Absence and Duplicate Foramen Spinosum in the Same Patient: An Extremely Rare Variation.

The foramen spinosum, one of the important openings at the base of the cranium, is the opening through which the middle meningeal artery enters the cranium. The variations of the foramen spinosum should be well known to be an important landmark in middle fossa surgeries and to understand better the clinical conditions related to the middle meningeal artery passing through it. A total of 35 bones (32 cranial base and 3 separate sphenoid bones) of individuals of unknown age, sex, and ethnicity in the Laboratory of the Department of Anatomy, Gaziantep University, Faculty of Medicine were examined bilaterally in this study. One of the 35 bones was found to have a duplicated foramen spinosum on the left side and an absence foramen spinosum on the right side. Foramen spinosum variations should be considered in middle fossa approaches and procedures involving the middle meningeal artery.

Comparison of 2-year follow-up outcomes of laparoscopic lateral suspension and sacrospinous fixation in apical compartment prolapse: an observational study.

PURPOSE: This study aimed to compare the results of patients with laparoscopic lateral suspension (LLS) and sacrospinous fixation (SSF). METHODS: This prospective observational study included 52 patients who underwent LLS and 53 patients who underwent SSF due to pelvic organ prolapse. The pelvic organ prolapse's anatomical cure and the frequency of recurrence have been recorded. Female Sexual Function Index, Pelvic Organ Prolapse Symptom Score, and complications were evaluated preoperatively and at the postoperative 24th month. RESULTS: In the LLS group, the subjective treatment rate was 88.4% and the anatomical cure rate for apical prolapse was 96.1%. In the SSF group, the subjective treatment rate was 83.0% and the anatomical cure rate for apical prolapse was 90.5%. There was a significant difference between the groups regarding Clavien-Dindo classification and reoperation (p < 0.05). Female Sexual Function Index, and the Pelvic Organ Prolapse Symptom Score were different between the groups (p < 0.05). CONCLUSIONS: This study showed that there is no difference between two surgical techniques in apical prolapse cure rates. However, the LLS seem preferable in terms of the Female Sexual Function Index, Pelvic Organ Prolapse Symptom Score, reoperation, and complications. We need larger sample size studies in terms of incidence of complications and reoperation.

Sternocleidomastoid Muscle in Fetuses: Classification, Morphometric Analysis, and Clinical Significance.

PURPOSE: This study aimed to examine variations and morphometric properties of the sternocleidomastoid muscle (SCM) in fetuses in terms of infancy and early childhood surgeries. MATERIALS AND METHODS: Neck regions of 27 fetuses (mean age: 23.30±3.40 wk, sex: 11 boys and 16 girls) fixed with 10% formalin were dissected bilaterally. Photographs of the dissected fetuses were taken in the standard position. Morphometric measurements, such as length, width, and angle, were performed on the photographs using the ImageJ software. In addition, the origin and insertion of SCM were detected. Taking into account the studies in the literature, a classification consisting of 10 types associated with the origin of SCM was carried out. RESULTS: No statistically significant difference was observed in the parameters in terms of side and sex ( P >0.05), except from the linear distance between the clavicle and motor point where the accessory nerve enters SCM (20.10±3.76 for male, 17.53±4.05 for female, P =0.022). Two-headed SCM (Type 1) was detected in 42 out of 54 sides. Two-headed clavicular head (Type 2a) was detected on 9 sides, and 3-headed (Type 2b) on 1 side. A 2-headed sternal head (Type 3) was detected on 1 side. A single-headed SCM (Type 5) was also detected on 1 side. CONCLUSION: Knowledge related to variations of the origin and insertion of fetal SCM may be helpful in preventing complications during treatments of pathologies such as congenital muscular torticollis in early period of life. Moreover, the calculated formulas may be useful to estimate the size of SCM in newborns.

COVID-19 disease does not cause ovarian injury in women of reproductive age: an observational before-and-after COVID-19 study.

