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Epithelial ovarian cancer is a highly metastatic disease and the leading cause of death among cancer of the female genital tract. Abnormal epidermal growth factor receptor (EGFR) signalling has been shown to be involved in epithelial–mesenchymal transition (EMT), an early step during metastasis. Additionally, over-expression of the E-cadherin repressor Snail, a key regulator of EMT, has previously been found to be associated with unfavourable prognostic features. Thus, the aim of our study was to elucidate the role of EGFR-dependent signalling pathways for Snail expression in ovarian cancer. For this purpose, we analysed 25 formalin-fixed and paraffin-embedded (FFPE) primary tumours and their corresponding metastases for the expression of 25 signalling pathway molecules by reverse phase protein arrays. We found a significant correlation of Snail with EGFR (Tyr1086) and p38 MAPK (Thr180/Tyr182) in primary ovarian carcinoma and with EGFR (Tyr1086) in their corresponding metastasis. Additionally, we showed that high expression levels of Snail in primary tumours combined with high expression levels of the phosphorylated p38 MAPK (Thr180/Tyr182) in metastasis lead to an increased risk for death in ovarian carcinoma patients. Thus, for future combinatorial cancer therapy, drug combinations that best target the deregulated protein network in each individual patient should be selected.

ObjectivesThis study aims to compare the performance of a bulk-fill and a nanofill resin composite in class II restorations after 6 years.Materials and methodsFifty patients having at least two class II carious lesions were recruited for the study. One lesion in each patient was randomly assigned to be restored using either the Tetric EvoCeram Bulk Fill (TB) or Filtek Ultimate (FU) resin composites with their respective adhesives. One hundred four restorations were placed by two calibrated operators. Restorations were evaluated at baseline and annually over the course of 6 years by two examiners using modified USPHS criteria. Data were statistically analyzed using the Chi-square and Cochran Q tests (p < 0.05).ResultsSixty-six restorations in 33 patients were evaluated after 6 years. Only one restoration was lost from FU group at 5 years. At the end of 6 years, marginal discoloration was observed in three (9.1%) TB and eight (36.4%) FU restorations creating a significant difference between the groups (p < 0.05). The FU group showed a significant increase in marginal discoloration at 6 years from the baseline (p < 0.05). Marginal adaptation was rated as Bravo for 9.1% and 24.2% of TB and FU restorations, respectively (p > 0.05). Significant degradation was observed within each group in terms of marginal adaptation (p < 0.05). There were no statistically significant differences between the groups for the other criteria tested (p > 0.05).ConclusionsBulk-fill restorations performed better for marginal discoloration. The remaining clinical performance criteria of bulk-fill and nanofill resin composite restorations were similar after 6 years.Clinical relevanceBulk-fill resin might be a better alternative to incrementally placed restorative in terms of marginal discoloration under clinical conditions.

PurposeThe aim was to determine sleep quality and related factors including restless leg syndrome in the 6th year medical students and medical residents in Pamukkale University, Faculty of Medicine, Denizli, Turkey.MethodsThe data collection phase of this cross-sectional study was completed between November 1st and December 31st, 2019, with a questionnaire including 59 items. Three hundred forty-one medical students and residents participated in the study. The Pittsburgh Sleep Quality Index was used to determine the participants’ sleep quality. The International Restless Legs Syndrome Study Group Diagnostic Criteria and the Restless Leg Syndrome Rating Scale were used for the diagnosis and for determining the seriousness of restless leg syndrome, respectively.ResultsThe mean age (SD ±) was 26.6 ± 3.2. Men (50%) and medical residents (59%) constituted the majority. Most of the participants (70%) had poor sleep quality, and 9% had restless leg syndrome. Despite losing their significance in multivariable analysis, a relationship existed between restless leg syndrome and sleep quality in bivariate comparisons (p = 0.04). According to the multiple variable analysis, age (p = 0.008), female gender (p = 0.04), insufficient income (p = 0.009), being on-medication (p = 0.007), being a current smoker (p = 0.01), not sleeping at the usual time (p = 0.04), and listening to music before sleeping (p = 0.03) were identified as independent risk factors for poor sleep quality.ConclusionsThe prevalence of poor sleep quality and restless leg syndrome are high in the 6th year medical students and residents. Necessary measures should be taken to reduce the effect of negative conditions on these vulnerable groups.

