The effectiveness of the trans-theoretical model in managing adult obese and overweight individuals.

Background & Objective: The prevalence of obesity is gradually increasing in our country and worldwide. Being obese and overweight are risk factors for chronic diseases. Obesity has a multifactorial etiology, so treatment should involve lifestyle changes, psychological strategies, pharmacologic treatment, and bariatric surgery. The present study aimed to investigate the effectiveness of the trans-theoretical stages of change (TTM SOC) model in managing adult obese and overweight patients. Methods: This prospective cohort study was conducted with 133 adults who were admitted to the Family Medicine Outpatient Clinic of Adana City Research and Training Hospital between April 1, 2017, and April 30, 2019. Socio-demographic characteristics, blood pressures, anthropometric measurements, and laboratory data were compared between the baseline and the first, third, and sixth months. Results: Body mass index (BMI) was higher among those with a low educational level. The mean age, the number of medications used, and the metabolic parameter values were significantly lower among the participants who did not have a chronic disease. Blood pressures, weight, BMI, plasma glucose and insulin, HOMA-IR, and triglyceride were statistically significantly higher at the baseline compared to follow-up values. Fasting plasma glucose was higher at the baseline in diabetic patients. The results were compared with Student t and One Way ANOVA tests. The Pearson correlation coefficient was used to demonstrate the association between baseline and repeated metabolic measurements. Conclusion: The trans-theoretical model is effective in managing adult obese and overweight individuals and also in glycemic control in obese Type-2 diabetics.

Genotoxicity evaluation of a new phthalazine substituted ß-lactam derivative in human lymphocytes.

The aim of present study, to evaluate the genotoxic potential of 1-(4-(3,3-dimethyl-1,6-dioxo-2,3,4,6,11,13-hexahydro-1H-indazolo[1,2b] phthalazine-13yl)phenyl)-2-phenylazetidine-3-yl-acetate which was synthesised assuming that it may be a pharmaceutical raw material and found to inhibit human carbonic anhydrase I, II isozymes. To determine the genotoxic potential of this phthalazine substituted ß-lactam compound, chromosomal aberration (CA) and micronucleus (MN) tests were implemented in human peripheral blood lymphocytes. In these tests, lymphocyte cultures were treated with four concentrations (30, 15, 7.5, 3.75 µg/mL) of test compound and simultaneously with negative control (sterile distilled water), solvent control (DMSO) positive control (MMC). According to our results, CA frequencies were significantly increased in two high applied concentrations (30, 15 µg/mL) compared with negative and solvent control. MN frequencies were significantly increased in three applied concentrations (30, 15, 7.5 µg/mL) except lowest concentration (3.75 µg/mL) compared with solvent control. Mitotic indices were also affected by treatment with test compound. The obtained results provide evidence to demonstrate that new phthalazine substituted ß-lactam derivative can exert genotoxic and cytotoxic effects in peripheral human lymphocytes especially at high concentrations.

Serum Galectin 7 is Not Useful to Predict Abortion in the First Trimester.

OBJECTIVE: Galectins are animal lectins that bind to surface glycoproteins expressed at the fetal-maternal interface. The aim of this prospective case-control study was to investigate the possible relationship between levels of maternal serum galectin-7 and threatened abortion (TA) and to determine whether serum galectin-7 had any prognostic value. METHODS: This prospective study was conducted between August 2014 and February 2015. Included in the study were 31 consecutive pregnant women who were hospitalized for TA between 6 and 14 weeks of gestation and 33 healthy gestational age matched pregnant women without any symptoms of miscarriage. Serum galectin-7 levels were measured via ELISA. RESULTS: The mean serum galectin-7 levels of the two groups were not significantly different (31 TA patients: 2.84 ± 0.43 pg/mL, 33 controls: 2.785 ± 0.32 pg/mL, p = 0.543). Six pregnancies in the TA group resulted in abortion (19.4%). CONCLUSION: Serum galectin-7 was not useful for predicting prognosis in TA.

Synthesis, characterization, and determination of genotoxic effect of a novel dimeric 8-hydroxyquinoline Cd(II) SCN complex.

