İstanbul Eğitim ve Araştırma Hastanesi

OBJECTIVE: The reliability and validity of the Turkish translation of the Young Mania Rating Scale (YMRS) were determined in this study, since it is the most common scale used in clinical studies of mood disorders. METHOD: Fifteen male and 15 female inpatients who were diagnosed as having "Bipolar Mood Disorder--Recent Episode Mania", were given YMRS by two experienced psychiatrists, while another experienced psychiatrist gave the Bech-Rafaelsen Mania Scale (BRMS) simultaneously to the same patient population hospitalized in Bakirköy State Hospital for Psychiatric and Neurological Diseases, Psychiatry and Mood Disorders Inpatient Unit 5. The internal consistency of the Turkish version of YMRS was evaluated by the Cronbach's Alpha test, while item/item, item/total, and cross validity correlations were evaluated by the Pearson correlation test. Inter-rater agreement and consistency was evaluated by weighted kappa analysis. RESULTS: The internal consistency coefficient (Cronbach's alpha) was 0.79 for both researchers. Correlations of the items individually with the YMRS total scores were between 0.407 and 0.847. Agreement of the interviewers for the items was between 63.3%-95% and kappa values for the items were between 0.114 and 0.849. Correlation coefficients of YMRS and BRMS of the researchers were 0.72 for the first researcher and 0.71 for the second researcher. CONCLUSION: The Turkish translation of YMRS was found to be valid and reliable.

Amaç: Çalışmada Türkçeye uyarlanan YAB-7 testinin , geçerlik, güvenirlik ve psikometrik özelliklerinin belirlenmesi amaçlandı. Yöntem: Çalışmaya YAB tanısı konulan 110 hasta 112 sağlıklı gönüllü katıldı. Başlangıç uygulamasının üç hafta sonrasında örneklemin belirli bir bölümüne YAB-7 testi yeniden uygulandı. Yapısal geçerlilik için ana bileşenler analizi, doğrulayıcı faktör analizi, ayırt edici özelliğin belirlenmesi için ROC analizi yapıldı. Değişik kesme değerlerinde pozitif öngörücü değer, negatif öngörücü değer, pozitif ve negatif olabilirlik oranı hesaplandı. Bulgular: YAB grubunda YAB-7 testi toplam puanları kontrol grubuna göre istatistiksel olarak anlamlı yüksek bulundu. YAB-7 testi tüm maddeleri arasında anlamlı ilişki, iç tutarlık ve aralıklı uygulamada iyi kararlılık gösterdiği görüldü. Yapısal geçerlilik için yapılan faktör analizinde YAB-7 testi faktör yapısının orijinal test ile benzer olduğu ve yapısal geçerliliğinin iyi olduğu saptandı. Doğrulayıcı faktör analizinde tek faktörlü yapıya iyi uyum gözlendi. YAB-7 testi için en kabul edilebilir kesme değeri 8 bulundu. Sonuç: YAB-7 Türkçe formunun klinik örneklemde orijinal forma benzer olarak yüksek geçerliğe, güvenilirliğe ve iyi psikometrik özelliklere sahip olduğu saptandı. YAB-7 Türkçe formunun yararlı bir tarama testi olarak değerlendirildi. (Nöropsikiyatri Arflivi 2013; 50: 53-58)

Complete IFN-gamma receptor ligand-binding chain (IFNgammaR1) deficiency is a life-threatening autosomal recessive immune disorder. Affected children invariably die of mycobacterial infection, unless bone marrow transplantation is undertaken. Pathogenic IFNGR1 mutations identified to date include nonsense and splice mutations and frameshift deletions and insertions. All result in a premature stop codon upstream from the segment encoding the transmembrane domain, precluding cell surface expression of the receptors. We report herein two sporadic and two familial cases of a novel form of complete IFNgammaR1 deficiency in which normal numbers of receptors are detected at the cell surface. Two in-frame deletions and two missense IFNGR1 mutations were identified in the segment encoding the extracellular ligand-binding domain of the receptor. Eight independent IFNgammaR1-specific mAb's, including seven blocking antibodies, gave recognition patterns that differed between patients, suggesting that different epitopes were altered by the mutations. No specific binding of (125)I-IFN-gamma to cells was observed in any patient, however, and the cells failed to respond to IFN-gamma. The mutations therefore cause complete IFNgammaR1 deficiency by disrupting the IFN-gamma-binding site without affecting surface expression. The detection of surface IFNgammaR1 molecules by specific antibodies, including blocking antibodies, does not exclude a diagnosis of complete IFNgammaR1 deficiency.

