"/" wiring (Durukan weave) to prevent sternal cutting by wires: a propensity score matched comparison with Robicsek weave.

Introduction: Sternal closure still causes morbidity/mortality following sternotomy. Robicsek weave, cable systems, rigid plates and nitinol clips are systems employed to prevent sternal dehiscence. Aim: The aim was to document the effectiveness of a novel method using standard sternal wires decreasing load on wires and spreading load on the lateral sternum to prevent sternal cutting by wires and thus sternal dehiscence. Material and methods: 756 patients who underwent coronary revascularization with sternotomy between July 2018 and November 2022 were retrospectively analyzed. Fifty patients with "/"wiring were compared with 50 patients with Robicsek weave by propensity score matching. "/" wiring (Durukan weave) spreads load laterally on the sternum by lateral sequential knotting of wires instead of midline knotting. Outcomes were superficial and deep sternal wound infection and non-infectious sternal dehiscence. Results: There were 50 patients in each group. Mean age of the patients was 65.74 ±7.47 in Robicsek weave and 66.12 ±7.23 in Durukan weave. The perioperative characteristics of patients were comparable as propensity score matching was performed. None developed superficial sternal wound infection in Robicsek weave, whereas 2% (1) in "/"wiring. There was no deep sternal wound infection in each group. Non-infectious sternal dehiscence did not occur in either group. Conclusions: "/" wiring seems to be a safe and cost-effective method for sternal closure for preventing sternal cutting by wires, therefore preventing sternal wound related problems and dehiscence. The method is cheap, easily applicable and less time consuming than Robicsek weave, which was proven to be the safest method for sternal wire closure.

Evaluation of Clinical Approach and Outcomes Staphylococcus aureus Bacteremia.

Objective: Despite appropriate treatment and early diagnosis methods, Staphylococcus aureus bacteremia (SAB) is still associated with a high mortality rate. This study aims to evaluate the clinical features and approaches to SAB and to analyze the parameters that may affect 7-day and 30-day mortality. Materials and Methods: Adult patients with SAB data between 2011 and 2018 were evaluated retrospectively. Clinical data, patient demographics, and 7-day and 30-day mortality rates were obtained from their medical records. Results: In total, 144 patients were included in the study; 57.6% (83/144) of patients were men, and the mean age was 65.2±16.5 years. The most common source of infection was the central-line catheter (38.9%), followed by intra-abdominal (21%), respiratory (16.7), infective endocarditis (5.6%), and osteoarticular foci (2.1%). Fifteen percent (15%) of the strains were methicillin resistant. Transthoracic echocardiography (TTE) was performed for 80.6% (116/144) patients. Infectious diseases specialist consultation within 96 hours from blood culture signal was requested in 79.9%. Overall, 7-day mortality was 11.8%, and 30-day mortality was 21.5%. Staying in intensive care units (ICU) increased the risk of 30-day mortality by 1.1 times, and respiratory-focused SAB increased the risk by 4.3 times. Conclusion: SAB is still a big threat. Staphylococcal pneumonia remains a severe infection. Several prognostic factors influence mortality. Identifying the source, ensuring source control, and appropriate initial therapy as soon as possible are critical for reducing mortality and morbidity in SAB.

Evaluation of the effect of periodontitis on quality of life using Oral-Dental Health-Related Quality of Life-United Kingdom scale.

OBJECTIVE: The aim of this study was to investigate the impact of periodontitis on oral health-related quality of life (OHQoL) using Oral-Dental Health-Related Quality of Life-United Kingdom (OHRQoL-UK) scale and evaluate the contributing factors. METHODS: 50 patients with untreated periodontitis and 50 individuals without periodontitis were enrolled in the study. All subjects received detailed periodontal examination. Plaque index (PI), gingival index (GI), probing depth (PD) and clinical attachment level (CAL) measurements were examined. OHRQoL was assessed by the Oral Health Quality of Life-United Kingdom (OHRQoL-UK) scale. Symptoms of periodontitis were monitored by visual analogue scale (VAS). Socio-demographic characteristics, medical history, smoking status, hygiene habits of the participants were recorded. This study is registered at ClinicalTrials.gov as NCT04240014. RESULTS: Total OHRQoL-UK scores were 38.24±6.47 in periodontitis patients and 55.88±9.38 in non-periodontitis individuals (p < 0.001). The scores of all 4 parameters were significantly lower in patients with periodontitis compared to healthy individuals (p <0.001). Higher PI, GI, PD and CAL values were associated with extensive negative impacts of periodontitis on OHRQoL (p < 0.001). According to the results of linear regression analysis, only periodontitis was found to associate with OHRQoL. Periodontal disease reduces the total quality of life score by 15.087 (ß= -15.087; 95% CI = [(-18.934)-(-11.240)]. CONCLUSIONS: Individuals with periodontitis has diminished OHRQoL compared to healthy individuals.

