Why Turkish Parents Refuse Childhood Vaccination? A Qualitative Study

BACKGROUND

Anti-vaccination is spreading among parents. In 2017, 23000 families in Turkey refused vaccinations for their children. Meanwhile an increase in infectious diseases was observed, which might be caused by vaccination rejection. The reasons why families do not vaccinate their children may be very different, such as side effects, or advocation for "healthy life" by gurus. However, the real reasons for vaccine refusal are unknown. Our aim is to determine the reasons for anti-vaccination in Turkey.

METHODS

In order to reveal the real reasons for not taking the vaccine, we planned to conduct interviews with the representatives of the vaccine rejection group using qualitative research methodology with the "grounded theory" method. We searched some anti-vaccination blogs to find candidates for interviews. Within the scope of our study, parental concerns about vaccinations were classified by analyzing the data obtained from semi-structured questions and interviews recorded with voice recorders in face-to-face interviews with 21 parents in 13 cities of Turkey.

RESULTS

The obtained findings were classified under the headings of ''mistrust'', ''vaccine efficacy-importance'', ''decision-making processes - bases'', and ''law-ethics''. Mistrust was the main theme, almost singularly, as the most important reason for vaccine rejection. The salient reasons for mistrusts were: Companies which produce vaccines especially international companies because of conspiratory beliefs; health authorities, because of the belief about non-transparency in epidemiologic data, immunization council etc. and healthcare professionals, because of their non-communicative and non-concerned attitude.

CONCLUSION

Mistrust is hard to overcome. The beliefs of the patients cannot be easily changed. As a result of our study, we made some recommendations for health authorities, healthcare professionals, companies and other related stakeholders.

The Development of Family Medicine Identity Scale

Aim: It is to put a scale into the use of the academic community which measures how well the doctors can interiorize the features concerning family practice the training of family practice specialization in our country, by developing a family practice identity scale that is peculiar to Turkey. Methods: Our research is the study of developing a scale. A 5-point Likert scale is generated by creating the questionnaire and then the aforementioned scale is studied to verify the validation and reliability in Turkey. The scale has been performed on 351 people who work as academicians, specialists and residents in the field of family practice. Results: During the analyses, while the first four factors whose eigenvalues are the highest are kept fixed, the questions from the other factors are distributed according to their content similarities. As a result, forty-six questions is obtained. Kaiser-Meyer-Olkin value conformity assessment the result was obtained at a very good level (KMO: 0.940) and Cronbach's alpha value was calculated as 0.952. The sub-scales are named by the contents of the questions: Patient-doctor communication, professional satisfaction, the scope of the working area and comprehensive approach, and biopsychosocial approach. It has been concluded that the scale is a valid and reliable questionnaire in Turkey after these advanced statistical analyses. Conclusion: "The Scale of Family Practice Identification" is developed successfully. With the aforementioned scale, by observing the professional progress of residents, the doctors that have an occupational identity and sense of belonging can be trained for the community of family practice. Keywords: family practice, reliability and validity, scales

Thiol levels in mild or moderate COVID-19 patients: A comparison of variant and classic COVID-19 cases

BACKGROUND

Various variants of the COVID-19 have started to attract attention recently. The clinical course of these variants and possible predictive parameters are being investigated. This study aimed to examine the relationship between thiol levels, which are indicators of oxidative stress, and variant COVID-19 types.

METHODS

In this cross-sectional study, patients with a diagnosis of classic COVID-19 and patients with a diagnosis of variant COVID-19 with mild and moderate symptoms followed in the clinical observatory of Ankara city hospital were included in the study group. The patients were divided into two groups according to the COVID-19 type as a variant and classic COVID-19, and a healthy control group was added for comparison. A complete blood count and thiol analysis were performed from the venous blood samples. Obtained results were compared between groups, and the ROC analysis was performed.

RESULTS

Thiol levels were significantly lower in patients with a diagnosis of COVID-19 compared with the control group. In terms of WBC, lymphocyte, neutrophil, NLR, ferritin and thiol parameters, patients with variant COVID-19 differed significantly from patients with a classic COVID-19 diagnosis. Thiol levels' cut-off values to distinguish between variant COVID-19 patients and control group from classical COVID-19 patients were almost identical (423 and 422 µmol/L, respectively).

CONCLUSIONS

It seems possible to use thiol as a sensitive, specific and cost-effective marker to suspect variant COVID-19 cases. Since this study is probably the first example in this subject, it would form a basis for further studies.

