[Effect of hypophosphatemia on weaning success from mechanical ventilation]. / Mekanik ventilasyon uygulanan hastalarda ventilatörden ayirma basarisini belirlemede hipofosfateminin yeri.

INTRODUCTION: Hypophosphatemia may cause acute respiratory failure and tissue hypoxia. In this study we investigated the effect of hypophosphatemia on weaning success. PATIENTS AND METHODS: A nested case-control study was conducted in a retrospective cohort of 76 patients who received invasive mechanical ventilation in 2005-2010 in the Medical Intensive Care Unit (MICU) of university hospital. Case patients (failure group) were those who could not be weaned in the first trial or who required post-extubation mechanical ventilation after first extubation. Control patients (success group) were successfully extubated in the first weaning attempt. RESULTS: Frequency of hypophosphatemia (P level < 2.5 mg/dL) at admission was 23.7%. Weaning failure rate was 71.1%. Risk of weaning failure in the presence of hypophosphatemia was 88.9%, whereas risk in the absence of hypophosphatemia was 65.5%, resulting in risk ratio of 1.36 (1.06 - 1.74) (p= 0.096). Mean (± SD) P levels in the success and failure groups were 3.6 ± 1.0 and 3.2 ± 1.0 mg/dL, respectively (p= 0.113). Logistic regression analysis revealed four independent risk factors which were presence of underlying chronic pulmonary disease, high organ dysfunction score (SOFA) at admission, high blood urea nitrogen at the day of weaning trial and low P level at admission to predict weaning failure. Each 1 mg/dL increment in P level resulted in decreased probability of weaning failure with an OR of 0.43 (0.21-0.88). CONCLUSION: In conclusion, a relation between hypophosphatemia and weaning failure was determined which has to be confirmed with prospective cohort and interventional studies with adequate power.

Diagnosis, treatment characteristics, and survival of women with breast cancer aged 65 and above: a hospital-based retrospective study.

BACKGROUND: Breast cancer incidence in women increases with age, while survival rates decrease. Studies interpret this result as meaning higher comorbidity, diagnosis at later stages of the disease, and less effective treatment in the elderly. The aim of this study is to evaluate the diagnosis and treatment characteristics of breast cancer and their effect on the survival of women aged 65 and above. METHODS: The data within the files of 1064 women with breast cancer, who were followed-up in Dokuz Eylul University Medical Faculty Hospital between 2000 and 2006, were reviewed retrospectively. The survival probabilities at years 1 and 5 were calculated by life table analysis. The Kaplan-Meier test was used for calculating mean survival time, and the differences between groups were evaluated by log-rank test. The backward elimination method was used for multivariate analysis, and a -2 log-likelihood ratio was used for comparison of different models. RESULTS: Of the patients, 25.3% were aged 65 and above at the time of the diagnosis. Patients in this group had more comorbidities and were more likely to be diagnosed at advanced stages than younger patients. Additionally, they had lower rates of surgical treatment, chemotherapy or radiotherapy. One and 5-year survival probabilities among age groups were 96.1% and 84.5%, respectively, for <65 years, 93.5% and 84.8%, respectively, for 65-69, 98.7% and 84.0%, respectively, for 70-74, and 85.5% and 59.6%, respectively, for 75 years and above. In the multivariate model, age, clinical stage, and comorbidity were found to be negatively associated with the survival rate. CONCLUSIONS: The survival of women with breast cancer aged 65 and above was affected negatively by age at diagnosis, clinical stage, and the presence of comorbidity. Early diagnosis also is very important for elderly women. Additionally, because of higher comorbidity, their evaluation and treatment should be planned by an interdisciplinary team.

Marriage characteristics and reproductive health of adolescents in Turkey: findings from Demographic and Health Surveys 1998 and 2008.

Adolescent marriage is an important issue given its social and medical consequences. This study focuses on the recent trends in adolescent marriage and reproductive health in Turkey to provide insights for action. Data from the Demographic and Health Surveys of 1998 and 2008 were used. Adolescent marriage and reproductive health indicators were assessed for urban-rural residences, demographic regions and educational levels. Logistic regression was used to predict marriage and birth in adolescence. Despite the decrease in the proportion of married adolescents from 1998 to 2008, the findings suggest no improvement in some marriage characteristics. In both surveys, over 60% of ever-married adolescents had been pregnant at least once. There is an increase in contraceptive use and antenatal care. Our findings showed that in Turkey, women living in rural areas, from poor households, with more traditional parental families, with less education, and who are not working are more likely to get married in their adolescent ages.

