The Use of Breast Magnetic Resonance Imaging Parameters to Identify Possible Signaling Pathways of a Serum Biomarker, HE4.

OBJECTIVES: This study aimed to investigate the relationship between breast magnetic resonance imaging (MRI) parameters; clinical features such as age, tumor diameter, N, T, and TNM stages; and serum human epididymis protein 4 (HE4) levels in patients with breast carcinoma and use this as a means of estimating possible signaling pathways of the biomarker, HE4. METHODS: Thirty-seven patients with breast cancer were evaluated by breast MRI and serum HE4 levels before therapy. Correlations between parameters including age, tumor diameter T and N, dynamic curve type, enhancement ratio (ER), slope washin (S-WI), time to peak (TTP), slope washout (S-WO), and the serum level of HE4 were investigated statistically. Human epididymis protein 4 levels of early and advanced stage of disease were also compared statistically. RESULTS: Breast MRI parameters showed correlation to serum HE4 levels and correlations were statistically significant. Of these MRI parameters, S-WI had higher correlation coefficient than the others. Human epididymis protein 4 levels were not statistically different in early and advanced stage of disease. CONCLUSIONS: High correlation with MRI parameters related to neoangiogenesis may indicate signaling pathway of HE4.

Is There a Relationship between Obstructive Sleep Apnea Syndrome Severity and Nesfatin-1?

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) and obesity frequently occur together. The relationship between increased appetite and obesity is well known; however, despite existing knowledge about the relationship between OSAS and obesity, it is not fully understood. OBJECTIVES: This study aimed to evaluate the relationship between OSAS and the appetite-suppressing hormone nesfatin-1 independent of body mass index (BMI). METHODS: A total of 134 cases were included in the study; 102 with OSAS (OSAS group) and 32 healthy controls (control group). All cases underwent polysomnography, and nesfatin-1 levels were determined. RESULTS: Nesfatin-1 levels were significantly lower in the OSAS group compared to the control group (3,776.5 ± 204.8 and 4,056.2 ± 101.5 pg/ml, respectively; p < 0.001). In addition, there was a statistically significant negative correlation between nesfatin-1 and the apnea hypopnea index (r = -0.543; p < 0.001). The statistically significant relationship persisted after adjusting for confounding intergroup factors such as age, gender and BMI (p < 0.001). In the OSAS group, there was a statistically significant correlation between nesfatin-1 and neck circumference (r = -0.304; p = 0.02) but not between nesfatin-1 and BMI and waist circumference. There was no statistically significant difference in nesfatin-1 levels between the sexes. CONCLUSION: OSAS patients have lower nesfatin-1 levels compared to controls, and a greater nesfatin-1 deficit corresponds to an increased severity of OSAS and an increased neck circumference. Replacement therapy may be a potential treatment for obese OSAS patients who have lower nesfatin-1 levels, which may have additional benefits through appetite suppression and weight loss.

Psychopathology and Related Psychosocial Factors in Children with Office Discipline Referrals at School: Evidence from a Developing Country.

Many childhood psychiatric disorders present their first symptoms as challenging behaviors at school. Evidence from cross-national studies enhance the understanding of the biological and cultural variables underlying these behaviours. In this study, we aim to identify the psychopathology among children with office disciplinary referrals and assess psychosocial risk factors related to this situation. Forty-seven students who had received an office discipline referral and eighty-three controls who had never been given an office disciplinary referral participated in this study. The Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children--Present and Lifetime, socio-demographic data form were administered to children to assess their respective psychopathologies and psychosocial risk factors. Attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, and obsessive compulsive disorder were significantly higher in children with Office discipline referrals. Psychiatric assessment should be one of the first steps in the evaluation processes of assessing challenging behaviors at school.

Sensitization pattern of inhalant allergens in children with asthma who are living different altitudes in Turkey.

Variability in children's allergic sensitization has been detected not only among different countries but also among cities within the same nation but yet different climatic areas. The aim of this study was to investigate the sensitization pattern of asthmatic children who lived in different altitude areas: the two largest Turkish cities, Istanbul (sea level) and Erzurum (high altitude). Five hundred and twelve asthmatic children (6-15 years old) from Istanbul (western Turkey, at sea level) and 609 from Erzurum (eastern Turkey, at an altitude of 1800 m) were included in the study. All participants underwent skin testing with common inhalant allergens, spirometry, total IgE level, and clinical examination. The positive sensitization ratio to aeroallergens in children with asthma living at sea level was statistically higher than that in children living in the high altitude group [p = 0.001, OR (odds ratio) 4.9 (confidence interval (CI) 3.67-6.459)]. However, pollen sensitization in asthmatic children living in high altitudes was significantly higher than that in children living at sea level [p = 0.00, OR 2.6 (CI 1.79-3.87)]. Children with asthma who live at high altitudes are characterized by higher pollen but lower mite sensitization rates than those living at sea level in Turkey. Different climatic conditions and altitudes may affect aeroallergen sensitization in children with asthma.

