The relationship between dietary profile and adherence to the Mediterranean diet with EDSS and quality of life in multiple sclerosis patients: a retrospective cross-sectional study

BACKGROUND

Multiple sclerosis (MS), one of the main neurological causes of disability seen at young ages, affects the quality of life of patients. Studies on which dietary pattern or consumption of food groups may have an impact on quality of life for MS patients are insufficient. The study was conducted to determine the relationship between adherence to Mediterranean diet and consumption levels of food groups on quality of life in multiple sclerosis patients.

METHODS

This study was conducted with 95 patients, 76 females and 19 males, aged 18-65 years, who had been diagnosed with MS for at least 2 years and did not have any other chronic disease. Food Frequency Questionnaire, Mediterranean Diet Adherence Screener (MEDAS), Expanded Disability Status Scale (EDSS) and Multiple Sclerosis Quality of Life-54 Instrument (MS-QoL-54) used as tools. Data were analyzed by SPSS 25.0.

RESULTS

Adherence to the Mediterranean diet was associated with EDSS and physical and mental quality of life parameters (CPH and CMH), independent of progression. It was associated with EDSS and CMH in progressive MS. A statistically significant negative weak correlation was found between daily milk and oilseed consumption and EDSS. Daily fruit consumption was associated with CMH, and vegetable consumption was associated with both CPH and CMH.

CONCLUSIONS

The Mediterranean diet may be an effective nutritional model in MS patients and may be related to the disability level and quality of life of the patients. Some food groups can be associated with the quality of life and disability level of MS patients.

Improving health-care planning for fracture patients in Türkiye: insights from a nationwide study

BACKGROUND

The distribution of fractures may vary according to age and gender. In a country like Türkiye, which has high population density and covers a large geographical area, it is important to understand the regional variations in fractures and identify the health institutions in which patients seek treatment to plan new health-care investments effectively. The objective of our study was to investigate the distribution of fractures across the seven regions of Türkiye considering age, gender, and the level of health institutions the patients visited.

METHODS

Between January 2021 and May 2023, the total number of fractures, locations of the fractures, patient age and gender, geographical regions, and levels of the health-care institutions to which the patients presented were examined through the e-Nabız personal health record system. Age groups were divided into pediatric (0-19 years), adult (20-64 years), and geriatric (≥65 years) categories. Geographical regions included the Marmara, Central Anatolia, Black Sea, Eastern Anatolia, Aegean, Mediterranean, and Southeastern Anatolia regions.

RESULTS

A total of 2,135,701 patients with 2,214,213 fractures were analyzed. Upper extremity fractures were the most common among all considered fracture groups (1,154,819 fractures, 52.2%). There were 643,547 fractures in the pediatric group, 1,191,364 fractures in the adult group, and 379,302 fractures in the geriatric group. While the total number of fractures was higher among men with 1,256,884 fractures (58.9%), the rate among women was higher in the geriatric group (67.2%). Geographically, the highest number of fractures was observed in the Marmara region (714,146 fractures), and 67.92% of all patients presented to secondary health-care institutions (1,500,780 fractures). The most commonly diagnosed fracture in the study population was distal radius fractures. The most common fracture in the geriatric group was femur fractures while distal radius fractures were the most common fractures in the adult and the pediatric groups.

CONCLUSION

By understanding the distribution of fractures in Türkiye based on fracture site, geographical region, age, and gender, it becomes possible to improve the planning of patient access to health-care services. In regions with limited health resources, a more successful resource distribution can be achieved by considering fracture distributions and age groups.

Dietary quality and mindful eating among pregnant women with and without gestational diabetes

Objective: The incidence of gestational diabetes mellitus (GDM) is increasing in parallel with maternal obesity. The main components of treatment are monitoring blood glucose levels with medical nutrition therapy and lifestyle modification in order to prevent short- and long-term materno-fetal complications. This study aimed to compare the diet quality and mindful eating among pregnant women with and without GDM. Methods: This case-control study included 68 pregnant women. Each participant was face-to-face interviewed using a structured questionnaire to obtain socio-demographic information, general health information, nutritional habits, and registered three days of food record. Mindful Eating Questionnaire (MEQ) and Healthy Eating Index (HEI) were applied in order to assess mindful eating and diet quality, respectively. Results: Mean pre-pregnancy body mass index of women was 27.42+5.44 kg/m2, 66.7% of the gestational diabetes group and 29.4% of the control group was obese. Differences in HEI adequacy subgroup scores between the groups were significant. Mean MEQ scores were 2.85±0.34 and 3.13±0.44 in pregnant women with gestational diabetes and control cases, respectively (r=0.61, p=0003, p<0.05). Conclusion: Our results showed that pregnant women with gestational diabetes had lower mindful eating and diet quality scores.