Prevalence of cerebral palsy in Turkish children between the ages of 2 and 16 years.

The aim of this cross-sectional study was to determine the prevalence of cerebral palsy (CP) among children in Turkey between the ages of 2 and 16 years. Samples were selected from cities, towns, districts, and villages using the cluster sampling method; 41,861 children were selected. Data was collected by parental interview and physical examination. One hundred and eighty-six children were identified with CP. The prevalence of CP was determined as 4.4 per 1,000 live births and included postnatally acquired CP. Origin of CP was classified as prenatal in 49 (26.6%), perinatal/neonatal in 34 (18.5%), postnatal in 11 (5.9%), and unclassifiable in 90 participants (48.9%; data was unobtainable for two individuals). Type of CP was diplegia in 39.8% of children, hemiplegia in 28%, tetraplegia in 19.9%, ataxia in 5.9%, and dyskinetic in 6.4%. Prenatal factors were seen more frequently in the groups with a high socioeconomic status while perinatal factors were encountered more often in those with a low socioeconomic status (p<0.05). Place of residence and sex had no significant effect on the prevalence of CP (p>0.05). This cross-sectional study shows that the prevalence of CP in Turkey is higher than that in developed countries but the aetiology is probably similar. Although the high prevalence of CP in Turkey could originate from an increased level of obstetric and neonatal problems, the lack of a possible aetiological factor in approximately half the children suggests that the high level might also be due to other factors, such as genetic disorders.

Respiratory syncytial virus epidemiology in Turkey.

Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections in infants and young children worldwide. This study was conducted to determine the prevalence of RSV among high-risk children admitted with respiratory symptoms in a developing country. This is a multicenter study conducted among children less than 24 months of age and admitted to the hospital with respiratory symptoms. The inclusion criteria included: lower respiratory tract symptoms on admission, gestational age less than 35 weeks, and admission age less than six months, or children less than 24 months of age with a diagnosis of bronchopulmonary dysplasia requiring medical treatment or intervention during the last six months or with an uncorrected congenital heart disease (other than patent ductus arteriosus). Nasopharyngeal samples were obtained with one of the three standard methods: nasopharyngeal aspirate, nasopharyngeal wash or nasopharyngeal swab. RSV antigen was determined by enzyme immunoassay using Abbott TESTPACK RSV (No. 8100/2027-16). Statistical analysis was performed using Student's t-test and chi-square test. In this study, 332 children (135 females, 40.7%; 197 males, 59.3%) were included, and the nasopharyngeal specimens of 98 (29.5%) children were determined to be RSV-positive. There were no differences in sex, age of gestation, age of admission, family education, number of siblings and smoking at home for RSV-positive and -negative cases. Furthermore, underlying disease and duration of hospital and intensive care unit stay were similar among groups. Only otitis media was more common among RSV-positive cases. No fatality at hospital was recorded. Frozen samples revealed more negative results. Most cases presented during winter and the number of RSV-positive cases was higher in cold and economically poor areas. Premature children and children with underlying medical condition acquire RSV irrespective of other sociodemographic risk factors, and most of them are hospitalized. Thus, an RSV vaccine seems the most effective mode of protection to decrease morbidity and mortality.

Hepatitis B and measles seroprevalence among Turkish children.

This study was performed to determine hepatitis B and measles seroprevalence among the population under 30 years of age in Turkey. Blood samples of 2,683 subjects from eight provinces of Turkey were studied. Measles IgG was determined by hemagglutinin inhibition method, and hepatitits B surface antigen (HBsAg), anti-hepatitis B surface antibody (anti-HBs) and anti-hepatitis B core antibodies (anti-HBc) were determined by ELISA method. Overall seropositivity for measles was found to be 59.6%. There was a significant difference in seropositivity among provinces. The seropositivity was found to increase with age. The overall seropositivities for HBsAg, anti-HBs and anti-HBc were found to be 5.4%, 17% and 15.1%, respectively. The seroprevalences differed significantly among provinces. Although seroprevalence for anti-HBs and anti-HBc increased with age, HBsAg seropositivity did not change significantly after one year of age. Seroprevalence was not affected by sex. It was concluded that every effort should be given to vaccinate infants as early as possible for hepatitis B and that the coverage of infancy measles vaccination should be increased with a second dose.