Peer teaching experience of the first year medical students from Turkey.

OBJECTIVE: To document peer teaching activity performed by first-year medical students and their views on the teaching activity. STUDY DESIGN: Survey. PLACE AND DURATION OF STUDY: Medical Education Department, Ataturk University, Erzurum, Turkey, in the 2012 - 2013 academic year. METHODOLOGY: Volunteer students were selected for peer teaching model by an academician from the Medical Education Department. Students were taught subjects selected from classes such as biochemistry and microbiology in the same way as the academicians do. Following each class activity, the teaching student was assessed by the other students on a 5-point rating scale. Written and verbal feedback was also obtained from both teaching students and participated students. Verbal feedbacks were noted by a faculty member and similar opinions were categorized. Data were analyzed by SPSS version 20 statistical program. RESULTS: Eleven students took part in the program. Feedback was received from students 171 times. The mean number of students participated was 24.4 ± 14.3 in each program. Statistical analysis revealed that mean value for teaching materials, peer instructors and teaching environment were 4.62 ± 0.49, 4.63 ± 0.47 and 3.88 ± 1. 27 respectively. CONCLUSION: Peer teaching method is a pretty good way of teaching for medical students. It is a practicable technique that can be used in medical training. Taking part in this program as a lecturer, student increased students' self-confidence in the learning and teaching activities. Quite positive feedbacks were received.

Self-assessment through videotaping compared with peer and trainer feedback.

OBJECTIVE: To assess and compare three different types of feedback for presentation skills, self, peer and trainer feedback. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Faculty of Medicine at Atatürk University, Erzurum, Turkey, from March 2012 to December 2012. METHODOLOGY: Participants were faculty members and instructor nurses. Each participant gave a 10-minute presentation, which was rated by peers, course trainers and the presenter himself/herself using a thirteen-item questionnaire (designed as a 5-point Likert scale). Peers and trainers conducted the assessment during the presentation while the self-assessment was done later by watching a video recording of the presentation. Comparison of the points between the groups was made using the two-way ANOVA. Pearson correlation analysis was conducted to evaluate the relationship between the mean scores of self-assessment, peer and trainer assessment. RESULTS: Ten faculty members, 27 instructor nurses and 4 trainers participated in the study. A total of 775 feedback reports were collected for 37 participants. There was no significant difference between the feedback scores of the evaluators as well as the occupation groups (p > 0.05). There was a strong positive and statistically significant correlation between trainer and peer (r = 0.73, p < 0.001). CONCLUSION: Consequently, there were no differences in the evaluations of presentation skills between different stakeholders. Trainers should use the video recording method to self-evaluate their presentation skills, and they should invite their peers from time to time to improve their own personal development by using peer review methods.

Frequency of Class I and II HLA alleles in patients with lung cancer according to chemotherapy response and 5-year survival.

INTRODUCTION: Lung cancer is the most common cause of cancer death in the world, and the most common type is non-small-cell lung cancer (NSCLC). At present, surgical resection, chemotherapy, and radiation therapy are the main treatments for patients with NSCLC, but unfortunately outcome remains unsatisfactory. OBJECTIVES: This study aimed to determine whether Class I and II histocompatibility leukocyte antigen (HLA) alleles are related with response to chemotherapy and survival of lung cancer. METHODS: A total of 65 NSCLC patients (56 men and 9 women, mean age 58.4 ± 11 years) were included in the study. Patient groups were compared with a control group of 88 unrelated healthy kidney or bone marrow donors in order to clearly identify susceptible and protective HLA alleles in lung cancer. Target lesions and tumor response were assessed using the Response Evaluation Criteria for Solid Tumors (RECIST) guidelines. Results were classified into two groups: complete-partial response and stable-progressive disease. RESULTS: We found that expression of HLA-A32, HLA-B41, HLA-B57, HLA-DRB1*13, and HLA-DQ5 were more frequent in the complete and partial response groups to chemotherapy than in the control group. The frequency of HLA-A11, HLA-A29, HLA-BW6, HLA-CW3, HLA-DR1*1, and HLA-DRB1*3 were determined to be higher in the stable and progressive disease groups taking chemotherapy than in the control group. Additionally, expressions of HLA-A2 and HLA-B49 were statistically related with 5-year survival. CONCLUSION: Our results suggested that expressions of HLA-BW6 and HLA-DRB1*13 alleles may be predictable markers for response to chemotherapy in lung cancer patients.

