GIS based evaluation of social determinants of children's health in Turkey: Case study of Istanbul.

Basic elements considered as social determinants of the health varies in political, socio-economic, structural and intermediary contexts. While socio-economic and political contexts are directly related with the social, economic, public and health policies in country scale. The structural context additionally includes socio-economic dimensions such as income, education, occupation, social class, gender and race/ethnicity. In addition to these basic determinants, the public health, and especially the children health is also affected by the intermediary determinants, which are material circumstances including physical conditions of the working, housing and neighborhood environments and consumption potential (i.e. healthy foods, proper clothing etc.). Existing experiences provided that, the children who grow up on low socioeconomic conditions or on inappropriate environmental conditions including the residential structures tend to become more often ill than the children living in better environmental and socio-economic conditions. This situation reveals the importance of the city planning in terms of providing better conditions for children's health. This study aims to evaluate the social determinants of children's health by the use of Geographic Information System (GIS) technology. For this purpose, a variety of social determinants in terms of political (quality and quantity of health services), structural (education and social class) and intermediary (physical environment, housing, and neighborhood) contexts were examined in Bakirköy and Esenler districts, which are located European side of Istanbul. For this purpose, 2017 dated official dataset including census information and the statistics on the quality and the quantity of the education and health services in two districts were used for examining the political and structural determinants. The spatial characteristics of the physical environment and housing conditions in the study area were constructed from cadastral maps and development plans by use of GIS tools. As a last step, children's health data that consists of pediatric patient visits and diagnosis reports from 12 hospitals in Bakirköy and Esenler districts were also examined for understanding the potential relationships between the social determinants and existing health conditions. Results of this research revealed that the Bakirköy district has better conditions in terms of all health determinants when compared with Esenler district. Therefore, the health status of children living in Bakirköy is expected to be better than those living in the Esenler, which coincides with the evaluation of official children health data.

R202Q/M694V as novel MEFV gene mutations in chronic periodontitis and familial Mediterranean fever.

BACKGROUND AND OBJECTIVE: Familial Mediterranean fever (FMF) and chronic periodontitis are inflammatory diseases leading to an increase in the number of inflammasomes. To date, no published studies have reported on mutations in the Mediterranean fever (MEFV) gene in patients with chronic periodontitis, although the roles of MEFV gene mutations in FMF and FMF-associated amyloidosis (FMF-A) are well known. Therefore, the aim of this study was to evaluate the frequencies of MEFV gene mutations and serum amyloid A (SAA) and high-sensitivity C-reactive protein (hs-CRP) levels in patients with chronic periodontitis, FMF and FMF-A. MATERIAL AND METHODS: The study population included 122 patients with FMF and 128 subjects who were systemically healthy. Clinical periodontal parameters, including the plaque index, gingival index, probing pocket depth, clinical attachment level and percentage of bleeding on probing were recorded. Blood samples were obtained from patients with FMF and systemically healthy controls, and all mutations located on exons 2 and 10 of the MEFV gene were analyzed by DNA Sanger Sequencing, which is the gold standard. SAA and high-sensitive CRP levels were also assessed. RESULTS: Mean gingival index, percentage of bleeding on probing, probing pocket depth and clinical attachment level, and the levels of SAA and hs-CRP were higher in the FMF-A group than those in the FMF and control groups. The two most relevant mutations in patients with FMF were heterozygous M694V (46.2%), and heterozygous R202Q (32.7%). The frequencies of the homozygous M694V and R202Q mutations in the FMF-A group were 53.8% and 46.1%, respectively. The complex R202Q/M694V homozygous state led to an increased risk of chronic periodontitis (odds ratio: 3.6), and FMF-A (odds ratio: 7.6). CONCLUSION: This is the first study to report the R202Q mutation in patients with periodontitis. Furthermore, the MEFV gene-mediated inflammatory pathway increased serum acute phase reactants, and the changes in the R202Q and M694V could play a role in inflammatory-genetic diseases, such as FMF, FMF-associated amyloidosis and chronic periodontitis.

Thrombolytic treatment in a patient with antiphospholipid syndrome : APS developing renal infarction.

Antiphospholipid syndrome (APS), a leading entity in acquired thrombophilia, is characterized by recurrent thrombosis, morbidity in pregnancy and presence of antiphospholipid antibodies (APA). Although the etiopathogenesis is unclear, APA against negatively charged phospholipids and phospholipid-protein complexes are held responsible for the clinical picture. In case of acute thrombosis due to APS, thrombolytic therapy is not a commonly administered treatment option. Here, we present a case with acute thrombosis in the left renal artery showing partial response to thrombolytic therapy.

