Nurhan Ince

Body composition after stroke.

The aim of this study was to compare the body composition, including lean tissue mass, fat tissue mass, and bone mineral content, of the paretic leg with that of the nonaffected leg in patients with stroke and to evaluate the effects of time since stroke, spasticity, and motor recovery on the body composition specifically within the first year after stroke. Thirty-five stroke patients with mean age and standard deviation of 62.69±9.54 years were included in the study. A full physical examination including Brunnstrom motor recovery and modified Ashworth spasticity scale was performed. Fat tissue mass (grams), lean tissue mass (grams), and bone mineral content (grams) of both the paretic and nonaffected lower extremities were obtained from the total body scans determined by using dual-energy X-ray absorptiometry (Lunar DPX-PRO). Lean tissue mass and bone mineral content of the paretic side were found to be significantly lower than those of the nonaffected side (P<0.05). A significant correlation was found between the lean tissue mass and bone mineral content of both the paretic and nonaffected legs after adjusting for age and weight (P=0.000, r=0.679; P=0.000, r=0.634, respectively). Bone mineral content and lean tissue mass of both the paretic and nonaffected sides showed a significant negative correlation with time since stroke in patients with stroke for ≤1 year (P<0.05). A higher lean tissue mass and bone mineral content were found in patients with moderate to high spasticity in comparison with patients with low or no spasticity (P<0.05). Stroke causes loss of lean tissue mass and bone mineral content prominently in the paretic side. The loss increases with increasing time since stroke. Spasticity seems to help in preventing the loss of bone mineral content and lean tissue mass.

Risk Factors for Mortality of Nosocomial Bacteraemia in Intensive Care Units

Objective: The aim of this study was to follow critically ill patients prospectively in intensive care units (ICUs) to determine risk factors for mortality and outcome associated with nosocomial bacteraemia (NB). Subjects and Methods: A case-control study of 176 patients was conducted to identify the risk factors for mortality of NB in ICU patients. The study was performed in emergency, surgical and general surgical ICUs with 23 beds during a 15-month period. A total of 1,450 patients were admitted to the ICUs during the study period. The USA Center for Disease Control and Prevention definitions were used to diagnose nosocomial infections. Nosocomial bacteraemia was defined as the isolation of one or more organisms from blood cultures taken at least 48 h after admission, which were not related to a problem present on admission. An assessment of whether the isolated organisms represented true bacteraemia rather than contamination was made by clinical or laboratory evidence of infection. Results: A total of 214 bacteraemia episodes were found in the 176 patients (64 female, 112 male; 51.3 ± 21.3 years old), 90 of whom died and 86 survived. The bacteraemia rate was 12.1%. The most common etiological agents of bacteraemia were Klebsiella pneumoniae: 46 (21.5%), methicillin-resistant Staphylococcus aureus: 46 (21.5%), Pseudomonas aeruginosa: 32 (14.9%), and Escherichia coli: 20 (9.3%). Multivariate analysis showed that the requirement of mechanical ventilation for more than 7 days (p < 0.001), total parenteral nutrition (p = 0.034), inotropic drug (p < 0.001), and increased creatinine level (p = 0.034) were independent risk factors for mortality of NB in ICUs. Conclusions: Nosocomial infections caused by Gram-negative bacteria continue to be one of the major sources of morbidity and mortality.

Tuberculous meningitis in adults – experience from Turkey

Background:  The annual incidence of tuberculous meningitis (TM) is unknown. TM is a disease that still often results in residual sequelae, and has a mortality rate ranging between 15 and 51%. Experience of countries such as Turkey where drug‐resistant tuberculosis and TM are prevalent is important.

Paraoxonase-1 55/192 genotypes in schizophrenic patients and their relatives in Turkish population.

