Biomedical subjects

Günay Can

Publications and source records attributed to Günay Can.

At least 19 recordsLinked to original sources

PubMed2007

Obstructive sleep apnea syndrome is associated with metabolic syndrome rather than insulin resistance.

The aim of this study was to investigate cross-sectionally the prevalence and covariates of obstructive sleep apnea syndrome (OSAS) and its relationship to metabolic syndrome (MS), insulin resistance (IR), and coronary heart disease (CHD) in a population sample of 1,946 men and women representative of Turkish adults. OSAS was identified when habitual snoring and episodes of apnea were combined with another relevant symptom. MS was diagnosed based on modified criteria of the Adult Treatment Panel III and IR by homeostatic model assessment (HOMA). OSAS was identified in 61 men (6.4%) and 58 women (5.8%), at a similar prevalence, after adjusting for covariates. Among individuals with OSAS, significantly higher odds ratios (ORs), adjusted for age, body mass index (BMI), and waist girth, were observed for MS, hypertension, and prevalent CHD, but not for HOMA or menopause. Significantly higher C-reactive protein existed only in women with OSAS who were also more frequent smokers. In logistic regression models, waist circumference, but not BMI nor hypertension, was significantly associated with OSAS among men. In women, by contrast, current cigarette smoking and hypertension were the significant independent covariates. Regression models controlling for sex, age, and smoking revealed that MS (and not IR per se) was associated significantly with OSAS (OR 1.94) in nondiabetic individuals. To conclude, abdominal rather than overall obesity in men and smoking among women are significant independent determinants of OSAS in Turkish adults. OSAS is associated with MS rather than IR per se. Relatively high prevalence of OSAS is observed in Turkish women in whom it is significantly associated with CHD.

Adult↗

PubMed2006

Prospective epidemiologic evidence of a "protective" effect of smoking on metabolic syndrome and diabetes among Turkish women--without associated overall health benefit.

UNLABELLED: Sex-specific effects of cigarette smoking on the development of metabolic syndrome (MS) and diabetes (DM), concomitant with its clinical impact on CHD, were prospectively evaluated in a cohort of 3385 participants (mean age 48 years), representative of Turks. Heavy smoking denoted smoking 11 or more cigarettes daily. During a mean 5.9-year follow-up, 485 incident cases of MS and 216 of DM were diagnosed. Among women, baseline characteristics as a whole were similar. Smoking status was inversely associated with waist circumference (p=0.004) and predicted in women hyperinsulinemia (p=0.045) after adjustment for age and body mass index. In the prediction of MS, heavy smoking was significantly "protective" (RR 0.50 [95% CI 0.26; 0.94]) in women and in both genders combined, after adjustment for age, baseline family income bracket and physical activity grade. As predictor of new DM, heavy smoking was significantly "protective" (RR 0.54 [95% CI 0.35; 0.83]) in all adults and in women (RR 0.13 [95% CI 0.02; 0.97]), after similar adjustment. Additional adjustment for insulin and CRP levels hardly modified in women the RRs, though attenuated to borderline significance risk for MS and DM due to smaller sample size. Risks of incident CHD and overall mortality were significantly elevated in smoking men, but not in women, when adjusted for age, serum total cholesterol, elevated BP, DM and physical activity grade. CONCLUSIONS: Heavy cigarette smoking is "protective" of future MS and DM in Turkish women, mainly via protection from obesity. A separate modest effect on central obesity appeared independent of plasma insulin concentrations. Evidence of a translated beneficial effect on subsequent CHD or all-cause mortality did not emerge.

Adult↗

PubMed2006

Is undernutrition a problem among Turkish school children?: Which factors have an influence on it?

Undernutrition is a frequent manifestation and an important health problem. The aim of this study was to analyse the variables of nutritional status among primary school children and to determine the risk factors associated with it. The study group was composed of 1576 students between 6 and 16 years of age. The prevalence of stunting, underweight, wasting were calculated according to WHO recommended cut-off points to define undernutrition. Chi-square tests, logistic regression analysis were used to investigate the relationship between the prevalence of undernutrition and the sociodemographic factors. The overall prevalence of stunting, underweight and wasting were found as 5.7, 4.6 and 1.0%, respectively. There were significant relationships between underweight and age, sex, number of family members, monthly family income. But, a significant correlation was found only between stunting and age. No correlation was found between wasting and sociodemographic factors. Undernutrition is still a common problem among primary school children in Istanbul. Identification of risk factors is essential for prevention of undernutrition.