In this article we present the results of three studies investigating methods for including men in antenatal education in Istanbul, Turkey. Participants were first-time expectant parents living in low and middle-income areas. After a formative study on the roles of various family members in health during the period surrounding a first birth, an antenatal-clinic-based education programme for women and for couples was carried out as a randomised, controlled study. Based on the results, separate community-based antenatal education programmes for expectant mothers and expectant fathers were tested. There was demand among many pregnant women and some of their husbands for including expectant fathers in antenatal education. In the short term, these programmes seemed to have positive effects on women and men's reproductive health knowledge, attitudes and behaviours. In the clinic-based programme the positive effects of including men were mainly in the area of post-partum family planning, while in the community-based programme positive effects among men were also seen in the areas of infant health, infant feeding and spousal communication and support. Free an tenatal education should be made available to all expectant mothers and when possible, men should be included, either together with their wives or in a culture such as that of Turkey, in separate groups.RésuméTrois etudes ont analysé des méthodes pour associer les hommes á l'éducation prénatale. Les participants, issus de quartiers à revenus faibles et moyens d'Istanbul, Turquie, attendaient leur premier enfant. Après une étude initiale des rôles en matiere de santé des membres de la famille pendant la période entourant une première naissance, un programme d'éducation a donné des soins prénatals en dispensaire aux femmes et aux couples, dans le cadre d'une etude aléatorie et contrôlée. En fonction des résultats, des programmes communautaires d'education prénatale, séparés pour les futurs péres et les futures mères, ont été testes. Beaucoup de femmes enceintes et quelques maris souhaitaient associer les futurs pères à l'éducation prénatale. A court terme, ces programmes semblaient avoir des effets positifs sur les connaissances, les attitudes et les comportements des hommes et des femmes en matière de santé génésique. Darts le programme mené au dispensaire, l'ínclusion des hommes avait des avantages touchant à la planification familiale post-partum, alors que les effets positifs du programme communautaire concernaient la santé infantile, 1'alimentation des nourrissons, la communication et le soutien entre époux. Une éducation prénatale gratuite devrait être proposée à toutes les futures mères et, lorsque c'est possible, les hommes devraient y être associés, soit avec leurs épouses soit, dans une culture comme celle de la Turquie, dans des groupes séparés.ResumenTres investigaciones analizaron los métodos para incluir a los hombres en la educación prenatal en Estambul, Turquia. Los participantes eran parejas que vivían en Areas de bajos y medianos ingresos, quienes esperaban su primer bebé. Después de un estudio formativo acerca de los roles de los distintos integrantes de la familia en relación a la salud durante el período previo y posterior a un primer nacimiento, se implementó un estudio aleatorio controlado en la forma de un programa educativo para mujeres y para parejas en una clínica prenatal. En base a los resultados, se probaron programas educativos prenatales comunitarios para mujeres embarazadas y sus parejas. Hubo una demanda entre muchas de las mujeres embarazadas y algunos de sus esposos para incluir a los futures padres en la educación prenatal. A couo plazo, estos programas parecían tener efectos positivos en las actitudes, comportamientos y conocimientos de la salud reproductiva de las mujeres y los hombres. En el programa de la clinica, los efectos positivos de incluir a los hombres se notaban principalmente en el ámbito de la planificación familiar postparto, mientras que en el programa comunitario, se notaban además los efectos positivos en los ámbitos de la salud y la alimentacion infantil, el apoyo de los hombres a sus esposas y la comunicacíon con ellas. Se recomienda ofrecer educacion prenatal gratuita a todas las mujeres embarazadas y cuando sea posible a los hombres, en conjunto con sus esposas o, en una cultura como la de Turquía, en grupos separados.

Cutaneous leishmaniasis (CL) caused by Leishmania protozoon parasites is a disease which is characterized by long-term nodulo-ulcerative lesions healing spontaneously with scarring. The disease has been well-known in Anatolia for centuries and has different names such as; Urfa boil, Antep boil, year boil, Halep boil, oriental sore and beauty scar. The causative agents are Leishmania tropica and Leishmania tropica/Leishmania infantum in Southeastern Anatolia and East Mediterranean, respectively. CL is a notifiable disease in Turkey and, according to the Ministry of Health official records, 46.003 new cases were reported between 1990 and 2010. Among those cases, 96% of them were reported from the Şanlıurfa, Adana, Osmaniye, Hatay, Diyarbakır, İçel and Kahramanmaraş provinces. Although 45% of cases were notified from Şanlıurfa in the past 20 years, its ratio is currently decreasing while other regions' ratios have been showing an increasing trend. Easier transportation between cities, increased travel migration of the population from rural areas to the peripheral suburbs with inadequate infrastructure and unhealthy housing are thought to be the main factors for spreading the disease from Southeastern Anatolia to other regions of Turkey. Lack of treatment of patients as reservoir hosts because of different reasons and ineffective and inadequate use of insecticides against vector sand flies have also played an important role in spreading the disease. Neglect of this disease by patients and health institutions can also be considered as other factors for the spreading. We believe that, after the strategic plan for leishmaniasis prepared by the Turkish Ministry of Health with the contribution of scientists in 2011 is put into practice, the control of the disease will be more effective.

