Ayşegül Uludağ

Pantoprazole-induced thrombocytopenia in patients with upper gastrointestinal bleeding

Abstract Proton pump inhibitors (PPIs) are highly effective drugs for patients suffering from peptic ulcer and gastro-esophageal reflux diseases, but recent studies have indicated possible risks with the long-term use of PPIs, such as osteoporosis, fractures, increased risk of pneumonia, diarrhea, iron and vitamin B12 deficiencies. There are publications written as a case study that indicate thrombocytopenia as side effects of PPIs, but there is no study on this subject. This study aimed to investigate the development of thrombocytopenia in patients with short-term use of PPI-infusion therapy. In this study, the records of the patients were evaluated retrospectively, for the period between January 2012 and January 2013. Thirty-five patients with upper gastrointestinal bleeding were enrolled. Platelet counts were analyzed before treatment, and on the first, second and third day of treatment, respectively. All patients were treated with intravenous pantoprazole. Hemogram values of patients were analyzed before and after PPI infusion treatment. Platelet counts were found to decrease from the first day to the third day of treatment (249 714.29/µl, 197 314.29/µl, 193 941.18/µl, 183 500/µl, respectively). The platelet count decrease was statistically significant (p < 0.001). After cessation of infusion therapy, platelet counts began to rise on the fourth day. Three patients had severe thrombocytopenia on the third day of the treatment. (69 000/µl, 97 000/µl and 49 000/µl respectively). Platelet counts recovered after discontinuation of treatment. In conclusion, this study demonstrates that PPIs may cause thrombocytopenia, and this result should not be ignored. In particular, patients with PPI infusion therapy should be monitored more closely.

Screening mixed depression and bipolarity in the postpartum period at a primary health care center

INTRODUCTION Mixed depression is a clinical condition accompanied by the symptoms of (hypo)mania and is considered to be a predictor for bipolar disorder. Compared to pure major depression, mixed depression is worse in progress. There are limited data on the prevalence of mixed depression since it is a relatively new entity. Therefore, the present study aimed to investigate the prevalence of mixed depression during the postpartum period which is risky for mood disorders. METHODS The study included 63 postpartum women. The participants were administered Beck Depression Scale, Edinburgh Postnatal Depression Scale (EPDS), Mood Disorders Questionnaire (MDQ), and Modified Hypomania Symptom Checklist-32 (mHCL-32). RESULTS The MDQ scores of the women with expected depression according to the EPDS cut-off scores, were significantly higher than the women with lower EPDS scores (t=-4.968; p<0.001). The modified hypomania scores were significantly higher in the women with higher depression scores compared to the women under EPDS cut-off scores (t=-4.713; p<0.001). According to the EPDS and BDS results, 27 (42.9%) and 14 (22.2%) women needed additional clinical examination for depression, respectively. In addition, 3 (4.8%) women require additional clinical examination for bipolar disorder. The scores for the first item of MDQ were above the cut-off value in 11 (17.5%) women. According to the mHCL-32 results, 50 (79.4%) women had at least 1 symptom, 45 (71.4%) women had at least 3 symptoms, and 43 (68.3%) women had at least 5 symptoms of mixed depression. CONCLUSION Postpartum mixed depression should be promptly diagnosed by using appropriate diagnostic tools, particularly by primary health care physicians. Patients with mixed depression should be closely monitored to avoid manic switch.

Effects of vaginal discharge on female sexual function

To assess the effects of vaginal discharge on female sexual dysfunction (FSD) by using the Female Sexual Function Index (FSFI).

Comparison of olive oil and lanolin in the prevention of sore nipples in nursing mothers.

