Retrospective evaluation and descriptive analysis of the prevalence of anatomical structures and variations in CBCT images before dental implant planning in a group Turkish population, part I.

PURPOSE: The aim of this study is to emphasize the importance of using cone-beam computed-tomography in order to determine the anatomical structures and their variations before the treatment in patients who apply to the dentist clinic for implant treatment. METHODS: In the study, CBCT images of 500 adult patients (240 female and 260 male), aged between 21 and 82 years, who applied for implant treatment due to missing teeth, were retrospectively analyzed. Anatomical structures and variations such as nasopalatine canal(NPC), canalis sinuosus(CS), antral alveolar artery(AAA), were evaluated in multiplanar reformation(MPR) sections which are axial, sagittal and coronal can be viewed in consistence with each other. RESULTS: The incidence of anatomical variation of CS in the right region was similar according to gender. The "Funnel" appearance of the NPC shape was found most common shape in both female and male patients (n = 89; 37.1% for females and n = 71; 27.3% for males). CONCLUSION: CBCT has become the most popular 3D imaging method in dental practice especially for planning dental implants. Understanding the relationship with important anatomical structures before implant applications is crucial in dealing with potential complications that may arise afterward. Assessing significant anatomical structures by CBCT and taking precautions against possible risks facilitate the work of dentists during and after procedures.

Postmortem Interval Estimation With Corneal Endothelial Cell Density.

OBJECTIVES: In the neonatal period, healthy people have the highest corneal endothelial cell density (CECD) (5000-7000 cells/mm2). Corneal endothelial cell density declines with age in adults (2500-3000 cells/mm2) and continues to decline in the postmortem period. We measured CECD in cases with different postmortem interval (PMI) and investigated its association with PMI. METHODS: A total of 555 corneas harvested from 285 cases with a known time of death were examined using a specular microscope. RESULTS: Postmortem corneal removal time ranged between 10 and 1395 minutes. The CECD averages were 2653 for right cornea and 2678 cells/mm2 for left cornea. An inverse but nonlinear relationship was found between age and CECD. In both men and women, there was an inverse and weak correlation between age and CECD (ρ = -0.282; P < 0.001; ρ = -0.264; P < 0.001, respectively). There was no significant relationship between postmortem corneal removal time and CECD (ρ = 0.049; P = 0.421; ρ = 0.011; P = 0.855 for right and left corneas, respectively). The highest decline in time dependent CECD was detected between the 480th and 540th minutes at -7.2%. CONCLUSIONS: We found no significant decrease in CECD numbers according to PMI or cause of death. Experimental studies on cases with known and standardized antemortem CECD values will provide essential results in estimating PMI.

The Effects of Water Immersion during First Stage of Labor on Postpartum Systemic Inflammatory Response.

OBJECTIVE: The systemic inflammatory response is a cascade of physiologic reactions that arise in response to trauma, infection, burn, or any kind of injury. This study aimed to determine the effects of water immersion during the first stage of labor on the systemic inflammatory indices in the postpartum period. MATERIALS AND METHODS: In this retrospective study, 125 healthy multiparous women with uncomplicated pregnancies between 37 and 41 weeks of gestation who elected for immersion in water during the first stage of labor were compared with multiparous uncomplicated term women who had conventional vaginal births on land (n=125). Age, parity, body mass index (BMI), gestational age, duration of labor, birth weight, Apgar scores, neonatal intensive care unit admissions, and ante- and postpartum whole blood parameters were noted. Antepartum and postpartum neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) were calculated for all patients as systemic inflammatory indices. RESULTS: Demographic characteristics and birth outcomes of both groups were similar except BMI, which was statistically significantly higher in the water immersion group. There were no statistical differences in antepartum NLR, MLR, PLR, and MPV between the 2 groups. However, postpartum NLR, MLR, PLR, and MPV were statistically significantly lower in the water immersion group compared to the controls. CONCLUSION: Water immersion during the first stage of labor might decrease systemic inflammatory indices in the early postpartum period.

Insufficiency of positive airway pressure treatment on increased mean platelet volume: a prospective controlled study in patients with obstructive sleep apnea syndrome.

