Center In Turkey Research Articles

Coronary artery anomalies and dominance: data from a single center in Turkey.

Coronary artery anomalies (CAA) are found in 0.2% to 1.3% of coronary angiograms. The aim of the presented study was to describe congenital CAA and their variations, also identifying the prevalence of these anomalies and coronary artery dominance in our center. A total of 7858 patients were included in the study retrospectively between August 2015 and March 2020. Patients undergoing coronary angiography (CAG) were reviewed by at least 2 independent and experienced observers. The Angelini's CAA Classification method was used to classify patients. Coronary dominance was determined according to the artery from which the posterior desending artery originated. CAA was detected in 88 (1.1%) out of 7858 patients. Of these patients, 73 (82.9%) had anomalies of origination and course called group A, 7 (7.9%) had anomalies of intrinsic coronary arterial anatomy called group B, and 8 (9.1%) had anomalies of coronary termination called group C. Anomalous collateral vessels called group D were not detected. RCA dominance was N.=5579 (70.99%), Cx dominance was N.=1021 (12.99%), and codominancy was N.=1258 (16.01%). The incidence of CAA was 1.1% in total and is compatible with other major studies. According to the Angelini CAA clasification, group B anomalies are observed more frequently than other studies. Cx dominance is moderately high.

Assessment of older acute hip fracture patients: from the view of geriatricians

Hip fractures are important causes of disability and mortality in older adults. The orthogeriatric assessment proved beneficial while it is limited in many developing countries. Herein, we aimed to report the results derived from the first two orthogeriatric assessment centers in Turkey. 103 older adults underwent geriatric assessment in the study period (November 2018-September 2020). We noted demographics, geriatric syndromes identified by a comprehensive geriatric assessment, laboratory parameters on admission, and mortality in the hospital. Descriptive statistics were generated for all study variables. Numerical variables were given as means ± standard deviation, and relative frequencies were given for categorical (qualitative) variables. Also, continuous data were given as a median, interquartile range (IQR) as appropriate. Mean age was 81.2±7.8 (range: 63-95), and 65% were female. While 58.3% of the patients were widowed, 4.9% were single. 22.3% were living alone. 35% were uneducated. 8.7% were smokers, 3.9% had reported using alcohol regularly. The mean time to preoperative evaluation of hip fracture patients by the geriatrician was 3.99 ± 3.80 [median=3; interquartile range (IQR)=3] days. 79.7% were either frail or prefrail (58.3%, frail; 21.4%, prefrail) before admission to the hospital. Before the hospitalization, 50.5% were undernourished [10.7%, malnutrition (MN); 39.8%, malnutrition risk (MNR)]. This rate became 73.8% during the early days of hospitalization (median=3 days, IQR=3) (28.2%, MN; 45.6%, MNR, respectively). 54.4% of the patients had a previous complaint of urinary incontinence before admission to the hospital; the most common (46.4%) incontinence type was urge incontinence. 44.7% of the patients reported having difficulty in falling asleep and/or maintaining sleep. 23.3% of the patients had positive screening test (Patient Health Questionnaire, PHQ-2) for depression. Delirium was screened positive in 28.2% of the patients on admission. 25.2% had reported severe pain before operation. 90% had at least one chronic disease, and 53.4% had polypharmacy. 37.9% of the patients had orthostatism symptoms before admission to the hospital. Most of the patients had some degree of dependency before admission. The scores of activities of daily living and instrumental activities of daily living were as follows: median=6, IQR=2, and median=3, IQR=8, respectively. 50.5% of the patients had a fear of falling, and the prevalence of falls in the last year was 36.9%. Among them, 21.4% had recurrent falls, and 15.5% had a history of one fall before the fall that caused the hip fracture. Hip fractures occurred due to falling at home in 77.7% of the patients, falling outside in 16.5%, and falling in a nursing home in 1.9%. 22.3% of the patients reported a previous fragility fracture, and 17.3% of the patients who reported a previous fragility fracture had recurrent fractures. Only 21.7% of the patients with fragility fractures had received treatment for osteoporosis. 36% of the patients used vitamin D, and 20.4% used calcium before the hip fracture. The values of c-reactive protein, hemoglobin, albumin, creatinine, and CKD-EPI at admission were as follows: median=40.5 mg/L, IQR=95.3; 11.2±1.96 g/dL; 3.5±0.5 g/dL; median=0.84 mg/dL, IQR=0.54; and median=68.8, IQR=38.5. Spinal anesthesia was applied in 76% of the patients. 7.1% of the patients died before surgery, and 4.3% died after operation during hospitalization. Our patients were older, mostly female, frail, and malnourished. Most of them were previously osteoporotic, but there was a lack of treatment for osteoporosis. In order to prevent fractures in the future, awareness of osteoporosis should be increased. A comprehensive orthogeriatric approach should be incorporated into these risky hip fracture patients to handle harmful consequences.

