Plasma pentraxin-3 levels and its role in childhood obesity-Is it anti-inflammatory? A matched group study

OBJECTIVE

Obesity has been associated with chronic low-grade systemic inflammation. This study aimed to investigate the relationship of pentraxin-3 (PTX-3) with anthropometric measurements, dietary content and physical activity level in children.

DESIGN

A matched group study.

PATIENTS

This study was conducted with 91 children aged 6-17 years, divided into two groups: "non-obese group" (Body Mass Index Standard Deviation Score [BMI SDS] <95th percentile) and "obese group" (BMI SDS ≥95th percentile).

MEASUREMENTS

Plasma PTX-3 levels.

RESULTS

The mean age of 91 children included in the study was 12.34 ± 2.86 years. Plasma PTX-3 levels were significantly higher in obese children (p = .028). No significant correlation was found between BMI SDS and plasma PTX-3 values, but a weak positive correlation was found when physical activity level was controlled (r = .176, p = .049). In addition, it was found that fat mass was a partial mediator of plasma PTX-3 level, and an increase in the amount of subcutaneous adipose tissue negatively affected plasma PTX-3 level. Plasma PTX-3 level showed a weak positive correlation (r = .223, p = .017) with physical activity score and dietary polyunsaturated fatty acid intake, while a weak negative correlation with neutrophil-to-lymphocyte ratio. One unit increase in physical activity score or polyunsaturated fatty acid level caused 0.730 and 2.061 unit increases in plasma PTX-3 level, respectively; while one unit increase in dietary fat intake caused 0.413-unit decrease.

CONCLUSION

There was an indirect relationship between the amount of subcutaneous adipose tissue and PTX-3 level. The results of our study suggested that plasma PTX-3 was associated with lower levels of inflammation in children.

Can the ADO Index Be Used as a Predictor of Mortality from COVID-19 in Patients with COPD?

Background

Several studies have shown that the risk of mortality due to COVID-19 is high in patients with COPD. However, evidence on factors predicting mortality is limited.

Research Question

Are there any useful markers to predict mortality in COVID-19 patients with COPD?.

Study Design and Methods

A total of 689 patients were included in this study from the COPET study, a national multicenter observational study investigating COPD phenotypes consisting of patients who were followed up with a spirometry-confirmed COPD diagnosis. Patients were also retrospectively examined in terms of COVID-19 and their outcomes.

Results

Among the study patients, 105 were diagnosed with PCR-positive COVID-19, and 19 of them died. Body mass index (p= 0.01) and ADO (age, dyspnoea, airflow obstruction) index (p= 0.01) were higher, whereas predicted FEV1 (p< 0.001) and eosinophil count (p= 0.003) were lower in patients who died of COVID-19. Each 0.755 unit increase in the ADO index increased the risk of death by 2.12 times, and each 0.007 unit increase in the eosinophil count decreased the risk of death by 1.007 times. The optimum cut-off ADO score of 3.5 was diagnostic with 94% sensitivity and 40% specificity in predicting mortality.

Interpretation

Our study suggested that the ADO index recorded in the stable period in patients with COPD makes a modest contribution to the prediction of mortality due to COVID-19. Further studies are needed to validate the use of the ADO index in estimating mortality in both COVID-19 and other viral respiratory infections in patients with COPD.

Is aortic knob width a novel predictor of mortality in hemodialysis patients?

OBJECTIVE: Identifying reliable predictors of mortality in end-stage renal disease patients is crucial for patient outcomes. Aortic knob width is a radiographic parameter used to assess cardiovascular diseases and atherosclerosis. This study investigated the association between aortic knob width and mortality in hemodialysis patients. PATIENTS AND METHODS: The study included data collected between 2007 and 2022 from 103 patients aged between 18 and 85 who had been undergoing hemodialysis treatment for at least one year. Patients were divided into two groups: survivors and deceased. The aortic knob width was measured using a posterior-anterior chest radiograph after midweek hemodialysis. The relationship between aortic knob width and mortality was investigated. RESULTS: Deceased patients had significantly larger aortic knob widths compared with survivors. The deceased group's hemodialysis (HD) duration was shorter, median age was older, Kt/V, hemoglobin, and albumin levels were lower, and the frequency of patients with hypertension, diabetes, and aortic wall calcification was higher. Aortic knob width greater than 37.98 mm was identified as a predictor of mortality in hemodialysis patients. Survival rates for aortic knob width <37.98 mm are 98.1% for 1 year and 64.9% for 15 years. For aortic knob width larger than 37.98 mm, survival rates are 88% for three years, 68% for five years, 45.2% for ten years, and 25% for fifteen years. The most important risk factors for increased aortic knob width were age, male sex, aortic calcification, and hypertension. CONCLUSIONS: Age, male gender, aortic calcification, and hypertension are the primary risk factors for increased aortic knob width in hemodialysis patients. Aortic knob width greater than 37.98 mm, which can be measured simply and rapidly using posterior-anterior chest radiography, may be a predictor of mortality.

