The relations of circulating agouti-related peptide and leptin with altered sleep architecture in patients with active Cushing's disease: a pilot study.

AIM: To evaluate sleep architecture of patients with Cushing's disease (CD) and to explore whether agouti-related peptide (AgRP) and/or leptin play a permissive role in sleep alterations in patients with active CD. METHODS: We performed polysomnography on 26 patients with active CD and age 26 age- and sex-matched control subjects. Blood samples were obtained from all participants for the analyzes of AgRP and leptin. The laboratory and sleep-related parameters were compared. RESULTS: The groups were similar in age, gender, and body mass index. The CD group had reduced sleep efficiency (71.6 ± 12.1% vs. 78.8 ± 12.6%, p = 0.042) and increased wake after sleep onset (WASO%) (24.7 ± 13.1% vs. 17.4 ± 11.6%, p = 0.040) as compared to control group. Seventeen patients with CD (65.4%) and 18 control subjects (69.2%) had obstructive sleep apnea. Serum AgRP (13.2 ± 7.4 pg/ml vs. 9 ± 3.1, p = 0.029), leptin (59.5 mcg/l, [IQR] 32.6-94.6 vs. 25.3 mcg/l, [IQR] 12.9-57.5, p = 0.007) were higher in CD group. AgRP and leptin correlated negatively with total sleep time, sleep efficiency, stage N2 sleep (%), and positively with WASO%. In multiple regression analyses, serum cortisol (ß = - 0.359, p = 0.042) and AgRP (ß = - 0.481, p = 0.01) were significant predictor of sleep efficiency. AgRP was also significant predictor of WASO% (ß = 0.452 and p < 0.05). CONCLUSIONS: Active CD carries an increased risk of impaired sleep efficiency and continuity which may worsen health-related quality of life. Elevated circulating AgRP and, to a lesser extent, leptin may be associated with decreased sleep efficiency and continuity in patients with CD. Patients with CD who have subjective sleep symptoms should be screened with polysomnography.

The relationship between temporal muscle thickness and disease activity in Cushing's disease.

OBJECTIVE: This study aimed to investigate the relationship between hypercortisolism and temporal muscle thickness (TMT) in Cushing's disease (CD). METHODS: A retrospective review of medical records was conducted for patients with CD who presented to our clinic between 2012 and 2022. Biochemical data and TMT measurements from sella imaging were evaluated during diagnosis and the first postoperative year. RESULTS: A total of 44 patients were included in the study, with an average age of 43.9 years, of which 38 were female. The mean TMT at the time of diagnosis was 19.07 ± 1.71 mm, with no significant difference between males and females (p = 0.097), and no correlation between the TMT and age at diagnosis (p = 0.497). There was an inverse relationship between TMT and serum cortisol levels, 24-h UFC, and midnight salivary cortisol at the time of diagnosis of CD (p < 0.05, for all). One year after surgery, TMT significantly increased in all patients compared to baseline (p < 0.001). Furthermore, patients who achieved postoperative remission had significantly higher TMT values compared to those who did not achieve remission (p = 0.043). Among the patients who achieved remission, those who achieved remission through surgery had significantly higher TMT compared to those who could not reach remission with surgery and patients who started medical treatment and achieved biochemical remission (p = 0.01). Patients with severe myopathy and sarcopenia had significantly lower TMT values than the others (p < 0.001). CONCLUSION: Temporal muscle thickness was found to be associated with disease activity and disease control in Cushing's disease.

Association of dipping pattern of blood pressure and atherosclerotic burden of coronary arteries in hypertensive patients.