Effects of mother-sung lullabies on vaccination-induced infant pain and maternal anxiety: A randomized controlled trial

PurposeThis study aimed to investigate the effects of mother-sung lullabies during vaccination on vaccine-induced pain in infants and anxiety in mothers. Design and methodsOur team conducted a randomized controlled trial with two parallel groups between March 4, 2020 and August 28, 2020, at two family health centers in Turkey. This study included 60 healthy-term infants (lullaby group: 30, control group: 30) aged two months, who received the Bacillus Calmette–Guérin (BCG) vaccine, and their mothers. We used the Information Form, the Neonatal Infant Pain Scale, the Intervention Follow-Up Form (including heart rate, oxygen saturation, and crying duration), and the State Anxiety Inventory as data collection tools. ResultsInfants in the lullaby group had significantly decreased pain responses than those in the control group (p < .05). Further, singing a lullaby resulted in significantly reduced maternal anxiety in the lullaby group compared to the control group (p < .05). ConclusionsThe lullaby singing method was effective for reducing infants' pain response and mothers' anxiety during vaccination. Practice implicationsThe lullaby method can be used to reduce pain during potentially painful procedures performed in infants and reduce anxiety in mothers.The study is registered under the ClinicalTrials.gov identifier NCT04692584.

Sacral neuromodulation treatment for urinary voiding dysfunctions: Results of treatment with the largest single-center series in a tertiary referral center in Turkey.

Background/aim: Sacral neuromodulation (SNM) is a minimally invasive treatment that modulates spinal reflexes to regulate bladder, urinary sphincter, and pelvic floor and has successfully been used in the treatment of refractory voiding dysfunctions. The aim of this study was to present our experience with SNM in a tertiary referral center with the largest number of patients and review the safety and efficacy of the procedure. Materials and methods: A total of 42 patients with refractory lower urinary tract symptoms were included into the study. After an initial test period, patients who showed more than 50% improvement in their symptoms underwent the second stage of SNM. Twelve patients had overactive bladder (OAB), bladder pain syndrome/interstitial cystitis (BPS/IC) and 17 had urinary retention. The clinical success was examined during follow-up by voiding diary, urodynamics, and global response assessment. Results: Between February 2015 and December 2020, a total of 29 patients underwent stages I&II SNM procedures. The mean ages of patients in OAB/BPS group and retention group were 40 (37-57 years) and 35 (27-44 years), respectively. Mean follow-up time was at least 1 year. Overall, 58.5% success rate was observed in OAB, BPS/IC, and urinary retention groups. Global response assessment score in both groups increased significantly (p = 0.001). No statistically significant difference was found between success or failure rates when sex and age were variable parameters (p > 0.05). Conclusion: SNM appears to be an effective and safe treatment option in restoring voiding dysfunctions in patients with refractory idiopathic and neurogenic voiding dysfunctions. Our initial series revealed favorable results; however, further studies with larger series and longer follow-up are needed.

Comparison of Clinical and Hematological Parameters of Janus Kinase 2, Calreticulin or Myeloproliferative Leukemia Virus Oncogene Mutant Essential Thrombocythemia and Triple-Negative Essential Thrombocythemia.

