Heavy Metal and Trace Element Levels in Hair Samples from Fishermen in Turkey: The Fish/Ermen Heavy Metal Study (FHMS).

Toxic chemicals from polluted seas can enter the human body through seafood consumption and cause health problems. The aim of this study was to evaluate the levels of selected heavy metals and trace elements among fishermen who frequently consumed seafood and controls who consumed seafood less frequently in four provinces on the shores of the Sea of Marmara, which is heavily polluted by industrial activities. Fourteen elements (antimony, arsenic, cadmium, chromium, copper, iron, lead, manganese, mercury, nickel, selenium, strontium, vanadium, and zinc) were analyzed in hair samples using the inductively coupled plasma-mass spectrometer method. Levels of arsenic (0.147 ± 0.067 µg/g vs. 0.129 ± 0.070 µg/g, p = 0.025), chromium (0.327 ± 0.096 µg/g vs. 0.269 ± 0.116 µg/g, p < 0.01), nickel (0.469 ± 0.339 µg/g vs. 0.403 ± 0.368 µg/g, p = 0.015), strontium (1.987 ± 1.241 µg/g vs. 1.468 ± 1.190 µg/g, p < 0.01), and zinc (103.3 ± 43.1 µg/g vs. 92.7 ± 37.4 µg/g, p = 0.047) were higher in the fisherman group than in the control group. No difference was found between the groups in terms of other elements. The findings suggest that heavy metal-trace element contamination in the Sea of Marmara may increase the exposure levels of individuals to some chemicals through seafood consumption.

Push and Pull Factors of Why Medical Students Want to Leave Türkiye: A Countrywide Multicenter Study.

Phenomenon: Physician immigration from other countries is increasing as developed countries continue to be desirable destinations for physicians; however, the determinants of Turkish physicians' migration decisions are still unclear. Despite its wide coverage in the media and among physicians in Türkiye, and being the subject of much debate, there is insufficient data to justify this attention. With this study, we aimed to investigate the tendency of senior medical students in Türkiye to pursue their professional careers abroad and its related factors. Approach: This cross-sectional study involved 9881 senior medical students from 39 different medical schools in Türkiye in 2022. Besides participants' migration decision, we evaluated the push and pull factors related to working, social environment and lifestyle in Türkiye and abroad, medical school education inadequacy, and personal insufficiencies, as well as the socioeconomic variables that may affect the decision to migrate abroad. The analyses were carried out with a participation rate of at least 50%. Findings: Of the medical students, 70.7% had emigration intentions. Approximately 60% of those want to stay abroad permanently, and 61.5% of them took initiatives such as learning a foreign language abroad (54.5%) and taking relevant exams (18.9%). Those who wanted to work in the field of Research & Development were 1.37 (95% CI: 1.22-1.54) times more likely to emigrate. The push factor that was related to emigration intention was the "working conditions in the country" (OR: 1.89, 95% CI: 1.56-2.28) whereas the "social environment/lifestyle abroad" was the mere pull factor for the tendency of emigration (OR: 1.73, 95% CI: 1.45-2.06). In addition, the quality problem in medical schools also had a significant impact on students' decisions (OR: 2.20, 95% CI: 1.83-2.65). Insights: Although the percentage of those who want to emigrate "definitely" was at the same level as in the other developing countries, the tendency to migrate "permanently" was higher in Türkiye. Improving working conditions in the country and increasing the quality of medical faculties seem vital in preventing the migration of physicians.

Characteristics and outcomes of 974 COVID-19 patients in intensive care units in Turkey.