Purpose – The purpose of this paper is to measure and compare the level of earthquake preparedness of individuals living in Eastern Anatolia region of Turkey, evaluate whether prior earthquake experience has an impact on earthquake preparedness and discuss the cultural factors that may play a role in determining the level of preparedness. Design/methodology/approach – Three locations were identified for the study. Aşkale and Erçiş district had experienced a major earthquake where Erzurum City Center had no major earthquake experience. A total of 174 participants were included in the study. Earthquake preparation was assessed using the Turkish version of the Wellington Earthquake Preparedness Scale by Spittal et al . (2006). Findings – The results showed a significant relationship between the place of living, earthquake experience and preparation. Those who had prior earthquake experience had higher preparation than those who had no prior earthquake experience. Home owners had taken more steps to prepare for an earthquake than non-home owners Individuals who were married had higher preparation scores than those who were single or widowed. A comparison of general perception of preparedness levels reported by participants having a major earthquake experience and no earthquake experience showed that Erçiş and Aşkale residents were significantly more prepared for an earthquake than Erzurum residents. Home ownership and past earthquake experience were found to be predictors of preparation. Originality/value – Although the Eastern Anatolia region of Turkey encounters many earthquakes resulting in mass destruction, the issue of whether individuals living in this region are ready and prepared for a possible earthquake has not been researched sufficiently.

Abstract Objectives: We evaluated the results of two different surgical methods for the treatment of adult diaphyseal fractures of both forearm bones.\r\nMethods: Forty-two adult patients with forearm fractures were retrospectively evaluated. Of these, 22 patients (7 women, 15 men; mean age 32 years; range 18 to 69 years) underwent open reduction and plate-screw fixation, and 20 patients (6 women, 14 men; mean age 33 years; range 18 to 70 years) underwent closed reduction and locked intramedullary nail fixation. The fractures were classified according to the AO/OTA system. The patients were assessed using the Grace-Eversmann criteria and the DASH (Disability of the Arm, Shoulder and Hand) questionnaire. The mean follow-up was 30 months (range 12 to 45) with plate-screw fixation, and 23 months (range 12 to 34) with intramedullary nailing.\r\nResults: The mean operation time was 65 minutes (range 40 to 97 min) with plate-screw fixation, and 61 minutes (range 35 to 90 min) with intramedullary nailing (p>0.05). The mean time to union was significantly shorter with intramedullary nailing (10 weeks vs. 14 weeks; p<0.05). According to the Grace-Eversmann criteria, the results were excellent or good in 18 patients (81.8%) and acceptable in four patients (18.2%) treated with plate-screw fixation, compared to 18 patients (90%) and two patients (10%), respectively, treated with intramedullary nailing. The mean DASH scores were 15 (range 4 to 30) and 13 (range 3 to 25), respectively. The two groups did not differ significantly with respect to functional results and DASH scores (p>0.05). Postoperative complications were seen in three patients (13.6%) and two patients (10%) with plate-screw fixation and intramedullary nailing, respectively. \r\nConclusion: The two fixation methods yield similar results in terms of functional healing and patient satisfaction in the management of adult forearm fractures. Özet Amaç: Erişkinlerdeki önkol çift kırıklarının cerrahi tedavisinde uyguladığımız iki farklı yöntemin sonuçları değerlendirildi.\r\nÇalışma planı: Önkol kırıklı 42 erişkin hasta geriye dönük olarak incelendi. Bunlardan 22 hasta (7 kadın, 15 erkek; ort. yaş 32; dağılım 18-69) açık redüksiyon ve plak-vida ile tespit yöntemi, 20 hasta (6 kadın, 14 erkek; ort. yaş 33; dağılım 18-70) kapalı redüksiyon ve kilitli kanaliçi çivi yöntemi ile tedavi edildi. Kırıklar AO/OTA sistemine göre sınıflandırıldı. Hastalar, son kontrollerde Grace-Eversmann ölçütlerine göre ve DASH (Disabilities of the Arm, Shoulder and Hand) skoru ile değerlendirildi. Ortalama takip süresi plak-vida grubunda 30 ay (dağılım 12-45 ay), kilitli kanaliçi çivi grubunda 23 aydı (dağılım 12-34 ay) idi. \r\nSonuçlar: Ortalama ameliyat süresi plak-vida grubunda 65 dk (dağılım 40-97 dk), kanaliçi çivi grubunda 61 dk (dağılım 35-90 dk) idi (p>0.05). Ortalama kaynama süresi kanaliçi çivi grubunda anlamlı derecede daha kısa bulundu (10 hafta ve 14 hafta; p<0.05). Grace-Eversmann ölçütlerine göre, plak-vida grubunda 18 hastada (%81.8) mükemmel ve iyi, dört hastada (%18.2) kabul edilebilir sonuç; kanaliçi çivi grubunda 18 hastada (%90) mükemmel ve iyi, iki hastada (%10) kabul edilebilir sonuç elde edildi. Ortalama DASH skoru ise sırasıyla 15 (dağılım 4-30) ve 13 (dağılım 3-25) bulundu; iki grup arasında fonksiyonel sonuç ve DASH skoru açısından anlamlı fark görülmedi (p>0.05). Ameliyat sonrası komplikasyon plak-vida grubunda üç hastada (%13.6), kanaliçi çivi grubunda iki hastada (%10) görüldü. \r\nÇıkarımlar: Erişkinlerdeki önkol çift kırıklarının cerrahi tedavisinde iki tespit yönteminin fonksiyonel iyileşme ve hasta memnuniyeti açısından sonuçları benzer bulundu.

