Gaziantep University Medical Faculty Research Articles

News from the European Journal of Therapeutics: A new issue and a new editorial board

News from the European Journal of Therapeutics: A new issue and a new editorial board

Multidetector computed tomography evaluation of origin, V2 segment variations and morphology of vertebral artery.

The current study aimed to determine the origin of vertebral artery (VA) on both sides and the levels of entry into respective foramen transversarium (FT), to evaluate possible effects of sex on the entry levels, and to investigate the frequency of VA dominance and VA hypoplasia based on the VA V2 segment. For this study, archived images of patients undergoing multidetector computed tomography (MDCT) examination of the chest and headneck for various reasons at Gaziantep University Medical Faculty Hospital were reviewed retrospectively. Three-dimensional reconstructions were performed for a total of 644 VA images from 322 patients using Horos software, and VA origin, the level of entry to FT and transverse diameters of both VA and FT were measured at the point of entry. It was found that, among males, the VA originated from the truncus brachiocephalicus on the right side in only 1 patient and from the aortic arch in 2 patients on the left side. Left VA emerging from the aortic arch was observed in 2 females. The right VA was found to enter the FT at C3 in 1 male, at C4 in 6 patients (5 males, 1 female), at C5 in 19 patients (3 males, 16 females), and at C6 in 300 patients (141 males, 159 females). The left artery entered the FT at C5 in 23 patients (9 males, 14 females) and at C6 in 298 patients (141 males, 157 females). Looking at the relationship between variations of VA origin and the levels of entry to the FT, it was observed that only one of the left VAs originating from the arcus aorta entered the FT at C6 and at C5 in all others. On the right side, there was only one VA originating from the truncus brachiocephalicus, which entered the FT at C3. Of the remaining 248 VAs originating from the subclavian artery, 5 VAs entered the FT at C4, 14 VAs at C5 and 229 VAs at C6. The measurements of VA diameters showed right VA hypoplasia in 14 patients and left VA hypoplasia in 17 patients. Also, the right VA dominance was found in 110 patients and the left VA dominance in 128 patients. A moderate, positive correlation was observed between VA and FT diameters in both sides. A regression analysis showed that a 1 mm change in the right VA diameter was associated with a 75% change in the FT diameter and a 1 mm change in the left VA diameter caused a 72% change in the FT diameter. An understanding of VA variations and FT morphometry is crucial for informed clinical practice. This will clearly affect the success rates of physicians in the diagnosis and treatment of pathologies involving cervical region. The presence of any VA variation in a patient should be investigated on computed tomography or magnetic resonance imaging images prior to surgery.

Prevalence of Accessory Sacroiliac Joint and Its Clinical Significance

Objective: To determine the prevalence of the accessory sacroiliac joint (ASIJ) on both computed tomography (CT) images and dry bones and ultimately, to contribute to the literature.
 Materials and Methods: CT images archived in the Radiology department of Gaziantep University Medical Faculty obtained from 145 individuals (104 males and 41 females) as well as 92 sacral bones were examined. 
 Results: The prevalence of ASIJ among 92 sacral bones was 15.2%. The ASIJ was more commonly (52%) located at the posterior portion of the SIJ at the level of the second dorsal sacral foramen. In 48% of the bones, ASIJ was identified just above the first dorsal sacral foramen. Unilateral ASIJ was observed in 10.8% and bilateral ASIJ in 4.4% of the sacral bones. On CT images, ASIJ was found in 7.8% of the males and 7.2% of the females. The total prevalence of sacroiliac joint variations was 28.9%, and 6.8% of them were ASIJs.
 Conclusion: It should be kept in mind that ASIJ may be a source of arthritis and chronic hip pain. The presence of ASIJ should be sought through imaging studies for early diagnosis of ASIJ.

