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No Association between Polymorphisms of Vitamin D and Oxytocin Receptor Genes and Autistic Spectrum Disorder in a Sample of Turkish Children
No full textObjective: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impairment in social skills and communication with repetitive behaviors. Etiology is still unclear although it is thought to develop with interaction of genes and environmental factors. Oxytocin has extensive effects on intrauterine brain development. Vitamin D, affects neural development and differentiation and contributes to the regulation of around 900 genes including oxytocin receptor gene. In the present study, the contribution of D vitamin receptor and oxytocin receptor gene polymorphisms in the development of ASD in Turkish community was investigated. To our knowledge, this is the first study examining these two associated genes together in the literature.
Methods: Eighty-five patients diagnosed with ASD according to DSM-5 who were referred to outpatient clinics of Child and Adolescent Psychiatry of Baskent University and Mersin University and 52 healthy, age and gender-matched controls were included in the present study. Vitamin D receptor gene rs731236 (Taq1), rs2228570 (Fok1), rs1544410 (Bsm1), rs7975232 (Apa1) polymorphisms and oxytocin receptor gene rs1042778 and rs2268493 polymorphisms were investigated using real time polymerase chain reaction method.
Results: No significant difference between groups in terms of distribution of genotype and alleles in each of polymorphisms for these genes could be found.
Conclusion: Knowledge of genes and polymorphisms associated with the development of ASD may be beneficial for early diagnosis and future treatment. Further studies with larger populations are required to demonstrate molecular pathways which may play part in the development of ASD in Turkey
Early Life Markers to Predict the Risk for Frequent Wheezing in Infants; Going on a Mysterious Road with an Old Friend, "The Eosinophil"
No full textObjective: In most cases of asthma, wheezing symptoms start in early childhood. Although there are studies evaluating the factors that play a role in the development of childhood asthma, the predictive markers for frequent wheezing in early childhood are still unclear. The aim of our study was to investigate the relation between the wheezing episodes and the familial, prenatal, and postnatal risk factors, and the sensitivity of serum eosinophilic cationic protein (ECP) and eosinophil levels for predicting frequent wheezing.
Materials and Methods: Fifty-seven children with acute wheezing and fifty healthy children aged between 1-36 months were included in the study. The children who had >= 3 episodes of wheezing in the next year after presentation were classified as the frequent wheezing group and those with fewer episodes were classified as the infrequent wheezing group. Administration of a comprehensive questionnaire about risk factors for wheezing; blood sampling for serum total IgE, ECP, eosinophil count, food and inhaled specific IgE levels and RSV/adenovirus serology; and skin prick tests were performed. Oral provocation tests were applied in cases of suspected food allergy.
Results: Male gender (p=0.024), low socioeconomic level (p=0.046), initiation of milk formula (p=0.009) and eggs (p=0.018) before the fourth month, the presence of mold / umidity at home (p=0.023), eczema (p= 7.9 mu g/L at enrollment had higher risk of frequent wheezing than those with serum ECP 7.9 mu g/L (p=0.008). The sensitivity of ECP >= 7.9 mu g/L for frequent wheezing was 75.9% and the specificity was 68.7%. Similarly, serum total IgE (>= 154 IU/ml) and total eosinophil count (>= 390 /mm3) were found to be significantly higher in infants in the frequent wheezing group than the other groups (p=0.049, p=0.019). The multivariate analysis showed that the risk of frequent wheezing was 6.6 fold higher in children with a serum ECP level >= 7.9 mu g /L and 5.3 fold higher in the presence of RSV / adenovirus infection (p=0.026, p=0.038, respectively).
