Centralization of mammography reporting with mobile trucks: Turkish experience.

Screening via mammography is a complex process to be implemented. OBJECTIVE: To report the initial results and the effectiveness of newly implemented Turkey's population based breast cancer screening program performed for 40-69 years old women; and effectiveness of the newly implemented out-sourcing mobile trucks and national central report center. The study is conducted prospectively in one year (March 2016-March 2017) in all 81 provinces of Turkey. Mammography images were transferred via on-line web based system to the central reporting center. BI-RADS Scores and KETEM models (Mobile vs. Stationary) were the parameters were compared. In total mammography images of 414.802 patients were transferred from 155 KETEMs to the central reporting center. From these patients; 95.872 (23,1%) were aged between 40 and 44. Among all images, 21.999 (5,3%) were BI-RADS 0-4-5, 391.123 (94,3%) were BI-RADS 1-2. Totally recall rate of the national reporting center was 5.3%. Number of patients screened per day were significantly higher in out-sourcing mobile trucks compared to stationary KETEMs (31.8 vs. 8.9; p < 0.05). This is the first and the largest breast cancer screening study which results of a population based mammography screening for 40-69 years old women are evaluated at the same time with the evaluation of the efficacy of newly implemented centralized reporting center and the mobile screening trucks in comparison with stationary cancer screening centers. According to the initial results; Turkey's newly implemented population based breast cancer screening system seems to be feasible and effective.

Initial results of population based cervical cancer screening program using HPV testing in one million Turkish women.

To evaluate the Turkey's nationwide HPV DNA screening program on the basis of first 1 million screened women. Women over age 30 were invited for population based screening via HPV DNA and conventional cytology. Samples were collected by family physicians and the evaluations and reports had been performed in the National Central HPV laboratories. The acceptance rate for HPV based cervical cancer screening after first invitation was nearly 36.5%. Since HPV DNA tests have been implemented, cervical cancer screening rates have shown 4-5-fold increase in primary level. Through the evaluation of all, HPV positivity was seen in 3.5%. The commonest HPV genotypes were 16, followed by 51, 31, 52 and 18. Among the 37.515 HPV positive cases, cytological abnormality rate was 19.1%. Among HPV positive cases, 16.962 cases had HPV 16 or 18 or other oncogenic HPV types with abnormal cytology (>ASC-US). These patients were referred to colposcopy. The colposcopy referral rate was 1.6%. Among these, final clinico-pathological data of 3.499 patients were normal in 1.985 patients, CIN1 in 708, CIN2 in 285, CIN3 in 436 and cancer in 85 patients and only pap-smear program could miss 45.9% of ≥CIN3 cases. The results of 1 million women including the evaluation of 13 HPV genotypes with respect to prevalence, geographic distribution and abnormal cytology results shows that HPV DNA can be used in primary level settings to have a high coverage rated screening program and is very effective compared to conventional pap-smear.

Survival of gynecological cancers in Turkey: where are we at?

OBJECTIVE: To investigate the 5-year relative survival rates in gynecological cancers diagnosed and treated in Turkey by year 2009 and to compare the results with developed countries. METHODS: Data of patients diagnosed for ovarian, corpus uteri or cervix uteri cancer at year 2009 are collected from 9 national cancer registry centers. Date of deaths are retracted from governmental Identity Information Sharing System (KPS). In order to calculate relative survival rates, national general population mortality tables are obtained from Turkish Statistical Institute (TurkStat). Hakulinen method is used for computing curves by R program. Data for European, Asian and some developed countries were obtained from official web pages. RESULTS: A total of 1,553 patients are evaluated. Among these, 713 (45.9%) are corpus uteri cancers, while remaining 489 (31.5%) are ovarian and 351 (22.6%) are cervix uteri. Five-year overall relative survival rates are 85%, 50%, and 62% for corpus uteri, ovarian, and cervix uteri, respectively. These figures are between 73%-87% for corpus uteri, 31%-62% for ovarian and 61%-80% for cervix uteri in developed countries. Stage is the most important factor for survival in all cancers. Five-year relative survival rates in corpus uteri cancers are 92%, 66%, and 38% for localized, regional, and distant metastatic disease, respectively. These figures are 77%, 57%, and 29% for ovarian; 80%, 50%, and 22% for cervix uteri. CONCLUSION: This is the first report from Turkey giving national overall relative survival for gynecological cancers from a population based cancer registry system.

Trends of Gynecological Cancers in Turkey: Toward Europe or Asia?

