LIMPRINT study - the Turkish experience

Background: Lymphedema and chronic oedema is a major healthcare problem in both developed and non-developed countries The LIMPRINT study is an international health service based study to determine the prevalence and functional impact in adult populations of member countries of the International Lymphoedema Framework (ILF). Methods: 1051 patients from 8 centers in Turkey were recruited using the LIMPRINT study protocol. Data were collected using the core and module tools which assess the demographic and clinical properties as well as disability and QoL. Results: Most of the Turkish patients were recruited from specialist lymphedema services and were found to be female, housewives and having secondary lymphedema due to cancer treatment. The duration of lymphedema was commonly less than 5 years and most of them had ISL Grade 2 lymphedema. Cellulitis, infection and wounds were uncommon. The majority of patients did not get any treatment or advice before. Most of the patients had impaired QoL and decreased functionality, but psychological support was neglected. Although most had social health security access to Lymphedema centres nevertheless access seemed difficult due to distance and cost. Conclusion: The study has shown the current status and characteristics of lymphedema patients, treatment conditions, the unmet need for the diagnosis and treatment as well as burden of the disease in both patients and families in Turkey. National health policies are needed for the prevention, diagnosis and treatment in Turkey that utilise this informative data

The effect of relaxation exercises on burden, burnout, and anxiety levels in palliative caregivers

Purpose The purpose of this study was to assess the effectiveness of relaxation exercises on burden, burnout, and anxiety levels in palliative caregivers. Design and Methods The single-group pretest-posttest design was used. The sample of the study consisted of 60 caregivers. Relaxation exercises were administered to caregivers 2 times a week for 4 weeks and 8 times. Burden, burnout, and anxiety levels were evaluated on the preinterventions and postinterventions. Findings The mean age of the caregivers was 43.82 +/- 10.19 years. The majority of the palliative patients were diagnosed with dementia (58.3%), the duration of diagnosis was between 1 and 5 years (70.0%). It was determined that relaxation exercises reduced to caregivers' burden, burnout, and state anxiety levels (p < 0.01). Practice Implications The study concluded that relaxation exercises had positive effect on caregivers' burden, burnout, anxiety levels

The Use Of Diagnostic Imaging In Low Back Or Leg Pain

Objectives: The aim of this study is to evaluate the imaging method preferences of physicians working in different clinics and departments for the patients suffering from low back and/or leg pain. Patients and methods: In this retrospective study, the radiological imaging types of 900 patients (301 males, 599 females; mean age 46.8 +/- 17.1 years; range 2 to 89 years) with low back and/or radicular leg pain who were admitted for the first time to the Physical Medicine and Rehabilitation (PMR), Orthopedics and Traumatology (OT), and Neurosurgery (NS) clinics in our hospital between July 2013 and August 2014 were reviewed. Age, sex, and radiological methods applied were recorded. The correlation between radiological methods and differences in terms of age and sex and how the radiological method preferences differed according to the departments were evaluated. Results: Of the patients, 22%, 35% and 34.7% were evaluated without using any imaging methods in the OT, PMR, and NS outpatient clinics, respectively. A total of 32.7%, 48.7%, and 8.7% of the patients were evaluated using lumbar X-ray in the OT, PMR, and NS outpatient clinics, respectively. A total of 19.3%, 11.7%, and 54.3% of the patients were evaluated using the lumbar magnetic resonance imaging (MRI) in the OT, PMR, and NS outpatient clinics, respectively. There were no statistically significant correlations between the age, sex, and imaging modality used. Conclusion: Our study results showed that the most common imaging tool which is used by the physicians in the PMR and OT clinics is lumbar X-ray, while the lumbar MRI is the most common tool in the NS clinics. However, we recommend that not only the medical, but ethical aspects and cost-effectiveness of the imaging modality to be selected should be considered.WoSScopu

The Reliability And Validity Of Lymphedema Quality Of Life Questionnaire-Arm In Turkish Patients With Upper Limb Lymphedema Related With Breast Cancer

