Mehmet Akman

The effects of iron deficiency on infants' developmental test performance.

Aim: To assess the effects of iron deficiency on developmental test scores in infants. Methods: This prospective, single‐blind, controlled clinical intervention study was made on 108 children aged 6–30 mo who applied to our paediatric outpatient clinic. The cases were classified as control (n= 31, haemoglobin ± 11 g/dl, serum ferritin >12 μg/l, MCV ± 70 fl), non‐anaemic iron deficiency (NAID, n= 40, haemoglobin ± 11 g/dl, serum ferritin ± 12 μg/l, MCV ± 70 fl) and iron deficiency anaemia (IDA, n= 37, haemoglobin < 11 g/dl, ferritin ± 12 μg/l, MCV >70 fl) due to their anaemia status. In each group, MCV, haemoglobin and ferritin levels were measured, and Denver Developmental Screening Test (DDST) and Bayley Scales of Infant Development (BSID‐I) were administered before and after a 3‐mo follow‐up. IDA and about half of the NAID subjects were treated with oral iron for 3 mo. Results: Subjects with iron deficiency showed significantly lower developmental test scores both with BSID‐I and DDST‐II compared to their iron‐sufficient peers (p < 0.05). After 3 mo of iron treatment, lower mental developmental test scores were no longer observed among the IDA and NAID groups whose anaemia and iron deficiency were also corrected. No significant differences were found between control NAID and control IDA groups on DGTT‐II results after treatment. The difference in motor and mental developmental scores did not appear to depend on environmental and family factors considered in the analyses.

Long-term Efficacy and Safety of Low-Dose and Dose-Escalating Interferon Alfa-2a Therapy in Refractory Behcet Uveitis

OBJECTIVE To investigate the long-term efficacy and safety of low-dose and dose-escalating therapy of interferon alfa-2a in the treatment of Behçet uveitis. METHODS This study included 37 patients with refractory Behçet panuveitis unresponsive to conventional immunosuppressive therapy. Induction interferon alfa-2a therapy was given as a daily dose of 3.0 million IU (MIU) subcutaneously for 14 days. Maintenance dose was achieved with 3.0 MIU 3 times per week given subcutaneously. The dosage was increased sequentially to 4.5, 6.0, and 9.0 MIU 3 times per week if uveitis relapses occurred. Total therapy duration was 24 months. Primary outcome measure was control of uveitis with quiescence during maintenance therapy. Ocular relapses per patient-year before and after initiation of interferon alfa-2a therapy and a corticosteroid-sparing effect were secondary outcomes. We also estimated the rate of remission after discontinuing interferon alfa-2a therapy. RESULTS During maintenance therapy, interferon alfa-2a controlled uveitis in 35 patients (95%). In 15 patients (41%), a maintenance dosage of 3.0 MIU 3 times per week controlled uveitis without any relapse. The rate of uveitis relapses decreased from 3.52 per patient-year before to 0.75 per patient-year after initiating interferon alfa-2a therapy. Seventeen patients were receiving systemic corticosteroids at the time of initiation of interferon therapy. During the maintenance stage, 9 patients were able to discontinue and 8 to taper systemic corticosteroid therapy. Survival analysis estimated that the rate of remission after discontinuation of interferon alfa-2a therapy was 76% by 3 months. The rate of remission remained stable thereafter. CONCLUSION A treatment protocol using a low-dose and dose-escalating therapy with interferon alfa-2a was able to control and achieve remission of uveitis in most patients with refractory ocular Behçet disease.

Vision- and health-related quality of life in patients with Behçet uveitis.