The relationship between body image and anthropometric measurements among adolescent girls during menstrual and non-menstrualtime periods: a cross-sectional study

Introduction: In recent studies, it has been suggested that anxiety about body image increases during menstruation in adolescents and may affect nutritional status. This study aimed to evaluate the relationship between adolescents' body images, body perceptions and anthropometric measurements during menstrual and non-menstrual time periods. Methods: This cross-sectional study was carried out in a private high school between September-November 2021. Participants were adolescent girls aged 14-18. The questionnaire included information about menstruation, anthropometric measurements, and the Body Cathexis Scale (BCS) and Stunkard Figure Rating Scale. Results: The mean age (total=291) was 15.9(1.13) years, body mass index (BMI) was 21.13(3.33) kg/m2, waist circumference was 70.48(8.87) cm and the BCS was 97.39(24.59). The majority of students have normal BMI. However, according to waist circumference 28.5% of the them were obese (≥ 90th percentile). Difference between actual BMIs and body image in the menstrual period was significant (p<0.001), the agreement with each other was slight (K=0.172). There was a significant difference (p<0.001) between actual BMIs and body image in the non-menstrual period and the agreement with each other was moderate (K=0.474). During non-menstrual periods, 79.7% of students with normal BMI perceived their body images as normal, and 70.5% of overweight students perceived as overweight. Conclusions: Since the menstruation is a period in which body image is perceived differently than it is, special consideration of adolescent girls in terms for eating disorders should be encouraged.

AB1529-HPR CROSS-CULTURAL ADAPTATION, RELIABILITY AND CONVERGENT VALIDITY OF THE TURKISH VERSION OF THE PRIMARY SJOGREN’S SYNDROME QUALITY OF LIFE QUESTIONNAIRE

Background

To completely comprehend the burden of an illness and the success of its treatment, it is essential to analyze the patients’ perspective on health-related quality of life. Because of this, the Primary Sjögren’s Syndrome-Quality of Life questionnaire (PSS-QoL) was developed, which evaluates the disease’s physical and psychosocial effects in PSS patients.

Objectives

In the literature, there is no Turkish questionnaire evaluating quality of life in patients with PSS. Therefore, the aim of this study was to translate and evaluate cross-culturally adaptation the PSS-QoL into the Turkish language and investigate its convergent validity and reliability in Turkish-speaking population with PSS.

Methods

Patients completed PSS-QoL questionnaire, the EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI) and Euro-QoL 5D (EQ-5D). To test the convergent validity of PSS-QoL, correlation between PSS-QoL and EQ-5D and ESSPRI were assessed with Pearson correlation test. In order to investigate the internal consistency and test-retest reliability, Cronbach’s alpha and Intraclass Correlation Coefficient (ICC) values interpreted, respectively.

Results

Seventy-nine patients with PSS (53.30 + 11.98 years, 74F/5M) were enrolled in the study. Good and moderate correlations were found between the PSS-QoL and ESSPRI (r: 0.818, p<0.001) and EQ-5D-pain/ discomfort (r:0.589, p<0.001). Correlations of subscales of PSS-QoL with subscales of ESSPRI and EQ-5D ranged from fair to strong (Table 1). Cronbach’s alpha and ICC values of the PSS-QoL total score were found to be as 0.955 and 0.914, respectively, indicating excellent reliability.

Table 1.

Correlations of PSS-QoL and EQ-5D, ESSPRI

PSS-QoLPhysicalDiscomfortDrynessPsychosocialtotal scorePSS-QoLPSS-QoLPSS-QoLPSS-QoLEQ-5D-mobility0.543**0.514**0.678**0.761**0.891**EQ-5D-usual activities0.466**0.342*0.371**0.233*0.460**EQ-5D-pain/discomfort0.589**0.651**0.710**0.442**0.394**EQ-5D-anxiety/depression0.574**0.570**0.557**0.436**0.439**EQ-5D-HS-0.625**-0.540**-0.495**-0.437**-0.547**ESSPRI-dryness0.589**0.706**0.448**0.722**0.348*ESSPRI-pain0.673**0.694**0.824**0.421**0.494**ESSPRI-fatigue0.780**0.668**0.669**0.497**0.690**

EQ-5D, Euro-QoL-5 dimension; ESSPRI, EULAR Sjögren’s Syndrome Patient Reported Index; HS, health state; PSS-QoL, Quality of Life in Primary Sjögren’s Syndrome. *p<0.05, **p<0.001.

Conclusion

This study demonstrated that Turkish version of PSS-QoL is reliable and valid tool to assess quality of life in PSS patients. Therefore, PSS-QoL can be used to assess quality of life in Turkish-speaking PSS patients.

References

[1]Lackner A, Stradner MH, Hermann J et al. Assessing health-related quality of life in primary Sjögren’s syndrome—the PSS-QoL. In Seminars in arthritis and rheumatism 2018; Vol. 48, No. 1,105-110.

[2]Beaton DE, Bombardier C, Guillemin F et al. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine 2000; 25(24):3186-3191.

[3]Group, The EuroQol. EuroQol-a new facility for the measurement of health-related quality of life. Health policy 1990; 16.3: 199-208.

[4]Seror R, Ravaud P, Mariette X et al. EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI): development of a consensus patient index for primary Sjögren’s syndrome. Annals of the rheumatic diseases 2011; 70(6), 968-972.

