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Abstract Objective Chevron osteotomy offers near‐excellent clinical results and adequate stability at lower shift percentages, among the techniques used to correct hallux valgus deformity. This cadaveric study aimed to compare the Chevron osteotomy with the reverse offset‐L osteotomy, which may provide a greater surface area and a more stable geometry to withstand higher cantilever forces at higher shift percentages. Methods Metatarsal bones obtained from 20 human cadavers with similar bone quality were divided into two groups: Chevron osteotomy was applied to the 1st group and reverse offset‐L osteotomy was applied to the 2nd group. The load‐to‐failure, displacement in the y‐axis, and total displacement values of both groups were compared statistically. Furthermore, bone densities were compared between the groups with computed tomography imaging. Results When outliers in both groups were excluded, a statistically significant difference was found in favor of reverse offset‐L (143 ± 42 vs. 204 ± 51.2 N, p = 0.02) in terms of failure load. The groups were similar in terms of displacement on the y‐axis and total displacement values. Bone densities were similar. Conclusion The reverse offset‐L osteotomy has been shown to withstand greater loads before failure compared to the standard Chevron osteotomy. This significant difference in load‐to‐failure may enable reverse offset‐L to provide reliable stability in osteotomies performed in advanced HV cases requiring higher shifts.

AbstractObjective To evaluate the serotype distribution and antibiotic resistance in pneumococcal infections in adults and to provide a perspective regarding serotype coverage of both current and future pneumococcal vaccines.Patients and methods This passive surveillance study was conducted with the Streptococcus pneumoniae strains isolated from the specimens of patients with pneumonia (materials isolated from bronchoalveolar lavage), bacteraemia, meningitis, pleuritis and peritonitis between 2015 and 2018. Serogrouping and serotyping were performed by latex particle agglutination and by conventional Quellung reaction using commercial type-specific antisera, respectively. The strains were analysed for penicillin, cefotaxime, erythromycin and moxifloxacin susceptibilities by E-test.Results In the whole study group (410 samples from adults aged ≥18 years), the most frequent serotypes were 3 (14.1%), 19 F (12%) and 1 (9.3%). The vaccine coverage for PCV13, PCV15, PCV20 and PPV23 was 63.9%, 66.6%, 74.1% and 75.9%, respectively, in all isolates. Penicillin non-susceptibility in invasive pneumococcal disease (IPD) was 70.8% and 57.1% in the patients aged

Abstract Background This study aimed to develop a classification system for lumbar disc degeneration using routine magnetic resonance images (MRIs) that is easily applicable and unaffected by existing classifications' limitations, and to compare its reliability, reproducibility, and discriminative power to the widely used Pfirrmann classification. Methods Five features were graded. This new classification system has eight grades, with at least one of these five features altering each grade. The T2‐weighted sagittal images were acquired using a rapid spin‐echo sequence with a repetition time of 2680 to 4900 milliseconds, an echo time of 100 to 109 milliseconds, and an echo train length of 17. Slice thick was 4 mm and the display field of view was 32 × 32 cm. The new classification system used five features: signal intensity, disc height, disc boundary regularity, and nucleus annulus separation. Increased signal intensity, decreased height, decreased regularity, and decreased nucleus‐annulus separation indicated degeneration. Four raters classified 400 discs from 80 patients using the Pfirrmann and Novel systems. Statistical analyses were conducted to investigate reliability and correlation. Results The overall ICC and kappa values were found to be higher in the novel classification. (0.988 indicating excellent agreement for ICC and 0.76/0.94 indicating good–very good agreement for kappa). The Kendall tau c value, which shows the correlation between the two classifications and indicates the validity of the new classification, was 0.872, which is very strong. Through the use of cross‐tabulations, the discriminatory power of the two newly added classification criteria was determined. Conclusions This study demonstrates the intra‐rater and inter‐rater reliability of an easy‐to‐use, discriminative novel morphometric MRI based classification system for lumbar disc degeneration. The differentiation of grades based on five distinct criteria may generate novel hypotheses regarding treatment selection and response monitoring, as well as new insights into the study of disc degeneration.