OBJECTIVE: The aim of this study was to evaluate nationwide gynecological cancer trends in Turkey. METHODS: National cancer registry data (2009-2013) of Turkish Ministry of Health were evaluated. Ovarian, cervical, endometrial, vulvar, vaginal, and tubal cancers are evaluated with respect to age of diagnosis, incidence rates within years, stage, histological distributions, and mortality rates. Data were collected from active cancer registry centers, which increased from 23% in 2009 to 47.5% coverage of the whole population by 2012, and mortality data (2010-2015) were obtained from the Turkish Statistical Institute. RESULTS: A total of 16,023 gynecological cancers were evaluated among 116,940 female patients with cancer (13.7%). Average incidence for gynecological cancers was 22.7 of 100,000, representing 8437 total new cases annually. Incidence changes within time were not statistically significant, when evaluated for each tumor type. Estimated risk of gynecological cancer development before the age of 80 years was 3.08% (95% confidence interval, 3.07-3.09). The most common gynecological cancers were uterine corpus cancers, which were followed by ovarian and cervical carcinomas. Ovarian and uterine cancer incidences were closer to European levels rather than Asian countries, whereas cervical cancer incidence was extremely low. Gynecological cancers constituted an important fraction of cancer-related mortality in women by comprising approximately 10.35% of cancer-related deaths. Mortality rates due to gynecological cancers did not show a statistically significant increase within years. CONCLUSIONS: This is the first national cancer registry report to be published for gynecological cancers by the Turkish Governmental Department. As a result, Turkish gynecological cancer epidemiological data were consistent with the data obtained from European and developed countries rather than Asian countries, except for cervical cancer incidence, which is extremely low.

Trends of Gynecological Cancers in Turkey: Toward Europe or Asia?

OBJECTIVE: The aim of this study was to evaluate nationwide gynecological cancer trends in Turkey. METHODS: National cancer registry data (2009-2013) of Turkish Ministry of Health were evaluated. Ovarian, cervical, endometrial, vulvar, vaginal, and tubal cancers are evaluated with respect to age of diagnosis, incidence rates within years, stage, histological distributions, and mortality rates. Data were collected from active cancer registry centers, which increased from 23% in 2009 to 47.5% coverage of the whole population by 2012, and mortality data (2010-2015) were obtained from the Turkish Statistical Institute. RESULTS: A total of 16,023 gynecological cancers were evaluated among 116,940 female patients with cancer (13.7%). Average incidence for gynecological cancers was 22.7 of 100,000, representing 8437 total new cases annually. Incidence changes within time were not statistically significant, when evaluated for each tumor type. Estimated risk of gynecological cancer development before the age of 80 years was 3.08% (95% confidence interval, 3.07-3.09). The most common gynecological cancers were uterine corpus cancers, which were followed by ovarian and cervical carcinomas. Ovarian and uterine cancer incidences were closer to European levels rather than Asian countries, whereas cervical cancer incidence was extremely low. Gynecological cancers constituted an important fraction of cancer-related mortality in women by comprising approximately 10.35% of cancer-related deaths. Mortality rates due to gynecological cancers did not show a statistically significant increase within years. CONCLUSIONS: This is the first national cancer registry report to be published for gynecological cancers by the Turkish Governmental Department. As a result, Turkish gynecological cancer epidemiological data were consistent with the data obtained from European and developed countries rather than Asian countries, except for cervical cancer incidence, which is extremely low.

Trends of Gynecological Cancers in Turkey: Toward Europe or Asia?

OBJECTIVE: The aim of this study was to evaluate nationwide gynecological cancer trends in Turkey. METHODS: National cancer registry data (2009-2013) of Turkish Ministry of Health were evaluated. Ovarian, cervical, endometrial, vulvar, vaginal, and tubal cancers are evaluated with respect to age of diagnosis, incidence rates within years, stage, histological distributions, and mortality rates. Data were collected from active cancer registry centers, which increased from 23% in 2009 to 47.5% coverage of the whole population by 2012, and mortality data (2010-2015) were obtained from the Turkish Statistical Institute. RESULTS: A total of 16,023 gynecological cancers were evaluated among 116,940 female patients with cancer (13.7%). Average incidence for gynecological cancers was 22.7 of 100,000, representing 8437 total new cases annually. Incidence changes within time were not statistically significant, when evaluated for each tumor type. Estimated risk of gynecological cancer development before the age of 80 years was 3.08% (95% confidence interval, 3.07-3.09). The most common gynecological cancers were uterine corpus cancers, which were followed by ovarian and cervical carcinomas. Ovarian and uterine cancer incidences were closer to European levels rather than Asian countries, whereas cervical cancer incidence was extremely low. Gynecological cancers constituted an important fraction of cancer-related mortality in women by comprising approximately 10.35% of cancer-related deaths. Mortality rates due to gynecological cancers did not show a statistically significant increase within years. CONCLUSIONS: This is the first national cancer registry report to be published for gynecological cancers by the Turkish Governmental Department. As a result, Turkish gynecological cancer epidemiological data were consistent with the data obtained from European and developed countries rather than Asian countries, except for cervical cancer incidence, which is extremely low.

The effects of ankaferd blood stopper on the recovery process in an experimental oesophageal perforation model.

