Prevalence, comorbidities and mediators of childhood anxiety disorders in urban Turkey: a national representative epidemiological study.

PURPOSE: The aim of this study is to evaluate the prevalence of anxiety disorders, its correlation with sociodemographic characteristics, its comorbidities with other psychiatric disorders and its predictors in school-aged children. METHODS: This study is part of a representative, multi-centered national study that is planned by the Turkish Association of Child and Adolescent Mental Health to evaluate the prevalence of psychopathology among elementary school students in Turkey between the years 2014-2015. Children are screened via Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime Version. Impairment is assessed by a 3-point Likert type scale independently by the parent and the teacher. The final sample included 5842 children with the mean age of 8.7 years. RESULTS: The prevalence of any anxiety disorder without considering impairment is 16.7% and considering impairment is 5.2% in children according to our study. We found significant differences for comorbid Attention Deficit Hyperactivity Disorder, Disruptive Behavior Disorder, Mood Disorders, Tic Disorders, Obsessive Compulsive Disorder, Enuresis Nocturna, Encopresis, and Intellectual Disability. Having a history of paternal physical disorder, living in the regions of Marmara, Mediterranean and Black Sea were found to be the main predictors of having childhood anxiety disorders according to the logistic regression analysis. CONCLUSION: Better understanding of childhood anxiety disorders, comorbid conditions and predictors will result in earlier diagnosis and more appropriate treatment.

Comparing the effects of self-management and hospital-based pulmonary rehabilitation programs in COPD patients.

BACKGROUND: Pulmonary rehabilitation (PR) is a core component of the management of patients with chronic obstructive pulmonary disease (COPD). Although several types of PR programs are implemented for patients with COPD on the basis of patient preferences or clinical protocols, the clinical efficiencies of these programs may vary, with each program having its own unique purpose, procedures, benefits, challenges, and effectiveness. AIM: The aim of this study was to compare the effects of self-management and hospital-based PR programs in COPD patients. MATERIALS AND METHODS: This study was prospective intervention research. Fifty-eight patients with stable COPD were randomly allocated to a hospital-based outpatient group and a self-management group before commencement of a 12-week PR program. Before and after the PR program, all patients were evaluated using the 6-min walk test, Modified Borg Scale, St. George's Respiratory Questionnaire, State-Trait Anxiety Inventory, and Standardized Mini-Mental Test. RESULTS: Pulmonary functions, dyspnea, quality of life, and 6MWT distance were significantly improvement the hospital-based PR than self-management PR (P < 0.05). Moreover, cognitive function significantly improved after the PR program in both groups with no significant intergroup difference (P > 0.05). CONCLUSIONS: Our findings suggest that PR is useful for to improvement functional capacity, quality of life, cognitive function and anxiety, in patients with COPD. A hospital-based PR is more effective than a self-management PR program.

Impact of sodium lactate, encapsulated or unencapsulated polyphosphates and their combinations on Salmonella Typhimurium, Escherichia coli O157:H7 and Staphylococcus aureus growth in cooked ground beef.