BackgroundResearch on how disclosure concerns affect health outcomes for people living with HIV (PLWH) has yielded inconsistent results. Theoretically, disclosure concerns could predict either poorer antiretroviral therapy (ART) adherence (PLWH worried about disclosure may not want to take their medication in front of others) or better ART adherence (stronger concerns may enhance treatment adherence to avoid unintentional disclosure). Furthermore, internalized stigma (which is positively associated with disclosure concerns) predicts worse ART adherence (an effect potentially in the opposite direction of the direct effect of disclosure concerns).Setting/methodsOne hundred eighty-six PLWH initiating HIV care at 4 US clinics completed measures of disclosure concerns, internalized stigma, and ART adherence. Viral load data were obtained from medical records. We examined the indirect effect of disclosure concerns on outcomes, adjusting for the suppressor effect of internalized stigma. That is, we examined whether the association between disclosure concerns and ART adherence/viral suppression is stronger and positive when controlling for the effect of internalized stigma.ResultsDisclosure concerns were more strongly associated with better viral suppression and ART adherence when internalized stigma was in the model, suggesting that internalized stigma suppressed this association. Similarly, internalized stigma led to higher disclosure concerns, which in turn led to better ART adherence and higher likelihood of viral suppression. However, internalized stigma also had a direct effect in the opposite direction of this indirect effect.ConclusionsFindings highlight the importance of addressing effects of internalized stigma and disclosure concerns jointly when attempting to understand effects on health outcomes among new-to-care PLWH.

Abstract Background Temporomandibular joint osteoarthritis (TMJ-OA) is a degenerative disease and manifests itself with pain and limitation of movement in the jaws. Arthrocentesis alone or in combination with intraarticular injections is one of the most commonly used treatment methods in these patients. The aim of the study is to examine the effectiveness of arthrocentesis plus tenoxicam injection and to compare it with arthrocentesis alone in patients with TMJ-OA. Methods Thirty patients with TMJ-OA who were treated randomly with either arthrocentesis plus tenoxicam injection (TX group) or arthrocentesis alone (control group) were examined. Maximum mouth opening (MMO), visual analog scale (VAS) pain values, and joint sounds were the outcome variables, which were evaluated at pre-treatment and at 1, 4, 12, and 24 weeks after treatment. Statistical significance was set at p

Background: Type 2 diabetes mellitus (T2DM) is a complex metabolic disease with a genetic predisposition. Methylenetetrahydrofolatereductase (MTHFR) gene is one of the candidate genes associated with T2DM and diabetic nephropathy (DN). This research was carried out to determine the frequency of the C677T polymorphism (rs1801133) of the MTHFR gene and examine the role of rs1801133 polymorphism in T2DM and DN development. Methods: DNA was obtained from peripheral blood samples (273 samples) using a DNA isolation kit. MTHFR rs1801133 polymorphism was determined using polymerase chain reaction (PCR), restriction fragment length polymorphism (RFLP), and electrophoresis. PCR products were cut by restriction enzyme HiNF I and analyzed by 2% agarose gel electrophoresis. The results were statistically analyzed. Results: Although MTHFR rs1801133 genotype frequencies showed statistically significant differences between the control and T2DM patient groups (p = 0.001), no statistically significant difference was found between individuals with and without DN. Conclusions: MTHFR gene rs1801133 polymorphism is related to T2DM but not to DN. CT and TT genotypes can be accepted as genetic markers.

There is limited research on the effects of stigma on health outcomes among new-to-HIV care individuals. We examined the effect of changes in internalized stigma over time on health behaviors and outcomes such as viral suppression, antiretroviral therapy (ART) adherence, and visit adherence among new-to-HIV care individuals. We also analyzed the mediating effects of adherence self-efficacy and depressive symptoms in these associations. Participants were 186 persons living with HIV who initiated care at four HIV clinical sites in the United States and had diverse geographical and ethnic backgrounds. Baseline and 48-week follow-up assessments included measures of internalized stigma, ART adherence, depressive symptoms, and adherence self-efficacy. HIV visit adherence and viral load data were extracted from clinic records. Age, race, gender, insurance status, and site were controlled in all analyses. Logistic regression analyses were used to examine predictors of adherence and viral suppression. Change (decrease) in internalized stigma was calculated by subtracting follow-up internalized stigma scores from baseline scores and served as the main predictor. Mediation analyses included calculation of 95% confidence intervals for the indirect effects using bootstrapping. Decreases in internalized stigma over time were positively associated with viral suppression, ART adherence, and visit adherence. Adherence self-efficacy significantly mediated these effects of decrease in internalized stigma on all outcomes. Depressive symptoms only mediated the association between decrease in internalized stigma and ART adherence. Interventions that address internalized stigma and depressive symptoms, as well as adherence self-efficacy, may significantly improve adherence and viral suppression outcomes for individuals new to HIV care.