BACKGROUND: Oesophageal perforation is a life-threatening pathology that is generally treated conservatively; however, surgical procedures are frequently performed. A topical haemostatic agent, Ankaferd Blood Stopper (ABS), also has beneficial wound-healing effects. AIMS: This study aimed to determine the effects of ABS following experimental oesophageal perforations. STUDY DESIGN: Animal experiment. METHODS: The experimental rats were classified into 6 groups (with 7 rats in each group). Pairs of groups (primary repair alone and primary repair + ABS) were terminated in the 1(st), 2(nd), and 3(rd) weeks following injury. The oesophageal perforations, which were 8-10 mm in length, were created using a nasogastric tube. The perforation sites were repaired with a 6-0 polyglactine thread in the primary repair groups. Additionally, ABS was sprayed over the perforation site in the treatment groups. Each oesophagus was evaluated histopathologically. RESULTS: There were fewer microabscesses and areas of necrosis in the ABS groups compared with the primary repair groups. The histopathological evaluation revealed that the ABS groups had less inflammation and more re-epithelisation compared to the primary repair groups (p=0.002 and p=0.003, respectively). Fibrosis in the ABS groups was moderate in the 2(nd) week and mild in the 3(rd) week. Comparing the groups with respect to the time intervals, only the 1(st) week groups showed a significant difference in terms of re-epithelialisation (p=0.044). CONCLUSION: Topical ABS application on the repaired experimental oesophageal perforation regions led to positive wound-healing effects compared with the rats that were administered the primary repair alone.

Gender differences in trauma mechanisms, and outcomes in a rural hospital which is not designed as trauma centre.

OBJECTIVES: This study aimed to investigate how trauma characteristics and outcomes differ between genders in a rural hospital. METHODS: Records of trauma patients admitted to a state emergency department (ED) in eastern Turkey, between January 2006 and December 2007 were reviewed and data were analysed based on gender. RESULTS: In total, 5379 (87.0%) men and 806 (13.0%) women, totalling 6185 patients, were assessed. Mean age was 26.5 (1 month - 80 years) years for men and 24.7 (2 month - 81 years) years for women. Men comprised 90.2%, 81.3% and 77.3% of the patients injured by assault, motor vehicle incidents and falls, respectively. Women comprised a significantly larger share of suicide attempts (70.8%) than men. Of the men injured, 90.6% were discharged after treatment in the ED. The per cent of hospitalised women (5.8%) was increased compared with the per cent of hospitalised men (p=0.011). There was a higher frequency of transfer among women (8.6%) when compared with men (p<0.001). Women had a mortality frequency of 1.2%, which was similar to the mortality per cent calculated for men. CONCLUSIONS: Men were at an increased risk for trauma, especially assault. The percentage of women injured and admitted to the ED due to assault was low compared with statistics reported in the literature. However, assault is the most common cause of trauma among women. The high per cent of hospitalisation and transfer among women may indicate that women are exposed to more severe trauma, and therefore experience increased morbidity compared with men.

Effect of Ankaferd Blood Stopper on air leakage in the lung and prevention of bleeding: an experimental study.

BACKGROUND: Air leakage and hemorrhage are important causes of morbidity and mortality in operations and traumas of the lung. Ankaferd Blood Stopper is a herbal product used for stopping hemorrhage. In our study, we investigated the efficacy of Ankaferd Blood Stopper in the prevention of air leakage in the lung and bleeding. METHODS: A total of twenty-one Wistar-Albino rats weighing 240 ± 20 grams were used in our study. An equal amount of injury was created in all groups by performing left thoracotomies. No interventions were made on tissue injury in the first group, and suturing was performed in the second group, and Ankaferd was applied in the third group. Air leakage and duration of bleeding were recorded in all groups. RESULTS: A statistically significant difference was found between the three groups in terms of air leakage time (p = 0,0001) and bleeding time (p = 0,0001). While a significant effect of Ankaferd was detected in terms of air leakage compared to standard surgery (p = 0,017), no difference was found in terms of bleeding time. CONCLUSIONS: Ankaferd Blood Stopper ceases the air leakage in the lung parenchyma significantly and effectively. No significant difference is seen compared to the standard surgery group, although it ceases bleeding significantly.

Differences in opinions on disaster myths between first-year and sixth-year medical students.

OBJECTIVE: We aimed to determine the influence of a medical school program on altering the opinion of medical students on disaster myths. METHODS: This cross-sectional survey study was conducted in October 2005 in Hacettepe University Faculty of Medicine, Turkey, with the participation of 191 (83.0%) first-year and 232 (80.8%) sixth-year medical students. The opinions of the students with regard to 22 disaster myths and the influence of the medical school program on these opinions were evaluated. Chi-square test was used in the statistical analysis. RESULTS: One hundred and fifty-nine first-year (83.2%) and 178 (76.7%) sixth-year students had knowledge about disasters (chi2=2.75, P=0.972). Television was cited as the leading source of knowledge among both first-year (63.9%, 122) and sixth-year (62.1%, 144) students. The medical school was the last resource for knowledge as reported by first-year students (0.5%, one student), and ranked fourth as a knowledge resource according to sixth-year students (47.0%, 109 students). Statistically significant differences were determined in opinions between the two groups of students, with sixth-year students having a higher rate of correct answers in only seven myths. In 17 myths, the number of correct responses for both groups was below 60%. CONCLUSION: If the myths and realities in disaster situations are valid, we demonstrated that the medical education curriculum at one of the leading medical faculties in Turkey failed to correct the misconceptions of the medical students. As the opinions of students regarding disaster myths may reflect those of their trainers, similar surveys conducted among the faculty would be informative.