A Critical Assessment of the Quality of Reporting of Ethical Protections in Medical Papers Published in Turkey.

The Declaration of Helsinki (DoH), the International Committee of Medical Journal Editors (ICMJE) recommendations, and the Committee on Publication Ethics (COPE) guidelines outline the basic principles for ethical conduct and publication of human-subject research, most notably informed consent (IC) and research ethics committee (REC) approval. This retrospective observational study was a first study to investigate the quality of reporting of these protections in a selected sample of medical papers published in Turkey. A total of 573 research articles published in the official journals of six leading Turkish medical schools between January 2018 and December 2020 were searched for information on obtaining (i) REC approval, (ii) written IC from research subjects or their legal guardians/representatives, and (iii) an REC-granted IC waiver when it was found, as stated in the DoH, "impossible or impracticable to obtain consent" from research subjects. Similarly, a total of 166 case reports were searched for a statement about publication-specific IC, as was recommended by COPE. Despite a statistically significant improvement over the years, the overall rates were found to be unsatisfactory. The protections were particularly misused or underused in retrospective research, where the rates of reporting written IC (15.41% vs. 48.61%) and REC approval with date and reference number information (45.38% vs. 61.11%) were significantly lower than in prospective research (p < .05). Both the practices of seeking and granting an IC waiver when no IC was obtained were extremely rare (n = 3). It was also found that the requirement of structured ethical information in research papers was associated with higher levels of ethics compliance, and that medical publishing in Turkey needed specific improvements, including better implementation of the protections already adopted in principle, clearer instructions for authors, more rigorous editorial scrutiny, and greater commitment to rejecting substandard submissions.

Correlation of the Grade Group of Prostate Cancer according to the International Society of Urological Pathology (Isup) 2014 Classification between Prostate Biopsy and Radical Prostatectomy Specimens.

ABTRACTWe aimed to assess the correlation between ISUP 2014 grades of needle biopsy (NB) and radical prostatectomy (RP) specimens and the parameters effecting this correlation. A total of 353 patients, who underwent a radical prostatectomy with diagnose of prostate cancer, were included in the study. Especially, the maximum percentage of core involved by cancer (MPCI) of upgraded group was significantly higher than those of correlated group and downgraded group. MPCI might be used as a preoperative value to determine risk classification and to help counsel patients with regard to treatment decision and prognosis of disease.

The 1918 "Spanish Flu" Pandemic in the Ottoman Capital, Istanbul.

Although the general course, possible transmission routes, and actual sociodemographic destruction of the 1918 influenza pandemic in the Western world are well documented, the literature lacks similar data about the Middle East. On the calamity's centenary, this article aims to contribute to filling this gap, investigating the presence and effects of the pandemic in Istanbul, the city bridging the West and East, then as the capital of the Ottoman Empire. After the retrieval of the most relevant articles in Vakit, a daily Istanbul newspaper active throughout the pandemic, a variety of items, including articles with firsthand pronouncements from contemporaneous medical authorities and a clinical account of supportive autopsy findings, are scrutinized and interpreted. The reviewed data are concluded to indicate no epidemiological or factual exception, showing significant parallelism with the Western experience of the pandemic in terms of increased influenza mortality and morbidity, severe clinical presentation, common misinformation and misdiagnosis, and failure to provide effective prevention and medical treatment.

A randomized, double-blind study of the ultrasound assessment of the effect of pharyngeal packing on perioperative gastric volume in nasal surgery.