IntroductionEssential thrombocythemia (ET) is one of the chronic myeloproliferative neoplasms. While Janus kinase 2 (JAK2) V617F mutation is defined in more than half of the patients with ET, calreticulin (CALR) or myeloproliferative leukemia virus oncogene (MPL) mutations are encountered more rarely. The discovery of the JAK2 V617F mutation in 2005, followed by the recognition of MPL and CALR mutations, brought up the idea of subdividing ET according to the mutation status. Our aim in this study is to investigate whether genetic mutations detected in patients diagnosed with ET cause a different clinical phenotype compared to triple-negative ET.MethodsThis retrospective study was conducted by evaluating the patients who were followed up with the diagnosis of ET in the hematology clinic of two tertiary centers in Turkey between 2009 and 2021. Patients with negative JAK2, CALR, and MPL mutations and meeting the diagnostic criteria for ET were defined as triple-negative ET. The patients were divided into two groups as triple-negative ET and mutation-positive ET according to the presence of a mutation. It was investigated whether there was a difference between these two groups in terms of demographic, laboratory, and clinical characteristics.ResultsA total of 109 patients were included in the study. The mean age of these patients was 54 (18-91) years and 85 (78%) patients were females. A total of 48 patients (44.0%) had JAK2 mutation, six (5.5%) had CALR mutation, and one (0.9%) had MPL mutation. It was observed that there was a significant difference between the two groups in terms of gender, mean age, and hemoglobin value. While 87% of patients with triple-negative ET were females, this rate was 69% in patients with mutation-positive ET (p = 0.036). The mean age was 41.8 years in triple-negative ET and 67.1 years in patients with mutation-positive ET (p = 0.0001). While the mean hemoglobin value was 12.9 g/dl in patients with triple-negative ET, it was 14.4 g/dl in patients with mutation-positive ET (p = 0.0001).ConclusionIt has been observed that ET with JAK2, CALR, or MPL mutations may have different phenotypic features compared to triple-negative ET, resulting in a clinical condition consisting of older patients with a higher erythrocyte count.

Benign nodules of the thyroid gland and 25-hydroxy-vitamin D levels in euthyroid patients.

BACKGROUND: The presence of nodules in the thyroid gland is common in iodine-deficient areas of the world. Recently, vitamin D levels were found to be lower than normal and sometimes deficient in malignant nodules of the thyroid.OBJECTIVE: Evaluate the relationship between the serum vitamin D levels and benign thyroid nodules in euthyroid patients.DESIGN: Cross-sectional.SETTING: Tertiary care center in Turkey.PATIENTS AND METHODS: Patients referred to the general surgery outpatient clinic and diagnosed with thyroid nodules were the study group. The control group consisted of healthy individuals without thyroid nodules. Age, BMI, thyroid ultrasonography, serum 25-hydroxyvitamin D, free T3, free T4, thyroid stimulating hormone, calcium, magnesium, phosphorous, total protein, albumin, glucose, creatinine levels and glomerular filtration rate (GFR) were compared between groups.MAIN OUTCOME MEASURE: Serum 25-hydroxy-vitamin D levels and size of the thyroid nodules.SAMPLE SIZE AND CHARACTERISTICS: Of 849 individuals, 453 were patients with thyroid nodules and 396 were healthy individuals.RESULTS: The mean serum vitamin D levels of patients with thyroid nodules were significantly lower than controls (P<.001). Serum vitamin D levels along with serum total protein levels and eGFR were independent variables associated with the presence of a thyroid nodule (P<.001, p=.005 and P=.017, respectively).CONCLUSION: These findings suggest vitamin D deficiency might be one of the pathophysiologic factors in development of thyroid nodules.LIMITATION: Single-center and possible information bias.CONFLICTS OF INTEREST: None.

Thalassemia-free and graft-versus-host-free survival: outcomes of hematopoietic stem cell transplantation for thalassemia major, Turkish experience.

We report the national data on the outcomes of hematopoietic stem cell transplantation (HSCT) for thalassemia major (TM) patients in Turkey on behalf of the Turkish Pediatric Stem Cell Transplantation Group. We retrospectively enrolled 1469 patients with TM who underwent their first HSCT between 1988 and 2020 in 25 pediatric centers in Turkey. The median follow-up duration and transplant ages were 62 months and 7 years, respectively; 113 patients had chronic graft versus host disease (cGVHD) and the cGVHD rate was 8.3% in surviving patients. Upon the last visit, 30 patients still had cGvHD (2.2%). The 5-year overall survival (OS), thalassemia-free survival (TFS) and thalassemia-GVHD-free survival (TGFS) rates were 92.3%, 82.1%, and 80.8%, respectively. cGVHD incidence was significantly lower in the mixed chimerism (MC) group compared to the complete chimerism (CC) group (p < 0.001). In survival analysis, OS, TFS, and TGFS rates were significantly higher for transplants after 2010. TFS and TGFS rates were better for patients under 7 years and at centers that had performed over 100 thalassemia transplants. Transplants from matched unrelated donors had significantly higher TFS rates. We recommend HSCT before 7 years old in thalassemia patients who have a matched donor for improved outcomes.

