Effects of Sleep Disorders on Hemoglobin A1c Levels in Type 2 Diabetic Patients.

BACKGROUND: Studies have reported the presence of sleep disorders in approximately 50-70% of diabetic patients, and these may contribute to poor glycemic control, diabetic neuropathy, and overnight hypoglycemia. The aim of this study was to determine the frequency of sleep disorders in diabetic patients, and to investigate possible relationships between scores of these sleep disorders and obstructive sleep apnea syndrome (OSAS) and diabetic parameters (fasting blood glucose, glycated hemoglobin A1c [HbA1c], and lipid levels). METHODS: We used the Berlin questionnaire (BQ) for OSAS, the Epworth Sleepiness Scale (ESS), and the Pittsburgh Sleep Quality Index (PSQI) to determine the frequency of sleep disorders and their possible relationships with fasting blood glucose, HbA1c, and lipid levels. RESULTS: The study included 585 type 2 diabetic patients admitted to family medicine clinics between October and December 2014. Sleep, sleep quality, and sleep scores were used as the dependent variables in the analysis. The ESS scores showed that 54.40% of patients experienced excessive daytime sleepiness, and according to the PSQI, 64.30% experienced poor-quality sleep. The BQ results indicated that 50.20% of patients were at high-risk of OSAS. HbA1c levels correlated significantly with the ESS and PSQI results (r = 0.23, P < 0.001 and r = 0.14, P = 0.001, respectively), and were significantly higher in those with high-risk of OSAS as defined by the BQ (P < 0.001). These results showed that HbA1c levels were related to sleep disorders. CONCLUSIONS: Sleep disorders are common in diabetic patients and negatively affect the control of diabetes. Conversely, poor diabetes control is an important factor disturbing sleep quality. Addressing sleep disturbances in patients who have difficulty controlling their blood glucose has dual benefits: Preventing diabetic complications caused by sleep disturbance and improving diabetes control.

Occupational allergic diseases in kitchen and health care workers: an underestimated health issue.

OBJECTIVE: This study evaluated the frequencies of allergic symptoms and rate of upper respiratory infections during the past year in the general population, kitchen workers (KW) and health care workers (HCW). METHODS: The European Community Respiratory Health Survey (ECRHS) was used to inquire retrospectively about asthma and asthma-like symptoms and the number of treatments required for previous upper respiratory tract infections (URTI: acute pharyngitis, acute sinusitis, etc.) during the past year for health care workers, kitchen workers, and members of the general population. Adjusted odds ratios by gender, age, and smoking status were calculated. RESULTS: 579 subjects (186 from the general population, 205 KW, and 188 HCW; 263 females, 316 males) participated in the study. Noninfectious (allergic) rhinitis was significantly higher in the HCW and KW groups than in the general population (P < 0.001). Cumulative asthma was significantly higher only in the HCW group (P < 0.05). In addition, the HCW and KW groups had significantly higher risks of ≥2/year URTI (OR: 1.59, 95% CI: 1.07-2.38 versus OR: 1.57, 95% CI: 1.05-2.38) than the general population. CONCLUSION: Occupational allergic respiratory diseases are an important and growing health issue. Health care providers should become familiar with workplace environments and environmental causes of occupational rhinitis and asthma.

Results of a national study on the awareness of and attitudes toward acute otitis media (AOM) among clinicians and the estimated direct healthcare costs in Turkey (TR-AOM Study).

