Lessons to be Learned: The Knowledge, Attitudes, and Practices of Turkish People towards the COVID-19 Pandemic.

Background: The world experienced the greatest pandemic of the 21st century with the emergence of a new and readily transmissible the coronavirus disease. Understanding knowledge, attitudes, and practices (KAP) of the public towards the pandemic is an essential part of developing effective preventive strategies. Aim: The objective of this study was to investigate the knowledge, attitudes, and practices (KAP) concerning the coronavirus (COVID-19) among population in Istanbul. Methods: This is a cross-sectional and multi-stage, stratified random sampling based on multi-center population of Istanbul. A total of 5,414 persons were contacted and 4361 participants (80.5%) gave consent. The data were analyzed using descriptive and multiple regression analyses. Results: There were significant differences between low education and high educational level with respect to age groups, gender, occupation, income, residence, number of rooms and family members (P < 0.001). Responses concerning knowledge of COVID-19 indicated that subjects with high education level were significantly higher regarding knowledge of the signs and symptoms of COVID-19 and methods of detecting COVID-19 respectively. Majority of the participants consider COVID-19 risk is higher than AIDS or Cancer (75.8% of low education vs. 67.2% of high education level (P < 0.001). Multivariate stepwise regression analysis revealed that monthly income status (P < 0.001), appropriate method of detecting COVID-19 (P < 0.001), occupational status (P < 0.001), medical mask prevent against COVID-19 (P < 0.001), eating or contacting wild animals (P < 0.001), isolation and treatment of people reduce risk (P < 0.001), isolation 14 days (P < 0.001), avoid going to crowded places such as train-metro, bus, restaurants and shopping (P = 0.003), COVID-19 spreads via-respiratory droplets (P = 0.004), afraid of travel (P = 0.026) were significantly associated with COVID-19 knowledge. Conclusions: The current study results revealed that the educational level and occupation especially sedentary are correlated positively with knowledge, attitude and practices. This finding is not surprising since higher education levels and professional status are associated with good KAP in most epidemic diseases including COVID-19. Nevertheless, the recent experience with COVID-19 has provided lessons on strategy and policy making.

Correlation of REG1A, Claudin 7 and Ki67 expressions with tumor recurrence and prognostic factors in superficial urothelial urinary bladder carcinomas.

Aim: Superficial urothelial urinary bladder tumors are neoplasms that frequently recur and have a potential for invasion and metastasis. REG gene family is composed of various acute phase reactants, lectins, antiapoptotic factors, and growth factors that are effective on pancreatic island cells, neural cells, and epithelial cells. REG1A and REG1B are two forms of the human REG1 gene. It is reported that they are expressed in several cancers and are correlated with the prognosis of the patient. Claudins are integral transmembrane proteins that interconnect cells. However, their role in human tumorigenesis is extremely controversial. The aim of this study is to evaluate the relationship of REG1A, claudin 7 protein expressions, and Ki67 proliferation index in superficial urothelial urinary bladder tumors with well-known parameters of prognosis and tumor recurrence, and also to clarify whether these parameters are independent prognostic factors or not. Materials and Methods: A hundred and eleven patients diagnosed with superficial urothelial carcinoma between 2011 and 2016 years in our hospital and followed up in our urology clinic were included in this study. The slides prepared from paraffin blocks were immunohistochemically stained with REG1A, claudin 7, and Ki67 antibodies. Results: REG1A showed positive staining in 37 (33%) and negative staining in 74 (67%) of urothelial tumors. Claudin 7 was positive in 24 (22%) and negative in 87 (78%) cases. REG1A expression showed a positive correlation with tumor stage and tumor recurrence; a high Ki67 proliferation index was positively correlated with tumor stage and grade. The loss of claudin 7 expression was related to tumor recurrence. Besides, tumors with REG1A expression and claudin 7 loss had a shorter survival independent of recurrence. Conclusion: In urothelial tumors, REG1A expression and loss of claudin 7 might be significant markers of prognosis that predict tumor recurrence.

