Evaluation of anti-COVID-19 measures taken by the parents of children with celiac disease: a cross-sectional study

ABSTRACT BACKGROUND: Coronavirus disease 2019 (COVID-19) causes negative life changes brought about through lockdowns, in addition to severe complications and death. Among these changes, asplenism or hyposplenism has been reported in patients with celiac disease. It has been reported that the risk of pneumococcal sepsis is higher in celiac patients with hyposplenism. Moreover, celiac patients present high risk of admission to hospital due to influenza. OBJECTIVE: To determine the degree of awareness of COVID-19 among parents of children with celiac disease and examine the measures that they take. DESIGN AND SETTING: Cross-sectional study at a university hospital in the Middle Anatolian region of Turkey. METHODS: The diagnosis of celiac disease was confirmed through a survey conducted online among 73 parents between May and July 2020. RESULTS: The mean age was 37.57 ± 6.56 years for the mothers, 41.15 ± 5.56 years for the fathers and 11.36 ± 4.36 years for the children. 90.4% of the parents reported that COVID-19 was transmitted through "speaking, coughing, sneezing and infection of the face after contact with virus-infected surfaces". Moreover, 78.1% indicated that they did not have any difficulty in finding gluten-free foods. CONCLUSION: These parents of children with celiac disease believed that their children's risk of developing COVID-19 did not differ from that of healthy children. It was also observed that appetite and states of nervousness were higher among these children with celiac disease during lockdowns and that their sleep patterns were affected.

Evaluation of anti-COVID-19 measures taken by the parents of children with celiac disease: a cross-sectional study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) causes negative life changes brought about through lockdowns, in addition to severe complications and death. Among these changes, asplenism or hyposplenism has been reported in patients with celiac disease. It has been reported that the risk of pneumococcal sepsis is higher in celiac patients with hyposplenism. Moreover, celiac patients present high risk of admission to hospital due to influenza. OBJECTIVE: To determine the degree of awareness of COVID-19 among parents of children with celiac disease and examine the measures that they take. DESIGN AND SETTING: Cross-sectional study at a university hospital in the Middle Anatolian region of Turkey. METHODS: The diagnosis of celiac disease was confirmed through a survey conducted online among 73 parents between May and July 2020. RESULTS: The mean age was 37.57 ± 6.56 years for the mothers, 41.15 ± 5.56 years for the fathers and 11.36 ± 4.36 years for the children. 90.4% of the parents reported that COVID-19 was transmitted through "speaking, coughing, sneezing and infection of the face after contact with virus-infected surfaces". Moreover, 78.1% indicated that they did not have any difficulty in finding gluten-free foods. CONCLUSION: These parents of children with celiac disease believed that their children's risk of developing COVID-19 did not differ from that of healthy children. It was also observed that appetite and states of nervousness were higher among these children with celiac disease during lockdowns and that their sleep patterns were affected.

Detection of pulmonary artery atherosclerosis by FDG-PET/CT: a new observation.

The aim of this study was to investigate the feasibility of FDG-PET/CT imaging to detect pulmonary artery atherosclerosis and to assess the correlation between pulmonary function testing (PFT) results and the overall pulmonary artery metabolic activity. Twenty-nine subjects between the ages of 57-75, with a history of clinical suspicion of lung cancer, underwent PET/CT imaging at 3 hours following the administration of FDG. Global FDG uptake in the central pulmonary artery branches was determined. Average SUVmax, SUVmean, and tissue-to-background (TBR) mean and maximum were calculated within each vessel. The degree of FDG uptake in non-COPD and COPD patients and its correlation with PFT were examined in this population. Furthermore, the results from patients were compared with those of 10 age-matched controls. Based on these data, the number of lesions with varying degrees of FDG uptake among patients was higher than that in the normal control group. However, there was no statistically significant difference in average SUVmax, average SUVmean, average TBRmax, or average TBRmean between non-COPD and COPD patients. This indicates that the atherosclerotic process is focal and is not diffuse in nature. Although the global quantitative data generated did not reveal evidence for diffuse artery inflammation in patients with COPD, qualitative examination showed clear-cut evidence for focally increased FDG uptake in the pulmonary arteries. This observation indicates the presence of atherosclerotic plaques which are prevalent in patients with COPD. Future prospective studies with larger numbers of subjects are needed to confirm this important observation.