RESEARCH QUESTION: Can the SARS-CoV-2 virus injure the ovaries? DESIGN: An observational before-and-after COVID-19 study at an academic medical centre. A total of 132 young women aged 18-40 were enrolled; they were tested for reproductive function in the early follicular phase, and their information was obtained from hospital data between January 2019 and June 2021. Serum FSH, LH, oestradiol, the ratio of FSH to LH and anti-Müllerian hormone (AMH) concentrations were measured for each patient both before and after COVID-19 disease. RESULTS: In women with unexplained infertility, the median serum AMH concentrations (and ranges) were 2.01 ng/ml (1.09-3.78) and 1.74 ng/ml (0.88-3.41) in the pre-COVID-19 disease and post-COVID-19 disease groups, respectively. There was no statistically significant difference in terms of serum concentrations of AMH between pre- and post-illness (P = 0.097). Serum FSH, LH, FSH/LH ratio and oestradiol concentrations of the patients before COVID-19 illness were similar to the serum concentrations of the same patients after COVID-19 illness. CONCLUSION: According to these study results and recent studies investigating the effect of COVID-19 on ovarian reserve, it is suggested that the SARS-CoV-2 virus does not impact ovarian reserve; however, menstrual status changes may be related to extreme immune response and inflammation, or psychological stress and anxiety caused by the COVID-19 disease. These menstrual status changes are also not permanent and resolve within a few months following COVID-19 illness.

Vaccination status among patients with the need for emergency hospitalizations related to COVID-19.

BACKGROUND: It is thought vaccines allowed for emergency use significantly reduce hospitalizations and emergency room visits. It is a matter of curiosity how many of the patients who come to the emergency department (ED) are vaccinated. We aimed to examine the characteristics of ED patients needing hospitalizations related to moderate and severe COVID-19 by vaccination status. METHODS: A retrospective study of 559 rRT-PCR-confirmed SARS-CoV-2 infection cases with moderate or severe COVID-19 needing hospitalization was performed in August 2021. Univariate and multivariate logistic regression analyses were performed for factors associated with mortality. RESULTS: The mean age of the patients was 60.8 ± 18.1 years old, and 54.2% (n = 303) of the patients were women. The most common comorbidities were hypertension (37.2%), diabetes mellitus (31.1%) and chronic obstructive pulmonary disease (13.8%), respectively. The number of patients with alpha variant was 399 (71.4%), and delta variant was 83 (14.8%). Fifty point 6% (n = 283) of the patients were fully vaccinated. The total number of patients who died in the study was 114 (20.4%), and the number of patients hospitalized in the intensive care unit was 168 (30.1%). The day between the last dose of vaccine and hospitalization was 117 ± 45.9 days. In multivariate logistic regression analysis: age (odds ratio (OR), 1.05; 95% confidence intervals (95% CI) 1.03-1.08- year increase), male gender (OR, 1.8; 95% CI, 1.1-2.9), presence of at least one comorbid disease (OR, 2; 95% CI, 1.1-3.7) and partial (OR, 0.24;95% CI, 0.09-0.6) and fully vaccinated status (OR, 0.1; 95% CI, 0.05-0.18) were associated with mortality among COVID-19 patients. CONCLUSIONS: In this study, age older than 65, unvaccinated, and comorbidities had significantly higher mortality. In multivariate regression analyses, age, vaccination status, comorbidities and the male gender were associated with mortality. Our study did not evaluate the vaccine efficacy but, a lower mortality rate was observed in those fully vaccinated with CoronaVac and Pfizer-BioNTech. Additionally, Alpha, Delta and other variants had the same mortality rates.

Arnold Kirkpatrick Henry (1886-1962) and his eponym (Master Knot of Henry): a narrative review.