In this study, a Cd(II) complex was synthesized using 8-hydroxyquinoline and thiocyanate as the ligands and structurally characterized with the combination of FTIR, 1H-NMR, 13C-NMR, UV-vis, and MS spectral data. Then, genotoxic effects of the prepared complex were investigated. Genotoxic properties of the dimeric 8-hydroxyquinolinthiocyanatoCd(II) [Cd2(8Q)2(SCN)2] complex synthesized as drug raw material were analyzed in human peripheral blood lymphocytes. Concentrations of 1, 2, 4, 6, and 8 µg/mL [Cd2(8Q)2(SCN)2] were used for 24 and 48 h durations. [Cd2(8Q)2(SCN)2] significantly increased chromosomal aberrations (CAs) at 4, 6, and 8 µg/mL concentrations after a 24- h period and 2 and 4 µg/mL after a 48-h period. [Cd2(8Q)2(SCN)2] significantly decreased the mitotic index (MI) at all concentrations, both at 24 and 48 h. Micronuclei frequency (MN) was not affected by [Cd2(8Q)2(SCN)2] treatment compared with the control. After application for a 48 h period, 6 and 8 µg/mL concentrations showed toxic effects both in chromosomal abnormality and in micronucleus tests. It also decreased the cytokinesis-block proliferation index (CBPI), but this result was statistically significant only at 6 and 8 µg/mL concentrations. In the comet assay (single-cell gel electrophoresis (SCGE)), significant increases in comet tail length, tail moment, and tail intensity were observed at all concentrations. [Cd2(8Q)2(SCN)2] displays clastogenic effect in the concentrations used in human peripheral lymphocytes at chromosomal abnormality, micronucleus tests, and cytokinesis-block proliferation index parameters. Further studies should be conducted in other test systems to evaluate the complete genotoxic potential of [Cd2(8Q)2(SCN)2].

Long-term effect of systemic isotretinoin on female fertility.

BACKGROUND/OBJECTIVE: Acne vulgaris is one of the most common diseases of the youth. Systemic isotretinoin is the only drug which acts on all of the etiopathogenic mechanisms of acne. Isotretinoin has some well-known side effects. Besides these, there is a suspicion whether it affects fertility or not. Previously, we conducted a study about isotretinoin's effect on ovarian reserve which showed deteriorative reserve. In this study, we aimed to evaluate the long-term effects of systemic isotretinoin on female fertility. MATERIALS AND METHODS: Of the 82 female patients who were enrolled in the first study, 79 patients were included in this study. Twelve months after the end of systemic isotretinoin treatment, patients were reevaluated by using the same parameters which include anti-Mullerian hormone (AMH), ovarian volume (OV), antral follicle count (AFC), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, free testosterone and total testosterone. RESULTS: The changes in the mean AMH, OV and AFC were statistically significant between the sixth and eighteenth months (the end of systemic isotretinoin treatment and 12 months treatment free). The mean AMH, OV and AFC values at the beginning and at the 18th month were statistically similar. CONCLUSION: The deteriorative effects of systemic isotretinoin treatment on ovarian reserve, which can be accepted as an indicator of female fertility, diminish in time.

The effect of systemic isotretinoin on male fertility.

BACKGROUND/OBJECTIVE: Acne vulgaris is one of the most common diseases of the youth. Systemic isotretinoin is the only drug which acts on all of the etiopathogenic mechanisms of acne. Isotretinoin has some well-known side effects. Besides these, there is a suspicion whether it causes infertility or not. In this study, we aimed to evaluate the effects of systemic isotretinoin on male fertility. METHODS: Eighty one male patients, who were older than 18 years of age, and had severe or refractory acne vulgaris were included in the study. They were given a total dose of 120 mg/kg of systemic isotretinoin over a period of six months. Before and after the study, the spermiogram parameters of the patients were evaluated to show any possible effect on male fertility. The patients' total testosterone, follicle stimulating hormone and luteinizing hormone levels were also evaluated. RESULTS: All of the spermiogram parameters changed positively (p < 0.05). There was no significant change in the hormone levels. CONCLUSION: Systemic isotretinoin has a positive effect on male fertility. Since the hormone levels did not change significantly, this positive effect of isotretinoin is not via the hypothalamic-pituitary-gonadal axis but can be due to its regenerative and proliferative effects on the testes.

