Ta grade 3/high grade non-invasive bladder cancer: Should we perform a second TUR?

PURPOSE: To evaluate the effect of second transurethral resection (TUR) on oncological outcomes, according to the presence or absence of detrusor muscle in the initial TUR of patients with pTa Grade 3/high grade (G3/HG) tumours, who received at least 1 year of maintenance Bacillus Calmette-Guerin (BCG) therapy. PATIENTS AND METHODS: In this retrospective study, we evaluated the effect of second TUR on oncological outcomes of 93 patients with pTa G3/HG tumours, according to the presence or absence of muscle in the initial TUR. All patients received maintenance BCG therapy according to the SWOG protocol. RESULTS: Median follow-up was 36 months. If muscle is present in the initial TUR, a second TUR significantly increased median time to first recurrence, compared to those without a second TUR (77.6 vs 36.9 mos, P = .0086). If muscle is missing in the initial TUR, a second TUR significantly decreased recurrence rate (20% vs 66.7%, P = .002), increased median time to first recurrence (78.9 vs 42.7 mos, P = .0001) and median time to progression (22 vs 7 mos, P = .05), compared to those without a second TUR. CONCLUSION: In patients with pTa G3/HG tumours, if the muscle is missing in the initial TUR, a second TUR should be performed in order to attain lower recurrence rates and longer median time to recurrence and progression. If the muscle is present in the initial TUR, a second TUR will only increase median time to first recurrence.

Two-Year Survival of High-Viscosity Glass Ionomer in Children with Molar Incisor Hypomineralization.

OBJECTIVE: We assessed the clinical survival of a high-viscosity glass ionomer (HVGI) at the 2-year follow-up to restore molar incisors severely affected by hypomineralization after selective carious tissue removal (SCR). The null hypothesis tested was that there are no differences in the overall survival times in the categories of the variables of interest. METHODS: A total of 134 fully erupted first molar incisors with hypomineralization, cavitated and with moderate-to-deep carious lesions without hypersensitivity or pain (MIH treatment need index 2a-c), were included in the study. HVGI (Equia Forte®; GC, Tokyo, Japan) restorations were applied after SCR to soft carious dentin. The follow-up lasted 2 years. The end point was defined as the absence of endodontic and restorative complications. Two-year, and 18-, 12-, and 6-month survival probabilities and standard errors were calculated using the Kaplan-Meier method. Survival probabilities according to patient gender, jaw, and lesion severity groups were compared using the log-rank test. Restorations were evaluated using the modified US Public Health Service criteria. RESULTS: HVGI restorations showed cumulative survival probabilities of 95.5% at 6 months, 94% at 12 months, 87.5% at 18 months, and 87.5% at 24 months. Survival probabilities according to patient gender, jaw, and lesion severity groups were not statistically significantly different (p > 0.05). Therefore, the null hypothesis was accepted. CONCLUSION: Following SCR, HVGI restoration provided moderate survival probabilities, suggesting that the SCR technique is effective.

The impact of omalizumab on quality of life and its predictors in patients with chronic spontaneous urticaria: Real-life data.

BACKGROUND: Omalizumab is a third-line treatment for chronic spontaneous urticaria (CSU). However, the real-life data on the impact of omalizumab on CSU-related quality of life (QoL) remain scarce. OBJECTIVES: To investigate the impact of omalizumab on QoL and its predictors in CSU. A retrospective cohort study was done. The response to therapy was evaluated using urticaria activity score over 7 days (UAS7) and urticaria control test (UCT); the impairment in QoL was assessed using dermatology life quality index (DLQI) and chronic urticaria quality of life questionnaire (CU-Q2oL). RESULTS: Forty-two patients were included. All scores improved from baseline to first month and remained stable at the third month of treatment (p < .001). The gender, age, and angioedema had no significant effect on QoL, but the complete responders (UAS7:0-1) had better improvement rates in all scores compared to others. The baseline UAS7, DLQI, and CU-Q2oL scores were lower at the baseline in complete responders (p = .0001). CONCLUSIONS: A rapid and continual improvement in QoL was obtained with omalizumab treatment. A better UAS7, UCT, DLQI, and CU-Q2oL score at the baseline might be a predictor of a better response to omalizumab and more improvement in QoL.