Morbidity and mortality characteristics of infants hospitalized in the Pediatrics Department of the largest Turkish military hospital in 2001.

A descriptive study was conducted in the pediatric inpatient unit of Gulhane Military Medical Academy, to investigate the morbidity and mortality characteristics of 532 infants hospitalized between January 1 and December 31, 2001, for treatment purposes. Of the study participants, 55.8% were boys and 44.2% were girls. The most common cause of hospitalization was neonatal hyperbilirubinemia (19.7%). The most common admission month was January (12.4%). Of 532 infants, 510 (95.9%) were discharged, whereas 22 patients died in the hospital. Twenty-one patients died in the neonatal period, and respiratory distress syndrome and neonatal sepsis were identified as the most common causes of death. Our finding of associations between male gender and low birth weight and hospital death is consistent with previous knowledge. Despite the high frequencies of pneumonia and gastroenteritis as admission diagnoses, the finding of only one pneumonia-related death and no gastroenteritis-related deaths in the study population is pleasing.

Evaluation of erythropoiesis by serum transferrin receptor and ferritin in infants aged 0-6 months.

The aim of this study was to evaluate erythropoiesis in 198 healthy babies aged 0-6 months by determination of their blood count, serum transferrin receptor (STfR), and ferritin levels. Anemia and microcytosis were present in 9% and 13% of the sample, respectively. Microcytosis rate was as high as 45% in 6-month-old babies. In infants with normal blood counts, the values of sTfR/ferritin and sTfR-F index were increasing with the increase of sTfR and decrease of ferritin beginning from 2 months of age. In the 5- to 6-month-old group, sTfR concentrations, sTfR/ferritin ratio, and sTfR-F index were higher in infants with anemia and microcytosis. This research showed a high frequency of iron deficiency detected in otherwise healthy babies. Only problems with early weaning practices were found to be significantly more common in babies with iron deficiency.

Prevalence of epilepsy in Turkish children between the ages of 0 and 16 years.

The aim of this cross-sectional study was to determine the prevalence of epilepsy in Turkey among children between the ages of 0 and 16 years. The study population consisted of 24,773,569 children living in Turkey. Because the prevalence of childhood epilepsy is reported to be 0.001 to 1% in the literature, the sample size was determined as 48,260, with 0.05 error type I and 0.10 error type 2 (power 0.90), and the effect size was 2. With the cluster sampling method, samples were selected from cities, towns, districts, and villages, and 46,813 (97%) children were reached. The study questionnaire contained sections with individual informational questions and questions for the selection of suspected epilepsy cases and physical examination results. The epilepsy classification was designed according to the classification of the International League Against Epilepsy (ILAE). The prevalence of epilepsy was determined as 0.8%; 55.2% of the subjects with epilepsy were grouped as generalized, 39% as partial, and 5.8% as unidentified. Age, place of residence, route of delivery, place of delivery, and social and economic status had no statistically significant effect on the development of epilepsy. Male gender, preterm, and post-term delivery increased the risk of developing epilepsy. Early diagnosis and treatment of epilepsy, as well as the education of health workers and families, are very important.

Screening for developmental dysplasia of the hip: results of a 7-year follow-up study.

BACKGROUND: Screening for developmental dysplasia of the hip (DDH) is widely recommended for all infants to prevent disability from late diagnosis of dislocation of the hip. The present study evaluates the results of screening for developmental dislocation of hip in a clinic in Turkey over the course of 7 years. METHODS: Hospital records of 5798 infants who were examined regularly until walking age at Gazi University well child clinics between January 1995 and December 2001 were reviewed. Infants with known risk factors for DDH such as breech presentation, family history of DDH or swaddling, and of infants with physical examination findings suggestive of DDH, were referred to orthopedic surgeons for diagnosis. Based on this final diagnosis, sensitivity, specificity, positive and negative predictive values of risk factors and physical examination findings were calculated. RESULTS: Of the 5798 infants, risk factors were detected in the medical history of 111 infants, and in 14 infants a musculoskeletal deformity was detected. In 606 infants the physical examination findings were suggestive of DDH. Ten patients were subsequently diagnosed with DDH. The sensitivity, specificity, positive predictive value and negative predictive values of having a risk factor for DDH in history were 10.0%, 98.1%, 0.9%, 99.8%, and having abnormal hip examination findings were 100.0%, 88.9%, 1.6% and 100.0%, respectively. CONCLUSIONS: A careful history and physical examination is the cornerstone of DDH screening. Serial hip examinations performed during health examination visits provide an opportunity to identify DDH cases. The sensitivity of risk factors in history and physical examination findings together is high enough to be accepted as a screening tool.

