GIRIS ve AMAC: Bir toplum icerisinde yetisen cocuklarin bedensel, sosyal ve ruhsal yonden saglikli gelismesi o toplumun kalkinmasi ve ilerleyebilmesi icin onemli bir faktordur. Cocuk istismari ve ihmali farkindalik duzeyinin yeterliligi tartisma konusudur. Calismamizin amaci ogretmenler, saglikcilar ve universite 1. sinif ogrencilerinin cocuk istismari ve ihmali konusunda bilgi duzeyini degerlendirmek ve onerilerini ileri calismalara temel olusturmasi icin belirlemektir. YONTEM ve GERECLER: Bu calismaya 70 saglik calisani, 95 ogretmen ve 200 ogrenci olmak uzere 365 kisi katilmistir. Anket sorulari Dunya Saglik Orgutu’nun (WHO) cocuk istismari ve ihmali tanimi temel alinarak hazirlanmistir. Saglikcilar, ogretmenler ve universiteye yeni baslamis ogrencilerin cocuk istismari konusundaki bilgi duzeyleri, yuz yuze anket uygulama metodu kullanilarak yapilan anketler ile degerlendirilmistir. BULGULAR: Calismamizin sonuclari, katilimcilarin buyuk bir kisminin cocuk istismari ve ihmali konusunda yetersiz bilgi birikimine sahip olduklarini gostermistir. TARTISMA ve SONUC: Bu veriler bolgesel ozellikler dikkate alinarak cocuk istismari ve ihmali konusunda egitim programlarinin olusturulmasina ve universite oncesi egitime bu programlarin entegre edilmesine ihtiyac oldugunu ortaya koymustur.

INTRODUCTION:Ventilator-associated pneumonia (VAP) is an important cause of mortality and morbidity in critically ill patients. We sought to determine the prognostic value of procalcitonin (PCT) and C-reactive protein (CRP) kinetics in critically ill patients who developed VAP.METHODS:Patients who were admitted to the intensive care unit (ICU) and developed VAP were eligible. Patients were followed for 28 days after the pneumonia diagnosis and blood samples for PCT and CRP were collected on the day of the pneumonia diagnosis (D0), and days 3 (D3) and 7 (D7) after the diagnosis. Patients were grouped as survivors and non-survivors, and the mean PCT and CRP values and their kinetics were assessed.RESULTS:In total, 45 patients were enrolled. Of them, 22 (48.8%) died before day 28 after the pneumonia diagnosis. There was no significant difference between the survivor and non-survivor groups in terms of PCT on the day of pneumonia diagnosis or CRP levels at any point. However, the PCT levels days 3 and 7 were significantly higher in the non-survivor group than the survivor group. Whereas PCT levels decreased significantly from D0 to D7 in the survivor group, CRP did not. A PCT level above 1 ng/mL on day 3 was the strongest predictor of mortality, with an odds ratio of 22.6.CONCLUSION:Serum PCT was found to be a superior prognostic marker compared to CRP in terms of predicting mortality in critically ill patients who developed VAP. The PCT level on D3 was the strongest predictor of mortality in VAP.

Objectives: The circumventricular organs (CVOs) are essential for most autonomic and endocrine functions. Trauma and bleeding can affect their function. The aim of this study was to investigate apoptosis and necrosis in CVOs in the early period after experimental subarachnoid hemorrhage (SAH) in rats, using annexin V affinity and caspase 3 immunostaining.Methods: Three experimental groups were used: Days 1 and 2 after SAH, and a control group, seven Wistar albino rats each. Subarachnoid hemorrhage was accomplished by transclival basilar artery puncture. Rats were perfused with 0.9% NaCl and 0.1M phosphate buffer pH 7.4 until heart stoppage. Apoptosis and necrosis in CVOs were measured by flow cytometry with annexin V staining, and by caspase 3 immunostaining.Results: Apoptosis in the organum vasculosum lamina terminalis (OVLT), median eminence (ME), and area postrema (AP) was significantly higher in the Day 1 group than in the control group. Apoptosis in the subfornicial organ (SFO), OVLT, ME, and AP was significantly higher in the Day 2 group than in the control group. There were significant differences between the Day 1 and Day 2 groups, except for AP. Necrosis in SFO and OVLT was significantly higher in the Day 2 group than in the Day 1 or control groups, whereas necrosis in the ME and AP did not differ between the three groups. Caspase 3-positive cell density was more intense in the Day 2 group than in the Day 1 and control groups.Discussion: Prevention of apoptosis may potentially improve impaired functions of CVOs after SAH.

