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Background Familial Mediterranean fever (FMF) is a hereditary autoinflammatory disease that requires lifelong colchicine treatment. Colchicine is the mainstay of the treatment which decreases the frequency and the severity of recurrent FMF attacks, also, prevents the development of amyloidosis. This study aimed to investigate the rates of colchicine treatment adherence in patients with FMF and the factors related to treatment non-adherence. Materials and methods This observational study was conducted with 179 patients with FMF between November 2018 and April 2019 in a tertiary rheumatology outpatient clinic. The sociodemographic and clinical data were recorded. Compliance Questionnaire on Rheumatology (CQR) was used to assess the treatment adherence and the Beliefs About Medicines Questionnaire (BMQ-T) was used to assess a patient?s beliefs about colchicine. The factors associated with adherence to the treatment were evaluated. Results The study included 113 male (63.1%) and 66 (36.9%) female patients with a mean age of 30 (25-44) years. The rate of the patients who declared regular colchicine usage was 66.5%. The frequency of non-adherent patients was 83.8% according to CQR. Treatment adherence was better in patients with comorbid diseases than those without (41.4% vs. 22%, respectively, p = 0.028). The frequency of married patients in the adherent group (72.4%) was higher than the non-adherent group (47.3%) (p = 0.013). The colchicine dose used in the adherent group was 1.5 (1.3-1.8) mg/day, whereas it was 1.5 (1.0-1.5) mg/day in the non-adherent group (p = 0.033). The adherence rate was rising with increasing scores of BMQ-T Specific Necessity. As the scores of BMQ-T General Overuse and General Harm increased, non-adherence to colchicine increased. Conclusion Evaluating adherence to colchicine treatment with objective methods is crucial to ensure sufficient treatment and prevent amyloidosis. Determining beliefs about colchicine may increase patients? adherence to treatment.

Background This study aimed to measure the levels of anxiety and burnout among healthcare workers, including attending physicians, residents, and nurses in intensive care units during the coronavirus disease 2019 (COVID-19) pandemic. Methods This is a cross-sectional survey analysis of healthcare workers in our institution. Data were collected on demographic variables, COVID-19 symptoms and test, disease status, anxiety level (assessed by the Beck Anxiety Inventory), and burnout level (measured by the Maslach Burnout Inventory). Subscales of the burnout inventory were evaluated separately. Results A total of 104 participants completed the survey. Attending physicians, residents, and nurses constituted 25%, 33.7%, and 41.3% of the cohort, respectively. In comparison to untested participants, those tested for COVID-19 had a lower mean age (p = 0.02), higher emotional exhaustion and depersonalization scores (p = 0.001, 0.004, respectively), and lower personal accomplishment scores (p = 0.004). Furthermore, moderate to severe anxiety was observed more frequently in tested participants than untested ones (p = 0.022). Moderate or severe anxiety was seen in 23.1% of the attending physicians, 54.3% of the residents, and 48.8% of the nurses (p = 0.038). Emotional exhaustion, personal accomplishment, and depersonalization scores differed depending on the position of the healthcare workers (p = 0.034, 0.001, 0.004, respectively). Conclusion This study revealed higher levels of anxiety and burnout in younger healthcare workers and those tested for COVID-19, which mainly included residents and nurses. The reasons for these observations should be further investigated to protect their mental health.

Background: The aim of the study was to evaluate the impact of stone density on operative complication rates in retrograde intrarenal surgery (RIRS). Materials and Methods: A total of 473 consecuti...

Affecting millions of people all over the world, the COVID-19 pandemic has caused the death of hundreds of thousands of people since its beginning. Examinations also found that even if the COVID-19 patients initially survived the coronavirus, pneumonia left behind by the virus may still cause severe diseases resulting in organ failure and therefore death in the future. The aim of this study is to classify COVID-19, normal and viral pneumonia using the chest X-ray images with machine learning methods. A total of 3486 chest X-ray images from three classes were first classified by three single machine learning models including the support vector machine (SVM), logistics regression (LR), artificial neural network (ANN) models, and then by a stacking model that was created by combining these 3 single models. Several performance evaluation indices including recall, precision, F-1 score, and accuracy were computed to evaluate and compare classification performance of 3 single four models and the final stacking model used in the study. As a result of the evaluations, the models namely, SVM, ANN, LR, and stacking, achieved 90.2%, 96.2%, 96.7%, and 96.9%classification accuracy, respectively. The study results indicate that the proposed stacking model is a fast and inexpensive method for assisting COVID-19 diagnosis, which can have potential to assist physicians and nurses to better and more efficiently diagnose COVID-19 infection cases in the busy clinical environment.