Comparison of lidocaine spray and paracervical block application for pain relief during first-trimester surgical abortion: A randomised, double-blind, placebo-controlled trial.

Surgical abortion is one of the most frequently performed gynaecological procedures and its associated pain has always been a problem in gynaecology. Here we studied the analgesic efficacy of lidocaine spray and paracervical block (PCB) in patients undergoing first-trimester surgical abortion. A randomised double-blind placebo-controlled study was conducted on 108 women requesting pregnancy termination. The subjects were randomly assigned into four groups: Group 1 (PCB plus lidocaine spray) (n=27), Group 2 (PCB) (n=27), Group 3 (lidocaine spray) (n=27) and Group 4 (placebo) (n=27). Intra-procedural and post-procedural pain scores were measured with a standard visual analogue scale (VAS). The median VAS scores during procedure in placebo, lidocaine spray, PCB plus lidocaine spray and PCB groups were 8 (7-9), 5 (4-8), 4 (3-4) and 5 (3-5), respectively. The most effective method of pain relief during first-trimester abortion can be achieved through a combined use of PCB plus lidocaine spray. Therefore, lidocaine spray is a non-invasive complementary anaesthetic method versus traditional PCB for first-trimester surgical abortion.

Comparison of blood and urine nephrin levels in preeclampsia and intrauterine growth retardation.

OBJECTIVE: To evaluate the relation between nephrin levels and preeclampsia severity by comparing serum and urine levels of nephrin in the severe and mild groups according to severity of associated intrauterine growth retardation (IUGR) development. METHODS: A total of 150 patients who attended our ante-natal clinic (ANC) were included in this study. We had 5 groups; Group 1:30 patients with mild preeclampsia (MP) and normal fetal development (NFD), Group 2:30 patients with severe preeclampsia (SP) and NFD, Group 3: 30 patients with MP and IUGR, Group 4: 30 patients with SP and IUGR and Group 5: 30 volunteers who were normotensive and non-preeclamptic. We obtained both blood and urine samples for measuring nephrin levels. RESULTS: Both serum and urine nephrin levels were significantly higher for the fourth group compared with all other groups (p<0.001). The levels of SP group with NFD were measured considerably higher than MP group out of IUGR and control group (p<0.001). Urine and serum nephrin levels with gestational age of delivery showed a negative correlation (r=-0.621, p<0.001) and also urine and serum nephrin levels with birth weight showed a negative correlation too (r=-0.655 p<0.001). CONCLUSION: Both serum and urine nephrin levels correlated with the severity of preeclampsia and IUGR development.

Assessment of Macular Peripapillary Nerve Fiber Layer and Choroidal Thickness Changes in Pregnant Women with Gestational Diabetes Mellitus, Healthy Pregnant Women, and Healthy Non-Pregnant Women.

BACKGROUND: Gestational diabetes mellitus (GDM) is a risk factor for the development of type II diabetes and it causes maternal and child morbidity. Screening for diabetic retinopathy (DR) is important because patients who develop DR have no symptoms until macular edema and/or proliferative diabetic retinopathy (PDR) are already present. The aim of this study was to determine the early retinal findings of GDM. MATERIAL AND METHODS: This study was conducted in a tertiary research center. We conducted a prospective cross-sectional study with 3 groups: Group 1 consisted of 36 pregnant women with GDM, Group 2 consisted of 24 healthy pregnant women, and Group 3 consisted of 38 healthy non-pregnant women of reproductive age. Spectralis optical coherence tomography (OCT) was used for the assessment. Macular, choroid, and retinal nerve fiber layer (RNFL) thicknesses were evaluated in patients with GDM and comparisons were made among pregnant women with GDM, healthy pregnant women, and healthy non-pregnant women for these parameters. RESULTS: The nasal part of the RNFL was significantly thinner in the GDM group than in the healthy pregnant group. None of the patients had retinopathy or macular edema at the time of examination. CONCLUSIONS: Decreased nasal part of RNFL thickness may be the first retinal change in patients with GDM. Our study suggests that OCT should be performed for the patients with GDM for detection of early retinal changes associated with GDM.

