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Abstract Objectives Acute central nervous system (CNS) infections in children can lead to neurological complications and mortality. This study aimed to identify the clinical manifestations, laboratory parameters, and cerebrospinal fluid characteristics indicative of CNS infections and define the risk factors that lead to pediatric intensive care unit (PICU) admission in the pediatric population of Şanlıurfa, a city in southeastern Turkey. Methods This retrospective analysis included patients aged 1 month to 18 years who were treated for acute CNS infections in the Şanlıurfa Training and Research Hospital between January 2020 and May 2023. Clinical data were obtained from the hospital electronic medical records. Results A total of 68 patients with acute CNS infections were included in this study. The median patient age was 3 (0.94–8.75) years. Fever was the most prevalent symptom in 92.6% of the patients. Of the total, 25% (n = 17) of the patients had an identified causative agent and 35.3% (n = 24) were admitted to the PICU. Serum C-reactive protein (CRP) levels were significantly higher in patients with bacterial meningitis than in those with viral meningitis (p = 0.007). Patients with impaired consciousness and seizure were significantly more likely to require admission to the PICU than patients without these conditions (both p

Abstract Aristotle discusses the ‘best constitutional regime’ in Books 7 and 8 of his work, Politics. The central concepts in this discussion are happiness and virtue. The combination of happiness and virtue finds its expression in virtuous friendship. The best constitutional regime assists individuals and society in reaching their highest potential, both individually and collectively. It provides the necessary institutional structure for the justice and welfare of society, which in turn fosters the development of virtuous friendships. According to Aristotle, the highest and most genuine relationship among people is ‘virtuous friendship’. Such friendships enable individuals to understand and support each other based on ethical values and to seek happiness together. This study argues that there is an identity between the nature of the best constitutional regime and virtuous friendship. This claim is based on the idea that the best constitutional regime is the perfect end (telos). In this sense, the perfect end is virtuous friendship.

Background and Objectives: Ischemic stroke (IS) in young is increasingly recognized as an important health problem in low- and middle-income countries (LMICs). Limited data is available from LMICs about the predictors of outcome and recurrence of IS in young. The study aims to assess the predictors of short-term and long-term functional outcome and the recurrence of the first-ever IS and transient ischemic attack in young. Methods: The clinical, radiological data, functional outcome, and recurrence of 569 IS patients aged 18–50 years were recorded. The etiological classification was done. The functional outcome was assessed using the modified Rankin scale (mRS), with a good outcome being mRS 0–2. Logistic regression was used to analyze the predictors of recurrence and outcome. Results: The most common risk factors were hypertension (40.3%) and diabetes mellitus (34.3%). Stroke of undetermined etiology (33.6%) was the most common etiological subtype. Among the cardioembolic subtypes, rheumatic heart disease constituted 47.4%. A good functional outcome at 1 year was seen in 76.3%. While baseline stroke severity predicted both the 3-month and 1-year functional outcome, age ≥40 years and male gender predicted poor outcome at 1 year. The risk of recurrent strokes at 1 year was 2.5%. On multiple logistic regression analysis, diabetes mellitus independently predicted recurrent vascular events at 1 year (odds ratio = 2.43, 95% confidence interval 1.07–5.50). Conclusions: We found a good functional outcome with a relatively low recurrence at 1 year among young IS patients. Baseline stroke severity, age, and male gender predicted a poor 1-year functional outcome.

In recent years, an evident rise in the frequency of candidaemia caused by non-albicans Candida species has been reported. Candida utilis is a low-virulence fungus that is commonly used in the food processing industry. Only a few studies have reported invasive infection due to C. utilis. In this paper, we present two cases of clinically manifested candidaemia and sepsis caused by C. utilis. This was a retrospective study carried out at a tertiary intensive care center in Turkey. Two C. utilis were isolated from blood culture over a 6-month period. C. utilis fungemia has mainly been reported in immunocompromised patients, neonates, and following surgical intervention. The two cases discussed here did not have a defined immunodeficiency. Both patients had common risk factors such as prolonged stay in the pediatric intensive care unit and the presence of a central venous catheter. Our aim in reporting these cases is to highlight C. utilis as a probable cause of candidemia in hospitalized pediatric patients and can be mortal.

Infections caused by resistant Gram-negative bacteria are a serious public health problem, with Klebsiella spp. being the most common cause and increasing over the years. There is a striking increase in antibiotic resistance worldwide. The aim of this study was to retrospectively evaluate the characteristics and treatment of bloodstream infections (BSIs) caused by Klebsiella spp. and to identify possible risk factors for extended-spectrum β-lactamase (ESBL) resistance in our hospital between August 2019 and March 2023. Of 250 Klebsiella isolates, 112 (44.8%) were ESBL producers and 138 (55.2%) were ESBL nonproducers. Catheter-related BSIs (CRBSIs) accounted for 49.6% of infections and were more common in the ESBL nonproducer group. Most of the Klebsiella spp. were K. pneumoniae (233/250). Most of the infections were healthcare-associated infections (85.6%). Most patients had an underlying disease, the most common underlying disease in the ESBL-producing group was neurometabolic disease (26.8%), whereas in the ESBL-non-producing group it was malignancy (35.5%). The median age of the ESBL-producing group was 14 months and was younger (p=0.01). Previous antibiotic use in the last 30 days, especially aminoglycosides (p

Rationale Rapid and timely treatment with intravenous thrombolysis and endovascular treatment (EVT) in patients with acute ischaemic stroke (AIS) and large vessel occlusion (LVO) significantly improves patient outcomes. Bridging therapy is the current standard of care in these patients. However, an incompletely answered question is whether one thrombolytic agent is better than another during bridging therapy.Aim The current study aims to understand if one thrombolytic agent is superior to the other during bridging therapy in the treatment of AIS and LVO.Sample size estimates Using 80% power and an alpha error of 5 %, presuming a 10% drop out rate, a total of 372 patients will be recruited for the study.Methods and design This study is a prospective, randomised, multicentre, open-label trial with blinded outcome analysis design.Study outcomes The primary outcomes include proportion of patients who will be independent at 3 months (modified Rankin score (mRS) ≤2 as good outcome) and proportion of patients who achieve recanalisation modified thrombolysis in cerebral infarction grade 2b/3 at first angiography run at the end of EVT. Secondary outcomes include proportion of patients with early neurological improvement, rate of symptomatic intracerebral haemorrhage (ICH), rate of any ICH, rate of any systemic major or minor bleeding and duration of hospital stay. Safety outcomes include any intracranial bleeding or symptomatic ICH.Discussion This trial is envisioned to confirm the theoretical advantages and increase the strength and quality of evidence for use of tenecteplase (TNK) in practice. Also, it will help to generate data on the efficacy and safety of biosimilar TNK.Trial registration number CTRI/2022/01/039473.

Çevre kirliliği ve ekonomik büyüme arasındaki ilişkinin yanı sıra literatürde ekolojik ayak izi ile ekonomik büyüme arasındaki ilişki de son zamanlarda yoğun ilgi gören bir konu haline gelmiştir. Bu çalışmanın amacı Türkiye’de 1961-2018 yılları arasında ekonomik büyüme ile ekolojik ayak izi arasındaki ilişkiyi, Granger nedensellik analizi kullanarak incelemektir. Bu analiz için, ekonomik büyüme ve ekolojik ayak izinin orijinal verilerinin yanı sıra, Azami Çakışan Kesikli Dalgacık Dönüşümü (MODWT) yöntemi ile frekanslara ayrıştırılan verilerin kısa, orta ve uzun dönem bileşenleri yeniden yapılandırılmıştır. Analiz sonuçları, orijinal verilere dayanarak iki serinin arasında nedensellik olmadığını göstermektedir. Ancak, kısa dönem Granger nedensellik sonuçları, orijinal serilerden elde edilen sonuçlarla çelişmekte ve karşılıklı nedensellik ilişkisi olduğunu göstermektedir. Nedensellik ilişkisi; orta dönemde kaybolurken, uzun dönemde ekonomik büyümeden ekolojik ayak izine doğru tek yönlüdür.

