Publications by authors named "Jale Karakaya"

95 Publications

Diffusion-weighted imaging for the differentiation of Ewing sarcoma from osteosarcoma.

Skeletal Radiol 2021 Apr 2. Epub 2021 Apr 2.

Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey.

Objective: The purpose of this study is to assess the ability of apparent diffusion coefficient (ADC) values in differentiating Ewing sarcoma and osteosarcoma.

Materials And Methods: This retrospective cross-sectional observational study included a total of 35 patients with a recent diagnosis of Ewing sarcoma (n = 13) and osteosarcoma (n = 22) who underwent conventional MRI and diffusion-weighted imaging (DWI). Three ADC measurements from the areas of the lowest diffusivity in ADC maps (ADC), and other areas with low diffusivity (ADC), were made independently by two observers on pre-treatment MRI, and the means of these measurements were compared using independent samples t-test. Intraclass correlation coefficient was calculated for inter-observer agreement.

Results: There was a significant difference between the ADC (P < 0.001) and ADC (P < 0.001) in Ewing sarcoma and osteosarcoma for both observers. For Ewing sarcoma and osteosarcoma, mean ADC was 0.566 ± 0.07 and 1.193 ± 0.33 × 10 mm/s; 0.551 ± 0.08 and 1.182 ± 0.33 × 10 mm/s; and mean ADC was 0.813 ± 0.11 and 1.510 ± 0.35 × 10 mm/s; 0811 ± 0.12 and 1.501 ± 0.33 × 10 mm/s for observers 1 and 2, respectively. Inter-observer correlation coefficient for mean ADC was 0.994 and for mean ADC was 0.995.

Conclusion: Diffusion-weighted imaging and ADC values could be used in the differentiation of Ewing sarcoma and osteosarcoma in borderline cases.
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http://dx.doi.org/10.1007/s00256-021-03741-8DOI Listing
April 2021

Magnetic resonance imaging findings of invasive breast cancer in different histological grades and different histopathological types.

Clin Imaging 2021 Feb 10;76:98-103. Epub 2021 Feb 10.

Hacettepe University Faculty of Medicine, Department of Radiology, Ankara, Turkey.

Background: The aim of this study was to evaluate the magnetic resonance imaging (MRI) findings of invasive breast cancer in different histopathological types (invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC) and mixed ductal-lobular carcinoma (MDLC)) and different histological grades.

Methods: A retrospective review was made of 1256 patients who underwent breast MRI at our hospital between January 2015 and December 2018. A total of 152 lesions (27 ILC, 102 IDC, 23 MDLC and 20 grade 1, 83 grade 2 and 49 grade 3) were included in the study. All the lesions were evaluated according to size, shape, margin, dynamic curve, ADC value and T2 signal intensity ratio (SIR).

Results: Most of the lesions tended to show type 2 and type 3 dynamic curve, type 1 dynamic curve was more commonly seen in ILC and grade 1 groups. IDC showed higher T2 SIR than the other types and grade 3 showed higher T2 SIR than other grades (p< 0,05) There was no statistically significant difference between the groups according to morphological features and mean ADC values (p > 0,05).

Conclusion: T2 SIR and dynamic curve can help the radiologists predict histopathological findings while morphological features and ADC values were not helpful in distinguishing histological types and grades.
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http://dx.doi.org/10.1016/j.clinimag.2021.01.039DOI Listing
February 2021

Multisystem inflammatory syndrome in children during the COVID-19 pandemic in Turkey: first report from the Eastern Mediterranean.

Clin Rheumatol 2021 Feb 12. Epub 2021 Feb 12.

Faculty of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey.

Objective: We aimed to describe the typical clinical and laboratory features and treatment of children diagnosed with multisystem inflammatory syndrome in children (MIS-C) and to understand the differences as compared to severe/critical pediatric cases with COVID-19 in an eastern Mediterranean country.

Methods: Children (aged <18 years) who diagnosed with MIS-C and severe/critical pediatric cases with COVID-19 and were admitted to hospital between March 26 and November 3, 2020 were enrolled in the study.

Results: A total of 52 patients, 22 patients diagnosed with COVID-19 with severe/critical disease course and 30 patients diagnosed with MIS-C, were included in the study. Although severe COVID-19 cases and cases with MIS-C share many clinical and laboratory features, MIS-C cases had longer fever duration and higher rate of the existence of rash, conjunctival injection, peripheral edema, abdominal pain, altered mental status, and myalgia than in severe cases (p<0.001 for each). Of all, 53.3% of MIS-C cases had the evidence of myocardial involvement as compared to severe cases (27.2%). Additionally, C-reactive protein (CRP) and white blood cell (WBC) are the independent predictors for the diagnosis of MIS-C, particularly in the existence of conjunctival injection and rash. Corticosteroids, intravenous immunoglobulin (IVIG), and biologic immunomodulatory treatments were mainly used in MIS-C cases rather than cases with severe disease course. There were only three deaths among 52 patients, one of whom had Burkitt lymphoma and the two cases with severe COVID-19 of late referral.

Conclusion: Differences between clinical presentations, acute phase responses, organ involvements, and management strategies indicate that MIS-C might be a distinct immunopathogenic disease as compared to pediatric COVID-19. Conjunctival injection and higher CRP and low WBC count are reliable diagnostic parameters for MIS-C cases. Key Points • MIS-C cases had longer fever duration and higher rate of the existence of rash, conjunctival injection, peripheral edema, abdominal pain, altered mental status, and myalgia than in severe/critical pediatric cases with COVID-19. • Higher CRP and low total WBC count are the independent predictors for the diagnosis of MIS-C. • MIS-C might be a distinct immunopathogenic disease as compared to pediatric COVID-19.
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http://dx.doi.org/10.1007/s10067-021-05631-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7879406PMC
February 2021

Comparison of the Parents' Evaluation of Developmental Status and Ages and Stages Questionnaire Developmental Screening Tests in a Eurasian Country.

J Dev Behav Pediatr 2021 Jan 25. Epub 2021 Jan 25.

Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey; Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey; and Department of Pediatrics, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey.