OBJECTIVE To investigate vision- and health-related quality of life in patients with Behçet disease. METHODS Fifty-one consecutive patients with Behçet uveitis were enrolled in the study from January 1 through June 30, 2008. The National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) and the 36-Item Short Form Health Survey (SF-36) were administered. Sociodemographic and clinical data were also collected. Main outcome measures were comparison of the NEI-VFQ-25 and SF-36 subscale item scores among subgroups and multivariate analysis of the NEI-VFQ-25 and SF-36 subscale item scores. RESULTS Patients rated the general health subscale score of the NEI-VFQ-25 and all subscale item scores of the SF-36 lower than the NEI-VFQ-25 subscales related to vision. The NEI-VFQ-25 subscale item scores showed significant differences with respect to age, educational level, Behçet uveitis activity and severity, and visual acuity in the better and worse eyes. The SF-36 subscale item scores revealed significant differences according to sex, educational level, and the systemic treatment used. In the best model of linear regression, independent variables accounted for 57.0% of the variance in the NEI-VFQ-25 subscale item (color vision subscale; adjusted R² = 0.57, P < .001) and for only 23.0% of the variance in the SF-36 subscale item score (role limitation owing to emotional problems subscale; adjusted R² = 0.23, P = .004). CONCLUSIONS General health is more affected than visual functioning in patients with Behçet uveitis. Sociodemographic and clinical variables had a significant effect on vision- and health-related quality of life. Multivariate analysis of the NEI-VFQ-25 and SF-36 subscales revealed that each subscale item score is affected by additional factor(s) other than those analyzed here.

Sudden infant death syndrome: How much mothers and health professionals know

Background:  Behavioral risk factors are associated with sudden infant death syndrome (SIDS). Education about the risk factors of SIDS is important for prevention. Our aim was to determine the knowledge and attitude of parents and health professionals about SIDS.

Analysis of age, refractive error and gender related changes of the cornea and the anterior segment of the eye with Scheimpflug imaging

PURPOSE To assess age, refractive error and gender related changes occurring in the cornea and the anterior segment of the eye using a Scheimpflug system. METHODS The study included 666 healthy eyed subjects with a mean age of 39.3±19.7 years (range: 3-85 years). All analyses were based on the right eyes of the patients as all measured parameters correlated well between the right and left eyes. Each parameter was correlated with age and the right eyes spherical equivalent (SE) using Pearson correlations. Univariate linear regression models were constructed for analyses of parameters. RESULTS The anterior corneal surface asphericity showed significant positive correlations whereas posterior corneal surface asphericity showed significant negative correlations with age. Anterior chamber depth (ACD), volume (ACV) and angle (ACA) showed significant negative correlations with age and SE. Age explained 25% of the variance in anterior corneal surface asphericity, 22% of variance in posterior corneal surface asphericity, 26% of variance in ACV, 27% of variance in ACD, and 19% of variance in ACA. In the SE model SE was identified to account for 25% of variance in ACV, 22% of variance in ACD, each, and 17% of variance in ACA. Significant differences were detected in anterior and posterior keratometry values, ACV, ACD and ACA among gender groups (p<0.01). CONCLUSIONS The cornea shows a tendency for a decrease in anterior corneal surface asphericity and an increase in posterior corneal surface asphericity with advancing age. Men have flatter corneas and women have shallower anterior chambers and narrower anterior chamber angles.

A course, 'The Human in Medicine', as an example of a preclinical medical humanities program: A summary of 7 years

Background: This article is based on the experience with ‘The Human in Medicine’ (HIM) courses that had been a part of the preclinical program of the Marmara Medical School. Aim: The evaluation of the HIM course in terms of its efficacy and the impressions of the students. Methods: Three groups of data were collected: (a) Students’ feedbacks about the courses, (b) HIM final scores and (c) a thematic/content analysis of randomly selected students’ reports. Stratified random sampling was used to select student reports for qualitative analysis. Content and thematic analyses were carried out by two researchers independently. Results: In general, the HIM program was evaluated as moderate or above moderate by 60–80% of the students. Content and thematic analysis of student reports showed that there was a rich variety in individual definitions, descriptions of causal relationships and suggestions for possible solutions about themes medicalization and stigmatization. Student reports on the case were analysed in concordance with psychologic and social parameters. Conclusion: As a conclusion these results showed that program goals were mainly achieved and the multidisciplinary, preclinical HIM program can be seen as efficient starting point to complement the biologic perspective of medical education with a social and humanistic perspective.