PURPOSE: The aims of this review were to form a more precise description for Master Knot of Henry (MKH), and to modify classifications related to interconnections between flexor hallucis longus (FHL) and flexor digitorum longus (FDL) for showing all configurations in the literature. METHODS: A literature search was performed in main databases to obtain information related to anatomical definitions and variations of MKH. The search was carried out using the following keywords: "Master Knot of Henry", "Chiasma plantare", "Flexor hallucis longus" and "Flexor digitorum longus". Information extracted from the studies was: sample size, numerical values, classifications, variation types, incidence of types, anatomical definitions of MKH, year of publication, and type of study. RESULTS: This study proposes that MKH should be defined as the intersection territory where FDL crosses over FHL in the plantar foot. The postchiasmatic plantar area located at distal to MKH (the narrow space between MKH and the division of FDL) should be termed as the triangle of Henry. Moreover, the classification systems showing different configurations related to interconnections situated at Henry's triangle were updated as eight types to present all forms in the literature. CONCLUSION: Our definitions may assist in determining the precise anatomical boundaries of MKH, and thus facilitate the use of MKH as a surgical landmark. In addition, our modified classification systems covering all variations in the current literature may be helpful for surgeons and anatomists to understand formations of the triangle of Henry, and the long flexor tendons of the lesser toes.

Impact of a high visceral adiposity index on female sexual dysfunction in sexually active women? Results of a cross-sectional study.

AIMS: To our knowledge, this is the first study investigating the impact of high visceral adiposity index (VAI) on female sexual dysfunction (FSD). We aimed to show the impact of increased levels of VAI on FSD compared with body mass index (BMI) and waist circumference (WC) particularly in those with metabolic syndrome (MeTS). METHODS: We included 158 participants in two groups: Group 1 (n = 68 with normal sexual function) and Group 2 (n = 90 with sexual dysfunction). Demographic, clinic data, presence of MeTS and comorbidities were recorded. The BMI, WC and the VAI were calculated. Sexual function was assessed using the female sexual function index. RESULTS: The mean age and all the anthropometric variables were similar between the groups (P > .05). MeTS was associated with lower arousal and lubrication scores than those without MeTS (P = .023). The higher VAI was associated with lower desire, lubrication and orgasm scores (P < .05). Each integer increase of the VAI weakly predicted decrease of desire (P = .015), arousal (P = .015), lubrication (P = .005) and satisfaction (P = .046). The WC and BMI were not a good predictor for FSD in women (OR=1.019, P = .318). CONCLUSION: The VAI was linked with lower scores in some female sexual function subdomains, but the correlation coefficient was low, indicating a weak association. Further studies with a higher number of participants are needed to conclude that the VAI may increase the risk of FSD, particularly in patients with MeTS.

Inappropriate Prescribing of Proton Pump Inhibitors in Outpatient Clinics.

Proton pump inhibitors are the commonly prescribed drugs for acid-related disorders. However, many of those prescriptions are inappropriate in inpatient and outpatient settings according to the recommended guidelines. Many studies have been conducted in inpatient clinics, but data about the appropriateness of proton pump inhibitor prescribing in outpatient clinics are scarce. Therefore, the aim of this study was to determine inappropriate proton pump inhibitor prescribing rates among patients admitted to a tertiary hospital family medicine outpatient clinic. A total of 259 patients (median age = 59 years; 72.6% women) were enrolled into the study and 35.9% of them had no proper indications to utilize proton pump inhibitors. Inappropriate proton pump inhibitor usage rate was significantly higher in patients older than 60 years compared with their younger counterparts (62.4% vs. 37.6%; p = .001). The most frequent reason to use a proton pump inhibitor with nonapproved indications was polypharmacy (41.9%). Despite endoscopic evaluation, 41.9% of the patients received a proton pump inhibitor without an approved indication. A significant proportion of nonindicated prescriptions were a consequence of continued prescribing without re-evaluating patients in outpatient clinics. Consideration of proton pump inhibitor indications according to the guidelines in every admission may prevent inappropriate prescriptions.

Does Type of Menopause Affect the Sex Lives of Women?

