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In this study, our aim was to investigate the prevalence of Mediterranean fever (MEFV) gene mutations in patients with ankylosing spondylitis (AS) and assessing their clinical significance. Ninety-five consecutive patients (12 women, 83 men) with active AS were included to the study. All patient’s relevant clinical data were recorded at the beginning and patient assessment measures were performed. The frequency of the eight most common MEFV mutations: M694V, V726A, E148Q, M680I, M694I, P369S, F479L, and the R761H were determined. Genetic analysis was carried out by the NanoChip® Molecular Genetics Workstation. NSAIDs were given to patients for treatment. The rate of MEFV mutations and their clinical significance were assessed. With regard to the MEFV mutation analysis, 30.5% of AS patients were found to have at least one mutation. The response rate to the NSAIDs (P = 0.825) or frequency of patients having active disease (P = 0.066) after the treatment, were not found different between the patients those have MEFV mutations and the patients those were non-carriers. Furthermore, no clinical and laboratory difference between MEFV mutation carriers and non-carriers were found. We think that although prevalence of MEFV mutations is significantly high in AS patients without clinical features of familial Mediterranean fever, its influence to the prognosis is less likely. Further investigations are needed to define the impact of MEFV mutations on the disease course of ankylosing spondylitis.

Background: Defective endothelial function, an initial step in the development of atherosclerotic plaque, is prevalent in moderate to advanced chronic kidney disease (CKD). In this study, the investigators hypothesized that fetuin-A, a calcification inhibitor, is a novel risk factor for the development of endothelial dysfunction in patients. Methods: 198 nondiabetic patients with a mean age of 44.0 ± 12.4 years and with different stages of CKD were studied. In addition to a detailed metabolic panel, flow-mediated dilatation assessed by high-resolution brachial ultrasonography was performed to determine endothelial dysfunction. Carotid intima-media thickness was also estimated by ultrasonography. Serum fetuin-A concentrations were determined by using a human ELISA method. Results: Endothelial dysfunction was observed in all stages (1–5) of CKD and worsened in parallel to the reduction in estimated glomerular filtration rate. Serum fetuin-A concentrations were also found to be decreased in all but stage 1 CKD. On multiple regression analysis, endothelial dysfunction was independently associated with fetuin-A (β = 0.745, p < 0.001) and intact parathyroid hormone concentrations (β = –0.216, p < 0.001). Conclusion: These data in a selected cohort of CKD patients indicate that fetuin-A may be one of the contributing factors for the development of endothelial dysfunction in CKD patients.

Purpose:To report the frequency, risk factors, and outcomes of screening for retinopathy of prematurity (ROP).Methods:Data of neonates with a gestational age of 34 weeks or less were analyzed and the predictors on the development of ROP were determined by using logistic regression analysis.Results:Of the 318 neonates, the frequency of ROP was 37.1% for any stage and 7.2% for stage 3 or greater. Treatment was needed in 16.1% of neonates with ROP. No treatment was required in neonates with a gestational age of greater than 32 weeks. Oxygen therapy, sepsis, gestational age of 32 weeks or less, and birth weight of less than 1,250 g were determined as the independent risk factors.Conclusions:Although frequency of ROP in Turkey is similar to that in the United States, the rate of severe ROP necessitating treatment seems to be higher in Turkey. Neonates with a gestational age of 32 weeks or less, a birth weight of less than 1,250 g, sepsis, and oxygen therapy may have a greater risk of developing ROP and screening should be intensified in the presence of these risk factors.

Introduction Recent surveys showed that the major reasons for avoiding vaginal delivery were the fear of childbirth and the concern for postpartum sexual health. Although sexual dysfunction is a disorder that affects a couple rather than an individual, all studies investigating the relationship between the mode of delivery and sexual problems have been conducted only in cohorts of women. Aim To determine the effect of mode of delivery on quality of sexual relations and sexual functioning of men by using the Golombock–Rust Inventory of Sexual Satisfaction (GRISS). Main Outcome Measure Mean score of sexual function and prevalence of sexual dysfunction in overall and specific areas of the GRISS were compared among the three groups. Methods A total of 107 men accompanying their wives in outpatient clinics of obstetrics and gynecology met inclusion/exclusion criteria. Three groups of men were defined; men whose partners had: (i) “elective cesarean delivery” (N = 21; mean age 32.2 ± 3.8 years); (ii) “vaginal delivery with mediolateral episiotomy” (N = 36; mean age 31.4 ± 4.5 years); and (iii) “not given birth” (N = 50; mean age 28.8 ± 4.0 years). Results Mean overall sexual function score (normal value P = 0.731). Prevalence of sexual dysfunction in men was 28.6% in the elective caesarean group, 19.4% in the vaginal delivery group, and 30.0% in the nulliparae group ( P = 0.526). Conclusion Overall sexual function of men was not affected by their partner's parity and mode of delivery. An elective cesarean section simply because of concerns about sexual function would not provide additional benefit to men, and could deny women a possible vaginal delivery, which is generally assumed to be safer than cesarean section. Gungor S, Baser I, Ceyhan T, Karasahin E, and Kilic S. Does mode of delivery affect sexual functioning of the man partner?.

WOS: 000373527100012 PubMed ID: 27044816 APOBEC3B belongs to a protein family of cytidine deaminases that can insert mutations in DNA and RNA as a result of their ability to deaminate cytidine to uridine. It has been shown that APOBEC3B-catalysed deamination provides a chronic source of DNA damage in breast cancers. We investigated APOBEC3B expression in four drug resistant breast cancer cell lines (Doxorubicin, Etoposide, Paclitaxel and Docetaxel resistant MCF-7 cell lines) using a novel RNA in situ hybridization technology (RNAscope) and compared expression levels with drug sensitive MCF-7 cell line. After RNAscope staining, slides were scanned and saved as digital images using Aperio scanner and software. Quantitative scoring utilizing the number of punctate dots present within each cell boundary was performed for the parameters including positive cell percentage and signal intensity per positive cell. In Doxorubicin and Etoposide resistant MCF-7 cell lines, APOBEC3B expression was approximately five-fold increased (23% and 24% respectively) with higher signal intensity (1.92 and 1.44 signal/cell, respectively) compared to drug sensitive MCF-7 cell line (5%, 1.00 signal/cell) with statistical significance. The increase of APOBEC3B expression in Docataxel resitant and Paclitaxel resistant MCF-7 cell lines was not very high. In conclusion, APOBEC3B expression was increased in some population of tumor cells of drug resistant cell lines. At least for some drugs, APOBEC3B expression may be related to drug resistance, subjecting to some tumor cells to frequent mutation. (C) 2016 Elsevier Masson SAS. All rights reserved. TUBITAK (The Scientific and Technological Research Council of Turkey)-International Postdoctoral Research Fellowship ProgrammeTurkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [2219] This study is supported by TUBITAK (The Scientific and Technological Research Council of Turkey)-2219 International Postdoctoral Research Fellowship Programme.