Abstract Background The aim of this study was to develop an oil formulation from a local betabaculovirus. Hyphantria cunea Drury (Lepidoptera: Erebidae) granulovirus (HycuGV-Hc1) was isolated from the infected larvae to test its efficacy on the pest. The oil formulation was prepared by mixing the viral suspension with sunflower oil and some adjuvants and named HycuGV-TR61. Crude virus and the formulations were carried out on third instar H. cunea larvae using 1 × 104–8 OBs /ml concentrations and were exposed to temperatures (28, 35, and 42 °C) and UV-B light at different periods (0, 1, 3, 5 h). Results The mortality rate, which was 50% at the lowest concentration (1 × 104 OB/ml), reached 99.86% at the highest concentration (1 × 108 OB/ml). LC50 values of fresh and old forms were calculated as 0.64 × 104 and 0.87 × 104 OBs/ml, respectively. Application of shelf life showed that there was non-significant change in the pathogenic activity of the formulation with time. In the experiments, it was observed that the activity decreased as the temperature and time of exposure increased. Significantly difference in larval mortality was observed when fresh and old formulations were exposed to 0, 1, 3 and 5 h to UV-B, (old: 96.7, 86, 80 and 60%; fresh: 97.1, 90, 85 and 62%, respectively). Conclusions The results revealed superior aspects of HycuGV-TR61, which was developed as a local viral biopesticide, its resistance to abiotic factors and its potential to be used in pest control.

INTRODUCTION: Cervical cancer is the fourth most common cancer in worldwide and the leading cause of death among gynecological cancers. Neferine is a bisbenzylisoquinoline alkaloid isolated from the seed embryo of Nelumbo Nucifera. Studies have shown that Neferine has anticancer effects on a variety of human cancer cells. Neferine can induce apoptosis in cancer cells by various mechanisms. In this article; we aimed to show the apoptotic effects of neferin, a natural compound on HeLa cells. METHODS: In this experimental study, 1 human cervical cancer cell line and 1 human embryonic kidney cell line as a control group were used. Cell cultures were obtained from the American Type Culture Collection. 3-4,5-dimethyl-thiazolyl-2,5-diphenyltetrazolium bromide test was performed to determine the maximal inhibition concentration dose of neferin. Expression levels of apoptotic genes and antiapoptotic genes were determined by real-time polymerase chain reaction. The study was repeated in triplicate. RESULTS: The maximal inhibition concentration dose at which neferin inhibited the viability of human cervical cancer cells was determined as 20 micromol. Also, Neferin increased the level of apoptotic genes while decreasing the level of antiapoptotic genes. DISCUSSION AND CONCLUSION: Neferin induced apoptosis by activating the expression of apoptotic genes on human cervical cancer cells.

