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

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

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

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

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

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

Spleen rupture due to brucellosis.

Brucellosis is a common zoonotic infection worldwide; it is caused by infection with the bacterial species Brucella and leads to severe diseases in humans and animals. In Turkey, this bacterial species has not been completely eradicated and is commonly found in animals (such as goats or sheep). Brucellosis can lead to various symptoms, affect multiple systems, and cause splenomegaly in the case of spleen involvement. In contrast to traumatic spleen ruptures, spontaneous spleen ruptures are rare and most commonly occur because of infectious causes. A 52-year-old man was treated at our infectious diseases clinic for Brucella endocarditis. Due to sudden abdominal pain, nausea, vomiting, and vertigo, the patient was evaluated by our team of doctors at the same clinic. The patient had widespread sensitivity in the abdominal region, as well as defense and rebound symptoms. Emergency abdominal tomography revealed a ruptured spleen and widespread hemorrhagic fluid in the abdomen. Exploration revealed multiple ruptures in the spleen capsule. The patient underwent splenectomy and did not experience any complications during the postoperative period. Spontaneous spleen rupture is a rare clinical condition that should be considered in patients who are hospitalized at internal medicine clinics for infectious, hematogenic, and metabolic causes, as well as in those who have sudden abdominal pain and hypovolemia.

Influence of Knowledge and Beliefs of Housewives on Attitudes About Organ Donation.

OBJECTIVES: Reluctance of families of deceased donors to provide approval for donation is a factor in low rates of deceased donor organ transplants. Decisions of women may be important for family approval. We investigated the influence of knowledge and beliefs of housewives on attitudes toward organ donation. MATERIALS AND METHODS: This cross-sectional study was conducted with 212 housewives attending Directorate of Religious Affairs centers and public education centers in Adana province between May and June 2018. A structured questionnaire to assess sociode-mographic information, knowledge, and beliefs about organ donation, as well as the Attitudes Toward Organ Donation Scale, was applied through face-to-face interviews. RESULTS: Mean age of participants was 42.9 ± 13.1 years, 68 (32.1%) had no formal education, and 125 women (59.0%) identified as low income. Of the women, 40 (18.9%) were single, 147 (69.3%) were married, 25 (11.8%) were divorced∕widowed, 104 (49.1%) were attending religious affairs centers, and 108 (50.9%) were attending public education centers. Mean score for the question "What is the religious drawback of donating organs?" was significantly higher in participants attending a Quran course (2.5 ± 1.4), and mean score of Attitudes Toward Organ Donation Scale decreased significantly as mean score for this question increased; the score for "Are you aware that the organ donation-related procedures are conducted within the law?" was 2.2 ± 1.2 (P < .001). Scores increased as knowledge level increased (r = 0.360, P < .001), and scores decreased as perception of organ donation as religiously objectionable increased (r = -0.258, P < .001). CONCLUSIONS: Participants with sufficient knowledge about organ donation, without religious objection to organ donation, and with awareness of the lawful status of organ donation had positive attitudes toward organ donation. Efforts toward improvement of community knowledge could increase rates of deceased donor organ donation.

Determination of Neurodegeneration in Polycystic Ovary Syndrome with Retinal Segmentation Analysis.

Purpose: To compare the thickness of each retinal layer in patients with polycystic ovary syndrome (PCOS) versus healthy, age-matched controls by using retinal segmentation analysis.Methods: In our cross-sectional study, 37 patients with PCOS (i.e., patient group) and 35 healthy individuals (i.e., control group) underwent spectral-domain optical coherence tomography imaging. Using built-in automatic retinal segmentation software to analyze the images collected, we compared the thickness of the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer, outer plexiform layer, outer nuclear layer, photoreceptor layer (PRL), retinal pigment epithelium (RPE), inner retinal layers, and outer retinal layers between the groups. To analyze the measurements, we used a traditional Early Treatment Diabetic Retinopathy Study (ETDRS) grid.Results: In ETDRS subfields, 6-mm nasal RNFL thickness; 3- and 6-mm nasal GCL thickness; 3-mm superior and 6-mm nasal IPL thickness; 1-mm central, 3-mm nasal, superior, and inferior, and 6-mm nasal and inferior PRL thickness; and 6-mm inferior RPE thickness were significantly thinner in patients with PCOS than that of healthy controls.Conclusion: The results of our retinal segmentation analysis indicate that patients with PCOS tend to have thinner GCL, IPL, and PRL than healthy, age-matched controls due to neurodegeneration likely caused by insulin resistance, or subclinical retinal inflammation.