Hypercholesterolemia is a major risk factor for atherosclerosis. Dysregulation of adipokines contribute to atherosclerotic diseases. Apelin has recently been shown to be secreted by the adipose tissue in association with hyperinsulinemia and inflammation. We searched plasma apelin levels in patients with elevated low density lipoprotein (LDL)-cholesterol having no additional disorder. Thirty-three patients with hypercholesterolemia and 50 age-, sex-, and body mass index-matched healthy controls were evaluated for their apelin, adiponectin and high sensitivity C-reactive protein (hsCRP) levels, and homeostasis model assessment (HOMA) indexes. Plasma apelin-12 and adiponectin were determined by ELISA and RIA, respectively. Plasma apelin levels were lower in patients with elevated LDL-cholesterol compared to healthy controls (p

Visfatin, a new adipokine, facilitates adipogenesis and has insulin-mimetic properties. We aimed to investigate the plasma visfatin levels in patients with newly diagnosed and untreated type 2 diabetes mellitus (T2DM) and impaired glucose tolerance (IGT), who had no obesity or hypertension. Twenty-two patients with T2DM, 18 subjects with IGT and 40 healthy controls were enrolled. Visfatin levels were measured along with the BMI, blood pressure, lipids, glucose, insulin, adiponectin and hsCRP levels, and HOMA-IR indexes. Age, sex and BMI were similar in all groups. Visfatin levels were higher in the diabetic group than the controls (p = 0.01). There was no significant difference in the visfatin levels between the T2DM and IGT groups as well as IGT group and healthy controls. Plasma visfatin concentrations did not differ between men and women. Visfatin levels did not correlate with BMI, blood pressure, plasma adiponectin, insulin, hsCRP, glucose and lipid levels or HOMA-IR indexes in the three groups. These results indicate that hyperglycemia causes an increase in plasma visfatin levels and, as in people with T2DM but not with IGT, this increase gets more prominent as the glucose intolerance worsens.

Pregnancy requires antenatal care either for mother and her baby from initial of pregnancy to delivery. Main aims of antenatal care are to identify probable mother’s disease and to determine health risk which would endanger mother and her baby. The aim of this study is evaluation of antenatal care frequency and its influencing factors in women who were complete 28 weeks of her pregnancy in GATA hospital and ZTB Hospital. The study conducted among on a total number of 200 women who consent involves in study. There was a statistically significant difference among two groups about distributions of maternal education level, maternal occupation which has income, husband’s education level, husband’s occupation, family’s total monthly income, ownership a social security (p

Objectives We evaluated the effects of nebivolol on platelet activation in hypertensive patients by measuring mean platelet volume (MPV) and plasma soluble P-selectin (sP-sel) levels and compared with those of the patients taking metoprolol. Materials and methods Eighty newly diagnosed hypertensive patients in grade 1 hypertension were enrolled in this prospective, blinded randomized study. Seventy two patients completed the study. After baseline assessment, each patient was randomly allocated to 5 mg daily dose of nebivolol ( n =37, 20 male) or 100 mg daily dose of metoprolol ( n =35, 18 male) and treated for 6 months. Blood pressure, heart rate, lipid profile, plasma glucose, sP-selectin levels, platelet counts and MPV were measured before and after treatment. Results At the end of 6 months, nebivolol significantly decreased MPV and plasma sP-selectin levels (7.59±0.78 fl vs. 7.42±0.74 fl, p p =0.002, respectively) compared to those of pretreatment. Although pretreatment sP-selectin levels of the two groups were similar, posttreatment plasma sP-selectin levels were significantly reduced with nebivolol compared with those of metoprolol group (1.21±0.36 ng/ml vs. 1.46±0.30 ng/ml, p =0.008). In contrast, metoprolol treatment did not cause any significant change in platelet activation parameters after treatment. Conclusion Beneficial effects of nebivolol on platelet activation were more potent than those of metoprolol. We consider that decreased platelet activation with nebivolol might play a role to reduce thrombotic risk in hypertensive patients.

Neopterin is an immunologic marker for the activation of the cell-mediated immune system and it is found to be elevated in autoimmune diseases. We aimed in this study to investigate the relationship between urinary neopterin levels and disease activity in patients with uveitis.31 patients with active uveitis and 13 patients with inactive uveitis were compared with 27 age and sex matched controls. Disease activity was evaluated by clinical examination and fundus florescein angiography findings. Samples were studied with High Performance Liquid Chromatography.Urinary neopterin levels in patients with active uveitis, inactive uveitis and control subjects were 274 +/- 98, 179 +/- 61 and 166 +/- 38 micromol/mol creatinine respectively (p001). The difference between active uveitis, inactive uveitis and control groups were statistically significant (p001).Urinary neopterin levels are found to be increased in patients with active uveitis. Neopterin can be used as a biochemical activity marker to support the clinical findings in patients with uveitis.

Aim: To investigate the relationship between hypermetropia and systemic hypertension. Methods: The study was performed on 2 groups of participants (a total of 1,162 participants). Group 1 comprised 370 patients with arterial hypertension and 205 age- and sex-matched normotensive subjects. Hypertension was defined as systolic blood pressure ≧140 mm Hg and/or diastolic blood pressure ≧90 mm Hg. Spherical equivalents between –0.50 and +0.50 dpt were regarded as emmetropia. Keratometry, anterior chamber depth (ACD) and axial length (AL) were measured with IOL Master (Zeiss, USA). Group 2 comprised 124 myopic, 206 emmetropic and 257 hypermetropic subjects. Differences for mean spherical equivalent, keratometry, ACD and AL measurements between hypertensive patients and control subjects (group 1) were compared using independent-sample t test and Mann-Whitney U test, and distributions of refractions were compared with the χ2 test. Distributions of hypertensive and normotensive subjects (group 2) among myopic, emmetropic and hypermetropic subjects were compared with the χ2 test. Results: Mean spherical equivalents of the patients with hypertension and of control subjects were –0.03 ± 1.63 and 0.22 ± 1.82 dpt, respectively (p = 0.182). The differences for keratometric values, ACD and AL were not significant (p = 0.151, 0.692 and 0.548, respectively). There was also no significant difference (p = 0.143) for hypertension ratios among myopic (66.1%), emmetropic (57.8%) and hypermetropic (55.6%) subjects. Conclusion: There is no association between systemic arterial hypertension and hypermetropia.

No-reflow is of prognostic value in ST-segment elevation myocardial infarction (STEMI) but has not been extensively investigated in young patients. Young patients with STEMI admitted within 12 hours from symptom onset and treated by primary percutaneous coronary intervention (pPCI) were recruited. Patients were classified into 2 groups based on postintervention thrombolysis in myocardial infarction (TIMI) flow grade; no-reflow: TIMI flow grade 0, 1 or 2 (group 1; n = 27; 21 men, mean age: 42 ± 4 years); and angiographic success: TIMI flow grade 3 (group 2; n = 118; 110 men, mean age: 43 ± 4 years). Adjusted odds ratios were 13.79 for female gender ( P < .001; confidence interval [CI] = 1.88-101.26), 2.09 for pain to balloon time ( P < .017; CI = 1.14-3.812), 12.29 for high TIMI thrombus grade ( P = .012; CI = 1.74-86.94), 0.04 for tirofiban use ( P < .001; CI = 0.01-0.22), 5.19 for mean platelet volume (MPV; P < .001; CI = 2.44-11.01), and 1.008 for platelet–lymphocyte ratio (PLR; P = .034; CI = 1.001-1.016). In conclusion, female gender, pain to balloon time, high TIMI thrombus grade, tirofiban, MPV, and PLR were independent predictors of no-reflow in young patients with STEMI after pPCI.

Background: The red cell distribution width–platelet ratio (RPR), a novel inflammatory marker is currently used to predict inflammation in chronic diseases. It may be associated with adverse outcomes among artery disease but its prognostic value in ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) has not been fully investigated. There is no data regarding the association between RPR and in-hospital major adverse cardiovascular events (MACEs). This study evaluated the relations between pre-procedural RPR and the in-hospital and long-term outcomes in STEMI patients undergoing primary PCI. Methods: This study included 580 STEMI patients (77% men, mean age: 59 ± 12 years). The patients were divided into two groups according to thrombolysis in myocardial infarction (TIMI) flow grades after primary PCI. No-reflow was defined as a post-PCI TIMI flow grade of 0, 1 or 2 (group 1). Angiographic success was defined as TIMI flow grade 3 (group 2). Results: Whole blood cell count, neutrophil and lymphocyte percentages, red cell distribution width, platecrit, neutrophil–lymphocyte ratio (NLR) and RPR values were higher among patients with no-reflow. On multivariate analysis, pain to balloon time, multivessel disease, TIMI thrombus grade, tirofiban, aspirin, previous coronary artery disease, NLR, platecrit and RPR remained independent predictors of no-reflow after primary PCI. Patients in no-reflow group tended to be higher percent in-hospital MACE, including nonfatal myocardial infarction and cardiovascular mortality compared to the reflow patients. Conclusions: Admission NLR, platecrit and RPR are independent correlates of no-reflow and in-hospital MACEs among patients with STEMI undergoing primary PCI.

