Analysis of factors on voice quality in thyroidectomy patients

OBJECTIVE

Vocal cord paralysis (VCP) is a serious complication in thyroidectomy operations; however, its management remains unclear. The present study evaluated the voice parameters of patients who underwent surgery using Intraoperative Neurophysiologic Monitoring (IONM).

PATIENTS AND METHODS

A total of 52 patients (41 females and 11 males) who underwent a total thyroidectomy operation were evaluated using objective and subjective voice analysis examinations before and after surgery. Acoustic parameters, such as Fundamental Frequency (F0), Shimmer, Jitter, Noise-to-Harmonic ratio (NHR), and aerodynamic parameters, including S/Z ratio and maximum phonation time (MPT), were analyzed. Objective findings, including the VHI-10 (Voice Handicap Index) and V-RQOL (Voice-Related Quality of Life), were also analyzed. The relationship between voice parameters and IONM values was investigated.

RESULTS

The objective analysis (acoustic and aerodynamic parameters) showed no difference (p>0.05). However, the subjective analysis, which involved the VHI-10 and V-RQOL measures, revealed a significant difference before and after the operation (p<0.05). The Spearman correlation analysis showed that the NHR postoperative 1st-month parameter negatively correlated (rho=-0.317, p<0.059), while the F0 postoperative 6th-month parameter positively correlated (rho=0.347) with the amplitude difference before and after dissection (Right R2-R1 difference) for the right RLN measured in IONM.

CONCLUSIONS

Patients who are planning to undergo a thyroidectomy procedure should undergo voice assessment during both the preoperative and postoperative periods. IONM could improve voice quality outcomes.

Investigation of cognitive functions in children with bone tumours and lymphoma in treatment process

BACKGROUND

Neurocognitive sequelae are among the most debilitating effects of cancer observed in children. Yet we know very little about the impact on neurocognitive functioning, especially cancer types that develop outside the central nervous system. This study aimed to assess and compare the cognitive functions (CoF) of children with bone tumours and lymphoma in the treatment process.

METHODS

The CoF of children with bone tumours (n = 44), lymphoma (n = 42) and their non-cancer peers (n = 55) were assessed with Dynamic Occupational Therapy Assessment for Children. The CoF of children with cancer were compared with their non-cancer peers. Then, children with bone tumours and lymphoma were compared in binary.

RESULTS

One-hundred forty-one children aged 6-12 years with a mean age of 9.4 (SD = 1.5) were included in this study. The orientation and visuomotor construction functions of children with bone tumours and orientation, praxis and visuomotor construction functions of children with lymphoma performed worse than their non-cancer peers (pk  < 0.001). While orientation, spatial perception, visuomotor construction and thinking operations functions of children with bone tumours and lymphoma were similar (pk  > 0.016), praxis functions of children with lymphoma were found to be worse than children with bone tumours (pk  < 0.016).

CONCLUSIONS

Our findings show that children with bone tumours and lymphoma in the process of treatment are at risk for impairment of their CoF. The findings highlight the importance of assessing CoF in children with bone tumours and lymphoma and considering specific differences between groups. It is essential to assess CoF and develop early intervention plans in these children.

Occupational performance and participation in children with developmental coordination disorders before and during Covid-19

INTRODUCTION

Developmental coordination disorder (DCD) is a neurodevelopmental disorder that affects children's occupational performance and participation. It is known that the Covid pandemic has adversely affected the whole world in many areas. We aim to investigate the occupational performance and participation of children with DCD before and during the COVID-19.

METHODS

Sixty-five children aged 5-12 years included in the study were assessed by the Canadian Measure of Occupational Performance and the Participation and Environment Measure for Children and Youth.

RESULTS

Statistically significant differences were detected in occupational performance and satisfaction scores (p < 0.01). Additionally, except for 'involvement in the home environment' (p > 0.05), there were statistically significant differences in all other areas of participation (p < 0.01).

CONCLUSION

The occupational performance and participation of children with DCD are impacted during COVID-19. In addition, it is seen that the desire of families to change regarding participation has increased due to COVID-19. It would be beneficial to include strategies to improve these areas in the rehabilitation processes.

Optimal patient position for percutaneous nephrolithotomy in horseshoe kidneys: Traditional prone or supine?

OBJECTIVE

Although it was stated that supine percutaneous nephrolithotomy (PCNL) was associated with relatively shorter surgical times and comparable success and complication rates, there is no consensus in the current literature concerning the safety and efficacy of supine PCNL in patients with horseshoe kidneys. We aimed to compare supine and prone PCNL regarding safety and efficacy in patients with horseshoe kidneys.

METHODS

Data of the patients with horseshoe kidneys who underwent PCNL for renal stones larger than 2 cm between January 2010 and May 2021 were retrospectively reviewed. The study patients were categorized as Group 1 (i.e., supine PCNL-SPCNL) and Group 2 (i.e., prone PCNL-PPCNL). Both groups were compared regarding demographic, clinical, and surgical data.

RESULTS

Sixty-five patients were included. Among these patients, 31 (47.7%) were in Group 1, while 34 (52.3%) were in Group 2. Both groups were statistically similar in terms of demographic data, stone characteristics, perioperative parameters, and complication rates (p > 0.05). There was no statistical difference in terms of additional treatment rates, stone-free rates in the postoperative second-day and third-month evaluations (p > 0.05). Mean surgical time was significantly longer in Group 2 (113 ± 17.1 min) than in Group 1 (90.6 ± 11.3 min) (p = 0.000).