Objective: The Parents' Evaluation of Developmental Status (PEDS) and the Ages and Stages Questionnaire (ASQ) are developmental screening tools that are commonly used in pediatric practice worldwide. We aimed to compare the screening results of the PEDS and the ASQ in children with a wide range of ages and to evaluate the degree of agreement between the tests across the age groups.

Methods: The study was conducted with the participation of 327 children aged 3 to 72 months. Participants were administered the PEDS and then the ASQ. Children with known developmental disabilities were included in the study to represent a real-world clinical practice setting and evaluated with a clinical workup.

Results: The median age of the children was 35.1 months, with a range of 3 to 72 months. The percentage of children with known developmental disabilities was 16.5%. The actual agreement between the PEDS and ASQ was 74% with a concordance represented by Cohen κ of 0.422 (p < 0.001) in the total sample. Furthermore, the agreement was higher in children aged 25 to 36 months and 37 to 48 months than for the other ages.

Conclusion: We compared the clinical features of the ASQ and PEDS across the age groups, and they demonstrated moderate agreement. The present study also showed the performance of the PEDS and suggests that it should certainly be used for developmental screening in routine child health care practice in Eurasia, thus supporting the use of such parent-completed developmental tools that should be encouraged for universal screening.
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http://dx.doi.org/10.1097/DBP.0000000000000912DOI Listing
January 2021

Does Internal Mammary Node Irradiation for Breast Cancer Make a Significant Difference to the Diameter of the Internal Mammary Artery? Correlation with Computed Tomography.

Breast Care (Basel) 2020 Dec 22;15(6):635-641. Epub 2020 Jun 22.

Department of Radiology, Hacettepe University Medical School, Ankara, Turkey.

Objective: Lymphatic irradiation in breast cancer improves locoregional control and has been shown to decrease distant metastasis. However, irradiation also accelerates the formation of atherosclerosis and can cause stenosis, not only in the coronary arteries but also in the internal mammary artery (IMA). The aim of this study was to investigate the effects of radiation on IMAs via computed tomography (CT).

Methods: We reviewed the data of 3,612 patients with breast cancer treated with radiotherapy (RT) between January 2010 and December 2016. We included 239 patients with appropriate imaging and nodal irradiation in the study. All patients were treated with lymphatic irradiation of 46-50 Gy, and a boost dose (6-10 Gy) to the involved internal mammary nodes (IMNs) when imaging studies demonstrated pathological enlargement. Bilateral IMA diameter and the presence of calcification were assessed via thin contrast-enhanced CT and those of ipsilateral irradiated IMAs were compared with those of contralateral nonirradiated IMAs.

Results: The mean diameter of irradiated IMAs was significantly shorter than that of nonirradiated IMAs, regardless of laterality. All vascular calcifications were determined on the irradiated side. A boost dose of radiation to the IMNs and radiation technique did not significantly affect the IMA diameter or the presence of calcification.

Conclusions: The diameter of the IMA is decreased due to RT regardless of laterality, radiation technique, and administration of a boost dose. Evaluation of vessels on CT before coronary artery bypass graft or flap reconstruction can help the surgeon select the most appropriate vessel.
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http://dx.doi.org/10.1159/000508244DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7768163PMC
December 2020

Sensory profile, ferritin and zinc levels in preschool-aged children with symptoms of attention deficit hyperactivity disorder.

Turk J Pediatr 2020 ;62(6):970-978

Division of Developmental Pediatrics, Department of Pediatrics, Ankara, Turkey.

Background: Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders and has a big impact on the well-being of children. The disorder can lead to noticeable functional limitations for children and bio-ecological factors also contribute to symptoms of ADHD. We aimed to investigate the associations between ADHD symptoms and some related bio-ecological factors including serum ferritin, zinc levels and sensory processing in preschool-aged children.

Methods: Twenty-two children who had been referred to the division of Developmental Pediatrics because of ADHD symptoms and 22 participants from the general pediatric outpatient clinics were included in the study. The symptoms of ADHD were evaluated with Conners` Parent Rating Scale-Revised Short form. Complete blood count, serum ferritin and zinc levels were also evaluated. A blind occupational therapist implemented sensory processing measurements. The characteristics of each participant such as prematurity, perinatal complications, developmental practices and sociodemographic data were also considered.

Results: Sensory processing measurement analysis revealed that all Sensory Profile scores were significantly lower in the children with ADHD symptoms compared to the control group indicating that the child shows the behavior more than desired. The low level of zinc (p=0.026, OR=6.153, 95% CI= 1.247-30.362) and the presence of perinatal complications (p=0.045, OR=10.864, 95% CI=1.059-111.499) increased the risk of ADHD symptoms. We could not find an association for ferritin levels in our study.

Conclusions: The evaluation of zinc level and sensory profile parallel to other strategies can be recommended during the management of ADHD symptoms in preschool children.
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http://dx.doi.org/10.24953/turkjped.2020.06.008DOI Listing
January 2020

Risk factors for recurrent pulmonary exacerbation in idiopathic pulmonary hemosiderosis.

Pediatr Pulmonol 2021 May 17;56(5):1060-1068. Epub 2021 Mar 17.

Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Objectives: To evaluate the risk factors of recurrent pulmonary exacerbation and poor prognosis in children with idiopathic pulmonary hemosiderosis (IPH).

Methods: In this multicenter study, 54 patients with a diagnosis of IPH were included. Medical records were retrospectively reviewed from three tertiary care hospitals between 1979 and 2019. Also, current information and the long-term progress of patients was determined by contacting the families by telephone.

Results: A total of 54 children were included. The median age of onset of symptoms was 4.5 years (3 months to 15.8 years). The median time from onset to diagnosis was 0.9 years (0.25 months to 12 years). The mean number of recurrent episodes per child in the recurrence-positive group was 3.55 (1-15). Univariate analysis demonstrated that patients presenting with hypoxia or requiring transfusion at the time of presentation had significantly more recurrence episodes (p = .002). Multivariate analysis showed that the presence of hypoxia at the time of initial presentation was a significant independent predictor of recurrent episodes (p = .027). The median follow-up was 3.3 years (0.75 months to 27 years). There was a significant relationship between the presence of hypoxia, transfusion history, antinuclear antibody positivity, and elevated transaminases at the time of initial evaluation and treatment response.