Abstract Background The influx of Syrian refugees into Turkey has highlighted the importance of supporting breastfeeding practices among this vulnerable population. We aimed to evaluate the breastfeeding and infant feeding attitudes of Syrian mothers based on the observations of Syrian healthcare workers (HCWs). Methods An online form including 31 questions was prepared in Turkish, Arabic, and English languages and distributed to HCWs, working in refugee health centers via e-mail, WhatsApp, or text message with the help of Ministry of Health in Turkey between January 2020 and March 2020. The questions were about HCWs’ characteristics (occupation, region of employment, duration of employment, participation in breastfeeding counseling course) and about HCWs’ observations of Syrian mothers’ breastfeeding and infant feeding practices. Results A total of 876 HCWs were included in the study; about 37.3% were physicians. Only 40.0% of HCWs reported that babies were predominantly fed with breast milk in the first three days after birth, 45.2% of HCWs indicated that mothers typically used sugary water as a prelacteal food, and 30.5% believed that breastfeeding was discontinued before 12 months. The main barriers to breastfeeding identified by HCWs included the lack of education, mental and physical health issues in the mother, food insecurity, low income, inadequate housing, lack of family planning, sociocultural environment, and limited access to quality health services. For complementary feeding, 28.0% of HCWs stated early introduction and 7.4% remarked delayed. HCWs believed grains, fruits and vegetables, and dairy products as top three foods for starting complementary food (59.5%, 47.8%, and 30.3% respectively). Healthcare challenges of Syrian pregnant and lactating mothers were reported to be associated primarily with “food, finance, and housing difficulties”, low maternal education, and cultural and environmental issues. HCWs recommended various solutions, such as supporting breastfeeding, offering nutrition and health support, promoting family planning, improving healthcare systems through legislation, and addressing cultural barriers. Conclusions To address breastfeeding issues among Syrian mothers, it is crucial to provide breastfeeding training to both HCWs and mothers. Expanding interventions that support breastfeeding-friendly practices, including community support and food aid for breastfeeding mothers, should also be considered to address the social determinants of breastfeeding.

Abstract 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.

Introduction: There are very limited data on the role of biomarkers correlating with the outcome in acute ischemic stroke (AIS). We evaluated the predictive values of the plasma concentrations of soluble serum stimulation-2 (sST2), matrix metalloproteinase-9 (MMP-9), and claudin-5 in AIS. Methods: The biomarker levels in the plasma samples of consecutive AIS patients collected at baseline, 12 h, and 24 h from stroke onset were quantified using immunoassays. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) and functional outcome at 90 days using the modified Rankin Scale (mRS), with scores above 3 defined as poor outcome. Receiver operating characteristic curve analysis and multiple logistic regression were performed for evaluating the discriminative power of each marker. Results: We included 108 patients in the study (mean age 62.3 ± 11.7 years). Median NIHSS score was 12 (interquartile range 8–18). High baseline glucose levels, systolic blood pressure, baseline NIHSS, low Alberta Stroke Program Early CT Score, and hemorrhagic transformation were associated with poor outcomes. Elevated sST2 at 12 h (50.4 ± 51.0 ng/mL; p = 0.047) and 24 h (81.8 ± 101.3 ng/mL; p = 0.001) positively correlated with poor outcomes. MMP-9 (p = 0.086) and claudin-5 (p = 0.2) were not significantly associated with the outcome, although increased expressions of both markers were observed at 12 h. Multiple logistic regression showed that sST2 levels ≥71.8 ng/mL at 24 h, with a specificity of 96.9%, emerged as an independent predictor of poor functional outcome (OR: 6.44; 95% CI: 1.40–46.3; p = 0.029). Conclusion: Evaluation of sST2 may act as a reliable biomarker of functional outcome in AIS.

Objective: To investigate the clinical and epidemiological features and outcome of Chryseobacterium and Elizabethkingia spp. infections in children, together with antimicrobial susceptibilities. Methods: This retrospective study was conducted at a tertiary pediatric hospital in Turkey. All patients infected with Chryseobacterium/Elizabethkingia spp. among those presenting to Ankara City Hospital between March 2014 and March 2022 were included. Results: A total of 49 cases were included and 29 cases were identified as Elizabethkingia. The median age was 14 (0.2-185.0) months. The majority (89.8%) of these patients had an underlying disease, including malignancy (42.9%). Bacteremia (46.9%) and central line-associated bloodstream infection (28.6%) were the most common infections. The thirty-day all-cause mortality rate was 12.2%. The most commonly used antibiotics were ciprofloxacin and trimethoprim-sulfamethoxazole (TMP-SMX). Forty-five (91.8%) isolates were susceptible to ciprofloxacin, 44 (91.6%) to TMP-SMX, and 21 (87.5%) to levofloxacin. Conclusions: Chryseobacterium and Elizabethkingia spp. are emergent, nosocomial pathogens and the majority of cases were older than the neonatal period. They were mainly seen in patients with long hospital stays, indwelling devices, and those who have received antibiotics within the last month, especially carbapenems. In addition, they were associated with bloodstream infection and malignancy. The most commonly useful antibiotics according to the resistance patterns were ciprofloxacin and TMP-SMX.

Nationale Forschung genießt aktuell viel zu wenig Beachtung, obwohl Österreich sich im europäischen Umfeld als forschungsintensiver Standort mit exzellenten Forschenden positionieren möchte. Das Projekt RIS Synergy befasst sich mit Möglichkeiten, nationale Forschung und Forschungskompetenz mit effizienten und international anerkannten Maßnahmen einer breiten Öffentlichkeit zugänglich zu machen und Forschende untereinander zu vernetzen. Dabei stehen internationale Erfahrungen erfolgreicher Umsetzungen und Anforderungen verschiedenster Zielgruppen im Vordergrund.

Das Projekt RIS Synergy (2020–2024) verfolgt institutionsübergreifend wesentliche Aspekte digitaler Transformation: Im Teilprojekt Schnittstellen und Standards werden standardisierte Austauschmöglichkeiten für Systeme von Förderorganisationen, Forschungsstätten und der öffentlichen Verwaltung geschaffen. Das Teilprojekt Konzeptstudie Forschungsportal befasst sich mit Rahmenbedingungen und Anforderungen eines nationalen Forschungsportals. RIS Synergy schafft Entlastung und Sichtbarkeit für den Wissenschaftsbetrieb durch die Umsetzung von Standards, die Digitalisierung von Services sowie die Vernetzung von Expertise. Der vorliegende Artikel gibt Einblick in Herangehensweise und Best Practices aus dem Projekt.

Dihalna pot pri otrocih se pomembno razlikuje od dihalne poti pri odraslih. Obstajajo anatomske in fiziološke posebnosti, na katere moramo biti posebej pozorni. Na prvem mestu sta dobra anamneza in klinični pregled, s katerima lahko predvidimo možno težko predihavanje z masko ali težave pri intubiranju. Obstajajo številni dejavniki, s pomočjo katerih lahko napovemo možnost težke intubacije, žal pa niso vsi vedno zanesljivi. Za vzpostavitev dihalne poti uporabljamo različne pripomočke, med katerimi ima vsak svoje mesto, svoje pozitivne in svoje negativne lastnosti. Endotrahelni tubus pa je edini pripomoček, ki varuje pred aspiriranjem. Ob težki intubaciji so nam v pomoč algoritmi za hitro in učinkovito reševanje težav. Pri otrocih lahko zaradi večje odzivnosti zgornjih dihal pride do laringospazma, kar je urgentno stanje in lahko hitro vodi v dihalni in celo srčni zastoj.