Disclosure of Interests

None declared

AB0877-HPR EXERCISE COMPLIANCE AND DISEASE STATUS IN PATIENTS WITH RHEUMATIC DISEASES DURING COVID-19 PANDEMIC

Background:

The COVID-19 pandemic affects the whole world in many ways. In an effort to slow down the infection, physical distancing and isolation policies have been implemented in Turkey, likewise the rest of the world. Thereby, rheumatic diseases require to obey the self-isolation recommendations strictly due to general vulnerability to infections in those patients. Due to the precautions taken for isolation, the physical inactivity level of the patients which would affect the disease activity has increased (1).

Objectives:

The primary purpose of this study was to assess the exercise compliance and clinical status of the patients with rheumatic diseases during the COVID-19 pandemic. The secondary aim of the study was to evaluate the physical activity level and quality of life of the patients during the pandemic.

Methods:

The research is a cross-sectional study. Seventy-nine patients with various rheumatic diseases were included in the study. Standard questions were used to evaluate the exercise habits, the level of pain and morning stiffness and severity of exacerbations. Pain and morning stiffness levels and attack severity were scored on a numerical rating scale (NRS) (0-10; with 0 indicating no pain/stiffness and 10 severe pain/stiffness). Attack duration was recorded in number of exacerbated days. Parameters were compared before and after the pandemic with Paired Samples T Test. The International Physical Activity Questionnaire-Short Form (IPAQ) and Nottingham Health Profile (NHP) Questionnaire were filled to assess the physical activity level and quality of life.

Results:

Twenty-eight percent of the patients were diagnosed with Familial Mediterranean Fever (FMF), 37% were Ankylosing Spondylitis (AS), 14% were Systemic Sclerosis (ScS) 14% were Systemic Lupus Erythematosus (SLE), 6% were Rheumatoid Arthritis, 1% were Primary Sjogren Syndrome (PSS). Less than half of the patients (46%) did continue exercising regularly during the pandemic and 30 (81%) of them performed only the exercises given by the therapist while 7 (9%) of them tried different exercise types from another source. The reason for discontinuation to exercising expressed by the incompliant patients were mostly “unwillingness” (17 of 37 patients). Pain, morning stiffness and number of attacks were better during the pandemic compared to before however, a statistically significant difference was found only for morning stiffness (p = .036). The results of IPAQ showed that the majority of the patients (n: 48) were physically inactive, while only 2 patients were active during the pandemic. The most deteriorated quality of life subcategory was energy level of the patients according to the NHP scores.

Conclusion:

This study results showed that patients with rheumatic diseases stayed physically inactive during the pandemic and the disease status has also been affected negatively. As the duration of the pandemic prolongs, levels of physical inactivity would increase and the progressive physical inactivity is expected to worsen patients’ symptoms more. However, as the pandemic appears to continue, face-to-face exercise therapy should still be avoided. For all those reasons above, alternative ways of therapy like tele-rehabilitation would come onto stage to cope with the increasing physical inactivity of the rheumatic patients.

References:

[1]Pinto AJ, Dunstan DW, Owen N, Bonfá E, Gualano B. Combating physical inactivity during the COVID-19 pandemic. Nature Reviews Rheumatology. 2020; 16(7):1-2.

Disclosure of Interests:

None declared

Effect of adherence to carbohydrate counting on metabolic control in children and adolescents with type 1 diabetes mellitus

PURPOSE

Carbohydrate counting provides better glycemic control and flexibility than other food planning methods. Consistent adherence to such a complex method is difficult, especially for youth. However, studies that determine adherence to this method and whether it alters metabolic control are limited. The aim of the current study was to determine adherence to this method and investigate its effect on metabolic control, anthropometric measurements, insulin dose, and energy intake.

METHODS

In this prospective cross-sectional study, 53 children and adolescents with type 1 diabetes mellitus aged 2 to18 years and receiving intensive insulin therapy were trained and followed for 6 months. Demographics, anthropometrics, insulin requirements, hemoglobin A1c (HbA1c), fasting lipids, and food records at baseline and study conclusion were evaluated. At the end of the study patients were divided into adherer and nonadherer groups according to carbohydrate estimate deviations from standardized daily sample menus and calculations for accurate insulin doses. More than 10-g variation in daily consumed carbohydrate amount or failure to decide bolus insulin dose was defined as a nonadherer.

RESULTS

The mean HbA1c, low-density lipoprotein cholesterol, and body mass index standard deviation score changed after the carbohydrate counting training while the mean HbA1c between groups was significant (P<0.05). Total daily insulin doses increased, and the mean high-density lipoprotein cholesterol levels decreased in both groups. There were significant correlations between HbA1c and carbohydrate deviation scores as well as HbA1c and caregiver's education level.

CONCLUSION

Since adherence to carbohydrate counting may affect metabolic control, health professionals should evaluate and monitor carbohydrate counting skills of caregivers and patients in order to improve efficiency.

