OBJECTIVE: A strong correlation exists between tenascin-C induction, and acute inflammation. Generally increased tenascin-C concentrations are correlated with various inflammatory, and infectious diseases. In patients with diagnosis of Inflammatory Bowel Disease (IBD) presence of tenascin-C in colonic mucosa demonstrates tissue repair, and its mucosal concentrations are correlated with local disease activity Therefore plasma levels of tenascin-C have been demonstrated to be a helpful indicator of the activity of inflammatory bowel diseases. In this study, firstly in the literature, we aimed to display the correlation between tenascin-C expression, and formation of intestinal stricture.
METHODS: A total of 43 patients (male, n=19; 44.2%; and female, n=24, 55.8%) aged between 19, and 63 years, with clinically, endoscopically, radiologically, and histopathologically confirmed definitive diagnosis of Crohn’s disease who were examined, diagnosed, and treated in the Gastroenterology Clinic of Haydarpasa Numune Training and Research Hospital between January 2011, and April 2012 were investigated. Serum tenascin- C levels were measured using commercial sandwich enzyme-linked immunosorbent assay Human Tenascin-C Purified Protein kit (Chemicon, Millipore(R), USA). Study groups were categorized based on the type of the disease as inflammatory (n=17; 39.5%), obstructive (27.2%), and fistule formation (n=10; 23.3%) Crohn’s disease. For statistical analysis SPSS (Statistical Package for Social Sciences) Statistics 15 program was used.
RESULTS: Median tenascin- C value in the obstructive group (6.57 ng/mL; range, 4.26-21.87 ng/mL) was statistically significantly higher than that detected in the inflammatory (1.74 ng/mL; range,1.29-3.16 ng/mL), and fistulizing (1.44 ng/mL; range, 0.74-2.47 ng/mL) groups (p=0.002).
CONCLUSION: Intestinal fibroblasts have an important role in the stricture formation process in CD. Transforming growth factor (TGF)-b1 cytokine is in the center of this process. A strong correlation exists between tenascin-C induction, and acute inflammation. As a known fact, serum tenascin-C levels can be used in the determination of activity of IBD. Starting from this point, serum tenascin-C levels can be useful in the categorization of the Crohn’s disease without the need for invasive methods. In the future, studies with larger patient series investigating use of serum tenascin-C in the prediction of stricturing Crohn’s disease should be conducted.

OBJECTIVE: The aim of this cross-sectional study was to determine the frequency of carpal tunnel syndrome
(CTS) among women using tea leaf scissors and compare it with normal population.
METHODS: Two hundred hands of 100 women using tea leaf scissors (tea leaf scissors group) and 112 hands of 56 healthy women (control group) were clinically and electrophysiologically evaluated for CTS. Women using tea leaf scissors were evaluated with visual analog scale (VAS) for pain and Boston Carpal Tunnel Syndrome Questionnaire for symptoms and functional status.
RESULTS: Carpal tunnel syndrome was diagnosed bilaterally in 62 (62%) and unilaterally in 7 (7%) women using tea leaf scissors, whereas 2 (3.57%) bilateral and 6 (10.71%) unilateral cases of CTS was diagnosed in controls. The differences in demographic factors were not statistically significant. In women with CTS using tea leaf scissors, mean symptom severity, functional status, and VAS scores were 2.73±0.60, 2.42±0.71 and 5.19±1.84, respectively. There was statistically significant difference in the frequency of CTS between women using tea leaf scissors and the control group and the risk of having CTS among women using tea leaf scissors was approximately 12 times greater (p<0.001).
CONCLUSION: In tea agriculture, working with repetitive flexions and extensions of the wrist highly increases
the risk of developing CTS.

OBJECTIVE: To evaluate the safety and efficacy of transobturator vaginal tape (TOT) in the management women with stress urinary incontinence (SUI) and to analyze functional results and subjective cure rates at follow- up visits.
METHODS: Eighty-three consecutive women with SUI underwent TOT procedure. Data related to operative time, pre- and post-operative complications were collected. Subjective cure was defined as the absence of any urine loss on physical activity.
RESULTS: Mean age of the patients was 53.2 years, and 66.3% of the patients had pure SUI. The mean operative time was 24.96 min in cases of isolated SUI treatment. The mean hospital stay was 1.53±0.68 days. At a mean follow-up of 32.8 months, the median subjective cure rate was 68.7 percent. Bladder injury (8.4%) was the only short and long term complication of this procedure.
CONCLUSION: TOT is a safe and effective procedure for SUI with a low rate of long- term complications. The
short -term complication like bladder perforation may develop based on the experience of the surgeons or concomitant pelvic surgery.