Imaging Aspects of Hepatic Alveolar Echinococcosis: Retrospective Findings of a Surgical Center in Turkey.

Radiologists should be aware of the findings of alveolar echinococcosis (AE) due to the diagnostic and management value of imaging. We are attempting to define the most common diagnostic imaging findings of liver AE, along with the prevalence and distribution of those findings. The patients’ US, CT, and MRI images were reviewed retrospectively. CT images were acquired with and without the administration of contrast medium. The MRI protocol includes T2-weighted images (WI), diffusion (WI), apparent diffusion coefficient (ADC) maps, and pre- and post-contrast T1WIs. The current study included 61 patients. The mean age of the population was 58.2 ± 9.6 years According to Kratzer’s categorization (US), 139 lesions (73.1%) were categorized as hailstorm. According to Graeter’s classification (CT), 139 (73.1%) lesions were type 1-diffuse infiltrating. The most frequent types were Kodama type 2 and 3 lesions (MRI) (42.6% and 48.7%, accordingly). P2N0M0 was the most frequent subtype. The current study defines the major, characteristic imaging findings of liver AE using US, CT, and MRI. Since US, CT, and MRI have all been utilized to diagnose AE, we believe that a multi-modality classification system is needed. The study’s findings may aid radiologists in accurately and timely diagnosing liver AE.

Neurologic manifestations in children with COVID-19 from a tertiary center in Turkey and literature review.

BackgroundSince December 2019, coronavirus disease 2019 (COVID-19) has become a global pandemic caused by highly transmissible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although respiratory disease and multisystem inflammatory syndrome in children (MIS-C) are main clinical presentations in children, numerous neurological manifestations are being described increasingly. We aimed to investigate new onset neurological symptoms associated with SARS-CoV-2 in pediatric patients in order to establish a possible relationship as well as to understand the underlying pathophysiological mechanisms between SARS-CoV-2 infection and neurological findings.MethodsWe analyzed retrospectively children who had neurologic manifestations temporally associated with SARS-CoV-2 infection at Hacettepe University İhsan Doğramaci Children's Hospital. We performed a literature search between March 20, 2020 and March 30, 2021. Articles that report children with COVID-19 related neurological manifestations were included.ResultsWe have observed 15 consecutive cases with new onset neurological manifestations along with confirmed SARS-CoV-2 infection. Age at hospitalization ranged from three months to 17 years. Ten patients had central nervous system involvement, and most common manifestation was encephalopathy (5/10), which is also one of the most common manifestations of the patients mentioned in the relevant 39 articles we reviewed.ConclusionChildren with COVID-19 can present with neurologic findings such as encephalopathy, seizures, cerebrovascular events as well as abnormal eye movements. Clinical suspicion and awareness are required to show the association between neurologic manifestations and COVID-19.

Fructose 1,6 bisphosphatase deficiency: outcomes of patients in a single center in Turkey and identification of novel splice site and indel mutations in FBP1.

Fructose 1,6 bisphosphatase (FBPase) deficiency is a rare autosomal recessively inherited metabolic disease. It is encoded by FBP1, and the enzyme catalyzes the hydrolysis of fructose-1,6-bisphosphate to fructose 6-phosphate. Patients with recurrent episodes of metabolic acidosis, hypoglycemia, hypertriglyceridemia, and hyperketonemia are present. In this study, we describe the clinical, biochemical, and molecular genetic features of six unrelated Turkish patients from six different families who weregenetically diagnosed with FBPase deficiency in ourclinic between 2008 and 2020. Their clinical and laboratory data were collected retrospectively. Next-generation sequencing (NGS) was performed for the molecular genetic analysis. All patients were hospitalized with recurrent hypoglycemia and metabolic acidosis episodes. Three out of six patients were presented in the neonatal period. The mean age at diagnosis was 26months. NGS revealed a known homozygous gross deletion including exon 2 in three patients (50%), a known homozygous c.910_911dupTT pathogenic variant in one patient (16%), a novel homozygous c.651_653delCAGinsTAA likely pathogenic variant, and another novel homozygous c.705+5G>A splice site variant. Leukocyte FBPase analysis detected no enzyme activity in the patient with homozygous c.705+5G>A splice site variant. We identified two novel mutations in this study. One of them is a splice site mutation which is five bases downstream of the exon, and the other one is an indel mutation. Both of the splice site and indel mutations are exceedingly rare in FBP1, and to the best of our knowledge, there are second splice site and indel variants reported in the literature. Exon 2 deletion is the most common mutation consistent with the previous reports in Turkish patients. FBPase is a frequent cause of hypoglycemia and metabolic acidosis, and the widespread use of molecular genetic analysis would contribute to the enlightenment of advanced genetic factors and possible genotype/phenotype correlation.

