Evaluating the role of strain ratio elastography in determining malignancy potential and calculating objective BIRADS US scores using ultrasonography and elastography features

Purpose: The aims of this study were, firstly, to evaluate solid breast masses based on their malignancy potential and to determine whether the strain elastography ratio (SER) can contribute to classical grey-scale ultrasonography findings, and secondly, to define objective BIRADS US scores using ultrasound (US) and SER findings. Material and methods: A total of 280 patients and 297 solid breast masses were evaluated using sonographic and elastographic data. The SER was measured for each lesion. Results: The positive predictive values (PPV) for each criterion was calculated to be between 35% and 83.3%. The lowest PPV was obtained from hypoechogenicity (35%) and the highest PPV was obtained for anti-parallel features (83.3%). The difference between the mean SER of benign and malignant lesions was statistically significant. After ROC analysis, the SER cut-off value was calculated to be 3.1 for determining if the mass was benign or malignant. Mass scores were calculated for each solid breast mass based on positive predictive values, and BIRADS US score was defined as the sum of mass scores. Conclusions: SER findings can be used as malignancy criteria in evaluating solid breast masses. BIRADS US score can be objectively determined based on US and elastography features instead of doing subjective scoring. As an additional result, all solid breast masses have the possibility to be malignant, even though US and elastography findings indicate the opposite

Evaluation of diagnostic value of conventional and color Doppler ultrasound with elastography strain ratios in differentiation between benign and malignant lymph nodes

Introduction: The aim of this study was to evaluate the diagnostic value of conventional ultrasonography (USG) and color Doppler ultrasonography (CDU) with elastography strain ratios (ESR) in discrimination between benign and malignant lymphatic nodes. Material and methods: Two hundred and forty-seven patients (252 lymph nodes) were included in this study. USG and CDU with ESR were performed. Materials were obtained by using fine-needle or vacuum-assisted aspiration methods depending on the site and condition of lymph nodes. The χ2 test and Student’s t-test were used for comparisons. Results: Ninety-two of 252 (36.5%) lymph nodes were malignant, and 160 (63.5%) were benign. Short axis, S/L ratio, presence or absence of the fatty hilum and extra-hilar vascularity were valuable, statistically significant indicators of malignancy. In contrast, long axis and ESR were not significant indicators of malignancy. The short axis cut-off value was calculated to be 12 mm and the S/L ratio cut-off value was calculated to be 1. Conclusions: Long axis of lymph nodes and strain ratios cannot be used as malignancy criteria, and their use is controversial despite the fact that some studies have found them valuable. On the other hand, our results support common knowledge that the short axis, S/L ratio, absence of the fatty hilum, and extrahilar vascularity are significant indicators

Evaluating qualitative and quantitative computerized tomography indicators of chronic obstructive pulmonary disease and their correlation with pulmonary function tests

Background: With increasingly aging populations, chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death today. Emphysematous changes, an important component of the disease, must be determined on HRCT, either qualitatively or quantitatively. The purpose of this study was to evaluate features that help determine emphysematous changes and correlate them with respiratory function tests (RFTs). Material/Methods: A total of thirty COPD patients and a control group of the same size, matched for age, were included in the study. The mean lung parenchyma density values on inspiration and expiration, visual HRCT scores, and pulmonary function tests were obtained. IBM SPSS statistical software (version 22) was used to perform correlation analysis (Pearson's coefficient) and the Mann-Whitney U test. Results: The most valuable RFTs for determining emphysematous changes were DLCO, FEV1, and FEV1/FVC, in that order. Quantitative measures of the mean lung density had the highest correlation with coefficient on expiration. Conclusions: As regards the comparison between objective and subjective density values, the HRCT-based visual density values are satisfactory. On the other hand, the best assessment can be performed with the use of mean density values on expiration. DLCO, FEV1, and FEV1/FVC were found to be valuable parameters in determining parenchymal changes

Tooth coronal index and a new staging system for dental age estimation in southern Turkish population