Graphical Abstract

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Sexual dysfunction and associated factors in Behçet's disease: a case-control study

Sexual health is an important part of a healthy life. The aim of this study is to define Behçet's sexual dysfunction and the factors affecting it. Sixty-nine patients with Behçet's disease (BD) and 74 healthy controls were included in the study. International Index of Erectile Function (IIEF), the Female Sexual Function Index (FSFI), the Beck Depression Inventory (BDI), and the Short Form Health Survey (SF-36) were filled out by patients and healthy control group (HCG). Follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin and estradiol or testosterone levels according to gender were measured in Behçet's patients. The rate of sexual dysfunction and its relationship with gonadal hormones, Beck depression and SF 36 subgroups were evaluated in Behçet's patients. Sixty-nine patients with BD (mean age 39.55 ± 11.7) and 74 HCG (mean age 36.9 ± 6.84) were included in the study. Sexual dysfunction was observed in 74% (49) of BD and 59.5% (44) of HCG (p = 0.047). Prolactin level is within normal limits in all patients. Although there are abnormal levels of gonadal hormones, no relationship was found with sexual dysfunction. Depression especially is more prevalent compared to the healthy population (p = 0.016). The presence of depression negatively affects sexual life. Depression, SF 36 physical role limitations, energy vitality, vitality and mental health were associated with sexual dysfunction in patients with Behçet's disease. Sexual dysfunction was associated with the presence of depression and SF-36 subscales in Behçet's patients.

Pretreatment Modified Glasgow Prognostic Score for Predicting Prognosis and Survival in Elderly Patients with Gastric Cancer Treated with Perioperative FLOT

The adverse effects of chemotherapy are more apparent in elderly patients and lead to worse prognosis and mortality. Identifying immunonutritional risk factors is of great importance in terms of treatment effectiveness, prognosis, and mortality in geriatric oncology. The modified Glasgow prognostic score (mGPS) is an immunonutritional index based on serum CRP and albumin levels. In this study, we aimed to investigate the role of mGPS in predicting prognosis and survival in elderly patients with gastric cancer receiving perioperative FLOT treatment. We retrospectively enrolled 71 patients aged over 65 years and grouped them according to their pretreatment mGPS score. Kaplan-Meier and Cox regression analysis showed overall survival was significantly worse in the mGPS 1 and mGPS 2 groups than in the mGPS 0 group (p = 0.005 and p < 0.001, respectively). Compared to the mGPS 0 group, the mGPS 1 group had a 6.25 times greater risk of death (95% CI: 1.61-24.28, p = 0.008), and the mGPS 2 group had a 6.59 times greater risk of death (95% CI: 2.08-20.85, p = 0.001). High BMI was identified as a significant risk factor for being in the mGPS 2 group (OR: 1.20, 95% CI: 1.018-1.425, p = 0.030). In conclusion, elevated pretreatment mGPS was associated with poor overall survival in elderly patients with gastric cancer treated with perioperative FLOT therapy. As such, pretreatment mGPS can be a simple and useful tool to predict mortality in this specific patient group.

Comparison of different cyclin-dependent kinase inhibitors and KI-67 levels on survival and toxicity in breast cancer treatment

OBJECTIVE

As cyclin-dependent kinase 4/6 (CDK 4/6) inhibitors, which play a crucial role in the cell cycle, palbociclib and ribociclib are two novel drugs that are recently being used in the treatment of breast cancer. Despite targeting the same pathway, these agents have different molecular activities and processes. KI-67 is known to play a significant role in cell proliferation that has been related to prognosis. This study investigated the impact of palbociclib, ribociclib, and KI-67 on toxicity and survival in breast cancer treatment.

PATIENTS AND METHODS

The study included 140 breast cancer patients in total. Patients were divided into groups based on the use of different CDK inhibitors and KI-67 values. Mortality, progression, treatment response rates, frequency, and severity of adverse events were assessed retrospectively.

RESULTS

The patients in our study had an average age of 53.62±12.71 years, and 62.9% of them were diagnosed at an early stage. 34.3% (n=48) of the patients progressed after receiving treatment, while 19.3% (n=27) of the patients died. The median follow-up time was 576 days, the maximum follow-up time was 1,471 days, and the median time to progression was 301 days (min=28-max=713). Mortality, progression, and treatment response rate between two different CDK inhibitors or KI-67 groups revealed no statistically significant differences.

CONCLUSIONS

Our data show a comparison between the effectiveness of palbociclib and ribociclib, and no noticeable difference is found in breast cancer patients' survival, progression, or severity of adverse effects. Likewise, there is no meaningful difference in KI-67 expression subgroups between progression and survival following treatment.

Avascular Necrosis in Renal Transplant Patients

OBJECTIVES

Kidney transplant recipients are at increased risk for avascular necrosis due to steroid use and accompanying comorbidities. Concerning risk factors, uncertainty still exists. We evaluated the clinical characteristics and risk factors of avascular necrosis in kidney transplant recipients.

MATERIALS AND METHODS

Symptomatic avascular necrosis was found by magnetic resonance imaging in 33 of 360 kidney transplant patients between 2005 and 2021. The patients' clinical characteristics, biochemical testing, and medications were evaluated.