Adolescent↗

PubMed2006

Serum gamma glutamyltransferase as a marker of metabolic syndrome and coronary disease likelihood in nondiabetic middle-aged and elderly adults.

The role of serum gamma glutamyltransferase (GGT) activity as a cardiovascular risk marker was studied basically cross-sectionally. After appropriate exclusions, 754 men and 802 women were available for analysis who were followed up briefly yielding only 16% of overall cases of coronary heart disease (CHD). GGT activity was measured kinetically. In multivariate analysis across 12 variables, waist circumference, sex, complement C3, moderate alcohol intake and uric acid were significant independent covariates of serum GGT. By analyzing the sample in tertiles, doubling in GGT activity was found associated with a rise of 74% in metabolic syndrome (MS) likelihood-independent of salient confounders (P < 0.001). This association was mediated by waist circumference. Individuals in the top versus the bottom tertile exhibited an odds ratio for CHD likelihood of 1.81 (95% CI 1.09; 3.02)-independent of age, sex, total cholesterol, systolic blood pressure, impaired fasting glucose, smoking status, alcohol usage and, notably, of waist circumference. This indicated that a doubling in serum GGT activity corresponded to a 45% excess in CHD likelihood, after adjustment for standard risk factors. In conclusion, waist circumference is a major determinant of serum GGT activity among Turkish adults. Doubling in activity is associated with a (largely waist girth mediated) rise by over one-half in the multiadjusted MS likelihood, and by nearly one-half in the CHD likelihood, independent of waist girth and major risk factors.

Aged↗

PubMed2006

Determinants and definition of abdominal obesity as related to risk of diabetes, metabolic syndrome and coronary disease in Turkish men: a prospective cohort study.

UNLABELLED: We aimed to investigate determinants of abdominal obesity and its clinical impact on metabolic syndrome (MS), diabetes (DM) and coronary heart disease (CHD) in men. METHODS: Prospective evaluation of 1638 male participants (aged 48.5+/-12.3), representative of Turkey's men who have a high prevalence of MS. For components of MS, criteria of NCEP guidelines were adopted, modified for abdominal obesity. Follow-up constituted 9650 person-years. RESULTS: Insulin level (relative risk [RR] 1.40 for doubling), C-reactive protein (CRP) and heavy smoking (protective) were independent predictors of newly developing abdominal obesity. High triglyceride and low HDL-cholesterol were significantly associated already with waist girth quartile II, apolipoprotein B with quartile III. Waist girth significantly predicted future MS from quartile II on, independent of insulin resistance (IR) by homeostatic model assessment, whereby its hazard ratio (HR, 2.6) exceeded double that of HOMA. CRP independently predicted MS. Age-adjusted HR of waist girth (1.59) was significant in predicting DM. Age- and smoking-adjusted top waist quartile conferred significant risk for incident CHD (RR 1.71) but not for overall mortality. As judged by sensitivity and specificity rates for future CHD, DM and MS, abdominal obesity was most appropriately defined with a waist girth of >or=95 cm, and an action level 1 of >or=87 cm was proposed for MS in this population. CONCLUSIONS: Serum insulin, CRP levels and (inversely) heavy smoking are predictors for abdominal obesity in Turkish men. Atherogenic dyslipidemia and elevated blood pressure are associated significantly already with modest rises in waist girth adjusted for age and smoking. Abdominal obesity shows substantial independence of IR in the development of MS. Increasing waist girth was predictive of MS, more strongly than of DM. Risk for CHD imparted by abdominal obesity is essentially mediated by risk factors it induces.

Abdominal Fat↗

PubMed2006

Discordance between insulin resistance and metabolic syndrome: features and associated cardiovascular risk in adults with normal glucose regulation.

