Zinc Supplementation in Very Low Birth Weight Infants: A Randomized Controlled Trial.

OBJECTIVE: Preterm infants have high zinc (Zn) requirements and are generally believed to be in a negative Zn balance in the early period of life. In this study, we aimed to investigate the effect of high-dose Zn supplementation in very low birth weight (VLBW: infants with birth weight < 1.5 kg) infants on feeding intolerance and development of mortality and/or morbidities including necrotizing enterocolitis (NEC) and late-onset sepsis (LOS). STUDY DESIGN: This is a prospective randomized trial. VLBW preterm infants with gestational age of <32 weeks were randomly allocated on the seventh day of life to receive extra amount of supplemental Zn along with the enteral feedings (9 + 3 mg), besides regular low-dose supplementation (3 mg), from enrollment until discharge. Outcome measures were feeding intolerance, NEC (stage ≥ 2), LOS, and mortality. RESULTS: A total of 195 infants (97 from study group and 98 from control group) were analyzed. A total of 46 (47.4%) infants in the study group and 64 (65.3%) infants in the control group ended up with feeding intolerance (p = 0.012). NEC was observed in 11 infants (11.2%) in the control group and only 1 infant (1%) in the study group (p = 0.003). There was a negative correlation between high-dose Zn supplementation and number of culture-proven LOS episodes (p = 0.041). This significance was also present for clinical sepsis, being higher in the control group (p = 0.029). No relationship between high-dose Zn supplementation and mortality and other morbidities (hemodynamically significant patent ductus arteriosus, bronchopulmonary dysplasia, retinopathy of prematurity, and severe intraventricular hemorrhage) was observed. CONCLUSION: Zn supplementation for VLBW infants is found to be effective to decrease feeding intolerance, NEC, and LOS episodes in this vulnerable population. Current data support the supplementation of VLBW infants with higher than regular dose of Zn. KEY POINTS: · Higher dose of Zn supplementation is shown to be a beneficial intervention in VLBW infants.. · Zn may decrease feeding intolerance, sepsis or NEC.. · Higher than regular dose of Zn seems to be safe..

A Multicenter Study of Genotype Variation/Demographic Patterns in 2475 Individuals Including 1444 Cases With Breast Cancer in Turkey.

Objective: Breast cancer (BC) is the most common cancer type in women and may be inherited, mostly in an autosomal dominant pattern. The clinical diagnosis of BC relies on the published diagnostic criteria, and analysis of two genes, BRCA1 and BRCA2, which are strongly associated with BC, are included in these criteria. The aim of this study was to compare BC index cases with non-BC individuals in terms of genotype and diagnostic features to investigate the genotype/demographic information association. Materials and Methods: Mutational analyses for the BRCA1/BRCA2 genes was performed in 2475 individuals between 2013-2022 from collaborative centers across Turkey, of whom 1444 with BC were designated as index cases. Results: Overall, mutations were identified in 17% (421/2475), while the percentage of mutation carriers in cases of BC was similar, 16.6% (239/1444). BRCA1/BRCA2 gene mutations were detected in 17.8% (131/737) of familial cases and 12% (78/549) of sporadic cases. Mutations in BRCA1 were found in 4.9%, whereas 12% were in BRCA2 (p<0.05). Meta-analyses were performed to compare these results with other studies of Mediterranean-region populations. Conclusion: Patients with BRCA2 mutations were significantly more common than those with BRCA1 mutations. In sporadic cases, there was a lower proportion with BRCA1/BRCA2 variants, as expected, and these results were consistent with the data of Mediterranean-region populations. However, the present study, because of the large sample size, revealed more robust findings than previous studies. These findings may be helpful in facilitating the clinical management of BC for both familial and non-familial cases.

Quality of life and sexual function after abdominal versus laparoscopic hysterectomy: a prospective study.