Infections in travellers returning to Turkey from the Arabian peninsula: a retrospective cross-sectional multicenter study.

Mass gatherings pooling people from different parts of the world-the largest of which is to Mecca, Saudi Arabia, for Hajj-may impose risks for acquisition and dissemination of infectious diseases. A substantial number of pilgrims to Hajj and Umrah are Turkish citizens (456,000 in 2014) but data are lacking on scale of the problem. We did a retrospective cross-sectional multicenter study in Turkey to explore the range of infections among inpatients who had recently returned from the Arabian Peninsula. Our inclusion criteria were patients who had acquired an infection during their trip to an Arabian Peninsula country, or who became symptomatic within 1 week of their return. The data were collected retrospectively for January 1, 2013 and March 1, 2015. 185 Turkish patients were recruited to the study across 15 referral centers with travel associated infectious diseases after returning from Arabian Peninsula countries (predominantly Saudi Arabia 163 [88.1 %] for religious purposes 162 [87.5 %]). Seventy four (40.0 %) of them were ≥ 65 years old with numerous comorbidities including diabetes (24.3 %) and COPD (14.1 %). The most common clinical diagnosis was respiratory tract infections (169 [91.5 %]), followed by diarrheal diseases (13 [7 %]), and there was one case of MERS-CoV. Patients spent a median of 5 (3-7) days as hospital inpatients and overall mortality was 1.1 %. Returning travellers from the Arabian Peninsula present as inpatients with a broad range of infectious diseases similar to common community acquired infections frequently seen in daily medical practices in Turkey.

A case of Amyopathic Dermatomyositis associated with Interstitial Pulmonary Disease.

Inflammatory myopathies are a heterogeneous group of diseases with unknown etiology characterized by inflammation of the skeletal muscles and proximal muscle weakness. Dermatomyositis (DM) is an idiopathic inflammatory myopathy with characteristic cutaneous findings such as heliotrope rash, Gottron's sign, Gottron's papules, shawl sign and machinist hand. Amyopathic dermatomyositis (ADM) is a rare but well-recognized clinical subtype of DM, constituting aproximately 10-20% of patients with this disease. It generally manifests only pathognomonic skin findings without clinical and laboratory evidence of muscle involvement. In this report, we present a rare case of ADM associated with interstitial pulmonary disease.

D-dimer and D-dimer/fibrinogen ratio in predicting pulmonary embolism in patients evaluated in a hospital emergency department.

OBJECTIVES: The D-dimer level, fibrinogen level, and D-dimer/fibrinogen ratio are used in the diagnosis of pulmonary embolism, but results vary. We evaluated these parameters in the diagnosis of pulmonary embolism in emergency clinic patients. METHODS: In this prospective study, 200 patients (pulmonary embolism, 100 patients; no pulmonary embolism, 100 patients) had D-dimer and fibrinogen levels measured before intervention. Pulmonary embolism was diagnosed with computed tomography angiography or ventilation-perfusion scintigraphy. RESULTS: Compared with patients who did not have pulmonary embolism, patients who had pulmonary embolism had significantly greater mean D-dimer level (pulmonary embolism, 6±7 µg/ml; no pulmonary embolism, 1±1 µg/ml; P⩽0·001) and D-dimer/fibrinogen ratio (pulmonary embolism, 3±3; no pulmonary embolism, 0·4±0·4; P⩽0·001), but similar mean fibrinogen levels (pulmonary embolism, 337±184 mg/dl; no pulmonary embolism, 384±200 mg/dl; not significant). In patients who had pulmonary embolism, mean D-dimer level and D-dimer/fibrinogen ratio were greater in high-risk than non-high-risk patients. With D-dimer cutoff 0·35 µg/ml, sensitivity was high (100%) and specificity was low (27%) for pulmonary embolism. With D-dimer/fibrinogen ratio cutoff 0·13, sensitivity was high (100%) and specificity was low (37%) for pulmonary embolism. CONCLUSION: A D-dimer level <0·35 µg/ml may exclude the diagnosis of pulmonary embolism. At a D-dimer cutoff 0·5 µg/ml and D-dimer/fibrinogen ratio cutoff 1·0, the D-dimer/fibrinogen ratio may have better specificity than D-dimer level in the diagnosis of pulmonary embolism, but the D-dimer/fibrinogen ratio may lack sufficient specificity in screening.

Device-associated nosocomial infection rates and distribution of antimicrobial resistance in a medical-surgical intensive care unit in Turkey.