The depression in women in pregnancy and postpartum period: A follow-up study.

AIM: This was a follow-up study to determine postpartum depression (PPD) and its causes in a population previously evaluated in the first trimester of pregnancy. METHODS: The study sample consisted of pregnant women who were evaluated in the first trimester and 360 women who were re-evaluated in the postpartum period. Detailed sociodemographic data were obtained from the women, and depression was assessed with the Edinburgh Postpartum Depression scale (EPDS) and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis I Disorders (SCID-I). RESULTS: In this follow-up study, the prevalence of PPD was 35% (n = 126). A depressive disorder in the first trimester of pregnancy, previous mental disorder, somatic disorder, exposure to domestic violence during pregnancy, baby's staying in the incubator and not breastfeeding were predictors of PPD. Exposure to violence and a history of previous depression predicted depression both in pregnancy and in the postpartum period. CONCLUSION: Depression rates are high in Eastern Turkey. Exposure to violence during pregnancy and the existence of a previous mental disorder were risk factors for perinatal depression in this study. Performing screening tests can identify women at risk of pregnancy-related depression. Prevention programs should be established in areas where the prevalence of depression is high.

The correlation of ECHO findings of right cardiac pathologies with BNP, uric acid, and CRP in OSAS.

BACKGROUND/AIM: Right cardiac pathologies develop in patients with obstructive sleep apnea syndrome (OSAS) and in most patients there are no symptoms in the early stages of right cardiac disorders. We aimed to evaluate a possible relationship between B-type natriuretic peptide (BNP), blood uric acid, C-reactive protein (CRP), and the right cardiac pathologies in patients with OSAS, and the role of these parameters in the management of patients with OSAS. MATERIALS AND METHODS: A total of 98 subjects, 31 (31.6%) controls and 67 (68.4%) with OSAS, were included in the study. All the subjects underwent polysomnography, and standard and tissue Doppler echocardiography (ECHO) examinations. BNP, CRP, and blood uric acid levels were measured in all patients. RESULTS: Upon evaluating the relationship between BNP and ECHO parameters, BNP levels were found to positively correlate with such ECHO parameters as pulmonary artery pressure. As for the association between CRP and ECHO findings, RV diameter exhibited a statistically significant positive correlation with them. Moreover, uric acid was found to statistically correlate positively with right atrium dimensions. CONCLUSION: BNP, CRP, and blood uric acid levels can be used as adjunctive parameters in the early diagnosis and follow-up of right heart pathologies in patients with OSAS.

What do trainers think about trainer training courses?

OBJECTIVE: To evaluate the effectiveness of the training-of-trainer courses given to medical school faculty members, and to ensure the standardisation of training.. METHODS: The study comprised faculty members attending seven training-of-trainer courses held at the Ataturk University, Turkey, from November 2010 to May 2011. Tests were administered to the participants evaluating their level of knowledge on course content before and after the five-day course, which covered topics including concepts of teaching/learning, curriculum development, assessment and evaluation, training methods, and training skills. Oral and written feedbacks were obtained from all participants on the last day of each course. Volunteers from among the participants evaluated the impact of training through a questionnaire after at least two months. SPSS 20 was used for statistical analysis. RESULTS: A total of 136 faculty members participated in the 7 training-of-trainer courses. The mean scores for the pretest and post-test were 6.6 +/- 2.2 vs. 13.9 +/- 3.7, (p < 0.001). Questions with highest percentage of correct answers in the pre-test were those about learning style 78 (70.9%) and the one about presentation skills (66.4%). CONCLUSION: A structured training-of-trainer course is effective in increasing faculty members' level of knowledge about training. Such programmes are necessary for faculty members who work in the academic field without receiving formal training in teaching as it is the case with medical education in several countries.

Evidence based medicine: teaching, learning and practice: results of a cross-sectional study from Turkey.

