The role of Covid-19 outbreak on well-being of healthcare employees of Turkey by considering gender differences.

In this paper, we explore the role of the Covid-19 outbreak on the well-being of healthcare employees (HE) in Turkey by adopting a survey method with 680 (188 men and 492 women) participants. Our results indicate that both the outbreak negatively affects the well-being of HE, and women face more levels of fear, negative feelings and violence than men. Within the context of this research, we contribute to the literature by considering the changing living conditions in the outbreak and adopting a comprehensive approach to reveal sub-level of well-being as subjective and psychological well-being rather than focusing on only mental health like previous studies.

Efficacy of golimumab on recurrent uveitis in HLA-B27-positive ankylosing spondylitis.

To evaluate the efficacy of golimumab on severe and frequent recurrent anterior uveitis in patients with HLA-B27-positive ankylosing spondylitis. In this study, 15 eyes of 12 HLA-B27-positive AS patients with resistant anterior uveitis who received 50 mg of subcutaneous golimumab (Gol) per month due to frequent uveitis recurrences were analyzed retrospectively between May 2013 and October 2015. Assessment criteria were uveitis activity, the number of recurrence of uveitis, visual acuity, systemic corticosteroid, or other drug requirement for maintenance of remission of AU. Twelve patients (15 eyes) with HLA-B27-positive ankylosing spondylitis and anterior uveitis have been treated with golimumab 50 mg/month. Remission of uveitis was observed in 12 eyes out of 15. Malign hypertension developed in one subject after the second dose of golimumab therefore the treatment was stopped and this subject was excluded from the study. Median follow-up time was 11 months (interquartile range: 8-18). No uveitic reaction was seen except in the patient who stopped treatment. No topical or systemic steroid necessity was needed except in two cases with oral 4 mg systemic maintenance. Visual acuity was significantly increased (p = 0.002). Golimumab may be a new and effective choice for maintaining remission and the prevention of recurrences of severe, resistant anterior uveitis in patients with HLA-B27-positive ankylosing spondylitis.

Handedness and breast cancer characteristics.

PURPOSE: Around 10% of the population is left-handed (LH) and the new data suggests that there is genetic as well as environmental influence on the hand preference. The purpose of this study was to evaluate the relationship between breast cancer and hand preference. METHODS: Breast cancer patients diagnosed and treated at the Department of Medical Oncology, Hacettepe University, Institute of Oncology between March 2006 and May 2010 were included in the study. The preferred handedness was asked in all patients and recorded in the patients' medical database. RESULTS: A total of 898 patients with breast cancer were analyzed for handedness, basic characteristics and survival. The median age was 48 years (range 20-83) and all but one patient were female. Of all, 434 (48.3%) patients were pre, 61 (6.8%) were peri, and 399 patients (44.4%) were postmenopausal. Nearly all of the patients (n=869, 96.7%) were operated and modified radical mastectomy was the most frequent type of surgery (N=654, 72.8%). Invasive ductal carcinoma was observed in 659 (73.3%) and in 659 patients (73.1%)estrogen receptors (ER) were positive. Similarly 569 (63.4 %) patients were progesterone receptor (PR) positive and 181 (20.2%) had HER2 overexpression. Most of the patients had T2 (434; 48.3%), N0 (376; 41.9%) and M0 (830; 92.4%) tumors. Of all, 55 (6.1%) patients were LH and the remaining 843 (93.9%) were right-handed (RH). There was no statistically significant difference between the groups related to ER or PR status, TNM classification, tumor localization, menopausal status, HER2 or histological subtype. However the median age of diagnosis in right-handers was higher (48-46 years, p=0.02). There were 10 (1.1%) patients who had already passed away at the time of analysis. The mean overall survival (OS) for RH patients was 33 months (range 1-281) and for LH patients it was 35 months (range 1-182) (p=0.751). The disease disease-free survival (DFS) was 29 months for both groups (p=1.00). CONCLUSION: In our trial the onset of breast cancer was 2 years earlier in LH patients with similar disease characteristics compared to RH patients. As a consequence, it may be advocated that the screening of LH patients should start earlier.

A young boy with affected heart and mind: arterial involvement in a patient with undiagnosed Behçet's disease.

Behçet's disesase is a vasculitis that manifests with oral and genital ulcerations, skin lesions, uveitis, vascular, central nervous system and gastrointestinal involvement. While most patients develop mucocutaneous and genital ulcers along with eye disease, other patients may also present with arthritis, frank vasculitis, thrombophlebitis and central nervous system disease. This is the first case in the literature, where the diagnosis of Behçet's disease was made secondary to concomitant involvement of coronary and carotid arteries.