The aims of this study were to investigate the extent of concordance between metabolic syndrome (MS) and insulin resistance (IR), the features of discordance, and the magnitude of their independent association with cardiovascular disease (CVD) risk. After exclusion of individuals with diabetes and impaired fasting glucose, the population sample of 1534 men and women, representative of Turkish adults (mean age, 52.2 years), were evaluated cross-sectionally and at a mean 2 years' follow-up. Metabolic syndrome was identified by criteria of the Adult Treatment Panel III, except for male waist circumference (>94 cm). Insulin resistance was defined by the upper quartile in the sample (>2.245) of the homeostatic model assessment (HOMA) index. Clinical fatal and nonfatal CVD existed or developed in 165 subjects. Waist circumference proved to be by far the strongest significant determinant of HOMA in both sexes, followed by triglycerides. The cohort was categorized into 4 by the presence or absence of MS and IR. Each of the latter represented 34% and 25%, but together constituted 45% of the sample, thus disclosing concordance in a third of the conditions combined. The nonconcordant IR/NoMS group was less common than the MS/NoIR group and was distinct from the latter in having significantly lower waist girth, blood pressure, apolipoprotein B and triglyceride levels, and higher high-density lipoprotein cholesterol, glucose, and insulin levels and physical activity in both sexes. When adjusted for 5 important risk factors, although the excess risk in men with MS failed to attain significance, men with IR were associated with a significant 1.9-fold CVD risk. The IR/NoMS group had a 2.2-fold (95% confidence interval, 0.97-5.11) CVD likelihood compared with the large insulin-sensitive group, after adjustment for age, sex, log C-reactive protein, low-density lipoprotein cholesterol, smoking status, physical activity, and the 2 groups of MS with or without IR. Overlapping between MS and IR is limited in either sex, and MS/NoIR is more common than IR/NoMS. Overall, IR is more significantly associated with CVD risk than MS in men and in both sexes after adjustment for important confounders. Insulin resistance without MS tends to implicate in middle-aged and elderly Turkish men roughly a 2-fold CVD risk, corresponding to 50% excess risk per 1 SD in HOMA index, independent of MS and important covariates.

Adult↗

PubMed2006

Prevalence, incidence, predictors and outcome of type 2 diabetes in Turkey.

OBJECTIVES: To investigate prospectively the incidence, certain predictors and outcomes of type 2 diabetes (DM), as well as to determine its prevalence cross-sectionally, in a representative sample of Turkish men and women. METHODS: Prospective evaluation of 3401 male and female participants (aged 48.2 +/-12 years). Follow-up constituted 19,050 person-years. Individuals with DM were diagnosed with criteria of the American Diabetes Association. Fatal and nonfatal coronary heart disease (CHD) was identified by clinical findings and Minnesota coding of resting electrocardiograms. Cut-points of > or = 95 cm in males and > or = 91 cm in females were selected for abdominal obesity. For prospective evaluations, cases with DM or CHD were excluded. RESULTS: Prevalence of DM in Turkish adults was estimated as 2.89 million (11.0% of the population aged > or = 35 years). Over a mean follow-up of 5.9 years, incident DM developed in 223 subjects, yielding an incidence per 1000 person-years of 11.0 in women and 12.4 in men. This corresponded to a 300,000 annual incidence. Following risk parameter levels but not HDL-cholesterol were significantly elevated at baseline in subjects developing DM compared to those without: age (5 years), waist girth (7 cm), blood pressure (12/6 mmHg), apolipoprotein B (7 mg/dl), total cholesterol (14 mg/dl), and fasting triglycerides (only in women, 52 mg/dl). Abdominal obesity (RR 2.61 [95%CI 1.87; 3.63]) and age in both genders, hypertension (RR 1.81 [95%CI 1.10; 2.98]) and low HDL-cholesterol in men alone were significant independent predictors of DM. Diabetes mellitus was a significant and independent predictor of fatal and nonfatal CHD, with a RR of 1.81 (95%CI 1.19; 2.75), after adjustment for sex, age, hypertension, waist circumference, serum total cholesterol and smoking status. CONCLUSIONS: The annual incidence of DM in Turkey rises very rapidly, currently stands at 300,000, and, hence, its prevalence also rises correspondingly. Insulin resistance appears to be a weak determinant of DM in Turkish women while abdominal obesity is the main determinant. Multivariately adjusted DM is a significant independent predictor of fatal and nonfatal CHD. These observations emphasize that measures to reverse or stop the "epidemic" of abdominal obesity are severely required.