Objectives Although hypertension has been shown to be one of the most important predictors of reduced arterial elasticity, there is not enough data about aortic elastic properties in patients with prehypertension. Accordingly, the current study was designated to evaluate aortic elastic features in young patients with prehypertension. Material and methods The study population consisted of 25 newly diagnosed prehypertensive individuals (18 men, mean age =34±6 years) and 25 healthy controls (16 men, mean age =33±6 years) eligible for the current study. Aortic strain, distensibility index and stiffness index β were calculated from aortic diameters measured by echocardiography and blood pressures simultaneously measured by sphygmomanometry. Results Prehypertensive patients were detected to have significantly lower aortic distensibility and strain indexes than the controls: (5.77 ± 1.91 vs. 8.63 ± 2.67 cm -2 dyn -1 x 10 -6 , respectively, P

Prediabetes has been associated with an increased risk of cardiovascular disease and mortality. Soluble P-selectin (sP-selectin) is an index of platelet activation and also a risk factor for future vascular events. sP-selectin levels were investigated in prediabetic subjects who had no confounding factors such as hypertension, obesity or dyslipidaemia. sP-selectin, hsCRP levels and HOMA-IR indexes were measured in 40 prediabetic subjects (n = 24 for IFG and n = 16 for IGT) and age-, sex- and BMI-matched 40 healthy controls. sP-selectin levels in prediabetic subjects were not significantly different compared with those in controls (p = 0.12). Prediabetic group had similar hsCRP (p = 0.29), higher HOMA-IR indexes (p < 0.001) and lower HDL cholesterol levels (p = 0.001) when compared with healthy controls. The power of the study was 0.93 for sP-selectin, 0.7 for hsCRP and 1.0 for HOMA. Our data suggest that sP-selectin may not contribute to the prothrombotic state as well as the accelerated atherogenesis associated with prediabetes.

Summary Objective There is controversy about the effects of statins on insulin resistance and plasma adiponectin. The aim of this study was to investigate the effects of fluvastatin treatment on these parameters in a group of dyslipidaemic patients who had no confounding factors for insulin resistance or alterations in plasma adiponectin. Design and patients Forty-nine patients [27 males, 22 females; mean age 47·2 ± 10·3 years; body mass index (BMI) 29·64 ± 3·2 kg/m2] with dyslipidaemia and 20 controls (six males, 14 females; mean age 45·3 ± 9·31 years; BMI 30·07 ± 4·04 kg/m2) were enrolled. All patients were treated initially with therapeutic lifestyle changes (TLC) for 6 weeks. Six out of 49 subjects were excluded from the study. Then, 24 out of 43 patients with high blood cholesterol despite TLC were allocated to fluvastatin 80 mg daily plus TLC, and the remaining 19 patients with normal cholesterol were subjected to TLC alone for additional 12 weeks. Measurements Plasma adiponectin, immunoreactive insulin levels, BMI, waist circumference, blood pressure, lipids, and glucose were determined. The insulin sensitivity index was quantified using the homeostasis model assessment (HOMA). Results TLC caused significant improvement in plasma insulin (P = 0·02) and elevation in plasma adiponectin (P = 0·02). Fluvastatin treatment decreased total cholesterol and low density lipoprotein (LDL)-cholesterol significantly (P = 0·01 and P = 0·02, respectively). No significant effect of fluvastatin was observed on plasma insulin or adiponectin or on the HOMA index. Conclusions Fluvastatin does not improve plasma adiponectin levels and insulin sensitivity, despite its beneficial effects on lipid levels. Our data, however, were limited by the fact that a more accurate method of assessing insulin sensitivity, the euglycaemic–hyperinsulinaemic glucose clamp technique, was not used.

Food handlers are an important factor for food-borne diseases in the military units where food is prepared and served by a single responsible subunit. To prevent food-borne diseases there is laboratory and hospital based periodical examination procedure. But it is not effective. For example; 153,012 of 417,163 chest radiograms, 107,543 of 1,087,056 urinalyses, and 198,135 of 336,314 outpatient examination for infectious diseases were for periodical examination but just only 3148, 318, and 7011 are positive respectively. Based on our findings current evaluation procedure of food handler in Turkish Armed Forces should be improved. A new procedure that would makes the periodic examinations more effective, lowers the laboratory costs, and lowers the workload of the military hospitals was proposed.

We assessed the impact of intermittent tamsulosin treatment on abnormal ejaculation.This prospective study was performed between January 2001 and December 2004. It included 405 patients who were at least 50 years old with lower urinary tract symptoms. This study was divided into 2 phases. In phase 1 patients received a 0.4 mg tamsulosin capsule daily after breakfast for at least 3 months. The second phase of this study was performed in the 30 patients with abnormal ejaculation. In this phase these patients received 0.4 mg tamsulosin once daily every other day. Patients were assessed at study entry and at study week 6.Abnormal ejaculation was reported as retrograde ejaculation by 18 patients, as decreased volume by 7 and as absent ejaculate by 5. Ejaculatory function recovered during intermittent tamsulosin treatment in 12 patients with retrograde ejaculation and in 7 with decreased volume or absent ejaculate. As a result, 19 of 30 patients (63.3%) with abnormal ejaculation recovered. A significant improvement in retrograde ejaculation was found after intermittent tamsulosin treatment (p = 0.02). Although there were improvements in decreased volume or absent ejaculate at week 6 of intermittent treatment, these differences were not statistically significant (p = 0.42 and 0.61, respectively).The results of the current study, which to our knowledge is the first report of the effect of intermittent tamsulosin treatment on abnormal ejaculation, show that this treatment modality is well tolerated and provides comparable improvements for abnormal ejaculation.

Background The diagnosis of endothelial dysfunction has been gaining clinical importance, but although endothelial function testing is available in the research setting, no technique yet exists that is simple, safe, reproducible and easily performed as a clinical screening method. The aim of this study was to design a new, scintigraphic method of imaging the flow-mediated dilation in the forearm, which represents the functional characteristic of endothelial dysfunction. Methods and Results The study group comprised 118 subjects in whom left forearm ischemia was induced by inflating a sphygmomanometer cuff to supra systolic pressure for 4.5 min. Later, dynamic acquisition (2 s frame/min) was initiated after the injection of technetium-99m methoxy-isobutyl isonitril into the dorsal pedal veins. Equivalent regions of interest were drawn on both arms to detect total activity counts during 1 min and the perfusion ratios (left arm/right arm) were calculated. The left arm counts (22,203.3±12,372.7) were significantly higher than the right arm counts (9,980.9±5,931.9) (p

Reports of tobacco-induced electrocortical activation and decrements in ocular blood flow in the acute phase indicated that this effect is mediated via nicotine's action or neuronal systems. In this study, pattern visual evoked potentials were investigated in a group of male smokers (22 right eyes of 22 subjects) in separate real smoking and sham smoking sessions. On each session, pattern visual evoked potentials were recorded before smoking, immediately after smoking, and five minutes after smoking. Latency and amplitude values for P100 peaks were assessed and analyzed in each smoking condition for both real smoking and sham smoking sessions. Real smoking significantly decreased P100 latency values (p value related to difference between pre-smoking and immediately after smoking conditions is 0.009) and increased P100 amplitude values (p value related to difference between pre-smoking and fifth minute after smoking is 0.039). Statistically no significant difference was observed in sham smoking sessions. Our results are consistent with smoking-induced stimulant effects on pattern visual evoked potentials.