Impact of Pulmonary Hypertension on Renal Functions in Obstructive Sleep Apnea Syndrome

Pulmonary hypertension (PH) is common in obstructive sleep apnea syndrome (OSAS). This study aimed to evaluate the effect of PH on kidney functions in patients with OSAS. The data of patients who were diagnosed as having OSAS after referral to the sleep center in the Gaziantep University Medical Faculty between January 2005 and June 2017 were evaluated. The estimated glomerular filtration rate was calculated with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Renal functions of the subjects who had data after 5 years were included for long-term analysis. A total of 2152 patients with OSAS (n = 1540), PH (n = 49), OSAS and PH coexistence (n = 359), and the control group (n = 204) were included in the study. Pulmonary arterial pressure (PAP) was 44.51 ± 23.73 in the PH group; it was 37.1 ± 13.14 in the group with OSAS + PH (P = 0.001) Urea and uric acid were found to be higher in the association of OSAS + PH. CKD-EPI was lower in the presence of PH or OSAS + PH than in the presence of OSAS. PH was present in 16.06% of males and 25.10% of females (P = 0.000), and PAP was detected as 35.80 ± 13.23 and 40.96 ± 16.65, respectively (P = 0.001). PH was present in 15.99% of males and 25.84% of females with OSAS (P = 0.000). The PAP of males with OSAS was 36.03 ± 13.46, and the PAP of females was 38.68 ± 12.55 (P = 0062). Urea, creatinine, and uric acid were higher and CKD-EPI was lower in male subjects in the presence of OSAS and PH, whereas the same scenario also was present in the presence of PH alone in female subjects. Long-term comparisons (n = 343) revealed significant decreases in the CKD-EPI in those with OSAS and OSAS + PH and these decrease were more pronounced in the presence of OSAS and PH. The regression analysis revealed that female patients had lower CKD-EPI in the presence of PH, although the presence of PH had no effect on CKD-EPI in males. PH is a risk factor for the deterioration of renal function in OSAS and more prominent in the long term.

How did the psychological impact of COVID-19 change healthcare workers in times of fighting the pandemic?

This study is the second leg of a two-leg project. In the first leg, the effect of the COVID-19 pandemic on healthcare workers (HCWs) was investigated in the period between the first case in Turkey and the arrival of the first case in the hospital. In this second leg, three months after the first evaluation, we aimed to investigate whether psychological effects of COVID-19 such as stress, anxiety, depression, and sleep quality have been changed on HCWs. This was a 3-month observational study. 169 hospital staff who participated in the first leg of the study were reached and asked to participate in the second leg evaluation in Gaziantep University Medical Faculty Hospital.110 HCWs accepted to participate. Impact of Event Scale (EIS-R), Depression Anxiety Stress Scale (DASS-21), and Pittsburgh Sleep Quality Index (PSQI) were used to assess in both two legs. Paired Sample T-test was used for comparison of normally distributed variables. Wilcoxon test was used for the comparison of abnormally distributed variables. SPSS 22.0 software was used in the analysis of variables. Of the HCWs with an average age of 33.9±6.6 years, 59% (65) were males. There was no significant difference between the two legs in terms of IES-R, DASS-21, and PSQI scales. This study suggests that the psychological effects of the COVID-19 pandemic on HCWs started with the pandemic, before the arrival of the first case in the hospital. Also, these psychological effects continued similarly without significant change after the initiation of direct contact with COVID-19 patients and even after the increase in COVID-19 patients in a hospital which in they work.

The variations and degenerative changes of sacroiliac joints in asymptomatic adults.

The sacroiliac joint has a structure in which the direction of the load relative to the articular surface is irrational, as the joint surface is not perpendicular to the trunk load axis; it is likely to incur more degenerative changes than other weight-bearing joints. This retrospective study consisted of a total of 145 cases - 104 (71.7%) men and 41 (28.3%) women - who were referred to Gaziantep University Medical Faculty Radiology Department Polyclinic for pelvic computed tomography (CT) from 2013 to 2018. The mean age was 33.5 years (range: 18-60 years). Pelvis CT images were performed according to the exclusion criteria specified by the experienced orthopaedic surgeon. Patients were excluded from the study if they were younger than the age of 18, had a condition involving the sacroiliac joint, had an endocrine disorder, or had a history of a trauma affecting the pelvis CT examination. In this current study, six types of anatomic variations were detected. Iliosacral complex variation has been determined as the most common type of variation. The incidence of variations of sacroiliac joint in all cases was 28.9%. Degenerative changes were seen in 5.5% of patients fewer than 30 years of age. When it comes to the patients whose age range is 30-60, the percentage of the degenerative changes is 12.4%. In patients who were 30 years and older, the prevalence of degenerative changes increased progressively with increasing age. In this study, it is thought that the knowledge of variations in normal population and degenerative changes will contribute to the better understanding of normal morphological structure of sacroiliac joint and to the anatomical literature. It's seen that there is not a statistically significant relationship between degenerative changes and anatomical variations.

