with group I. CONCLUSIONS: The inhalation and epidural anesthesia combination was determined to be the ideal anesthesia technique for improved peripheral microcirculation. Spinal anesthesia, either separately or in combination with inhalation anesthesia, has adverse effects on microcirculation.

Complementary and alternative medicine use among Turkish diabetes patients.

OBJECTIVES: To measure the frequency of complementary and alternative medicine (CAM) use among patients with diabetes mellitus, to determine demographic characteristics making it more likely to using CAM, and to find out how benefits, if any, were perceived by patients. DESIGN: A 24-item survey questionnaire administered to 371 return patients with diabetes mellitus. SETTING: Outpatient clinic of the Department of Endocrinology and Metabolism department of Gülhane Military Medical Academy, Ankara, Turkey. MAIN OUTCOME MEASURES: Questionnaire-based measures of demographics, motives, expectations, and effects of using CAM, and types and reported perceived benefits of CAM practiced on patients with diabetes mellitus. RESULTS: Forty-one percent of patients (n=152) used at least one of CAM practices; and age, birthplace, educational status, duration of diabetes and family type were significant factors in such behaviour. CONCLUSIONS: Patients born in cities, having more education and longer duration of diabetes, at relatively young ages and living in large families were more likely to use CAM. More than half of those using CAM (n=80, 52.7%) reported as benefits the feelings of either strengthening of body, or being in good psychological condition, or disappearance of several symptoms.

Health beliefs and breast self-examination in a sample of Turkish nursing students and their mothers.

AIM: To describe health beliefs and breast self-examination practice of Turkish female nursing students and their mothers. BACKGROUND: Breast cancer is the most frequently diagnosed cancer and the second leading cause of cancer deaths among Turkish women. Breast self-examination is one of the primary methods for early detection of breast cancer in asymptomatic women. DESIGN: The study was designed as a cross-sectional and comparative survey. The data were obtained from 392 participants, including female nursing students (n = 196) and their mothers (n = 196) in Ankara, Turkey. METHODS: Data were collected by using a personal data form and the Champion's Health Belief Model Scale. Descriptive statistics, paired samples t-test, chi-square test, reliability analysis, Pearson correlation coefficients and logistic regression analysis were conducted. RESULTS: The percentage of nursing students who performed breast self-examination regularly was statistically higher than that of their mothers. The scores of health motivation, benefits and confidence were significantly higher in nursing students. The mothers' perceived susceptibility and barriers were significantly higher than their daughters. The frequency of breast self-examination practice was affected by the level of education, the mother's or daughter's monthly performance of breast self-examination and the level of perceived barrier to breast self-examination. CONCLUSIONS: There were differences in health beliefs related to breast self-examination and its practice between nursing students and their mothers. The results of this study showed that monthly performance of breast self-examination was more common among women who graduated from high school and university, whose mother or daughter performed breast self-examination regularly every month and those with lower levels of perceived barriers. RELEVANCE TO CLINICAL PRACTICE: It is essential that nurses be aware of the factors that contribute to monthly performance of breast self-examination. Cultural factors should be considered in planning educational programmes about breast self-examination practice. Interventions should be designed to enhance nursing students' proficiency in performing breast self-examination.

QT dispersion during hypobaric hypoxia.

OBJECTIVE: Hypoxia is one of the major concerns in aviation. Clinical hypoxia has been shown to increase QT dispersion (QTd). We aimed to examine QTd during hypobaric chamber training to observe the effect of hypobaric hypoxia on QT dispersion. METHODS: A total of 38 healthy male aviators volunteered to take part in this longitudinal study. Subjects' electrocardiograms were recorded by 12-lead digital Holter device before, during, and after hypobaric exposure at simulated altitude of 30,000 ft. Data from 23 of the subjects, aged 27.91+/-6.02 years (range 22-39) was used. QT intervals were measured manually. QT dispersion and heart rate adjusted QTd (QTcd) were calculated for each subject. Statistical significance of changes in parameters was analyzed using the Friedman test. Comparison of pre-post exposure clusters was made using Dunn's test. RESULTS: QT dispersion values were as following: prehypoxic 64.09+/-8.39 ms, hypoxic 50.35+/-11.06 ms and posthypoxic 59.83+/-9.06 ms (Median: 64, 50, 60; Mean rank: 2.65, 1.28, 2.07) (p=0.0001 for prehypoxic-hypoxic, p=0.046-prehypoxic-posthypoxic, and p=0.002 for posthypoxic-hypoxic). Heart rate values were as following: prehypoxic 74.09+/-6.43 beats/min, hypoxic 127.1+/-17.39 beats/min, and posthypoxic 95.17+/-11.35 beats/min (Median: 75, 122, 92; Mean rank: 1, 3, 2) (p=0.0001 for prehypoxic-hypoxic, prehypoxic-posthypoxic, and posthypoxic-hypoxic). The change in QTd and HR during hypobaric chamber exposure was statistically significant but, the change in QTcd was not (p<0.001, p<0.001, p>0.1, respectively). CONCLUSION: From the findings of present study, it is not possible to directly comment on the validity of QTd in revealing arrhythmogenic predisposition of healthy subjects exposed to hypobaric hypoxia. The relationship between QT dispersion and hypobaric hypoxic exposure is not clear, particularly when QTd is corrected for the increased heart rate. QT dispersion measurement has not been proven a reliable and practical method to show arrhythmia predisposition during a hypobaric hypoxic exposure in healthy individuals.

High serum levels of neopterin in patients with Crimean-Congo hemorrhagic fever and its relation with mortality.

OBJECTIVE: Neopterin is generated and released in increased amounts by macrophages upon activation by interferon-gamma during cellular immune response. In this study, we aimed to investigate serum neopterin levels in patients with Crimean-Congo hemorrhagic fever (CCHF) and its clinical significance as a predictor factor of mortality. METHODS: Neopterin concentrations on the first day of hospitalization were measured in serum samples from 51 CCHF patients. Serum neopterin levels and other clinical-laboratory parameters for fatal and nonfatal CCHF patients were compared. RESULTS: Serum neopterin levels (73.22+/-54.30 nmol/L) were highly elevated in all CCHF patients (p<0.0001) with higher levels in fatal group (153.66+/-81.34 nmol/L, p=0.0001) compared to nonfatal disease (55.99+/-24.09 nmol/L). In univariate analysis, the level of neopterin on the first day of hospitalization, bleeding, platelet count, aspartate transferase and lactate dehydrogenase were associated with mortality. In multivariate analysis, only the serum level of neopterin was associated with mortality. As a mortality risk factor, area under the curve was 0.939 (p=0.0001, 95% confidence interval: 0.85-1.00). CONCLUSIONS: In this first study of serum neopterin levels for CCHF, elevated serum neopterin level showing strong activation of monocytes/macrophages was a risk factor for CCHF.