Objectives The aim of this study is to evaluate the long-term clinical performance of a glass ionomer (GI) restorative system in the restoration of posterior teeth compared with a micro-filled hybrid posterior composite. Materials and methods A total of 140 (80 Cl1 and 60 Cl2) lesions in 59 patients were restored with a GI system (Equia) or a micro hybrid composite (Gradia Direct). Restorations were evaluated at baseline and yearly during 6 years according to the modified-USPHS criteria. Negative replicas at each recall were observed under SEM to evaluate surface characteristics. Data were analyzed with Cohcran’s Q and McNemar’s tests ( p  < 0.05). Results One hundred fifteen (70 Cl1 and 45 Cl2) restorations were evaluated in 47 patients with a recall rate of 79.6% at 6 years. Significant differences were found in marginal adaptation and marginal discoloration for both restorative materials for Cl1 and Cl2 restorations ( p  < 0.05). However, none of the materials were superior to the other ( p  > 0.05). A significant decrease in color match was observed in Equia restorations ( p  < 0.05). Only one Cl2 Equia restoration was missing at 3 years and another one at 4 years. No failures were observed at 5 and 6 years. Both materials exhibited clinically successful performance after 6 years. SEM evaluations were in accordance with the clinical findings. Conclusions Both materials showed a good clinical performance for the restoration of posterior teeth during the 6-year evaluation. Clinical relevance The clinical effectiveness of Equia and Gradia Direct Posterior was acceptable in Cl1 and Cl2 cavities subsequent to 6-year evaluation.

Background. Pertussis is a disease leading to high morbidity and mortality in neonates and infants. Bronchiolitis is the most common cause of hospitalization especially in children < 2 year-old. Although the clinical findings are different in these two diseases, it is sometimes difficult to make this distinction in partially or fully vaccinated children. This study aimed to identify the incidence, clinical and laboratory effects of B. pertussis as a causative agent in hospitalized children with acute bronchiolitis. Methods. The study included patients diagnosed with acute bronchiolitis and admitted to the Division of Pediatric Infectious Diseases from January 2012 to December 2015, aged 24 months or younger, evaluated for viruses and bacteria with polymerase chain reaction in respiratory tract secretions. Results. The study included 380 patients hospitalized with acute bronchiolitis. Of these patients, 85.8% were identified to be positive for at least one respiratory pathogen. The most commonly identified pathogens were respiratory syncytial virus (RSV) A/B, rhinovirus, parainfluenza virus, adenovirus, bocavirus and metapneumovirus A/B. B. pertussis was only detected in 5 patients (1.5%). In the patients with B. pertussis identified, coinfection with another virus was observed including rhinovirus (n= 2), influenza A virus (n= 1), coronavirus OC43 (n= 1) and RSV A/B (n= 1). The presence of B. pertussis did not appear to cause any significant clinical or laboratory differences in patients. Conclusions. B. pertussis is a rare pathogen in patients admitted to hospital for acute bronchiolitis. However, in patients who do not respond to standard bronchiolitis treatment, B. pertussis should be considered as a causative agent. Early identification of this pathogen is important in terms of quarantining the patient, administering appropriate antimicrobial treatment, and prophylactic treatment to household and other close contacts.

Background Antibiotic-associated diarrhea is one of the most frequent side effects of antimicrobial therapy. We assessed the epidemiological data of antibiotic-associated diarrhea in pediatric patients in our region. Methods The prospective multi-center study included pediatric patients who were initiated an oral antibiotic course in outpatient clinics and followed in a well-established surveillance system. This follow-up system constituded inclusion of patient by the primary physician, supply of family follow-up charts to the family, passing the demographics and clinical information of patient to the Primary Investigator Centre, and a close telephone follow-up of patients for a period of eight weeks by the Primary Investigator Centre. Results A result of 758 cases were recruited in the analysis which had a frequency of 10.4% antibiotic-associated diarrhea. Among the cases treated with amoxicillin-clavulanate 10.4%, and cephalosporins 14.4% presented with antibiotic-associated diarrhea. In the analysis of antibiotic-associated diarrhea occurrence according to different geographical regions of Turkey, antibiotic-associated diarrhea episodes differed significantly ( p  = 0.014), particularly higher in The Eastern Anatolia and Southeastern Anatolia. Though most commonly encountered with cephalosporin use, antibiotic-associated diarrhea is not a frequent side effect. Conclusion This study on pediatric antibiotic-associated diarrhea displayed epidemiological data and the differences geographically in our region.

Healthcare workers (HCWs) were among the first groups to be vaccinated in Turkey. The data to be obtained by the vaccination of HCWs would guide wide spread vaccination programs. The study included 330 HCWs working at Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty Hospital and vaccinated with inactive CoronaVac (Sinovac Life Sciences, China) SARS-CoV-2 vaccine in two doses (28 days apart). Anti-Spike /RBD IgG levels were measured 14 days after the first dose and 28 days after the second dose. Chemiluminescent microparticle immunoassay (CMIA) (ARCHITECT IgG II Quant test, Abbott, USA), which is 100% compatible with plaque reduction neutralization test (PRNT), was used. Of the participants, 211 (63.9%) were female, 119 (36.1%) were male, and mean age was 39.6 ± 7.7 years. In those without prior COVID-19 history; (n = 255) antibody positivity was detected as 48.2% (95% CI: 42.1–54.3) 14 days after the first dose of vaccine, and 99.2% (95% CI: 98.1–100) at day 28 after the second dose. Antibody titers were significantly lower in patients with hypertension (p = 0.011). In those with prior history of COVID-19 (n = 75); both the antibody positivity rates after the first vaccine (48.2% vs 100%, p = 0.000) and the anti-spike/RBD antibody levels after the second vaccine (with a ≥ 1050 AU/mL titer equivalent to PRNT 1/80 dilution) was significant than infection-naive group (25.9% vs. 54.7%, p = 0.000). Antibody positivity after two doses of vaccination for all study group was 99.4% (95% CI: 98.6–100). Two doses CoronaVac produce effective humoral immunity in HCWs. Antibody response is significantly higher in those with prior history of COVID-19 than infection-naive group. Given no significant benefit of the second dose, a single shot of vaccination may be sufficient for those with prior history of COVID-19. Monitoring humoral and cellular immune responses, considering new variants, is required to validate this approach.