RESULTS

We found the frequency of avascular necrosis to be 9.7% during the follow-up period. If the total steroid dosage used was more than 4 g in the first 3 months, the risk of developing avascular necrosis increased 4.08 times, and the presence of cytomegalovirus disease increased the risk by 4.03 times. Avascular necrosis was observed bilaterally in 60.6% of cases and at the femoral head in 66.7%. The frequency of avascular necrosis was highest in the first and second years posttransplant.

CONCLUSIONS

We found that avascular necrosis appears most frequently in the first 2 years after kidney transplant and the most important risk factors are cumulative steroid dose and cytomegalovirus disease. In the follow-up of kidney transplant patients, it is important to use low-dose steroid doses if possible. Of note, preventing the development of cytomegalovirus disease by screening and prophylaxis for cytomegalovirus is also important in reducing the development of avascular necrosis.

Human papillomavirus vaccine administration among women in the Eastern Mediterranean region of Turkey: prevalence and barriers

OBJECTIVE

Human papillomavirus (HPV) vaccines are very effective in preventing HPV infection and related diseases. This study aimed to determine the prevalence of the HPV vaccine administration and barriers to vaccination among women aged 15-49 years.

SUBJECTS AND METHODS

This cross-sectional study was conducted on 401 women aged 15-49 years. The prevalence of women who received the HPV vaccine, their knowledge about HPV in general, HPV screening tests, HPV vaccine and the current HPV vaccination program were evaluated. Barriers to getting the HPV vaccine were questioned.

RESULTS

The mean age of women who had received the HPV vaccine was 30.87±8.89 and the mean age at the first sexual intercourse was 22 years. 3.2% of women received HPV vaccine. The most important factor impeding the vaccination was unawareness of the HPV vaccine and the high cost of the vaccine. If the vaccine was free, most (81.2%) of the participants stated that they would vaccinate themselves and their children (72.8%). The highest lack of information was observed about the vaccination program and vaccinated women were more informed about HPV, HPV screening tests, HPV vaccine and the vaccination program. The increase in the knowledge about the HPV vaccination program increased the probability of getting vaccinated by an odds ratio (OR) of 4.43 times.

CONCLUSIONS

The most important barriers to HPV vaccination were the lack of public funding for vaccines and the lack of information. We recommend increasing educational activities on the HPV vaccination program and public funding of vaccination.

COVID-19: booster(s) vs. hospitalization and Intensive Care Unit admission

OBJECTIVE

As the pandemic continues, different vaccine protocols have been implemented to maintain the protection of vaccines and to provide protection against new variants. The aim of this study was to assess hospitalized patients' vaccination status and document the efficacy of boosters.

PATIENTS AND METHODS

The patients that were hospitalized due to COVID-19 were enrolled from 28 hospitals in Turkey for five months from September 2021. 5,331 confirmed COVID-19 patients from collaborating centers were randomly enrolled to understand/estimate the distribution of vaccination status in hospitalized patients and to compare the efficacy of vaccination/booster protocols.

RESULTS

2,779 men and 2,552 women of which 2,408 (45.2%) were admitted to Intensive Care Units participated in this study. It was found that the highest risk reduction for all age groups was found in groups that received 4 doses. Four doses of vaccination for every 3.7 people under 50 years of age, for every 5.7 people in the 50-64 age group, and for every 4.3 people over 65 years of age will prevent 1 patient from being admitted to intensive care. Regardless of the type of vaccine, it was found that the risk of ICU hospitalization decreased in those who were vaccinated compared to those who were not vaccinated. Regardless of the type of vaccine, the ICU risk was found to decrease 1.25-fold in those who received 1 or 2 doses of vaccine, 1.18-fold in those who received 3 doses, and 3.26-fold in those who received 4 doses.

CONCLUSIONS

The results suggested that the addition of a fourth dose is more effective in preventing intensive unit care even in disadvantaged groups.

Relationship between low-frequency electromagnetic field and computer vision syndrome

OBJECTIVE

This study aimed to determine the prevalence of computer vision syndrome (CVS) among secretaries working in different departments of a university hospital in Turkey and its relationship with low-frequency electromagnetic field (LF-EMF) exposure.

SUBJECTS AND METHODS

This cross-sectional study included 143 secretaries working in different departments of the hospital. Besides eye examinations, CVS Syndrome Questionnaire (CVS-Q) Scale and Ocular Surface Disease Index Scale (OSDI) were applied to the participants. LF-EMF of the work environment were measured with a 6010 Gauss/Teslameter device and the light intensity with an LX-1102 Device.

RESULTS

The mean age of participants was 39.6 years, with a male-to-female ratio of 25.2% to 74.8%. CVS-Q scale revealed 83.9% of computer vision syndrome among participants. A weak positive correlation was found between CVS-Q and LF-EMF, while a moderately strong, negative correlation was found between LF-EMF and Schirmer test of both eyes. The work environment LF-EMF values were significantly higher among the participants diagnosed with CVS (p<0.05). The risk of CVS was found to increase 3.27 times when the ambient LF-EMF was >1,725 µT and an increase of 0.004 units in the CVS-Q score was calculated for each one-unit increase in the LF-EMF of the environment.