Purpose Retrograde intrarenal surgery (RIRS) is a safe and effective treatment option for upper urinary tract stones smaller than 2cm. Although several studies have documented perioperative and postoperative complications related to RIRS, there exists limited data regarding the readmission and rehospitalization of patients after RIRS. The aims of the study were to document the rates of readmission and rehospitalization after RIRS and to determine the predictive factors for readmission and rehospitalization. Materials and Methods In this study, we retrospectively analyzed patients who underwent RIRS for the treatment of renal stone disease and were unexpectedly readmitted to the hospital within 30 days after discharge. The hospital admission systems were used to determine readmissions and rehospitalizations. Readmission and rehospitalization rates, causes, and treatment procedures were evaluated. Univariate and multivariate analyses of clinicodemographic properties were performed to evaluate possible predictive factors for readmission and rehospitalization after RIRS. Results A total of 1,036 patients were included in the study. Of these patients, 103 (9.9%) were readmitted to the hospital. Among these readmissions, 35 patients (33.9%) were rehospitalized and 14 (13.6%) underwent surgical intervention. The most common reasons for readmission were renal colic and fever. The presence of preoperative pyuria (odds ratio [OR] 1.86), stone volume (OR 1.54), postoperative complications (OR 3.66), and stone-free status (OR 0.46) were predictive factors for readmission, whereas hospitalization time (OR 1.32), postoperative complications (OR 9.70), and stone-free status (OR 0.06) were predictive factors for rehospitalization after RIRS. Conclusion Nearly 10% of patients who underwent RIRS were readmitted to the hospital within the first month after discharge, and some were rehospitalized. Preoperative pyuria, high stone volume, presence of postoperative complications, and low stone-free status predicted this readmission and rehospitalization. Clinicians must recognize these predictive factors and inform their patients about this possibility.

Background/Aim: Adult-onset Still’s disease (AOSD) is a multi-systemic, autoinflammatory disorder. Several activity scores have been proposed but none of them have been adopted universally. Our aim was to create a clinician-friendly activity scoring system by using simple clinical and laboratory parameters. Methods: AODS patients according to Yamaguchi criteria were included in this cross-sectional, multi-center study. Derivation and validation cohorts were constituted. Demographic, clinical and laboratory evaluation at study visit; patients’, and physicians’ global assessments of disease activity (both VAS/ Likert scale) were recorded. To develop the score; ordinal logistic regression model was used to determine independent predictors of patient’ global assessments of disease activity. Clinically and statistically significant variables were weighted according to regression coefficients. Then, performance of the score was tested on the validation cohort. Results: Total of 197 consecutive AOSD patient (125 in derivation, 72 in validation cohorts) were included. Final Still Activity Score was fever (2 points), arthralgia (2 points, plus 1 point if arthritis was present in ≥2 joints), neutrophilia≥65% (1 point) and ferritin≥350 ng/mL (1 point) (maximum of 7 points). The SAS yielded an AUC value of 0.98(0.96-1.00) in the derivation cohort and 0.91(95%CI:0.85-0.98) in the validation cohort to discriminate high AOSD activity from moderate-inactive AOSD. Correlation of SAS with PtGA was 83% for the derivation cohort and 76% for the validation cohort. Conclusions: SAS has shown a good test performance to distinguish active AOSD patients from the others. SAS may be a useful method for evaluating disease activity of AOSD patients in daily practice. Funding: None to declare. Declaration of Interest: None to declare. Ethical Approval: The present study was conducted in compliance with the Helsinki Declaration and was approved by the Local Ethics Committee of Hacettepe University (GO- 20/824). A written informed consent form was completed by all participants.

Biometry is the science that enables living things to be distinguished by examining their physical and behavioral characteristics. The facial recognition system (FCS) is a kind of biometric system. FCS provides a unique mathematical model by determining the distance between the cheekbones, chin, nose, eyes, jawline, and similar positions using the facial features of the persons. Determining the gender and age group of chosen persons’ from face images is the main purpose of this study. It is targeted to distinguish the gender of the person and to obtain information about the person is children or adults by making essential works on the images. Convolutional neural network (CNN) is one of the deep face recognition algorithms that widely used to recognize facial images. This study is suggested as a study that detects noise in images using the fuzzy logic-based filter method and classifies this cleared data by gender using the matrix completion and CNN. TensorFlow which is a machine learning library that used to train and tests deep learning methods is used for experiments. The customer photographs taken during using the system are transformed into a matrix expression through a system trained using this algorithm. The obtained results indicated that the offered technique detects age and gender with a 96% accuracy value and 1.145 seconds time.

