The effects of chronic pain on oral health related quality of life in patients with anterior disc displacement with reduction.

AIM: The aim of this study was to evaluate the effects of chronic pain on oral health related quality of life (oral QoL) in patients with anterior disc displacement with reduction (DDwR). MATERIAL AND METHODS: Thirty-seven patients who had disc displacement with reduction (DDwR, F/M: 23/14, median age: 29, range: 23-49) were selected. These patients had chronic pain and had not been undergoing any treatment protocols for the previous six months. Age- and gender-matched healthy subjects healthy control, F/M: 23/14, mean age: 33.0 +/- 15.7 years) were used as a control group. Data were collected by means of a clinical examination and a questionnaire about pain status which included a jaw disability checklist RDC/TMD (Research Diagnostic Criteria for Temporomandibular Disorders). Pain status was scored between 0 (no pain) and 10 (poor pain status) by the patients. Oral health related quality of life (oral QoL) over the previous six months was evaluated by an oral health impact profile-14 (OHIP-14) questionnaire. RESULTS: OHIP-14 score was significantly higher in patients with DDwR (median:17, min-max:6-39) than healthy controls (9, 0-18) (p = 0.000). The median duration of orofacial pain was 12 (range 7-120) months. Statistically significant correlations were observed between OHIP-14 score and the worst pain intensity in the past six months (7, 0-10) (r = 0.5 p = 0.007) and average pain intensity in the past six months (5.5, 1-10) (r = 0.4 p = 0.018). In addition, an increase in OHIP-14 score was observed in patients experiencing difficulty in smiling/laughing, cleaning their teeth or face, swallowing or talking, according to the jaw disability checklist (p = 0.042, p = 0.001, p = 0.023 and p = 0.007, respectively). CONCLUSION: Poor oral QoL was related to chronic pain and limitations in jaw function in patients with DDwR.

The chemical oceanographic consequences of environmental restoration projects in the Golden Horn estuary (Marmara Sea, Turkey).

The input of industrial and domestic waste to the horizontal circulation in the Golden Horn Estuary of Marmara Sea has resulted in one of the most polluted estuaries in the past. Consequently, the dissolved oxygen concentrations in both the surface and bottom waters decreased toward to the estuary head during 1998-2005. In contrast, the total suspended solids content of the surface water decreased toward to the estuary mouth. However, construction of the operational collector system surrounding the estuary during the process of rehabilitation projects, combined with the opening of the middle pontoons of the Valide Sultan Bridge, resulted in gradually improved water quality of the estuary with a concomitant decrease in pollution. However, phytoplankton blooms and eutrophication persist especially in the innermost part of the Golden Horn in 2005. The region from the estuary mouth up to Camialti has a dynamic structure, and sufficient circulation seemingly occurs in this part of the Golden Horn.

A composite index for determining the impact of oral ulcer activity in Behcet's disease and recurrent aphthous stomatitis.

BACKGROUND: Although number, frequency and healing time of oral ulcers and pain are generally used for clinical practice and studies in Behcet's disease (BD) and recurrent aphthous stomatitis (RAS), no standardized activity index is currently present to monitor clinical manifestations associated with oral ulcers. The aim of this study was to develop a standardized composite index (CI) to assess oral ulcer activity in BD and RAS. METHODS: In this cross-sectional study, 121 patients with BD and 45 patients with RAS were included. Sixty-five percentage of BD and 68.9% of RAS patients were in active stage during the previous 3 months. The developed CI included the presence of oral ulcers, ulcer-related pain and functional status and was evaluated in patients with both active and inactive disease for content validity. RESULTS: Composite index score was observed to be higher in active patients with RAS (6.94 + or - 2.19) compared with active BD patients (6.01 + or - 2.04) (P = 0.04). The number of oral ulcers and healing time of oral ulcers were significantly higher in RAS compared with BD (P = 0.018, P = 0.001 respectively). CI score correlated with the number of oral ulcers in both BD and RAS (P = 0.000, P = 0.002 respectively). CI score was '0' for inactive patients without oral ulcer in BD and RAS. CONCLUSIONS: The presented CI as an oral ulcer activity index seems to be a reliable and suitable tool for evaluating the clinical impact and disease-specific problems in BD and RAS.