BACKGROUND: To analyze the association between obstructive sleep apnea syndrome (OSAS) and some hematological variables such as mean platelet volume (MPV), platelet distribution width (PDW), and the impact of positive airway pressure (PAP) treatment on these parameters. METHODS: The participants of the present prospective study consist of 36 OSAS patients diagnosed with polysomnography and recommended PAP treatment and 30 healthy members as the control group. Complete blood analyses were conducted to the patient group twice; before the initiation of the PAP treatment and 1 month after regular PAP use. The control group was administered a complete blood analyses only once. Patient and control group were compared in terms of various parameters such as MPV, PDW, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), white blood cell (WBC) values, and platelet counts. RESULTS: MPV value of the patient group was before and after PAP treatment significantly higher than the control group (respectively; Z = 2.246; p = 0.025, and Z = 2.033; p = 0.042). However, there were no statistically significant differences in the values before and after PAP treatment in the patient group (Z = 0.727; p = 0.467). In terms of platelet numbers and PDW values, no significant differences were determined (p > 0.05). CONCLUSION: MPV value was significantly elevated in OSAS patients. However, the 1 month of PAP treatment was insufficient in decreasing elevated MPV values.

Vaccination rates for Syrian population under temporary protection in Turkey.

OBJECTIVES: The aim of this study was to gather information on demographic and health indicators, primarily vaccination status, of Syrians under temporary protection in five provinces of Turkey and to develop infrastructure for vaccination planning. METHODS: The population under study consists of 89,986 Syrian children, 0-4 years of age, residing in Ankara, Mersin, Gaziantep, Izmir, and Bursa. Initially, we planned to evaluate 2,339 children, although a total of 2,827 children were evaluated by the end of the study. RESULTS: Of these children, 74% were born in Turkey, while 20% were born in Syria. In addition, 22.4% (n = 634) of the children were never vaccinated, and of these, 67.0% (n = 425) were born in Turkey. In other words, one in five Syrian children born in Turkey (20.3%) had never been vaccinated. Of the Syrian children under temporary protection, the missing vaccinations were as follows: hepatitis B (54.7%); Bacillus Calmette-Guérin (62.5%); five-component combined vaccine (64.6%); conjugated pneumococcal vaccine (58.0%); oral polio vaccine (70.8%); measles, mumps, and rubella (76.6%); varicella (66.8%); and hepatitis A vaccine (76.0%). CONCLUSION: It is important to increase the immunization rates of Syrian children under temporary protection and establish regular vaccination procedures.

Expression of Immunomodulatory Molecules PD-1, PD-L1, and PD-L2, and their Relationship With Clinicopathologic Characteristics in Endometrial Cancer.

Chemotherapeutic agents are not very effective in treating advanced endometrial cancers (ECs). Recent studies have demonstrated the immune evasion mechanism of tumors and possible remedies. Programmed cell death protein 1 (PD-1), programmed death ligand 1 (PD-L1), and programmed death ligand 2 (PD-L2) are immunomodulator molecules that have been the focus of research in lung cancer, melanoma, and renal cell cancer. However, there are few studies concerning EC. This retrospective study aimed to determine PD-1, PD-L1, and PD-L2 expression immunohistochemically in EC, and to study their correlation with clinicopathologic tumor characteristics. This study comprised 127 patients with EC. Anti PD-1, PD-L1, and PD-L2 antibodies were examined immunohistochemically on sections obtained from tissue microarray paraffin blocks. No staining with PD-1 in tumor cells was seen; however, we found positive staining in tumor cells at 36.2% with PD-L1 and 64.4% with PD-L2, and at 61.6% with PD-1, 36.2% with PD-L1, and 93.2% with PD-L2 in immune cells. When comparing staining and clinicopathologic findings, most of the PD-L1 negative tumors (both in tumor and immune cells) were FIGO Stage I, which was significantly higher than stage II-III-IV tumors (P<0.05). There was a statistically significant association between the FIGO grade and the PD-L1 score in immune cells (P=0.009), and between staining of PD-1, PD-L1, and PD-L2 and age (P=0.004, 0.013, and 0.043, respectively). Interaction between PD-1, PD-L1, and PD-L2 may be a potential target for immunotherapy in elderly and advanced stage EC patients.