THU0608-HPR VALIDITY OF SIX MINUTE STEPPER TEST IN EVALUATION OF FUNCTIONAL EXERCISE CAPACITY IN PATIENTS WITH ANKYLOSING SPONDYLITIS

Background:

In most patients with ankylosing spondylitis (AS), exercise capacity decreases due to pulmonary dysfunction, chest wall restriction and peripheral muscle weakness. The six-minute walk test (6MWT) is a validated simple field, hence frequently used to evaluate exercise capacity. However, 6MWT has some limitations, especially the fact that it requires a corridor of at least 30 meters long to perform this test which can limit its use in some centers. Shorter corridors force patients to turn more frequently, slowing down the pace of walking that reduces potential walking distance. To overcome technical and spatial limitations, 6-minute stepper test (6MST) has been proposed to evaluate exercise capacity. In the literature 6MST has been suggested for a variety of diseases. Since, it requires only a limited amount of space and equipment and is feasible, easy to perform, well tolerated.

Objectives:

In the literature, there is no study in which 6MST is used to evaluate exercise capacities of patients with AS. Therefore, the aim of this study was to evaluate validity of 6MST in AS population in comparison to 6MWT.

Methods:

6MWT and 6MST were performed in 51 patients with AS (52.26±13.33 years, 30F/21M). Demographic and clinical characteristics were recorded. Functional exercise capacity was evaluated using 6MWT and 6MST. The total distance of 6MWT was compared to the total number of steps of 6MST. Before, during and after 6MWT and 6MST, heart rate (HR), oxygen saturation (SpO2), breathing frequency (BF), blood pressure (BP), dyspnea and fatigue were assessed using modified Borg scale.

Results:

The number of steps on the 6MST was significantly correlated with the distance of the 6MWT (r=0.61, p<0.0001). Dyspnea (p=0.04) and leg fatigue (p<0.0001) was significantly higher in 6MST than in 6MWT. HR, SpO2, BF, BP and fatigue were similar in both 6MST and 6MWT.

Conclusion:

The 6MST is a valid test to evaluate exercise capacity in patients with AS. It is also an appropriate alternative to the 6MWT for determining exercise capacity when the 6MWT is not feasible due to technical restrictions. The 6MST can be proposed as a new exercise capacity evaluation tool in AS, as it is valid, reliable, portable and inexpensive.

References:

[1]van der Esch, Martin, et al. Respiratory muscle performance as a possible determinant of exercise capacity in patients with ankylosing spondylitis. Australian Journal of Physiotherapy, 2004;50(1):41-46.

[2]ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166(1):111–117.

[3]Grosbois JM, Riquier C, Chehere B, et al. Six-minute stepper test: a valid clinical exercise tolerance test for COPD patients. Int J Chron Obstruct Pulmon Dis. 2016;11:657–663.

Disclosure of Interests:

None declared

THU0633-HPR CORE MUSCLE ENDURANCE IN PATIENTS WITH ANKYLOSING SPONDYLITIS

Background:

It is stated that the muscles responsible for spinal stability around the trunk show long-term activity at low intensity in daily life, therefore, endurance insufficiency can cause loss of functionality and spinal stabilization and may induce pain (1).

Objectives:

The primary purpose of this study was to compare the core muscle endurance of individuals with AS with the core muscle endurance of healthy individuals. The secondary aim of the study was to examine the association between core muscle endurance and balance, disease activity, spinal mobility, functional status, physical activity level and fatigue in individuals with AS.

Methods:

The research is a cross-sectional study. 41 patients with AS and 40 healthy controls were included in the study. The core muscle endurance of both groups was assessed with trunk extension test, trunk flexion test, right and left side plank tests (2). In addition, in the AS group relationship between core endurance and balance, thoracic kyphosis angle, disease activity, functionality, spinal mobility, physical activity and fatigue was examined. Balance was evaluated with BIODEX Balance Systems and thoracic kyphosis angle was evaluated with a digital inclinometer. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), International Physical Activity Questionnaire (IPAQ), Fatigue Severity Scale (FSS) were used to assess disease activity, functionality, spinal mobility, physical activity and fatigue respectively.

Results:

Significant differences were found between AS group and control group in core endurance were summarized in Table 1. Additionally, significant relationships were observed between core endurance and all the assessed parameters except thoracic kyphosis angle (p<0.05), (Table 2).

Table 1.

Comparision of Core Endurance between AS and Control Groups

AS Group (n=41)Median (IQR)Control Group (n=40)Median (IQR)PTrunk Extensor Test (sec)44.0 (12.0–77.5)98.25 (63.75-120.0)<0.001Trunk Flexor Test (sec)41.0 (15.0–66.0)93.0 (55.85-120.0)<0.001Dominant Side Plank Test (sec)29.0 (9.8–62.0)43.27 (28.57–68.25)0.046Non-Dominat Side Plank Test (sec)32.0 (10.0–61.32)41.25 (25.0- 62.37)0.092

p>0.05, Mann-Whitney U Test; AS: Ankylosing Spondylitis, IQR: Interquartile Range sec: seconds

