Disrupted harmony of the skull skeleton: Middle ear resonance in acromegaly.

OBJECTIVES: This study aims to investigate whether the middle ear resonance frequency (RF) is affected in acromegaly, which causes growth in the skull bone. METHODS: Thirty acromegaly patients and 38 volunteers were included in the study. Pure tone average scores and middle ear RF values of the groups that underwent pure tone audiometry, tympanometry, and multifrequency tympanometry tests were compared. RESULTS: The pure tone mean was 14.95 ± 12.13 in acromegaly patients and 5.70 ± 8.52 in the control group (p:0.18). Sensorineural hearing loss(SNHL) was observed in 16.6% of the patients. The average middle ear RF was calculated as 815 ± 179.05 Hz in patients with acromegaly and 773 ± 127.15 in the control group. (p = 0.0001). CONCLUSION: This study is the first to evaluate middle-ear RF in acromegaly patients. Acromegaly-induced changes in soft tissues and bone structures impact middle ear functions. In this patient group, we found an increase in middle ear RF without conductive-type hearing loss and a 16.6% rate of SNHL.

Assessment of healthcare needs on disabled earthquake survivors after the Malatya earthquake.

BACKGROUND: The earthquake that occurred in Turkey on February 6, 2023 is considered the biggest disaster of the century, having a major impact on 10 provinces of Turkey. This study might provide the necessary data for healthcare services planning for disabled earthquake survivors according to their needs after the Malatya earthquake. MATERIALS AND METHOD: This mixed-patterned study was conducted in Malatya between February 17 and 20, 2023, with 30 disabled earthquake survivors. It was a mixed-methods study which involved both qualitative study using a semi-structured interview and quantitative analysis using both the Disability Status Analysis Questionnaire and the Exercise of Self-Care Agency Scale (ESCA). RESULTS: The study determined four themes: "Accessibility to Assistive Devices," "Establishment of Special Facilities for Disabled Individuals after the Earthquake," "Suitability of Living Areas," and "Accessibility to Campgrounds and Tent Cities." The ESCA mean score of all disabled earthquake survivors was 87.47 ± 13.75 and those with multiple disabilities had lower ESCA scores (P < .05). CONCLUSION: It was found that disabled earthquake survivors had difficulties in meeting their basic needs after the earthquake. It is considered vital to include disabled individuals and their families in disaster planning and to teach them about these plans.

Diabetes and bacterial co-infection are two independent risk factors for respiratory syncytial virus disease severity.

Diabetes mellitus (DM) is common among older adults hospitalized with lower respiratory tract infection, yet information on the impact of DM on disease severity is limited. This study retrospectively analyzed 46 Turkish patients infected with respiratory syncytial virus (RSV), with information on their comorbidities, co-infection status, and symptoms. Patients are grouped into four severity levels from mild to severe, according to lung parenchymal infiltration status and oxygen level. Similar to previously published studies, we found that comorbidities of diabetes, heart failure, hypertension, co-infection of any type, bacterial co-infection, and age are associated with the disease severity. Cough is the most common symptom (89%) followed by fever (26%) and myalgia, dyspnea, and weakness (around 20%). Using a second-order analysis (two-variable regression), we identified two independent risks for disease severity, the first is represented by diabetes, and the second is represented by bacterial co-infection. We observed two patients whose more severe symptoms were not associated with an older age, but associated with a combination of diabetes and bacterial co-infection. To confirm the true causality from the statistical correlation, further studies are needed.

Approximate reciprocal relationship between two cause-specific hazard ratios in COVID-19 data with mutually exclusive events.

COVID-19 survival data presents a special situation where not only the time-to-event period is short, but also the two events or outcome types, death and release from hospital, are mutually exclusive, leading to two cause-specific hazard ratios (csHR d and csHR r ). The eventual mortality/release outcome is also analyzed by logistic regression to obtain odds-ratio (OR). We have the following three empirical observations: (1) The magnitude of OR is an upper limit of the csHR d : |log(OR)| ≥ |log(csHR d )|. This relationship between OR and HR might be understood from the definition of the two quantities; (2) csHR d and csHR r point in opposite directions: log(csHR d ) ⋅ log(csHR r ) < 0; This relation is a direct consequence of the nature of the two events; and (3) there is a tendency for a reciprocal relation between csHR d and csHR r : csHR d ∼ 1/csHR r . Though an approximate reciprocal trend between the two hazard ratios is in indication that the same factor causing faster death also lead to slow recovery by a similar mechanism, and vice versa, a quantitative relation between csHR d and csHR r in this context is not obvious. These results may help future analyses of data from COVID-19 or other similar diseases, in particular if the deceased patients are lacking, whereas surviving patients are abundant.

