Sibel Kiran

Impact of Ramadan on demographics and frequencies of disease‐related visits in the emergency department

The objective of this study was to determine whether Ramadan is changing frequencies and demographics of visits due to certain diseases. Data obtained from the charts of the adult patients admitted into the emergency department (ED) due to 10 predetermined entities between 2000 and 2004 were analysed. Demographic variables analysed separately for certain entities visiting the ED in Ramadan were not found to be different from visits in other times of year. Visit frequencies for hypertension and uncomplicated headache in Ramadan were significantly higher than in non‐Ramadan months (χ2 test, p = 0.015 for hypertension, p < 0.001 for uncomplicated headache). Mean age of the patients admitted to the ED due to diabetes‐related conditions in Ramadan was significantly lower than in pre‐ and post‐Ramadan months (59.91 ± 14.60 and 62.11 ± 14.61, respectively) (Mann–Whitney U‐test, p = 0.032). The patients with diabetes presenting in Ramadan were found significantly younger than their peers in the rest of the year. For other diseases, Ramadan does not appear to be a risk factor.

Plateletcrit and red cell distribution width are independent predictors of the slow coronary flow phenomenon.

BACKGROUND AND PURPOSE Endothelial dysfunction may play a role in the pathogenesis of the slow coronary flow (SCF) phenomenon. A detailed examination of blood cellular components has not been performed for this condition. We investigated the relationship between SCF and whole blood cell counts. METHOD Records of 17,315 patients who underwent coronary angiography between January 2006 and December 2012 were evaluated retrospectively. A total of 146 patients with SCF were compared with 148 patients with normal coronary arteries according to demographic data, complete blood count, and biochemical parameters. RESULTS The following parameters were significantly higher in SCF patients than in patients with normal coronary arteries: percentage of smokers (36.3% vs. 25%, p=0.036), body mass index (26.69 ± 2.84 vs. 26.07 ± 3.15, p=0.049), white blood cells (WBCs) (7.52 ± 1.43 × 10(3)mm(-3) vs. 7.01 ± 1.42 × 10(3)mm(-3), p=0.002), red cell distribution width (RDW) (13.68 ± 1.42% vs. 13.15 ± 1.13%, p<0.001), platelets (250.29 ± 50.96 × 10(3)mm(-3) vs. 226.10 ± 38.02 × 10(3)mm(-3), p<0.001), plateletcrit (PCT) (0.214 ± 0.40% vs. 0.184 ±0.29%, p<0.001), mean platelet volume (8.63 ± 1.10fL vs. 8.22 ± 0.83 fL, p<0.001), platelet distribution width (PDW) (16.58 ± 0.76% vs. 16.45 ± 0.57%, p=0.028), and neutrophils (4.44 ± 1.25 × 10(3)mm(-3) vs. 4.12 ± 1.24 × 10(3)mm(-3), p=0.029). Positive PCT values [odds ratio (OR), 4.165; 95% confidence interval (CI), 2.493-6.959; p<0.001) and RDW (OR, 1.304; 95% CI, 1.034-1.645; p=0.025) were independent predictors of SCF. CONCLUSION Although within the normal range, the increased numbers of WBCs and neutrophils in patients with SCF suggest that SCF may be a subclinical inflammatory condition. Furthermore, increased RDW and PDW in SCF patients may cause microvascular blood flow resistance due to impaired cell deformability. The PCT provides reliable data regarding total platelet mass and may be a useful predictor of SCF.

Analysis of glomerular filtration rate, serum cystatin C levels, and renal resistive index values in cirrhosis patients

Abstract Background: The aim of this study was to evaluate the relation of glomerular filtration rate (GFR) to serum cystatin C levels, renal resistive index (RRI), serum creatinine and creatinine clearance in patients with different stages of cirrhosis. Methods: The study sample was 25 cirrhotic patients (10 females and 15 males; mean age 57.3±2.04 years), 10 in the compensated stage without ascites and 15 in the decompensated stage with new-onset ascites. None had azotemia nor were on diuretic treatment. The control group comprised 25 healthy adults (11 female and 14 men; mean age 56.56±1.91 years). Serum cystatin C, RRI, serum creatinine and creatinine clearance were measured. GFR was determined by technetium99m-diethylene triamine pentaacetic acid renal scintigraphy. Results: Cirrhosis cases had lower mean scintigraphic GFR than controls (64.5±4.03 vs. 87.96±4.16 mL/min, p<0.05). Serum cystatin C and RRI were significantly higher in the cirrhotic group compared to controls (1.16±0.09 mg/L and 0.68±0.01 vs. 0.86±0.03 mg/L and 0.64±0.01, respectively; p<0.05). Subgroup comparative analysis showed that only two parameters, scintigraphic GFR and serum cystatin C, were significantly different between compensated and decompensated cirrhotics (75.62±4.9 mL/min and 0.89±0.07 mg/L vs. 57.23±5.14 mL/min and 1.34±0.13mg/L, respectively; p<0.05). Scintigraphic GFR showed significant correlation with cystatin C, but not with serum creatinine or creatinine clearance (r=–0.877, p<0.05) in decompensated patients. No correlation was observed between scintigraphic GFR and RRI or between serum cystatin C and RRI in all subjects. A receiver operator characteristics curve showed that cystatin C at a cutoff value of 1.01 mg/L can significantly differentiate patients with GFR <70 mL/min with 80% sensitivity and 80% specificity. Conclusions: Serum cystatin C, but not serum creatinine or RRI measurement, correlates with GFR in each stage of liver failure and has a significant diagnostic advantage in detecting lower GFR in such cases. Clin Chem Lab Med 2007;45:890–4.