Aim    The aim of this study was to determine the association between the dipping pattern of BP and coronary artery disease in hypertensive patients.Material and methods    A total of 356 hypertensive patients were included in the study. The results of ambulatory BP monitoring, echocardiography, and coronary computerised tomographic angiography were evaluated retrospectively. The patients were divided into two groups on the basis of their ambulatory BP monitoring: 1) patients with the dipping pattern of BP; 2) patients with the non-dipping pattern (NDP).Results    Among the 356 patients, 145 were male (40.7 %). The smoking status was higher in patients with NDP (p=0.023). The statin usage in patients with the dipping pattern was higher in patients with NDP (p=0.027). There were no significant differences in the echocardiographic findings. 58.6 % of the patients without plaque formation had the dipping pattern of BP (p<0.05), however 84.4 % of patients with >50 % plaque formation had the NDP of BP (p<0.001).Conclusion    The NDP of BP might be related to the increased atherosclerotic process in coronary arteries, and pa-tients with NDP might have an increased atherosclerotic burden for coronary arteries when compared with patients with a dipping pattern.

Questioning How to Define the "Ultra-High-Risk" Subgroup of Neuroblastoma Patients.

Neuroblastic tumours exhibit heterogeneity, which results in different therapeutic outcomes. Neuroblastoma is categorized into three major risk groups (low, intermediate, high risk). Recent identification of new genes raised the possibility of new biomarkers to identify sub-risk groups. In this retrospective cross-sectional study, we aimed to assess new biomarkers defining the ultra-high-risk subgroup within the high-risk group that differ in clinical situation with very bad prognosis. Twenty-five low- and 29 high-risk groups of patients were analysed for their expression of ALK, ATRX, HIF1a, HIF2a (EPAS), H2AFX, and ETV5 genes at the RNA level. Immunohistochemistry was performed to confirm the protein expression level of ALK. The risk group of patients was determined according to the International Neuroblastoma Risk Group Stratification System. Spearman correlation analysis and Mann-Whitney-U nonparametric test were used to assess the importance of expression levels among the groups. P < 0.05 was considered as significant. Sensitivity of the results was checked by ROC curve analysis. All analysed genes were found to be highly expressed in the high-risk group compared to the low-risk group, except for ETV5. When the ultra-high-risk and highrisk groups were compared, ALK was found to be highly expressed in the ultra-high-risk group. Our results show that ALK may be a candidate gene whose mRNA expression levels can distinguish the ultrahigh- risk subgroup of patients in the high-risk group of patients with non-familial neuroblastoma.

Comparison of inflammation markers with prediction scores in patients with community-acquired pneumonia.

OBJECTIVE: The lymphocyte-to-C-reactive protein ratio (LCRP) and Systemic Immune-Inflammation Index (SII) can successfully predict 28-day mortality rates with community-acquired pneumoniaMETHODS: This prospective study was conducted in 2018. Hospitalized patients underwent follow-up evaluations 28 days after admission. RESULTS: A total of 345 patients with CAP were enrolled in this study. All-cause mortality at the 28th day of follow-up was 13.6 %. There were statistically significant results between the 2 groups (survivors and non-survivors), in terms of the LCRP, SII, PSI, and CURB-65 values. Moreover, the optimal LCRP cutoff for predicting 28-day mortality was determined to be 4, with 89 % sensitivity, 73 % specificity. Based on the average SII>3551for predicting 28-day mortality, the sensitivity, specificity was 63.8 %, 68.1 % respectively. When the value of the cutoff PSI was ≥130 points, the sensitivity, specificity was 68 %, 65 %, respectively. Based on 3 points and above as the cutoff value of the CURB-65 score, the sensitivity, specificity was 80 %, 68 %, respectively. ROC curve analysis revealed that the areas of LCRP, SII, PSI, and CURB-65 under the AUC in terms of 28-day mortality were 0,820,0,737,681, and 0,773, respectively,CONCLUSIONS: LCRP and SII level are valuable for predicting the mortality rate among patients with CAP at ED admission (Tab. 3, Fig. 3, Ref. 27).

The Utility of CONUT Score in Diffuse Large B Cell Lymphoma Patients.