Predictors of burnout and job satisfaction among Turkish physicians.

BACKGROUND: Burnout is associated with decreased job performance and low career satisfaction. It has a special significance in health care, where staff experience both psychological-emotional and physical stress. AIM: To investigate levels of job satisfaction and burnout among Istanbul physicians, and the relationships between demographic characteristics, job characteristics, job satisfaction and burnout. DESIGN: Questionnaire-based survey. METHODS: We collected data from a randomly selected sample group of 598 physicians from different health-care institutions in Istanbul. A questionnaire regarding sociodemographic characteristics of the physicians, the Maslach Burnout Inventory (MBI) and the Minnesota Job Satisfaction Questionnaire (MSQ) were all administered during face-to-face interviews. RESULTS: Job satisfaction was inversely correlated with emotional exhaustion and depersonalization, and positively correlated with personal accomplishment. Under multilevel regression, the most significant and common predictors of all burnout dimensions and job satisfaction were the number of vacations at individual level, and public ownership of healthcare facilities at group level. Number of shifts per month was also a significant predictor of all burnout dimensions. DISCUSSION: Organizational efforts aimed at increasing the level of job satisfaction among physicians could help to prevent burnout.

Treatment and control of hypertension in Turkish population: a survey on high blood pressure in primary care (the TURKSAHA study).

Although the management and the control rates of hypertension are generally low throughout the world, there are substantial differences between the countries. The aim of this study was to determine the control rate of blood pressure and the characteristics of the patients who have been admitted to primary care units in Turkey. Our study included 16,270 patients aged above 18 years who were diagnosed as hypertensive in representative nationwide sample of 1,000 primary care units in Turkey. The mean age of the patients was 60+/-11 years (60.1% women). Of 16,270 patients, 15 187 (93.3%) were on an antihypertensive treatment, whereas 1,083 (6.7%) were receiving no treatment. The patients who were women, diabetic, smoker, obese, and those who had a concomitant cardiovascular disease (CVD) had a higher rate of antihypertensive treatment. Of 15,187 treated patients, 4,912 (30.2%) had a controlled systolic blood pressure, 7,063 (43.4%) a controlled diastolic blood pressure, and in 3,931 (24.2%), both were under control. A logistic regression analysis demonstrated that age (OR 1.33), diabetes (OR 4.96), body mass index (OR 1.41) and the presence of a CVD (OR 1.19) were predictors for blood pressure being under control. The blood pressure control rates ranged between 16.6 and 30.5% among seven geographical regions. In the primary care units in Turkey, the blood pressure control rate is consistently low in treated hypertensive patients. In addition, there are differences between the geographical regions in both the proportion of those receiving medications and the blood pressure control rates.

Prevalence of iron deficiency among schoolchildren of different socio-economic status in urban Turkey.

OBJECTIVE: To investigate the prevalence of iron deficiency among schoolchildren of different socio-economic status (SES), living in the three largest cities of Turkey. DESIGN: Cross-sectional study. SETTINGS: Primary schools of Istanbul, Ankara and Izmir. SUBJECTS: Schoolchildren aged 12 and 13 y (males: 504; females: 510) from nine primary schools. Inclusion of subjects in the study was on a voluntary basis. METHODS: Data were obtained on children SES, anthropometry, haematological and biochemical indices of iron status and consumption of food items related to dietary iron bioavailability. One-way analysis of variance was mainly applied, for the evaluation of the tested hypotheses, using Bonferroni correction in order to take into account the inflation of Type I error. RESULTS: Iron deficiency (serum ferritin <15 microg/l) prevalence was 17.5% among boys and 20.8% among girls. Furthermore, iron deficiency was significantly more prevalent among boys of lower SES, who were also found to have significantly lower levels of serum iron, serum ferritin, transferrin saturation, mean corpuscular haemoglobin and mean corpuscular haemoglobin concentration compared to those of higher SES. In terms of dietary factors affecting iron bioavailability, low SES boys exhibited significantly higher frequency of tea consumption and lower frequency of citrus fruit, red meat and fish consumption, compared to their higher SES counterparts. CONCLUSION: The prevalence of iron deficiency was relatively high, particularly among lower SES schoolboys. Higher tea and lower citrus fruits, red meat and fish consumption by boys of lower SES may provide an indication about the possible role of certain dietary patterns in the different manifestation of this medical condition among the socio-economic groups. However, further research is needed.