Effect of the COVID-19 pandemic on medication adherence in psychiatric disorders

The aim of this study is to investigate the effect of COVID-19 pandemic and the restrictions taken on the medication, thus treatment adherence of patients with psychiatric disorders. A semi-structured form prepared by the authors and the Morisky treatment adherence scale were applied to the patients who were regularly followed up in Gaziantep University Medical Faculty Psychiatry outpatient clinic for 6 months before March 11, 2020, which was the first date of the COVID-19 case in Turkey and who visited the outpatient clinic for follow-up after the pandemic. 206 patients who met the study criteria were evaluated. Of these patients, it was found that 29 (14.1%) had their medication adherence impaired due to non-pandemic reasons. Analysis was performed with the remaining 177 patients. The average age of patients was 41.73 ± 13.48. According to the general characteristics of the participants, 117 were women and 60 men. With regard to the treatment adherence rates, 69 patients (39%) were not affected by the pandemic in which treatment adherence was high, 46 (26%) had moderate treatment adherence, and 62 (35%) showed poor treatment adherence. The comparison of patients in terms of treatment adherence according to their diagnosis revealed no statistically significant difference (p = 0.100). To the best of our knowledge, this is the first study investigating the medication (treatment) adherence of patients with psychiatric disorders who were on treatment before the pandemic. Studies with large samples are warranted to better understand the effect of the pandemic on treatment adherence.

Bir Üniversite Hastanesinde Çalışan Çocuk Sağlığı Profesyonellerinin Kendi Çocuklarını Anne Sütüyle Besleme Uygulamaları

Giriş: Sağlık uzmanlarının kişisel emzirme deneyimleri, hastalardaki emzirme konularını danışma ve yönetme konusundaki davranışları etkilemede önemlidir. Bu çalışma bir üniversite hastanesinde çalışan çocuk sağlığı profesyonellerinin kendi çocuklarını anne sütüyle besleme uygulamalarını belirlemek amacıyla yapılmıştır. Yöntem: Kesitsel tipte olan bu çalışma Temmuz 2019-Eylül 2019 tarihleri arasında Gaziantep Üniversitesi Tıp Fakültesi Eğitim Araştırma Hastanesi'nde yapılmıştır. Çocuk Sağlığı ve Hastalıkları Bölümünde çalışan 16 doktor ve 36 hemşire (toplam 52) çalışmaya alınmıştır. Veriler 17 sorudan oluşan anket formu ile yüz yüze görüşme tekniği ile toplanmıştır. Tanımlayıcı istatistikler SPSS 24.0 paket programı kullanılarak yapılmıştır.Bulgular: Bu çalışmada katılımcıların en küçük yaştaki çocuklarının 6 ay ile 17 yaş arasında ve %76,9’unun sezaryenle doğduğu bulundu. Doğum sonrası ilk bir saatte emzirilme oranı %86,5, ilk besin olarak anne sütünün verilmesi %82,7 olarak belirlendi. Çalışmada ilk altı ay sadece anne sütüyle beslenme oranı %44,2 idi. Katılımcıların çoğunluğu (%90,4) biberon, yarısı (%50) emzik kullanmıştı. Çocukların %30,8’ine ilk bir ayda, yarısından fazlasına (%59,6) altı aydan önce formül mama verildiği saptandı. İki yaşına kadar emzirilen ve yaşı iki yaşından küçük olup halen emzirilen çocukların oranı %25 idi. Anne sütüyle beslenmenin sonlandırılmasında en önemli nedenler; annenin çalışması %38,5 ve anne sütü yetersizliği %13,5 olarak belirtildi.Sonuç: Emzirmeye iyi bir başlangıç yapıldığı fakat emzirme sürecinin başarısız olduğu bulunmuştur. Annelerin çalışmasının, çocukların yarıdan fazlasına altı aydan önce formül mama verilmesinin ve biberon kullanılmasının yaygın olmasının bu durumu etkilediği düşünülmüştür. Bir kadın sağlık profesyoneli veya eşi olması durumunda da emzirme süresi boyunca bilgilendirilmeli ve desteklenmelidir.