Investigation of Carbapenem resistance mechanisms in Klebsiella pneumoniae by using phenotypic tests and a molecular assay.

INTRODUCTION: The aim of this study was to investigate the presence of carbapenemase production and carbapenem resistance mechanisms in 47 carbapenem resistant Klebsiella pneumoniae isolates by phenotypic confirmatory tests and molecular assay. METHODOLOGY: Carbapenem resistance genes KPC, OXA-48 and NDM were investigated with the BD MAX CRE assay kit in the BD MAX real time PCR instrument. Modified Hodge test, MBL gradient strip test, D70C Carbapenemase Detection Set, Temocillin gradient strip test methods were used as phenotypic confirmatory tests. Clonal relationship between study isolates was investigated with pulsed-field gel electrophoresis. RESULTS: Analysis with BD MAX CRE assay revealed OXA-48 positivity in 17 (36%) strains, NDM positivity in 6 (13%) strains and coexistence of OXA-48 + NDM positivity in 8 (17%) strains. In 16 (34%) strains, none of the KPC, OXA-48 and NDM genes were detected. While MHT was the most sensitive phenotypic confirmatory test, D70C disc set had not been considered as a useful tool to assist the search for carbapenemase production. Temocillin gradient test alone could not be considered as sufficient to detect the presence of OXA-48. PFGE analyses revealed that 23 of 31 carbapenemase producing strains were in three major PFGE genotypes (A, B and C). CONCLUSIONS: This study revealed that carbapenem resistance observed in K. pneumoniae isolates was mainly due to OXA-48 and NDM genes and the increase of carbapenem resistance among K. pneumoniae strains in our hospital was due to the interhospital spread of especially 3 epidemic clones.

Effects of Wi-Fi (2.45 GHz) and Lactic Acid Bacteria on Oral Pathogens and Caries Development in Rats.

PURPOSE: To evaluate the effects of Wi-Fi and lactic acid bacteria on salivary mutans streptococci and caries formation. MATERIALS AND METHODS: Wistar rats and their offspring were equally divided into two main groups and seven subgroups. Experimental groups were exposed to Wi-Fi during pregnancy and lactation. Subgroups were divided according the administration of the beneficial bacteria L. plantarum 167.P6.5 and L. rhamnosus M17-10.2. In the 8-week experimental period after weaning at 21 days, Mutans streptococci counts and the number of carious lesions were determined. RESULTS: The MS count ratios at the end of 8 weeks were statistically significantly lower than those at the end of 4 weeks in all groups given L. rhamnosus (p < 0.05). A strong correlation was found between the total MS count and sulcal caries scores (r = 0.507). No statistically significant difference was observed between groups exposed to Wi-Fi and other groups in terms of microorganism count and caries scores (p < 0.05). CONCLUSIONS: These results suggest that lactic acid bacteria, especially those originating from an oral source, may be of benefit as probiotics for the prevention of oral pathogens and dental caries. Perinatal and lactational exposure to Wi-Fi does not predispose to caries development in rats.

Diagnostic importance of 18F-FDG PET/CT parameters and total lesion glycolysis in differentiating between benign and malignant adrenal lesions.