CONCLUSION

Although it is traditionally performed in the prone position, the supine approach is as safe and effective as the prone approach. In addition, the supine approach is associated with significantly shorter surgical times.

Where Exactly Is the Therapist in Virtual Reality and Game-Based Rehabilitation Applications? A Randomized Controlled Trial in Children with Specific Learning Disability

Objective: Children with specific learning disability (SLD) experience problems in visual perception that influence academical skills and activities of daily living. Virtual reality and game-based rehabilitation applications are becoming increasingly popular in rehabilitation, including visual perception rehabilitation. However, the usage of commercially available and easily accessible games as intervention tools raises the question whether rehabilitation conducted with these games is really rehabilitation, or just casual gameplay. Therefore, we aimed to investigate the effects of a nonactively supervised (game-based intervention program [GIP]) and an actively supervised (therapist guided game-based intervention program [TGGIP]) on the visual perception skills of children with SLD. Materials and Methods: This study was designed as a single-blind randomized, controlled trial of a TGGIP on visual perception skills in children with SLD compared with the self-oriented, nonsupervised program (GIP). A total of 138 children with SLD participated in the study and were randomly divided into two groups (TGGIP and GIP). Children's visual perception skills were assessed with Motor-Free Visual Perception Test-3. Results: Both groups showed significant improvements in visual perception after the intervention programs (P < 0.05). However, the TGGIP (a supervised and structured intervention program) was significantly more effective in improving the visual perception skills compared with the GIP (a standard, nonsupervised, and unstructured intervention program) (P < 0.05). Conclusion: We think that the TGGIP methodology that we designed acts as a facilitator for therapists in using trademarked, commercially available, and easily accessible games for structured and supervised virtual reality and game-based rehabilitation applications.

A novel model using computed tomography parameters to predict shock wave lithotripsy success in ureteral stones at different locations

OBJECTIVE

To combine non-contrast computerized tomography (NCCT)-based parameters with stone and patient characteristics that are already known to affect shock wave lithotripsy (SWL) success and assess this novel model's effectiveness in predicting SWL success for single ureteral stones in different locations.

MATERIALS AND METHODS

Data of patients treated by SWL for a single ureteral stone between January 2017 and January 2019 were retrospectively reviewed. Demographic parameters of patients and stone characteristics were combined with NCCT-based parameters. NCCT-based parameters included the presence or absence of hydronephrosis, perinephric stranding, periureteral edema, diameter of the proximal ureter, ureteral wall thickness (UWT) at ureteral stone site. The logistic regression method was used for the development of a useful predictive model. Subsequently, the receiver operating curve was used to determine cut-off levels, and a scoring system was developed for prediction of SWL success.

RESULTS

Stone-free rate was 77,1% (267/346) in the entire cohort. Univariate analysis revealed that age, stone volume, density, perinephric stranding, diameter of proximal ureter, and UWT, were associated with SWL success. In multivariate analysis, proximal ureteral stone location, stone volume, density, and UWT were independent predictors of SWL success. The formula used during logistic regression analysis was: 1/[1 + exp {-8.856 + 0.008 (stone volume) + 0.002 (stone density) + 0.673 (UWT) + 1026 (proximal ureteral stone)}]. The scores of 0, 1, 2, 3 and 4 were associated with 97,8%, 83,4%, 60,8%, 33,2% and 11,1% success rates, respectively, in the prediction model based on these parameters.

CONCLUSION

We conclude that our model can facilitate decision-making for SWL treatment of ureteral stones in different locations.

Subjective health and associative social factors in emerging adults with different levels of participation limitations—A cross-sectional study

Background

Participation was shown to be associative with subjective health (SH) in many different populations, including emerging adults.

Objectives

This study aimed to investigate SH and associative variables in emerging adults with different levels of participation limitations.

Methods

Healthy university students who were between 18–25 years of age were included. SH was assessed with the visual analog scale. The participants were grouped based on P-Scale. Multiple linear regressions were conducted to determine the associative variables of SH for each P-Scale group.

Results

A total of 572 participants were included. General health-related quality of life was associated with SH in all P-Scale groups. Other prominent findings of this study showed perception of health, income, and lifestyle were among the most significant associative variables of SH.

Conclusion

Variables associated with emerging adults’ SH change with their participation restrictions. Therefore, different approaches are needed to improve the subjectively perceived health status of emerging adults.

What are the factors affecting IVF success in women with hypogonadotropic hypogonadism?

OBJECTIVE

This study aimed to investigate in vitro fertilization (IVF) outcomes in women with hypogonadotropic hypogonadism (HH) and unexplained infertility and investigate factors affecting the pregnancy rate among HH patients.

MATERIALS AND METHODS

This retrospective cohort study was conducted at Zeynep Kamil Maternity and Children's Diseases Training and Research Hospital, Turkey, a tertiary care referral center. The medical records of 143 women who underwent IVF treatment at this hospital between 2015 and 2020 were reviewed. Sixty-three had hypogonadotropic hypogonadism (HH) and 74 had unexplained infertility. Demographics, hormonal profile, IVF cycle characteristics, and pregnancy rates were recorded. The factors affecting the ongoing pregnancy rates were evaluated among HH patients.