Extramedullary myeloma in ectopic parathyroid adenoma: A case report.

Extramedullary myeloma, a subgroup of multiple myeloma, is a rare condition characterised by extra-skeletal infiltration of clonal plasma cells. Although parathyroid adenoma's co-morbidity with multiple myeloma is common, extramedullary myeloma, an ectopic parathyroid adenoma has not been reported in the literature. This is the first study in literature that presents extramedullary myeloma that infiltrated ectopic parathyroid adenoma in the mediastinum after multiple myeloma treatment. In its course of relapse, the extramedullary myeloma created mass effect and no laboratory findings were present due to its non-secretory nature.

Prevalence of Helicobacter pylori Infection among Type 2 Diabetes Mellitus.

BACKGROUND: Several conducted studies have reported a higher and more frequent Helicobacter pylori infection rate in type 2 diabetes mellitus (T2DM). The aim of this study was to investigate the prevalence and its association between H. pylori infection and T2DM. MATERIALS AND METHODS: A case and control study was conducted based on 529 T2DM patients and 529 control. H. pylori was assessed by Serum anti-H. pylori immunoglobulin G (IgG) and IgA. Furthermore, patients were investigated for fasting blood glucose (FBG) levels, glycosylated hemoglobin (HbA1c), serum cholesterol, and other biochemistry parameters. RESULTS: The findings showed a positive significantly higher antibody titer for H. pylori infection (IgA > 250) in diabetic patients (50.7%) compared to controls (38.2%) (P < 0.001). Similarly, H. pylori infection for IgG > 300 titer was higher in T2DM patients (73.5%) compared to controls 61.8%) (P < 0.001). Further, the mean values were statistically significant diabetes with H. pylori infection for IgG > 300 titer and IgA > 250 titer, regarding Vitamin D, HbA1C (P < 0.001), FBG, calcium, creatinine, total cholesterol, LHDL, triglyceride levels, uric acid, bilirubin, thyroid-stimulating hormone (TSH), and systolic and diastolic blood pressure. The diabetic patients showed higher prevalence rate of symptoms than controls included: hypertension (14.3%), vomiting (15.5%), muscular symptoms (35.2%), bloating/distension (13.2%), abdominal pain (17%), nausea (9.6%), anemia (17%), kidneys (20.8%), chronic bronchitis (14.7%), gastrointestinal (23.8%), and diarrhea (20.4%). CONCLUSIONS: The current study revealed that H. pylori infections were significantly higher in diabetic patients compared to controls. Furthermore, T2DM patients infected with H. pylori positive reported a higher prevalence rate of symptoms than H. pylori negative.

Predictors risk factors for acute complex appendicitis pain in patients: Are there gender differences?

