Life expectancy associated with different ages at diagnosis of type 2 diabetes in high-income countries: 23 million person-years of observation

BACKGROUND

The prevalence of type 2 diabetes is increasing rapidly, particularly among younger age groups. Estimates suggest that people with diabetes die, on average, 6 years earlier than people without diabetes. We aimed to provide reliable estimates of the associations between age at diagnosis of diabetes and all-cause mortality, cause-specific mortality, and reductions in life expectancy.

METHODS

For this observational study, we conducted a combined analysis of individual-participant data from 19 high-income countries using two large-scale data sources: the Emerging Risk Factors Collaboration (96 cohorts, median baseline years 1961-2007, median latest follow-up years 1980-2013) and the UK Biobank (median baseline year 2006, median latest follow-up year 2020). We calculated age-adjusted and sex-adjusted hazard ratios (HRs) for all-cause mortality according to age at diagnosis of diabetes using data from 1 515 718 participants, in whom deaths were recorded during 23·1 million person-years of follow-up. We estimated cumulative survival by applying age-specific HRs to age-specific death rates from 2015 for the USA and the EU.

FINDINGS

For participants with diabetes, we observed a linear dose-response association between earlier age at diagnosis and higher risk of all-cause mortality compared with participants without diabetes. HRs were 2·69 (95% CI 2·43-2·97) when diagnosed at 30-39 years, 2·26 (2·08-2·45) at 40-49 years, 1·84 (1·72-1·97) at 50-59 years, 1·57 (1·47-1·67) at 60-69 years, and 1·39 (1·29-1·51) at 70 years and older. HRs per decade of earlier diagnosis were similar for men and women. Using death rates from the USA, a 50-year-old individual with diabetes died on average 14 years earlier when diagnosed aged 30 years, 10 years earlier when diagnosed aged 40 years, or 6 years earlier when diagnosed aged 50 years than an individual without diabetes. Using EU death rates, the corresponding estimates were 13, 9, or 5 years earlier.

INTERPRETATION

Every decade of earlier diagnosis of diabetes was associated with about 3-4 years of lower life expectancy, highlighting the need to develop and implement interventions that prevent or delay the onset of diabetes and to intensify the treatment of risk factors among young adults diagnosed with diabetes.

FUNDING

British Heart Foundation, Medical Research Council, National Institute for Health and Care Research, and Health Data Research UK.

Health Service Experiences of the Foreign Origin SGMs in Finland: An Intersectional Analysis

Background

The size of the sexual and gender minority (SGM) population in Finland is estimated to be between 5 and 15 per cent of the total Finnish population. In the 2019 School Health Promotion Survey, approximately 7-8 per cent of participants who identified as belonging to sexual or gender minorities, also identified as being of foreign origin. Research on the experiences of individuals who belong to sexual and/or gender minorities and also identify as members of the foreign origin population in Finland is, however, limited.

Methods

Qualitative data on SGMs among foreign origin populations were collected by the Finnish Institute for Health and Welfare as a part of the Manifold More project. The data collection was implemented through a participatory approach. Semi-structured interviews (n = 40) with the members of the target population and focus group interviews (n = 8) with organizations and projects that work to support the target population were collected. The data was gathered and analyzed with an intersectional approach. Through the analysis, the experiences of sexual and gender minorities who also identify as members of the foreign origin population in Finland were explored.

Results

The preliminary results suggest that professionals of health and well-being services often lack an intersectional understanding and LGBTQI+ specific matters in their work. This often generates discriminative and detrimental situations when the target population is using health and well-being services.

Conclusions

There is a growing need for examining the health disparities among the diverse group of SGMs and incorporate an intersectional understanding to the services of health and wellbeing professionals.

Key messages

Health professionals need to pay specific attention to LGBTQI+ specific matters. It is necessary to incorporate intersectionality in health to services of health and wellbeing.

Does atopy affect the course of viral pneumonia?

Background

The presence of atopy is considered as a risk factor for severe respiratory symptoms in children. The objective of this study was to examine the effect of atopy on the course of disease in children hospitalised with viral pneumonia.

Methods

Children between the ages of 1 and 6 years hospitalised due to viral pneumonia between the years of 2013 and 2016 were included to this multicentre study. Patients were classified into two groups as mild–moderate and severe according to the course of pneumonia. Presence of atopy was evaluated with skin prick tests. Groups were compared to evaluate the risk factors associated with severe viral pneumonia.

Results

A total of 280 patients from nine centres were included in the study. Of these patients, 163 (58.2%) were male. Respiratory syncytial virus (29.7%), Influenza A (20.5%), rhinovirus (18.9%), adenovirus (10%), human metapneumovirus (8%), parainfluenza (5.2%), coronavirus (6%), and bocavirus (1.6%) were isolated from respiratory samples. Eighty-five (30.4%) children had severe pneumonia. Atopic sensitisation was found in 21.4% of the patients. Ever wheezing (RR: 1.6, 95% CI: 1.1–2.4), parental asthma (RR: 1.5, 95% CI: 1.1–2.2), other allergic diseases in the family (RR: 1.8, 95% CI: 1.2–2.9) and environmental tobacco smoke (RR: 1.6, 95% CI: 1.1–3.5) were more common in the severe pneumonia group.

Conclusions

When patients with mild–moderate pneumonia were compared to patients with severe pneumonia, frequency of atopy was not different between the two groups. However, parental asthma, ever wheezing and environmental tobacco smoke exposure are risk factors for severe viral pneumonia in children.

Ultra-low dose of intravitreal bevacizumab in retinopathy of prematurity

AIM

We aimed to investigate the effectivity of the 0.0625 mg dose of bevacizumab in patients with retinopathy of prematurity (ROP) and compare the results with 0.625 mg dose of intravitreal bevacizumab (IVB) injection.

METHODS

The medical records of the patients with type 1 ROP who received IVB monotherapy were retrospectively reviewed. Demographic and clinical characteristics of the patients were recorded. The patients were classified into two groups with respect to received dose of bevacizumab as follows: group F (n = 46) (full dose of bevacizumab-0.625 mg/0.025 ml) and group L (n = 45) (low dose (one tenth) of bevacizumab-0.0625 mg/0.025 ml).