BACKGROUND: The aim of the present study was to examine the efficacy of simple laboratory parameters including neutrophil-to-lymphocyte ratio (NLR), platelet count (PLT), mean platelet volume (MPV), and serum bilirubin level in the diagnosis of acute appendicitis and recognition of perforated appendicitis. METHODS: Records of 3392 patients who underwent appendectomy in a 10-year period were reviewed retrospectively. Patients were divided into 2 groups according to histopathological examination results: Group 1 had normal appendix, Group 2 had acute appendicitis. Patients with acute appendicitis were divided into subgroups: Group 2A had simple acute appendicitis, while Group 2B had perforated appendicitis. Efficacy of the aforementioned laboratory parameters was evaluated in the diagnosis of acute appendicitis and recognition of perforated appendicitis. Independent variables were determined by univariate analysis and multivariate analysis was performed. Receiver operating characteristic (ROC) curve analysis was used to identify significant parameters in multivariate analysis. Cut-off values, sensitivity, specificity, and accuracy calculations performed for parameters with area under curve (AUC) >0.600 were accepted as "significant parameters." RESULTS: White cell count (WCC), bilirubin, and NLR were significant parameters for the diagnosis of acute appendicitis. Cut-off values were 11900/mm3 for WCC (sensitivity: 71.2%; specificity: 67.2%; OR: 5.13), 1.0 mg/dl for bilirubin (sensitivity: 19.1%; specificity: 92.4%; OR: 2.96), and 3.0 for NLR (sensitivity: 81.2%; specificity: 53.1%; OR: 4.27). Serum bilirubin and NLR were independent variables for the diagnosis of perforated appendicitis. Cut-off values were 1.0 mg/dl for bilirubin (sensitivity: 78.4%; specificity: 41.7%; OR: 2.6) and 4.8 for NLR (sensitivity: 81.2%; specificity: 53.1%; OR: 2.6). CONCLUSION: Presence of at least 1 of the following findings in a patient suspected of having acute appendicitis was significantly associated with a definite diagnosis: WCC >11.900 mm3, serum bilirubin >1.0 mg/dl, NLR >3.0. In patients with acute appendicitis, serum bilirubin >1.0 mg/dl or NLR >4.8 were significantly associated with the presence of perforation. While WCC is a significant parameter for diagnosis of acute appendicitis, no significant association with perforated appendicitis was found. PLT and MPV were not useful parameters when diagnosing acute appendicitis.