Family planning practices and opinions on population growth of family planning healthcare providers in Turkey

The purpose of this study was to investigate the opinions of health professionals (HPs) who provide family planning counselling (FPC) within the scope of primary health care services since they are perceived as role models by the society. The number of HPs providing family planning counselling in primary health services in Turkey was 43,000 and 40,000 of these individuals were invited to participate in this observational, cross-sectional study via e-mail and social media. There were 740 responders and all were included in the study. Physicians providing FPC within the scope of primary health care services consisted of 45.1% of the responders and the remaining were nurses. Among all HPs, 59.7% had insufficient awareness regarding Turkey's population growth. Most of the HPs (52.4%) believed that the ideal number of children was 2 or less. The abortion rate was 9.1% in all pregnancies of HPs. The rate of caesarean section was 56% in all live births. According to responses, 75.6% of all pregnancies experienced by HPs were planned. According to 42.1% of the HPs, abortion must be performed if there is a life-threatening situation for the mother or if the fetus has some abnormalities. The most common method of birth control used by married HPs between the ages of 18 and 49 was male condoms (39.9%), while the pull-out method ranked first in the general population (25.5%). It was found that HPs, who had different opinions and practices about family planning than the general population, had insufficient awareness regarding population growth. Increased awareness of demography and FPC among HPs will likely contribute to the quality of service and the general wellbeing of the population.

Factors Affecting the Behavior and Duration of Breastfeeding Among Physician Mothers

BACKGROUND

Increasing breastfeeding duration may help physician mothers better counsel their patients. To improve the breastfeeding duration of physician mothers, the factors that may influence their breastfeeding duration should be known.

RESEARCH AIM

To investigate the breastfeeding behavior and duration among physician mothers and to determine the factors that influence breastfeeding practices.

METHODS

This was an online prospective cross-sectional self-report survey. A 26-item author-created data-collecting tool inquiring sociodemographic and work characteristics, medical history of delivery, and breastfeeding history was sent to female physicians who had infants between 12 and 60 months of age via an online social group, "Physician Mothers," with 11,632 members. Participants (N = 615) responded, and descriptive statistics were analyzed.

RESULTS

Participants' mean duration of exclusive breastfeeding was 4.8 months (SD = 1.9). The total breastfeeding length was a mean 15.8 months (SD = 7.6). The rate of breastfeeding duration for at least 24 months was 17.8% (n = 75). The most common reason for weaning from breastfeeding was workplace-related conditions (23.6%, n = 145). Participants reported that the mean time of resuming night shifts after delivery was 8.6 months (SD = 4.7). The rate of participants who were unable to use their breastfeeding leave rights partially or completely was 43.6% (n = 268).

CONCLUSION

Although legislation is in place to allow working mothers to breastfeed their infants, these legal rights were not used properly. Physician mothers should be fully supported in using their breastfeeding leave rights, and workplace conditions should be improved to enable physician mothers to breastfeed their infants for extended periods.

AB0812 IS THE VISCERAL ADIPOSITY INDEX ASSOCIATED WITH THE PRESENCE OF CARDIOVASCULAR RISK SCORES AND COMORBIDITY IN PSORIATIC DISEASE?

Background:

Psoriatic disease (PsD) is a chronic immune-mediated inflammatory disorder and predominantly involves the skin and joints. There is a better known relationship between the severity of PsD with some comorbidities such as metabolic syndrome, cardiovascular disease and obesity. Visceral Adiposity Index (VAI) has been shown to be an important marker, gender- dependent for insulin resistance, adipose tissue function and distribution.

Objectives:

The aim of this study was to evaluate the relationship between the VAI and cardiovascular risk scores of patients with psoriatic arthritis.

Methods:

This study was conducted with 101 PsD patients who fulfilled the classification criteria for Psoriatic Arthritis (CASPAR) criteria and 98 healthy subjects. Demographic and clinical data were recorded. Disease activity was evaluated with the Health Assessment Questionnaire (HAQ), Disease Activity Index for Psoriatic Arthritis (DAPSA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Disease Activity Index (BASFI) and Psoriasis Area Severity Index (PASI). The SCORE, Framingham index, metabolic syndrome (MetS), Body mass index (BMI) and VAI values of the patients and the VAI values of the healthy subjects were calculated.

