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Invasive aspergillosis (IA) is an important cause of morbidity and mortality. In this study, we aimed to present our 10-year IA experience in a single center. Fifty-nine pediatric patients diagnosed with IA were included in the study. The male/female ratio of these patients was 42/17. The median age was 8.75 years. Hematologic malignancy was present in the majority of the patients (40/59, 68%). The mean duration of neutropenia was 18.5 days. Cytosine arabinoside was the most common immunosuppressive therapy directed at T-cells at the time of IA diagnosis. IA cases were categorized as proven (27%), probable (51%) and possible (22%) according to the 2008 EORTC/MSG criteria. The most common site of invasive aspergillosis was the lungs (78%) and nodules were the most frequent radiological finding (75.5%). In 38 (64.4%) patients receiving antifungal prophylaxis, prophylactic agents included fluconazole (30.5%), liposomal amphotericin B (23.7%), posaconazole (8.5%) and voriconazole (1.7%) Initial treatment was most commonly administered as monotherapy (69.5%). The median duration of antifungal treatment was 67 days. A total of 11 (18.6%) deaths occurred due to aspergillosis. We will probably continue to see IA frequently in pediatric patients with increased use of corticosteroids, biological agents, and intensive immunosuppressive chemotherapies.

The aim of this single-center retrospective study was to determine the changes in the burden of allcause pneumonia, bacterial pneumonia and empyema in children aged 0-18 years after the availability of 7-valent pneumococcal conjugated vaccine (PCV7) and 13-valent pneumococcal conjugated vaccine (PCV13) in our country. Children aged 0-18 years who were hospitalized with the diagnosis of pneumonia and treated in Ankara between January 1, 2006 and December 30, 2019 were included in the study. The burden of disease according to the years was calculated as follows: after determining the number of patients with all-cause pneumonia, bacterial pneumonia and the empyema who were admitted to the pediatric infectious diseases service, we divided those numbers to admission numbers to all outpatient clinics in that year as the ratio in 100 000. The years 2006-2007 were accepted as pre-vaccine period, 2009-2010 as PCV7 period and 2012-2019 as PCV13 period. As 2008 and 2011 were the years when PCV7 and PCV13 vaccines implemented into the routine vaccination schedule, they were accepted as transition years and the patient data from these years were not used. All of the patients data were obtained from the patient files. There was a significant decrease in the disease burden of all-cause pneumonia in 0-18 years age and 0-24 months age group after PCV13 period compared to PCV7 period (p0.001 and p0.001). A statistically significant decrease was found in all-cause pneumonia among children older than 60 months after PCV13 period compared to PCV7 period and pre-vaccine period (p0.05 and p0.01, respectively). When pre-PCV13 (PCV7 and pre-vaccine periods together) and post-PCV13 periods were compared; in 0-18 years age, 0-24 months age and 24-60 months age groups, there was a significant decrease in the burden of disease due to all-cause pneumonia after PCV13 (p0.001, p0.001 and p0.05) period. When the bacterial pneumonia disease burden in PCV13 period was evaluated, bacterial pneumonia disease burden in 0-18 years and 0-24 months age group was found to be significantly lower than in both pre-vaccine and PCV7 periods (p0.001 and p0.001). After PCV13 vaccine, the disease burden due to bacterial pneumonia was found to be significantly lower in 0-18 years age, 0-24 months age and older than 60 months age groups compared to pre-PCV13 period (p0.001, p0.001 and p0.01). When PCV7 and PCV13 periods were compared in 0-18 years age group, a significant decrease was found in hospitalizations due to empyema after PCV13 (p0.05). In conclusion, PCV7 and PCV13 led to a significant reduction in the incidence of all-cause pneumonia and bacterial pneumonia in children.

Neisseria meningitidis is a significant worldwide cause of bacterial meningitis and sepsis. High case-fatality rates and severe complications in survivors can occur. We present a 1-month 23-day-old case diagnosed with meningococcal meningitis and sepsis, in which serogroup Z of N. meningitidis was isolated from cerebrospinal fluid and blood cultures and treated with ceftriaxone for 7 days. Our patient is the first case of N. meningitidis serogroup Z–induced invasive meningococcal infection in Turkey. N. meningitidis serogroup Z is not included in the current meningococcal vaccines. It is concerning that a nonvaccine serogroup caused this invasive meningococcal disease and that even if the vaccine would cover this serogroup, it has happened before the usual age of administration. Therefore, meningococcal disease surveillance should continue, and an effective prevention and control strategy for nonvaccine serogroups should be implemented.

Objective: In this study, we aimed to examine the effect of atrial fibrillation (AF) on mortality in COVID-19 patients and the risk scores that can be used in determining risky AF patients. In addition, we aimed to examine the place of oral anticoagulant use in treatment. Materials and Methods: Records of patients diagnosed with COVID-19 were retrospectively reviewed. Among these patients, 48 patients with a diagnosis of AF were identified. Intensive care need, mortality, CHA2DS2VASC and HAS-BLED scores of the patients were recorded. CRP and D-Dimer levels were recorded. Oral anticoagulant treatments used by the patients were recorded. Results: The CHA2DS2VASC (intensive care: 4,50±1,41, internal medicine service: 2,50±1,05, p

The monogenic causes of very early-onset inflammatory bowel disease (VEO-IBD) have been defined by advanced genetic studies, which were usually related to primary immunodeficiencies. Receptor-interacting serine/threonine-protein kinase-1 RIPK-1 protein is an important signalling molecule in inflammation and cell death pathways. Its deficiency may lead to different clinical features, via immunodeficiency and/or inflammation. Here we discussed an infant with malnutrition, VEO-IBD, reccurrent infections and polyathritis, who had a partial deletion in RIPK1 gene, adjacent biphenyl hydrolase-like (BPHL) gene, and a homozygous p.Glu148Gln mutation in Mediterranean fever (MEFV) gene. The superimposing effect of immune dysregulation of these two defective genes may lead to severe clinical presentation of our patient.