Effect of port-care frequency on venous port catheter-related complications in cancer patients.

PURPOSE: Subcutaneous central venous port catheters (SCVPC) are of great importance in the treatment of patients with malignancies since they provide secure vascular access. Our aim was to assess the impact of long-term catheter care frequency on the frequency of port-related complications. PATIENTS AND METHODS: Two hundred and seven patients who had not been on active chemotherapy through their SCVPC for at least 3 months were enrolled into the study. Those who received catheter care every 3 months or more frequently were assigned to the frequent care group, and the others to the infrequent care group. The patients were examined for port-related complications and thrombosis including port occlusion. Routinely in our clinic, catheter care was done by using 300 IU of heparin. RESULTS: According to the frequency of SCVPC care, 49 (23.7 %) patients were in the frequent care group and 158 (76.3 %) were in the infrequent care group. Median follow-up of all patients was 671 days (range 133-1712). Median frequency of port care in the frequent care group was 90 days (range 30-90), but 441.5 days in the infrequent care group (range 91-1630). None of the patients experienced port-related severe complications during the follow-up time. None of them presented with port occlusion. When the groups were analysed for thrombus (symptomatic and asymptomatic), there was no statistically significant difference (6.4 vs 13.8 %, p = 0.17). Those patients who had received more than first-line chemotherapy were found to have more thrombi than the patients who were treated with only one type of chemotherapy protocol (28.6 vs 10.2 %, p = 0.01), and the patients who had metastatic disease at the last control were found out to have thrombi more frequently than the non-metastatic patients (24.3 vs 9.3 %) (p = 0.01). CONCLUSIONS: In the present study, there was no difference in port-related severe complications between frequent and infrequent care groups during follow-up. However, the rate of thrombosis was slightly higher in the infrequent port care group.

Recurrent uveitis due to sildenafil usage in a patient with Behçet's disease.

Behçet's disease (BD) may cause uveitis and retinal vasculitis in nearly half of the patients. Uveitis is one of the most serious complications that can lead to blindness. Sildenafil (Viagra(R)) and the other phosphodiesterase type 5 (PDE5) inhibitors are the first-line options for the treatment of erectile dysfunction, but transient visual symptoms and serious ocular side effects have been reported in PDE5 inhibitor users. Herein, we report a case with BD who applied to our outpatient unit with recurrent uveitis after sildenafil therapy.

Tocilizumab for giant cell arteritis: an amazing result.

Giant cell arteritis (GCA), previously Horton's disease, is a systemic vasculitis affecting the middle-sized or large arteries in patients older than 50 years of age. The mainstay of the treatment of GCA is glucocorticoid therapy. Herein, we present a case with giant cell arteritis resistant to oral and intravenous steroid, intravenous cyclophosphamide and mycophenolate mofetil, but successfully treated with tocilizumab.

A confusing case: pulmonary lesions including cavities, isolated left heart endocarditis and inferior vena cava thrombosis in a patient with perforated diverticulitis.

There are numerous causes of pulmonary cavitary lesions as infection (bacterial, parasitic and invasive fungal), Wegener granulomatosis (WG) and other vasculitis, sarcoidosis, malignancy, septic thromboembolism, airways disease (cystic bronchiectasis and bullae), pneumatoceles and traumatic parenchymal laceration. Herein, we present a case with perforated diverticulitis causing pulmonary cavitary lesions and a septic thrombus in the neighboring inferior vena cava.

Triple DMARD combination for rheumatoid arthritis resistant to methotrexate and steroid combination: a single-center experience.

The mainstay of RA treatment is the disease-modifying antirheumatic drugs, and triple DMARD combination is now known to be better than monotherapies. Our aim in this trial was to report our clinical experience with triple DMARD therapy for resistant rheumatoid arthritis. Data of 140 patients with RA resistant to methotrexate and steroid combination were evaluated retrospectively. One hundred and nineteen (85 %) were female, and the median age at diagnosis was 56 (29-82) years. The median time between the diagnosis and beginning of triple therapy was 45.5 (6-564) months. Fifty-two (37.1 %) patients (group 1) on triple therapy protocol achieved remission, but the others (88; 62.9 %) (group 2) did not. The mean DAS28 scores for the study group before triple DMARD therapy and after 12 months under triple DMARD therapy were 4.93 and 3.24, respectively. The DAS28 scores after 12 months for groups 1 and 2 were 2.57 and 3.64. The median follow-up period for patients in group 1 was 60 months (23-118), and the mean DAS28 score at the time of the analysis for group 1 was 2.36. Triple DMARD combination may save one-third of the MTX-resistant RA patients from the serious side effects and the cost of anti-TNF.