BACKGROUND: In our previous report on Turkish COVID-19 patients requiring intensive care, the 24 patients in a single ICU were elderly and mortality was high. We extended our analysis to include patients admitted to ten ICUs. OBJECTIVES: Report the demographics, clinical features, imaging findings, comorbidities, and outcomes in COVID-19 patients. DESIGN: Retrospective. SETTING: Intensive care unit. PATIENTS AND METHODS: The study includes patients with clinical and radiological confirmed or laboratory-confirmed COVID-19 infection who were admitted to ten ICUs between 15 March and 30 June 2020. MAIN OUTCOME MEASURES: Clinical outcomes, therapies, and death during hospitalization SAMPLE SIZE: 974, including 571 males (58%). RESULTS: The median age (range) was 72 (21-101) years for patients who died (n=632, 64.9%) and 70 (16-99) years for patients who lived (n=432, 35.2%) (P<.001). APACHE scores, and SOFA scores were higher in patients who died than in those who survived (P<.001, both comparisons). Respiratory failure was the most common cause of hospitalization (82.5%), and respiratory failure on admission was associated with death (P=.013). Most (n=719, 73.8%) underwent invasive mechanical ventilation therapy. CONCLUSIONS: The majority of patients admitted to the ICU with a diagnosis of COVID-19 require respiratory support. LIMITATIONS: Although the Turkish Ministry of Health made recommendations for the treatment of COVID-19 patients, patient management may not have been identical in all ten units. CONFLICT OF INTEREST: None.

Occupational Risks for Anaesthesiologists and Precautions.

Anaesthesiology is an extremely stressful and risky branch of medicine. New techniques, new procedures, and innovations in anaesthesia increase the responsibilities and obligations of anaesthesiologists day by day. Operating rooms and intensive care units, which are the working environment of anaesthesiologists, are considered to be an unhealthy workplace. Anaesthesiologists are exposed to various potential physical, chemical, biological, ergonomic, and psychosocial risk factors and hazards in their work environments. The occupational risks anaesthesiologists are exposed to threaten their health and may cause their professional performance to decline. This article aimed to raise awareness about the occupational risks, hazards, and precautions in anaesthesiology practice.

Heavy Metal Concentrations in Trachurus Mediterraneus and Merlangius Merlangus Captured from Marmara Sea, Turkey and Associated Health Risks.

Rapid industrialization and excessive human population growth may cause deterioration in marine water quality and biodiversity. Heavy metals are one of the most common pollutants in the seas and marine organisms, including demersal and pelagic fish, can accumulate them from the environment. Assessment of the ecological risk of heavy metals from fish has an important role in public health. In this study, some heavy metal (Pb, Cd, As, Cr, Hg, Cu, Zn, and Fe) concentrations were determined in the muscle tissues of two commonly consumed fish species, Trachurus mediterraneus (Mediterranean horse mackerel) and Merlangius merlangus (Whiting), which are the fifth (14,222 tons/year) and sixth (6814 tons/year) highest commercial catches of marine fish species in Turkey, respectively. Heavy metal concentrations of samples collected from four sites (Adalar, Izmit Bay, Yalova, and Tekirdag) in the Marmara Sea were determined using ICP-MS. Fish samples caught at Yalova station were found to have the highest heavy metal concentrations. According to the World Health Organization (WHO), in terms of the mean values, only As, and Cr were higher than permissible limits in T. mediterraneus, while Pb, Cd, As, and Cr were higher in M. merlangus. Arsenic concentrations were higher than maximum limits in both T. mediterraneus and M. merlangus. The estimated weekly intake (EWI) was calculated to assess the potential health impact. The EWI for arsenic, cadmium, lead, and mercury for some sites was above the provisional tolerable weekly intake.

Heavy Metals and Trace Elements in Whole-Blood Samples of the Fishermen in Turkey: The Fish/Ermen Heavy Metal Study (FHMS).

