Spatial analysis of perinatal mortality rates with geographic information systems in Kocaeli, Turkey.

OBJECTIVES: To determine the spatial patterns of perinatal mortality in Kocaeli, Turkey using geographic information systems (GIS); to examine whether regional differences exist for the period selected; and whether these differences are linked to regional risk factors. STUDY DESIGN: Ecological research. METHODS: Data were obtained from the linked birth-death records data registry maintained by Kocaeli Provincial Health Directorate. Mortality data are added to the geodatabase on a monthly basis. Spatial patterns of mortality rates were determined with GIS by mapping the case differences in the districts, and spatial autocorrelation was used to examine the spatial pattern of mortality rates in the region. RESULTS: Various risk factors contributing to spatial variation of perinatal mortality were revealed in the region. Districts with high mortality rates were shown to be sensitive to these risk factors. The results of this study confirm the direct link between perinatal mortality and poor environmental conditions in the study region. The analyses applied in the study showed that some complex demographic and socio-economic factors should be associated with perinatal mortality rates to identify the geographic patterns of mortality. CONCLUSIONS: Implementation of spatial tools within GIS for mortality data showed the efficiency of GIS in perinatal mortality surveillance. This study also demonstrated the capability and utility of GIS to clarify the geographical distribution of perinatal mortality rates in the study area.

Association of glomerular filtration rate and inflammation with left ventricular hypertrophy in chronic kidney disease patients.

BACKGROUND: Although left ventricular hypertrophy (LVH) is an independent predictor of mortality in patients with end stage renal disease, few have examined its prevalence before the initiation of dialysis. The aim of this study was to investigate the relationship between LVH, estimated glomerular filtration rate (GFR), and inflammatory markers in patients with chronic kidney disease (CKD). METHODS: Forty-one CKD patients (18 women, 23 men, mean age 53±17 years) with an estimated GFR between 15 and 59 mL/min (mean 34.2 mL/min) were enrolled and the following tests performed: routine serum biochemical analyses, high sensitivity C-reactive protein (hs-CRP), fibrinogen, ferritin, and homocysteine, and left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF), and left ventricular fractional shortening (LVFS). RESULTS: LVH was diagnosed in 32/41 patients (78%). CKD patients with LVH (n=32) had significantly higher hs-CRP (p=0.012), fibrinogen (p=0.031), and lower serum albumin (p=0.028) levels than those without LVH (n=9). In all patients, LVMI correlated positively with hs-CRP (r=0.483, p=0.002) and serum fibrinogen (r=0.426, p=0.015). Estimated GFR correlated positively with LVEF (r=0.414, p=0.007) and LVFS (r=0.376, p=0.018). CONCLUSIONS: Important positive associations exist between markers of inflammation and LVMI in patients with CKD. In addition to hs-CRP, elevated fibrinogen may portend the development of LVH in patients with CKD who are not yet on dialysis.

Association of adiponectin, resistin and high sensitive CRP level with the metabolic syndrome in childhood and adolescence.

Early markers are required in pathophysiological process of obesity, MS and type 2 diabetes. We aimed to clarify the usefulness of serum adipokines (adiponectin, AD and resistin) and inflammatory markers to identify obese and overweight children with MS. Three hundred and seven of 2 491 subjects aged 11-19 with BMI> or =85 centile selected with a multistage, stratified sampling were included. Their height, weight and waist circumference were measured, all subjects underwent physical examination and standard OGTT. AD, resistin and hs-CRP were measured from baseline blood sample. The mean age of subjects was 14.2+/-1.8, 57.7% was girl (n=177) and 42.3% (n=130) boy. Of the 307 subjects 40 (13%) were classified as having MS. Serum AD levels were significantly lower in boys (p=0.02), and decreased while BMI increased, but this trend was not significant (p>0.05). Although median resistin values were higher in obese than others (20, 18.5, 17 ng/ml, respectively) it was not significant (p>0.05). In obese subjects, hs-CRP levels were significantly high (0.21 mg/L) (p=0.000). All three markers in obese and overweight children with and without MS were not significant (p>0.05). Girls with MS had lower adiponectin levels than those without MS. Waist circumference had the highest sensitivity and specificity for predicting MS in ROC analysis. The area under the curve (AUC) was 0.831 for WC standard error (SE) 0.033; 95% CI 0.767-0.896; p<0.0001. But the AUCs for the adiponectin, resistin, hs-CRP were not significant. In this study, we observed that adipokines or inflammatory markers have no predictive value in the diagnosis of MS. We concluded that the best marker for MS diagnosis is the measurement of waist circumference.