BACKGROUND: Pharyngeal packing (PP) is commonly performed to reduce the incidence of perioperative blood ingestion (PBI) in nasal surgery (NS), and thus the incidence and severity of postoperative nausea and vomiting (PONV). This study examined the effects of PP on the perioperative gastric volume (GV) and PONV in patients undergoing NS, by ultrasound assessment. METHODS: Patients undergoing elective NS [septoplasty, septo-rhinoplasty (SRP) and functional endoscopic sinus surgery (FESS)] were randomised to receive or not receive PP. In the PP group, pharyngeal packs were placed after the orotracheal intubation. Ultrasound assessments were performed for all patients preoperatively (before the anaesthesia induction) and postoperatively (before the extubation). The antero-posterior (AP) and cranio-caudal (CC) antral diameters, antral cross-sectional area (ACSA), and total GV were calculated. PONV incidence and severity were rated. These variables were compared between timepoints and groups, and in the subgroup analyses according to the surgery type. Pearson correlation analysis was performed to assess correlations between the variables. RESULTS: AP and CC diameters and ACSAs were greater postoperatively than preoperatively in the PP and non-PP groups (n = 44 each; all p < 0.05). Postoperative AP and CC diameters and the ACSA were greater in the non-PP than in the PP group (all p < 0.05). Postoperative AP diameters were greater than preoperatively in patients undergoing SRP and FESS, and the postoperative CC diameter and ACSA were greater than preoperatively in patients undergoing SRP (all p < 0.05). Surgery duration was correlated positively with postoperative AP diameter (r = 0.380, p < 0.05), CC diameter (r = 0.291, p < 0.05), and ACSA (r = 0.369, p < 0.05). Patients who underwent septoplasty surgery, PP was decreased PONV incidence and severity at the first four hours, postoperatively (p < 0.05). CONCLUSIONS: The study findings indicate that PP reduces the increase in the perioperative GV due to PBI in an elective NS. It is therefore a useful and safe means of reducing the risk of perioperative pulmonary aspiration in such surgeries. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCT), ACTRN12619000487112 , 25/03/2019, Trial registration retrospectively registered.

Plateletcrit: A possible biomarker of inflammation in hepatitis A infection.

OBJECTIVES: Hepatitis A (HepA) virus is a common infection worldwide that causes inflammation of the liver. Platelet index, particularly plateletcrit (PCT) which shows percentage of blood occupied by platelets, is thought to be potential marker of inflammation. Therefore, we aimed to investigate the changes in PCT percentages during HepA infection. SUBJECTS AND METHODS: Seventy-three children with a diagnosis of acute HepA infection and 68 age- and sex-matched healthy controls were enrolled in this study. Their values of platelet indices [PCT and mean platelet volume (MPV)] obtained from complete blood counts, which were analyzed by XN-1000 analyzer, were statistically compared with each other. RESULTS: PCT and MPV of the patients were found to be higher than those of controls (8.89 ± 1.30 vs 8.03 ± 0.89 for MPV and 0.29 ± 0.11 vs 0.24 ± 0.05 for PCT; P = 0.000, P = 0.002, respectively). In addition, PCT and platelet counts showed a significant negative correlation with alanine aminotransferase (ALT) levels, which indirectly represents inflammation in the liver (PCT: r = -0.368, P = 0.002; platelet count: r = -0.304, P = 0.009). In contrast, MPV levels were not found to demonstrate any correlation with ALT (r = -0.205, P = 0.082). CONCLUSION: Both MPV and PCT are capable of reflecting the inflammation during acute HepA inflammation. Also, PCT shows a significant negative correlation with the degree of inflammation.

Association between neutrophil/lymphocyte ratio with ductus arteriosus patency in preterm newborns.

OBJECTIVE: The aim of this study was to assess the influence of neutrophil to lymphocyte (N/L) ratio and platelet indices on patent ductus arteriosus (PDA) in preterm infants. BACKGROUND: PDA is a common problem with potentially serious associated morbidities in preterm neonates. METHODS: Premature infants with hemodynamically significant PDA (n = 47) and a control group without PDA (n = 50) who were hospitalized in the neonatal intensive care unit were retrospectively evaluated. The characteristics, perinatal factors, N/L ratio, platelet counts and other platelet indices of the infants in both groups during the first 3 days of life were recorded. RESULTS: Platelet counts were significantly lower in the patient group than in the control group (p = 0.0343). There was a marked positive correlation between body weight and N/L ratio in preterm infants with PDA (p = 0.0001). PDA was associated with low platelet count. CONCLUSION: Our results showed that N/L ratio is positively correllated with body weight in PDA group. These data suggest that platelet counts and N/L ratio might be useful predictors for the early diagnosis and evaluation of the clinical course of PDA in preterm infants (Tab. 2, Ref. 28).

Gordon's model applied to nursing care of people with depression.