AIMS: Acute otitis media (AOM) is one of the most frequent diagnoses and reasons for prescribing antibiotics in children. The aims of this prospective study were the following: (1) to assess the continuing education of physicians and the sources of information about AOM; (2) to assess the current knowledge of and attitudes toward AOM as well as the compliance with AOM guidelines; (3) to evaluate opinions about vaccines against AOM; and (4) to estimate the potential costs of AOM on the healthcare system in Turkey. METHODS: This is a web-based cross-sectional survey of a national convenience sample of 600 physicians in Turkey (325 pediatricians (PEDs), 214 family physicians/general practitioners (FP&GPs) and 61 otolaryngologists (ENTs)). RESULTS: Approximately 38.6% of participants (39.4% of PEDs, 44.3% of GP&FPs and 14.7% of ENTs) stated that pneumatic otoscopy is essential for AOM diagnosis. Regarding the most common etiological agents of AOM in children, 54.2% of PEDs, 51.4% of FP&GPs and 57.4% of ENTs stated that the most common causative agents of AOM are Streptococcus pneumoniae and non-typeable Haemophilus influenzae. Nearly 76% of participants indicated they use direct antibiotic therapy when they diagnose AOM in certain situations. The first-line choice of antibiotic therapy is amoxicillin clavulanate, and 67% of participants prefer to use antibiotic therapy for 7-10 days. Approximately 31% of all participants stated that "viruses" are the main cause of AOM; however, 62% of these participants reported using antibiotic therapy. In comparison, 32% participants from private clinics prefer to treat AOM primarily with observation, a rate that is significantly higher than that of other clinical settings. Physicians who prefer to use observation strategy also prefer the combination of paracetamol and NSAIDs. Approximately 41% of participants have undergone postgraduate medical education on the topic of AOM. In total, 73% of all participant physicians believe that otitis media is a vaccine-preventable disease. With the information from all of the participants, the calculated mean cost per case of AOM is 28 ± 4 USD. In Turkey, the estimated incidence of AOM is 24,000-33,000 cases per 10,000 children <5 years of age (1,820,000-2,100,000 cases per year), and the estimated total cost of AOM is 61,152,000 USD (not including acute otitis media-related complications and otitis media-related hospitalizations). CONCLUSION: The medical and economic burden of AOM to the health economics in Turkey is considerable. Specific educational programs and evidence-based national guidelines concerning AOM should be implemented. Improving diagnostic accuracy with education will lead to improved management, judicious use of antibiotics, decreased antibiotic resistance, and potential economic benefits. A more prudent use of antibiotics would also lower the economic burden of this disease. Vaccination seems to be promising for the prevention of AOM.

Effects of Ramadan fasting on biochemical and hematological parameters and cytokines in healthy and obese individuals.

BACKGROUND: The typical nutritional plan in Ramadan may have beneficial influences on the inflammatory state, as well as on metabolic and anthropometric parameters. We aimed to investigate the effects of Ramadan fasting on biochemical and hematological parameters and cytokines in healthy and obese individuals. METHODS: This study was performed during the Ramadan holy month (September and October 2007). The study group consisted of 10 obese males and the control group consisted of 10 males with a normal body mass index (BMI), who were admitted to the Family Medicine Outpatient Clinic of Dicle University Medical Faculty in Diyarbakir, Turkey, and who indicated that they were going to fast throughout the entire month of Ramadan. Individuals with any acute or chronic disease or medication during the study were excluded. Height, weight, BMI, and waist and hip circumferences were measured. High-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), urea, creatinine, insulin, total protein, albumin, C-reactive protein (CRP), lactic dehydrogenase (LDH), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and cytokine levels were evaluated. RESULTS: The average age of the participants was 27.4 ± 5.2 years. Of the study group, 7 fulfilled the criteria of metabolic syndrome. Significant weight reduction, significant decrease in BMI, and significant decrease of homeostasis model assessment of insulin resistance (HOMA-IR) and fasting blood glucose (FBG) were observed in study group; weight and BMI reduction were insignificant and no significant change was observed in FBG levels, but a significant increase was observed in HOMA-IR in the control group. Post-Ramadan systolic and diastolic blood pressure values, serum white blood cells (WBC) count, interleukin-2 (IL-2), IL-8, tumor necrosis factor-α (TNF-α, TG, and ALT levels were significantly lower in both groups compared to pre-Ramadan values. CONCLUSION: Ramadan fasting has beneficial influences on the inflammatory state, as well as metabolic and anthropometric parameters.

The evaluation of serum cystatin C, malondialdehyde, and total antioxidant status in patients with metabolic syndrome.

BACKGROUND: This study was designed to determine if serum cystatin C (Cys C) levels are affected by metabolic syndome and whether they correlate with lipid peroxidation and total antioxidant status (TAS) in this disorder. MATERIAL/METHODS: Cases with metabolic syndrome diagnosed according to the ATP III criteria (18 females, 12 males) were compared with healthy control subjects (20 females, 17 males) matched by age and gender. Plasma Cys C, malondialdehyde (MDA), and TAS levels were studied. RESULTS: Compared with the controls, Cys C and MDA levels were significantly higher (p<0.001 and p<0.001, respectively), whereas TAS was lower (p<0.001) in metabolic syndrome patients. A significant positive correlation between MDA and Cys C (r=0.308, p<0.05) and a significant negative correlation between TAS and Cys C levels (r=-0.358, p<0.01) were found. CONCLUSIONS: As Cys C and MDA levels increased but TAS decreased, Cys C may be an important indicator in the pathogenesis of metabolic syndrome.

