Are there predictors that can determine neoadjuvant treatment responses in rectal cancer?

BACKGROUND/AIMS: This study aimed to determine a predictive bioindicator that would detect the treatment response of patients diagnosed with rectal cancer and treated with neoadjuvant chemoradiotherapy (nCRT). MATERIALS AND METHODS: The data collected from 37 patients receiving nCRT were retrospectively evaluated. The p53 score and gene instability in MLH1 and MSH2, which are among the DNA mismatch repair (MMR) genes, were evaluated using immunohistochemical methods. The neutrophils-leukocytes ratio (NLR), carcinoembryonic antigen (CEA), and carbohydrate antigen (CA) 19-9 values were obtained as hematological parameters from computer records. The pathologic analysis of the therapy response after nCRT was classified according to the modified grading system by Ryan et al. Results: The changes in the NLR, CEA, and CA19-9 values before and after treatment were statistically significant (p<0.001 and p=0.005). A near significant effect of the decrease of the CEA value in the 5th week after treatment was detected on the pathological response score (p=0.075). The p53 mutation score in those patients with any residue was higher than the total response. Overall, 89.2% of the patients exhibited MMR positivity (stability), and 10.8% of the cases with MRM negativity (instability) had a macroscopic residue. Cases with pathological total response were MRM positive. CONCLUSION: Consequently, in most of the patients treated with nCRT, the treatment caused tumor and nodal remission. In the prediction of this therapy response, hematological and genetic parameters, such as NLR, P53, MLH1, and MSH2, play a predictive role.

Work-related injuries sustained by emergency medical technicians and paramedics in Turkey.

BACKGROUND: Evaluated in the present study were locations, descriptions, and results of work-related injuries (WRIs) sustained by emergency medical technicians (EMTs) and paramedics in Turkey's most crowded city, Istanbul. METHODS: After the present study had been accepted by the urban health authority, a questionnaire was emailed to the healthcare personnel of Istanbul's 195 ambulance stations. RESULTS: Included in the present study were the responses of 901 members of staff (660 EMTs and 241 paramedics), with a mean age of 29.5±6.1 (min: 18; max: 61). The majority of participants (94.9%) had encountered verbal abuse from the public, and 39.8% had encountered physical violence from patients' relatives. Levels of satisfaction with work in emergency medical services (EMS) was also evaluated, and 510 participants (57.6%) were unhappy. Regarding gender, female employees were more likely to be verbally attacked (p=0.01), while males were more likely to be physically attacked (p=0.001). It was reported that motor vehicle accidents (MVAs) were the most common cause of WRIs (81.4%), followed by needle-stick injuries (52.2%), ocular exposure to blood and other fluids (30.9%), and sharp injuries (22.5%). Only 10.5% (n=95) of WRIs were reported to authorities; 488 (54.2%) of participants just attended to the practice to prevent possible WRIs. CONCLUSION: For paramedics and EMTs, risk of WRI is obviously high. Strategies to decrease and prevent verbal and physical violence should be developed.

The Reliability of Turkish "Basic Life Support" and "Cardiac Massage" Videos Uploaded to Websites.

OBJECTIVE: In this study, the reliability of Turkish cardiac massage and Basic Life Support (BLS) videos, which have already been downloaded from three website such as YouTube, Google, Yahoo following the publication of 2010 cardiopulmonary resuscitation (CPR) guideline and their suitability to the same guideline were researched. MATERIALS AND METHODS: The videos uploaded to the three web-site to search videos on internet were queried by using the keywords "cardiac massage" and "basic life support". Videos that had been uploaded between January 2011 and July 2014 were analyzed and scored by two experienced emergency specialists. RESULTS: A total of 1126 videos were obtained. 1029 of the videos (91.4%) were excluded by researchers. 97 videos were detected to accord with study criteria. Despite most of the videos were found on Google website by keywords, the enormous part of videos proper to criteria were sourced from YouTube website (n=65, 67.0%). One fourth of the videos (24.7%) were observed to not be suitable for 2010 CPR guideline. AED usage was mentioned slightly in the videos (14.4%). Median score of the videos is 5 (IQR: 4-6). The rate and scores of the videos uploaded by official institution or association were significantly higher than others (p=0.007 and 0.006, respectively). Moreover, scores of the videos compatible with guidelines uploaded by official institution or association and medical personal were also found higher (p=0.001). CONCLUSION: Eventually, all the data obtained in this study support that Turkish videos were not reliable on the subject of BLS and cardiac massage. It is promising that videos with high follow-up rates also have been scored higher.