RESULTS

Both treatment dose regimens have similar outcomes. Moreover, the mean retinal vascularization time seemed to be significantly higher in group F compared to group L, 168 ± 65 and 97 ± 29 days, respectively (p < 0.001). Disappearance of plus sign is observed earlier in group F (2.45 ± 1.7 vs 3.66 ± 2.46 days, respectively, p = 0.03).

CONCLUSIONS

The low dose (0.0625 mg) of IVB treatment was effective as full (0.625 mg) dose in ROP treatment. Moreover, our results showed that low-dose treatment might provide faster retinal vascularization than the regular used dose. On the other hand, disappearance of the plus sign takes longer time in patients treated with low dose compared to eyes treated with full dose of IVB that should be taken into account.

Status and awareness of cervical, breast, and colon cancer screening in a Turkish city

PURPOSE OF INVESTIGATION

Mortality and morbidity rates of cervical, breast, and colorectal cancers (CRC) can be decreased via effective screening strategies. Developing countries are to be expected to establish and implement their own programs.

MATERIALS AND METHODS

To evaluate regional awareness and status of cervical, breast, and CRC screening, a questionnaire-based study was conducted in 500 volunteers from a Turkish community hospital.

RESULTS

Awareness rates were 57.4% for Pap smear, 61.2% for mammography, and 25.4% for CRC. Implementation rates were 19.2%, 23.9%, and 12%, respectively. Positive family history for gynecologic cancer and past cervical ablative procedure parameters were related to higher Pap smear rates. Educational level, breast self-exam, and positive Pap smear history parameters were related to higher mammography rates. Factors related to higher colorectal cancer screening rates were nulliparity and positive Pap smear history.

CONCLUSION

Cancer screening rates for this Turkish city are still below the expected levels despite recently revitalized national screening program. For success, it is essential not only to educate rural populations but also to train negligent healthcare providers regularly.

Impacts of maternal anxiety on non-stress test parameters

OBJECTIVE

To determine the association between antenatal maternal anxiety with non-stress test (NST) parameters, which is an indi- cator test of fetal well-being in the third trimester.

MATERIALS AND METHODS

Between January and December of 2013, 212 pregnant women, with 36-41 weeks of gestation were assessed with measures of distress and anxiety with Beck Anxiety Inventory (BAI) and with NST. The new National Institute Child Health and Human Development (NICHD) 2008 guideline criteria were used for interpretation of NST. Anxiety scores were grouped as minimal, mild, moderate, and severe. The impact of anxiety on NST parameters were investigated.

RESULT

Anxiety scores were inversely correlated with fetal heart rate (FHR) accelerations (r = -0.631, and r = -0.855), number of fetal movements (r = -0.633, r = -0.860), FHR variability scores (r = -0.650, r = -0.877). and NST scores (r = -0.505, r = 0.729), (for all p < 0.001). NST scores were lower in severe anxiety group than the others.

CONCLUSION

The study showed that severe form of anxiety significantly affects NST parameters in near-term pregnancies.

The protective effects of pomegranate on liver and remote organs caused by experimental obstructive jaundice model

OBJECTIVE

We aimed to investigate the protective potential of pomegranate extract on the liver and remote organs in rats with obstructive jaundice.

MATERIALS AND METHODS

The rats were split into 4 groups. In Group 1 (G1) (sham group) rats, the common bile duct was mobilized without any ligation. Group 2 (G2) received a combination of the sham operation and synchronous treatment with pomegranate. Group 3 (G3) received common bile duct ligation (CBDL). Group 4 (G4) were subjected to CBDL and treatment with pomegranate. After 8 days, we measured total oxidative status (TOS) and antioxidant capacity in the rats' liver tissue and remote organs, and evaluated blood levels of malondialdehyde and total antioxidant capacity (TAC).

RESULTS

G3 rats showed significantly raised malondialdehyde level as compared to G1 rats (p < 0.001). Following the pomegranate therapy, a decrease in malondialdehyde was observed (p = 0.015). TAC levels were significantly raised in the G3 rats compared to the G1 rats (p = 0.004). TAC levels dropped after pomegranate therapy (p = 0.011). CBDL caused elevated TOS levels in the liver and remote organs, with a statistically significant increase in the lung tissue (p = 0.002). TOS levels in the CBDL groups decreased after pomegranate treatment (p < 0.001).

CONCLUSIONS

This study reveals the marked protective effect of pomegranate on the liver and remote organs in obstructive jaundice.

Protective Effects of Carvacrol Against Methotrexate-induced Liver Toxicity in Rats

BACKGROUND

To investigate whether carvacrol (CAR) pretreatment reduces the severity of methotrexate (MTX)-induced hepatotoxicity in rats.

METHODS

A total of 24 rats were equally divided into three groups : group I, control ; group II, MTX-treated ; and group III, CAR+MTX-treated. On Day 1 group III received a one-time intraperitoneal dose of CAR (73 mg/kg), and on Day 2 both groups II and III received a single dose of intraperitoneal MTX (20 mg/kg). The rats were then sacrificed so to harvest blood and liver tissue samples to determine malondialdehyde (MDA), total antioxidant capacity (TAS), total oxidant status (TOS), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP) levels. Histological specimens were examined via light microscopy.

RESULTS

Levels of MDA, ALT, AST and ALP in rat liver tissue samples were significantly higher in the MTX-treated group relative to the control group. However, TAS was significantly reduced in the MTX-treated group when compared to controls. Pretreating rats with CAR counteracted the effect of MTX exposure as MDA was significantly decreased and TAS was elevated in liver tissues when contrasted with the MTX-treated group. Furthermore, histological examination demonstrated significant liver injury in the MTX-treated group versus the CAR+MTX group.

CONCLUSIONS

Pretreatment with CAR markedly diminished liver damage induced by MTX. Therefore, CAR administration preceding MTX treatment might be a promising therapeutic modality to prevent and/or lessen the extent of MTX-induced hepatotoxicity.

Low "quotient" Lp(a) concentration mediates autoimmune activation and independently predicts cardiometabolic risk

OBJECTIVE

We determined whether U-shaped relationships exist between serum lipoprotein[Lp](a) and cardiometabolic risk.