Risk factors for overall and persistent diarrhoea in infancy in Antalya, Turkey: a cohort study.

The aim of this study was to identify factors that influence the incidence of diarrhoea in infancy. The study was a prospective cohort study conducted in two primary healthcare unit areas in Antalya, Turkey. A total of 204 infants were followed until they were aged 1 year. Morbidity surveillance and anthropometric measurements were carried out by home visits every 2 months. The average incidences were found to be 2.76 episodes per child-year for overall diarrhoea and 18.56 episodes per 100 child-years for persistent diarrhoea. Relative risks, confidence intervals and logistic regression analyses were used to assess the associations. For both overall diarrhoea and persistent episodes, increased risks were associated with having an uneducated mother (RR=1.89 and 5.33, respectively) and a self-employed father (RR=1.89 and 3.77, respectively). Among environmental factors, living in a slum was associated with both overall (RR=1.68) and persistent (RR=2.69) diarrhoea, whereas living in a crowded house (RR=1.70), having no kitchen (RR=2.27) or having an unhygienic toilet (RR=1.93) were found to be significant for overall episodes alone. Factors related to the infant were preterm birth (RR=1.64), low birth weight (RR=2.05), and first breastfeed given more than 1 h after birth (RR=1.64). Nutritional status was also associated with overall or persistent diarrhoea: underweight children (RR=2.15, persistent diarrhoea only), stunted children (RR=1.67 and 2.14, respectively) or wasted children (RR=1.54 and 3.20, respectively). By logistic regression analysis, both overall and persistent diarrhoea were found to be associated with mother's education.

The effect of combined spinal-epidural (CSE) anaesthesia and size of spinal needle on postoperative hearing loss after elective caesarean section.

The exact aetiology of vestibulocochlear dysfunction after spinal anaesthesia is unknown. Low-frequency hearing loss occurs after spinal anaesthesia. The aim of this study was to investigate the effects of combined spinal-epidural (CSE) anaesthesia and size of spinal needle on vestibulocochlear dysfunction, using pure tone audiometry performed pre- and on the first and the second day postoperatively. Forty-five patients who were to undergo elective caesarean section were evaluated. In group I, CSE anaesthesia (18 G Tuohy, 25 G Whitacre pencil-point-design spinal needles) was performed in 15 patients. In group II, spinal anaesthesia was performed in 15 patients with 25 G Whitacre pencil-point-design spinal needles and, in group III, spinal anaesthesia was performed in 15 patients with 22 G Whitacre pencil-point-design spinal needles. In the pre- and on the first and the second day postoperatively, the pure tone audiogram was performed in the audiology laboratory of our hospital, using a calibrated Kamplex Diagnostic Audiometer AC 40 in a noise-free room. When the CSE anaesthesia group and 22 G spinal group were compared for change in hearing between the pre- and postoperative periods, a statistically significant difference was observed at R-right ear 125 Hz (P < 0.025) and at L-left ear 125 Hz (P < 0.023), and at L-left ear 1000 Hz (P < 0.036) and at R-right ear 1500 Hz (P < 0.006), and at L-left ear 1500 Hz (P < 0.022). At other frequencies, the difference was insignificant. When the CSE anaesthesia group and 25 G spinal group were compared for change in hearing between the pre- and postoperative periods, no statistically significant difference was detected at any frequency tested. When 22 G spinal group and 25 G spinal group were compared for change in hearing between the pre- and postoperative periods, there was some hearing loss at low frequency, although this difference did not reach statistical significance. The positive correlation of low-frequency hearing loss and increased pressure in the epidural space (which decrease the risk of cerebrospinal fluid leakage through the dura) suggests that cerebrospinal fluid leakage via the spinal puncture hole is not the only factor involved. Perioperative fluid replacement alone may not prevent hearing loss but CSF loss through the dural puncture site should also be prevented.