Diagnosis of COVID-19 in Patients with Acute Pulmonary Embolism.

Acute pulmonary embolism (PE) and coronavirus disease -2019 (COVID-19) are life-threatening diseases associated with significant morbidity and mortality. Yet little is known about their co-existence.This study explored clinical and laboratory differences between PE patients who tested positive with real-time reverse-transcription polymerase chain reaction (PCR+) and those who tested negative (PCR-) for SARS-CoV-2. Also, to determine whether ferritin D-dimer ratio (FDR) and platelet D-dimer ratio (PDR) can be used to predict COVID-19 in patients with PE. Files of 556 patients who underwent a computed tomography pulmonary angography (CTPA) examination were retrospectively investigated. Out of them, 197 were tested positive and 188 negative for SARS-CoV-2. One hundred thirteen patients (57.36%) in the PCR+ group and 113 (60.11%) in the PCR- group had a diagnosis of PE. Complaints, respiratory rate, and oxygen saturation level in the blood (SpO2) were recorded at the first admission. Monocyte and eosinophil levels remained low, whereas FDR and PDR were higher in the PCR+ group. No difference was detected in ferritin, D-dimer levels, comorbidities, SpO2, and death rates between the two groups. Cough, fever, joint pain, and higher respiratory rate were more common in the PCR+ group. A decrease in white blood cell, monocyte, and eosinophil levels, whereas an increase in FDR and PDR levels may predict COVID-19 in patients with PE. PE patients complaining of cough, fever, and fatigue should undergo PCR testing as common symptoms. COVID-19 does not seem to increase the risk of mortality in patients with PE.

Comparison of Head and Neck Cancer Distribution in Turkish and Syrian Populations.

BACKGROUND: Although oral health improves in several countries, global problems are still present. Predictably, the disadvantaged and poor population groups in both developing and developed countries have high rate of malign disease. The aim of this study was to evaluate the prevalence of head and neck cancers (HNCs) and to compare them between Syrian and Turkish population. METHODS: A total of 4570 patients confirmed to have HNC histopathologically from Hatay Mustafa Kemal University Hospital Pathology report archive were retrospectively evaluated. Among them, 452 were Syrian patients while 4118 were Turkish patients. Data were collected from 2010 to 2017. Gender and age information were taken from medical records. According to the pathological results, HNCs were classified. RESULTS: In 474 patients, HNCs were inscriptived, of which 317 were in males and 157 in females aged 23-80 years with histologically approved cancer of head and neck area. Overall, 100 were Syrian patients while 374 were Turkish patients. In both Syrian and Turkish patients, the most observed HNC was squamous cell carcinoma (SCC). CONCLUSION: Nowadays, the prevalence of cancer is higher because of the excessive consumption of alcohol, tobacco, chewing, and smoking. For the higher cancer incidence in Syrian refugees, we thought that the impact of war such as stress may have been effective as well as the known several etiologic factors of cancer. For the increased risk of cancer, the early diagnosis of this become more important.

Does transcutaneous nerve stimulation have effect on sympathetic skin response?

OBJECTIVE: This study examined the effects of transcutaneous electrical nerve stimulation (TENS) on the sympathetic nerve system by sympathetic skin response test. METHODS: Fifty-five healthy volunteers received either: (i) 30minutes TENS (25 participants) (ii) 30minutes sham TENS (30 participants) and SSR test was performed pre- and post-TENS. The mean values of latency and peak-to-peak amplitude of five consecutive SSRs were calculated. RESULTS: A significant amplitude difference was found between TENS and sham TENS group both in right and left hand (p=0.04, p=0.01, respectively). However there was no significant latancy difference between two groups (p>0.05 ). CONCLUSION: TENS has an inhibitory effect on elicited SNS responses when compared with sham TENS control group.

Evaluation of purified protein derivates test at tuberculosis dispensary in Hatay, Turkey, applied to Turks and Syrian refugees (2012-2015).