Adult↗

PubMed2005

Prevalence of anemia and the risk factors among schoolchildren in Istanbul.

Anemia is a frequent manifestation and an important health problem. The aim of this study was to found the prevalence of anemia among primary schoolchildren and determine the risk factors associated with anemia. The study group was composed of 1531 students between 6 and 16 years old from 14 primary schools located in seven different regions of Istanbul. Data were collected via a questionnaire filled out by parents. For all students, a complete blood cell count detected by an automated cell counter and anemia prevalence was determined according to Dallman criteria. The overall prevalence of anemia was found to be 27.6 per cent. There was no significant relationship between the prevalence of anemia and the students' age, gender, parents' educational level and employment, and monthly family income by logistic regression analysis. Only the number of family members and malnutrition were risk factors for anemia. Today, anemia is a common problem among primary schoolchildren in Istanbul. Identification of the risk factors is essential for the prevention of anemia.

Adolescent↗

PubMed2005

Plasma triglycerides, an independent predictor of cardiovascular disease in men: a prospective study based on a population with prevalent metabolic syndrome.

BACKGROUND AND METHODS: We aimed to assess whether fasting plasma triglycerides independently predicted future fatal and nonfatal cardiovascular disease (CVD) in a population having a high prevalence of the metabolic syndrome. In the Turkish Adult Risk Factor Study, a population-based survey, 2682 men and women 20 years of age or over with fasting triglyceride values available and free of CVD at baseline examination in 1990, were prospectively followed up till 2003/04. Triglyceride concentrations were measured by the enzymatic dry chemistry method and stratified into sex-specific quintiles. Information on the mode of death was obtained from first-degree relatives and/or health personnel of local health office. Diagnosis of coronary heart disease and stroke among survivors was based on history, physical examination of the cardiovascular system and Minnesota coding of resting electrocardiograms. A total of 120 fatal and 221 new nonfatal CVD occurred among adults (mean age 43+/-14) during a mean 9.3 years of follow-up. RESULTS: CVD was significantly and independently predicted by the top versus the bottom fasting triglyceride quintile in logistic regression analyses when adjusted for age, sex, BMI, systolic blood pressure, total cholesterol, lipid-lowering medication, status of smoking and of glucose regulation (relative risk [RR] in men and all adults 2.38 and 1.79, respectively, p both <0.02). This corresponded to hazard ratios (HR) of 1.43 in men and 1.28 in men and women combined. Adjustment for HDL-cholesterol instead of total cholesterol in the same model gave also significant HRs corresponding to 1.42 in men and 1.32 in sexes combined. CONCLUSIONS: Fasting triglycerides are predictive of future CVD among men with an HR of 1.4, independent of age, diabetes, lipid-lowering medication, traditional risk factors including total cholesterol or HDL-C, in a population in which metabolic syndrome prevails. A modest independent risk increment in women did not reach significance.

Adult↗

PubMed2005

Dyslipidemic hypertension: distinctive features and cardiovascular risk in a prospective population-based study.

