Evaluation of the Urinary System Diseases Sections in the Book Cerrahiyetü'l Haniyye (Imperial Surgery) by Sabuncuoglu Serefeddin.

OBJECTIVES: Serefeddin Sabuncuoglu (1385-1465) is a medical scholar who wrote the first illustrated surgical book (Cerrahiyetü'l Haniyye [Imperial Surgery]) in the history of Turkish and Islamic medicine. Sabuncuoglu benefited from the books of medical scholars before him and translated the book et-Tasreef of Abul-Qasim Khalaf Ibn Abbas Alzahrawi (Albucasis), which was the most important surgical book of its time. In this study, the urinary system disease sections of the textbook by Serefeddin Sabuncuoglu were examined. MATERIALS AND METHODS: Cerrahiyetü'l Haniyye and et-Tasreef were evaluated by comparative textual analysis methodology in terms of urinary system diseases and its treatments. RESULTS: The textbooks contain the same definitions of the cauterization of the kidney, cauterization of the urinary bladder, the treatment of urine retention, bladder irrigation with the syringe, and the forms of the instruments for the extraction of a stone from men and women. Serefeddin Sabuncuoglu made additions to the kidney and bladder cauterization and bladder irrigation sections. Colorful miniatures containing images of the procedures performed on the patients are found in Cerrahiyetü'l Haniyye. CONCLUSIONS: The urinary system disease section in Cerrahiyetü'l Haniyye is a translation of et-Tasreef in general, with some additional information and drawings. The surgical instruments and procedures described by both physicians have reached the present day with changes.

Development of the Inclination Toward Conscientious Objection Scale for Physicians.

This study aims to develop a valid and reliable scale to assess whether a physician is inclined to take conscientious objection when asked to perform medical services that clash with his/her personal beliefs. The scale, named the Inclination toward Conscientious Objection Scale, was developed for physicians in Turkey. Face validity, content validity, criterion-related validity, and construct validity of the scale were evaluated in the development process. While measuring criterion-related validity, Student's t-test was used to identify the groups that did and did not show inclination toward conscientious objection. There were 126 items in the initial item pool, which reduced to 42 after content validity evaluation by five experts. After necessary adjustments, the scale was administered to 224 participants. Both exploratory and confirmatory factor analyses were performed to investigate factor structure. The split-half method was employed to assess scale reliability, and the Spearman-Brown coefficient was calculated. Cronbach's alpha reliability coefficient was used to estimate the internal consistency of the scale items. The distinctiveness of the items was evaluated using Student's t-test. The lower and upper 27% groups were compared to assess the distinctiveness of the scale. The items were loaded on four factors that explained 85.46% of the variance: "Conscientious Objection - Medical Profession Relationship," "Conscientious Objection in Medical Education and Medical Practice," "Conscientious Objection with regard to the Concept of Rights" and "Conscientious Objection - Physician's Professional Identity and Role." The final scale has 40 items, and was found to be valid and reliable with high internal consistency.

The REM-sleep-related characteristics of narcolepsy: a nation-wide multicenter study in Turkey, the REMCON study.