INTRODUCTION: It was aimed to determine the presence of metallo-beta-lactamases (MBL) and oxacillinases (OXA) enzymes in Acinetobacter baumannii complex (ABC) isolates, which show decreased sensitivity to carbapenems isolated from blood cultures and to investigate the relationships of isolates among each other and with European clones (EU) I, II, III. METHODS: The study included ABC isolate which has reduced sensitivity to at least one of either imipenem or meropenem which was isolated from blood samples obtained from 74 patients who were admitted to the hospital between 2008 and 2009. Identification of isolates and their antimicrobial susceptibilities were performed using BD Phoenix Automated System (Becton-Dickinson, USA). OXA and MBL genes were investigated by polymerase chain reaction (PCR). The clonal relationship of the isolates was determined by pulsed-field gel electrophoresis (PFGE) method. RESULTS: MBL genes and blaOXA-24-like gene were not determined in any of the isolates. blaOXA-51-like was detected in all isolates, blaOXA-58-like gene in 32 isolates and blaOXA-23-like gene in 26 isolates. Using PFGE method, it was detected that fifty-five blood isolates carrying the blaOXA23-like and/or blaOXA-58-like gene were clustered under six clusters. The similarity of EU clones with clinical ABC isolates in the clusters was found to be over 90%. DISCUSSION AND CONCLUSION: ABC isolates producing oxacillinase in our hospital; The presence of association with EU clone III, which is reported very rarely in our country, and the detection of possible related isolates with EU clones I and II show the potential for the spread of these clones in our hospital and in our country.

Objective: Chevron osteotomy offers near‐excellent clinical results and adequate stability at lower shift percentages, among the techniques used to correct hallux valgus deformity. This cadaveric study aimed to compare the Chevron osteotomy with the reverse offset‐L osteotomy, which may provide a greater surface area and a more stable geometry to withstand higher cantilever forces at higher shift percentages. Methods: Metatarsal bones obtained from 20 human cadavers with similar bone quality were divided into two groups: Chevron osteotomy was applied to the 1st group and reverse offset‐L osteotomy was applied to the 2nd group. The load‐to‐failure, displacement in the y‐axis, and total displacement values of both groups were compared statistically. Furthermore, bone densities were compared between the groups with computed tomography imaging. Results: When outliers in both groups were excluded, a statistically significant difference was found in favor of reverse offset‐L (143 ± 42 vs. 204 ± 51.2 N, p = 0.02) in terms of failure load. The groups were similar in terms of displacement on the y‐axis and total displacement values. Bone densities were similar. Conclusion: The reverse offset‐L osteotomy has been shown to withstand greater loads before failure compared to the standard Chevron osteotomy. This significant difference in load‐to‐failure may enable reverse offset‐L to provide reliable stability in osteotomies performed in advanced HV cases requiring higher shifts. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to investigate the relationship between refractive outcomes with the extent of retinal vascularization and severity of the plus disease in infants treated with intravitreal bevacizumab (IVB). Methods: Pre-IVB fundus images (PFIs), final fundus images (FFIs), and refractive outcomes of the 93 infants who underwent IVB monotherapy for type 1 and aggressive retinopathy of prematurity (A-ROP) were retrospectively evaluated. Quantitative measurements were performed on PFIs and FFIs. Pre-IVB plus severity was scored on a five-leveled scale. Correlation between spherical equivalent (SE) with pre-treatment and final extent of the temporal retinal vascularization and pre-treatment severity of plus disease was analyzed. Results: There was a linear and low positive correlation between the extent of pre-IVB and final temporal retinal vascularization with final SE (p = 0.000, r = 0.267; P = 0.002, r = 0.274, respectively). There was a low negative correlation between the pre-IVB plus severity score with final SE (p = 0.012, r = -0.192). Gestational age (GA), birth weight (BW), IVB dose, presence of additional IVB, or laser treatments were not correlated with refractive outcome. Out of 171 eyes, 38 eyes had >1 D myopia. In the univariate logistic analyses, pre-IVB retinal zone and pre-IVB and final extent of the temporal retinal vascularization were found to be related to the development of >1 D myopia (p = 0.002, odds ratio (OR) = 0.298; P = 0.000, OR = 0.281; P = 0.001, OR = 0.317; respectively). Conclusion: Our study indicates that the pre-treatment and final extent of retinal vascularization were the main parameters that were related to final refractive outcomes in IVB-treated eyes for type 1 and A-ROP.