RESULTS

Anti-Mullerian hormone (AMH) levels were lower among women with HH compared to those with unexplained infertility (1.64±1.2 vs. 3.0±2.13). IVF cycle characteristics and ongoing pregnancy outcome (20.28% vs. 22.97%) were similar between the groups; however, the total dose of human menopausal gonadotrophin (HMG) used (5127.74±1845.8 vs. 2035.71±1387.45) was higher in the HH group. Increased estradiol level (2596.35±1085 vs. 1869.9±1203.4), endometrial thickness (10.82±1.74 vs. 8.43±2.33), higher number of total oocytes retrieved (12.14±4.34 vs. 8.43±5.44) were correlated with higher ongoing pregnancy rates among the HH group.

CONCLUSIONS

IVF success rates were similar between the HH and unexplained infertility groups. Although AMH level was not a prognostic factor for IVF success, higher doses of HMG were needed to achieve pregnancy in the HH group. The factors affecting the ongoing pregnancy rates in the HH group were higher estradiol level, increased endometrial thickness, and a higher number of oocytes retrieved.

The relationship of motor development with sensory processing among infants born very preterm: a prospective case-control study

BACKGROUND

Little is known about the relationship between sensory processing and motor development in very preterm infants. The purpose of this study was to explore the relationship of motor development with sensory processing among such infants with developmental delay and those who had typical development at the ages of 8 and 12 months.

METHODS

This prospective case-control study included 61 preterm infants (31 males, 30 females, mean gestational age: 29.1 weeks). The infants had a gestational age of 32 weeks or less and a current corrected age of 8 months, and they had spent at least 15 days in the neonatal intensive care unit. Motor development was assessed with the Neuro-sensory Motor Developmental Assessment (NSMDA), and sensory processing was evaluated with the Test of Sensory Functions in Infants (TSFI).

RESULTS

There were very strong positive correlations between the gross and fine motor scores of the NSMDA and the TSFI`s subdomain scores and total scores (r=0.85-0.93, p < 0.001). There were also very strong negative correlations between the functional level according to the NSMDA and the subdomain scores and total scores of the TSFI (r=-0.89-0.94, p < 0.001).

CONCLUSIONS

The results show that sensory processing and motor development are related parts of the development of very preterm infants. In the early rehabilitation process, therapists should comprehensively take motor and sensory development into consideration.

Cross-cultural adaptation, reliability, and validity of the Turkish Adult Sensory Processing Scale

Introduction

Sensory processing is crucial to adaptive behavioural responses in occupational therapy. Nevertheless, information on sensory processing in adults is limited. The Adult Sensory Processing Scale (ASPS) measures behavioural responses indicative of sensory processing in different sensory systems. The study aimed to examine the cultural adaptation, reliability and validity of the ASPS-Turkish (ASPS-T).

Methods

The ASPS-T was administered to 405 individuals, who were aged 18 to 64 (38.5 ± 11.4) years. The cross-cultural adaptation and translation procedures were conducted following Beaton’s guidelines. Internal consistency was examined by Cronbach’s alpha. Criterion-related validity of the ASPS was determined by the Adolescent/Adult Sensory Profile using Construct validity and was examined by confirmatory factor analysis using AMOS.

Results

The study included 405 participants (271 female and 134 male). Exploratory factor analysis with varimax rotation determined 11 factors with 55.15% total variance. In confirmatory factor analysis (CFA), model fit indices showed an acceptable fit. The reliability of the scale was 0.834, and test–retest reliability changed from 0.94 to 0.99, illustrating high internal consistency and excellent reliability of the scale.

Conclusions

The ASPS-T is reliable and valid for analysing sensory processing patterns of adults in the Turkish population.

Livedoid cutaneous metastasis of signet-ring cell gastric carcinoma

Cutaneous metastasis of gastric cancer is extremely rare. Nodular forms are more common and inflammatory forms are exceptionally encountered. Herein, we report a case of inflammatory cutaneous metastasis of signet-ring cell gastric cancer (poorly cohesive gastric carcinoma with signet-ring cell component) masquerading as livedo reticularis. To our knowledge, such a clinical presentation of cutaneous metastasis has not been reported for gastric cancer. It is imperative to preserve a high index of clinical suspicion for diagnosing cutaneous metastases. Our case highlights the importance of obtaining a skin biopsy in patients with a known history of internal malignancy. Bizarre, newly erupting, evolving, persistent, or treatment-refractory dermatologic lesions (such as nodules, ulcers, erythematous, reticular, or livedoid patches) might be clues for an underlying internal malignancy and require prompt histopathological sampling. Personal medical history, histopathological examination, and immunohistochemical profiling are equally important in distinguishing primary cutaneous carcinomas from secondary metastatic deposits. Early recognition of a cutaneous metastasis might enable appropriate staging and timely intervention, thereby prolonging survival.