BACKGROUND: Assessment of nutritional status is gaining more importance in cancer patients because nutritional status is associated with response to chemotherapy, side effects of cancer treatment and disease progression. Several studies that were performed on patients with solid malignancies have shown the clinical significance of CONUT score (Controlling nutritional status). AIMS: Therefore we tried to show the utility of CONUT score in newly diagnosed Diffuse Large B Cell Lymphoma (DLBCL) patients which is the most frequently seen B Cell Lymphoma type. METHODS: Data of the 81 patients diagnosed with DLBCL were retrospectively evaluated. The primary endpoint of our study was to evaluate and classify newly diagnosed DLBCL patients according to the CONUT score and secondary endpoint was to show any relationship with CONUT score and overall survival. Patients' demographics, treatment details, stages, extranodal involvements, the presence of bulky disease, response to treatment options and overall survivals were evaluated from medical recordings. RESULTS: Univariate cox regression analysis CONUT score was associated with overall survival (HR: 2.34-95% CI: 1.55-3.24 P = 0.040). On multivariate Cox regression analysis model CONUT score ≥5 was found to be an independent prognostic factor for overall survival (HR: 4.96-95% CI: 1.77-13.97- P = 0.002). CONCLUSION: The value of obtaining nutritional status in cancer patients is underestimated and CONUT score is simple, easily applicable and in our opinion is going to fill the gap especially in DLBCL patients.

Incidence of decompression sickness in hypobaric hypoxia training.

Simulated flight in a hypobaric chamber is a fundamental component in the physiological training of aviators. Although rare, there is always a risk of decompression sickness (DCS) in trainees during hypobaric hypoxia training. In this study we aimed to determine the incidence of altitude-induced DCS and the symptoms manifested in trainees and inside chamber observers (ICOs) during the training sessions. We retrospectively reviewed the records of DCS cases during the period of January 1, 2011, and October 1, 2018. The records of 6,657 trainees and 615 ICOs were evaluated. The gender distribution in 6,657 trainees was 6,578 (98.81%) male and 79 (1.19%) female. The numbers of DCS cases in trainees and ICOs were six (0.09%) and two (0.33%), respectively [(ICOs versus trainees - odds ratio (OR): 3.574; 95% CI 0.720-17.744; (p > 0.05)]. All ICOs were male; no DCS incident was observed among female trainees. Recompression treatments were applied on site, and complete recovery was achieved in all cases. Overall DCS incidence was found to be 0.11% among the 7,193 male subjects, which included trainees and ICOs. The higher incidence of DCS in ICOs was attributed to the physical activities performed at altitudes by ICOs. In such training, established instructions have to be strictly followed by physicians, ICOs and trainees. All trainees and ICOs should be aware of the symptoms and signs of DCS, and medical support including a recompression facility, should be provided on site during hypobaric hypoxia training.

Pros and Cons for Fluorescent in Situ Hybridization, Karyotyping and Next Generation Sequencing for Diagnosis and Follow-up of Multiple Myeloma.

Multiple myeloma (MM) is one of the plasma cell-related hematological malignancies exceeding 10.0% of all marrow cells, and they make a paraprotein that is a marker of the disease. Myeloma is one of the most common types of hematological malignancies in humans. Genetic bio-markers have been used for prognostic markers in patients diagnosed with MM. The genetic and genomic changes have been identified using karyotyping, fluorescent in situ hybridization (FISH), next generation sequencing (NGS), specifically whole-genome sequencing or exome sequencing. Circulatory plasma cells, circulating free DNA (cfD-NA) and microRNAs (miRNAs) comprised in liquid biopsy are potentially used in diagnosis/prognosis of MM. In this study, we analyzed and compared results of karyo-typing, FISH and NGS in 35 MM cases. Diagnostic strategies are expanding rapidly and newly developed NGS-based testing may help the understanding of the complexities of genetic alterations in karyotypically normal cases.

Electronic Compressibility of Magic-Angle Graphene Superlattices.