Pathologic Outcomes of Candidates for Active Surveillance Undergoing Radical Prostatectomy: Results from a Contemporary Turkish Patient Cohort.

INTRODUCTION: To evaluate the pathological outcomes of Turkish men meeting the criteria for Active Surveillance (AS), who elected to undergo immediate radical prostatectomy (RP). MATERIAL AND METHODS: Retrospective analysis including 1,212 patients with clinically localized prostate cancer (PCa) who met the eligibility criteria for AS. The primary outcomes were pathological upstaging and pathological upgrading. RESULTS: Nine hundred ninety-one patients were eligible for analysis after the central review of the submitted data. The mean prostate-specific antigen (PSA) level was 6.89 (0.51-15) ng/mL and the mean biopsy core number was 12 (8-47). The mean tumor positive core on final biopsy pathology was 1.95 (1-6) (16.6% [2.1-33.3%]). Overall, 30.6% of the men experienced a Gleason sum (GS) upgrade and 13.2% had pathological upstaging. For GS upgrade, the percentage of tumor-positive cores and free-to-total-PSA ratio were significant both in univariate analysis and multivariate logistic regression analysis. Variables predicting pathological upstaging were percentage of tumor-positive cores and PSA density, which were significant in univariate analysis. However, only PSA density was significant in multivariate logistic regression. Although biochemical recurrence-free survival was longer in patients without GS upgrade, it was not statistically significant between patients with and without any GS upgrade (mean 133.7 vs. 148.2 months, p = 0.243). A similar observation was made for patients with or without pathological upstaging (mean 117.1 vs. 148.3 months, p = 0.190). CONCLUSIONS: Upgrading and upstaging at RP are quite common among Turkish men with clinically low-risk PCa, who are candidates for AS, and a great majority of them experienced long-term PSA control.

Development and validation of a semi-quantitative food frequency questionnaire to assess dietary intake in Turkish adults.

OBJECTIVE: To validate the original food frequency questionnaire in Turkish adult population. METHODS: The cross-sectional study was conducted in June and December 2008 and 2009, and comprised adults of either gender aged 30-70 years. All subjects were Caucasians and were native Turkish speakers. The food frequency questionnaire containing 229 most frequently consumed foods under 7 topics was used for data collection. It was completed twice and the 24-hour dietary recall four times in a year. In order to assess the validity of the questionnaire, Pearson correlation, attenuation coefficient, measures of agreement between the two methods, weighted kappa statistics and Bland-Altman plots were employed. SPSS 16 was used for statistical analysis. RESULTS: Of the 120 subjects in the study, 71(59%) were males and 49(41%) were females with an overall mean age of 50.16±9.76 years. The correlation of estimated nutrient intake between the food frequency questionnaire and 24-hour dietary recall varied between 0.200 and 0.468, energy-adjusted regression was between 0.044 and 0.611 and attenuation coefficients of regression were between 0.339 and 0.658 for the selected macro and micro nutrients. Bland-Altman plots showed an acceptable agreement between the two methods. When nutrient intake was categorised in quartiles, proportions of the same or adjacent quartiles were 98.3%, 98.4%, 98.3%, 96.7% and 95% for energy, fat, protein, carbohydrates and fibre, respectively. CONCLUSIONS: The first food frequency questionnaire developed in Turkish language was an adequate and valid tool to assess the nutritional habits of the local population.

Application of Rasch analysis to Turkish version of ECOS-16 questionnaire.