Foodborne illnesses affect the health of consumers worldwide, and thus searching for potential antimicrobial agents against foodborne pathogens is given an increased focus. This research evaluated the influence of sodium lactate (SL), encapsulated (e) and unencapsulated (u) polyphosphates (PP; sodium tripolyphosphate, STP; sodium acid pyrophosphate, SPP), and their combinations on Salmonella Typhimurium, Escherichia coli O157:H7 and Staphylococcus aureus growth in cooked ground beef during 30 day storage at 4 or 10 °C. pH, water activity (aw), oxidation-reduction potential (ORP) and S. Typhimurium, E. coli O157:H7 and S. aureus counts were determined. S. Typhimurium was not found in SPP-SL combination groups after 30 day storage at 4 °C (P <0.05). Lower S. Typhimurium levels were determined in only SL containing groups stored at 10 °C than group with only tested microorganism (MO, P < 0.05). Although there was no change in S. Typhimurium load in all SL incorporated groups during 10 °C storage, S. Typhimurium count increased in other groups (P < 0.05). E. coli O157:H7 in MO and STP groups showed an increase at 4 °C, whereas it decreased in SPP-SL combination groups (P < 0.05). A gradual increase in E. coli O157:H7 at 10 °C was determined in MO and only PP incorporated groups, whereas there was a decrease in STP-SL or SPP-SL combination groups (P < 0.05). E. coli O157:H7 count was stable in SL containing groups during 10 °C storage. A gradual decrease in S. aureus was determined in all treatments at 4 °C, whereas S. aureus count increased in MO and uSTP groups during 10 °C storage (P < 0.05). There was no change in S. aureus level in only eSTP or uSPP or ueSTP containing groups at 10 °C, meantime it decreased in other groups (P < 0.05). The lowest S. aureus load was achieved by uSPP-SL or eSPP-SL or ueSPP-SL combinations after 30 days at both storage temperatures (P < 0.05). In general, pH was higher in samples with STP than those with SPP and control (P < 0.05). The lowest aw was generally obtained in all SL containing groups at both storage temperatures (P < 0.05). Lower ORP was determined in all PP incorporated groups during storage at both temperatures compared to others (P < 0.05). ORP in all treatments generally increased (P < 0.05) during storage at both storage temperatures. This study showed that encapsulation is not a factor affecting antimicrobial efficiency of PP and using PP-SL combinations have synergistic effect on reducing the viability of S. Typhimurium, E. coli O157:H7 and S. aureus and their subsequent growth ability in cooked ground beef.

Fetal sodium valproate exposure causes Baller-Gerold syndrome phenotype: both phenotypes in the same family.

Baller-Gerold syndrome (BGS) is characterized by craniosynostosis and preaxial upper-limb malformations, and it has an autosomal recessive inheritance. Valproate syndrome occurs after exposure to valproic acid in utero, and is characterized by trigonocephaly. Both syndromes can also present with other malformations. Herein, we report a female newborn and her brother who both had a history of fetal exposure to maternal anti-epileptic drugs, especially sodium valproate. On physical examination of the female patient, craniosynostosis, trigonocephaly, right radius aplasia and hypoplastic thumb, and cardiac and renal malformations were determined, and she was diagnosed with BGS phenotype. The brother's examination revealed trigonocephaly, polymastia and hypospadias, and he was diagnosed with valproate syndrome. Based on these patients, we aimed to add further evidence in the literature indicating that the use of sodium valproate alone and in combination with other anti-epileptic drugs throughout pregnancy can increase the risk of serious fetal congenital malformations depending on the doses.

An Unusual Presentation of Kawasaki Disease: Gallbladder Hydrops and Acute Cholestatic Hepatitis.

Kawasaki disease is the most common vasculitis of childhood. In its classical form, at least four of five diagnostic criteria including cervical lymphadenopathy (1.5 cm or more), nonsuppurative conjunctivitis, intraoral mucosal changes, edema in hands and feet, and maculopapular rash are required with prolonged fever over 5 days. Atypical cases which are different from the classical type or incomplete cases which does not include all the diagnostic criteria can be seen. The typical Kawasaki disease is a self-limiting disease with fever lasting for an average of two weeks. In such patients who have not been diagnosed and whose treatment has been delayed, coronary artery aneurysm, myocardial depression, arrhythmia, and vascular complications may increase morbidity and mortality. We would like to present a rare case of an atypical patient with gallbladder hydrops and acute cholestatic hepatitis.

Effects of methylphenidate on leptin and appetite in children with attention-deficit hyperactivity disorder: an open label trial.