METHODS

In population-based nondiabetic and diabetic middle-aged adults (n=1 428 and 241, respectively) who had been genotyped for the LPA rs10455872 A>G polymorphism, we adjusted the Lp(a) concentration for the effects of genotype and other covariates. Via sex-specific equations we estimated expected Lp(a) concentration in each participant, and the quotient between observed to expected Lp(a) values was determined. Lp(a) and Lp(a) quotient tertiles served to identify non-linear associations with outcomes.

RESULTS

Incident 81 cases of diabetes and 128 of coronary heart disease (CHD) developed at 5.1 years' follow-up. Lp(a) concentration was linearly associated with the LPA genotype, gender, total cholesterol, (inversely) fasting insulin, which together with age formed the variables to derive the equations. In logistic regression for incident diabetes, the low Lp(a) quotient tertile was a predictor (RR 1.95 [95%CI 1.10; 3.47]) alike the low Lp(a) tertile, additively to major confounders. Cox regression models comprising sex, age, LPA genotype, smoking status, systolic pressure and serum HDL-cholesterol disclosed that, compared with the mid-tertile, both low (HR 1.77) and high Lp(a) quotient tertiles significantly predicted incident CHD, especially in women.

CONCLUSION

Elevated cardiometabolic risk is conferred by apparently reduced circulating Lp(a) assays supporting the notion that "low" serum Lp(a), mediating autoimmune activation, is a major determinant of cardiometabolic risk.

Posterior reversible encephalopathy syndrome in obstetric patients. Report of three cases with literature review

Posterior reversible encephalopathy syndrome (PRES) is a serious clinico-neuroradiological maternal complication in pregnancy. Although it has various etiologies such as hypertensive encephalopathy, renal failure, autoimmune disorders, sepsis, multiple organ failure, and treatment with immunosuppressant or cytotoxic agents, pregnancy and postpartum complicated by hypertensive disorders more frequently lead to this condition. PRES is clinically characterized by headache, confusion, seizures, vomiting, and visual disturbances with radiographic vasogenic edema especially affecting symmetrical parietal and occipital lobes. The underlying pathophysiology is still a matter of debate. Prompt recognition and early intervention greatly improve the prognosis, so that obstetricians should be well aware of this rare entity. Timely imaging is of crucial importance especially in patients with an uncertain diagnosis for determining the appropriate treatment and preventing the possible development of neurologic deficits. In the present report, three cases of PRES are presented with clinical and radiological findings in pregnancies complicated by severe pre-eclampsia and eclampsia. The latest literature in the field is also carefully reviewed.

Comparison of diagnostic methods for evaluation of postmenopausal bleeding

OBJECTIVE

To determine and compare diagnostic accuracy parameters of saline infusion sonohysterography (SIS), transvaginal ultrasonography (TVUSG), and hysteroscopy (H/S) based on histopathologic results which are accepted to be the gold standard in patients with postmenopausal bleeding (PMB).

MATERIALS AND METHODS

Forty-seven patients who applied to Gynecology clinic of Adnan Menderes University, School of Medicine with PMB complaint aged between 43-76 years were included to the study. Fractioned curettage (F/C) and H/S guided biopsy were used for endometrial sampling. Diagnostic accuracy parameters (sensitivity, specificity, and positive and negative predictive values) of different methods; TVUSG, SIS, and H/S based on histopathologic findings were investigated.

RESULTS

Specificity and sensitivity values calculated based on histopathologic results for all endometrial cavity lesions were found, respectively: 44.4% and 25% for TVUSG, 88.8% and 60.7% for SIS, and 100% and 77.7% for HIS.

CONCLUSION

SIS is superior to TVUSG and as effective as H/S for assessment of endometrial cavity lesions in patients with PMB.

Similar prevalence, different spectrum: IgE-mediated food allergy among Turkish adolescents

BACKGROUND

Scarcity of reliable data on food allergy prevalence exists in Turkey. We aimed to assess reported and confirmed IgE-mediated food allergy prevalence, and define the spectrum of allergenic food.

METHODS

We prospectively evaluated the ISAAC Phase II study population for food allergy. Participants that reported experiencing food allergy symptom in the last year and/or were skin prick test positive for a predefined list of food allergens, were interviewed via telephone, and those considered as having food allergy were invited to undergo clinical investigation, including challenge tests.

RESULTS

A total of 6963 questionnaires were available. Parental reported food allergy prevalence and skin prick sensitisation rate were 20.2 ± 0.9% and 5.9 ± 0.6%. According to the above-defined criteria, 1162 children (symptom positive n=909, skin prick test positive n=301, both positive n=48) were selected and 813 (70.0%) were interviewed via telephone. Out of 152 adolescents reporting a current complaint, 87 accepted clinical investigation. There were 12 food allergies diagnosed in nine adolescents, with food allergy prevalence of 0.16 ± 0.11%. The most common foods involved in allergic reactions were walnut (n=3) and beef meat (n=2), followed by hen's egg (n=1), peanut (n=1), spinach (n=1), kiwi (n=1), cheese (n=1), hazelnut (n=1) and peach (n=1).

CONCLUSIONS

While parental reported food allergy prevalence was within the range reported previously, confirmed IgE-mediated food allergy prevalence among adolescents was at least 0.16%, and the spectrum of foods involved in allergy differed from Western countries, implying environmental factors may play a role.

Fibrosis in heart failure subtypes

BACKGROUND

The differences in concentrations of biomarkers between heart failure patients with dilated cardiomyopathy (HF-D) and with ischemic cardiomyopathy (HF-I) have yet to be defined. The objectives of this study were to compare the concentrations and correlation of biomarkers of inflammation, extracellular matrix (ECM) turnover and oxidative stress parameters between these populations.

PATIENTS AND METHODS

Our study consisted of 36 subjects with HF-D (LVSD = 47.2 ± 7.3 mm, LVDD = 65.1 ± 6.3 mm), 44 subjects with HF-I (LVSD = 38.0 ± 4.4 mm, LVDD = 58.5 ± 6.0 mm) and 38 controls without heart failure. Concentrations of matrix metalloproteinase (MMP)-1, MMP-2, MMP-9, MMP-13, Galectin-3, prolidase, TNF-alpha, and oxidative stress index (OSI) were measured.