BACKGROUND: This study aimed to evaluate the quality of life (QoL) and sexual function of women who underwent total abdominal hysterectomy and total laparoscopic hysterectomy. METHODS: In this prospective cohort study, a total of 121 patients who underwent total abdominal hysterectomy (N.=65) and total laparoscopic hysterectomy (N.=56) operations for benign indications were included. Sociodemographic features, obstetric histories, and clinical characteristics of the patients were noted. Quality of life assessment was conducted with the World Health Organization Quality of Life-BREF questionnaire, which has five domains: overall quality of life + health, physical health, psychological health, social relationships, and environment. Sexual function was assessed by the Golombok-Rust Inventory of Sexual Satisfaction Scale with subscales of infrequency, non-communication, avoidance, non-sensuality, dissatisfaction, vaginismus, and anorgasmia. The patients were asked to fill in both questionnaires before the operation and six months after the operation. RESULTS: Of the 121 patients, 104 of them completed the postoperative surveys. In the total laparoscopic hysterectomy group, the individual improvements of the overall quality of life + health physical, and psychological health domains were statistically higher than the total abdominal hysterectomy group. In terms of sexual function, the total abdominal hysterectomy group had worse avoidance, non-sensuality, dissatisfaction, and vaginismus subscale scores and total score both in the preoperative and postoperative period compared to the total laparoscopic hysterectomy group. However, the individual differences and the number of patients exhibiting sexual dysfunction before and after surgery were not statistically significant in both groups. CONCLUSIONS: Laparoscopic hysterectomy was superior to abdominal hysterectomy in improving the quality of life of the patients. Both abdominal and laparoscopic hysterectomies were not found to affect female sexuality.

The effect of antioxidants in Ehrlich Ascites Cancer.

A fundamental goal in molecular oncology is to unravel the underlying mechanisms which cause the cell transformation. In line with this approach, genome-wide functional screening approaches have revealed exciting insights into heterogeneous nature of cancer. Rapidly expanding horizons of research have unraveled myriad of pathways which play instrumental role in carcinogenesis and metastasis. Oxidative stress has also been reported to be significantly involved in cancer onset and progression. In line with this approach, oxidative stress modulating chemicals have always been sharply divided into antioxidants and oxidative stress-inducing agents. Conceptual and experimental advancements have enabled us to critically analyze full potential of these two different groups of chemicals in cancer chemoprevention. Different antioxidants are currently being analyzed in different phases of clinical trials. Although it has been reported in the literature that antioxidant supplements reduce tumor cells in some tumors or cause volume reduction in solid tumor sizes, there is no definite consensus. Therefore, an antioxidant supplement guideline based on more detailed clinical research and as a result of these is needed to achieve the best care for cancer patients and to avoid risky treatments for cancer patients.

Complementary and Alternative Medicine Attitudes of Gynecologic Patients: Experience in a Tertiary Clinic / Atitudes de pacientes ginecológicos em medicina alternativa e complementar: Experiência em uma clínica terciária

Abstract Objective To evaluate the knowledge, attitudes, and behaviors regarding complementary and alternative medicine methods of patients who were admitted to gynecology outpatient clinics. Methods In the present survey, a questionnaire on complementary and alternative medicine practices was applied on 1,000 women (ages between 18 and 83 years old) who were admitted to the gynecology outpatient clinic of a tertiarymaternity hospital. Demographic features and knowledge, attitudes, and behaviors about these methods were inquired in face-to-face interviews. Results While 80.7% of the total participants thought that complementary and alternative medicine was beneficial, only 37.5% of them had used these methods previously. The rate of prior knowledge on this subject was of 59.7% and the source of information was physicians for 8.5% of the patients. However, 72.4% of all participants wanted to obtain information on these methods and 93.7% wanted to be informed by physicians. In the decision tree model, having knowledge about complementary and alternative medicine was the most effective factor determining its use (p<0.001). Phytotherapy was found to be the most used method, with 91.4%. The most preferred plant was onion (18.9%), and the most common reasons for herbal use were stress (15.4%) and fatigue (15.2%). Conclusion More than one-third of the patients who applied to the gynecology outpatient clinics used one of the complementary and alternativemedicine methods at least once. As gynecologists and obstetricians, we need to be more knowledgeable about these methods to provide correct guidance to our patients for accessing accurate and effective information.