Increased Nitrosative Stress and Oxidative DNA Damage in Patients with Carbon Monoxide Poisoning

Carbon monoxide (CO) remains the most common cause of lethal poisoning around the world. Influence of the brain, which is the most susceptible organ of hypoxia in patients with CO poisoning (COP), is a determining factor of the severity of the clinical condition and mortality. In this study, we aimed to investigate nitric oxide (NO•), peroxynitrite (ONOOˉ), 8-hydroxydeoxyguanosine (8-OHdG) levels and nitric oxide synthase (NOS) activity in the serum of patients with COP during admission and treatment processes. The study was conducted prospectively on 36 patients who were admitted to Gaziantep University Medical Faculty Emergency Medicine Department between November 2015 and March 2016 due to COP. The serum samples were prepared for all the COP patients on admission. They were repeated at 180th min of treatment. The samples were taken once from the control group. We showed that admission levels of NO˙, ONOOˉ, and 8-OHdG, and NOS activity in patients with COP were higher than those observed at 180th min. These values were also higher in COP patients compared to control group. These findings suggested that nitrosative stress might play a role in the pathophysiology of COP and increase DNA damage.

Efficacy and Safety of Electroconvulsive Therapy in Adolescents: A Retrospective Chart Review Study From Turkey.

The aim of this study was to report the efficacy and safety of electroconvulsive therapy (ECT) in manic, depressed, psychotic, and catatonic adolescent patients. Medical records of 78 adolescents who had received ECT in Department of Psychiatry, Gaziantep University Medical Faculty, during 2011 to 2017 were reviewed. Sixty-two subjects in this sample were identified to have complete records and met the study inclusion criteria. The mean ± SD age of subjects was 17.11 ± 1.04 years and female sex was 53.2% (n = 33). Primary the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision or the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnoses were bipolar mood disorders (n = 33, 53.2%), major depressive disorder (n = 16, 25.8%), schizophrenia (n = 8, 12.9%), and schizoaffective disorders (n = 5, 8.1%). Electroconvulsive therapy was significantly effective in treating manic, depressive, psychotic, and catatonia symptoms as evidenced by significant differences in pretreatment and posttreatment scores in outcome measures including Hamilton Depression Rating Scale, Young Mania Rating Scale, Positive and Negative Syndrome Scale, and Clinical Global Impression-Severity Scale (P < 0.001). Presence of comorbidity adversely affected treatment response (P = 0.001). However, ECT was also effective in those with comorbid diagnoses (P < 0.001). Depressive symptoms in patients with bipolar depression responded better than those with unipolar depression (P = 0.012). Electroconvulsive therapy was generally safe with subjective memory complaints (85%), headache (69%), and prolonged seizure (8%) as the reported adverse effects possibly related to ECT. Four subjects (6%) developed a manic switch during ECT. Electroconvulsive therapy is an effective and a safe treatment option in adolescent patients with severe and resistant psychopathology. Although comorbidity may decrease treatment response, ECT seems to be effective even in the presence of multiple psychiatric diagnoses.

Comparison of clinical indications and postoperative histopathological diagnoses of hysterectomy specimens with benign preliminary diagnoses

Aim: Hysterectomy specimens constitute a large section of routine pathology practice as hysterectomy operations widely performed all over the world to manage benign gynecological disorders by the gynecologists. In this study, we aimed to evaluate hysterectomy specimens obtained due to benign preliminary diagnoses by comparing them with regard to clinical indications and postoperative histopathological diagnoses. Material and Methods: Nine hundred and forty-seven cases who underwent hysterectomy at Gaziantep University Medical Faculty Hospital between January 2012 and December 2016 were retrospectively re-evaluated with regard to clinical indications and postoperative histopathologic diagnoses. Results: Leiomyoma was the most common hysterectomy indication and accounted for 34.1% (n:323). Other indications in descending order of prevalence were as follows; abnormal uterine bleeding (n:290, 30.6%), endometrial hyperplasia (n:113, 11.9%), uterine prolapse (n:107, 11.3%), adenomyosis (75, 7.9%) and abnormal placentation (n:39, 4.1%). According to the final histopathological results of the hysterectomy specimens, leiomyomas (n:325, 34.3%) were the most common postoperative diagnosis followed by adenomyosis (n: 150, 15.8%) and endometrial hyperplasia (n: 113, 11.9%). Abnormal placentation was found in 39 cases (4.1%). Squamous intraepithelial lesions of the uterine cervix were found in 39 cases (4.1%), endometrial adenocarcinomas in 10 cases (0.9%) and granulosa cell tumor, smooth muscle tumor with uncertain malignant potential, and leiomyosarcoma and granulosa cell tumor in one patient each (0.09%). We found more than one pathology in 280 cases. The most common pathology was leiomyomas coexisting with adenomyosis (n: 170, 17.9%), while others included leiomyoma coexisting with endometrial polyp (n:56, 5.9%), and leiomyoma coexisting with endometrial polyp and adenomyosis (n:54, 5.7%). Conclusion: Incidental detection of conditions such as cervical squamous intraepithelial lesions and endometrial adenocarcinomas in hysterectomy materials obtained for benign preliminary diagnoses support the importance of cervical screening test and endometrial sampling as routine processes in preoperative surgical examinations. This also stresses the importance of macroscopic examination and increased sampling in suspicious cases for pathologists. Keywords: Histopathological Diagnosis; Hysterectomy; Surgical Indication.