OBJECTIVE: Metabolic syndrome (MetS) is increasing around the world due to abdominal obesity with altered eating habits and decreased physical activity. The aim of this study was to determine the risk factors for gastroesophagial reflux disease (GERD) symptoms and the prevalence of GERD in patients with MetS.
METHODS: Five hundred patients (MetS, n=300 and the control group, n=200) were enrolled in the study. A detailed questionnaire reflux symptoms and behavioral habits was performed.
RESULTS: Sixty percent of the subjects were with MetS. GERD rate was significantly higher in the group with MetS compared to subjects without MetS (50.7% vs 26%). Women were more likely to have GERD in both groups (62.6% of women and 28.6% of men ýn the MetS group while corresponding rates were 37% vs 16.7% in the control group). Waist circumferences were found to be higher in female MetS patients with GERD.
CONCLUSION: GERD is present approximately in every one of the two patients with MetS. Every patient who
has MetS should be evaluated in terms of GERD symptoms.

OBJECTIVE: With the use of any drug comes the possibility of unintended consequences which when harmful are referred to as adverse drug reactions (ADRs). The development of national pharmacovigilance systems is the responsibility of all health workers. The aim of this study was to investigate the knowledge of nurses about pharmacovigilance and attitudes about ADR and adverse event reporting.
METHODS: This descriptive-cross sectional study was performed in 112 nurses working in a public hospital. The questionnaire was applied about pharmacovigilance and adverse drug reactions. The knowledge, attitudes and practices about adverse drug reactions were asked.
RESULTS: The 74.1% of the nurses definition of “severe adverse effect” of drug therapy. The ratio of participants who knew that ADRs are reported to contact person responsible from pharmacovigilance was 34.9%. Although 70.5% of nurses knew the necessity of ADR reporting, the 8% of the nurses knew Turkish Pharmacovigilance Center (TÜFAM). Only 8% of nurses reported ADRs in their professionality.
CONCLUSION: Although most of the participants knew the importance of ADR event reporting, event reporting was low. Thiese results showed that there is a lack of knowledge about pharmacovigilance. Futher studies with different settings and healthcare staff are needed to improve awareness about pharmacovigilance.

OBJECTIVE: To investigate the effect of botulinum toxin type-A (BTX-A) on spasticity and function in patients with focal spasticity.
METHODS: Patients attended to the outpatient clinic of physical medicine and rehabilitation department with a diagnosis of focal spasticity and had BTX-A injections because of spasticty were evaluated for the study. Demographic data, exercise status, orthoses, drugs used for spasticity, functional status, stages of spasticity of muscles before and after 1st and 3rd months of BTX-A injection according to Modified Ashworth Scale (MAS) were evaluated retrospectively. MedCalc 11.6 statistical program was used for statistical analyses. Statistical significance was defined as p<0.05.
RESULTS: Forty-nine patients with focal spasticity were recruited for the study (35 men, 14 women). Mean age of the patients was 21.59±20.09 years. The patients had cerebral palsy (CP, n=28), 19 had hemiplegia (n=19) and paraplegia (n=2). Forty-three patients were using orthoses and exercising regularly. Mean Pediatric Functional Independence Measurement (WeeFIM) scores of the patients with CP was 54.82±28.91 and according to the Gross Motor Function Classification System (GMFCS) the patients were in stages 2 (14%), 3 (46%), 4 (11%) and 5 (29%). Mean Functional Independence Measure (FIM) of hemiplegic and paraplegic patients was 80.80±20.88. Brunnstrom staging scores for upper extremity (3.52±0.96), hands (2.68±0.82), lower extremity (4.57±1.01) were calculated. MAS muscles demonstrated statistically significant decrease in spasticity at the end of first and third months (p<0.05).
CONCLUSION: We saw a significant decrease in the spasticity of upper and lower extremities in patients with
focal spasiticity who received BTX-A injections. We suggest that if BTX-A injections are supported with orthoses and exercise programs, then functional status of the patients would be better.

OBJECTIVE: To evaluate the endoscopic findings of dyspeptic patients unresponsive to proton pump inhibitors (PPIs) and analyze if there is any correlation between these findings and dyspeptic symptoms via predetermined inquiry.
METHODS: Patients between 18 and 45 years of age were selected among those referred to our unit for upper GI endoscopy due to failure to achieve improvement in dyspeptic complaints with PPI. Patients who consent to participate in and eligible for the study were questioned for their symptoms using questionnaires.
RESULTS: A total of 446 patients with female preponderance (60%) were included in the study. Endoscopic results were listed as: 147 (32.9%) normal, 16 (3.6%) gastric ulcer, 36 (8.1%) duodenal ulcer, 216 (48.4%) gastritis, 7 (1.5%) duodenitis and 24 (5.4%) esophagitis. A total of 122 patients were classified as functional dyspepsia. While incidence of persistent bloating was distinctly higher in patients with gastritis compared to those with normal endoscopic findings (p: 0.000), but its incidence was comparable between ulcer and normal patients. No statistical difference was detected between gastritis, ulcer and normal endoscopy patients considering incidence of early satiety. Compared to those with normal endoscopy patients, incidence of epigastric pain was significantly higher among patients with gastritis and ulcer (p: 0.002 and p: 0.000 respectively). Incidence of heartburn was higher in patients with gastritis compared to those with normal endoscopy findings, but it was similar to those with ulcer. While incidence of persistent bloating was distinctly higher in patients with gastritis compared to those with normal endoscopy (p: 0.000), it was the same between ulcer and normal patients. No statistical difference was detected between gastritis, ulcer and normal endoscopy patients considering incidence of early satiety.
Compared to those with normal endoscopy patients, incidence of epigastric pain was significantly higher among patients with gastritis and ulcer (p: 0.002 and p: 0.000 respectively)
Incidence of heartburn was higher in patients with gastritis compared to those with normal endoscopy, but the same in those with ulcer.