Summary: Background: There is a high burden of stroke, including recurrent stroke, in India. We aimed to assess the effect of a structured semi-interactive stroke prevention package in patients with subacute stroke to reduce recurrent strokes, myocardial infarction, and death. Methods: This was a multicentre, randomised, clinical trial conducted in 31 centres of the Indian Stroke Clinical Trial Network (INSTRuCT). Adult patients with first stroke and access to a mobile cellular device were randomly allocated (1:1) to intervention and control groups by the research coordinators at each centre using a central, in-house, web-based randomisation system. The participants and research coordinators at each centre were not masked to group assignment. The intervention group received regular short SMS messages and videos that promoted risk factor control and medication adherence and an educational workbook, in one of 12 languages, and the control group received standard care. The primary outcome was a composite of recurrent stroke, high-risk transient ischaemic attack, acute coronary syndrome, and death at 1 year. The outcome and safety analyses were done in the intention-to-treat population. The trial is registered with ClinicalTrials.gov, NCT03228979 and Clinical Trials Registry-India (CTRI/2017/09/009600) and was stopped for futility after interim analysis. Findings: Between April 28, 2018, and Nov 30, 2021, 5640 patients were assessed for eligibility. 4298 patients were randomised to the intervention group (n=2148) or control group (n=2150). 620 patients were not followed up at 6 months and a further 595 patients were not followed up at 1 year because the trial was stopped for futility after interim analysis. 45 patients were lost to follow-up before 1 year. Acknowledgment of receipt of the SMS messages and videos by the intervention group patients was low (17%). The primary outcome occurred in 119 (5·5%) of 2148 patients in the intervention group and 106 (4·9%) of 2150 patients in the control group (adjusted odds ratio 1·12; 95% CI 0·85–1·47; p=0·370). Among the secondary outcome measures, alcohol cessation and smoking cessation were higher in the intervention group than in the control group (alcohol cessation 231 [85%] of 272 in the intervention group vs 255 [78%] of 326 in the control group; p=0·036; smoking cessation 202 [83%] vs 206 [75%]; p=0·035). Medication compliance was better in the intervention group than in the control group (1406 [93·6%] of 1502 vs 1379 [89·8%] of 1536; p

Abstract Background We evaluated (a) opinion of Syrian and Turkish healthcare workers (HCWs), and perceptions and attitudes of Syrian refugee mothers, pregnant women, fathers and grandmothers on age-appropriate breastfeeding, (b) the effect of cultural characteristics, migration and pandemics on Syrian’s infant nutrition, and (c) the suggestions of HCWs and Syrian family members to improve breastfeeding practices in the Syrian refugee society in a qualitative study. Methods The qualitative study consisting of structured focus group discussions (FGDs) was held in four provinces in Turkey where Syrian refugees live intensely in September and October 2020. Seven different types of online FGDs were held with Turkish HCWs working in maternity hospitals, Syrian HCWs working in Refugee Health Centers (RHCs), Syrian pregnant women, mothers, fathers, and grandmothers. In total, we carried out 46 FGDs with 335 individuals. Thematic analysis of the transcripts in a deductive-inductive fashion was carried out with MAXQDA 11. Results Most Syrian HCWs did not get any training on breastfeeding counseling. The short duration of breastfeeding in Syrian refugees was seen to be related to the cultural characteristics, and migration. Some cultural characteristics can be summarized as “believing that breastfeeding harms mother’s health”, “adolescent marriages”, “wanting to have as many children as possible”, “giving anise to infants and not breastfeeding at night”, “prelacteal feeding”, “believing that milk is not enough”, “over controlling mother–child interaction by grandmothers, which limits the interaction”, “short pregnancy intervals”, and “not using modern family planning techniques”. We found out that migration increased the tendency for adolescent pregnancies, deepened the poverty, and decreased family social support. We did not observe any change in breastfeeding practices during pandemics. Conclusions Breastfeeding counseling programs should be designed in consideration of cultural characteristics of Syrian HCWs and family members. Continuing health education programs for family members with socially appropriate interventions to prevent adolescent marriages are important.

Background: Timely and effective recanalization to salvage the penumbra is the main determinant of outcome in acute ischemic strokes. Randomized controlled trials on late window mechanical thrombectomy (MT) have proved its safety and efficacy upto 24 h after stroke onset. We looked at the impact of time to reperfusion on vessel recanalization rates and short-term outcome in patients undergoing MT for large vessel occlusion. Methods: The clinical, imaging, and outcome of all patients undergoing MT upto 24 h from last seen normal was extracted from a prospectively maintained ischemic stroke database from January 2012 till September 2019. Results: There were 145 patients with a mean (SD) age of 58.2 (±14) years. Of them, 28 had wake up/unknown time of onset stroke and 9 presented beyond >360 min. There were 23 vertebrobasilar strokes. Median National Institute of Health Stroke scale score (NIHSS) at admission was 16.4 (Inter quartile range (IQR) 12–21). CT-Alberta Stroke program early CT score (CT-ASPECTS) was excellent (8–10) in 39 (31.6%) and fair (5–7) in 77 (63.6%) patients in anterior circulation strokes. About 25% underwent bridging therapy. Recanalization rates did not differ between those presenting early (

Background: Understanding SARS-CoV-2 seroprevalence among health care personnel is important to explore risk factors for transmission, develop elimination strategies and form a view on the necessity and frequency of surveillance in the future. Methods: We enrolled 4927 health care personnel working in pediatric units at 32 hospitals from 7 different regions of Turkey in a study to determine SARS Co-V-2 seroprevalence after the first peak of the COVID-19 pandemic. A point of care serologic lateral flow rapid test kit for immunoglobulin (Ig)M/IgG was used. Seroprevalence and its association with demographic characteristics and possible risk factors were analyzed. Results: SARS-CoV-2 seropositivity prevalence in health care personnel tested was 6.1%. Seropositivity was more common among those who did not universally wear protective masks (10.6% vs 6.1%). Having a COVID-19-positive co-worker increased the likelihood of infection. The least and the most experienced personnel were more likely to be infected. Most of the seropositive health care personnel (68.0%) did not suspect that they had previously had COVID-19. Conclusions: Health surveillance for health care personnel involving routine point-of-care nucleic acid testing and monitoring personal protective equipment adherence are suggested as important strategies to protect health care personnel from COVID-19 and reduce nosocomial SARS-CoV-2 transmission.

Introduction: Carotid Endarterectomy (CEA) is the standard treatment for patients with symptomatic carotid stenosis. Data from Low- and Middle-Income Countries (LMIC) is sparse on CEA and its outcomes. We aimed to describe the profile of our patients, and factors associated with periprocedural cerebral ischemic events in patients with symptomatic carotid stenosis who underwent CEA in our institute. Methods: Retrospective review of patients with symptomatic carotid stenosis(50-99%) who underwent CEA between January 2011 and December 2021 was done. Clinical and imaging parameters and their influence on periprocedural cerebral ischemic events were analysed. Results: Of the 319 patients (77% males) with a mean age of 64 years (SD ±8.6), 207 (65%) presented only after a stroke. Majority (85%) had high grade stenosis (70%) of the symptomatic carotid. The mean time to CEA was 50 days (SD ±36), however only 26 patients (8.2%) underwent surgery within 2 weeks. Minor strokes and TIA occurred in 2.2%, while major strokes and death occurred in 4.1% patients. None of the clinical or imaging parameters predicted the periprocedural cerebral ischemic events. The presence of co-existing significant (50%) tandem intracranial atherosclerosis (n=77, 24%) or contralateral occlusion (n=24, 7.5%) did not influence the periprocedural stroke risk. Conclusion: There is a delay in patients undergoing CEA for symptomatic carotid stenosis. Majority have high grade stenosis and present late only after a stroke reflecting a lack of awareness. CEA can be performed safely even in patients with significant intracranial tandem stenosis and contralateral carotid occlusion.