Survival analysis of single agent gemcitabine therapy in patients with metastatic breast cancer

Aim: Gemcitabine has demonstrated experimental and clinical antitumor activity in various human neoplasms including pancreas, ovary, non-small cell lung and breast tumors. We aimed to investigate the factors affecting progression-free survival (PFS) and overall survival (OS) of patients who received single agent gemcitabine for metastatic breast cancer.Material Methods: Twenty-eight patients with metastatic breast cancer who were treated with gemcitabine in Gaziantep University Medical Faculty Medical Oncology Department between March 2007 and December 2018 were evaluated retrospectively. Gemcitabine 1000 mg / m2 was administered as a single agent treatment on the 1st and 8th days, every 21 days.Results: Twenty-seven (96.4%) of the patients were female and 1 (3.6%) was male. The median age was 52 years(range 35-76). Median PFS was 5 months (95% confidence interval 2,41-7,58) and median OS was 26 months (95% confidence interval 11,73-40,26). The median PFS of the patients with only lung metastasis was 16 months and the other patients were 4 months (Log-rank p = 0.020)Conclusion: Gemcitabine is a very well tolerated agent with sufficient efficacy for patients with metastatic breast cancer who were preferred to use single agent chemotherapy than combination therapies. Patients with only lung metastasis may benefit more from single agent gemcitabine in metastatic breast cancer.Keywords: Metastatic breast cancer; gemcitabine; progression-free survival; overall survival.

PAP smear test in the diagnosis of endometrial carcinoma: How useful is it? what does it indicate?

Aim: Endometrial carcinoma constitutes the most common gynecological malignancy. Although early diagnosis is important as in all other malignancies, there still exists no screening-imaging modality that can be used effectively in the diagnosis of endometrial carcinomas. This study investigated the role of the cervical Papanicolaou (PAP) smear test in the diagnosis of endometrial carcinoma and evaluated the correlation of the results with histological and prognostic data. Material and Methods: Data obtained from 367 patients who underwent hysterectomy and lymph node dissections due to endometrial carcinoma at Gaziantep University Medical Faculty Hospital between 2010 January-2018 June were retrospectively evaluated. PAP smear results of 75 of these patients, who had undergone cervical PAP smear screening preoperatively (in a 1-36 month period), were evaluated independently by two pathologists. The relationship of the results with diagnosis and prognostic data was investigated. Results: Of the 75 cases included in the study; 58 were endometrioid endometrial carcinomas, 9 were serous carcinomas, 6 were malignant mixed Mullerian tumours, 1 was clear cell carcinoma, and 1 was adenosquamous carcinoma. Atypical glandular cells were detected in 29 cases (38.6%). While the evaluation of the relationship of positive cases with histological and prognostic data revealed no relationship with histological tumor type or cervical and lymph node involvement, depth of myometrial invasion presented a significant result. Conclusion: Although rates of endometrial carcinoma detection with PAP smear screening are not very high, they are also not negligible. The detection of an increase in smear positivity rate in correlation with an increase in myometrial invasion depth in our study is quite significant as it represents an important parameter with implications for the surgical procedure.