RESULTS

Serum levels of MMP-2, MMP-9, and prolidase were significantly increased in HF-I group compared to healthy controls (p = 0.039, 0.019, 0.012 respectively), whereas the increases in MMP-1 and MMP-13 were not significant. This significance was stronger in the HF-D group than the HF-I group (p = 0.004, 0.001, 0.002 respectively). TNF-α, a marker of inflammation, was significantly increased in heart failure (p = 0.004) but there was no difference between HF-D and HF-I groups; however, Galectin-3 was significantly increased in the HF-D group compared to the HF-I group (p = 0.005). OSI showed the same response pattern as TNF-α (p = 0.019, 0.002 respectively). There was a positive correlation of MMP-9 levels with prolidase activity (r = 0.612, p: 0.003).

CONCLUSIONS

MMPs and Galectin-3 are important in cardiac remodeling; prolidase may share an undefined role in fibrosis in heart failure and may have a role in the diffuse fibrosis of heart failure.

The protective effect of ellagic acid on lung damage caused by experimental obstructive jaundice model

AIM

This study aimed to investigate protective effects of ellagic acid on lungs in an experimental obstructive jaundice model.

METHODS

Four groups were established, each consisting of ten randomly selected rats: Group 1: sham, Group 2: ellagic acid, Group 3: obstructive jaundice, and Group 4: obstructive jaundice + ellagic acid. Ellagic acid was administered orally at a dose of 60 mg/kg/day to group 2 and 4. The animals were sacrificed eight days later. The total oxidative status and the total antioxidant capacity in their lung tissue were determined, and malondialdehyde levels in their blood were measured. Histopathological changes in the lungs were examined.

RESULTS

In the obstructive jaundice group treated with ellagic acid, there was a decrease in malondialdehyde levels and a reduction in the total oxidative status and the oxidative stress index, whereas the total antioxidant capacity increased (p < 0.001). The histopathological examination showed that neutrophil leukocyte infiltration and edema formation decreased and destruction of lung parenchyma disappeared following the treatment with the ellagic acid (p < 0.05).

CONCLUSION

This study shows that ellagic acid has a protective effect against oxidative damage in lung tissue in obstructive jaundice.

Coronary disease risk prediction algorithm warranting incorporation of C-reactive protein in Turkish adults, manifesting sex difference

BACKGROUND AND AIM

An algorithm is needed for predicting coronary heart disease (CHD) risk in Turkish adults who have a high prevalence of metabolic syndrome (MetS).

METHODS AND RESULTS

Ten-year risk of CHD was estimated in 2232 middle-aged adults free of CHD at baseline, followed over 7.6-years. Cox proportional hazard regression was used to predict CHD. Discrimination was assessed with area under receiver operating characteristics curve (AROC). CHD developed in 302 subjects. In multivariable analysis, high-density lipoprotein (HDL)-cholesterol levels were borderline predictive in men; smoking status and HDL-and low-density lipoprotein (LDL)-cholesterol levels were not predictive in women. Age, presence of diabetes, systolic blood pressure and C-reactive protein (CRP) were predictors in both sexes, while smoking status and LDL-cholesterol were so in men only. AROC of the model was 0.789 in men, and 0.806 in women (p < 0.001 each). An algorithm using the stated seven variables was derived separately for each sex. After age adjustment, men and women in the highest quintile of risk score were significantly and 20-27-fold more likely to develop CHD than those in the lowest quintile.

CONCLUSIONS

In a population with prevalent MetS, low-grade inflammation is independently relevant for CHD, as are serum lipoproteins and smoking status. The derived algorithm is effective in estimating CHD risk among Turkish adults.

Pregnancy outcome of Moroccan and Turkish women in Belgium

OBJECTIVE

To compare perinatal outcome in women from Turkish and Moroccan descent versus autochthonous women in Belgium.

METHODS

Retrospective cohort study, data from an existing database, coupled with sociodemographic data from birth certificates.

RESULTS

There were more teenage pregnancies in the Moroccan and Turkish group, Moroccan women delivered more frequently after age 40 but Turkish women less frequently. In Moroccan and Turkish women the level of education was lower, they had less hypertension, fewer pregnancies after artificial reproductive technology and preterm deliveries, more diabetes and more grand multiparity. Moroccan women demonstrated more HIV infection. Planned cesarean section was less frequent in the Moroccan and Turkish group, and there was no difference for secondary cesarean section. Belgian women had more induction of labor, instrumental vaginal delivery and epidural anesthesia. There were more babies with low birth weight in both the Moroccan and Turkish group. Moroccan woman had more babies with a birth weight above 4500 g. Total perinatal death rate was higher for Moroccan women while there was no difference between Belgian and Turkish babies.

CONCLUSION

Moroccan women demonstrated higher rates of HIV infection and perinatal mortality, while in both Turkish and Moroccon women diabetes was higher and hypertension less frequent. Belgian women underwent more interventions during pregnancy.

An algorithm to predict risk of type 2 diabetes in Turkish adults: contribution of C-reactive protein

BACKGROUND AND AIM

An algorithm for predicting Type 2 diabetes (DM) risk in a population with prevalent metabolic syndrome (MetS) is needed since ethnicity influences the pathogenesis of DM.

MATERIAL AND METHODS

The 8- yr risk of DM was estimated in 2261 middle-aged Turkish adults free of DM at baseline who were followed for over 7.6 yr. DM newly developed in 212 subjects. Cox proportional hazard regression and 15 variables were used to predict DM. Discrimination was assessed with area under receiver operating characteristics curve (AROC).

RESULTS

In multivariable analysis, height, family income brackets, systolic blood pressure, smoking status, alcohol usage, and HDL-cholesterol levels were not predictive in either sex. In addition to sex, family history of DM, fasting glucose, and waist circumference were predictors, in men, age and non-HDL-cholesterol, while in women physical inactivity and serum C-reactive protein were so. AROC of the final model was 0.783 in men, 0.772 in women (p<0.001 each). An algorithm using the stated 7 variables was developed separately for each sex. Men and women in the top quintile of risk score were, respectively, 20 and 50 times and significantly more likely to develop DM than those in the bottom quintile. The predictive value of the algorithm was validated in 2 split samples.

