Reducing the stress of mothers in the postpartum period: psychological inflexibility or mother-infant bonding.

BACKGROUND: Parental stress is a critical problem because it affects both the mental health of the mother and children's development. In addition to many factors related to birth and marriage, mother - infant bonding and psychological inflexibility are essential factors that can affect stress. In this study, we examined the effects of the psychological processes of mothers and factors related to pregnancy, mother, environment on parental stress, and their relationships. METHODS: A sociodemographic variables scale, Acceptance and Action Questionnaire-II, Postpartum Bonding Questionnaire, and Parental Stress Scale were completed by 115 mothers in their first postpartum year. The model created with the correlation and regression results was subjected to path analysis. RESULTS: Breastfeeding, psychological inflexibility, and mother - infant bonding are related to parental stress. The bonding problem is the mediator of the relationship between psychological inflexibility and parental stress. The entire effect of sleep quality on parental stress occurred through psychological inflexibility. CONCLUSION: Efforts should be directed towards improving the bond between the mother and infant and enhancing the mother's psychological flexibility to lessen the negative impacts of stress. Breastfeeding should not be treated categorically, and its potential adverse effects should not be ignored.

Declared and real physical activity in obese individuals as assessed by the questionnaire and accelerometer.

BACKGROUND: Due to the lack of precise research data related to the evaluation of the physical activity level (PAL) among obese individuals, the aims of the study were to evaluate declared and real volume of physical activity, and to assess the correlations between these methods. METHODS: The study consisted of 30 female (Mage=32.9±7.3 years) and 16 male (Mage=36.4±8.4 years) a total of 46 obese volunteer individuals were included (Mbmi: 37.6±6.6 kg/m2, Mbmi: 34.2±4.3 kg/m2; body fat percentage: 42.1% and 35.2%, respectively). A cross-sectional study was conducted on the obese people. The information form was prepared for obese individuals who applied the Health Institutions and body composition measurements were performed with Tanita BC-1000. PAL was assessed objectively by a Sense Wear Armband (SWA) for 7 consecutive days- and seven day later the participants fill out the International Physical Activity Questionnaire - Short Form (IPAQ-SF). For statistical analysis, the data were presented as mean values, Standard deviations (SD), frequency (f), and percentage (%). Spearman's Rho Correlation were used, and the significant level was P<0.05. RESULTS: According to IPAQ and SWA, 69.6% (10.9% plus 58.7%) of the participants (N.=32) estimated activity levels as "correct." The PAL of 30.4% (N.=14) of the participants does not seem to be consistent. According to the IPAQ and SWA, the rates of moderate-vigorous physical activity (MVPA) were 80.4%, 67.4% respectively. Weak correlation was found-between IPAQ-MET and SWA-step/day and SWA-MET respectively (r(s)=0.381; 0.410 (P<0.01). CONCLUSIONS: Physical activity level being assessed by a subjective method was different from the objective method in obese individuals. In addition to this, sample groups and limitations should be taken into consideration when determining suitable methods.

Optical coherence tomography neurodegenerative findings in patients with bipolar disorder.

INTRODUCTION: Neuroimaging studies of patients with bipolar disorder (BD) have recently revealed neurodegenerative changes in the central nervous system. Optical coherence tomography (OCT) imaging of the retina, as an extension of brain, may be a biomarker in understanding the neurobiology of the disease. To assess OCT as a tool to detect neurodegeneration in BD we compared the retinal changes between patients with BD and healthy individuals. METHODS: We performed complete ophthalmological examinations and took OCT images for 70 eyes of 70 patients with BD, and for age and sex-matched individual controls. We compared retinal nerve fiber layers (RNFLs) and total retinal (TR) thickness in the peripapillary areas; and ganglion cell complexes (GCCs) and TR thickness in the maculas between the groups. RESULTS: The mean age of the patients was 40.41 ± 13.22 years and that of the controls 40.20 ± 13.03 years. The men/women ratios were 37/33 in both groups. BD was significantly associated with a decrease in the average peripapillary RNFL, with the average peripapillary TR, and with the average GCC thickness (P = .033, P = .008, and P = .009, respectively). The peripapillary RNFL and TR thinnings were prominent in the superior (P = .039, P = .033, respectively) and inferior quadrants (P = .031, P = .018, respectively). The BD effects on GCC thinning was prominent in the superior half (P = .001) and in the nasal sectors (except in the inner superonasal sector; all P < .05). BD was associated with a decrease in macular TR thickness only at the inner superior sector (P = .014). Disease duration was inversely correlated with the peripapillary RNFL, TR, and macular GCC thicknesses (P < .05). DISCUSSION: Our findings support the neurodegeneration hypothesis in the etiopathogenesis of BD. OCT, a non-invasive neuro-imaging method, may be useful for BD diagnosis and follow-ups.