Blood-Type-A is a COVID-19 infection and hospitalization risk in a Turkish cohort.

We have shown in an ethnically homogenous Turkey cohort with more than six thousand cases and 25 thousand controls that ABO blood types that contain anti-A antibody (O and B) are protective against COVID-19 infection and hospitalization, whereas those without the anti-A antibody (A and AB) are risks. The A + AB frequency increases from 54.7 % in uninfected controls to 57.6 % in COVID-19 outpatients, and to 62.5 % in COVID-19 inpatients. The odds-ratio (OR) for lacking of anti-A antibody risk for infection is 1.16 (95 % confidence interval (CI) 1.1-1.22, and Fisher test p-value 1.8 × 10-7). The OR for hospitalization is 1.23 (95 %CI 1.06-1.42, Fisher test p-value 0.005). A linear regression treating controls, outpatients, inpatients as three numerical levels over anti-A antibody leads to a p-value of 5.9 × 10-9. All these associations remain to be statistically significant after conditioning over age, even though age itself is a risk for both infection and hospitalization. We also attempted to correct the potential effect from vaccination, even though vaccination information is not available, by using the date of the data collection as a surrogate to vaccination status. Although no significant association between infection/hospitalization with Rhesus blood system was found, forest plots are used to illustrate possible trends.

Investigation of comorbidities of COVID-19 patients with hepatosteatosis using latent class analysis.

Introduction: Coronavirus Disease 2019 (COVID-19) disease first appeared in Wuhan, China in December 2019. Subsequently, the pandemic spread rapidly throughout the entire world. The number of people who died from COVID-19 is rising daily due to the growing number cases. This retrospective study aims to classify patients with hepatosteatosis (HS) who had COVID-19, depending on additional disease characteristics and to compare survival times and death rates. Material and methods: The study included 433 individuals with COVID-19 and HS at Amasya University Sabuncuoglu Serefeddin Education and Research Hospital. Additional disease characteristics of patients with HS were analyzed using latent class analysis (LCA) and the patients were divided into two groups. Results: The study results indicate that the survival time of the first group, which was formed as a result of the LCA, was significantly lower than that of the second group (p = 0.038). The rate of diabetes, coronary artery disease, chronic rhythm disorder, chronic obstructive pulmonary disease (COPD) and chronic kidney disease was significantly higher in group 1 than in group 2 (respectively p < 0.001; p < 0.001; p < 0.001; p < 0.001; p = 0.015). Discussion: In patients with HS, the presence of diabetes, coronary artery disease, chronic rhythm problem, COPD, and chronic renal disorders contributes to an increase in death rates due to COVID-19.

Is diabetes onset at advanced age a sign of pancreatic cancer?

AIM: Pancreatic cancer is the 11th most common cancer in the world. The importance of early diagnosis and treatment for curative treatment is very high. Many studies have shown a relationship between diabetes mellitus (DM), smoking, genetic factors, obesity, nutritional habits and sedentary life and pancreatic ductal adenocarcinoma (PDAC). In this study, we aimed to investigate the relationship between DM onset age and PDAC. MATERIALS AND METHODS: 158 patients with PDAC and DM were compared with 244 patients with DM in the control group. We retrospectively analyzed PDAC risk factors with a focus on DM onset age. RESULTS: It was calculated that the risk of PDAC increased 8.5 times in patients diagnosed with DM after 60 years of age compared to those diagnosed with DM before 60 years of age (HR = 8.54, 95% CI 5.66-12.90, p<0.0001). The interval between the diagnosis of DM and the diagnosis of PDAC peaked at 32 months (95% CI 27.90-35.56). When the age of DM onset was evaluated, it was observed that peaks were around 50 years in the group without PDAC and 60 years in the group with PDAC. CONCLUSION: In patients with DM onset after the age of 60, we recommend keeping in mind the increased risk of PDAC and evaluating these patients for PDAC, even if they are asymptomatic. KEY WORDS: Diabetes, Early detection of cancer, New onset diabetes, Pancreatic cancer, Relative risk, Screening.