Resumo Objetivo Avaliar o conhecimento, as atitudes e os comportamentos em relação aos métodos de medicina complementar e alternativa de pacientes internadas em ambulatórios de ginecologia. Métodos Na presente pesquisa, um questionário sobre práticas de medicina complementar e alternativa foi aplicado a 1.000 mulheres (idades entre 18 e 83 anos) que foram admitidas nos ambulatórios de ginecologia de uma maternidade terciária. Características demográficas e conhecimento, atitudes e comportamentos sobre esses métodos foram investigados em entrevistas pessoais. Resultados Enquanto 80,7% do total de participantes achavam que a medicina complementar e alternativa era benéfica, apenas 37,5% deles haviam usado esses métodos anteriormente. A taxa de conhecimento prévio sobre o assunto foi de 59,7% e a fonte de informação foi médica para 8,5% dos pacientes. No entanto, 72,4% de todos os participantes queriam obter informações sobre esses métodos e 93,7% queriam ser informados por médicos. No modelo de árvore de decisão, ter conhecimento sobre medicina complementar e alternativa foi o fator mais eficaz para determinar seu uso (p<0,001). A fitoterapia foi o método mais utilizado, com 91,4%. A planta preferida foi a cebola (18,9%), e osmotivos mais comuns para o uso de ervas foram estresse (15,4%) e fadiga (15,2%). Conclusão Mais de um terço das pacientes que se inscreveram no ambulatório de ginecologia utilizaram um dos métodos de medicina complementar e alternativa pelo menos uma vez. Como ginecologistas e obstetras, precisamos ter mais conhecimento sobre estes métodos a fimde fornecer orientações corretas aos nossos pacientes para o acesso a informações precisas e eficazes.

Drug exposure in early pregnancy might be related to the effects of increased maternal progesterone in implantation period.

AIM: This short communication aims to evaluate the relation in between drug exposure time and early pregnancy regarding gestational weeks. METHODS: The study covers the referrals made to the Department of Pharmacology for a teratogenic consultation in a 3-year period. From the recordings of pregnant women, the last menstrual period and the starting date of medication were used to determine the time of prescription with regard to gestational weeks. RESULTS: In all of the three years, potentially teratogenic medication was prescribed more frequently in the 3rd, 4th and 5th gestational weeks (in between 15-35 days of pregnancy). Approximately 75% of the pregnant women in the study were prescribed with drugs, most frequently with analgesics, antibiotics, gastrointestinal drugs and antidepressants, in these gestational weeks. CONCLUSIONS: The timing of prescriptions in early pregnancy frequently coincides with the increased levels of maternal progesterone in implantation period. Progesterone may lead to negative mood symptoms of an increased pain perception, anxiety, irritability and aggression in some of the pregnant women and therefore causes an increased stress condition which in turn may result in pain, infection and inflammation in the individual. Taking the frequently used medications into consideration, the reason for prescriptions in this period might be related to the symptoms originating from the effects of progesterone. Future studies are needed to better demonstrate this association of drug exposure and effects of maternal progesterone in early pregnancy.

Multiple sub-epidermal calcified nodule mimicking eruptive xanthoma: a case report and review of the literature.

Sub-epidermal calcified nodule (SCN) is an uncommon form of idiopathic calcinosis. It usually occurs in children, particularly in the head and neck region, presenting as a solitary, painless, yellow-white nodule with papillomatous features. These lesions occur twice as common in males compared with females. The pathogenesis is uncertain, but the clinical and histological features of this lesion are distinctive. We report a case of 22-year-old man with multiple nodules bilaterally located on the dorsum of hands simulating eruptive xanthoma. Histopathological examination of one of the excised lesion confirmed the diagnosis showing epidermal and sub-epidermal deposition of calcium. This paper presents a review of the literature and adds a new case of SCN.

Assessment of cervical cancer risk in women between 15 and 49 years of age: case of Izmir.

BACKGROUND: The aim of the study was to determine risk factors for cervical cancer for women in Izmir. METHODS: This cross-sectional, descriptive field covered a population of 4319 women of reproductive age (15-49) (household registration in the Mukhtar's office-2007). A total of 1,637 women were included in the sample given a four-part questionnaire through face-to-face interview by visiting the women in their homes in order to determine socio-demographic factors, obstetric history, genital hygiene and the use of family planning methods. In addition, during the data collection process, the women were given group training in order to raise awareness of cervical cancer. The number and percentage distributions of the data were calculated. RESULTS: While the average age of the women was 31.9±9.77 (Min: 15.00-Max: 49.00), education level of 43.4% of them was elementary school only. It was determined that 70.3% of the women experienced at least one pregnancy, 71.0% had vaginal delivery and 75.9% used a contraceptive method. In the study it was determined that among the cervical cancer related risks vaginal delivery, vaginal lavage and having three or more pregnancies had the highest rates, while having sexual intercourse before 16 years of age and having more than one sexual partner constituted lower rates. The rate of the women who stated not having a smear in the last three years was 82.4%. CONCLUSIONS: Considering the case in terms of having Pap smear test, women's awareness on the risk factors and early diagnosis of cervical cancer was found to be low. Due to this reason, awareness of women has to be raised through education.

