A modified DRASTIC model for groundwater vulnerability assessment using connecting path and analytic hierarchy process methods.

Groundwater plays a vital role in supporting water for the different needs of domestic, agricultural, and industrial sectors, and its vulnerability assessment to pollution is a valuable tool for establishing protective and preventive management. DRASTIC is a well-known GIS-based model for assessing groundwater vulnerability to pollution, which uses seven parameters including depth-to-water level, net recharge, aquifer media, soil media, topography, the impact of the vadose zone, and hydraulic conductivity. The predefined weights of DRASTIC parameters have made a barrier to its applicability for different regions with different hydroclimatic conditions. To overcome this problem, it has been suggested to apply analytic hierarchy process (AHP) method for modifying the model by adjusting the weights of the parameters. AHP is a widely used method to elicit experts' judgments about different involving parameters through constructing pairwise comparison matrixes (PCMs). Since AHP calculates the weights by performing pairwise comparisons between the parameters, achieving consistent comparisons is difficult when the number of parameters increases. The objective of this research is to modify the DRASTIC model by integrating the connecting path method (CPM) and AHP. The proposed methodology involves asking experts to perform a number of pairwise comparisons between the parameters and then construct an incomplete PCM using the obtained information. To complete the missing values in the PCM, CPM is employed. The CPM is an effective approach that not only estimates missing judgments but also ensures minimal geometric consistency. The proposed method along with DRASTIC and pesticide DRASTIC models is applied to Khoy County, which is located in the northwest part of Iran. The efficiency of the proposed method was further confirmed through the results of the Pearson coefficient test conducted on nitrate concentrations. The test revealed correlation values of 0.47, 0.27, and 0.57 for DRASTIC, pesticide DRASTIC, and modified DRASTIC, respectively. These results demonstrated that the proposed method provides a more precise evaluation of groundwater vulnerability.

Characteristics of beef allergy in schoolchildren in Turkey.

BACKGROUND: The prevalence of immunoglobulin E (IgE) mediated beef allergy in childhood is unknown. We investigated the prevalence and characteristics of IgE-mediated beef allergy in urban schoolchildren. METHODS: This cross-sectional study recruited 6000 randomly selected urban schoolchildren ages 6-17 years from the city center of Giresun in the eastern Black Sea region of Turkey during 2013. Children with suspected IgE-mediated beef allergy, determined by a self-administered questionnaire, after providing written consent, were skin-prick tested with commercial beef and cow's milk solutions and prick-prick tested with raw, boiled, and fried beef. Levels of serum-specific IgE to beef specific IgE and serum-specific IgE to cow's milk were determined by using fluorescent enzyme immunoassay. All children with suspected beef allergy were invited for a double-blind, placebo controlled food challenge (DBPCFC) to determine the prevalence of IgE-mediated beef allergy. RESULTS: The response rate to the questionnaire was 82.2%. The estimated prevalence of parental-reported IgE-mediated beef allergy was 2.6%. The prevalence of IgE-mediated beef allergy confirmed by DBPCFC was 0.30% (95% confidence interval, 0.18-0.5%). Positive challenge responses were observed in 70.6% (p = 0.027), 76.9% (p = 0.027), and 73.3% (p = 0.028) of the children with a positive family history of beef allergy, positive skin test results, and positive beef specific IgE values, respectively. A beef specific IgE value of >5 kUA/L alone or a combination of a positive family history of beef allergy, positive skin test results, and beef specific IgE values of >3 kUA/L yielded a positive response to DBPCFC. CONCLUSION: The presence of a family history of beef allergy, beef specific IgE value, and skin test result positivity are independently associated with positive DBPCFC results, and combined evaluation of these three parameters increased the positive predictive power of the tests.

Efficacy of golimumab on recurrent uveitis in HLA-B27-positive ankylosing spondylitis.

To evaluate the efficacy of golimumab on severe and frequent recurrent anterior uveitis in patients with HLA-B27-positive ankylosing spondylitis. In this study, 15 eyes of 12 HLA-B27-positive AS patients with resistant anterior uveitis who received 50 mg of subcutaneous golimumab (Gol) per month due to frequent uveitis recurrences were analyzed retrospectively between May 2013 and October 2015. Assessment criteria were uveitis activity, the number of recurrence of uveitis, visual acuity, systemic corticosteroid, or other drug requirement for maintenance of remission of AU. Twelve patients (15 eyes) with HLA-B27-positive ankylosing spondylitis and anterior uveitis have been treated with golimumab 50 mg/month. Remission of uveitis was observed in 12 eyes out of 15. Malign hypertension developed in one subject after the second dose of golimumab therefore the treatment was stopped and this subject was excluded from the study. Median follow-up time was 11 months (interquartile range: 8-18). No uveitic reaction was seen except in the patient who stopped treatment. No topical or systemic steroid necessity was needed except in two cases with oral 4 mg systemic maintenance. Visual acuity was significantly increased (p = 0.002). Golimumab may be a new and effective choice for maintaining remission and the prevention of recurrences of severe, resistant anterior uveitis in patients with HLA-B27-positive ankylosing spondylitis.