Background: The impact of gender on acute ischemic stroke, in terms of presentation, severity, etiology, and outcome, is increasingly getting recognized. Here, we analyzed the gender-related differences in etiology and outcome of ischemic stroke in South India. Methods: Patients with first ever ischemic stroke within 1 week of onset presenting to the Comprehensive Stroke Care Centre, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India, were included in our study. Clinical and risk factor profile was documented. The stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) at onset, and stroke subtype classification was done using Trial of Org 10172 in Acute Ischemic Stroke criteria. The 3-month functional outcome was assessed using the modified Rankin Scale (mRS) with excellent outcome defined as an mRS ≤2. Results: Of the 742 patients, 250 (33.7%) were females. The age, clinical profile, and rate of reperfusion therapies did not differ between the genders. Women suffered more severe strokes (mean NIHSS 9.5 vs. 8.4, p = 0.03). While large artery atherosclerosis was more common in men (21.3% vs. 14.8%, p = 0.03), cardioembolic strokes secondary to rheumatic heart disease were more common in women (27.2% vs. 19.7%, p = 0.02). Men had a better 3-month functional outcome compared to women (68.6% vs. 61.2%, p = 0.04), but was not statistically significant after adjusting for confounders. Conclusion: Our data, from a single comprehensive stroke unit from South India, suggest that stroke in women are different, yet similar in many ways to men. Guideline-based treatment can result in comparable short-term outcomes, irrespective of admission stroke severity.

Abstract Background Screen media exposure has been increasing in the preschool years. Risky aspects of screen exposure have many potential negative effects on children’s health. We aimed to evaluate problematic screen exposure in Turkish preschool children by using a unique tool called the “Seven-in-Seven Screen Exposure Questionnaire” and to investigate factors associated with problematic screen exposure. Methods A questionnaire form was designed including general descriptive questions in the first part. In the second part, a questionnaire we designed called the “Seven-in-Seven Screen Exposure Questionnaire” was conducted to evaluate problematic screen exposure characteristics. The questionnaire included seven items: daily screen time, viewing with parent(s), setting screen limits, screen exposure during meals and in the hour before bedtime, age of onset of screen exposure, and viewing low-quality content. The total problematic screen exposure score (range 0–13) was generated by summing scores from the seven items. Total scores are classified into two categories: low (

Introduction Health care workers (HCWs) are disproportionately exposed to infectious diseases and play a role in nosocomial transmission, making them a key demographic for vaccination. HCW vaccination rates are not optimal in many countries; hence, compulsory vaccination policies have been implemented in some countries. Although these policies are effective and necessary under certain conditions, resolving HCWs’ hesitancies and misconceptions about vaccines is crucial. HCWs have the advantage of direct contact with patients; hence, they can respond to safety concerns, explain the benefits of vaccination, and counter antivaccine campaigns that escalate during pandemics, as has been observed with COVID-19. Method A short survey was carried out in May–June 2020 on the vaccination status of HCWs working with pediatric patients with COVID-19. The survey inquired about their vaccination status (mumps/measles/rubella [MMR], varicella, influenza, and diphtheria/tetanus [dT]) and willingness to receive hypothetical future COVID-19 vaccines. The respondents were grouped according to gender, age, occupation, and region. Results In total, 4927 HCWs responded to the survey. Most were young, healthy adults. The overall vaccination rates were 57.8% for dT in the past 10 years, 44.5% for MMR, 33.2% for varicella, and 13.5% for influenza. Vaccination rates were the highest among physicians. The majority of HCWs (81%) stated that they would be willing to receive COVID-19 vaccines. Conclusion Although vaccination rates for well-established vaccines were low, a majority of HCWs were willing to receive COVID-19 vaccines when available. Education and administrative trust should be enhanced to increase vaccination rates among HCWs.

Background: High-resolution vessel wall imaging (HRVWI) can aid in differentiating the various intracranial vasculopathies, but has been sparingly used in the diagnosis of primary angiitis of central nervous system (PACNS). This study is aimed to describe the vessel wall imaging characteristics of PACNS. Materials and Methods: Patients with confirmed diagnosis of PACNS according to the Calabrese and Mallek criteria who had abnormal HRVWI were included in this retrospective descriptive study. Magnetic resonance image of brain, conventional four-vessel cerebral digital subtraction angiogram, and HRVWI were read by a neuroradiologist. The vessel wall parameters assessed were T1W and T2W appearances, pattern of wall thickening and contrast enhancement, and remodeling index. Results: HRVWI done in 21 patients with PACNS yielded abnormality in 20 (95.2%) who were included in the analysis. The mean age at presentation was 42.55 ± 9.48 years and 14 (70%) were males. The median number of vessels involved were four (range 2–12). The commonest vessels affected were proximal middle cerebral artery (70%) and internal carotid artery (55%). Vessel wall thickening was concentric, eccentric, and absent in 12 (60%), 1 (5%), and 7 (35%) patients, respectively. Vessel wall enhancement was diffuse in 17 (85%), eccentric in 1 (5%), and absent in 2 (10%) patients. One patient had T2W hyperintense stenotic lesion. Remodeling index was negative in 11 (55%) patients. Conclusion: Distinctive vessel wall appearances were observed by HRVWI in PACNS, concentric vessel wall thickening and enhancement being more frequent. Hence, HRVWI can be considered as an additional noninvasive imaging modality in the diagnosis of PACNS.

Background: Obstructive sleep apnea (OSA) is reported in a high proportion of cardiac surgical patients, up to 73%. STOP-BANG is a validated questionnaire for screening of outpatients for OSA with high sensitivity. There is sparse literature from India regarding the prevalence of OSA in preoperative cardiovascular patients and the utility of screening tools. Aims: We sought to study the utility of the STOP-BANG questionnaire as a screening tool for OSA in cardiovascular patients validating it with ambulatory level 3 polysomnography. Materials and Methods: It was a prospective study where consecutive patients getting admitted for coronary artery bypass surgery (CABG) from August 2017–February 2019 were recruited. All the patients were screened with the STOP-BANG questionnaire. 53 patients underwent overnight level 3 polysomnography using Apnea-Link. Correlations were made between clinical symptoms, STOP-BANG score, and OSA severity, measured using Apnea hypopnea index (AHI). Results: We had 120 patients(103 males) with a mean age 60 years. Snoring was the most common sleep complaint. Our cohort had a high prevalence of vascular risk factors (DM 72.3%, hypertension 59.2%, dyslipidemia 60%) and 11.7% were obese (BMI >30). The median STOP-BANG score was 3 (IQR 2) with 83 having scores ≥3. Median AHI was 5.6 with AHI ≥5 in 28 patients and AHI 15 or above in 14 patients. Among the clinical parameters, arousals with respiratory difficulty at night, higher neck circumference, and tonsillar hypertrophy showed a significant association with PSG-proven OSA.STOP-BANG scores 3 or above had a sensitivity of 75% in predicting OSA. Conclusions: Our study shows that in cardiovascular patients less symptomatic for sleep complaints, the STOP-BANG questionnaire is a useful screening tool for OSA in outpatient settings. Among clinical parameters, airway narrowing and neck circumference can predict OSA.