Objective: The data related to association among hypertension, insulin resistance, and plasma adiponectin concentration is controversial. We aimed to evaluate the relationships among these factors in a young hypertensive group who had no confounding factors. Design and methods: Thirty newly diagnosed and formerly untreated hypertensive males (mean age 23.4±4.0 yr; body mass index: 24.9±2.2 kg/m2), and 60 healthy control subjects (mean age 22.5±3.2 yr; body mass index: 24.6±1.6 kg/m2) were enrolled. Insulin resistance was calculated by homeostasis model assessment (HOMA). Results: The two groups were similar in terms of age, body mass index, fasting glucose, total cholesterol, HDL and LDL cholesterol, adiponectin, insulin, HOMA, and hsCRP levels. Mean triglyceride levels in hypertensive patients were significantly higher than the controls (p=0.02). Conclusions: These results indicate that young, newly diagnosed, uncomplicated patients with hypertension have similar plasma adiponectin levels and insulin sensitivities when compared to healthy controls. We suggest that high blood pressure itself may not be associated with insulin resistance or low adiponectin levels in patients with new onset, uncomplicated hypertension.

Objective: We aimed to investigate the long-term cardiac mortality and the relationship between cardiac mortality and electrocardiographic abnormalities in patients with diphtheritic myocarditis who survived after hospital discharge. Materials and Methods: Between 1991 and 1996, 32 patients (all males, mean age 21.00 ± 3.77 years) surviving diphtheritic myocarditis were included in the study and they were followed up for an average of 16.3 months (range 10.3–26.8 months) after hospital discharge. Clinical evaluation, ECG, and echocardiography were performed on admission, daily while in hospital and at the time of discharge. ECG changes were permanent during the follow-up period. The causes of death of the patients during follow-up period were inferred from the death records of the patients and talking to the people witnessing cardiac arrest. Results: We observed that the patients with left bundle branch block (LBBB) and T wave inversion at hospital discharge had lower survival rates than that of the patients without these ECG changes in the long term. Although univariate Cox regression analysis identified LBBB (P = 0.001) and T wave inversion (P = 0.014) as the predictors of survival, only LBBB was an independent predictor of survival in multivariate Cox regression analysis. Adjusted hazard ratio was calculated as 13.67 for LBBB (P = 0.001; CI = 2.81–66.28). Conclusion: Diphtheritic myocarditis does not only demonstrate a malignant clinical course during acute phase of the disease, but also during the long-term follow-up period, especially in patients with LBBB and T wave inversion. Besides, T wave inversion and LBBB can help us to predict survival rate of the patients in long term. Moreover, LBBB is an independent predictor of long-term survival in diphtheritic myocarditis.

We studied the effects of biofeedback treatment on voiding and urodynamic parameters in children with voiding dysfunction.We prospectively studied 188 children between June 1998 and November 2003. Biofeedback was performed with a urodynamics processor that enables simultaneous recording of urine flow and electromyography, and visual display of flow/electromyography activity. At the beginning of the study this treatment was performed once weekly. After patients understood the concept and performed homework regularly sessions were scheduled at 3 to 4-week intervals and continued for 6 months. All children were evaluated at 6 months and again at 2 years after completing biofeedback training.The number of the children completing biofeedback was 168 (89.4%). Improvement was obtained in all parameters, ranging from 59.2% to 87.8% at 6 months. Maximum improvement was acquired with flattened voiding in 65 of 74 children (87.8%), whereas the least improvement was acquired with daytime wetting in 58 of 98 children (59.2%). These improvements continued at 2-year followup, and ranged from 53.1% to 87.3%. While the rate of improvement for nocturnal enuresis, staccato voiding, detrusor-sphincter dyssynergia, vesicoureteral reflux and urinary tract infection had increased, the remaining parameters had decreased at 2-year followup.Biofeedback training is a simple, effective and well tolerated treatment modality in children for various parameters resulting from bladder dysfunction. Motivation and willingness to participate in biofeedback treatment are important selection criteria.

Summary Background:Diabetic patients have been reported to have impaired coronary collateral vessel growth, although they have excessive neovascularization in the retina. Hypothesis:This study was designed to compare coronary collateral circulation (CCC) in patients with proliferative diabetic retinopathy (PDR) with that in patients without DR. Methods:Ninety diabetic patients with chronic total occlusion in at least one major epicardial coronary artery were enrolled in the study. Groups 1 and 2 consisted of 48 patients without DR and 42 patients with PDR, respectively. Coronary collateral circulation (CCC) was analyzed according to the Rentrop system. Each group was also divided into two subgroups according to poor and good CCC. Serum vascular endothelial growth factor (VEGF) levels were measured using the enzyme-linked immunosorbent assay (ELISA) kit. Results: The mean Rentrop collateral score was higher in Group 1 than in Group 2 (2.39 ± 1.07 vs. 1.76 ± 0.76, respectively, p < 0.001). When the two groups were compared with respect to poor and good CCC, poor CCC was higher in patients with PDR (64 vs. 36%, respectively, p = 0.01). Serum VEGF levels were higher in patients with PDR than in those without DR (219 ± 99 vs. 139 ± 98 pg/ml, p < 0.001); however, patients with poor and good CCC had similar VEGF levels. Conclusions:We have shown that patients with PDR have a lower coronary collateral score than patients without DR. Also, serum VEGF was significantly higher in patients with PDR than in those without DR. These findings have suggested that diabetes mellitus may have a different action on retinal and coronary circulation.

Background Statins exert a variety of favourable effects on the vascular system not directly related to their lipid lowering function known as pleiotropic effects. There are not enough data regarding the effects of prior statin use on coronary blood flow after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Accordingly, in the present study, we aimed to investigate the effects of prior statin use on coronary blood flow after primary PCI in patients with AMI using the Thrombolysis In Myocardial Infarction (TIMI) frame count method. Methods The study population consisted of 200 patients (161 men; mean age = 62 ′ 7 years) referred to cardiology clinics with AMI who subsequently underwent successful primary PCI. The study population was divided into two groups according to statin use before primary PCI. Group 1 consisted of 98 patients (75 men; mean age = 63 ′ 7 years) not taking statin and group 2 consisted of 102 patients (86 men; mean age = 61 ′ 7 years) taking daily dose of at least 40 mg atorvastatin for at least 6 months. Coronary blood flow was determined by TIMI frame count method using the angiographic images obtained just after PCI and stenting. Results Only mean TIMI frame count was detected to be significantly lower in patients taking at least 40 mg atorvastatin for at least 6 months compared with that of the patients taking no statin (P

Background: Several studies demonstrated that P wave dispersion (PWD) increased after coronary occlusion. The effect of primary percutaneous coronary intervention (PCI) on PWD needs to be elucidated. Methods: The study consisted of 125 patients with acute myocardial infarction (110 men, mean age 59.8 ′ 7.8 years) undergoing primary PCI. The patients were divided into three groups according to thrombolysis in myocardial infarction myocardial perfusion grade (TMPC) after successful PCI. Groups 1 (n = 12), 2 (n = 9), and 3 (n = 104) included the patients with TMPC 0/1, 2, 3, respectively. Electrocardiograms were obtained before and approximately 66 ′ 18 minutes after PCI. Results: PWD and P m a x i m u m after PCI were significantly lower than the preintervention values (P < 0.001 for both). When PWD and P m a x i m u m values after PCI were compared among groups, PWD and P m a x i m u m in groups 1 and 2 were found to be higher than those of group 3 (P < 0.001 for PWD and P m a x i m u m ). Atrial fibrillation (AF) occurred in 14 patients. P m a x i m u m and PWD in patients with AF were higher compared to those of the patients without AF (P < 0.001 for both P wave parameters). Also more frequent AF attacks were observed in group 1 compared to group 3 (P < 0.001). Conclusions: PWD and P m a x i m u m after primary PCI were lower compared to the preintervention values. Prolonged PWD in patients with poor myocardial perfusion can contribute to increased mortality, and also it can can be combined with ST segment resolution to predict clinical reperfusion and might help in predicting AF.