Results:

Mean BMI (kg/m2) was calculated as 29.63 5.66. According to the SCORE measurements, 53 (52.5%) patients were at low risk, 45 (44.6 %) at moderate risk, and 3 (3 %) at high risk. No patients were at very high risk. According to the Framingham score, 72 patients (71.3%) were at low risk, 22 patients (21.8%) at intermediate risk and 7 patients (6.9%) at high risk. The risk was found to be statistically significantly higher in the PsD group compared to the healthy control group in respect of metabolic syndrome, obesity (BMI >30) and VAI levels (p<0.05). Significantly higher VAI levels were determined in PsD patients with metabolic syndrome, BMI> 30 (obesity), diabetes mellitus and hypertension compared to without these comorbidities (p<0.05). A statistically significant correlation was determined between low and moderate risk Framingham score, and the VAI levels of PsD patients. Correlations were determined between disease activity and metabolic and cardiovascular risks of patients. A weak correlation was observed between VAI levels and the Framingham score (Table).

Conclusion:

Patients with psoriasis are more susceptible to obesity and other diseases such as metabolic syndrome, dyslipidemia, cardiovascular diseases, insulin resistance and diabetes. Therefore, control of bodyweight in PsD patients is important for management of the disease. Since VAI can be calculated simply from routinely taken measurements, the VAI level can be used to determine cardiovascular risk and VAI may also provide clues about comorbidities in patients with newly diagnosed PsD.

Table.

Correlations (r) between disease activity and metabolic and cardiovascular risks of patients

ParametersBASDAIPASIDAPSABASFIHAQVAISCOREFramingham risk scoreFramingham risk score0.020.0950.285**0.202**0.0670.299**0.5231SCORE-0.079-0.0260.0950.065-0.010.05810.523**VAI0.1280.1920.1010.1050.01910.0580.299**HAQ0.1290.1350.421**0.284**10.019-0.010.067BASFI0.764**0.140.484**10.284**0.1050.0650.202*DAPSA0.462**0.341**10.484**0.421**0.1010.0950.285**PASI0.09210.341**0.1400.1350.192-0.0260.095BASDAI10.0920.462**0.764**0.1290.128-0.0790.024

Abbreviation; VAI: Visceral Adiposity Index, SCORE: Systematic Coronary Risk Evaluation Index, Health Assessment Questionnaire (HAQ), Disease Activity Index for Psoriatic Arthritis (DAPSA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Disease Activity Index (BASFI) and Psoriasis Area Severity Index (PASI).*p<0.05, **p<0.001

Disclosure of Interests:

None declared

Awareness, Treatment and Control Rates of Hypertensive Patients in Ankara

Aim: It was aimed to evaluate the awareness levels of patients about hypertension, treatment and control rates. Methods: The descriptive study included 203 patients between ages of 35–80 with a previous diagnosis of hypertension to the primary care outpatient clinic of Ankara Numune Training and Research Hospital in September 2011-January 2012. A 42-item questionnaire was used and 19 questions were used to determine the level of awareness among them. Nine measurements were in the office by the researcher and 12 measurements at home by the patient. Results: 25.6% of the patients were males and 74.4% were females. The median age was 59 years (IQR=13). The section for scoring the awareness levels revealed following: 27.1% of patients were non-aware, 58.6% had a low level of awareness and 14.3% had a high level of awareness. 72.9% of the patients were aware, 93.1% were taking antihypertensive treatment, while 42.4% measured blood pressures both at home and at office are under control. Awareness level is related to diet, exercise, education, salt usage, blood pressure measurement frequency, doctor referral frequency, education and knowledge level about hypertension, blood pressure monitoring branch, antihypertensive treatment status, hypertension duration, number of antihypertensive drugs and regular usage rates; but hypertension control was only associated with salt use, antihypertensive treatment and number of antihypertensive drugs. Conclusion: Hypertension is a common problem in our country and as we have seen in our studies, awareness rates are insufficient. Although the treatment rates are high, the control rates are not sufficient. This suggests that patients' compliance with treatment is not at the desired level. The most important thing to do in this regard is to raise awareness by increasing public awareness about hypertension. In this respect, primary care physicians have a great responsibility.