Objectives: This study aims to adapt Lymphedema Quality of Life Questionnaire-Arm (LYMQOL) into Turkish and to test its reliability and validity in Turkish patients with upper limb lymphedema related with breast cancer. Patients and methods: Between June 2015 and November 2015, the Turkish LYMQOL-Arm was obtained using forward-backward translation method and administered to a total of 135 female patients (mean age 51.8 +/- 9.8 years; range, 31 to 82 years) with upper limb lymphedema with European Organization for Research and Treatment of Cancer-QoL Breast Cancer-specific version (EORTC QLQ-BR23) and Functional Assessment of Cancer Therapy-Breast-4 (FACT-B+4) questionnaires. A test-retest interval of seven-days was used to assess the reliability. The validation studies were carried-out by means of construct-validity using Spearman's rank correlation-coefficient. Internal consistency and test-retest-reliability were assessed using Cronbach's alpha and intra-class correlation-coefficient (ICC), respectively. Results: 135 patients completed the questionnaire with upper limb lymphedema related with breast cancer completed the questionnaires. The mean lymphedema duration was 21.1 +/- 28.7 (median: 6) months. Internal consistency and reliability of the Turkish LYMQOL-Arm was good with Cronbach's alpha (0.88-0.90) and test-retest ICC (0.45-0.71). External construct validity was highly confirmed by expected correlations with comparator scales, EORTCQLQ-BR23 and FACT-B+4 (p<0.01). Conclusion: The Turkish version of the LYMQOL-Arm is a valid and reliable tool for evaluating QoL in female patients with upper limb lymphedema related with breast cancer.WoSScopu

Serum carbonic anhydrase I and II autoantibodies in patients with chronic lymphocytic leukaemia

Demir, Selim/0000-0002-1863-6280;WOS: 000456093400006PubMed: 30588172Cancer is the second most important cause of mortality, and millions of people either have or have had the disease. Leukaemia is one of the most common forms of cancer. Autoantibodies that have developed against the organism's self-antigens are detected in the sera of subjects with cancer. in recent years carbonic anhydrase (CA) autoantibodies have been determined in some autoimmune diseases and carcinomas, but the mechanisms underlying this immune response have not yet been fully explained. the purpose of this study was to determine CA I and II autoantibodies in subjects with chronic lymphocytic leukaemia (CLL) and to provide a novel perspective regarding the autoimmune basis of the disease. Autoantibody levels were investigated using enzyme-linked immunosorbent assay (ELISA) in serum samples from 37 patients with CLL and 37 healthy peers. Anti-CA I titres in the CLL group were significantly higher compared with the control group (p = 0.0001). However, there was no significant difference between CLL and control groups in terms of anti-CA II titres (p = 0.278). the prevalences of CA I and II autoantibodies in patients with CLL in this study were 27% and 24.3%, respectively. Our results suggest that these autoantibodies may be involved in the pathogenesis of CLL. More extensive studies are now needed to reveal the entire mechanism

Circulating parameters of oxidative stress and hypoxia in normal pregnancy and HELLP syndrome

Demir, Selim/0000-0002-1863-6280WOS: 000451837100015PubMed: 30129291Background. the HELLP syndrome (Hemolysis, Elevated Liver enzymes and Low Platelets) is a complication of severe pre-eclampsia, a condition characterized by oxidative stress elevation caused by disequilibrium between lipid peroxidation and antioxidant defense mechanisms, which, in turn, results in endothelial compromise and free radical-mediated cell damage. While several studies have examined the relationship between pre-eclampsia and oxidative stress, research investigating oxidative and hypoxic status in HELLP syndrome is limited. Objectives. the aim of this study was to compare the levels of oxidative stress markers - total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), and malondialdehyde (MDA) - and a hypoxia marker- carbonic anhydrase IX (CA IX) - in patients with HELLP syndrome and in healthy pregnant women. Material and methods. A total of 23 women with HELLP syndrome and 30 healthy pregnant women were included in the study. Serum levels of oxidative stress markers were determined using colorimetric methods, while serum levels of CA IX were measured using an enzyme-linked immunosorbent assay (ELISA) kit. Results. the TOS, OSI, MDA, and CA IX levels were significantly higher in women with HELLP syndrome than in the controls (p = 0.0001, p = 0.0001, p = 0.0001, and p = 0.008, respectively). Conclusions. Increased levels of oxidative stress and hypoxia markers in women with HELLP syndrome suggest that oxidative stress and hypoxia may be significantly involved in the pathophysiology of the disease. Furtherfollow-up studies are now needed to investigate the prognostic roles of these parameters in patients with HELLP syndrome

