Lipoprotein-associated phospholipase-A2 activity and its diagnostic potential in patients with acute coronary syndrome and acute ischemic stroke.

BACKGROUND: The study examined the Lp-PLA2 activity at the patients presented to the emergency department with acute coronary syndrome (ACS) or acute ischemic stroke (AIS), as well as its diagnostic value. METHODS: The prospective study included consecutive male and female patients aged >18 years that presented to the our emergency department with ACS or AIS between November 2009 and January 2010. Blood samples were obtained immediately following diagnosis in the ACS and AIS groups. The diagnostic value of Lp-PLA2 was determined based on receiver operating characteristic curves, sensitivity, specificity, predictive values, likelihood ratios and accuracy rates. RESULTS: In all, 34 ACS and 32 AIS patients were included in the study, and the control group included 35 patients. Lp-PLA2 enzyme activity was significantly lower in the ACS and AIS groups than in the control group (26.7 ± 13.8, 31.4 ± 13.6, and 41.4 ± 8.1 nmol min-1·mL-1, respectively; p < 0.0001, p = 0.022). In the ACS group the area under the curve (AUC) was 0.825 (95%CI: 0.722-0.929), sensitivity was 71% for an optimal Lp-PLA2 cut-off value of 31.4 nmol min-1·mL-1, and specificity was 91%, whereas in the AIS group the AUC was 0.768 (95%CI: 0.652-0.884), sensitivity was 75% for an optimal Lp-PLA2 cut-off value of 38.1 nmol min-1·mL-1, and specificity was 74%. CONCLUSIONS: Lp-PLA2 enzyme activity was significantly lower during the early stage of both ACS and AIS. The obtained statistic data suggest that low Lp-PLA2 enzyme activity can be used for diagnostic purposes.

Workplace Violence in the Health Sector in Turkey: A National Study.

Violence in the workplace is an increasing occupational health concern worldwide. Health care workers are at high risk of assault. To develop, monitor, and manage prevention policies, baseline data should be available. This cross-sectional study was designed to determine the current extent of workplace violence nationwide in Turkey. The study population of 12.944 health care workers was a stratified sample of all health care workers (612,639) in the country. A probabilistic sampling was made on the basis of the "multistage stratified random cluster sampling method." This study was conducted by a structured questionnaire in a face-to-face interview. The questionnaire items were adapted and translated into Turkish based on questionnaires of International Labor Organization, International Council of Nurses, World Health Organization, and Public Services International. The percentage of health care workers who experienced workplace violence in Turkey in the previous 12 months was 44.7%. The types of violence included physical 6.8%, verbal 43.2%, mobbing (bullying) 2.4%, and sexual harassment 1%. Multivariate analysis showed that level of health care system, type of institution, gender, occupation, age, working hours, and shift work were independent risk factors for experiencing workplace violence ( p < .05). Our study indicates that the workplace violence among health care workers is a significant problem. The results of the study can serve as the basis for future analytical studies and for development of appropriate prevention efforts.

Vitamin B12 levels of subjects aged 0-24 year(s) in Konya, Turkey.

Research reports indicate that vitamin B12 levels show racial differences, which suggests that using the reference ranges of varied populations may lead to inaccurate results. This study aimed to determine normal serum levels of vitamin B12 among children and young people in the Konya region of Turkey. It evaluated 1,109 samples; 54 were from cord-blood and 1,055 were from healthy subjects aged 0-24 year(s), who were admitted to primary healthcare centres. The normal reference levels obtained for vitamin B12 at 2.5-97.5 percentile (P2.5-P97.5) range were 127-606 pg/mL for girls, 127-576 pg/mL for boys, and 127-590 pg/mL for the entire study group. The reported reference values for vitamin B12 in other studies were higher than the current results. Vitamin B12 levels vary from country to country; comparisons between countries may not be valid, and normal levels for each population should be obtained.

Effects of sildenafil and vardenafil on erectile dysfunction and health-related quality of life in haemodialysis patients: a prospective randomized crossover study.

BACKGROUND: Erectile dysfunction (ED) is prevalent in end-stage renal disease (ESRD) and has been associated with impaired health-related quality of life (HRQoL). HRQoL, in turn, is related to morbidity and mortality in ESRD patients. Previous studies have shown improved HRQoL with ED treatment using sildenafil and vardenafil. However, no study has examined the effects of sildenafil or vardenafil on HRQoL in impotent ESRD patients. Furthermore, vardenafil has never been tested and its safety profile has not been determined in ESRD patients. The aim of this randomized crossover study was to compare the effects of sildenafil and vardenafil on measures of HRQoL and on ED scores as well as to determine the safety profile of vardenafil in ESRD patients. METHODS: In 32 haemodialysis patients with impotence, ED and HRQoL were evaluated by the International Index of Erectile Function (IIEF-5) and the 36-item Short-Form Health (SF-36) surveys, respectively. Patients were randomized into sildenafil and vardenafil groups. After a 4-week treatment and 2-week washout periods, crossover was performed and an additional 4-week treatment was administered. IIEF-5 and SF-36 surveys were given before and after each treatment period. Adverse effects were evaluated by interview. Friedman tests and Bonferroni-adjusted Wilcoxon signed-rank tests were used to compare groups and for post hoc analysis, respectively. RESULTS: IIEF-5 and SF-36 scores were significantly improved by both sildenafil and vardenafil compared to pretreatment values. There were no differences between sildenafil and vardenafil with respect to the studied parameters. Adverse effect profiles were also similar. No patient dropped out because of side effects. CONCLUSIONS: Sildenafil and vardenafil caused similar improvements in ED and HRQoL in haemodialysis patients. Vardenafil was well tolerated in our patient population.