BACKGROUND The aim of this study was to investigate factors affecting the sex lives of middle-aged women, and whether surgical menopause affects sexual function differently from natural menopause, by comparing effects on sexual performance of women with similar demographic features. MATERIAL AND METHODS The study included 151 women with surgical menopause (SM), 357 women with natural menopause (NM), and 186 perimenopausal women (PM). The women were asked to complete a 6-question survey of sexual performance parameters. The relationship between the demographic and clinical features and hormone levels of the groups and sexual function parameters were evaluated. We also compared these parameters between the 3 study groups, and paired comparisons were made between the SM group and the NM group. RESULTS Demographic features, serum DHEA-S, total testosterone, and FSH levels were found to have statistically significant effects on sexual performance of women (p<0.05). The sexual function scores for the frequency of sexual desire, coitus, and orgasm were significantly higher in the PM group, whereas vaginal lubrication scores were lower compared to the NM and SM group (p<0.05). In paired comparison of NM and SM, the scores for the frequency of coitus, orgasm, and vaginal lubrication were significantly higher in the SM group, while sexual desire frequency scores were higher in the NM group (p<0.05). CONCLUSIONS Our study approached to this topic in an extended manner and found significant relationships between several demographic-clinical and hormonal factors. SM was found to not affect female sexual performance, except for sexual desire, more than NM.

Maternal Serum and Fetal Cord Blood C-Reactive Protein Levels but not Procalcitonin Levels Are Increased in Idiopathic Intrauterine Growth Restriction.

BACKGROUND The aim of the present study was to compare procalcitonin and CRP levels in maternal serum and fetal cord blood samples of patients with idiopathic intrauterine growth restriction (IUGR) vs. a control group of appropriate for gestational age (AGA) infants. MATERIAL AND METHODS The present prospective study included 43 patients: 27 patients with idiopathic IUGR (IUGR group) and 26 AGA infants at similar gestational ages (control group). Maternal serum and fetal cord blood samples were collected from the control group and IUGR group at time of delivery. Procalcitonin and CRP levels were analyzed in maternal blood. Procalcitonin and CRP levels were analyzed in fetal cord blood. RESULTS The median value of CRP levels in maternal blood was 47.5 mg/dl in the IUGR group and 15.255 mg/dl in the AGA group (p=0.001). The mdian CRP level in cord blood was 36.4 mg/dl (range, 17.3-47.2) in the IUGR group and 10.1 mg/dl (range, 4.07-16.5) in the control group, and the difference was statistically significant (p=0.001). The median maternal serum procalcitonin level was 0.05 µg/l in the IUGR group and 0.04 µg/l in the AGA group, and the difference was not statistically significant (p=0.435). The median procalcitonin value in fetal cord blood was 0.06 µg/l in the IUGR group and 0.04 µg/l in the AGA group, and the difference was not statistically significant (p=0.741). CONCLUSIONS Maternal serum and fetal cord CRP levels were higher in the IUGR group; however, there was no difference in procalcitonin, which is another inflammatory indicator, between the groups.

Serum prolidase level in patients with brucellosis and its possible relationship with pathogenesis of the disease: a prospective observational study

Background/aim: Changes in collagen metabolism and fibroblastic activity may play a role in the pathogenesis of brucellosis. The prolidase enzyme plays an important role in collagen synthesis. We aimed to investigate the association of prolidase levels with brucellosis. Materials and methods: Serum prolidase levels in 20 patients newly diagnosed with brucellosis were compared with levels in 30 healthy control subjects. Patients with brucellosis were reassessed 3 months later for prolidase, other laboratory measurements, and response to treatment. Results: The levels of serum prolidase were significantly higher in brucellosis patients compared with those of healthy controls. Prolidase, sedimentation, and C-reactive protein levels were significantly lower after antibrucellosistreatment than before treatment. Conclusion: The current study is the first to demonstrate significantly increased serum prolidase levels in patients with brucellosis compared with healthy controls. Prolidase levels also significantly decreased with antibrucellosis treatment. This finding provides a new experimental basis to understand the pathogenesis of brucellosis in relation to collagen metabolism. The increase in serum prolidase levels might be related to several factors such as tissue destruction, increased fibroblastic activity, and granuloma formation, all of which are involved in the natural history of brucellosis.

Investigation of binding properties of dicationic styrylimidazo[1,2-a]pyridinium dyes to human serum albumin by spectroscopic techniques.