Table.2

Association between core endurance and other parameters

Trunk Extensor TestTrunk Flexor TestDominant Side Plank TestNon-Dominant Side Plank TestPain (VAS)-0.535*-0.339*-0.369*-0.203Stiffness (VAS)-0.496*-0.234-0.377*0.224Overall Stability Index-0.480*-0.488*-0.725*-0.702*BASFI-0.505*-0.441*-0.562*-0.574*BASMI-0.587*-0.390*-0.613*-0.501*BASDAI-0.468*-0.202-0.433*-0.345*Kyphosis Angle(o)-0.262-0.287-0.215-0.258IPAQ-0.354*-0.355*-0.523*-0.451*FSS-0.545*-0.445*-0.542*-0.502*

*: Spearman’s Correlation Coefficient (rho), p<0.05; VAS: Visual Analog Scale, BASDAI: Bath Ankylosing Spondylitis Disease Activity Index, BASFI: Bath Ankylosing Spondylitis Functional Index, BASMI: Bath Ankylosing Spondylitis Metrology Index, IPAQ:International Physical Activity Questionnaire, FSS: Fatigue Severity Scale

Conclusion:

Core muscle endurance is lower in patients with AS and it is in relation with many factors regarding the disease. The use of these tests may provide additional information about the patients’ situation for clinicians.

References:

[1]Özyürek, S., D. Bayraktar, and A. Genç,Are the alterations in body posture related to decreased trunk muscleendurance in healthy young adults? Journal of back and musculoskeletal rehabilitation, 2018. 31(3): p. 431-436.

[2]McGill, S.M., Low back stability: from formal description to issues for performance and rehabilitation. Exercise and sport sciences reviews, 2001. 29(1): p. 26-31.

Disclosure of Interests:

None declared

Long-term results of scapulothoracic arthrodesis with multiple cable method for facioscapulohumeral dystrophy: do the results deteriorate over time?

Aims

The present study aimed to investigate the long-term functional results of scapulothoracic fusion using multifilament cables in patients with facioscapulohumeral dystrophy (FSHD) to identify if the early improvement from this intervention is maintained.

Patients and Methods

We retrospectively investigated the long-term outcomes of 13 patients with FSHD (18 shoulders) in whom scapulothoracic fusion using multifilament cables was performed between 2004 and 2007. These patients have previously been reported at a mean of 35.5 months (24 to 87). There were eight men and five women with a mean age of 26 years. Their mean length of follow-up of our current study was 128 months (94 to 185). To evaluate long-term functional results, the range of shoulder flexion and abduction, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were analyzed with a comparison of preoperatively, interim and at the final outcomes. The fusion was examined radiographically in all.

Results

The complication rate was 33% (six of 18 scapulothoracic fusions) in 13 patients, which comprised failure of fusion in four shoulders (four patients) all occurring within the first year postoperatively. In two shoulders (one patient) wound problems arose due to attribution from the cables which required shortening but the fusion developed satisfactorily. At the final examination, the mean QuickDASH score and range of movement significantly improved in all but one patient (p < 0.001, p < 0.001 and p < 0.001). In the comparison of 13 patients' mid- and long-term results, the mean QuickDASH score decreased from 9.8 (sd 6.7; 3 to 26) in the third year to 9.1 (sd 5.6; 3 to 22) in the tenth year (p = 0.7); the mean range of shoulder flexion and abduction decreased from 129° (sd 22°; 90° to 160°) and 124° (sd 12; 100° to 150°) at the mid-term to 103° (sd 12°; 80° to 120°) and 101° (sd 8°; 80° to 120°) at the long-term, respectively (p = 0.78 and p = 0.65).

Conclusion

Scapulothoracic fusion using a multiple cabling method can confer a considerable improvement in clinical and functional outcomes for most patients with FSHD after a long follow-up period. The technique requires careful execution to avoid complications. Cite this article: Bone Joint J 2018;100-B:953-6.

Investigation of genotoxic effects of doripenem using cytogenetic and molecular methods

The main aim of this study was to investigate the genotoxic effects of doripenem (DRP) using both cytogenetic and molecular test systems. Although there have been some studies reporting the effects of DRP, none of them has shown the genotoxic effects of DRP. In order to achieve the main aim of the study, the human peripheral lymphocytes were treated with 100 μg/ml, 200 μg/ml, and 400 μg/ml concentrations of DRP for 24 and 48 hours, and the chromosome aberration (CA) and micronucleus (MN) methods were used as the cytogenetic tests and RAPD-PCR method was used as the molecular test to determine the genotoxic effects of DRP. DRP did not induce the chromosome aberrations and micronucleus frequencies at all concentrations and at all treatment periods. So, it was concluded that DRP did not show any cytotoxic effect. However, DRP increased the number of polymorphic bands and decreased the ratio of genomic template stability, especially at the 48-hour treatment period. In this study, according to the obtained results, it was determined that DRP failed to show any genotoxic risk at the therapeutic doses. This result also indicates that DRP could be a reliable antibiotics according to its rapid metabolism.