Selected heavy metal-trace element (Ag, As, Ba, Cd, Cu, Hg, Pb, Sb, Se, Sr, and V) levels were determined by the ICP-MS method in whole-blood samples of fishermen and control group who accommodate in four provinces of the Marmara Sea. Mercury (1.267 ± 1.061 µg/L to 0.796 ± 0.853 µg/L) and lead (17.8 ± 9.0 µg/L to 12.0 ± 6.83 µg/L) levels were higher in the fishermen group than that of control group (p < 0.001 for both). There was no difference between the fishermen group and the control group in terms of whole-blood levels of other elements. Total monthly fish consumption was 9340.4 gr in the fishermen group and 326.4 gr in the control group, and the difference between the groups was significant (p < 0.001). There was no difference between the groups in terms of having amalgam dental filling (p > 0.05). The results suggest that consuming high amounts of sea products caught from the Marmara Sea is a source for some heavy metals such as mercury and lead, which poses a public health risk. Unlike the control group, the positive correlation between arsenic, copper, and strontium levels and age in fishermen can also be evaluated as an indicator of chronic exposure.

Perfusion Index and ultrasonography in the evaluation of infraclavicular block.

BACKGROUND: It has been reported that noninvasive, objective tests are needed for determining the success of peripheral nerve blocks because conventional methods necessitate the cooperation of the patient. It is also known that the brachial plexus block causes vasodilatation and an increase in blood flow due to its sympathectomy effect. Our study aimed to determine whether Perfusion Index (PI) and measured regional hemodynamic changes using ultrasound were reliable parameters in evaluating the early success of an infraclavicular block. METHODS: Forty ASA I-III patients who were administered a successful infraclavicular block were included in this study. In addition to the baseline hemodynamic measurements, PI and regional hemodynamic parameters, such as brachial artery diameter (BAD), brachial arterial area (BAA), blood flow (BF), end-diastolic velocity (EDV), Resistance Index (RI), peak systolic velocity (PSV), and time average velocity (TAV) were measured. After completing the block procedure, all values were rerecorded at the 10th, 20th, and 30th minute. Patients with a successful block during the first 10 minutes were assigned to Group A, while patients with a successful block after the 10th minute were assigned to Group B. RESULTS: Statistically significant differences were observed for all regional hemodynamic variables and PI after 10 minutes. When the regional hemodynamic data and PI were compared between the groups, differences were identified for PI, BF, PSV, EDV, and TAV. Within the measured parameters, EDV was the parameter showing the greatest proportional change. CONCLUSIONS: Changes in EDV, especially RI and PI, provide more effective and objective results for the assessment of early regional block success.

Selenium, copper, zinc, iron levels and mortality in patients with sepsis and systemic inflammatory response syndrome in Western Black Sea Region, Turkey.

OBJECTIVE: To evaluate the changing levels of selenium, copper, zinc and iron in patients with sepsis and systemic inflammatory response syndrome and their influence on mortality. METHODS: The prospective study was conducted at a tertiary care university hospital in Zonguldak city in the western Black Sea region of Turkey from January 2012 to December 2013, and comprised patients with sepsis and systemic inflammatory response syndrome. Blood samples were taken on 1st, 3rd, 5th and 7th days to measure serum selenium, copper, zinc and iron levels. Patients' demographic data, presence of additional diseases and mortality were recorded. RESULTS: Of the 57 patients, 28(49.1%) were female and 29(50.9%) were male, with an overall mean age of 60.3±19.4 years, mean height of 166.1±11.4cm, mean weight of 76.5±17.5kg. Copper and zinc levels were in the normal range, while selenium and iron levels were lower than the limit values at all measuring periods. There was no significant difference between first and other days in accordance with element levels (p>0.05). Baseline copper levels in patients with malignancy were lower than patients without malignancy (p< 0.05). In hypertensive patients, baseline copper levels were higher and 7th day levels were lower than non-hypertensive (p< 0.05). Baseline selenium levels of those who died were lower than the other patients (p< 0.05). Selenium and iron levels were decreased in patients with sepsis-systemic inflammatory response syndrome and copper levels were lower in patients with malignancy, hypertension and chronic obstructive pulmonary disease (p< 0.05). There was no change in zinc levels of the patients. CONCLUSIONS: Reduced basal selenium levels of patients with sepsis and systemic inflammatory response syndrome were associated with mortality.

The effects of two bathing methods on the time of separation of umbilical cord in term babies in Turkey.