Conclusion: In conclusion, our study suggested that the increase in serum ECP levels and the presence of RSV / denovirus infection significantly increased the risk of frequent wheezing in children with acute wheezing attacks
Tek taraflı periferik vestibüler bozukluğu olan hastalarda statokinesigram ve parametrelerinin video baş savurma testi ve otolitik reflekslerle olan korelasyonu
No full textPeriferik vestibüler bozukluklar, vestibüler labirent ya da vestibüler sinirlerdeki
patolojilerden kaynaklanır. Bu bozukluklarda, vertigo, postüral instablite ve denge kaybı gibi
semptomlar görülmektedir. Vestibüler sistemin değerlendirilmesinde, detaylı öykü ve fizik
muayenenin yanı sıra, sıklıkla kullanılan birkaç test bulunmaktadır. Literatürde bu testlerin
birbiriyle ilişkisini inceleyen herhangi bir çalışma bulunmaması bizde bu araştırmayı yapma
ihtiyacı doğurmuştur.
Bu çalışmanın amacı, tek taraflı periferik vestibüler bozukluğu olan hastalarda,
statokinesigramın ne ölçüde etkilendiğini incelemektir. Bu bağlamda, dinamik/ statik
postürografi ile tek taraflı vestibüler bozukluğu tanısına katkıda bulunan video baş savurma
testi (VHIT) ve vestibüler uyarılmış myojenik potansiyeller (VEMP) testlerinin ilişkisini
incelemektir.
Bu çalışma “tek taraflı periferik vestibüler bozukluk” tanısı almış, semptomları en az
üç aydır devam eden ve yaşları 40 ile 82 yaş arasında değişen 30 hastanın katılımı ile
gerçekleştirildi. Hastalara; statokinesigram (SKG), stabiliteninin limiti testi (limits of
stability), öne-arkaya postüral stabilite, sağa-sola postüral stabilite alt parametrelerini içeren
statik/dinamik sensoryal organizasyon testleri (dinamik postürografi); semisirküler kanalların
VOR kazanç ve ortalama hız parametrelerini içeren VHIT ve servikal- oküler VEMP testleri
uygulandı. Dinamik postürografi; farklı koşullardaki postüral stabiliteyi, VHIT; kanalların
VOR kazanç ve fonksiyonlarını; VEMP testleri ise, otolit fonksiyonunu ölçmekteydi.
Değişkenler arasındaki doğrusal ilişki pearson korelasyon analizi ile incelendi.
Analizler sonucunda, arkaya stabilite limiti ile posterior kanal hız ölçümleri arasında
negatif yönlü, orta derecede (r=-0,555; p=0,032); sola stabilite limiti ile anterior ve lateral
kanal hızları arasında pozitif yönlü orta derecede (r=0,528; p=0,043 / r=0,549; p=0,034);
anterior kanal kazancı ile servikal VEMP dalga latansları arasında negatif yönlü kuvvetli
derecede (r=-0,807; p=0,015 / r=-767; p=0,026); gözler açık SKG alanı ile servikal VEMP N1
dalga amplitudu arasında pozitif yönlü, çok yüksek derecede (r=0,826; p=0,011); gözler açık
ön-arka postüral stabilite ile posterior kanal hızı arasında negatif yönlü, yüksek derecede (r=-
0,643; p=0,010); gözler kapalı ön-arka postüral stabilite ile anterior kanal kazancı arasında,
negatif yönlü, orta derecede (r=-0,580; p=0,024); gözler kapalı ön-arka postüral stabilite ile
posterior kanal hızı arasında, negatif yönlü, yüksek derecede (r=-0,661;p=0,007); örümcek
ön-arka postüral stabilite ile posterior kanal hızı arasında negatif yönlü, yüksek derecede (r=- 0,614; p=0,015); servikal VEMP P1 dalga amplitudu ile örümcek sağ-sol postüral stabilite ve
laterak kanal hızları arasında negatif yönlü yüksek derecede (r=-0,772; p=0,025 / r=-0,843;
p=0,009); stabilite limiti total alanı ile anterior kanal hızı arasında pozitif yönlü, orta derecede
(r=0,574; p=0,025); lateral kanal kazancı ile servikal VEMP dalga latansları arasında negatif
yönlü yüksek derecede (r=-0,780; p=0,022; r=-0,722; p=0,043); gözler açık SKG alanı ile
lateral ve anterior kanal hızları arasında pozitif yönlü orta derecede (r=0,534; p=0,040;
r=0,602;p=0,018); gözler kapalı ön-arka postüral stabilite ile lateral kanal hızı arasında pozitif
yönlü orta derecede (r=0,520; p=0,047); gözler kapalı sağ-sol postüral stabilite ile servikal
VEMP P1 latansı arasında negatif yönlü, çok yüksek derecede (r=-0,835; p=0,010); örümcek
SKG alanı ile anterior kanal hızı arasında pozitif yönlü, orta derecede doğrusal ilişki
bulunmuştur (r=0,614; p=0,015).
