Assessment of Palliative Care in Lung Cancer in Turkey.

OBJECTIVE: To investigate the symptoms of lung cancer in Turkey and to evaluate approaches to alleviate these symptoms. SUBJECTS AND METHODS: This study included 1,245 lung cancer patients from 26 centers in Turkey. Demographic characteristics as well as information regarding the disease and treatments were obtained from medical records and patient interviews. Symptoms were evaluated using the Edmonton Symptom Assessment Scale (ESAS) and were graded on a scale between 0 and 10 points. Data were compared using the χ2, Student t, and Mann-Whitney U tests. Potential predictors of symptoms were analyzed using logistic regression analysis. RESULTS: The most common symptom was tiredness (n = 1,002; 82.1%), followed by dyspnea (n = 845; 69.3%), appetite loss (n = 801; 65.7%), pain (n = 798; 65.4%), drowsiness (n = 742; 60.8%), anxiety (n = 704; 57.7%), depression (n = 623; 51.1%), and nausea (n = 557; 45.5%). Of the 1,245 patients, 590 (48.4%) had difficulty in initiating or maintaining sleep. The symptoms were more severe in stages III and IV. Logistic regression analysis indicated a clear association between demographic characteristics and symptom distress, as well as between symptom distress (except nausea) and well-being. Overall, 804 (65.4%) patients used analgesics, 630 (51.5%) received treatment for dyspnea, 242 (19.8%) used enteral/parenteral nutrition, 132 (10.8%) used appetite stimulants, and 129 (10.6%) used anxiolytics/antidepressants. Of the 799 patients who received analgesics, 173 (21.7%) reported that their symptoms were under control, and also those on other various treatment modalities (dyspnea: 78/627 [12.4%], appetite stimulant: 25/132 [18.9%], and anxiolytics/antidepressants: 25/129 [19.4%]) reported that their symptoms were controlled. CONCLUSION: In this study, the symptoms progressed and became more severe in the advanced stages of lung cancer, and palliative treatment was insufficient in most of the patients in Turkey.

The effect of feto-maternal blood type incompatibility on development of gestational diabetes mellitus.

OBJECTIVE: To assess the relation between fetal and maternal blood type (ABO, Rh) incompatibility and development of gestational diabetes mellitus (GDM). MATERIALS AND METHODS: A total of 500 pregnant women underwent diagnostic test for GDM by a 100-g oral glucose tolerance test (OGTT) after an 8 to 12-h overnight fast participated in this study. OGTT was performed between the 24-28 weeks of gestation, but participants who were at high risk for GDM were tested after the first prenatal visit. In the postpartum period, maternal and infant blood types were determined. Presence of GDM was evaluated in terms of matched and unmatched fetal and maternal ABO and Rh blood types separately. RESULTS: GDM was detected in 235 participants. Unmatched ABO blood types between the mother-infant pairs were present in 44.7% (n=105) of GDM (+) and 35.8 % (n=95) of GDM (-) patients. Incompatible feto-maternal ABO blood type was positively correlated with development of GDM which was marginally significant. (p=0.045; R=1.2;95% CL; 1.004-1.48). However, Rh feto-maternal blood type incompatibility was not related with development of GDM. CONCLUSIONS: Feto-maternal ABO blood type incompatibility may be a weak risk factor for the development of GDM.

Polymorphisms of toll-like receptors 2, 3 and 4 in patients that do and do not enter labour spontaneously at term.