In vitro literature studies have suggested that atherosclerotic oxidized low density lipoprotein (OxLDL) inhibits trophoblast invasion. The objective of this study was to determine the levels of OxLDL and to examine the relationship between antioxidative estradiol, estriol, and prooxidative progestin in normal and preeclamptic placental tissues and measure the serum activity of antioxidative paraoxonase (PON1). The study included 30 preeclamptic and 32 normal pregnant women. OxLDL was determined with ELISA, estradiol, unconjugated estriol, and progesterone that were determined with chemiluminescence method in placental tissues. Serum PON1 activity was determined with spectrophotometric method. Levels of OxLDL (P = 0.027), estriol (P < 0.001), estradiol (P = 0.008), and progesterone (P = 0.009) were lower in the placental tissues of preeclamptic group compared to the normal pregnant women. Serum PON1 activity was higher in preeclamptic group (P = 0.040) and preeclamptic group without intrauterine growth restriction (P = 0.008) compared to normal pregnant women. Tissue estriol of preeclamptic group without/with IUGR (P < 0.001, P = 0.002) was lower than the normal group. Results of our study suggest that the events leading to fetoplacental insufficiency lead to a reduction in the levels of estriol limit deposition of OxLDL in placental tissues. The serum PON1 activity is probably important in the inhibition of OxLDL in preeclampsia.

The aim of this study is to evaluate antibiotic susceptibilities, emm gene types, toxin gene profiles and clonal relatedness of group A streptococci (GAS) isolates obtained from patients and carriers. A total of 79 clinical isolates from patients and 60 isolates from carriers were included in the study. Emm typing, toxin gene detection for speA, speB, speC, speG and smeZ genes and pulsed-field gel electrophoresis (PFGE) was performed. Twenty-one distinct emm types were detected; the most common types were emm12, emm89, emm1, emm77, emm4 and emm3. The detection rates of both emm types and the toxin genes didn't differ significantly between patients and carriers. The presence of speA and smeZ was significantly higher in emm1 and speG was significantly lower in emm4 when compared to the other emm types. The rate of clustering obtained with PFGE wasn't significantly different in patients and carriers. As a result, twelve of the 21 emm types detected in this study were covered by the 26-valent vaccine, constituting 77.7% of the emm typeable isolates; however the emm4 type which is one of the most common types in the present study is not among this coverage.

This study was performed to compare the mortality associated with carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-sensitive A. baumannii (CSAB) infections, to identify potential risk factors for CRAB infections, and to investigate the effects of potential risk factors on mortality in CRAB and CSAB patients. This retrospective case-control study was conducted in a university hospital between January 1, 2005 and December 30, 2006. One hundred and ten patients with CRAB and 55 patients with CSAB infection were identified during the study period. The mortality rate was 61.8% and 52.7% in CRAB and CSAB cases, respectively (P = 0.341). In CRAB cases, the risk factors for mortality were identified as intubation (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.0-10.1; P = 0.042) and high APACHE II score (OR, 1.2; 95% CI, 1.1-1.3; P = 0.000), by multivariate analysis. Previous use of carbapenem (OR, 6.1; 95% CI, 2.2-17.1; P = 0.001) or aminopenicillin (OR, 2.5; 95% CI, 1.2-5.1; P = 0.013) were independently associated with carbapenem resistance. Although the mortality rate was higher among patients with CRAB infections, this difference was not found to be statistically significant. Previous use of carbapenem and aminopenicillin were found to be independent risk factors for infections with CRAB.