Çalışmanın bulguları dikkate alındığında, tek taraflı periferik vestibüler bozukluğu
olan hastalarda, dinamik postürografi alt parametrelerinden sitatokinesigramın, farklı
ölçülerde etkilendiği ve VHIT ile VEMP testleri ile farklı kuvvetlerde ilişkili olduğu
bulunmuştur. Bu sonuçların, vestibüler rehabilitasyon programlarının planlanması aşamasında
dikkate alınmasını önermekteyiz.
Peripheral vestibular disorders are resulted from vestibular labyrinth or vestibular
nerve pathologies. In these disorders, it is also possible to observe symptoms such as vertigo,
postural instability and poor balance. Some other tests exist for evaluating vestibular system
as well as detailed medical history and physical examination. Not finding any studies
investigating the relation between these tests in literature created a need to conduct this study.
The aim of this study are to examine the level of effect that statokinesigram (SKG) has
exposed on patients having Unilateral Peripheral Vestibular Disorder (UPVD), in this context,
to investigate the relation between Video Head Impulse Test (VHIT) and Vestibular Evoked
Myogenic Potential (VEMP) Test, which contributes diagnosis of UPVD and Static /
Dynamic Posturography.
This study has been conducted with 30 patients whose ages differ between 40-82 years
and diagnosed UPVD, and their symptoms lasting at least 3 months. Static/ Dynamic Sensory
Organization Test (SOT) including sub-parameters of SKG, Limits of Stability (LOS) Test,
antero-posterior postural stability, medio-lateral postural stability, VHIT including VOR gains
and head velocity and cervical-ocular VEMP tests were all administered to patients. Dynamic
Posturography assesses postural stability in different conditions, VHIT assesses VOR gains
and functions of canals, VEMP assesses otoliths functions. Linear correlation between
variations was examined with Pearson Correlation Analysis.
Regarding the analysis in this study shows that a negative correlation-moderate degree
(r=-0.555; p=0.032) has been found between LOS posterior and posterior SSC peak head
velocity, and a positive correlation-moderate degree (r=0.528; p=0.043 / r=0.549; p=0.034)
between LOS left and Anterior/ Lateral SSC peak head velocity. In addition to this, a negative
correlation-high degree (r=-0.807; p=0.015 / r=-767; p=0.026) between Anterior SSC VOR
gain and cervical VEMP Latans, and a positive correlation-high degree (r=0.826; p=0.011)
between eyes open SKG area and cervical VEMP N1 Amplitude, and a negative correlationhigh
degree (r=-0.643; p=0.010) between eyes open antero-posterior postural stability and
posterior SSC peak head velocity have been observed. In addition correlations were
following; a negative correlation-moderate degree (r=-0.580; p=0.024) between eyes closed
antero-posterior postural stability and Anterior SSC VOR gain, and a negaive correlation-high
degree (r=-0.661;p=0.007) between eyes closed antero-posterior postural stability and
posterior SSC peak head velocity, and a negative correlation-high degree (r=-0.614; p=0.015) between cobweb antero-posterior postural stability and posterior SSC peak head velocity, and
a negative correlation-high degree (r=-0.772; p=0.025 / r=-0.843; p=0.009) cervical VEMP P1
amplitude and cobweb right-left postural stability / lateral SSC peak head velocity have been
found. Additionally, a positive correlation-moderate degree (r=0.574; p=0.025) between LOS
total area and anterior SSC peak head velocity, and a negative correlation-high degree (r=-
0.780; p=0.022; r=-0.722; p=0.043) between lateral SSC VOR gain and cervical VEMP
latans, and a positive correlation-moderate degree (r=0.534; p=0.040; r=0.602; p=0.018)
between eyes open SKG area and lateral/anterior SSC peak head velocity have been come by.