CONCLUSIONS

A relationship between CVS, dry eye and EMF was observed among people exposed to LF-EMF. Regular measurement of EMF in work environments, and developing protective behaviours (work-break intervals, 20-20-20 rule, etc.) can be recommended.

The Bad Bug is Back: Acinetobacter Baumannii Bacteremia Outbreak during the COVID-19 Pandemic in an Intensive Care Unit

Background

Epidemiology of nosocomial infections may show variability because of under-estimation of infection control measures (ICMs) in coronavirus disease 19 (COVID-19) outbreak.

Aim

To investigate the Acinetobacter bacteremia outbreak developed in an intensive care unit (ICU) between March 20 to May 15, 2020, examine the risk factors, and re-evaluate ICM retrospectively.

Material and Methods

A retrospective cohort analysis was conducted to determine the risk factors, pulsed field gel electrophoresis (PFGE) was performed for analysis of the outbreak, ICM practices were observed by a team, and infection control interventions were undertaken.

Results

Acinetobacter bacteremia developed in 17 patients (21.5%) within 79 COVID-19 patients included in the study. The mean age of the bacteremic patients was 67.3 (SD = 14.82) years, and 82.4% of them were male; of these, 15 died, leading to 88.2% mortality. The bacteremia rate was higher compared with a 14-month period preceding the COVID-19 pandemic (17/79 versus 12/580 patients, respectively). PFGE revealed that the outbreak was polyclonal. On multi-variate analysis, the bacteremia development rate was 13.7 and 5.06 times higher with central venous catheter (CVC) use and in patients with chronic obstructive pulmonary disease (COPD), respectively. The mortality rate was higher in bacteremic patients (p = 0.0016). It was observed that ICMs were not followed completely, especially change of gloves and hand hygiene. Contamination of A. baumannii was observed in 38% of the gloves.

Conclusion

COPD and CVC use were determined as risk factors for Acinetobacter bacteremia development, and failures in ICM may have led to cross-contamination of endemic A. baumannii. The outbreak could be controlled within 3 weeks of interventions.

The Relationship Between the Oxytocin Level and Rejection Sensitivity, Childhood Traumas, and Attachment Styles in Borderline Personality Disorder

OBJECTIVE

In this study, it is aimed to investigate the relationship between the oxytocin level and the rejection sensitivity, childhood mental traumas, and attachment styles in patients diagnosed with borderline personality disorder (BPD).

METHODS

Participants between the ages of 18-30 were included in the study. The patient group consists of 31 participants and the healthy control group consists of 31 participants. Sociodemographic/Clinical Variables Questionnaire, Relationship Scales Questionnaire, Rejection Sensitivity Questionnaire and Childhood Trauma Questionnaire were administered to the participants included in the study. Serum oxytocin levels of the participants were measured using the Elisa method.

RESULTS

The oxytocin levels were found to be significantly lower in patients with BPD than in healthy control subjects, whereas the rejection sensitivity and childhood traumas were found to be significantly higher. No difference was found between the patient and control groups in terms of attachment styles, yet it was determined that there may be differences between the oxytocin levels of the BPD patients according to the attachment styles the patients have.

CONCLUSION

In conclusion, the findings of this study revealed that the rejection sensitivity in BPD patients is not associated with oxytocin levels and childhood traumas, indicating the need to assess the BPD patients in terms of other biopsychosocial factors related to the etiopathogenesis of BPD.

The risk estimation and assessment of heavy metal exposure by biomonitoring in the breast milk of mothers in the Cukurova Region, Turkey

Toxic heavy metals released into the environment through various industrial processes have potential adverse effects on the environment and human health. In order to reveal these adverse health effects, it is vital to carry out toxicological studies by performing biomonitoring. This study aimed to assess the level of Cr, As, Cd, Hg, and Pb in the breast milk samples of mothers in the Cukurova region, Turkey, and its association with health risk to infants. Ten-milliliter postpartum milk samples were collected from 34 breast-feeding mothers in the first 2 months of their postpartum period and living in the Cukurova region, Adana. The measurement of target heavy metals levels was performed by using inductively coupled plasma mass spectroscopy (ICP-MS). The average breast milk levels of Cr, As, Cd, Hg, and Pb were 8.25, 1.64, 0.37, 2.60, and 12.12 μg/L, respectively. Evaluation of breast milk samples for these toxic heavy metals revealed the high exposure level for Cr and As. However, the mothers who participated in the study were not occupationally exposed to these metals. This study showed that Cr, As, Cd, Hg, and Pb cross the placenta and blood-brain barrier prenatally and accumulate in breast milk postnatally.