Objective: With the increasing use of wearable technologies (smartphones and smartwatches), it has become possible to measure vital signs outside healthcare institutions without the need for an additional medical device. With the advancement in technologies, the accuracy of vital signs measured by smartphones and smartwatches has also increased. In this study, the accuracy of smart devices in the measurement of heart rate and saturation, which are two vital signs that are difficult to detect in conditions such as hypotension were investigated. Materials and methods: The study was prospectively conducted in a tertiary healthcare center. In hypotensive patients who presented to the emergency department (ED) and required an arterial blood gas evaluation, oxygen saturation and heart rate values measured by a smartphone, those measured with a vital signs monitor (VSM) at the time of admission to the ED and oxygen saturation values measured by a blood gas analyzer (BGA) were compared. Results: A total of 200 patients, 117 women and 83 men, were included in the study. It was determined that the correlation coefficients of the heart rate values measured by the vital signs monitor and smartphone were in a high statistical agreement. When the saturation values measured by the vital signs monitor, smartphone, and blood gas analyzer were compared, it was found that the intra-class correlation coefficients of the saturation values measured by the smartphone with reference to the blood gas analyzer and vital signs monitor were 0.957 and 0.949, respectively, indicating an excellent agreement. Conclusion: Smartphones have as high efficiency as reference devices in measuring heart rate and saturation in hypotensive patients. In this way, hypotensive patients who need medical help can also have the opportunity to measure their vital parameters with their smartphones, without the need for any other medical device, before applying to the hospital or emergency health system. This may contribute to the improvement of the quality of life of the patients and the early and accurate information of the health care providers about the patient's health parameters.

Purpose: Bisphenol A (BPA) is an environmental toxin, clearly capable of initiating epigenetic modifications, leading to the development of numerous human illnesses such as metabolic, reproductive, and behavioural abnormalities. It also causes oxidative stress, which has been shown to be alleviated by selenium supplementation. The purpose of this study was to determine the effect of training of BPA exposure during pregnancy on urine BPA levels. Methods: This research enrolled 30 pregnant women who were in their first trimester and were free of chronic illness. Women were asked questions on their sociodemographic features, anthropometric measures, obstetric characteristics, BPA awareness level, BPA exposure and the Health Practices in Pregnancy Scale as a Pre-test and Post-Test. The initial urine samples were taken from women in their first trimester and stored in BPA-free bags. Then, training was delivered to encourage BPA exposure reduction and maternal health awareness. First-trimester face-to-face instruction and brochure distribution were followed by refresher, reminder, and follow-up trainings during the second and third trimesters. Urine samples from women in their second and third trimesters were obtained again. The levels of BPA in urine were measured using the liquid chromatography-mass spectrometry on 90 samples. Each person's urine concentration differs, thus the creatinine level in all samples was also calculated and compared to the BPA content, and the results were evaluated. Results: Our study shown that BPA exposure may be lowered by training. It has been demonstrated that reducing BPA exposure and increasing knowledge can result in an improvement in health status. Additionally, it has been demonstrated that trainings greatly minimize exposure-causing behaviours. Conclusion: It was discovered that while the duration of a single training does not make a meaningful effect, the continuing of reminder trainings did make a substantial difference in the urine BPA level.

Abstract The purpose of this study was to evaluate the antifibrotic and antioxidant roles of theophylline (Theo), a bioactive compound, in bleomycin (BLM)-induced pulmonary fibrosis in Wistar albino rats. Assigned into 4 groups were 32 Wistar albino rats, comprising the control group (administered 0.9% isotonic saline), BLM group (treated with BLM at a dose of 2.5 mg/kg), BLM+Theo group (treated with Theo at a dose of 75 mg/kg + BLM at a dose of 2.5 mg/kg), and Theo group (treated with Theo at a dose of 75 mg/kg). In the BLM group, a significant decrease was observed in the catalase and glutathione peroxidase enzyme activities, and reduced glutathione (GSH) (p < 0.05, p< 0.05, p< 0.001, respectively), while the malondialdehyde (MDA) levels (p< 0.001) were significantly elevated when compared to the control group. However, the MDA levels in the BLM+Theo group were also significantly higher than in the control group (p< 0.01). Similarly, the GSH levels were significantly higher in the BLM+Theo group than in the BLM group (p< 0.05). The results indicated that Theo reduced the BLM-induced activation of nuclear factor-kappaB (NF-κB) and decreased interleukin-6 (IL-6) levels, together with significant amelioration of the immunohistochemical and histopathological architecture in the lung tissues. It was concluded that the administration of Theo had a positive effect on the GSH level, and activation of NF-κB and IL-6 expression, which were significant proinflammatory markers in the BLM-treated rats.