ACUTE RECANALIZATION OF THROMBO-EMBOLIC ISCHEMIC STROKE WITH APERIO DEVICE

Introduction: There are a large number of studies in the literature reporting the clinical results of second generation stent retriever mechanical thrombectomy (MT) devices for acute ischemic stroke (AIS). A limited number of studies have been conducted with Aperio, another MT device that went into clinical use in recent years. This study aims to evaluate the efficacy of Aperio in patients diagnosed with AIS and the factors affecting the success of recanalization. Material method: A total of 26 patients (18 females and 8 males) diagnosed with acute ischemic stroke (AIS) with a mean age of 63.92±13.88, who underwent MT with the Aperio (Acandis®,GmbH–Pforzheim, Germany) device in Neurology Clinic of Gaziantep University Medical Faculty between 2015-2017. The diseases of the patients, the onset of neurological symptoms, times to arrive the hospital, National Institute of Health Stroke Scale (NIHHS) scores and catheterization times were recorded from the files of the patients retrospectively. From the scanned files, AIS patients who were intervened only with Aperio mechanical thrombectomy device were included in the study. The recanalization success after MT was defined as mTICI (modified Thrombolysis In Cerebral Infarction) 2b and 3 (ensuring recanalization more than 50%). Results: MCA M1 (57.7%) was the most common lesion in the angiographic imaging of the patients, and ICA was present in 23.1% of the patients. The blood flow was restored (mTICI 2b and 3) in 77% of the patients. The MT success was found to be correlated with the time from the onset of symptoms of the patients until the time when they were taken to the angiography laboratory (p=0.003). When the cut-off value from the onset of symptoms to the time when the patients were taken to angiography was taken as 5.5 hours, the sensitivity was found to be 90% and specificity to be 83.3% for a successful thrombectomy (AUC SE.: 0.879 (0.083), p

The effect of demographic features on aortic arch anatomy and its role in the etiology of cerebrovascular disease.

PurposeThe aim of this study was to retrospectively evaluate the distribution of aortic arches, the relationship with demographic characteristics, and the results of carotid and vertebral artery stenting procedures in patients diagnosed with cerebrovascular disease through the intra-arterial digital subtraction angiography (DSA) technique.MethodsA retrospective examination was performed on 288 patients diagnosed with cerebrovascular disease, who underwent DSA in the Department of Neurology of Gaziantep University Medical Faculty and Kahramanmaraş¸ Sütçü Imam University Medical Faculty. The patients were examined in respect of demographic features and aortic arch anatomic structure characteristics. All demographic characteristics, DSA, carotid, and vertebral artery stent results were recorded.ResultsThe patients comprised 60.1% males and 39.9% females with a mean age of 58.25 years. Type 2 aortic arch was found in 175 (60.7%) patients, Type 2 aortic arch in 99 (34.3%) patients, and Type 3 aortic arch in 14 (4.8%) patients. The right carotid artery stenosis rate was found to be higher in patients with Type 2 aortic arch (P=0.013). When the patients were evaluated according to the presence of a bovine arch, there was no significant difference in terms of age, carotid, and vertebral artery lesions (P>0.05).ConclusionThe aortic arch and its branching properties were not found to have a direct effect on increased risk of cerebrovascular disease or stenting rates. This study can be considered to raise awareness for new studies to demonstrate the effect of aortic arch anatomic differences on cerebrovascular diseases.

Missed appointments and medication non-compliance among consecutive psychiatric patients

Objective: Non-compliance to treatment and missing control appointments is common especially in psychiatric outpatient clinics. In studies, non-compliance rates in psychiatric disorders vary widely depending on the patient population. Studies about treatment compliance had been conducted mostly in patients who had a particular psychiatric disorder or used particular psychotropic drugs. Studies evaluating treatment compliance of patients who had different psychiatric diagnoses or treated with different drugs seems to be scarce. Methods: We aimed to evaluate the rates of compliance with recommended drugs and attendance to the next appointment of 100 consecutive patients who applied to psychiatric outpatient clinic of Gaziantep University Medical Faculty Hospital for the first time and diagnosed with a disorder and the reasons for non-attendance and factors associated with non-compliance. Results: The non-attendance rate for the following appointment was 48%. We grouped our patient sample into two; Group I was named as “attenders” and included 52 patients, Group II was named as “non-attenders” and consisted of 48 patients. The mean value of the days patients did not use their medication was found to be 7.75±8.973. All patients were evaluated according to Morisky Medication Adherence Questionnaire; 31 patients were defined as low, 42 patients as moderate and 27 patients as high compliant to therapy. In bivariate logistic regression analysis if the patient lives outside the city (aOR: 5.410, 95% CI: 1.751, 16.718), presence of referral (aOR: 0.403, 95% CI: 0.136, 1.195), diagnosis of bipolar disorder (aOR: 0.085, 95% CI: 0.008, 0.935), and missed medication for more than 3 days (aOR: 5.924, 95% CI: 2.257, 15.552) were found to be the variables that may predict the missed appointments. With these variables, we correctly predicted the presence of treatment compliance problem as 75% and absence of treatment compliance problem as 76.9% with an overall as 76%. Conclusions: Missed first appointment rates were reported as between 36-50%. Therefore, in the early times of a psychiatric treatment, it is important to evaluate the patient in terms of treatment compliance by having the knowledge of which factors may increase the non-compliance and reconsider our approach to the patient in order to ensure a more effective relationship that will help us to adhere the patient into the course of treatment. However, the results about these factors are inconsistent and not clear. Most of the socio-demographic variables were found to be insufficient to estimate non-compliance in high rates. In concordance with the literature, we also found that most of the variables were not statistically significantly different between attenders and non-attenders except two as mentioned in results. Also, it was reported that initial appointments and early times of a treatment period when the adherence between the psychiatrist and the patient was not built sufficiently increase the non-compliance. In our study, patients were meeting with the psychiatrist for the first time; this can be accounted for the high non-compliance rate. The therapeutic relationship, focusing on the factors effecting non-compliance, and changing our attitudes towards those patients are helpful in reducing the non-compliance rates.