Effect of paracetamol, dexketoprofen trometamol, lidocaine spray, pethidine & diclofenac sodium application for pain relief during fractional curettage: A randomized controlled trial.

BACKGROUND & OBJECTIVES: Patients frequently experience pain of moderate to severe degree during gynaecologic procedures. This prospective, randomized, placebo-controlled trial was aimed to investigate the analgesic efficacy of preoperative oral dexketoprofen trometamol, intravenous paracetamol, lidocaine spray, pethidine and diclofenac sodium on fractional curettage procedure. METHODS: A total of 144 multiparous women were randomly allocated to one of the six groups. The first group (control group) consisted of 22 participants and they did not receive any treatment. The second group had 26 participants receiving oral 25 mg dexketoprofen trometamol. The 23 participants of the third group received two puff lidocaine sprays on cervical mucosa. t0 he forth group consisted of 25 participants receiving 100 mg pethidine. In the fifth group, the 23 participants received 1000 mg intravenous paracetamol and the sixth group consisted of 25 participants receiving diclofenac sodium. RESULTS: Pethidine was the best choice for reducing pain score during curettage procedure (t2:intra-operative). All analgesic procedures were significantly effective in reducing pain during postoperative period (t3). Significant pain reduction was achieved for both intra- and postoperative period by using analgesics. INTERPRETATION & CONCLUSIONS: The results of our study showed that lidocaine puffs provided the best pain relief than the other analgesics used. Therefore, lidocaine may be considered as the first choice analgesic in fractional curettage (NCT ID: 01993589).

The effect of isotretinoin on ovarian reserve based on hormonal parameters, ovarian volume, and antral follicle count in women with acne.

UNLABELLED: BACKGROUD/AIMS: Widely prescribed in routine practice, isotretinoin has an unknown impact on ovarian reserve. With a long history in acne treatment and numerous potential side effects, it is surprising that very few prospective studies have investigated its effect on ovarian reserve. Therefore, we aimed to evaluate the impact of oral isotretinoin on ovarian reserve based on hormonal parameters, anti-Müllerian hormone (AMH), ovarian volume (OV), and antral follicle count (AFC) in women of reproductive age with acne. METHODS: Our study group consisted of 82 women of reproductive age with acne who were treated with oral isotretinoin. The patients were evaluated for ovarian reserve prior to therapy and reevaluated 6 months after isotretinoin treatment with regard to hormonal parameters, AMH, OV, and AFC. RESULTS: Significant differences were found between the pre- and posttreatment period for AMH [2.20 ng/ml (25th-75th percentile 1.14-4.07) vs. 1.31 ng/ml (0.32-2.28)], total AFC [16 (14-18.25) vs. 12.5 (10-15)], and total OV [23 ml (18-29) vs. 15 ml (13-18); p < 0.001]. CONCLUSION: Our study is the first to analyze the levels of serum AMH, AFC, and OV together in patients treated with oral isotretinoin for acne. The results of our study demonstrated that oral isotretinoin had a significant negative effect on ovarian reserve.

Influence of maternal body mass index on sonographic fetal weight estimation prior to scheduled delivery.