BACKGROUND: The concept of Focused Assessment with Ultrasound for Trauma (FAST), which was introduced by Rozycki et al. in 1996, has started a new era in the management of trauma patients. Today, Advanced Trauma Life Support (ATLS) suggests bedside ultrasonography (USG) evaluation of trauma patients. We aimed to investigate the usability and the reliability of handheld ultrasound (Vscan) in determining free fluid during the initial evaluation of trauma patients. METHODS: This was a multi-center, prospective study involving multiple trauma patients who presented to three hospital emergency departments (EDs). FAST was completed using Vscan by an emergency physician and an abdominal USG was performed by a radiologist on all patients. Results of Vscan, abdominal USG and other radiological studies, if performed, were compared. RESULTS: A total of 216 patients were included in the study. Of those, 203 had negative Vscan results, while 13 had positive results. When USG performed by a radiologist was considered as the gold standard, Vscan sensitivity for FAST was 88.9%, specificity was 97.6%, negative predictive value was 99.5%, and positive predictive value was 61.5% in our study. CONCLUSION: Vscan, as the smallest portable imaging device, seems to have a promising future as an indispensable gadget, equal to stethoscopes, in evaluating trauma and other critical patients.

OBJECTIVE: In this study, primary tumors' fluorine-18-fluorodeoxyglucose (F-FDG) uptake in luminal A, luminal B, triple-negative, and human epidermal growth factor receptor type-2 subtypes of breast cancer was evaluated. In addition, the relationship between the primary tumor maximum standardized uptake value (SUVmax) value and the presence of distant metastasis and axillary involvement was evaluated. PATIENTS AND METHODS: Whole-body F-FDG PET/computed tomography (CT) imaging of 493 patients (mean age; 54.6±13.2 years) diagnosed with primary breast cancer were analyzed retrospectively. PET/CT imaging was obtained 60 min after the intravenous administration of F-FDG. F-FDG uptake of the lesions was assessed by calculating the SUVmax. Histopathological analyses were carried out on the basis of biopsy samples before PET/CT. For histopathological staging, the Scarff Bloom Richardson classification system was utilized, and patients were classified into luminal A, luminal B, triple-negative, and human epidermal growth factor receptor type-2 molecular subtypes. RESULTS: 82.9% of the patients had invasive ductal carcinoma, 5.8% had invasive lobular carcinoma, 4.2% had apocrine carcinoma, 3.8% had mucinous carcinoma, and 3.4% has mixed carcinoma. Although the highest mean SUVmax was calculated in apocrine tumors (12.4±7.2), the lowest mean SUVmax was calculated in lobular carcinoma (6.8±4.6), and a statistically significant difference was found between the histological groups (P<0.001). F-FDG uptake was reported to be significantly higher in the triple-negative subtype than the luminal types, and in the luminal B subtype than the luminal A subtype. A statistically significant relation was found between primary tumor SUVmax and distant nodal, organ metastasis (P=0.003 and <0.001, respectively). CONCLUSION: Increased primary tumor F-FDG uptake was associated with aggressive molecular subtypes in this study. The relationship of distant nodal and organ metastasis with primary tumor SUVmax showed that increased F-FDG uptake is important in terms of management of therapy and prognosis.

BACKGROUND: Gastric cancer is the 2nd most common cause of cancer-related deaths, and the morbidity rate after surgery is reported to be as high as 46%. The estimation of possible complications, morbidity, and mortality and the ability to specify patients at high risk have become substantial for an intimate follow-up and for proper management in the intensive care unit. This study aimed to determine the prognostic value of the preoperative platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) and their relations with clinical outcomes and complications after gastrectomy for gastric cancer. METHODS: This single-center, retrospective cohort study evaluated the data of 292 patients who underwent gastrectomy with curative intent between January 2015 and June 2018 in a tertiary state hospital in Ankara, Turkey. A receiver operating characteristic curve was generated to evaluate the ability of laboratory values to predict clinically relevant postoperative complications. The area under the curve was computed to compare the predictive power of the NLR and PLR. Then, the cutoff points were selected as the stratifying values for the PLR and NLR. RESULTS: The area under the curve values of the PLR (0.60, 95% CI 0.542-0.657) and NLR (0.556, 95% CI 0.497-0.614) were larger than those of the other preoperative laboratory values. For the PLR, the diagnostic sensitivity and specificity were 50.00 and 72.22%, respectively, whereas for the NLR, the diagnostic sensitivity and specificity were 37.50 and 80.16%, respectively. The PLR was related to morbidity, whereas the relation of the NLR with mortality was more prominent. This study demonstrated that the PLR and NLR may predict mortality and morbidity via the Clavien-Dindo classification in gastric cancer patients. The variable was grade ≥ 3 in the Clavien-Dindo classification, including complications requiring surgical or endoscopic interventions, life-threatening complications, and death. Both the PLR and NLR differed significantly according to Clavien-Dindo grade ≥ 3. In this analysis, the PLR was related to morbidity, while the NLR relation with mortality was more intense. CONCLUSION: Based on the results of the study, the PLR and NLR could be used as independent predictive factors for mortality and morbidity in patients with gastric cancer.

