Analysing Crime Scene Data, Medical Records and Forensic Information to Determine the Causes of Suicides.

OBJECTIVE:  To analyse crime scene data, medical records, and forensic information to unveil insights into the causes and traits of suicides. STUDY DESIGN:  Descriptive study. Place and Duration of the Study: Department of Family Medicine, Kayseri City Hospital, Kayseri, Turkiye, between January 2020 to December 2021. METHODOLOGY:  A suicide investigation team (doctor, social worker, psychologist) was created to study cases and conduct on-site psychological autopsies. Triggered by emergency calls, the team interviewed suicide victims' relatives using semi-structured questionnaires, gathering data on personal details, time, method, and potential motives. Medical records revealed psychiatric history and medication use, while national judicial systems were reviewed for legal records. RESULTS:  A total of 158 fatal suicides were studied. Males accounted for 73.4%, females 26.6%. The leading cause was psychiatric illness (43%), chiefly depression (39%). Suicide peaked in the fall, especially in September, mainly at 23:00-23:59. Home was the common site (58.9%), and hanging was the primary method (44.3%). Prior hospitalisation for suicide attempts was 7.5%. Criminal records were held by 16.4% (26 individuals). CONCLUSION:  The results support the idea that suicides have seasonal patterns and that there are temporal windows of increased risk for suicide. KEY WORDS:  Suicide reasons, Suicide time, Psychological autopsy, Seasonal and temporal patterns.

Prevalence of COVID-19 infection in asymptomatic school children.

BACKGROUND: With the onset of the COVID-19 pandemic, discussions regarding the prevalence of COVID-19 in children and the association of this with education have started. This study aimed to determine the prevalence of COVID-19 infection in asymptomatic school children within a limited period while face-to-face education continued. METHODS: This is a descriptive and retrospective study. Screening was carried out in the schools in the three major districts of the metropolitan municipality when face-to-face education was practiced. COVID-19 RT-PCR swab samples were collected from 4,658 students from 46 schools at preschool, primary, secondary, and high school levels by using the stratified sampling method. Screening results were retrospectively analyzed by the researchers. RESULTS: The mean age of the children included in the study was 10.6±3.2 (5-17). Only 46 students` COVID-19 RT-PCR results were positive; the positivity rate was higher in male students than in female students (p > 0.05); the students living in the third region had a higher positivity rate than the other students, there was a statistical difference between them (p < 0.001); there were no positive cases in 26 (56.7%) schools, and the spreader rate of the school children was 0.98%. CONCLUSIONS: We determined in the study that the prevalence of COVID-19 infection was not high in asymptomatic school children in the period when schools were open. This may play a role in directing the education and training during the pandemic.

Effectiveness of STOPP/START criteria in primary prevention of polypharmacy and under-treatment in older patients.

AIM OF THE STUDY: STOPP/START criteria appear to be a useful tool to curb inappropriate prescribing (IP), which encompasses errors of both, over and under-treatment. This study aimed to find out whether application of STOPP/START reduces the IP effectively in primary care. METHODS: This prospective cross-sectional study was conducted in two family health centers (FHCs) in Istanbul. All older adults who applied to FHCs between 01-07-2018 and 01-07-2020 were enrolled. The potential inappropriate medications (PIMs) and potential prescription omissions (PPOs) were identified according to STOPP/START version 2 criteria. Mean drug consumptions before and after STOPP/START were compared using Student's t-test. RESULTS: Among 1023 participants there were 626 females and 397 males. The mean age was 73.33±7.30 years. The number of the patients seen at FHCs was 657 (64.2%) while 366 (35.8%) of them were visited at home. Of the patients, 383 (37.8) were 75 years old or older and 631 (62.2%) of them were under 75. Overall number of drugs consumed per patient was 5.49±3.93 while it was 6.01±3.71 and 4.55±4.138 for outpatients and home patients respectively (p<0.001). By application of STOPP criteria, among the 5616 medications consumed by the overall patients, 881(%15.6) of them were found to be potentially inappropriate. 424 (41.4%) patients were using at least one PIM. This ratio was 354 (53.8%) in outpatients and 70 (19%) in home patients. START criteria identified 380 (%7.4) PPOs. There were 246 (24.0%) patients at least with one PPO; 155 (42.3%) of whom were home patients and 91 (13.8%) were outpatients. Regarding the age groups; PIM ratio was 35.5% in patients under 75 and 52.1% over 75 whereas PPO ratio was 22.5% under 75 and 26.8% over 75. CONCLUSION: This study supports the data reporting the effectiveness of STOPP/START criteria in primary care units in implementing appropriate prescription criteria.