CONCLUSIONS

A marker of low grade inflammation provides useful predictive ability beyond other simple predictors in a female population with MetS prevailing. The derived simple algorithm may be useful in estimating the 8-yr risk of DM among middle-aged Turkish men and women.

Prevalence, burden, and risk factors of atopic eczema in schoolchildren aged 10-11 years: a national multicenter study

BACKGROUND

Little is known about the epidemiology of atopic eczema (AE), and studies from the Mediterranean region and the Middle East are limited.

OBJECTIVE

We investigated the frequency, burden, and risk factors of AE in a developing country.

METHODS

The International Study of Asthma and Allergies in Childhood Phase II questionnaire was used to survey a representative sample of 10 to 11-year-old children in Turkey. Children were examined by allergists, and parents completed standardized questionnaires.

RESULTS

Among 6755 children, the prevalence of having eczema during one's lifetime or currently was 17.1% and 8.1%, respectively. The prevalence of visits to the doctor, nocturnal awakening, school absenteeism, and drug usage was 36.3%, 56%, 9.7%, and 28.7%, respectively. Associated factors were current rhinoconjunctivitis (odds ratio [OR], 2.53; 95% confidence interval [CI], 1.99-3.21), current wheezing (OR, 2.10; 95% CI, 1.58-2.79), family history of allergic disease (OR, 1.62; 95% CI, 1.21-2.18), low birth weight (OR, 1.79; 95% CI, 1.08-2.94), and exposure to animals in the first year of life (OR, 1.47; 95% CI, 1.06-2.03).

CONCLUSIONS

In a developing Mediterranean country, the prevalence of AE is comparable to that of developed countries in the same region and lower than that observed in developed countries elsewhere. The course of the disease and risk factors of AE probably differ in developing countries.

Lost intrauterine contraceptive device inserted 42 years before: a case report

OBJECTIVE

The management of a lost abdominal intrauterine contraceptive device (IUD) is discussed together with a review of the relevant literature.

THE CASE

The IUD is one of the most commonly used, effective, cheap and safe methods of contraception in Turkey. However, IUD insertion may result in uterine perforation which may lead to a variety of abdominal complications or can remain asymptomatic in the abdomen for a long time without causing any complications. An asymptomatic case of a woman with an IUD inserted 42 years before is presented. To the best of our knowledge this is the longest time an IUD (found by X-ray) has been localized in the abdomen.

CONCLUSION

We suggest that in asymptomatic patients with an IUD localized in the abdomen, the risks of both operating and not operating should be discussed thoroughly and in such cases, follow-up without surgery may be considered as an alternative approach.

Papillary serous adenocarcinoma of the uterine cervix: a case report

Papillary serous adenocarcinoma of the endocervix (PSAE) is a rarely encountered neoplasm. The literature includes only a limited number of well documented case studies. The present study reports a case of papillary serous adenocarcinoma originating from the endocervix.

Rectal cancer in pregnancy: a case report

Rectal cancer in pregnancy is a rare but a life-threatening disease. This paper presents a case of rectal cancer in pregnancy, discussed in light of the literature.

Thrombin activatable fibrinolysis inhibitor (TAFI) is not associated with recurrent miscarriage

AIM(S)

The present study aimed to discover whether there is an association between thrombin-activatable fibrinolysis inhibitor (TAFI) antigen levels and recurrent miscarriage (RM). In particular, TAFI antigen levels of women with RM were compared with those of a control group of women with previous uncomplicated pregnancies.

METHOD(S)

Group 1 comprised 48 women with RM, defined as the occurrence of two or more fetal losses before 20 weeks of gestation. Group 2 (the control group) was made up of 40 women who had undergone at least two healthy pregnancies and had no history of miscarriage. Group 1 was then stratified in to two groups according to the number of pregnancy losses and group 1A (2 pregnancy losses) consisted of 22 women whereas group 1B (three or more pregnancy losses) consisted of 26 women.

RESULTS

No difference was observed with regard to serum TAFI antigen levels between groups 1 and 2. There was also no statistical difference in serum TAFI antigen levels between group 1A and group 1B.

CONCLUSION

The findings of the current study indicated that TAFI antigen levels are not associated with RM. Further multi-centric research with more subjects is needed to better evaluate the role of TAFI in RM.

Integration of GARD Turkey national program with other non-communicable diseases plans in Turkey

For the prevention and control of non-communicable diseases (NCD), an action plan on NCDs is intended to support coordinated, comprehensive and integrated implementation of strategies and evidence-based interventions across individual diseases and risk factors, especially at the national and regional levels by World Health Organization (WHO). The Global Alliance against Chronic Respiratory Diseases (GARD) is making every attempt to align with WHO's non-communicable diseases action plan. GARD activities have been commenced in over 40 countries and in 11 countries an integrated NCD action plan is being prepared or has already been initiated. This integrated approach of GARD has also targeted to GARD Turkey project. The Turkish Ministry of Health has decided to apply this national control program in conformity with other NCD action plans. This article is intended to summarize these integration efforts of GARD Turkey (the National Control Program on Chronic Airway Diseases) with other NCD national programs.

The spread pattern of right and left epithelial ovarian cancers

OBJECTIVE

No attention has been paid in the past to the spread pattern of right and left epithelial carcinomas of the ovaries. We aimed to investigate the incidence, spread pattern and distribution of lymph node metastasis in epithelial ovarian cancer (EOC), comparing right versus left EOC of any stage, where the contralateral ovary is apparently and histologically tumor-free.

METHODS

Out of a total of 442 patients with EOC, 318 (72%) patients in the study had bilateral and 124 (28%) patients had unilateral ovarian cancer. The study enrolled 60 (48%) patients with right and 64 patients with left ovarian involvement (52%) where the contralateral ovary was tumor-free. Groups Right and Left were compared in terms of age, the tumor status of the lymph nodes, surgical stage, histology, grade, tumor extension out of the ovaries, omental tumor involvement and also omental and nodal involvement together.

RESULTS

The comparisons of the variables between Groups Right and Left did not show significant differences except for metastasis patterns in the left iliac lymph nodes and omentum (p < 0.05). Independent of age and histological type of the tumor, women with left-side EOC showed a significantly higher incidence of metastasis in the left iliac lymph nodes (OR: 7.04, 95% CI, 1.36-36.44) and omentum (OR: 2.87, 95% CI, 1.03-8.01), when compared to right-side EOC (p < 0.05).