Awareness about dental amalgam among Turkish dentists and patients: a questionnaire and search engine based cross-sectional study.

OBJECTIVES: There has been considerable controversy concerning the health risks and benefits of using mercury-containing amalgam. This study aimed to evaluate the Turkish dentists' and patients' preference and opinion about amalgam and to assess Internet search trends about amalgam. METHODS: The study consists of three stages. The first two stages of the study are cross-sectional studies to verify both the patients' perception with amalgam restorations and dentists' attitudes regarding the use of dental amalgam. The third stage of the study evaluated the Internet search trends of Turkish people about mercury and amalgam related concerns between 2004 and 2018. RESULTS: A total of 320 patients (180 female, 140 male) and 1,211 dentists (533 female, 678 male) participated in this study. Majority of the patients have no idea about the type of dental restorations and effect of dental materials on their health. 188 (58.8%) participants stated that they would not prefer amalgam restoration in their teeth as amalgam is unaesthetic. A total of 24% (291) of the dentists used amalgam routinely; 9.5% (156) of them used amalgam rarely, and 63.1% (764) did not use amalgam at all. The reason for not using amalgam included the patients' desire and unaesthetic properties. According to the Internet search trends, Turkish people do not know as much about amalgam as people in the rest of the world. CONCLUSION: Awareness about dental amalgam is low among patients studied. Although dentists do not use dental amalgam frequently, they disagree on banning dental amalgam.

The Knowledge Level of Dentists in Turkey About Their Potential Role on the Disaster Victims Identification (DVI) Team.

OBJECTIVE: Although dentists are valuable assets in identification teams during disaster events, forensic dentistry is not used effectively in the identification studies conducted in Turkey, and the importance of dental data is ignored. The aim of this study was to determine the level of knowledge of dentists regarding their duties and responsibilities during major disasters. METHODS: This descriptive study was conducted between December 2015 and June 2016. Registered dentists (n=20.280) of the Turkish Dental Association were invited to complete the organization's online survey. A total of 539 dentists participated in the volunteer workshop. Data were analyzed using SPSS, version 22.0 (IBM Corp, Armonk, NY). The chi-square analysis was used to evaluate the knowledge level of dentists by group regarding disaster victim identification (DVI) - the process and procedure of recovering and identifying victims of major disasters (eg, earthquake, terrorist attack). RESULTS: The dentists included in the study consisted of 320 (59.4%) females and 219 (40.6%) males with a mean age of 37.4±12.6 years. The number of specialists and general dentists were 249 (45.6%) and 297 (54.4%), respectively; 249 (69.71%) dentists who had knowledge about forensic dentistry stated that they received this information during their formal training. The percentage of dentists who were aware of the existence of an organization of a disaster response operation in Turkey was 74.2%, but only 20.5% (n=110) had knowledge about DVI. We found that 92.9% (n=104) of these dentists believed that dentists should be included in the team for the identification of disaster victims. On the other hand, only half (52.3%) of the dentists with knowledge of DVI wanted to work on the identification teams. The majority (99.1%) considered DNA analysis to be the safest method for identification. CONCLUSION: Our findings show that, although dentists know about the identification process, they do not have enough relevant knowledge. (Disaster Med Public Health Preparedness. 2019;13:533-538).

Papanicolaou smear findings in solid-organ transplant recipients compared with normal subjects according to the Bethesda 2001 system.