A composite ranking of risk factors for COVID-19 time-to-event data from a Turkish cohort.

Having a complete and reliable list of risk factors from routine laboratory blood test for COVID-19 disease severity and mortality is important for patient care and hospital management. It is common to use meta-analysis to combine analysis results from different studies to make it more reproducible. In this paper, we propose to run multiple analyses on the same set of data to produce a more robust list of risk factors. With our time-to-event survival data, the standard survival analysis were extended in three directions. The first is to extend from tests and corresponding p-values to machine learning and their prediction performance. The second is to extend from single-variable to multiple-variable analysis. The third is to expand from analyzing time-to-decease data with death as the event of interest to analyzing time-to-hospital-release data to treat early recovery as a meaningful event as well. Our extension of the type of analyses leads to ten ranking lists. We conclude that 20 out of 30 factors are deemed to be reliably associated to faster-death or faster-recovery. Considering correlation among factors and evidenced by stepwise variable selection in random survival forest, 10 ~ 15 factors seem to be able to achieve the optimal prognosis performance. Our final list of risk factors contain calcium, white blood cell and neutrophils count, urea and creatine, d-dimer, red cell distribution widths, age, ferritin, glucose, lactate dehydrogenase, lymphocyte, basophils, anemia related factors (hemoglobin, hematocrit, mean corpuscular hemoglobin concentration), sodium, potassium, eosinophils, and aspartate aminotransferase.

Alpha variant (B.1.1.7) of SARS-CoV-2 increases fatality-rate for patients under age of 70 years and hospitalization risk overall.

The emergence of new SARS-CoV-2 variants is a challenge to the control of this pandemic. It is therefore important to collect and to analyze data related to the infection caused by different variants. We have obtained more than 3,700 COVID-19 patients between April 2020 and March 2021 from Tokat, Turkey (roughly 3,100 outpatients and close to 600 inpatients) where about 30% were infected with Alpha variant (B.1.1.7). Descriptive statistics was used to characterize different subgroups. Both logistic regression and cause-specific Cox survival analysis of competing-risk was run on inpatients, to examine the impact of Alpha variant on hospitalization, on mortality and on other factors. We observed that the Alpha variant is over-represented in inpatients than outpatients so infection by Alpha variant increases the chance for hospitalization. The impact of Alpha variant on mortality seems to depend on the patient's age. For patients under age of 70, the case-fatality-rate was 0.84% (5.3%) for patients without (with) Alpha variant (Fisher's test P-value = 2.4 × 10-10). For patients above age of 70, the trend is opposite: the case-fatality-rate is 31.5% (13.6%) for patients without (with) Alpha variant (Fisher's test P-value = 0.0016). The two opposite trends would cancel each other, making other analyses such as cause-specific Cox regression and logistic regression non-significant. The Alpha variant increases the risk for hospitalization, increases the case-fatality-rate for lower age group, and decreases the case-fatality-rate for the upper age group. If the increase of case-fatality-rate in not the most senior group holds true, it should provide useful information for a vaccination planning to counter the impact of Alpha variants.

[Evaluation of Efficacy of Ribavirin on Laboratory Test and Severity Score in Crimean-Congo Hemorrhagic Fever in Children]. / Çocuklarda Kirim-Kongo Kanamali Atesinde Ribavirinin Laboratuvar Testi ve Siddet Skoru Üzerindeki Etkinliginin Degerlendirilmesi.