Prevalence and behavioural correlates of enuresis in young children

Objectives:  Previous studies based on clinical samples report that enuresis in children is associated with behavioural problems and reduced self‐esteem, but the relationship between behavioural problems and enuresis remains controversial. This population‐based study investigated the prevalence and behavioural correlates of enuresis in a group of preparatory school children.

Succinylcholine or rocuronium? A meta‐analysis of the effects on intubation conditions

This meta‐analysis was undertaken to compare the effects of succinylcholine (SCH) and rocuronium (RCR) on endotracheal intubation (ETI) conditions. Eligible randomised controlled trials (RCTs) were identified via medline and a manual search of references. The frequencies of excellent and unacceptable ETI conditions in subjects receiving SCH 1.0–1.5 mg/kg and RCR 0.6–1.2 mg/kg were determined using standard statistical methods. Inclusion criteria were met by 16 RCTs, representing 1362 subjects. SCH was associated with a 17.7% increase (95% CI = 13–22) in the frequency of excellent ETI conditions and a 5.1% decrease (95% CI = −7.3 to −2.9) in the frequency of unacceptable ETI conditions, when compared with RCR. In the subgroup undergoing true rapid sequence intubation, SCH was associated with a 19.1% increase (95% CI = 13.7–24.5) in the frequency of excellent ETI conditions. SCH appears to be superior to RCR in creating excellent ETI conditions and avoiding unacceptable ETI conditions.

Assessment of QRS duration and presence of fragmented QRS in patients with Behçet's disease.

BackgroundQRS prolongation and the presence of QRS fragmentation in 12-lead ECG are associated with increased mortality and sudden cardiac death in the long term. In this study we aimed to assess QRS duration and fragmentation in patients with Behçet’s disease (BD). MethodsA total of 50 patients (mean age 42.7±12.0 years) previously diagnosed with BD were recruited. In addition, a control group consisting of 50 healthy people (mean age 39.4±12.5 years) was formed. The longest QRS duration was measured in surface 12-lead ECG and QRS complexes were evaluated in terms of fragmentation. Serum C-reactive protein levels were also obtained. ResultsQRS duration and corrected QT duration were significantly longer in patients with BD compared with controls (102.75±11.91 vs. 96.99±10.91 ms, P=0.007; 438.55±30.80 vs. 420.23±28.06 ms, P=0.003, respectively). Fragmented QRS (fQRS) pattern was more common in patients with BD than controls [n=27 (54%) vs. n=16 (32%), P=0.026]. Disease duration was longer in patients with BD with fQRS compared with those without (12.67±8.68 vs. 7.09±7.06 years, P=0.010). Furthermore, C-reactive protein level was higher in patients with BD with fQRS compared with those without (6.53±4.11 vs. 4.97±6.32 mg/dl, P=0.043). Correlation analysis revealed no association between disease duration and QRS duration (r=0.219, P=0.126). ConclusionQRS duration is greater and fQRS complexes are more frequent in patients with BD. These findings may indicate subclinical cardiac involvement in BD. Given the prognostic significance of ECG parameters, it is reasonable to evaluate patients with BD with prolonged and fQRS complexes more in detail such as late potentials in signal averaged ECG in terms of cardiac involvement.