Alterations on high HbF levels may be associated with KLF1 gene mutations

The KLF1 gene synthesizes a transcription factor in the zinc finger structure that regulates the transcription of β-, γ-globin, and Foxm1 genes. This factor plays an important role in the erythropoiesis mechanism by modifying the chromatin structure and is involved in the regulation of transcription in the opening of the β-globin gene. β-globin gene expression could be disrupted by a mutation, which may be a possible cause of a disruption in regulation of the promotor of the β-globin gene where the KLF1 transcription factor binds. This can lead to an inherited high fetal hemoglobin (HbF) ratio in people. Therefore, the main aim of this study was to determine the effects of KLF1 mutations on these high levels of HbF. In this study, in order to determine the relationship between the KLF1 mutations and the high HbF levels three exons along with the 5'-UTR and 3'-UTR regions of the KLF1 gene were sequenced of 53 volunteers. In this study, 3 variations in the non-coding regions of the KLF1 gene were not associated with a high level of HbF. Five variations were detected in the second exon of KLF1 gene. One of these is a frame shift that occurs when GG bases are inserted between the 59-60 codons, and the other four variations occur as a base substitution variations.  No correlation was found between high HbF levels and neutral variants. Only polar-nonpolar amino acid changes were found at two points. At one of them, a significant drop in the high HbF levels was observed, while the other was observed to be high near to the critical limit. These findings suggested that variations in function of the KLF1 gene can alter the HbF levels.

Alterations on high HbF levels may be associated with KLF1 gene mutations

The KLF1 gene synthesizes a transcription factor in the zinc finger structure that regulates the transcription of β-, γ-globin, and Foxm1 genes. This factor plays an important role in the erythropoiesis mechanism by modifying the chromatin structure and is involved in the regulation of transcription in the opening of the β-globin gene. β-globin gene expression could be disrupted by a mutation, which may be a possible cause of a disruption in regulation of the promotor of the β-globin gene where the KLF1 transcription factor binds. This can lead to an inherited high fetal hemoglobin (HbF) ratio in people. Therefore, the main aim of this study was to determine the effects of KLF1 mutations on these high levels of HbF. In this study, in order to determine the relationship between the KLF1 mutations and the high HbF levels three exons along with the 5'-UTR and 3'-UTR regions of the KLF1 gene were sequenced of 53 volunteers. In this study, 3 variations in the non-coding regions of the KLF1 gene were not associated with a high level of HbF. Five variations were detected in the second exon of KLF1 gene. One of these is a frame shift that occurs when GG bases are inserted between the 59-60 codons, and the other four variations occur as a base substitution variations.  No correlation was found between high HbF levels and neutral variants. Only polar-nonpolar amino acid changes were found at two points. At one of them, a significant drop in the high HbF levels was observed, while the other was observed to be high near to the critical limit. These findings suggested that variations in function of the KLF1 gene can alter the HbF levels.

The analysis of lncRNA HOTAIR rs12826786 C>T polymorphism and gastric cancer susceptibility in a Turkish population: lack of any association in a hospital-based case-control study

BACKGROUND

The HOX transcript antisense intergenic RNA (HOTAIR), a well-known long noncoding RNA (lncRNA), has been widely identified to participate in pathogenesis of multiple cancers. An aberrant up-regulation and biological functions have been observed in gastric cancer (GC). A common single nucleotide polymorphism (SNP) (rs12826786 C>T) at the HOTAIR has been reported to influence HOTAIR expression, but its association with GC has yet to be investigated in Turkish population.

AIM

The aim of the present study was to investigate whether HOTAIR rs12826786 C>T polymorphism could be involved in the risk of GC susceptibility in Turkish population.

METHODS

We genotyped HOTAIR rs12826786 C>T polymorphism in 312 Turkish individuals including 105 GC patients and 207 healthy controls matched on age and gender by a Real-Time Polymerase Chain Reaction (PCR) with the TaqMan assay.

RESULTS

No statistically significant differences were found in the allele or genotype distributions of the HOTAIR rs12826786 C>T polymorphism among GC and healthy control subjects (P > 0.05).

CONCLUSIONS

Our results demonstrate that the HOTAIR rs12826786 C>T polymorphism has not been in any major role in genetic susceptibility to gastric carcinogenesis, at least in the population studied here. Independent studies are needed to validate our findings in a larger series, as well as in patients of different ethnic origins.

Relationship between programmed cell death-1 polymorphisms and clearance of hepatitis B virus

Programmed cell death-1 (PD-1) plays a critical role in regulating T-cell function during hepatitis B virus (HBV) infection. This study investigated the relationship between the polymorphisms of PD-1 gene and the susceptibility to HBV infection. Single nucleotide polymorphisms (SNPs) in PD-1 gene at positions +7146 G>A (guanine to adenine substitution) and +7209 C>T (cytosine to thymine substitution) were analysed using a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method in 220 subjects with chronic hepatitis B infection and 165 spontaneous clearance of HBV subjects. However, no statistically significant differences were found in the genotype distributions of the PD-1 +7146 G>A and PD-1 +7209 C>T polymorphisms among chronic hepatitis B and spontaneous clearance subjects. According to stratified analyses, borderline significance was observed between PD-1 +7146 GA genotype and risk of HBV chronicity in the subgroup of male gender (OR = 1.88, 95% 0.95-3.71; P = 0.07). Our findings demonstrate for the first time that the PD-1 +7146 G>A and PD-1 +7209 C>T polymorphisms have not been any major role in genetic susceptibility to chronicity of HBV infection, at least in the population studied here. Independent studies are needed to validate our findings in a larger series, as well as in patients of different ethnic origins.