OBJECTIVE: The aim of the study was to evaluate results of purified protein derivates (PPD) test applied at the Tuberculosis Dispensary between 2012-2015 in Hatay, Turkey, where a large number of Syrian refugees have migrated since the Syrian civil war began in 2011. METHODS: PPD test records from the Electronic Tuberculosis Management System at the Tuberculosis Dispensary from 2012-2015 were analyzed based on nationality, age groups, BCG scar availability, and PPD reaction. The annual risk of tuberculosis infection (ARTI) was calculated based on years for each age group in Turks and Syrian refugees and the trend was evaluated. Student-t, Chi-square, and Mantel-Haenszel tests were used in statistical analyses, p < 0.05 was considered significant. RESULTS: In total, 5,255 PPD tests were made, 15.5% were Syrian refugees. BCG scar was missing in 48.5% of Turks and 87.3% of refugees (p < 0.001). The 0-5 age group represented the lowest rate (Turks 3.2%, refugees 4.3%) and the 19-64 age group represented the highest rate (Turks 51.1%, refugees 54.1%) of positive PPD reaction among individuals without BCG scar. Among individuals without BCG scar, more positive PPD reactions developed in refugees of the 6-18 group than in Turks (Turks 16.9%, refugees 46.4%, p < 0.001). Among individuals with BCG scar, more positive PPD reactions developed among refugees of the 0-5 (Turks 7.8%, refugees 24.0%, p = 0.049) and 19-64 (Turks 36.6%, refugees 58.8%, p = 0.028) age groups. ARTIs between 2012-2015 were 0.2%, 1.0%, 1.3%, and 1.4% among Turks, (except 2012) 2.3%, 0.3%, 2.4% among refugees in the 0-5 age group, 1.1%, 2.0%, 1.7%, and 1.5% among Turks, and 8.5%, 6.6%, 7.3%, and 2.4% among refugees in the 6-18 age group, respectively. CONCLUSION: Higher positive PPD reactions and ARTIs were found among Syrian refugees, more specifically in the 6-18 age group.

An evaluation of knowledge, attitudes, and behaviors of employees of a university hospital in an H1N1 influenza pandemic.

INTRODUCTION: In this study, we aimed to evaluate the knowledge, attitudes, and behaviors concerning the transmission routes of an H1N1 pandemic and the protective measures of health professionals at a university hospital in Turkey. METHODOLOGY: A stratified systematic sampling method was used to select the sample size of the study group. A total of 22 professors, 29 researchers, and 26 nurses were included in the study. RESULTS: The mean scores of the individuals were 8.4±2.5 (over 20) for knowledge about H1N1 transmission, 27.6±4.0 (over 60) for knowledge about protection against H1N1, 25.8±4.2 (over 45) for correct or appropriate attitudes, and 33.6±8.9 (over 60) for correct behaviors. A negative correlation between total knowledge and behavior was found (p < 0.001, r = -0.543). CONCLUSIONS: In epidemics, standard protection measures should be known and applied. Regarding this topic, the web page of the Ministry of Health comes to the forefront as a reliable source of information in addition to scientific explanations.

Iodine, copper, zinc, selenium and molybdenum levels in children aged between 6 and 12 years in the rural area with iodine deficiency and in the city center without iodine deficiency in Hatay.

AIM: Thyroid diseases related with iodine deficiency are observed commonly in our country and in the world. In this study, we aimed to investigate iodine deficiency in urine and selenium, zinc, copper or molybdenum deficiency which may accompany this in children aged between 6 and 12 years in two schools in the province of Hatay (endemic goitre region). MATERIAL AND METHODS: This study is a case-control field-study in which students aged between 6 and 12 years were included. One hundred fourteen subjects from the village of Tanisma related to the center of our province and 100 subjects from the city center of Hatay (Antakya) were included in the study. Iodine, selenium, zinc, copper and molybdenum levels were measured in the urine samples of the students included in the study. RESULTS: Iodine deficiency was found with a severe (5%), moderate (18.4%) and mild degree (43%), respectively in the village of Tanisma. Mild iodine deficiency (7%) was found in the center of Hatay. No moderate and severe iodine deficiency was found in the control group. A significant difference was found between the groups in terms of urine iodine excretion (p<0.001). A significant correlation was found between the levels of iodine, selenium, zinc and molybdenum (p<0.05). A moderately positive correlation was found between iodine and selenium (p<0.001). A moderately positive correlation was found between iodine and zinc levels (p<0.001) and a weak correlation was found between iodine and molybdenum (p<0.01). No significant correlation was found between iodine level and copper level (p>0.05). CONCLUSIONS: Selenium and zinc deficiency may accompany iodine deficiency. Selenium and zinc deficiency should be considered in individuals who are found to have iodine deficiency especially in endemic goitre regions.