Experimental infection of sheep with bovine herpesvirus type-5 (BHV-5): acute and latent infection.

We demonstrated that sheep are susceptible to acute and latent infection by bovine herpesvirus type-5 (BHV-5). Lambs inoculated intranasally with two South American BHV-5 isolates replicated the virus with titers up to 10(7.1) TCID50/ml for up to 15 days and showed mild signs of rhinitis. Four lambs in contact with the inoculated animals acquired the infection and excreted virus for up to seven days. One lamb developed progressive signs of neurological disease and was euthanized in extremis. Clinical signs consisted of tremors of the face, bruxism, ptyalism, incoordination, lateral flexion of the neck and head, circling, walking backwards, recumbency and paddling. The virus was detected in the anterior and posterior cerebrum, dorso- and ventro-lateral cortex, cerebellum, pons, midbrain and olfactory bulb. Viral nucleic acids were demonstrated in neurons and astrocytes of the anterior and ventro-lateral cortex by in situ hybridization. Histological changes consisting of non-suppurative meningitis, perivascular mononuclear cuffing, focal gliosis, neuronal necrosis and intranuclear inclusions were observed in the anterior cerebrum, ventro-lateral cortex and midbrain. Dexamethasone treatment at Day 50 pi resulted in reactivation of the latent infection and virus shedding in 13/16 (81%) of the lambs. Together with previous reports of BHV-5 antibodies in sheep, these findings show that sheep are fully susceptible to BHV-5 suggesting that infection by BHV-5 in sheep may occur naturally.

Factors affecting dental job satisfaction: a cross-sectional survey in Turkey.

In this cross-sectional study, a randomly selected group of dentists (n = 855) from nine provinces of Turkey were interviewed for their levels of intrinsic, extrinsic, and overall job satisfaction. The proportion of overall job satisfaction was computed as the proportion of dentists who had mean general satisfaction scores > or = 4 on a 5-point, Likert-type scale and was found to be 40.8% for the sample as a whole. The significant factors that affected overall satisfaction were age, the type of social insurance possessed, income level, the presence of dental auxiliaries, and the number of patients examined per day. Multivariate analysis of the data revealed that the type of social insurance, the amount of monthly income, and the number of patients examined per day were the most common and statistically significant predictors of intrinsic, extrinsic, and overall satisfaction in Turkish dentists.

Utilisation of dental services in Turkey: a cross-sectional survey.

AIM: To assess the factors affecting the utilisation of dental service in Turkey. METHOD: A cross-sectional study using a sample of 866 adults randomly selected from nine provinces, collecting data on socio-demographic characteristics, frequency of dental visits and attitudes toward dental services in face-to-face interviews. RESULTS: 40.4% of adults had visited a dentist within the previous year. Logistic regression analysis showed that gender and educational level were significant factors affecting the utilisation of dental services, with women using dental services significantly more than men and those having higher education compared to those having low education. Satisfaction from the services of the private dental offices and private hospitals was higher than from state hospitals. Age, reasons for dental visit and the place of the last visit were found to be the most significant predictors of satisfaction. CONCLUSION: Utilisation of dental services is low amongst Turkish adults. Women and individuals with higher levels of education use dental services more than others. The majority of the people prefer private dental offices, where the patient satisfaction is high.

Rehabilitation and water quality monitoring in the Golden Horn.