BACKGROUND: The prevalence, features, and risk of cardiovascular disease (CVD) in dyslipidemic hypertension (DH) was investigated in a prospective population-based study. Dyslipidemic hypertension was defined in terms of blood pressure, plasma triglycerides, and HDL-cholesterol consistent with the metabolic syndrome criteria of the National Cholesterol Education Program guidelines. High-normal or hypertensive values not meeting the other two criteria were designated as "simple hypertensives" (SH). METHODS: A sample of 2225 men and women and free of CVD at baseline were followed up for a mean of 4.1 years. The proportions of DH, SH, and normotensives were 16%, 37%, and 47%, respectively. All persons with DH had metabolic syndrome by definition, whereas metabolic syndrome formed 44.6% of SH. Fatal and nonfatal CVD, diagnosed by clinical findings and Minnesota coding of resting electrocardiograms, developed in 166 subjects. RESULTS: Compared to SH, sex- and age-standardized individuals with DH had significantly higher body mass index, apolipoprotein B, fasting insulin, glucose, and C-reactive protein levels, had higher prevalence of impaired fasting glucose and metabolic syndrome. Cox regression analysis revealed a 1.57-fold higher (confidence interval 1.08-2.28) hazard ratio (HR) for CVD in DH than in SH, after adjustment for sex, age, LDL-cholesterol, and smoking status. The sex- and age-adjusted HR of DH was furthermore 1.45-fold higher than the remaining subjects with metabolic syndrome (P = .096). Among persons with DH, age, presence of diabetes, and pulse pressure proved to be independent predictors for CVD. High LDL-cholesterol levels and fasting hyperinsulinemia were associated with borderline significantly elevated relative risks among dyslipidemic hypertensives. CONCLUSIONS: Dyslipidemic hypertension, prevailing in 1 of every 6 adults, implicates characteristic features, confers excess CVD risk compared to the remainder of hypertensives and carries half the attributable cardiovascular risk due to metabolic syndrome.

Adult↗

PubMed2005

Cross-sectional study of complement C3 as a coronary risk factor among men and women.

In the present study, we examined (i) whether C3 (complement C3) was an independent marker of prevalent CHD (coronary heart disease), and (ii) which preferential associations existed between C3 and some cardiovascular risk factors when jointly analysed with CRP (C-reactive protein) and fibrinogen. In a cohort of 756 unselected adults, 39% of whom had the metabolic syndrome, C3 and other risk variables were evaluated in a cross-sectional manner. In a logistic regression model for the likelihood of CHD, a significant OR (odds ratio) of 3.5 [95% CI (confidence intervals), 1.27 and 9.62)] for C3 was obtained after adjustment for smoking status, TC (total cholesterol) and usage of statins. A similar model, also comprising systolic blood pressure, with a cut-off point of >or=1.6 g/l C3 exhibited a 1.9-fold risk (95% CI, 1.01 and 3.58) compared with individuals below the cut-off point. Both analyses displayed an adjusted OR of 1.37 for each S.D. increment in C3. The significant relationship of C3 with a likelihood of CHD also proved to be independent of CRP. In multiple linear regression models, associations were tested for each acute-phase protein with measures of obesity, fasting insulin, triacylglycerols (triglycerides), TC, HDL (high-density lipoprotein)-cholesterol, physical activity, smoking status, diagnosis of metabolic syndrome and family income. When both genders were combined, C3 was independently associated with serum triacylglycerols, waist circumference, BMI (body mass index) and TC. CRP was independently associated with waist circumference, TC, family income (inversely) and physical activity, and fibrinogen with BMI, TC, smoking status and metabolic syndrome. In summary, elevated levels of complement C3 are associated with an increased likelihood of CHD independent of standard risk factors and regardless of the presence of acute coronary events, suggesting that C3 might be actively involved in coronary atherothrombosis. Unlike CRP and fibrinogen, C3 was preferentially associated with waist girth and serum triacylglycerols.

Adult↗

PubMed2005

[Lipoprotein (a) in a population-based study: more significant in Turkish women than men?].