Finally, this study has come up with a positive correlation-moderate degree (r=0.520;
p=0.047) between eyes closed antero-posterior postural stability and lateak SSC peak head
velocity, and a negative correlation-high degree (r=-0.835; p=0.010) between eyes closed
medio-lateral postural stability and cervical VEMP P1 latans, and a positive correlationmoderate
degree (r=0.614; p=0.015) between cobweb SKG area and anterior SSC peak head
velocity.
In line with these findings, this study presents that SKG being sub-parameters of
Dynamic Posturography has been affected in various degrees in patients experiencing UPVD,
and SKG has a correlation with VHIT and VEMP in various degrees. We strongly suggest
these findings to be taken into consideration in planning of vestibular rehabilitation programs
Effects of volume-controlled equal ratio ventilation with recruitment maneuver and positive end-expiratory pressure in laparoscopic sleeve gastrectomy: a prospective, randomized, controlled trial
No full textBackground/aim: We compared the effects of volume-controlled equal ratio ventilation (VC-ERV) and volume-controlled conventional ratio ventilation (VC-CRV) on oxygenation, ventilation, respiratory mechanics, and hemodynamic status during mechanical ventilation with recruitment maneuver (RM) and positive end-expiratory pressure (PEEP) in patients undergoing laparoscopic sleeve gastrectomy.
Materials and methods: A total of 111 patients scheduled for laparoscopic sleeve gastrectomy were randomized to ventilation with inspiratory to expiratory ratio of 1:1 (Group VC-ERV) or 1:2 (Group VC-CRV) following tracheal intubation. RM (40 cmH2O, 15 s) and PEEP (10 cmH2O) were administered to all patients. Arterial blood gas samples were taken and peak airway pressure (Ppeak), mean airway pressure (Pmean), dynamic compliance (Cdyn), mean arterial pressure, heart rate, SpO2, and EtCO2 were recorded at 4 time points. Postoperative respiratory complications were recorded.
Results: Oxygenation, ventilation, Pmean levels, and hemodynamic variables were similar in both groups. VC-ERV significantly decreased Ppeak and increased Cdyn compared to VC-CRV at all time points of the operation (P < 0.05). No pulmonary complication was observed in any patients.
Condusion: VC-ERV provides significantly lower Ppeak and higher Cdyn with similar oxygenation, ventilation, hemodynamic parameters, and Pmean levels when compared to VC-CRV during mechanical ventilation with RM and PEEP in laparoscopic sleeve gastrectomy
Benign Paroxysmal Positional Vertigo Diagnosed in a Patient with Idiopathic Cervical Dystonia
No full textIdiopathic cervical dystonia (CD) is a focal dystonia characterized by involuntary contraction of the muscles of the neck causing twisting movements and abnormal head and neck postures. Its etiology is unclear: however. intracerebral neuronal circuit pathologies are highly considered. On the contrary, benign paroxysmal positional vertigo (BPPV) is the most common peripheral vertigo diagnosed. We present a patient with CD suffering from severe vertigo who was diagnosed with BPPV. This is a very unique case representing the co-occurrence of a rare central nervous system pathology and a peripheral inner ear disease. The cause and effect relation between two pathologies is under scope. We present a 55-year-old woman with CD attended our clinic with severe vertigo and nausea. Left posterior semicircular canal BPPV (PSCC BPPV) was diagnosed. Involuntary head and neck muscle contractions caused by CD appear to have contributed to the development of BPPV in this case. However, increased neuronal activities causing CD could also have led to BPPV in the vestibular nuclear level. Further investigations are essential. Peripheral vestibular pathologies and their association with CD are not clearly determined in the literature so far. To our knowledge, there are no other cases reported regarding this co-occurrence
Does the primary route of spread have a prognostic significance in stage III non-serous epithelial ovarian cancer?