We report the first electronic compressibility measurements of magic-angle twisted bilayer graphene. The evolution of the compressibility with carrier density offers insights into the interaction-driven ground state that have not been accessible in prior transport and tunneling studies. From capacitance measurements, we determine the chemical potential as a function of carrier density and find the widths of the energy gaps at fractional filling of the moiré lattice. In the electron-doped regime, we observe unexpectedly large gaps at quarter- and half-filling and strong electron-hole asymmetry. Moreover, we measure a ∼35 meV minibandwidth that is much wider than most theoretical estimates. Finally, we explore the field dependence up to the quantum Hall regime and observe significant differences from transport measurements.

A new screening index for pesticides leachability to groundwater.

Given the fact that pesticides exist in the aquatic environment at very low concentrations, it is clear that their analysis require expensive analytical techniques. Water authorities in Turkey are in need of assessing the likelihood of pesticide occurrence in groundwater in order to identify minimum number of pesticides that would be included in monitoring programs. To this purpose, the pesticides used in Turkey are ranked and those having higher leaching potentials are identified using pesticide screening leaching indexes. A total of 15 indexes (AF, AFR/AFT, Hamaker's RF, Briggs's RF, LPI, VI, LIX, GUS, Hornsby, LEACH, MLEACH, PLP, GWCP, LIN and GLI) was adopted and leaching potentials of 157 pesticides used in Turkey were estimated. Because each index is based on different pesticide/soil characteristics, each produced a different ranking. In order to emphasize variation in rankings and bring out a strong pattern, the statistical technique of Principal Component Analysis was used and a new composite index named as "YASGEP-P" was developed, the most relevant components (indices) were identified and the corresponding factor scores were calculated. This new index came out as a composite of GUS, LIX, MLEACH, LIN, Briggs's RF, Hamaker's RF, PLP and AFR indices. It was seen that all these indices except AFR are almost equally dominant and increase the value of YASGEP-P index, whereas AFR is also dominant but causes a decrease in YASGEP-P index value. The new index developed tends to discriminate between the relatively more soluble/less sorbable and more sorbable/less soluble pesticides. With the use of this composite index, the pesticides used in Turkey were sorted from the most leachable to least leachable and the priority pesticides to be monitored in the groundwaters were identified.

Time resolved Fabry-Perot measurements of cavity temperature in pulsed QCLs.

Temperature rise during operation is a central concern of semiconductor lasers and especially difficult to measure during a pulsed operation. We present a technique for in situ time-resolved temperature measurement of quantum cascade lasers operating in a pulsed mode at ~9.25 µm emission wavelength. Using a step-scan approach with 5 ns resolution, we measure the temporal evolution of the spectral density, observing longitudinal Fabry-Perot modes that correspond to different transverse modes. Considering the multiple thin layers that make up the active layer and the associated Kapitza resistance, thermal properties of QCLs are significantly different than bulk-like laser diodes where this approach was successfully used. Compounded by the lattice expansion and refractive index changes due to time-dependent temperature rise, Fabry-Perot modes were observed and analyzed from the time-resolved emission spectra of quantum cascade lasers to deduce the cavity temperature. Temperature rise of a QCL in a pulsed mode operation between -160 °C to -80 °C was measured as a function of time. Using the temporal temperature variations, a thermal model was constructed that led to the extraction of cavity thermal conductivity in agreement with previous results. Critical in maximizing pulsed output power, the effect of the duty cycle on the evolution of laser heating was studied in situ, leading to a heat map to guide the operation of pulsed lasers.

Frailty in patients with acute myeloid leukaemia, conceptual misapprehension of chronological age.

In haematology practice, patients with acute myeloid leukaemia (AML) are generally assessed for frailty only if they are older and not able to tolerate intensive and remission targeted treatments. We aimed to focus on frailty in patients with AML, in all ages and aimed to evaluate its role and practicality in daily routine. Data of patients diagnosed and treated for AML between 2006 and 2016 are recorded and assessed for their survival predictivity. One hundred and ninety-seven patients were <65 years of age and 175 were ≥65. Majority of the younger patients showed ECOG 2 performance (119, 60.4%). Combined with ECOG scale, G8 scale showed survival predictivity in younger patients as well as older patients. Nutritional status showed a strong predictivity in younger patients while remained insignificant in older patients. VES13 scale showed similar predictivity strength for survival in both age groups (p = .001). Young AML patients should be thoroughly evaluated as older patients. ECOG performance evaluation should be supported with further scales. Young patients with lower ECOG scores may be regarded as vulnerable with scales embracing dimensions such as nutrition, perception of disease, depression and cognition. Nutrition should be within the main goals of intensive treatment and is related with survival.