OBJECTIVE: Serum lipoprotein(a) [Lp(a)] concentrations, determined in 665 persons in the 2003/04 survey of the Turkish Adult Risk Factor Study, were investigated in regard to distribution, determinants and relationship to cardiovascular risk factors, metabolic syndrome (MS) and coronary heart disease (CHD). METHODS: Diagnosis of MS was based on Adult Treatment Panel III criteria, that of CHD on the presence of clinical findings and Minnesota coding of resting electrocardiograms. Metabolic syndrome was observed in 44%, CHD in 14% of the study sample. Behring nephelometry was used for Lp(a) values measurements which were log-transformed for analyses because of skewing. RESULTS: Geometric mean values of Lp(a) in 286 men and 379 women, aged 55.5 +/-12.0 years, were 9.46+/-2.90 mg/dL and 10.46+/-3.00 mg/dL (p>0.2), respectively. Apart from a slight correlation with age, Lp(a) exhibited significant positive correlations with apolipoproteins A-I and B, low density lipoprotein-cholesterol (LDL-C) (r =0.15), total cholesterol, high density lipoprotein-cholesterol (HDL-C), systolic blood pressure and log C-reactive protein, and inverse ones with thyroid stimulating hormone (r =-0.25) in men, and log gamma glutamyltransferase in women. Further 10 variables were not significantly correlated in either gender. In linear regression analyses for independent covariates of Lp(a), positive associations were noted with serum total cholesterol and systolic blood pressure, and inverse ones with waist circumference, triglycerides and (only in women) with gamma glutamyltransferase. Logistic regression analyses revealed in men no association with either MS or CHD likelihood. Among women, age-adjusted Lp(a) was associated inversely at a borderline significance with MS, as did levels of Lp(a) >30 mg/dl vs. the remaining sample, controlled for age and MS, display an odds ratio (OR) of 1.62 for prevalent CHD (p=0.20). An OR of 1.92 (p<0.19) was noted in all adults for the coexistence of Lp(a) >30 mg/dl and LDL-C >150 mg/dl, after controlling for age, MS, smoking status and LDL-C categories. CONCLUSION: Lipoprotein(a), the variance of which is known to be overwhelmingly due to the apo(a) isoforms, proved to have a significant inverse independent association with a measure of abdominal obesity. Lipoprotein(a) levels appeared not to be associated with risk for MS or CHD among men. In women, however, high Lp(a) levels were accompanied with an environment less prone to MS, and - without attaining significance -- tended to be associated with CHD likelihood, independent of age and MS. Further studies are warranted in this area.

Adult↗

PubMed2004

Evidence for a complex risk profile in obese postmenopausal Turkish women with hypertriglyceridaemia and elevated apolipoprotein B.

The aim of the present study was to examine possible pathophysiological relationships among a wide array of proatherogenic risk factors in postmenopausal women. Fasting lipids, apoB (apolipoprotein B), BMI (body mass index) and waist circumference were measured in 178 women (59.4+/-7.2 years) from the Turkish Adult Risk Factor Study. Fasting levels of complement C3, insulin, SHBG (sex hormone-binding globulin), cortisol, oestradiol, testosterone and DHEA-S (dehydroepiandrosterone sulphate) were also determined. This is the first study to examine the relationships of all these variables with apoB. In the first of two different approaches, three groups of obese women were compared. Group 1 comprised women who were normolipidaemic with normal apoB; group 2, women who were hypertriglyceridaemic, but with normal apoB; and group 3, women who were hypertriglyceridaemic with elevated apoB. Complement C3, fasting insulin and glucose were significantly higher and HDL-C (high-density lipoprotein-cholesterol) and SHBG levels were significantly lower in group 3 than in group 1. In the former group, the testosterone/SHBG ratio tended to be higher, indicating more free testosterone, than in group 1. The mean risk score in group 3 and the odds ratio for coronary disease by logistic regression analysis were significantly higher, 2.56 (confidence intervals, 1.12-5.85; P=0.026), compared with the two other groups combined. In examining the whole group, apoB levels correlated significantly with a wider array of pro-atherogenic risk factors than did LDL-C (low-density lipoprotein-cholesterol), particularly being linked to complement C3 and glucose, as well as the risk score. Complement C3 demonstrated the widest associations and was significantly linked with BMI, waist circumference, insulin, glucose, fibrinogen, triacylglycerols (triglycerides) and apoB and was inversely correlated with HDL-C and SHBG. SHBG was also correlated inversely with a wide spectrum of risk variables. In summary, in Turkish women, apoB was linked with a complex array of proatherogenic risk factors, and hypertriglyceridaemia with elevated apoB was associated with a higher risk of coronary disease.

Aged↗

PubMed2004

Comparison of 3 different methods of anesthesia before transrectal prostate biopsy: a prospective randomized trial.