Background and Objectives. One way to measure arterial stiffness is the ambulatory arterial stiffness index (AASI), which is the relationship between diastolic and systolic ambulatory blood pressure (BP) over 24-hours. Methods. We studied the difference in AASI between obese and lean children. AASI was calculated from 24- hour ambulatory blood pressure monitoring in 53 obese children (33 girls) and compared with age-matched 42 healthy subjects (20 girls). Hypertension was defined according to the criteria of the American Heart Association. To evaluate inflammation, the blood level of high-sensitive C-reactive protein was measured. Results. The mean age was 10.6 ± 2.83 years in obese children and 11.3 ± 3.17 years in healthy subjects. Hypertension was determined in three (5.6%) obese children. The median heart rate-SDS, pulse pressure and blood pressure values did not differ between the two groups. The mean AASI was significantly higher in obese children compared to healthy subjects (0.42 ± 0.15 vs. 0.29 ± 0.18, p < 0.001). AASI significantly correlated with nighttime SBP-SDS, nighttime SBP-load, systolic and diastolic nocturnal dipping, with no independent predictor. Conclusion. This study confirms that AASI is increased in obese children. AASI calculation is a useful, costeffective, and an easy method to evaluate arterial stiffness. Early detection of increased arterial stiffness can help clinicians come up with preventive measures in the management of patients.

Background and aimsPneumonia is the most important cause of death in children in many countries. The use of inappropriate antibiotics in the treatment of pneumonia is associated with multi drug resistant microorganisms that lead to increased morbidity and mortality. Therefore, the causative microorganism should be detected for avoidence of unnecessary antibiotic usage. Underlying diseases are predisposing factors for recurrent pneumonia. The choice of pneumonia treatment should be based on causative microorganisms and underlying diseases. In this study we aimed to evaluate the frequency of recurrent pneumonia and underlying disease in hospitalised children, to identify the distribution of causative microorganisms and to compare our data with previous studies.MethodsBetween January 2003 and December 2015 children hospitalised due to pneumonia were retrospectively owerviewed. The patients who met criteria for recurrent pneumonia were included in this study. Demographic, clinical, laboratory and imaging results were collacted from the data system.ResultsDuring 13 years, 129 (9.2%) hospitalised children met criteria of recurrent pneumonia. Underlying diseases were detected in 95 (73.6%) patients. Rhinovirus, adenovirus and respiratory synstial virus were the most frequent causative agents.ConclusionThe majority of patients who were hospitalised due to recurrent pneumonia had an underlying disease. The most common cause was aspiration syndrome and viruses were leading causative agents for recurrent pneumonia. As a result; It should kept in mind that viruses can be commonly seen in recurrent pneumonia. Appropriate treatment choice should be made according to the underlying disease, clinical condition, laboratory and radiological data of the patient.

9.5 month-old boy presented with a one-month history of cough and lymphadenopathy. The mother was diagnosed with pulmonary tuberculosis when the baby was 1,5 months old. Thus, the breastfeeding was stopped and isoniazid prophylactic therapy was recommended to baby. However, the treatment was only applied between 6–9 months old by the family. He was evaluated for pneumonia at first and nonspecific antibiotic therapies were started. After ten-day treatment, the symptoms didn’t get better. He was again evaluated and three serial samples of gastric aspirates that sent for ARB and Tbc PCRes were positive. Chest CT revealed that concerning the whole middle and lower lobes in the right lung at the widespread consolidation area, necrotic areas where the largest reached over 23 × 13 mm was monitored. He was administered a four-drug anti-tuberculous treatment of INH (11.5 mg/kg), rifampicin (15 mg/kg), pyrazinamide (25 mg/kg), etambuthol (18.75 mg/kg). At the first month of treatment all acid fast stains and PCR were negative. Even though ChestCT were the same, findings showed remarkable improvement After 2 months the child was discharged to his home with two-drug- maintence therapy. As well as early diagnosis and treatment, directly observed therapy is crucial in tuberculosis.