Quantitative Analysis of Structural Alterations in the Choroid of Patients With Active Behçet Uveitis

Purpose: To quantitatively analyze in vivo morphology of subfoveal choroid during an acute attack of Behçet uveitis. Methods: In this prospective study, 28 patients with Behçet uveitis of ⩽4-year duration, and 28 control subjects underwent enhanced depth imaging optical coherence tomography. A novel custom software was used to calculate choroidal stroma-to-choroidal vessel lumen ratio. Subfoveal choroidal thickness was measured at fovea and 750 &mgr;m nasal, temporal, superior, and inferior to fovea. Patients underwent fluorescein angiography and indocyanine green angiography. Receiver operating characteristic curve and area under the curve were computed for central foveal thickness. The eye with a higher Behçet disease ocular attack score 24 was studied. The main outcome measures were choroidal stroma-to-choroidal vessel lumen ratio and choroidal thickness. Results: The mean total Behçet disease ocular attack score 24, fluorescein angiography, and indocyanine green angiography scores were 7.42 ± 4.10, 17.42 ± 6.03, and 0.66 ± 0.73, respectively. Choroidal stroma-to-choroidal vessel lumen ratio was significantly higher in patients (0.413 ± 0.056 vs. 0.351 ± 0.063, P = 0.003). There were no significant differences in subfoveal choroidal thickness between patients and control subjects. Choroidal stroma-to-choroidal vessel lumen ratio correlated with retinal vascular staining and leakage score of fluorescein angiography (r = 0.300, P = 0.036). Central foveal thickness was significantly increased in patients (352.750 ± 107.134 &mgr;m vs. 263.500 ± 20.819 &mgr;m, P < 0.001). Central foveal thickness showed significant correlations with logarithm of minimum angle of resolution vision, Behçet disease ocular attack score 24, total fluorescein angiography score, retinal vascular staining and/or leakage and capillary leakage scores of fluorescein angiography, and total indocyanine green angiography score. At 275 &mgr;m cutoff, diagnostic sensitivity and specificity of central foveal thickness for acute Behçet uveitis were 89% and 72%, respectively (area under the curve = 0.902; 95% CI = 0.826–0.978, P < 0.001). Conclusion: There was choroidal stromal expansion which was not associated with thickening of the choroid. Central foveal thickness may be used as a noninvasive measure to assess inflammatory activity in early Behçet uveitis.

Screening for Depression and Anxiety in Patients with Active Uveitis

ABSTRACT Purpose: To screen for psychological disorders in patients with active uveitis. Methods: Patients were screened for depression (BDI-II), state anxiety (STAI-I), VR-QOL (NEI-VFQ-25), and HR-QOL (SF-36). Association of depression and anxiety with sociodemographic and clinical parameters and with VR-QOL and HR-QOL were analyzed. Multivariate linear regression models were constructed for NEI-VFQ-25 and SF-36 subscales. Results: Of 99 patients, 37.3% screened positive for depression and 52.5% for anxiety. Depressed patients had lower visual acuity in the better seeing eye (p = 0.013) and more frequently panuveitis (p = 0.018). Anxious patients were younger (p = 0.009), had earlier onset of uveitis (p = 0.015), and had more frequently panuveitis (p = 0.016). Bivariate comparisons showed significant associations between psychological disorders and VR-QOL and HR-QOL. Significant bivariate associations were mostly lost in multivariate analyses for anxiety, but were preserved for depression. Conclusions: A positive screening test for depression and anxiety is common in patients with uveitis. Low vision and panuveitis are associated with depression. Depression is associated with impairment of VR-QOL and HR-QOL.