PURPOSE: Benign adrenal lesions are prevalent in oncologic imaging and make metastatic disease diagnoses difficult. This study evaluates the diagnostic importance of metabolic, volumetric, and metabolovolumetric parameters measured by fluorine-18-fluorodeoxyglucose (F-FDG) PET/CT in differentiating between benign and malignant adrenal lesions in cancer patients. PATIENTS AND METHODS: In this retrospective study, we evaluated F-FDG PET/CT parameters of adrenal lesions of follow-up cancer patients referred to our clinic between January 2012 and November 2016. The diagnosis of adrenal malignant lesions was made on the basis of interval growth or reduction after chemotherapy. Patient demographics, analysis of metabolic parameters such as maximum standard uptake value (SUVmax), tumor SUVmax/liver SUVmean ratio (T/LR), morphologic parameters such as size, Hounsfield Units, and computed tomography (CT) volume, and metabolovolumetric parameters such as metabolic tumor volume and total lesion glycolysis (TLG) of adrenal lesions were calculated. PET/CT parameters were assessed using the Mann-Whitney U-test and receiving operating characteristic analysis. RESULTS: In total, 186 adrenal lesions in 163 cancer patients (108 men/54 women; mean±SD age: 64±10.9 years) were subjected to F-FDG PET/CT for tumor evaluation. SUVmax values (mean±SD) were 2.8±0.8 and 10.6±6; TLG were 10.8±9.2 and 124.4±347.9; and T/LR were 1±0.3 and 4.1±2.6 in benign and malignant adrenal lesions, respectively. On the basis of the area under the curve, adrenal lesion SUVmax and T/LR had similar highest diagnostic performance for predicting malignant lesions (area under the curve: 0.993 and 0.991, respectively, P<0.001). Multivariate logistic regression analysis showed that T/LR, adrenal lesion SUVmax, and Hounsfield Units were independent predictive factors for malignancy rather than TLG. CONCLUSION: Irrespective of whether TLG was statistically highly significant for differentiating benign from malignant adrenal lesions, it did not reach the expected performance with a low negative predictive value. This may be because of the malignant but small and benign but large lesions on metabolovolumetric calculation.

Non-pharmacological strategies used to reduce procedural pain in infants by nurses at family health centres.

OBJECTIVE: To determine the methods used by nurses working in family health centres to decrease pain during medical procedures in infants. METHODS: This descriptive, cross-sectional study was conducted at family health centres in the county town of Bandirma, and city centres of Karaman and Gaziantep, Turkey, in September and October 2015, and comprised nurses. Data was collected through face-to-face interviews using a questionnaire. SPSS 15 was used for data analysis. RESULTS: Of the 144 participants, 71(49.3%) were aged 31-40 years, 74(51.4%) had a bachelor's degree, and 76(52.8%) had worked in a family health centre for 1-5 years. It was observed that 91(63.3%) nurses used contact/massage for decreasing the pain during vaccinations and 72(50.3%) used skin-to-skin contact during heel lance. A statistically significant difference was found between the level of education and use of non-pharmacological methods (p<0.05). CONCLUSIONS: Nurses used different non-pharmacologic methods during invasive procedures.

Comparison of the effectiveness of three different methods in decreasing pain during venipuncture in children: ball squeezing, balloon inflating and distraction cards.

AIMS AND OBJECTIVES: This study aimed to investigate three different distraction methods (squeezing a soft ball, balloon inflation and distraction cards) on pain and anxiety relief in children during phlebotomy. BACKGROUND: Needle-requiring medical procedures such as venipuncture, phlebotomy and intramuscular injections are common and significant sources of pain for children, and these cause anxiety, distress and fear. DESIGN: This study was a prospective, randomised controlled trial. METHODS: The sample consisted of children (n = 120) who required blood tests. Data were obtained through face-to-face interviews with the children, their parents and the observer before and after the procedure. The children's pain levels were assessed and reported by the parents and observers, and the children themselves who self-reported using Wong-Baker FACES. The children's anxiety levels were also assessed using the Children's Fear Scale. RESULTS: One hundred and twenty children (mean age: 9·64 ± 2·07 years) were included. No difference was found between the groups in the self-, parent- and observer-reported procedural pain levels (p = 0·446, p = 0·467, p = 0·318 respectively). Furthermore, no significant differences were observed between the groups in procedural child anxiety levels according to the parents and observer (p = 0·323, p = 0·144 respectively). CONCLUSION: Pain and anxiety relief was seen in the three methods used during phlebotomy; however, no statistically significant difference was observed. RELEVANCE TO CLINICAL PRACTICE: This study contributes to the literature on nonpharmacologic pain relief methods during phlebotomy in children.

Effect of flick application on pain level and duration of crying during infant vaccination.