Evaluation of bone mineral density and 25-hydroxyvitamin D levels in subjects with silica exposure.

OBJECTIVE: The purpose of the study was to evaluate the bone mineral density (BMD) and 25-hydroxyvitamin D (25(OH)D) levels in patients with silica exposure. MATERIALS AND METHODS: The study included 104 male subjects with silica exposure and 36 healthy subjects. Posterior-anterior radiographs were classified according to the International Labour Office (ILO) Classification. Category 0 patients were classified as Group I (n = 54), category I patients were classified as Group II (n = 25), Category II and III patients were classified as Group III (n = 25). RESULTS: Femoral neck BMD values were significantly lower in Group III (p = 0.007). Lumbar vertebrae BMD values were significantly lower in all groups with silica exposure than in the control group (p = 0.000). The osteoporosis rate was significantly higher in Group III (p = 0.000). Subjects with silica exposure were determined to have diminished 25(OH)D levels (p = 0.012). CONCLUSION: The results of this study demonstrated that subjects with silica exposure have diminished BMD and 25(OH)D levels.

The Effects of Lead Exposure on Serum Uric Acid and Hyperuricemia in Young Adult Workers: A Cross-sectional Controlled Study.

OBJECTIVES: This study aims to evaluate the relationship between serum uric acid levels and renal functions in asymptomatic subjects who had occupational lead exposure, particularly for shorter durations whereby saturnine gout has also been discussed. PATIENTS AND METHODS: In this retrospective study, files of 100 males (mean age 34.5±5.9 years; range, 21 to 47 years) with occupational risk for lead exposure and 100 healthy male controls (mean age 34.47±5.8 years; range 21 to 47 years) were reviewed. Demographic characteristics of the subjects and laboratory test results were recorded from the files. Creatinine clearance and 24-hour urinary creatinine were measured in the lead-exposed group. RESULTS: In the lead-exposed group, mean serum uric acid level was higher than those of the control group (p<0.001). Lead exposure time was negatively correlated with 24-hour urinary creatinine levels (r= -0.373, p<0.001). In addition, serum uric acid levels were positively correlated with serum creatinine levels (r=0.412, p<0.001) in the exposed group. Six patients had hyperuricemia (serum uric acid level >6.8 mg/dL) in the lead- exposed group; however, all subjects' serum uric acid level was lower than 6.8 mg/dL in the control group (p=0.029). Although 22 subjects had higher uric acid levels than 6.0 mg/dL in the lead-exposed group, only one control had higher uric acid level than 6.0 mg/dL (p<0.001). CONCLUSION: In light of our results, we may conclude that workers with lead exposure have higher frequency of hyperuricemia and higher serum uric acid levels than those of the control group. Therefore, we may imply that higher serum uric acid levels may be associated with renal impairment in lead-exposed subjects even in the earlier stages of exposure.

Ultrasonographic Assessment of the Femoral Cartilage Thickness in Patients with Pes Planus: A Multicenter Study by TURK-MUSCULUS.

OBJECTIVE: The aims of this study were to measure the distal femoral cartilage thicknesses of patients with pes planus by using ultrasound imaging and to explore whether ultrasound measurements are associated with degree of pes planus. DESIGN: One hundred seven patients (61 men, 46 women; aged 18-45 yrs) with pes planus and 107 age- and sex-matched as well as body mass index-matched healthy controls were enrolled in this study. After clinical assessment of the patients, measurements for pes planus were done on the radiographs, and ultrasound imaging of the distal femoral cartilage was performed from the right medial condyle, the right lateral condyle, the right intercondylar area, the left medial condyle, the left lateral condyle, and the left intercondylar area. RESULTS: Femoral cartilage values were thicker than those of the control group at all measurement sites (except for the right lateral condyle) (P's < 0.05). In a subgroup analysis regarding the sex difference, right medial condyle and left medial condyle values in the male subjects as well as right lateral condyle, right intercondylar area, left lateral condyle, and left intercondylar area values in the female subjects were found to be thicker (all P < 0.05). CONCLUSIONS: The distal femoral cartilages of the pes planus patients seem to be thicker, and this finding could possibly stem from excessive mechanical stress on the knee joint caused by impaired lower extremity biomechanics.