Association Between Internet Use and Sleep Problems in Adolescents.

INTRODUCTION: Sleep problems are commonly encountered in adolescents. It has been shown that electronic media have a negative influence on the sleep quality and daytime functioning in adolescents. This study aims to investigate the association between internet use and sleep problems in adolescents. METHOD: A total of 1212 adolescents were recruited to the study. Self-report study questionnaire included two main parts: Young's Internet Addiction Scale (IAS) and a semi-structured inquiry on sleep habits/problems. RESULTS: Of the study sample, 16% (n=198) reported their sleep quality as bad or very bad. One-fourth of the sample reported using internet everyday and 27% of them reported spending more than one hour when online. The mean IAS total score was 35.56±13.87. Adolescents with a higher IAS score reported getting to bed later in the night, needing more time to fall asleep and having an increased number of awakenings in the night than the adolescents with lower IAS score (p=.001). They were also found to have higher frequencies of several sleep problems including difficulty in initiating and sustaining sleep, difficulty in waking up and feelings of sleepiness in day. In addition, sleep quality of them was worse when compared to the adolescents with a lower IAS score (p=.001). CONCLUSION: Problematic sleep habits and sleep problems were found to be more frequent in adolescents with a higher IAS total score. Health care providers must be aware of the possible negative impact of excessive and uncontrolled internet use on adolescents' sleep habits.

The relationship between women's mental health and domestic violence in semirural areas: a study in Turkey.

UNLABELLED: The authors examine the relationship between emotional disorders and domestic violence (DV) in 395 women of different ethnicities in Turkey. PRIME MD (Primary Care Evaluation of Mental Disorders) was used for diagnosis. This is a cross-sectional and epidemiological research. RESULTS: showed that the prevalence of emotional disorders, anxiety, and somatoform disorders was 22.8%, 24.8%, and 16.9%, respectively. The mean DV score was 2.98±1.32 over 10.00. DV scores were higher when women did not want to get married or did not have their family's blessing for marriage. Observed scores were also high for civil marriage cases, or when women had a job, had low income, or were afraid of their husbands (P<.05). The number of comorbid diagnoses increased with increase in DV scores (P<.001). Mean DV scores were higher for women diagnosed with major depression, partial remission or recurrence of major depression, panic disorder, and common anxiety (P<.05). The authors recommend that if physicians suspect any emotional disorders in women in primary care, they should evaluate for DV.

Myocardial perfusion SPECT and dobutamine stress tissue Doppler imaging in evaluation of patients with stable angina pectoris.

OBJECTIVE: To evaluate longitudinal function of ischemic and nonischemic myocardial tissue detected by Tc-99m MIBI single photon emission computed tomography (SPECT) prior to coronary revascularization in patients with stable angina pectoris. METHODS: We studied 24 consecutive patients (mean age 62+/-9 years; 5 women) with stable angina pectoris. All patients underwent myocardial perfusion SPECT. Tissue Doppler imaging (TDI) was performed to detect myocardial systolic velocities of anterior, inferior, septum and lateral walls at rest and peak dobutamine stress. RESULTS: A total of 96 segments were visualized with SPECT study. Maximum mean septal, lateral, anterior and inferior TDI systolic velocities were similar in ischemic and nonischemic segments (6.73+/-1.04 cm/sec, 6.93+/-1.34 cm/sec, respectively) at rest. At peak stress, maximum mean TDI systolic velocities were lower in the 37 ischemic segments (11.00+/-2.03 cm/sec) than 59 nonischemic segments (13.76+/-1.97 cm/sec, p = 0.001). Because we detected ischemia in whole group using both diagnostic tests, coronary angiography was decided. Critical coronary artery stenosis related to ischemic segments was detected and coronary revascularization decided. CONCLUSION: TDI with dobutamine stress can be used in patients with stable angina pectoris. In this study, we observed that quantitative data by TDI associated with SPECT showed an agreement for coronary revascularization.