CONCLUSION

In this cohort of patients, we found that left-side unilateral EOC was more likely to metastasize to the left iliac lymph nodes and omentum than the right side where the contralateral ovary was tumor-free. This might be due to the difference in lymphatic drainage on the right and left side and/or the influence of peritoneal fluid movements. This suggestion needs to be supported by further studies.

The WHO global alliance against chronic respiratory diseases in Turkey (GARD Turkey)

In order to prevent and control non-communicable diseases (NCDs), the 61st World Health Assembly has endorsed an NCD action plan (WHA resolution 61.14). A package for essential NCDs including chronic respiratory diseases (CRDs) has also been developed. The Global Alliance against Chronic Respiratory Diseases (GARD) is a new but rapidly developing voluntary alliance that is assisting World Health Organization (WHO) in the task of addressing NCDs at country level. The GARD approach was initiated in 2006. GARD Turkey is the first comprehensive programme developed by a government with all stakeholders of the country. This paper provides a summary of indicators of the prevalence and severity of chronic respiratory diseases in Turkey and the formation of GARD Turkey.

A prospective randomized comparative study of the effects of intranasal and transdermal 17 beta-estradiol on postmenopausal symptoms and vaginal cytology

CONTEXT

Investigating the adverse effects of oral hormone replacement therapy (HRT), the clinical effectiveness of alternative combinations and route of administrations.

AIM

To compare the effects of intranasal and transdermal 17 beta-estradiol combined with vaginal progesterone on vasomotor symptoms and vaginal cytology.

SETTINGS AND DESIGN

A 12-week, prospective, randomized comparative study was conducted between July 2005 and September 2006.

MATERIALS AND METHODS

Eighty postmenopausal women aged between 42-57 years, who had scores of > or =1.7 on the menopause rating scale-I (MRS-I) items "1-6", were randomly assigned to receive intranasal (300 microg/day, n =40) or transdermal (50 microg/day, n =40) 17 beta-estradiol continuously. All patients also received a vaginal progesterone gel twice weekly. Vasomotor symptoms were evaluated at weeks 0, 4, 8 and 12. Vaginal maturation index (VMI) was evaluated at weeks 0 and 12 of the study.

STATISTICAL ANALYSES

The Mann-Whitney U and the Wilcoxon tests were used. P < 0.05 was regarded as significant.

RESULTS

Thirty-two women in the intranasal and 29 women in the transdermal group completed the study. The total score of the MRS, the sum-scores of Factor 1 "HOT FLUSHES" and Factor 2 "PSYCHE" significantly decreased in both groups at week 4. Factor 3 "ATROPHY" scores significantly decreased only in the transdermal group at week 12. The VMI showed no changes within and between the two groups at the end of the study.

CONCLUSION

Intranasal and transdermal 17beta-estradiol combined with vaginal progesterone gel as a continuous HRT caused a similar decrease in vasomotor symptoms but did not have any significant effect on VMI after 12 weeks of treatment in this study population.

Folate and vitamin B12 levels in abnormal pap smears: a case control study

OBJECTIVE

This study aimed to explore the risk of abnormal cervical cytology in relation to serum folate and vitamin B12 levels, and demographic characteristics.

PATIENTS AND METHODS

A case-control study was carried out among women attending the gynecology clinic for cervical cytology screening. At the follow-up clinic visit, fasting blood samples were collected from 103 cases with abnormal cervical cytology of the cervix and 175 controls with cytological normal smears and serum folate and vitamin B12 levels were measured. Data from cases and controls were compared. Logistic regression analysis was used to estimate the relative odds of abnormal cytology with increasing vitamin B12 levels.

RESULTS

There were no significant differences between cases and controls in demographic characteristics and mean folate levels (p > 0.05). The mean vitamin B12 level of cases was significantly lower than that of controls (p < 0.001). Dichotomized logistic regression analyses of vitamin B12 levels were significantly different (p < 0.001). The predicted percentages at a cut-off value of 0.5 were as follows: sensitivity 70.0%, specificity 74.6%, positive predictive value 71.8% and negative predictive value 72.6%. The logistic regression analysis of the 1st and the 4th quartiles of vitamin B12 levels showed a significant difference p < 0.001, OR: 1.525 (CI, 1.175-1.875).

CONCLUSION

The results of this study suggest that lower vitamin B12 levels are associated with abnormal cervical cytology. It is recommended that women should consume not only folate-rich foods such as fruits and vegetables but also vitamin B12-rich foods such as meat, fish, milk products and eggs in a balanced way.

Calcitonin expression of high endothelial venules during lymphocyte migration in human pharyngeal tonsil

The migration routes of lymphocytes through high endothelial venules (HEVs) of control and hypertrophic pharyngeal tonsil (HPT) tissue sections were investigated by immunohistochemistry using the expression of a hormone [calcitonin (CT)] and two calcium-dependent endothelial adhesion molecules (E-selectin and P-selectin), as well as electron microscopy. A marked increase in CT-specific staining was observed in the endothelial cells of HEV in the HPT group compared to the control group. Expressions of E-selectin and P-selectin on HEVs of control group were faint, when compared to the strong expression of these selectins on HEVs of HPT. Electron microscopically, we demonstrated that lymphocytes transmigrated through HEV and observed the close membranous contact between endothelial cells and lymphocytes during this process. We speculate that increasing CT during inflammation may be important for lymphocyte migration through the HEVs via controlling the expression of E-selectin and P-selectin.