The aim of this study is to reevaluate validity of Turkish version of the ECOS-16 questionnaire by using Rasch analysis in post-menopausal women with osteoporosis. ECOS-16 (Assessment of health related quality of life in osteoporosis) is a quality of life questionnaire, which is convenient for measuring the quality of life of post-menopausal women with osteoporosis. 132 post-menopausal women with osteoporosis who attended Uludag Universtity, Atatürk Rehabilitation and Research Center between January 2010 and March 2011 were included in this study. The subjects filled out Turkish version of ECOS-16 questionnaire by themselves. The Rasch model was used for assessing construct validity of ECOS-16 data. Internal consistency was assessed by Cronbach's alpha coefficient. The mean infit and outfit mean square (z std) were found as 1.08 (0.1) and 1.02 (-0.1), respectively. The separation indices for the item and person were found as 7.72 and 3.13; the separation reliabilities were 0.98 and 0.91, respectively. Cronbach's alpha coefficient was found as 0.90. The construct validity of ECOS-16 questionnaire was assessed by Rasch analysis.

Clinical performance of short fiber reinforced composite and glass hybrid on hypomineralized molars: A 36-month randomized split-mouth study.

OBJECTIVES: This study aimed to assess the clinical performance outcome at 36 months of molars with molar incisor hypomineralization and carious lesions, treated with two different restorative approaches following selective caries removal. METHODS: The children aged 6 to 12 years (18 female, 13 male) included in the study had at least two carious permanent first molars diagnosed with molar incisor hypomineralization. Sixty-two molars were restored in a split-mouth design. In all subjects, selective caries removal was performed so that caries was completely removed from the cavosurface walls and only soft dentin was left above the pulp chamber. Short fiber reinforced composite (SFRC; EverX Flow™) covered by micro-hybrid composite (G-Aenial® posterior composite) and Glass Hybrid (GH; Equia Forte® HT) were used as restorative materials. The restorations were evaluated according to modified United States Public Health Service (USPHS) criteria at baseline, 6, 12, 18, 24, and 36 month follow-ups. RESULTS: During the 36-month follow-up, eight GH and four SFRC restorations failed. The clinical success of both restorations decreased statistically over time (p < 0.001 for both). When variables such as restoration type, sex, age, tooth type, and time were included in the model, the risk of failure of the restorations of the left lower first molar was statistically significantly higher than that of the left upper first molar (p < 0.002). CONCLUSION: Direct composite restorations with SFRC and GH restorations perform similar clinical success with selective caries removal in the management of permanent molars affected by molar incisor hypomineralization. CLINICAL SIGNIFICANCE: SFRC or GH restorations with similar clinical success might be preferred for the management of MIH-affected molars.

Prognostic implication of serum vascular endothelial growth factor in advanced hepatocellular carcinoma staging.

BACKGROUND: Staging systems have considerable impact on hepatocellular carcinoma (HCC) treatment approaches and outcomes. There is an unmet need to improve their stratification ability. We have evaluated four commonly used staging systems and assessed whether angiogenic biomarker vascular endothelial growth factor (VEGF) could improve their prognostic stratification. MATERIAL AND METHODS: Four staging systems; Okuda, Cancer of the Liver Italian Program (CLIP), Barcelona Clinic Liver Cancer (BCLC), and Child-Pugh were evaluated in 78 HCC patients; their stratification abilities were detected by Kaplan-Meier curves and log-rank test; their accuracies of predicting survival were compared with the concordance index. Serum VEGF levels were measured using ELISA method. Recursive partitioning was used to determine the optimal VEGF cutoff. The prognostic significance of VEGF cutoff and other parameters were analyzed using univariate and multivariate models. RESULTS: None of the staging systems demonstrated better discriminatory ability in predicting survival. The four staging systems did not reveal significant differences in probability of survival across their intermediate-advanced stages. Optimal cutoff identified for VEGF was 445 pg/mL. In advanced HCC, VEGF level (p = 0.004) and in early HCC, bilirubin level (p = 0.009) were identified as the independent prognostic factors. Survival comparison with high and low VEGF levels was significant for advanced HCC, while insignificant for early disease. CONCLUSION: Staging systems with conventional parameters did not provide good prognostic stratification for survival in advanced HCC population. Serum VEGF level was an independent predictor of survival in advanced HCC, and provided more survival homogeneity within the advanced stages of conventional staging systems.