Investigating the compatibility, interchangeability, and clinical usability of BOT2-BF and BOT2-SF in primary school-aged children with and without developmental dyslexia

The aim of our study was to determine the sensitivity and specificity levels of BOT2-BF and BOT2-SF tests applied to children with developmental dyslexia and to examine their clinical usability. This study was designed as a case-controlled study. 82 (study group 41, control group 41) 7-12 year children were included. The study occurred three stages. In the first place, the similarities and differences of BOT2-BF and BOT2-SF tests observed in clinical practices were examined by taking the feedback of experts and test correlations. In the second step, BOT2-BF and BOT2-SF tests were examined with reference to the Core Outcome Set (COS) evaluation criteria. In the last step, in order to examine the sensitivity and specificity levels of the tests, assessments were performed in two groups with 1-week intervals. According to the COS results, the BOT2-BF test was examined better than the BOT2-SF test under cross-cultural validity title. The sensitivity and specificity of BOT2-SF were 0.92 and 0.51, and for BOT2-BF were 0.92 and 0.41, respectively. This study will help clinicians working on children with developmental dyslexia to decide the type of test they will use to evaluate and easy access to materials motor proficiency.

Effectiveness of a task-oriented training on occupational performance, functional independence, and fatigue in children with childhood cancer: a randomized-controlled trial

Abstract Objective The objective of the study is to explore the effectiveness of task-oriented training (TOT) on occupational performance, functional independence, and fatigue of children with cancer. Method Two hundred and thirteen children (101 females, 112 males) with cancer were randomized to experimental (n = 112; 9.53±2.23 years) or control (n = 101; 7.93±1.98 years) groups. The experimental group received a TOT together with a conventional occupational therapy (COT), while the control group received only a COT. Both groups received 20 sessions of therapy. The outcomes regarding occupational performance via the Canadian Occupational Performance Measure, functional independence via the Functional Independence Measure for Children and fatigue via the Visual Analog Scale were evaluated by the blind evaluators before and after the interventions in the hospital setting. Results The occupational performance and satisfaction (p<0.001) scores showed statistically significant differences in the experimental group compared to the control group (p<0.01). A statistically significant improvement was determined in functional independence for both groups (p< 0.001). The experimental group indicated a significant reduction in fatigue (p values for fatigue before, during, after activity, morning and evening: p< 0.001) and in the control group (P values for fatigue all situation: p< 0.05). Conclusion The TOT seems to ensure more beneficial effects in increasing occupational performance, improving functional independence in daily activities, and decreasing fatigue at the early phases of inpatient treatment of childhood cancer.

Investigation on participation, supports and barriers of children with specific learning disabilities

BACKGROUND

Children with specific learning disabilities (SLD) have been observed to face participation restrictions in their daily life.

AIMS

This study aims to examine the participation and environmental features of children with SLD compared to non-disabled children.

METHODS AND PROCEDURES

This study was designed as a case-controlled study. Parents of children between 5 and 17 years of age with SLD (n = 90) and those who are non-disabled (n = 88) were included in this study to do the Participation and Environment Measure for Children and Youth (PEM-CY).

RESULTS

Differences between groups were found statistically significant in home, school, and community settings between both participation and environmental features (p < 0.05). Children with SLD participated less frequently in school settings and were less involved in activities in home and school settings. Parents of children with SLD desired more change in their child's participation in all settings. Environmental factors were significantly more likely to be identified as barriers in the participation of children with SLD.

CONCLUSION AND IMPLICATIONS

This study provides information about participation patterns and environmental factors for many children with SLD. The results provide insights into a rehabilitation program that may improve the participation of children with SLD, and on where greater efforts are needed to support participation and environmental features for children with SLD.

The Effects of Virtual Reality on Motor Functions and Daily Life Activities in Unilateral Spastic Cerebral Palsy: A Single-Blind Randomized Controlled Trial

Aim: This study was designed to investigate the effects of virtual reality (VR) through Kinect on both gross and fine motor functions and independence in daily living activities in children with unilateral spastic cerebral palsy (USCP). Materials and Methods: This study was designed as a single-blind, randomized, controlled trial. Sixty children with USCP were randomized and split equally between the VR intervention group (10 females and 20 males with a mean age of 10.5 ± 3.62 years) and the traditional occupational therapy (TOT) intervention group (13 females and 17 males with a mean age of 10.06 ± 3.24 years). Both groups were evaluated in terms of motor functioning via the Bruininks-Oseretsky Test of Motor Proficiency-Short Form (BOTMP-SF) and were assessed in accordance with independence in daily activities via the WeeFunctional Independence Measure (WeeFIM). Interventions were conducted for 8 weeks with the main objective of improving motor functions and independence in daily activities. Results: Total motor functions and total independence in daily lives in both groups improved after 8 weeks of intervention. A comparison between groups revealed significantly greater improvements in both gross and fine motor functions and daily activities in the VR group than in the TOT group (P < 0.001). Conclusion: The Kinect-based VR intervention approach is important to improving motor functions and independence in daily activities of children with USCP.

The impact of occupation-based problem-solving strategies training in women with breast cancer

Background

By identifying the occupations of women with breast cancer who have performance problems, to examine the impact of the application of occupation-based problem-solving strategies (OB-PSS) training on cancer-related fatigue, depression, and quality of life.

Methods

The study comprises 22 women outpatients in the clinic. Socio- demographic and Clinical Features Information Collection Form, Canadian Occupational Performance Measure (COPM), Cancer Fatigue Scale (CFS), Beck Depression Inventory (BDI), The European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire C-30 and BR23 (EORTC QOL-C30 - EORT QOL-BR23) tests have been applied to survivors. OB-PSS training was conducted on a face-to-face basis once a week for 6 weeks.