Radiographic findings of bisphosphonate-related osteonecrosis of the jaws: Comparison with cone-beam computed tomography and panoramic radiography.

OBJECTIVE: The aim of this study is to assess radiographic findings of bisphosphonate-related osteonecrosis of the jaws (BRONJ) and to evaluate the efficiency of cone-beam computed tomography (CBCT) and panoramic radiography (PR) by comparing with each other. MATERIALS AND METHODS: The data of 46 patients treated with bisphosphonates for at least 1 to 10 years were retrospectively examined. 27 patients were selected for study group. The first inclusion criteria was an available CBCT or PR. The patients had at least one clinical symptom of exposed bone, intraoral or extraoral swelling and purulent secretion or fistula formation. In accordance with the position papers of the American Association of Oral and Maxillofacial Surgeons, the patients were classified into stages. CBCT and PR images were evaluated by dividing the jaws in 6 segments. Presence of bone sclerosis, cortex irregularity, persistent sockets, periosteal response, sequestration, and osteolysis were recorded. RESULTS: The radiographic findings of BRONJ were mostly determined at posterior mandible with Stage 2 predominancy. Fifteen patients (55.6%) had previous tooth extraction. 9 of them had exposed bone at the same time. Seven patients had exposed bone without extraction. CBCT findings (P < 0.01) except persistent socket (P = 0.157) were found statistically significant by comparison with PR. Extraction socket finding was detected the same in segments with a percentage of 90.9%. CONCLUSION: This study showed that CBCT findings except extraction socket were significantly higher than PR. CBCT combined with clinical examination can be used effectively to determine the borders of effected areas especially at advanced cases.

Comparison of different femoral fixation implants and fit techniques for tunnel widening and clinical outcome in ACL reconstruction using hamstring autograft.

PURPOSE: The purpose of the current study is to investigate in different femoral fixation devices whether tight (undersize drilled) fit technique decreases the tunnel widening and improves the clinical outcome compared to conventional technique in ACL reconstruction using hamstring tendon autograft. METHODS: 93 patients, who underwent Arthroscopic ACL reconstruction whether cortical-cancellous suspension (CP) or cortical suspension (BF) used as fixation device for the hamstring tendon autograft, were included in the study. The cases also grouped as undersize drilled (tight fit) and normal drilled (normal fit) according to their autograft size. There was no difference in demographic data of these four subgroups (CP-TF, CP-NF, BF-TF, and BF-NF) preoperatively. RESULTS: The patients, who had been followed for at least 2 years were included in the study. They were looked for their clinical outcome (Lysholm and IKDC scoring), tunnel widening (on AP and lateral radiographs), and also anterior translation. The BF-TF subgroup showed significantly the best clinical results compared to other three subgroups. There was no difference between BF-TF, CP-TF, and CP-NF in terms of tunnel widening. CONCLUSION: Button fixation of femoral side in ACL reconstruction surgery has good clinical outcome and lower complication rate. Undersize drilling might be preferred in button fixation in order to reduce TW and improve stability and clinical satisfaction. LEVEL OF EVIDENCE: Therapeutic case series, Level IV.

Histopathology of ipsilateral and contralateral ovaries and plasma interleukin 6 levels after unilateral ovarian torsion.