Effectiveness of the "pain-free dental injection" (PaFein) teaching model in reducing children's pain: A randomized, controlled study.

PURPOSE: This study explores the effectiveness of a comprehensive structured teaching model - the "PaFein" - for instructing postgraduate pediatric dental residents in the provision of pain-free local anesthesia to children. METHODS: Ten postgraduate pediatric dental residents and 172 children between the ages 5 and 13 participated in the study following ethical approval. The previously measured baselines guided the randomization of study and control groups. The study group (five residents) attended the PaFein course (9 hours). Based on power calculations, residents performed dental injections (8 mandibular block, 8 palatal/lingual and 14 buccal infiltrations) in randomly assigned child patients. Demographic data of residents/children, parental and self-report anxiety scores and Visual Analogue Scale (VAS) pain scores were noted to examine children's anxiety and pain during dental injections. RESULTS: Children's mean anxiety score did not differ significantly between groups; however, VAS pain reports during dental injections (a, b, c, d) were found lower in the PaFein study group than the control group (p < 0.05). VAS pain reports for (a) buccal injections were 1.08 and 1.9 (p = 0.02); (b) inferior alveolar nerve blocks were 1.58 and 3.37 (p = 0.0002); (c) palatal/lingual injections were 1.34 and 3.02 (p < 0.0001); (d) total means were 1.28 and 2.59, respectively (p = 0.0001). VAS pain reports of anxious and non-anxious children in the PaFein study group (1.63 and 1.17) were also lower than the control group (3.33 and 2.39) (p < 0.0001 and p = 0.005). CONCLUSION: The "PaFein" teaching model was found to be effective in training dental residents to reduce dental injection pain in children, including the anxious ones.

Sleep assessment in preterm infants: Use of actigraphy and aEEG.

OBJECTIVE: Objective methods to monitor the sleep of preterm infants at the neonatal intensive care unit (NICU) are required to prevent potentially adverse neurodevelopmental outcomes. This study aimed to determine the concordance of actigraphy and amplitude-integrated electroencephalogram (aEEG) against gold standard direct observation (DO) in assessing sleep/wake states of typically developing preterm infants. METHODS: This prospective observational study was conducted in a single center level III NICU. Sleep variables were measured using Philips Respironics Mini-Mitter® Actiwatch-2 for 24 h and compared with 8-h matched data of aEEG and DO. Sensitivity-specificity analysis, Cohen's kappa, prevalence-adjusted and bias-adjusted kappa (PABAK), and Bland Altman plots were generated. RESULTS: Seventeen preterm infants were recruited. A total of 11252 epochs were studied. Sensitivity (86.4%), agreement rate (67.9%), and predictive value for wake (47.9%) for the actigraphy were highest at the automatic activity threshold whereas specificity (54.5%) and predictive value for sleep (75.5%) were highest at low threshold. The sensitivity of aEEG was 79.3% and the specificity was 54.3%. At all thresholds, the agreement was largely equivalent with low kappas (0.14-0.17) and PABAK coefficients (0.22-0.35) for actigraphy and DO. Moderate agreement was observed between aEEG and DO according to the PABAK coefficient (0.44). Mean differences in sleep parameters were not different between DO and aEEG as well as DO/aEEG and actigraphy at medium threshold (p > 0.05). CONCLUSIONS: Actigraphy at medium threshold can be used in depicting sleep in typically developing preterm infants at NICU. aEEG may be an alternative adjunctive method to actigraphy for the evaluation of sleep/wake states in the NICU setting. CLINICAL TRIAL REGISTRATION NUMBER: NCT04145362.

Relation between eating habits and a high body mass index among freshman students: a cross-sectional study.