INTRODUCTION: This study aimed to establish the association between alexithymia and various factors, mainly somatization, and to determine the predictors of alexithymia in depressed patients. METHODS: A total of 90 patients with major depressive disorder who met The Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) diagnostic criteria were administered the Toronto Alexithymia Scale (TAS), Beck Depression Inventory, Symptom Checklist-90 (SCL-90), Somatosensory Amplification Scale, and Symptom Interpretation Questionnaire. The patients were classified into two groups as alexithymic and non-alexithymic with respect to the TAS cut-off points (≥59=alexithymic). Predictors of alexithymia were tested by multiple linear regression analysis. RESULTS: Of all patients, 36 (40%) were in the alexithymic group. The percentage of women, depression severity, level of general psychopathology and distress, and somatic symptom reporting (SCL-90), as well as the tendency to somatosensory amplification and three forms of somatic symptom attributions, were significantly higher in alexithymic patients than in non-alexithymic patients. Furthermore, age, depression severity, somatic symptom reporting, and the tendency to attribute physical symptoms to somatic causes were predictors of alexithymia. CONCLUSION: The results indicated an intimate association between alexithymia and somatization in depressed patients. Therefore, when evaluating depressed patients with alexithymia, their tendency for somatization should be considered, and alexithymic individuals should be assessed with particular attention, considering that somatization can mask the underlying depressive condition.

Gossypiboma is the technical term for a retained surgical sponge. Because of legal-ethical concerns, there have not been many publications on this topic. Delays in diagnosis and treatment might increase mortality and morbidity. Radiological imaging is used in diagnosis. We present a case of gossypiboma that had fistulized to bulbous following hydatic cyst surgery. We established the diagnosis with endoscopy and followed its migration endoscopically.

OBJECTIVE: The aim of this study was to evaluate the behaviour and knowledge skill levels of Turkish orthopedic surgeons about fluoroscopy usage and radiation safety. METHODS: The questionnaire, consisting of nineteen questions, was sent to orthopaedic surgeons and requested by a total of 323 surgeons online. The questions were about personal information, training and behaviours related to radiation and fluoroscopy usage, and the use of protective equipment. RESULTS: A total of 277 individuals completed the questionnaire. The answers of 180 surgeons whose working duration was more than 1 year and also who participated in at least one fluoroscopy requiring operation per week, were analysed. 22 (12%) participants answered that they were trained on fluoroscopy usage. Sixty people (33.3%) reported that they did not use any protective equipment regularly. The most commonly used protection methods were lead aprons 123 (68.3%). Thyroid protectors were used by 92 participants (52.1%). There was no significant difference between the groups when comparing the use of protective equipment according to the academic title. Only 19 (10.6%) of the surgeons noted that they used dosimeter regularly, and 15 (83.3%) of them reported that they controlled their dosimeters. CONCLUSION: In this study, Orthopedic surgeons were found not to be adequately trained about use and risks of fluoroscopy and also not to be equipped about methods for preventing radiation damage.

PURPOSE: In this prospective study, PET findings of 18 F-FDG PET/CT in breast cancer staging were compared with 68 Ga-FAP inhibitor (FAPI) 04 PET/CT findings in selected cases with relatively low 18 F-FDG uptake in the primary tumor or with suspected nodal or distant metastases. PATIENTS AND METHODS: Twenty-four women with a median age of 45 years (range, 36-67 years) who underwent initial staging 18 F-FDG PET/CT for breast cancer underwent 68 Ga-FAPI-04 PET/CT imaging within the same week. SUV max and quantities of primary tumors and locoregional and distant metastatic lesions were recorded from both images, and these data were compared statistically. RESULTS: The histological subtypes of primary tumors were 11 invasive lobular, 8 invasive ductal, and 5 mucinous subtypes. More intense 68 Ga-FAPI-04 uptake (mean, 17.1 ± 7.9; 7.4-38.5) was detected in all primary tumoral lesions compared with 18 F-FDG (mean, 6.3 ± 3.9; 1.5-20.5) ( P = <0.001, Z = 4.107). Additional lesions showing 68 Ga-FAPI-04 uptake in the breast were detected in 29.2% (n = 7) of patients. In 8.3% (n = 2) of the patients, the primary lesion showed only 68 Ga-FAPI-04 uptake. In 68 Ga-FAPI-04 PET/CT, 25% (n = 6) of the patients showed more lymph node involvement and more intense uptake in the ipsilateral axilla. In addition, infraclavicular (level 3) lymph nodes in 4 patients (16.7%), supraclavicular lymph nodes in 1 patient, and internal mammary lymph nodes in 1 patient were detected only on 68 Ga-FAPI-04 PET/CT. In a patient with lung and bone metastases, 68 Ga-FAPI-04 uptake was higher, and the lung nodule showed only 68 Ga-FAPI-04 uptake. CONCLUSIONS: In selected low-FDG-affinity breast cancer patients, 68 Ga-FAPI-04 PET/CT showed the primary tumor with higher sensitivity and higher SUV max values compared with 18 F-FDG PET/CT. In addition, it is believed that this method may contribute to the management of patients' treatment by increasing the nodal stage.