Detecting pain severity with full cup test in painful diabetic peripheral neuropathy.

OBJECTIVES: The aim of this study was to test the utility and validity of the full cup test (FCT) to assess the severity of pain in subjects with painful diabetic peripheral neuropathy (PDPN). METHODS: Subjects with diabetic PDPN were enrolled for this prospective, cross-sectional study. Other causes of PDPN and subjects with cognitive impairment were excluded. The diagnosis of neuropathic pain was made using the results of a physical examination and the Douleur Neuropathique 4 questionnaire. Pain severity was assessed with a FCT and a visual analog scale (VAS) administered before and after treatment. The correlation of FCT with VAS was evaluated to examine validity. RESULTS: A total of 43 (33 female, 10 male) subjects were included. The mean age was 61.9±8.25 years and the mean disease duration was 13.02±7.6 years. Type I diabetes mellitus (DM) was present in 2 (4.7%) subjects and Type II DM in 41 (95.3%) subjects. The mean glycated hemoglobin level was 8.9±1.9 mmol/mol. When the mean VAS and FCT scores were analyzed, the results were 6.7±2.05 and 66.35±23.2, respectively, pretreatment and 4.6±2.2 and 41.36±23.5 posttreatment, which were both statistically significant (p<0.001, p<0.001). The mean control period was 23.4 days (min-max: 15-30 days). The VAS and FCT scores in pretreatment and posttreatment demonstrated a high positive correlation (rs=0.86, p<0.001; rs=0.843, p<0.001). CONCLUSION: The FCT can be useful to detect pain severity in PDPN.

Is the presence of echo-rich periportal cuffing in the liver indicator for abdominal inflammation in pediatric patients?

AIMS: Hyperechoic/echo-rich periportal cuffing (ErPC) is defined as an increase in echogenicity relative to the adjacentliver parenchyma. Thickening in the periportal area may occur with proliferation of bile ducts, hemorrhage, oedema, fibrosis,inflammatory changes or a combination of these. The aim of this study is to determine which intraabdominal inflammatory diseases are associated with the presence of ErPC in the pediatric population and to calculate the sensitivity and specificity of this finding. MATERIAL AND METHODS: In this prospective study 200 consecutive children who underwent abdominal ultrasonography (US) were included: group 1, the patient group (100 children with appendicitis, gastroenteritis, mesenteric lymphadenitis, intestinal infection, terminal ileitis and invagination as cause of intra-abdominal inflammation) and group 2, the control group (100 children). RESULTS: The ErPC was positive in 74 (74%) cases in the patient group and in 3 (3%) in the control group. According to final diagnoses, we found ErPC in most of patients with gastroenteritis (16/17), perforated appendicitis (10/11), mesenteric lymphadenitis (5/6) and acute appendicitis (27/37). The sensitivity of ErPC in indicating intra-abdominal inflammation was 0.80 and its specificity was 0.87. No significant correlation between ErPC and age, gender and CRP was found but a moderate and significant positive correlation between ErPC and WBC (p=0,010; r=0.255) was detected. Very good concordance between observers in terms of the presence of ErPC on abdominal US was found (concordance 97% and kappa 0.93). CONCLUSIONS: We consider that the presence of ErPC in pediatric patients, when evaluated alongside clinical and laboratory findings, has a high sensitivity and specificity for inflammatory intra-abdominal pathology.

Effect of high-risk human papillomavirus in esophageal squamous cell carcinoma in Somalian and Turkish cases.