Transported education is a part of social life for students living in settlements without school. The social studies course includes all aspects of the social life of primary and secondary school students. This study, which aims to examine how transported education shapes students' attitudes toward the social studies course, was carried out based on the scope mentioned earlier. A sequential explanatory design from the mixed research method was used in the study. In the participant group of the study, a total of 198 students studying in a secondary school providing transported education in Erzurum, Turkey, took place. The data of the study, in which statistical and qualitative data were collected together, were collected through scale and semi-structured interview form. Kruskal Wallis, one of the non-parametric statistical tests, was used in the analysis of statistical data, and content analysis was used in qualitative data analysis. In the study, it was determined that the scores of the participants' attitudes toward the social studies course did not differ according to the class variable. In the study, it was also determined that the students had positive opinions about transported education, and they thought that transported education was a helpful structure for them to socialize and gain knowledge and skills about daily life. Various suggestions have been developed depending on the results of the study.

Democracy and human rights are essential concepts for people as they are fundamental elements of human life. Demonstrating the importance of democracy and human rights in terms of human life can be achieved by educating people. Democracy and human rights education is given to primary and secondary school students through social studies lessons. As a matter of fact, social studies have content based on all situations, facts, and events related to human social life. In primary and secondary education, the knowledge, skills, and values people should have in their social life are presented to students through social studies education. In this study, the concepts of democracy and human rights were examined in terms of content and historical development, the place of these concepts in human education was tried to be discussed, and their importance in terms of social studies education was examined. The study stated that democracy and human rights education are essential facts in terms of human life. That theoretical and practical knowledge about democracy and human rights can be gained through education. On the other hand, the importance of the concepts of democracy and human rights in terms of social studies, an interdisciplinary field of education, has also been tried to be revealed in the study.

With the integration of technology into learning environments, traditional learning approaches have begun to leave their place to current learning approaches. One of the current learning approaches that has been popularly used recently is blended learning. Because of the various advantages it provides, blended learning is preferred by learners, teachers, and educational institutions. With the current COVID-19 pandemic, higher education institutions' interest in blended learning has increased. This growing interest raises the issue of how efficient blended learning should be. In this context, researchers investigated the requirements of effective blended learning for higher education institutions in this chapter. In the chapter, the researchers also discuss the contents of blended learning models that can be used in higher education, current research, blended learning adoption process in higher education, and tips for effective blended learning.

Objective:We aimed to evaluate the efficacy and role of high-sensitivity troponin T in children with a confirmed SARS-CoV-2 infection and also the correlation of troponin T levels with symptoms, and echocardiographic findings were analysed.Methods:Two hundred and fourteen patients with a confirmed SARS-CoV-2 infection between the dates of 28 March and 15 August 2020 were enrolled in this retrospective single-centre study. Patients with comorbidities and diagnosed as multisystem inflammatory syndrome in children were excluded. Demographic data, clinical and laboratory parameters were evaluated. The patients were classified and compared according to the troponin positivity. The correlation of troponin T with symptoms and echocardiographic findings was analysed.Results:The most common symptoms in the whole study group were fever (53.3%) and cough (24.8%). Troponin T levels were elevated in 15 (7%) patients. The most common symptom in patients with troponin positivity was also fever (73.3%). Troponin T positivity was significantly higher in patients under the age of 12 months and troponin T levels were negatively correlated with age. C-reactive protein levels were elevated in 77 (36%) of the patients in the whole group and 7 (46.7%) of 15 patients with troponin positivity. C-reactive protein levels were similar between groups.Conclusion:Routine troponin screening does not yield much information in previously healthy paediatric COVID-19 patients without any sign of myocardial dysfunction. Elevated troponin levels may be observed but it is mostly a sign of myocardial injury without detectable myocardial dysfunction in this group of patients.

Amaç: Tromboelastogram parametrelerindeki değişiklerin standart olarak önerilen AntiFXa aktivitesi ile karşılaştırılarak bu testin enoksaparin tedavisinin monitörizasyonundaki rolünün incelenmesidir. Gereç ve Yöntem: ST segment yükselmesi olmayan miyokard infarktüsü tanısıyla koroner yoğun bakım ünitesine yatırılan 25 hasta çalışmaya alınmıştır. Hastalara yatış anında iki tüp kan alınmış ve 1mg/kg enoksapirinin üçüncü dozu yapıldıktan 4 saat sonra iki tüp kan daha alınmıştır. Hastalara AntiFXa, tromboelastogram, aktive koagülasyon zamanı bakılmıştır. Bulgular: Enoksoparin uygulaması sonrası aktive koagülasyon zamanı değerinde bir miktar artış izlenmekle birlikte bunun anlamlı olmadığı görüldü (p₌0.094). Enoksoparin sonrası tromboelastogram parametrelerinden maksimum amplitüde(MA) azalmış (MA bazal 65.4±11.9 sonra 63.4±7.8), R zamanı artmış (5±1.7 den 8.4±4.6,), K zamanı artmış (1.89±1.06 dan 2.56±1.4), açı azalmıştır. (66.34±5.6 dan 57.9±11.4). AntiFXa artmıştır (0.122±0.06 dan 0.501±0.359). Sonuç: Tromboelastogram parametreleri değerlendirildiğinde tipik artmış bir prokoagülan aktivite olmamakla birlikte kısmen artmış bir fibrinolitik aktivite saptanmıştır.