Abstract The role of oxidative stress, as well as inflammation in the pathogenesis of methotrexate (MTX)-induced oral mucositis, is a known fact. The anti-inflammatory, antitumor, antimicrobial, and antioxidant properties of taxifolin—the effect we tested against MTX-induced oral mucosal damage—are well known. Objective Evaluating biochemically and histopathologically the effects of taxifolin on methotrexate-induced oral mucosal damage in rats. Methodology In the taxifolin+MTX (TMTX) group, 50 mg/kg taxifolin was orally administered to rats by gavage. In the MTX and healthy (HG) groups, normal saline was applied to rats as solvent by the same method. One hour after administration of taxifolin and solvent, 5 mg/kg MTX was orally administered to rats in the MTX and TMTX groups. Taxifolin and methotrexate were administered once a day for 30 days. Macroscopic, biochemical, and histopathological evaluations were performed on the inner cheek and tongue tissues of rats. These parts were removed after rats were killed with a high-dose anesthesia. Results Taxifolin with MTX prevented the increase in oxidant and pro-inflammatory parameters, such as malondialdehyde (MDA), tumor necrosis factor alpha (TNF-α), interleukin 1 beta (IL-1β), interleukin 6 (IL-6), on the inner cheek and tongue tissues of rats. Moreover, taxifolin antagonized the decrease in total glutathione (tGSH). Taxifolin decreased MTX-induced histopathological damage. Conclusion These findings suggest that taxifolin may be useful to treat MTX-associated oral mucositis.

Introduction: Although there are many forms of education, learning by doing is one of the most efficient ways of learning in the field of medicine. In Turkey, intern doctors can perform and observe many emergency interventions in the presence of supervisors during their emergency service internship. This study aimed to examine whether intern doctors have developed the necessary emergency response skills concerning some vital situations after emergency medicine internship involving their applied training and observation. Methods: This prospective cross-sectional study was conducted between June 2, 2022, and September 1, 2022, in the emergency department of a tertiary hospital. In the study, the emergency response skills of intern doctors were measured with a questionnaire prepared using scenarios in which emergency situations were described. Results: The participants’ emergency response skills were improved in the most of emergencies described in the questionnaire. However, there was no significant improvement in emergency intervention skills related to the approach to ventricular tachycardia and multi-trauma patients (P=0.771 and P=0.45, respectively). Conclusion: Doctors doing internship in the emergency medicine clinic receive both theoretical and applied training, which increase their ability to respond to emergency situations. However, there is a need to identify emergency situations in which internship training does not sufficiently improve intervention skills and try new methods to improve the related skills.

Objective: Nowadays, non-invasive methods are emerging in the evaluation of cardiovascular diseases. The aim of this study was to determine the diagnostic performance of cardiac magnetic resonance (CMR) imaging and cardiac ultrasound imaging (Echo) in cardiac patients diagnosed with Echo previously. Methods: In total of 32 various cardiac patients with Echo findings including congenital and acquired heart pathologies who applied to our clinic were included in the study. The distribution of cardiac pathologies including valve dysfunctions, right and left ventricular wall lesions and movement disorders, atrioventricular hypertrophy, septal defect, pericardial effusion-mass, additional congenital or acquired vascular pathologies and additional thoracic pathology, age and gender correlations were determined. The CMR and Echo findings were compared statistically. Results: It was found that 12 (37.5%) of the individuals were female, 20 (62.5%) were male, aged between 6 and 80 years with an average age of 29.9 years. The cardiac parameters were positive in 27 (84.4%) patients according to Echo and were positive in 22 (68.8%) patients according to CMR. There was no statistically significant correlation between CMR and Echo for cardiac pathology detection rates (p> 0.05).However, only 18 out of 22 patients who were positive on CMR were positive on Echo. CMR was superior in detecting congenital cardiac pathologies. Conclusion: Echo has a diagnostic advantage and in general, CMR and Echo findings overlap in cases with valve dysfunctions, ventricular wall motion disorders, and hypertrophy, whereas we found that Echo findings were insufficient for diagnosis of congenital heart pathologies.