Is cancer risk reduced in multiple sclerosis? Results from a tertiary referral center.

BACKGROUND: Multiple sclerosis (MS) patients may be protected against cancer because of increased immune surveillance. However, aberrant T/B cell functioning in MS may increase the risk of cancer. We aimed to compare the frequency of cancer among patients with MS with an appropriate control group matched by the variables such as age, gender, tobacco smoking history, body mass index (BMI), and family history of cancer. METHODS: The MS patients who were registered and followed up at the MS Center in Hacettepe University Hospitals and appropriately matched with controls were included. A self-administered questionnaire with links to the online survey was delivered. RESULTS: Overall, 1037 responses out of 2074 in MS patients and 506 responses out of 1500 control group were included. Fourteen (1.35%) of MS patients and 18 (3.6%) of the controls were diagnosed with cancer. The odds ratio of having cancer in patients with MS compared to the control group was 0.389 (95% CI = 0.161-0.940, p < 0.05). DISCUSSION: There was no statistically significant difference in age, gender, tobacco smoking, and BMI between the groups after propensity score matching. The odds of having cancer were lower in our MS patients compared to the controls. The autoimmune changes responsible for the pathogenesis of MS may be responsible for the decrease in cancer risk.

Posttraumatic stress disorder in health-care workers after two major earthquakes centered in Kahramanmaras, Turkey.

OBJECTIVES: Earthquakes are one of the most studied uncontrollable natural conditions that cause negative psychological consequences. Although health-care workers (HCWs) are trained to manage trauma in the out-of-hospital area, uncontrollable tragic events in the earthquake field and exposure to life-threatening situations may cause psychological disorders. This study aimed to investigate the risk of the development of probable posttraumatic stress disorder (PTSD) and the factors affecting it in HCWs working in the region during major earthquakes centered in Kahramanmaras. METHODS: The questionnaire, which consists of the Turkish version of the 20-item PTSD Checklist for DSM-5 (PCL-5) self-report measure assessing DSM-5 symptoms of PTSD, was applied to HCWs. The Turkish version of the PCL-5 proved validity and reliability, with a cutoff point of ≥47 to diagnose probable PTSD. RESULTS: In this study, of the 79 HCWs, 62.7% were male. The overall probable PTSD rate was 37.9% (n = 30). Female participants had a significantly higher probable PTSD rate than males (P < 0.001). The nurses met probable PTSD criteria statistically significantly more than the doctors (P = 0.026). The multiple regression analysis for predictors of probable PTSD revealed that female gender, previously working in a level 1 hospital, and being a nurse were among the independent risk factors. CONCLUSION: This study showed that the probable PTSD rate was high among HCWs and that female HCWs were at higher risk for PTSD. HCWs, especially females working in the disaster area, should be closely monitored, and more mental health services should be provided to ensure that HCWs receive the necessary support in the postdisaster period.

Splenic infarction and pulmonary embolism as a rare manifestation of COVID-19.

Coronavirus disease 2019 (COVID-19) disease leads to a hypercoagulable state and associated with thrombotic events that can cause mortality and morbidity. Thrombotic events include both venous and arterial thrombosis. In this case report, we present a 68-year-old COVID-19 patient with multisystemic infarction who was admitted to the hospital by splenic infarction and later pulmonary embolism diagnosed during the stay in hospital despite anticoagulant use. It is important for emergency physicians to know that patients who had COVID-19 infection but not confirmed or not tested can visit the emergency department due to complications of COVID-19 infection such as thromboembolic events primarily.

Tobacco Containing Scenes in Some Selected Turkish Movies Released Between 1992 and 2016.

OBJECTIVE: Movies are among the most widely used media for advertising, promotional, and sponsorship activities of the tobacco industry, and the industry has been making huge investments in this sector for many years. In this study, the effects of movie scenes depicting the use of tobacco products, and the possible effects of the laws governing such scenes, were examined. MATERIAL AND METHODS: The sample of the study consisted of 50 films, the first 2 of which were the most watched each year, between the years 1992 and 2016, according to the data of the Center for Turkish Cinema Studies and the boxofficeturkiye.com websites. The scenes depicting the use of tobacco products were analyzed using the data collection form developed by the researchers. Each movie was evaluated separately by 2 researchers. RESULTS: A tobacco product was used in 82% of the 50 films watched. Men (87%), individuals between the ages of 25 and 64 (78.0%), and leading actors (40%) used more tobacco products, and the most frequently used product was the cigarette (93.1%). The number andduration of scenes containing tobacco was greater by 1.6 times before the first law was passed, and between the passage of the first law and the passage of the second law (P > .05, P > .05). The number and duration of the scenes decreased between the passage of the first and the second laws and after the second law was passed, by 3.6 and 5.3 times, respectively (P < .05, P < .05). CONCLUSION: Consistent and comprehensive tobacco control policies have been effective in reducing the number of scenes that contain tobacco in the movies produced in Turkey. A comprehensive and multidisciplinary approach is required to overcome the tobacco industry's impact on cinema.

Bone scintigraphy as a gatekeeper for the detection of bone metastases in patients with prostate cancer: comparison with Ga-68 PSMA PET/CT.

OBJECTIVES: Gallium-68-labeled prostate-specific membrane antigen (Ga-PSMA) positron emission tomography (PET)/computed tomography (CT) is a valuable diagnostic tool for the detection of bone metastases in patients with prostate cancer (PCa). However, bone scintigraphy (BS) with technetium-labeled diphosphonates is cheap and widely available for the same patient population. PSMA PET comes with a cost, and financial constraints in the present economic environment may require its more selective use. In this study, we aimed to compare the diagnostic performance of BS with Ga-PSMA PET/CT for the detection of bone metastases in patients with PCa and correlate the results with various clinical and biochemical variables. MATERIALS AND METHODS: Ninety-five patients who underwent Ga-PSMA PET/CT and BS within 3 months for newly diagnosed or recurrent PCa were extracted from our database. Lesion, region and patient-based analyses were performed. Clinical and imaging follow-up was used as the reference test. Results were compared with tumor grade, serum prostate-specific antigen (PSA), and alkaline phosphatase (ALP) values. RESULTS: On the patient-based analysis, 75% (42/56) and 98.2% (55/56) of the patients with bone metastases were correctly diagnosed by BS and Ga-PSMA PET, respectively. In 26/95 patients with equivocal lesions on BS, Ga-PSMA PET correctly reclassified skeletal involvement in 11 and excluded metastases in 15 patients BS missed bone metastases in 3 patients. The true-positive rate of BS in patients with serum ALP ≥ 120U/L and PSA ≥ 50 ng/ml was 95.8% and 87.5 respectively. CONCLUSION: Ga-PSMA is superior to BS for the evaluation of metastatic disease in patients with PCa. However, BS can also detect bone metastases in patients with PCa with a minimum sensitivity of 75%. Biochemical data are helpful to select patients with a high pretest probability who should undergo BS first as a part of the initial workup from an economic point of view. Due to its higher cost, Ga-PSMA PET should be performed in a selective group of patients when BS results are inconclusive or metastasis-directed therapy is planned.