VACCINATION PRACTICES OF ADULT FAMILIAL MEDITERRANEAN FEVER PATIENTS IN TURKEY.

[Abstract Not Available

Metacognitive awareness of grades 6, 7 and 8 students in reading process

AbstractMetacognitive awareness shows diversity from person to person according to their features, such as their language skill levels and age groups. The purpose of the study was to investigate the differences among 6th, 7th, and 8th grades in respect to their metacognitive awareness in the field of reading. The research was conducted using a correlational method. The study group consisted of 101 students from a public school in Kutahya province of Turkey. The result of the study revealed that there was a positive correlation between grade level and metacognitive awareness in reading, but the difference was not statistically significant

Utilization of biotechnological drugs in rare diseases requiring the use of off-label drugs in children in Turkey

Background/aim: Pediatric patients, especially those with rare diseases, represent a population that has a high tendency towards off label drug use (OLDU) and needs a more careful practice of pharmacotherapy than in adults. We aimed to investigate biotechnological drug use in children with rare diseases requiring OLDU. Materials and methods: This retrospective study examined all single-diagnosed OLDU applications (n = 5792) for 4992 children (<18 year) in Turkey. Applications of rare diseases were selected, and their descriptive characteristics were examined, including demographic features of patients, biotechnological drug utilization status, and disease categories. The off-label statuses of the drugs at the end of 2020 were also examined. Results: In total, 77.7% (n = 4501) of OLDU applications were made for rare diseases. Biotechnological drug use was higher in rare disease applications than in nonrare diseases (37.9% vs. 19.2%, respectively; p < 0.0001). Canakinumab was the top applied biotechnological drug (73.2%). Compared to that in small-molecule drugs, the mean age of patients was higher in biotechnological drug-containing applications (8.1 +/- 5.3 vs. 9.7 +/- 4.9, respectively; p < 0.0001). Biotechnological drug use was higher in nonneoplastic rare diseases (40.3%) than in neoplastic rare diseases (26.4%), (p < 0.0001). At the end of 2020, the approval status of the off-label indications covered in 2016 was significantly higher for rare (24.4%) vs. nonrare (5.2%, p < 0.0001) diseases and for biotechnological (32.3%) vs. small molecule (13.9%, p < 0.0001) drugs. In total, 87.7% of the drugs would have to be still used in the off-label setting at the end of 2020. Conclusion: It was seen that more than three-quarters of the pediatric OLDU applications are for rare diseases, and the need for biotechnological OLDU in this group is almost 2-fold of small-molecule drug use. While further projected findings imply a higher approval tendency for rare diseases and biotechnological drugs, there seems to be more room for improvement for pediatric drug use.Marmara Universit