Sore nipple is a frequently encountered problem among lactating women. This problem might cause severe pain and might end up with discontinuation of suckling. An effective method to prevent sore nipples have not been defined yet. Olive oil is an easily accessible and relatively cheap substance. Although it had been used for sore nipples in the Mediterranean countries for many years, the usage of olive oil in the management of sore nipples has not been discussed in the literature yet. We aimed to define a new, safe, effective, and cheap modality for preventing sore nipples. We conducted the study on the patients who were delivered in our clinic between February 2012 and June 2012. Ethical committee approval and the written consent of patients were obtained. An education on breastfeeding was given to all patients by the same nurse. Patients’ nipples were examined to evaluate if both of them were suitable for suckling or not. Patients who did not give consent, could not breastfeed in the first 24 hours, had a difference between nipples that might affect suckling, had contraindication for breastfeeding, did not have sore nipples with their previous babies, and had an allergy to either olive oil or lanolin were excluded. Patients were requested to put olive oil on one nipple and lanolin on the other one before suckling and breastfed the baby without cleaning the ointment. They were asked to use the same ointment to the same nipple every time until the end of the study. They were advised to use one of the modalities for both nipples if they were satisfied with the modality. They were also advised to record the time they chose the modality if a selection was done. After a month, patients were evaluated once more. They were asked about satisfaction from the modalities, their choice if there was, and the pain during the suckling. Data were analyzed with the SPSS version 11.5 software program (SPSS, Inc., Chicago, IL). A value of p < 0.05 was defined as statistical significance. The mean age of the 31 patients included to our study was 27.84 – 6.33 years. Among the study group 64.5% of them were primiparous, and 51.6% of them were delivered by cesarean section. Education levels of patients were evaluated: nine (29%) of them graduated from a primary school, 17 (54.9%) of them graduated from a secondary school, and five (16.1%) of them graduated from a university. From the study group, 15 patients (48.4%) lived in an urban area with a downtown, and 16 (51.6%) of them lived in rural areas. In total, 18 (58.1%) patients preferred olive oil, five (16.1%) preferred lanolin, three (9.7%) continued to use both modalities, and five (16.1%) of them gave up both methods at the end of 1 month ( p < 0.001). Although nine (29%) patients decided to choose one of the methods in the first week of the delivery, the rest made their choice after 1 week. Of the ones who had decided in the first week of delivery, eight (89%) patients chose olive oil, and one of them gave up both methods. When a regression analysis was done for age, education levels, gravidas, parities, pain during suckling, delivery route, and method choice, we found a significant relationship only between the pain during suckling and the choice of method. As it is well established, breastmilk is the ideal nutrition for a newborn. In a population-based study that examined the breastfeeding rate and patterns among 3,161 infants younger than 6 months, it was found that 22.8% of mothers experienced sore nipples. Unfortunately, sore nipple might cause breastfeeding cessation. When Mohammadzadeh et al. compared hind milk rubbing after suckling and lanolin usage three times a day with the control group, they concluded that there was no difference among groups in terms of clinical manifestations of sore nipples. Tachev et al. concluded that highly purified lanolin (Lansinoh ; Lansinoh Laboratories, Alexandria, VA) was suitable for both preventing and treating sore nipples. Melli et al. recommended peppermint gel for sore nipples compared with placebo and lanolin. Olive oil has strong antioxidant and antimicrobial properties, and it had been used for wound healing for a long time. It is also known that even parenteral usage of olive oil for newborns is safe. So it is well tolerated by the babies and the families. To our knowledge this is the first article that evaluates the satisfaction of lactating women with olive oil for preventing sore nipples in the English literature. Using the contralateral nipple of the patient as a control group is the major factor that strengthens our study. In this way we eliminated many factors that might affect our results.

Vision screening in children: Is 7-9 years of age a threshold for visual impairment?