Background: We aimed to compare the clinical, laboratory and radiological findings of confirmed COVID-19 and unconfirmed patients. Methods: This was a single-center, retrospective study. Results: Overall, 620 patients (338 confirmed COVID-19 and 282 unconfirmed) were included. Confirmed COVID‐19 patients had higher percentages of close contact with a confirmed or probable case. In univariate analysis, the presence of myalgia and dyspnea, decreased leukocyte, neutrophil and platelet counts were best predictors for SARS-CoV-2 RT-PCR positivity. Multivariate analyses revealed that only platelet count was an independent predictor for SARS-CoV-2 RT-PCR positivity. Conclusion: Routine complete blood count may be helpful for distinguishing COVID-19 from other respiratory illnesses at an early stage, while PCR testing is unique for the diagnosis of COVID-19.

Inner ear malformations are one of the common causes of hearing loss. Common cavity is extremely rare among the types of inner ear anomalies. In this study, 8-years development period of a boy with common cavity is presented. In case of side effect such as facial nerve stimulation or insufficient hearing and language development with cochlear implant use, auditory brainstem implant may be indicated on the contralateral side. Our case had a re-implantation due to facial nerve stimulation after cochlear implant. After the second cochlear implant activation, everything seemed fine, facial nerve stimulation was seen again in the patient and the child refused to wear cochlear implant. This suddenly stopped his auditory perception and language development. Our patient started to regress. As a team, we decided that our case needed an auditory brainstem implant. Improvements in auditory perception and language development were observed in our patient after auditory brainstem implant.

This study aimed to investigate the effects of blood glucose control and the kidneys' functions, depending on fasting, in the streptozotocin-induced diabetes model in rats via TNF-α, NLRP-3, TGF-β1 and VCAM-1 mRNA expression in the present study. 32 Wistar albino rats were allocated randomly into four main groups; H (Healthy, n = 6), HF (Healthy fasting, n = 6), D (Diabetes, n = 10), DF (Diabetes and fasting, n = 10). Blood glucose and HbA1c levels significantly increased in the D group compared to the healthy ones (p 0.05). However, the fasting period significantly improved blood glucose and HbA1c levels 14 days after STZ induced diabetes in rats compared to the D group. Similar findings we obtained for serum (BUN-creatinine) and urine samples (creatinine and urea levels). STZ induced high glucose levels significantly up-regulated TNF-α, NLRP-3, TGF-β1 and VCAM-1 mRNA expression and fasting significantly decreased these parameters when compared to diabetic rats. Histopathological staining also demonstrated the protective effects of fasting on diabetic kidney tissue. In conclusion, intermittent fasting regulated blood glucose level as well as decreasing harmful effects of diabetes on kidney tissue. The fasting period significantly decreased the hyperglycemia-related inflammatory cytokine damage on kidneys and also reduced apoptosis in favor of living organisms.

OBJECTIVE To report the audiological, rehabilitative, and surgical outcomes of revision surgery for pediatric auditory brainstem implant (ABI) users. STUDY DESIGN Retrospective cohort. SETTING Tertiary referral center. PATIENTS Five pediatric ABI users who had revision surgery for device malfunctions. INTERVENTIONS Revision surgery for ABI malfunctions. MAIN OUTCOME MEASURES The findings of free-field audiometry with the device, the Meaningful Auditory Integration Scale, and the pattern discrimination, word identification, sentence recognition, and expressive and receptive language tests before the device failure and after revision surgery were obtained from the patient records and compared. RESULTS The revision rate for pediatric ABI was 6.45%. The Meaningful Auditory Integration Scale and expressive-receptive language scores showed improvements following revision surgery, while the aided thresholds, pattern perception, and word identification scores did not change. Individual differences in performance for these measures were observed. CONCLUSION Equal or improved performance after the revision surgeries in the current study showed that revision surgery is successful and important for pediatric ABI users. It is essential to consider remedying the loss of auditory input in sensitive periods of pediatric development.