Relationship between P561T and C422F polymorphisms in growth hormone receptor gene and mandibular prognathism

OBJECTIVE

To evaluate the allele and genotype frequencies of the P561T and C422F polymorphic sites of the growth hormone receptor (GHR) gene and the relationship between mandibular prognathism (MP) and these two single-nucleotide polymorphisms (SNPs).

MATERIALS AND METHODS

A total of 99 subjects with severe skeletal Class III MP who planned to undergo orthognathic surgery and 99 subjects with Class I occlusion were examined in this study to evaluate the relationship between MP and two SNPs in exon 10 of the GHR gene. GHR was chosen as a candidate gene because growth hormone plays an important role in cartilage growth. A blood sample was used to extract genomic DNA, and the polymerase chain reaction-restriction fragment length polymorphism method was used to determine genotypes of P561T and C422F. The Minitab 14.0 packet program was used to perform statistical analysis.

RESULTS

Allele frequencies of the C422F and P561T variants were determined. Because of the low allele frequency of the control group, statistical analysis could not be performed to test the difference between MP and control groups. Therefore, the data were combined to determine the association between the P561T polymorphism and craniofacial measurements. Effective mandibular length (condylion-gnathion) and lower face height (anterior nasal spina-menton) were associated with the P561T variant.

CONCLUSION

This finding supports that the GHR might be a candidate gene for mandibular morphogenesis in this population.

Long-term stability of dentoalveolar, skeletal, and soft tissue changes after non-extraction treatment with a self-ligating system

OBJECTIVE

To evaluate the long-term effects of self-ligating brackets (SLBs) on transverse dimensions of arches and skeletal and soft tissues and to quantitatively evaluate the treatment outcome after non-extraction treatment with SLBs.

METHODS

The sample consisted of 24 (18 female and six male) subjects, with a mean age of 14.23 ± 2.19 years, who received treatment with the Damon®3 appliances. Complete records including cephalometric radiographs and plaster models were obtained before treatment (T1), immediately after treatment (T2), six months after treatment (T3), and two years (T4) after treatment. Digital study models were generated. Twenty lateral cephalometric, six frontal cephalometric, and eight dental cast measurements were examined. The Peer Assessment Rating index was used to measure the treatment outcome. The Wilcoxon test was applied for statistical analysis of the changes.

RESULTS

There were significant increases in all transverse dental cast measurements with active treatment. There was some significant relapse in the long term, particularly in maxillary width (p < 0.05). Statistically significant increases were found in nasal (p < 0.001), maxillary base, upper molar, lower intercanine, and antigonial (p < 0.05) widths in T1-T2. Lower incisors were proclined and protruded in T1-T2.

CONCLUSIONS

SLBs correct crowding by mechanisms involving incisor proclination and protrusion and expansion of the dental arches, without induction of clinically significant changes in hard and soft tissues of the face.

A functional polymorphism in pre-microRNA-196a-2 contributes to the susceptibility of hepatocellular carcinoma in a Turkish population: a case-control study

MicroRNAs (miRNAs) are an abundant class of small nonprotein-coding RNAs with posttranscriptional regulatory functions as tumour suppressors and oncogenes. Aberrant expression and structural alteration of miRNAs are thought to participate in tumourigenesis and cancer development. It has been suggested that the presence of single-nucleotide polymorphisms in precursor miRNAs (pre-miRNAs) can alter miRNA processing, expression, and/or binding to target mRNA and represent another type of genetic variability that can contribute to the development of human cancers. Recent studies have indicated that the miR-196a-2 rs11614913 (C→T) polymorphism could alter mature miR-196a-2 expression and target mRNA binding. To determine the association of the miR-196a-2 rs11614913 polymorphism with the risk of hepatocellular carcinoma (HCC) development in a Turkish population, a hospital-based case-control study was designed consisting of 185 subjects with HCC and 185 cancer-free control subjects matched for age, gender, smoking and alcohol status. The genotype frequency of the miR-196a-2 rs11614913 polymorphism was determined by using a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay. Our data shows that the CC genotype of the miR-196a-2 rs11614913 polymorphism is associated with increased risk of HCC development in this Turkish population (OR = 2.41, 95% CI: 1.30-4.50, P = 0.005). Furthermore, according to stratified analysis, a significant association was observed between the homozygote CC genotype and HCC risk in the subgroups of male gender (OR = 3.12, 95% CI: 1.53-6.34, P = 0.002) and patients with hepatitis B virus (HBV)-related HCC (OR = 2.88, 95% CI: 1.33-6.22, P = 0.007). Because our results suggest for the first time that the miR-196a-2 rs11614913 polymorphism may be a genetic susceptibility factor for HCC (especially in the male gender and HBV-infected patients) in the Turkish population, further independent studies are required to validate our findings in a larger series, as well as in patients of different ethnic origins.