The impact of circulating 25-hydroxyvitamin and oral cholecalciferol treatment on menstrual pain in dysmenorrheic patients

This study aims to determine Vitamin-D level in patients with primary dysmenorrhea and investigate the effect of Vitamin-D replacement on symptoms. About 100 patients in the 18-30 age group followed-up with primary dysmenorrhea diagnosis were included in this observational study. The pain severity was assessed using the visual analog scale (VAS). 25-hydroxy vitamin D(25(OH)D) levels of the patients were measured and the replacement therapy was applied according to measurement results. The patients were followed for three months in total. At the end of the three-month period, the 25(OH)D level was measured and the VAS score was assessed once more after the therapy. 25(OH)D level was insufficient in 23.0%, deficient in 45.0%, and severely deficient in 32.0% of the patients. It was found that the VAS score increased as the 25(OH)D level decreased (r = -0.320; p = .002). A significant reduction was observed in VAS scores after Vitamin-D treatment in all three groups; the amount of reduction in VAS score was determined to be higher in the patients with severely deficient levels of 25(OH)D, compared to the patients with deficient or insufficient levels (p < .001). A significant and negative correlation was found between Vitamin-D and symptoms associated with dysmenorrhea in our study. The Vitamin-D replacement therapy led to a significant decrease in symptoms.

Early Results of Valved Bovine Jugular Vein Conduit for Right Ventricular Outflow Tract Reconstruction

Objective

Many congenital cardiac anomalies present with accompanying severe right ventricular outflow tract (RVOT) obstruction or interruption requiring surgical correction. RVOT reconstruction by means of a conduit is often necessary in the majority of these patients in the early years of life and there are several proposed conduits for this purpose.

Methods

Fourteen patients with different congenital cardiac pathologies underwent RVOT reconstruction with the newly developed bovine valved jugular vein conduit (The Contegra conduit). The function of the conduit is observed by echocardiographic examinations at the hospital discharge and at follow-up visits with special attention to the function of the venous valve and to any gradient on the RVOT.

Results

There were two perioperative mortalities. All the surviving patients are followed for a mean period of 8.07 months (range 2 to 33 months). The function of the venous valve was determined, in 4 patients (33.33%) as without regurgitation, in 7 patients (58.3%) as mild regurgitation and in 1 patient (8.33%) as mild-to-moderate regurgitation. The reconstructed RVOT was free of any significant gradient at the hospital discharge (mean 10.83 ±10.18 mmHg) and at the follow-ups (mean 12.916 ±12.33 mmHg). There was not a trend towards an increase in the gradients following discharge.

Conclusion

The early results of the Contegra valved conduit are very satisfactory. This graft can be a good alternative for RVOT reconstruction, particularly in the neonatal and infant patient group. These patients can be managed by homograft replacement of their conduit in later years.

Evaluation of prehypertension and masked hypertension rate among clinically normotensive patients

BACKGROUND

The present cross-sectional study was aimed to identify pre-hypertension and masked hypertension rate in clinically normotensive adults in relation to socio-demographic, clinical and laboratory parameters.

METHODS

A total of 161 clinically normotensive adults with office blood pressure (OBP) <140/90 mmHg without medication were included in this single-center cross-sectional study. OBP, home BP (HBP) recordings and ambulatory BP monitoring (ABPM) were used to identify rates of true normotensives, true pre-hypertensives and masked hypertensives. Data on sociodemographic and clinical characteristics were collected in each subject and evaluated with respect to true normotensive vs. pre-hypertensive patients with masked hypertension or true pre-hypertensive. Target organ damage (TOD) was evaluated in masked hypertensives based on laboratory investigation.

RESULTS

Masked hypertension was identified in 8.7% of clinically normotensives. Alcohol consumption was significantly more common in masked hypertension than in true pre-hypertension (28.6 vs. 0.0%, p = 0.020) with risk ratio of 2.7 (95% CI 1.7-4.4). Patients with true pre-hypertension and masked hypertension had significantly higher values for body mass index, waist circumference, systolic and diastolic OBP and HBP (p < 0.05 for each) compared to true normotensive subjects. ABPM revealed significantly higher values for day-time and night-time systolic and diastolic BP (p = 0.002 for night-time diastolic BP, p < 0.001 for others) in masked hypertension than true pre-hypertension.

CONCLUSIONS

Given that the associations of pre-hypertension with TOD might be attributable to the high prevalence of insidious presentation of masked hypertension among pre-hypertensive individuals, ABPM seems helpful in early identification and management of masked hypertension in the pre-hypertensive population.