Appetite suppression is one of the most common side effects of methylphenidate (MPH), which is used for treatment of attention-deficit hyperactivity disorder (ADHD). Relation of appetite and leptin is well known but there is no report regarding MPH use and leptin. In this study we compared the baseline leptin levels of ADHD children with the controls and studied the interaction between MPH and leptin-insulin level in ADHD children under MPH treatment. The major finding of this study is that at a total daily dose of 0.6 mg/kg short-acting MPH treatment, one does not observe significant side effects related to appetite suppression and metabolic features as measured via body mass index, insulin and leptin levels. Thus this range seems to be safe in developing ADHD children with minimum side effects regarding appetite for short-term treatment.

Distribution of the metatarsophalangeal sesamoids in Turkish subjects.

No statistically significant pattern of metatarsophalangeal sesamoid distribution has been reported in the literature in relation to genetic pool or group, unilaterality or bilaterality, or sesamoid division. A study was undertaken to evaluate the presence and distribution of the metatarsophalangeal sesamoid bones of the foot in Turkish subjects. A total of 602 foot radiographs from 371 patients without forefoot complaints other than those of the hallux were included in the study. Absence or hypoplasia of the first-ray sesamoids was seen on 0.7% of the radiographs, and second-, third-, fourth-, and fifth-ray sesamoids were present on 2.8%, 0.5%, 1.0%, and 15.1% of the radiographs, respectively. Fifth-ray sesamoids were more prevalent in men (odds ratio, 2.71; 95% confidence interval, 1.52-4.84). The frequency of a normal foot profile (two sesamoids in the first ray) was 83.2%. Divisions of the sesamoids were seen on 4.0% of the radiographs at the first ray and on 20.9% at the fifth ray. Distribution and division of sesamoids were predominantly bilateral (kappa = 0.91, 0.91, and 0.95 for the first, second, and fifth digits, respectively; P < .001).

Comparison of injection modalities in the treatment of plantar heel pain: a randomized controlled trial.

In a prospective randomized study of plantar heel pain, 44 patients were treated with injection of 1 mL of 2% prilocaine using the peppering technique, 1 mL of 2% prilocaine combined with 2 mL of autologous blood, or 1 mL of 2% prilocaine mixed with 40 mg of methylprednisolone acetate. At 6-month follow-up, clinical improvement was evaluated by using a 10-cm visual analog scale and the rearfoot score of the American Orthopaedic Foot and Ankle Society. Results were analyzed using sample t-tests within groups and repeated-measures analyses of variance between groups. Mean +/- SD visual analog scale scores in the peppering technique, autologous blood injection, and corticosteroid injection groups improved from 6.4 +/- 1.1, 7.6 +/- 1.3, and 7.28 +/- 1.2 to 2.0 +/- 2.2 (P < .001), 2.4 +/- 1.8 (P < .001), and 2.57 +/- 2.9 (P < .001), respectively. Mean +/- SD rearfoot scores in the same groups improved from 64.1 +/- 15.1, 71.6 +/- 1, and 65.7 +/- 12.7 to 78.2 +/- 12.4 (P = .018), 80.9 +/- 13.9 (P = .025), and 80.07 +/- 17.5 (P = .030), respectively. There were no statistically significant differences among the groups. Good outcomes have been documented using the peppering technique and autologous blood injection for the treatment of lateral epicondylitis. Although the curative mechanisms of both injection modalities are based on a hypothesis, they seem to be good alternatives to corticosteroid injection for the treatment of plantar heel pain.

Ovarian cancer presenting as an axillary mass: Case series and literature review.