Thymosin alpha 1 attenuates lipid peroxidation and improves fructose-induced steatohepatitis in rats.

OBJECTIVES: The aim of this study was to investigate the effects of thymosin alpha(1) (Talpha(1)) in rats having fructose-induced steatosis. Fructose leads to experimental steatosis in the liver by exerting its effect on some components of the oxidant/antioxidant system, and on several cytokines (interleukin-1beta, -2, and -6) in blood. METHODS: Twenty-four rats at random were divided into three groups (each group containing eight animals); the control group (C), which received a purified diet; the high-fructose-fed group (F); and the high-fructose-fed and Talpha(1) injected group (F + T). After the experimental period of 10 days, liver lipid peroxidation and antioxidant status, and blood IL-1beta, IL-2, and IL-6 levels were quantified. RESULTS: In comparison with the C group, the F group had a higher nitric oxide (NO) level, xanthine oxidase (XO) activity, and lipid peroxidation, as indicated by concentrations of thiobarbituric acid reactive substances (TBARS), and lower superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities in the liver. In the F + T group, these markers were near the values of the control group. In addition, increased IL-1beta and IL-6 levels were kept at near to normal levels with treatment of Talpha(1), but not IL-2 levels. In the F group, the most consistent findings in the histologic sections of liver tissues were the macrovesicular and microvesicular steatosis. Talpha(1) treatment protected the majority of the liver cells, while minimal macrovesicular and microvesicular steatosis was observed in the remaining cells. CONCLUSIONS: These results show that a high-fructose diet in rats leads to hepatic steatosis and a defect in the free radical defense system, and that treatment of Talpha(1) may improve these biochemical and morphologic changes in the fructose-fed rat livers.

Left ventricular diastolic function and circadian variation of blood pressure in essential hypertension.

The purpose of this prospective study was to determine the relationship between circadian blood pressure and left ventricular diastolic function in essential hypertension. The study population included 25 patients aged 56 +/- 18 years with non-dipper hypertension and 25 age- and sex-matched patients with dipper hypertension. They underwent conventional Doppler echocardiography and color tissue Doppler from apical 4- and 2-chamber views. In non-dipper patients, diastolic left ventricular function was reduced significantly. The transmitral E wave decreased (0.55 +/- 0.2 vs 0.62 +/- 0.2 m/s, P < 0.05), the transmitral A wave increased (0.77 +/- 0.1 vs 0.70 +/- 0.1 m/s, P < 0.01), the transmitral E/A ratio decreased (0.78 +/- 0.1 vs 0.86 +/- 0.2, P < 0.05), and the transmitral E-wave deceleration time increased in non-dipper patients (211 +/- 44 vs 196 +/- 42 ms, P < 0.05). The isovolumic relaxation time increased (112 +/- 15 vs 105 +/- 14 m/s, P < 0.05). The mean left ventricular myocardial velocities also differed significantly; the early diastolic velocity decreased (5.9 +/- 2. 1 vs 77 +/- 3.1 cm/s, P < 0.01), the late diastolic velocity increased (9.5 +/- 2.7 vs 8.7 +/- 1.6 cm/s, P < 0.05), and the E/A ratio decreased (0.68 +/- 0.55 vs 0.94 +/- 0.39, P < 0.01). These findings suggest that non-dipper hypertensive patients who have impaired left ventricular diastolic function should be identified early for careful follow-up and possible referral to a specialized center.

Assessment of cardiac autonomic regulation in children with monosymptomatic nocturnal enuresis by analysis of heart rate variability.

The pathogenesis of monosymptomatic nocturnal enuresis is controversial. Various urodynamic studies showed bladder hyperactivity in enuretic children. But the exact cause is not precisely known. The aim of this study was to understand whether the autonomic nervous system dysfunction is involved in this bladder hyperactivity or not. Heart rate variability measurement is widely used for evaluation of cardiac autonomic activity. We evaluated cardiac autonomic nervous system functions in monosymptomatic nocturnal enuretic children by using 24-hour Holter electrocardiogram. The study group consisted of 32 enuretic children (20 boys and 12 girls) and the control group consisted of 20 healthy children (12 boys and 8 girls). In these two groups, we assessed cardiac autonomic regulation by analysis of heart rate variability, and found a significantly higher parasympathetic activity in enuretic children than controls. We suggest that the parasympathetic nervous system hyperactivity plays a role in nocturnal enuresis by causing vesical hyperactivity in monosymptomatic enuretic children.