CONCLUSION: Most (67.1%) of the patients between 18 and 45 years of age with no alarm symptoms had diagnoses that required use of a PPI. Hence, the patients should be carefully evaluated before referring for endoscopy.

OBJECTIVE: Home Health Care Unit a unit provides health services for elderly, bedridden and individuals with chronic diseases at home along within the frame of the diagnosis, and treatments of the relevant experts. Therefore, it is intended to reduce the probable physical and emotional burden related to the patient that arise by commuting to the hospital, to increase the number of empty beds for other patients and to improve the living standard by reducing the risk of hospital infection. In this study, the demographic characteristics of housebound patients, their general disease and its relationship with age and gender was investigated.
METHODS: The following study was performed on 626 active patients of Malatya State Hospital Home Health Care Unit from January to November 2014. Data were analyzed using Microsoft Excel Program.
RESULTS: The study included 60.5% (n=379) female and 39.5% (n=247) male patients. The highest group consisted of patients with 80 years or above 37.7% (n=236). Cerebrovascular disease (CVD) (n=95; 25.0%), senility (n=56; 14.8%) and Alzheimer’s disease (n=50; 13.2%) were commonly observed in women. Male patients had CVD (n=54; 21.8%), femur fracture or gonarthrosis which required surgery (n=28; 11.3%), and fracture due to trauma or traffc accidents (n=28; 11.3%), senility and Alzheimer’s disease (n=218.5%).
CONCLUSION: In recent years home health care units became even more important after the gradual increase in the elderly population and injuries due to accidents. This study can help to provide home health care units in a more effcient manner by educating the staff and relatives who take care of the patients.

Myiasis is the infestation of live vertebrates with dipterous larvae. Aural myiasis involves infestation of the external ear and/or middle ear. It is a rare clinical state that usually occurs in patients who have mental or physical disabilities. Although myiasis is a self-limiting disease, it can be associated with fatal complications like penetration within the central nervous system. We present a 87-year-old patient suffering from Alzheimer’s disease with aural myiasis and also discuss the clinical presentation and efective therapies with a review of the literature.

Local anesthetic intoxication is a medical emergency with high mortality. These drugs have not spesific antidotes, quick differential diagnosis and supportive treatment required in the case of exposure to toxic doses. We report the complications and anesthetic management of a patient who was scheduled for right carpal tunnel syndrome surgery under regional anesthesia, but mistakenly received injection of 140 mg procaine added to 10% 10 mL lidocaine (10 mL=1000mg) instead of 2% lidocaine (10mL=200 mg) as part of an axillary plexus blockade.

Velocardiofacial syndrome (VCFS), also known as “Shprintzen syndrome” or “22q11.2 deletion syndrome” is an autosomal dominant genetic disorder with a wide range of phenotypical findings. It is majorly characterized by cleft palate, dysmorphic face, conotruncal cardiac anomalies, growth retardation, neurologic disorders and learning
disabilities. Our case was the first child of her family and she had a cleft palate, dysmorphic face, tetralogy of Fallot (TOF), growth retardation and a mild neuromotor developmental delay. It is important to recognize this syndrome and inform the family about the probable future health problems of their babies as early as possible. Genetic counselling is crucial for the subsequent pregnancies. Therefore, we wanted to review the literature about the differential diagnosis and genetics of velocardiofacial anomalies.

Myoclonus-dystonia syndrome (MDS) is a rare disease manifesting myoclonus as the only neurological symptom which may be accompanied by dystonia. It usually starts in the first or second decade of life. It has a benign course with spontaneous remissions but can cause functional disability in some patients. In this paper, we report a patient diagnosed as probable MDS on the basis of clinical and electrophysiological features who showed marked improvement under levetiracetam treatment.

5q-syndrome is a special subgroup of myelodysplastic syndrome in terms of follow-up and treatment. Lenalidomide is an immunomodulatory drug that is frequently used in the treatment of multiple myeloma. Some clinical studies have shown that lenalidomide treatment is effective in 5q syndrome and significantly decreases the transfusion dependency in these patients. In this paper, we would like to share a dramatic response of lowered transfusion dependency after treatment with low-dose lenalidomide in a patient who received myelodysplastic syndrome diagnosis and isolated 5q anomaly in our clinic.