INTRODUCTION: Narcolepsy type 1 (NT1) is caused by hypocretin deficiency, the pathophysiology of narcolepsy type 2 (NT2) has not been delineated. Except for the hypocretin deficiency and cataplexy, all clinical and laboratory features used in the diagnosis of NT2 are identical to those used for NT1. The aim of this study was to assess the rapid eye movement (REM) sleep-related characteristics in the patients with narcolepsy; the characteristics of REM sleep in polysomnography (PSG) and multiple sleep latency test (MSLT) recordings, the quantification of REM sleep without atonia (RSWA) and atonia index, and the analysis of rapid eye movements (REMs) during REM sleep. MATERIALS AND METHODS: This study was planned by the Sleep Medicine Study Group of the Turkish Neurology Society, and conducted in 11 centers in eight cities in Turkey. The analysis of RSWA was analyzed by reviewing all REM sleep periods on nocturnal PSG and MSLT recordings per standard criteria. The total duration of the increased muscle tone during REM sleep in the chin and bilateral leg electromyography (EMG) recordings was calculated as RSWA index. The REMs index was also investigated the relation to the RSWA. RESULTS: A total of 274 patients were involved; 147 patients (53.6%) were males and 127 patients (46.4%) were females; the mean age was 29.1 ± 12.0 years. The diagnosis of NT1 was made in 166 patients (60.6%), and 108 patients (39.4%) were diagnosed as having NT2. The mean Epworth sleepiness scale score was significantly higher in patients with NT1 than the patients with NT2 (P = 0.001). The diagnosis of REM sleep behavior disorder (RBD) was made in 19.3% of the patients with NT1 versus in 2.8% of the patients with NT2 (P < 0.001). The percentage of SOREMP in PSG recordings was significantly higher in patients with NT1 (37.1%) than those with NT2 (18.9%, P = 0.001). MSLT showed that the mean sleep latency was shorter in patients with NT1 compared to those with NT2 (P < 0.001). The total duration of REMs on electrooculography recordings was also significantly higher in patients with RSWA in comparison with the patients without RSWA (P = 0.002). Total duration of REMs was significantly and positively correlated with the duration of RSWA on chin-EMG and leg-EMG recordings (P = 0.001). ROC analyses showed an RSWA index of ≥2% for the RSWA on chin-EMG with a sensitivity of 86.7% and a specificity of 71.3% (P < 0.001). The REMs index ≥20% was associated with the presence of RSWA with a sensitivity of 70.0% and a specificity of 57.1% (P = 0.008). CONCLUSIONS: In this nation-wide study, we identified for the first time that the increase in REMs density during REM sleep may be a major correlate of the RSWA. Significant positive correlations were demonstrated between the total duration of REMs on electrooculography recordings and the mean durations of RSWA in both chin and leg EMG recordings. A REMs index of >20% was demonstrated to have a moderate sensitivity and specificity in the diagnosis of RSWA. As observed in chin RSWA index, REMs index also showed a significantly high association with RBD, in comparison to RSWA per standard criteria.

Ethical discourse of medical students and physicians on conscientious objection: A qualitative study in Turkey.

This study is an investigation of the views of medical students (N=15) and physicians (N=14), in Turkey, on conscientious objection through elaboration on their experiences in medical practice within the framework of conscientious objection, and evaluation of the data from an ethical perspective. The data received from in-depth interviews were evaluated by using the thematic content analysis method. They were then divided into contexts and themes as follows: "Refusal to provide healthcare services," "scope of conscientious objection," and "impact of conscientious objection (in case of legal entitlement)." The opinions of our research participants suggest that conscientious objection has become widespread in medical practices. It is argued that the tendency of healthcare providers and patients to find temporary resolutions to ethical dilemmas only complicates such resolutions. It is imperative, therefore, to set a rational limit on conscientious objection so as to prevent the adoption of an attitude shaped completely by the personal beliefs of the physician or the patient.

Assessing Industrial Robot agility through international competitions.

Manufacturing and Industrial Robotics have reached a point where to be more useful to small and medium sized manufacturers, the systems must become more agile and must be able to adapt to changes in the environment. This paper describes the process for creating and the lessons learned over multiple years of the Agile Robotics for Industrial Automation Competition (ARIAC) being run by the National Institute of Standards and Technology.

Absenteeism and Delay to Work Due to Sleep Disorders in the Turkish Adult Population: A Questionnaire-Based National Survey.

Sleep problems may have negative effects on work-life balance, overall health, and safety. We aimed to investigate the association between sleep disorders and absenteeism and delay to work (being late or tardy) among the working adult population. The study was conducted by using data from a large survey of working adults who participated in the Turkish Adult Population Epidemiology of Sleep Study (TAPES) managed by Turkish Sleep Medicine Society (TSMS). Secondary analyses was employed to examine absenteeism and delay to work and their associations with sleep problems, including sleepiness by Epworth Sleepiness Scale (ESS), parasomnias, sleep apnea (by Berlin Questionnaire), sleep quality (by Pittsburgh Sleep Quality Index), and restless leg. History of any absenteeism and delay to work was observed in 276 (18%) and 443 (29%) out of 1,533 working adults, respectively. In the multivariate analyses, absenteeism was associated with younger age, female gender and poor sleep quality, while delay to work was associated with younger age, poor sleep quality, parasomnia, and sleepiness. In the presence of absenteeism and delay to work, sleep disorders including sleepiness, poor sleep quality, and parasomnia should be considered. Such evaluation may improve worker well-being and provide some additional benefits in terms of increasing productivity and lowering work-related costs.