Bu çalışma, tarihsel kurguya dayanan iki önemli eserin edebi olarak karşılaştırılmasını ele almaktadır. Nitekim gerçek savaş deneyimlerine dayanarak ün kazanan İngiliz Roman yazarı Pat Barker’ın Kızların Suskunluğu adlı eserinde İlyada destanında konuşulmamış kadınların, çocukların hikâyelerine epik yapıyı bozarak gerçekçi ve canlı bir şekilde yer verilmiştir. Eserinde Romantizme karşı durarak gerçekçi bir yaklaşımla metinlerarasılıktan faydalanarak savaşın geride bıraktıklarına dair bir kadın gözüyle tecavüz, kölelik, ölüm, gözyaşı, yıkım ve hayatta kalma mücadelesi gibi konulara değinmiştir. İlyada destanında yer alan kurgulara farklı bir bakış açısıyla yeni bir tarihsel kurgu geliştirmiştir. Yıkıma uğramış ve paramparça olmuş hayat hikâyelerini toplama ve bir araya getirmeye dönük tasvirlere yer vererek, erkek gözü ve kalemiyle yazılmış mitoloji ve destansı kahramanlıkların tam aksine bir kurguyla betimlemiştir. Bu çalışmada savaş deneyimlerinin arka planını anlatan Kızların Suskunluğu adlı eser, Pat Barker’ın tarihsel kurguyu oluşturma biçimi ve yöntemi çerçevesinde analiz edilecektir. Bu doğrultuda ilgili çalışma, yazarın eserini kaleme alırken tarihsel kurgu kurallarını uygulamadığına dair bilgiler iletmektedir., This study deals with the literary comparison of two important works based on historical fiction. In Silence of the Girls by the British novelist Pat Barker, who gained fame based on her genuine war experiences, the stories of the unnarrated women and children in the Iliad epic are included in a realistically and lively, disrupting the epic structure. By opposing Romanticism in her work, she made use of intertextuality with a realistic approach and touched upon the things left behind by the war, such as rape, slavery, death, tears, destruction, and the struggle for survival. She developed a new historical fiction with a different perspective to the fictions in the Iliad. With descriptions of collecting and bringing together the destroyed and shattered life stories, she depicted them with a fiction that is in stark contrast to mythology and epic heroism written with a male gaze and writing perspective. In this study, Silence of the Girls, which tells the background of the war experiences, will be analysed within the framework of Barker's form and method of creating historical fiction. In this direction, the related study suggests that the author did not apply the rules of historical fiction while writing her work.

“Amerika” gezi gözlemlerine dayalı Avrupa ve ABD kültürünün hesaplaşmasına radikal bir boyut kazandıran edebi bir eserdir. Okuyucuya sunulan/yansıtılan gerçekliğin yazar tarafından eserde nasıl yansıtıldığının incelenmesi önem arz etmektedir. Bu nedenle çalışmanın temel amacı, Amerikan yaşam biçimi ve kültürüne farklı bir perspektifle bakan Baudrillard’ın kendi kavram repertuvarları olan “Hipergerçeklik” ve “Simulasyon” çerçevesinde eserde geçen kavramları yorumlamak ve değerlendirmektir. Bu çalışmada, Baudrillard’ın sosyal ve kültürel öğelerin dışında “Yıldızsal Amerika” tanımlaması ve betimleme yaklaşımları ele alınarak göndermelerde bulunduğu ve okuyucuda oluşturmak istediği yeni anlam ve bakış açısı tartışılmaktadır. Aynı zamanda yeni düzen ve özgür yaşamı niteleyen hipergerçek Amerika ile başarısız Avrupa’nın modern Batı anlayışı üzerine sorgulama, inceleme ve araştırılmasını kapsamaktadır. Nitekim Avrupa belli bir feodalite, aristokrasi, burjuvazi, ideoloji ve devrim gibi tipleri icat ederek ütopya konusunda başarısız taraf iken Amerika ütopyanın gerçekleştiği yer olmuştur., "America" is a literary work bringing a radical dimension to the reckoning of European and US culture based on travel observations. How the author conveys the reality presented / reflected to the reader is esential. Therefore, the overall aim of this study is to interpret and evaluate the concepts in “America” such as Hyperreality and Simulation with different and broad perspective of Baudrillard on the American lifestyle and culture. In this study, Baudrillard's definition of "Astral America", apart from social and cultural elements, and the new meaning and perspective he wants to create in the reader are discussed. It also includes the investigation, questioning, and research of the modern Western understanding of the failed Europe and hyperreal America, characterizingthe new order and free life. Whilst Europe is the unsuccessful party of utopia by creating a certain type of feudalism, aristocracy, bourgeoisie, ideology and revolution, America is where utopia is achieved.

Paul Eluard Ve Nazım Hikmet’te Renklerin Dili Şiirde Renkler Açısından Karşılaştırmalı Bir Yaklaşım, Medine Sivri tarafından 2008 yılında kaleme alınır. Paul Eluard Ve Nazım Hikmet’te Renklerin Dili Şiirde Renkler Açısından Karşılaştırmalı Bir Yaklaşım kitabı Karşılaştırmalı Edebiyat, şiir, renk, Paul Eluard ve Nazım Hikmet gibi anahtar sözcükleri içeren bu çalışmaya, Türk ve Fransız Edebiyatlarının önemli iki şairin tüm şiirlerinde, erek metinlerden hareketle renklerin dili, bilinçli ya da bilinçsiz olarak kullandıkları renklere varlıkbilimsel ve felsefi açıdan yükledikleri anlamlara; bunun şiirlerine biçem ve içerik açısından kazandırdıklarına karşılaştırmalı bir yöntemle yaklaşılmaktadır. Kitapta Karşılaştırmalı Edebiyat bilimi verileri çerçevesince renk odaklı karşılaştırmalı metin çözümlemesi yapılmaktadır. Karşılaştırmalı edebiyat çalışmaların ülkemiz edebiyatına sunacağı katkının önemine dikkat çekerek edebiyatımızın zenginliğini tüm dünyaya duyurmanın yolunun bu tür çalışmalardan geçtiğinin altını çizilmektedir.

The emergence of the concept of romanticism represents a literary movement that has an argument against Classicism in terms of method, although there is controversy about its beginning and ending period. Although the authors were not defined as Romantic at the beginning of the era, they took part in the Romantic era category after a while. William Blake, a Romantic poet, vividly included elements of Romanticism in his poems. All the phenomena characterized by imagination, subjectivity, freedom of thought and expression, and idealization of nature in the Romanticism movement are heavily featured in his poems. He used his imagination and visionary in his poems through embodiment. Many of the poets of the Romantic era were greatly influenced by the war between England and France and the French Revolution. Blake was also influenced and wrote his works against the old classical era ideas with a deep inspiration. This study focuses on the Romantic elements in Blake’s poem The Ecchoing Green, which he wrote in a free, dramatic, and romantic mood. The poem will be analysed within the framework of imagination, mysticism, symbolism, love of freedom, importance given to childhood, nature, pastoral environment, and lyricism in the Romantic movement., Romantizm kavramının ortaya çıkışı, başlangıç ve bitiş periyoduyla ilgili karmaşıklık söz konusu olsa da yöntem açısından Klasisizm’e karşı sav barındıran bir edebi akımı temsil etmektedir. Yazarlar dönemin başlangıcında romantik olarak adlandırılmasalar da bir süre sonra romantik dönem kategorisinde yer almışlardır. Romantik bir şair olan William Blake, Romantizmin unsurlarını şiirlerinde canlı bir şekilde yer vermiştir. Şiirlerinde Romantizm akımında yer alan hayal gücü, öznellik, düşünce ve ifade özgürlüğü ve doğanın idealleştirilmesi ile karakterize edilen tüm fenomenler yoğun bir şekilde yer almaktadır. Şiirlerinde hayal gücünü ve vizyonerliğini somutlaştırarak kullanmaktadır. Romantik dönem şairlerinin birçoğu, İngiltere ile Fransa arasındaki savaştan ve Fransız Devrimi’nden oldukça etkilenmiştir. Blake de bu etkilenmelerin ortasında kalarak, eski klasik dönem fikirlerine karşı eserlerini derin bir ilhamla kaleme almıştır. Bu çalışmada Blake’in özgür, dramatik ve romantik ruh haliyle yazmış olduğu Yankıyan Yeşillik adlı şiirinde yer alan romantik unsurlar incelenecektir. Eser, Romantik akımda yer alan hayal gücü, mistisizm, sembolizm, özgürlük sevgisi, çocukluğa verilen önem, doğa, pastoral ortam ve lirizm çerçevesinde analiz edilecektir.