Case Report: Lupoid cutaneous leishmaniasis mimicking verruca plana

Cutaneous leishmaniasis (CL) is an infectious disease caused by various species of leishmania protozoan parasites. Lupoid CL is a rare form of CL that has a stunning similarity to other granulomatous cutaneous conditions of infectious or inflammatory origin. Verruca plana, also known as a "flat wart", is a benign proliferation of the skin resulting from infection with human papilloma virus (HPV). Herein, we presented a case of lupoid CL mimicking verruca plana on the face. © 2017 Ozlu E et al

Diagnostic performances of intravoxel incoherent motion and conventional diffusion-weighted imaging in the differential diagnosis of benign and malignant portal vein thrombus

WOS: 000442351800008PubMed ID: 29411058To evaluate the diagnostic accuracy of intravoxel incoherent motion (IVIM) and diffusion-weighted imaging (DWI) parameters in the differential diagnosis of portal vein thrombus (PVT). Thirty-five patients with PVT were enrolled in this retrospective study. Precontrast axial in-phase and out-of-phase T1-weighted (W) turbo field echo (TFE), axial and coronal T2-W single-shot turbo spin echo, IVIM with b values between 0 and 1300 s/mm(2) and conventional DWI with b factors of 50, 400, and 800 s/mm(2) with single-shot echo-planar imaging, and postcontrast dynamic T1-W volumetric interpolated breath-hold examination images obtained with 1.5 T MR unit were evaluated. For quantitative analysis of conventional DWI, an ADC map was reconstructed from conventional DWI using all b values. For quantitative evaluation of IVIM, the SI was calculated from each b value. A specific software program was applied to calculate D (true diffusion coefficient), D* (pseudodiffusion coefficient associated with blood flow), and f (perfusion fraction). The differentiation between benign and malignant PVT was based on the criteria outlined in the study by Catalano et al. (Radiology 254:154-162, 2010). The ADC values of the malignant PVT were significantly lower than those of benign PVTs (p = 0.005). Malignant PVTs had a tendency to show higher f values in comparison with benign PVTs without statistical significance (p = 0.750). The best discriminative parameter was ADC values, which demonstrated a sensitivity of 80.0% and a specificity of 72.7% with cut-off value of 1.00 x 10(-3) mm(2)/s. ADC values might be more superior tool than IVIM parameters in differentiation between malignant and benign PVT

Relationship between human leukocyte antigen (HLA) alleles and pediatric autoimmune neuropsychiatric disorders associated with Streptococcal infections (PANDAS)

WOS: 000458742100007Purpose: The aim of this study is to examine the relationship between Pediatric autoimmune neuropsychiatric disorders associated with Streptococcal infections (PANDAS) and Human Leukocyte Antigen (HLA) alleles. Materials and Methods: HLA alleles of 41 children patients, whom are diagnosed with rapid onset of obsessive compulsive disorder (OCD), and 88 healthy children are analyzed by using PCR. Results are evaluated by using univariate and multivariate logistic regression analysis. Results: DRB8, DRB5.2 and DQ5 alleles increase risk of disease while Al, B18 and B35 alleles decrease risk of disease. Conclusion: Findings of this study will help researchers to examine related genes in PANDAS and the effects of gene products on development of the disease. Presentation of exogenic antigens to T-helper cells by HLA class II loci is determined in different autoimmune diseases. Similarity of these findings with PANDAS etiology and risk increasing alleles found in this study being HLA class II is remarkable

Detection of autoantibodies against carbonic anhydrase I and II in the plasma of patients with gastric cancer

Demir, Selim/0000-0002-1863-6280WOS: 000401601400009PubMed: 28680333Cancer is the second leading cause of death and gastric cancer is the fourth most common cancer type worldwide. Investigation of autoantibodies in cancer patients has been a popular research area in recent years. the aim of the current study was to investigate carbonic anhydrase I and II (CA I and II) autoantibodies in the plasma of subjects with gastric cancer based on the information and considerations of autoimmune relation of gastric cancer. Anti-CA I and II antibody levels were investigated by ELISA in plasma samples of fifty two patients with gastric cancer and thirty five healthy peers. Anti-CA I and II antibody titers of the gastric cancer group were significantly higher compared with the control group (p = 0.004, p = 0.0001, respectively). Plasma anti-CA I levels of the metastatic group were lower than the non-metastatic group and this difference was found statistically significant (p < 0.05), but there was no statistical difference between plasma anti-CA II levels of the groups. CA I and II autoantibody titers in patients with gastric cancer were found higher compared to healthy subjects and the results suggest that these autoantibodies may be involved in the pathogenesis of gastric cancer