Conclusions: The present study provides substantial information regarding factors that may affect recurrent exacerbations and prognosis in children with IPH. Demonstrating hypoxia as an independent risk factor in recurrence episodes could guide physicians in the planning of treatment strategies.
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http://dx.doi.org/10.1002/ppul.25189DOI Listing
May 2021

Predictive value of cytokine/chemokine responses for the disease severity and management in children and adult cases with COVID-19.

J Med Virol 2021 05 1;93(5):2828-2837. Epub 2020 Dec 1.

Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey.

The disease course of children with coronavirus disease 2019 (COVID-19) seems milder as compared with adults, however, actual reason of the pathogenesis still remains unclear. There is a growing interest on possible relationship between pathogenicity or disease severity and biomarkers including cytokines or chemokines. We wondered whether these biomarkers could be used for the prediction of the prognosis of COVID-19 and improving our understanding on the variations between pediatric and adult cases with COVID-19. The acute phase serum levels of 25 cytokines and chemokines in the serum samples from 60 COVID-19 pediatric (n = 30) and adult cases (n = 30) including 20 severe or critically ill, 25 moderate and 15 mild patients and 30 healthy pediatric (n = 15) and adult (n = 15) volunteers were measured using commercially available fluorescent bead immunoassay and analyzed in combination with clinical data. Interferon gamma-induced protein 10 (IP-10) and macrophage inflammatory protein (MIP)-3β levels were significantly higher in patient cohort including pediatric and adult cases with COVID-19 when compared with all healthy volunteers (p ≤ .001 in each) and whereas IP-10 levels were significantly higher in both pediatric and adult cases with severe disease course, MIP-3β were significantly lower in healthy controls. Additionally, IP-10 is an independent predictor for disease severity, particularly in children and interleukin-6 seems a relatively good predictor for disease severity in adults. IP-10 and MIP-3β seem good research candidates to understand severity of COVID-19 in both pediatric and adult population and to investigate possible pathophysiological mechanism of COVID-19.
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http://dx.doi.org/10.1002/jmv.26683DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7753701PMC
May 2021

Turkish validation of the maternal responsiveness global rating scale in slow-to-talk toddlers.

Turk J Pediatr 2020 ;62(5):802-811

Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Background: The relation between maternal responsiveness and language development has been shown in previous literature however it is difficult to evaluate responsiveness because of the difficulties involved when coding the specific patterns of parent-child interactions. The maternal responsiveness global rating scale is important because it requires less time and expertise from professionals and predicts the language outcome of children. The aim of the study was to adapt the Maternal Responsiveness Global Rating Scale into Turkish, thereby making it accessible to a variety of professionals, and creating a way to use this useful scale.

Methods: Twenty-seven 18- to 42-month old children who had been admitted to the Developmental Pediatrics outpatient clinic with concerns of speech delay and had received a diagnosis of language disorder with the standardized language test were included in the study. The general development and language development of each participant was evaluated using Denver II, Bayley-third edition and Pre-school Language Scale-5. After the translation study of the Maternal Responsiveness Global Rating Scale, video collecting and rating procedures and finally reliability and validity analyses were implemented.

Results: The results of this study demonstrated that the Turkish translation of the Maternal Responsiveness Global Rating Scale shows strong evidence of adequate reliability and validity and is a feasible tool to measure responsiveness in routine child health care practice for children with language delay.

Conclusions: This in expensive, easy-to-use and reliable tool may be recommended in order to identify which slow-to-talk toddlers and their mothers need early intervention and may be used by community-based practitioners and researchers in Turkey to support language development during early intervention stages.
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http://dx.doi.org/10.24953/turkjped.2020.05.012DOI Listing
January 2020

Diagnostic value of lung ultrasonography in children with COVID-19.

Pediatr Pulmonol 2021 05 27;56(5):1018-1025. Epub 2020 Nov 27.

Department of Pediatric Infectious Disease, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Background: Lung ultrasound (LUS) has been successfully used in the diagnosis of different pulmonary diseases. Present study design to determine the diagnostic value of LUS in the evaluation of children with novel coronavirus disease 2019 (COVID-19).

Methods And Objectives: Prospective multicenter study, 40 children with confirmed COVID-19 were included. LUS was performed to all patients at admission. The chest X-ray and computed tomography (CT) were performed according to the decision of the primary physicians. LUS results were compared with chest X-ray and CT findings and diagnostic performance was determined.

Results: Of the 40 children median (range) was 10.5 (0.4-17.8) years. Chest X-ray and LUS were performed on all and chest CT was performed on 28 (70%) patients at the time of diagnosis. Sixteen (40%) patients had no apparent chest CT abnormalities suggestive of COVID-19, whereas 12 (30%) had abnormalities. LUS confirmed the diagnosis of pulmonary involvement in 10 of 12 patients with positive CT findings. LUS demonstrated normal lung patterns among 15 of 16 patients who had normal CT features. The sensitivity and the area under the receiver operating characteristics (ROC) curve (area under the ROC curve) identified by the chest X-ray and LUS tests were compared and statistically significantly different (McNemar's test: p = .016 and p = .001 respectively) detected. Chest X-ray displayed false-negative results for pulmonary involvement in 75% whereas for LUS it was 16.7%.

Conclusions: LUS might be a useful tool in the diagnostic steps of children with COVID-19. A reduction in chest CT assessments may be possible when LUS is used in the initial diagnostic steps for these children.
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http://dx.doi.org/10.1002/ppul.25127DOI Listing
May 2021

Postural instability in children with severe inner ear malformations: Characteristics of vestibular and balance function.

Int J Audiol 2021 Feb 4;60(2):115-122. Epub 2020 Sep 4.

Department of Otorhinolaryngology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Objective: To investigate the postural instability and vestibular functions in children with severe inner ear malformations (IEMs).

Design: A prospective case-control study.

Study Sample: The study group consisted of 10 children using unilateral auditory brainstem implant (ABI) with labyrinthine aplasia or rudimentary otocyst. The age-matched control groups consisted of 10 unilateral cochlear implant (CI) users with normal inner ear structures and 10 healthy peers. All tests were performed to implant users when the implants were off.