Results

When activity distribution results in accordance with the performance areas are studied, women with breast cancer were seen to suffer problems mostly in their most productive areas (housework management). As a means of solving these performance problems, they developed adaptive strategies like including additional new steps to these activities. Statistically meaningful results have been obtained between measurements before and after the treatment process through all tests (p < 0.01).

Conclusions

OB-PSS provides positive gains in women with breast cancer in terms of a reduction in the degree of cancer-related fatigue and depression, and a progress in performance and satisfaction levels particularly in activities where performance problems are experienced and an improvement in quality of life. OB-PSS training could be used as an appropriate rehabilitation approach for coping with problems in women’ life with breast cancer.

Internet use patterns and Internet addiction in children and adolescents with obesity

BACKGROUND

There are no data regarding the Internet addiction (IA) rates and patterns in youth with obesity.

OBJECTIVE

This study aimed to explore the prevalence and patterns of IA in children and adolescents with obesity. The relationship between IA and body mass index (BMI) was also investigated.

METHODS

Study includes 437 children and adolescents with age ranging from 8 to 17 years: 268 with obesity and 169 with healthy controls. The Internet addiction scale (IAS) form was administered to all participants. The obesity group also completed a personal information form including Internet usage habits and goals. Linear regression analysis was utilized to assess the contributions of Internet use habits and goals to BMI in the obesity group and IAS scores to BMI in both groups.

RESULTS

A total of 24.6% of the obese children and adolescents were diagnosed with IA according to IAS, while 11.2% of healthy peers had IA (p < 0.05). The mean IAS scores for the obesity group and the control group were 53.71 ± 25.04 and 43.42 ± 17.36, respectively (p < 0.05). The IAS scores (t = 3.105) and spending time more than 21 h week^-1 on the Internet (t = 3.262) were significantly associated with increased BMI in the obesity group (p < 0.05). Other Internet habits and goals were not associated with BMI (p > 0.05). The IAS scores (t = 8.719) were also found to be associated with increased BMI in the control group (p < 0.05).

CONCLUSIONS

The present study suggests that obese children and adolescents were found to have higher IA rates than their healthy peers, and the results indicate an association between IA and BMI.

The Assessment of a Drama Therapy Process for Patients with Severe Psychiatric Patients

Introduction

Drama therapy is a useful therapy method for improving the life quality of psychiatric patients. Drama therapy is a rehearsal of everyday life. In this therapy method, clients actively join the creative process in order to better understand their life experiences.

Objectives

Drama therapy may improve patients’ ego functions, psycho-social and self-expression abilities, problem-solving skills, real-life adaptations and contribute to patient's psychiatric treatment.

Aim

The main aims were to examine the curative effects of drama group therapy and the effects of drama therapy on functionality in psychiatric patients.

Method

The study was performed at the Istanbul University Faculty of Medicine. Patients were referred from the Psychiatry Polyclinic of this university to Art Therapy and Rehabilitation Program. Drama therapy is an applied drama-based art group therapy. The 10 subjects in our study, ranged from 20 to 50 years old. This therapy group gathered once a week for a ninety minute session. Subjects continued their medical care and received psychotherapy throughout the 24-week study. The therapy plan included an introduction, a warm-up session, a drama therapy work and a sharing session. Patients were assessed in pre and post-treatment with Global Assessment of Functioning and Wilcoxon Signed Ranks Test was used for statistical analysis. Yalom's Group Curative Factors Scale was applied.

Result

There was a significant decrease in loss of functioning (P < .05). In Group Curative Factors, the means of hope, identification, group cohesion and altruism were determined high.

Conclusion

Our study demonstrates that drama therapy has positive effects on patients with severe psychiatric patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Investigation of hand function among children diagnosed with autism spectrum disorder with upper extremity trauma history

BACKGROUND

The present study was designed to compare hand function in autistic children with history of upper extremity trauma with that of autistic children those who do not have history of trauma.

METHODS

The study group included total of 65 children diagnosed with autism spectrum disorder (ASD) and was divided into 2 groups: children with trauma history (Group I) and control group (Group II) (Group I: n=28; Group II: n=37). Hand function was evaluated with 9-Hole Peg Test and Jebsen Hand Function Test. Somatosensory function was evaluated using somatosensory subtests of Sensory Integration and Praxis Test. Results were analyzed with Student's t-test and Mann-Whitney U test using SPSS version 20 software.

RESULTS

Hand function and somatosensory perception test scores were statistically significantly better in children without upper extremity trauma history (p<0.05). When association between hand function tests and upper extremity somatosensory perception tests was taken into account, statistically significant correlations were found between all parameters of hand function tests and Manual Form Perception and Localization of Tactile Stimuli Test results (p<0.05).

CONCLUSION

Autistic children with upper extremity trauma history had poor somatosensory perception and hand function. It is important to raise awareness among emergency service staff and inform them about strong relationship between somatosensory perception, hand function, and upper extremity trauma in children with ASD in order to develop appropriate rehabilitation process and prevent further trauma.