Ultrasonographic measurement of the femoral cartilage thickness in patients with occupational lead exposure.

The objective of the present study is to compare distal femoral cartilage thicknesses of patients with occupational lead exposure with those of healthy subjects by using ultrasonography. A total of 48 male workers (a mean age of 34.8±6.8 years and mean body mass index (BMI) of 25.8±3.1 kg/m(2)) with a likely history of occupational lead exposure and age- and BMI-matched healthy male subjects were enrolled. Demographic and clinical characteristics of the patients, that is, age, weight, height, occupation, estimated duration of lead exposure, and smoking habits were recorded. Femoral cartilage thickness was assessed from the midpoints of right medial condyle (RMC), right lateral condyle (RLC), right intercondylar area (RIA), left medial condyle (LMC), left lateral condyle (LLC), and left intercondylar area (LIA) by using ultrasonography. Although the workers had higher femoral cartilage thickness values at all measurement sites when compared with those of the control subjects, the difference reached statistical significance at RLC (P=0.010), LMC (P=0.001), and LIA (P=0.039). There were no correlations between clinical parameters and cartilage-thickness values of the workers. Subjects with a history of lead exposure had higher femoral cartilage thickness as compared with the healthy subjects. Further studies, including histological evaluations, are awaited to clarify the clinical relevance of this increase in cartilage thickness and to explore the long-term follow-up especially with respect to osteoarthritis development.

Effects of isotretinoin treatment on cartilage and tendon thicknesses: an ultrasonographic study.

Effects of retinoic acid on collagen synthesis and cartilage have previously been shown. However, its effects on cartilage and tendons in humans have not been studied yet. Therefore, in order to provide a morphologic insight, the aim of this study was to measure femoral cartilage, Achilles and supraspinatus tendon thicknesses in patients under systemic isotretinoin treatment by using ultrasound. Fifteen patients (nine F, six M) who used isotretinoin for their acnes were included. All patients were treated with isotretinoin 0.5 mg/kg/day for the first month, and the dosage was escalated up to 1 mg/kg/day thereafter. Distal femoral cartilage, supraspinatus, and Achilles tendons thicknesses have been evaluated both before the treatment and at the end of the third month. Femoral cartilage thicknesses were assessed from three midpoints bilaterally; medial condyle, lateral condyle, and intercondylar area. Short/long-axis diameters and cross-sectional area of the Achilles tendons and axial tendon thicknesses of supraspinatus tendon were evaluated from the nondominant side. The mean age of the patients was 20.1 ± 4.9 years, and body mass index was 21.7 ± 2.5 kg/m(2). Although posttreatment cartilage measurements of 30 knees were lower for the three midpoints, it reached significance only for lateral condyle (p = 0.05). In addition, posttreatment tendon measurements were not statistically significant compared with pretreatment values (all p > 0.05). Systemic isotretinoin treatment seems to make cartilage thinner. Further studies considering histological and molecular evaluations with more sample sizes are awaited.

Distribution of Streptococcus pneumoniae serotypes that cause parapneumonic empyema in Turkey.

Streptococcus pneumoniae is the most common etiological cause of complicated pneumonia, including empyema. In this study, we investigated the serotypes of S. pneumoniae that cause empyema in children. One hundred fifty-six children who were diagnosed with pneumonia complicated with empyema in 13 hospitals in seven geographic regions of Turkey between 2010 and 2012 were included in this study. Pleural fluid samples were collected by thoracentesis and tested for 14 serotypes/serogroups using a Bio-Plex multiplex antigen detection assay. The serotypes of S. pneumoniae were specified in 33 of 156 samples. The mean age ± the standard deviation of the 33 patients was 6.17 ± 3.54 years (range, 0.6 to 15 years). All of the children were unvaccinated according to the vaccination reports. Eighteen of the children were male, and 15 were female. The serotypes of the non-7-valent pneumococcal conjugated vaccine (non-PCV-7), serotype 1, serotype 5, and serotype 3, were detected in eight (14.5%), seven (12.7%), and five (9.1%) of the samples, respectively. Serotypes 1 and 5 were codetected in two samples. The remaining non-PCV-7 serotypes were 8 (n = 3), 18 (n = 1), 19A (n = 1), and 7F/A (n = 1). PCV-7 serotypes 6B, 9V, 14, 19F, and 23F were detected in nine (16.3%) of the samples. The potential serotype coverages of PCV-7, PCV-10, and PCV-13 were 16.3%, 45.4%, and 60%, respectively. Pediatric parapneumonic empyema continues to be an important health problem despite the introduction of conjugated pneumococcal vaccines. Active surveillance studies are needed to monitor the change in S. pneumoniae serotypes that cause empyema in order to have a better selection of pneumococcal vaccines.