OBJECTIVES: Solid-organ transplant recipients are at increased risk of developing cancer including cervical cancer compared with woman in the general population, mostly due to long-term immunosuppressive therapy. The Papanicolaou smear remains the primary method of screening cervical pathology including preinvasive and invasive lesions. The objective of this study was to evaluate Pap smear findings in solid-organ transplant recipients, determine the prevalence of abnormal smears, and compare these patients with the general population. MATERIALS AND METHODS: We retrospectively examined 111 women patients who received liver or kidney transplant between January 1990 to December 2012 at Baskent University Ankara Hospital. Pap smear findings were compared with normal control patients matched for same age and technical procedure of cervical cytology. To selection of control patients, propensity score matching program was performed. All Pap smears were re-examined according to Bethesda 2001 criteria. RESULTS: In 111 transplant patients, 2 patients (1.8%) had atypical squamous cells of undetermined significance, 8 patients (7.2%) had low-grade squamous intraepithelial lesion, 15 patients (13.5%) had Candida infection, 2 patients (1.8%) had Trichomonas vaginalis, 1 patient (0.9%) had herpes simplex infection, 13 patients (11.7%) had bacterial vaginosis, 15 patients (13.5%) had reactive changes due to inflammation, and 18 patients (16.2%) had atrophy. When we compared our results with the control group, there were statistically significant differences (P ≤ .05) between the 2 groups in epithelial cell abnormalities (low-grade squamous intraepithelial lesion), Candida infection, bacterial vaginosis, and atrophy. CONCLUSIONS: Pap smear screening potentially may help recognize cervical preinvasive and invasive lesions. The risk of developing cervical intraepithelial neoplasia is greater in transplant recipients because of immunosuppressive therapy. The incidence of low-grade squamous intraepithelial lesion was significantly greater in transplant recipients than the general population. Intensive follow-up with Pap smear in transplant recipients is important in the early detection of these lesions.

Feasibility of the interferon-gamma enzyme-linked immunospot assay in chronic renal failure patients and immunocompetent subjects: a head-to-head comparison.

Diagnosis of latent Mycobacterium tuberculosis infection (LTBI) by the tuberculin skin test (TST) is hampered due to anergy and impaired sensitivity in chronic renal failure (CRF) patients. We aimed to compare the diagnostic performance of the TST with that of interferon-gamma immunospot (T-SPOT.TB®) assay in diagnosing LTBI in CRF and immunocompetent (IC) patients. A total of 74 CRF and 75 IC patients prospectively underwent the TST and T-SPOT.TB. Latent M. tuberculosis infection estimated by TST and T-SPOT.TB was detected in 69% and 43 of CRF; 52 and 35% of IC patients, respectively. The sensitivity and specificity of the T-SPOT.TB were 73 and 74% in IC, whereas 50 and 55% in CRF patients. In conclusion, the prevalence of LTBI was noteworthy in both IC and CRF patients. T-SPOT.TB was less sensitive and specific than the IC group in CRF patients. Both T-SPOT.TB and TST were not associated with the TB exposure.

The prevalence, etiologic agents and risk factors for urinary tract infection among spinal cord injury patients.

BACKGROUND: Urinary tract infections (UTIs) are important causes of morbidity and mortality in patients with spinal cord injury and 22% of patients with acute spinal cord injury develop UTI during the first 50 days. OBJECTIVES: The aim of this study was to determine the prevalence, etiologic agents and risk factors for asymptomatic bacteriuria and symptomatic urinary tract infections in patients with spinal cord injury. PATIENTS AND METHODS: This was a prospective investigation of spinal cord injury patients with asymptomatic bacteriuria and symptomatic urinary tract infections in Baskent University Medical Faculty Ayas Rehabilitation Center and Ankara Physical Therapy and Rehabilitation Center between January 2008 and December 2010. The demographic status, clinical and laboratory findings of 93 patients with spinal cord injury were analyzed in order to determine the risk factors for asymptomatic or symptomatic bacteriuria. RESULTS: Sixty three (67.7%) of 93 patients had asymptomatic bacteriuria and 21 (22.6%) had symptomatic urinary tract infection. Assessment of the frequency of urinary bladder emptying methods revealed that 57 (61.3%) of 93 patients employed permanent catheters and 24 (25.8%) employed clean intermittent catheterization. One hundred and thirty-five (48.0%) of 281 strains isolated form asymptomatic bacteriuria attacks and 16 (66.6%) of 24 strains isolated from symptomatic urinary tract infection attacks, totaling 151 strains, had multidrug resistance (P > 0.05). One hundred (70.4%) of 142 Escherichia coli strains and 19 (34.5%) of 55 Klebsiella spp strains proliferated in patients with asymptomatic bacteriuria; 8 (80%) of 10 E. coli strains and 4 (80%) of 5 Klebsiella spp. strains were multidrug resistant. CONCLUSIONS: The most common infectious episode among spinal cord injury patients was found to be urinary tract infection. E. coli was the most common microorganism isolated from urine samples. Antibiotic use in the previous 2 weeks or 3 months, hospitalization during the last one-year and previous diagnosis of urinary tract infection were the risk factors identified for the development of infections with multi-drug resistant isolates. Urinary catheterization was found to be the only independent risk factor contributing to symptomatic urinary tract infection.