Objective: The present study aimed to assess the prevalence of decreased visual acuity, strabismus, and spectacle wear in children aged 5 to 13 years. Methods: A cross-sectional study was performed in primary education schools. A total of 1938 participants, including 940 females (48.5%) and 998 males (51.5%) with a mean age 8.96 ± 2.31 (5-13 years old), were screened. The comparisons were performed with gender, age, and age groups. The children attended to vision screening were assigned to three age groups as 5-6 years, 7-9 years, and 10-13 years. Results: The prevalence of the parameters was detected as decreased visual acuity 12.4%, strabismus 2.2%, and spectacle wear 6.9%. The prevalence of decreased visual acuity was significantly higher in girls and in children aged 7-9 years old (p = 0.013, p < 0.001). The prevalence of spectacle wear was significantly higher in girls and in children aged 7-9 years old (p = 0.019, p < 0.001). There was a visual acuity decrease in 33 of 106 (31.1%) children despite wearing own spectacle. There was no significant difference among three age groups for strabismus. Conclusion: Increased prevalence of decreased visual acuity, as well as the higher frequency of spectacle wear in children at ages of 7-9 years old may point out a threshold for visual impairment.

Female sexual dysfunction in androgenetic alopecia: Case-control study.

INTRODUCTION We sought to evaluate the association of female sexual dysfunction (FSD) with androgenetic alopecia (AGA) and metabolic syndrome (MetS) in premenopausal women. METHODS From December 2013 to June 2015, we performed a case-control, prospective study of 115 patients with AGA and 97 age-matched control patients without AGA from among premenopausal women who visited dermatology clinics of the two reference hospitals. Comprehensive history, anthropometric measurements, and questionnaire administration were performed for each of the total of 212 women. The Female Sexual Function Index (FSFI) was used to assess the key dimensions of female sexual function. AGA was assessed and graded by an experienced dermatologist according to Ludwigs classification. The MetS assessment was made according to the NCEP-ATP III criteria. RESULTS In univariate analysis, age, weight, waist circumference, hip circumference, waist-to-hip ratio, body mass index (BMI), AGA, MetS, cardiovascular event, marital status, hypertension, high fasting plasma glucose, high triglyceride, large waist, total testosterone, and free testosterone were associated with presence of FSD. In logistic regression analysis, age (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.13-1.30; p<0.001), AGA (OR 3.42, 95% CI 1.31-8.94; p=0.017), MetS (OR 5.39, 95% CI 1.34-21.62; p=0.012), and free testosterone (OR 0.18, 95% CI 0.09-0.37; p<0.001) were independently associated with FSD. CONCLUSIONS Our study suggests that age, AGA, MetS, and free testosterone may have strong impact on sexual function in premenopausal women. Further studies with population-based and longitudinal design should be conducted to confirm this finding.

Prevalence of skin disorders in primary and secondary school age children in Canakkale, Turkey: a community-based survey

Introduction Skin lesions may be of dermatological importance, affect appearance, and cause problems communicating with peers and may be especially more significant in childhood. Aim Information on the prevalence of pediatric dermatoses in Western Turkey. This study was aimed to define the existing data. Material and methods A cross-sectional study was conducted in Canakkale, Turkey, in September-December 2013. It involved 1,957 students from five randomly selected primary and secondary schools. Each student was interviewed for age, gender, and family history, and a dermatologic examination was performed by a dermatologist. Data were coded and analyzed. Results Of the students, 79.9% revealed at least one dermatosis. The most common disease was benign neoplasms (76%), followed by pigmentary disorders (26.8%), and xerosis (5.8%). In primary schools, the acquired melanocytic nevus, hypopigmented macule, and xerosis; in secondary school the acne was statistically significantly more common. Acne and xerosis was more common in girls, and pityriasis alba was statistically more common in boys. Students who had at least one dermatosis were positively correlated with monthly income. Conclusions In Turkish school age children, the prevalence of dermatosis is 79.9%. It may be due to not using preventive means for adequate protection from the sun and other environmental factors. Infectious dermatosis and atopic dermatitis are rare and it may depend on the adequacy of public health work.