The binding interaction between two dicationic styrylimidazo[1,2-a]pyridinium dyes and human serum albumin (HSA) was investigated at physiological conditions using fluorescence, UV-vis absorption, and circular dichroism (CD) spectroscopies. Analysis of the fluorescence titration data at different temperatures suggested that the fluorescence quenching mechanism of HSA by these dyes was static. The calculated thermodynamic parameters (ΔG°, ΔH° and ΔS°) indicated that hydrogen bonding and van der Waals forces played a major role in the formation of the dye-HSA complex. Binding distances (r) between dyes and HSA were calculated according to Förster's non-radiative energy transfer theory. Studies of conformational changes of HSA using CD measurements indicate that the α-helical content of the protein decreased upon binding of the dyes. Copyright © 2016 John Wiley & Sons, Ltd.

Role of vascular endothelial growth factor and placental growth factor expression on placenta structure in pre-eclamptic pregnancy.

AIM: Pre-eclampsia is a hypertensive disease that is characterized by high blood pressure and proteinuria after 20 gestational weeks and complicates 3-8% of all pregnancies. It is classified as either mild or severe pre-eclampsia according to severity, and the aim of this study was to investigate the structural differences between these two classifications. METHODS: Placenta samples were collected from 68 women who underwent cesarean delivery. Total volume of villi and numerical density of vascular endothelial growth factor (VEGF)- and placental growth factor (PIGF)-positive cells were estimated on stereology and evaluated using one-way ANOVA. RESULTS: There was no significantly difference in total villi volumes between the groups (P > 0.05). In contrast, on immunohistochemistry, the numerical density of VEGF-positive cells in severe pre-eclampsia was significantly different to the control and mild pre-eclampsia groups (P<0.05). Additionally, the numerical density of PIGF-positive cells in the mild and severe pre-eclampsia group was significantly higher than in the control group (P<0.01). CONCLUSION: There is no relationship between villi volume and pre-eclampsia, although growth factors play a role in placental changes. The present results were supported by histopathology and several studies in the literature.

A rare cause of acute abdominal pain: Herlyn-Werner-Wunderlich syndrome.

Herlyn-Werner-Wunderlich (HWW) syndrome is a rare müllerian duct anomaly with uterus didelphys, unilateral obstructed hemivagina, and ipsilateral renal agenesis. Patients with this syndrome generally present after menarche with pelvic pain and mass and, rarely, primary infertility in later years. Strong suspicion and knowledge of this syndrome are mandatory for an accurate diagnosis. A 14-year-old female patient presented with acute retention of urine and abdominopelvic pain. Her condition was diagnosed with the use ultrasonography and magnetic resonance imaging as a case of HWW syndrome. She was treated with vaginal hemiseptal resection. The HWW syndrome should be considered among the differential diagnoses in girls with renal anomalies presenting with pelvic mass, symptoms of acute abdominal pain, and acute urinary retention.

Kisspeptin expression levels in patients with placenta previa: A randomized trial.

BACKGROUND: This study aimed to explore the potential influence of kisspeptin (KISS1) levels on the etiology of placenta previa for early pregnancy diagnosis. METHODS: The study included 20 pregnant women diagnosed with placenta previa and 20 pregnant woman with normal pregnancies between 2021 and 2022. Plasma KISS1 levels were determined through biochemical analysis, while genetic analysis assessed KISS1 and KISS1 receptor gene expression levels. Immunohistochemical methods were employed to determine placenta KISS1 levels. RESULTS: The evaluation of KISS1 concentration in serum revealed a significant decrease in the placenta previa group compared to the control group (P < .001). KISS1 gene expression level 0.043-fold decreased in the placenta previa group (P < .001). Furthermore, the KISS1 receptor gene expression level increased 170-fold in the placenta previa group. CONCLUSIONS: Results from biochemical, immunohistochemical, and genetic analyses consistently indicated significantly reduced KISS1 expression in patients with placenta previa. These findings suggest a potential link between diminished KISS1 levels and the occurrence of placenta previa. KISS1 may play a critical role in the etiology of placenta previa. Detailed studies on angiogenesis, cell migration and tissue modeling should be conducted to understand possible mechanisms.

Using the Amsler Grid Test for Age-Related Macular Degeneration Screening.