OBJECTIVES: This study aimed to examine the relation between eating habits and a high body mass index (BMI) in first-year freshman university students and included 2525 freshman university students 18 to 22 years old from a Turkish population. METHODS: In this study, 48% of the students were men. They were asked to complete a questionnaire on their dietary habits including the frequency of their consumption of individual food items, demographic data, and smoking habit. RESULTS: The effects of eating habits on increased BMI (≥25) were analyzed. Of 2259 subjects included in the analyses, 322 were overweight or obese and 1937 had normal and thin BMI (<25). Multivariate analyses identified male gender, recent weight change, and high number of meals as independent predictors of obesity/overweight. Frequent consumptions of beer, alcoholic drinks other than beer and wine (e.g., spirits including whisky, gin, raki, vodka), coffee, tea, coke, red meat, variety meat, and eggs were associated with a significantly higher risk of obesity/overweight, whereas frequent consumption of snacks was associated with a low risk. CONCLUSIONS: Findings of further studies, possibly taking into consideration the absolute quantities of consumption along with cultural and local issues, would guide the adoption of healthier feeding behaviors in this particular age group.

Caries experience and oral hygiene status of a group of visually impaired children in Istanbul, Turkey.

PURPOSE: To evaluate the caries experience, oral hygiene status and oral health knowledge of a group of visually impaired students. MATERIALS AND METHODS: The study was conducted at one of the largest visually impaired children's schools among students aged between 7 and 16 years (n = 178) in Istanbul, Turkey. A 16-item questionnaire was asked in addition to a clinical tooth examination. The 16-item verbal questionnaire was developed to record the students' general health, impairment, the socioeconomic profile and education level of their parents, oral health knowledge, sources of information about oral health and oral hygiene habits. Oral hygiene was assessed according to Greene and Vermillion's Simplified Oral Hygiene Index (OHI-S). To measure the oral hygiene status, OHI-S index scores were recorded. Additionally, DMFT and dft indices were documented. RESULTS: Only 26.40% of children were caries free, and only 2.2% of students had good oral hygiene. A total of 3.3% of these students were mildly retarded and 2.8% of them had a developmental disability. Visually impaired children exhibited a fair-to-poor level of oral hygiene. CONCLUSION: Maintenance of oral hygiene remains the greatest challenge in the care of visually impaired children.

Pectus cross bars increase hospital readmission rates due to serous pleural effusion.

OBJECTIVE: Pectus Excavatum's (PE) surgical treatment should be patient specific. In this article, we aimed to compare parallel and cross bar variations of the Nuss method and analyze if there is any difference in results. METHODS: In this study, a total of 891 patients treated with the Nuss method between August 2005 and February 2018 were considered. These were retrieved from a prospectively recorded PE database. Of these, 276 double-bar patients were included in the study. Patients with parallel bars (225 cases) and patients with crossed bars (51 cases) were compared in terms of age, gender, symmetry, family history, additional anomalies, mean operation time, postoperative hospital stay (days) and hospital readmission rate. RESULTS: The mean age was measured at 20.7 for parallel bar patients and 20.1 for crossed bars patients. There was no statistically significant difference in terms of age, gender, and mean operation time between two groups. On the other hand, statistical significance was found between two groups when analyzing the deformities' symmetry, patients' family history and additional anomalies. The statistically significant difference of postoperative hospital stay between two groups is clinically negligible. Postoperative hospital readmission rates due to serous pleural effusion were found to be significantly increased in patients with crossed bars (p < 0.001). CONCLUSION: While pleural effusion requiring readmission was statistically more frequent in cross bars, in centers where thoracentesis can be managed, Nuss method can still be applied safely, even in cases with difficult, complex deformities. LEVEL OF EVIDENCE: III. Treatment study.

Effect of casein phosphopeptide amorphous calcium fluoride phosphate and calcium glycerophosphate on incisors with molar-incisor hypomineralization: A cross-over, randomized clinical trial.