Are blood pressure values compatible with medication adherence in hypertensive patients

BACKGROUND AND AIM In the management of hypertension (HT), maintaining the medication adherence with treatment is as important as starting treatment. Studies have shown that the majority of patients taking medication do not reach their target values. This study aimed to investigate the relationship between the patient medication adherence and blood pressure (BP) values and reflection to general well-being. MATERIAL AND METHODS The study included 259 primary HT patients. The patients with BP measurements completed the Medication Adherence Self-Efficacy Scale-Short Form 13 and the World Health Organization-5 (WHO-5) well-being index. A Holter device was attached, and 24 h BP monitoring was completed. RESULTS The mean points for medication adherence scale was 29.2 ± 10.3 (1-40) and mean WHO-5 points was 13.7 ± 4.6 (4-25) for patients. Clinical mean systolic BP was 140.0 ± 12.6 and diastolic 84.8 ± 9.0 mm Hg, while 24 h mean BP was systolic 119.5 ± 10.6 and diastolic 73.3 ± 8.1 mm Hg. While there was negative correlation between medication adherence scale scores and clinical systolic BP (r = -0.171; P = 0.006), there was no correlation with other BP readings. There was no correlation with the WHO-5 score and clinical readings, though there was a positive correlation between ambulatory mean systolic and diastolic BP (r = 0.141; P = 0.023 and r = 0.123; P = 0.049, respectively). There was positive correlation between the patients medication adherence scores and the WHO-5 scores (r = 0.141; P = 0.023). CONCLUSION When clinicians assess medication adherence of patients, they should benefit from objective BP measurements and scales. Subjective and objective findings are important while making clinical decision.

Effects of Sleep Hygiene Education on Subjective Sleep Quality and Academic Performance

1 Erkan Melih Sahin1, Levent Ozturk2, Demet Gulec Oyekcin3, Aysegul Uludag4 1Department of Family Medicine, Canakkale Onsekiz Mart University Faculty of Medicine, Canakkale, 2Department of Physiology, Trakya University Faculty of Medicine, Edirne, 3Department of Psychiatry, Canakkale Onsekiz Mart University Faculty of Medicine, Canakkale, 4Department of Family Medicine, Canakkale Onsekiz Mart University, Faculty of Medicine, Canakkale, Turkey Uyku Hijyeni Eğitiminin Etkileri / Effects of Sleep Hygiene Education Effects of Sleep Hygiene Education on Subjective Sleep Quality and Academic Performance

Çocuklarda kulak burun boğaz muayene sonuçları ve etkileyen faktörler: Okul tabanlı-kesitsel çalışma

Giris: Calismada okul cagi populasyonunda kulak burun ve bogaz muayenesi yaparak sik gorulen patolojileri ve bu durumlarla iliskili faktorleri saptamak amaclanmaktadir. Yontem: Kesitsel desendeki calisma Eylul-Aralik.2013 tarihleri arasinda Canakkale il merkezindeki ilk ve ortaokullarda yapildi. Ogrencilerin ve ailelerinin hastalik oykulerini ve aliskanliklarini sorgulayan anket uygulandi. Kulak, burun ve bogaz muayeneleri yapilarak, ogrencilerin muayene formlarina not edildi. Bulgular: Calismaya toplam 1938 ogrenci alindi. Ogrencilerin 1369 (%70,6)’u ilkokul, 569 (%29,4)’u ortaokulda egitim gormekteydi. Ogrencilerin yas ortalamasi 8,6 ± 2,3 idi. Calismada sirasiyla tonsiller hipertrofi %25,2, kepce kulak %14,8, otitis media %3,3, anterior nazal deviasyon %10,4 siklikta gozlendi. Kepce kulak erkek ogrencilerde daha fazlaydi (p0,05). Sonuc: Okul cocuklarinda sirasiyla tonsiller hipertrofi, anterior nazal deviasyon ve otitis media en sik saptanmistir. Ogrencilerin ve ailelerinin tibbi oyku ozellikleri ile ailelerin tibbi oyku ve aliskanliklari, kulak, burun ve bogaz patolojisinin varligi icin risk faktoru degildi.