Crimean-Congo hemorrhagic fever (CCHF) is endemic in Tokat province. It is observed in all age groups. The case fatality rate varies 20-30% in hospitalized patients and 0-5% among children. Ribavirin use and supportive measures are the main treatment modalities, but the effects of ribavirin in CCHF are controversial. Most of the studies investigating the effectiveness of ribavirin are done by comparing the initial and the final laboratory values. The purpose of this study was to evaluate the effects of oral ribavirin use in children with CCHF by using all the clinical and laboratory findings and to investigate the presence of unnoticed results. In the study, the data of 67 patients under 19 years old who were hospitalized and followed up with a diagnosis of CCHF during 2012-2020 epidemic period were retrospectively analyzed. Epidemiological and demographic characteristics, clinical and laboratory data were retrieved from the patient files. We implemented a linear mixed-effects model to assess the effects of the ribavirin, taking into account the repeated measures of the data. Ribavirin was given to 33 (49.2%) of the patients. 54 (80.6%) of the patients were male, 13 (19.4%) were female, 52 (77.6%) of the patients were living in rural areas and 15 (22.4%) were living in urban areas. The mean age was 15.1 (median= 15.5, range= 8-18) years in patients who did not receive ribavirin, and 15.2 (median= 15, range= 11-18) years in ribavirin administered patients. At the time of admission 63 (94%) of the patients had fever, 60 (89.6%) had fatigue, 38 (56.7%) had rash, 48 (71.6%) had myalgia, 30 (44.8%) had headache, 25 (37.3%) had abdominal pain, 30 (44.8%) had vomiting, 21 (31.8%) had diarrhea, 29 (43.3%) had drowsiness, 29 (43.3%) had bleeding in the mucosa and 27 (40.3%) had petechiae. Drowsiness and mucosal bleeding rates were significantly higher in patients who received ribavirin (p<0.05). The time from tick bite to hospital admission was 4.85 (median= 4.5, range= 2-9) days in patients who did not receive ribavirin, and 4.64 (median= 5, range= 2-9) days in ribavirin administered patients. The mean length of the hospital stay in patients who did not receive ribavirin was 6.68 (median= 7, range= 4-10) days, while it was 7.45 (median= 8, range= 3-13) days in those treated with ribavirin. Linear-mixed effect test results showed that ribavirin decreased hemoglobin (Hb) (95% GA= -0.12/-0.02), suppressed white blood cell count (WBC) (95% GA= -0.15/-0.02) and absolute lymphocyte count (ALC) (95% GA= -0.12/0.05), and decreased alanine aminotransferase (ALT) (95% GA= -9.32/-1.49), lactate dehydrogenase (LDH) (95% GA= -25.06/-2.36) and severity score index (95% GA= -0.28/-0.004). As a result, ribavirin suppressed Hb, WBC and ALC levels in children with CCHF, but decreased liver enzymes and severity score much faster in the elapsed time.

Prognostic value of the neutrophil-to-lymphocyte ratio and carbohydrate antigen 19-9 in estimating survival in patients with metastatic pancreatic cancer.

BACKGROUND: The predictive value of different prognostic biomarkers has been studied in various cancer types. AIMS AND OBJECTIVES: The purpose of this study was to examine the degree of risk and prognostic significance of pretreatment neutrophil-to-lymphocyte ratio (NLR) and carbohydrate antigen (CA) 19-9 levels in patients with metastatic pancreatic cancer (PC) and reveal its relevance with survival. MATERIALS AND METHODS: Clinical and laboratory data of 118 patients with metastatic PC at the time of diagnosis were retrospectively analyzed. The overall survival (OS) was estimated according to the Kaplan-Meier method. To determine the prognostic factors affecting PC, the Cox regression analysis was performed. RESULTS: The average age of the patients was 67 ± 9.57 years. The patients were analyzed during the follow-up period, and their average OS was 12 months (95% confidence interval [CI] = 9.73-14.26). The cutoff value was 3.54 (area under the curve [AUC] = 0.653, 95% CI = 0.56-0.73, P = 0.006) for NLR and 437 (AUC = 0.670, 95% CI = 0.57-0.75, P = 0.002) for CA19-9. Statistically significant difference was found between CA19-9 (P < 000.1) and NLR (P < 000.1) and OS. Analysis of multivariate Cox regression showed that NLR (hazard ratio [HR] = 2.17, 95% CI = 1.17-4.03, P = 0.013) and CA19-9 (HR = 1.81, 95% CI = 1.08-3.03, P = 0.022) were important prognostic factors in OS analysis. CONCLUSION: Pretreatment NLR and CA19-9 levels were found to be reliable estimative markers for poor prognosis in patients with metastatic PC. Our findings revealed that NLR and CA19-9 levels can be used to estimate the survival of patients with PC. We believe that our findings will shed light on the management of treatment protocols for patients diagnosed with metastatic PC.