The prevalence and risk factors for osteoporosis among 18- to 49-year-old Turkish women.

The aim of this study was to determine the prevalence of osteoporosis and associated risk factors in Turkish women aged 18-49 years. A population-based, cross-sectional study was conducted between January and April 2014. The sample (n = 1,792) was comprised of women aged 18-49 years, who resided in Cubuk, Ankara, Turkey, and were selected by simple random sampling. The data were collected in face-to-face interviews using an Individual Information Form and an Osteoporosis Risk Estimation Scale. Bone mineral density was assessed using standard dual-energy X-ray absorptiometry. Multiple logistic regression and chi-square analyses were used for analyses. Most participants (80.1%) were at low risk of developing osteoporosis, while 6.9% were at medium to high risk of developing the disease. From bone mineral density levels, 33.3% were osteopenic; 4.0% were osteoporotic; 33.3% were osteopenic at the femoral neck; and 6.7% were osteoporotic at the lumbar vertebra L1-L4. Further, results of multiple logistic regression analyses showed that osteoporosis risk was significantly associated with smoking, having light skin, multiparity, and having a family history of osteoporosis (p < .05). These results indicated that public health screening strategies for protecting women's bone health at earlier ages than previously thought might be beneficial.

The Japanese Orthopedic Association Back Pain Evaluation Questionnaire: A Turkish validation study.

BACKGROUND: The aim of this study was to apply cross-cultural adaptation and validity assessment to the Turkish translation of the Japanese Orthopedic Association Back Pain Evaluation Questionnaire applied to patients conservatively monitored for lumbar disc hernia and narrowing of the lumbar canal. METHODS: The questionnaire was translated into Turkish based on guidelines. In respect of the comprehensibility of the obtained pre-final version of the questionnaire, a pilot test was applied to 20 healthy individuals. The patients were requested to complete the final version of the questionnaire after an orthopedic and physical therapy assistant doctor (resident) had completed the diagnosis and demographic information. To evaluate the retest reliability, the test was applied a second time, 14 days (±3 days) after the first application, again in the Orthopedics and Physical Therapy Outpatient Clinic. RESULTS: The study was completed with a total of 215 individuals, comprising 107 patients and 108 healthy volunteers. When Turkish version of the questionnaire scale was evaluated of the patients and healthy volunteers together, the internal consistency was determined at the levels of Cronbach's α excellent. The lowest correlations of all the questionnaire scale items with the scale sub-dimensions was at the level of r = 0.509, which demonstrated that there was a sufficient validity level of the Turkish translated questionnaire scale. A statistically significant direct correlation at a high level was seen between the pre and post points in all the scale sub-dimensions. CONCLUSIONS: The results of the current study showed that Turkish version of the questionnaire had sufficient reliability and validity in the evaluation of low back pain and resulting dysfunction and disability in patients with LDH and narrowing of the lumbar canal.

Reliability and validity of the Turkish version of the Prosthesis Embodiment Scale for Lower Limb Amputees.

BACKGROUND: Prosthetic embodiment is the perception of the prosthesis as a part of the body, and it is important for acceptance and adequate and effective use of the prosthesis. OBJECTIVE: The aim of this study was to investigate the validity and reliability of the Turkish version of the Prosthesis Embodiment Scale for Lower Limb Amputees. METHODS: This cross-sectional study included a total of 88 lower limb amputees. Internal consistency was evaluated using Cronbach α coefficient. The test-retest reliability of the scale, which was reapplied after 7-10 d, was evaluated using intraclass correlation coefficient. Principal component analysis with Varimax rotation was used to analyze the factor structure. Spearman correlation coefficient with Trinity Amputation and Prosthesis Experience Scale subscales was calculated for concurrent validity. RESULTS: The mean age of the participants was 45.13 ± 15.05 years, and 76.1% were male. Internal consistency (Cronbach α = 0.905) and test-retest reliability (intraclass correlation coefficient = 0.822) were high. 76.1% of the total variance could be explained by the 3 dimensions. Significant correlation was found with the Trinity Amputation and Prosthesis Experience Scale subscales (r = 0.542 for psychosocial adjustment subscale, r = -0.452 for activity restriction subscale, r = 0.490 for prosthesis satisfaction subscale, p < 0.001). CONCLUSIONS: The results of this study showed that the Turkish version of the Prosthesis Embodiment Scale for Lower Limb Amputees is a valid and reliable tool that can be used to evaluate prosthetic rehabilitation outcomes.