Hemoglobinopathy awareness among high school students in Antakya (Antioch), Turkey.

Hemoglobinopathy is a major public health problem in Eastern Mediterranean, Turkey, where homozygote babies continue to be born. We wanted to present the knowledge of high school students and their attitudes on hemoglobinopathy in Antakya (center of Hatay).The study was performed on 11th grade students in 17 high schools and 486 students in the center at Antakya. We used a questionnaire and frequency tables and chi-square tests were used. Of the students who took part, 37.7% were previously informed about hemoglobinopathies, while 62.3% were not. There was no significant relationship between the school types and their being previously informed (p > 0.05). There was an index case for 28% of the students, and 25.4% of the students who did not have any diseased person around them were previously informed (p < 0.01). While the range of percentage of correct answers was between 17.5% (about treatment of the diseases) and 73.3% (about the carrier status), these percentages seemed to be higher for those who stated that they were previously informed (22.2% about treatment and 85.8% about the carrier status). As much as 83.7% of the students stated that they wanted to be educated about hemoglobinopathies in the school and 89.1% wanted to know if they were carriers. Our study suggests that there is an urgent need to revise the Hemoglobinopathy Control Programme especially with regard to the enlightenment of the students and public.

Formaldehyde technique in dimensional stability of free fascia: an animal study.

CONCLUSION: Despite the fact that this was a study done with fascia other than the temporalis, we found that non-formaldehyde-formed and formaldehyde-formed fascia graft shrunk by a mean value of 26.5% and 16.7%, respectively, which was statistically significant. This finding might be the explanation for the consistently reported successful outcomes in tympanoplasty carried out with formaldehyde-formed temporalis fascia. However, this study should be validated with autologous human temporalis fascia graft. OBJECTIVES: To determine whether there is any difference in the dimensional stability of free fascia grafts when formed with formaldehyde or not. MATERIALS AND METHODS: In a total of 22 rats, free fascias were prepared with 4% buffered formaldehyde solution in 11 and without formaldehyde in the other 11 rats. All fascia grafts of 1 x 1 cm were implanted under the insicion site of the same rat (autograft). All rats were re-operated after 5 days to measure the dimensions of the grafts. The postoperative changes in the dimensions were calculated. RESULTS: By the 5th day, the mean non-formaldehyde-formed graft surface area was 73.51+/-13.43 mm(2) and the mean formaldehyde-formed graft surface area was 83.28+/-10.50 mm(2) respectively. After 5 days there was a mean decrease in surface area of the non-formaldehyde-formed and formaldehyde-formed grafts of 26.49+/-13.43 mm(2) and 16.72+/-10.50 mm(2), respectively. It was found that formaldehyde-formed fascia exhibited significantly superior dimensional stability when compared with non-fixed fascia during the 5 days of the early healing phase (p=0.031).

Skin diseases in patients with beta-thalassemia major.