Nasal Natural Killer/T-cell Lymphoma with Skin, Eye, and Peroneal Nerve Involvement.

UNLABELLED: Nasal-type natural killer (NK)/T-cell lymphoma (NKTL) is a rare disease strongly associated with Epstein-Barr virus and is often localized to the upper aerodigestive tract at presentation. Extranodal NKTL may involve any extranodal site and disease beyond the nasal cavity is highly aggressive, with short survival time and poor response to therapy. Herein we present a 57-year-old male that had been treated with systemic chemotherapy and cranial radiotherapy for nasaltype NKTL in the palate with skin, right eye, and right peroneal nerve involvement. He was given salvage chemotherapy consisting of 3 cycles of ICE and his response to the therapy was satisfactory, except for persistent right drop foot. About 6 weeks later, the patient presented with bilateral total loss of vision and proptosis; therefore, DHAP chemotherapy was started. Unfortunately, after 1 cycle of the second salvage chemotherapy, he died due to severe fungal infection of the hard palate. Despite the fact that involvement of any extranodal site is possible, concurrent involvement of many systems in NKTL patients is unusual. Nasal-type NKTL has a poor prognosis, despite local radiotherapy and systemic chemotherapy. Physicians should be aware of this rare disorder than can only be diagnosed after extensive immunohistochemical studies. CONFLICT OF INTEREST: None declared.

Traditional Dual Growing Rod Technique in the Management of Early Onset Scoliosis and Its Effects on Spinal Growth and Lung Development: The Mid-Term Prospective Results.

OBJECTIVE: The purpose of this study was to investigate the safety and effectiveness of the traditional dual growing rod (TDGR) technique, using only pedicle screws for fixation with more frequent lengthening while evaluating scoliosis correction in the growing spine, spinal growth rates, and the differences in lung volumes. PATIENTS AND METHODS: In this single-centre prospective study, 27 patients with a follow-up of over three years were included in the study. Only pedicle screws were used as foundations for fixation. Routine lengthening procedures were performed every six months. Data were recorded including the age of initial surgery, gender, number of lengthenings, follow-up, and complications. The Cobb angle of the major curve, kyphosis angle, T1- S1 length, space available for lung (SAL) ratio, coronal and sagittal balance, and the height of all patients were measured and recorded preoperatively, immediately postoperatively, and finally before and after every lengthening. RESULTS: The average follow-up time was 46.3 months (36-64 months). The correction rate was 69.5% for Cobb angle and 43.2% for kyphosis between preoperative and final follow-up period. The time between two lengthenings was 6.9 months, and the mean T1-S1 length increase was 1.78 cm per year. The SAL ratio increased from 0.885 preinitially to 0.985 at the last follow-up. The complication rate was determined as 9.6% in 187 procedures. Acceptable improvements were determined in the specified parameters with low complication rates with the use of this technique. CONCLUSION: The TDGR technique with proximal and distal pedicle screws as anchors is a safe and effective treatment for deformity control in selected patients with early onset scoliosis (EOS). Repetitive surgical interventions are the negative side of this technique.

The efficacy of in situ local autograft in adolescent idiopathic scoliosis surgery: a comparison of three different grafting methods

Background/aim: This study was performed to show the efficacy of in situ local autograft with a comparison of in situ local autograft, local autograft with allograft, and local autograft with posterior iliac crest autograft.Materials and methods: In this prospective randomized study, a total of 65 adolescent idiopathic scoliosis (AIS) patients were separated into 3 groups: Group 1 using local autograft and allograft, Group 2 using local autograft only, and Group 3 using local autograft and posterior iliac crest autograft. Posterior segmental instrumentation was also applied to all patients. The mean follow-up period was 28.5 months (range, 15-40 months). Pseudarthrosis was investigated with the multiplanar and three-dimensional images obtained using multislice computed tomography, thoracolumbar bone single-photon emission computed tomography, and three-phase regional and whole body bone scintigraphy. Results: Pseudarthrosis was not observed in any patient. Fusion was obtained in all patients at the end of the follow-up periods.Conclusion: Similar results were obtained in respect of fusion in all 3 groups. Without the use of additional grafts, sufficient fusion can be achieved with the use of local autograft alone for posterior spinal fusion in patients with AIS.