To assess the association of polymorphisms of toll-like receptors (TLRs) 2, 3 and 4 with the delay in onset of labour at term pregnancies, patients delivering at > 37 weeks and without pre-eclampsia, IUGR or a history of preterm delivery were prospectively evaluated. TLR2 Arg753Gln, TLR3 (c.1377C/T) and TLR4 Asp299Gly and Thr399Ile polymorphisms were genotyped by using PCR-RFLP. Patients labouring spontaneously before the 41st week were compared with those who did not labour spontaneously until this week in terms of baseline characteristics, TLR 2, 3 and 4 polymorphisms. The same comparisons were also performed by using a 40th week cut-off. Chi-square test, two-sample t-test or Mann-Whitney U tests were used for comparisons, as appropriate. In total, 79 patients delivering after 37 weeks were evaluated. All had CC genotype for TLR2 Arg753Gln and TLR4 Thr399Ile. There were no significant differences for TLR4 Asp299Gly GA and TLR3 (c.1377C/T) polymorphisms between patients spontaneously entering or not entering labour until the 41st week; the same was true when the 40th week cut-off was used. Delay in onset of labour at term pregnant women does not seem to be affected by the presence of TLR 2, 3 or 4 polymorphisms. Further studies are needed.

Association between omentin levels and insulin resistance in pregnancy.

AIMS: Omentin is a new adipokine secreted mainly from visceral adipose tissue. Serum omentin is found to be reduced in patients with impaired glucose tolerance, type 2 diabetes mellitus, obesity and insulin resistant states. Despite the fact that pregnancy is also characterized with hyperinsulinemia, literature is lacking about data of omentin levels and its association with insulin resistance in pregnant women. We aimed to evaluate the association of omentin levels and insulin resistance in pregnant women and to compare these levels with those of non-pregnant, non-diabetic women. METHODS: Uncomplicated pregnant women who admit to our outpatient clinics for routine follow-up were included in the study group. Non-pregnant women without diabetes mellitus were served as control group. Fasting glucose, insulin, omentin levels and HOMA IR were recorded. SPSS 15.0 for Windows was used for statistical analysis. RESULTS: There were 36 pregnant women in the study group and 37 healthy, non-pregnant women in the control group. Serum omentin and fasting glucose levels were significantly decreased and fasting insulin was significantly increased in the study group compared to control group. CONCLUSION: Omentin might be an indicator of insulin resistance in pregnant women. Larger prospective studies are needed to claim whether omentin can have a clinical use for diagnosis of gestational diabetes mellitus.

Dexamethasone added to levobupivacaine in ultrasound-guided tranversus abdominis plain block increased the duration of postoperative analgesia after caesarean section: a randomized, double blind, controlled trial.

OBJECTIVES: When added to local anaesthetics, dexamethasone can prolong the duration of peripheral blocks. Dexamethasone has a long and efficient glucocorticoid structure and presents anti-inflammatory properties. The aim of this study was to determine the effect of dexamethasone on the block duration added to levobupivacaine used for transversus abdominis block (TAP) applied to patients who underwent caesarean section. PATIENTS AND METHODS: Forty-two patients with spinal anaesthesia in an American Society of Anesthesiologists (ASA) I-II risk group were included in the study and divided into two groups. Bilateral 30 ml 0.25% levobupivacaine and 2 ml 0.9% NaCl for the levobupivacaine group and bilateral 30 ml 0.25% levobupivacaine and 2 ml dexamethasone (8 mg) for the dexamethasone group were administered in a TAP block performed with ultrasonography. The time need for the first analgesic in the postoperative period was recorded. The numeric evaluation scale, and the total additional analgesic amounts were recorded. RESULTS: The time before the administration of the first additional analgesic dose was prolonged significantly in the dexamethasone group compared to the levobupivacaine group (p = 0.004). The pain scores were lower in the dexamethasone group for superficial pain. A significant difference for the dexamethasone group was observed in the evaluation of deep pain. The total consumption of tramadol was significantly lower in the dexamethasone group (p = 0.001). CONCLUSIONS: The utilization of dexamethasone, which has a prolonging effect on the transversus abdominis plane block, may be an alternative to epidural opioid analgesia in caesarean section. We observed that dexamethasone added to levobupivacaine in a TAP block applied for analgesia following a caesarean section procedure prolonged the time required for analgesia.

Relationship of thyroid hormone levels and thyroid autoantibodies with early pregnancy loss and infertility.

