Fears of children and the cultural context: The Turkish norms

The present study was undertaken to identify children's fears in terms of their age, gender and Socio Economic Status (SES) characteristics. Another aim of the study was the adaptation and the standardization of the Fear Survey Schedule for Children (FSSC) to Turkish population and to determine its psychometric properties. FSSC was given to 1237 Lower SES children aged 9–13 years. To understand the effects of social and environmental factors the results were compared with 644 children from high socio-economic level and 118 children of Turkish immigrant labourer families residing in Holland. The most prevalent 10 fear items in all three groups were also determined. Results indicated that girls had more intense and frequent fears at all age levels than boys. Low SES children reveal more fears compared to their high SES pears of their self reported fears. Fears related to death and separation occupy the top positions and religious fears that are mentioned very often by children especially by those in the lower SES group. Test-retest reliability, internal consistency and the factorial structure of the scale have proved it to be a valuable and reliable tool for research and clinical purposes in Turkey.

---

Zusammenfassung Die vorliegende Studie wurde unternommen, um Ängste von Kindern im Hinblick auf deren Alter, Geschlecht und sozioökonomischen Status zu identifizieren. Ein weiteres Ziel der Studie war die Adaptation und Standardisierung des Fear Survey Schedule for Children (FSSC) für eine türkische Population und die Bestimmung seiner psychometrischen Eigenschaften. Der FSSC wurde bei 1.237 Kindern mit niedrigerem sozioökonomischen Status und einem Alter von 9–13 Jahren durchgeführt. Um die Einflüsse von sozialen und Umweltfaktoren zu verstehen, wurden die Ergebnisse mit denen von 644 Kindern mit hohem sozioökonomischen Status und 118 Kindern aus in Holland lebenden türkischen Gastarbeiterfamilien verglichen. Die 10 Angst-Items mit der höchsten Prävalenz in allen drei Gruppen wurden ebenfalls bestimmt. Die Ergebnisse zeigten, daß Mädchen in allen Altersstufen Ängste intensiver und häufig verspüren als Jungen. Die Kinder mit niedrigem sozioökonomischen Status gaben von sich aus mehr Ängste an als ihre Altersgenossen mit hohem sozioökonomischen Status. Ängste, die sich auf den Tod beziehen, und Trennungsängste stehen an erster Stelle. Religiöse Ängste werden von Kindern häufig angegeben, besonders von denen aus der Gruppe mit niedrigem sozioökonomi-schen Status. Test-Retest-Reliabilität, innere Konsistenz und der faktorielle Aufbau der Skala haben bewiesen, daß das FSSC ein wertvolles und zuverlässiges Instrument für Forschung und Klinik in der Türkei darstellt.

---

Résumé La présente étude fut entreprise pour identifier les peurs des enfants en fonction de leur âge, de leur sexe et de leur statut socio-économique. Un autre but de l'étude fut l'adaptation et le standardisation de la Fear Survey Schedule for Children (FSSC) à une population turque et de déterminer ses propriétés psychométriques. La FSSC fut proposée à 1237 enfants à bas niveau socio-économique âgés de 9 à 13 ans pour comprendre les effets des facteurs environnementaux et sociaux, les résultats furent comparés avec 644 enfants d'un niveau sociéconomique élevé et 118 enfants de familles de travailleurs turcs immigrants résidant en Hollande. Les 10 items de peur les plus prévalents dans ces 3 groupes furent aussi déterminés. Les résultats indiquaient que les filles avaient des peurs plus intenses et fréquentes à tous les âges que les gar¢ons. Les enfants d'un statut socio-économique bas montraient plus de peur auto-reportée comparés leur peur avec un statut plus élevé. Les peurs liées à la mort et à la séparation occupaient des positions culminantes et les peurs religieuses étaient mentionnées très souvent par les enfants spécialement par ceux à bas niveau économique. La fiabilité testretest, la consistance interne et la structure factorielle de l'échelle ont prouvé qu'elle était un instrument valable et fiable pour la recherche et le projets cliniques en Turquie.