Anemia as a risk factor for low bone mineral density in postmenopausal Turkish women.

BACKGROUND: We investigated the association of bone mineral density (BMD) by detected dual-energy X-ray absorptiometric (DXA) method and hemoglobin (Hb) levels in a large sample. METHODS: The current study enrolled 371 postmenopausal women (82 anemic patients), who were screened for osteopenia or osteoporosis by DXA. Patients with osteopenia or osteoporosis (T score<-1.0 SD) were grouped as having low bone mass (LBM). RESULTS: Anemic patients were older and had significantly higher duration of menopause. When compared with subjects with normal Hb, anemic patients had significant lower femur t score, femur BMD, femur Z score, spinal t score, spinal BMD and spinal Z score (p<0.001). Additionally, the ratio of subjects with LBM in the femur and spine were significantly high in anemic patients (p<0.002, p<0.002, respectively). There were significant correlations between Hb values and femur t score, femur BMD, spine t score, and spine BMD values of the study population in bivariate correlation analysis (r=0.150, p=0.004, r=0.148, p=0.004, r=0.160, p=0.002, r=0.164, p=0.001, respectively). Furthermore, presence of anemia was found to be an independent predictor of LBM for spine [OR: 2.483 (95% CI: 1.309-4.712), p<0.005] in logistic regression analysis. Additionally, number of anemic patients was significantly high in low femur and spine BMD groups (56 vs. 26; p=0.01, 66 vs. 16; p=0.002, respectively). CONCLUSION: We have found that the presence of anemia was as an independent predictor of LBM for spine after adjusting for body mass index and other confounders in postmenopausal Turkish women.

The effect of breast-feeding duration on bone mineral density in postmenopausal Turkish women: a population-based study.

INTRODUCTION: In the present study, we investigated the effects of breast-feeding time on bone mineral density (BMD) later in life. MATERIAL AND METHODS: The current study was based on a retrospective analysis of 586 postmenopausal women with a mean age of 60.8 years, who were screened for osteoporosis by dual energy X-ray absorptiometry (DXA).They were classified into 4 groups with respect to the duration of their breast-feeding as never (group 1), 1-24 months (group 2), 25-60 months (group 3), or > 60 months (group 4). Bone mineral density results for the femur neck and lumbar spine were classified into 3 groups according to WHO criteria as normal (T score > -1.0 SD), osteopenia (T score -1.0 to -2.5 SD), and osteoporosis (T score < -2.5 SD). Patients with osteopenia or osteoporosis (T score < -1.0 SD) were considered as having low bone mass (LBM). RESULTS: We found a correlation between duration of lactation and femur BMD or spine BMD in the study population (r = 0.116, p < 0.005; r = -0.151, p = 0.001, respectively). Significant differences were found between femur BMD and spine BMD of groups in one-way ANOVA analysis (p = 0.025, p = 0.005, respectively). Additionally, when compared with the other three groups, group 4 was older and had longer duration of menopause (p < 0.01). In logistic regression analysis, age and body mass index were found as independent risk factors of LBM [odds ratio: 1.084 (95% CI 1.031-1.141); odds ratio: 0.896 (95% CI 0.859-0.935)], while duration of lactation was not found as an independent predictor of LBM. CONCLUSIONS: In this study, we have found that changes of bone metabolism during lactation had no effect on postmenopausal BMD measured by DXA. Consequently, it can be suggested that long breast-feeding duration is not a risk factor for low bone mass later in life.

Relationship between blood pressure levels and bone mineral density in postmenopausal Turkish women.