Cyclic Alternating Pattern in Obstructive Sleep Apnea Patients with versus without Excessive Sleepiness.

BACKGROUND: One of the main hypotheses on the development of daytime sleepiness (ES) is increased arousal in obstructive sleep apnea (OSA). Cyclic alternating pattern (CAP) is considered to be the main expression of sleep microstructure rather than arousal. Therefore, we aimed to investigate whether there is any difference between OSA patients with versus without ES in terms of the parameters of sleep macro- and microstructure and which variables are associated with Epworth Sleepiness Scale (ESS) score. METHODS: Thirty-eight male patients with moderate to severe OSA were divided into two subgroups by having been used to ESS as ES or non-ES. RESULTS: There was no difference between two groups in clinical characteristics and macrostructure parameters of sleep. However, ES group had significantly higher CAP rate, CAP duration, number of CAP cycles, and duration and rate of the subtypes A2 (p = 0.033, 0.019, 0.013, and 0.019, respectively) and lower mean phase B duration (p = 0.028) compared with non-ES group. In correlation analysis, ESS score was not correlated with any CAP measure. CONCLUSIONS: OSA patients with ES have increased CAP measures rather than those without ES.

Contribution of an educational video to surgical education in laparoscopic appendectomy.

OBJECTIVE: With recent widespread advances in laparoscopy, providing education on this subject has become a significant challenge. The aim of this study was to determine the degree of contribution made by surgeons to laparoscopic education through an educational video. MATERIAL AND METHODS: A total of 40 volunteer general surgery residents and specialists participated in our study. Before watching the approximately six-minute educational video prepared for laparoscopic appendectomy, the participants were asked to fill out participant information forms and information measurement questionnaire forms. After the video, the participants were asked to fill out the information measurement questionnaire forms a second time; additionally, attitude evaluation forms and education evaluation questionnaire forms were presented to the participants for completion, and statistical analysis was performed. Furthermore, the total watching duration and the number of times the video was paused were recorded. RESULTS: A total of 40 surgeons participated in the study (75% residents and 25% specialists). When the results of the information determination questionnaire forms filled out by the resident and specialist groups before and after the video were compared, it was observed that the scores of both groups significantly increased after watching the video (p=0.001). A statistical significance was identified between the length of time the video was watched and the education evaluation form scores of the participants (p<0.01). It was observed that the longer the video was watched, the greater the increase in the education evaluation scores. The results of the attitude evaluation forms implied that the video could be produced more professionally. CONCLUSION: Although education is an inevitable requirement of laparoscopic surgery, many teaching methods are available. Awareness-enhancing videos prepared on this topic can be efficient in providing laparoscopic education.

Plasma apelin level in patients with restless legs syndrome and its association with periodic leg movements.

OBJECTIVES: Apelin is an antioxidant and anti-inflammatory molecule secreted by adipose tissue and has a protective effect on cardiac and neuronal tissue. Recent studies have reported that the risk of vascular disease is increased in restless legs syndrome (RLS). We aimed to measure plasma levels of apelin in patients with RLS. Additionally, we wanted to determine if there is any relationship between apelin levels and RLS disease severity and the periodic leg movement index (PLMI). METHOD: A total of 14 RLS patients with moderate-to-severe symptoms and 14 age- and body mass index (BMI)-matched healthy controls participated in the study. All participants had no concomitant medical disorder nor took medications. The international RLS rating scale (IRLSS) was used to determine disease severity. Polysomnography (PSG) served to exclude other sleep disorders such as sleep-related breathing disorders and to measure sleep parameters. RESULTS: The mean plasma apelin level was significantly lower in the patient group compared to the control group independent of IRLSS score and PSG findings (p = 0.004). After comparison between the RLS patient group and control group, the patient group was divided into two subgroups based on a PLMI above or below 15 events per hour. A reduced mean apelin level was observed in the patient group having a PLMI above 15 compared to the patient group with PLMI below 15 and the control group (p = 0.003). There was no correlation between plasma apelin levels and disease severity and PLMI in the two patient subgroups. CONCLUSIONS: RLS patients especially those with a PLMI above 15 have low plasma apelin levels independent of disease severity and sleep parameters such as sleep duration and quality. Decreased apelin levels may explain the increased risk for vascular diseases in those patients.