Allogeneic stem cell transplantation (SCT) offers a potential cure for some hematological malignancies. For those patients without a family donor, unrelated donor (MUD) registries serve for identifying the best donor. In the present study, we aimed to give a cross-sectional report of our registry's activity and experience as the first established national MUD registry in the country. The study is retrospective and covers the period of 2016 to 2019. A total of 1855 donor searches were performed, and 642 were included in the study. All data were electronically obtained from the institutional database system. All SCTs were either 10/10 or 9/10 HLA matched and originated from an international registry. The most preferred stem cell source was peripheral blood (70.2%). A quarter of transplants were performed using bone marrow, and cord blood was used with a rate of 1.4%. The pandemic-related problems were similar for the other two national registries. During the pandemic, 71 of 432 patients who were searched for donors underwent stem cell transplant(SCT). The low number was related mostly with postponing of SCTs and/also difficulties in continuing of volunteering and in achievement of stem cells from international registry. During the Covid19 pandemic, the SCT activity of centers decreased according to the national, and international guidelines. The study revealed an organized, and multidirectional capacity of the registry and also the adaptation to unpredicted conditions such as pandemic. On the other hand, there is a need for more effective strategies for donor recruitment and retention programme.

Rosacea is a chronic inflammatory cutaneous disease that can be associated with cardiometabolic disorders. Oxidative stress is included in the pathogenesis of rosacea, and thiol-disulfide homeostasis (TDH) acts as antioxidants.To evaluate the TDH and metabolic parameters in patients with rosacea.A total of 42 rosacea patients and 50 controls participated in this prospective study. Demographic data, clinical entities, anthropometric measurements, and laboratory findings were recorded. Additionally, TDH was measured by an automated spectrophotometric method.Rosacea patients had greater body mass index values (27.9 ± 5.2 kg/m² vs. 23 ± 1.4 kg/m², p 0.001), waist-hip ratios (0.87 ± 0.1 vs. 0.77 ± 0.8, p 0.001), and insulin resistance (3.0 ± 2.0 vs. 1.3 ± 0.5, p 0.001) compared with controls. Disulfide levels, the disulfide/native thiol ratio (DNTR), and the disulfide/total thiol ratio (DTTR) were increased (p 0.05) in rosacea patients. Native thiol and total thiol levels and the native/total thiol ratio (NTTR) were decreased in rosacea patients (p 0.05). Different rosacea subtypes had no effect on oxidative stress markers. The duration of illness and insulin resistance values significantly correlated with DNTR and DTTR in the rosacea group (p 0.05).Rosacea has a metabolic milieu with increased oxidative stress and insulin resistance.

Objective We aimed to investigate effects of different concentrations (0.5-5%) of Sodium Hypochlorite (NaOCl) solution on healthy tissues, and determine the optimal concentration that does not harm to tissue. Materials and methods 30 tibias of 15 male Wistar albino rats were used. The tibias were randomly divided into 5 groups (Salin, 0.5%, 1%, 2.5%, and 5% NaOCl). Tibias were reamed intramedullary, and irrigated with 20 ml of saline or increasing concentrations of (0.5-5%) NaOCl. The tibias were embedded in paraffin and the sections were stained with hematoxylin-eosin. All sections were assessed for edema, acute inflammation, or necrosis according to their density, in bone marrow and soft tissues. Results Pairwise comparisons revealed that irrigation of tibia with saline or 0.5% NaOCl solutions was not statistically significant in terms of necrosis in the bone marrows (p=0.320). However, irrigation of rat tibia with saline caused less necrosis in the bone marrows compared to high concentrations (1%, 2.5%, and 5%) of NaOCl (saline and 1% NaOCl, p=0.017; saline and 2.5% NaOCl, p=0.0007; saline and 5% NaOCl, p=0.001). Conclusion As an irrigation solution, the effects of 0.5% NaOCl are similar to those of saline in terms of edema, inflammation, and necrosis. There is a need for evaluation of necrosis for extended periods such as one week or one month by immunohistochemical methods and flow cytometry.

PURPOSE This study aims to investigate the effects of loneliness, perceived social support, and depression on medication adherence of patients with ankylosing spondylitis (AS). DESIGN AND METHODS This cross-sectional study was conducted with 119 AS patients. Data were collected using the Morisky-Green-Levine Medication Adherence Scale, the UCLA Loneliness Scale (ULS), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Beck Depression Inventory (BDI). FINDINGS Nonadherent patients were younger (P = .033), scored higher on the ULS (P = .015), and BDI (P = .024) scales, and lower on the MSPSS scale (P = .039) and on family support (P = .002). PRACTICAL IMPLICATIONS The biopsychosocial aspects of patients with AS should be managed holistically to improve their medication adherence.