Awareness and Knowledge Levels of 18-Year-Old and Older Individuals Regarding Human Papillomavirus (HPV) and HPV Vaccine in Hatay, Turkey.

The aim of this study was to evaluate the knowledge and awareness levels of 18-year-old and older women and men on HPV infection, HPV vaccine, and the potential risk factors in Hatay, Turkey. In our study, it was found that overall 27.0 and 23.2% of the participants reported having heard of HPV infection and HPV vaccine. The rate of participants who had heard of HPV infection and HPV vaccine was higher in women than in men (p < 0.000). Thirteen percent of the participants was aware of the fact that HPV triggers cervical cancer, 10.2% penile cancer, and 16.7% genital warts, respectively. The overall vaccination rate of the participants was 2.7%. When the total knowledge score of the participants about HPV infection and HPV vaccine was evaluated according to independent variables, it was found that being a woman, urbanization, and having a high level of education had a positive effect on knowledge score, while never having heard of HPV infection and HPV vaccine had a negative effect on knowledge score (p < 0.000). It was determined in the linear regression model that gender, educational status, residential area, and having heard of HPV infection before influenced knowledge levels. It was determined that the relation between these variables and the total knowledge scores of the participants was statistically significant (p < 0.05). It was also determined that women who had higher educational levels, those who were living in urban areas, and those who had heard HPV infection before had higher knowledge levels. The level of knowledge of the participants about HPV infection and HPV vaccine was found to be very low. Having adequate knowledge about HPV infection and increasing the acceptance of HPV vaccination in public will play an important role in decreasing the rate of mortality and morbidity of the different HPV-associated cancers in women and men.

Seroprevalence of hepatitis B surface antigen and associated risk factors among pregnant women.

INTRODUCTION: Hepatitis B infection is a serious global public health problem. The aim of the study was to assess the seroprevalance of hepatitis B surface antigen (HBsAg), as well as the risk factors associated with hepatitis B virus (HBV) infection among pregnant women attending antenatal care clinics of the University Hospital in Antioch, Turkey. METHODOLOGY: This descriptive cross-sectional study was carried out between May 2016 and December 2016. The Chi-squared was utilized to estimate the statistical significance of the association between socio-demographic variables and HBsAg status. The results were generated as proportions odds ratio (OR) with their 95% confidence intervals (Cl) and calculated by using both univariate and multivariate logistic regression analysis. RESULTS: The seroprevalence of HBsAg was found to be 2.1%. A significant association was observed between age and HBsAg seropositivity (p = 0.027). History of blood transfusion (AOR = 9.51, 95% CI = 1.92-46.80, p = 0.006), history of hepatitis (AOR = 11.13, 95% CI = 2.02-61.28, p = 0.006), tattooing (AOR = 13.64, 95% CI = 2.52-73.76, p = 0.002) and a history of household/close contact (AOR = 11.10, 95% CI = 1.56-78.65, p = 0.016) were significantly associated with the risk of HBV infection. CONCLUSIONS: Data regarding the seroprevalence of HBsAg and risk factors associated with HBV infection in pregnant women plays a crucial role in evaluating the effectiveness of the public health protection policies and the strategies to control the disease.

[Age-related prevalence of toxoplasmosis among pregnant women in Hatay: Estimation depending on model]. / Hatay'da gebelerde toksoplazmozun yasa bagli prevalansi: Modele bagli tahmin.