The effects of statin treatment on adrenal and sexual function and nitric oxide levels in hypercholesterolemic male patients treated with a statin.

BACKGROUND: Erectile dysfunction complaints among men treated with a statin are not uncommon. OBJECTIVES: To evaluate the effect of lowering low-density lipoprotein cholesterol (LDL-C) to target levels using varying doses of atorvastatin therapy in hypercholesterolemic male patients on adrenocortical hormones, sexual functions, and serum nitric oxide (NO) levels. METHODS: Eleven hypercholesterolemic male patients who had LDL-C levels greater than 160 mg/dL were included in the study and 11 healthy male individuals served as controls. Following basal hormone measurements, 1-and 250-mcg adrenocorticotropic hormone stimulation tests were performed in both groups, and blood sampling was performed at 0, 30, and 60 minutes for the determination of blood levels of cortisol, total testosterone (TT), free testosterone (FT), 11-deoxycortisol, and dehydroepiandrostenedione. Depending on baseline LDL-C concentrations, atorvastatin therapy was given to patients with daily doses of 5 or 10 mg and the study procedures were repeated once patients reached risk stratified goal LDL-C levels. LDL-C values after treatment were classified into 3 groups as LDL-C > 160 mg/dL, LDL-C 100 to 130 mg/dL and LDL-C < 100 mg/dL. NO levels were measured at baseline and after statin therapy. Erectile function was assessed both objectively and subjectively by using penile somatosensory evoked potential (SEP) and the International Index of Erectile Function-5 Questionnaire, respectively, at 3 different LDL-C levels. RESULTS: With regard to adrenocorticotropic hormone stimulation test (1 or 250 mcg) results, peak cortisol levels before and after statin treatment among 3 LDL-C groups and among controls did not differ significantly. However, peak TT and FT hormone levels decreased in conjunction with decreasing levels of LDL-C among the statin-treated patients, whereas dehydroepiandrostenedione and 11-11-deoxycortisol peak values did not change. N1 latency obtained during SEP, which is the first negative deflection, was prolonged with decreasing levels of LDL-C and a significant decrease in International Index of Erectile Function-5 scores were observed. When LDL-C levels of ≥ 160 mg/dl was reduced to 100 to 130 mg/dl, maximal NO elevations were noted. CONCLUSIONS: Our results suggest that decreased LDL-C levels caused by different doses of atorvastatin treatment did not associate with significant changes in adrenal hormone levels. In contrast, there was a significant relationship between attained LDL-C on statin therapy and TT and FT levels. Electrophysiologically, abnormal SEP responses obtained in the patient group with LDL-C levels below 100 indicate a negative impact on the integrity of the somatosensory pathway, which plays a role in erectile function. Reducing LDL-C with a statin was associated with both decreased testosterone levels and erectile dysfunction.

Efficiency of a Combination of Pharmacological Treatment and Nondrug Interventions in Childhood Narcolepsy.

Objective Narcolepsy is a chronic sleep disorder characterized by excessive daytime sleepiness, cataplexy, hypnagogic and/or hypnopompic hallucinations, and sleep paralysis. It is one of the most important causes of excessive daytime sleepiness in the pediatric population. The aim of this study is to present the clinical and laboratory findings, and treatment results of pediatric patients with narcolepsy. Materials and Methods We studied five unrelated consecutive children with narcolepsy, focusing on clinical and laboratory features, the therapy and outcome over the 33-month follow-up period. Results The study subjects included two boys and three girls. The mean age at diagnosis was 11.8 ± 3.3 years (range: 8-16 years). Three patients had cataplexy. There were no hypnagogic hallucinations and/or sleep paralysis in any patients. All patients were educated about sleep hygiene, appropriate nutrition, and regular exercise. Three patients were treated with modafinil, while two patients received methylphenidate. Sodium oxybate was added to existing treatment in patients with cataplexy. Cataplexy attacks did not respond well to the treatment in one patient; therefore intravenous immunoglobulin therapy was given. Conclusions Early diagnosis is important to help narcoleptic patients in improving their quality of life. A combination of pharmacological treatment and nondrug interventions can greatly improve children's clinical symptoms.