Hydroxyethyl starch 6%, 130/0.4 vs. a balanced crystalloid solution in cardiopulmonary bypass priming: a randomized, prospective study.

BACKGROUND: Since the advent of cardiopulmonary bypass, many efforts have been made to avoid the complications related with it. Any component of the pump participates in occurrence of these adverse events, one of which is the type of prime solution. In this study, we aimed to compare the effects of 6% hydroxyethyl starch 130/0.4 with a commonly used balanced electrolyte solution on postoperative outcomes following coronary bypass surgery. METHODS: Two hundred patients undergoing elective coronary bypass surgery were prospectively studied. The patients were randomized in to two groups. First group received a balanced electrolyte solution and the second group received 6% hydoxyethyl starch 130/0.4 as prime solution. The postoperative outcomes of the patients were studied. RESULTS: The mean age of the patients was 61.81 ± 10.12 in the crystalloid group whereas 61.52 ± 9.29 in the HES group. There were 77 male patients in crystalloid group and 74 in HES group. 6% hydroxyethyl starch 130/0.4 did not have any detrimental effects on renal and pulmonary functions. The intensive care unit stay and postoperative hospital length of stay were shorter in hydroxyethyl starch group (p < 0.05 for each). Hydroxyethyl starch did not increase postoperative blood loss, amount of blood and fresh frozen plasma used, but it decreased platelet concentrate requirement. It did not have any effect on occurrence of post-coronary bypass atrial fibrillation (p > 0.05). CONCLUSIONS: 6% hydroxyethyl starch 130/0.4 when used as a prime solution did not adversely affect postoperative outcomes including renal functions and postoperative blood transfusion following coronary bypass surgery.

May toxicity of amiodarone be prevented by antioxidants? A cell-culture study.

BACKGROUND: Atrial Fibrillation is the most common arrhythmia encountered following cardiac surgery. The most commonly administered drug used in treatment and prophylaxis is amiodarone which has several toxic effects on major organ functions. There are few clinical data concerning prevention of toxic effects and there is no routinely suggested agent. The aim of this study is to document the cytotoxic effects of amiodarone on cell culture media and compare the cytoprotective effects of commonly used antioxidant agents. METHODS: L929 mouse fibroblast cell line was cultured and 100,000 cells/well-plate were obtained. First group of cells were treated with increasing concentrations of amiodarone (20 to 180 µM) alone. Second and third group of cells were incubated with one-fold equimolar dose of vitamin C and N-acetyl cysteine prior to amiodarone exposure. The viability of cells were measured by MTT assay and the cytoprotective effect of each agent was compared. RESULTS: The cytotoxicity of amiodarone was significant with concentrations of 100 µM and more. The viabilities of both vitamin C and N-acetyl cysteine treated cells were higher compared to untreated cells. CONCLUSIONS: Vitamin C and N-acetyl cysteine are commonly used in the clinical setting for different purposes in context of their known antioxidant actions. Their role in prevention of amiodarone induced cytotoxicity is not fully documented. The study fully demonstrates the cytoprotective role of both agents in amiodarone induced cytotoxicity on cell culture media; more pronounced with vitamin C in some concentrations. The findings may be projectile for further clinical studies.

Is the T-cell-based interferon-gamma releasing assay feasible for diagnosis of latent tuberculosis infection in an intermediate tuberculosis-burden country?