The usage of videos in undergraduate students’ engineering education has gained importance in recent years. Videos, which are used as a supportive tool in traditional engineering education, have become a source of information in online learning environments. The aim of this study is to examine the effects of educational videos on engineering undergraduate students’ laboratory applications and its examination of opinions developed within the scope of e-learning. For this purpose, the sample consisting of 50 undergraduate students from the civil engineering department has been used for this research. Pre-test and post-test process conducted within the scope of in this research were resulted in a meaningful difference after the analyses of Paired Samples t-Test (p=0.02) was made. This result shows that online learning platforms in engineering education and educational videos positively affect the students’ attitude. In addition, it is found out that educational videos affect the learning process as a useful educational source. Moreover, the instructors’ educational videos, which are Digital Learning Materials, positively impact the students’ motivation during the courses.

Objective Multisystemic inflammatory syndrome in children (MIS-C) is characterized by persistent fever, systemic hyperinflammation, and multiple-organ dysfunction. There are a few reports about MIS-C presenting with acute abdomen. The aim of this study was to demonstrate the clinical characteristics and treatment options for MIS-C-related acute abdomen and appendicitis. Methods This was a retrospective study conducted between April 2020 and October 2020 in our pediatric intensive care unit in Turkey. Patients between the ages of 1 month and 18 years who presented with acute abdomen and were ultimately diagnosed with MIS-C were included. Results Seven patients with a median age of 12.5 (interquartile range 10.5–13) years were enrolled. Four were females. The most frequent symptoms were fever, abdominal pain, and vomiting. Three patients had involvement of the appendix that required surgical intervention. All pathology reports were compatible with appendicitis. The other patients also had an acute abdomen. One patient had malignant hyperthermia during induction of anesthesia, so surgery was postponed and medical management was commenced. The clinical picture regressed with immunomodulation. All patients were treated with intravenous immunoglobulin and steroids. Four patients with acute abdomens improved with immunomodulation, and surgery was not needed. Conclusion MIS-C may present with an acute abdomen. Immunomodulation should be considered instead of surgery if the clinical course is not complicated.

Objective: Appendicitis is a common surgical emergency among children. The coronavirus pandemic affected the system of hospitals more than any other field, and great amount of people were concerned about visiting the hospitals for any reason. In this study, it was aimed to evaluate the profile of appendicitis by emphasizing perforated and acute appendicitis in the pandemic period and to compare the rates with previous three years. Material and Methods: Charts of the children who underwent laparoscopic appendectomy due to appendicitis between March 11-September 30 between 2017-2020 were retrospectively analyzed in terms of demographic data, duration of symptoms, duration between hospital admission and surgery, radiologic imaging and perioperative outcomes. Results: This study includes 467 children who underwent laparoscopic appendectomy. There were 97 procedures in 2020, 111 in 2019, 146 in 2018 and 113 in 2017. Multiple comparison tests revealed that age did not show difference; but onset of symptoms in admission (p= 0.004), hospitalization time before surgery (p< 0.001), total hospitalization time (< 0.001) showed statistically significant difference between years. Pairwise comparisons showed that these parameters were increased in 2020 compared to other years. Perforated appendicitis rate was significantly increased in 2020 when compared to previous years. Conclusion: Although there is no direct relation between appendicitis and COVID-19 infection in the current knowledge, perforated appendicitis was found to be increased in children during the COVID pandemic. Reason of the higher rate of perforated appendicitis may be multifactorial; however, the pandemic appears to have a role in increased morbidity in children with appendicitis indirectly due to delay of hospital admissions.

Giriş ve Amaç: Yüksek Lipoprotien (a) [Lp (a)] düzeylerinin artmış koroner arter hastalığı riski ile ilişkili olduğu bilinmektedir. Çalışmamızda ilk kez akut koroner sendrom tanısı ile başvuran hastalarda, serum Lp (a) seviyesi ile klinik prezentasyon arasındaki ilişkiyi araştırmayı planladık. Gereç ve Yöntem: İlk kez akut koroner sendrom tablosu ile başvuran hastalar prospektif olarak çalışmamaıza dahil edildi. Hastalara ait demografik veriler dosya kayıtlarından toplandı. Lp (a) ve diğer lipid parametrelerinin ölçümü başvuru sonrası en az sekiz saatlik açlığı takiben alınan venöz kandan yapıldı. Bulgular: 105 ST segment elevasyonlu miyokard infarktüsü (STEMI), 132 ST segment elevasyonu olmayan miyokard infarktüsü (NSTEMI) hastası olmak üzere toplam 237 hasta çalışmaya dahil edildi. Yaş ve cinsiyet açısından gruplar arasında anlamlı bir fark yoktu. Serum Lp (a) seviyeleri STEMI hastalarında daha yüksek saptansa da iki grup arasında anlamlı bir fark yoktu [10.2 (19.7) mg/dl vs. 8.5 (12.7) mg/dl, p: 0.393]. Lp (a) ≥ 30 mg/dl olup, LDL ≥ 100 mg/dl olanlar, LDL < 100 mg/dl olanlara göre 4.95 kat daha fazla STEMI kliniği ile prezente olmakta idiler (odds oranı:4.95, % 95 güven aralığı:1.31-16.5, p:0.027). Diğer taraftan LDL ≥ 100 mg/dl olup, Lp (a) ≥ 30 mg/dl olanların, Lp (a) < 30 mg/dl olanlara göre 2.45 kat daha fazla STEMI kliniği ile prezente olduklarını saptadık (odds oranı:2.45, % 95 güven aralığı:1.04-5.6, p:0.039). Sonuç: Lp (a) ≥ 30 mg/dl ve LDL ≥ 100 mg/dl olan hastaların akut koroner sendrom klinik prezentasyonlarının STEMI lehine olduğunu saptadık. Bu hasta grubunda daha erken ve etkin yaşam tarzı değişikliklerine ihtiyaç gözükmektedir.