BACKGROUND: Beta-thalassemia major affects multiple organs and is associated with considerable morbidity and mortality. The goal of this analysis was to document the frequency of skin diseases among patients with beta-thalassemia major. METHODS: A sample of 78 patients with beta-thalassemia major was recruited and interviewed at the thalassemia clinic between April and June 2008. A dermatologist completed a skin examination of each patient and recorded any skin disease present. The patients' laboratory results and treatment modalities were recorded from the charts. RESULTS: Sixty-five (83.3%) of the 78 patients examined had a diagnosed skin disease: pruritus (37.2%), xerosis (34.6%), scars (24.4%), ephelides (23.1%), skin irritation/erythema caused by deferoxamine pump (12.8%), idiopathic guttate hypomelanosis (6.4%), pityriasis alba (6.4%), tinea infections (5.1%), verruca vulgaris (5.1%), urticaria (3.8%), hyperhidrosis, contact dermatitis, and acne (2.6%), necrobiosis lipoidica (1.3%), melasma (1.3%), and others (14.1%). Pruritus and xerosis increased in frequency with age. The mean serum ferritin level was higher in patients with xerosis than in those without (5607.7 +/- 2997.5 ng/mL and 4285.2 +/- 4732.4 ng/mL, respectively) (P1/4 0.005). Moreover, xerosis was observed significantly more frequently inpatients using deferoxamine and deferiprone than in those using deferasirox (P1/4 0.047, P1/4 0.027, and P1/4 0.273, respectively). CONCLUSION: Skin diseases, especially pruritus and xerosis, are observed highly frequently inpatients with beta-thalassemia major. Treatment is needed for these patients who already have other significant morbidities.

Dermatoglyphs in patients with beta-thalassemia major and their thalassemia carrier parents.

Dermatoglyphs are cutaneous ridges on the fingers, palms, and soles, formed during early intrauterine life. During this period, and only then, genetic and environmental factors can influence their formation. Beta-thalassemia major is an genetic disease. The aim of the present work was to analyze dermatoglyphs traits in subjects with beta-thalassemia major and their thalassemia carrier parents. The sample included 59 patients with beta-thalassemia major (39 males, 20 females). We also analyzed a total of 61 thalassemia carrier parents. There were 38 mothers and 23 fathers in the study. The control group comprised 120 healthy subjects (64 men, 56 women). All ten fingers and right hand palm prints of all participants were taken and statistically analyzed. The results of analyses showed that the frequency of loops on the fifth finger of left hand was significantly higher in female patients than that of carriers and controls (p < 0.05). It was also significantly higher in female patients than that male patients (p = 0.03). The increase in mean c-d ridge count was noticed in female patients only (p = 0.04) compared to carriers and controls. In addition to that there was also differences according to the mean c-d ridge count between female and male patients (p = 0.01). Our study showed that dermatoglyphs were helpful for the diagnosis of beta-thalassemia major. However, it does not help to detect thalassemia carriers. This study is the comprehensive dermatoglyphic research on thalassemia, and its dermatoglyphic data will be useful for future research in genetics and medicine.

Frequency of metabolic syndrome among hemodialysis patients according to NCEP-ATP III and IDF definitions.

Objective. Patients with chronic renal failure (CRF) have an increased risk of death from cardiovascular diseases. The metabolic syndrome is a common risk factor for cardiovascular diseases. In the present study, it was aimed to evaluate the frequency of metabolic syndrome using the National Cholesterol Education Program Adults Treatment Panel III (NCEP-ATP III) and the International Diabetes Federation (IDF) definitions in patients with end-stage CRF undergoing hemodialysis (HD). Materials and Methods. A total of 222 cases undergoing HD were enrolled in the study. After obtaining medical history and physical examination, blood samples were collected from each patient for the measurements of fasting blood glucose, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides. Results. Among HD patients evaluated according to both IDF and NCEP-ATP III definitions, the diagnosis of metabolic syndrome was confirmed by IDF in 56.5% of those fulfilling the criteria for NCEP-ATP III. Similarly, 86% of the undiagnosed patients according to NCEP-ATP III were confirmed by IDF definitions. The sensitivity and positive predictive value of NCEP-ATP III for metabolic syndrome were 81.25% and 64.8%, respectively. The area under the Receiver Operating Characteristic (ROC) curve for NECP-ATP III and IDF was 0.730. False-positive rate and probability ratio for NECP-ATP III were 0.352 and 2.49, respectively. In other words, among the patients who were diagnosed with metabolic syndrome according to NCEP-ATP III definitions, the proportion of subjects whose diagnosis was confirmed by IDF definitions was 2.49-fold higher than those with unconfirmed diagnosis. Conclusion. It is logical to evaluate patients with CRF for metabolic syndrome and cardiovascular risk factors at the time of diagnosis and regularly thereafter due to the high ratio of metabolic syndrome in this population.