Adequacy of spine surgery fellowship training in Turkey: Results of a survey.

The aim of this study was to determine the adequacy of spine surgery fellowship training (SSFT) in Turkey and what is needed for further development by interviewing current fellows. Forty male orthopaedics and traumatology or neurosurgery specialists who had completed SSFT in three different spine centers in Turkey between 2010 and 2018 were asked to complete a survey with 29 questions about SSFT in Turkey. Thirty specialists responded, and the collected data were analyzed. Twenty-seven (90%) participants were orthopaedic and traumatology specialists and three (10%) were neurosurgery specialists, with a mean age of 39 (range = 35-53) years. Most participants received their residency training in the provinces where their fellowship training took place (11 (37%) in İstanbul and 7 (23%) in Ankara). The mean duration between residency training and the start of SSFT was 4 (range = 0-14) years, and the mean SSFT duration was 8 (range = 1-18) months. Seventy percent of participants had participated in spine surgery cases during their residency. Twenty-three (77%) participants reported that spine surgery training in their hospital during their residency was inadequate. Seventeen (57%) participants felt that they could not independently perform spine surgery cases before SSFT. All three centers (100%) participating in the study that offered SSFT were non-public institutions such as private hospitals and private university hospitals of medicine managed by a dedicated mentor with personal commitment, without any accreditation for SSFT. While 25 (83%) participants indicated that they felt competent enough to perform a standard spinal deformity surgery case independently at the end of SSFT, 5 (17%) indicated the opposite. This proportion, which was 43% at the end of residency, increased to 83% after SSFT. The results of this study have demonstrated the importance of SSFT in spine surgery as a specialty with a potentially high risk of complications that require prolonged case observation, challenging work-up, and adequate equipment. In this regard, there is a need for regulations on accreditation in government health facilities that provide ideal conditions. We propose to offer SSFT to all surgeons interested in spine surgery in Turkey by conducting further studies supported by an optimal health sector that ensures the appropriate requirements, in accordance with the declaration of TOTEK (The Turkish Orthopaedics and Traumatology Education Council), training workshops, and an accredited master's degree program in spine surgery or subspecialty.

Relationship between functional capacity and socioeconomic status in a cohort of Turkish heart failure patients.

New York Heart Association (NYHA) classification predicts prognosis for heart failure (HF) patients. Socioeconomic status (SES) has the potential to affect treatment strategy and disease course. The present objective was to investigate whether SES of Turkish HF patients affected NYHA classification. Turkish research team-HF (TREAT-HF) is a questionnaire study with 52 questions, the purpose of which is to aid in the assessment of various qualities of HF patients. The 2013 TREAT-HF cohort included 503 patients from 11 centers in Turkey. Patients were divided into 2 groups according to NYHA functional classification: I-II, a better functional classification, or III-IV, a poorer functional classification. In addition, patients were analyzed according to gender. Evaluated were NYHA functional classifications of 459 (326 males and 133 females) patients with a mean age of 59.7±14.07 years and a mean ejection fraction (EF) of 31.7±9.22%. Total monthly family income level of ≥1000 TL, younger age, higher EF, and male gender were independently associated with better NYHA functional classification. In addition to EF, regular weight control was found to be independently associated with better NYHA classification for females, while younger age and income of ≥1000 TL were independently associated with better NYHA classification for males. The present results demonstrated that SES was associated with NYHA functional classification in a cohort of Turkish HF patients.