     

Management of peripartum hysterectomies performed on patients with placenta percreta in a tertiary central hospital

Objective: The main objective of this study is to analyse the circumstances and management of peripartum hysterectomies performed on patients with placenta percreta.

Methods: This study included 37 patients who were diagnosed with placenta percreta, a condition in which the placenta invades the uterine wall, and who therefore underwent a peripartum hysterectomy. Their demographic characteristics, history of past caesareans, uterine surgery and curettage, duration of hospitalization, admission to an intensive care unit, neonatal outcomes, skin and uterus incision type, hypogastric artery ligation (HAL), complications, quantities of transfused ES (erythrocyte suspensions), and FFP (fresh frozen plasma), maternal morbidity and mortality and postoperative pathology results were retrospectively reviewed.

Results: All pregnant patients who underwent a caesarean hysterectomy due to placenta percreta had a history of caesarean section and also of placenta praevia totalis. Bilateral HAL was performed in two patients (5.4%), owing to uncontrollable bleeding during the bladder dissection. The complications most frequently observed were bladder injury (13.5%), followed by infection (8.1%) and relaparotomy (5.4%). There was no mortality. Twenty-three (62.2%) of the patients had ES and 11 patients (29.7%) had FFP transfusions. According to the histopathology findings, 33 of the 37 patients (89.1%) reportedly had placenta percreta, three patients had placenta increta, and one patient had placenta accreta. Analysis of the neonatal status at birth showed that the gestational age was, on average, the 35th week. The birth weight was normal in relation to the gestational week, but the first and fifth minute Apgar score, which measures the physical condition of an infant, was found to be lower than the normal range.

Conclusions: If a pregnant patient undergoes uterine surgery or has a history of a caesarean with placenta praevia, she is likely to have placenta percreta. In placenta percreta cases with bladder invasion; careful suturing of the high-volume vessels on the posterior wall of the bladder, through the bladder serosa is important in reducing the amount of bleeding and preventing future fistula formation.     

Creutzfeldt-Jakob disease presenting as hyperparathyroidism and generalized tonic status epilepticus.

Creutzfeldt-Jakob disease is the most common disorder among the very rare human transmissible subacute spongiform encephalopathies. Sporadic, familial or iatrogenic forms of the disease can be seen. The common presentations of the disease include rapidly progressive cognitive decline, behavioral changes, visual disturbances and cerebellar dysfunction. Hyperparathyroidism and toxicity of lithium and bismuth have been reported to induce similar symptoms and EEG findings, leading to a Creutzfeldt-Jakob like syndrome. We report a very rare case of Creutzfeldt-Jakob disease presenting with hyperparathyroidism and generalized tonic status epilepticus.     

Caspase-3 and VEGF immunopositivity in seminiferous tubule germ cells in cases of obstructive and non-obstructive azoospermia in smokers versus non-smokers

Purpose  To investigate immunostaining pattern of caspase-3, an apoptosis marker, and vascular endothelial growth factor (VEGF), an hypoxia marker in testis biopsy specimens collected either from smoking or non-smoking patients with azoospermia. Methods  Testis biopsy specimens were obtained from thirty seven non-smoker and thirty eight smoker patients. Using immunochemistry technique, caspase-3 and VEGF were evaluated in all intratubular spermatogenic and interstitial Leydig cells. Result(s)  Caspase-3 expression was significantly increased in germ cells in maturation arrest specimens in smoker azoospermic patients. No statistically significant difference was present between smokers and non-smokers for caspase-3 expression in Sertoli cell. However, the VEGF immunopositive Leydig cells were statistically higher in smokers. There were no differences between groups in terms of germ cell immunopositivity. Conclusion  Our results support the hypothesis that increased apoptosis contributes significantly to impaired spermatogenesis. We conjecture that germ cell apoptosis may be augmented by hypoxic microenvironments and environmental toxicants in smoking azoospermic men. Capsule The evaluation of caspase-3 and VEGF immunopositivity in smoking patients with azoospermia     

Adrenocortical steroid response to ACTH in different phenotypes of non-obese polycystic ovary syndrome

Background

Adrenal androgen excess is frequently observed in PCOS. The aim of the study was to determine whether adrenal gland function varies among PCOS phenotypes, women with hyperandrogenism (H) only and healthy women.