Toxoplasmosis, caused by the obligate intracellular protozoan Toxoplasma gondii, is a common parasitic infection affecting approximately one-third of the world population. T.gondii infections are usually acquired by ingesting raw or insufficiently cooked meat and from unwashed fruits and vegetables contaminated with soil or water with cat feces. Primary infection acquired during pregnancy can cause severe congenital abnormalities in the fetus such as neurologic and ocular malformations, abortion, or stillbirth according to the degree of infection. The aim of this study was to estimate the prevalence and rate of seroconversion of T.gondii IgG antibodies in a selected population of pregnant women in Hatay by using a mathematical model. T.gondii-specific serological screening test results of 11.564 pregnant women who have attended the Private Antakya Mosaic Obstetrics and Gynecology Hospital between 01.04.2009 and 31.04.2016 were analysed in the study. The prevalence of T.gondii-specific IgG antibodies in the studied population were found as 48.70% (95% CI, 0.48-0.50). The prevalence of T.gondii-specific IgG antibodies were increased linearly with age in our study population. The relationship between age and prevalence was statistically significant (p< 0.001). The age-specific rate of seroconversion was estimated as 0.8% for T.gondii infection in pregnant women. It was observed that the rate of T.gondii-specific IgG antibodies decreased from 55.12% (95% Cl, 0.52-0.57) detected in 2009 to 42.22% (95% Cl, 0.37-0.46) in 2016. The estimated number of cases carrying the risk of primer T.gondii infection was calculated as 69 in the study population. Our results have suggested that the prevalence of T.gondii-specific antibodies is high among pregnant women in Hatay. Early maternal diagnosis and treatment methods may reduce the risk of transplacental transmission during pregnancy. The on time diagnosis can only be achieved with prenatal serological screening. The knowledge of the incidence and prevalence of toxoplasma infection in pregnant women plays a crucial role in estimating the burden of the disease and evaluating the effectiveness of the public health protection policies including screening programmes. Expanding of training activities, drawing attention to hygiene, taking nutritional precautions and increasing awareness of toxoplasmosis in pregnant women are important to prevent congenital toxoplasmosis or minimize the disease.

Cognitive and behavioral characteristics of children with caustic ingestion.

BACKGROUND/AIM: Children with attention-deficit/hyperactivity disorder (AD/HD) have risk taking behavior and are more prone to sustaining injury. It is aimed to evaluate the cognitive and behavioral characteristics of children with caustic ingestion. PATIENTS AND METHODS: Ninety two children with a history of nonsuicidal caustic ingestion (CI, n=46) and healthy subjects (HS, n=46) admitted to pediatric surgery department were enrolled into the study. Patients in groups were evaluated for age, sex, number of siblings and educational status of the parents. Before filling the questionnaires, the children were undergone flexible endoscopy and treated accordingly. Conners Parents Rating Scale-revised long form (CPRS-R:L), validated for Turkish Children, was used to evaluate the cognitive and behavioral characteristics of children. Parents rate their child's behavior with a four-point Likert scale. Subscales of CPRS-R:L including cognitive problems/inattention (CG/I), hyperactivity (H), attention deficit hyperactivity disorder index (AD/HD-I), Conners' Global Index-discomfort-impulsivity (CGI-DI), DSM-IV-symptom subscale-inattention (DSMIV, SS-I), DSM-IV-symptom subscale-hyperactivity-impulsivity (DSM-IV, SS-HI), DSMIV-symptom subscale-total score (DSM-IV SS-T) were used to determine the severity of the AD/HD symptom. Demographic features and cognitive/behavioral characteristics of children with caustic ingestion were compared with healthy subjects. RESULTS: The median age of the patients was 4 (2-14 years) in both CI and HS groups. Female male ratio was 13:33 in CI and 12:34 in HS. Sixty seven percent of patients were preschool children (younger than 5 years of age) in both CI and HS groups. There was no difference between groups for number of siblings (p>0.05). Parents of HS group had higher educational status than parents in CI (p<0.05). When subscale scores of CPRS-R:L compared between CI and HS groups, CI group had higher CGI-DI scores than HS (p<0.05). Children younger than five years of age had higher scores of H, emotional instability and total CG/I in CI than HS group (p<0.05). CONCLUSION: Children with caustic ingestion had impulsiveness behavior when compared to healthy children. In addition to impulsivity, hyperactivity can be also assessed as a risk factor for caustic ingestion in children younger than 5years of age. We suggest that association between AD/HD behavior and risk of sustaining injuries was also confirmed for caustic ingestion in children.