Plasma and Breast Milk Pharmacokinetics of Tenofovir Disoproxil Fumarate in Nursing Mother with Chronic Hepatitis B-Infant Pairs

Tenofovir use is associated with lower risk of mother-to-infant transmission of the virus, and discontinuation of the treatment is not safe. However, the safety of the drug during pregnancy and breastfeeding is not clear. In this study, we aimed to determine the tenofovir concentration in plasma of mother-infant pairs along with breast milk in chronic hepatitis B patients during the lactation period. A total of 11 mother-infant pairs were enrolled in the study. All the mothers received tenofovir disoproxil fumarate (TDF) 245 mg/day for at least 1 month because of chronic hepatitis B infection. Maternal blood, breast milk, and infant blood samples were obtained concomitantly. Tenofovir concentrations were determined by liquid chromatography-tandem mass spectrometry. The median concentrations of tenofovir in maternal plasma and breast milk samples were 88.44 (interquartile range [IQR], 62.47 to 116.17) ng/ml and 6.69 (IQR, 4.88 to 7.03) ng/ml, respectively. Tenofovir concentrations were undetectable (<4 ng/ml) in all of the infant plasma samples. The ratio of tenofovir concentration in breast milk to that in maternal plasma was 0.07. Tenofovir disoproxil fumarate passes through the breast milk in a small amount. Infants had no detectable tenofovir level in their plasma. Our study suggests that tenofovir disoproxil fumarate treatment is safe during the breastfeeding period in chronic hepatitis B patients.

The Use of Pesticides in Suicide Attempts in the Eastern Mediterranean Region of Turkey

OBJECTIVE

In parallel with common usage areas, pesticide poisonings are encountered in the community due to reasons such as no wearing of protective clothing and masks during use, unintentional consumption and suicide-intended intake. In this study was aimed to examine the cases who applied to the emergency department with pesticide poisoning and share of suicide cases.

METHOD

This study is a retrospective record study based on the files of 234 patients who reported to the emergency department for pesticide and rodenticide poisoning between 2014 and 2018. The patients were compared in terms of sociodemographic, substance type, prognosis, and accident/suicide status. Chi-square test, Binary logistic regression analysis were used in the analysis of the data.

RESULTS

Organophosphates was the most common substance recorded as a cause of poisoning, while rat poison placed second. 38% of the acute poisoning cases were suicide attempts. Poisoning among men was found to be prominently due to accident whiles among women suicidal poisoning was more prominent. While the mortality rate is 4.7% in all acute intoxication cases, the mortality rate in poisonings with suicidal purposes is 5.6%. Patients with psychiatric diseases have a 28-fold higher risk of intoxication of attempting suicide. The most common comorbid psychiatric disorders in acute pesticide poisoning are anxiety and depression.

CONCLUSION

A major proportion of pesticide poisoning cases is suicide attempts. Suicide attempt is at the forefront in women and death rates are higher in people with psychiatric illness. It may be advisable to avoid the easy accessibility of pesticides.

The Relationship Between Peritraumatic Dissociation and Anxiety Level, Perceived Stress, Anxiety Sensitivity and Coping with Earthquake Stress in Post-Earthquake Acute Stress Disorder Patients

OBJECTIVE

The present study aims to determine the effects of anxiety sensitivity, anxiety level, perceived stress and coping strategies on peritraumatic dissociation in post-earthquake acute stress disorder (ASD) patients.

METHOD

Sociodemographic data form, Beck Anxiety Index (BAI), Perceived Stress Scale (PSS), Anxiety Sensitivity Index-3 (ASI-3), Coping with Earthquake Stress Scale, and Peritraumatic Dissociation Scale (PDEQ) were applied to 477 patients diagnosed with ASD.

RESULTS

Anxiety sensitivity cognitive sub-dimension explained 31.5%, anxiety explained 7%, and perceived stress explained 1% of the variation in peritraumatic dissolution development. A moderate positive correlation was determined between peritraumatic dissolution and anxiety, a weak positive correlation was found between peritraumatic dissolution and perceived stress, a weak positive correlation was determined between peritraumatic dissolution and positive thinking, and a very weak negative correlation was determined between peritraumatic dissolution and seeking social support. A moderate positive correlation was determined between peritraumatic dissolution and physical, cognitive and social sub-dimensions of anxiety sensitivity.

CONCLUSION

The most important finding in the study was the fact that the highest contribution to the development of peritraumatic dissolution was by the cognitive sub-dimension of anxiety sensitivity. It could be suggested that individuals with high anxiety sensitivity may experience higher peritraumatic dissolution and these individuals could have a higher risk of PTSD later on.

Evaluation of awareness regarding skin moisturisation and moisturiser usage frequency in individuals over 65 years of age

OBJECTIVE

Skin dryness is a common dermatological problem among older people.We aimed to evaluate the frequency of moisturiser use and awareness of its benefits among older people.

METHODS

This cross-sectional descriptive study included 556 individuals over 65 years of age, all of whom were patients at family medicine and dermatology outpatient clinics at a tertiary teaching hospital. Data were summarised descriptively and analysed using binary logistic regression analysis.

RESULTS

Of the 556 individuals who participated in the study, 241 were women and 315 were men. Moisturisers were being used by 217 patients (39%), and 91 patients (16.4%) classified the use of skin moisturisers as skincare.