A strategy to optimize CT use in children with mild blunt head trauma utilizing clinical risk stratification; could we improve CT use in children with mild head injury?

AIM: The purpose of our study was to investigate the impact of clinical risk classification on optimization of the rationale of CT scanning in children with mild blunt head trauma. Exposed effective radiation dose values of CT scanning were also evaluated. METHODS: Children with isolated pediatric mild head trauma admitted in a single center over a 5-year period (n=3102, >2 years and <16 years of age) were retrospectively reviewed. The study group comprised 806 patients with a mean age of 7.4±2.1 years (range, 2-15 years). The patients were categorized into low and high risk groups with regard to presence of predefined signs and symptoms. Effective radiation dose values were calculated. RESULTS: Incidences of the pathologic CT findings related to trauma were significantly different between low (n=10) 1.9% and high (n=90) 29.8% risk groups. Certain predefined signs and symptoms (e.g., vomiting, suspected skull fracture and loss of consciousness) were related significantly with pathologic CT findings attributed to trauma. Estimated mean effective dose values were 3.91±0.38mSv for 2-6 year old (n=557), and 3.33±0.12mSv for 7-16 year old patients (n=349). CONCLUSION: The pediatric victims of mild head trauma patients within high risk group and those with vomiting, suspected skull fracture and loss of consciousness should undergo head CT scanning. The manufacturer settings on the CT scanners for children should be revised to alleviate untoward radiation exposure.

Relation of age and sex with carotid intima media thickness in healthy children.

BACKGROUND/AIM: To investigate the age- and sex-associated carotid intima media thickness (clMT) changes in healthy children to determine the age- and sex-specific normal range of values for childhood. MATERIALS AND METHODS: This study examined 91 healthy school-age children aged 7-15 years prospectively. Standardized sonographic cIMT measurements and analyses were performed. Body mass index and blood pressure were obtained, and atherosclerotic risk factors were investigated. Age- and sex-specific cIMT measurements for different age groups were calculated and the relation with sex was investigated. RESULTS: Regarding the total study group, mean cIMT measurements for age groups 7-9, 10-12, and 13-15 years were 4.1 + 0.5 mm, 4.4 ± 0.6 mm, and 4.6 ± 0.4 mm, respectively. cIMT did not differ between boys and girls in the same age group. Age related analyses showed significant variations among the age groups with positive correlation between cIMT and age. CONCLUSION: Our results suggest that age-related physiologic thickening of the carotid artery intima-media occurs not only in adults but also in children and that sex is not a factor for cIMT differences in childhood.

Compliance status of product labels to the international code on marketing of breast milk substitutes.

The aim of this study was to determine the compliance status of product labels regarding Article 9 of the International Code on Marketing of Breast-milk Substitutes (the Code) in Denizli province, Turkey. A cross-sectional study design was employed to determine the compliance status. The product labels were obtained from a convenience sample of five supermarkets, one store and 5 pharmacies in the City centre and district of Honaz. Using a data collection form prepared by previously published studies, data were collected between July 26, 2010 and August 06, 2010. Data collection form included 13 criteria. In addition, we checked the boxes for the availability of a Turkish written label. Forty product labels of 7 companies were reached and evaluated. These products consisted of 83.0% of the products marketed by these companies in Turkey. Thirty seven (92.5%) of the labels violated Article 9 of the Code in terms of one or more criteria. Thirty four (85.0%) of the labels had photos or pictures idealizing the use of infant formula. Nine (22.5%) had a photo, a picture or any representation of an infant, and five (12.5%) had text which idealize the use of infant formula or discouraging breastfeeding. Eight (20%) did not state that breastfeeding is the best. Four (10%) had a term such as 'similar to breast milk or human milk'. In conclusion, the majority of the product labels of breast milk substitutes marketed in our country violate the Code. It is appropriate that the Turkish Ministry of Health, medical organizations, companies, and NGOs work more actively to increase awareness of this issue.