Purpose: Increase in chronic diseases significantly increases the use of integrative medicines in symptom management. This study aims to determine the use of integrative medicines and the levels of hopelessness of individuals with chronic obstructive pulmonary disease (COPD). Material and Methods: This descriptive and cross-sectional study was conducted in a chest disease services with 259 COPD’s patients. Data were collected with the Questionnaire Form and Beck’s Hopelessness Scale. Results: Of the participants, the most common integrative medicine was herbal methods (66.2%). The hopelessness level of the group using integrative medicine was high, but the difference between the groups was not statistically significant. The participants received information about the use of integrative methods from TV, radio and magazine and used integrative methods in symptom management. Conclusion: The most common integrative medicine used was herbal methods. In addition, level of hopelessness did not affect integrative medicine’s usage. The results of such findings are to identify the causes of integrative medicine use and to ensure education for healthcare professionals.

Research on organizational identity (OI) and organizational identification (OID) has long considered the two concepts as inseparable. There is also a rising concern among scholars that OID and organizational commitment (OC) might be misrepresented and used interchangeably. These together raise the question: can OI, OID, and OC substitute each other, or should firms make an effort to establish all three differentially in order to capitalize on their unique effects on performance outcomes? In this study, we aim to address these unanswered inquiries with regards to how OI, OID, and OC are interrelated yet distinct constructs that in turn play unique roles in increased performance outcomes. We argue that, OI, OID and OC are distinct constructs that have differential effects on performance outcomes. By first looking at the effect of OI and OID on OC, we aimed to understand the differential relationship of OI and OID with OC. Also, we aimed to examine the concurrent effects of all three constructs namely OI, OID, and OC on individual performance. Drawing on the social identity and social categorization theories, we develop and empirically test a conceptual model where we examine the effects of OI and OID on OC and the effect of OC on individual performance. Through examining the data collected by 345 employees in the education sector, we show that OI and OID have positive significant effects on OC. Further, the results of our hierarchical multiple regression analyses reveal that OI, OID, and OC have positive and significant effects on individual performance.

Although rare, serious adverse effects may be seen after vaccination. Especially, the whole-cell pertussis vaccine has been held responsible for neurological side effects, as the most important problem in vaccination. With the advancement in vaccination technologies, whole-cell pertussis vaccine has been replaced by acellular pertussis vaccine, and neurological side effects have been significantly reduced. Herein, we present a 2-month-old male infant who suffered from generalized tonic-clonic seizures many times, possibly due to acellular pertussis after pentavalent vaccination, including diphtheria, acellular pertussis, tetanus, inactive polio, Haemophilus influenzae type B, and conjugate pneumococcal vaccine (BCG, DaBT-IPA-Hib, CPV).

Günümüzde özellikle yoğun çalışma temposu, kişisel sorunlar, çalışanlardan artan beklentiler, iş-yaşam dengesizlikleri ve görece düşük ücretli çalışanları zorlayan hayat şartları gibi nedenlerle, çalışanlar arasında iletişim sorunları ortaya çıkabilmekte ve her çalışan kimi zaman çalışma ortamında kaba davranışlar sergileyebilmektedir. Organizasyonlar, farklı kişisel ve kültürel özelliklere sahip, farklı etnik kökenlerden gelen ve farklı yaşam koşullarına sahip olan çalışanlardan oluşan yapılardır ve bu nedenle kendine özgü duygu, düşünce, tutum ve algılamaları olan çalışanların kimi zaman kaba ve nezaketsiz davranışlar sergileyebildikleri görülmektedir. Ancak bu tarz davranışlar, çalışanların işine karşı göstermiş olduğu olumlu ya da olumsuz genel tutum olarak tanımlanan çalışan memnuniyeti üzerinde olumsuz etkilere sebep olabilmektedir. Çalışanların işine ve çevresine karşı duyduğu mutluluk duygusu ise olumsuz etkilendiğinde önemli bir verim kaybı ve etkin olmayan performans sonuçları ortaya çıkabilmektedir. Bu bağlamda, bu çalışmada algılanan işyeri nezaketsizliğinin çalışan memnuniyeti üzerindeki etkileri tespit edilmeye çalışılmıştır. Bu amaç doğrultusunda Selçuk Üniversitesi’nde görev yapmakta olan 265 araştırma görevlisi üzerinde ampirik bir araştırma yapılmıştır. Araştırmada, nicel veri toplama tekniklerinden birisi olan anket tekniğinden yararlanılmıştır. Örneklem üzerinden elde edilen veriler, SPSS Statistical Package for Social Sciences paket programı ile analiz edilmiştir. Korelasyon analizi sonuçlarına göre, algılanan işyeri nezaketsizliği ile çalışan memnuniyeti arasında orta düzeyde negatif ve istatistiksel olarak anlamlı bir ilişki olduğu bulunmuştur. Çalışan memnuniyetinin içsel tatmin ve dışsal tatmin olmak üzere iki boyutu vardır. Katılımcıların algılanan işyeri nezaketsizliği ile “içsel doyum” arasında orta düzeyde negatif ve anlamlı ilişki olduğu tespit edilirken, “dışsal doyum” ile de orta düzeyde negatif ve anlamlı bir ilişki görülmüştür. Yapılan regresyon analizi sonucunda ise; araştırma görevlilerinin algıladığı işyeri nezaketsizliğinin memnuniyetleri üzerindeki etkisinin negatif ve anlamlı olduğu tespit edilmiştir. Ayrıca algılanan işyeri nezaketsizliği değişkeninin dışlayıcı davranış boyutunun çalışan memnuniyetini negatif yönde etkilediği tespit edilmiştir. Düşmanca tavır, mahremiyetin ihlali ve dedikoduculuk boyutlarının ise çalışan memnuniyeti değişkeni üzerinde anlamlı bir etkisinin olmadığı ortaya konulmuştur. Araştırma sonuçlarının, işletme veya kurum yöneticilerine ve bu alanda çalışan akademisyenlere önemli katkılar sağlayacağı düşünülmektedir.

Her geçen gün internetin kullanımının artması, kullanıcıların internetten 7/24 alışveriş yapabiliyor olmaları online mağazaların da artmasına yol açmıştır. Elektronik ticaretin giderek yaygınlaşması, online ortamda rekabeti de artırmaktadır. Bu durum işletmeleri kullanıcıları elde tutmak için yollar aramaya sevk etmiştir. Yani işletmeler açısından yeniden satın alma kavramı önem kazanmıştır. Online alışverişte müşterilerin yeniden satın alım yapmalarının sağlanması, işletmelerin yeni müşteri bulma çabalarından daha az maliyetlidir. Dolayısıyla kullanıcılar için önemli olan web sayfasına güven kavramı ve her zaman iletişime geçebilecekleri bir müşteri temsilcisi bulma kavramlarının yeniden satın almaya etkisi önem kazanmıştır. Bu çalışmada, web sayfasına güven ve canlı desteğin yeniden satın alma niyeti üzerindeki etkisinin ne ölçüde olduğu ve aralarında nasıl bir ilişki olduğu temel olarak 6 hipotez sınaması aracılığıyla incelenmektedir. Araştırma internetten alışveriş yapan 346 kişi üzerinde anket aracılığıyla gerçekleştirilmiştir. Araştırma sonuçları incelendiğinde canlı destek, web sayfasına güven ve yeniden satın alma niyeti arasında pozitif ilişkiler bulunmuş olup, ortaya konulan hipotezler doğrulanmıştır.