BURNOUT AND OCCUPATIONAL PARTICIPATION AMONG TURKISH DENTAL STUDENTS

The aim of the present study was to investigate the prevalence of burnout and occupational participation limitation among dental students in a dental school in Turkey. Four hundred fifty-eight dental students (females=153; males=305) were included in the study. The age range varied from 17-to-38 years. Maslach Burnout Inventory-Student Version (MBI-SV) and Canadian Occupational Performance Measure (COPM) were used to gather data. Descriptive analyses, t-test, and Kruskall-Wallis test for independent groups were used for data analyses. The results indicated that 26% of all the students have burnout in terms of emotional exhaustion (25%), cynicism (18%), and academic efficacy (14%). The results showed that burnout is statistically significant in relation to demographics (p<0.05). Twenty-four percent of the students showed considerably decreased occupational performance and satisfaction scores, which suggested occupational participation limitations. Occupational performance and satisfaction scores were inversely correlated with emotional exhaustion and cynicism, while directly correlated with reduced academic efficacy (p<0.05). The results of the present study indicates that burnout and occupational participation limitation can be seen among dental students. Students with burnout may also have occupational participation limitation. Enriching dental education programs with different psychological strategies may be useful for education of healthy dentists and improve the quality of oral and dental health services.

Meyerson Phenomenon as a Component of Melanoma in situ

Meyerson phenomenon (MP) is characterized by a symmetrical area of erythema and scales encircling a central lesion, which is most commonly a banal melanocytic nevus. Herein, we describe an unusual case with MP representing an eczematized response to a melanoma in situ and review the literature covering this entity. A 56-year-old man presented with a 6-month history of a pruritic, pigmented lesion on the trunk. The patient had no other significant medical history and no notable family history of similar lesions. Physical examination revealed an irregular, hyperpigmented plaque, 1 cm in diameter, with a surrounding halo of erythematous, scaly areas on the right abdominal region (Figure 1, a). On dermatoscopical examination, an irregular, broadened pigment network, radial streaming, and a focal blue-white veil, encircled by a homogenous, erythematous zone was observed (Figure 1, b). Based on clinical and dermatoscopical findings, a presumptive diagnosis of MP occurring on an early melanoma was made and the lesion was excised with a 5 mm safety margin. Histopathological examination of the excised material revealed a central intraepidermal atypical, confluent melanocytic proliferation with angular, hyperkeratotic, and irregular nuclei and a prominent fixation artifact around the cells (Figure 1, c). Human melanoma black (HMB-45) immunostaining highlighted the confluence of the neoplastic melanocytic proliferation. Lymphohistiocytic infiltration with melanophages was also identified in the upper dermis. An interesting feature was the presence of subacute spongiotic dermatitis around the melanocytic lesions (i.e. parakeratosis, serum/crusting, spongiosis, lymphocyte exocytosis, and acanthosis). Immunohistochemical staining with the Langerhans cell marker, CD1a, revealed an increased cell population in the perilesional, erythematous halo (Figure 1, d). A diagnosis of MP existing on melanoma in situ was established with clinical and histopathological findings. No recurrence of the eczematized components or melanocytic lesions was identified despite 1-year follow-up. Also called halo dermatitis and halo eczema, MP presents as an eczematized, perilesional plaque around various lesions, mainly of banal melanocytic nevi (1). Occurrence of halo dermatitis around a melanocytic nevus was first described by Meyerson in 1971. Other cutaneous disorders with MP include those of dysplastic nevus, melanoma, seborrheic keratosis, stucco keratosis, nevus sebaceous, dermatofibroma, vascular malformations, nevus flammeus, molluscum contagiosum, basal cell carcinoma, squamous cell carcinoma, and keloid formation (2-7). History of atopy and atopic dermatitis is observed in a subset of patients, which was absent in our case. Rarely, patients with Behçet's disease, severe sunburn, and cessation of interferon therapy have also been associated with this entity. MP is described to be more frequent in young males and has a tendency to occur in summer. As far as we are aware, there are only two cases of melanoma with features of MP in the literature. Rodin et al. presented a case report showing features of MP around a melanoma in situ arising on a dysplastic nevus (8). By way of comparison, a pre-existing precursor dysplastic nevus was not identified in our case. Dermatoscopic features including scar-like depigmentation and negative pigment network also differed from our case which featured a broadened pigment network, radial streaming, and blue-white veil. The other case report was of a 50-year-old man, presenting with an atypical melanocytic lesion several years in duration showing an erythematous halo (9). Histopathological examination was consistent with a Clark level 2 superficial spreading melanoma, which was cured with excision with no recurrence despite long-term follow-up. As far as we are aware, our case report is the first to describe de novo melanoma in situ without dermal invasion or a precursor dysplastic nevus. The etiopathology of MP is unclear; however it is considered to be immune-mediated. Up-regulation of intercellular adhesion molecule-1 on keratinocytes and dermal endothelial cell surfaces has been shown, suggesting the involvement of adhesion molecules in pathogenesis (10). We hypothesize that increased Langerhans cell population, as observed in our case, results in a delayed immune response reminiscent of an eczematous process in MP. Excision of the central lesion has been reported to precipitate the resolution of dermatitis, as in our case, in which recurrence of the erythematous, scaly eruption was not observed after removal of the central lesion despite a 1-year follow-up period. Some authors recommend pre-treatment of the lesion with topical corticosteroids to suppress the eczematous process in the adjacent skin. Coexistence of MP around a melanocytic nevus (Meyerson nevus) with halo nevus and progression of Meyerson nevus to halo nevus has also been reported. We suggest that melanoma may occur as a component of MP, and careful dermatoscopic examination is essential to differentiate between pigmented lesions with a perilesional erythematous halo.