Objective: To evaluate ischemia in right ventricle (RV) in patients with small caliber of right coronary artery (RCA).Patients and Methods: The study population consisted of 60 consecutive patients undergoing coronary angiography within 3 months. The patients were divided into three different groups according to lumen diameter of RCA and coronary dominance. Group 1, 2, and 3 consisted of patients with small diameter of RCA, dominant RCA, and dominant circumflex artery, respectively. RV ischemia was assessed by using pulse-wave tissue Doppler sampling obtained from RV free wall close to the lateral tricuspid annulus at the apical four-chamber view during dobutamine stress echocardiography (DSE).Results: When the mean systolic velocity percentages of increase from low to peak dose dobutamine in patients with small RCA were compared to those of other groups, statistically significant difference was found between group 1 and the other groups (P = 0.007 for group 1 vs group 2; P = 0.01 for group 1 vs group 3). The mean systolic velocity at peak dobutamine dose of patients with small caliber of right coronary artery was statistically lower than the other groups (P = 0.001 for group 1 vs group 2, P < 0.001 group 1 vs group 3).Conclusions: There are a group of patients with small diameter of RCA causing probable ischemia in RV and small caliber of RCA can really matter in these patients.

Background: Prolongation of P-wave times and increase of P-wave dispersion (PWD) were shown to be independent predictors of atrial fibrillation (AF). Angiotensin II receptor blockers (AARBs) and angiotensin-converting enzyme inhibitors (ACEIs) have beneficial effects on atrial conduction times. However, there are not enough data about the comparative effects of those drugs onPWD. Hypothesis: We aimed to compare the effects of telmisartan and ramipril on PWD after 6-month treatment in hypertensive patients. Methods: In all, 100 newly diagnosed hypertensive patients were enrolled in the study and were randomly assigned to two groups. Group 1 and Group 2 each consisted of 50 patients, taking daily doses of 80 mg telmisartan and 10 mg ramipril, respectively. Twelve-lead surface electrocardiograms (ECG) were recorded from all patients before and after 6-month drug therapy. The P-wave duration (Pdur) measurements were calculated from the 12-lead surface ECG. Results: When pretreatment PWD and P maximum values were compared with post-treatment values, a statistically significant decrease was found in both groups after 6 months (Group 1 and 2; p < 0.001 for PWD and Pmaximum). P-wave dispersion and Pmaximum values after treatment in Group 1 were statistically significantly lower than those in Group 2 after the 6-month treatment period (p = 0.01 for PWD; p = 0.008 for Pmaximum). Conclusions: Telmisartan has a much greater lowering effect on PWD and Pmaximum values than ramipril. This finding may be important in the prevention of AF in hypertensive patients.

Angiotensin-converting enzyme inhibitors, calcium channel blockers, and preoperative intravenous heparin use are independent risk factors for vasoplegic syndrome after cardiac surgery. We prospectively studied whether preoperative methylene blue administration would prevent the vasoplegic syndrome in these high-risk patients.One hundred patients scheduled for coronary artery bypass graft surgery who were at high risk for vasoplegia because they were preoperatively using angiotensin-converting enzyme inhibitors, calcium channel blockers, and heparin were randomly assigned to either receive preoperative methylene blue (group 1, n = 50) or not receive it (group 2, controls, n = 50). Methylene blue (1% solution) was administered intravenously at a dose of 2 mg/kg for more than 30 minutes, beginning in the intensive care unit 1 hour before surgery.Although similar in terms of all demographic and operative variables, the two groups differed significantly in terms of vasoplegic syndrome incidence (0% in group 1[0 of 50] vs 26% in group 2 [13 of 50]; p0.001). In 6 patients, the vasoplegic syndrome was refractory to norepinephrine. Four of these patients survived; the other 2 had vasoplegic syndromes that were refractory to aggressive vasopressor therapy, and they ultimately died of multiorgan failure. Stroke occurred in 1 patient. The two study groups also differed significantly in terms of average intensive care unit stay (1.2 +/- 0.5 days in group 1 vs 2.1 +/- 1.2 days in group 2; p0.001) and average hospital stay (6.1 +/- 1.7 days in group 1 vs 8.4 +/- 2.0 days in group 2; p0.001).Our results suggest that preoperative methylene blue administration reduces the incidence and severity of vasoplegic syndrome in high-risk patients, thus ensuring adequate systemic vascular resistance in both operative and postoperative periods and shortening both intensive care unit and hospital stays.

Objective: Previous studies have demonstrated that low plasma adiponectin concentrations are associated with essential hypertension. It has also recently been shown that adiponectin plays an essential role in the modulation of angiogenesis. These data led us to hypothesize that adiponectin might contribute to end-organ damage in hypertension.Methods: In the present study we have evaluated the relationship between plasma adiponectin concentrations and hypertensive retinopathy. One hundred and ten patients newly diagnosed with essential hypertension (EHT) (mean age, 46.79±5.0 years; body mass index (BMI), 26.47±2.23 kg/m2; male/female ratio, 58/52) and 57 healthy normotensive control subjects (NT) (mean age, 46.84±5.4 years; BMI, 26.66±2.65 kg/m2; male/female ratio, 33/24) were enrolled.Results: Plasma adiponectin levels were significantly lower in EHT than in NT (P< 0.001). In addition, adiponectin concentrations were strongly correlated with systolic and diastolic blood pressures in EHT (r= −0.757,P< 0.001;r= −0.761,P< 0.001) while there was no correlation in the NT group. Plasma adiponectin in patients with grade 0 hypertensive retinopathy (n= 52) was significantly higher than that of the patients with grade 1 (n= 30) and 2 (n= 28) hypertensive retinopathy (P< 0.001 for each). Plasma adiponectin in patients with grade 0 hypertensive retinopathy was also significantly lower than that in the NT group (P< 0.001). The estimated threshold of plasma adiponectin concentration for hypertensive retinopathy was 17 μg/ml. This critical adiponectin level served largely to separate patients with retinopathy from those without.Conclusion: Our results have shown that plasma adiponectin concentrations decrease progressively with higher grades of hypertensive retinopathy even after correction for other atherogenic risk factors, suggesting that a critical adiponectin level is needed for the development of retinopathy.

Sexually transmitted disease (STD) is an important health problem as all over the world in our country. We aimed to determine the level of male adolescents’ knowledge about STD particularly about HIV/AIDS and evaluate the factors regarding to their knowledge. This study was performed in November – December 2004 in Etimesgut Military Troop. Three hundred twenty five person was selected by simple randomized methods, and 310 person accepted to participate in this study. All participants were young male military persons and the mean age was 21,8+1,7. The best known topic was “How many times can a condom used?” (86,5%). AIDS was the best known STD (76,1%) , and the Gonore was second, 49,7%, but syphilis was only known 6,5%. Over all knowledge score was 6,4+2,3 (max:10). Mean score of participants who had not graduated elementary school, were only 4,2. We realized that this result increased with education level. Mean score was 7,1 in participants with high school or upper education level and difference between these two groups was statistically significant (p=0,001). Participants who were born and living in the west part of the country had the highest mean score (7,8 and 7,1 respectively). Consequently, young adults who’ve been at high risk about STD, have knowledge needs, especially who live in the east region. It will be useful to have education programmes about this subject. [TAF Prev Med Bull 2005; 4(1.000): 16-24]

CD40 ligand interaction with its receptor (CD40) not only mediates lymphocyte communication, but also associates with chronic inflammation and atherothrombosis. High soluble CD40L (sCD40L) levels were reported in dyslipidemia, diabetes mellitus, and coronary disease. So far, there are no data about sCD40L levels in hypertension. We investigated sCD40L and high sensitive C reactive protein (hsCRP) levels in 30 nonobese young hypertensive men and 30 matched controls. sCD40L and hsCRP levels were not different, and there were no correlations between blood pressure and sCD40L or hsCRP levels. These results might indicate lack of any inflammatory state in new onset hypertension.