PURPOSE: Periprostatic nerve block (PNB) is the most common anesthesia technique used before prostate biopsy. However, needle punctures for anesthetic infiltration may be painful and cause higher infectious complications. We assessed whether addition of rectal lidocaine gel would improve its efficacy. We also investigated the efficacy and safety of tramadol, a codeine derivative, as a noninvasive method. MATERIALS AND METHODS: A total of 300 patients who underwent prostate biopsies were randomized into 4 groups of controls, PNB, perianal/intrarectal lidocaine gel plus PNB and tramadol. Pain was assessed with a numeric analog scale. RESULTS: Each group consisted of 75 patients, and there was a statistically significant difference among pain scores (p = 0.001). Mean pain scores were 4.63 for controls, 2.57 for PNB, 2.03 for infiltration plus gel group and 3.11 for tramadol. Pain and discomfort were least in PNB plus gel arm. The difference of pain score between PNB alone and tramadol group did not reach statistical significance. Infectious complications were higher in the combination group, whereas there were no complications with tramadol. CONCLUSIONS: Any form of analgesia/anesthesia was superior to none. The combination of PNB plus gel provided significantly better analgesia compared to PNB alone or tramadol. If this can be duplicated in other trials, the combination may be accepted as the new gold standard of anesthesia for prostate biopsy. The efficacy of tramadol was similar to that of PNB, and was free of complications. Therefore, tramadol may have a role before prostate biopsy, which needs to be explored.

Aged↗

PubMed2004

Enuresis: prevalence, risk factors and urinary pathology among school children in Istanbul, Turkey.

BACKGROUND: Enuresis is a common problem among children and adolescents, and can lead to important social and psychological disturbances. The aim of the present study was to establish the prevalence of enuresis among school children and determine the risk factors associated with this disorder. METHODS: A cross sectional population-based study was conducted in 1576 children. The pupils enrolled in the study were chosen randomly from 14 primary schools located in seven different regions of Istanbul. Data were collected via a questionnaire completed by parents. Enuretic children were invited to the pediatric nephrology outpatient clinic of Cerrahpasa Medical School, Istanbul, Turkey. A detailed history was taken, physical and ultrasonographic examinations, urinalysis and urine culture were performed. The relationship between the prevalence of enuresis and the patients' age, gender, region, the parental educational level and employment status, number of family members, and the family's monthly income were tested by means of chi(2 ) and logistic regression analysis. The comparison between the two enuretic groups (monosymptomatic nocturnal enuresis group vs diurnal enuresis only and diurnal-nocturnal enuresis group) regarding the sociodemographic factors were tested with the chi(2) test and P < 0.05 was accepted as statistically significant. RESULTS: The study group was composed of 1576 school children aged between 6 and 16 years. The overall prevalence of enuresis was 12.4%. When the chi(2) test was used, a significant relationship was found between the prevalence of enuresis and age, educational level of the father, the family's monthly income, and number of family members. However, when logistic regression analysis was applied, there was a statistically significant relationship only between enuresis, and age and number of family members. In the whole group, monosymptomatic enuresis nocturna was found to be more common in boys. When the two enuretic children groups (monosymptomatic nocturnal, diurnal only and nocturnal-diurnal enuretics) were compared with each other regarding gender, parental educational and employment status, and number of family members, statistically significant differences were found. Both maternal and the paternal low educational status were found to be associated with monosymptomatic enuresis nocturna. Likewise, monosymptomatic enuresis nocturna was found to be more common in the children of the unemployed mothers, while diurnal enuresis was more common in the children of unemployed fathers. Nocturnal enuresis was found to be associated with large families. No statistically significant difference was demonstrated between the two groups of enuretics regarding age and family income levels. The rate of urinary abnormalities in the whole group was 7.1%. CONCLUSIONS: Enuresis is a common problem among school children and associated urinary abnormalities are not uncommon. Identification of children at risk is an essential first step before choosing the individualized management for each enuretic child.

Adolescent↗

PubMed2003

The significance of perineural invasion as a prognostic factor in patients with gastric carcinoma.