Günümüzde, birçok ülkede gıda güvenliği sistemleri ve yasal zorunluluklar uygulanmasına rağmen gıda kaynaklı hastalık ve salgınlar milyonlarca insanı etkilemeye ve binlercesinin ölümüne sebep olmaya devam etmektedir. Gıda kaynaklı hastalıklar ayrıca büyük ölçekli geri çağırmalara, pazar talebinin azalmasına ve tüketicilerin gıda ürünlerine olan güveninin kaybolmasına neden olmaktadır. Gıda güvenliği, üretim ortamında bulunan çeşitli patojenik ve bozulmaya sebep olan mikroorganizmaların gıdaya kontaminasyonu yoluyla tehlikeye girmektedir. Mikroorganizmalar genellikle gıda ortamına hammadde, hava, su, çalışan personel ve zararlılar yoluyla girmekte ve gıda işleme ortamında hayatta kalıp çoğalabilmektedirler. Hem gıda ürünlerini hem de üretim ortamını mikrobiyolojik olarak izleme kombinasyonu, gıda güvenliğini ve kalitesini sağlamak için kritik öneme sahiptir. Çevresel izleme programı (ÇİP), bir tesisteki genel hijyen uygulamalarının ve kontrol programlarının etkinliğini değerlendirerek, gıda ürünlerinin olası mikrobiyel kontaminasyonunu önlemeyi sağlayan bir izleme programıdır. Bu derlemede ÇİP kurulum metodolojisi ve literatürde yer alan mevcut araştırma çalışmaları harmanlanarak gıda sektörü için bilimsel modeller sunulmaktadır., Nowadays, foodborne outbreaks still affect millions and kill thousands of people despite implementation of food safety management systems and legal obligations in many countries. Foodborne illness also cause large-scale recalls, reduced market demand, and consumers loss of confidence in food products. Food safety and quality are endangered since microbiological contamination by various pathogenic and spoilage microorganisms in production environment. Microorganisms, generally introduced into the food environment through raw materials, pests, air, water, employees, can survive in food processing environments. The combination of microbiological monitoring of both food products and the production environment is critical to ensuring food safety and quality. Environmental monitoring program (EMP) is a monitoring program that allows evaluate the effectiveness of general hygiene practices and control programs to prevent possible microbial contamination of food. In this review, scientific models are given for food sector by combination the EMP methodology and existing research studies in literature.

Background and Objectives Osteoarthritis (OA) is a major public health burden. While knee and hip joints are most commonly affected, the glenohumoral (shoulder) joint is also frequently involved. We evaluated the pharmacokinetics and safety/tolerability of triamcinolone acetonide extended-release (TA-ER) and triamcinolone acetonide crystalline suspension (TAcs) in patients with shoulder OA. Methods In this phase 2, randomized, open-label, single-dose study (NCT03382262), adults with moderately-to-severely symptomatic shoulder OA for ≥ 6 months randomly received a single ultrasound-guided intra-articular (IA) injection of TA-ER 32 mg or TAcs 40 mg. Safety was evaluated throughout 12 weeks post-injection; blood samples for pharmacokinetic evaluations were collected pre-injection and through Day 85 post-injection. Results Among 25 randomized patients, 12 received TA-ER and 13 received TAcs. Most patients were female (60%), and all had moderate (72%) or severe (28%) shoulder OA. Adverse events (AEs) were reported by four (33%) patients following TA-ER and three (23%) following TAcs injection. No AE was serious or led to study discontinuation. Systemic exposure following TAcs was approximately 1.5-fold higher than that following TA-ER injection (geometric mean [GM] AUC0–last 873,543 vs 557,602 h × pg/mL). GM Cmax was also higher in TAcs- than TA-ER-treated patients (2034 vs 1283 pg/mL). Bioequivalence testing confirmed lower systemic TA exposure following TA-ER than TAcs IA injection. Conclusion These pharmacokinetic data confirm protracted release of TA from TA-ER following IA injection in patients with shoulder OA. Lower peak and systemic TA exposure following TA-ER suggests TA-ER could potentially confer an improved systemic safety profile over TAcs. Trial Registration Number NCT03382262 (December 22, 2017 retrospectively registered).