Objectives: The aim of this study is to identify the epidemiological, clinical, and laboratory features of coronavirus disease 2019 (COVID-19) in children.Methods: A retrospective study was conducted by pediatric infectious disease specialists from 32 different hospitals from all over Turkey by case record forms. Pediatric cases who were diagnosed as COVID-19 between March 16, 2020, and June 15, 2020 were included. Case characteristics including age, sex, dates of disease onset and diagnosis, family, and contact information were recorded. Clinical data, including the duration and severity of symptoms, were also collected. Laboratory parameters like biochemical tests and complete blood count, chest X-ray, and chest computed tomography (CT) were determined.Results: There were 1,156 confirmed pediatric COVID-19 cases. In total, male cases constituted 50.3% (n = 582) and females constituted 49.7% (n = 574). The median age of the confirmed cases was 10.75 years (4.5–14.6). Of the total cases, 90 were younger than 1 year of age (7.8%), 108 were 1–3 years of age (9.3%), 148 were 3–6 years of age (12.8%), 298 were 6–12 years of age (25.8%), 233 were 12–15 years of age (20.2%), and 268 cases were older than 15 years of age (23.2%). The most common symptom of the patients at the first visit was fever (50.4%) (n = 583) for a median of 2 days (IQR: 1–3 days). Fever was median at 38.4°C (38.0–38.7°C). The second most common symptom was cough (n = 543, 46.9%). The other common symptoms were sore throat (n = 143, 12.4%), myalgia (n = 141, 12.2%), dyspnea (n = 118, 10.2%), diarrhea (n = 112, 9.7%), stomachache (n = 71, 6.1%), and nasal discharge (n = 63, 5.4%). When patients were classified according to disease severity, 263 (22.7%) patients were asymptomatic, 668 (57.7%) patients had mild disease, 209 (18.1%) had moderate disease, and 16 (1.5%) cases had severe disease. One hundred and forty-nine (12.9%) cases had underlying diseases among the total cases; 56% of the patients who had severe disease had an underlying condition (p < 0.01). The need for hospitalization did not differ between patients who had an underlying condition and those who do not have (p = 0.38), but the need for intensive care was higher in patients who had an underlying condition (p < 0.01). Forty-seven (31.5%) of the cases having underlying conditions had asthma or lung disease (38 of them had asthma).Conclusions: To the best of our knowledge, this is one of the largest pediatric data about confirmed COVID-19 cases. Children from all ages appear to be susceptible to COVID-19, and there is a significant difference in symptomatology and laboratory findings by means of age distribution.

Background: Narcolepsy and idiopathic hypersomnolence (IHS) are rare disorders. In Western populations, the reported prevalence of narcolepsy is 0.02%–0.05%. In Indian subcontinent, there are few reports on narcolepsy and none on IHS so far. Here, we compared the clinical and polysomnographic profile of narcolepsy/IHS among the pediatric and adult groups. Materials and Methods: The patients presenting with excessive daytime sleepiness (EDS) attending sleep clinic from January 2010 to December 2015 were included. Patients were diagnosed with narcolepsy type 1 (NT1), narcolepsy type 2 (NT2), and IHS based on the International Classification for Sleep Disorders criteria. Patients with secondary causes of EDS were excluded from the study. Results: A total of 56 patients were included in the study (29 males and 27 females). The mean age of symptom onset was 29 years (males – 34 years and females – 24 years). Twelve (21%) patients had NT1, five (9%) patients had NT2, whereas 38 (68%) patients had IHS compared to narcolepsy, the IHS had an older mean age at presentation. The average time from symptom onset to diagnosis was 71 months. Classical tetrad of narcolepsy was rarely found in pediatric cohort, but they had more behavioral problems and weight gain. Pediatric cohort of IHS also reported behavioral problems. The mean sleep-onset latency was 3.1 min, while the mean rapid eye movement latency was 7.2 min. Conclusion: The pediatric narcolepsy patients tend to have less classical symptoms and more behavioral/eating problems as compared to adult cohort. There is significant delay in diagnosing narcolepsy, indicating the need to increase awareness among the physicians about this rare treatable disorder.

Objectives: Elevated red blood cell distribution width (RDW) is an independent prognostic factor for cardiovascular events that are major causes of mortality in patients with carbon monoxide (CO) poisoning. Due to the limited number of studies, we aimed to investigate the relationship between RDW levels and long-term mortality for these patients. Method: This retrospective study included patients with CO poisoning, who presented to the emergency department. Baseline characteristics, laboratory results and survival status were retrieved from patients' hospital records. The severity of poisoning was determined according to COHb level and/or clinical signs and symptoms. Results: The study included 571 patients (median age was 37.0 years) and less than half of these patients were male (n = 206, 36.1%). There were mild-moderate CO poisoning in 389 (68.1%) patients and severe poisoning in 182 (31.9%). At a median follow-up of 6.2 years, there were 33 deaths (5.8%). Univariate cox-regression analysis demonstrated that age, gender, presence of hypertension or diabetes mellitus, levels of hemoglobin, RDW, creatinine and alanine-aminotransferase, and white-blood-cell count were potential covariates of long-term all-cause mortality. In the multivariate analysis, the median age and RDW level remained independent predictors of mortality (age, Odds ratio [OR]: 1.070 95% confidence interval [CI]: 1.030–1.110, p = 0.001; RDW, OR: 1.221 95% CI: 1.042–1.431, p = 0.013). Patients with higher RDW levels had a significantly worse prognosis in terms of mortality than with lower RDW levels (log-rank test, p = 0.003). Conclusion: This study demonstrated that RDW level is an independent predictor of long-term mortality in patients with CO poisoning. Keywords: Carbon monoxide poisoning, Red blood cell distribution width, Long-term mortality

Giderek artan uluslararası insan hareketliliği göçü birçok açıdan inceleme nesnesi haline getirmiştir. Birçok boyutu olan göç ve göçmen politikalarının en önemli alanlarından birisi entegrasyondur. Asimilasyondan farklılıkları gözeterek uyuma birçok yorumu bulunan entegrasyonun tek bir tanımı yoktur. Ancak entegrasyona ilişkin çeşitli göstergeler oluşturulmuştur ve eğitim bunlardan biridir. Bu bağlamda çalışmanın amacı Avrupa’da uygulanan göçmen entegrasyon politikalarının eğitim alanı üzerinden incelenmesidir. Çalışma üç bölüme ayırılmıştır. Birinci bölümde entegrasyon kavramı ve alternatif yaklaşımlar ele alınmıştır. Sonraki bölümde entegrasyon türleri ve göstergeleri incelenmiştir. Son bölümde Avrupa ülkelerinin eğitimde geliştirdiği entegrasyon politikaları iki alt başlıkta çözümlenmiştir. Sonuç olarak Avrupa ülkelerinin bir kısmının çokkültürlü, diğer bir kısmının ayırımcı modeli benimsedikleri ortaya konmuştur.

Intrinsic and dandelion-like microflower nano-rod structures of boron-doped ZnO thin films were synthesized with an ecofriendly and cost-effective chemical bath deposition technique from an aqueous solution of zinc nitrate hexahdyrate [Zn(NO3)2.6H2O] as a precursor solution and boric acid as a doping solution. The boron concentrations were 0.1, 0.3, 0.5, 1.0, 3.0, 5.0, and 7.0 by volume. Scanning electron micrographs showed that doping with boron appears to hinder the vertical alignment of crystallites. Additionally, independent hexagonal nano-rod structures were observed to coalesce together to form dandelion-like structures on the film’s surface. The atomic ratio of the elements was determined via the X-ray photoemission spectrum technique. There were no substantial changes in the vibration structure of the film upon doping in terms of the Raman spectra. The optical band gap of ZnO (3.28 eV) decreased with B doping. The band gap of the ZnO:B film varied between 3.18 and 3.22 eV. The activation energy of the ZnO was calculated as 0.051 eV, whereas that of the ZnO:B film containing 1.0% B was calculated as 0.013 eV at low temperatures (273–348 K), versus 0.072 eV and 0.183 eV at high temperatures (348–523 K), respectively. Consequently, it can be interpreted that the 1% B-doped ZnO, which has the lowest activation energy at both low and high temperatures, may find some application areas such as in sensors for gases and in solar cells.