Results: All median VOR gains in the ABI group (median anterior, lateral, and posterior canal 0.15, 0.05, and 0.05, respectively, for the non-implanted sides) were significantly lower than those of the control groups (median VOR gains ≥ 0.90 in both control groups). There were no oVEMP and cVEMP responses in the study group. The mean BOT-2 balance scores of the ABI (3.70 ± 1.34) group was dramatically lower than those of the CI (9.40 ± 2.88) and healthy control (16.20 ± 4.16,  < 0.001).

Conclusions: The postural instability in children with severe IEMs was higher than those in CI users with normal inner ear structures and healthy peers. The level of deficiency in the labyrinthine was more important for postural stability in children.
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http://dx.doi.org/10.1080/14992027.2020.1808250DOI Listing
February 2021

Motor repertoire is age-inadequate in infants with cystic fibrosis.

Pediatr Res 2020 Jul 27. Epub 2020 Jul 27.

Department of Pediatric Chest Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Background: General movements (GMs) in infants occur as fidgety movements (FMs) between postterm 9 and 20 weeks. We aimed to evaluate FMs and motor repertoire in infants with cystic fibrosis (CF) and their relation with clinical findings.

Methods: Demographic and clinical characteristics were recorded. FMs and motor repertoire were analyzed from a 5-min video recording of each infant. Videos were rated based on the Prechtl General Movement Assessment and motor optimality score (MOS) was calculated.

Results: The analysis included 18 infants with CF and 20 healthy infants at postterm age of 3-5 months. MOS was significantly lower in the infants with CF compared to controls (p < 0.05). Fifty percent of the infants with CF had abnormal or absent/sporadic FMs. MOS was negatively associated with hospitalization duration (r = -0.378, p = 0.036); and positively associated with vitamin A level in CF infants (r = 0.665, p = 0.026).

Conclusions: Infants with genetically anticipated severe CF phenotype tended to have lower MOS. MOS may be used in addition to genetic testing to predict disease severity in infants with CF. Infants with CF, absent/sporadic FMs, and lower MOS could be considered for planning specific age-adequate early intervention programs.

Impact: Motor repertoire was age-inadequate in infants with cystic fibrosis (CF).50% of infants with CF had abnormal or absent/sporadic fidgety movements (FMs).Motor optimality score (MOS) was positively associated with vitamin A level and negatively correlated with hospitalization duration in infants with CF.MOS tended to decrease as genetically anticipated disease severity increased; thus, MOS might enable us to predict disease severity in CF. The relationship between motor repertoire and phenotype and genotype is unclear and warrants further study.CF infants with absent/sporadic FMs, and lower MOS could be considered for planning early intervention.
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http://dx.doi.org/10.1038/s41390-020-1082-4DOI Listing
July 2020

Cross-cultural adaptation, validity, and reliability of Turkish version of Identification of Functional Ankle Instability (IdFAI) scale.

Acta Orthop Traumatol Turc 2020 May;54(3):300-304

Department of Physiotherapy and Rehabilitation, Hacettepe University, School of Health Sciences, Ankara, Turkey.

Objective: This study aimed to develop the Turkish version of Identification of Functional Ankle Instability (TV_IdFAI) scale and evaluate its validity and reliability.

Methods: A total of 100 participants (54 men and 46 women; 50 volleyball players and 50 sedentary individuals) between 18 and 38 years of age were included this study. The construct validity, reference validity, sensitivity, specificity, and test-retest reliability of TV_IdFAI were evaluated. For the test-retest reliability, the scale was applied to all participants again in 10-14 days. A correlation between the scale scores and test-retest results was examined with intraclass correlation coefficient. To evaluate the construct validity, a factor analysis method was used. For reference validity, a sports physician evaluated all participants and the clinical diagnoses were compared with total score of the scale. Sensitivity and specificity were calculated to evaluate the classification success of the scale with specified cutoff.

Results: TV_IdFAI scale was grouped under two separate factors. It was determined that the variance for factor 1, factor 2 and for scale was 46.68%, 15.70%, and 62.38%, respectively. There was a statistically significant relationship 0.74 (95% CI 0.64-0.84; p<0.001) between the physician's diagnosis and TV_IdFAI in terms of reference validity. The sensitivity and specificity of TV_IdFAI was 0.61 and 0.80, respectively. The reliability of TV_IdFAI was 0.94 (95% CI 0.92-0.96; p<0.001).

Conclusion: This study shows that TV_IdFAI is a simple, easy to apply, reliable, and valid scale to define functional ankle instability in Turkish population.

Level Of Evidence: Level II, Diagnostic study.
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http://dx.doi.org/10.5152/j.aott.2020.03.256DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7586761PMC
May 2020

The ProFitMap-neck - a questionnaire for measuring symptoms and functional limitations in neck pain: reliability, validity and cross-cultural adaptation of the Turkish version

Turk J Med Sci 2020 06 23;50(4):937-944. Epub 2020 Jun 23.

Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey

Background/aim: The Profile Fitness Mapping neck questionnaire (ProFitMap-neck) is a reliable and valid assessment instrument for measuring neck-related symptoms and functional limitations in people with neck pain, but a Turkish version of it had not been published. The purpose of this study was to investigate the adaptation, validity, and intrarater reliability of the Turkish version of the ProFitMap-neck.

Materials And Methods: Two hundred and thirty-five individuals with chronic neck pain were enrolled in the study. Intrarater reliability was assessed by intraclass correlation coefficient (ICC) and Cronbach’s alpha was calculated for internal consistency. For concurrent validity, ProFitMap-neck scores were compared with neck disability index (NDI) and visual analoguepain scale (VAS) scores using Pearson’s correlation coefficient analysis. The ProFitMap-neck, NDI, VAS, and short form health survey (SF-36) were administered to all participants.

Results: For intrarater analysis, ICC ranged between 0.72 and 0.84. The total score was 0.83, indicating excellent reliability. The correlation of the ProFitMap-neck with NDI and VAS was 0.71 and 0.68, respectively, indicating good concurrent validity.