Objectives: To evaluate the use of the Amsler grid test (AGT) in screening for age-related macular degeneration (AMD), one of the most common causes of blindness, in primary healthcare settings. Materials and Methods: The AGT was applied to 700 eyes of 355 people aged 50 and over who applied to a family health center in Ankara and had no eye complaints. The test was considered positive if the lines on the AGT card were seen as broken or curved, there was a difference in shape or size between the squares, or a color change or blurring was described in any area. An ophthalmologist was consulted if the AGT was positive in one or both eyes. Patients considered suitable by ophthalmologists were evaluated with optical coherence tomography. AGT results were compared with ophthalmologist examination and tomography findings in terms of AMD detection. Results: The AGT was positive in 97 (13.9%) and negative in 603 (86.1%) out of 700 eyes included in the study. A total of 184 eyes, 79 with a positive AGT and 105 eyes with a negative test, were evaluated by an ophthalmologist. As a result of examinations and tests performed by ophthalmologists, AMD was detected in a total of 67 eyes: 42 of 79 eyes with positive AGT and 25 of 105 eyes with negative AGT but referred to an ophthalmologist for different reasons. In our study, the AGT had 62.7% sensitivity and 68.4% specificity. Conclusion: The AGT is an inexpensive and easily applicable test. Although moderate sensitivity and specificity were found in our study; further studies are needed to evaluate the suitability of its use for AMD screening in primary care with limited facilities.

Short-acting ß2-agonists (SABA) overuse in asthma and patients' perceptions for this behavior.

BACKGROUND: Short-acting ß2-agonists (SABA) overuse is associated with poor asthma control. The Global Initiative for Asthma (GINA) 2019-updated strategy report has therefore taken a paradigm shift in reliever therapy recommendations. OBJECTIVES: (I) To investigate the status of SABA overuse and medication dispensing patters in asthma in the Netherlands (II) validate dispensing data for SABA overuse identification and (III) understand patients' perspectives towards this SABA-taking behavior to inform future improvement strategies. METHODS: An annually repeated cross-sectional study was conducted from 2017 to 2021 using pharmacy dispensing data in a real-world setting, including asthma patients aged 18-45 with ≥1 inhaler. A following qualitative study was performed in identified SABA overusing patients with a questionnaire and semi-structured interviews, supported by theoretical frameworks. RESULTS: Dispensing data was available from 87 % of all community pharmacies (n = 1994) in 2017 and 95 % (n = 2005) in 2021. SABA overuse prevalence was constant for the five study-years with 20.6 % (±0.5 %). Increased ICS-formoterol and decreased SABA dispenses were observed in starters of inhalation therapy in 2021. 53 asthma patients completed the questionnaire of whom 43 patients confirmed SABA overuse, generating a positive predictive value of 81 %. Key behavioral drivers covered 7 themes regarding capability (knowledge; skills; memory, attention and decision process) motivation (emotion; beliefs about-capabilities; consequences) and opportunity (environmental context). CONCLUSION: SABA overuse remains in one-fifth of asthma patients across the Netherlands, requiring careful attention from healthcare professionals. Dispensing data is a valid measure for SABA overuse in a clinical setting, facilitating patient selection. To meet patients' varied supporting needs, integration of tailored behavioral interventions is essential.

Electrospun nanofibers: building blocks for the repair of bone tissue.