Smoking prevalence, behaviour and nicotine addiction among coal workers in Zonguldak, Turkey.

To assess the smoking status of coal workers, as coal dust exposure and concomitant cigarette smoking contribute to the increased prevalence of pulmonary interstitial fibrosis, chronic obstructive pulmonary disease and other pulmonary diseases. A survey was conducted to determine the smoking prevalence, behaviour and nicotine addiction in coal workers. The target population consisted of 475 underground coal workers who lived in Zonguldak city of Turkey, and we reached 389 of them. Each subject completed a detailed smoking history questionnaire (included 56 question). Chest X-rays and pulmonary function tests were performed to evaluate patients' related diseases and complications. Smoking status of the workers was as follows; Sixty-nine never smokers (17.7%), 62 ex-smokers (15.9%) and 258 current smokers (66.3%). The mean age of starting smoking was similar among ex and current smokers (15.9 +/- 4.2 versus 15.0 +/- 4.0). The most common reason for starting smoking was smoking interest (50%) and friends' influence (15.5%). The most frequent reason stated for successful smoking cessation was experience of smoking-related symptoms or development of a medical condition (51%). The most important reason given by current smokers for smoking cessation attempts was increased chance of developing lung cancer, pneumoconiosis and other diseases (22.9%). Nicotine addiction was assessed by the Fagerstroem test. Mild (0-3 points), moderate (4-6) and severe (7 or more) addiction ratios were found to be 39.1%, 44.2% and 16.7% respectively. Ex-smokers had the highest prevalence of large and small airway obstruction on spirometry. Smoking prevalence is high in coal workers living in Zonguldak city of Turkey. Most of the smokers know that smoking is dangerous and want to quit smoking. A detailed smoking history during medical surveillance may help the occupational physician to develop a system in which such individuals can be referred to comprehensive smoking cessation programs.

Guttate psoriasis-like lesions following BCG vaccination.

A 7-year-old boy presented to our clinic with a 1-week history of guttate psoriasis-like lesions after BCG vaccination. Although the patient did not have any history of psoriasis, his father and uncle had a history of psoriasis vulgaris. He was treated successfully with topical corticosteroid. Complete healing was seen after 3 weeks and the patient was still in remission 4 months after the cessation of the therapy. We proposed that patients who have psoriasis or predisposition to psoriasis must be carefully followed after BCG vaccination.

Cardiac autonomic activity in obstructive sleep apnea: time-dependent and spectral analysis of heart rate variability using 24-hour Holter electrocardiograms.

To analyze the function of cardiac autonomic regulation in patients with obstructive sleep apnea syndrome (OSAS), we enrolled 36 patients with OSAS and divided them according to the apnea hypopnea index (AHI) into 2 groups: Group I (n=19) had mild OSAS (AHI < 20) and Group II (n=17) had severe OSAS (AHI > or = 20). The findings were compared with those of 24 healthy control subjects who were matched for age, sex, blood pressure, and body mass index. All participants underwent 24-hour Holter monitoring, with continuous time-dependent and spectral analysis of heart rate variability. In addition, we performed arrhythmia analysis. Frequent or repetitive ventricular arrhythmias (> or = 30 premature ventricular beats/hour) were detected in 15 (42%) patients with OSAS and in 6 (25%) members of the control group. In both mild and severe OSAS, SDNN was significantly lower than in controls, and SDANN findings were similar. In mild OSAS, RMSSD values were not significantly lower than in controls, but in severe OSAS they were. The ULF, VLF, LF and LF/HF values of both groups of OSAS patients were significantly higher than those of controls, but their HF values were lower. The mean LF/HF ratio during the same period was significantly higher in Group II than in Group I and the control group. Our results suggest that cardiac autonomic activity may be altered in patients with OSAS throughout a 24-hour period, that this alteration occurs even in the absence of hypertension, heart failure, or other disease states, and that it is linked to the severity of OSAS.

Treatment of intracoronary thrombus using tirofiban in a patient with normal coronary arteries.