This study aimed to investigate the role of high-risk human papillomavirus (Hr-HPV) in Somalian and Turkish patients with esophageal squamous cell carcinoma (ESCC). In the sections obtained from paraffin-embedded blocks, the results of invasive tumor, peripheral tumor dysplasia and normal mucosa were examined. Samples containing 45 and 47 ESCC, 46 and 42 dysplasia in Somalian (n = 52) and Turkish (n = 53) cases, respectively, were included in the study. We examined the presence of 14 types of Hr-HPV in ESCC collected from Somalia and Turkey by Aptima® Panther System. Hr-HPV types were not detected in Somalian cases. p16INK4a is positive in 5 (11.4%) tumors and 6 (13%) dysplasia. p53 is positive in 28 (62.2%) tumors and 35 (76.1%) dysplasia. HPV16-18/45 are positive only in one of the Turkish cases. p16INK4a is positive in 5 (10.6%) tumors and 4 (9.5%) dysplasia. p53 is positive in 31 (63.3%) tumors and 24 (57.1%) dysplasia. No reaction was detected in normal mucosa samples in both countries. This study is regional. Although the findings did not reflect the general population, the present study shows that the effect of HPV on carcinogenesis in Somalian and Turkish ESCC patients was not significant.

Two-Year Results of Community-Based Screening Program for Human Papilloma Virus DNA in Çorum Province.

OBJECTIVE: The Turkish Ministry of Health started a community-based screening program using Human Papilloma Virus (HPV) DNA in 2014. In our study, we aimed to investigate the results of this survey in Çorum province between the years of 2016-17 to determine the shortcomings and deficiencies in practice. MATERIAL AND METHOD: All of the women between the ages of 30 and 65 years who had undergone High risk HPV DNA screening in Çorum province between 2016 and 2017 were included in the study. High risk HPV types were divided into three categories as type 16, 18 and others. The target group of patients to be screened were compared with the numbers reached in the survey. After colposcopic biopsy, the clinicopathological correlation of the patients who underwent colposcopic biopsy was determined via pathology reports. RESULTS: HPV DNA was detected in 817 women (3.5%). HPV types 16, 18 and others were found to be positive in 216, 32 and 569 individuals, respectively. Cervical biopsy was performed with colposcopy in 212 (26%) women. As the result of colposcopy, LSIL and HSIL were detected in 63 and 56 patients, respectively. 34.5% of patients with the diagnosis of any kind of dysplasia received treatments. CONCLUSION: It was determined that 44% of HPV DNA-positive patients were not subjected to the appropriate processes according to the national guidelines. This shows that despite the screening, the desired therapeutic effect could not be achieved.

Cold effect in median nerve conductions in clinical carpal tunnel syndrome with normal nerve conduction studies.

Clinical diagnosis of carpal tunnel syndrome (CTS) is confirmed by nerve conduction studies (NCS). In some cases, NCS may be normal. We aimed to demonstrate changes of distal motor latency (DML) and nerve conduction velocity (NCV) pathology of demyelination in entrapment neuropathy with cold application in case of clinical CTS with normal NCS. This prospective, cross-sectional, randomise, case-control involved 15 patients (25 hands) with clinically definite unilateral or bilateral CTS and normal nerve conduction studies (NCS), and 11 controls (22 hands). Ice pack was applied to median nerve trasse at wirst with monitoring skin temperature. NCS of median nerve were examinated again. Increases of DML, decrease of velocity of median nerve were observed in two groups after post-cooling. The change in NCV was greater than the change in DML. Cold effect was evident in DML and NCV in the patient group. This could be sign of the demyelination pathology. We think that cold application is influential to determine electrophysiologic abnormalities in clinic CTS with normal NCS.

The association between the prevalence of restless leg syndrome, fatigue, and sleep quality in patients undergoing hemodialysis.

OBJECTIVE: To determine the prevalence of restless legs syndrome (RLS) in patients with chronic renal failure (CRF) and to compare CRF patients with or without RLS in terms fatigue and sleep quality. METHODS: A cross-sectional study was conducted on 220 patients (18-75 years) who were undergoing dialysis 3 times weekly in Çorum Province, Corum, Turkey, between January 2014 and January 2016. The diagnosis of RLS was based on the diagnostic form proposed by the international RLS study group. Sleep quality was evaluated using the Pittsburgh sleep quality index (PSQI), and severity of fatigue was determined by using fatigue severity scale (FSS). RESULTS: Of all the participants, 16.8% (n= 37) (Group 1) were found to have RLS, while 183 patients had no RLS (Group 2). The mean ages were similar between groups. With respect to laboratory analyses, a p-value of less than 0.05 was considered in Group 1 than in Group 2. Restless legs syndrome was mild (7.1%), moderate (46.4%) and severe (39.3%) in patients with RLS. Factors associated with the severity of RLS included weight, duration of dialysis, anuria, iron, total iron binding capacity, calcium and transferrin saturation. The PSQI and FSS scores were significantly worse in Group 1 (p less than 0.001). CONCLUSION: Restless legs syndrome is a common condition in patients undergoing hemodialysis; the results of our study confirm the adverse effects of RLS in terms of many aspects of sleep quality and fatigue.