Misuse of Methylphenidate and Attitudes About Methylphenidate Among Resident Physicians

Objective: Misuse of methylphenidate (MPH) has been found to be highly prevalent in young individuals. MPH misuse is more frequent among college students. In the present study, we aimed to evaluate the frequency of misuse of MPH and knowledge level about this agent among resident physicians.Method: A group of 212 resident physicians working in Gaziantep University Medical Faculty Hospital were enrolled in our study. Of this group, 176 (83%) agreed to participate. Participants were asked to complete a twelve item questionnaire and a sociodemographic data sheet designed by the department of psychiatry.Results: Of the participants, 124 (70.5%) were male and 52 (29.5%) were female. Mean age was 29.25±3.04 (range: 24–44) years. Of the participants, 100 were resident physicians in internal medicine, whereas 57 were in surgical specialties and 19 in basic sciences. It was found that 39 participants (22.2%) had previously used MPH without a medical indication. Of the participants who reported misuse of MPH, 19 participants indicated that they started using MPH by recommendation of their colleagues, whereas 20 participants indicated that they started using MPH by their own decision. Twenty eight participants (15.9%) stated that they used MPH during the preparation period for the Medical Specialty Entrance Exam, while 11 participants (6.25%) stated that they used MPH in a period unrelated to the Medical Specialty Entrance Exam. No significant difference was detected between male (n=30; 24.2%) and female participants (n=9; 17.3%) regarding the frequency of misuse of MPH.Conclusion: This study shows that the frequency of misuse of MPH is high among resident physicians. Multi-centered studies are needed to generalize this conclusion.

PP-327 Association of Epicardial Adipose Tissue and Plasma Homocysteine with Metabolic Syndrome in Patients with Normal Coronary Arteries

The Role of Red Blood Cell Distribution width and NeutrophileLeucocyte ratio in Behcet Disease’s Patients. Mehmet Murat Sucu, Bunyamin Kisacik, Yavuz Pehlivan, Vedat Davuto glu, Mehmet Kaplan. Gaziantep University Medical Faculty Department of Cardiology Gaziantep; Gaziantep University Medical Faculty Department of Rheumatology Gaziantep. Objective: Behcet’s disease (BD) is a multisystem disorder. The red cell distribution width (RDW), which is the coefficient of variation of the red cell mean corpuscular volume is, a quantitative description of anisocytosis, or variation in red cell size. This study aimed to determine whether or not RDW could be used for the assessment of disease activity in BD. All clinical data about the patients were obtained from medical charts. Methods: Wehave studied this patients between the years 2008e2013 at our institution. The serum C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), hemoglobin concentration, platelet and white blood cell counts, neutrophileleucocyte ratio (NLR) and RDW were assessed in 236 BD patients; (131 male/105 female, mean age: 36.5 9,6 years) comprised of 72 healthy patients;( (39 male/33 female, mean age: 36,9 11,8 years). Independent samples t-tests were used for comparison. Results: The CRP level, ESR, hemoglobin concentration, hematocrit, and RDW increased according to disease activity in behcet patients (p<0.05).MeanRDW(15,1 2,5%vs, 14,0 1,4%; respectively; p<0.001), NLR(3,2 3 vs, 2,2 1,2; respectively; p<0.001), ESR(17,2 17,2hvs, 11,6 13,7h; respectively; p<0.05) and CRP (8,2 13,6mg/dl vs, 3,0 0,6 mg/dl; respectively; p<0.001) were different between the groups. Conclusions: Our results might suggest that the red blood cell distribution and neutrophileleucocyte ratio might play a role in behcet’s disease. Higher NLR, an emerging marker of inflammation, is associated with in behcet’s diseases.