Validity and reliability of Turkish version of "Hospital Survey on Patient Safety Culture" and perception of patient safety in public hospitals in Turkey.

BACKGROUND: The Hospital Survey on Patient Safety Culture (HSOPS) is used to assess safety culture in many countries. Accordingly, the questionnaire has been translated into Turkish for the study of patient safety culture in Turkish hospitals. The aim of this study is threefold: to determine the validity and reliability of the translated form of HSOPS, to evaluate physicians' and nurses' perceptions of patient safety in Turkish public hospitals, and to compare finding with U.S. hospital settings. METHODS: Physicians and nurses working in all public hospitals in Konya, a large city in Turkey, were asked to complete a self-administrated patient safety culture survey (n = 309). Data collection was carried out using the Turkish version of HSOPS, developed by Agency for Healthcare Research and Quality (AHRQ). Data were summarized as percentages, means, and SD values. Factor analysis, correlation coefficient, Cronbach's alpha, ANOVA, and t tests were employed in statistical analyses. Items on patient safety were categorized into 10 factors. Factor loadings and internal consistencies of dimension items were high. RESULTS: Most of the scores related to dimensions, and the overall patient safety score (44%) were lower than the benchmark score. "Teamwork within hospital units" received the highest score (70%), and the lowest score belonged to the "frequency of events reported" (15%). The study revealed that more than three quarters of the physicians and nurses were not reporting errors. CONCLUSION: The Turkish version of HSOPS was found to be valid and reliable in determining patient safety culture. This tool will be helpful in tracking improvements and in heightening awareness on patient safety culture in Turkey.

A survey on patient safety culture in primary healthcare services in Turkey.

OBJECTIVE: To evaluate the patient safety culture in primary healthcare units. DESIGN: A cross-sectional study, utilizing the Turkish version of the Hospital Survey on Patient Safety Culture developed by the Agency for Healthcare Research and Quality and a demographic questionnaire. SETTING: Twelve primary healthcare centers in the center of the city of Konya, Turkey. PARTICIPANTS: One hundred and eighty healthcare staff, including general practitioners (GPs), nurses, midwives and health officers. INTERVENTION: None. MAIN OUTCOME MEASURE(S): The patient safety culture score including subscores on 12 dimensions and 42 items; patient safety grade and number of events reported. RESULTS: Fifty-four (30%) of the participants were GPs, 48 (27%) were nurses, 51 (28%) were midwives and 27 (15%) were health officers. The mean overall score for positive perception of patient safety culture in primary healthcare units was 46 +/- 20 (43-49 CI). No differences were found by staff members' profession. Among the dimensions of patient safety, those with the highest percentage of positive ratings were teamwork within units (76%) and overall perceptions of safety (59%), whereas those with the lowest percentage of positive ratings were the frequency of event reporting (12%) and non-punitive response to error (18%). Reporting of errors was infrequent with 87% of GPs, 92% of nurses and 91% of other health staff indicating that they did not report or provide feedback about errors. CONCLUSIONS: Improving patient safety culture should be a priority among health center administrators. Healthcare staff should be encouraged to report errors without fear of punitive action.

Evaluation of application of multiple needle pricks on the pathergy reaction.

BACKGROUND: The pathergy reaction (PR) to a needle prick is a well-known feature of Behçet's disease (BD). Although PR is accepted as a major criterion in this disease, there is a lack of a standardized method to measure PR. The aim of this study was to evaluate the effect on the positive rate of PR of the application of numerous (one to six) needle pricks. METHODS: Six needle pricks were performed on 105 patients with BD. The results of the test were noted from the proximal to the distal region for each area of each patient. The positive rates of all combinations (one, two, three, four, five, and six needle pricks) were calculated as percentages by a computer-based program (SPSS version 13 for Windows), and the mean percentage rates were obtained. RESULTS: There was an increase in the percentage of positive PR rates in each combination relative to the former combination. When one needle prick was performed, the mean percentage positive PR rate was 13%. The positive PR rates were 19%, 24%, 28%, 30%, and 33% for two, three, four, five and six needle pricks, respectively. The greatest increase in the mean percentage of positive PR rates was detected for the application of the two needle prick combination. CONCLUSION: There is no consensus about the number of needle pricks required to detect PR, and multiple needle pricks have been used in many studies. We suggest that two needle pricks are suitable for the PR skin test as a useful adjunct to the diagnosis of BD.

The effects of mannitol and melatonin on MRI findings in an animal model of traumatic brain edema.