Objective: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral cause of vertigo. It can be defined as transient vertigo induced by rapid change in head position, associated with a characteristic paroxysmal positional nystagmus. Posterior canal benign paroxysmal positional vertigo is the most frequent form of BPPV. The aim of our study was to investigate and compare the effectiveness of Epley maneuver and Brand-Daroff home exercises for the treatment of posterior canal BPPV.Methods: A total of 50 patients between 27 and 76 years of age who were diagnosed with unilateral posterior canal into BPPV were randomized prospectively into two groups. In Group-1, modified particle repositioning maneuver and in Group-2 Brandt-Daroff exercises were utilized as treatment. Patients were followed weekly. Cure weeks were recorded. The patients were followed for 12 to 24 months for recurrence.Results: The recovery rates at the first, second and third week controls were 76%, 96% and 100% for Group-1 (modified Epley maneuver) and 64%, 88% and 100% for Group-2 (Brandt-Daroff exercises) respectively. The recovery rates were similar for both groups. The average follow-up duration was 18 months. In Group 1, 7 patients (28%) and in Group 2, 5 patients (20%) had recurrence, which was also similar with no statistical difference.Conclusion: It was concluded that both Brandt-Daroff Exercises and Modified Epley maneuvers were almost equally effective in the treatment of BPPV.doi: https://doi.org/10.12669/pjms.343.14786How to cite this:Cetin YS, Ozmen OA, Demir UL, Kasapoglu F, Basut O, Coskun H. Comparison of the effectiveness of Brandt-Daroff Vestibular training and Epley Canalith repositioning maneuver in benign Paroxysmal positional vertigo long term result: A randomized prospective clinical trial. Pak J Med Sci. 2018;34(3):558-563.

OBJECTIVES: This study aimed to phenotype healthy individuals and patients with arthritic knees in the Turkish population according to the Coronal Plane Alignment of the Knee (CPAK) classification. PATIENTS AND METHODS: The retrospective cross-sectional study included 207 healthy individuals (109 males, 98 females; mean age: 32.9±8.4 years; range, 20 to 45 years) with a total of 414 knees (Group 1) and 296 patients (155 females, 141 males; mean age: 54.5±7.9 years; range, 43 to 80 years) with a total of 408 arthritic knees (Group 2) who met the inclusion criteria and underwent evaluation using digital long-leg radiographs between January 2019 and July 2023. Mechanical lateral distal femoral angle and medial proximal tibial angle were measured. Subsequently, the arithmetic hip-knee-ankle angle (aHKA) and joint line obliquity (JLO) were calculated. Based on the results obtained, participants in both groups were categorized according to the CPAK classification. RESULTS: In Group 1, the mean aHKA was 0.3°±2.5°, and the mean JLO was 175.2°±3.5°. In Group 2, the mean aHKA was -1.4°±3.9°, and the mean JLO was 174.6°±3.7°. The most common CPAK type in healthy individuals (Group 1) was type 2 (41.5%), followed by type 3 (14.7%) and type 1 (14.5%). In arthritis patients (Group 2), the most common CPAK type was type 2 (31.6%), followed by type 1 (28.2%) and type 3 (13.5%). CONCLUSION: The CPAK classification serves as an important guide for categorizing lower extremity alignment. In the Turkish population, healthy individuals most commonly exhibited CPAK type 2, 3, and 1 alignments, respectively, while osteoarthritic patients predominantly displayed CPAK type 2, 1, and 3 alignments.