Thrombocyte and Erythrocyte Indices in Sepsis and Disseminated Intravascular CoagulationSepsis is the inflammatory response against infection. The existence of DIC during sepsis indicates a poor prognosis and coagulation abnormalities and thrombocytopenia may exist. The aim of this study was to investigate platelet and erythrocyte indices in sepsis patients with DIC and without DIC. In both groups coagulation tests, platelet count and indices, erythrocyte count and indices were retrospectively analysed. In the sepsis plus DIC patients the prothrombin time and D-dimer values were found significantly higher and fibrinogen, platelet and plateletcrit were found significantly lower than in the sepsis without DIC group. The analysis of mean platelet volume, platelet distribution width, erythrocyte count and indices revealed no significant differences between the two groups. These results showed us that the depression of bone marrow in septic patients with DIC and without DIC did not differ. The activation of the coagulation system might probably be the cause of thrombocyte depletion in DIC.

Prostate Specific Antigen (PSA), a member of kallikrein family, is a specific serine protease of prostatic tissue. In some case reports, changes in PSA levels after acute myocardial infarction (AMI) have been reported. In this study we evaluated variations in PSA levels post-AMI. Twenty-six male patients who had PSA levels within reference limits were included in the study. The diagnosis of AMI was confirmed by clinical findings, ECG (electrocardiogram) and cardiac marker studies. Serum total PSA (tPSA) and free PSA (fPSA) levels were measured at days 0 (day of admission), 1, 2 and 3 after AMI. PSA/albumin ratio was also calculated in order to evaluate the effect of dilution. A statistical analysis of the results of all patients revealed significant decrease in tPSA levels and tPSA/Albumin ratio at day 2 when compared to days 0 and 3, which showed a similar pattern. Changes of fPSA and fPSA/ Albumin ratio according to days were not found significant. In only four patients we found increased levels of tPSA and increased fPSA levels in three of them. These patients displayed severe problems such as renal failure, cardiac failure, ventricular aneurysm and cerebral ischemia due to cardiac arrest. The lower tPSA levels on day 2 suggest that tPSA can be eliminated rapidly from the circulation on days 1 and 2, probably through the formation of complexes of tPSA with acute phase proteins.

Background: This study was coinducted to investigate Staphylococcus aureus carriage in patients undergoing hemodialysis and peritoneal dialysis and to evaluate the clonal relationship between carriage and clinical isolates.Methods: Surveillance for S aureus carriage was performed in 30 hemodialysis patients, 40 peritoneal dialysis patients, 13 workers in the unit, and 40 controls. The clonal relatedness of isolates was assessed by pulsed-field gel electrophoresis.Results: Screening cultures yielded 8 (26.6%) isolates from the hemodialysis patients, 9 (22.5%) from the peritoneal dialysis patients, 4 (30.7%) from the staff, and 8 (20%) from the controls. All of the isolates were methicillin-susceptible except one from a hemodialysis patient. There was no significant difference in carriage rate among the study groups. A history of hospital admission in the previous 6 months and a history of infection was associated with an increased carriage rate. A total of 23 genotypes were established for the 28 isolates, demonstrating high clonal heterogenecity. Six clinical isolates from 4 hemodialysis patients and 4 clinical isolates from two peritoneal dialysis patients were molecularly evaluated to compare isolates obtained from infection with carriage isolates of the same patients. All but one of these clinical isolates were "indistinguishable/closely related" to the isolates obtained from the same patients as carriage isolates.Conclusion: Opur data show a clear association between S aureus carriage and S aureus infection. Determining the S aureus carriage state of patients undergoing dialysis can help guide infection prevention measures and treatment strategies.

We evaluated the asymmetric hand measurements in right- and left-handed individuals. 343 men and 290 women aged 18-42 years (22.11 +/- 2.07) participated in the study. There were no statistically significant differences when right-left differences in hand length, third finger length, palmar length, and the digit index value were evaluated according to hand preference and sex. Statistically significant differences were found for right-left differences in hand width, hand-shape index, and the palmar length/width according to hand preference. The strong left-handers, weak left-handers, and ambidextrous individuals in the study group all exhibited asymmetry favoring the left and were considered together. Similarly, the strong and weak right-handers exhibited asymmetry favoring the right hand and were considered together. The difference between these two groups was significant. When the data were evaluated according to sex, significant differences were found between the subgroups. In particular, right-left differences in the hand-shape index and palmar length/width values of the strong left-handers, weak left-handers, and ambidextrous individuals were found to be statistically significant according to sex; in contrast, the strong and weak right-handers showed no significant differences according to sex. These results suggest a relation of hand asymmetry to hand preference in a Turkish population.