Examination of a board game approach to children’s involvement in family-based weight management vs. traditional family-based behavioral counseling in primary care

The most effective intervention model for childhood obesity is known as family-based behavioral group treatments. There are also studies that investigate the effects of educational games for children to gain healthy eating and physical exercise habits. The aim of this study was to compare the efficacy of a family-based group treatment with an educational game (Kaledo) intervention in childhood obesity. Kaledo is a board game that was designed to improve nutritional knowledge and healthy life style habits. It is played with nutrition and activity cards that players can select from, and a total score is calculated in the end of the game according to energy intake and expenditure. Obese children between 9 and 12 ages were involved in this study. Participants randomly divided into behavioral and game intervention groups. Clinical evaluation was performed in the first and second counseling in both groups. Marmara University Family Medicine Department Obese Children and Adolescents Interview Form, Physical Activity Evaluation Form, and Three-day Food Record Form were used for this purpose. Strengths and Difficulties Questionnaire-Parent Report Version and Children’s Depression Inventory were used for the assessment of psychiatric symptoms. After the clinical evaluation, an education session about healthy eating and physical activity was attended by both groups. After that, for the behavioral groups, parents and children were assigned to different groups, while for the game intervention group, parents were assigned to behavioral sessions and children were assigned to game (Kaledo) sessions. A total of six sessions with 1-h duration and 2-week interval were performed in both groups. Height and weight were measured in each session and analysis was performed on the data of the children who participated in all of the sessions. Although a total of 108 children were clinically evaluated, 52 children and their parents, 26 in the behavioral group and 26 in the game intervention group, participated in two or more sessions. Twenty-four participants, 12 in behavioral and 12 in the game intervention group, finished the study by participating in all of the six sessions. Thus, dropout rate was 74%. BMI and BMI z-scores decreased in both groups compared with the initial measures and these changes were statistically significant. For the behavioral group, these changes were − 1.01 (25.44 to 24.43, p = 0.03) and − 0.17 (2.07 to 1.90, p = 0.000) and for the game group, − 0.74 (26.98 to 26.24, p = 0.007) and − 0.09 (2.07 to 1.98, p = 0.003). There were no significant differences between behavioral and game intervention groups in point of BMI and BMI z-scores (p = 0.130 and p = 0.706).Conclusion: Family-based behavioral group treatment and game (Kaledo) intervention were found to be effective in childhood obesity management in this research. There was no significant difference between the two interventions. According to this study, these intervention models can be advised to primary care physicians to be used in the management of childhood obesity.What is Known:- Family-based behavioral group treatment is known as the most efficient model for childhood obesity management.What is New:- In this study, for the first time, a game (Kaledo) intervention was found to be effective in childhood obesity management.- Compared with family-based behavioral group treatment, there was no significant difference between the two interventions.

Nutritional status, Healthy Eating Index and eating attitudes of the adolescents in Istanbul: a cross-sectional study.

Abstract Background: The aim of this study was to evaluate dietary quality of adolescents by using the Healthy Eating Index (HEI) and to assess their eating attitudes by the EAT-26 Eating Attitude Test. Methods: Eight schools; four primary schools and four secondary schools were randomly selected from the school list of official website of Istanbul Education National Directorate. Five hundred and ninety-eight students who met the inclusion criteria included in the study, 24 h dietary recalls were collected to calculate their HEI scores and eating attitudes were evaluated by EAT-26 Eating Attitude Test. Their weight, height and waist circumference were measured. Results: According to HEI scores, only two (0.3%) of adolescents had high quality diet, 379 (63.4%) had diet quality that needed improvement and 217 (36.3%) had poor diet. Regarding Eating Attitude Test scores, 513 (85.8%) had normal attitudes regarding eating behaviors. Conclusion: Almost all of the participants need either development or major changes in their eating behaviors. Interventions aiming high quality diet among adolescents are strongly recommended.