Bu çalışmanın temel amacı Anadolu İmam Hatip Liselerinde görev yapan öğretmenlerin örgütsel bağlılık ve örgütsel kimlik algılarının örgütsel vatandaşlık davranışlarına olan etkisini tespit etmektir. Bu kapsamda 2019-2020 eğitim öğretim yılında Türkiye İstatistik Kurumunun Türkiye Bölgeler Sınıflamasında Düzey 1 olarak belirlediği 12 coğrafi bölgeden seçilen, 23 ildeki 1506 Anadolu İmam Hatip Lisesi öğretmeninin görüşüne başvurulmuştur. Araştırma, nicel araştırma yöntemlerinden ilişkisel tarama modelinde tasarlanmıştır. Araştırmada veri toplama araçları olarak “İmam Hatip Okulları Örgütsel Kimlik Algısı Ölçeği”, “Örgütsel Bağlılık Ölçeği” ve “Örgütsel Vatandaşlık Davranışı Ölçeği” kullanılmıştır. Katılımcılardan toplanan veriler; Aritmetik Ortalama, Pearson Korelasyon ve Çoklu Doğrusal Regresyon Analizi ile çözümlenmiştir. Araştırma sonuçlarına göre öğretmenlerin örgütsel bağlılık, örgütsel kimlik ve örgütsel vatandaşlık davranışları arasında pozitif yönde anlamlı ilişki olduğu belirlenmiştir. Çoklu doğrusal regresyon analizi sonuçlarına göre öğretmenlerin örgütsel bağlılık ve örgütsel kimlik algılarının örgütsel vatandaşlık davranışları üzerinde etkisinin olduğu tespit edilmiştir. Çalışma bulguları bir bütün olarak değerlendirildiğinde, öğretmenlerin örgütsel kimlik ve örgütsel bağlılığa ilişkin algı düzeylerinin artmasının onların örgütsel vatandaşlık davranışlarının yükselmesine neden olduğu söylenebilir.

In Turkey, the seven-valent pneumococcal conjugated vaccine (PCV7) was included in the childhood national immunization programme in April 2008 and was replaced by the 13-valent pneumococcal conjugated vaccine (PCV13) in April 2011. In this retrospective, single-center study, it was aimed to determine the serotype distribution and antimicrobial resistance in Streptococcus pneumoniae isolates of pediatric patients with invasive pneumococcal disease (IPD) after the introduction of PVC7 and PVC13. Fifty pediatric patients diagnosed with meningitis and sepsis/bacteremia between October 2009 and October 2019 were included in the study. The pediatric patient group consisted of previously healthy patients diagnosed with meningitis and sepsis/bacteremia with S.pneumoniae isolated in their blood or cerebrospinal fluids. Patients with pneumonia-associated bacteremia and empyema were not included in the study. Serotyping of the isolates was performed by Quellung reaction using specific antisera (Statens Serum Institute, Denmark) and antibiotic (penicillin and ceftriaxone) susceptibility was determined by antibiotic gradient method based on Clinical Laboratory Standards Institute (CLSI) criteria. Of the children, 29 (58%) were boys and 21 (42%) were girls. The median age of the patients was 19 months (1 month-18 year). When the children under the age of five were evaluated, it was found that 30 (79%) patients were diagnosed with occult bacteremia/sepsis and 8 (21%) with meningitis. The overall annual incidence rate of IPD among the healthy children aged5 years decreased significantly from 9.35/100000 to 0.83/100000 (p0.001). Serotype identification was determined for 44 of 50 pneumococcal isolates . However, since six patients with underlying disease were not included in the evaluation, the remaining 38 isolates were found to be one of the serotypes included in PCV7 and PCV13 at a rate of 28.9% (n= 11) and 44.7% (n= 17), respectively. While the rate of PCV13 serotypes seen in the PCV7 period was 81.8%, this rate decreased to 29.6% within eight years after PCV13 administration. The rate of non-vaccine serotypes was determined as 54.5% in PCV7 period and 70.3% in PCV13 period. The rate of non-vaccine serotypes in patients under 5 years was 60% in the period of PCV7 and 75% in the period of PCV13. The proportion of non-vaccine serotypes has increased over time. However, this difference was not statistically significant (p0.05). The most common serotypes detected in isolates were 19F, 23F, 7F, 31 and 24B. According to the minimum inhibitory concentration values of the isolates recovered from patients with meningitis, penicillin and ceftriaxone resistance rates were found as 43.9% and 9.8%, respectively. In conclusion, our study showed that there was a 91.1% decrease in the incidence of IPD in healthy children aged under five years after the implementation of PCV7 and PCV13. It was determined that while the rate of serotypes in vaccine content decreased, there was an increase in non-vaccine serotypes. In addition no significant change was observed in antibiotic resistance rates over the years.