AIM: Ovarian cancer is a common cause of death in women worldwide. The purpose of this article was to report a case series and draw physicians' attention to the benefits of histpathologic techniques in determining uncommon metastatic diseases. METHODS: In this study, we report a case series of axillary involvement of ovarian cancer in 6 patients. The data were collected between 2006 and 2015 by analyzing patient's characteristics, and biochemical and immunohistochemical features. No pathologic lesions were detected in breasts. Specific immunohistochemical methods such as GCDFP-15, CA12-5, WT-1, and PAX-8 supported evidence of metastasis from ovarian cancer to axillary lymph nodes. RESULTS: Biochemical tests showed increased levels of CA12-5 in all patients. In 5 patients, GCDFP-15 was negative and WT-1 was positive with specific immunohistochemical staining. PAX-8 was positive in 3 of 5 patients. CONCLUSIONS: Physicians need to be aware that histopathologic and immunohistochemical results can make a significant contribution in determining the true primary tissue of metastatic adenocarcinoma, even in the absence of typical clinical findings.

Impact of Added Encapsulated Phosphate Level on Lipid Oxidation Inhibition during the Storage of Cooked Ground Meat.

The effect of levels (0.1%, 0.2%, 0.3%, 0.4%, 0.5%) of added encapsulated (e) phosphate (sodium tripolyphosphate, STP; sodium hexametaphosphate, HMP; sodium pyrophosphate, SPP) on lipid oxidation inhibition during storage (0, 1, and 7 d) of ground meat (chicken, beef) was evaluated. The use of eSTP and eSPP resulted in lower and higher cooking loss (CL) compared to eHMP, respectively (P < 0.05). Increasing encapsulated phosphate level (PL) enhanced the impact of phosphates on CL in both chicken and beef samples (P < 0.05). Encapsulated STP increased pH, whereas eSPP decreased pH (P < 0.05). pH was not affected by PL. The highest orthophosphate (OP) was obtained with eSTP, followed by eSPP and eHMP (P < 0.05). The level of OP determined in both chicken and beef samples increased (P < 0.05) during storage. Increasing PL caused an increase in OP (P < 0.05). The highest reduction rate in the formation of thiobarbituric acid reactive substances (TBARS) and LPO for both meat species were obtained with eSPP, followed by eSTP and eHMP (P < 0.05). Increasing PL resulted in lower TBARS and LPO (P < 0.05). Findings suggest that encapsulated phosphates can be a strategy to inhibit lipid oxidation for the meat industry and the efficiency of encapsulated phosphates on lipid oxidation inhibition can be enhanced by increasing PL.

The relation of joint laxity and trunk rotation.

A study was designed to evaluate the joint laxity during scoliosis screening, and to show if there is a relation of joint laxity values to the trunk rotation. One thousand, two hundred and seventy-three children (598 females, 675 males) with an average age of 10.4 years were screened with a scoliometer and forward bending for trunk rotations. Scapular and shoulder elevations, flexible pes planus were recorded and joint laxity was evaluated with the Beighton score. There was high inter-observer and intra-observer reliability for both scoliometer and Beighton scores. In 41 children (3.2%) with Beighton score 7 or higher, trunk rotation measurements were higher than for the rest of the children. Trunk rotation measurements of 7 degrees or higher were found in 30 children, who were more lax than the rest of the group and were invited for radiography, with a detection of curves between 11 and 18 degrees in 10 of them. The Beighton score is a practical and reliable method for defining joint laxity. Although the number of patients with scoliosis was limited, there are findings supporting the relation between joint laxity and scoliosis. Moreover, there was increased laxity in children with increased trunk rotations. Ligamentous laxity may be one of the causes changing the contour of the back.

Effects of Different End-Point Cooking Temperatures on the Efficiency of Encapsulated Phosphates on Lipid Oxidation Inhibition in Ground Meat.