A systematic review and network meta-analysis on comparative efficacy, acceptability, and safety of treatments in acute bipolar mania in youths.

BACKGROUND: The evidence of treatment options' efficacy on acute bipolar manic episodes is relatively less in youths than adults. We aimed to compare and rank the drug's efficacy, acceptability, tolerability, and safety for acute mania in children and adolescents. METHOD: We systematically reviewed the double-blinded, randomized controlled trials (RCTs) comparing drugs or placebo for acute manic episodes of bipolar disorder in children and adolescents using PRISMA guidelines. We searched PubMed/MEDLINE, EMBASE, Web of Science, EBSCO, Scopus, the Cochrane Central Register of Controlled Trials, and https://clinicaltrials.gov from inception until November 20, 2022. Response to treatment was the primary outcome, and random-effects network meta-analyses were conducted (PROSPERO 2022: CRD42022367455). RESULTS: Of 10,134 citations, we included 15 RCTs, including 2372 patients (47 % female), 15 psychotropic drugs, and the placebo. Risperidone 0.5-2.5 mg/day, aripiprazole 30 mg/day olanzapine, quetiapine 400 mg/day, quetiapine 600 mg/day, asenapine 5 mg/day, asenapine 10 mg, ziprasidone, and aripiprazole 10 mg were found to be effective (in comparison with placebo) in children and adolescents, respectively (τ2 = 0.0072, I2 = 10.2 %). The tolerability of aripiprazole 30 mg/day was lower than risperidone 0.5-2.5 mg/day and olanzapine. Oxcarbazepine had the highest discontinuation due to the adverse effects risk ratio. LIMITATIONS: Efficacy ranking of the treatments could be performed by evaluating relatively few RCT results, and only monotherapies were considered. CONCLUSIONS: Efficacy, acceptability, tolerability, and safety are changing with the doses of antipsychotics for children and adolescents with acute bipolar manic episodes. Drug selection and optimum dosage should be carefully adjusted in children and adolescents.

Methylation of SOCS3 in Myeloproliferative Neoplasms and Secondary Erythrocytosis/Thrombocythemia.

OBJECTIVE: Myeloproliferative neoplasms (MPNs) like essential thrombocythemia (ET), polycythemia vera (PV), and primary myelofibrosis (PMF) are acquired clonal hematopoietic stem cell disorders and originate from a multipotent hematopoietic stem cell. The SOCS1 and SOCS3 genes are negative regulators of the JAK/STAT signal pathway. In this study we investigate the promoter methylation of these genes in the pathogenesis of MPNs and secondary erythrocytosis/thrombocythemia. MATERIALS AND METHODS: Promoter methylation of SOCS1 and SOCS3 genes was analyzed with methylation-specific PCR. PCR products were analyzed by agarose gel electrophoresis. RESULTS: No disease-specific CpG island methylation of SOCS1 was observed. Hypermethylation of the SOCS3 promoter was identified in 5 out of 19 (26.3%) PV cases, 2 out of 21 (9.5%) ET cases, 1 out of 5 (20%) PMF cases, and 9 out of 42 (21.4%) cases of secondary erythrocytosis/thrombocythemia. CONCLUSION: The results revealed that promoter methylation of the SOCS3 gene suggests a possible role for SOCS3 methylation in the pathogenesis of MPNs and secondary erythrocytosis/thrombocythemia. CONFLICT OF INTEREST: None declared.

Determination of the factors contributing to depression and anxiety in advanced stage lung cancer patients.