A descriptive study was conducted in the pediatric inpatient unit of Gulhane Military Medical Academy, to investigate the morbidity and mortality characteristics of 532 infants hospitalized between January 1 and December 31, 2001, for treatment purposes. Of the study participants, 55.8% were boys and 44.2% were girls. The most common cause of hospitalization was neonatal hyperbilirubinemia (19.7%). The most common admission month was January (12.4%). Of 532 infants, 510 (95.9%) were discharged, whereas 22 patients died in the hospital. Twenty-one patients died in the neonatal period, and respiratory distress syndrome and neonatal sepsis were identified as the most common causes of death. Our finding of associations between male gender and low birth weight and hospital death is consistent with previous knowledge. Despite the high frequencies of pneumonia and gastroenteritis as admission diagnoses, the finding of only one pneumonia-related death and no gastroenteritis-related deaths in the study population is pleasing.

There is no absolute treatment of HIV/AIDS, therefore preventive measures have great importance on the control of the disease. There are many studies in which the knowledge deficiency of health personnel about HIV/AIDS and their negative attitudes towards HIV/AIDS patients were reported. This descriptive study was realized among health noncommisioned officer students in February 2004. Data were collected using questionnaires, designed by researchers. All participants were male. Mean age of those was 18.3+1.1. It was striking that only 39.2% of students know that hepatitis B is a sexually transmitted disease and knowledge deficiency about some transmision routes of the disease has been found among students. The students reported that school education is the primary soure of information of the disease. Newspapers and televison have been found as major information sources as reported in many studies conducted among adeloscents. As we considered the knowledge level and attitudes of students about HIV/AIDS, careful asssesment of the content and the duration of lectures in the curriculum on sexually transmitted disease and the emphasizing the importance of the subject to every health personnel at every occations would be beneficial. [TAF Prev Med Bull 2004; 3(6.000): 111-118]

Background Satisfactory results of bileaflet preserving mitral valve replacement (MVR) had forced several institutes to preserve both leaflets during MVR. Modifications were required to prevent the preserved tissue from interfering with prosthetic valve function, to implant an adequate size of valve and to prevent left ventricle outflow tract (LVOT) obstruction. Materials and methods Conventional MVR was performed to 51 patients (group 1) and bileaflet preserving MVR was performed to 43 patients (group 2). Mitral anterior leaflet incised from the middle of the leaflet to mitral annulus without chordal injury in group 2 patients. Sutures were placed through the mitral annulus first and then passed from the bottom to the tip of anterior leaflet. Posterior leaflet was also preserved. Prosthetic valve was put down into the mitral annulus and sutures were ligated. Excessive anterior leaflet tissue was attached to left atrial wall. Results Cross-clamping time was 45 +/- 5.33 minutes versus 61.32 +/- 4.43 minutes (p = 0.0001) and total cardiopulmonary bypass time was 60.80 +/- 4.44 minutes versus 80.55 +/- 3.65 minutes (p = 0.0001) in groups 1 and 2, respectively. Inotropy requirement was higher in group 1 (p = 0.0058). When compared with preoperative values postoperative left ventricle ejection fraction (LVEF) increased both at rest (from 52.74% +/- 3.88% to 62.86% +/- 3.18%, p = 0.0001) and during exercise (from 53.16% +/- 3.16% to 64.11% +/- 2.46%, p = 0.0001) in bileaflet preserving MVR group. But in conventional MVR group LVEF decreased postoperatively both at rest (from 51.45% +/- 4.27% to 48.27% +/- 3.35%, p = 0.0001) and during exercise (from 54.47% +/- 7.36% to 42.96% +/- 3.58%, p = 0.0001). Conclusion Leaflet preserving MVR operation not only improves the left ventricular performance but also reduces the mortality and morbidity after MVR. LVEF increases both at rest and during exercise. Risk of LVOT obstruction can be completely eliminated with our simple technique.

Adiponectin appears to be an important modulator for metabolic and vascular diseases. A case-controlled study was designed to measure plasma adiponectin levels and investigate the effects of rosiglitazone on adiponectin levels in type 2 diabetic patients with proteinuria. Sixty-four patients (mean age, 46.1+/-4.6 yr; 30 male, 34 female) and 26 healthy volunteers (mean age, 45.3+/-4.8 yr; 14 male, 12 female) were included. Patients with proteinuria were treated with 4-mg/d rosiglitazone (n=21, 10 males, 11 females) for 4 wk. Adiponectin levels in patients were significantly lower than those of controls (p0.001). There were significant negative correlations between adiponectin concentrations and insulin levels as well as homeostasis model assessment (HOMA) index in patient's group (r=-FONT "Optima"0.538, p0.001; r=-FONT "Optima"0.393, p=0.001, respectively). There was also a significant negative correlation between plasma adiponectin concentrations and the degree of proteinuria (r=-FONT "Optima"0.526, p=0.002). Plasma adiponectin levels in patients with proteinuria (n=31; 3.91+/-2.57 microg/mL) were significantly lower than those without proteinuria (n=33; 10.15+/-1.97 microg/mL) (p0.001). After the treatment period, adiponectin levels significantly increased (p0.001) and proteinuria, plasma insulin, and HOMA indexes significantly decreased in treatment group (p0.001, p0.001, p0.001, respectively). The results suggest that adiponectin is inversely correlated with proteinuria and treatment with peroxisome proliferator-activated receptor-gamma (PPAR-gamma) agonist rosiglitazone both corrects proteinuria and increases the low adiponectin levels in diabetic patients.

Chemotherapy and radiation therapy are associated with increased formation of reactive oxygen species and depletion of critical plasma and tissue antioxidants. In patients undergoing high-dose chemotherapy, the plasma antioxidant concentration has been shown to decrease. However, these studies in which the oxidative stress status were investigated have a small number of patients and they are heterogeneous. In this study, the changes in certain trace elements together with oxidative stress parameters were investigated in 36 patients who had undergone autologous stem cell transplantation because of solid and hematological malignancies. Blood samples of the patients were examined before the high-dose chemotherapy (baseline), before stem cell transplantation (day -1), and after stem cell transplantation on day 1, 3, and 6. Erythrocyte zinc, silver, and iron levels were measured by atomic absorption spectrophotometry; malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) levels were measured by UV-vis spectrophotometry. After high-dose chemotherapy, significant increases in the levels of MDA, GSH-Px, and SOD were observed. On the other hand, Cu levels remained the same while the levels of erythrocyte Zn and Fe were increased. Significant correlation was observed among MDA, GSH-Px, and SOD (p

WOS: 000439318400001, Objective: The aim of this study was to investigate the cephalometric parameters that impair the consistency between the Wits and ANB measurements, which are used in the determination of anteroposterior jaw relationships by logistic regression analysis in the Turkish population. Methods: This retrospective study was conducted on 207 lateral cephalometric radiographs of 100 females (mean age: 15.5 +/- 1.09 years; age range: 14.2-17.3 years) and 107 males (mean age: 15.1 +/- 0.93 years; age range: 14.1-16.9 years) obtained from the archives of the orthodontic department. Lateral cephalometric radiographs were divided into two groups according to the presence of inconsistency between the ANB angle and Wits appraisal. The cephalometric parameters that cause the inconsistency were determined using a logistic regression method with the creation of three different regression models. Results: We found posterior rotation of the mandible (SN-MP degrees) (OR=1.09; p=0.029) as an independent predictor of the inconsistency in Model 1. In Model 2, SN-MP degrees (OR=1.11; p=0.016) was also found to be effective on the development of the inconsistency. In Model 3, inclination of the occlusal plane (OP-SN degrees) (OR=1.07, p=0.02) was the independent predictor of the inconsistency. Conclusion: An increase in SN-MP degrees and OP-SN degrees are effective in the development of inconsistency between the ANB and Wits appraisals in the Turkish population.