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

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

Long-term effect of systemic isotretinoin on female fertility.

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

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

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

Platelet Distribution Width as a Predictor of Metastasis in Gastric Cancer Patients.

INTRODUCTION: There are few known predictors of gastric cancer (GC). In this study, we evaluated the relationship between peripheral blood parameters and disease in patients with GC. Our aim was to identify a predictor of the development of metastasis. MATERIALS AND METHODS: Pretreatment peripheral blood parameters, including neutrophil, lymphocyte, and platelet counts; median platelet values (MPVs); and platelet distribution width (PDW), of patients diagnosed with GC were assessed. The independent T test was used in comparisons between two groups with a normal distribution, the Mann-Whitney U test in comparisons between two groups without a normal distribution, the Kruskal-Wallis test to compare more than two groups, and the Dunn's multiple comparison test to compare subgroups. A p value <0.05 was considered statistically significant. RESULTS: In GC patients, neutrophil and platelet counts, but not lymphocyte counts and MPVs, increased significantly with disease stage progression. Among patients who developed a metastasis during follow-up, the relationship between PDW and the risk of metastasis was statistically significant (p = 0.04). Both lymphocyte and platelet levels had a statistically significant relationship to survival (p = 0.04 and p = 0.02, respectively). CONCLUSIONS: Our results showed that in patients with GC, PDW, one of the standard parameters measured in a complete blood count, is a predictor of metastasis. Therefore, the PDW may be an important consideration in the surgical and chemotherapeutic treatment planning of patients with GC. Treatment strategies should also take into account lymphocyte and platelet levels, both of which were shown to be significantly related to survival.

The relationship between expectation, experience and perception of labour pain: an observational study.

The present study was aimed to assess the relationship between pain expectation before labour, labour pain and pain perception after the labour. Pregnant women were asked to rate their pain level on a standard continuous visual analogue scale at various time points. Pain expectancy (PE), labour pain (LP) and postpartum pain perception (PPP) scores were calculated. The final study group was composed of 230 pregnant women after exclusions. Mean age of pregnant women was 26.2 ± 5.79. The mean PE, LP, and PPP scores were 70.11 ± 18.82, 75.72 ± 19.2 and 65.84 ± 19.56, respectively. The difference among pain scores was statistically significant (p < 0.001). There was a positive correlation between PE and LP or PE and PPP scores (p = 0.27 and p = 0.21). The correlations were statistically significant (p = 0.01 or p = 0.01). In addition, there was a positive correlation between LP and PPP scores (p = 0.87) and the correlation was statistically significant (p = 0.01). This study showed that, if pregnant women had lower expectations of pain before the labour, they indeed experienced lower amount of pain during the labour.

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

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

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

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

Broadband ultrasonic spectroscopy for the characterization of viscoelastic materials.

In this study, non-destructive experimental method based on acoustic through transmission technique along with broadband spectroscopy is proposed in order to determine the linear viscoelastic material properties in 20-400 kHz range. Material properties such as phase velocity and attenuation coefficient of longitudinal and shear waves are measured. Diffraction correction developed for focused transducers is used to eliminate the spreading error due to the spherical wave generated by the hydrophone which is used as a transmitter. Method is validated on polymethyl methacrylate (PMMA). Both longitudinal wave velocity, shear wave velocity and attenuation coefficient of longitudinal wave of PMMA are in agreement with the previously reported values which are given in the literature. Attenuation coefficient of shear wave in PMMA is measured successfully and in agreement with the theoretical predictions. Longitudinal wave velocity and corresponding attenuation coefficient of gelatine gel are also measured.

Successful laparoscopic management of a rare complication after embryo transfer: ovarian pregnancy. A case report and up-to-date literature review.

Ovarian pregnancy (OP) after embryo transfer is very rare. Due to the rarity and the asymptomatic nature, there are still difficulties in diagnosis and treatment. The traditional operative treatment for OP has been oophorectomy. However, the desire to maintain reproductive capability and improvements in laparoscopy have more recently led to conservative laparoscopic techniques. This rare complication could be diagnosed early and managed by a conservative laparoscopic approach. Here we present a survey of the literature and a case of successful laparoscopic management of ovarian pregnancy after intracytoplasmic sperm injection and embryo transfer. The current case is the first case in the literature in which ovarian pregnancy occurred after a single embryo transfer. We also summarize the literature about management of ovarian pregnancy after embryo transfer.