Background: The diagnosis of cancer and initiation of treatment disrupt physical, emotional, and socio-economical stability of the patients by reducing the quality of lives and ultimately leading to depression and anxiety. We aimed to observe the indicators for anxiety and depression among lung cancer (LC) patients by comparing with other cancer (OC) patients. Methods: This study has been conducted between 2017 and 2019. Questionnaires were provided for both LC and OC patients. Results: Two hundred and thirty patients with the ages varied between 18 and 86 (median: 64.0) were included in the study. A total of 115 patients (case group) were diagnosed as LC, and the remaining were with OC diagnosis (control). No difference was determined between the groups in means of median anxiety and depression scores. Patients who required assistance in hospital procedures, daily life activities, and self-care had higher depression and anxiety scores (p < 0.05) compared to those did not require assistance. Anxiety and depression scores in OC groups showed a remarkable difference according to performance status (p < 0.001). The depression score of the patients who stated that they did not know their social rights was remarkably higher than those of the patients who stated that they know their social rights. We found no relationship between depression and anxiety scores because of disease caused income loss and expense increase. Conclusion: For LC patients, declaration of requirement for assistance and supportive care in daily life can be an important indication for anxiety and depression. Lung cancer patients, especially those informed by health care professionals and provided psychosocial support following the information, require a patient-specific professional management approach.

Ocular pharmacokinetics and toxicity of nanoparticular acetazolamide: In vivo distribution and safety of PHBV-ACZ nanoparticle.

Diabetic macular edema (DME) is defined as fluid accumulation in the macular region, between the retinal layers, due to many diseases, especially diabetes. DME is one of the major complications of diabetic retinopathy (DRP). Carbonic anhydrase inhibitors (CAI) are a pharmaceutical agent used in different fields, especially glaucoma treatment. Acetazolamide (ACZ), which is a CAI, is an active substance that has been used off-label for many years in the treatment of macular edema due to diabetes and many other diseases. The low solubility and bioavailability of ACZ limit its use in the treatment of DME. In this study, a nanoparticulate formulation was developed that would increase the solubility and bioavailability of ACZ and allow it to be administered intravitreally. ACZ was loaded on poly(3-hydroxybutyrate-co-3-Hydroxyvalerate) (PHBV) nanoparticles and the loading efficiency was 71.58 ± 1.22%. Toxicity of nanoparticles after intravitreal application was evaluated with anterior segment and posterior segment examination findings, intraocular pressure (IOP) measurements and electrophysiological tests. At the end of the 3-month follow-up, electroretinography (ERG) measurements demonstrated that ACZ loaded PHBV (PHBV-ACZ) nanoparticles did not cause loss of function in retinal cells. On histological examination, rare degenerative changes were observed in several cell groups. In addition, pharmacokinetic studies were performed to determine the tissue distribution of ACZ at various periods. ACZ was identified in vitreous humor and retina at the highest concentration. Based on our results, the prepared nanoparticle formulation can release long-term CAI for DRP therapy and accordingly can reduce the need for monthly intravitreal injections.

Respiratory syncytial virus prophylaxis in preterm infants: a cost-effectiveness study from Turkey.