BACKGROUND: Psychiatric nurses should consider the patient's biological, psychological and social aspects. Marjory Gordon's Functional Health Pattern Model ensures a holistic approach for the patient. AIM: To examine the effectiveness of Gordon's Functional Health Pattern Model in reducing depressive symptoms, increasing self-efficacy, coping with depression and increasing hope in people with depression. DESIGN: A quasi-experimental two-group pre-test and post-test design was adopted. METHODS: Data were collected from April 2013 to May 2014 from people with depression at the psychiatry clinic of a state hospital in Turkey; they were assigned to the intervention (n = 34) or control group (n = 34). The intervention group received nursing care according to Gordon's Functional Health Pattern Model and routine care, while the control group received routine care only. The Beck Depression Inventory, Beck Hopelessness Scale and Depression Coping Self-Efficacy Scale were used. RESULTS: The intervention group had significantly lower scores on the Beck Depression Inventory and Beck Hopelessness Scale at the post-test and 3-month follow-up; they had higher scores on the Depression Coping Self-Efficacy Scale at the 3-month follow-up when compared with the control group. LIMITATION: The study was conducted at only one psychiatry clinic. The intervention and control group patients were at the clinic at the same time and influenced each other. Moreover, because clinical routines were in progress during the study, the results cannot only be attributed to nursing interventions. DISCUSSION: Nursing models offer guidance for the care provided. Practices based on the models return more efficient and systematic caregiving results with fewer health problems. CONCLUSION: Gordon's Functional Health Pattern Model was effective in improving the health of people with depression and could be introduced as routine care with ongoing evaluation in psychiatric clinics. More research is needed to evaluate Gordon's Nursing Model effect on people with depression. Future studies could focus on the effects of this nursing model on people with other psychiatric disorders. IMPLICATIONS FOR NURSING AND HEALTH POLICY: This study highlighted that psychiatric nurses' role decreased depressive symptoms and hopelessness, and increased coping and self-efficacy in people with depression.

Salivary glucose concentration and excretion in normal and diabetic subjects.

The present report aims mainly at a reevaluation of salivary glucose concentration and excretion in unstimulated and mechanically stimulated saliva in both normal and diabetic subjects. In normal subjects, a decrease in saliva glucose concentration, an increase in salivary flow, but an unchanged glucose excretion rate were recorded when comparing stimulated saliva to unstimulated saliva. In diabetic patients, an increase in salivary flow with unchanged salivary glucose concentration and glucose excretion rate were observed under the same experimental conditions. Salivary glucose concentration and excretion were much higher in diabetic patients than in control subjects, whether in unstimulated or stimulated saliva. No significant correlation between glycemia and either glucose concentration or glucose excretion rate was found in the diabetic patients, whether in unstimulated or stimulated saliva. In the latter patients, as compared to control subjects, the relative magnitude of the increase in saliva glucose concentration was comparable, however, to that of blood glucose concentration. The relationship between these two variables was also documented in normal subjects and diabetic patients undergoing an oral glucose tolerance test.

Reproducibility of grading systems for endometrial endometrioid carcinoma and their relation with pathologic prognostic parameters.

The FIGO grading for endometrial endometrioid carcinomas is widely accepted. In 2000, a novel binary architectural grading system was suggested that divided endometrioid carcinomas into low- and high-grade tumors. We aimed to evaluate the interobserver reproducibility of the FIGO, the architectural binary, and nuclear grading systems and the correlation between these grading systems and pathologic prognostic factors for endometrial endometrioid carcinoma. Eighty-eight endometrial endometrioid carcinomas from hysterectomy specimens were reevaluated by two pathologists independently. Kappa values for the FIGO, the binary, and the nuclear grading systems were 0.65, 0.67, and 0.09, respectively. The reproducibility of the FIGO and the binary grading systems was similar and substantial. FIGO grade 1 (60.2%) patients were comparable to binary low-grade (63.6%) patients. Most of the FIGO grade 3 (83%) patients were binary high grade. FIGO grade 2 patients were distributed between binary low and high grades. The FIGO grade 1 and 2 cases judged to be of binary high grade had deep myometrial invasion, and more cases had vascular invasion in comparison with FIGO grade 1 and 2 cases judged to be of binary low grade. In uni- and multivariate analyses, both grading systems, depth of myometrial invasion, vascular invasion, cervical involvement, and stage had no effect on overall survival. But binary high grade and vascular involvement are adverse prognostic factors on recurrence-free survival. Binary high-grade patients can be assigned as high-risk patients.