Conclusion: The ProFitMap-neck is an evaluation instrument with sufficient validity and reliability to be used for evaluating Turkish patients with neck pain. Use of this scale can reveal how, how often, and how much these patients’ pain affects their symptoms and functional activities.
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http://dx.doi.org/10.3906/sag-1912-43DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7379424PMC
June 2020

Choroidal vascularity index as a biomarker of systemic inflammation in childhood Polyarteritis Nodosa and adenosine deaminase-2 deficiency.

Pediatr Rheumatol Online J 2020 Apr 3;18(1):29. Epub 2020 Apr 3.

Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey.

Background/purpose: To assess EDI-OCT (enhanced depth imaging optical coherence tomography) of choroid for inflammatory signs in children with polyarteritis nodosa (PAN) and adenosine deaminase-2 deficiency (DADA-2).

Methods: In this cross-sectional study conducted between June 2017 and September 2018, we evaluated children diagnosed with PAN (n = 11) and DADA-2 (n = 4) and an age- and sex-matched control group (n = 15). Demographic and laboratory data were retrospectively analyzed from patient charts. Disease activity was assessed using the pediatric vasculitis activity score (PVAS). Choroidal images were obtained with spectral domain-OCT to measure choroidal thickness (ChT) at 5 points (750 and 1500 μm from the foveal center in the temporal and nasal quadrants and beneath the fovea), and to calculate the total subfoveal choroidal area (TCA), luminal area (LA), stromal area (SA), and the choroidal vascularity index (CVI).

Results: The median (min-max) age was 8 (4-16) years in PAN patients, 6 (5-16) years in DADA-2 patients and 8 (8-10) years in control group at the OCT visit (p = 0.214). The ChT at 3 points and the TCA, LA, and SA were higher in children with both PAN and DADA-2 patients compared to those of the control group (p < 0.0001, p = 0.049, p = 0.007, p = 0.007, p = 0.006, p = 0.033, respectively). The CVI was similar in both groups. No association was observed between the OCT findings, PVAS, and the erythrocyte sedimentation rate, and serum leukocyte and C-reactive protein levels.

Conclusion: Similar CVI scores were obtained from PAN and DADA2 patients under treatment and from healthy controls. Increased subfoveal ChT without any other signs of ocular involvement may suggest choroidal thickening as a sign of mild subclinical inflammation.
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http://dx.doi.org/10.1186/s12969-020-0417-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118843PMC
April 2020

Do early parental postnatal depression, attachment style and perceived social support affect neurodevelopmental outcomes of premature infants?

Infant Behav Dev 2020 05 31;59:101444. Epub 2020 Mar 31.

Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, Ankara, Turkey.

Background: The birth of a premature infant is both a stressful event for both parents and associated with an increased rate of postnatal depression (PND). Additionally some mothers may have delayed feelings of attachment to their babies because of the medical procedures or possible medical complications. Social support is known as an important factor for well-being in the postnatal period. However there is scarce data about these factors for fathers. We aimed to identify the impact of parental PND, attachment style and social support on premature infant development considering the prematurity degree and risk groups.

Methods: This prospective study was conducted by including 96 infants who were born preterm. Mothers and fathers were given Edinburgh Postnatal Depression Scale (EPDS), Adult Attachment Style Scale (AASS), and Multidimensional Scale of Perceived Social Support (MSPSS) to fill out when their infants' corrected age was 3 months. The developmental evaluation was conducted with Bayley III at the corrected 6 months and 18 months of age.

Results: Postnatal depression scores were more in mothers than fathers, the rates of secure attachment and social support were similar between mothers and fathers. Factors associated with the neurodevelopmental outcomes including prematurity degree and risk groups, EPDS, AASS and MSPSS scores were analyzed for both parents. In multivariate analysis, fathers' depression scores were inversely associated with cognitive development (p = 0.030, R = 0.080, B=-0.283) and mothers' anxious/ambivalent attachment style was inversely associated with language development (p = 0.011, R = 0.108, B=-0.329) at the age of corrected 6 months old.

Conclusions: Our findings underscore that the efforts to improve developmental outcomes of premature infants should include parental well-being taking into account new fathers' depressive symptomatology and maternal anxious/ambivalent attachment.
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http://dx.doi.org/10.1016/j.infbeh.2020.101444DOI Listing
May 2020

Respiratory viruses: What is their role in acute exacerbations in children with cystic fibrosis?

Pediatr Pulmonol 2020 07 30;55(7):1646-1652. Epub 2020 Mar 30.

Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Background: Respiratory viruses (RVs) are frequently present in the airways of patients with cystic fibrosis (CF) during pulmonary exacerbations (PEx).

Method And Objectives: This prospective, longitudinal study was performed to examine the role of RVs in acute exacerbations in children with CF. Sputum samples or additional midturbinate swabs were tested from all children using a polymerase chain reaction panel. The primary aims of the study were to determine the prevalence and etiologic role of RVs in exacerbations of CF and to compare changes with RV-positive and RV-negative infections. The secondary aims were to determine the predictive factors for RV-related exacerbations.

Results: From 50 patients with PEx, 23 (48.9%) sputum samples were virus-positive. With a combination of sputum and swab, viral positivity increased to 56%. The virus-positive group presented more frequently with hypoxia (oxygen saturation <93%) than the virus-negative group (P = .048). Virus-positive exacerbations were not associated with an increase in colonization rates or greater lung function decline over 12 months.

Conclusions: RVs frequently present during PEx of CF. However, predicting viral infections is difficult in this group. Only the presence of hypoxia may raise the suspicion of an accompanying viral agent. The combination of sputum and nasal swab samples increases the diagnostic yield in viral infections of CF. Despite their high frequency, the presence of RVs had no impact on clinical outcomes, such as a decline in lung function and increased colonization rates.
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http://dx.doi.org/10.1002/ppul.24750DOI Listing
July 2020

Multivariate Analysis of Risk Factors Predisposing to Kinesiophobia in Persons With Chronic Low Back and Neck Pain.

J Manipulative Physiol Ther 2019 10 23;42(8):565-571. Epub 2019 Nov 23.

Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey.

Objective: The purpose of this study was to analyze the interaction between kinesiophobia and pain-related variables classified according to International Classification of Functioning in individuals with chronic neck and low back pain by using multivariate analysis.