AIM: To investigate the possible effect of maternal obesity on the accuracy of sonographically estimated fetal weight in the third-trimester shortly before induction of labor and to compare the accuracy of the estimation between normal weight, overweight, and class I, class II and class III obese groups. METHODS: This was a prospective study of singleton pregnancies with sonographic fetal weight estimation prior to scheduled delivery. Women were classified according to current body mass index (BMI) into five categories: normal (BMI 18.5-24.9 kg/m(2), n = 41), overweight (BMI 25.0-29.9 kg/m(2), n = 44), obese class I (BMI 30.0-34.9 kg/m(2), n = 40), obese class II (BMI, 35.0-39.9 kg/m(2), n = 38) and obese class III (BMI ≥ 40.0 kg/m(2), n = 35). The estimated fetal weight was compared with the actual birthweight, and the difference between them was recorded as the error. RESULTS: Mean absolute error of sonographic fetal weight estimation was 106.97 ± 80.83 g, 198.88 ± 124.32 g, 248.82 ± 122.75 g, 308.31 ± 138.97 g and 446.00 ± 151.46 g in the normal, overweight, obese class I, obese class II, and obese class III groups, respectively (P < 0.001). The corresponding mean absolute percentage errors were 3.51 ± 2.76, 6.37 ± 3.91, 7.93 ± 4.81, 9.87 ± 4.32 and 14.06 ± 5.83 (P < 0.001). CONCLUSIONS: Maternal obesity decreases the accuracy of sonographic fetal weight estimation. Clinicians should be aware of the limitations of sonographic fetal weight estimation, especially in obese patients.

Screening occult anal sphincter injuries in primigravid women after vaginal delivery with transperineal use of vaginal probe: a prospective, randomized controlled trial.

PURPOSE: Here we aimed to evaluate the incidence of obstetric anal sphincter injuries in spontaneous primigravid deliveries with mediolateral episiotomy beyond 36 gestational weeks. METHODS: We performed a prospective, randomized controlled study including 201 primigravid women that delivered vaginally. Anal sphincter anatomy and integrity was evaluated before hospital discharge in all cases with transvaginal sonography (5-9 MHz) (Siemens Sonoline G50 and Voluson 730 Expert). The vaginal ultrasound probe is placed in the fourchette of the vaginal introitus to obtain the transverse section of the anal sphincter. RESULTS: In the cases with sphincter defect, mean gestational week and second stage of labor were prolonged significantly (p = 0.039 and p < 0.0001, respectively). The mean perineal body distance in cases with sphincter injury, as detected by sonography, 2.18 ± 0.33 cm, is compared to 2.31 ± 2.43 cm in cases without injury. There was a significant difference between the two groups (p = 0.0142). Shoulder dystocia was significantly higher in cases with sphincter injury, compared to cases without injury (p = 0.011). No clinical findings were reported in 11.5 % of cases (Sonography findings 1A∓, 1B∓) and 3.5 % of cases had clinical and sonographic findings (Sonography findings 2A∓, 2B∓). "Occult tears" were considered as those cases not detected clinically, but detected by sonography (11.5 % of all cases). Two months after examination, a moderate incontinence (Wexner continence scale) was found in 71.5 % of cases with overt sphincter tear, which was significantly different to the non-overt sphincter tear group. Multiple logistic regression analyses for sphincter injuries identified prolonged second stage of labor and shoulder dystocia as two independent risk factors. CONCLUSION: Here, we found that only a portion of anal sphincter injuries can be detected after physical examination, with many of cases of "occult tears" escaping notice. These cases of occult anal sphincter injury are detectable by sonography with transperineal use of a vaginal probe. Based on these findings, we propose that this technique is convenient for obstetric, gynecologic and proctologic evaluation of sphincter anatomy.

The effect of impaired 50-gram oral glucose challenge test on fetal abdominal wall thickness.

BACKGROUND: Patients with impaired 50-g oral glucose challenge test (OGCT) have not been investigated for fetal anterior abdominal wall thickness until now. We aimed to investigate patients with impaired 50-g OGCT, but not gestational diabetes and match them with healthy uneventful pregnant participants for anterior abdominal wall thickness, estimated fetal weight, fetal gender, biparietal diameter, femur length and abdominal circumference. METHODS: A total of 99 pregnant women between 26 and 28 weeks of gestation were enrolled in the study. These patients were divided into two groups according to their 50-g OGCT results. Fifty-one pregnant women with uncomplicated healthy singleton pregnancies constituted our control group, and 48 singleton pregnant women with impaired 50-g OGCT but normal 100-g oral glucose tolerance test constituted our study group. RESULTS: We detected statistically significant high body mass index in impaired 50-g glucose test group. Biparietal diameter, femur length, abdominal circumference and estimated fetal weight values were not significantly different between groups; however, anterior abdominal wall thickness value was significantly width in impaired 50-g glucose test group. Moreover, there were no statistically significant differences between two groups for gender of fetuses. CONCLUSION: Impaired 50-g glucose test in pregnancy is related not only to increased maternal body mass index but also to fetal fat distribution. Although fetal abdominal circumference measurement and estimated fetal weight were not different between study and control group, increased anterior abdominal wall thickness can be detected in impaired 50-g OGCT group.