BACKGROUND: The aim of the research is to determine the effect of flick application to reduce pain on pain level and duration of crying during vaccination. METHOD: This research was carried out on one-month-old babies in a family health center between March and June 2015. The babies coming for the second dose of Hepatitis B vaccine were divided into experiment and control groups. The babies in experiment group were flicked just before they were vaccinated. On the other hand, the babies in control group were vaccinated in usual way, with no other application. The pain level of babies in both groups was determined using "Neonatal Infant Pain Scale". In addition, babies' duration of crying was recorded. RESULTS: In the study, it was detected that there was not a significant difference between pain score averages of babies in experiment and control groups (p > 0.05) before the application, however a significant difference in pain score average was detected during the application (p < 0.01) and after the application (p < 0.001). Babies' duration of crying was compared and it was determined that babies in experiment group cried for shorter period, but no relevance was found (p > 0.05). CONCLUSIONS: Flick application at vaccination area could be used to reduce pain during vaccination at babies.

Perineural invasion in prostate biopsy specimens is associated with increased bone metastasis in prostate cancer.

BACKGROUND: We aimed to evaluate the relationship between perineural invasion (PNI) and bone metastasis in prostate cancer (PCa). METHODS: We retrospectively reviewed the data of 633 PCas who had whole-body bone scan (WBBS) between 2008 and 2014. We recorded the age, clinical T-stage, total PSA (tPSA) prior to biopsy, Gleason sum (GS), and PNI in transrectal ultrasound guided biopsy (TRUS-Bx) and digital rectal examination findings. Bone metastases were assessed with WBBS and magnetic resonance image if WBBS was suspicious. We divided the patients into two groups according to NCCN criteria: (Group 1) bone scan not indicated, (Group 2) bone scan indicated. RESULTS: There were 262 patients in Group 1 and 371 in 2. There is not significant relationship between PNI and bone metastasis in Group 1. However, there is very limited number of metastatic patients (n = 12) in this group. There is a strong relationship between PNI and bone metastasis in Group 2 (P = 0.001). Sensitivity, specificity and positive predictive value of PNI for bone metastasis were 72.4%, 81.7%, and 77.7%, respectively. In this group, tPSA, GS, positive DRE, and PNI were significant covariates for prediction of bone metastasis in univariate and multivariate analysis (except age). The most powerful predictor was PNI, and it increased the risk of bone metastasis 11-fold. CONCLUSIONS: PNI in the TRUS-Bx specimens is the most powerful predictive histopathological feature for bone metastasis, by increasing the risk of bone metastasis 11-fold in NCCN bone scan indicated patients (Group 2).

Patient satisfaction with family practice in Turkey: Three-year trend from 2010 to 2012.

BACKGROUND: After the health reform in 2003, a need emerged to monitor patient satisfaction in Turkey. OBJECTIVE: To evaluate patient satisfaction with family practice in Turkey and compare with some other European countries. METHODS: The study was performed on a countrywide representative sample from all the 81 provinces of Turkey. Data were collected during the years 2010-2012 from patients visiting family practice centres. A three-year repeated cross-sectional study was conducted using the EUROPEP instrument. Twenty-six questions with a five-point Likert scale were applied. Primary outcome measures of the study were the mean EUROPEP scores (min. 1, max. 5). RESULTS: Mean (± SD) EUROPEP scores for the years 2010 (n = 34 472), 2011 (n = 34 764), and 2012 (n = 32 667) were 4.09 ± 0.77, 4.29 ± 0.59, and 4.42 ± 0.54 respectively (F = 1565.37; P < 0.001). The mean satisfaction percentage was calculated as 88.3%. Areas of lowest satisfaction were 'Being able to speak to the GP on the telephone,' 'Getting through to the practice on the phone,' and 'Physical conditions of the family practice.' CONCLUSION: Although in small increments, patient satisfaction with family practices in Turkey has increased during the last few years.

Pulmonary 18F-FDG microembolism detected on only delayed image in a PET/CT study.