Background Little is known about the targets in the CNS that mediate ethanol analgesia. This study explores the role of spinal astrocyte aldehyde dehydrogenase-2 (ALDH2), a key ethanol-metabolising enzyme, in the analgesic effects of ethanol in mice. Methods Astrocyte and hepatocyte ALHD2-deficient mice were generated and tested in acute and chronic pain models. Cell-type-specific distribution of ALDH2 was analysed by RNA in situ hybridisation in spinal slices from astrocytic ALDH2-deficient mice and their wild-type littermates. Spinal ethanol metabolites and γ-aminobutyric acid (GABA) content were measured using gas chromatography/mass spectrometry and liquid chromatography/mass spectrometry. Results ALDH2 mRNA was expressed in both astrocytes and neurones in spinal cord slices. Astrocyte ALDH2-deficient mice had decreased expression of ALDH2 mRNA in astrocytes, but not in neurones. Astrocyte ALDH2 deficiency inhibited ethanol-derived acetate, but not acetaldehyde content in spinal cord tissues. Depletion of spinal astrocyte ALDH2 selectively inhibited ethanol-induced anti-nociceptive effect, but not the effect of ethanol, on motor function. Astrocyte ALDH2 deficiency abolished ethanol-induced GABA elevation. The ethanol metabolite acetate produced anti-nociception and increased GABA synthesis in a manner similar to ethanol. I.T. delivery of either GABAA or GABAB receptor antagonists prevented ethanol and acetate-induced analgesia. Conclusions These findings provide evidence that ALDH2 in spinal astrocytes mediates spinal ethanol metabolism and ethanol-induced analgesic effects by promoting GABA synthesis and GABAergic transmission in spinal cord.

Identifying substantial data and their normative values related to velopharyngeal structures in cleft palate patients may have clinical significance, in order to selection of surgical intervention and prediction of postsurgical outcomes. Previous studies are lack of referring certain anatomic locations or distances that may have affect on speech intelligibility, especially in dynamic state. The aim of this study is to investigate effectiveness of magnetic resonance imagings on the velopharyngeal sphincter function and the correlation with speech intelligibility after functional cleft palate repair. Seventeen patients with repaired cleft palate by single surgeon were enrolled in this study.Quantitative velopharyngeal measures from the oblique coronal plane and midsagittal plane in static and dynamic positions were collected. Patients' speech intelligibility was evaluated by using Pittsburgh Weighted Speech Scale and nasalance score was also measured. Correlation analysis methods were used for evaluating relation between MRI gathered measurements and speech intelligibility scores for determiningconsequential data.Our study shows that the velar knee-posterior pharyngeal wall distance measurement while explosive sound production is the most related data with speech intelligibility. Although future works with more sample number is needed, according to current study the authors think magnetic resonance imagings is a very helpful method in providing reliable information.

espanolIntroduccion: La relacion entre la inflamacion y el cancer ha sido durante mucho tiempo el foco de interes de los investigadores. Hay muchos marcadores inflamatorios estudiados con este proposito en la literatura. En este contexto, nos centramos en los efectos del recuento de plaquetas y el indice de masa plaquetaria (PMI) como marcadores inflamatorios en el diagnostico de cancer testicular localizado de bajo volumen. Materiales y metodos: Se incluyeron en el estudio 38 pacientes con cancer testicular localizado con una edad media de 30,84 ± 5,79 anos y 38 pacientes con varicocele como grupo control con una edad media de 32,8 ± 9,7 anos. El numero de plaquetas, el volumen medio de plaquetas y el valor de PMI se calcularon a partir de muestras de sangre periferica obtenidas. Resultados: El numero de plaquetas y los valores de PMI fueron estadisticamente significativamente mas altos en los pacientes con cancer testicular en comparacion con el grupo de control (p Conclusiones: Tanto el recuento de plaquetas como los valores de PMI se pueden utilizar como una prueba simple en el diagnostico de cancer testicular, ademas de los marcadores tumorales sericos precisos bien conocidos como AFP (alfa fetoproteina), hCG (gonadotropina corionica humana) y LDH (lactato deshidrogenasa). EnglishIntroduction: The relationship between inflammation and cancer has long been the focus of researchers' interest. There are many inflammatory markers studied for this purpose in the literature. In this context, we focused on the effects of platelet counts and platelet mass index (PMI) as inflammatory markers in the diagnosis of low-volume localized testicular cancer. Materials and methods: Thirty-eight patients with localized testicular cancer with a mean age of 30.84 ± 5.79 years and 38 patients with varicocele as a control group with a mean age of 32.8 ± 9.7 years were enrolled in the study. Number of platelets, mean platelet volume and value of PMI were calculated from peripheral blood samples obtained. Results: Number of platelets and PMI values were statistically significantly higher in patients with testicular cancer compared with the control group (p Conclusions: Both platelet counts and PMI values can be used as a simple test in the diagnosis of testicular cancer besides the well-known accurate serum tumor markers as AFP (alpha fetoprotein), hCG (human chorionic gonadotropin) and LDH (lactate dehydrogenase).