In this work, the oceanographic aspects of the Golden Horn and some results of the Golden Horn Rehabilitation Project are presented. The hydrographic structure of the Golden Horn responds rapidly to the conditions in the southern Bosphorus, which is especially true for the outer parts of the estuary up to the Valide Sultan Bridge (VS). West of this bridge which was blocked by the pontoons of the bridge, carries the major pollution load and is dependent on the underlying water and surface mixing, for its renewal. The dissolved oxygen concentrations were measured below the detection limit in the region between the VS and Eyüp-Sütlüce (ES) section during the majority of the measurement periods where H2S has been determined simultaneously until February 2000. Although the microbial contamination of the estuary stations is very high, decreases in the contamination at stations are observed. The highest concentrations are recorded at the ES-VS section and supported by Fecal Coliform data during the rainy months in general despite the operational collector system surrounding the estuary. An obvious decrease of pollution in comparison with the data of the previous years is clearly observed as an encouraging result of the rehabilitation efforts achieved so far.

Peroneal nerve dysfunction after high tibial osteotomy. An anatomical cadaver study.

An anatomical cadaver study was carried out on 13 human cadavers to disclose the close anatomical relationship between the peroneal nerve and the surgical area of the high tibial osteotomy techniques. The common peroneal nerve passes within 3 to 6 mm. of the posterior aspect of the fibular head and neck and divides into its superficial and deep branches, 22 to 28 mm. distal to the fibular apex. Generally the extensor hallucis longus (EHL) muscle is innervated by one of the motor branches of the deep peroneal nerve which is anatomically located 74 to 82 mm. distal to the fibular apex. To avoid neurological complications with a high tibial osteotomy, fibular osteotomy should be carried out at the junction of the middle and distal thirds of the fibula without excessive medial and anterior displacement of fragments; a small fibular segment should be resected in knees which have a severe deformity and need a significant angle correction.

[High tibial osteotomy for varus deformity of more than 20 degrees]. / Ostéotomies tibiales hautes valgisantes de plus de 20 degrés.

INTRODUCTION: This study was undertaken to evaluate the results of high tibial osteotomies on varus gonarthrosis, on which a mechanical angular correction of more than 20 degrees was performed. MATERIAL AND METHODS: This retrospective study concerned 46 knees in 38 patients. The average patients age at operation was 60 (min. 51, max. 71). All the patients were evaluated clinically according to the Knee Society Scoring System and radiologically (standing AP, lateral views and monopodal whole leg weight bearing X-Rays) both pre and post operatively. 3 knees have been excluded because of various reasons. The average follow up of the remaining 43 knees was 50.3 months (min. 24, max. 109 months). The preoperative mechanical axis deviation was 22.8 degrees (min. 16, max. 36 degrees). RESULTS: Postoperatively an optimum valgus alignment was obtained in 31 knees. In 12 knees, the peroperative correction decreased and the mechanical axis was again in varus but with less deformity. According to The Knee Society Scoring System at the last follow-up, the Knee Score was 83, and the Knee Functional Score was 81 (54 and 55 respectively preoperatively). Three cases were reoperated. One internal fixation and bone grafting for nonunion, one reosteotomy for recurrence of the deformity and one total knee replacement for persisting pain were performed. The most frequent complication was the loss of correction which was encountered in 12 knees. Age, follow-up period and alignment were not found to influence significantly the results. Only the arthritis stage, according to Ahlback's radiographic evaluation, was found to be an important factor influencing the results. DISCUSSION: Dome shaped osteotomy's results were surprisingly good in these patients. This technique, performed with a cheap fixator, allowed an operatively exact correction of the deformity, an early active mobilization and progressive weight bearing. The dome shaped osteotomy displaces the tibial tuberosity medially and if needed anteriorly, treating effectively the patello-femoral arthrosis which is frequently present in these highly deformed knees. CONCLUSION: Chosen because of necessity by the authors, the dome shaped osteotomy stabilized by a Charnley fixator, performed on knees needing an important angular correction, has given surprisingly good mid term results. Furthermore the good results obtained support our belief of not enlarging the arthroplasty indications against those of the osteotomies, even in severe gonarthrosis.

Does patellar ligament length change after dome-type high tibial osteotomy?