Domestic felines’ re-emerging infectious and neglected zoonotic diseases are a significant focus of global “One Health” efforts. This study aimed to rapidly diagnose 14 pathogens, including zoonoses by using PCR primers in 167 client-owned symptomatic cats, routinely accepted to the Veterinary Clinics of Tekirdag. The prevalence of pathogens investigated were as follows: Babesia canis canis (24%), Babesia microti (2.4%), Hepatozoon felis (10.8%), Cytauxzoon felis (6.6%), Bartonella henselae (40.1%), Anaplasma platys (30.5%), Anaplasma phagocytophilum (7.2%), Rickettsia felis (26.3%), Borrelia burgdorferi (21%), and hemotropic Mycoplasma sp. (11.4%). There was a significant difference between the prevalence of the pathogens (χ2 = 152.26, df = 9, p < 0.001). There was also a statistical difference between the gender of the cats in terms of the prevalence of all pathogens considered together (χ2 = 4.80, df = 1, p = 0.028), where the female cats showed a higher prevalence. This was not the case for the different age groups (χ2 = 2.92, df = 1, p = 0.088). The lowest infection was observed for B. microti (p < 0.001), while the highest infection was observed for B. henselae (p < 0.01). Leishmania donovani, Plasmodium spp., Ehrlichia chaffeensis, and Neoehrlichia mikurensis PCR test results were negative in all samples. In conclusion, house cats of Tekirdag are apparently highly susceptible to some neglected zoonoses important for “One Health”, and their prevalence in the region is most probably underestimated. Hence, applying PCR tests to assist fast clinic diagnosis in routine, may be an efficient option to protect the public as well as the cats from severe diseases.

Introduction and Objective: The neutrophil-to-lymphocyte ratio (NLR) is established as a reliable marker of systemic inflammation. Low-grade inflammation has a key role in the pathogenesis and progression of hypertension (HTN). Blood pressure (BP) load, defined as the percentage of abnormally elevated BP readings, is a good marker of HTN severity. We aimed to evaluate the relationship between HTN severity and NLR using averaged ambulatory BP readings and BP load. Methods: A total of 300 patients with untreated essential HTN were included in this cross-sectional study. Patients were divided into quartiles according to NLR values (first: 2.48). Averaged ambulatory BP values and BP load were assessed for each quartile. Results: In the interquartile evaluation there were no differences between quartiles in terms of baseline demographic, clinical and echocardiographic characteristics (p>0.05). Daytime systolic BP (SBP), 24-hour diastolic BP (DBP), daytime DBP, daytime SBP load, 24-hour DBP load and daytime DBP load were found to be significantly higher in the upper two quartiles (p 2,48). Os valores médios da PA em ambulatório e a carga da PA foram avaliados para cada quartil. Resultados: Na avaliação interquartis, não houve diferença entre quartis nas características demográficas, clínicas e ecocardiográficas basais (p > 0,05). A PA sistólica diurna (PAS), a PA diastólica (PAD) a 24 horas, a PAD diurna, a carga da PAS diurna, a PAD a 24 horas e a PAD diurna foram significativamente mais elevadas nos dois quartis superiores (p < 0,05 para todos). Na análise de correlação, os valores do logaritmo de RNL foram positivamente correlacionados com a PAS a 24 horas, com a PAD, com a PAS carga e com a PAD carga (coeficientes de Pearson de 0,194, 0,197, 0,157 e 0,181, respetivamente; p

Introduction: Several studies have shown that high admission glucose is associated with poor outcomes after stroke, but the impact of maintenance of normoglycemia on functional outcome during hospitalization for acute ischemic stroke is less well established. Aims: The aim of this study was to examine the independent association of postadmission glycemic status in the 1st week with 3-month functional outcome in patients with acute ischemic stroke. Methods: Patients with acute ischemic stroke admitted within 48 h of symptom onset with National Institutes of Health Stroke Scale (NIHSS) of ≥4 were selected from a prospectively maintained database by chart review. Demographic data, risk factors, NIHSS, and blood glucose values in the 1st week were collected. The primary outcome was Modified Rankin Scale (mRS) score at 3 months (good outcome-mRS ≤2). Results: Over 3 years, 342 patients were enrolled with 220 (64.32%) males. Mean age was 60.5 ± 13.4 years, and median admission score on NIHSS was 10 (interquartile range: 6–16). Blood glucose values persistently

Objective: Effects of various conditions on coronary artery dimensions is an important research topic, and data regarding effect of aortic valvular diseases are limited. Aim of the present study was to investigate effects of aortic regurgitation (AR) and aortic stenosis (AS) on coronary artery dimensions. Methods: Coronary dimensions of 95 patients (35 with isolated AR, 30 with isolated AS, and 30 without any valvular disease) were calculated. Patients with severe coronary artery disease and concurrent moderate to severe additional valvular disease were excluded. Mean diameter of major coronary arteries was determined using quantitative coronary angiography. Results: The 3 study groups were similar in terms of baseline characteristics. Diameter of left main coronary artery was found to be greater in AR group than AS group (2.66+-0.57 mm/m2 vs 2.36+-0.49 mm/m2; p=0.015). Mean diameter of left anterior descending and left circumflex arteries were found to be similar in AR and AS groups, and greater than control group. Mean diameter of right coronary artery was found to be greater in AR group compared with controls; however, no significant difference was found in same measurement between AS group and controls. Conclusion: Present study findings indicate that coronary dimensions in AR group tend to be greater than AS group. Further studies investigating factors that affect coronary dimensions would be beneficial in order to demonstrate mechanisms and differences in AR and AS groups.

Introduction: Calcific aortic valve disease, a chronic progressive disorder, is the leading cause of valve replacement among elderly patients. The lymphocyte/monocyte ratio has been recently put forward as an inflammatory marker of relevance in several cancers as well as in cardiovascular disease. This study aims to assess the correlation between severity of calcific aortic stenosis and the lymphocyte/monocyte ratio. Methods: The study retrospectively included 178 patients with a diagnosis of calcific aortic stenosis and 139 age- and gender-matched controls. The patients were divided into two groups according to the severity of aortic stenosis: mild-to-moderate and severe. Results: An inverse correlation was discerned between the severity of the aortic stenosis process (mean gradient) and the lymphocyte/monocyte ratio (r=-0.232, p=0.002). The lymphocyte/monocyte ratio was observed to decrease as the severity of aortic stenosis increased (p

We present a joint theoretical and experimental study of the oxygen K-edge spectra for LaFeO_{3} and homovalent Ni-substituted LaFeO_{3} (LaFe_{0.75}Ni_{0.25}O_{3}), using first-principles simulations based on density-functional theory with extended Hubbard functionals and x-ray absorption near edge structure (XANES) measurements. Ground-state and excited-state XANES calculations employ Hubbard onsite U and intersite V parameters determined from first principles and the Lanczos recursive method to obtain absorption cross sections, which allows for a reliable description of XANES spectra in transition-metal compounds in a very broad energy range, with an accuracy comparable to that of hybrid functionals but at a substantially lower cost. We show that standard gradient-corrected exchange-correlation functionals fail in capturing accurately the electronic properties of both materials. In particular, for LaFe_{0.75}Ni_{0.25}O_{3} they do not reproduce its semiconducting behavior and provide a poor description of the pre-edge features at the O K edge. The inclusion of Hubbard interactions leads to a drastic improvement, accounting for the semiconducting ground state of LaFe_{0.75}Ni_{0.25}O_{3} and for good agreement between calculated and measured XANES spectra. We show that the partial substitution of Ni for Fe affects the conduction-band bottom by generating a strongly hybridized O(2p)-Ni(3d) minority-spin empty electronic state. The present work, based on a consistent correction of self-interaction errors, outlines the crucial role of extended Hubbard functionals to describe the electronic structure of complex transition-metal oxides such as LaFeO_{3} and LaFe_{0.75}Ni_{0.25}O_{3} and paves the way to future studies on similar systems.