INTRODUCTION: We investigated the association between bone mineral density (BMD) detected by dual-energy X-ray absorptiometric (DXA) method and blood pressure (BP) in a large sample of postmenopausal women. MATERIAL AND METHODS: The current study was based on a retrospective analysis of 586 postmenopausal women with a mean age of 60.8 ±8.8 years, who were screened for osteopenia or osteoporosis by DXA. Patients with hypertension (HT, n= 306) were compared with normotensive (NT, n = 290) individuals. Bone mineral density results for the femur neck and spine were classified into 3 groups according to World Health Organization criteria: normal (T score > -1.0 SD), osteopenia (T score -1.0 to -2.5 SD) and osteoporosis (T score < -2.5 SD). Patients with osteopenia or osteoporosis (T score < -1.0 SD) were grouped as having low bone mass (LBM). RESULTS: There were no significant differences in femur T score, femur BMD, femur Z score, spinal T score, spinal BMD and spinal Z score between hypertensive and normotensive groups. The group of patients with low bone mass calculated from femur T scores had higher age, systolic BP, duration of hypertension and duration of menopause, but lower BMI. Similarly, patients with low spine BMD had higher age and duration of menopause, but lower BMI. Linear regression analysis showed a significant correlation between systolic BP and femur BMD and T score values. Furthermore, logistic regression analysis revealed that hypertension is an independent predictor of spinal osteopenia and osteoporosis. CONCLUSIONS: The presence of hypertension is an independent predictor of spinal low bone density in Turkish women after menopause.

Defects along the T(H)17 differentiation pathway underlie genetically distinct forms of the hyper IgE syndrome.

BACKGROUND: The hyper IgE syndrome (HIES) is characterized by abscesses, eczema, recurrent infections, skeletal and connective tissue abnormalities, elevated serum IgE, and diminished inflammatory responses. It exists as autosomal-dominant and autosomal-recessive forms that manifest common and distinguishing clinical features. A majority of those with autosomal-dominant HIES have heterozygous mutations in signal transducer and activator of transcription (STAT)-3 and impaired T(H)17 differentiation. OBJECTIVE: To elucidate mechanisms underlying different forms of HIES. METHODS: A cohort of 25 Turkish children diagnosed with HIES were examined for STAT3 mutations by DNA sequencing. Activation of STAT3 by IL-6 and IL-21 and STAT1 by IFN-alpha was assessed by intracellular staining with anti-phospho (p)STAT3 and -pSTAT1 antibodies. T(H)17 and T(H)1 cell differentiation was assessed by measuring the production of IL-17 and IFN-gamma, respectively. RESULTS: Six subjects had STAT3 mutations affecting the DNA binding, Src homology 2, and transactivation domains, including 3 novel ones. Mutation-positive but not mutation-negative subjects with HIES exhibited reduced phosphorylation of STAT3 in response to cytokine stimulation, whereas pSTAT1 activation was unaffected. Both patient groups exhibited impaired T(H)17 responses, but whereas STAT3 mutations abrogated early steps in T(H)17 differentiation, the defects in patients with HIES with normal STAT3 affected more distal steps. CONCLUSION: In this cohort of Turkish children with HIES, a majority had normal STAT3, implicating other targets in disease pathogenesis. Impaired T(H)17 responses were evident irrespective of the STAT3 mutation status, indicating that different genetic forms of HIES share a common functional outcome.

The bronchodilatory effects of loratadine, terbutaline, and both together versus placebo in childhood asthma.

AIM: To assess the bronchodilatory effect of loratadine in children with mild-to-moderate asthma and to determine whether loratadine interacts with terbutaline. METHODS: The effect on pulmonary functions of a 10 mg oral dose of loratadine, with and without inhaled terbutaline powder (0.5 mg), was determined in 13 patients with a mean (SE) age of 10.63 (0.77) years (range from eight to 17 years) at 11 time points during 8 h in a randomized, double-blind, placebo controlled, crossover study. Forced expiratory volume in 1 s (FEV1) was the primary measure of efficacy. RESULTS: Although loratadine alone produced an increase in FEV1 relative to baseline, this was not statistically significant (p > 0.05). Terbutaline with, and without loratadine, significantly increased FEV1 from 1 to 5 h according to baseline (p < 0.004). When compared with the placebo, loratadine significantly increased FEV1 from 150 min to 8 h (p < 0.05). Also, terbutaline alone, or in combination with loratadine, significantly increased FEV1 from 30 min to 7 h (p < 0.004, from 30 min to 5 h; p < 0.05, between 6-7 h). Although the mean increase in FEV1, with terbutaline + loratadine in combination, was greater than with terbutaline alone, the difference was not significant (p > 0.05). CONCLUSION: Loratadine has a mild bronchodilatory effect in the study period and does not interfere with the bronchodilatory effect of terbutaline in childhood asthma.