Genotoxicity evaluation of HMG CoA reductase inhibitor rosuvastatin.

The genotoxic potential of rosuvastatin as one of the statin drugs was assessed by chromosomal aberrations (CAs), micronucleus (MN) and DNA damage by comet assay in the human peripheral blood lymphocytes. Rosuvastatin was used at concentrations of 0.0625, 0.125, 0.25, 0.5 and 1 µg/mL for these in vitro assays. In all assays, a negative and positive control were also included. CA frequencies were significantly increased in all concentrations at 24 hours and significantly increased in all concentrations except 0.0625 µg/mL at 48 hours, compared to the negative control. Rosuvastatin has a decreased mitotic index (MI) at 0.5- and 1-µg/mL concentrations at 24 hours and at 0.25, 0.5 and 1 µg/mL at 48 hours. A significant increase was observed for induction of MN in all treatments, compared to the negative control. Cytokinesis-block proliferation indices were not affected by treatments with rosuvastatin. In the comet assay, significant increases in comet tail length and tail moment were observed at 0.0625-, 0.5- and 1-µg/mL concentrations. Comet intensity was significantly increased in all concentrations except 0.0625 µg/mL. According to these results, rosuvastatin is cytotoxic and clastogenic/aneugenic in human peripheral lymphocytes. Further studies should be conducted in other test systems to evaluate the full genotoxic potential of rosuvastatin.

Assessment of the genotoxic effects of organophosphorus insecticides phorate and trichlorfon in human lymphocytes.

In vitro genotoxic effects of organophosphorus insecticides Phorate (PHR) and Trichlorfon (TCF) were investigated using four genotoxicity endpoints. Different concentration ranges between 0.25-2.00 µg mL(-1) of PHR and 2.34-37.50 µg mL(-1) of TCF were applied to lymphocytes. PHR and TCF significantly increased the frequency of chromosomal aberrations (except 2.34 µg mL(-1) for TCF) and sister chromatid exchanges at all treatment times and concentrations. Most of the used concentrations induced a significant increase in the frequency of micronuclei. Furthermore, PHR and TCF significantly decreased the mitotic index at the higher concentrations after 24- and 48-h treatments. In the comet assay, PHR and TCF significantly increased the comet tail at all concentrations. However, the comet tail intensity was significantly increased at only the highest concentration of PHR and at all concentrations of TCF. According to these results, PHR and TCF possess clastogenic, mutagenic, and DNA damaging effects in human lymphocytes in vitro.

Evaluation of the macula, retinal nerve fiber layer and choroid thickness in postmenopausal women and reproductive-age women using spectral-domain optical coherence tomography.

OBJECTIVE: Menopause is a physiological life period that potentially affects various organs and systems. Therefore, a wide spectrum of signs and symptoms of eyes may be clinically observed in the postmenopausal period. AIM OF THE STUDY: To evaluate the macular, retinal nerve fiber layer (RNFL) and choroidal thickness alterations by using spectral-domain optical coherence tomography (SD-OCT) in postmenopausal women and compare with healthy reproductive-age women controls. MATERIAL AND METHODS: The study population included a healthy reproductive-age control group (n = 72) and postmenopausal study group (n = 72). Retinal thickness parameters were measured by SD-OCT. Peripapillary RNFL thickness parameters, macular thickness and choroidal thickness were evaluated. RESULTS: Superior inner macula, temporal inner macula, inferior inner macula, nasal inner macula, inferior outer macula and choroid thickness were significantly thinner in the postmenopausal study group than the healthy reproductive-age control group (p = 0.007, p = 0.037, p = 0.027, p = 0.006, p = 0.016, p < 0.001, respectively). After adjusting for age, only choroid thickness was significantly thinner in the postmenopausal study group than controls (p (†) = 0.005). CONCLUSIONS: This study revealed that choroidal thickness measured by SD-OCT was significantly thinner in postmenopausal women than healthy reproductive-age women. We can speculate that the decrease in choroidal thickness in postmenopausal women may indicate a reduced estrogen-dependent vasodilatory effect in ophthalmic artery secondary to menopausal estrogen deficiency.