Information, attitudes and behavior of Turkish people concerning COVID-19.

INTRODUCTION: This study aims to evaluate the knowledge, attitudes and behavior of people towards COVID-19 and to evaluate compliance with practices such as social isolation, curfews, mask use and hand hygiene. METHODOLOGY: A month after the COVID-19 infection was observed in Turkey, a standard questionnaire link was sent to participants via the online questionnaire platform to determine the knowledge, attitude, and behavior of the public. The survey results of 503 people were evaluated. RESULTS: During the COVID-19 pandemic 81.2% of the participants stayed at home, 79.1% of the participants wore a mask, 74% of the participants expressed to be following social distancing rules, 54.1% confirmed the use of hand sanitizers and 43.9% confirmed the use of gloves (43.9%), which are considered to be personal protective measures. The knowledge of terms such as 'quarantine' and 'isolation' was 94% and 97.4% respectively and 37.2% of the participants were of the opinion that the COVID-19 virus was produced in a laboratory environment. Within the research group, a rate of 65.6% of the participants found their own knowledge of COVID-19 to be sufficient. The participants found the announcements of official institutions more reliable than the announcements on television programs, the internet and social media. CONCLUSIONS: The public information on COVID-19 was found to be sufficient. In order to prevent the spreading of the pandemic, participants were partially compliant to rules such as staying at home, using masks, maintaining hand hygiene and social isolation. Compared to men, women's use of protective equipment was higher.

The Effect of Chronic Diseases, Age and Gender on Morbidity and Mortality of COVID-19 Infection.

BACKGROUND: We aimed to reveal how chronic diseases, age and gender affected morbidity and mortality in patients with Coronavirus disease of 2019 (COVID-19). METHODS: Medical records of all reverse transcription polymerase chain reaction (RT-PCR) positive COVID-19 patients followed up in hospital and home isolation between 13th of Mar 2020 and 12th of May 2020 were retrospectively reviewed. The patients were from Kayseri Province, Turkey. Patients' demographic and clinical characteristics and the factors associated with morbidity and mortality were analyzed. RESULTS: Of all the patients, 773 (95.8%) were alive and 34 (4.24%) died. The fatality rate was 4.2%. There were differences between the age groups in terms of fatality rate (P<0.001). The fatality rate in patients above the age of 65 yr was significantly higher. The fatality rate in the male gender was 2.44 times higher (P<0.05). It was 1.104 times higher in advanced age (P<0.001) and 10.893 times higher in patients with at least one comorbid disease (P<0.05). Hypertension increased mortality by 3.635 times (P<0.05) and chronic pulmonary diseases by 2.926 times (P<0.05). CONCLUSION: Advanced age, male gender and accompanying chronic diseases have adverse effects on the course and severity of the disease and hospitalization. They also increased the rate and risk of mortality.

Continue or stop applying wet cupping therapy (al-hijamah) in migraine headache:A randomized controlled trial.

BACKGROUND: and purpose: Although wet cupping therapy (WCT) is currently in use, clinical investigations of its efficiency are scarce. The aim of this study was to evaluate the short- and long-term effects of WCT on headache and disability associated with migraine. MATERIALS AND METHODS: This was an open-label trial conducted at Karabuk University Training and Research Hospital between May 2016 and January 2018. WCT was applied once a month to migraine patients. At the end of 3 months, patients were randomized into two groups using block randomization method. Control group (Group 1) consisted of 53 patients and the intervention group (Group 2) 56 patients. Evaluation was performed to both groups before treatment and at the 6th and 12th months using the migraine disability assessment (MIDAS). RESULTS: Group 1 received three sessions, whereas Group 2 continued treatment for 12 months. Visual analog scale (VAS) and MIDAS values at the 12th month were significantly higher compared with 6-month values in Group 1 (p < 0.001) and lower in Group 2 (p < 0.001). Both VAS and MIDAS scores of the patients in Group 2 improved significantly better than those in Group 1. No adverse effects were seen. CONCLUSION: WCT reduced pain and disability in patients with migraine, and the efficacy increased when the application was continued. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT03503903.

Epidemiological features of tularaemia in Central Anatolia, Turkey.