CONCLUSION

We found that individuals over 65 years of age had insufficient knowledge regarding the use and benefits of skin moisturisers.

Examining the relationship between inflammation markers and anthropometric values in primary care

Background

In recent studies, adipose tissue appears to be associated with inflammation. In this study, it was aimed to determine the relationship between inflammation markers and anthropometric measurement values and blood lipid values for purpose in primary health units.

Methods

The universe of this study has comprised healthy adults admitted to a community health units' diet clinic in a city of eastern Turkey in the city in 2019. Blood analyzes were done in the family medicine laboratory, those with high leukocyte values were excluded and 274 adults were included in the study. The relationship between blood lipid values, complete blood count, inflammation markers, neutrophil lymphocyte ratio (NLO), platelet lymphocyte ratio (PLO) and lymphocyte monocyte ratio (LMO) and anthropometric measurements of adults were investigated. Spearman correlation test, Kruskal Wallis test, Multiple Linear Regression test were used in the analysis of the data.

Results

The average age of 274 people participating in the study is 34.07 ± 9.92. According to BMI, no significant difference was found between NLO, PLO and MLO ratios. Significantly weak negative correlation between PLO and skeletal muscle, basal metabolic rate, body fluid amount and lean mass; a negative correlation between HDL and BMI, amount of body fat and amount of internal lubrication were found (p &lt; 0,003). The increase in the amount of skeletal muscle causes a decrease in the level of total cholesterol, while the increase in the amount of internal lubrication causes an increase in the level of total cholesterol. A positive weak correlation was found between NLO and LDL(p &lt; 0,001), a very weak positive correlation between NLO and total cholesterol and a very weak positive correlation between LMO and LDL(p &lt; 0,014).

Conclusions

It was observed that there was a very weak correlation between anthropometric values and cholesterol levels and inflammation markers, and moderate levels of blood lipid values in healthy individuals.

Key messages

In primary care, measuring the body composition of healthy people at least once a year appears to be a valuable practice. Exercises that increase skeletal muscle and reduce the amount of internal fat should be recommended to patients with high cholesterol or healthy people at risk.

Evaluation of chronic disease follow-up training of family physicians in primary care units

Background

Chronic diseases are a major cause of morbidity and mortality due to late diagnosis and insufficient treatment. This study deals with the training on chronic diseases organized by the Ministry of Health in the provinces. The aim of this study was to measure the effectiveness of training programs for family physicians in a province.

Methods

This semi experimental study was carried out during the training held in Bingöl that is eastern city of Turkey, on 22-26 October 2018 and 19-20 December 2018. The universe of the study consisted of family physicians working in the province. Of the 90 family physicians working in the province, 75 participated in the study. The training was conducted by the researchers and (before-after) 16-question test to the participants were used. The trainings cover the sub-heading Cardiovascular Risk Assessment and Diagnosis and Treatment of Hypertension. The family physicians were divided into 7 groups and were given 7-hour training. SPSS 25 program was used to analyze the data. In the analysis of data, Wilcoxon test, Cochran’s Q test and Bayesian approach samples t test were used.

Results

The average number of correct before training was 7.33 (min: 2 - max: 13), after training 12.64 (min: 7- max: 16; p &lt; 0.001). After the training, participants’ correct answers to 15 questions increased (p &lt; 0.001). Increase rate is 71%. Bayesian factor was found to be &lt; 0.001 according to the results of Bayesian approach t test. There is definite evidence against the H0 hypothesis. According to the results of this quasi-experimental study, training is very effective.

Conclusions

In this study, it was shown that the education of the family physicians about the chronic diseases of the Ministry of Health is effective in increasing the knowledge level of family physicians.

Key messages

The training of the family physicians in charge of the primary health care is important. This study showed that education is very effective accorging to the pre-training.

Smoking and substance abuse prevalence in adolescents in a city of Turkey

Background

The aim of this study was to determine the prevalence of smoking and abuse of substance among young people aged 14-18 in a city of Turkey and to determine the relationship between smoking and substance abuse risk.

Methods

This cross-sectional study was conducted on high school students studying in Bingöl city center. The universe of the study consists of 14000 students studying in 14 high schools. The minimum sample size required to be reached in the sample size analysis with reference to 80% power and 99% confidence interval was found to be 1235. According to the stratified sampling method, the students were randomly reached in schools and questionnaires were conducted under supervision by taking their consent. Chi-square test, Binary Logistic Regression test were used for data analysis.

Results

The mean age of the students was 15.71 ± 1.16 (min-max: 14-18) and 49.5% were male. The prevalence of smoking among all students is 15.8%, addictive substance use / trial frequency 5% except smoking. The prevalence of smoking among male students is 24.1%, in female students 7.7%. The rate of using addictive substance was found to be 8.2% for male students and 1.9% for female students except smoking. According to the results of Logistic Regression; substance abuse increases 8 (95% CI:3,32-19,95) fold in smokers (p = 0,001) and 2.5 (95% CI:1,10-5,38) fold in men (p = 0,027). The risk of substance use increases 1.05 (95% CI:1,02-1,08) fold as the number of cigarettes smoked daily (p = 0,001). Substance abuse risk of 18-year-olds shows increase 1.5 (95% CI:1,06-1,93) fold according to 14 years old (p = 0,021).