BACKGROUND: Umbilical cord infection developing subsequent to bacterial colonization is one of the outstanding reasons of newborn mortality and morbidity in underdeveloped and developing countries. OBJECTIVES: This study aimed to evaluate the influence of sponge and tub bathing methods on umbilical cord separation time in full term babies in Turkey. PATIENTS AND METHODS: This quasi-experimental and randomized controlled study was performed on 100 healthy term newborn babies and their mothers. One-hundred full-term babies (51 sponge bathing, 49 tub bathing) born at a state hospital between 14.03.2013 and 18.05.2013 with gestational age of 38-42 weeks, weighing 2500 grams and above and met the selection criteria were included as the study sample. Two booklets were prepared about sponge bathing and tub bathing. Mothers were instructed about sponge bathing and tub bathing, umbilical cord care in prenatal and postnatal periods. The first postnatal visit was performed at the hospital. Home visits and telephone calls were continued until the day of cord separation. Number, percent, mean and standard deviation values, qui-square and Mann-Whitney U tests were used for data assessment. RESULTS: The time of separation of umbilical cord in babies who were given sponge bathing (6.1 ± 1.4) was shorter compared to those given tub bathing (8.3 ± 2.5) (P < 0.005). CONCLUSIONS: Since wetting of umbilical cord during tub bathing delays the separation of umbilical cord, sponge bathing is recommended for newborns until the umbilical cord falls off.

Effects of various anesthesia maintenance on serum levels of selenium, copper, zinc, iron and antioxidant capacity / Efeitos da manutenção de várias anestesias sobre os níveis séricos de selênio, cobre, zinco e ferro e a capacidade antioxidante / Efectos del mantenimiento de varias anestesias sobre los niveles séricos de selenio, cobre, cinc y hierro y la capacidad antioxidante

BACKGROUND AND OBJECTIVES: In this study, we aimed to investigate the effects of sevoflurane, desflurane and propofol maintenances on serum levels of selenium, copper, zinc, iron, malondialdehyde, and glutathion peroxidase measurements, and antioxidant capacity. METHODS: 60 patients scheduled for unilateral lower extremity surgery which would be performed with tourniquet under general anesthesia were divided into three groups. Blood samples were collected to determine the baseline serum levels of selenium, copper, zinc, iron, malondialdehyde and glutathion peroxidase. Anesthesia was induced using 2-2.5 mg kg-1 propofol, 1 mg kg-1 lidocaine and 0.6 mg kg-1 rocuronium. In the maintenance of anesthesia, under carrier gas of 50:50% O2:N2O 4 L min-1, 1 MAC sevoflorane was administered to Group S and 1 MAC desflurane to Group D; and under carrier gas of 50:50% O2:air 4 L min-1 6 mg kg h-1 propofol and 1 µg kg h-1 fentanyl infusion were administered to Group P. At postoperative blood specimens were collected again. RESULTS: It was observed that only in Group S and P, levels of MDA decreased at postoperative 48th hour; levels of glutathion peroxidase increased in comparison to the baseline values. Selenium levels decreased in Group S and Group P, zinc levels decreased in Group P, and iron levels decreased in all three groups, and copper levels did not change in any groups in the postoperative period. CONCLUSION: According to the markers of malondialdehyde and glutathion peroxidase, it was concluded that maintenance of general anesthesia using propofol and sevoflurane activated the antioxidant system against oxidative stress and using desflurane had no effects on oxidative stress and antioxidant system. .