Factors affecting daily instrumental activities of the elderly

BACKGROUND/AIM

In order to determine elderly people's capabilities in daily activities, we evaluated the factors that may affect their daily instrumental activities.

MATERIALS AND METHODS

We performed an observational, analytical, and cross-sectional study on 101 patients above 60 years of age in 2008 and 2009. We applied the Lawton Instrumental Activity of Daily Living (IADL) scale, the Standardized Mini-Mental State Examination (SMMSE), and the Geriatric Depression Scale (GDS) during one-on-one interviews with the patients. Demographic data and disability levels were also recorded. These data were used to evaluate the possible effects of factors on the IADL scale.

RESULTS

Statistical analyses indicated that total scores of instrumental activities are affected negatively by increased age, female sex, and literacy (P < 0.001, P = 0.005, and P = 0.021), whereas scores are affected positively by educational level (P = 0.047).

CONCLUSION

Our findings suggest that increased age, sex, literacy, and education levels influence elderly people's daily instrumental activities. Daily functional activities and factors influencing these activities should be determined in order to increase elderly people's quality of life and independence. It is important to evaluate elderly people's capabilities in daily activities.

Circadian rhythm of blood pressure in patients with benign prostatic hyperplasia

OBJECTIVE

Nocturia, a common and bothersome symptom of benign prostatic hyperplasia (BPH), may cause sleep disturbances. Patients with nocturia may have difficulty returning to their normal sleep after repeated episodes of waking and voiding. Therefore, nocturia may have an impact on the circadian rhythm of blood pressure (BP). The association between nocturia and the circadian rhythm of BP was investigated in this study.

MATERIAL AND METHODS

A total of 100 male patients who had been diagnosed with BPH and 53 healthy male subjects were included in the study. Nocturnal urinary frequency was assessed by means of a questionnaire and recorded in both groups. Ambulatory BP monitoring was performed in all patients over a 24-h period.

RESULTS

Patient characteristics and laboratory parameters were similar in both groups. Seventy-five patients (75%) in the BPH group and 20 subjects (37.7%) in the control group were non-dippers, i.e. they did not have a normal nocturnal fall in BP, and this difference was statistically significant (p=0.001). Eighty-nine patients in the BPH group and 13 in the control group had nocturia. Seventy-one patients (79.8%) with nocturia were non-dippers and the difference compared to the patients without nocturia in the BPH group was significant (p=0.003), whereas four patients with nocturia (30.8%) were non-dippers in the control group.

CONCLUSIONS

Our findings indicate that non-dipping was more prevalent in elderly men with BPH and nocturia. BPH and nocturia may be etiological factors in the pathogenesis of non-dipping, which is an indicator of early cardiovascular disease. Further studies must focus on this relationship and, especially, on whether treatment of nocturia and BPH helps to treat non-dipping or not.

Probrain natriuretic peptide for assessment of efficacy in heart failure treatment

N-terminal probrain natriuretic peptide (NT-proBNP) is elevated in patients with heart failure. Numerous clinical trials have evaluated the efficacy of spironolactone in heart failure; however, no studies have directly examined the effects of spironolactone treatment on NT-proBNP level. This study investigated whether NT-proBNP levels decrease with daily spironolactone treatment. The study consisted of 117 adult patients with heart failure. All participants were divided into 3 groups, class I, class II, and class III, according to the New York Heart Association classification system. Patients were randomly assigned to receive spironolactone or were treated with another drug, other than spironolactone, as placebo. NT-proBNP plasma samples were taken at baseline and after 6 mo of treatment. A total of 62 patients were treated with daily spironolactone; 55 patients were followed with available treatment without spironolactone. The baseline demographic and laboratory parameters were similar for patients in all groups. At the end of 6 mo, spironolactone-treated patients had significantly lower NT-proBNP levels and significantly better ejection fractions than did patients in all New York Heart Association classes who were not treated with spironolactone. Results suggest that spironolactone decreases plasma NT-proBNP concentrations, and that the measurement of plasma NT-proBNP levels may be helpful in assessing therapeutic efficacy in patients who are treated for heart failure.