Background Oxidative stress and free radical-induced toxicity have been implicated in the pathophysiology of schizophrenia. In this study, we examined paraoxonase (PON1)-55/192 polymorphisms and PON1 activity in patients with schizophrenia, first-degree relatives of schizophrenic patients, and healthy controls. Methods This study consisted of 292 healthy participants, 267 unrelated patients with schizophrenia and 311 first-degree relatives of schizophrenic patients. PON1 55 (rs 854560) and PON1 192 (rs 662) polymorphisms were performed by restriction fragment length polymorphism. Results The frequencies of the QQ and LL genotypes were significantly overpresented in controls compared with those of schizophrenic patients and their relatives. In contrast, the RR genotype was more prevalent in patients than their relatives and healthy controls. The frequencies of the LM and QR genotypes in relatives were higher than controls. Serum PON1 activities of controls were significantly higher when compared with both schizophrenic patients and their relatives. The RR and LL genotypes were associated with a significantly increased PON1 activity as compared with QR or QQ and MM or LM genotypes, respectively, in all groups. Conclusion This is the first study that shows the association between PON1-55/192 polymorphisms and schizophrenia. Our data suggest that the subjects carrying R allele or RR genotype might be susceptible to schizophrenia and subjects with QQ or LL might be protected against schizophrenia. First-degree relatives of schizophrenic patients have higher heterozygote genotypes, suggesting that this group can shift either to patient or control group depending on their allele types and environmental factors. PON1 genetic variations are also associated with PON1 activities. Reduced PON1 activity in patients and their relatives might result from the combined effects of more than one polymorphic variant in PON1 or other genes and/or increased oxidative stress, supporting the hypothesis that reactive oxygen species-mediated cellular damage might contribute to the neuropathology of schizophrenia.

Gait speed and related factors in Parkinson’s disease

[Purpose] The aim of this study was to investigate the relationship between gait speed and various factors in ambulatory patients with idiopathic Parkinson’s disease. [Subjects] Fifty ambulatory patients with idiopathic Parkinson’s disease who were admitted to an outpatient clinic were included in this cross-sectional study. [Methods] The Hoehn and Yahr Scale was used for measurement of the disease severity. Gait speed was measured by the 10-Meter Walk Test. Mobility status was assessed by Timed Up and Go Test. The Hospital Anxiety and Depression Scale was used for evaluation of emotional state. Cognitive status was examined with the Mini-Mental State Examination. The Downton Index was used for fall risk assessment. Balance was evaluated with the Berg Balance Scale. Comorbidity was measured with the Cumulative Illness Rating Scale. The 36-Item Short Form Health Survey was completed for measurement of quality of life. [Results] The mean age was 66.7 (47–83) years. Twenty-eight (56%) patients were men. Gait speed was correlated positively with height, male gender, Mini-Mental Examination score, Berg Balance Scale score and physical summary scores of the 36-Item Short Form Health Survey. On the other hand, there was a negative correlation between gait speed and age, disease severity, TUG time, Downton Index, fear of falling, previous falls and the anxiety and depression scores of the Hospital Anxiety and Depression Scale. There was no correlation between gait speed and comorbidity. [Conclusion] The factors related with the slower gait speed are, elder age, clinically advanced disease, poor mobility, fear of falling, falling history, higher falling risk, and mood disorder.

Evaluation of turbidimetric inhibition immunoassay (TINIA) and HPLC methods for glycated haemoglobin determination.

Various factors may affect the accuracy of hemoglobin (Hb) A1c measurements that are widely used to monitor glycemic control in diabetic patients. This study was aimed to compare the values of HbA1c obtained by two different methods, Roche Tina‐quant second and thirdgeneration HbA1c assays based on the turbidimetric inhibition immunoassay (TINIA), and high‐performance liquid chromatography (HPLC) cation‐exchange method used by Arkray Adams HA‐8160 analyzer.

Una definición de las quejas premenstruales en adolescentes (un estudio preliminar- Estambul-Turquía)

This descriptive - analytical study was carried out during the year 2000 in order to formulate a classification system to determine the adolescents at high risk for Premenstrual Syndrome (PMS) and who need a detailed evaluation. Subjects were divided two groups according to DSM- IV criteria for premenstrual dysphoric disorder (PMDD) and Premenstrual Assessment Form (PAF) scoring system. The most frequent symptoms in Group I were marked anxiety or feelings of being on-edge and persistent anger and irritability or increased interpersonal conflicts and in Group II were lethargy, easy fatigability or marked lack of energy. Visits to the doctor for PMS symptoms and interruption in school attendance were more frequent in Group I which shows more severe symptoms. In addition, most symptoms were observed in a higher proportion in Group I than Group II. This difference was statistically significant. By envisaging some restrictions prior to prospective studies in developing countries, broad field studies that differentiate the risk groups and include all classes with all kinds of sociodemographic features should be performed to develop retrospective criteria for PMS with different complaints in various cultural structures.