Background Multisystem inflammatory syndrome in children (MIS-C) is characterized by persistent fever, abdominal pain, vomiting, diarrhea, rash, conjunctivitis, headaches, and mucocutaneous manifestations and it can cause circulatory dysfunction, resulting in hypotension, shock, and end-organ injury in the heart and other organs and possibly death. In this study, we aimed to analyze the clinical spectrum, treatment options and outcomes of children with MIS-C who were admitted to our pediatric intensive care (PICU). Materials and Methods Clinical and laboratory findings and treatment of the patients admitted to the PICU with MIS-C between April 2020 and January 2021 were recorded, and their outcomes were evaluated. Results Nineteen patients with a median age of 12.5 years (interquartile range (IQR): 5.8–14.0 years) were admitted. Eleven (57.8%) were males. The most frequent clinical and laboratory features were fever (100%), abdominal pain (94.7%), rash (63.1%), headache (68.4%), diarrhea (47.3%), seizure (10.5%), cardiac dysfunction (52.6%), acute kidney injury (26.3%), lymphopenia (84.2%), and thrombocytopenia (36.8%). However, 8 patients needed mechanical respiratory support, 11 patients needed inotropes, 2 patients needed plasma exchange, and 1 patient needed continuous renal replacement therapy. All patients received corticosteroids, 17 patients (89.2%) received intravenous immunoglobulin, 2 patients received anakinra, 10 patients received acetylsalicylic acid, and 6 patients received enoxaparin. Median PICU length of stay was 3 days (IQR: 2–5) and only one patient died. Conclusion In conclusion, MIS-C may present with a variety of clinical manifestations, and it can lead to life-threatening critical illness. Most children need intensive care and the response to immunomodulation is usually favorable.

Despite the lack of supporting data, many clinics perform sheath removal 4-6 hours after femoral percutaneous coronary intervention to reduce the risk of possible access site complications. This study aims to examine the effects of sheath removal immediately after the procedure on access site complications and patient comfort.This prospective study included 349 patients who underwent percutaneous coronary intervention via the femoral site and 6 French guiding catheters. The sheath in the early group was removed immediately after the procedure without checking the activated clotting time levels but after 4 hours in the late group. Access site complications were recorded and patient comfort was evaluated using the Visual Analog Scale.Patients were divided into 2 groups: patients in the early removal group (n=171) and in the late removal group (n= 178). There was no statistically significant difference between the 2 groups in terms of access site complications. Three patients in the early removal group and 4 patients in the late removal group developed a hematoma. Six patients in the early removal group and 10 patients in the late removal group showed ecchymosis.TheVisualAnalogScalescorewas statistically significantly lower intheearly removal group compared with that in the late removal group [2 (1-3) vs. 3 (2-4), P.001].This study shows that immediate sheath removal is safe and more comfortable for patients with percutaneous coronary intervention who received weightadjusted dose of heparin, regardless of the percutaneous coronary intervention levels after the procedure.

OBJECTIVES: The aim of this study was to investigate the relationship between the C-reactive protein/albumin ratio and the prognosis of hypertensive COVID-19 patients. METHODS: It was designed as a single center retrospective study. PCR positive COVID-19 patients who were followed up in the intensive care unit (ICU) and received antihypertensive treatment were included in the study. The patients were divided into two groups as survivor and non-survivor. C-reactive protein/albumin (CAR) ratios of the patients were compared. The cut-off value was determined as a mortality predictor. The effect of CAR on mortality was evaluated using Logistic Regression analysis. RESULTS: 281 patients were included in the study. Groups consisted of 135 (non-survivor) and 146 (survivor) patients. CAR was significantly higher in the non-survivor group (p

BACKGROUND Myocardial bridge (MB) is generally considered as a benign condition, but it may trigger atherosclerosis, especially in the adjacent proximal coronary artery segment. In this study, we aimed to investigate whether the Framingham risk score (FRS) or atherogenic indices are risk factors for coronary atherosclerosis in patients with MB in the left anterior descending coronary artery (LAD). METHODS We performed a retrospective study evaluating 155 patients who have MB in LAD. The patients were evaluated in two groups according to the presence of atherosclerosis (74 patients in atherosclerotic group vs. 81 patients in non-atherosclerotic group). Baseline characteristics, FRS and atherogenic indices were reviewed between groups. Significant independent risk factors for coronary atherosclerosis were investigated by logistic regression analysis. RESULTS Patients in atherosclerotic group were significantly older (58.15 ± 10.04 vs. 50.22 ± 9.27 years, p

In this study, we investigated whether the CHA2DS2-VASc score could be used to estimate the need for hospitalization in the intensive care unit (ICU), the length of stay in the ICU, and mortality in patients with COVID-19. Patients admitted to Merkezefendi State Hospital because of COVID-19 diagnosis confirmed by RNA detection of virus by using polymerase chain reaction between March 24, 2020 and July 6, 2020, were screened retrospectively. The CHA2DS2-VASc and modified CHA2DS2-VASc score of all patients was calculated. Also, we received all patients' complete biochemical markers including D-dimer, Troponin I, and c-reactive protein on admission. We enrolled 1000 patients; 791 were admitted to the general medical service and 209 to the ICU; 82 of these 209 patients died. The ROC curves of the CHA2DS2-VASc and M-CHA2DS2-VASc scores were analyzed. The cut-off values of these scores for predicting mortality were >= 3 (2 or under and 3). The CHA2DS2-VASc and M-CHA2DS2-VASc scores had an area under the curve value of 0.89 on the ROC. The sensitivity and specificity of the CHA2DS2-VASc scores were 81.7% and 83.8%, respectively; the sensitivity and specificity of the M-CHA2DS2-VASc scores were 85.3% and 84.1%, respectively. Multivariate logistic regression analysis showed that CHA2DS2-VASc, Troponin I, D-Dimer, and CRP were independent predictors of mortality in COVID-19 patients. Using a simple and easily available scoring system, CHA2DS2-VASc and M-CHA2DS2-VASc scores can be assessed in patients diagnosed with COVID-19. These scores can predict mortality and the need for ICU hospitalization in these patients.