Prevalence of abnormalities in thyroid hormones and thyroid autoantibodies in patients with a history of early pregnancy loss (EPL) (n = 17) and unexplained infertility (UI) (n = 25), were compared with that of 45 control patients. TSH, antithyroid peroxidase (anti-TPO) and antithyroglobulin (anti-TG) antibody levels in UI and EPL groups were similar to that of the control group. TSH was normal in 39, 22 and 13 of control, UI and EPL patients, respectively. Among patients with a normal TSH, fT4 was higher (p < 0.001) and fT3 was lower (p < 0.001) in infertile patients when compared with the control group. Thyroid function tests seem to be associated with infertility but their association with EPL is weaker. Infertility seems to be associated with a high fT4 and low fT3 status. Thyroid autoantibodies do not seem to be associated with either infertility or EPL.

Association of recurrent pregnancy loss with chromosomal abnormalities and hereditary thrombophilias.

BACKGROUND: Recurrent pregnancy loss (RPL) which is generally known as >3 consecutive pregnancy losses before 20 weeks' gestation is seen in 0.5-2% of women. OBJECTIVE: To evaluate the association of parental and fetal chromosomal abnormalities with recurrent pregnancy loss in our area and to analyze the frequency of three types of hereditary thrombophilia's; (MTHFR C677T polymorphisms, FV Leiden G1691A mutation and Prothrombin (factor II) G20210A mutation) in these female patients. METHODS: The present case-control retrospective study was performed between February 2007 and December 2011 on 495 couples, who had two or more consecutive pregnancy losses before 20 weeks' gestation. We used conventional cytogenetic analysis and polymerase chain reaction-restriction fragment length polymorphism. RESULTS: Parental chromosomal abnormality was detected in 28 cases (2.8% of all cases, 5.7% of the couples) most of which (92.9%) were structural abnormalities. All of the structural abnormalities were balanced chromosomal translocations. Chromosomal analysis performed from the abortion materials detected a major chromosomal abnormality in 31.9% of the cases. The most frequently observed alteration in the hereditary thrombophilia genes was heterozygote mutation for the MTHFR C677T polymorphisms (n=55). CONCLUSION: Balanced translocations are the most commonly detected chromosomal abnormalities in couples being evaluated for recurrent pregnancy loss and these patients are the best candidates for offering prenatal genetic diagnosis by the help of which there is a possibility of obtaining a better reproductive outcome.

Antiemetic effects of dexamethasone and ondansetron combination during cesarean sections under spinal anaesthesia.

BACKGROUND: Nausea and vomiting are frequently seen in patients undergoing cesarean section (CS) under regional anesthesia. We aimed to compare the antiemetic efficacy of ondansetron and dexamethasone combination with that of the use of each agent alone to decrease the incidence of post-delivery intraoperative nausea and vomiting (IONV) during CS under spinal anesthesia. OBJECTIVE: To compare the antiemetic efficacy of ondansetron and dexamethasone combination with that of the single use of each agent to decrease the incidence of postdelivery IONV during CS under spinal anesthesia. METHODS: A randomized, prospective, double blind study was performed on 90 patients undergoing planned CS under spinal anesthesia. Patients received 4mg ondansetron in Group O, 8mg dexamethasone in GroupD, 4mg ondansetron+8mg dexamethasone in Group OD intravenously within 1-2 minutes after the umbilical cord was clamped. Frequency of postdelivery IONV episodes was recorded. RESULTS: A total of 86 eligible patients were included in the study. There were 29 patients in Group O, 29 patients in Group D and 28 patients in Group OD. There were no statistically significant difference between the groups in terms of baseline characteristics and intraoperative managements. Frequency of intraoperative nausea, retching and vomiting experiences were similar between the groups (p>0.05). CONCLUSION: Single dose 4mg ondansetron, 8mg dexamethasone, or combined use of 8mg dexamethasone+4mg ondansetron, given intravenously is all effective agents for the control of postdelivery IONV. Combined use of dexamethasone and ondansetron for the same indication does not seem to increase the antiemetic efficacy.

Anal atresia, abnormal genitalia, and absent thumb: congenital malformations associated with mosaic ring chromosome 13.