Objectives: The aim of this cross-sectional epidemiologic study was to investigate the prevalence and distribution of musculoskeletal disorders causing unfitness to Turkish Military Service. Methods: This study has been carried out by examining the medical reports of 1.777.500 people who applied to the Turkish Armed Forces for military service between 2009-2011. Age and geographic region of individuals were compiled and organized in groups. Musculoskeletal disorders were classified mainly as fracture sequel, spine disorders, absence of phalanges, extremity amputation, aggressive or multiple benign tumors of bones and pes planus. Results: Unfitness to military service caused by musculoskeletal disorders was found to be 6.53‰ in 2009, 7.10‰ in 2010 and 7.28‰ in 2011. The prevalence of musculoskeletal diseases has increased by years. The prevalence of fracture squeal by years was found to be 2.83‰ in 2009, 3.10‰ in 2010 and 3.03‰ in 2011. In this study, the most common musculoskeletal disorders were: limitation of joint mobility (0.89‰), degeneration of joint surface (0.69‰), lower and upper limb discrepancies (0.60‰), posterior fusion surgery (0.59‰) and the absence of the phalanges in hand (0.51‰). We found an increase in both the prevalence of posterior fusion surgery and the absence of the phalanges in study group. Conclusion: These results has given information about severe musculoskeletal disorders among young adult male in Turkey. New studies including young adult female will add important information to our knowledge about musculuskelatal problems in our community.

Our aim was to investigate the use of a balloon catheter device in comparison with metal cannula for hysterosalpingography (HSG) in terms of patient comfort. A total of 168 patients were randomised for HSG either with a balloon catheter (n = 83) or metal cannula (n = 85). Scores of pelvic pain during insertion of the devices, injection of the contrast medium and 1 h after the procedure were evaluated using the Wong Baker Faces Pain Rating Scale; complications and reinsertion rates were also noted. The pain scores were significantly lower in the balloon catheter group (p < 0.001). The reinsertion rate of metal cannula was higher (8.2% vs 2.4%) as well as the incidence of nausea being the most common short-term adverse effect (14.1% vs 1.2%) in the metal cannula group (p = 0.002). Performing HSG with a balloon catheter is advantageous for decreasing the pain and side-effects related to the procedure, when compared with the use of a metal cannula.

Introduction Haemorrhage from the injured extremity is a significant cause of preventable death in military settings. This study evaluated the effect of training on the efficacy of the combat application tourniquet (CAT) and to define standards for military personnel. Method Participants from a training tank battalion were randomised. Data collected included age, body mass index, mean arterial pressure, hand dominance, femoral artery diameter and skin thickness. The study involved tourniquet application times (AT) and application success rates in basic, after-training and eyes-closed phases. Doppler ultrasound was used to identify the presence or absence of popliteal, radial and ulnar artery pulses. Results A total of 102 trainees participated. In the after-training phase, the left and right upper extremity ATs were 35±13.1 s, and 34.8±13.5 s and the right and left lower extremity ATs were 20.6±6.0 s and 20.5±5.5 s, respectively. The overall tourniquet success rates in three successive study phases were 69.6%, 82.4% and 91.2%, respectively. A negative significant relationship was found between extremity circumference and tourniquet success. Discussion The results show that the efficacy of CAT application increases with training. Further studies are required to investigate the reasons underlying application failures. This single group prospective randomised study involves level of evidence 4.

Psoriasis vulgaris is associated with an increased risk of atherosclerosis. Carotid intima-media thickness (cIMT) may predict atherosclerosis.We assessed the correlation between bilirubin (a potent endogenous antioxidant) levels and cIMT in patients with psoriasis vulgaris. We also compared the levels of serum total bilirubin (TBil) and its fractions in control subjects and patients with psoriasis.We enrolled 115 participants (60 patients with psoriasis vulgaris and 55 control subjects). The levels of indirect bilirubin were calculated as the difference between TBil and direct bilirubin values. cIMT was measured in both common carotid arteries.TBil levels were lower in patients with psoriasis than in the control group [median (range) 0.55 (0.30-1.23) vs. 0.59 (0.30-1.44) mg/dL] as were indirect bilirubin [0.43 (0.22-1.00) vs. 0.48 (0.25-1.12) mg/dL] and direct bilirubin [0.10 (0.01-0.23) vs. 0.13 (0.03-0.32) mg/dL]. Only direct bilirubin differed significantly (p=0.0002) but the number of patients with higher values of TBil and indirect bilirubin were significantly greater in the control group (p=0.0019 by the Fisher's test). The patients with psoriasis had a significantly greater cIMT compared with control subjects (0.54±0.08 vs. 0.50±0.07 mm, p=0.005). High-sensitivity C-reactive protein levels were higher in patients with psoriasis compared with controls (2.95±3.50 and 0.99±0.72 mg/L, p0.001). There was a negative correlation between cIMT and TBil levels (r=-0.383, p0.01). The results of the correlations were reinforced by multiple regression analysis.To our knowledge, this is the first study to assess the association between TBil and cIMT in patients with psoriasis. Our results support the concept that psoriasis vulgaris is associated with an increased risk of atherosclerosis.

Clinical features, cerebrospinal fluid (CSF) examination, and neuroimaging findings can yield a presumptive diagnosis of tuberculosis meningitis (TM). However, confirmed diagnosis depends on the culture of Mycobacterium tuberculosis from the CSF [1]. Generally, the decision to begin with tuberculostatic treatment cannot await the proof of the causative agent and the prognosis of the disease may be devastating even if treatment is started promptly [2]. Sometimes the clinicians are confused from the diagnostic burden whether to start therapy for TM or not. In some TM cases without microbiological confirmation, the clinical and laboratory parameters resolve very quickly after the initiation of antibiotics. There remains another controversy in this situation, i.e. whether the clinician will stop therapy or continue for 12 months. There is little knowledge on the changes of CSF biochemical parameters during antituberculosis therapy in TM patients. What happens to the biochemical profile in CSF in due course? To the authors’ knowledge there are no data in the literature on this issue. Our study, which was performed between 1 January 2000 and 31 December 2004, focuses on these CNF changes in biochemical profiles for TM patients receiving therapy. There is a chain of military hospitals over the country in Turkey. If a soldier is diagnosed as TM in 1 of the military hospitals, the patient is given antibiotics and sent home for 2 /3 months of rest following the hospitalization necessary for patient stabilization. The patient returns to hospital either in an emergency situation or following the end of the official rest period. Thus, all TM patients return to military hospitals every 2 to 3 months, but the patient does not necessarily apply to the hospital where the disease is diagnosed. Generally the patient applies to the military hospital nearest to where he lives, i.e. another institution may follow a TM case diagnosed in our hospital in the follow-up periods or we may follow a previously diagnosed case in another military hospital during the therapeutic course. In every periodical visit the patient was punctured once again either to delineate the status of infection or to present an official clue to provide the patient with an additional rest time. After the end of 12-month therapy, the surveillance of the patient is stopped. Therefore we have sparse data on TM patients which we may have encountered at any period during anti-tuberculosis therapy. All the cases were young males ranging from 20 to 28 y of age without immunosuppression. Dexamethasone was given to all patients in standard dosages