JUSTIFICATIVA E OBJETIVOS: Investigar os efeitos da manutenção de sevoflurano, desflurano e propofol sobre nos níveis séricos de selênio, cobre, zinco, ferro e malondialdeído, as mensurações de glutationa peroxidase e a capacidade antioxidante. MÉTODOS: Foram alocados em três grupos 60 pacientes agendados para cirurgia unilateral de membros inferiores, feita com torniquete sob anestesia geral. Amostras de sangue foram coletadas para determinar os níveis séricos basais de selênio, cobre, zinco, ferro, malondialdeído e glutationa peroxidase. A anestesia foi induzida com 2-2,5 mg kg-1 de propofol, 1 mg kg-1 de lidocaína e 0,6 mg kg-1 de rocurônio. Na manutenção da anestesia, sob gás de transporte de 50% O2 e 50% N2O (4 L min-1), sevoflurano a 1 CAM foi administrado ao Grupo S e desflurano a 1 CAM ao Grupo D e, sob gás de transporte em mistura de 50% O2 e 50% ar (4 L min-1), 6 mg kg h-1 de propofol e 1 mg kg h-1 de fentanil foram administrados ao Grupo P. No pós-operatório, amostras de sangue foram novamente coletadas. RESULTADOS: Apenas nos grupos S e P os níveis de MDA diminuíram em 48 horas de pós-operatório; os níveis de glutationa peroxidase aumentaram em comparação com os valores basais. Os níveis de selênio diminuíram no Grupo S e no Grupo P, os níveis de zinco diminuíram no Grupo P, os níveis de ferro diminuíram em todos os grupos e não houve alteração nos níveis de cobre em nenhum grupo no período pós-operatório. CONCLUSÃO: De acordo com os marcadores de malondialdeído e glutationa peroxidase, concluímos que a manutenção da anestesia geral com propofol e sevoflurano ativou o sistema antioxidante contra o estresse oxidativo e o uso de desflurano não teve efeitos sobre o estresse oxidativo e o sistema antioxidante. .

JUSTIFICACIÓN Y OBJETIVOS: Investigar los efectos del mantenimiento de sevoflurano, desflurano y propofol sobre los niveles séricos de selenio, cobre, cinc, hierro y malondialdehído, las medidas de glutatión peroxidasa y la capacidad antioxidante. MÉTODOS: Fueron ubicados en 3 grupos 60 pacientes programados para cirugía unilateral de miembros inferiores, realizada con torniquete bajo anestesia general. Fueron recogidas muestras de sangre para determinar los niveles séricos basales de selenio, cobre, cinc, hierro, malondialdehído y glutatión peroxidasa. La anestesia fue inducida con 2-2,5 mg/kg-1 de propofol, 1 mg/kg-1 de lidocaína y 0,6 mg/kg-1 de rocuronio. En el mantenimiento de la anestesia, bajo gas portador de 50% de O2 y 50% de N2O (4 L/min-1), sevoflurano a 1 CAM fue administrado al grupo S; y desflurano a 1 CAM al grupo D y bajo gas portador en mezcla de 50% O2 y 50% aire (4 L/min-1), 6 mg/kg/h-1 de propofol y 1 µg/kg/h-1 de fentanilo fueron administrados al grupo P. En el postoperatorio se recogieron de nuevo muestras de sangre. RESULTADOS: Solamente en los grupos S y P los niveles de malondialdehído disminuyeron en las 48 h del postoperatorio; los niveles de glutatión peroxidasa aumentaron en comparación con los valores basales. Los niveles de selenio disminuyeron en el grupo S y en el grupo P, los niveles de cinc disminuyeron en el grupo P, los de hierro disminuyeron en todos los grupos y no hubo alteración en los niveles de cobre en ningún grupo en el período postoperatorio. CONCLUSIÓN: De acuerdo con los marcadores de malondialdehído y glutatión peroxidasa, llegamos a la conclusión de que el mantenimiento de la anestesia general con propofol y sevoflurano activó el sistema antioxidante contra el estrés oxidativo y el uso de desflurano no tuvo efectos sobre el estrés oxidativo y el sistema antioxidante. .

[Effects of various anesthesia maintenance on serum levels of selenium, copper, zinc, iron and antioxidant capacity]. / Efeitos da manutenção de várias anestesias sobre os níveis séricos de selênio, cobre, zinco e ferro e a capacidade antioxidante.