Tularaemia has become a public health threat in Turkey. Our aim was to examine the epidemiological characteristics of 154 tularaemia cases reported from Kayseri, Central Anatolia, between 2010 and 2017. Clinical diagnosis was confirmed by micro-agglutination test (≥1/160 titres). Most patients (56.5%) were residing in rural areas. The year with the highest case load was 2011 (40% of all cases). Tularaemia was reported in all seasons, but mostly in February (26.1%). Morbidity rates were higher in women and people aged ≥65 years. The tularaemia incidence in Kayseri was higher than in the whole country between 2011 and 2016, though after the initial outbreak between 2010 and 2012, it seems to have become less frequent.

Mean platelet volume and red cell distribution width as potential new biomarkers in children with gastroesophageal reflux disease.

The aim of this study was to calculate the corrected rate of reflux in children with gastroesophageal reflux (GER)-like complaints by 24-hour pH monitoring and esophagogastroduodenoscopy (EGD), and to determine the utility of mean platelet volume (MPV) and red cell distribution width (RDW) as diagnostic biomarkers of GER disease (GERD) in children. The subjects in this prospective study were 109 children, 6 to 18 years old. Of them, 74 subjects were with GER symptoms and 35 healthy controls. The subjects were divided into three groups: those who underwent 24-hour pH monitoring (Group 1), those who underwent EGD together with pH monitoring (Group 2), and the healthy controls (Group 3). The results of pH monitoring and EGD and hematological parameters with controls were compared between Groups 1 and 2. In Groups 1 and 2, the overall rate of reflux was 40%, of esophagitis was 27.8%, and of Helicobacter pylori infection was 31.2%. The MPV and RDW cut-offs in subjects with reflux were ≤ 8.97 (sensitivity 89%, specificity 89%) and ≤ 12.78 (sensitivity 80%, specificity 97%), with an area under the Receiver Operating Characteristic (ROC) curve ± standard error (AUC ± SE) = 0.917 ± 0.027 (P < 0.001) and AUC ± SE = 0.866 ± 0.036 (P < 0.001), respectively. The endoscopic procedures are not practical due to being invasive and expensive. However, hemogram is a simple test which can be performed in an outpatient clinic. MPV and RDW calculated in hemogram could be easy, cost-effective, and high sensitive new biomarkers that can be used in children with GERD.

Self-assessment of residents in respect of attitudes to communication.

AIM: As communication skills are essential for medical practice, many medical schools have added communication skills training to their curricula in recent years. The aim of this study was to determine and compare the attitudes to communication skills of family medicine, internal medicine and general surgery residents. MATERIALS AND METHODS: Family medicine, internal medicine and general surgery residents of three training and research hospitals and one university hospital in Ankara were included in this cross-sectional study. A questionnaire was used for obtaining information about age, gender, marital status, graduation date and whether receiving any training for communication skills. The Turkish version of the Communication Skills Attitude Scale was used. RESULTS: In all, 58 (50%) family medicine, 30 (25.9%) internal medicine, and 28 (24.1%) general surgery residents were accepted to participate in the study. Of the 116 residents, 58 (50%) were female and 58 (50%) were male, with a mean age of 29.47±4.63 years, and 68 (58.6%) of them were married; 59.5% of the participants received training about communication skills and 56.5% of them received it at medical school. The mean positive attitude scale (PAS) score was 3.85±0.58, and the mean negative attitude scale (NAS) score was 2.42±0.52. The PAS scores of female residents were higher than those of males (P=0.01). The PAS scores of residents who received communication skills training were higher than the scores of those who had not (P=0.01). The PAS scores of family medicine residents were higher and the NAS scores were lower than those of internal medicine and general surgery residents. CONCLUSION: The communication skill attitudes of family medicine residents were better than those of internal medicine and general surgery residents.

The Impact of Nutritional Status and Complete Blood Count Parameters on Clinical Outcome in Geriatric Critically Ill Patients.