OBJECTIVE: To assess the level of understanding related to the significance of evidence-based medicine among physicians. METHODS: The cross-sectional study was conducted between March and October 2012 using an online questionnaire that was sent out to physicians and academics working as faculty at training hospitals across Turkey. The questionnaire consisted of questions about the knowledge, attitude and behaviour towards evidence-based medicine. Seven of the questions pertained to the learning of evidence-based medicine, six were about teaching evidence-based medicine, and six were about its practice. SPSS 20 was used for statistical analyses. RESULTS: The questionnaire was returned duly filled by 79 physicians. Of them, 41 (51.9%) were males; and 57 (72.2%) were part of the faculty. Only 1(1.2%) participant had attended a course about evidence-based medicine during undergraduate education, while 19 (24.05)had attended one after graduation. Besides, 26 (32.9%) academics were teaching some concepts of evidence-based medicine, and 21 (26.6%) were giving some information about clinical guidelines. CONCLUSION: The study found that levels of learning and teaching of evidence-based medicine among physicians were inadequate. They should be emphasised at both pre- and post-graduate tiers.

Value of MRI sequences for prediction of invasive breast carcinoma size.

INTRODUCTION: In this retrospective study, we compared transverse short tau inversion recovery (STIR), transverse diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) map and first post-contrast fat-saturated fast low-angle shot (FLASH) 3D T1 with pathology results in terms of their accuracy in estimating breast carcinoma size. METHODS: Magnetic resonance imaging data for 47 patients with invasive breast carcinoma, who were treated surgically, were reviewed. The longest dimension (LD) of the index lesion was measured using STIR, DWI, ADC map and first post-contrast FLASH 3D T1, and this was compared with the LD measured on the pathology specimen. RESULTS: All four MRI sequences overestimated the LD by an average of about 1 mm with 95% limits of agreement approximately 0 to 2 mm. This is not considered to be clinically significant in tumours of 10 mm or larger. CONCLUSION: Magnetic resonance imaging serves as an accurate tool in sizing breast carcinomas. ADC may be a useful evaluation tool for sizing carcinomas without requiring contrast material.

The association of human leukocyte antigen polymorphisms with disease severity and latency period in patients with silicosis.

BACKGROUND: Denim sandblasting may cause silicosis as a result of free crystalline silica inhalation. Its pathogenesis remains unclear, but autoimmunity may play a role in the development of silicosis. The present study aimed to investigate the relationships between human leukocyte antigen (HLA) and the severity and latency period of silicosis. METHODS: 48 silicotic patients in the Eastern part of Turkey were classified according to their latency period and disease severity. The distribution of HLAs according to disease severity and latency period was assessed. RESULTS: A23 (7.5%), B49 (7.5%), and B51 (25%) were more common in the mild group than in the severe group, and B55 (8.9%) and DR4 (17.9%) were more common in the severe group than in the mild one. Only B51 was significantly more common in the mild group than in the severe one (25%, n = 10 vs. 7.1%, n = 4; p = 0.016). CONCLUSIONS: This study suggests that HLA antigens may play a particular role in the severity of silica-induced lung disease, but there was no association between HLA and progression time of the disease.

The effects of serum cholesterol, LDL, and HDL levels on gallstone cholesterol concentration.

OBJECTIVE: Gallbladder stones are common in the Western world, and 70% to 80% of gallstones are cholesterol stones. This study investigates the effects of serum cholesterol, LDL, and HDL levels on gallstone cholesterol concentration. METHODOLOGY: The gallstones of 75 patients with cholelithiasis were examined using spectrophotometry. RESULTS: High serum cholesterol and LDL levels were associated with high cholesterol stone rates (86.7% vs. 40.0%, P < 0.001; 75.0% vs. 48.9%, P < 0.05, respectively). Similarly, high serum cholesterol and LDL levels were correlated with high gallbladder stone cholesterol concentrations (63.6% vs. 44.4%, P < 0.001; 62.3% vs. 46.0%, P < 0.001, respectively). In contrast, low serum HDL levels do not seem to affect the occurrence of gallbladder cholesterol stones (60.0% vs. 58.3%, respectively, P > 0.05) or gallbladder stone cholesterol concentrations (50.8% vs. 52.4%, respectively, P > 0.05). CONCLUSION: The relationship between cholesterol, LDL, and HDL levels and cholesterol gallstone formation is multifactorial and complex and is also dependent on other individual properties.

The incidence and severity of pulmonary hypertension in obstructive sleep apnea with hypothyroidism.