The aim of this study was to determine the prevalence of enterotoxigenic Bacteroides fragilis (ETBF) in the patients with diarrhea in our region and to assess the association between diarrhea and bft gene subtypes. The presence of ETBF and bft gene subtypes were investigated in 200 stool samples from patients with diarrhea, diagnosed as gastroenteritis, which were sent to Clinical Microbiology Laboratory at Zonguldak Karaelmas University, Training and Research Hospital and in 200 stool samples from age-matched healthy subjects between April 14, 2009 and October 28, 2009. Nested - polymerase chain reaction was used to detect the presence of bft gene directly from stool samples. The bft gene subtypes were determined by PCR in case of ETBF detection. The presence of bft gene was detected in 29 (15%) of patients and 27 (14%) of control group. bft-1 and bft-2 were found in 24 and five stool samples from 29 diarrheic patients with ETBF, respectively. Among 27 control patients with ETBF, bft-1 and bft-2 were found in 24 and three samples, respectively. No bft-3 subtypes were identified in our study. ETBF was found as a single pathogen in 9% of the patients with diarrhea, while there was an accompanying pathogen in 6% of the patients. The proportion of coinfection with another pathogen among ETBF positive patients was 38%. Cooccurance with ETBF was present in nine of 18 patients with Rotavirus and two of five patients with Entamoeba histolytica. In conclusion; there was no statistically significant difference between the prevalence of ETBF in diarrheal patients and that of the control group. When the patients and controls were compared for each age group, no statistically significant difference in ETBF rates was found. There was no significant difference between groups with respect to bft subtypes; bft-1 was identified as the most common subtype. The rate of coinfection of ETBF and Rotavirus was high.

Numerous studies have investigated the potential impact of migration on psychiatric morbidity levels. Relatively little research has studied how the symptom profiles of patients with similar disorders and similar backgrounds are linked to the culture in which they live. Such research requires comparisons of immigrant patient samples with samples of patient who remain in their country of origin. In this study we compared symptoms in Turkish patients with depression living in Ankara, Turkey, and Berlin, Germany. To understand symptoms of patients with depression, not only the culture of origin but also the cultural context in which patients have been living needs to be considered as an important factor. The new culture can be associated with distinct, and not necessarily more serious, symptom profiles.

The aim of the study was to translate and test the reliability and validity of the Leeds Multiple Sclerosis Quality of Life Scale (LMSQoL) in Turkish patients with multiple sclerosis (MS). Demographic data of MS patients who had a registration in and followed up by a university hospital were recorded. The LMSQoL and Turkish Quality of Life questionnaire were applied to the patients. The internal consistency of the scales was assessed by Cronbach's alpha coefficient. The validity of LMSQoL was examined by using correlation between the total scores of LMSQoL and Turkish Quality of Life questionnaire. Test-retest reliability was examined by using the correlation for the first and second applications of LMSQoL. Sixty-nine MS patients, (40.6% male, 59.4% female) were enrolled in the study. Cronbach's alpha coefficient was found as 0.67 for the three positive items of LMSQoL. For the five negative items, Cronbach's alpha was found as 0.78. The correlation coefficient between the total scores of the scales was 0.80 (P<0.001). The Turkish version of the LMSQoL is a reliable and valid instrument and can be effectively used for measuring the impact of MS on the QoL.

Background and purpose: Apolipoprotein E (apoE) polymorphism is suggested to be a risk factor in stroke in some populations, either by affecting lipid parameters or independently. Its effect on lipoprotein(a) [Lp(a)] is not known. The roles of apoE polymorphism and of high Lp(a) levels in atherosclerotic stroke (AS) in the Turkish population are unclear. Our aim was to investigate the relationship of apoE alleles and Lp(a) level with AS and the relationship of apoE alleles with Lp(a) and other lipid parameters.Methods: ApoE polymorphisms and lipid parameters were prospectively evaluated in 85 patients and 77 controls with normal brain imaging.Results: Only hypertension, diabetes mellitus, associated vascular diseases and decreased high-density lipoprotein cholesterol levels were found to be independent risk factors for stroke. However, in the presence of apoE/E4 allele, increased low-density lipoprotein cholesterol (LDL-chol), apolipoprotein B (apoB) and Lp(a) levels and in the presence of apo E/E3 allele, only Lp(a) levels were determined as risk factors.Conclusion: This study showed that while apoE polymorphism was not a risk factor itself, high Lp(a). LDL-chol and apoB were determined to be risk factors in E3 or E4 carriers. (C) 2008 Elsevier B.V. All rights reserved.