Background/aim The aim of this study is to present our experience on various endovascular treatment modalities of basilar fenestration aneurysms and to review our findings along with the literature data. Materials and methods A total of 24 patients with 26 BAF aneurysms who have admitted to our clinics were endovascularly treated, and two centers were used for this purpose. All patients were evaluated with computed tomography (CT), CT angiography (CTA) and digital subtraction angio graphy (DSA) before the procedure. Results Whole aneurysms were successfully occluded with 100 per cent rate of technical success. Procedure-related complications were encountered in two patients. Our comprehensive literature research has revealed that most of the papers related with the topic were case reports. In the literature, it has been reported from 46 studies that 101 patients with 113 BAF aneurysms were endovascularly treated between years 1993 and 2019. The overall positive outcome, clinical success, and the complication rate values of the studies in the literature were 97, 91 and 8.8 percent, respectively, whereas these values were 100%, 92% and 7.6% in our study. Conclusions Despite the low number of cases in the current study, it is by far the most comprehensive series in the literature to date. Our results suggest that BAF aneurysms can be successfully and safely treated with different endovascular techniques, with the gradually increased use of stents in recent years.

Aim:Traumatic rib fractures are a common injury in the trauma population and may cause severe pain in cases of both isolated rib fractures and chest injuries. The aim of our study was to compare the early pain control of intercostal block with that of intravenous analgesia + intercostal nerve block in patients with rib fractures admitted to the emergency department due to blunt thoracic trauma.Materials and Methods:Patients admitted to the emergency department due to blunt thoracic trauma in a tertiary medical facility were evaluated retrospectively. Forty-eight patients were included in the study. The patients were divided into two groups: on in which only intercostal nerve block was performed and another in which intravenous analgesia + intercostal block were performed concurrently.Results:Nine patients (18.7%) were given only intercostal block, while 39 patients (81.3%) were given intravenous analgesia + intercostal nerve block. Considering the early pain results of group A (intercostal nerve block) and group B (intravenous analgesia + intercostal nerve block), significant improvement was observed in group B in terms of pain results after the first 15 minutes.Conclusion:We conclude that the combination of intravenous nonsteroidal anti-inflammatory drugs or opioid derivatives and intercostal nerve block would be an effective combination in pain control in patients with rib fractures. In addition, intercostal nerve block would be beneficial in pain control and increase respiratory efficiency in patients with rib fractures, since it is both easy to apply and accelerates healing by providing effective analgesia. Due to these positive effects, we believe that it reduces the duration of hospital stay and would offer great advantages in terms of efficiency and cost.

Approximately 7 million people are reported to be undergoing radiotherapy (RT) at any one time in the world. However, it is still not possible to prevent damage to secondary organs that are off-target. This study, therefore, investigated the potential adverse effects of RT on the brain, using cognitive, histopathological, and biochemical methods, and the counteractive effect of the α2-adrenergic receptor agonist dexmedetomidine. Thirty-two male Sprague Dawley rats aged 5–6 months were randomly allocated into four groups: untreated control, and RT, RT + dexmedetomidine-100, and RT + dexmedetomidine-200-treated groups. The passive avoidance test was applied to all groups. The RT groups received total body X-ray irradiation as a single dose of 8 Gy. The rats were sacrificed 24 h after X-ray irradiation, and following the application of the passive avoidance test. The brain tissues were subjected to histological and biochemical evaluation. No statistically significant difference was found between the control and RT groups in terms of passive avoidance outcomes and 8-hydroxy-2′- deoxyguanosine (8-OHdG) positivity. In contrast, a significant increase in tissue MDA and GSH levels and positivity for TUNEL, TNF-α, and nNOS was observed between the control and the irradiation groups (p