The diagnosis of active and latent tuberculosis infection (LTBI) remains a challenge, especially in light of the fact that the tuberculin skin test (TST), which has been used to diagnose LTBI for over a century, has many well-known drawbacks. This study aimed to compare the diagnostic performance of the T-cell-based interferon-gamma releasing assay (IGRA) T-SPOT.TB with the TST for the diagnosis of LTBI in an intermediate tuberculosis (TB)-burden country with high BCG coverage. For this purpose, a total of 91 participants, including culture-confirmed TB patients, healthy contacts known to have been exposed to Mycobacterium tuberculosis, and healthy volunteers, selected from a BCG-vaccinated population were recruited. The sensitivities of the T-SPOT.TB and TST were 79.3 and 25.8%, and the specificities were 75.9 and 56.7%, respectively. The negative- and positive-predictive values for T-SPOT.TB and TST were 78.6 and 76.7% and 42.5 and 38.1%, respectively. The diagnostic performance of the TST in LTBI diagnosis is therefore severely diminished in BCG-vaccinated populations, with the sensitivity and specificity of the T-SPOT.TB assay being markedly higher. IGRAs have been reported to have higher diagnostic sensitivity and specificity in low TB-incidence settings than those seen here. Further larger scale studies in high and intermediate TB-incidence settings are therefore warranted.

Prevalence and risk factors of monosymptomatic nocturnal enuresis in Turkish children.

OBJECTIVES: To determine the prevalence of primary monosymptomatic nocturnal enuresis (PMNE) and assess risk factors that can cause this disease. METHODS: After the determination of 15 primary schools in the provincial center of Ankara, questionnaires were given to 15,150 students to be answered by their parents. Detailed urologic history was obtained and physical examination applied to the students whose parents answered the questionnaire. After excluding children with polysymptomatic NE, 14060 questionnaires of MNE patients were evaluated. Demographic features with social and medical history of students and their parents, general approach of family to the children, school success of the students and general behavioral attitudes, method of toilet training and the presence of nocturnal enuresis were questioned. RESULTS: MNE was determined in 9.0% (n: 1266) of the students and nocturnal enuresis frequency was higher in boys than girls (P<0.05). Univariate analysis revealed gender, method of toilet training, sleep problems, school success, and general approach of the family to children and general behavioral attitudes of the children as significant factors. In logistic regression analysis; age, male gender, toilette training with threatening method, deep sleeper, sleep walking, being introverted and shy, significantly increases the risk of nocturnal enuresis. CONCLUSIONS: The current study suggests that the methods of toilet training are extremely important to prevent bedwetting and behavioral disorders due to enuresis. Parents should be well-informed about the appropriate toilet training method.

The 5-year incidence of type 2 diabetes mellitus in women older than 15 years in Ankara, Turkey: a population-based study.

BACKGROUND: Type 2 diabetes mellitus (DM) is a significant cause of morbidity and premature mortality especially in adults. In Turkey, there are few studies on DM incidence. This study aimed to determine the incidence of type 2 DM in women 15 years or older in Turkey. METHODS: This prospective cohort study was performed from December 2002 to May 2003. Preliminary population-based screening was performed in 1997 and 1998 on women 15 years or older living in 4 villages in the Gölbasi, Ankara province. Five hundred sixty-three women who were considered nondiabetic in the first study comprised the population for the present study. Data collection was accomplished by using a questionnaire and randomly measuring the blood glucose levels of the women. The chi and Fisher exact tests were used to analyze the risk factors for DM. RESULTS: The 5-year incidences of type 2 DM, impaired glucose tolerance, and impaired fasting glucose were 2.3%, 0.4%, and 0.7%, respectively. The 5-year incidence of type 2 DM increased with age (P < 0.05). The DM incidence was 6.2% in those with mixed-type hypertension and 4.0% in those with a body mass index of 30 kg/m or higher. At 5-year follow-up, age (>or=35 years), hypertension, and body mass index (>or=30 kg/m) were the risk factors for incidence of abnormal glucose metabolism (P < 0.05). CONCLUSIONS: The incidence of abnormal glucose metabolism in this study is in accord with that in the literature. Our results will contribute to our understanding of the incidence of DM in women in Turkey.

Self-medication with antibiotics: questionnaire survey among primary care center attendants.

PURPOSE: The aim of this study was to determine the frequency and reasons for self-medication with antibiotics within the last 12 months among primary healthcare center attendants aged 18 or over, in Ankara. METHODS: A questionnaire was applied by face to face interview technique to 2696 subjects attending at five primary healthcare centers. Information on demographic characteristics, intention to self-medication with antibiotics and self-medication within last 12 months were collected. RESULTS: It was found that 28% of the subjects were storing antibiotics at home. The percentage of self-administering antibiotics was 19.1% in the last 12 months. The most common reasons for self-administration of antibiotics were sore throat (59.6%), fever (46.2%), and cough (40.0%). Other reasons were dental infection, rheumatism, and fatigue. According to age groups, the most common self-medicating group was those aged 40-49 with 23% while the least self-usage was in the 60-69 age groups with 11.8%. Male sex, being single, educational level of secondary school or higher, being employed and not having social security increased self-administration of antibiotics (p < 0.05). CONCLUSIONS: The study indicated the need for legal regulations regarding the sale of antibiotics without prescription and, health education is required for the community to decrease the inappropriate use of antibiotics and self-medication.