No full textBackground: The purpose of this retrospective study was to determine the prognosis of non-serous epithelial ovarian cancer (EOC) patients with exclusively retroperitoneal lymph node (LN) metastases, and to compare the prognosis of these women to that of patients who had abdominal peritoneal involvement.
Methods: A multicenter, retrospective department database review was performed to identify patients with stage III non-serous EOC at 7 gynecologic oncology centers in Turkey. Demographic, clinicopathological and survival data were collected. The patients were divided into three groups based on the initial sites of disease: 1) the retroperitoneal (RP) group included patients who had positive pelvic and / or para-aortic LNs only. 2) The intraperitoneal (IP) group included patients with > 2 cm IP dissemination outside of the pelvis. These patients all had a negative LN status, 3) The IP / RP group included patients with > 2 cm IP dissemination outside of the pelvis as well as positive LN status. Survival data were compared with regard to the groups.
Results: We identified 179 women with stage III non-serous EOC who were treated at 7 participating centers during the study period. The median age of the patients was 53 years, and the median duration of follow-up was 39 months. There were 35 (19.6%) patients in the RP group, 72 (40.2%) in the IP group and 72 (40.2%) in the IP/RP group. The 5-year disease-free survival (DFS) rates for the RP, the IP, and IP/ RP groups were 66.4%, 37.6%, and 25.5%, respectively (p = 0.002). The 5-year overall survival (OS) rate for the RP group was significantly longer when compared to those of the IP, and the IP/RP groups (74.4% vs. 54%, and 36%, respectively; p = 0.011). However, we were not able to define "RP only disease" as an independent prognostic factor for increased DFS or OS.
Conclusions: Primary non-serous EOC patients with node-positive-only disease seem to have better survival when compared to those with extra-pelvic peritoneal involvement
The comparison of physical activity, disability, and quality of life of pregnant women in different trimesters
No full textObjective: The purpose of this study was to compare the physical activity, disability, and quality of life in pregnant women in different trimesters. Material and Methods: This was a retrospective cohort study and a total of 91 pregnant women (first trimester n=20, second trimester n= 34, third trimester n=37) were enrolled. The physical activity levels were evaluated with the International Physical Activity Questionnaire; the disability was evaluated with the Oswestry Low Back Pain Questionnaire, and the quality of life levels was determined with the Short Form-36 questionnaire. Results: The demographic features of the pregnant women were similar in different trimesters (p>.05). The comparison of their physical activity levels in terms of trimesters, the level of moderate and vigorous physical activities, and the activity level of walking showed no difference (p>.05). The total physical activity level in the second trimester was higher than in the first trimester (p=.048); the level of disability due to low back pain was significantly higher in the third trimester than other trimesters (p=.003); and the physical function parameter of the quality of life scale was significantly lower in the third trimester compared to the first and the second ones (p=.001). However, there were no significant differences in the other parameters of the quality of life (p>.05). Conclusion: The levels of physical activity, physical functioning and disability varied in different trimesters. It can be stated that the progress of the pregnancy decreases physical function and triggers disability due to low back pain; however, the change in the level of physical activity is related to the adaptation to pregnancy and not to gestational age. Copyright © 2018 by Türkiye Klinikleri
Frequency and duration of smoking scenes in Turkish movies