Clinical manifestations of COVID-19 in children at a pediatric tertiary center in Turkey

Limited studies have been published on practices and management of coronavirus disease-2019 (COVID-19) in children from the beginning of the pandemic. With this study, we aimed to share the clinical and epidemiological characteristics of infection in pediatric patients and our experiences. COVID-19 Polymerase Chain Reaction (PCR) test positive pediatric patients we followed up in our hospital between March to December 2020 were included in the study. The epidemiological, laboratory, radiological, and clinical data of the patients were analyzed retrospectively. During the study period, 246 test positive pediatric patients were admitted. The median age was 9 years (2 months-17 years), girls accounted for 53,7%, and 76 (31%) patients were asymptomatic. The cough was the predominant symptom (48%), followed by fever (43%) and sore throat (15%). There was a household contact in 199 (81%) of all cases and 32 (12%) patients had comorbidity and chronic illness. The most common laboratory findings; lymphopenia (26%), eosinopenia (21%), monocytosis (18%), high C-reactive protein (20%). Distribution according to case classes; asymptomatic (32,2%), mild (52,4%), moderate (13,8%), severe (1.2%), critical (0.4%). Of all cases, 48 (19.5%) were inpatients and 11 (4.5%) were in intensive care. Chest tomography was performed in 25 (10%) patients and 10 (4%) were abnormal. As a treatment, 22 (8%) patients received favipiravir, 1 (0.4%) lopinavir-ritonavir, 16 (%6) antibiotics, 4 (1.6%) methylprednisolone and 3 (1.2%) low molecular weight heparin. COVID-19 is often asymptomatic and mild in children, it may rarely have a severe course. More caution should be exercised in children under 1 year of age and patients with comorbidities.

The characteristics of gifted children with learning disabilities according to preschool teachers

ABSTRACT The present study aimed to examine the opinions of preschool teachers regarding the characteristics of twice exceptional (2E) children. The research was conducted with the participation of 41 preschool teachers working at schools in a provincial centre in Turkey. The data were collected using a semi-structured interview form consisting of four questions. The research results indicate that the participants consider 2E children both in terms of their strengths and weaknesses. More than half of the participants (51%) stated that giftedness and learning disabilities (LD) cannot coexist in a child, or that they did not have any knowledge of this coexistence. Furthermore, the research found that the participants focused on certain characteristics of children with giftedness and LD, thus ignoring 2E.

Surgical, pathological and clinical features of advanced collorectal cancers with metastasectomy. "Onco-Colon Turkey Registry" real-life data.

299 Background: The contribution of metastasectomy to progression-free survival (PFS) and overall survival (OS) in patients (pts) with advanced stage colorectal cancer has been demonstrated in clinical trials. However, clinical trials may not represent the efficacy of treatment given to the whole population in daily practice, therefore evaluation of real-life data is needed. Methods: The demographic, pathological and clinical characteristics of 1064 RAS wild type pts were recorded in 28 centers in Turkey between January 2016 and March 2019 as part of the Onco-Colon Registry Program ( NCT04757311 ). Metastasectomy was performed in 169 patients (15.9%). In this study, pts with and without metastasectomy were compared in terms of demographic, histopathological and clinical features and treatment results. Results: Median follow-up time was 24 months(mos) (1-74), median age was 59 years (30-81). 32.5% of the pts were women. The proportion of pts with primary right colon was determined to be 16.8%. Synchronous metastasis was detected in 76.3% of those who underwent metastasectomy. Isolated liver metastasectomy was performed in 85.8% of the pts. It has been shown that 21.1% of the pts have MSI-H and 23.3% have a mucinous component. Metastasectomy was performed after conversion therapy in 54.8% of pts. In the patient group who underwent metastasectomy after medical treatment, the median time between the beginning of treatment and metastasectomy was found to be 7 mos (2-34). When the patient characteristics were compared, no significant difference was found between the groups with and without metastasectomy (p &gt; 0.05). The median PFS (mPFS) was 13.5 mos in the group that underwent metastasectomy and 9.9 mos in the group that was not performed (p &lt; 0.0001; HR: 0.63 (95% CI: 0.51-0.77). The median OS (mOS) was 47.3 mos in the group that underwent metastasectomy and 24.3 mos in the group without metastasectomy (p &lt; 0.0001; HR: 0.36 (95% CI: 0.27-0.48). Conclusions: The significant contribution of metastasectomy on mPFS and mOS was shown in this reallife data based trial, where no difference was found in terms of general participation characteristics. In daily practice, prolonged mPFS and mOS emerges as pts who are followed-up radiologically at regular intervals from the beginning and who are appropriate for surgery have the chance of metastasectomy.