Clinical and ultrasonographic evaluation of pelvic masses

AMAÇ: Bu çalışmada pelvik kitle tanısı almış hastaların ultrasonografik bulguları, Ca125 değerleri, malignite indeks riski (RMI), rezistans indeksi ve patoloji sonuçlarının malign ve benign ayrımını sağlamadaki etkinlikleri incelenmiştir. Materyal ve Metot: İki bin iki ile 2004 yılları arasında pelvik kitle tanısı alan 114 hasta değerlendirildi. Pelvik kitlelerin ultrasonografik malignite kriterleri (4 cm’den büyük kitle, solid, kistik, multiloküle, septalı, komplike kist, asit varlığı, düzensiz kist cidarı ve papiller yapı), Ca125 değerleri (?35U/ml), Doppler sonografik rezistans indeksi (RI?0.42) ve malignite risk endeksi (RMI?200) değerleri incelendi. Postoperatif patolojik tanılarına göre ovaryen karsinom ve borderline tümörler “malign” grubuna alınırken, fonksiyonel kistler benign pelvik kitleler grubunda değerlendirildi. Bahsi geçen parametrelerin preoperatif dönemde benign/malign kitlelerin ayrımını sağlayıcı etkinlikleri ile ilgili tanımlayıcı istatistikleri yapıldı. BULGULAR: Hastaların ortalama yaşı 39 (sınırlar 12-75) idi. On altı hasta postmenopozal idi. Yüz on dört hastanın 91’i ( %79) opere edildi. Hastaların 54’ü ( %59) operatif laparoskopi ile (malign tanı yok), 37’si ( %41) eksploratif laparotomi (13’ü malign) ile opere edildi. Cerrahi tedavi gerekli görülmeyen hastaların 18’i ultrasonografi ve Ca125 ile 5’i de ultrasonografik kist aspirasyonu sonrasında takip edildi. Opere edilmeyip takip edilen hastaların hiçbirinde 1 yıllık takip sonrası ovaryen malignite düşündüren bir bulgu saptanmadı. On üç hastanın postoperatif histopatolojisi malign idi (1 clear cell karsinom, 1 undiferensiye karsinom, 1 adenokarsinom, 1 malign Brenner tümörü, 1 karsinom metastazı, 4 borderline ovaryen tümör). Yetmiş sekiz hastanın histopatolojisi benign (13 endometrioma, 3 matür kistik teratom, 3 torsiyon, 2 tuboovaryen abse, 1 dejenere myom, 56 benign kist) idi. Malign/benign ayrımında RMI, Ca125 ve RI değerlerinin sensitivitelerinin %38 ile %69 arasında, spesifitelerinin %71 ile %99 arasında, pozitif prediktif değerlerinin %23 ile %83 arasında, negatif prediktif değerlerinin de %92 ile %94 arasında bulunduğunu göstermektedir. TARTIŞMA: Doppler ultrasonografinin malign/benign ayrımında sadece ultrasonografi ve Ca125 değerinin kombine edilmesi, ya da sadece malignite risk endeksine göre daha etkin olduğu saptandı. Malignite risk endeksinin literatürdeki bazı verilerden farklı olarak düşük sensitivitesinin sunulan çalışmadaki vaka sayısının az olmasıyla bağlantılı olabileceği düşünülmüştür. Ca125, Malignite risk endeksi ve Doppler sonografinin kombine kullanımı pelvik kitlelerin değerlendirmesinde tanısal etkinliği artırmaktadır.OBJECTIVES: Ultrasonographic findings, Ca125 levels, risk of malignity index, resistance index and pathologic results of pelvic masses were examined to determine their efficiency in malignant and benign differentiation. MATERIALS-METHODS: Onehundredfourteen patients with a diagnosis of pelvic mass between the years 2002-2004 were evaluated. The menopausal status, ultrasonographic appearance (mass lesion greater than 4 cm, solid, cystic, multiloculated, uniloculated, septated, complicated and existence of papillary structures), serum Ca125 levels (cut-of&amp;#8805; 35U/ml), Doppler sonographic resistance index (cut-off&amp;#8804; 0.42) and RMI (risk of malignancy index, cut-off&amp;#8805;200) were recorded. Ovarian carcinomas and borderline tumours were classified in the malignant group in the evaluation of the efficiency of these paramaters in malignant/benign differentiation. RESULTS: Patients mean age was 39 (Range 12-75). Sixteen patients were postmenopausal. Ninety one (79 %) of 114 patients were operated. Fifytfour patients (59 %) were laparoscopically operated (none of them was malignant), whereas explorative laparotomy was performed for 37 (41 %) patients (13 of them were malignant). Eighteen (15.8 %) of the remaing patients were followed-up by ultrasonography and serum Ca-125 determinations, and ultrasonographic cyst aspiration was performed in 5 patients (4.4 %). Postoperative histopathology of 13 patients showed malignant characteristics (1 clear-cell carcinoma, 1 undifferentiated carcinoma, 1 adenocarcinoma, 1 Brenner tumor, 1 carcinoma metastasis, and 4 borderline tumors) and 78 patients showed benign characteristics (13 endometriomas, 3 mature cystic teratomas, 3 ovarian torsions, 2 tuboovarian abcesses, 1 degenerated myoma, 56 benign cysts). The sensitivity of RMI, CA125 and RI in the differentiation of malignant/benign tumors ranged between 38-69 %, the specifity between 71-99 %, the positive predictive value between 23-83 % and the negative predictive value between 92-94 %. DISCUSSION: In the differentiation of malignant/benign lesions Doppler ultrasonography was found to be more effective than only ultrasonography and Ca125 or RMI. The low sensitivity of RMI was attributed to the insufficient number of cases in our study. The combination of these 3 parameters will increase the effectivity of clinical judgement of pelvic masses

Effects of Metformin on Menstrual Cyclicity in Women with Polycystic Ovary Syndrome