Treatment of lateral epicondilitis using three different local injection modalities: a randomized prospective clinical trial.

BACKGROUND: To determine the effectiveness of three different local injection modalities in the treatment of lateral epicondilitis. METHODS: In a prospective randomized study on lateral epicondilitis, 75 patients were divided into three equal groups A, B and C (n = 25) and were treated using three different method of local injection. The patients in group A were treated with local injection of a steroid (1 mL triamcinolone) combined with local anaesthetic (1 mL lidocaine), those in group B were treated with injection of local anaesthetic (1 mL lidocaine) combined with peppering technique and those in group C with local injection of a steroid (1 mL triamcinolone) combined with local anaesthetic (1 mL lidocaine) and peppering technique. The outcome was defined by measuring the elbow pain during the activity using a 10-cm visual analogue scale (VAS) and satisfaction with the treatment using a scoring system based on the criteria of the Verhaar et al. at 3 weeks and 6 months after the injection and compared with the pre-treatment condition. RESULTS: There were significant (P = 0.006) differences in the successful outcomes between the three groups at 6 months. In group C in which local steroid + peppering injection technique were used; excellent results were obtained in 84% of patients comparing to 36% and 48% for patients in groups A and B, respectively. The successful outcomes were statistically higher in group C comparing to group A (P = 0.002) and group B (P = 0.011). In all groups, there was a significantly lower pain (VAS) at the 3-week and 6-month follow-ups comparing to the pre-treatment condition. VAS measured at 6-month follow-up were significantly lower in group C comparing to other groups (P = 0.002). CONCLUSION: In the treatment of lateral epicondilitis, combination of corticosteroid injections with peppering is more effective than corticosteroid injections or peppering injections alone and produces better clinical results.

Causes of nosocomial pneumonia and evaluation of risk factors in a university hospital in Turkey.

OBJECTIVE: To determine the incidence, risk factors, mortality rate, and organisms causing nosocomial pneumonia (NP). METHODS: We carried out this study in the Intensive Care Units (ICUs), General Medical and Surgical wards of Baskent University, Training and Research Hospital in Adana, Turkey, between November 2000 and August 2002. Patients were observed from the time of admission until 48 hours after discharge from the hospital. RESULTS: In this study, 618 (2.1%) nosocomial infections (NIs) were detected in 29778 patients. One hundred and fifteen of these infections were NP and investigated with surveillance prospectively. The most frequently isolated microorganisms in NP were methicillin-resistant Staphylococcus aureus (MRSA) 32.8%, Pseudomonas species 21.5%, methicillin-sensitive Staphylococcus aureus (MSSA) 10.2%, Klebsiella species (9.1%) and Acinetobacter species 5.9%, E. coli; 5.4% (10/186), Streptococcus species; 4.8% (9/186), Candida species; 4.8% (9/186), Enterobacter species; 2.7% (5/186) and the other bacteria; 2.7%. The predominant pathogens isolated in this study were MRSA (33.8%), Pseudomonas species (16.9%) and MSSA (16.9%) in early-onset pneumonias and MRSA (32.2%), Pseudomonas species (24.0%), and Klebsiella species (10.7%) in late-onset pneumonias. CONCLUSION: This study demonstrated that the possibility of developing NP, significantly increases with such risk factors as decreased level of consciousness, respiratory failure, mechanical ventilation and tracheostomy. Each center should know its patients' profile, the factors that increase the infection, the antibiotic resistance patterns of microorganisms, and the distribution of hospital infections in every department. Strategies to prevent both development of antibiotic resistance and spread of resistant organisms are necessary.