BACKGROUND AND OBJECTIVES: In this study, we aimed to investigate the effects of sevoflurane, desflurane and propofol maintenances on serum levels of selenium, copper, zinc, iron, malondialdehyde, and glutathion peroxidase measurements, and antioxidant capacity. METHODS: 60 patients scheduled for unilateral lower extremity surgery which would be performed with tourniquet under general anesthesia were divided into three groups. Blood samples were collected to determine the baseline serum levels of selenium, copper, zinc, iron, malondialdehyde and glutathion peroxidase. Anesthesia was induced using 2-2.5mgkg(-1) propofol, 1mgkg(-1) lidocaine and 0.6mgkg(-1) rocuronium. In the maintenance of anesthesia, under carrier gas of 50:50% O2:N2O 4Lmin(-1), 1 MAC sevoflorane was administered to Group S and 1 MAC desflurane to Group D; and under carrier gas of 50:50% O2:air 4Lmin(-1) 6mgkgh(-1) propofol and 1µgkgh(-1) fentanyl infusion were administered to Group P. At postoperative blood specimens were collected again. RESULTS: It was observed that only in Group S and P, levels of MDA decreased at postoperative 48th hour; levels of glutathion peroxidase increased in comparison to the baseline values. Selenium levels decreased in Group S and Group P, zinc levels decreased in Group P, and iron levels decreased in all three groups, and copper levels did not change in any groups in the postoperative period. CONCLUSION: According to the markers of malondialdehyde and glutathion peroxidase, it was concluded that maintenance of general anesthesia using propofol and sevoflurane activated the antioxidant system against oxidative stress and using desflurane had no effects on oxidative stress and antioxidant system.

Long-term fluoroquinolone use before the prostate biopsy may increase the risk of sepsis caused by resistant microorganisms.

OBJECTIVES: To evaluate the effect of long-term fluoroquinolone treatment before the biopsy in terms of post procedure sepsis. Three-week fluoroquinolone management before the biopsy may lower serum prostate specific antigen (PSA) levels and prevent unnecessary biopsies. METHODS: A total of 558 patients were referred to our clinic for transrectal ultrasound (TRUS)-guided prostate biopsy. Of the patients, 205 had received levofloxacin 500 mg once a day for 3 weeks before the biopsy to lower the serum PSA levels (group 1). A total of 353 patients had not received any antibiotics before the procedure (group 2). In terms of the postbiopsy sepsis rate, group 1 and group 2 as well as patients who underwent biopsies in the early period and the latter period of the study were compared. RESULTS: Sepsis was diagnosed in 17 patients (3.0%) after biopsy. Of these patients, 11 (5.4%) and 6 (1.7%) were in group 1 and group 2, respectively (P = .0297, OR: 3.28, 95% CI: 1.10-10.13). Sepsis was diagnosed in 7 patients (1.9%) and 10 patients (5.0%) in the early and the latter period of the study, respectively (P = .0771, OR: 0.38, 95% CI: .13-1.09). Escherichia coli was the causative agent in all patients with a positive culture. In addition, 1 patient also had meticillin-resistant Staphylococcus epidermidis (MRSE). All of the E. coli isolates were resistant to fluoroquinolones, and 55.6% were positive for extended spectrum ß-lactamases (ESBL). CONCLUSIONS: Long-term fluoroquinolone use to prevent unnecessary prostate biopsy may result in postbiopsy sepsis caused by fluoroquinolone resistant microorganisms.

Diagnostic value of serum ghrelin levels in prostate cancer.

PURPOSE: Expression of recently identified growth hormone-releasing peptide, ghrelin, and its receptor has been demonstrated in prostate cancer (PCA) cell lines. It was also shown that ghrelin has increased cell proliferation in vitro when added to PCA cell lines. The aim of this study was to evaluate the diagnostic value of serum ghrelin levels in detection of PCA. MATERIAL AND METHOD: 30 patients with PCA and 50 patients with benign prostate hyperplasia (BPH) were enrolled in the study. The serum ghrelin levels of PCA and BPH patients were compared. The correlations between ghrelin and age groups, body mass index, total prostate-specific antigen (PSA) levels, free/total PSA ratio, Gleason score, and prostate volume were also studied. RESULTS: There were no statistically significant differences between the two groups and parameters mentioned above in terms of serum ghrelin levels (p > 0.05). CONCLUSION: Although ghrelin has been shown to induce PCA cell proliferation by in vitro studies, its role in the diagnosis of PCA was not demonstrated in our clinical study. Insufficient secretion of ghrelin into serum or the effect of other sources of ghrelin to serum ghrelin levels could be responsible for this discrepancy.