Dental age indicators should be evaluated in different populations. The aim of the study was to evaluate the accuracy of the estimated age results of tooth coronal index (TCI) and to develop a new staging system using panoramic radiography for the southern Turkish population. The study group consisted of panoramic radiographs of 1000 individuals aged 11–77 years. The study group was divided into four subgroups according to age of patients: Group 1 (11–18 years of age), Group 2 (18–29 years), Group 3 (30–50 years), Group 4 (51–77 years). The mandibular first molar was measured. TCI and a new staging system were assessed in the southern Turkish population by two observers. The novel model includes six new parameters. Multiple regression models, intraclass correlation coefficient and Durbin-Watson analysis were used. The estimation error of TCI and the novel model were 14.25 and 11.04, respectively. The parameters of the novel model were more powerful than TCI’s. There was no significant difference in sex. For both methods, the estimated age in Group 3 (between 30–50 years) provides the highest accuracy in all age groups. The results showed that the novel age estimation model is more reliable in the southern Turkish population.No sponso

Follow-up results of laser saphenous ablation

Objectives: This retrospective study aimed to evaluatethe efficacy and durability of endovenous laser ablationwith 940 nanometer wavelength with at least one-yearfollow-up.Materials and methods: Between December 2009 andFebruary 2012, a total of 68 incompetent great saphenousveins and 4 small saphenous veins were treated byendovenous laser ablation, using 940 nanometer wavelengths.Patients underwent standard clinical and duplexfollow-up examinations with a mean of 18 months (range12 to 26 months) after endovenous laser ablation. Patientsatisfaction regarding the procedure was assessed withthe use of a visual analog scale (range 1 to 100).Results: Post-procedural duplex scans showed total occlusionof the treated great saphenous veins in 56 patients(97%) and sub-total occlusion in 2 (3%) patients.For small saphenous veins, post-procedural duplex scansshowed total occlusion in 4 (100%) patients.The average pre-procedure modified clinical picture, etiology,anatomic distribution and pathophysiology clinicalscore improved significantly after 12 months. Complicationsfrom our series included swelling and induration in3 patients (5%), skin pigmentation in 3 patients (5%). Patientsatisfaction with the surgical outcome was 83.2 %(±11.8, n=58).Conclusions: Our results seem to be satisfying, and thisstudy has reaffirmed the effectiveness and durability ofendovenous laser ablation with 940 wavelengths in thetreatment of great saphenous vein insufficiency.Key words: Duplex ultrasound, endovenous technique,saphenous vein, venous insufficiency

Electrocardiography interpretation training in emergency medicine: methods, resources, competency assessment, and national standardization

Objective(s). The aim of this study was to evaluate the status of electrocardiography (ECG) training in emergency medicine residency programs in Turkey, and the attitude of the program representatives towards standardization of such training. Methods. This investigation was planned as a cross-sectional study. An 18-item questionnaire was distributed to directors of residency programs. Responses were evaluated using SPSS (v.16.0), and analyzed using the chi-square test. Results. Thirty-nine program directors (out of 42) responded to the questionnaire. Twenty-eight of them stated they did not have a formal ECG training curriculum. The most preferred ECG education method was clinical education in the Emergency Department; the most common education resource was ECG textbooks; and the most common evaluation method was case scenarios. Only thirteen of the programs had an obligation to prove competency. The most common competency-assessment method was obtaining a passing grade based on an instructor’s observation. The majority of program directors are of the opinion that there should be a formal ECG teaching curriculum, and that a national ECG training program and national ECG database should be formed. Conclusions. The majority of programs do not have a formal ECG interpretation curriculum, which is an obligation to prove competency. As a result, their training methods, resources, and assessment tools were determined to be subjective

Sağlık personelinde kızamık, kızamıkçık, kabakulak ve suçiçeği seroprevalansının değerlendirilmesi