Diffusion-weighted MRI of the kidneys in patients with familial Mediterranean fever: initial experience.

PURPOSE: To evaluate the feasibility of diffusion-weighted magnetic resonance imaging (DW-MRI) in the assessment of renal function in patients with familial Mediterranean fever (FMF). MATERIALS AND METHODS: Thirty healthy volunteers who had no history of renal disease, hypertension or vascular disease and 60 patients with FMF were included in the study. Transverse diffusion-weighted multisection echo-planar MRI was performed with the following diffusion gradient b values: 0, 111, 222, 333, 444, 556, 667, 778, 889 and 1000 s/mm(2). The apparent diffusion coefficient (ADC) values, urine protein and serum creatinine levels, and glomerular filtration rates of the healthy volunteers, patients with renal involvement, and patients without were compared by using ANOVA test. ADCs of the kidneys were calculated separately for low (ADC(low); b = 0, 111, 222, 333 s/mm(2)), average (ADC(avg); of all b values), and high (ADC(high); b = 778, 889, 1000 s/mm(2)) b values to enable the differentiation of the relative influence of perfusion fraction and true diffusion. ADC(high) reflects almost only diffusion, whereas ADC(low) is composed of both diffusion and perfusion. RESULTS: There was statistically significant difference between ADC(low) values of the FMF patients with renal involvement and the control group (P < 0.05). Negative correlation was found between the duration of disease and ADC(low) values of the kidneys (r = -0.223, P = 0.087). CONCLUSION: DW-MRI of the kidneys might allow early detection of the renal changes in patients with FMF. This might prevent the progression of disease by giving proper medical treatment. Further studies with larger numbers of FMF patients and more experience on MRI technique are required to help define more conclusively the precise role of DW imaging in detection of renal changes.

MDCT of biliary cysts in children with biliary atresia: clinical associations and pathologic correlations.

PURPOSE: To evaluate the association of biliary cyst formation with cholangitis, portoenterostomy, biochemical abnormalities, using multidetector computed tomography (MDCT) and pathologic findings of end-stage liver disease. MATERIALS AND METHODS: We retrospectively reviewed the 42 MCDT studies, clinical history and laboratory findings of 36 children with biliary atresia. RESULTS: Biliary cysts were detected in 58% of the patients on MDCT images. The cysts were not associated with cholangitis, portoenterostomy surgery, or biochemical abnormality. Hepatic artery anomaly was also common in our series (25%) and more common in patients with biliary cysts which was statistically significant (P < 0.05). Eighteen livers were available for pathologic examination. The only statistically significant finding between the patients with and without biliary cysts were biliary epithelial damage and inflammatory reaction around the cysts which were common in the patients with biliary cysts (P < 0.05). CONCLUSION: The damage to the bile duct epithelium and inflammatory reaction around the biliary epithelium support the theory of obstruction and bile leaks in the etiogenesis of biliary cysts. This is the first report of the association between hepatic artery variations and the biliary cysts; this may be important in pretransplant evaluation.

An analysis of clinical features of pulmonary giant hydatid cyst in adult population.

BACKGROUND: We performed an analysis of giant hydatid cysts (GCHs) detected in the adult population by comparison with the features of other simple hydatid cysts (CHs) in the light of the relevant literature. METHODS: The records of 74 adult patients who were operated on in our clinic for pulmonary CHs between 2001 and 2005 were retrospectively evaluated. Cysts that were 10 cm or larger in diameter on any plane were considered GCHs. The cysts were classified into 2 groups as GCHs (group A) and other (group B). The groups were then compared for age, sex, symptom, cyst location, preoperative complications, surgical procedure performed, operative morbidity, and mortality. RESULTS: Of 74 patients, 10 (13.5%) were in group A and 64 were in group B. No differences were detected between the clinical presentation, gender distribution, surgical procedure performed, and postoperative morbidity and mortality rates of GCHs and other cysts in adults. In both groups, there were no significant differences between the rates of involvement of 2 lungs (P = .527). However, both groups had lower lobe involvement, more markedly in group A (81.8% and 45.5% respectively; P = .023). Two patients in group A (20%) and 18 patients in group B (28.1%) had complicated cysts. CONCLUSIONS: The tendency of GCH to involve the lower lobe of the lung compared to smaller cysts suggests underlying mechanisms other than lung elasticity in the late onset of the symptoms parallel to cyst growth.