OBJECTIVE: The purpose of this study is to determine the predictive risk factors for appendicitis and the cost-effectiveness of using abdominal helical computed tomography (CT) in comparison to abdominal ultrasonography (US) for the diagnosis of acute appendicitis in patients. SUBJECTS AND METHODS: The typical case was a patient with abdominal pain in the right lower quadrant and suspicion of appendicitis. A total of 643 patients who were consequently treated with appendectomy upon diagnosis of acute appendicitis between January 2015 and December 2018 were included in the study. The four diagnostic alternatives chosen were US, CT, biochemistry parameters, and physical examination in the hospital. RESULTS: There were statistically significant differences between male and female patients with regards to age, BMI, cigarette smoking, sheesha smoking, family history of diabetes, hypertension and family history of gastrointestinal discomfort (GI), anxiety (P < 0.001), red eye (P = 0.006), dizziness (P = 0.021), headache (P < 0.001), muscular symptoms, weakness and cramps (P < 0.001), bloating or swollen stomach (P < 0.001), UTI (P < 0.001), chest pain (P < 0.001), guarding (P < 0.001), loss of appetite (P = 0.004), nausea (P < 0.001) vomiting (P = 0.042), anorexia (P = 0.009), and constipation (P = 0.002). Moreover, there were statistically significant differences between male and female patients for pain (P < 0.001), pain right belly (P = 0.027), severe crumps (P = 0.007), high temperature and fever (P < 0.001), irritable bowel syndrome (P < 0.001), right iliac fossa (RIF) pain (P = 0.008), rebound tenderness (P = 0.024), positive bowel sounds (P = 0.029), and pointing tenderness (P < 0.001). Multivariate stepwise logistic regression showed nausea (P < 0.001), C-reactive protein (CRP) (P < 0.001), dizziness (P = 0.016), vomiting (P < 0.001), muscular symptoms (P = 0.007), irritable bowel syndrome (P = 0.034), guarding (P = 0.040), and loss appetite (P = 0.046) were considered at higher risk as predictors for appendicitis patients. CONCLUSIONS: CT is more cost-effective than the US and clinical examination for determining appendicitis. The current study suggested that nausea, C-reactive protein, dizziness, vomiting, muscular symptoms, irritable bowel syndrome, guarding, and loss appetite were considered as higher risk predictors for appendicitis patients.

Assessment of the Gail Model in Estimating the Risk of Breast Cancer: Effect of Cancer Worry and Risk in Healthy Women.

Background: There has been substantial interest in developing methods to predict the risk of breast cancer. The Gail model is one the first model have been widely used to identify women at higher risk of breast cancer. Aim: This study aimed to determine the 5-year and the general life-time risk of breast cancer and also to determine breast cancer predictors in women using the Gail model. Methods: We used the Gail model to estimate the risk of breast cancer in female Turkish outpatients aged above 35 years in this cross-sectional study. Age, life-style habits, breast-feeding duration, family history of breast cancer, and body mass index were compared between high and low-risk subjects. We have performed the Patient Health Questionnaire 9-item (PHQ-9) and the Generalized Anxiety Disorder 7-item (GAD-7) tools on patients regarding depression and anxiety. We also assessed the association of these covariates with the estimated risk of breast cancer in multivariate linear regression analysis. Results: We enrolled 1065 subjects with a mean age of 52.9 ± 8.4 years. The mean of the five-year risk for breast cancer was 1.33%±0.6. Meanwhile, the mean of lifetime risks for breast cancer was 10.15%±3.18, respectively. Nearly one-third of the participants had one child, 55.9% had breast-fed their children more than six months. Meanwhile, 18.5% of the subjects had a high depression score, 15.2% had a high anxiety score. Higher age, age at first birth, and parity; lower age at menarche; presence of menopause and family history of breast cancer were higher in the high-risk group. Higher age, and age at first birth; lower age at menarche; family history of breast cancer, presence of menopause, and parity were independently associated with higher breast cancer risk. Conclusion: We identified certain risk factors for breast cancer in our study population and Gail model is a reliable and useful breast cancer risk prediction model for clinical decision-making. This study contributes to the body of evidence in order to facilitate early detection and better plan for possible malignancies in Turkish population.

Low Vitamin D Deficiency Associated With Thyroid Disease Among Type 2 Diabetic Mellitus Patients.