OBJECTIVES: The aim of this study was to compare the effects of mannitol and melatonin on brain edema secondary to trauma using magnetic resonance imaging (MRI). METHODS: A mild traumatic brain injury with the Feeney method was performed upon twelve New Zealand rabbits. Three hours after the trauma was inflicted, MRI images were obtained, then the subjects were divided into two groups: a mannitol group and a melatonin group. The mannitol group (n = 6) was given 2 gr/kg of 20% mannitol IV over 10 minutes and the melatonin group (n = 6) received 100 mg/kg of melatonin IV over 30 minutes. Thirty-three hours after the first MRI, MRI was repeated. The 3-hour and 36-hour post-trauma MRI images in both groups were scored regarding signs of edema and extent of brain tissue protrusion in a blinded fashion by a staff radiologist. Intragroup and intergroup comparisons were made using the Fisher exact test and chi square test. Comparison of brain tissue protrusion measurements was done using the Mann Whitney U test. RESULTS: Signs of raised intraventricular pressure, contusion and parenchymal edema were more prevelant, and parenchymal protrusion was more prominent on the 36-hour MRI in both mannitol and melatonin groups. No significant difference was found between the melatonin and mannitol groups in any parameter in the MRI images performed 3 and 36 hours after the head trauma. CONCLUSIONS: In this animal model, melatonin and mannitol had similar effects on brain edema, as demonstrated on MRI 3 and 36 hours after head trauma.

Fibrinolytic markers and neurologic outcome in traumatic brain injury.

AIMS: To determine the usefulness of fibrinolytic markers as early prognostic indicators in patients with isolated head trauma. MATERIALS AND METHODS: Sixty-two consecutive patients (26 women and 36 men; mean age 61 years, range 2-76 years) with isolated head trauma seen within the first three hours of the trauma were included in the study. The Glasgow Coma score (GCS), platelet counts (Plt), prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, fibrin degradation products (FDP) and D-dimer levels were measured. Head computerized tomography (CT) findings were categorized as brain edema, linear fracture, depressed fracture, contusion and bleeding. Plt counts, PT, PTT, fibrinogen, FDP, D-dimer levels and CT findings were compared with both GCS and mortality in the first week. Statistical significance was accepted at P

Analysis of chromosomes 9 and 11 aneuploidy frequency in pleural effusion of patients with and without malignancy: interphase FISH technique.

Fluids of body cavities result in a series of pathophysiological events associated with non-malignant and malignant conditions that lead to the formation of exudative effusion. Diagnosis of effusion from the patients is frequently troublesome for the cytologist because of the differentiation and biological behavior of different cells type in effusion. In the present study, chromosomal aneuploidy status in effusion cells derived from 32 patients including 14 patients with non-malignant and 18 patients with malignant diseases [including malign mesothelioma (n = 6), adeno carcinoma (n = 10), small cell carcinoma (n = 2)] was analyzed by using fluorescence in situ hybridization (FISH) with centromere specific probes for chromosomes 9 and 11. There was significant difference in the incidence of chromosomal 9 and 11 aneuploidies when compared with controls (P = 0.000). However, aneuploidies of chromosomes 9 and 11 in effusion cells from patients with malignant disease had significantly higher than in effusion cells from patients with non-malignant (P = 0.000), suggesting that chromosomes 9 and 11 are frequently involved in the status of disease. The present study indicates that there is a association between chromosomes aneuploidies and pleural effusion cell status. Chromosome aneuploidies in non-malignant group may be an indicator of premalignancy.

Twelve-month prevalence of obsessive-compulsive disorder in Konya, Turkey.

We conducted a household survey of 3,012 adults aged 18 and over in order to estimate the prevalence of DSM-IV obsessive-compulsive disorder (OCD) in urban areas in Konya, Turkey. Trained psychiatry interns administered the 2.1 version of the OCD section of the Composite International Diagnostic Interview (CIDI). The 12-month period prevalence rate of OCD was 3.0%. The mean age of onset of OCD was 25.9 +/- 12.5 (range, 7 to 63) years. The prevalence rate of OCD was slightly higher among females (males 2.5%, females 3.3%), but the difference was not statistically significant. The relative risk for divorced, separated, or widowed subjects was approximately 4.2 times higher for OCD than others (2.7% v 10.5%). The 1-year prevalence of OCD inversely related to age group in male subjects, but increased with age in female subjects. The prevalence rate of OCD was not different by the level of education, except it was statistically higher among subjects who were literate but had no schooling, of which the causal relationship was high prevalence rate of OCD among female literate-but no schooling subjects. Subjects with few (one or two) and more siblings (seven or more) had a significantly higher prevalence rate of OCD than subjects with moderate numbers of siblings (three to six). No significant difference was found according to employment, fertility, birth order, and income of the subjects. About 30% of subjects with OCD had only obsessions, whereas 68.5% had both obsessions and compulsions. Only one subject (1.1%) with OCD met compulsion criteria without obsessions. The prevalence rate of OCD we found in Konya, Turkey was similar to the prevalence rates of most epidemiological studies.