Frequency of gastroesophageal reflux disease in nonatopic children with asthma-like airway disease

Gastroesophageal reflux disease (GERD) is commonly associated with asthma; however, frequency in nonatopic children with asthmatic symptoms is unknown. The aim of this study was to determine the frequency of gastroesophageal reflux (GER) in nonatopic children with asthma-like airway disease that recur despite conventional asthma treatment and to evaluate the clinical response to lansoprazole treatment. Twenty-five nonatopic children aged between 1 and 16 years who have asthma-like airway disease and 25 healthy children were included in the study. All cases underwent 24 h pH monitoring with dual sensor catheters. Additionally, acid suppressor treatment was administered to patients diagnosed as having GERD and clinical response was evaluated. Major symptoms encountered in the patient group included wheezing and cough (88%, and 32%, respectively). Reflux episodes were more common in distal esophagus during the prone position (reflux index (RI) of 11.5+/-10.3 vs. 16.2+/-9.4 during supine vs. prone). All distal esophageal parameters were significantly higher in the patient group except number of reflux episodes lasting longer than 5 min (RI of 13.3+/-13.1 vs. 3.9+/-2.9 in the patient vs. control groups, respectively). There was a significant improvement in symptoms and requirement for medication with treatment (number of systems decreased from 2.3+/-0.6 to 0.4+/-0.6, P=0.00). In conclusion, GERD is significantly more common in nonatopic children with asthma-like airway disease compared to the controls and clinical improvement is significant after acid suppressor treatment. Thus, we suggest that children followed-up with the diagnosis of nonatopic asthma with recurrent exacerbations despite adequate asthma treatment have a high frequency of GER and that lansoprazole treatment may be considered early in management.

Clitoromegaly in type 2 neurofibromatosis: a case report and review of the literature

OBJECTIVE

Genitourinary neurofibromatosis (NF) is a rare disorder and clitoral involvement has been reported infrequently. In the English literature there are only 26 reported cases with clitoral involvement in NF.

CASE

A 28-year-old female with clitoral enlargement, previously diagnosed with NF 2, was successfully treated by removal of the clitoral mass that increased in size during the previous two years. Clitoroplasty was performed while preserving the glans of clitoris. Histopathologic examination revealed plexiform neurofibroma.

CONCLUSION

To the best of our knowledge the patient is the 27th reported clitoromegaly case with NF, but the first case reported with NF 2 or central NF in the English literature.

Non-invasive evaluation of the adaptations of cardiac function in the neonatal period: a comparison of healthy infants delivered by vaginal route and caesarean section

Postnatal adaptations of cardiac hemodynamics in infants born vaginally or by caesarean section may be different. These cardiac functions were evaluated by Doppler echocardiography to assess adaptation differences. Cardiac output, heart rate, stroke volume, mean arterial pressure, total systemic vascular resistance, ejection fraction, and ductus arteriosus diameter were determined and compared at 1, 24 and 72 h of life in 22 infants born vaginally (group 1) and 23 born by caesarean section (group 2). One hour after delivery, heart rate, mean blood pressure, and total systemic resistance were found to be higher in group 1 infants (P < 0.01, P < 0.05, P < 0.05 respectively). Stroke-volume measurements were significantly higher in group 2 (P < 0.05). The ejection fraction and cardiac output values were similar in both groups. At 24 and 72 h, no significant differences were observed in measurements of infants born vaginally or by caesarean section. We did not find a parameter negatively affecting healthy newborns in either mode of delivery. However, under pathological conditions affecting the cardiovascular system at 1 h of life, including perinatal infections and hypoxemia, a lower stroke volume, higher heart rate, higher mean blood pressure, and higher peripheral resistance may cause additional work load to the cardiovascular system in infants born vaginally.

Doppler echocardiographic evaluation of pulmonary arterial pressure in children with allergic rhinitis

In children, persistent upper airway obstruction may lead to increased pulmonary arterial pressure (PAP). Allergic rhinitis (AR) is one of the frequent cause of persisting upper airway obstruction by nasal blockage in childhood. Regular use of nasal topical corticosteroids are effective in reducing nasal blockage and obstruction. However, whether symptomatic children with AR have increased PAP and curative effect of topical steroids are not known. The aims of this study were to clarify whether children having active symptoms of AR have increased PAP and to investigate the curative effect of reducing nasal obstruction by topical corticosteroids. Twenty-three children, aged between 5 and 16, diagnosed as AR, consisted of 17 seasonal AR (SAR) and seven perennial AR (PAR), were included in the study. Nineteen age and sex matched healthy children were received as controls. PAP was measured by using Doppler echocardiography in all subjects and symptom scores of AR were recorded in rhinitis group. After first evaluation, nasal steroid, budesonid, was given to rhinitis group for three months. Mean systolic PAP was 33.4+/-3.1 for children with AR mmHg and 23.6+/-4.3 mmHg for the control group. The difference was statistically significant (P<0.05). Mean systolic PAP of children with PAR was significantly higher than children with SAR (P<0.05). In rhinitis group, mean PAP decreased significantly after relief of upper airway obstruction by nasal corticosteroid therapy to normal level of 24.9+/-3.6 mmHg (P<0.05). Our results showed that children with AR may have significantly higher PAP than healthy subjects and decreased to normal levels after relieving nasal blockage by nasal corticosteroids. Nevertheless, Doppler echocardiography is a safe, non-invasive and practical tool for cardiac investigation of children with AR. Therefore, in symptomatic period, evaluation of PAP of children with AR by using Doppler echocardiography may be useful in the planning and following of their therapy.

Effect of inhaled steroid therapy on distribution of Tc-99m DTPA radioaerosol in asthmatic children

The aim of this study was to evaluate the effect of inhaled steroid therapy on the distribution of inhaled Tc-99m DTPA in asthmatic children. Twenty-one asthmatic children and 15 healthy controls were entered in this study. The distribution of radioaerosols was scored by using a modified standardized score system over both lungs and expressed as homogeneity score/patient. The baseline homogeneity score was calculated before the inhalation therapy of budesonide (400 micrograms/day) for six months. The homogeneity score was repeated at the end of the second and sixth months of therapy. Asthmatic symptom scores and peak-flow rate variability, which were observed to improve throughout the study, were also recorded. Although homogeneity scores of the controls demonstrated no abnormality, mean baseline homogeneity scores of asthmatics was significantly high, 1.7 +/- 0.4/patient, and decreased to 0.6 +/- 0.2 and 0.3 +/- 0.1/patient at the end of second and sixth months, respectively (p < 0.05). These results revealed significant improvement in the radioaerosol distribution after inhaled steroid therapy. It was concluded that the lack of homogeneity in the distribution of Tc99m-DTPA in the lung, as an indicator for ventilation defects, may be accepted as a useful, noninvasive tool to monitor the efficacy of the therapy with inhaled agents in childhood asthma.