The protective effect of erdosteine against cyclosporine A-induced cardiotoxicity in rats

Cyclosporine A (CsA) is a frequently used immunosuppressive agent in transplant medicine to prevent rejection and in the treatment of autoimmune diseases. However, CsA generates reactive oxygen species, which causes nephrotoxicity, hepatotoxicity and cardiotoxicity. The use of antioxidants reduces the adverse effects of CsA. The aim of this study is to determine the protective effects of erdosteine on CsA-induced heart injury through tissue oxidant/antioxidant parameters and light microscopic evaluation in rats. CsA cardiotoxicity was induced by administrating an oral dose of 15mg/kg CsA daily for 21 days. The rats were divided into four groups: control group (n=4), CsA administrated group (15mg/kg, n=5), CsA+erdosteine administrated group (10mg/kg day orally erdosteine, n=4) and only erdosteine administrated group (10mg/kg day orally n=5). CsA treated rats showed increase in the number of infiltrated cells and disorganization of myocardial fibers with interstitial fibrosis. The number of infiltrated cells, disorganization of myocardial fibers and interstitial fibrosis was diminished in the hearts of CsA-treated rats given erdosteine. The malondialdehyde, the protein carbonyl content and nitric oxide levels were increased in the cyclosporine A group in comparison with the control and CsA plus erdosteine groups. The activities of superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH-Px) were higher in CsA plus erdosteine group than CsA group. However, the CAT, GSH-Px and SOD activities were significantly lower in CsA group than in control group and erdosteine group. These results suggest that erdosteine has protective effect against CsA-induced cardiotoxicity.

Relation between serum calcium, phosphate, parathyroid hormone and 'nondipper' circadian blood pressure variability profile in patients with normal renal function

BACKGROUND AND AIMS

In patients with renal disease, an association between abnormal circadian blood pressure profile and abnormalities in bone and mineral metabolism, including vascular calcifications, is well known. However, such a link has not yet been reported in hypertensive patients with normal renal function. We aimed to evaluate if higher serum phosphate, calcium, parathyroid hormone (PTH) level and the calcium x phosphate (Ca x P) product would be associated with a nondipper hypertension, in patients with normal renal function and without any PTH disorder.

METHODS

190 hypertensive subjects with the following inclusion criteria were enrolled: (1) normal phosphate and PTH levels; (2) glomerular filtration rate (GFR) >60 ml/min, and (3) no history of calcium, phosphate, vitamin D medication and hyperparathyroidism.

RESULTS

Of the total population, 76 patients (40%) were classified as dippers and 114 (60%) as nondippers. Nondipper patients had higher levels of phosphate (3.70 +/- 0.61 vs. 3.35 +/- 0.44 mg/dl, p = 0.001), Ca x P product (35.4 +/- 6.5 vs. 31.5 +/- 5.0, p = 0.001) and PTH (75.7 +/- 28.8 vs. 46.6 +/- 17.1 pg/ml, p = 0.000) compared to dipper patients. Independent predictors (multiple regression) for nondipper hypertension were PTH (beta = 0.43, p = 0.001) and phosphate (beta = 0.9, p = 0.03).

CONCLUSION

We demonstrate a graded independent relation between higher levels of phosphate, PTH, Ca x P product and the risk of nondipping in hypertensive patients with an estimated GFR of >60 ml/min and normal mineral metabolism.

Effect of treatment of hyperuricemia with allopurinol on blood pressure, creatinine clearence, and proteinuria in patients with normal renal functions

BACKGROUND

Hyperuricemia has been associated with the development of hypertension, cardiovascular, and renal disease. However, there is no data about the effect of lowering uric acid level on hypertension, renal function, and proteinuria in patients with glomerular filtration rate (GFR) >60 ml/min. We therefore conducted a prospective study to investigate the benefits of allopurinol treatment in hyperuricemic patients with normal renal function.

MATERIALS AND METHODS

Forty-eight hyperuricemic and 21 normouricemic patients were included in the study. Hyperuricemic patients received 300 mg/day allopurinol for three months. All patients' serum creatinine level, 24-h urine protein level, glomerular filtration rate, and blood pressure levels were measured at baseline and after three months of treatment.

RESULTS

A total of 59 patients completed the three-month follow-up period of observation. In the allopurinol group, serum uric acid levels, GFR, systolic and diastolic blood pressure, and C-reactive protein (CRP) levels significantly improved (P < 0.05). However, urine protein excretion remained unchanged (P > 0.05). No correlation was observed between changes in GFR and changes in CRP, or blood pressure in the allopurinol group. No significant changes were observed in the control group (P > 0.05).