Focal 18F-FDG pulmonary uptake on PET without corresponding abnormality on CT is an incidental and rare finding. This artifact is associated with iatrogenic FDG microembolus as a result of vascular endothelium damage during injection. We present a pulmonary FDG microembolus in a patient evaluated for suspicion of gallbladder cancer not in early (standard 1-hour imaging after FDG injection) but in delayed image. To our knowledge, this is the first case that describes the possibility of FDG microembolism on only delayed image in a PET/CT study.

Metabolic effects of pulmonary obstruction on myocardial functioning: a pilot study using multiple time-point 18F-FDG-PET imaging.

RATIONALE: The aim of this study was to evaluate fluorine-18 fluorodeoxyglucose (18F-FDG) uptake in the right ventricle (RV) of patients with chronic obstructive pulmonary disease (COPD) and to characterize the variability of 18F-FDG uptake in the RV at different time points following radiotracer administration using PET/computerized tomography (CT). Impaired RV systolic function, RV hypertrophy, and RV dilation are associated with increases in mean pulmonary arterial pressure in patients with COPD. Metabolic changes in the RV using 18F-FDG-PET images 2 and 3 h after tracer injection have not yet been investigated. METHODS: Twenty-five patients with clinical suspicion of lung cancer underwent 18F-FDG-PET/CT imaging at 1, 2, and 3 h after tracer injection. Standardized uptake values (SUVs) and volumes of RV were recorded from transaxial sections to quantify the metabolic activity. RESULTS: The SUV of RV was higher in patients with COPD stages 1-3 as compared with that in patients with COPD stage 0. RV SUV was inversely correlated with FEV1/FVC pack-years of smoking at 1 h after 18F-FDG injection. In the majority of patients, 18F-FDG activity in RV decreased over time. There was no significant difference in the RV myocardial free wall and chamber volume on the basis of COPD status. CONCLUSION: The severity of lung obstruction and pack-years of smoking correlate with the level of 18F-FDG uptake in the RV myocardium, suggesting that there may be metabolic changes in the RV associated with lung obstruction that can be detected noninvasively using 18F-FDG-PET/CT. Multiple time-point images of the RV did not yield any additional value in this study.

Identification of the traditional methods of newborn mothers regarding jaundice in Turkey.

AIMS AND OBJECTIVES: To detect traditional methods applied for the treatment of newborn jaundice by mothers in Turkey. BACKGROUND: Traditional methods are generally used in our society. Instead of using medical services, people often use already-known traditional methods to treat the disease. In such cases, the prognosis of the disease generally becomes worse, the treatment period longer and healthcare costs higher, and more medicine is used. DESIGN: A cross-sectional descriptive study. METHODS: The participants of this study were 229 mothers with newborn babies aged 0-28 days in one university hospital and one public children's hospital in Sanliurfa. The study was conducted between March and May 2012. In this research, the Beliefs and Traditional Methods of Mothers for Jaundice Questionnaire, which was formed by searching the relevant literature, is used as a data collection tool. The data are evaluated by percentage distributions. RESULTS: Mothers apply conventional practices in cases of health problems such as jaundice, and application of these methods is important to mothers. Moreover, mothers reported applying hazardous conventional methods in cases of neonatal jaundice, such as cutting the area between the baby's eyebrows with a blade, cutting the back of the ear and the body and burning the body, which are not applied in different cultures. CONCLUSIONS: Education regarding the effects of conventional methods being applied in families should be provided, and the results of this study should serve to guide further studies in assessing the effects of such education. RELEVANCE TO CLINICAL PRACTICE: This approach can support beneficial practices involving individual care and prevent the negative health effects of hazardous practices.

Reduced heart rate response to dipyridamole in patients undergoing myocardial perfusion SPECT.