Electrophysiological Identification of Central Sensitization in Patients with Chronic Prostatitis.

PURPOSE: Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a chronic pain condition and a com­mon problem in urology clinics. Although many different etiologies and mechanisms exist, the exact cause of the disease has been unknown. Central sensitization (CS) is defined as an augmentation of responsiveness of central cortical neurons to input from peripheral nociceptive structures. Somato-sensory evoked potentials (SEPs) is an electroneurophysiological method to assess cortical activity in somatosensory area of brain related to sensorial stimuli. We aimed to determine the presence of CS using the SEPs of dorsal penile nerve stimulation in patients with CP/CPPS. MATERIALS AND METHODS: Seventeen male patients diagnosed CP/CPPS and 17 male healthy controls were pro­spectively included in the study. For SEP study, electrical stimulus was applied with penile ring electrodes. Re­cording electrodes were placed as active to Cz' and reference electrode on Fz' according to the 10-20 Interna­tional System. Latency of N50 was defined as the second negative (up-ward) deflection of the W-shaped averaged cortical waveform. RESULTS: N50 latencies were significantly shortened in the patient group compared to the healthy controls (P < .001). CONCLUSION: These results support the presence of central sensitization because of exaggerated trans-mission of pain sensation to the somatosensory cortex. Therefore, normalization of transmission might be an important step in treatment of pain in patients with CP/CPPS. This study can be counted as an important guiding on pathogenesis and treatment of disease.

Prevalence of insomnia and its clinical correlates in a general population in Turkey.

AIM: The prevalence of insomnia is influenced by environmental factors. This study aimed to investigate the prevalence of insomnia and its sociodemographic and clinical correlates in a general population-based survey in Turkey. METHODS: This population-based study included 4758 subjects among 5021 who participated in the Turkish Adult Population Epidemiology of Sleep Disorders study. Questionnaire items evaluating insomnia were adapted from the International Classification of Sleep Disorders II and the DSM-IV-TR. Subjects with restless legs syndrome were excluded. RESULTS: Insomnia was found to be associated with older age (18-24 years, 9.8%; 25-44 years, 11.7%; 45-64 years, 13.8%; 65 years or older, 13.9%), lower income level (<500 USD, 16.5%), time spent watching TV (6-8 h or more, 18.4%), tea consumption in the evening (≥6 glasses, 14.5%) and smoking status (current and ex-smoker, both 14.2%) in multiple logistic regression analysis. In respect to other medical disorders, insomnia was significantly associated with the presence of hypertension, diabetes and heart diseases after the adjustment for relevant risk factors for each disease, across all age and sex groups. CONCLUSIONS: Insomnia is a major health problem in our population, affecting subjects in the working age group and those of lower socioeconomic status. It should especially be screened in patients with chronic diseases. A relatively low proportion of insomnia diagnosed as a sleep disorder suggests that this condition and its clinical correlates are possibly under-recognized.

A circumcision method in an old surgical textbook (Cerrahiyyetul Haniyye): reminding of a forgotten procedure.

PURPOSE: Circumcision is one of the historical surgical procedures. Some sources throughout the history contain various definitions about different circumcision methods. we described the details of the method, and aimed to remind the possibility of contemporary usage. MATERIALS AND METHODS: We compared circumcision chapters of Sabuncuoglu and Zahrawi to explain the historical origin of Sabuncuoglu's favorite circumcision method. RESULTS: We found a method which might be summarized as "knotting with rope technique" in one of historical textbooks named as Cerrahiyyetul Haniyye (Imperial Surgery) written by Serefeddin Sabuncuoglu (1385-1468?) in 1465. CONCLUSION: This circumcision method is not used currently. In addition this method has not been defined in the history of medical literature yet.

Comparison of motor pattern of periodic limb movements in patients with restless legs syndrome and obstructive sleep apnea syndrome.