The main aim of this study was to evaluate the cost-effectiveness of respiratory syncytial virus (RSV) prophylaxis with palivizumab in Turkey, by comparing hospitalization rates and costs as well as results of risk analyses in preterm infants who were treated either with palivizumab or conservatively. This retrospective study was undertaken in two centers on infants born with a gestational age of ≤32 weeks during the 2010-2011 seasons. Patients were divided into two groups based on status of RSV prophylaxis. The records of 272 infants were included in the final analysis, 201 (73.9%) of which had received palivizumab (Group 1), while 71 (26.1%) were not given any form of RSV prophylaxis. The difference between groups in terms of demographic characteristics and risk factors for RSV infection was statistically insignificant (p>0.05). Thirteen patients (6.5%) in Group 1 and 5 patients (7%) in Group 2 were hospitalized for lower respiratory tract infections (LRTIs) (p>0.05). In newborns born at ≤286/7 weeks of gestation, RSV prophylaxis with palivizumab was associated with a 38.75% decrease in hospitalization rates due to LRTIs compared to the untreated group (8% in the untreated group vs. 4.9% in the palivizumab group; p=0.577). The hospitalization rate due to LRTIs for infants in Group 1 born after 29-32 weeks of gestation was 7.5% compared to a rate of 6.5% in Group 2, with a statistically insignificant difference (p=0.828). In infants with bronchopulmonary dysplasia (BPD) born at ≤286/7 weeks of gestation, treatment with palivizumab was associated with a 39.1% decrease in LRTI-related hospitalization rates (14.3% in the untreated group vs. 8.7% in the palivizumab group; p=0.677). This clinical study is the first of its kind from Turkey to evaluate the cost-effectiveness of palivizumab treatment as prophylaxis against RSV infections in preterm infants, where hospitalization rates and costs of patients treated with palivizumab were compared with those of infants who were treated conservatively. Our study results suggest that administration of palivizumab does not have any cost benefit, regardless of gestational age. However, a reduction in hospitalization rates in association with palivizumab treatment was observed in infants born at ≤286/7 weeks of gestation with or without BPD.

The relationship between meiotic spindle imaging and outcome of intracytoplasmic sperm injection: a retrospective study.

Meiotic spindle analysis with a non-invasive technique, the PolScope, is used to protect the meiotic spindle from damage during microinjection. To evaluate the predictive feature of PolScope, we have designed a retrospective study to analyse the correlation between the meiotic spindle visualisation with regard to spindle location and outcomes of assisted reproductive technologies (ART), including patient age, previous cycles, the number of the collected oocytes, fertilisation rates (FR), pronuclear scoring (PNS) and embryo scoring of the days from two to five. All of the data belonging to 1496 oocytes from 190 patients were statistically analysed. We found that the oocytes having PolScope visualised spindle have higher FR, and also observed that when the spindle located at 0°-30° according to the first polar body, gave the highest FR. PNS gave higher scores in the spindle visualised group, but spindle angle did not affect PNS outcomes. Although a correlation was found between spindle visualisation and developed embryo qualities, particularly at day 2 and 3, spindle angles did not affect embryo quality. We conclude that PolScope microscopy has an efficiency to estimate FR, and cleavage stage embryo development.

Can serum oestradiol be a predictor of quality of oocytes and embryos, maturation of oocytes and pregnancy rate in ICSI cycles?

Our aim was to assess the influence of ratios of oestradiol (E2) to either number of follicles ≥ 14 mm on the day of human chorionic gonadotropin administration (E2/fol) or the number of oocytes retrieved (E2/o) during oocyte pick up and total serum E2 levels on the day of embryo transfer (ETE2) on the outcome of ICSI cycles. The assessed outcomes were number of oocytes retrieved (NRO), number of mature oocytes (NMO), number of fertilised oocytes (NFO), number of transferred embryos (NTE), qualities of oocytes (OQS), qualities of embryos (EQS) and pregnancy rates (PR). Two hundred and twenty-seven ICSI-ET cycles admitted to our IVF clinic during a 2-year period with normal ovarian reserve receiving long luteal GnRH agonist protocol were included. The E2/fol levels correlated positively with NRO (r = 0.202, p = 0.002), NMO (r = 0.199, p = 0.003) and NFO (r = 0.159, p = 0.018). However, we observed negative correlations between E2/o and NMO (r = -0.329, p <0.001), NFO (r = -0.219, p = 0.001), EQ5 (r = -0.203, p = 0.040). Oocyte quality scores were not affected from either E2/fol or E2/o levels. Implantation, clinical and ongoing PRs were comparable between groups categorised due to E2/fol, E2/o and ETE2. It seems that high E2/fol ratio may have beneficial effects on NRO, NMO and NFO while E2/o may adversely affect these parameters. Neither of the E2 levels is associated with pregnancy rates in women with normal ovarian reserve.

Transient tachypnea of the newborn: effects of labor and delivery type in term and preterm pregnancies.