Background: With the emergence of lifestyle diseases in epidemic proportions, obstructive sleep apnea (OSA) is being increasingly recognized in less developed countries as well. Aim: We sought to study the demographic, clinical, and polysomnographic (PSG) predictors of OSA severity in a cohort of South Indian patients. Materials and Methods: Consecutive patients with PSG proven OSA [apnea hypopnea index (AHI) ≥5/h] were prospectively recruited. The study period was from January 2012 to December 2012. Demographic data, history of vascular risk factors, substance abuse, sleep quality, snoring, and witnessed apneas were collected using a structured pro forma. In addition, PSG variables such as AHI, sleep latency and efficiency, duration of slow wave and rapid eye movement (REM) sleep, and other parameters were collected. Correlations between AHI severity and clinical and PSG parameters were done. Results: There were 152 (119 males and 33 females) subjects with a mean age of 53.8 years and body mass index (BMI) of 29.31. Mean AHI was 36.2/h (range: 5.1-110) and 66 subjects had severe OSA. Around 12% had the presenting complaint as insomnia, mainly of sleep maintenance. Of the subjects, 35% had witnessed apneas and 67% had excessive daytime sleepiness (EDS); 40% of patients had ≥2 risk factors. PSG parameters showed short sleep onset latency with a high arousal index. Mean apnea duration was 24.92 s. We found that age >55 years, BMI >25 kg/m2, witnessed apneas, EDS, hypertension, dyslipidemia, reduced slow wave sleep duration, mean apnea duration >20 s, and desaturation index >10/h correlated well with OSA severity while the arousal index, sleep latency and efficiency, and exposure to smoking and alcohol showed no association. Conclusions: Older subjects with witnessed apneas are likely to have more severe OSA. Even though overall sleep architecture was similar between the groups, severe OSA had shorter slow wave sleep, longer apneas, and higher nocturnal hypoxemia.

In today’s competitive world, companies are fighting not only in the customer market but also in the employee market. Companies are striving to attract and retain talented employees. Recruitment advertisements play an important role in attracting talented employees during the recruitment process. Effectively prepared recruitment ads can inform potential employees about job posts and convince them to apply for the job. This study investigates the effects of ad informativeness, ad truthfulness, appropriateness and attitude toward the ad on the intentions to apply for advertised job. A field study on university students revealed that ad informativeness, appropriateness and attitude toward the ad positively influence the intentions to apply for the advertised job, while ad truthfulness does not exert a significant effect on the intentions After discussing the findings in detail, theoretical and managerial implications are provided.

Objectives: Coronary artery fistula is an infrequent malformation, and the prevalence was reported as approximately 0.1-0.4% in previous studies. However, the number of studies about microfistulas from coronary arteries to the left ventricle is inadequate, especially in the Turkish population. The purpose of this study was to evaluate the prevalence and clinical features of microfistulas in subjects undergoing coronary angiography for the assessment of coronary artery disease. Study design: In this retrospective study, we researched the cardiac catheterization laboratory database between January 2008 and July 2013. The presence of microfistulas was established according to the following criteria: 1) direct filling of the heart cavity during selective coronary injection without interposing 'capillary' phase or venous filling, and 2) visualization of small vessels interposed between the epicardial coronary vessels and the heart cavity and emptying into the heart. Results: Microfistulas were found in 12 (0.11%) of the 11403 coronary angiographies. There were 7 (58.3%) female patients (mean age, 70.2+-10.8 years), and contemporary severe coronary artery stenosis was noted in 2 (16.7%) patients. Chest pain was the most frequently encountered complaint, followed by dyspnea. Microfistulas originated from the left anterior descending artery (100%), circumflex artery (66.7%), and right coronary artery (58.3%). In addition, multiple microfistulas were seen in 6 (50%) patients, bilateral microfistulas in 3 (25%) patients and unilateral microfistula in 3 (25%) patients, and all of them terminated in the left ventricle. Conclusion: Our study found an overall incidence of microfistulas of 0.11%. Microfistula is a rare cardiac anomaly that sometimes causes cardiac symptoms; otherwise, it is detected during routine coronary angiography.

Primary angiitis of the central nervous system (PACNS) is a rare disorder affecting both medium- and small-sized vessels. Intracranial haemorrhages though less reported are in the form of parenchymal haemorrhage and subarachnoid haemorrhage. We report a case of PACNS with intraventricular haemorrhage due to aneurysms secondary to progression of vasculitis.

Post-stroke dysphagia is a common problem after stroke. About 8-13% patients have persistent dysphagia and are unable to return to pre-stroke diet even after 6 months of stroke. Use of percutaneous endoscopic gastrostomy (PEG) may be required in these patients, which may be psychologically unacceptable and impair the quality of life. In those with cricopharyngeal dysfunction leading on to refractory post-stroke dysphagia, cricopharyngeal myotomy and injection of botulinum toxin are the treatment options. We present a case of vertebrobasilar stroke who had persistent dysphagia due to cricopharyngeal dysfunction with good recovery of swallowing function following cricopharyngeal myotomy 1.5 years after the stroke.

Observational learning is probably one of the most powerful factors determining progress during child development. When learning a new skill, infants rely on their own exploration; but they also frequently benefit from an adult’s verbal support or from demonstration by an adult modelling the action. At what age and under what conditions does adult demonstration really help the infant to learn a novel behavior? In this review, we summarize recently published work we have conducted on the acquisition of tool use during the second year of life. In particular, we consider under what conditions and to what extent seeing a demonstration from an adult advances an infant's understanding of how to use a tool to obtain an out-of-reach object. Our results show that classic demonstration starts being helpful at 18 months of age. When adults explicitly show their intention prior to demonstration, even 16-month-old infants learn from the demonstration. On the other hand, providing an explicit demonstration (look at how I do it) is not very useful before infants are ready to succeed by themselves anyway. In contrast, repeated observations of the required action in a social context, without explicit reference to this action, considerably advances the age of success and the usefulness of providing a demonstration. We also show that the effect of demonstration can be enhanced if the demonstration makes the baby laugh. Taken together, the results from this series of studies on observational learning of tool use in infants suggest, first, that when observing a demonstration, infants do not know what to pay attention to: demonstration must be accompanied by rich social cues to be effective; second, infants’ attention is inhibited rather than enhanced by an explicit demand of look at what I do; and finally a humorous situation considerably helps infants understand the demonstration.

In today’s globalized competitive environment, in order to survive and compete in the market, firms should use their resources productively. Especially in sectors requiring intensive labor force such as textile sector, human resource has become more important. Job satisfaction will not only enable firm’s survival in the market, but also provides competitive advantage. In line with this, the factors effecting job satisfaction should be identified and improved in accordance with the expectations of employees. In this paper, the effect of wage and career expectations of employees and their potential of creativity on job satisfaction is studied. With the help of literature, a survey model is formed and the relationships between variables are tested through factor, reliability, correlation and regression analysis. According to correlation analysis, it is found that all variables are correlated with job satisfaction and career expectation has the strongest relationship. In regression analysis, the effect of wage, career expectations and creativity variables together on job satisfaction is analyzed. According to this analysis, it is found that career expectation has a significant effect on job satisfaction.