BACKGROUND: The geriatric population in intensive care units (ICUs) has recently increased. The aim of this study was to analyse the impact of initial complete blood count (CBC)-related parameters and nutritional status on morbidity and mortality in geriatric ICU patients. METHODS: A retrospective analysis was made of geriatric patients admitted to our tertiary adult ICU for 1 year. Patients with a length of stay (LOS) of < 48 h, with hematological malignancy or age < 65 years age were excluded from the study. Initial albumin level was considered to reflect nutritional status. The prevelance and risk factors of mortality and microbiologically documented infection (MDI) were analysed. RESULTS: The study included a total of 243 patients with a mean age of 78.96 ± 6.62 years. The overall mortality rate was 40.7%. The most common cause for admission was acute respiratory failure and sepsis (17.2% vs. 16.8%). The most common MDI sources were lower respiratory tract, bloodstream, and urinary tract infections. Patients with thrombocytopenia on admission had a higher mortality rate than patients with normal platelet count (P = 0.019). The initial albumin level of non-survivors was significantly lower than that of survivors (P = 0.001). There was a significant negative correlation between albumin level and LOS (r = -0.157; P = 0.000). Patients with hypoalbuminemia (albumin < 3.2 g/dL) at the time of diagnosis had higher mortality, LOS and MDI rates than those with normal albumin levels (P < 0.05). There was no significant relationship between any other CBC-related parameter and infection and mortality (P > 0.05). CONCLUSIONS: Thrombocytopenia and hypoalbuminemia may be considered as major risk factors for morbidity and mortality in critically ill elderly patients.

Changing Efficacy of Wet Cupping Therapy in Migraine with Lunar Phase: A Self-Controlled Interventional Study.

BACKGROUND The aim of this study was to evaluate the effect of blood-letting with wet cupping therapy (WCT) in migraine treatment and to determine whether there was any difference according to the phase of the moon when the treatment was applied. MATERIAL AND METHODS This self-controlled study was conducted in Karabuk between 2014 and 2016. Patients who were diagnosed with migraine were enrolled in the study. Migraine disability assessment questionnaire (MIDAS), demographic characteristics, migraine attack frequency and duration, and family history was used to assess the severity of headache. WCT was applied in 3 sessions and the questionnaire was administered before and 3 months after the final WCT session. Wilcoxon signed-rank test was used in pre-and posttreatment measurements, and the Chi-square test was used to check independence in two-way categorical tables. RESULTS A total of 85 patients were included. The reduction in MIDAS scores and number of migraine attacks was significantly greater in the WCT applications made in the first half of the month compared to those in the second half of the month. Although the reduction in visual analog scale (VAS) scores was greater in the second half of the month, it was also significant in the applications made in the first half of the month. CONCLUSIONS WCT was found to be an effective treatment of migraine. The effect on MIDAS, VAS, and the number of attacks was significantly better when the application was made in the second half of the month compared to those made in the first half.

An evaluation of thyroid autoimmunity in patients with beta thalassemia minor: A case-control study.

OBJECTIVE: The tendency to autoimmune diseases has been reported to be increased in beta thalassemia minor (BTM). The aim of this study was to evaluate whether thyroid autoimmunity is higher in BTM. METHODS: Patients with BTM (n=86) and a healthy control group (n=93) were included in this cross-sectional case-control study. The two groups were compared in terms of anti-thyroglobulin (anti-TG) and anti-thyroid peroxidase (anti-TPO) and thyroid hormones. RESULTS: In the BTM group, thyroid hormones and serum anti-TG and anti-TPO antibody levels were not statistically different from those of the control group. The BTM and control groups were similar in terms of anti-thyroid antibody (ATA) positivity prevalence. In the BTM group, anti-TG was 11.6% and anti-TPO was 14% positive, while these values were 14% and 12.9% positive, respectively in the control group (p=0.806 and p=0.989, respectively). The proportion of anti-TG and/or anti-TPO antibody positive subjects was found to be 20.9% in the BTM group, and 20.4% in the control group (p=0.919). The ratios of subjects with euthyroidism, hyperthyroidism and hypothyroidism were similar in both groups. CONCLUSIONS: As the thyroid autoimmunity prevalence in the BTM group was not increased compared to the control group, it can be considered that there is no necessity for routine ATA and thyroid hormone testing in subjects with BTM.

A comparison of the efficacy of varenicline and bupropion and an evaluation of the effect of the medications in the context of the smoking cessation programme.