An evaluation of the difficulties and attitudes mental health professionals experience with people with personality disorders

INTRODUCTION

Working with people with a personality disorder (PD) can arouse strong feelings, and cause difficulties as well as different attitudes among mental health workers (MHWs). While attitudes towards people with PD and the difficulties experienced by MHWs have been previously investigated, the reciprocal relationship between the two has not been thoroughly investigated.

AIM/QUESTION

This study aims to investigate (1) affective reactions of MHWs to people with personality disorders, (2) the difficulties that MHWs experience while working with these patients, (3) their attitudes towards these patients, and (4) the interaction between these variables.

METHOD

The data for this study were collected through a Personal Information Questionnaire, the Difficulty of Working with Personality Disorders Scale and the Attitudes towards Patients with Personality Disorders Scale from 332 MHWs from several mental health clinics in Turkey, all of whom were experienced in working with people with PD.

RESULTS

The results indicate that the participants described 'difficulty in forming a relationship, understanding the client, and establishing cooperation' among the primary reasons of difficulties. This study also shows that there is a strong relationship between MHWs' feelings of boredom/discontent, guilt/pity and a tendency to display positive behaviours/an inability of establishing borders against people with PD.

DISCUSSION

The findings of this study imply that the level of education, expertise, psychotherapy treatment and clinical supervision of MHWs all affect perceived difficulties and attitudes towards people with PD. It is also noted that among nurses, a higher level of education results in reduced experience of difficulties while working with patients with PD.

IMPLICATION FOR PRACTICE

The results foreground the need for specific skills to be developed in MHWs through theoretical training, case-focused supervision and receiving personal psychotherapy for MHWs.

Is there any effect of oocyte count retrieved in the OPU procedure on pregnancy outcomes?

We aimed to investigate whether the number of oocytes retrieved during ovum pick-up has any effect on pregnancy outcomes when using the gonadotropin-releasing hormone or GnRH long agonist or antagonist protocols. A retrospective study was conducted between 2012 and 2014. The patients were grouped according to the number of oocytes retrieved at ovum pick-up; < 10 oocytes (Group 1), 10-14 oocytes (Group 2) and ≥ 15 oocytes (Group 3). Biochemical pregnancy rates were compared among the three groups. Statistical analysis was performed using one-way ANOVA test for continuous variables and chi-square test for categorical variables. In total, 825 treatment cycles were included in the study. Groups 1, 2 and 3 consisted of 514, 206 and 105 patients, respectively. There was no difference among the three groups regarding biochemical pregnancy rates (22.8%, 28.6% and 28.6%; p = 0.166, respectively). The results of our study suggest that the number of eggs retrieved has no effect on pregnancy outcome in assisted reproductive technology treatment.

Pigmented Bowen's disease of the genitalia masquerading as malignant melanoma

Pigmented Bowen's disease is a rare subtype of in situ squamous cell carcinoma of the skin and mucosa, with a potential risk of invasion and metastasis. It is universally accepted that human papillomavirus (HPV) is the cause of genital Bowen's disease. Herein we report an unusual case of pigmented Bowen's disease of the genital area that clinically simulated malignant melanoma. Accurate diagnosis could only be established after histological examination. Polymerase chain reaction (PCR) analysis showed that the lesion harbored HPV 16 DNA. Although pigmented Bowen's disease is rare, it should be considered in the differential diagnosis of all pigmented lesions of the genitalia. This case report highlights the necessity of biopsy and histopathological examination for every suspicious cutaneous lesion.

Neuroimaging and clinical characterization of Sotos syndrome

Sotos syndrome is a well-known overgrowth syndrome characterized by excessive growth during childhood, macrocephaly, distinctive facial appearance and learning disability. This disorder is caused by mutations or deletions in NSD1 gene. The aim of this study is to examine the relationship between the neuroimaging and clinical features of children with Sotos syndrome. Six Turkish children with Sotos syndrome were followed up about 3-7 years. The diagnosis was confirmed with molecular genetic analysis. We identified the pathogenic NSD1 mutation including three novel in all patients. All the patients had a characteristic facial gestalt of Sotos syndrome consisting of triangular face with prominent forehead, frontoparietal sparseness of hair and small nose. However, the degree of psychomotor and intellectual development was variable. Severe learning defect and speech delay were remarkable in two patients. The neuroimaging analysis showed abnormalities in four of six patients including bilateral large ventricles, thinning of the corpus callosum and persistent cavum septum pellucidum et vergae. Typical craniofacial appearance is the primary finding for the diagnosis of the disease even in the infantile period. However, the degree of psychomotor and intellectual development is very variable and does not correlate with the neuroimaging findings.

Tumor-stage mycosis fungoides of the vulva successfully treated with local low-dose radiotherapy

Mycosis fungoides (MF) is the most common type of primary cutaneous T-cell lymphoma. According to the proposed guidelines for MF, skin-directed therapies are the treatment of choice for patients with limited stage disease. We present a case of early-stage MF, who progressed to tumor-stage MF during the postpartum period, showing a solitary ulcerated tumor on the vulva, which was successfully treated with local response-based, low-dose radiotherapy.