This study investigates whether there was a shortening of the patellar ligament--which is seen on other techniques--after dome-type high tibial osteotomy (HTO). Forty patients who had undergone unilateral HTO for primary knee arthrosis were retrospectively reviewed. Maquet barrel-vault dome-type HTO associated with a lower segment fibular osteotomy was used as the operative technique. To allow early mobilization, only a simple Charnley external fixator was used. The mean interval between operation and final radiographic examination was 55 months (range: 11 to 131 months). The pre-operative and postoperative Insall-Salvati index (IS), Blackburne-Peel index (BP), and Caton-Deschamps index (CD) were calculated. With respect to pre-operative measurements, a significant decrease in all indices was observed postoperatively. The mean pre-operative IS index was 1.03 and this changed to 0.90 postoperatively; the mean pre-operative BP index was 0.86 and became 0.80 postoperatively; and the mean pre-operative CD index was 0.97 and this became 0.90 post-operatively. Except for the IS index, BP and CD indices were in correlation with each other both pre-operatively and postoperatively. The length of the follow-up period did not have a significant effect on the patellar ligament changes. Dome osteotomy, and an external fixator to allow early mobilization, does not prevent patellar ligament shortening.

Iron deficiency prevalence and dietary patterns by school district in Istanbul.

INTRODUCTION: The aim of this study was to record the prevalence of iron deficiency (serum ferritin concentration <15 microg L(-1)) among schoolchildren and identify possible factors related to the development of this medical condition. MATERIALS AND METHODS: The study population consisted of 504 schoolchildren attending three primary schools, located in two districts of Istanbul with higher and lower socio-economic level (SEL) respectively. Certain biochemical and haematological indices of iron status were measured. Dietary intake was estimated using the 24-h recall technique and a food frequency questionnaire. RESULTS: The prevalence of iron deficiency in the lower SEL school district was twice that of the higher SEL school district (42% and 21.2% respectively). Furthermore, the levels of serum ferritin, mean corpuscular volume, mean corpuscular haemoglobin (all P < 0.001) and mean corpuscular haemoglobin concentration (P = 0.016) were higher for students in the higher than in the lower SEL school district. Consumption of tea, cola beverages and dairy products was more frequent by children living in the lower than in the higher SEL school district. Furthermore, consumption of red meat and citrus fruits was less frequent by boys in the lower than in the higher SEL school district. CONCLUSIONS: Iron deficiency was more prevalent among children from the lower SEL school district. Different patterns in the consumption of foods and beverages that inhibit or enhance intestinal iron absorption between children in the two school districts could provide some explanation for the observed differences in the prevalence of iron deficiency.

A phase II study of biweekly dose-intensified oral capecitabine plus irinotecan (bXELIRI) for patients with advanced or metastatic gastric cancer.

Capecitabine, a prodrug of 5-FU, has been reported to generate maximal tumour activity at tumour sites and/or to improve drug tolerability as compared with 5-FU infusion, and it has also been demonstrated to act synergistically with irinotecan against some solid cancers. A previous study concluded that dose-intensified biweekly capecitabine seems to be more effective at increasing both response rate and progression-free survival time than conventional dose and schedule of capecitabine in colon cancer. We conducted this study to ascertain the efficacy and toxicity of dose-intensified biweekly capecitabine and irinotecan combination chemotherapy in chemotherapy-naïve advanced or metastatic gastric cancer patients. Patients were treated with irinotecan 130 mg m(-2) intravenously for 90 min on days 1 and 15. Capecitabine at 3500 mg m(-2) day(-1), divided into two sessions per day, was administered for seven consecutive days from days 1 and 15, and followed by a 7-day drug-free period, respectively. Fifty-five eligible patients were enrolled in this study from November 2003 to April 2006. There were 22 women and 33 men: median patient age was 54 years (range: 27-81). A total of 200 treatment cycles were administered at a median number of four per patient (range: 1-9). Intent-to-treatment analysis showed that one patient achieved complete response (1.8%), 23 partial response (41.8%), 15 stable disease (27.3%), 10 progressive disease (18.2%) and 6 were non-evaluable (10.9%). The overall response rate was 43.6% (95% confidence interval: 30.2-56.9). The common grade 3-4 toxicities were neutropenia in 12 (21.8%), nausea/vomiting in 3 (5.4%) and diarrhea in 4 (7.2%) patients. Median time to progression was 5 months (range: 0.5-11 months), median survival duration was 11 months (range: 0.5-45 months) and median response duration was 6 months (range: 0.5-9 months). Biweekly dose-intensified capecitabine and irinotecan combination chemotherapy was active for the treatment of advanced or metastatic gastric cancers with a tolerable safety profile.