OBJECTIVE: The aim of the present study was to evaluate the time-dependent histopathologic changes in both ovaries and to determine the time-dependent levels of plasma interleukin 6 (IL-6) after unilateral ovarian torsion. MATERIALS AND METHODS: An experimental animal study included 48 female Sprague-Dawley rats which were distributed to six groups: control group (Group 1), sham-operated control group (Group 2), and four unilateral ovarian torsion groups with torsion duration of three, six, 12, and 24 hours (Group 3, 4, 5, and 6, respectively). Histopathologic criteria (follicular degeneration, vascular congestion, hemorrhage, inflammatory cell infiltration, and total tissue damage score) were evaluated in both ovaries, and plasma IL-6 levels were measured. RESULTS: At 24 hours after torsion began, mean total tissue damage score was similar between ovaries that had torsion and contralateral ovaries. Mean plasma IL-6 level did not change during the 24 hours after torsion began (p = 0.584). CONCLUSIONS: In addition to ovaries that had torsion, histopathologic abnormalities also occurred in contralateral ovaries. These results suggest that contralateral ovaries are not quiescent after unilateral ovarian torsion. Plasma IL-6 levels did not change significantly during the 24 hours after ovarian torsion began, resulting in a limitation of its diagnostic use in the early course of the disease.

Can platelet-rich plasma be used safely in intra-abdominal operations?

OBJECTIVES: In this study, it was aimed to investigate whether or not platelet­rich plasma (PRP) causes intra-abdominal adhesions and therefore, whether or not PRP can be used safely in intra-abdominal operations. METHODS: Of the total of 35 animals, 5 were used as donors for the preparation of platelet­rich plasma (PRP). The surgical procedures were performed on the remaining 30 animals. These rats were randomized and divided into 3 groups of 10. In Group 1, no adhesion induction was performed. Adhesion was induced by cecal abrasion and peritoneal resection model in Groups II and IIII. In Group 2, no treatment was given. In Group 3, 1 cc PRP was applied on the cecum. The rats were sacrificed on postoperative day 21. RESULTS: According to adhesion scores, the difference between the sham and PRP groups was not statistically significant. There was also no significant difference between the control and PRP groups, but the adhesion scores in the PRP group was lower than those in the control group. On histopathological evaluation, the difference between the sham and PRP groups was not statistically significant. There was also no significant difference between the control and PRP groups, but the average fibrosis and inflammation scores in the PRP group were lower than those in the control group. CONCLUSION: The results of the present study have demonstrated that PRP neither reduced nor exacerbated postoperative adhesions. Thus, PRP can be used safely in experimental and clinical studies where it will be applied intra-abdominally (Tab. 2, Fig. 3, Ref. 11).

Right ventricular outflow tract function in chronic obstructive pulmonary disease.

BACKGROUND: It is clinically important to evaluate the severity of right ventricular (RV) overload in patients with chronic obstructive pulmonary disease (COPD), which is often associated with changes in the structure and the function of the right ventricle. Noninvasive and reliable assessment of RV function would be an essential determinant of RV load and a clinically useful factor for assessing cardiovascular risk in COPD patients. OBJECTIVE: The aim of this study was to investigate the clinical application value of right ventricular outflow tract (RVOT) systolic function measured by transthoracic echocardiography in patients with COPD. PATIENTS AND METHODS: We prospectively investigated COPD male patients and compared them with healthy controls. In addition to RV conventional echocardiographic parameters, RVOT size and fractional shortening (RVOT-FS) parameters were also assessed. RESULTS: Fifty-five COPD patients (all men; mean age, 62 ± 9 years) participated in the study, and were compared with a control group consisting of 21male, healthy, nonsmoking subjects with a mean age of 58 ± 11 years. The RVOT-FS was impaired in COPD patients than healthy controls (27.8 ± 15.5 vs. 57.5 ± 8.6, p < 0.001), and was correlated positively with tricuspid annular plane systolic excursion (TAPSE; r = 0.583, p < 0.001) and pulmonary acceleration time (r = 0.666, p < 0.001) and inversely with pulmonary artery systolic pressure (r = 0.605, p < 0.001) and functional capacity(r = - 0.589, p < 0.001). There was a statistically significant difference in RVOT-FS among the COPD subgroups with regard to New York Heart Association functional classification (p < 0.001). CONCLUSION: The RVOT-FS is a noninvasive easily applicable measure of RV systolic function and is well correlated with functional capacity in COPD patients. Its combination with long-axis measurements via TAPSE and transtricuspid Doppler analysis may provide a comprehensive evaluation of the RV performance in COPD patients.