Preoperative diagnosis of bronchial atresia presenting with recurrent respiratory symptoms in an infant

Bronchial atresia (BA) is a rare respiratory malformation that may be diagnosed from infancy to adulthood. A typical feature of the disease is involvement of the left upper lobe and a mass-like lesion surrounded by a hyperlucent and nondeflating zone. We present a six-month-old male infant who was diagnosed by contrast-enhanced spiral computed tomography (CT) with three-dimensional (3D) technology, and by Tc-99m-macroalbumin aggregate (Tc99m-MAA) radionuclide scintigraphy. We stress that early diagnosis of BA can be made noninvasively using contrast-enhanced spiral CT and radionuclide scintigraphy. 3D computed tomographic reformation allows a more accurate diagnosis as well as a more specific approach to management and follow-up.

Effect of enalapril on proteinuria, phosphaturia, and calciuria in insulin-dependent diabetes

Elevated urinary calcium and phosphate excretion have been observed in children with insulin-dependent diabetes mellitus (IDDM). This may be related to a defect in tubular reabsorption. It is well known that converting enzyme inhibition decreases microalbuminuria and may prevent or retard diabetic nephropathy. We investigated whether enalapril also improves the defect in calcium and phosphate reabsorption. We studied 16 children and young adults (age 12-21 years) with IDDM and persistent microalbuminuria before and during 12 weeks of enalapril treatment. Before treatment microalbuminuria, urinary calcium excretion, and fractional tubular phosphorus reabsorption (TPR) were 153+/-53 microg/min, 5.5+/-0.9 mg/kg per day, and 71.4+/-3.6%, respectively. At the end of the 12th week, microalbuminuria had decreased to 20.3+/-7.9 microg/min and calcium excretion to 3.3+/-0.4 mg/kg per day (P<0.01), while the TPR increased to 80.1+/-3.8% (NS). The renal threshold phosphate concentration increased from 1.8+/-0.15 to 2.92+/-0.23 mg/dl (P<0.01). The fasting serum glucose and hemoglobin Alc levels did not change significantly during the study. Systolic and diastolic blood pressures were 120.4+/-2.2 / 79.3+/-1.4 mm Hg and 110.5+/-1.8 / 71.3+/-0.9 mm Hg before and after 12 weeks, respectively. We conclude that enalapril treatment improves not only microalbuminuria but also abnormal calcium and phosphate excretion in microalbuminuric children with IDDM.

A case of Lenz microphthalmia syndrome

Lenz microphthalmia syndrome was first described by Lenz et al in 1955. The cardinal features of the syndrome are microphthalmia or anophthalmos, narrow shoulders, other skeletal anomalies, and dental and urogenital malformations. Here we present a case of Lenz microphthalmia syndrome who shows the typical characteristics and, additionally, dysgenesis of the corpus callosum associated with dilatation of the lateral ventricles. The patient, a 13 year old male, was referred to our hospital by a dental hospital for genetic counselling. On physical examination, height, weight, and head circumference were below the 3rd centile and he had brachymicrocephaly, a preauricular tag, microphthalmia, missing teeth, narrow shoulders, long, proximally placed thumbs, hypospadias, cryptorchidism, and a normal IQ. Ophthalmological examination showed microcornea, sclerocornea, absence of the pupil, no vision in the left eye and decreased vision and a small pupil in the right eye in addition to his bilateral microphthalmia. Cranial MRI showed dilatation of the lateral ventricles and dysgenesis of the corpus callosum.

Childhood asthma and atmospheric conditions

Bronchial asthma is the most common chronic respiratory illness in childhood. It is characterized by paroxysmal bronchospastic periods. There are many studies giving reasons to explain the bronchospasm periods. One of the reasons, atmospheric conditions, is effective in creating a clinical picture of asthmatic patients. In the present study, the correlation between atmospheric conditions and asthmatic symptoms in children was investigated using peak expiratory flow rate (PEFR) as the respiratory function test. Twenty-one children with bronchial asthma were monitored in the study. They were followed as outpatients of the Ege University Medical Faculty, Department of Pediatric Allergy and Pneumotology, between November 1993 and June 1994. Atmospheric conditions were recorded from the local meteorology center. Complaints and the PEFR of children were compared with the meteorological data. Asthmatic symptoms were increased by low temperatures in all asthmatic children. An increase was detected in the extrinsic group by relative humidity and ratio of cloud, but in the intrinsic group only by relative humidity.

A case of Marden-Walker syndrome with Dandy-Walker malformation

A 5-month-old girl with Marden-Walker syndrome is presented. This is a rare autosomal recessive syndrome. So far, approximately 20 cases have been described in the literature. The patient was hospitalized because of difficulty in feeding and slow spontaneous movements. Her parents were first cousins. She was diagnosed with clinical findings of growth and motor retardation, typical facial appearance, congenital heart disease, arachnodactyly, joint contractures, and a Dandy-Walker malformation on magnetic resonance imaging.

Long-term prognosis after a first myocardial infarction in Turkey: determinants of mortality and reinfarction

Long-term prognosis of a first myocardial infarction and factors associated with late cardiac mortality and reinfarction were studied in 718 survivors. Patients have been followed up for 1-10 years (mean 57.6 +/- 39.6 months). None of the patients underwent coronary bypass surgery in the follow-up period. Cumulative mortality rates were 8.6% in the first year, 17.9% in 3 years, 26.4% in 5 years and 36.5% in 10 years. The type and site of myocardial infarction (Q-wave versus non-Q-wave and anterior versus infero-posterior) were found to have no independent prognostic importance. The cardiac mortality was best predicted by the occurrence of congestive heart failure in the coronary care unit. Other determinants of late outcome were the presence of ventricular arrhythmias, left bundle branch block, and the occurrence of stable or unstable angina pectoris or reinfarction during the follow-up period. Usage of antiplatelet or anticoagulant drugs was not found to affect mortality. Reinfarction rates were 4, 9.9, 15.5 and 28% in 1, 3, 5 and 10 years, respectively, and no relation was found between the type and location of myocardial infarction and reinfarction rate. Reinfarction was higher in patients receiving anticoagulants and in patients with postmyocardial infarction angina. Our findings suggest that the prognosis of patients with a first acute myocardial infarction in Turkey is not different from that in Western populations and factors influencing prognosis are similar to those previously reported.