We report a 64-year-old Turkish man who presented with unstable angina pectoris. Coronary angiography revealed massive intracoronary thrombus, which completely occluded the distal part of the left circumflex coronary artery. The thrombotic segment and the rest of the coronary tree were free of atherosclerosis. The patient was treated with intravenous tirofiban, a glycoprotein IIb/IIIa inhibitor. A control angiography was performed one week later and showed total dissolution of the thrombus with tirofiban therapy.

Effect of iodine supplementation on goiter prevalence among the pediatric population in a severely iodine deficient area.

We evaluated goiter status and urinary iodine excretion (UIC) of 304 school-children (7-12 years old) 3 years after a law was passed for mandatory production of iodinated salt in an area previously characterized by severe iodine deficiency in Zonguldak, a mountainous city in the West Black Sea region in Turkey. We examined all the children for goiter by palpation, measured sonographic thyroid volumes (STV) and UIC. Eighty-two percent of families had been using iodinated salt. UIC was above 100 microg/l in 71.2% of the children and median UIC was sufficient (143.5 microg/l). The prevalence of goiter was lower at ultrasound (14.6%) than by palpation (19.4%). Median STV values were within recommended normal limits at all ages. Although Zonguldak had been a highly endemic region, it became mildly endemic 3 years after mandatory iodination of salt, with decrease of goiter prevalence.

Fourteen-year trend of tuberculosis dynamics in the northwest of Turkey.

BACKGROUND: The incidence of tuberculosis (TB) in different countries as estimated by the World Health Organization (WHO) vary from 23/100,000 and less in industrialized countries, 191/100,000 in Africa and 237/100,000 in South East Asia. OBJECTIVES: The aim of this study was to analyze the dynamics of TB in the northwest of Turkey, between 1988 and 2001. METHODS: All pulmonary TB cases reported to the National Tuberculosis Center by local TB dispensaries during 1988-2001 were analyzed. The number of new and relapsed TB cases were documented and classified according to age and type of TB (standard classification of TB patients according to disease type: pulmonary, new, smear positive; pulmonary, smear negative; relapse, and extrapulmonary). We recorded information about the prevalence of TB in different patient groups (patients with a contact history, patients who were detected in active community screening or passive case finding), TB trends in different age groups, type of TB, patients who had relapses, percentage of patients who were lost to follow-up. RESULTS: A total number of 288,996 patients were examined at Zonguldak Tuberculosis Dispensary between 1988 and 2001. Case notification rates of TB decreased over the study period. Respiratory TB was the most commonly encountered form of disease (>90%). The percentage of TB decreased in the 0- to 14-, 15- to 24-year-olds and increased in the 25- to 44- and 45- to 64-year-olds. CONCLUSION: Properly designed disease surveillance systems are critical for monitoring the TB trends so that each country can identify its own high-risk groups and target interventions to prevent, diagnose, and treat the disease.

A training model for cutaneous surgery.

BACKGROUND: Training models are necessary for development of many skills in medical education. OBJECTIVE: To develop a training model for improvement of simple surgical procedure skills. METHODS: A convex, rectangular, smooth-surfaced wooden plate covered by first cotton material and then polyethylene stretch film was used. Skins of rats that had been used previously for experimental studies were attached on the wooden plate. In order to see efficacy of our model, we decided to use it in a cutaneous surgery workshop. Theoretical and practical information about surgical sutures, punch biopsy, excisional biopsy, rotational flap, and Z-plasty procedures was given to the participant physicians. Surgical skills of participants were scored before and after the practical part of workshop. RESULTS: Thirty-three physicians were enrolled voluntarily to the workshop. All participants showed statistically significant increase in scores (P < 0.05). CONCLUSION: The similarity to human skin and the easy setup make this training model an ideal teaching tool to improve the skills of physicians for simple cutaneous surgery.

Levels of serum IL-1beta, IL-2, IL-8 and tumor necrosis factor-alpha in patients with unstable angina pectoris.