Fetal anterior abdominal wall thickness may be an early ultrasonographic sign of gestational diabetes mellitus.

OBJECTIVE: The aim of the study was to investigate standard biometric measurements, such as biparietal diameter (BPD), femur length (FL), abdominal circumference (AC), estimated fetal weight (EFW) and anterior abdomen wall thickness (AAWT) in fetuses complicated by gestational diabetes mellitus (GDM) at the time of GDM screening, and to compare the results with healthy pregnant controls. METHODS: A total of 124 pregnant women between 26 and 28 weeks' gestation were included in the study. These patients were divided into two groups based on their 75-g oral glucose tolerance test results. The study group consisted of 55 pregnant women with GDM, and 69 healthy pregnant women constituted our control group. RESULTS: The study groups did not differ with respect to the mean BPD, FL, AC and EFW; however, the mean AAWT was significantly higher in the GDM group, 4.07 ± 0.46 mm versus 3.28 ± 0.37 mm in the control group (p < 0.001). CONCLUSIONS: The only fetal sonographic measurement found to significantly differ between the study groups was the AAWT in 26 weeks at the time of gestational diabetes screening, suggesting that measuring the AAWT may have a role in the evaluation of fetal growth in pregnancies complicated by gestational diabetes.

The effect of systemic isotretinoin on male fertility.

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

Lidocaine 10% spray to the cervix reduces pain during intrauterine device insertion: a double-blind randomised controlled trial.

OBJECTIVE: Fear of pain during intrauterine device (IUD) insertion can be a barrier to widespread use of this safe and highly effective contraceptive method. Our objective was to determine the effectiveness of topical 10% lidocaine spray for pain control during IUD insertion. METHODS: A total of 200 subjects with the request for IUD insertion were included in the study. The patients were randomly divided into two groups: lidocaine spray (n=100) and placebo (n=100). The pain experienced during the procedure was measured immediately after insertion by a standard Visual Analogue Scale (VAS) administered by a separate researcher with maintenance of allocation concealment. RESULTS: The mean pain score during the procedure was 1.01±1.20 in the lidocaine spray group and 3.23±1.60 in the placebo spray group (p<0.001). Lidocaine spray treatment significantly lowered the overall procedural pain score compared with placebo. CONCLUSIONS: Significant pain reduction during IUD insertion can be achieved by using 10% lidocaine spray alone. Lidocaine spray can be accepted as a non-invasive, easy to apply and more comfortable local anaesthetic method for IUD insertion. TRIAL REGISTRATION NUMBER: NCT02020551.

Successful use of laparoscopic myomectomy to remove a giant uterine myoma: a case report.

INTRODUCTION: Uterine leiomyomas are the most common benign neoplasms of the female reproductive tract. Myomectomy is the preferred surgical treatment in reproductive-aged women who desire to retain their fertility. The use of a laparoscopic approach for large myomas is still controversial, although there are several compelling reasons for its use. The laparoscopic removal of giant uterine myomas is rare, and only a few cases have been published in the literature. CASE PRESENTATION: We report the case of a 33-year-old white woman who was referred to our clinic with progressive abdominal distension. An ultrasonic examination revealed a markedly enlarged uterus containing a 17 cm uterine myoma. Laparoscopic myomectomy was selected as the treatment option. The laparoscopy confirmed the 17 cm fundal intramural myoma. The myoma was totally enucleated and removed without disturbing her endometrial cavity. The myometrial defect was repaired with a continuous suture using the V-loc suture in two layers. The entire myoma was removed using a tissue morcellator. The total weight of the myoma removed was 2005g, and the operation lasted for 140 minutes. Her postoperative course was unremarkable. CONCLUSIONS: Laparoscopic myomectomy offers many advantages compared with abdominal myomectomy. Although the use of a laparoscopic approach to treat very large myomas is controversial and technically demanding, we successfully performed a laparoscopic myomectomy in a patient with a giant myoma. This case confirms the efficiency, reliability, and safety of a minimally invasive surgical approach to treating a giant uterine myoma. Laparoscopic myomectomy can be performed by experienced surgeons regardless of the size of the myoma.