BACKGROUND: Within the scope of minimally invasive dentistry, the use of different biocompatible remineralization agents on incisors affected by molar-incisor hypomineralization (MIH) gains importance. OBJECTIVE: To evaluate the effect of casein phosphopeptide amorphous calcium fluoride phosphate (CPP-ACFP) and calcium glycerophosphate (CaGP) in mineral density (MD) of white/creamy and yellow/brown demarcated opacities on incisors affected by MIH by means laser fluorescence (LF). METHODS: As a cross-over, randomized trial, twenty-two children with 167 incisors affected by MIH were recruited and randomly assigned to one of the two different agents and crossed over to other agents with two weeks washout in between. Incisors were examined by using LF at all before and after three months periods. RESULTS: The results of the paired t-tests for determining the period effect between the baseline findings showed significant difference in white/creamy and yellow/brown demarcated opacities of LF values for both groups (p < 0.05). The difference between both groups according to after categorization of 20% increasing in MD in the percent of change before and after application on LF values; was not found statistically significant in white/creamy (p = 0.970) and yellow/brown (p = 0.948) opacities. CONCLUSIONS: The primary outcome was CPP-ACFP and CaGP had a positive effect in decreasing hypomineralization on MIH-affected enamel for three months period.

Investigating the Level of Knowledge of the Community about Oral and Dental Health.

OBJECTIVES: This study aimed to determine the knowledge and approaches of the participants about oral and dental health. MATERIALS AND METHODS: This was a questionnaire-based cross-sectional survey. Participants' demographic characteristics, tooth brushing habits, selection of toothpaste, and reasons for visiting the dentist were examined in this study. Participants' knowledge levels of fluoride and their attitudes toward the most common fluoride applications among preventive treatments were also evaluated. Data entry and analyses were performed using SPSS statistical software. Descriptive and inferential statistics and chi-square test were used for analyzes. RESULTS: A total of 2,744 voluntary participants including 1,938 (70.6%) females and 806 (29.4%) males responded; 1,391 (50.7%) participants know the contents of their toothpaste; 1,680 (61.2%) participants point out that fluoride is effective in preventing dental caries. Female participants reported a statistically significant difference in their knowledge of what is fluoride when compared with male participants (p = 0.0001). The knowledge level of participants who had higher levels of education were statistically significantly different when compared with the participants who had lower education levels about fluoride and fluoride applications (p = 0.0001). CONCLUSIONS: The results of this study indicate that participants' attitudes toward oral health and dental care need to be improved.

Seasonal variation of C-reactive protein and atherosclerotic cardiovascular events in hemodialysis patients.

BACKGROUND: Atherosclerotic cardiovascular diseases (ACVD) is the most common cause of mortality in hemodialysis (HD) patients and the annual mortality in this population is about 10%. Inflammation is one of the most important predictor of ACVD morbidity and mortality in these patients. Recent studies demonstrated that levels of inflammatory markers and ACVD mortality vary seasonally in healthy population and in high-cardiac-risk populations. In this retrospective analysis, we aimed to determine seasonal variation of inflammation and ACVD morbidity and mortality in HD patients. MATERIAL AND METHODS: Data were retrieved retrospectively for 1 year. Patients with acute or chronic infections or inflammatory conditions were excluded from the analysis. Laboratory data and ACVD-related events were retrieved from patients' files and these data were classified into seasonal periods. RESULTS: Sixty-two patients were included in the final analysis. During follow-up period, geometric means of serum hsCRP levels were similar in all of the seasonal periods (4.17, 4.17, 4.57, and 4.17 mg/L in winter, spring, summer, and autumn, respectively). Means of hsCRP values were significantly higher in patients with active-ACVD compared to patients with no-ACVD in winter (3.38 vs. 13.18 mg/L, p < 0.05) and in autumn (3.63 vs. 23.4 mg/L, p < 0.05). There were 5 mortality and 7 morbidity and 12 combined morbidity and mortality related to ACVD and the distribution of these events were similar in all of the seasonal periods. CONCLUSIONS: Our study demonstrates that hsCRP levels and ACVD events do not show seasonal variation in HD patients.

The association between individual attachment patterns, the perceived social support, and the psychological well-being of Turkish informal caregivers.