Amaç: Sağlık personeli, infeksiyon hastalıkları açısından toplum geneline göre artmış bir risk altındadır. Sağlık personelinin bağışıklanması, hem personelin korunmasını sağlayacak hem de sağlık hizmeti verilen ortamlarda ve toplumda hastalıkların yayılımını önleyecektir. Bu çalışmada, hastanemizin sağlık personelinde aşıyla önlenebilir hastalıklardan olan kızamık, kızamıkçık, kabakulak (KKK) ve suçiçeği antikorlarının belirlenerek etkin bir bağışıklama programı oluşturulması ve serolojik taramanın maliyet etkinliğinin değerlendirilmesi amaçlandı. Yöntemler: Bu çalışma 10 Mart 2014-10 Ocak 2015 tarihleri arasında Bülent Ecevit Üniversitesi Sağlık Uygulama ve Araştırma Merkezi’nde yapıldı. Katılımcıların yaş, cinsiyet, meslek, bölüm, çalışma süreleri, çocukluklarının geçtiği yerleşim birimleri, hastalık geçirme öyküleri ve aşılanma durumları bir anket formuyla sorgulandı. Spesifik IgG antikorları “enzyme-linked immunosorbent assay” yöntemiyle araştırıldı. Bulgular: Çalışmaya toplam 384 gönüllü sağlık personeli dahil edilmiş olup katılanların %61.2’si kadın, %38.8’i erkek, yaş ortalaması 32.43±6.4 idi. Serolojik test sonuçları değerlendirildiğinde seropozitiflik düzeylerinin kızamık için %92.2, kızamıkçık için %98.2, kabakulak için %94 ve suçiçeği için %94.3 olduğu belirlendi. Sağlık personelinde hastalık geçirme öyküsünün duyarlılığı kabakulak ve kızamık için yüksek değerlerde bulunurken (sırasıyla %81.6 ve %80.5), kızamıkçık için %43.4 olduğu bulundu. Hastalığı geçirme öyküsü için pozitif prediktif değerler, kızamık, kızamıkçık, kabakulak ve suçiçeği için sırasıyla %95.6, %98.9, %97.5 ve %96.9 olarak saptandı. Maliyet etkinlik çalışması sonucunda, gerek KKK gerekse suçiçeği için serolojik tarama yapılarak aşılama uygulanması lehine sırasıyla 1432 TL ve 18 253 TL gibi bir maliyet farkı saptandı. Özellikle suçiçeği için aşılama öncesi öykü negatifliğinin veya seronegatifliğin gösterilmesinin maliyet etkin olduğu belirlendi. Sonuçlar: Özellikle riskli bölümlerde çalışan sağlık personelinin bağışıklık durumunun serolojik testlerle taranması ve duyarlı sağlık personelinin aşılanması gerektiği sonucuna varılmıştır

Modelling climate and societal resilience in the Eastern Mediterranean in the last Millennium

This article analyses high-quality hydroclimate proxy records and spatial reconstructions from the Central and Eastern Mediterranean and compares them with two Earth System Model simulations (CCSM4, MPI-ESM-P) for the Crusader period in the Levant (1095–1290 CE), the Mamluk regime in Transjordan (1260–1516 CE) and the Ottoman crisis and Celâlî Rebellion(1580–1610 CE). During the three time intervals, environmental and climatic stress tested the resilience of complex societies.We find that the multidecadal precipitation and drought variations in the Central and Eastern Mediterranean cannot be explained by external forcings (solar variations, tropical volcanism); rather they were driven by internal climate dynamics. Our research emphasises the challenges, opportunities and limitations of linking proxy records, palaeoreconstructions and model simulations to better understand how climate can affect human history

Allt lugnt efter Lugna Gatan? : En kvalitativ studie om upplevelser av Fittjaområdet efter nedläggningen av Lugna Gatan i Fittja

Fittja är en av Sveriges mest brottsutsatta förorter och därför har organisationen Lugna Gatan arbetat som trygghetsvärdar i området. Efter många år lades Lugna Gatans verksamhet ner och det påverkade många i området. Men hur påverkades de? Denna studie besvarar fråge­ställningen om hur de verksamma personerna i Fittjaområdet upplevde tiden med Lugna Gatan och tiden efter att de lämnat. Intervjuer gjordes med verksamma inom området och slutsatsen var att Lugna Gatans arbete skapade en trygghet i området som saknas med den nya aktören Skyddsvärnet, men Skyddsvärnet har däremot lyckats med att förbättra arbetet inom skolan till skillnad från Lugna Gatan.