Morphology of the Gluteal Region in the Female Population 5 to 83 Years of Age

This study evaluated the development of gluteal region morphology in the female population 5 to 83 years of age. For the study, 132 female subjects were placed into four groups: prepubertal (ages 5 to 8 years; n = 10), pubertal (ages 9 to 14 years; n = 38) postpubertal (ages 15 to 41 years; n = 34), and menopausal–postmenopausal (older than 42 years; n = 29). The age, weight, and height of the subjects were routinely recorded, and body mass index was estimated. In addition, 11 measurements were performed on the gluteal region. The data were analyzed by Pearson and Spearmen correlation analyses using SSPS 11.0 for Windows. In the prepubertal group, the intergluteal sulcus and infragluteal sulci did not actively change. Weight gain was the major factor influencing the shape of the gluteal region, whereas age had no effect. In the puberty group, the gluteal region expanded in all directions. During this period, it was difficult to determine any specific relation between measurements because of significant correlation involving all parameters. However, it should be mentioned that among the four groups, only in pubertal group did age significantly affect the shape of the gluteal region. In other three groups, weight seemed to be a major determinant. In the pospubertal and menopausal–postmenopausal groups, the buttocks sagged with weight gain, contrary to the belief that this happens with aging. This causes movement of the infragluteal sulci in downward and lateral directions as well as lengthening of intergluteal sulcus.Although the gluteal shape is open to the effects of demographic factors such as ethnicity, feeding habits, and lifestyle, according to these findings, it might be advised that in the assessment of the gluteal region morphology, it would be better to consider its dynamic nature. Reshaping its only one part, which can be devastating unless the whole gluteal region and upper limb are addressed.

Differences in sex, angiographic frequency, and parameters in patients with coronary artery anomalies: single-center screening of 25 368 patients by coronary angiography.

BackgroundAlthough the prevalence of coronary artery anomalies varies in different series, the precise population frequency is unknown. Materials and methodsThe medical records of all patients who underwent coronary angiography between January 2002 and August 2012 were retrieved, and 238 cases with coronary anomalies were evaluated. Unlike other studies, we compared several angiographic parameters (fluoroscopy time, number of images, and catheters used) in addition to frequency and sex data. ResultsThe angiographic frequency of coronary artery anomalies was 0.94%. The most common coronary anomaly was a left anterior descending-circumflex artery originating from separate ostia (0.29%). The second most common anomaly was a right coronary artery (RCA) originating from the left sinus of Valsalva (sV) (0.23%). Overall, coronary artery anomalies (1.28 vs. 0.80%; P<0.001) and a left anterior descending-circumflex artery originating from separate ostia (41.3 vs. 25.3%, P=0.010) were more frequent in women than in men. The percentage of patients requiring more than two catheters during the procedure was significantly higher for an RCA originating from the left sV (45.7 vs. 16.7%, P<0.001) and in hypertensive patients (85.7 vs. 70.8%, P=0.015). On comparing the three most common coronary anomalies, an anomalous RCA originating from the left sV had a significantly higher value for at least one angiographic parameter. ConclusionAn anomalous RCA originating from the left sV is the most difficult type of anomaly to perform the ostial coronary cannulation during procedure. The results of this study may lead to the development of more suitable diagnostic catheters for an anomalous RCA originating from the left sV.

Associations between Temporary Employment, Alcohol Dependence and Cigarette Smoking among Turkish Health Care Workers

This study aims to investigate the association between contract type (temporary vs permanent employment) and unhealthy behaviour (alcohol dependence and cigarette smoking) in a sample of Turkish health care workers (N = 480). The authors hypothesize that temporary compared with permanent workers are more likely to depend on alcohol and to smoke cigarettes owing to increased work-related stress. Conditional logistic regressions were used to estimate the odds ratios of alcohol dependence and smoking status according to contract type. Controlling for gender, occupational position, education, family status, age, tenure and income, temporary workers compared with permanent workers were 5.6 times more likely to be alcohol dependent. However, no significant differences were established for smoking status. The study underlines the association between temporary employment and alcohol dependence, and, in particular, the possibility of reversed causation and possibilities for generalizing results to other populations and to other countries, as an important route for future research.

Occupational Exposure to Ethylene Oxide and Risk of Lymphoma

Background: Ethylene oxide, a high-volume commodity, is an established human carcinogen, although the relevant epidemiologic evidence is limited. Methods: We explored the association between occupational exposure to ethylene oxide and risk of lymphoma in a case-control study, including 2347 lymphoma cases first diagnosed in 1998–2004 and 2463 controls, from 6 European countries. The diagnosis of lymphoma was based on the 2001 World Health Organization Classification of lymphoma. Occupational exposure to ethylene oxide was retrospectively assessed by industrial hygienists and occupational physicians based on detailed self-reported information. We modeled risk of lymphoma with unconditional logistic regression analysis as a function of various exposure measures, adjusting for age, sex, and participating center. Results: Thirty-one cases and 27 controls (1.2% of the total study population) were defined as ever having been exposed to ethylene oxide (odds ratio = 1.3 [95% confidence interval [CI] = 0.7–2.1]). Lymphoma risk showed a 4.3-fold increase associated with medium-high frequency of exposure to ethylene oxide (95% CI = 1.4–13). Among major subtypes, chronic lymphocytic leukemia was consistently associated with ethylene oxide exposure, related in a dose-response manner to probability, frequency, and duration of exposure, as well as to cumulative exposure and (less definitively) with exposure intensity. Conclusions: Our results add to the evidence that ethylene oxide is a human carcinogen.