Oral health related quality of life is affected by disease activity in Behçet's disease.

OBJECTIVES: This study aimed to investigate oral and general health related quality of life (QoL) in patients with Behçet's Disease (BD) and to assess the performance of Turkish versions of oral health related quality questionnaires. SUBJECTS AND METHODS: Ninety-four BD patients, 24 patients with recurrent aphthous stomatitis (RAS), 113 healthy controls (HC) and 44 dental patients were investigated. QoL was assessed by oral health impact profile-14 (OHIP-14), oral health related quality of life (OHQoL) and short form-36 (SF-36) questionnaires. RESULTS: OHQoL, OHIP-14 and SF-36 subscale scores were significantly worse in patients with BD compared with those in HC (P < 0.05). Both OHIP-14 and OHQoL scores were significantly worse in active patients compared with inactives in BD and RAS (P < 0.05). Scores of SF-36 Role physical, Role emotional and Vitality were also lower in active patients than in inactives in BD (P < 0.05). Scores of OHIP-14 and OHQoL were significantly worse in patients treated with colchicine compared with those treated with immunosuppressives (P < 0.05). CONCLUSIONS: Both oral and general QoL was impaired in BD and associated with disease activity and treatment modalities. Translated Turkish versions of OHIP-14 and OHQoL were also observed to be valid and reliable questionnaires for further studies.

Prevalence and distribution of oral lesions: a cross-sectional study in Turkey.

OBJECTIVES: The purpose of this study was to evaluate the prevalence and distribution of oral lesions (OLs) in Turkish population. SUBJECTS AND METHODS: In this cross-sectional study, 765 residents (F/M: 375/390) were selected by the cluster sampling method and examined according to WHO criteria. RESULTS: Excessive melanin pigmentation (6.9%) was the most common lesion in the study population. The tongue lesions observed in this study were as follows: fissured tongue (5.2%), varices (4.1%), hairy tongue (3.8%), geographic tongue (1.0%), atrophic tongue papillae (0.7%) and ankyloglossia (0.3%). The denture-related lesions were denture stomatitis (4.3%), suction irritation (0.8%), denture hyperplasia and torus palatinus as bony lesion (0.5%) and traumatic ulcers (0.3%). In regression analysis, being 65 years old and over was found as a statistically significant risk factor for the occurrence of pigmentation, fissured tongue, varices, hairy tongue, denture stomatitis and petechiae (P < 0.05). CONCLUSIONS: Pigmentation, fissured tongue and denture stomatitis were observed to be the most common lesions in Turkish population. Elderly population was a significant risk factor for occurrence of some OLs.

Cementless total knee arthroplasty in ochronotic arthropathy: a case report with a 4-year follow-up.

Alkaptonuria is an inherited metabolic disorder characterized by the absence of the enzyme homogentisic acid oxidase, which leads to the accumulation of homogentisic acid, produced during normal metabolism of phenylalanine and tyrosine. Ochronosis, which is the dark pigmentation of connective tissues in patients with long-lasting alkaptonuria, can cause severe cartilage destruction in large joints and the vertebral column. Knee joint involvement, which occurs at relatively early ages, can be quite restrictive. Arthroplasty may be the treatment of choice in these patients because of limited mobility and diffuse involvement of the joint. We report a 48-year-old man who had been treated with cementless total knee arthroplasty. Theoretically, there are no bone ingrowth deficits that might be detrimental for the stabilization of cementless prostheses in ochronotic arthropathy because the bone tissue is not primarily affected by the disease. The 4-year follow-up of cementless total knee arthroplasty was satisfactory without any evidence of loosening.