INFLAMMATORY BOWEL DISEASE-LIKE PHENOTYPE IN A YOUNG GIRL WITH PROLIDASE DEFICIENCY: A NEW SPECTRUM OF CLINICAL MANIFESTATION.

Prolidase deficiency (PD) is an inherited disorder associated with cutaneous ulcers, intellectual disability, unusual facial appearance, skeletal deformities, hematological anomalies, splenomegaly, and chronic infections. We report a girl with PD who presented with early inflammatory bowel disease (IBD). A 2-month-old girl with a dysmorphic face presented with recurrent respiratory tract infections, vomiting, diarrhea and hepatosplenomegaly. She had steatorrhea, abnormal liver enzymes, hypergammaglobulinemia, autoantibody positivity and steatohepatitis in liver biopsy. On follow-up, skin lesions, pruritus and developmental delay were added. At the age of 21 months, IBD was diagnosed with persistent diarrhea, fever, hypoalbuminemia, elevated inflammatory markers, fecal leukocytes and aphthous ulcers in colon. Remission was achieved with prednisone and continued with mesalasine. Thrombocytopenia developed after 3 years. Her findings prompted us to further investigations. PD as the underlying molecular cause of the disease was detected by exome sequencing. In conclusion, PD should be considered in the differential diagnosis of some IBD patients.

Minimum prick test panel for adult patients with asthma and rhinitis in Ankara, Turkey.

OBJECTIVE: Determination of the number and type of allergens needed to be tested in epidemiological studies is important in order to identify most of the sensitized subjects with a cost-effective approach. This study aimed to investigate the minimum skin prick test panel for the identification of at least 95% of the sensitized subjects with symptoms of asthma and/or allergic rhinitis (AR) in Ankara, Turkey. METHODS: Skin prick test results of 7492 patients who were referred to our outpatient clinic with clinical symptoms of asthma and/or AR between 1991 and 2005 were evaluated retrospectively. Seven allergens were tested in all and 13 allergens in 4202 patients. The allergen group needed for detection of 95% of the sensitized subjects was determined for both the 7 and 13 allergen panels. The study protocol was approved by the local ethics committee of Hacettepe University. RESULTS: The atopy prevalences in the whole study population and in 4202 patients tested with the 13 allergen panel were calculated as 32.2% and 42.6%, respectively. Three allergens (Phleum pratense, Dermatophagoides pteronyssinus and Artemisia vulgaris) within the 7 allergen panel were adequate for the identification of at least 95% of the sensitized subjects. Olea europae was added to the previous three allergens when the 13 allergen panel was applied. CONCLUSION: Three to four allergens are sufficient for identification at least 95% of sensitized subjects with asthma and/or AR in Ankara, Turkey.

Manual versus computer-automated semen analysis.

OBJECTIVE: To evaluate agreement of conventional sperm analysis with computer-aided semen analysis (CASA) regarding concentration, motility, and morphology using samples from infertile men. MATERIALS AND METHODS: In this study a total of 195 male partners of couples who underwent evaluation of infertility were included. All semen samples were examined by conventional method and CASA in terms of morphology, motility, and concentration. Pearson correlation analysis and the Bland-Altman method were used to assess correlation and agreement between conventional semen analysis and CASA measurements. RESULTS: When the two methods were compared in terms of concentration, motility, and morphology, there was a statistically significant correlation in all variables. The best correlation was obtained for sperm concentration. However, there was a poor correlation for sperm morphology between conventional method and CASA. Sperm concentration and morphology obtained by CASA were 14% and 87% lower, respectively; motility was 21% higher than the conventional method. CONCLUSION: Although CASA systems are objective and rapid, they should be evaluated in terms of cost-effectiveness, however they may be useful in over-loaded assisted reproductive technique (ART) clinics.