The prevalence of mental retardation by gender, age of diagnosis and location in Zonguldak province, Turkey.

OBJECTIVE: To evaluate the prevalence of mental retardation by gender, age of diagnosis, and location in Zonguldak, Turkey. METHODS: The data of 1909 mentally retarded children recorded between 1995 and 2003 was obtained from the Learning Disability Guidance and Research Centre. Age, gender, IQ scores, the age of diagnosis, and living areas of cases were evaluated. RESULTS: The distribution of mental retardation was as follows; 304 cases (15.9%) were profound and severe, 1060 (55.6%) were moderate and mild, and 545 (28.5%) were borderline. The prevalence of mental retardation was 12.1% (male: 15.1%, female: 9.1%). Of the cases, 1327 (69.5%) lived in urban areas. CONCLUSION: Most individuals with severe mental retardation become enrolled in the service system during early childhood, but children with mild mental retardation, especially those with no other neurological impairments, may never enter the system or may not do so until puberty. Most of our cases were diagnosed between the ages of 6 and 10. This proves the importance of school guidance of learning disability and their collaboration with The Learning Disability Guidance and Research Center.

Sagittal alignment of the lumbar spine in a Turkish population.

OBJECTIVE: To understand the normal lumbar spine in the sagittal plane, and the range of lumbar lordosis. METHODS: This study was carried out in the Department of Anatomy, School of Medicine, Duzce University, Duzce, Turkey in the year 2005. We retrospectively reviewed T1-weighed sagittal spin-echo MRIs of the lumbar spine in 413 individuals (188 male, 225 female) aged between 13-82 years, and evaluated the angle of lumbar lordosis (ALL), sacrohorizontal angle (SHA), and lumbosacral angle (LSA). RESULTS: The ALL and SHA were significantly greater in females than in males (p<0.05). Weak, but significant correlations were detected between age and ALL, SHA, and LSA for females (p<0.05). The LSA was significantly greater for individuals over 41 years (p<0.05) when the entire study group was considered, and it was also significantly greater for individuals over 51 years in females (p<0.05). The LSA was significantly greater in the 7th decade than in the 3rd decade (p<0.05). CONCLUSION: The results of this study provide insight into the sagittal alignment of the lumbar region for a Turkish population, and can serve as a reference for further clinical studies to improve the planning of spinal surgery.

Tularemia, a reemerging disease in northwest Turkey: epidemiological investigation and evaluation of treatment responses.

An outbreak of tularemia occurred in three provinces in Turkey in February 2004 and reemerged in the same provinces in February 2005. A total of 61 cases, 54 of which were confirmed with the micro-agglutination test, were diagnosed with oropharyngeal tularemia. No culture for Francisella tularensis was attempted, but PCR for F. tularensis was positive in aspiration material of suppurated lymphadenitis of 7 patients. F. tularensis detection with PCR was negative in water samples, but epidemiologic and environmental findings suggested that contaminated water or food was the cause of the outbreaks. Late initiation antibiotic therapy could not prevent suppuration and draining of the involved lymph nodes.

Letrozole vs. clomiphene citrate in patients with ovulatory infertility.