Respiratory Problems in Tannery Workers in Istanbul

Tannery workers are exposed to many chemical and physical hazards. The current study involved 730 workers from 23 leather factories located in the Tuzla Organized Industry Region, Istanbul. Participants were interviewed and underwent clinical examination. After the basic physical examination, respiratory functions were measured by spirometer and the workers questioned about asthma. Health problems included gastrointestinal complaints (7.30%), bronchitis (3.11%) and asthma (3.0%). Signs of bronchial obstruction — wheeze and rhonchus — were detected in 71 (9.72%) workers. A deficit in the values of FVC%, FEV 1%, FEV1/FVC%, PEF%, FEF25— 75% was set nominally at 80% of the respiratory function test parameters. Decreased pulmonary function results were found for FVC% in 36 (4.93%) workers, FEV1 in 71 (9.72%), FEV1/FVC in 18 (2.59%), PEF in 183 (25.1%) and FEF25—75% in 204 (27.94%). The number of those with respiratory obstruction detected by spirometry was 294 cases (40.27%), more than the number of cases, 263 (36.02%), who claimed res- piratory problems in the questionnaire. This study was a contribution towards efforts to improve the factory envi- ronment and control workplace risks. Together with med- ical examinations before and during employment and provision of continuous health services and training will reduce the risk of occupational disease to a minimum. Introduction Leather production is one of the worlds oldest trades, consisting of a chemical process that turns animal hides into the much less perishable material, leather. As part of this process, after the removal of the epidermis and subcu- taneous tissue, the dermal collagen fibres are stabilized by means of chemical treatment known generically as tanning [1]. Employees who work in tanneries are liable to be affected by their exposure to lots of hazardous materials and processes during tanning. These hazards can be grouped into four categories: biological, physical and chemical hazards and work accidents.

The use of family planning methods in an administrative district of Istanbul

In Turkey, the first population and family planning law was accepted by the government in 1965, and this law was revised in 1982. This study was carried out to evaluate the family planning methods of women who applied to rural health centers of Küçükçekmece and were willing to use the health-care service and consultancy about birth control methods. The data of the study were gathered by means of an appropriate inquiry form and face-to-face interview with the women willing to use the family planning service between September 1998 and June 1999 at the health-care centers of Küçükçekmece of Istanbul. There were 699 women participants in the study. The last pregnancy of 27.2% (n = 175) of the women had been undesired; 86.8% of all the women who participated in the study declared that they did not desire any more children, but only 81.3% (n = 568) out of these were using a method to protect from pregnancy. The most frequently known (84.8%) and used (45.9%) method of the participants was an intrauterine device (IUD), and 80.8% of the women using an IUD wanted to continue using that method. A total of 223 women (39.3%) using any method protecting from pregnancy became pregnant. Approximately half (57.8%) of those occurred during the use of withdrawal. According to the findings of this study, the level of knowledge about family planning and the consequent behavior of the women within the fertile age group are better than the average of Turkey, but still not satisfactory.

Biological Hazards in Tannery Workers

A total of 431 workers from 14 leather factories located in the Tuzla Organized Industry Region, Istanbul were involved in the study. Subjects were interviewed and examined individually with regard to asthma symptoms. Physical examinations were undertaken and respiratory function measured by spirometer. Moreover, the atmosphere of the working areas in the factories was assessed microbiologically. The fungal genera most often detected were Penicillium spp., followed by Aspergillus spp., Alternaria spp., Scopulariopsis spp., and Cladosporium spp. multiplying at differing rates. The number of those physically examined with indications of peripheral respiratory obstruction was 176 (40.8%) while those with suspected asthma following questioning was 153 (35.5%). The obstruction demonstrated by the use of respiratory function tests was associated with the mold isolated from the environment and was included in the logistic model that was developed as a risk factor for increasing obstruction. Workers employed in tanneries encounter many health problems. These may be reduced by: improving the factory environment, environmental control of allergens, elimination of allergen reservoirs, control of humidity and reducing exposure to excessive heat or cold. In addition there should be air filtration and vacuum cleaning to control dust mites and control of other workplace risks not necessarily associated with tanning. Importantly, workers should have medical examinations before employment and periodic examinations during training and employment to reduce the risk of occupational diseases to a minimum.