Conclusions

Smoking and addictive substance use in adolescents are particularly remarkable in male students (8.2%). This result is higher than the data reflecting Ä°stanbul (7%). This may be due to the fact that the province is located at the crossing point of drug traffic. Smoking increases the risk of other addictive substances (marijuana, heroin, etc.).

Key messages

Smoking and substance abuse is an important health problem in adolescents according to this study. Male students smoke are at risk of substance abuse more than female.

Distribution of Cancer cases and survival analysis results: A retrospective cohort study

Background

Cancer was the second leading cause of death in Turkey. The aim of this study is to examine the changes in the incidence of cancer cases and survival analysis in a region.

Methods

This retrospective cohort study was carried out on data of 977 people had been diagnosed with cancer between the years 2013-2015 in Bingol province located in the east of Turkey. All cancer cases are included in the study. The data of the patients were obtained from the Ministry of Health Cancer Registry System and International Disease Classification Oncology (ICD-O) codes published by World Health Organization were used. Patients were evaluated topographically (tissue originating from the lesion) in 41 categories. Kruskal Wallis, Mann Whitney U test, Chi-square test and Cox regression analysis were used to analyze the data.

Results

The mean age of the patients was 58.73 ± 16.80 (min: 1-max: 107). It was observed that 28.7% of the patients died during the follow-up period and 71.3% of the patients were alive. 30% of the cancer cases digestive system, 11% respiratory system, 23% female breast- genitalia, 15% blood-lymph-thyroid, 11.8% muscle-bone, 15,4% other cancer species. In men, lung, stomach, colon, prostate; breast, thyroid and skin cancers are more common in women respectively. The incidence rate for all age groups was 97 per hundred thousand in 2013, 161 per hundred thousand in 2015. The increase trend did not differ by gender. The mean follow-up period of the patients who died was 388 days and 1541 days for the living patients. The risk of death is increased significantly in patients who cannot be operated (RR = 2.779, HR = 3.048). In patients not receiving chemotherapy, the risk of death is reduced significantly (RR = 0.656, HR = 0.340).

Conclusions

The incidence of cancer increases in the study area. Survival times vary according to treatment efficacy. Broad-based cohort studies evaluating the effects of treatment types on survival may be recommended.

Key messages

Cancer in the study area shows a significant increase from year to year. The average 5-year survival period of cancer patients was found is 71% as a good result.

Prevalence of malnutrition in COPD and its relationship with the parameters related to disease severity

Objective

The aim of the study was to determine the nutritional status and anthropometric values in a group of patients with COPD and to examine the relationship between these factors and disease severity.

Methods

A total of 105 COPD patients were included in this cross-sectional study. The patients underwent spirometric exmination. Mini nutritional assessment form was applied, and the anthropometric values of the patients were measured by bioelectrical impedance method. Nutrient registration forms were given using a 3-day, 24-hour recall method to assess the nutrient uptake. COPD severity was determined using the Global Initiative for Chronic Obstructive Lung Disease criteria, and the correlations between nutritional status and disease severity parameters were measured.

Results

The prevalence of malnutrition in our patients with COPD was found to be 17%. Spirometric parameters were found to be significantly lower in patients with low body mass index (BMI) and malnutrition. As the modified Medical Research Council dyspnea scale score increased, the frequency of malnutrition increased (P=0.002). Positive significant correlation was found between spirometric variables and muscle mass and fat external tissue volume of the patients. Patients receiving higher protein content in diet showed a better muscle mass amount (P<0.001).

Conclusion

Our study results confirmed that malnutrition is an important and frequently encountered problem in COPD patients, and spirometric values of the patients with malnourishment and with low BMI are significantly lower. We think that nutritional status should be evaluated in every COPD patient, and nutritional intake should be tailored individually.

The course of spinal tuberculosis (Pott disease): results of the multinational, multicentre Backbone-2 study

We aimed to describe clinical, laboratory, diagnostic and therapeutic features of spinal tuberculosis (ST), also known as Pott disease. A total of 314 patients with ST from 35 centres in Turkey, Egypt, Albania and Greece were included. Median duration from initial symptoms to the time of diagnosis was 78 days. The most common complications presented before diagnosis were abscesses (69%), neurologic deficits (40%), spinal instability (21%) and spinal deformity (16%). Lumbar (56%), thoracic (49%) and thoracolumbar (13%) vertebrae were the most commonly involved sites of infection. Although 51% of the patients had multiple levels of vertebral involvement, 8% had noncontiguous involvement of multiple vertebral bodies. The causative agent was identified in 41% of cases. Histopathologic examination was performed in 200 patients (64%), and 74% were consistent with tuberculosis. Medical treatment alone was implemented in 103 patients (33%), while 211 patients (67%) underwent diagnostic and/or therapeutic surgical intervention. Ten percent of the patients required more than one surgical intervention. Mortality occurred in 7 patients (2%), and 77 (25%) developed sequelae. The distribution of the posttreatment sequelae were as follows: 11% kyphosis, 6% Gibbus deformity, 5% scoliosis, 5% paraparesis, 5% paraplegia and 4% loss of sensation. Older age, presence of neurologic deficit and spinal deformity were predictors of unfavourable outcome. ST results in significant morbidity as a result of its insidious course and delayed diagnosis because of diagnostic and therapeutic challenges. ST should be considered in the differential diagnosis of patients with vertebral osteomyelitis, especially in tuberculosis-endemic regions. Early establishment of definitive aetiologic diagnosis and appropriate treatment are of paramount importance to prevent development of sequelae.