Effects of 0.5% encapsulated (e) phosphates (sodium tripolyphosphate, STP; sodium hexametaphosphate, HMP; sodium pyrophosphate, SPP) on lipid oxidation during storage (0, 1, and 7 d) of ground meat (chicken, beef) after being cooked to 3 end-point cooking temperatures (EPCT; 71, 74, and 77 °C) were evaluated. The use of STP or eSTP resulted in lower (P < 0.05) cooking loss (CL) compared to encapsulated or unencapsulated forms of HMP and SPP. Increasing EPCT led to a significant increase in CL (P < 0.05). Both STP and eSTP increased pH, whereas SPP and eSPP decreased pH (P < 0.05). The higher orthophosphate (OP) was obtained with STP or SPP compared to their encapsulated counterparts (P < 0.05). The lowest OP was determined in samples with HMP or eHMP (P < 0.05). A 77 °C EPCT resulted in lower OP in chicken compared to 74 and 71 °C (P < 0.05), dissimilar to beef, where EPCT did not affect OP. In encapsulated or unencapsulated form, using STP and SPP enhanced reduction in TBARS and lipid hydroperoxides (LPO) compared with HMP (P < 0.05). Regardless of the phosphate type, more effective lipid oxidation inhibition was achieved by the use of encapsulated forms (P < 0.05). Increasing EPCT resulted in lower TBARS in beef and higher LPO values in both beef and chicken samples (P < 0.05). Findings suggest that encapsulated phosphates can be a strategy to inhibit lipid oxidation for meat industry and the efficiency of encapsulated phosphates on lipid oxidation inhibition can be enhanced by lowering EPCT.

Preoperative chemotherapy for T2 breast cancer is associated with improved surgical outcome.

BACKGROUND: The aim of this study is to compare the clinical outcome in T2 breast cancer patients who underwent preoperative chemotherapy (PC) and who did not. The study also tried to define a subgroup of patients, who are more beneficial after PC in terms of lower re-excision rates, better cosmetic results and local recurrence free survival. MATERIALS AND METHODS: 251 consecutive patients treated for nonmetastatic T2 invasive breast cancer were analyzed retrospectively. Of those; 141 underwent primary surgery (PS) followed by chemotherapy, whereas 110 were treated with combination of PC and surgery. RESULTS: The patients who were treated with PC had a significantly higher incidence of negative margins and lower rate of re-excision (5% vs. 16%, p = 0.02). Of all patients attempted breast conserving surgery (BCS), patients in the PC group were more likely to undergo BCS as their definitive operation compared to patients with PS group (BCS rates; PC group: 99% vs. PS group: 92%, p = 0.05). Multifocal disease (OR: 7, 95% Cl, 2.7-18.4, p = 0.0001) and PC (OR = 0.2; 95% CI, 0.06-0.72, p = 0.01) were factors associated with margin positivity in patients treated with BCS. There was no statistically significant difference in 5 year local-recurrence free survival rates between 2 groups. CONCLUSIONS: Our study shows that PC significantly decreases the re-excision in patients undergoing BCS with primary T2 breast tumors. This data suggests that any patient with a tumor greater than 2 cm might be considered for PC to increase BCS success with final negative margins.

Camptodactyly, myopia, and fibrosis of the medial rectus of the eye in two sibs born to consanguineous parents: autosomal recessive entity?

Unaffected but consanguineous parents suggest autosomal recessive inheritance of a previously apparently undescribed syndrome of camptodactyly, fibrosis of the medial rectus muscle of the eye, severe myopia, facial anomalies, joint contractures, and mild scoliosis in a 13-year-old Turkish girl and her 11-year-old brother. The girl also had ptosis.

Rapid repair of titanium particle-induced osteolysis is dramatically reduced in aged mice.