PP-326 The Role of Red Blood Cell Distribution width and Neutrophil–Leucocyte ratio in Behcet Disease’s Patients

The Role of Red Blood Cell Distribution width and NeutrophileLeucocyte ratio in Behcet Disease’s Patients. Mehmet Murat Sucu, Bunyamin Kisacik, Yavuz Pehlivan, Vedat Davuto glu, Mehmet Kaplan. Gaziantep University Medical Faculty Department of Cardiology Gaziantep; Gaziantep University Medical Faculty Department of Rheumatology Gaziantep. Objective: Behcet’s disease (BD) is a multisystem disorder. The red cell distribution width (RDW), which is the coefficient of variation of the red cell mean corpuscular volume is, a quantitative description of anisocytosis, or variation in red cell size. This study aimed to determine whether or not RDW could be used for the assessment of disease activity in BD. All clinical data about the patients were obtained from medical charts. Methods: Wehave studied this patients between the years 2008e2013 at our institution. The serum C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), hemoglobin concentration, platelet and white blood cell counts, neutrophileleucocyte ratio (NLR) and RDW were assessed in 236 BD patients; (131 male/105 female, mean age: 36.5 9,6 years) comprised of 72 healthy patients;( (39 male/33 female, mean age: 36,9 11,8 years). Independent samples t-tests were used for comparison. Results: The CRP level, ESR, hemoglobin concentration, hematocrit, and RDW increased according to disease activity in behcet patients (p<0.05).MeanRDW(15,1 2,5%vs, 14,0 1,4%; respectively; p<0.001), NLR(3,2 3 vs, 2,2 1,2; respectively; p<0.001), ESR(17,2 17,2hvs, 11,6 13,7h; respectively; p<0.05) and CRP (8,2 13,6mg/dl vs, 3,0 0,6 mg/dl; respectively; p<0.001) were different between the groups. Conclusions: Our results might suggest that the red blood cell distribution and neutrophileleucocyte ratio might play a role in behcet’s disease. Higher NLR, an emerging marker of inflammation, is associated with in behcet’s diseases.

TRP genes family expression in colorectal cancer and its relationship with prognostic factors.

513 Background: Different factors are effective in the development of colorectal cancer (CC). With the discovery of that TRP (transient receptor potential) genes family is an important component of calcium channel, about 30 members of the family of TRP ion channel in mammals have been determined up to the present. TRP channels are associated with many pathological conditions like cancer and cardiovascular diseases as well as the physiological significance of them.. The aim of this study is to investigate TRPM, TRPV and TRPC gene expression levels in tumor tissues of CC patients and to analyze the relationship of expression in tumor tissue of colorectal cancer with other known prognostic factors. Methods: In this study, 93 CC patients whose follow-up and treatment realized in Medical Oncology Department of Gaziantep University Medical Faculty Hospital were analyzed retrospectively. Level of TRP gene expression in paraffin blocks of normal and cancerous colorectal tissue samples of 93 patients were studied at the level of mRNA with real-time PCR. Results: From normal and cancerous colorectal tissues of 37 female and 56 male patients diagnosed with colorectal cancer, expressions of TRPV3, TRPV4, TRPV5, TRPM4, and TRPC6 genes in tumor tissue were detected lower when compared to normal tissue (p &lt; 0.05). When expression levels of other TRP genes in tissues were compared, any significant difference was not found (p &gt; 0.05). There was no meaningful difference between prognostic factors and gene expressions of tumor tissues statistically (p &gt; 0.05). Conclusions: Expression of many proteins in cancer cells compared to normal cells increases or decreases. In CC, TRPV3, TRPV4, TRPV5, TRPM4, and TRPC6 genes of which expression in cancerous tissue decreases may be thought as potential genes contributing to tumorigenesis. To verify this hypothesis, it should be supported with further studies.