PURPOSE: Few studies have investigated the prognostic significance of perineural invasion (PNI) in gastric cancer. Therefore, we examined the association between PNI and clinicopathological factors and the effect of PNI on overall survival in patients with gastric carcinoma. METHODS: Paraffin sections of surgical specimens from 354 patients who underwent gastric resection were stained with hematoxylin and eosin. PNI was assessed histologically as positive when cancer cells were seen in the perineurium or neural fascicles. Survival analysis was done in 219 patients with T(2,3,4) tumors who underwent potentially curative resection. Data were collected prospectively. RESULTS: PNI was positive in 211 of the 354 patients (59.6%). The ratio of undifferentiated tumors, tumors with vascular invasion, and lymph node metastasis was significantly higher in the PNI-positive patients than in the PNI-negative patients ( P < 0.0001 for all three associations). As the depth of mural invasion increased, so did PNI positivity ( P < 0.0001). The overall survival of the PNI-positive patients was significantly worse than that of the PNI-negative patients in the univariate analysis ( P = 0.0009). However, PNI had no independent prognostic significance in the multivariate Cox proportional hazards model analysis. When the patients were separated into subgroups, PNI had prognostic value in patients with T(3) tumors ( P = 0.036) and no lymph node metastasis ( P = 0.005) in the univariate analysis, but no prognostic significance in the multivariate analysis. CONCLUSIONS: Although the incidence of PNI is high in gastric carcinoma and increases with the progression of disease, it does not provide any additional information to the classical prognostic parameters.

Adult↗

PubMed2003

Prevalence and risk factors of iodine deficiency among schoolchildren.

The aim of this study was to demonstrate the prevalence of iodine deficiency among schoolchildren and the risk factors influencing it. One thousand five hundred and seventy-three schoolchildren were chosen from 14 schools in seven different regions in Istanbul. After all data relating to sociodemographic factors and the use of iodized salt were recorded, iodine contents of urine samples were determined by the Sandell Kolthoff reaction. Chi-squared and multiple regression analysis were used for the investigation of the correlation between iodine deficiency and risk factors. The prevalence of goitre (> or = 2 grade) was 1.9 per cent. The median urine iodine level was in the normal range (10.5 microg/dl). In 46.2 per cent of the students the urine iodine levels were below 10 microg/dl and 13.9 per cent of the students had urine iodine levels below 5 microg/dl. The prevalence of iodine deficiency was significantly higher in younger (< or = 10 years) children, in children with less educated mothers and fathers, and with poorer and more crowded families (p < 0.01, p < 0.01 and p < 0.01, p < 0.001, respectively). The rate of iodine deficiency was significantly higher in females than in males and also higher in children who lived on the European side of Istanbul than on the Anatolian side of Istanbul (p < 0.0001, p < 0.0001, respectively). The rate of use of iodized salt was 44.4 per cent and the iodine deficiency rate was not affected by the use of iodized salt (p > 0.05). Although the median urine iodine level was in the normal range, in 46.2 per cent of the students urine iodine levels were low (< 10 microg/dl). As there seems to be no effect from the use of iodized salt in iodine deficiency, the use of a more stable potassium iodate for the fortification of salt may be required.

Adolescent↗

PubMed2002

Bacteremia in childhood cancer.

Infection-related mortality affects the overall survival rates of children who are receiving treatment for cancer. The leading cause of mortality is bacteremia and sepsis related to it in febrile neutropenic patients. All positive blood cultures of febrile neutropenic patients treated in the Department of Pediatric Hematology-Oncology, Cerrahpasa Medical School, between January 1995 and January 2001 were reviewed. Cultures grew 159 micro-organisms, 95 (60 per cent) of which were Gram-positive bacteria, 56 (35 per cent) were Gram-negative bacteria and eight (5 per cent) were fungi. Coagulase-negative staphylococci (63, 40 per cent) and S. aureus (8, 5 per cent) were the most frequent Gram-positive pathogens. Klebsiella, E. coli, Enterobacter and Pseudomonas infections were the primary Gram-negative pathogens. Twenty cases were lost because of sepsis: in 11 cases (55 per cent) Gram-negative bacteria, in eight cases (40 per cent) Gram-positive bacteria, and in only one case a fungus were the causative organisms. Although vancomycin was not included in the first-line treatment, the mortality rate of Gram-positive bacteremia was 8 per cent. In Gram-negative bacteremia it was 20 per cent. Gram-negative pathogens, which were resistant to multiple antibiotics, caused the mortality. Drug resistance and mortality due to micro-organisms must be taken into consideration while febrile neutropenia protocols are prepared.

Adolescent↗