BACKGROUND: Within the context of the support program for smoking cessation, initiated by the Turkish Ministry of Health in 2011, those who present at 'smoking cessation' centres and are found to be suitable for pharmacological treatment are given varenicline and bupropion free of charge. As the smoking cessation programme is centralized, the selection of the medication is made randomly to provide a fixed distribution rate. The aim of this study was to evaluate the efficacy of both varenicline and bupropion in smoking cessation and to evaluate the effect of the smoking cessation programme. METHODS: A total of 405 individuals who met the study criteria were included in the study. Smoking habits and degree of dependence were determined in all the participants with the Fagerstrom test for nicotine dependence (FTND) and bupropion or varenicline therapy was initiated in those who were eligible. Patients were followed up at 15 days then at 1, 2, 3, 6 and 12 months after smoking cessation. A level of CO < 5 ppm and 'point prevalence abstinence' were used as the criteria of success for smoking cessation and this evaluation showed the non-smoking status in the previous 7 days. RESULTS: The mean age of the participants was 35.19 ± 7.73 years and 82.8% (n = 334) were male. Of the participants, 60.2% (n = 244) were given varenicline and 39.8% (n = 161) bupropion. The mean FTND and package/year was not significantly different between the groups. The rates of success in the 1st and 2nd weeks, and 1st, 3rd and 6th months were significantly higher in the varenicline group than in the bupropion group (p < 0.05). At the end of one year, the rate of smoking cessation was determined as 13.9% (n = 34) in the varenicline group and 6.2% (n = 10) in the bupropion gruop. The difference was statistically significant (p = 0.015). At the end of 1 year when the previous 7 days smoking status was evaluated with the 'point prevalence abstinence' measurement as the success criteria, success rates were 20.5% with varenicline and 18.6% with bupropion and the difference was not significant (p = 0.646). The individuals who used the medications for 45 days or longer were more successful in smoking cessation (p < 0.001). The most common reasons given for discontinuing the medication were the side-effects (31.5%). No significant difference was determined between the groups in respect of the side-effects observed. CONCLUSIONS: Although the rates of smoking cessation in all the other control points were higher with varenicline than with bupropion, no significant difference was found between the success rates of varenicline and bupropion used in smoking cessation based on the last 7 days at the end of one year. Those who used the medications for 45 days or longer were more successful in smoking cessation.

Candida glabrata Pneumonia in a Patient with Chronic Obstructive Pulmonary Disease.

Pneumonia remains an important cause of morbidity and mortality among infectious diseases. Streptococcus pneumoniae and viruses are the most common cause of pneumonia. Candidiasis in such patients has been associated with haemodialysis, fungal colonization, exposure to broad-spectrum antibiotics, intensive care unit (ICU) hospitalization, and immunocompromised patients. The most common cause of infection is C. albicans. The case presented here is of a 66-year-old male patient diagnosed with C. glabrata. The patient suffered from chronic obstructive pulmonary disease.

Moxifloxacin related thrombocytopeniae: A case report.

Drug-induced thrombocytopenia can be caused by various medications, most frequently, antibiotics. There have been reports of thrombocytopenia cases due to the usage of quinolone antibiotics, although moxifloxacin-related thrombocytopenia has been reported very rarely. The case is here presented of a 60-year old male with chronic obstructive pulmonary disease who presented with complaints of progressively worsening dyspnea. After hospitalization, progressive thrombocytopenia was detected which had started on the 3rd day of moxifloxacin treatment. Other causes of thrombocytopenia were excluded and the thrombocyte count returned to normal after discontinuation of moxifloxacin.

Effect of maternal age on pregnancy outcome and cesarean delivery rate.

BACKGROUND: The aims of this retrospective study were to evaluate the maternal and prenatal outcomes between 35 years and older pregnancies and younger pregnancies, and the effects of the age of pregnancy, mother and newborn. METHODS: Pregnant women who gave birth in Vakif Gureba Training and Research Hospital, Clinic of Obstetrics and Gynecology in 2006 were retrospectively screened. Pregnant women aged 35 years and over were included in this study and the pregnant women between age range of 30 - 34 years were included in the control group. RESULTS: Pregnancy rate was found as 7.1% in 35 years and older women in all the deliveries, cesarean delivery rate was found as 46.1% in this group at 1 year period. However, cesarean delivery rate was 40.9% in the control group. Cesarean delivery rate was found as 31.6% in all the deliveries. The most common cause of cesarean section indication was fetal distress in advanced maternal age (AMA) (11.7%), whereas previous cesarean section was found as the most common cause in the control group (15.1%). CONCLUSION: No significant difference was found between AMA group and normal pregnancies in terms of preterm labor, caesarian section, morbidity, mortality and chronic diseases such as hypertension and diabetes mellitus.