Bone, one of the hardest structures of the body, is the basic constituent of the skeletal system, which gives the shape to the body, provides mechanical support for muscles and soft tissues, and provides movement. Even if there is no damage, bone remodeling is a permanent process to preserve and renew the structural, biochemical, and biomechanical integrity of bone tissue. Apart from the remodeling, bone healing is the highly complicated process of repairing deficiencies of bone tissue by the harmonious operation of osteoblasts, osteocytes, osteoclasts, and bone lining cells. Various materials can be used to both trigger the bone healing process and to provide mechanical support to damaged bone. Nanofiber scaffolds are at the forefront of these types of systems because of their extremely large surface area-to-volume ratio, small pore size, and high porosity. Nanofibers are known to be highly functional systems with the ability to mimic the structure and function of the natural bone matrix, facilitating osteogenesis for cell proliferation and bone regeneration. Electrospinning is an easy and fast method to produce non-woven structures consisting of continuous ultrafine fibers with diameters ranging from micrometers down to nanometers. The simplicity and cost-effectiveness of the electrospinning technique, its ability to use a wide variety of synthetic, natural, and mixed polymers, and the formation of highly porous and continuous fibers are the remarkable features of this method. The importance of nanofiber-based scaffolds in bone tissue regeneration is increasing because of suitable pore size, high porosity, osteoinduction, induction of bone growth with osteoconduction, adaptability to the target area, biodegradation, and appropriate mechanical properties, which are among the main parameters that are important in the design of polymeric bone grafts. The aim of this review is to cast light on the increasing use of nanofiber-based scaffolds in bone tissue regeneration and give an insight about bone regeneration, production techniques of the electrospun nanofibers, and varying formulation parameters in order to reach different drug delivery goals. This review also provides an extensive market research of electrospun nanofibers and an overview on scientific research and patents in the field.

An evaluation of the use of inhalers in asthma and chronic obstructive pulmonary disease.

Objectives: Inhaled therapy is the treatment of choice for obstructive lung diseases such as asthma and chronic obstructive pulmonary disease (COPD). However, the maximum benefit from such therapy depends on the correct use of inhaler devices. In this study, our primary aim was to evaluate inhaler techniques in patients with asthma and COPD in order to identify common errors. In addition, we investigated the effect of various parameters on the rate of inhaler misuse. Methods: We enrolled a total of 300 asthma/COPD patients, who presented at the Chest Diseases and Family Medicine Outpatient Clinics of a tertiary hospital located in Ankara, Turkey. We used a face-to-face survey that included questions about sociodemographic features and inhaler therapy. Subsequently, we requested patients to demonstrate how they use their inhalers and assessed their inhalation technique according to checklists. Results: Of the 300 patients, 70.2% used their inhaler drugs incorrectly. The rate of misuse among metered dose inhaler (MDI) users was significantly higher than those using dry powder inhalers (DPIs) (77.6% vs 64%; p = 0.002). When DPI devices were analyzed, the rates of misuse were significantly higher in Handihaler users (p = 0.012) and Diskus inhaler users (p = 0.009) when compared to Sanohaler users. Gender, type of disease (asthma/COPD), duration of inhaler use, and duration of illness had no impact on the rate of misuse. However, an advanced age (>60 years old), a level of education lower than high school, and the use of MDI were all identified as factors associated with misuse. The most common mistake was 'failing to breath out before inhalation' for all types of devices (for MDI: 66.7%, and for DPI: 71.1-82.8%). Conclusions: The rate of inhaler drug misuse was high. The identification of factors associated with misuse could provide information to implement appropriate actions to reduce the rates of misuse.

Application of aza-BODIPY as a Nitroaromatic Sensor.

Nitroaromatic explosive detection with high sensitivity and selectivity is requisite for civilian and military safety and the ecosystem. In this study, aza boron dipyrromethene (aza-BODIPY) dye was selected as a fluorescent-based chemosensor against nitroaromatic compounds (NACs) including 2,4,6-trinitrophenol (picric acid, TNP), 2,4,6-trinitrotoluene (TNT), and 2,4-dinitrotoluene (DNT). This dye molecule exhibits sharp fluorescent behavior with high quantum yields beyond the near-infrared region (NIR) and is considered as a potential candidate for the detection of NACs. O'Shea's approach was used to synthesize tetraphenyl-conjugated aza-BODIPY molecules. Quenching of fluorescence emission of aza-BODIPY at 668 nm after the exposure to NACs was investigated under acetonitrile-water and acetonitrile-ethanol solvent conditions. The quenching responses and its mechanism were examined by considering the Stern-Volmer relationship Stern-Volmer constants (Ksv) for TNP (in water), TNP (in ethanol), TNT, and DNT, which are predicted to be 1420, 1215, 1364, and 968 M-1, respectively, all of which are sufficiently above the limit of detection (LOD) values. Thus, the present study opens up the possibility of the usage of aza-BODIPY molecules as a low-cost, light-weight sensor for the detection of NAC explosives.