OBJECTIVE: To compare the effectiveness of letrozole and clomiphene citrate (CC) in ovulatory patients with borderline male factor infertility, early stage endometriosis, and unexplained infertility. DESIGN: Prospective quasi-randomized trial. SETTING: University infertility clinic. PATIENT(S): Forty-six consecutive patients with ovulatory infertility were recruited. Twenty-five patients (67 cycles) were given CC and 21 patients (52 cycles) were given letrozole. Both drugs were given orally on days 3-7 of menses. INTERVENTION(S): Letrozole, CC, ovulation induction, IUI, timed intercourse. MAIN OUTCOME MEASURE(S): Number of follicles, endometrial thickness, and pregnancy rates. RESULT(S): The median serum E2 concentration on the day of hCG administration in the letrozole and CC groups were 191.5 pmol/L and 476.0 pmol/L, respectively. The median endometrial thickness on the day of hCG were 8 mm in both groups. Ovulation occurred in 81% (42/52) of the letrozole-treated and 85% (57/67) of the CC-treated patients. Pregnancy rate (PR) per cycle was 9% (5/52) in the letrozole group and 12% (8/67) in the CC group. CONCLUSION(S): Letrozole and CC have comparable effectiveness in ovulatory patients with borderline male factor infertility, early stage endometriosis, and unexplained infertility.

Plasma total homocysteine levels in a healthy Turkish population sample.

OBJECTIVE: The objective of this study is to determine the reference values of homocysteine levels from a sample of healthy native Turks, and the relationship of these levels with gender, age and other risk factors. METHODS AND RESULTS: Plasma homocysteine level was measured in 159 healthy Turkish individuals. Homocysteine levels were determined by the HPLC method and differences between sex and age groupings (20-40 years, 41-60 years, and 61 and older) were compared. Mean homocysteine levels were 8.91 +/- 1.41 micromol/l. The median homocysteine level was 8.35 micromol/l (men 8.80, women 7.0). Homocysteine levels significantly increased with age (r = 0.49) and higher in men than in women in each age group (p < 0.05) (men: 9.51 +/- 1.40; women 7.38 +/- 1.36; p < 0.001). The cut-off point for high homocysteine level is selected to be the value that marks the upper 20% of the control population distribution (12.26 micromol/l). Postmenopausal > 60-year-old women manifested significantly higher increases in total homocysteine concentrations than 20 to 40-year-old premenopausal women. There were no significant correlations between homocysteine and body mass index, glucose, total and lipoprotein lipids, C-reactive protein, creatinine, smoking and alcohol consumption except blood pressure and uric acid. CONCLUSIONS: These data indicate the significance of sex- and age-associated differences of homocysteine levels in native Turkish subjects. Upper reference limits for the plasma total homocysteine concentration increased with age and were higher for men than for women at all ages. Focusing public health initiatives on this issue may reduce the high prevalence of cardiovascular disease in the Turkish population.

[The effect of combined use of vitamin C, vitamin E, and ibuprofen on flap viability: an experimental study]. / C vitamini, E vitamini ve ibuprofenin birlikte kullanilmasinin flep yasamina etkisi: Deneysel çalisma.

OBJECTIVES: Many studies have been carried out to investigate the individual effects of vitamin C, vitamin E, and ibuprofen on flap viability, with favorable results. This study aimed to determine the effect of combined use of these agents on flap viability. DESIGN AND METHODS: Sixty Wistar rats weighing 250-300 grams were divided into six groups, equal in number, to receive saline solution (group 1, control), vitamin C (group 2), vitamin E (group 3), vitamin C and E (group 4), ibuprofen (group 5), and vitamin C, vitamin E, and ibuprofen (group 6). Following ketamine anesthesia, a caudally based reverse McFarlane flap on the back of the rats, 3x10 cm in size, was elevated and sutured back. The agents were administered intraperitoneally once daily for seven days, after which viable flap areas were estimated. RESULTS: The percentages of the viable area of the flaps in groups 1, 2, 3, 4, 5, and 6 were 58.0%, 68.1%, 61.4%, 73.4%, 69.1%, and 80.5%, respectively. The use of vitamin C, vitamin E, and ibuprofen in combination resulted in a significantly greater flap viability compared to individual uses. CONCLUSION: Administering vitamin E and vitamin C together has a greater effect on flap viability than used alone; however, the benefit is the greatest with the addition of ibuprofen.