High level of circulating red cell distribution width (RDW) and neutrophil/lymphocyte (N/L) ratio may reflect ongoing vascular inflammation and play an important role in pathophysiology of hypertension. We evaluate the effects of nebivolol and metoprolol on the RDW and N/L in new essential hypertensive patients. After baseline assessment, 72 patients were randomly allocated to 5 mg/d of nebivolol (n = 37, 20 men) or 100 mg/d of metoprolol (n = 35, 18 men) and treated for 6 months. Blood pressure (BP), heart rate (HR), RDW, and N/L were measured before and after treatment. BP significantly decreased with both drugs (P < 0.001). Analog reduction was observed for resting HRs (P < 0.001), but metoprolol caused greater HR fall as compared with nebivolol (P < 0.001). After 6 months of treatment, nebivolol significantly lowered not only RDW but also the total white blood cell and N/L (P < 0.001, P = 0.023, P = 0.017, respectively). No changes were observed in metoprolol group. Percent decrease in RDW was found to be significantly higher in nebivolol than in the metoprolol group (P = 0.001) and remained also after correction for confounders (P = 0.012). Nebivolol improved RDW and N/L to a greater extent than metoprolol in patients with hypertension. These favorable effects may participate, together with the BP reduction, at the favorable properties of the drug in hypertension

Objective: Disability is one of the significant problems that the public faces as regards social aspects, economics, public health and politics. Our aim was to review the prevalence of diseases causing disabilities in young adult men who are declared “unfit for military service” in Turkey after medical examination. Methods: We reviewed the prevalence of diseases among 113,175 young adult men who were referred for medical examination between 2009 and 2011. Results: Prevalence of unfitness for military service was 5.56% in 2009, 6.74% in 2010 and 6.77% in 2011. Leading causes for young adult men to be rejected from military service was intellectual disability 6.88, hearing loss 3.71, epilepsy 1.59, schizophrenia 1.54 and diabetes mellitus 1.47 per thousand people. Conclusion: Screening for the prevalence of disability conditions is an important data source for policies to be developed. Supporting such survey with community based studies in different populations in future shall be beneficial for improvement of policies in social and health fields.

SummaryBackground Psoriasis vulgaris is an inflammatory disease characterized by epidermal hyperproliferation, leucocyte adhesion molecule expression and leucocyte infiltration. Psoriasis is associated with an increased risk of cardiovascular disease. Endothelial dysfunction is widely regarded as being the initial process in the development of atherosclerosis. Human endothelial cell-specific molecule-1 (endocan) is a novel human endothelial cell-specific molecule. Previous studies suggested that endocan may be a novel endothelial dysfunction marker. Objectives To investigate the relationship between serum levels of endocan and both cardiovascular risk and disease activity in patients with psoriasis vulgaris. Methods A total of 29 patients with psoriasis vulgaris and 35 control subjects were included in the study. Endocan, high-sensitivity C-reactive protein (hsCRP) and carotid artery intima–media thickness (cIMT) were measured in all subjects. Results Serum endocan levels were significantly different between the two groups (P

Objective: This study aims to determine antibiotic usage rates, causes of antibiotic usage and inappropriate usage rates in a university hospital with a 1200-bed capacity. Results: Of 666 patients staying in the hospital on the day of study, 262 (39.7%) were on antibiotics. Of those, 145 (55.3%) were on surgical wards, 98 (37.4%) were on medical wards and 19 (7.3%) were on paediatric wards. Of those 262 patients, 157 (59.9%) were taking only one type of antibiotic, 79 (30.2%) were taking two and 26 (9.9%) were taking three or more types of antibiotic. Antibiotic usage was appropriate in 55.7% (146 patients) and inappropriate in 44.3% (116 patients). The inappropriate antibiotic usage rate was 75.9% (88 patients) among patients on surgical wards. The most common cause of inappropriate usage was unnecessarily long prophylaxis time (68.2%, 60 patients). Inappropriate antibiotic usage was found in 24 (24.5%) patients out of 98 patients on medical wards. When the causes of antibiotic usage were analysed, it was found that the cause of antibiotic usage was infection in 36.2% (95 patients), prophylactic in 35.9% (94 patients), and empirical in 27.9% (73 patients). On the day the study was conducted, 367 antimicrobial drug were prescribed to 262 patients. The drugs most commonly prescribed were antibiotics from the cephalosporin (n=99, 27.0%) and fluoroquinolone (n=74, 20.2%) groups. When the diagnosis of 95 patients who were on antibiotics due to infection was reviewed, the most common infections were respiratory tract infections (n=36, 37.9%), urinary system infections (n=12, 12.6%), upper respiratory tract infections (n=8, 8.4%), bloodstream infections (n=6, 6.3%) and prosthesis infections (n=6, 6.3%).

e15623 Background: Testicular cancer is a chemosensitive tumor that may be curable even in relapsed disease. Those patients who do not respond to standard combination chemotherapy or relaps may be treated with high-dose chemotherapy (HDC) with autologous stem cell transplantation (ASCT) as salvage therapy. Methods: Eighty five patients that received HDC and ASCT between Feb 1993 - Dec 2012 in different university clinics of Turkey were retrospectively reviewed and evaluated. Results: Median age of the patients was 24 (range: 11-54 years) and 63 patients (74,1%) had stage III, 21 (24,7%) had stage II disease at initial diagnosis. The primary tumor location was testis in 71 patients (83,5%), and 14 patients (16,5%) had extragonadal region origin. Evaluation of metastatic focuses before HDC and ASCT was as follows: Liver metastasis (n = 23, 27.05%), lung involvement (n = 23, 27.05%) and multiorgan involvement (n =14, 16.47%) and other metastatic involvements (n=4, 4.7%). ICE (ifosfamide, carboplatin, etoposide) regimen was performed as HDC in all patients. Median follow-up was 59 (range: 8-218) months. Pre-ASCT patients’ condition was complete remission (n=28, 32.9%), partial remission (n=36, 42.4%) and never in CR (n=21, 24.7%) respectively. 32 patients (37.6%) relapsed or progressed within 1 year after HDC and ASCT median relaps was time 3 months (range: 0.3 - 36.13). Transplant related mortality was %3.5 and 3 patients died within the engraftment period after HDC. Five-year overall survival rate was 59.7%. Conclusions: HDC and ASCT is an effective and safe approach for patients with metastatic and refractory germ cell testicular cancer patients that do not respond to standard combination chemotherapy.

Prehypertension is characterized by an increased cardiovascular risk and by an increased prevalence of target organ damage compared with the pure normotensive state. The present study was designed to assess in prehypertensive subjects the possible relationships between early left ventricular dysfunction, vascular inflammation and aortic stiffness. The study population consisted of 31 untreated prehypertensive subjects (age: 34±6 years, mean±SD) and 31 age-matched pure normotensive controls. Left ventricular function was assessed by echocardiography, aortic distensibility parameters were derived from aortic diameters measured by ultrasonography, and high-sensitivity C-reactive protein was assessed by latex-enhanced reagent. Prehypertensive subjects displayed a significantly lower E/A ratio and a significantly greater deceleration time and isovolumetric relaxation time compared with normotensive controls. They also displayed aortic systolic diameter, diastolic diameter and mean aortic stiffness index beta significantly increased while systo-diastolic diameter change, mean aortic distensibility and aortic strain were significantly reduced compared with controls. Values of inflammatory markers were increased. At multiple regression analysis, E/A ratio was significantly related to high-sensitivity C-reactive protein and aortic stiffness index beta, after correction for age, left ventricular mass index and mean blood pressure (β coefficient=-0.49, overall r2=0.24, p=0.01 and β coefficient=-0.46, overall r2=0.21, p=0.02, respectively). Thus, in prehypertension, left ventricular dysfunction is significantly related to vascular inflammation and aortic stiffness, suggesting that early cardiac and vascular alterations may have an increased inflammatory process as a common pathophysiological link. © 2013 Scandinavian Foundation for Cardiovascular Research.