BACKGROUND/AIM: Periodic limb movements (PLMs) are repetitive and stereotypical movements of the lower extremities that occur during sleep. The purpose of this study was to analyze the leg muscle activity patterns in PLMs seen in restless legs syndrome (RLS) and obstructive sleep apnea syndrome (OSAS). MATERIALS AND METHODS: In this study, 1260 PLMs from 4 patients with RLS and 4 patients with OSAS were analyzed. The spreading and frequency characteristics of the gastrocnemius, medial hamstring, and vastus muscles were examined separately for each muscle in addition to the tibialis anterior muscle already included in the standard polysomnography recording. RESULTS: A greater number of PLMs (57.34%) were observed in patients with RLS. A greater number of apnea-related PLMs (59.83%) were observed in patients with OSAS. The number of PLMs with spreading characteristics was higher in both patient groups. In both groups, the first muscle to contract was most frequently the tibialis anterior. Analysis of the subsequent contraction patterns showed no regular course in RLS and OSAS patients. CONCLUSION: PLMs may occur with a nonstereotypical muscle spreading pattern generated by different, independent, and, most frequently, unsynchronized spinal generators.

The effect of sleep duration and quality on academical success of the elementary school children in Kayseri Turkey.

OBJECTIVE: To assess the sleeping habits of primary school children and establish link between sleeping hours and academic achievement. METHODS: The cross-sectional study was conducted between April and June 2007, involving 2422 students of 6-8th grades in 12 primary schools located in Kayseri, Turkey. A questionnaire was presented to the students on the basis of probability sampling method. Academic performance was evaluated with regard to their school grades. SPSS 20 was used for statistical analysis. RESULTS: Of the total 2422 questionnaires distributed, 1966 (81.2%) were used for further evaluation. The mean sleeping period of the students during school days was 8.86 +/- 1.10 hours. The number of students having difficulty in waking up in the morning was 940 (47.8%), while 910 (46.3%) were confused when they woke up during the night, and the 886 (45.1%) had nightmares, while 609 (31.0%) were sleepy all day long. As the sleeping period increased, the probability of a mediocre achievement in science lessons increased by 1.33 fold and poor achievement increased by 1.57 fold. Besides, the probability of a mediocre achievement in mathematics lessons increased by 1.36 fold, and poor achievement increased by 1.67 fold. For Turkish language lessons, these increases were found to be 1.40 and 1.60 respectively. Correlation analysis showed a significant negative relationship between sleeping time and successful scores in Turkish (r = -0.65, p < 0.025) and science (r = -0.061, p < 0.036) lessons. CONCLUSION: As the sleeping period increased, the academic achievement of the students was negatively affected. The academic success was low in children who felt sleepy throughout the day.

Obstructive sleep apnoea syndrome is associated with relative hypocortisolemia and decreased hypothalamo-pituitary-adrenal axis response to 1 and 250µg ACTH and glucagon stimulation tests.

OBJECTIVE: The investigations regarding the effect of obstructive sleep apnoea syndrome (OSAS) on hypothalamo-pituitary-adrenal (HPA) axis revealed conflicting results. We aimed to evaluate the effects of OSAS on HPA-axis with dynamic tests. METHODS: This study was carried out on 26 patients with OSAS and 15 subjects without OSAS which, were defined according to the International Classification of Sleep Disorders. Patients were enrolled from either Endocrinology outpatient clinic or Neurology Sleep Center. Participants for the control group were included from the patients admitting to Endocrinology Department with the complaint of obesity or volunteers from hospital staff. All the participants were evaluated by polysomnography (PSG) and dynamic tests of HPA axis (dexamethasone suppression test, 1 and 250µg ACTH and glucagon stimulation tests). RESULTS: Serum basal and peak cortisol levels were found to be lower in OSAS patients when compared to the control group during 1µg ACTH and glucagon stimulation tests. When the area under curve (AUC) of cortisol responses to dynamic stimulation tests were calculated according to trapezoid formula, patients with OSAS were found to have lower values compared to control group. AUC responses of all three dynamic stimulation tests were found to be negatively correlated with AHI. CONCLUSION: OSAS is associated with relative hypocortisolemia in the morning with reduced responses to 1 and 250µg ACTH and glucagon stimulation tests.

Obstructive sleep apnoea prevalence in non-arteritic anterior ischaemic optic neuropathy.