Baş döndürücü teknolojik gelişimin bir sonucu olarak son otuz yılda medyaların, edebiyat ve sanat alanında etkileşimi ile ortaya çıkan ürünlerin, geleneksellikten uzak yeni yöntem ve yaklaşımlarla kullanılması günümüz medyalararasılık ilişkilerine yeni boyutlar kazandırmıştır. Bu hızlı değişimler medyalararasılık yaklaşımının yaygınlaşmasına ve yeni çalışmaların doğmasına zemin hazırlamıştır. Bu çalışmada, rotoskop ve renk anahtarı yöntemiyle Vincent Van Gogh tarzıyla yağlı boya ile yapılmış tablolardan perdeye aktarılmış Vincent’ten Sevgilerle 2017 adlı sinema filminin medyalararasılık ilişkileri açısından incelenip, nasıl ve ne şekilde sinema boyutunu etkilediğine dönük araştırma bulguları yorumlanarak değerlendirilmektedir. Sinema ve medyalararasılık kavramlarına dönük yapılan tartışmalar göz önünde bulundurularak rotoskop ve animasyon metodunun sinema tekniğine yansıması ele alınmaktadır. Ayrıca çalışmada, yağlıboya tablolarının yeniden resmedilerek, animasyonun perdeye aktarılma stratejisinde farklı sanat türleri ve medyalar olarak resim ve sinemanın birbiriyle kurduğu ilişki ve yaklaşım irdelenmektedir. Sinema ve medyalararasılık süreçlerine ilişkin kuramsal referans çerçevesi Irina O. Rajewsky, Jürgen E. Muller, Wolf, Gabriele Rippl ve Ersel Kayaoğlu gibi araştırmacıların tanım ve açıklamalarını kapsamaktadır. Yapılan irdelemeler sonucunda çalışmada, Vincent Van Gogh’un bizzat kendi fırçasından yaratılmış sanat eserlerine (tabloları ve mektuplarına) dayalı yaşam öyküsünün son dönemini anlatan Vincent’ten Sevgilerle’nin sinemaya özgü tekniklerle medyasal birleşiminin, transformasyonunun ve hibritleşmesinin yani sinemaya görüntü olarak aktarımının gerçekleştirildiği bulgusuna ulaşılmıştır.

Background: Diabetes mellitus (DM) remains a major public health problem. The accompanying small and large vessel diseases lead to organ system dysfunction associated with a high morbidity and mortality This study adressed the effect of diabetes on cardiac venous system by assessment of the coronary sinus strain. Methods: 49 patients with and 53 without DM were included in the study, whose heart failure and heart valve pathology were excluded. Coronary sinüs strain (CSS) was evaluated with echocardiography in both groups. In addition, the aortic strain (AS) was assessed in both groups to evaluate the effects of DM on the arterial system. Results: CSS was 113.16±17.89 in the patient group and 165.12±19.30 in the control group. We observed a significant difference between the mean CSS of the patients and the controls (p

Leishmania is a vector-induced endemic tropical disease caused by protozoans. The most common cutaneous, mucosal and visceral forms are the cutaneous form. The main drugs in treatment are pentavalent antimony compounds, but their side effects create limitation of use. Local antimony compounds are used primarily in the treatment of cutaneous leishmaniasis. In some cases, alternative treatment modalities are required due to insufficient response to local treatment. Systemic amphotericin B treatment is one of the alternative treatments. In a patient who developed cutaneous leishmania at 21 months and who did not respond with local meglumine antimoniate therapy, a total of 21 mg / kg dose of systemic amphotericin B was given intermittently and successful results were obtained.

Influenza is an important cause of respiratory illness in children and is still an important cause of morbidity and mortality in children. The influenza virus subtypes determine the prevalence of the epidemic and pandemic influenza, the hospitalization and mortality rates in children each year. Surveillance of the circulation of different influenza virus strains is important in ensuring a good strain con-cordance for the composition of the annual influenza vaccine. The Global Influenza Hospital Surveillance Network® (GIHSN) is an international institution in which tertiary hospitals from many countries participate and where epidemiological surveillance of influenza disease is conducted. Six centers from Turkey participated in the study organized by GIHSN during the influenza season 2016 2017. The aim of this study was to demonstrate the frequency of influenza, virus types, clinical characteristics and vaccination rates in children admitted to our hospital with influenza-like symptoms in the influenza season 2016-2017. Informed consents were obtained from patients. 217 pediatric patients were screened with in the 24th and 48th hours of the hospitalization. Then a nasal/nasopharyngeal swab were collected from 184 patients who met the inclusion criteria. Real-time reverse-transcription polymerase chain reaction (rRT-PCR) was used to obtain laboratory results. Influenza virus, influenza virus subtypes were studied by rRT-PCR. The 83.3% of the patients with positive influenza was under 5 years of age. The rate of influenza positivity was 16.3% (n= 30 patients). Influenza A (H3N2) was the predominant strain in children. The 70% of isolates were influenza A (H3N2) and the 30% were influenza B (Yamagata). There were no case of influenza A (H1N1) or influenza B (Victoria). In 30% of cases with influenza positivity, there was an underlying disease. The most prevalent of them were neuromuscular disease followed by cardiovascular disease and asthma. Tobacco exposure was 86.6% in influenza positive cases. The empirical oseltamivir prescription rate was 28.2%. The vaccination rate of the influenza vaccine was very low (1.6%). The out of 3 patients with influenza positivity were admitted to pediatric intensive care unit, and 2 of them required mechanical ventilation. None of these patients required extracorpereal membrane oxygenation and did not die. Our results highlight the importance of surveillance for influenza and in particular, influenza vaccination rates of groups with risk for morbidity and mortality, such as children, need to be increased.