PURPOSE: To determine whether timing or type of delivery affects the incidence of transient tachypnea of the newborn (TTN) in late preterm and term pregnancies. METHODS: The cases of 85 newborns delivered at Fatih University Hospital and diagnosed with TTN between January 2006 and March 2009 were reviewed. For every newborn with TTN, four infants who were not transferred to the neonatal intensive care unit (n = 340) were randomly selected and adjusted for year of delivery. Findings for delivery type (cesarean [CS] + labor, elective CS [ECS], vaginal), gestational age at delivery, and other relevant parameters were compared in the TTN and control groups. RESULTS: Forty-five (53%) of the 85 TTN newborns were premature and 73 (86%) were delivered by CS. Multivariate regression analysis identified male gender, CS delivery, lower gestational age, absence of PROM as risk factors for onset of TTN. In the CS + labor and ECS subgroups, the risk of TTN was significantly higher for babies delivered prior to 38 weeks' gestation than for those delivered at 38 weeks or later (OR = 8.13 and 95%CI = 3.58-18.52 vs. OR = 7.14 and 95%CI = 2.81-18.18, respectively; p < 0.001 for both). However, there was no increased risk of TTN in either of these subgroups when babies delivered at 38 weeks' gestation were compared with those delivered at ≥39 weeks (p > 0.05). At all gestational ages investigated in the study, infants delivered vaginally were less likely to develop TTN than those delivered via CS + labor or ECS. CONCLUSIONS: Lower gestational age, CS delivery, and male sex are independent risk factors for TTN. Performing ECS no earlier than 38 weeks' gestation may decrease the risk of TTN. Labor before CS is not sufficient to decrease the frequency of TTN, even after 37 weeks of gestation, whereas vaginal birth appears be protective against TTN.

Complementary and Alternative Medicine Attitudes of Gynecologic Patients: Experience in a Tertiary Clinic.

OBJECTIVE: To evaluate the knowledge, attitudes, and behaviors regarding complementary and alternative medicine methods of patients who were admitted to gynecology outpatient clinics. METHODS: In the present survey, a questionnaire on complementary and alternative medicine practices was applied on 1,000 women (ages between 18 and 83 years old) who were admitted to the gynecology outpatient clinic of a tertiary maternity hospital. Demographic features and knowledge, attitudes, and behaviors about these methods were inquired in face-to-face interviews. RESULTS: While 80.7% of the total participants thought that complementary and alternative medicine was beneficial, only 37.5% of them had used these methods previously. The rate of prior knowledge on this subject was of 59.7% and the source of information was physicians for 8.5% of the patients. However, 72.4% of all participants wanted to obtain information on these methods and 93.7% wanted to be informed by physicians. In the decision tree model, having knowledge about complementary and alternative medicine was the most effective factor determining its use (p < 0.001). Phytotherapy was found to be the most used method, with 91.4%. The most preferred plant was onion (18.9%), and the most common reasons for herbal use were stress (15.4%) and fatigue (15.2%). CONCLUSION: More than one-third of the patients who applied to the gynecology outpatient clinics used one of the complementary and alternative medicine methods at least once. As gynecologists and obstetricians, we need to be more knowledgeable about these methods to provide correct guidance to our patients for accessing accurate and effective information.