Analysis of menstrual, reproductive, and life-style factors for breast cancer risk in Turkish women: a case-control study.

The aim of this study was to investigate the association between menstrual, reproductive, and life-style factors and breast cancer in Turkish women. In a hospital-based case-control study in Ankara, 622 patients with histologically confirmed breast cancer were compared with 622 age-matched controls, admitted to the same hospital for acute and non-neoplastic diseases. Unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CI) related to risk factors. Overall, menopausal status and age at menopause were found to be significantly associated with breast cancer. Having a full-term pregnancy and early age at first birth were associated with decreased breast cancer risk (OR = 0.45, 95% CI = 0.30-0.66; OR = 0.34, 95% CI = 0.22-0.53, respectively). Postmenopausal women with lactation longer than 48 mo had reduced risk of breast cancer (OR = 0.36, 95% CI = 0.14-0.93). In conclusion, decreased parity, late age at first birth, early menopause, and shorter duration of lactation were the most important determinants of breast cancer risk in Turkish women.

[Prevalence of smoking between the doctors, nurses and medical faculty students at some health facilities in Turkey]. / Türkiye'de çesitli saglik kurumlarinda doktor, hemsire ve tip fakültesi ögrencilerinin sigara içme boyutu.

Smoking is an important behaviour among health professionals who are role models for the public. For this reason 22 studies are selected which are smoking behaviours among doctors, nurses and students of medical school in Turkey. Smoking prevalence is found 32.6-66.2%, 40.3-68.6% and 15.1-36.6% among doctors, nurses and students of the medical faculties respectively. Smoking is fairly widespread among health professionals. Health professionals who are assumed to be role models for the public have to be considered primarily in cigarette control programs.

Hepatitis A seroprevalence in a random sample of the Turkish population by simultaneous EPI cluster and comparison with surveys in Turkey.

This study was conducted to determine the hepatitis A virus (HAV) seroprevalence in nine provinces representative of Turkey as a whole. These provinces are representative of the country's geographical location, and demographic, economic and social characteristics. In each province, sample sizes were determined using published data on HAV seroprevalence, and sample sizes for each province and for the cluster were calculated for each group of subjects under the age of 30 for seroprevalence estimates within a 95% confidence interval. The samples were selected by a cluster method, and the planned recruitment was a total of 4,800 subjects, including 600 subjects each from five large provinces (Istanbul, Ankara, Izmir, Adana, Diyarbakir) and 450 subjects from each of the remaining four provinces (Samsun, Erzurum, Trabzon, Edirne). These numbers were distributed in accordance with the percentages for age groups in five-year increments starting from age five for the population under the age of 30 living in the rural and urban areas in each province. This study of 4,462 subjects under the age of 30 in nine provinces of Turkey identified an overall HAV seroprevalence rate of 71.3%. The distribution of HAV seroprevalences by age showed a steady increase from one year of age from 42.7% to 91.1% at 25-29 years of age. HAV seroprevalence was slightly higher in female subjects (73%) than in male subjects (69.3%). By educational status, seroprevalences were comparable except in young children under age six. Seroprevalence was notably higher in large families with six and more members (80.1%) than in small families with five or fewer members (66.7%). According to our study results, 50% of Turkish children are seropositive for HAV by the age of 10 years. We believe the date support the need for a routine primary immunization policy in Turkey and the development of effective prophylactic programs after possible exposure. Consequently, an immunization policy can be developed for each region according to its epidemiological conditions.

Factors influencing sleeping pattern of infants.

Many families apply to pediatricians with complaints of sleep problems of their infants. It is very important to inform families about the sleep pattern of infants and factors influencing it, and to answer their questions about infantile sleep. A questionnaire was given to 165 families to elucidate the factors influencing continuous sleep pattern of the baby. Our study demonstrated that 50% of four-month-old and 96% of nine-month-old infants acquired continuous sleep pattern. Our figures were compatible and even higher than those in the literature. None of the factors studied has an independent effect on infantile continuous sleep pattern in multifactorial analysis. Early weaning does not facilitate acquisition of continuous sleep pattern by the baby. This will help to support prolonged breast-feeding. It may be advisable not to keep children beside their mother during sleep for a long period of time. Care of the children by the maternal grandmother may facilitate their acquisition of continuous sleep pattern.