Because of the deletion of a segment of the chromosome during the formation of a ring, several clinical findings may be associated with ring chromosomes. Ring chromosome 13 is one of such disorders in which the genotype-phenotype correlation is stronger by virtue of the accumulating literature. It can be associated with multiple congenital abnormalities and severe mental retardation. We report a case with mosaic ring chromosome 13 whose prenatal ultrasound revealed bilateral ventriculomegaly. Anal atresia, unidentifiable external genitalia, and an absent thumb were observed in the postmortem examination.

Effect of hypericin on the ADAMTS-9 and ADAMTS-8 gene expression in MCF7 breast cancer cells.

AIM: To investigate the effects of hypericin which is obtained from the plant Hypericum perforatum on the expression and the regulation of ADAMTS8 and ADAMTS9 genes in MCF7 breast cancer cells and on the viability of these cells. MATERIALS AND METHODS: MCF7 cells were cultured and were separately exposed to 2, 10 and 50 µl/mL of hypericin. After 24 hours, RNA was isolated from these cells and converted to cDNA. The expression levels of ADAMTS8 and ADAMTS9 genes were evaluated using the Reverse Transcription Polymerase Chain Reaction. XTT (2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide, disodium salt) cell viability assay was used to determine cytotoxicity. RESULTS: ADAMTS9 expression in MCF7 cells were increased 1.8 and 3.6 fold with the use of 2 and 10 µl/mL of hypericin, respectively; and decreased 0.7 fold with the use of 50 µl/mL of hypericin. There was no significant change in the ADAMTS8 expression. Rapid cell death was observed in the cancer cells when hypericin was used at a dose of ≥ 50 µl/mL. CONCLUSIONS: The increase in ADAMTS9 expression can be a useful factor in the prevention of possible metastasis in breast cancer and for the occurrence of a tumor suppressive effect. Hypericin increases the expression of ADAMTS9, therefore, it may show its antitumoral and antiapoptotic effects by means of ADAMTS9.

Prenatal detection of Pai syndrome without cleft lip and palate: a case report.

Pai syndrome is a rarely encountered disease characterized by findings of median cleft lip, facial skin polyps, nasal mucosal polyps and midline central nervous system lipoma. We report a case with prenatal detection of a pericallosal lipoma and a skin tag on the forehead. After delivery, the diagnosis was confirmed as a case of Pai syndrome.

The facilitating effect of cigarette smoke on the colonization of instilled bacteria into the tracheal lumen in rats and the improving influence of supplementary vitamin E on this process.

OBJECTIVE: The aim of the present study was to investigate the direct influence of cigarette smoke on the bacterial colonization of the lower respiratory tract and the effect of supplementary vitamin E on the colonization of instilled bacteria into the trachea of rats that do not have the chronic airway pathology associated with smoking. METHODOLOGY: Thirty male Wistar albino rats, weighing approximately 250 g, were used as experimental animals. A 0.1 mL bacterial suspension containing six bacterial species (Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumonia, Proteus mirabilis, Haemophilus influenza, Peptostreptococci spp.), isolated previously from pharynx of rats, were instilled into the trachea of three groups of rat (10 control, 10 cigarette smoke-treated and 10 cigarette smoke- and vitamin E-supplemented rats). The smoke-treated rats were exposed to cigarette smoke for 3 days prior to and after intratracheal instillation. The third group of rats were given vitamin E supplements (100 mg/kg per day). Tracheobronchial lavage samples of all rats were quantitatively cultured after 3 days from the instillation. RESULTS: The colony numbers of isolated bacteria were significantly higher in cigarette smoke-treated rats than in the control group and in the smoke- and vitamin E-supplemented rats (P < 0.05). Only S. aureus and S. epidermidis were isolated from vitamin E-supplemented rats, while instilled all six bacterial species were isolated from the other two groups. CONCLUSIONS: It is concluded that smoking impairs the elimination of bacteria or facilitates colonization of bacteria in the lower respiratory tract of rats. Supplementary treatment with vitamin E reduces the effect of cigarette smoke; however, some bacteria may be resistant to this action of vitamin E.