Efficacy of regorafenib and 5-fluorouracil-based rechallenge treatment in the third-line treatment of metastatic colorectal cancer: A Turkish oncology group study.

202 Background: The optimal treatment for metastatic colorectal cancer (mCRC) after the second line is still controversial. Regorafenib (Reg) revealed promising results by improving overall survival compared to best supportive care. However, in real-world practice rechallenge chemotherapy (CTr) is often preferred even though supporting evidence is not enough. We aim to compare the efficacy of regorafenib and 5-fluorouracil-based (5-FU) rechallenge treatment in the third line setting of mCRC. Methods: In this retrospective multi-institutional trial, mCRC patients from 21 centers in Turkey progressing after 2 lines of chemotherapy between 2012-2020 were analyzed. Patients who were treated with Reg or rechallenge therapy in the third-line setting were eligible. Rechallenge chemotherapy was identified as the re-use of the 5-FU based regimen which was administered in one of the previous treatment lines. Overall survival (OS), objective response rate (ORR), progression free survival (PFS) and toxicity were analyzed. Chi-square, Kaplan-Meier method and Cox regression analysis were used for analysis. Results: The clinical data of 441 mCRC patients were analyzed. Of these, 284 received regorafenib while 156 received rechallenge chemotherapy. The mean age was 57 and 56% was male. Median OS since the diagnosis was better with CTr than with Reg (48 months (95% CI, 43.4–52.6) vs. 39 months (95% CI, 35.4–42.5), p&lt;0.001). Median OS after the third-line treatment was 12.0 (95% CI, 9.9–14) and 9.0 months (95% CI, 7.5–10.4) for CTr and Reg groups, respectively (p&lt;0.001). PFS was 6 months for patients receiving CTr and 4 months for those treated with Reg (p = 0.139). ORR was significantly higher in CTr group than Reg (p&lt;0.001). BRAF status, MSI status and treatment type (CTr vs. Reg) are factors found associated with OS in Cox regression analysis (p&lt;0.001, p=0.021 and p&lt;0.001, respectively). Adverse effects were seen in 82% and 68.2% of patients receiving Reg and CTr, respectively. Discontinuation of treatment due to adverse effects was higher in patients treated with Reg (10% vs. 2.5%). Conclusions: Our analysis revealed that rechallenge is an appreciated option, in both efficacy and toxicity, when the limited treatment options for mCRC is considered. Although regorafenib treatment contributes to survival, CTr shows better disease control. Our study has the highest number of patients in the literature. Still, prospective studies are mandatory for validation of CTr in the third-line treatment of mCRC.

Antimicrobial Resistance of E. coli and Salmonella Isolated from Wild Birds in a Rehabilitation Center in Turkey.

Wildlife plays a critical role as a reservoir for zoonosis especially pathogenic enteric bacteria. In this study we evaluated the presence of E. coli and Salmonella isolates from wild birds and determined their antimicrobial resistance. Intestine and fecal samples from 82 dead wild birds obtained from rehabilitation centre, were examined by microbiological analysis, antibiotic susceptibilities against of 18 antimicrobials and presence of tetracycline resistance genes by multiplex and singleplex PCR were investigated. A total of 51 E. coli were identified as well as Salmonella Kentucky and Salmonella Bisberg. A majority of the E. coli isolates were resistant to lincomysin (100%), penicilline (96.1%), kanamycin (80.4%), tetracycline (68.6%), and oxytetracycline (64.7%). All Salmonella serotypes were resistant to lincomycin, nalidixic acid and penicilline.In addition, 58.82% of E. coli isolates had phenotypic resistance to at least three or more antimicrobials. Our results indicated that the high frequency of tetracycline resistance (68.62%) due to the tet (A), tet (B), and tet (D) genes. This is the first report isolating S. Bisberg and determining antibiotic susceptibility of E.coli and Salmonella isolates from wild birds in Turkey. These results will help providing better understand of the dissemination of antibiotic resistancy in the environment, which can be used to potentially decrease spread through bird migration. Moreover, these results help assess the risk of spread of resistance from wild birds to humans.