CONCLUSION

We bring indirect evidence that hyperuricemia increases blood pressure, and decreases GFR. Hence, management of hyperuricemia may prevent the progression of renal disease, even in patients with normal renal function, suggesting that early treatment with allopurinol should be an important part of the management of chronic kidney disease (CKD) patients. Long-term follow-up studies are warranted to identify the benefits of uric acid management on renal function and hypertension.

Right ventricular outflow tract reconstruction for tetralogy of fallot with abnormal coronary artery: experience with 35 patients

BACKGROUND

An abnormal coronary artery crossing the right ventricle outflow tract (RVOT) complicates complete repair of tetralogy of Fallot (TOF). We have evaluated surgical options for RVOT reconstruction for this group of patients.

METHODS

Between 1984 and 2002, 35 TOF patients with abnormality of coronary arteries underwent total correction. Age of these patients ranged from 1 to 14 years (mean 5.8 +/- 2.8 years). All patients were diagnosed by echocardiography and 25 patients had cardiac catheterization. All the abnormal coronary arteries were spared at the operation. In 24 patients a transannular patch was applied for RVOT reconstruction. In three patients with an adequate pulmonary annulus, oblique ventriculotomy incisions, and in two patients, transatrial approaches were performed. "Two-patch" technique was chosen for two patients. In four patients placement of an extracardiac conduit was necessary.

RESULTS

Mortality was observed in four patients, in two of them due to suspected myocardial ischemia. None of the surviving patients needed reoperation. All of them were in NYHA class I. The follow-up period for patients without extracardiac conduit was between 14 and 96 months (mean 50.2 months) and for the patients with extracardiac conduit ranged 36 to 98 months (63.5 months). The mean gradients measured by echocardiography were, respectively, 5 mmHg (range 0 to 35 mmHg) and 23.75 mmHg (range 20 to 25 mmHg).

CONCLUSIONS

Definitive repair of TOF patients with abnormal coronary arteries can be performed in early childhood, but care should be taken to leave at least 1 cm of myocardium between the sutureline and the abnormal coronary artery. Detailed evaluation of the patients preoperatively is mandatory to identify the strategy and timing of the operation.

Relationship between Retinopathy and Cognitive Impairment among Hypertensive Subjects

BACKGROUND

The relationship between hypertension and cognitive impairment has been investigated in the literature; several clinical studies suggested a relationship between hypertension and retinopathy.

METHODS

We examined the relationship between the retinopathy status and cognitive functions by using the Mini-Mental State Examination (MMSE) among hypertensive subjects older than 40 years who were admitted to our Family Medicine, Internal Medicine and Ophthalmology clinics. The subjects were categorized into three groups: group 1 = control subjects (n = 39), group 2 = hypertensive patients without retinopathy (n = 32), and group 3 = hypertensive patients with retinopathy (n = 25).

RESULTS

The number of patients with total MMSE scores less than 24 was distributed as follows: group 1: 3 patients (7.7%), group 2: 4 patients (12.5%), and group 3: 14 patients (56%). Hypertension was found to be related with a significant decrease in total MMSE scores in comparison with group 1 subjects (p < 0.001). Furthermore, retinopathy significantly correlated with lower MMSE scores among hypertensive patients (p = 0.001). Compared with group 1, group 3 showed a significant decrease in orientation (p = 0.001), registration (p = 0.001), attention and calculation (p = 0.004), recall (p = 0.009), and total (p < 0.001) MMSE scores. We also found a significant decrease in recall (p = 0.032) and total (p = 0.034) scores in group 3 when compared with group 2. There was a significant decrease in registration (p = 0.002) and total (p = 0.029) MMSE scores in group 2 when compared with group 1. We also observed negative correlations between duration of the disease and orientation (R = -0.597, n = 32, p = 0.001), and between duration of the disease and total (R = -0.495, n = 32, p = 0.006) scores in group 2.

CONCLUSIONS

Hypertension was found to be related with a decline in MMSE scores. This relation was even more significant in the group of hypertensive patients with retinopathy. Thus, we suggest that cognitive tests be routinely used in the follow-up of hypertensive patients.

Hirsutism: common clinical problem or index of serious disease?