BACKGROUND: The aim of this study was to investigate the relationship between vitamin D deficiency and thyroid diseases among type 2 diabetes mellitus (T2DM) patients. METHODS: This was a cohort case and control study, 546 T2DM patients and 546 control study participants were enrolled, aged between 25 and 65 years. The subjects were also investigated for fasting blood glucose levels (FBG), post prandial glucose (PPG,) glycosylated hemoglobin (HbA1c), thyroid stimulating hormone (TSH), T3, T4, and presence of other comorbid conditions. Thyroid fine needle aspiration biopsy was suggested to patients whose thyroid nodules were greater than 1.00 cm. RESULTS: There were significant differences between T2DM patients and control subjects regarding BMI (kg/m2), physical activity, cigarette smoking, sheesha smoking, family history of diabetes, hypertension and family history of thyroid nodules. The clinical biochemistry values among T2DM for vitamin D, calcium, magnesium, potassium, phosphorous, fasting blood glucose, cholesterol, HbA1c, HLDL, LDL, triglyceride, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were lower than control subjects, but higher in creatinine, albumin, TSH, T3, and T4 which appeared statistically significant differences (P < 0.001). Also, the study revealed statistically significant differences between subjects vitamin D deficiency and with thyroid nodules for calcium, magnesium, phosphorous, HbA1c, high density lipoprotein (HDL), SBP and DBP, TSH, T3, and T4 among T2DM patients and control subjects (P < 0.001). Multivariable stepwise logistic regression analysis showed that TSH, HbA1c, vitamin D deficiency, SBP (mm Hg), BMI, family history of DM, serum calcium level and family history of thyroid were considered at higher risk as predictors of thyroid among T2DM patients. CONCLUSIONS: This study suggests that obesity, HbA1c, the environment, and genetic susceptibility among T2DM, may increase the risk of thyroid disease and cancer. Although evidence has shown that thyroid cancer incidence has been rising more rapidly over time than the occurrence of cancers of other sites, due to an increase of obesity, diabetes and lack of physical activity, this study lacks of direct evidence supporting this conclusion.

The Impact of Metabolic Syndrome on Increased Risk of Thyroid Nodules and Size.

AIM: The present research aimed to determine the relation between metabolic syndrome (MetS) and thyroid volume and nodule prevalence among Turkish population patients. METHODS: This retrospective cohort study was carried on 850 patients between the ages of 20 and 65 who visited the diabetic, endocrinology, and general surgery outpatient clinics in the Mega Medipol and Medipol Hospital between January 2014 and December 2017. This study included sociodemographic information, body mass index (BMI), diabetes mellitus (DM), systolic (SBP) and diastolic (DBP) blood pressures, and clinical biochemistry results such as serum triglyceride, total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein (LDL) cholesterol, hemoglobin A1c (HbA1c), fasting blood glucose levels, thyroid-stimulating hormone (TSH), T3, T4, and other MetS parameters. Thyroid fine needle aspiration biopsy was suggested to patients whose thyroid nodules were greater than 1.00 cm. The definition and diagnostic of MetS used as proposed by the National Cholesterol Education Program-Third Adult Treatment Panel. RESULTS: There were statistically significant differences between patients with thyroid nodules and those without regarding age, gender, BMI, physical activity, cigarette smoking, shisha smoking, family history of diabetes, hypertension, and thyroid. Meanwhile, statistically significant differences were found between with and without MetS for calcium (P = .028), magnesium (P < .001), potassium (P < .001), fasting blood glucose (P = .047), HbA1c (P < .001), HDL (P < .001), LDL (P < .001), albumin (P = .008), bilirubin (P = .002), triglyceride (P = .011), SBP (P = .001) and DBP (P = .011), TSH (P = .005), T3 (P < .001), and T4 (P < .001). Furthermore, there were statistically significant differences between participants with and without thyroid nodules for calcium (P < .001), magnesium (P < .001), potassium (P < .001), fasting blood glucose (P = .010), HbA1c (P = .019), HDL (P < .001), LDL (P = .012), albumin (P = .002), bilirubin (P < .001), triglyceride (P < .001), SBP (P < .001) and DBP (P = .004), TSH (P = .015), T3 (P < .001), and T4 (P < .001). Multivariate stepwise logistic regression analysis used for independent predictors for the presence of thyroid nodules which TSH (P < .001), family history of thyroid and DM (P < .001), age in years (P = .025), DBP and SBP (P < .001), BMI (P = .014), HDL-C (P = .034), and waist circumference (in cm; P = .044) were considered at higher risk as a predictors of thyroid with patients with MetS. CONCLUSION: The results of the current study confirm a strong positive association between MetS and thyroid nodules risk among patients with MetS. This study suggest that the patients with MetS can be considered as a marker to have moderately increased risk of future thyroid nodules and cancer. Meanwhile, MetS, obesity, and hyperglycemia could be a qualifiable and modifiable risk factor for thyroid nodules. The regularly glycemic control may be the most important treatment for the reduction of incidence or the prevention of thyroid.