As a result of rapid technological development, the use of products that emerged with the interaction of media, literature, and art in the last three decades, with new methods and approaches that are far from traditional, have brought new dimensions to today’s intermediality. These rapid changes have paved the way for the spread of the intermedia approach and the emergence of new studies. This study sheds light on the movie, Loving Vincent 2017, an adaptation from oil paintings created in Vincent Van Gogh’s style with the rotoscope and chroma key method, in terms of intermediality along with evaluations and interpretations on the research findings on how intermediality affects the art of cinema. Considering the discussions on the concepts of cinema and intermediality, the reflection of the rotoscope and animation method on the cinema technique was addressed. In addition, the relationship and joint approach of painting and cinema as different art genres and media as part of the strategy to adapt animation into the cinema by rendering oil paintings. The theoretical framework regarding the processes of cinema and intermediality includes definitions and explanations of researchers such as Irina O. Rajewsky, Jürgen E. Muller, Wolf, Gabriele Rippl, and Ersel Kayaoğlu. As a result of the analysis, it was found that the media combination, transformation, and hybridization of Vincent Van Gogh, which tells the last period of his life story based on works of art (oil paintings and letters) created by Vincent Van Gogh’s own brush, with cinema-specific techniques was ensured, in other words, it was transferred to the screen as an image., Baş döndürücü teknolojik gelişimin bir sonucu olarak son otuz yılda medyaların, edebiyat ve sanat alanında etkileşimi ile ortaya çıkan ürünlerin, geleneksellikten uzak yeni yöntem ve yaklaşımlarla kullanılması günümüz medyalararasılık ilişkilerine yeni boyutlar kazandırmıştır. Bu hızlı değişimler medyalararasılık yaklaşımının yaygınlaşmasına ve yeni çalışmaların doğmasına zemin hazırlamıştır. Bu çalışmada, rotoskop ve renk anahtarı yöntemiyle Vincent Van Gogh tarzıyla yağlı boya ile yapılmış tablolardan perdeye aktarılmış Vincent’ten Sevgilerle 2017 adlı sinema filminin medyalararasılık ilişkileri açısından incelenip, nasıl ve ne şekilde sinema boyutunu etkilediğine dönük araştırma bulguları yorumlanarak değerlendirilmektedir. Sinema ve medyalararasılık kavramlarına dönük yapılan tartışmalar göz önünde bulundurularak rotoskop ve animasyon metodunun sinema tekniğine yansıması ele alınmaktadır. Ayrıca çalışmada, yağlıboya tablolarının yeniden resmedilerek, animasyonun perdeye aktarılma stratejisinde farklı sanat türleri ve medyalar olarak resim ve sinemanın birbiriyle kurduğu ilişki ve yaklaşım irdelenmektedir. Sinema ve medyalararasılık süreçlerine ilişkin kuramsal referans çerçevesi Irina O. Rajewsky, Jürgen E. Muller, Wolf, Gabriele Rippl ve Ersel Kayaoğlu gibi araştırmacıların tanım ve açıklamalarını kapsamaktadır. Yapılan irdelemeler sonucunda çalışmada, Vincent Van Gogh’un bizzat kendi fırçasından yaratılmış sanat eserlerine (tabloları ve mektuplarına) dayalı yaşam öyküsünün son dönemini anlatan Vincent’ten Sevgilerle’nin sinemaya özgü tekniklerle medyasal birleşiminin, transformasyonunun ve hibritleşmesinin yani sinemaya görüntü olarak aktarımının gerçekleştirildiği bulgusuna ulaşılmıştır.

Background: Invasive Trichosporon infections are rarely seen opportunistic fungal infections in children and mainly affect immunocompromised patients. This multicenter retrospective study has rewieved the characteristics, risk factors, treatment modalities and outcomes of bloodstream infections caused by Trichosporon species in children diagnosed over the past ten years in Turkey. Methods: The study was performed with the participation of 12 of 55 hospitals invited from Turkey. In each center, the patients with bloodstream infections caused by Trichosporon spp. between January 2010 and December 2020 were retrospectively ascertained and the results were reported to the study coordinator by means of a simple case report. Data were collected on patient demographics, underlying condition(s), treatment of.infections caused by Trichosporon spp, and 7 and 30- day mortality rates. Results: A total of 28 cases with fungemia caused by Trichosporon spp. were included in the study. The most common underlying disease was paediatric cancers (39.3%). T. asahii infections were detected in 78.5 % (n=22) of patients. A various spectrum of antifungal treatment regimens were used including intravenous amphotericin B monotherapy in 35.7%, intravenous amphotericin B and voriconazole combination in 32.1% and intravenous voriconazole monotherapy in 28.6% of the patients. The overall mortality rate was 28.5 %. The mortality rates were 12.5% in the voricanozole, 30% in the amphotericin B and 33.3% in combined voriconazole -amphotericin B arms Conclusions: Invasive Trichosporon infections with an important impact of patients quality of life are almost related to underlying diseases with an overall mortality rate of 28.5%. Voriconazole was found to be associated with lower mortality rates when compared with other treatment regimens. (c) 2021 SFMM. Published by Elsevier Masson SAS. All rights reserved.

In this study, we aimed to evaluate the clinical and laboratory features of the patients with rotavirus (RV) antigen positivity on or following admission to the pediatric intensive care unit (PICU).Patients admitted to the PICU due to community-acquired rotavirus (CA-RV) or hospital-acquired rotavirus (HA-RV)-induced gastroenteritis between January 1, 2013, and December 31, 2019 were evaluated.Thirty-four patients with a mean age of 14.00 ± 19.17 months were enrolled. Fortyfour percent were girls. Twenty (58.8%) patients had a history of chronic diseases. Nine (26.5%) patients had CA-RV and 25 (73.5%) patients had HA-RV infection. RV antigens were simultaneously found in 44.1% (n = 14) of the other patients at the time of diagnosis. In the study sample, 5 patients had hyponatremia, 8 had hypernatremia, 6 had hypokalemia, 4 had hypoalbuminemia, 21 had leukocytosis, 2 had leukopenia and 3 had thrombocytopenia, and 17 had elevatedC-reactive protein (CRP) levels. Three patients had seizures, 1 patient had cardiac arrest, and 2 patients had secondary bacteremia. The mean (SD) PICU length of stay was 6 (6.02) with CA-RV gastroenteritis. All CA-RV patients survived, but 8 of the HA-RV patients succumbed to causes other than RV.RV-related PICU admission is not rare, and occasional severe clinical consequences occur, especially in young children, with both CA-RV and HA-RV gastroenteritis. Appropriate timely intervention and meticulous follow-up improve survival.

Asthma is increasingly recognized as a heterogeneous entity, encompassing a variety of different subgroups, or phenotypes, which share clinical and inflammatory characteristics. However, it is only recently that molecular pathways have been both identified and successfully targeted in association with these clinical–inflammatory phenotypes. This integration of clinical–inflammatory and molecular pathways has enabled the broad differentiation of “asthma” into those with and without type-2 inflammation, on the basis of elevations in pathways downstream of type-2 cytokines, such as periostin, exhaled nitric oxide, and blood eosinophils. Although these rather general downstream biomarkers can identify patients more likely to respond to novel type 2–targeted therapies, they may have limited ability to determine which patients respond best to which type 2–targeted therapy, or even who will respond less than optimally, despite elevation in the biomarkers. In addition, new biomarkers and targets are required for the 50% of patients with asthma without elevations in these type-2 biomarkers. The path forward will require integrated ’omics approaches, development of more complex mouse models of asthma, as well as identification and validation of novel biomolecular pathways.