Variation in Renin-Angiotensin system and salt-sensitivity genes and the risk of diabetes mellitus associated with the use of thiazide diuretics.

BACKGROUND: Variation in the renin-angiotensin system (RAS) and salt-sensitivity genes may influence the effect of thiazides on the risk of diabetes. We assessed whether polymorphisms in RAS and salt-sensitivity genes influenced the risk of diabetes associated with thiazides. METHODS: Nested case-control study was conducted among antihypertensive drug users. Pharmacy records and questionnaires were used to assess new onset diabetes (cases), to ascertain antihypertensive use and risk factors for diabetes. Cases were matched to controls (up to five) who were not (yet) diagnosed with diabetes mellitus. We genotyped angiotensin-converting enzyme (ACE) (G4656C), angiotensinogen (AGT) (M235T), angiotensin II type 1 receptor, (AGTR1) (A1166C), adducin 1 (alpha) (ADD1) (G460T), guanine nucleotide binding protein (G protein), beta-polypeptide 3 (GNB3) (C825T). RESULTS: Among 497 incident cases of type 2 diabetes and 2,633 controls, AGTR1 CC genotype carriers had no increased risk of diabetes due to thiazides (odds ratio (OR) 0.63 (95% confidence interval (CI): 0.28-1.40)) compared to AGTR1 1166A allele carriers (OR 1.79 (95% CI: 1.43-2.23)) receiving thiazides (synergy index (SI) for interaction 0.32 (95% CI: 0.15-0.68)). Although homozygous ACE GG subjects and ACE C allele carriers both had an increased risk of diabetes associated with thiazide use, this risk was more increased for ACE GG subjects (SI 1.70 (95% CI: 1.08-2.66)), particularly at doses > or =1 daily defined dose (DDD) (=25 mg hydrochlorothiazide)/day (SI 2.0 (95% CI: 1.20-3.32)). Among GNB3 T allele carriers, the risk of diabetes due to thiazide use was less increased than among homozygous GNB3 CC subjects (SI 0.62 (95% CI: 0.41-0.93)). CONCLUSION: The risk of diabetes due to thiazide use was not increased among AGTR1 1166 CC homozygous subjects and less increased among GNB3 T allele carriers. The ACE 4656 GG genotype enhanced the risk of diabetes due to thiazides.

BmBKTx1, a novel Ca2+-activated K+ channel blocker purified from the Asian scorpion Buthus martensi Karsch.

BmBKTx1 is a novel short chain toxin purified from the venom of the Asian scorpion Buthus martensi Karsch. It is composed of 31 residues and is structurally related to SK toxins. However, when tested on the cloned rat SK2 channel, it only partially inhibited rSK2 currents, even at a concentration of 1 microm. To screen for other possible targets, BmBKTx1 was then tested on isolated metathoracic dorsal unpaired median neurons of Locusta migratoria, in which a wide variety of ion channels are expressed. The results suggested that BmBKTx1 could specifically block voltage-gated Ca(2+)-activated K(+) currents (BK-type). This was confirmed by testing the BmBKTx1 effect on the alpha subunits of BK channels of the cockroach (pSlo), fruit fly (dSlo), and human (hSlo), heterologously expressed in HEK293 cells. The IC(50) for channel blocking by BmBKTx1 was 82 nm for pSlo and 194 nm for dSlo. Interestingly, BmBKTx1 hardly affected hSlo currents, even at concentrations as high as 10 microm, suggesting that the toxin might be insect specific. In contrast to most other scorpion BK blockers that also act on the Kv1.3 channel, BmBKTx1 did not affect this channel as well as other Kv channels. These results show that BmBKTx1 is a novel kind of blocker of BK-type Ca(2+)-activated K(+) channels. As the first reported toxin active on the Drosophila Slo channel dSlo, it will also greatly facilitate studying the physiological role of BK channels in this model organism.