Effects of spectral shifting in an inertial confinement fusion system

The main objective is to study the effects of spectral shifting in an inertial confinement system for kT/shot energy regime on the breeding performance for tritium and for high quality fissile fuel. A protective liquid droplet jet zone of 2 m thickness is used as coolant, energy carrier, and breeder. Flibe as the main constituent is mixed with increased mole-fractions of heavy metal salt (ThF4 or UF4) starting by 2 moles% up to 12 moles%. Spectrum softening within the inertial confinement system reduces the tritium production ratio (TBR) in the protective coolant to a lower level than unity. However, additional tritium production in the 6Li2DT zone of the system increases TBR to values above unity and allows a continuous operation of the power plant with a self-sustained fusion fuel supply. By modest fusion fuel burn efficiencies (40 to 60 %) and with a few mol.% of heavy metal salt in the coolant in form of ThF4 or % UF4, a satisfactory TBR of > 1.05 can be realized. In addition to that, excess fissile fuel of extremely high isotopic purity with a rate of ∼ 1000 kg/year of 233U or 239Pu can be produced. Radiation damage through atomic displacements and helium gas production after a plant operation period of 30 years is very low, namely dpa < 1 and He < 2 ppm, respectively.

Performance analysis of 233U for fixed bed nuclear reactors

Criticality and burn up behavior of the Fixed Bed Nuclear Reactor (FBNR) are investigated for the mixed fuel 233UO2/ThO2 as an alternative to low enriched 235UO2 fuel. CERMET fuel with a zirconium matrix and cladding has been used throughout the study. The main results of the study can be summarized as follows: Reactor criticality is already achieved by ∼2% 233UO2 with the mixed 233UO2/ThO2 fuel. At higher 233U fractions, reactor criticality rises rapidly and exceeds keff > 1.5 already by 9% 233UO2. With 100% 233UO2, start up criticality can reach keff = 2.0975. Time dependent reactor criticality keff and fuel burn up have been investigated for two different mixed fuel 233UO2/ThO2 compositions, namely: 4% 233UO2 + 96% ThO2 for a reactor power of 40 MWel (120 MWth) and 9% 233UO2 + 91% ThO2 for a reactor power of 70 MWel (210 MWth). Sufficient reactor criticality (keff > 1.06) for continuous operation without fuel change can be sustained during ∼5 and 12 years with 4% and 9% 233UO2 fractions in the mixed fuel, leading to burn ups of ∼36000 and >105000MWD/t, respectively. Thorium based fuel produces no prolific uranium. Plutonium production remains negligible.

CANDU reactors with reactor grade plutonium/thorium carbide fuel

Reactor grade (RG) plutonium, accumulated as nuclear waste of commercial reactors can be re-utilized in CANDU reactors. TRISO type fuel can withstand very high fuel burn ups. On the other hand, carbide fuel would have higher neutronic and thermal performance than oxide fuel. In the present work, RG-PuC/ThC TRISO fuels particles are imbedded body-centered cubic (BCC) in a graphite matrix with a volume fraction of 60%. The fuel compacts conform to the dimensions of sintered CANDU fuel compacts are inserted in 37 zircolay rods to build the fuel zone of a bundle. Investigations have been conducted on a conventional CANDU reactor based on GENTILLYII design with 380 fuel bundles in the core. Three mixed fuel composition have been selected for numerical calculation; (1) 10% RG-PuC + 90% ThC; (2) 30% RG-PuC + 70% ThC; (3) 50% RG-PuC + 50% ThC. Initial reactor criticality values for the modes (1), (2) and (3) are calculated as k∞,0 = 1.4848, 1.5756 and 1.627, respectively. Corresponding operation lifetimes are ∼2.7, 8.4, and 15 years and with burn ups of ∼72000, 222000 and 366000 MW.d/tonne, respectively. Higher initial plutonium charge leads to higher burn ups and longer operation periods. In the course of reactor operation, most of the plutonium will be incinerated. At the end of life, remnants of plutonium isotopes would survive; and few amounts of uranium, americium and curium isotopes would be produced.

Minor actinide burning in a CANDU thorium reactor

Nuclear waste actinides can be used as a booster fissile fuel material in form of mixed fuel with thorium in a CANDU reactor in order to assure the initial criticality at startup. Two different fuel compositions have been found useful to provide sufficient reactor criticality over a long operation period: 1) 95% thoria (ThO2)+5% minor actinides MAO2 and 2) 90% ThO2+5% MAO2+5% UO2. The latter allows a higher degree of nuclear safeguarding through denaturing the new 233U fuel with 238U. The temporal variation of the criticality k∞ and the burn-up values of the reactor have been calculated by full power operation for a period of 10 years. The criticality starts by k∞>1.3 for both fuel compositions. A sharp decrease of the criticality has been observed in the first year as a consequence of rapid plutonium burnout in the actinide fuel. The criticality becomes quasi constant after the 2nd year and remains close to k∞ = ∼1.06 for ∼10 years. After the 2nd year, the CANDU reactor begins to operate practically as a thorium burner. Very high burn up could be achieved with the same fuel material (up to 200000 MW.D/MT), provided that the fuel rod claddings would be replaced periodically (after every 50000 or 100000 MW.D/MT). The reactor criticality can be maintained until a great fraction of the thorium fuel is burnt up. This would reduce fuel fabrication costs and nuclear waste mass for final disposal per unit energy drastically.