Anti-Saccharomyces cerevisiae antibodies (ASCA) in spondyloarthropathies: a reassessment.

OBJECTIVES: Seronegative spondyloarthropathies, especially ankylosing spondylitis (AS), is shown to be associated with inflammatory bowel disease. Anti-Saccharomyces cerevisiae antibodies (ASCA) is a valid serological marker for Crohn's disease. Presence of ASCA is controversial in AS. In this study, we aimed to investigate the prevalence of ASCA in spondyloarthropathies and its relationship with disease activity and severity. METHODS: One hundred and seventy-five patients with AS, 47 patients with undifferentiated spondyloarthropathy (uSpA) and 103 healthy controls (HCs) were studied. All patients were questioned for demographic features and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores. Radiological damage is assessed by Bath Ankylosing Spondylitis Radiology Index (BASRI) and modified Stroke Ankylosing Spondylitis Spinal Score (mSASSS). ASCA levels were measured with standard ELISA kits. RESULTS: There was an overall increased prevalence of ASCA IgA in AS and uSpA compared with HCs (20.6 and 19.1% vs 5.8%, P = 0.0008 and P = 0.02, respectively). No association was observed between ASCA positivity and erythrocyte sedimentation rate, C-reactive protein levels and BASDAI scores. However, ASCA-positive patients had higher BASRI scores [median BASRI: 7 (2-12) vs 6 (2-12); P = 0.037]. Although not reaching significance, they also had reduced chest expansion and higher Bath Ankylosing Spondylitis Functional Index (BASFI) scores. ASCA-positive AS patients also required anti-tumour necrosis factor therapy more frequently (P = 0.006). CONCLUSIONS: ASCA IgA seems to be more prevalent in AS and uSpA. ASCA can also be a marker of radiological damage and a more severe course in AS.

The use of self-expanding metallic urethral stents in the treatment of recurrent bulbar urethral strictures: long-term results.

OBJECTIVE: To evaluate the effectiveness and long-term results of using a self-expanding metallic urethral stent (Urolumetrade mark, American Medical Systems, Minnetonka, MI, USA) to treat recurrent bulbar urethral strictures. PATIENTS AND METHODS: Between 1990 and 1999, 65 stents were placed in 60 men (mean age 45.2 years, range 20-71) with a urethral stricture (mostly caused by trauma and present for a mean of 4.3 years, range 0.16-26) and who had previously undergone different unsuccessful treatments. RESULTS: During a mean (range) follow-up of 3.8 (1-9) years the strictures in 52 of the 60 patients (87%) were treated successfully. All patients initially had postvoid dribbling incontinence, but this resolved in most within one week; 19 patients remain incontinent. CONCLUSION: The Urolume is a cost-effective alternative to other treatments for recurrent bulbar urethral strictures of whatever cause.

Ophthalmic findings in GAPO syndrome.

BACKGROUND: The main manifestations of GAPO syndrome are growth retardation (G), alopecia (A), pseudoanodontia (P), and optic atrophy (O). CASES: This syndrome has been described in 21 patients from 16 different families. Four cases are from Turkey and have been presented by Sayli and Gül. The purpose of our study is to document the cases from Turkey and discuss the ophthalmological and neuro-ophthalmolgical findings of these and other reported GAPO cases. OBSERVATIONS: All patients in the literature and our 4 cases have severe growth retardation with delayed bone age in infancy, characteristic facial appearance (high and bossed forehead, midface hypoplasia), alopecia or severe hypotrichosis, and pseudoanodontia. Optic atrophy was present in 1 of our cases and in 5 previous cases. Glaucoma was present in 5 cases, including 2 of ours. Buphthalmia and keratopathy secondary to glaucoma were also observed. White eyelashes, seen only in our cases, may be a sign of "early senility." CONCLUSIONS: Optic atrophy is not a constant finding in GAPO syndrome. Glaucoma may accompany the ocular findings. This syndrome has been attributed to either ectodermal dysplasia or the accumulation of extracellular connective tissue matrix, due to an enzyme deficiency involved in its metabolism. Current studies show that an elastin defect and secondary changes in collagen may be important in the pathogenesis of the disease.