We evaluated hand grip- strength in right- and left-handed individuals with different degrees of preferences. Six hundred and thirty-three individuals (343 men, 290 women) aged between 18 and 42 years (22.11 +/- 2.07) participated. Hand preference was determined using the Edinburgh Handedness Inventory. A hydraulic hand dynamometer was used to measure the grip-strengths, while sitting with the elbow in 90 degrees flexion and the Forearm in semi-pronation, lying on ail arm rest. The mean value of three trials was recorded. Statistically significant differences were observed among strongly right-handed men, weakly right-handed men, ambidextrous men, weakly left-handed men, and strongly left-handed men for right-hand grip strength. The differences between strong left- and strong right-handed men, weak right-handed and strong left-handed men, ambidextrous, and strong left-handed men were the primary reasons for the significance. No statistically significant difference was found among the different hand preference groups of men for the left hand, and no statistically significant difference was detected among different hand preference,groups of women for either hand. Our study provides insight into the relationship between handedness and hand performance based on grip strength in a Turkish population.

Background and Objectives Quality of life (QOL) of immigrant groups with mental disorders should be compared with similar patients in the country of origin. Therefore, this study evaluated the QOL in Turkish patients who were in treatment because of depressive disorders in Ankara and Berlin. Subjects and Methods Patients with depressive disorders were recruited from services in Ankara and Berlin. The same researcher interviewed all patients and assessed socio-demographic characteristics, symptomatology, psychiatric diagnosis and QOL. Results QOL of patients in Ankara was significantly higher than that of patients in Berlin. Satisfaction with specific life domains also showed significant differences between the two groups. Factors positively associated with QoL in Berlin were marital status, shorter duration of marriage, fewer occupants per household, a relaxed religious attitude, being informed about the illness by the physician, and lower levels of symptoms. In Ankara, only initial help seeking behavior and level of depressive symptoms were associated with QOL. Conclusion QOL of Turkish patients with depression in Berlin appears lower than that of similar patients in Ankara. Different factors may influence QOL of Turkish patients with depression living in the place of origin and having emigrated to Germany.

Not all clinical laboratories have an osmometer, and calculations for osmolality are a frequently used method for determining osmolality. The purpose of this study was to evaluate the performance of four formulas for the estimation of osmolality, with cryoscopic measurement as the reference standard in intracranial hemorrhage (ICH) and head injury (HI) patients who were not treated with mannitol. Forty HI and 31 ICH patients treated in the Neurosurgery Department were included in the study. Every 6 h over a period of 24 h, serum samples were collected from patients and osmolality was measured. In conclusion, our study shows that only formulas F1 [Osmolality = 1.86(Na) + 1.86(K) + Glucose + Urea] and F4 [Osmolality = 1.86(Na) + Glucose + Urea + Ethanol + 9] can be used to evaluate osmolality in ICH patients who were not treated with mannitol. In HI patients, none of the formulas should be used to calculate osmolality.

This study evaluated the relationship between hand and eye preferences in 343 men and 290 women aged between 18 and 42 years (22.11 +/- 2.07). Right-handed men preferred their right eyes, whereas left-handed men preferred their left eyes (p < .001). No significant differences were detected between right-eye preference and a preference for both eyes in men (p > .05), but a significant difference was observed between left-eye preference and a preference for both eyes (p = .008). Right-handed women preferred their right eyes, whereas left-handed women preferred their left eyes (p < 0.05). No significant differences were found between right or left eye preference and a preference for both eyes in women (p > .05). The results suggest that cultural differences among study groups and individual differences within study groups explain the inconsistencies regarding hand and eye preferences. Moreover, the findings broaden our knowledge about eye preference in relation to hand preference in a Turkish population.