Can ratio of blood/curettage material HCG be used as a reliable method for differentiating miscarriage and ectopic pregnancy?

UNLABELLED: Objective : There is an increasing rate of ectopic pregnancy with the use of assisted reproductive techniques. There is currently no serum test to differentiate ectopic pregnancy from miscarriage. Early and accurate detection of ectopic pregnancy may prevent the development of complications. The aim of this study was whether the ratio of serum/curettage material hCG could provide us with reliable and early diagnosis in distinguishing miscarriage and ectopic pregnancies and also to measure the diagnostic accuracy rate of this method. METHODS: A total of 24 patients were evaluated. Twelve of them were diagnosed as an ectopic pregnancy and 12 of them were diagnosed as a miscarriage. All the patients' diagnoses were confirmed pathologically. Non-of the patient had viable fetus. All participants underwent curettage protocol. Serum and curettage material were obtained at the same time. HCG measurements were done from blood and curettage material. RESULTS: Ratio of Blood/Curettage Material HCG provides fast and reliable results within a few hours with 91.7% accuracy rates. CONCLUSION: Ratio of blood/curettage material HCG can be used as a reliable method for differentiating ectopic pregnancy and miscarriage.

The Awareness and Attitude of Physicians to Older Adult Routine Vaccination Scheme.

Purpose: Immunization is one of the main components of preventive medicine measures. Influenza, pneumococcal, tetanus, and shingles vaccines are recommended for older adults routinely. This study aimed to show the knowledge and attitudes of the physicians to older adults' vaccination schemes. Patients and Methods: An electronic self-reported questionnaire was sent to physicians between March and July 2021 in Turkey. Sociodemographic characteristics, professional experience, area of expertise, and practice setting of the participants were recorded. As multiple-choice questions; the routinely recommended vaccines, and vaccines suggested in their daily practice before and after the COVID-19 pandemic were enquired. Results: A total of 435 participants were included in the study. 43.9% of the patients were primary family physicians, and 36.8% were internists. 63.4% of the participants had reported reviewing the National Vaccination Scheme. 94.5% of the medical doctors indicated that they had recommended any vaccination to their patients. 20.9% of the practitioners could select four or five of the routinely recommended vaccines. Reviewing the National Adult Vaccination Scheme and being an internist were positively related to predicting the recommended vaccines. The recommendation rates of influenza and pneumococcal conjugate (PCV13) were seen at 88% and 78%, respectively. Except for PCV13, recommendation rates of other routine vaccines were decreased after the pandemic. Conclusion: Awareness of routine vaccination schedules should be improved among health-care professionals, and reminders for immunization should be provided periodically in each health-care setting.

Evaluation of the hypertensive patients in southeastern Anatolia; demographic features and target organ damage.

We investigated the socio-demographic characteristics, blood and pulse pressure, and end organ damage of hypertensive patients applying to an outpatient cardiology clinic in southeastern Anatolia. End organ damage in 100 consecutive hypertensive patients was defined by left ventricular hypertrophy, retinopathy, and albuminuria. The determined independent risk factors of left ventricular hypertrophy were advanced age and low educational level; of nephropathy were high pulse pressure and unawareness of the name of anti-hypertensive drug; and for retinopathy were high pulse pressure and female gender. In order to prevent end organ damage, the most important aspect to focus on is patient training and pulse pressure.