Epidemiology and Prevalence of Blastocystis spp. in North Cyprus.

AbstractThis study was conducted to investigate the prevalence of Blastocystis spp. and its subtypes (STs) in North Cyprus; and to evaluate the presence of this parasite and its STs with respect to demographic, socioeconomic, and epidemiological factors, as well as gastrointestinal symptoms. Stool samples were collected from 230 volunteers. Each participant also filled out a questionnaire. The samples were examined microscopically by native-Lugol and trichrome methods and further tested by polymerase chain reaction (PCR) and sequencing. Prevalence of Blastocystis spp. infection was found to be 10.5%, 10.5%, and 27.8%, by direct microscopy, trichrome method, and PCR, respectively. No other parasites were detected in the specimens except Giardia spp. (n = 2; 0.8%) and Entamoeba coli (n = 1; 0.4%). The most common Blastocystis STs were ST3 (20; 31.2%), ST2 (18; 28.2%), ST1 (8; 12.5%), and ST4 (7; 11%); whereas other STs were identified as ST6 (3; 4.7%), ST7 (2; 3.2%), and non-ST (6; 9.4%). Presence of Blastocystis spp. and its STs was not significantly related to any of the demographic, socioeconomic, and epidemiological factors. Furthermore, no significant association of Blastocystis spp. and its STs with gastrointestinal symptoms was found. This study is the first investigation of the epidemiology of Blastocystis spp. in North Cyprus. Distribution of Blastocystis spp. and its STs among demographic, socioeconomic, and epidemiological factors showed complete homogeneity. Presence of the parasite and its STs was not significantly related with the gastrointestinal symptoms among symptomatic and asymptomatic individuals. These findings suggest that Blastocystis spp. may be part of the intestinal flora in humans.

Prognostic Importance of Bone Marrow Uptake on Baseline 18F-FDG Positron Emission Tomography in Diffuse Large B Cell Lymphoma.

AIM: To define the role of 18F-flourodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) in the detection of bone marrow (BM) involvement in patients with diffuse large B cell lymphoma (DLBCL). MATERIALS AND METHODS: Fifty-four (mean age: 55.5 ± 18.3 years, 20 female and 34 male) DLBCL patients who underwent pretreatment 18F-FDG PET/CT were included to the study. Focal or diffuse BM 18F-FDG uptake that is higher than mediastinal blood pool uptake was accepted as positive. After staging of disease by CT and 18F-FDG PET/CT, all the patients received R-CHOP treatment after diagnostic blinded bone marrow biopsy (BMB). Presence of positive BM uptake in 18F-FDG PET/CT and histopathological examination results of BMBs were analyzed by Chi-square test. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of 18F-FDG PET/CT in the detection of BM involvement were calculated. Prognostic importance of the presence of BM 18F-FDG uptake was analyzed by Kaplan-Meier analysis. RESULTS: BM 18F-FDG uptake was detected in 8 patients. Histopathological examination of BMB revealed BM involvement in 6 out of 8 patients. BMB was negative in all patients who have no 18F-FDG uptake in the evaluation of PET/CT images. Sensitivity, specificity, accuracy, PPV, and NPV of 18F-FDG PET/CT in the detection of BM involvement were calculated as 100%, 96%, 96%, 75%, and 100%, respectively. In the Kaplan-Meier analysis, we found that presence of pretreatment 18F-FDG uptake in BM has a prognostic importance. Whereas mean time to progression (TTP) in patients with BM uptake was 32.25 ± 10.9 months and mean TTP in those without was 51.69 ± 3.6 months (p = 0.013). CONCLUSIONS: BM uptake in pretreatment 18F-FDG PET/CT is an important prognostic factor in DLBCL patients. Moreover, in consideration of high NPV, 18F-FDG PET/CT could eliminate unnecessary BMB in FDG-negative patients.