BACKGROUND: This study aimed to investigate the relations among the psychological well-being (i.e. depression and state/trait anxiety levels), attachment patterns (i.e. secure, ambivalent, avoidant), and the perceived social support from family/friends/significant others of caregivers of cancer patients in Turkey. METHODS: Fifty-one caregivers of adult cancer patients were recruited from the oncology outpatient clinic of the Marmara Medical School Hospital in Istanbul. Caregivers were assessed with the Adult Attachment Scale, the Beck Depression Inventory, State-trait Anxiety Inventories, and the Multidimensional Scale of Perceived Social Support. RESULTS: Stepwise multiple regression analysis indicated that depression was predicted by ambivalent attachment and the perceived social support from family. The support from significant others was the significant predictor of trait anxiety and the caregivers' ambivalent attachment score was the significant predictor of state anxiety. CONCLUSIONS: We assert that ambivalent attachment pattern could confer a vulnerability to psychological distress in cancer caregivers. Assessing the psychological experiences and needs of caregivers and being aware of possible risk factors (such as attachment patterns) and protective factors (social support network) for depression and anxiety might be helpful for successful programmes and interventions that support the caregivers of cancer patients.

Awareness of cardiovascular risk factors among university students in Turkey.

AIM: To determine the awareness of cardiovascular risk factors among university students in Turkey. BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death in developed countries. The use of tobacco products and unhealthy diet are prominent habits that increase the risk of CVD. METHODS: Healthy university students (n = 2450) aged between 18 and 22 years in Istanbul filled out the questionnaire about the awareness of CVD risk factors and participated in this cross-sectional study. They were asked several questions with regard to the importance of CVD risk factors. FINDINGS: The leading responses for men and women were, respectively, high cholesterol (58.3; 72.3%), stress (58.8; 71.8%), hypertension (50; 64.2%), smoking (53.1; 58.7%), obesity (46.8; 64.3%), diabetes (41.7; 52.7%), inactivity (43.3; 47.8%), and CVD in family history (31.8; 44.4%). Unhealthy diet (9.7; 15.3%), exposure to second-hand cigarette smoking (24.4; 34%), and poor socioeconomic status (22.6; 22.3%) were also considered to be important. The study also revealed that men disregard the risk factors more frequently. Another comparison between body mass index groups revealed that obese subjects gave significantly lower importance to cardiovascular risk factors. CONCLUSION: Observations indicate that awareness levels of CVD risk factors have to be improved among university students. It is emphasized that primary healthcare workers are very important in the screening of CVD risk factors in an opportunistic and systematic way and in providing consultancy on changing risky behaviors (diet, smoking, etc.). Therefore, it is of utmost importance that primary healthcare workers make interventions to reduce the risk level by determining the CVD risk.

The mid-term effect of left ventricular assist devices on renal functions.

BACKGROUND: In this study, we aimed to investigate the mid-term effects of left ventricular assist devices on kidney functions. METHODS: Between January 2015 and December 2017, a total of 61 patients (53 males, 8 females; mean age 46.4±11.2 years; range, 20 to 67 years) who underwent left ventricular assist device implantation were retrospectively analyzed. Glomerular filtration rate was evaluated preoperatively and at 24 and 48 h, at one week, and at one, three, and six months postoperatively. According to the preoperative glomerular filtration rates, the patients were divided into three groups: glomerular filtration rates ?60 mL/min/1.73 m2 ( Group 1 ), g lomerular f iltration rates 61-90 mL/min/1.73 m2 (Group 2), and glomerular filtration rates >90 mL/min/1.73 m2 (Group 3). RESULTS: In all groups, the glomerular filtration rate significantly increased at one week and one month postoperatively, compared to preoperative values (p<0.001 and p<0.01, respectively). However, the glomerular filtration values at six months significantly decreased, compared to the values at one week and one month postoperatively (p<0.001 and p<0.001, respectively). The most significant drop to preoperative values was observed in Group 3 (p=0.02) at three months and it dropped below the preoperative level at six months (p<0.001). CONCLUSION: Our study results suggest that left ventricular assist devices can significantly increase the glomerular filtration rate in short-term, irrespective of baseline values. However, this improvement may recede later, particularly in patients with normal renal functions, and it may even disappear following the third postoperative month.