OBJECTIVE: A mild decrease in blood pressure and increase in heart rate (HR) are considered normal hemodynamic responses to dipyridamole. In this study, we tried to investigate HR response to dipyridamole and its predictors in patients undergoing gated myocardial perfusion single photon emission computed tomography (SPECT). METHODS: 201 consecutive patients undergoing dipyridamole stress Tc99m-MIBI or Tl-201 gated myocardial perfusion SPECT were prospectively enrolled. Dipyridamole was infused over 4 min and radiopharmaceutical was injected 3 min after the end of infusion. A reduced heart rate response to dipyridamole considered if the HR ratio (peak HR/rest HR) was 1.20 or less. Stress (sLVEF), rest (rLVEF) left ventricular ejection fractions, stress and rest motion (SMS, RMS) and thickening scores (STS, RTS) were derived automatically by QGS. Summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) for myocardial perfusion were calculated. Patients were grouped according to HR response and groups were compared. A logistic regression analysis was used to determine independent predictors of reduced HR response. RESULTS: Reduced HR response was found in 78 % of patients. Patients with abnormal HR response were more frequently had a history of diabetes mellitus, chronic renal failure, and had lower high-density lipoprotein (HDL) levels. Peak HR, SSS, SRS, sLVEF and rLVEF were lower; rest HR, RTS, and the number of patients with ≤ 45 % sLVEF and rLVEF were higher in reduced HR response group (all p < 0.05). There was no difference between groups by means of gender, rest and peak systolic or diastolic tension, SDS, SMS, STS, RMS, history of hypertension, peripheral arterial disease, metabolic syndrome, coronary interventions, digoxin, calcium channel blocker or beta blocker usage. Multivariable logistic regression analysis demonstrated that the independent predictors of reduced HR response were HDL, rest HR and SSS. When HDL was removed from the model, chronic renal failure also emerged as an independent predictor. CONCLUSION: Reduced HR response to dipyridamole is associated with ventricular dysfunction, cardiac autonomic neuropathy. Low HDL levels also seem to be related with reduced HR response.

The effect of training administered to working mothers on maternal anxiety levels and breastfeeding habits.

AIM AND OBJECTIVE: This study was conducted to determine the effect of training administered to working mothers and its duration on maternal anxiety levels and breastfeeding habits. BACKGROUND: Within the scope of Health for All in the 21st Century project, a goal was set to increase the rate of infants fed exclusively by breastfeeding during the first six months of life to 80% by the year 2015. DESIGN: A randomised design with repeated measures. METHODS: During collection of pretest data, a Personal Information Form, a Questionnaire Form and a State Trait Anxiety Inventory were administered to the mothers in the experimental and control groups. Five home visits were conducted starting two weeks before the date when mothers returned to work and ending when the infants became six months old. Breastfeeding techniques were taught to these mothers. Data were subjected to Proc MEAN, FREQ, anova and GENMOD procedures. RESULTS: The rate of natural feeding (breastfeeding exclusively) among trained mothers was greater than untrained mothers. The frequency of breastfeeding affects maternal anxiety levels; the anxiety level of mothers decreased with increasing frequency of breastfeeding. CONCLUSION: Educating working mothers about breastfeeding reduces their anxiety levels and influences positively their breastfeeding habits. RELEVANCE TO CLINICAL PRACTICE: With the support of health-care staff to increase awareness and knowledge on the value and sufficiency of breast milk, the rate and period of natural feeding increased significantly among working mothers.

Methods used to eliminate colic in infants in the eastern parts of Turkey.

OBJECTIVE: Infant colic is a common problem characterized by excessive crying and fussing. There is not a consistent treatment method used to eliminate colic. Mothers make use of various models together to eliminate colic in their infants. This study was carried out to delineate the methods used by mothers to eliminate colic in their infants and to determine the efficacy of the various methods. DESIGN: Descriptive study. METHODS: The study was performed by visiting the homes of 186 babies (1-3 months of age) whose mothers had previously registered at a health center in Eastern Turkey between January 1 and February 28, 2005. Questionnaires and Wessel's criteria were used to obtain the data. The methods used by mothers to eliminate colic were classified as behavioral, natural, and drug treatments and were examined accordingly. RESULTS: According to mothers' statements, 75.8% of the babies had colic, while according to the Wessel criteria, 51.1% had colic symptoms. One hundred percent of the mothers used behavioral treatments, 66% used drug therapies, and 64.5% used natural treatment methods to eliminate colic. CONCLUSIONS: Mothers indicated that they achieved the most benefit from behavioral interventions, followed by natural therapies, and the least from drug treatments.