OBJECTIVE: In our clinic, we aimed to investigate the effect of preoperative risk factors and postoperative complications on reoperation and mortality in cases with Behçet's disease which presents very rare coronary artery involvement. METHODS: Thirteen patients with Behçet's Disease who had undergone coronary artery bypass grafting in our center between 2003 and 2015 were analyzed. We evaluated the clinical and laboratory findings, complications and mortality rates of our patients in light of the literature. RESULTS: The mean age was 38.5 (30-55; 3 women). The mean time from onset of Behçet's disease to coronary artery disease was 4,7 (3-11) years. Fifty-four percent of the patients were asymptomatic. Coronary artery disease of these was exposed while peripheral vascular surgery was planned due to complications of Behçet's disease. Symptomatic patients presented angina pectoris (31%), acute coronary syndrome (8%) and arrhythmia (8%). In coronary pathology of patients, distal type obstruction (31%), aneurysm and pseudoaneurysm (31%), proximal segment thrombus (15%), chronic type stenosis and occlusions (31%) were present. Early mortality (15%) was due to acute myocardial infarction while the late mortality (15%) was due to cerebral and gastrointestinal bleeding. Reoperation was due to bleeding in one case on the 1st postoperative day and due to acute pulmonary embolism in another case in the 3rdpostoperative year. CONCLUSION: In Behçet's disease, coronary artery bypass grafting is a procedure with high mortality, especially in the acute period. The on-pump surgery technique in these cases can be safely performed for multiple bypasses and in patients above 40 years old.

Background: We investigated the effects of nutritional vitamin D supplementation on markers of bone and mineral metabolism, i.e. serum levels of fibroblast growth factor 23 (FGF23), Klotho, bone alkaline phosphatase (BAP) and sclerostin, in two cohorts with chronic kidney disease (CKD). Methods: In all, 80 vitamin D-deficient children were selected: 40 with mild to moderate CKD from the ERGO study, a randomized trial of ergocalciferol supplementation [estimated glomerular filtration rate (eGFR) 55 mL/min/1.73 m2], and 40 with advanced CKD from the observational Cardiovascular Comorbidity in Children with Chronic Kidney Disease (4C) study (eGFR 24 mL/min/1.73 m2). In each study, vitamin D supplementation was started in 20 children and 20 matched children not receiving vitamin D served as controls. Measures were taken at baseline and after a median period of 8 months. Age- and gender-related standard deviation scores (SDSs) were calculated. Results: Before vitamin D supplementation, children in the ERGO study had normal FGF23 (median 0.31 SDS) and BAP (-0.10 SDS) but decreased Klotho and sclerostin (-0.77 and -1.04 SDS, respectively), whereas 4C patients had increased FGF23 (3.87 SDS), BAP (0.78 SDS) and sclerostin (0.76 SDS) but normal Klotho (-0.27 SDS) levels. Vitamin D supplementation further increased FGF23 in 4C but not in ERGO patients. Serum Klotho and sclerostin normalized with vitamin D supplementation in ERGO but remained unchanged in 4C patients. BAP levels were unchanged in all patients. In the total cohort, significant effects of vitamin D supplementation were noted for Klotho at eGFR 40-70 mL/min/1.73 m2. Conclusions: Vitamin D supplementation normalized Klotho and sclerostin in children with mild to moderate CKD but further increased FGF23 in advanced CKD.

Treatment of acute lymphoblastic leukemia is unsatisfactory in adults due to disease and patient-related factors and probably because adult chemotherapy regimens are weaker than pediatric protocols. Worries about inadequacy of adult regimens urged many hematologists, including us, to reconsider their routine treatment practices. In this retrospective multicenter study, we aimed to evaluate results of hyper-CVAD treatment in comparison to other intensive protocols. All patients aged ≤65 years who were commenced on intensive induction chemotherapy between 1999 and 2011 were included in the study. Sixty-eight of 166 patients received hyper-CVAD, 65 were treated with CALGB-8811 regimen and 33 with multiple other protocols. Limited number of patients who were treated with other intensive protocols and mature B-acute lymphoblastic leukemia cases who were mostly given hyper-CVAD were eliminated from the statistical analyses. In spite of a favorable complete remission rate (84.2%), overall (26.3 vs. 44.2% at 5 years, p = 0.05) and disease-free (24.9 vs. 48.2%, p = 0.001) survival rates were inferior with hyper-CVAD compared to CALGB-8811 due to higher cumulative nonrelapse mortality risk (29.7 vs. 5.9%, p = 0.003) and no superiority in cumulative relapse incidence comparison (45% for both arms, p = 0.44). Hyper-CVAD, in its original form, was a less favorable regimen in our practice.