An organized palliative care system was lacking in Turkey before 2010. One of the pillars of Turkish Cancer Control Programme is palliative care. The Pallia-Turk project in this respect has been implemented by the Ministry since 2010. The project is unique since it is population based and organized at the primary level. This means, the whole population (>70 million) will have the quickest and easiest way for access to palliative care. This manuscript briefly summarizes the situation before the project and updates what has been done in last 2 years with the project.

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Background: Recurrent aphthous stomatitis is a common disease characterized by single or multiple, self-healing, well-circumscribed, periodic ulcers occurring in the oral cavity. Although the relationship between recurrent aphthous stomatitis and oxidative stress has been extensively reviewed in the past, its relationship with prolidase enzyme levels has not been previously investigated. Aim: The aim of this study is to investigate plasma antioxidant status and prolidase enzyme levels in patients with recurrent aphthous stomatitis. Methods: The serum total oxidant status, total antioxidant status, oxidative stress index, prolidase and paraoxonase levels of 34 recurrent aphthous stomatitis patients (mean age 35.1) and 34 healthy controls (mean age 37.7) were compared in this study. Results: Total oxidant status was significantly higher in the recurrent aphthous stomatitis group (P < 0.005). The mean total oxidant status value was 5.19 mmol/L in the recurrent aphthous stomatitis group, while it was 2.90 mmol/L in the control group. Oxidative stress index was significantly higher in the recurrent aphthous stomatitis group (P = 0.016*). The mean oxidative stress index level was 0.28 AU in the recurrent aphthous stomatitis group, while it was 0.18 AU in the control group. When control and patient groups were compared, there was no significant difference between groups with regard to the total antioxidant status (P = 0.343). The total antioxidant status levels were 1.09 and 1.14 mmol/L in control and patient groups, respectively. There was no statistically significant difference between PON1 levels of recurrent aphthous stomatitis and control groups (P = 0.218). Mean PON1 levels were 326 U/L in the recurrent aphthous stomatitis group and 381 U/L in the control group. Prolidase levels were not significantly different between recurrent aphthous stomatitis and control groups (P = 0.955). The mean prolidase level was 219.79 U/L in the recurrent aphthous stomatitis group and 219.26 U/L in the control group. Limitations: The limitation of this study is the small size of both patient and control groups and exclusion of pediatric patients., Similar studies performed in pediatric patient populations with a comparison to adults may be useful in providing meaningful results. Conclusions: We detected that the total oxidant status and oxidative stress index was higher in patients with recurrent aphthous stomatitis as compared to healthy controls. We could not demonstrate a significant difference in total antioxidant status, PON1 and prolidase values.

Palliative care is an emerging topic in Turkey within recent years. Currently, there are only few number of palliative care services across the country and majority of the centers are pain control units. Morphine consumption rate per capita is low, accessibility and availability of morphine products are also limited. One of the main headings of Turkish Cancer Control Programme 2009-2015 is palliative care and a serial palliative care unit implementation with continuous training programmes is planned to be finalized until 2015. This article reviews the current palliative care situation in Turkey, opioid availability in Turkey and also briefly summarizes Pallia-Turk Project which is unique with respect to many different aspects for implementation, and can be a good model for many other countries that still did not have such an implemented palliative care program.

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