Nitrogen recovery from source-separated human urine using clinoptilolite and preliminary results of its use as fertilizer

The use of source separated human urine as fertilizer is one of the major suggestions of the new sanitation concept ECOSAN. Urine is rich in nitrogen, phosphorus and potassium which act as plant nutrients, however its salinity is high for agricultural and landscape purposes. Moreover, characteristics change significantly throughout storage where salinity increases to higher values as the predominant form of nitrogen shifts from urea to ammonium. Transferring nitrogen in human urine onto the natural zeolite clinoptilolite and using the subsequently recovered ammonium from the exhausted clinoptilolite for agricultural/landscape purposes is suggested as an indirect route of using urine in this work. Results reporting the outcome of the proposed process together with characterization of fresh and stored urine, and preliminary work on the application of the product on the landscape plant Ficus elastica are presented. Up to 97% of the ammonium in stored urine could be transferred onto clinoptilolite through ion exchange and about 88% could be recovered subsequently from exhausted clinoptilolite, giving an overall recovery of 86%. Another important merit of the suggested process was the successful elimination of salinity. Preliminary experiments with Ficus elastica had shown that the product, i.e. clinoptilolite exhausted with ammonium, was compatible with the synthetic fertilizer tested.

Relationship between functional polymorphism in the Aurora A gene and susceptibility of hepatocellular carcinoma

Aurora A is considered a potential cancer susceptibility gene owing to overexpression or amplification of Aurora A gene that causes centrosome dysfunction, chromosome instability, tumourigenic transformation and checkpoint abnormalities. Functional coding region polymorphism F31I in the Aurora A gene has recently been shown to be associated with several human cancers, but its association with hepatocellular carcinoma (HCC) has yet to be investigated. Genetic polymorphism of Aurora A was investigated in 128 confirmed subjects with HCC and 128 cancer-free control subjects matched on age, gender, smoking and alcohol consumption by using a polymerase chain reaction-restriction fragment length polymorphism assay. Allele and genotype associations of Aurora A F31I polymorphism with HCC susceptibility were observed in comparisons between the patient and control samples (respectively; P = 0.005, P = 0.012). The proportion of the genotypes containing I31 allele in patients with HCC (39.8%) was significantly higher than that in patients without HCC (22.7%) (P = 0.003). The distribution F31I genotype was significantly associated with increased risk of HCC (P = 0.003, odds ratio = 2.26, 95% confidence interval = 1.31-3.90 for FI + II genotypes vs FF genotype). Our results suggest for the first time that the Aurora A F31I polymorphism may be a genetic susceptibility factor for HCC.

Production of monoclonal antibodies against a 19-kD recombinant Plasmodium vivax MSP1 for detection of P. vivax malaria in Turkey

Plasmodium vivax malaria, which is transmitted to humans by mosquitoes, is one of the most important parasitic diseases in Turkey. The major protein on the surface of asexual erythrocytic stage merozoites of P. vivax (Pv) is 200 kD and called major merozoite surface protein-1 (PvMSP1). Polyclonal antibodies against the 19-kD C-terminal fragment of PvMSP1 (PvMSP1(19)) are protective in monkey models of P. vivax and associated with protection in field studies. In this research, monoclonal antibodies were produced against PvMSP1(19). A total of 214 IgG(1) antibody-releasing hybridomas were obtained and three monoclonal antibodies were produced (PvMSP1(19).1, PvMSP1(19).2, and PvMSP1(19).3) and selected for further study. They have now been purified from ascitic fluid on a Staphylococcus protein A affinity column. These are the first monoclonal antibodies produced against P. vivax in Turkey and the first monoclonal antibodies produced against this recombinant PvMSP1(19) in the world. The monoclonal antibodies will be used to study the epidemiology of P. vivax in patients with malaria in Turkey, and to develop better strategies for early diagnosis and treatment of the disease in our population.

Removal of ammonium from human urine through ion exchange with clinoptilolite and its recovery for further reuse

Ammonium, from separately collected human urine, had been removed through transfer onto the ammonium selective natural zeolite, clinoptilolite, through ion exchange. In the subsequent treatment steps of washing with tap water, ammonium removed from urine was eluted from the surface of the clinoptilolite to be recovered for further reuse. Different quantities of clinoptilolite were used for a survey of the capacity of the zeolite for the process and to identify removal efficiencies based on initial ammonium loads. The highest surface concentration attained under experimental conditions employed was 15.44 mg ammonium per gram of clinoptilolite for an initial concentration of 110 mg ammonia per litre, and the highest removal was 98%, obtained for a loading of 1 mg ammonium per gram clinoptilolite. In the subsequent elution process, better removals were observed as pH was increased and the highest removal was attained at pH 13. The recovery was calculated as 9.73 mg ammonium per gram of clinoptilolite, corresponding to an efficiency of 63% only through washing with tap water. The results have given positive indications for the possibility of using ion exchange with clinoptilolite for the removal of ammonium from human urine and an incentive for improving methods of elution for its recovery for further reuse.