Comparison of community-onset healthcare-associated and hospital-acquired urinary infections caused by extended-spectrum beta-lactamase-producing Escherichia coli and antimicrobial activities

OBJECTIVE

We aimed to compare community-onset healthcare-associated (CO-HCA) and hospital-acquired (HA) urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli in terms of epidemiology, clinical outcomes and antimicrobial activities.

METHODS

Patients from both groups with ESBL-producing E. coli detected by urine culture between January 2009 and January 2011 were included in this retrospective study. Relevant demographical, microbiologic and clinical data were obtained from case records.

RESULTS

A total of 173 patients (mean age of 58 years, 74% female) were included, of whom 75 (43.4%) had a CO-HCA UTI and 98 (56.6%) had an HA UTI. Eighty (46.2%) patients had more than one comorbid disease, of whom 57 (32.5%) had urological problems. The most common clinical manifestations were pyelonephritis (43.9%) and urosepsis (16.2%). An age of > 65 years (p = 0.005) in addition to urinary catheterisation (p = 0.001), urosepsis (p = 0.001) and mortality (p = 0.001) were significantly more common in the HA UTI group. Acute cystitis (p = 0.027), complicated cystitis (p = 0.001) and non-urologic neoplasm (p = 0.032) were significantly more common in the CO-HCA UTI group. No isolate was resistant to carbapenems or fosfomycin. Sensitivities to nitrofurantoin, amikacin, trimethoprim sulfamethoxazole-trimoxazole and quinolones were 97.6%, 89%, 29.4% and 17.9% respectively. Both groups showed similar rates of antibiotic resistance.

CONCLUSION

ESBL-producing E. coli should be taken into consideration in patients with a CO HCA UTI, not only in hospital settings but also in outpatient settings. We suggest ertapenem as a first-line empirical treatment for patients with an upper UTI and fosfomycin and nitrofurantoin for those with a lower UTI when ESBL-producing E. coli is suspected.

Coexistence of blaOXA48 and aac(6′)-Ib-cr Genes in Klebsiella Pneumoniae Isolates from Istanbul, Turkey

This study evaluated the presence of carbapenem hydrolysing β-lactamase genes and plasmid-mediated quinolone resistance (PMQR) determinants in 22 Klebsiella pneumoniae isolates collected from the Istanbul Medical Faculty, Turkey, which reduced the susceptibility or resistance to carbapenem. The VITEK® 2 system and E-tests were used to determine the minimum inhibitory concentrations needed to inhibit bacterial growth. Genes were screened by polymerase chain reaction, and gene transferability was evaluated by transconjugation. Strain clonality was investigated by pulsed-field gel electrophoresis (PFGE). All strains were OXA-48 β-lactamase producers and three (13.6%) were also positive for the aac(6′)-Ib-cr gene. Most of the strains harboured other b-lactamase (bla) genes such as blaTEM, blaSHV, blaCTX-M and blaVEB-1. The transconjugants mostly harboured blaOXA-48 and other β-lactamases separately. PFGE revealed eight pulsotypes among the isolates. The coexistence of blaOXA-48 and PMQR in K. pneumoniae isolates may present a significant threat to health, especially in the nosocomial setting.

Environmental contamination during a carbapenem-resistant Acinetobacter baumannii outbreak in an intensive care unit

During a three-month period in 1999, 25 strains of carbapenem resistant Acinetobacter baumannii were isolated from 12 of 170 hospitalized intensive care unit (ICU) patients, of which 16 were considered to be clinically significant. These strains were indistinguishable by biotyping and antibiograms, but genotyping was not performed. Appropriate antibiotic treatment, isolation precautions, and infection control education of the staff failed to halt the outbreak. Environmental contamination was therefore investigated, and A. baumannii was found out in 22 (39.3%) of 56 environmental samples obtained by swabbing. Different antibiotic sensitivity patterns were obtained in the majority of these isolates, but four (7.1%) of the strains were found to have the same sensitivity pattern as the strain causing the outbreak. As a result the ICU was closed, equipment and the environment cleaned, with hypochlorite and terminal disinfection carried out. No bacteria were grown on repeat environmental cultures. Environmental contamination has an important reservoir role in outbreaks of A. baumannii in ICUs and must be eradicated in order to overcome such outbreaks.