No full textBACKGROUND: Comprehensive tobacco control law in Turkey bans advertisement, promotion of tobacco products and sponsorship by the tobacco industry. Advertisement of tobacco products was banned on television, billboards and press media, but not on movie films. METHODS: To evaluate the frequency and duration of smoking in the movies, 60 most watched Turkish films which were on the vision during the second half of 2016 were determined for this descriptive study. Two young males having a university degree were trained on the aim and methodology of the study. Then the two observers viewed the films independently and recorded smoking scenes or direct appearance of tobacco products on a standard form. RESULTS: There were tobacco products or smoking views in 36 (60%) out of total 60 movies. In these movies there were 4.75 times tobacco occurrences as an average (median 3). Average duration of smoking occurrences was almost 3.5 min (198 s). Smokers were mostly main characters and smoking occurrences were mostly in exciting or romantic atmosphere, which are attractive for young people. DISCUSSION: In the light of Framework Convention on Tobacco Control (Article 13), smoking scenes in movies are considered as kind of tobacco advertisement and promotion, which influences smoking behavior particularly the young people. Therefore, control and prevention of smoking occurrences in movies are important for the protection of children and young people to start smoking. Some health warnings and anti-tobacco messages may be placed in the movies, to reduce tobacco views in the movies
Effects of pre-operative individualized education on anxiety and pain severity in patients following open-heart surgery
No full textObjectives: Individualized education is important for preparing patients for the operation both physically and psychologically. This study investigated the effects of pre-operative individualized education for open-heart surgery patients on post-operative anxiety and pain severity.
Methods: This quasi-experimental study was conducted in a university hospital between January and October 2014 and involved 109 patients. Data were collected through a form developed by the authors, the State-Trait Anxiety Inventory (STAI), and the visual analog scale (VAS). Patients underwent STAI 1 day before the operation to identify their sources of anxiety and educational needs, and then individualized education was given accordingly. 1 day after the operation, STAI was used to measure patients' state anxiety level, and VAS was used to measure their pain level. The effect of demographic variables on differences in anxiety and pain was investigated.
Results: The average age of the participants was 59.62; 69.7% were male, 92.7% were married, 49.5% graduated from primary school, and the majority (71.6%) had coronary heart disease. The most common sources of anxiety reported the participants included lack of knowledge, being away from family, risk of death, and pain. An analysis of the participants' pre-operative mean scores for state anxiety displayed statistically significant differences (P < 0.05) according to age groups and gender. No significant difference was detected between mean pre- and post-operative state anxiety scores. There was a statistically significant relationship between mean pre- and post-operative state anxiety scores and mean pain scores.
Conclusions: The individualized education is given to patients before surgery was found to have potential effects on their post-operative pain levels
Mid-term clinical outcomes of new generation drug-eluting stents for treatment of diffuse coronary artery disease
No full textObjective: Diffuse coronary artery disease (CAD) is a challenging issue in clinical cardiology practice. There are limited data about percutaneous revascularization in these patients.
Methods: This study was an observational clinical evaluation. The records of patients with diffuse CAD revascularized with new-generation drug-eluting stents (DES) were researched retrospectively. Patients treated with multiple, overlapping new-generation DES (at least 60mm in length per vessel) were included. The incidence of major adverse cardiac events (MACE), defined as cardiac death, stent thrombosis, non-fatal myocardial infarction, and target lesion revascularization (TLR), at the end of the first year following the index procedure was recorded.
Results: A total of 71 patients (with 75 coronary vessels) treated with new-generation DES for diffuse CAD were enrolled in the study. Zotarolimus-eluting stents were used in 48 vessels and biolimus A9-eluting stents were used in 27 vessels. The median total stent length per vessel was 75.0 mm (60.0-106.0) and the median number of stents implanted was 3 (2-4) for each vessel. The cumulative incidence of MACE at the end of the first year was 11.2% (8 patients). The presence of diabetes mellitus (DM) and ST-segment elevated myocardial infarction (STEMI) were defined as independent clinical risk factors related to MACE development.
Conclusion: Coronary artery revascularization with new-generation drug-eluting stents can be a good choice in the treatment of selected patients with diffuse CAD. DM and STEMI were found to be related to poorer clinical outcomes with this treatment option in our study