OBJECTIVES: Inflammation is the most important mechanism of plaque disruption playing an essential role in acute coronary syndromes. It is controversial whether the inflammatory mediators are the cause or the result in the development of plaque rupture. Stimulation of interleukins increases adhesion molecules, fibrinogen and plasminogen activator inhibitors,which cause the activation of inflammation and thrombosis. However, the importance of interleukins in acute coronary syndromes has not been clearly defined. We did not find any article concerning relations between the levels of serum interleukin(IL)-1beta, IL-2, IL -8 and tumor necrosis factor (TNF)-alpha in patients with unstable angina pectoris (UAP). So the aim of this study was to determine the levels of serum I -1b, IL-2, IL-8 and TNF-alpha during the early stage of UAP. METHODS AND RESULTS: Thirty-seven patients with UAP(12 females and 25 males; mean age, 57.5 +/- 9.7 years) within 6 h of admission and 20 healthy volunteers(eight females and 12 males; mean age, 51.3 +/- 6.3 years) were included in the study. IL-1beta, IL-2, IL-8 and TNF-alpha levels were measured using the enzyme-linked immunosorbent assay method. Patients with acute or chronic inflammation, renal failure or chronic heart failure were excluded from the study. The age, gender and risk factors of the study and control groups were similar. The levels of IL-1beta, IL-8 and TNF-alpha were significantly increased (p < /0.0001, p < /0.001 and p < /0.016, respectively) in patients with UAP. There was no difference of IL-2 levels between the UAP group and controls. CONCLUSION: We detected high levels of IL-1beta, IL-8 and TNF-alpha in patients with UAP during early phase. We suggest that proinflammatory cytokines (e.g. IL-1beta,IL-8, TNF-alpha) may play an important role in the development of atherosclerosis and its complications.

Chronic pulmonary disease in rural women exposed to biomass fumes.

INTRODUCTION: Biomass (organic) fuels cause indoor air pollution when used inside dwellings. We evaluated the frequencies of chronic obstructive pulmonary disease (COPD) and chronic bronchitis (CB) among rural women using biomass fuels for heating and cooking and compared them to women living in urban areas where such fuels are not used. METHODS: From electoral lists we randomly selected 242 women living in rural areas near Kayseri, Turkey and 102 women living in apartments in the city having central heating and cooking with fuels other than biomass ones. Using a translated version of the American Thoracic Society questionnaire, with additional questions from the British Medical Research Council questionnaire, trained interviewers conducted personal interviews. They also collected information on fuels used for cooking and heating. All study subjects underwent a physical examination and measurement of pulmonary function. RESULTS: We found that rural women were younger than urban women (mean age [and standard deviation], 40.5 [14.1] yr v. 43.6 [11.9] yr). More urban than rural women were current (14.7% v. 4.5%, p < 0.001) or past (11.8% v. 1.2%, p < 0.001) smokers. CB was more prevalent among rural women than urban women (20.7% v. 10.8%, p < 0.03). Similarly, COPD was more prevalent in rural women (12.4% v. 3.9%, p < 0.05). Although the pulmonary function tests were within normal limits, FEV, values in rural women were found to be relatively low compared with those of urban women (p < 0.05). INTERPRETATION: Rural women exposed to biomass fumes are more likely to suffer from CB and COPD than urban women even though the prevalence of smoking is higher among the latter group.

A randomized placebo-controlled trial of mebendazole for halitosis.

OBJECTIVE: To test whether mebendazole, an antiparasitic drug, would affect recovery from halitosis. DESIGN: We conducted a randomized, double-blind, placebo-controlled trial between April 1999 and September 2001. SETTING: A referral medical center. PATIENTS: One hundred sixty-two children aged 5 to 16 years whose parents complained about their chronic bad breath. INTERVENTIONS: Children were randomly assigned to receive mebendazole (n = 82) or placebo (n = 80). MAIN OUTCOME MEASURE: Parents whose children had halitosis were evaluated for halitosis at 2 months of treatment by questionnaire. The microbiologist investigated the stool samples of children for parasitosis at the beginning of the trial and also at the end of the trial in children who were treated with mebendazole. RESULTS: Among those children who had evidence of parasites in stool samples at the beginning of the trial, 18 of 28 who were treated with mebendazole recovered from halitosis, compared with 2 of 24 who received placebo (relative risk [RR] for recovery, 7.7; 95% confidence interval [CI], 2.0-29.9). Among those who did not have stool parasites, 14 of 52 improved with mebendazole, compared with 10 of 48 taking placebo (RR, 1.3; 95% CI, 0.6-2.6). Mebendazole intake made a significant difference whether or not the children had parasites (P =.002). CONCLUSIONS: Parasitosis should be considered as a possible cause of halitosis in the pediatric patient population. Mebendazole therapy seems to offer benefit to those children with parasites as a potential cause of their halitosis.