The aim of this study was to explore the rate of device-associated nosocomial infections (DANIs) and the distributions of causative agents and patterns of antibiotic resistance in the medical-surgical intensive care unit (ICU) over a 3-year period and to compare these rates with those reported by National Nosocomial Infections Surveillance System and International Nosocomial Infection Control Consortium. A total of 1,798 patients were hospitalized in our ICU for 13,942 days, of which 309 patients had DANIs, indicating an overall infection rate of 22.1 per 1,000 ICU-days. The central line-associated bloodstream infection rate was 6.4 per 1,000 catheter-days, whereas the ventilator-associated pneumonia rate was 14.3 per 1,000 ventilator-days and the catheter-associated urinary tract infection rate was 4.3 per 1,000 catheter-days. Overall, 87.4% of all Staphylococcus aureus DANIs were caused by methicillin-resistant strains. With respect to Pseudomonas aeruginosa, 30.9% of the strains were resistant to ciprofloxacin, 23.3% to amikacin, 43.1% to ceftazidime, 19.1% to piperacillin-tazobactam, and 34.7% to imipenem. Furthermore, 1.9% of the Enterococcus spp. were resistant to vancomycin, and 51.1% of Enterobacteriaceae were resistant to ceftriaxone. DANI rates decreased over the 3-year study period, which was likely in response to the infection control measures implemented in our ICU.

Adrenomedullin: possible predictor of insulin resistance in women with polycystic ovary syndrome.

The aim of the study was to investigate adrenomedullin (ADM) levels and its relation with insulin resistance in women with polycystic ovary syndrome (PCOS). Twenty-nine women with PCOS and 29 age- and body mass index (BMI)- matched control subjects were included in the study. PCOS was defined according to criteria by the Rotterdam European Society of Human Reproduction and Embryology/American Society for Reproductive Medicine (ESHRE/ASRM)-sponsored PCOS consensus workshop group. A full clinical and biochemical examination including basal hormones and metabolic profile was performed. Insulin resistance was calculated by using the homeostasis model assessment of insulin resistance index (HOMA-IR). Plasma ADM levels were measured by high performance liquid chromatographic (HPLC) method. Plasma ADM, fasting insulin levels and HOMA-IR were significantly higher in patients with PCOS than the control group. ADM levels were positively correlated with insulin levels and HOMA-IR index. The best cut-off value of ADM levels to identify the presence of insulin resistance (HOMA-IR≥2.7) was 30.44 ng/ml. Calculated odds ratio of insulin resistance by using logistic regression analysis, as predicted by ADM, was 0.15 (95% confidence interval, 0.037-0.628; p=0.009). In multiple regression analysis, ADM level was an independent predictor of HOMA-IR index. Our finding indicated that ADM levels increased in women with PCOS in accordance with HOMA-IR. ADM could be a significant independent determinant of insulin resistance in women with PCOS.

Monitoring vaccination coverage in Istanbul using the lot quality assurance sampling and geographic information system.

The quality of vaccination services provided for children aged 12-23 months was determined in different districts of Istanbul, Turkey. Quality was assessed through a lot quality assurance sampling method, using data extracted from interviews conducted in 2001 with the mothers or carers of the children. Concurrently, geographic information system technology was used for integrated evaluation of the data from different lots and for presentation of the results as thematic maps. The results of this study helped to identify districts of the city in which vaccination services were below the expected level of quality and where an unacceptable number of children were not being fully vaccinated. Subsequent to this study, actions were taken by the agencies responsible to improve the coverage and quality of the vaccination services in these districts of Istanbul.

The antinociceptive effect of tramadol-venlafaxine combination on the paw withdrawal threshold in a rat model of neuropathic pain.

The combination of venlafaxine and tramadol was compared with the single use of these agents to investigate the antinociceptive effect on paw withdrawal latency (PWL) to paw pressure in rats with neuropathic pain. Rats were divided into 4 groups: group 1 received saline (0.2 ml i.p.); group 2 received venlafaxine (22 mg/kg i.p.); group 3 received tramadol (20 mg/kg i.p.); and group 4 received venlafaxine + tramadol. No statistically significant changes were observed in the saline and venlafaxine groups with respect to PWL in the lesioned paw. However, tramadol produced a significant antinociceptive effect on the lesioned paw at 30 min compared with the saline and venlafaxine groups. A more potent antinociceptive effect was observed in the tramadol + venlafaxine group, beginning at 60 min and lasting for 1 h. The combination of venlafaxine + tramadol was more effective in increasing the pain threshold in this animal model of neuropathic pain than either of these drugs administered alone.