Methods

The study included 119 non-obese patients with PCOS (age: 22.2?±?4.1y, BMI:22.5?±?3.1?kg/m²), 24 women with H only and 39 age and BMI- matched controls. Among women with PCOS, 50 had H, oligo-anovulation (O), and polycystic ovaries (P) (PHO), 32 had O and H (OH), 23 had P and H (PH), and 14 had P and O (PO). Total testosterone (T), SHBG and DHEAS levels at basal and serum 17-hydroxprogesterone (17-OHP), androstenedione (A4), DHEA and cortisol levels after ACTH stimulation were measured.

Results

T, FAI and DHEAS, and basal and AUC values for 17-OHP and A4 were significantly and similarly higher in PCOS and H groups than controls (p?<?0.05 for all) whereas three groups did not differ for basal or AUC values of DHEA and cortisol. Three hyperandrogenic subphenotypes (PHO, OH, and PH) compared to non-hyperandrogenic subphenotype (PO) had significantly and similarly higher T, FAI, DHEAS and AUC values for 17-OHP, A4 and DHEA (p?<?0.05). All subphenotypes had similar basal and AUC values for cortisol.

Conclusion

PCOS patients and women with H only have similar and higher basal and stimulated adrenal androgen levels than controls. All three hyperandrogenic subphenotypes of PCOS exhibit similar and higher basal and stimulated adrenal androgen secretion patterns compared to non-hyperandrogenic subphenotype.

     

Sutureless amniotic membrane transplantation combined with narrow-strip conjunctival autograft for pterygium

To study the efficacy and safety of sutureless amniotic membrane transplantation combined with narrow-strip conjunctival autograft and to investigate the clinical outcomes. Thirty eyes of 30 patients with primary pterygia were treated in this institutional study with excision followed by sutureless amniotic membrane transplantation combined with narrow-strip conjunctival autograft using fibrin glue tissue adhesive. The main outcome measures were the operating time for ocular surface reconstruction, the size of the pterygium and of the conjunctival autograft, postoperative complications, subjective complaints, and recurrences. The mean pterygium size was 3.12 ± 0.92 mm and the mean operating time was 4.58 ± 1.10 min. Twenty-nine patients (96.7%) had no complaints after first postoperative week. Twenty-eight (93.3%) patients had no recurrences after 1 year follow-up. The sutureless amniotic membrane transplantation combined with narrow-strip conjunctival autograft is an effective procedure with low rate of recurrence. This technique can be considered as a preferred grafting procedure for primary pterygium but further randomized controlled studies including larger populations are needed.     

A prospective study of etiology of childhood acute bacterial meningitis, Turkey

Determination of the etiology of bacterial meningitis and estimating cost of disease are important in guiding vaccination policies. To determine the incidence and etiology of meningitis in Turkey, cerebrospinal fluid (CSF) samples were obtained prospectively from children (1 month-17 years of age) with a clinical diagnosis of acute bacterial meningitis. Multiplex PCR was used to detect DNA evidence of Streptococcus pneumoniae, Haemophilus influenzae type b (Hib), and Neisseria meningitidis. In total, 408 CSF samples were collected, and bacterial etiology was determined in 243 cases; N. meningitidis was detected in 56.5%, S. pneumoniae in 22.5%, and Hib in 20.5% of the PCR-positive samples. Among N. meningitidis-positive CSF samples, 42.7%, 31.1%, 2.2%, and 0.7% belonged to serogroups W-135, B, Y, and A, respectively. This study highlights the emergence of serogroup W-135 disease in Turkey and concludes that vaccines to prevent meningococcal disease in this region must provide reliable protection against this serogroup.