OBJETIVO: Avaliar o conhecimento, as atitudes e os comportamentos em relação aos métodos de medicina complementar e alternativa de pacientes internadas em ambulatórios de ginecologia. MéTODOS: Na presente pesquisa, um questionário sobre práticas de medicina complementar e alternativa foi aplicado a 1.000 mulheres (idades entre 18 e 83 anos) que foram admitidas nos ambulatórios de ginecologia de uma maternidade terciária. Características demográficas e conhecimento, atitudes e comportamentos sobre esses métodos foram investigados em entrevistas pessoais. RESULTADOS: Enquanto 80,7% do total de participantes achavam que a medicina complementar e alternativa era benéfica, apenas 37,5% deles haviam usado esses métodos anteriormente. A taxa de conhecimento prévio sobre o assunto foi de 59,7% e a fonte de informação foi médica para 8,5% dos pacientes. No entanto, 72,4% de todos os participantes queriam obter informações sobre esses métodos e 93,7% queriam ser informados por médicos. No modelo de árvore de decisão, ter conhecimento sobre medicina complementar e alternativa foi o fator mais eficaz para determinar seu uso (p < 0,001). A fitoterapia foi o método mais utilizado, com 91,4%. A planta preferida foi a cebola (18,9%), e os motivos mais comuns para o uso de ervas foram estresse (15,4%) e fadiga (15,2%). CONCLUSãO: Mais de um terço das pacientes que se inscreveram no ambulatório de ginecologia utilizaram um dos métodos de medicina complementar e alternativa pelo menos uma vez. Como ginecologistas e obstetras, precisamos ter mais conhecimento sobre estes métodos a fim de fornecer orientações corretas aos nossos pacientes para o acesso a informações precisas e eficazes.

Vascular endothelial growth factor, basic fibroblast growth factor, insulin-like growth factor-I and platelet-derived growth factor levels in human milk of mothers with term and preterm neonates.

Human milk is a complex biological fluid. It contains many nutrients, anti-infectious and biologically active substance. Human milk also contains many angiogenic polypeptides. We have determined four of these: Vascular endothelial growth factor (VEGF), basic fibroblast growth factor (b-FGF), insulin-like growth factor- I (IGF-I) and platelet-derived growth factor (PDGF). The aim of this study was to compare the concentrations of VEGF, b-FGF, IGF-I and PDGF in human milk collected from mothers with preterm and term neonates. Human milk samples were collected from 29 mothers of preterm (<37 weeks) and from 29 mothers of term (38>weeks) infants at days 3, 7 and 28 postpartum. Milk samples were analyzed for VEGF, b-FGF and PDGF by enzyme-linked immunosorbent assay and IGF-I was measured by radioimmunoassay method. Human milk levels of VEGF, IGF-I and b-FGF were significantly higher (p<0.001). Furthermore, within-preterm group concentrations of VEGF, IGF-I and PDGF significantly differed during postpartum days 3-7-28 (p<0.001, p<0.05, p<0.001, respectively), but did not do so for b-FGF concentrations. In term groups, concentrations of IGF-I and VEGF significantly differed (p<0.05, p<0.001, respectively), but did not do so for concentrations of b-FGF and PDGF. This is the first report of simultaneous measurements of four major angiogenic factors in human milk collected from mothers with preterm and term. Our results suggest that three of four angiogenic factors, VEGF, b-FGF and IGF-I, are higher concentration in human milk which collected from preterm mothers than those of terms.

The prevalence and risk factors of asthma and allergic diseases among working adolescents.

Certain occupational groups are known to be at particularly high risk of developing allergic diseases. The objective of the present study was to evaluate the prevalence of allergic diseases among working adolescents. The International Study of Asthma and Allergies in Childhood questionnaire was used. Four hundred and thirty six adolescents working in motor, lathe-finish, coiffure and textile and 366 high school students as control group were enrolled to the study. Mean age was 16.8 +/- 1.2 years and 82.9% of them were male. There was no significant difference among groups for ever and current wheezing while doctor diagnosed asthma was higher in lathe- finish group (p = 0.036). Family history of allergy, history of allergic rhinitis, and active smoking were found to be risk factors for asthma and related symptoms. Working in coiffure (p = 0.054), and textile (p = 0.003) were significant risk factors for ever allergic rhinitis. Working in lathe finish (p = 0.023), coiffure (p = .002), and textile (p < 0.001) were associated with a higher risk for current allergic rhinitis. Working in coiffure was a risk factor for ever eczema (p = 0.008) and doctor diagnosed eczema (p = 0.014). It was concluded that working in lathe-finish was associated with doctor diagnosed asthma and active smoking was a risk factor for asthma and related symptoms. Working in coiffure, textile and lathe- finish were risk factors for rhinitis, and working in coiffure was a risk factor for eczema. Preventive measures should be taken at the onset of employment in order to prevent or reduce the detrimental effects of exposures in these occupational groups.