Hirsutism is a clinical condition commonly encountered in the practice of primary care medicine. The etiology and the age of the patient when it occurs vary widely. Causes range from a basic illness or condition (drug exposure, smoking, idiopathic, and obesity) to complex and serious diseases (Cushing's syndrome, neoplasms, congenital adrenal hyperplasia, insulin-resistance syndromes, hyperprolactinemia, polycystic ovary syndrome, and hyperthecosis). Hirsutism may appear in childhood as well as in older persons. Some drugs (oral contraceptives, L-thyroxine, danazol, and diazoxide), tobacco smoke, some syndromes (polycystic ovary syndrome, obesity, insulin resistance, hyperprolactinemia, hyperthecosis, congenital adrenal hyperplasia, and idiopathic), and some neoplasms (adrenal or ovarian) may lead to hirsutism. The most frequently defined "causes" of hirsutism are polycystic ovary syndrome and idiopathic hirsutism. In hirsutism of gradual onset, hyperprolactinemia, insulin-resistance syndromes, hyperthecosis, polycystic ovary syndrome, and idiopathic hirsutism may be responsible. Cushing's syndrome, neoplasms, and congenital adrenal hyperplasia should be suspected if there has been rapid onset.

Clinical importance of gamma glutamyltransferase in the Ankara-Pursaklar region of Turkey

OBJECTIVE

The aim of this study is to determine the etiologies of serum gamma glutamyltransferase (GGT) elevation and relations between multiple etiologies prevalent in the Pursaklar region of Ankara in Turkey.

PATIENTS AND METHODS

The patients referred to the Family Medicine and Internal Medicine departments with various complaints from the Pursaklar region of Ankara between July 2000 and July 2002 were evaluated, and values for GGT, alkaline phosphatase (ALP), and alanine aminotransferase (ALT) levels were determined. GGT elevation was classified as being associated with hepatic, biliary, and other origins.

RESULTS

For GGT elevation, hepatobiliary etiologies were more prevalent. The most prevalent hepatic etiology was nonalcoholic steatohepatitis, followed by biliary etiologies. The most prevalent etiology of biliary origin was cholelithiasis. Other etiologies, in order of prevalence, were drug exposure and urinary infection. There were no gender-related differences for distribution of GGT elevation; however, the GGT values for women were higher than those for men.

Radiation-induced coronary artery disease

Radiation-induced heart disease must be considered in any patient with cardiac symptomatology who had prior mediastinal irradiation. Radiation can affect all the structures in the heart, including the pericardium, the myocardium, the valves and the conduction system. In addition to these pathologies, coronary artery disease following mediastinal radiotherapy is the most actual cardiac pathology as it may cause cardiac emergencies requiring interventional cardiological or surgical interventions. Case A 36-year-old man was admitted to the clinic with unstable angina pectoris of one month duration. The patient had no coronary artery disease risk factor. The history of the patient revealed that he had mediastinal radiotherapy due to Hodgkin's disease at 10-year of age. Coronary arteriography showed total occlusion of the left anterior descending artery and 70% stenosis of the proximal right coronary artery. Both arteries are dilated with placement of two stents. Control coronary arteriography at the end of the first year showed patency of both stents and the patient is free of symptoms. Previous radiotherapy to the mediastinum should be considered as a risk factor for the development of premature coronary artery disease. Percutaneous transluminal coronary angioplasty with stent placement or surgical revascularization are the preferred methods of treatment. Preoperative assessment of internal thoracic arteries should be considered prior to surgery. As the radiation therapy is currently the standard treatment for a number of mediastinal malignancies, routine screening of these patients and optimal cardiac prevention during radiotherapy are the only ways to minimize the incidence of radiation-induced heart disease.

Accessory mitral valve tissue causing severe subaortic stenosis with dextrocardia in a premature newborn

We report an unusual case of left-ventricular outflow obstruction caused by accessory mitral valve tissue associated with dextrocardia and ventricular septal defect in a seven-day-old, 2200 grams premature infant, who was referred with a heart murmur. The diagnosis was made by two-dimensional and Doppler echocardiography which demonstrated the accessory tissue as well as a 100 mmHg peak systolic gradient between the left ventricle and the aorta. Ten days after the presentation the infant underwent emergency surgery after respiratory arrest and recurrent episodes of syncope. The accessory mitral valve tissue and its fibrous extension were excised and the ventricular septal defect was closed. We believe that surgical treatment of patients with accessory mitral valve tissue should be performed early because of the possibility of acute deterioration. Combined aortotomy and interatrial approach is very helpful in evaluating the anatomy and the mitral valve function as well as delineating the tissue to be excised.