AIMS: The aim of this study was to show the prevalence of obstructive sleep apnoea (OSA) in non-arteritic anterior ischaemic optic neuropathy (NAION). METHODS: 20 patients diagnosed with NAION were included in the study. 20 age and sex matched subjects with similar risk factors for NAION, such as diabetes mellitus (DM) and hypertension (HT), constituted the control group. All cases underwent polysomnography for investigation of the presence of OSA. Cases with an Apnoea-Hypopnoea Index >5 were accepted as having OSA. RESULTS: Mean ages of the patients and controls were 60.90±8.14 and 61.15±7.23 years, respectively. There were no significant differences between the patient and control groups in terms of age, gender, body mass index, smoking/alcohol consumption or systemic diseases. In the patient group, 85% were diagnosed with OSA compared with 65% in the control group (p>0.05). CONCLUSIONS: We found a high prevalence of OSA in patients with NAION but it was also high in the control group (p>0.05). This may be due to the fact that the two groups were matched for the same risk factors for NAION. The study indicates that OSA is not a risk factor for NAION in itself but is the contributing factor as it has effects on the vascular endothelium in DM, HT and atherosclerosis.

The importance of associations in the struggle against tuberculosis in Turkey.

Tuberculosis is a disease as old as human history and has affected every area of human life. The struggle against tuberculosis had been started by non-governmental organizations and achieved success after second world war. In Anatolia as well as all over the world fight against tuberculosis, with the leading names in medicine, started during the Ottoman Empire. In the following years of struggle within the executive team will host association (Istanbul Anti-tuberculosis Association) was founded in 1918. Due to political developments that occurred shortly after standing association studies, in 1923, the Republic of Turkey in Izmir during the re-started. In the 1925 and 1927 a national medical congress, tuberculosis as the main election issue, was organized, and then in 1928 in Istanbul Tuberculosis Association again take action in the fight against decisive role in association studies have begun to undertake. In the years 1953-1973, UNICEF, Ministry of Health and later efforts Turkish National Anti-tuberculosis Association jointly significant results were obtained in the fight against tuberculosis. These positive statements given the lethargy environment, economic and political crises in the last 10 years, in parallel with the increase of tuberculosis around the world experiencing, there was an increase in Turkey. In 1986, the National Anti-Tuberculosis Federation was founded by Anti-Tuberculosis Associations. The Anti-Tuberculosis Federation has put in practice DOTS programme in 2005 in Turkey. In conclusion, we evaluate that the Anti-Tuberculosis Associations in Turkey have played a major role in struggle against tuberculosis in Turkey since the last century.

Assessment of nitric oxide, advanced oxidation protein products, malondialdehyde, and thiol levels in patients with restless legs syndrome.

OBJECTIVES: We aimed to determine the importance of oxidative stress in the pathogenesis of restless legs syndrome (RLS) by quantification of advanced oxidation protein products and total thiol levels (as markers of oxidative protein damage), nitric oxide levels (as an antioxidant and endothelial function), and malondialdehyde levels (as a marker of lipid peroxidation) in patients with RLS. DESIGN AND METHODS: A total of 22 patients with primary RLS were enrolled in the study and 20 age-and-gender-matched healthy subjects were enrolled as a control group. Serum nitric oxide, malondialdehyde, thiol levels, and plasma advanced oxidation protein products levels were determined by spectrophotometric methods. RESULTS: Serum nitric oxide and thiol levels were lower in the patient group than in controls (p = 0.007 and p = 0.017, respectively). Plasma advanced oxidation protein products levels and serum malondialdehyde levels were found to be higher in patients with RLS than in controls (p = 0.017 and p = 0.008, respectively). Serum malondialdehyde level was found to be positively correlated with plasma advanced oxidation protein products levels (p = 0.039). Serum thiol level was found to be negatively correlated with plasma advanced oxidation protein products levels (p = 0.030). CONCLUSIONS: Increased advanced oxidation protein products, malondialdehyde levels, and decreased thiol and nitric oxide levels, may suggest that patients with RLS are under oxidative stress. Although both lipid peroxidation and protein oxidation may have a role in atherosclerosis in RLS, those factors may be related to the pathogenesis of RLS.