Relationship of the Presence of Lingual Concavity and Mandibular Canal Location: A Retrospective Two-Center Study

Aim: To evaluate the possible relationship between the position of the mandibular canal (MC) on digital panoramic images (PI) and the presence of a lingual concavity (LC) on Cone-Beam Computed Tomography (CBCT) scans in two different populations.Materials and methods: In this retrospective study, the digital archives of a private imaging center in Turkey and at The Academic Center for Dentistry Amsterdam (ACTA) in Netherlands patients who had both panoramic and CBCT images, taken between January 2016 and June 2016 due to various indications. A total of 248 patients were assessed. MC position was defined on digital panoramic radiographs; the presence of LC was assessed on CBCT images. In all statistical methods, p value &amp;lt;0.05 was considered statistically significant. The Mc Nemar test and the receiver operating characteristics (ROC) curve analysis (AZ), were performed for data analysis.Results: Considering all patients, the presence of LC was 28% and 31% for the left and right premolar regions and 75% and 77% for the left and right molar regions, respectively. There was no significant difference between right and left sides and between the Turkish and Dutch populations with respect to the presence of LC. Considering all patients, the presence of a LC was higher in the molar region than in the premolar region for both right and left sides with a statistical significance (p&amp;lt;0.001). Conclusions: The higher percentages of LC in the molar region in both populations suggests that a preoperative local CBCT assessment is justified specifically before implant placement in the mandibular molar region. The location of the MC on the PI was not a very strong indication of the presence of a LC.

Field reconnaissance and structural assessment of the October 30, 2020, Samos, Aegean Sea earthquake: an example of severe damage due to the basin effect.

An earthquake with a magnitude ranging from Mw = 6.9 (KOERI) to Mw = 7.0 (USGS) struck Samos Island in the Aegean Sea on October 30, 2020, with an epicentre 70 kms from the İzmir city centre in Turkey. The earthquake took place at 14:51 local time (11:51 UTC). The peak ground acceleration (PGA) of this earthquake was recorded to be 0.179 g at the epicentre of the earthquake. This earthquake occurred at a depth of 17.26 km (AFAD (2020) İzmir Earthquake Report, (In Turkish)) and lasted 16 s. The main shock from the earthquake triggered a tsunami that hit the building stocks built near the coast. During the gradual deregulation of COVID-19 pandemic regulations, various events caused considerable damage to the building stock, particularly in the Izmir Seferihisar and Bayraklı regions and resulted in a massive disruption of daily habits. The main shock caused 117 deaths in both Turkey and Greece, and 1632 people were also injured in Turkey. Moreover, several injuries occurred in Greece. A total of 103 buildings collapsed, 700 were severely damaged, 814 buildings were moderately damaged, and 7889 were slightly damaged. The basic aim of this paper is to briefly present the past and present seismotectonic characteristics of the region, present building stock, and former structural conditions before the earthquake, assess structural performance and classify distinguished earthquake-induced failures and damage due to the basin effect.

General dentists staffing requirement based on workload in the public dental health centers in Turkey

ABSTRACT Background The Turkish healthcare system struggle with absolute shortages and imbalanced distribution of healthcare personnel. The present study aimed to measure the gap between the actual number of dentists and the ideal dentist staffing complement and evaluate the distribution of dentists among six public oral and dental health centers. Methods The workload indicators of staffing need method, developed by the World Health Organization, was used to determine the staffing requirement in these centers. Face-to-face interviews were held with 109 dentists agreeing to participate in the study. Results The results revealed the total number of actively serving dentists to be 145, the staffing requirement to be 154, and the workload to be 0.94. The actual number of dentists, therefore, needs to be increased by 6%. The most significant activities generating the workload among dentists and increasing staffing requirement were permanent tooth extraction, two-sided amalgam bonding, and fixed dental prosthesis. The number of dentists required for preventive oral health services was found to be only 4.98. Conclusion It was found high dental workload and imbalanced distribution of the participating dentists. Workload-based human resources planning may increase efficiency, effectiveness, and equality in healthcare services.