Methods: The 504 persons with chronic neck and low back pain filled out questionnaires assessing impairments in body functions and structures, limitations in activities of daily living, participation, and personal factors. Univariate analyzes were performed to investigate whether there are differences between individuals with and without kinesiophobia or not. Binary logistic regression analysis was used to evaluate whether independent variables were statistically significant predictors.

Results: In the univariate analyses, the persons who had high-level kinesiophobia had a significantly lower level of education and had significantly higher scores for the Million Visual Analogue Scale, Neck Disability Index, Hospital Anxiety and Depression Scale, and Nottingham Health Profile (P < .001). In the final logistic regression analysis, only educational level (P = .01), Million Visual Analogue Scale (P = .002) and Hospital Anxiety and Depression Scale (P = .008, P = .012) were retained significantly as the predictors of kinesiophobia.

Conclusion: In this group of people with chronic neck and low back pain, educational level, low back pain-associated disability, and emotional states like depression and anxiety were associated with kinesiophobia.
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http://dx.doi.org/10.1016/j.jmpt.2019.02.009DOI Listing
October 2019

Scintigraphic evaluation of renoprotective effects of coenzyme Q10 in a rat renal ischemia-reperfusion injury.

Nucl Med Commun 2019 10;40(10):1011-1021

Departments of Nuclear Medicine.

Purpose: Renal ischemia-reperfusion injury (RIRI) may occur secondary to several reasons leading to renal failure. Coenzyme-Q10 (CoQ10) is a well-known antioxidant. However, the effects CoQ10 against RIRI have not been evaluated. Our aim was to evaluate protective effects of CoQ10 to renal ischemia-reperfusion by biochemical, immunohistochemical and scintigraphic findings.

Methods: Thirty Wistar-albino rats were randomly separated into groups of 10; Group Sham; Group ischemia-reperfusion (IR) had left renal pedicle clamping; Group CoQ10+IR had IR and CoQ10. Twenty-four hours later after reperfusion, scintigraphy was performed and after that, rats were sacrificed. To demonstrate effects of RIRI, serum urea and creatinine levels and tissue levels oxidative stress markers were evaluated. Both kidneys were subjected to histopathological evaluation and to confirm RIRI-induced immunohistochemical aspects of apoptosis, terminal-deoxynucleotidyl-transferase mediated-deoxyuridine-triphosphate-nick-end-labeling assay and caspase-3 were assessed.

Results: Tissue oxidative stress, histopathologic changes, apoptosis scores and quantitative scintigraphic parameters were significantly higher in Group IR compared with Group Sham. Although tissue oxidative stress levels and histopathologic changes were not significant, quantitative scintigraphic parameters of contralateral kidney of Group IR were significantly increased. Compared with Group IR, Group CoQ10+IR presented decreased tissue oxidative stress levels; decreased scores of histopathology and apoptosis; and decreased quantitative scintigraphic parameters with increased split renal function in ischemic kidney.

Conclusions: Our results suggest that other than its antioxidant properties, CoQ10 shows antiperoxidative, antiapoptotic and antiinflammatory potential in protecting renal functioning of ischemic kidney. Furthermore, our results show that renal scintigraphy is a feasible method to detect early changes in renal functioning after RIRI.
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http://dx.doi.org/10.1097/MNM.0000000000001070DOI Listing
October 2019

Can Radiologist and Pathologist Reach The Truth Together in The Diagnosis of Benign Fibroepithelial Lesions?

Eur J Breast Health 2019 Jul 1;15(3):176-182. Epub 2019 Jul 1.

Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.

Objective: Benign fibroepithelial lesions (BFL) lesions of the breast are various and predominantly benign, although a few can be locally aggressive. Definitive diagnosis of some BFL can be challenging from core needle biopsy (CNB). Radiological findings can help guide the management of the lesions. The aim of this study was to investigate the accuracy rate of CNB results and evaluate the radiological findings of the most common BFL according to the final excision pathology results. The secondary aim was to assess the contribution of the imaging findings to CNB results.

Materials And Methods: A retrospective review was made of 266 patients diagnosed with suspicious BFL, conventional fibroadenoma, complex fibroadenoma, cellular fibroadenoma and benign phyllodes tumor (PT). The study included 132 patients who underwent surgical excision. The radiological and histopathological findings were evaluated.

Results: While 66 patients were diagnosed with more descriptive results on CNB, the other 66 patients were diagnosed with suspicious BFL. Agreement between CNB and excisional pathology was good, when CNB provided a definite diagnosis. While conventional and complex fibroadenoma were observed to have hypo or normal vascularity, cellular fibroadenoma and PT showed hypervascularity. Oval shaped and homogeneous internal echo pattern were significantly associated with conventional fibroadenoma. A heterogeneous internal echo pattern was seen in complex fibroadenomas and PT.

Conclusion: CNB often reaches the correct diagnosis alone when it gives a definite diagnosis. The radiological findings which help in the differentiation of BFL are hypervascularity, oval shape and internal heterogeneity. More accurate results can be obtained when histopathological and radiological findings are evaluated together.
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http://dx.doi.org/10.5152/ejbh.2019.4656DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6619778PMC
July 2019

Imaging Findings and Clinicopathological Correlation of Breast Cancer in Women under 40 Years Old.

Eur J Breast Health 2019 Jul 1;15(3):147-152. Epub 2019 Jul 1.

Department of Pathology, Hacettepe University School of Medicine, Ankara, Turkey.

Objective: The aim of this study was to evaluate the clinical, imaging and histopathological features of breast cancer in patients aged under 40 years of age. The relationship between radiological characteristics and histopathological features was also investigated.

Materials And Methods: The study included 131 patients aged under 40 years, diagnosed pathologically with breast cancer. A retrospective evaluation was made of the imaging and clinicopathological findings and the relationship between pathological and imaging findings was investigated.