Review of Hydatid Cyst with Focus on Cases with Unusual Locations.

OBJECTIVE: This study has been conducted so as to contribute to health statistics of hydatid cyst by the data obtained from our clinic, and to discuss hydatid cysts in unusual locations. MATERIAL AND METHOD: Cases diagnosed as hydatid cyst at Dr. Lutfi Kirdar Kartal Research and Education Hospital Pathology Clinic between 2007 and 2015 have been evaluated based on criteria such as age, sex and location. RESULTS: A total of 364 cases, 209 females and 155 males, have been included in the study. The subjects in the cases are aged between 4 and 81 (mean: 38.84). Regarding the sites, 254 (69.8℅) of the cases are located in liver, and 53 (14.6℅) in the lung. Fifty-seven cases (15.6℅) have been detected in unusual sites other than the lung or liver. The rate of isolated organ involvement, other than the lung and liver, has been found to be 10.3℅. CONCLUSION: Since hydatid cyst can be found in all the body sites, it should be taken into account in the differential diagnosis of all cystic lesions.

Subepithelial pelvic hematoma of the kidney (Antopol-Goldman Lesion).

Renal pelvic hematoma (Antopol Goldman lesion) is a rare but significant condition that may clinically mimick a renal or a pelvic neoplasm. Differential diagnosis and optimal treatment are still not known certainly. A 80-year-old male patient admitted to the emergency department with gross hematuria/clot retention and right flank pain. Magnetic resonance imaging (MRI) imaging revealed a filling defect in the right renal pelvis. Diagnostic flexible uretrorenoscopy was performed and a renal pelvic tumor was excluded. A 6 Fr double J (DJ) ureteral catheter was placed for 4 weeks while the patient was under an antifibrinolytic therapy. Filling defect was not detected at 3(rd) month control MRI. During 6 months of the follow-up period, gross hematuria or any abnormal radiological finding was not encountered.

Is retrograde flexible nephrolithotripsy feasible for calyceal diverticular stone?

The aim of this study is to manage the calyceal diverticular (CD) stone, several treatment options were applied but it is still a challenging condition of endourology. In this retrospective study, we aim to report the results of our patients with CD stones treated with retrograde flexible nephrolithotripsy (RFNL). A total of 47 patients (55 procedures) who underwent RFNL by a single surgeon for CD stones from January 2004 to March 2013 were evaluated retrospectively. The demographic properties and initial complaints of those patients have been recorded along with their comorbidities and previous history of stone management. Moreover, the size and number of the stones, the duration of the surgery, fluoroscopy time, stone-free rate (SFR) and postoperative complications of the patients have been evaluated. The mean age was 41.8 years (range 16-71). Of the study population, 31 (65.9%) were male. Mean stone size was 21.1 (7-52) mm whereas in 3 (6.4%) of the cases the stones could not be reached. Mean duration of the surgery was 92.8 (57-163) min whereas mean fluoroscopy time was 35.9 (14-103) s. After 3 months of follow-up period, the SFR was 85.1%. No major complications occurred. RFNL with holmium laser and nitinol basket catheter application is a feasible and successful procedure in the management of CD stones. With its high success rates, low incidence of complications and minimal morbidity when compared with other treatment options, RFNL has the potential of becoming the preferred treatment option in the minimally invasive management of patients with CD stones.