BACKGROUND: Hypothyroidism and obstructive sleep apnea (OSA) are both common health problems and can be seen together. Each of these 2 diseases can cause pulmonary hypertension (PH). We aimed to determine whether hypothyroidism with OSA has a significant effect on the frequency and severity of PH. MATERIAL AND METHODS: A total of 236 patients were included in the study. Patients were divided into 3 groups: Group I, Obstructive Sleep Apnea (n=149); Group II, Hypothyroidism (n=56); and Group III, Obstructive Sleep Apnea-Hypothyroidism (n=31). All patients underwent polysomnography and echocardiography and serum levels of thyroid-stimulating hormone (TSH) and free thyroxine 4 (FT4) were analyzed. RESULTS: There were 167 male and 69 female participants, and the mean age was 47.8 ± 11.5 (Group I: 81.9% male, 18.1% female; Group II: 44.6% male, 55.4% female; Group III: 64.6% male, 35.4% female). Distribution of mean pulmonary arterial pressure on echocardiography was statistically different among the 3 groups (x(2)=14.99, p=0.006). When adjusted according to the apnea-hypopnea index (AHI), age, and body mass index (BMI), a significant relation with PH was determined (p=0.002). CONCLUSIONS: The combination of hypothyroidism with OSA is associated with an increased frequency and severity of PH. When PH is found out of line with the severity of OSA, thyroid dysfunction should be investigated.

Perceived self-efficacy and academic performance of medical students at Ataturk University, Turkey.

OBJECTIVE: To determine the association of perceived self-efficacy with academic performance of pre-clinical medical students. STUDY DESIGN: A cross-sectional analytical study. PLACE AND DURATION OF STUDY: Medical Education Department, Ataturk University, Turkey, from March to May 2012. METHODOLOGY: Participating students were members of the first to third year medical students class considered to be preclinical years at Ataturk University. A validated and reliable questionnaire consisted of 10 questions applied to assess the general self-efficacy of the medical students in pre-clinical years and evaluate whether their self-efficacy has relation to their academic performance. Responses and studied variables were compared using ANOVA and Pearson correlation test as applicable. RESULTS: The mean scores of three consecutive examinations were compared with self-efficacy mean scores of three classes. A validated and reliable questionnaire was used for assessment of self-efficacy. There was no correlation found in between mean examination scores and self-efficacy mean scores in first year (r = -0.11, p = 0.276), second year (r = 0.20, p = 0.180), and third year (r = -0.040, p = 0.749). However, comparison of mean scores between male and female demonstrated significant difference (p = 0.001) and males dominant in self-efficacy scores. CONCLUSION: The results illustrate in pre-clinical years at medical schools the general self-efficacy does not play any role in their performance.

Temperament and character traits in patients with epilepsy: epileptic personality.

Personality and behavioral changes in epilepsy are well documented. However, neither the quantitative characteristics nor the etiology of these changes is clear yet. Cloninger has developed a psychobiological personality model that provides a way to evaluate personality in a dimensional way. This study examined the relationship between epilepsy and Cloninger's dimensional psychobiological personality model. A total of 73 epilepsy outpatients and 79 healthy controls were examined using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I Disorders, the Turkish version of the Temperament and Character Inventory, and an epilepsy questionnaire. Epilepsy patients had higher harm avoidance (HA) and lower persistence, self-directedness (SD), and cooperativeness scores than healthy controls did. In epileptic subjects, there was no correlation between age and duration of epilepsy. Subjects with partial seizures had higher HA scores and lower SD scores than generalized ones. Comorbid depression was represented with lower SD scores. In multiple linear regression models, only major depressive disorder predicted lower scores of SD. This study confirms specific personality changes among epileptics according to Cloninger's dimensional personality model and indicates a relationship between the characteristics of epilepsy and psychiatric comorbidity.

Prevalence of Blood Brotherhood among High School Students in Erzurum and the Effect of Peer-led Education on this Practice.

OBJECTIVE: This study aimed to assess the prevalence of blood brotherhood (BB) in Erzurum, Turkey and to observe the effect of education interventions on this risky cultural behavior. MATERIALS AND METHODS: This study was designed as a cross-sectional intervention, based on minor interventions through a peer-led awareness campaign regarding the transfer of blood-borne diseases through BB rites. This study was conducted from February through May 2007 at 29 high schools in Erzurum. RESULTS: The study population was 53.8% (n=1,522) males and 46.2% (n=1,307) females. The proportion of the students who have participated in BB rituals was 24.1% (n=558). There was a statistically significant link between BB and a history of having Hepatitis B Virus (HBV) infection, family history of HBV and male gender (p<0.05). After the structured peer-led education the intention to participate in BB rituals decreased from 30.0% to 20.6% (p<0.001). CONCLUSION: The prevention of BB rituals, which can result in the transfer of blood-borne diseases, requires urgent public awareness campaigns led by healthcare professionals.