Results: Most of the cancers were detected from clinical symptoms, especially a palpable mass (76.3%). The most common histological type of tumor was invasive ductal carcinoma and 64.8% of the tumors were high grade tumors. The predominant features were irregular borders (92.4%), microlobulated-angulated contours (43.5%), hypo-homogeneous internal echogenicity (80.9%) on ultrasonography, and the presence of a mass (41.2%) and suspicious microcalcifications (40.2%) on mammography. Magnetic resonance imaging commonly showed mass enhancement (66.7%) with type 2 or 3 dynamic curve (92.6%). High-grade tumors were associated with posterior acoustic enhancement (p: 0.03) while low-grade tumors presented with spiculated margins more than high grade tumors (p: 0.04).

Conclusion: Breast cancer in women aged under 40 years usually presents with a self-detected palpable mass and can show different imaging findings according to the histological grade. Ultrasonography is the main modality for the diagnosis of breast cancer in young women, but mammography and magnetic resonance imaging can help in both diagnosis and evaluation of the extent of disease.
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http://dx.doi.org/10.5152/ejbh.2019.4606DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6619779PMC
July 2019

Upper airway features of unilateral cleft lip and palate patients in different growth stages.

Angle Orthod 2019 07 29;89(4):575-582. Epub 2019 Jan 29.

Objectives: To compare growth-related changes of skeletal and upper airway features of unilateral cleft lip and palate subjects (UCLP) with non-cleft control (NCC) subjects by using lateral cephalograms.

Materials And Methods: The sample comprised 238 subjects, collected cross-sectionally, divided into 2 groups: 94 with UCLP, and 144 NCC, subdivided into 4 groups according to their growth stages by using cervical vertebral maturation stage (CVMS). The subgroups were defined as early childhood (stage 1), prepubertal (stage 2: CVMS I and II), pubertal (stage 3: CVMS III and IV), and postpubertal (stage 4: CVMS V and VI).

Results: The maxilla was more retrognathic at stages 2, 3, and 4 in females with UCLP. The mandible was more retrognathic in UCLP at stage 1 in males, and stages 2 and 3 in females. ANB (angle between NA plane and NB plane) was significantly smaller in UCLP subjects at stage 4 for both sexes. A vertical growth pattern was seen in UCLP subjects except males at stages 2 and 3, and females at stage 2. Posterior airway space was significantly narrower at all stages in males and after stage 1 in females. Middle airway space was significantly wider at all stages in females and after stage 1 in males. Epiglottic airway space was significantly narrower in males at stage 3.

Conclusions: Age- and sex-dependent differences in skeletal morphology and upper-airway widths of the UCLP subjects were identified when compared with controls.
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http://dx.doi.org/10.2319/022518-155.1DOI Listing
July 2019

High-intensity inspiratory muscle training in bronchiectasis: A randomized controlled trial.

Respirology 2019 03 12;24(3):246-253. Epub 2018 Sep 12.

Faculty of Medicine, Department of Chest Medicine, Hacettepe University, Ankara, Turkey.

Background And Objective: Inspiratory muscle training (IMT) enhances velocity of inspiratory muscle contraction and modifies inspiratory and expiratory time. This study aimed to examine the impact of high-intensity IMT (H-IMT) on exercise capacity in bronchiectasis.

Methods: Forty-five patients were included. Lung function, respiratory muscle strength and endurance, exercise capacity, dyspnoea, fatigue and quality of life (QOL) were evaluated. Patients were randomized into two groups: H-IMT and control groups. Twenty-three patients underwent H-IMT for 8 weeks, using threshold loading with a target workload of maximal inspiratory pressure (MIP) of at least 70%, with 3-min cycles (as 2-min training: 1-min rest intervals) for 21 min. There was a total period of 14 min of loaded breathing and 7 min of recovery. The control group (n = 22) underwent low-intensity IMT at 10% of the initial MIP and was maintained at the same intensity until the end of the training.

Results: After training, both MIP and maximal expiratory pressure (MEP) and the incremental shuttle walk distance were increased in the H-IMT group compared with the control group (P < 0.05). There was a significant difference in constant threshold load, time and pressure-time units in the H-IMT group (P < 0.05) but not in the control group (P > 0.05). A significant decrease was found in fatigue in both groups (P < 0.05). The Leicester Cough Questionnaire social score for the H-IMT group decreased significantly after the treatment (P < 0.05).

Conclusion: The H-IMT increased exercise capacity in patients with non-cystic fibrosis bronchiectasis. It has also positive effects on respiratory muscle strength and endurance, and social aspects of QOL.
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http://dx.doi.org/10.1111/resp.13397DOI Listing
March 2019

The effect of stabilization exercises on diaphragm muscle thickness and movement in women with low back pain.

J Back Musculoskelet Rehabil 2018 ;31(2):323-329

Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Background: Diaphragm is an important component of spinal stability. In presence of low back pain, there may be some alterations in this muscle like other muscles that are responsible for lumbal stabilization.

Objective: This study aims to assess the effects of stabilization exercises on diaphragm muscle thickness and motion along with lumbopelvic stability.

Methods: Twenty-one women with low back pain participated in the study. Stabilization exercises including motor control training were performed on treatment group (n= 11). In control group (n= 10), strentghening exercises were peformed for back muscles, abdominal muscles and hip muscles. The patients underwent a total of 30 sessions of treatment, 3 days in a week for 10 weeks. The diaphragm muscle thickness and motion was evaluated using ultrasound (US), and lumbopelvic stability was evaluated using lumbopelvic stability tests.

Results: After the treatment, in the treatment group, increase in diaphragm thickness and improvement in lumbopelvic stability were statically significant (p< 0.05). However, there were no significant changes in diaphragm motion in both groups (p> 0.05).

Conclusions: As a result, stabilization exercises increase diaphragm muscle thickness and improve lumbopelvic stability in women with low back pain. Therefore, stabilization exercises should be considered as a part of the treatment program in low back pain.
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http://dx.doi.org/10.3233/BMR-169749DOI Listing
August 2018

Ocular Causes of Abnormal Head Position: Strabismus Clinic Data.

Turk J Ophthalmol 2017 Aug 15;47(4):211-215. Epub 2017 Aug 15.

Private Practice, Ankara, Turkey.

Objectives: To determine the most common ocular causes and types of abnormal head position (AHP) and describe their clinical features.

Materials And Methods: Patients with AHP who had been followed in the strabismus unit were retrospectively reviewed. Demographic features and orthoptic characteristics were recorded.