Topical tetracycline in the treatment of acne vulgaris.

BACKGROUND: Topical tetracycline was the first topical antibiotic approved for the treatment of acne, its use has been limited because of the skin penetration problems of the active ingredient. OBJECTIVES: The objective of this study was to evaluate the effectiveness of a new formulation of topical tetracycline [Imex, tetracycline hydrochloride 3%, 20g] monotherapy in the treatment of mild to moderate acne vulgaris. METHODS: The sample group consisted of 87 volunteer students of both sexes with grade 1 to grade 2 acne as assessed by Investigator's Global Assessment (IGA) severity grading system. Subjects were instructed to apply topical tetracycline twice daily for 8 weeks. Subject were evaluated at baseline and at weeks 2, 4, and 8. RESULTS: Of 87 subjects, 68 completed the 8-week treatment period. The mean reduction rates of opened comedones were 55.4%, closed comedones were 27.1%, papules were 24.8%, pustules were 27.3%. After 8 weeks of treatment, a statistically significant reduction was only observed in the mean counts of the papules and pustules (P < 0.001). CONCLUSION: Tetracycline is a well-tolerated topical agent and is particularly effective in the treatment of inflammatory lesions in acne.

Burnout and its correlates among nursing staff: questionnaire survey.

AIM: This paper is a report of a study to determine the burnout level and its correlates in nurses. BACKGROUND: Healthcare providers and especially nurses are generally considered a high risk group regarding work stress and burnout and this syndrome has been a major concern in the field of occupational health. METHOD: The study was carried out at a university hospital in Turkey during May-June 2005. A total of 418 nurses from the 474 working at the hospital at the time (88.2%) answered a self-administered questionnaire including the Maslach Burnout Inventory. FINDINGS: All the nurses were female, with a mean age of 30.6 (5.4) and a median age of 29 years. The mean score was 17.99(6.35) for the Emotional Exhaustion subscale, 5.72 (3.87) for the Depersonalization subscale and 19.83 (4.66) for the Personal Accomplishment subscale. Emotional Exhaustion decreased with increasing age (P < 0.05). Total time in the job, weekly working hours, shift-working and the unit where employed influenced burnout scores (P < 0.05). Not being happy with relations with superiors, not finding the job suitable, feeling anxious about the future, perceived poor health, problems with personal life and financial difficulties were also factors influencing burnout scale scores (P < 0.05). CONCLUSION: It is necessary to consider nurses having the characteristics shown as the correlates of burnout in this study as a target group, to screen periodically the burnout status and improve their working conditions, especially relationships with colleagues.

Induced abortion frequency in Ankara, Turkey, before and after the legal regulation of induced abortion.

OBJECTIVE: To determine the effects of the 1983 law that legalized induced abortion on the number and place of abortions, and on the use of family planning (FP) methods before and after abortion, and to determine the demographic characteristics and reproductive health features according to the order of abortion. METHOD: This study included 2455 married, widowed or divorced women presenting at Mother and Child Health-Family Planning Centres in Ankara. A questionnaire was used for data collection. RESULT: Nearly three out of 10 (28.7%) of the women had undergone at least one induced abortion. In the age groups 45-54 and 55-64, 49 and 37.3%, respectively, had had one or more terminations of pregnancy (TOPs). The induced abortion rate increased following the enacting of the law. In the 15-24 and in the 55-64 age group, 55.6 and 89%, respectively, of the women had been aborted by a private physician. Before the index pregnancy, 63.1% were not using contraception compared with 37.3% thereafter. The rate of use of FP increased after the law was passed. CONCLUSION: Although the most common reason for having an abortion was unwanted pregnancy in all age groups and nearly 60.0% of the women aged less than 55 reported that they were not using any FP method at the time of the TOP, the proportion of women having undergone at least one of these procedures increased after the law was passed, indicating that abortion is used as a FP method.