Are the women with Sjögren's Syndrome satisfied with their sexual activity?

OBJECTIVE: Females with Sjögren's Syndrome (SS) often experience vaginal dryness and dyspareunia, along with glandular and extraglandular symptoms. We aimed to evaluate sexual function and life quality in women with SS. METHODS: Forty-six premenopausal women with SS and 47 age-matched controls were studied. Age, duration of the disease, medications, and comorbid diseases were noted. Participants completed 36-Item Short Form Health Survey (SF-36) and Female Sexual Function Index (FSFI). Patients were asked about vaginal discharge and itching in the last month, and if they informed their rheumatologists about any sexual problems. Gynecologic examinations were performed and vaginal smears were taken on each participant. RESULTS: The median total scores of FSFI were significantly lower in the SS group than the controls [17.12 (2.4-27.8) and 27.4 (16.9-36.0), respectively, p<0.001]. In the SS group, 37 (80.4%) and in the control group 18 (38.3%) of patients were sexually dissatisfied (p<0.001). Vaginal dryness and lubricant use were significantly increased in patients with SS compared to controls (p<0.001). Life quality scores were significantly lower in patients with SS than the controls (p<0.001). Vaginal dryness was negatively correlated with FSFI total (r=-0.312, p=0.035) and subscores except desire and arousal. Physical functioning, role physical and role emotional scores were positively correlated with total FSFI scores (r=0.449, p=0.002, r=0.371, p=0.011, r=0.299, p=0.043, respectively). CONCLUSIONS: Women with SS experience less satisfaction with sexual activity, which can be affected by age, vaginal dryness, physical pain, and impaired function due to the disease. Therefore, rheumatologists should pay attention to these symptoms and management.

Anconeus interposition arthroplasty in acute multiligamentous elbow injuries with irreparable radial head fractures: a novel approach.

OBJECTIVE: The purpose of this study was to evaluate the results of a new reconstruction with anconeus interposition arthroplasty in acute multiligamentous elbow injuries with irreparable radial head fractures. METHODS: Five patients (3 males, 2 females) with a mean age of 42.6 years who underwent reconstruction with anconeus arhtroplasty were evaluated. With lateral approach, lateral capsuloligamentous structures were repaired, the radial head was excised, and anconeus interposition arthroplasty was performed. With medial intervention, the medial collateral ligament was repaired, and the ulnar nerve was transposed anteriorly. Clinical and radiological evaluation was performed the end of a mean follow-up period of 63 months. RESULTS: Mean Mayo Elbow Performance, Oxford Elbow, and Disabilities of the Arm, Shoulder and Hand (DASH) scores were 91, 41.4, and 13.76, respectively. Average elbow extension loss was 10.2° and average forearm supination loss was 5.2°. Dynamic elbow instability tests were within normal limits. On elbow radiographs, the average increase in cubitus valgus angle was 5.4°. No patient reported limitation in daily activities. There was no heterotopic ossification in any patient. Mean radial shortening was 1.39 mm, and no patient suffered from wrist pain at final follow-up. Average Mayo wrist score was 91 points. CONCLUSION: The combination of repair of the medial and lateral structures, radial head resection, and anconeus interposition arthroplasty may be a good alternative in the treatment of acute multiligamentous elbow injuries with irreparable radial head fracture.

Can Plateletcrit be a Marker for Recurrent Pregnancy Loss?

AIM: To determine the utility of platelet (PLT) indices for the prediction of recurrent pregnancy loss (RPL). METHODS: In all, 208 patients who experienced 2 or more first trimester spontaneous abortions and 95 controls who had no abortions were studied. The hematological markers, including plateletcrit (PCT) and neutrophil (Neu) to lymphocyte (Lym) ratio (NLR), were measured. Thrombophilia genetic tests for factor V Leiden mutation, prothrombin G202I0A mutation, and methylenetetrahydrofolate reductase C677 T and A1298C mutations were performed. RESULTS: The PLT count, PCT, white blood cell count, red cell distribution width (RDW), Lym and Neu count, and NLR were significantly higher in patients with RPL than in controls. The RDW, PLT, and PCT values were higher in the low-risk group, whereas mean PLT volume values were lower than the high-risk group values. CONCLUSION: Plateletcrit is a low-cost, widely available marker for prediction of RPL in patients with a history of at least 1 abortus.