OBJECTIVE: To evaluate eff ects of metformin on menstrual cyclicity in women with polycystic ovary syndrome. STUDY DESIGN: The study was designed as pre-, post prospective clinical trial. To enter the study, patients had to have well-documented PCOS, be oligo-(six cycles or less in the preceding year) or amenorrheic (absence of menstrual cycles for 1 year), and not have exclusionary diseases or drugs. Metformin 500 mg orally twice daily was administered for 6 months. Serum fasting insulin, glucose, FSH, LH, estradiol, progesterone, prolactin, free testosterone, DHEAS, total cholesterol, triglyceride, AST, ALT, HDL, LDL, VLDL were measured. Quantitative insulin sensitivity check index (QUICKI) was used to measure the insulin resistance. Blood samples were collected at the initiation of therapy and 6 months after. Follow-up 6 months was scheduled with interval history, review of menstrual status, assessment of any metformin-related side effects, brief physical and laboratory examination. RESULTS: Total 13/23(39.1%) of the patients with metformin treatment resumed normal menses 6 months after. Nine of 19 oligomenoreic women (47.4%) resumed regular normal menses; 4 of 4 (100%) amenoreic women resumed oligomenoric menses. The fasting blood glucose, fasting blood insulin, free testesteron, VLDL levels were decreased after 6 months of treatment (p=0.005; p= 0.002; p= 0.008; p=0.006 respectively ). First and sixth months measurements of QUICKI were found significantly different (p=0.000). CONCLUSION: Metformin therapy is well tolerated by the majority of patients and may be clinically useful, in nonobese patients with PCOS and menstrual disturbances

Pandemic influenza A (H1N1 2009) pneumonia developed in a pregnant woman with kyphoscoliosis

Gebelerde pandemik İnfluenza A (H1N1-2009) enfeksiyonuna bağlı ciddi komplikasyon geliştiği, hastaneye yatış oranlarının daha fazla olduğu ve bu olgularda oluşan solunum yetmezliği tablosunun tedavisinin çok daha zor olduğu bildirilmiştir. Bu olgu sunumunda konjenital kifoskolyozu olan ve influenza A (H1N1) virüs enfeksiyonu sonrası ciddi pnömoni ve ARDS tablosu gelişen bir gebenin tanı ve tedavi süreci anlatılmaktadır. Yirmi dokuz yaşında, 31 haftalık ikiz gebeye toplum kökenli pnömoni (TKP) ve influenza pnömonisi ön tanılarıyla ampisilin-sulbaktam, azitromisin, oseltamivir ve bronkodilatör tedavisi başlandı. Tedavinin dördüncü gününde genel durumu, bilinci ve arteriyel kan gazı değerlerinde bozulma olması üzerine acil sezaryen uygulandı. Operasyon sonrası solunum yetmezliği devam eden hasta entübe halde yoğun bakım ünitesine alındı. Aralıklı SIMV, PSV-CPAP modlarında takip edildi fakat yeterli solunum hacmi oluşturamadığı görülerek permisif hiperkapni uygulandı. Hasta solunum destek tedavisinin 19. gününde ekstübe edildi. Reanimasyon ünitesine kabulünün 29. gününde şifa ile taburcu edildi. Hastamız gebelik ve kifoskolyoz nedeniyle pandemik İnfluenza A (H1N1-2009) enfeksiyonu için yüksek risk grubundaydı. Erken hospitalizasyon, antimikrobiyal tedavi ve uygun solunumsal destek tedavisinin mortaliteyi engellediğini düşünmekteyizIn pregnant women development of serious complications, higher hospitalization rates, and difficulties encountered in the management of pulmonary failure due to pandemic Influenza A (H1N1-2009) infection have been reported. In this case report diagnostic and therapeutic work-up of a pregnant woman who had congenital kyphoscoliosis and developed serious pneumonia and ARDS after Influenza A (H1N1) viral infection were described. Ampicillin-sulbactam, azithromycin, oseltamivir and bronchodilator treatment was begun for 29-year-old woman at 31 weeks of twin pregnancy with initial diagnoses of community-acquired or influenza pneumonia. Emergency cesarean delivery was performed due to worsening in her general health state, consciousness and arterial blood gas values in the fourth day of the treatment. Following operation, her respiratory failure persisted, and the entubated patient was taken to the intensive care unit. She was followed-up at SIMV, PSV-CPAP modes intermittently without achievement of sufficient tidal levels, so permissive hypercapnia was administered. She was extubated on the 19th day of respiratory support treatment, and discharged from hospital on 29th day of her admission to the reanimation unit. Our patient was in high risk group for pandemic Influenza A infection (HINI-2009) because of pregnancy and kyphoscoliosis. We consider that early hospitalization, antimicrobials, and respiratory support treatments have prevented mortality