Results: A total of 163 patients including 61 women (37.4%) and 102 men (62.6%), with a mean age of 19.9±18.3 were recruited. The most common causes of AHP were determined as fourth cranial nerve palsy (33.7%), Duane retraction syndrome (21.5%), sixth cranial nerve palsy (11%), nystagmus blockage syndrome (9.8%) and Brown syndrome (6.7%). Other less frequent causes were A-V pattern strabismus, comitant strabismus, thyroid orbitopathy and third cranial nerve palsy. The most common types of AHP were head tilt (45.4%) and face turn (36.8%). Out of 142 patients whose visual acuity could be evaluated, 28.2% had amblyopia. The frequency of amblyopia varied depending on the diagnosis (p<0.001), while there was no relation between amblyopia and different types of AHP (p=0.497). Stereopsis and fusion could be tested in 128 patients and 43.8% of them had stereopsis and fusion. The presence of stereopsis and fusion was found to be related with the diagnosis (p=0.001), whereas it was not related with the types of AHP (p=0.580). The presence of amblyopia was not significantly associated with fusion (p=1.000) or stereopsis (p=0.602).

Conclusion: There are many ocular pathologies that cause AHP. Patients with similar diagnoses may have different types of AHP. Patients may have amblyopia and impaired binocularity despite AHP. Therefore, all patients with AHP should be examined in detail and these points should be considered in the treatment plan.
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http://dx.doi.org/10.4274/tjo.42068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5563549PMC
August 2017

Response to "The Association of Chronic Topical Prostaglandin Analog Use With Meibomian Gland Dysfunction: Comment".

J Glaucoma 2017 09;26(9):e223-e224

Department of Ophthalmology, Hacettepe University Faculty of Medicine Ankara, Turkey.

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http://dx.doi.org/10.1097/IJG.0000000000000702DOI Listing
September 2017

Rapid lung magnetic resonance imaging in children with pulmonary infection: reply to Sodhi et al.

Pediatr Radiol 2017 05 7;47(6):766. Epub 2017 Mar 7.

Department of Radiology, Division of Pediatric Radiology, Hacettepe University School of Medicine, Sıhhiye, 06100, Ankara, Turkey.

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http://dx.doi.org/10.1007/s00247-017-3812-2DOI Listing
May 2017

Do Histopathological Features and Microcalcification Affect the Elasticity of Breast Cancer?

J Ultrasound Med 2017 Jun 27;36(6):1101-1108. Epub 2017 Feb 27.

Department of Pathology, Ministry of Health Ankara Training and Research Hospital, Ankara, Turkey.

Objectives: The aim of this study was to evaluate any association between histological grade, molecular subtypes of breast cancer, and strain elastography, and to investigate whether microcalcification affects the stiffness of tumor in breast cancers with the same histological grade.

Methods: Between April 2015 and March 2016, 94 lesions of 94 patients with the diagnosis of invasive ductal carcinoma were included in the study. Strain elastography was performed on all patients before biopsy. Histological grades (Grades 1, 2, and 3), molecular subtypes (luminal A, luminal B, Her-2, and basal-like), and strain ratio (SR) were compared. In the same histological grades, patients were divided into two groups according to the presence of microcalcifications, and the groups were compared with each other.

Results: Compared with Grades 1 (20.5) and 2 (23.7), Grade 3 (11.7) showed lower SR values (Grade 3-2, P = .01; Grade 3-1, P = .2). The groups with microcalcification had slightly higher SR in all histological grades, but not of statistical significance. In molecular subtypes, luminal A and B demonstrated higher SR, whereas HER2 and basal-like had lower SR (P > .05 for all group comparisons).

Conclusions: Grade 3 invasive ductal carcinomas are different from other grades with lower SR values. The presence of microcalcifications and molecular subtypes do not affect elasticity like a high histological grade does.
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http://dx.doi.org/10.7863/ultra.16.06064DOI Listing
June 2017

Bedside Diode Laser Photocoagulation Under Remifentanil Analgesia for Retinopathy of Prematurity: Early Structural Outcomes.

Turk J Ophthalmol 2016 Oct 17;46(5):209-214. Epub 2016 Oct 17.

Hacettepe University Faculty of Medicine, Department of Biostatistics, Ankara, Turkey.

Objectives: To evaluate one-year structural outcomes of bedside diode laser photocoagulation with remifentanil analgesia for retinopathy of prematurity (ROP) and discuss clinical and demographic characteristics of infants and other possible risk factors that may affect the outcome.

Materials And Methods: The medical records of premature infants who were treated with bedside transpupillary diode laser photocoagulation under remifentanil analgesia for ROP were evaluated for clinical and demographic characteristics, accompanying systemic risk factors, laser parameters, complications of treatment, retreatment rate and one-year structural outcomes.

Results: One-hundred and ninety-five eyes of 99 infants (59 males, 40 females) were recruited for the study. The mean gestational age and birth weight were 27.4±2.3 weeks (23-34) and 1003.3±297.8 g (570-2250), respectively. Laser therapy was performed for high-risk prethreshold ROP in 66.2% of eyes, aggressive posterior ROP (APROP) in 15.4% and threshold ROP in 18.4%. The mean number of laser spots was 1510.4±842.1 per laser session. No adverse effects of laser photocoagulation were observed except small lens opacities in two eyes and corneal opacity in one eye. Retreatment was needed in only three eyes, and vitreoretinal surgery was needed in six eyes of six patients despite laser treatment. Anatomic outcome was favorable in 189 eyes (96.9%) at the end of a 1-year follow-up. Presence of dilated and tortuous iris vessels (p=0.002) and tunica vasculosa lentis (p=0.009) along with type of ROP (APROP and stage 4a ROP at initial presentation) (p=0.001) were associated with poor anatomical outcome.

Conclusion: Accurate and timely bedside transpupillary diode-laser photocoagulation under remifentanil analgesia is an effective and safe treatment modality for ROP, and may prevent vision-threatening retinal detachment and reduce the need for vitreoretinal surgery.
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http://dx.doi.org/10.4274/tjo.04557DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5200832PMC
October 2016