Aseptic loosening is the most common cause of orthopaedic implant failure. This process is thought to be due to osteolysis induced by implant-derived wear particles. Teitelbaum and colleagues have recently developed a promising murine calvarial model of wear particle-induced osteolysis. However, prior to this study, this model had only been assessed qualitatively. We now report a reproducible, quantitative version of the calvarial model of wear particle-induced osteolysis, in which the extent of osteolysis (and repair) of entire parietal bones is assessed by histomorphometry of contact microradiographs. Using this model, we found that the osteolytic response is transient and rapidly repaired in one month old mice. The extent of osteolysis peaks 7 days after particle implantation and returns to baseline levels by 13 days. A similar amount of osteolysis and even more extensive repair is observed when particles are implanted repeatedly. In contrast, aged mice develop progressive osteolysis with no detectable repair. As a result, 26 month old mice have approximately 17-fold more osteolysis than one month old mice 21 days after particle implantation. Skeletally mature, adult mice (4-16 months old) show an intermediate pattern of response. Osteolysis in these mice peaks at 7 days after particle implantation but it is repaired more slowly than in the one month old mice. Taken together, these results underscore the role of an imbalance between bone resorption and bone formation in the development of aseptic loosening and suggest that agents that stimulate bone formation maybe useful in prevention or treatment of aseptic loosening.

Role of Chlamydia trachomatis infections in infertility due to tubal factor.

The prevalence of IgG antibodies to C. trachomatis was determined in 185 infertile women who underwent laparoscopy, and 110 pregnant women with no known infertility problems. In addition, chlamydial antigens were evaluated by EIA in cervical samples taken from all subjects. Subjects with tubal infertility had the highest prevalence of chlamydial antigen and antibody (P less than 0.01). While the percentage of subjects with antigen and antibody positive was 11.6 per cent, those with antigen negative and antibody positive averaged 55.8 per cent among women with tubal related infertility. The results of our study provide additional support to the concept that infertility of tubal etiology often is a sequela of a previous chlamydial infection.

Influence of turkey meat on residual nitrite in cured meat products.

A response surface experimental design was employed to estimate residual nitrite level at various initial nitrite concentrations, percent turkey meat in the formula, and heat quantity (F) values using a typical wiener as the test system. Pork and mechanically separated turkey were used as the meat ingredients. Residual nitrite and pH were measured at day 1, 7 days, 14 days, and 49 days after processing. Protein, fat, salt, moisture, and CIE (L*a*b*) color values were also determined. Results showed that the effect of turkey meat on residual nitrite level was significant (P < 0.01). An increased amount of turkey meat in the formula resulted in lower residual nitrite levels at a fixed pH. The residual nitrite level was initially proportional to initial nitrite concentration, but it became a nonsignificant factor during longer storage time. Differences in heat quantity had a significant effect (P < 0.05) on residual nitrite level initially. Greater heat quantity decreased residual nitrite level in finished cured meat products at a fixed pH. However, this effect became nonsignificant during longer storage. Reduction of residual nitrite in wieners because of turkey meat addition at a fixed pH was due to characteristics of the turkey tissue, but the mechanism of action remains unknown. It was also established that commercial wieners had a higher pH if poultry meat was included in the formulation.

A new technique for creating an abdominal window in a hip spica cast.

Opening an abdominal window in a hip spica type of cast can be a troubling maneuver for both orthopaedic surgeon and patient. We present a simple device to create an abdominal window more easily.

[The effect of percutaneous trigger finger release on normal anatomic structures and long-term results of the procedure]. / Tetik parmak tedavisinde perkütan cerrahi girisimin normal anatomik yapilara etkisi ve uzun dönem sonuçlari.

OBJECTIVES: To evaluate the long-term results and possible complications of percutaneous release in the treatment of trigger finger. METHODS: We performed percutaneous pulley release with the use of a 16 gauge needle in 25 fingers of 22 patients (16 females, 6 males; mean age 54 years; range 45 to 72 years). Open exploration was added to the procedure in 10 patients to determine the efficacy and safety of the technique. The mean follow-up was 24 months (range 18 to 35 months). RESULTS: Triggering and pain were eliminated in all fingers postoperatively. Exploration showed that a complete anatomical release of the pulley was obtained in all fingers. Apart from some superficial abrasions, there were no tendinous injury or other complications. In one case, an unintentional skin incision occurred during manipulation of the needle. CONCLUSION: Due to low complication rates and ease of the procedure with a successful release, percutaneous technique proved an appropriate alternative in the treatment of trigger finger.