The healthy development of the attachment which starts in the prenatal period and continues after the birth strengthens, positively supports the newborn care and contributes to raising healthy individuals in the future. This study was carried out to determine the effect of mother-fetus attachment that develops during pregnancy on mother-infant attachment in the postpartum period. This descriptive, correlational and longitudinal study was conducted with 150 volunteer mothers who could be reached again within 1-4 months after birth. Data were collected by the Questionnaire Form, the Prenatal Attachment Inventory (PAI) and the Maternal Attachment Scale (MAS). When the relationship between participants' PAI (41.20 ± 11.35) and MAS (26.05 ± 5.13) point averages was examined, it was observed that there was a weak, positive and statistically significant relationship between the two scales (

Background/Aim: Cardiovascular involvement in patients with coronavirus disease 2019 (COVID-19) is closely related to the course of the disease; however, this issue has not been adequately studied in Turkey. Thus, we aimed to investigate the electrocardiography (ECG) findings in noncritical patients with COVID-19 in Turkey. Methods: This retrospective cohort study was conducted on non-critical patients with COVID-19 with no history of any cardiac disease. The laboratory parameters and ECG findings of the patients at the time of admission were analyzed. Results: In total, 100 patients with a mean age of 56.8 (16.7) years were included in the study, among which 54 were males. The rate of patients having at least one abnormal ECG finding, ST segment pathology, and elevated troponin level were 58%, 26%, and 48%, respectively. The respiratory rate and mean troponin level were higher and the mean lymphocyte count was lower in patients with ST segment pathology than in patients without. The respiratory rate, fibrinogen level, and incidence of T negativity and abnormal ECG findings were higher, and the lymphocyte count was lower in patients with elevated troponin levels than in patients with normal troponin levels (P 0.03 mg/mL (P

Summary Background In Covid-19 pneumonia, high mortality rates reported in intubated patients have raised non-invasive methods of respiratory support. Objective We aimed to evaluate the impact of HFNC application on intubation requirement, intensive care length of stay, and short-term mortality in patients with COVID-19 pneumonia. Material-method Patients receiving oxygen by reservoir mask or HFNC therapy in our intensive care units due to COVID-19 pneumonia were included in the study. Group H consisted of patients who received HFNC, and Group K consisted of patients who received conventional oxygen therapy (COT). The number of patients intubated, duration of intensive care stay and short-term mortality were recorded. Results 43 patients were included. The short-term mortality and the number of patients with intubation need was lower in Group H. There was no significant difference between the Groups in the length of intensive care stay. Conclusion Administration of HFNC in respiratory failure secondary to COVID-19 pneumonia decreases the need for intubation and mortality.

Gebelikten itibaren ele alındığında yaşamın ikinci yılına kadar ilk 1000 günde optimum beslenme, hem çocukluk hem de yetişkinlik döneminde bireysel sağlık durumunu şekillendirmede önemli bir potansiyeline sahiptir. Bebeklik döneminde doğru beslenme, ilk altı ay tek başına, iki yıl ve ötesine kadar devam ettirilebilecek olan anne sütü ile miktarı ve besin değeri dikkate alınarak yeterli ve kaliteli tamamlayıcı beslenme ile beslenmedir. Literatürde prematüre bebeklerin (gestasyon yaşı

COVID-19 (SARS-CoV-2) causes multiple inflammatory complications, resulting not only in severe lung inflammation but also harm to other organs. Although the current focus is on the management of acute COVID-19, there is growing concern about long-term effects of COVID-19 (Long Covid), such as fibroproliferative changes in the lung, heart and kidney. Therefore, the identification of therapeutic targets not only for the management of acute COVID-19 but also for preventing Long Covid are needed, and would mitigate against long-lasting health burden and economic costs, in addition to saving lives. COVID-19 induces pathological changes via multiple pathways, which could be targeted simultaneously for optimal effect. We discuss the potential pathologic function of increased activity of the endocannabinoid/CB1 receptor system and inducible NO synthase (iNOS). We advocate a polypharmacology approach, wherein a single chemical entity simultaneously interacts with CB1 receptors and iNOS causing inhibition, as a potential therapeutic strategy for COVID-19-related health complications.

Seven-transmembrane receptors signal via G-protein- and β-arrestin-dependent pathways. We describe a peripheral CB1R antagonist (MRI-1891) highly biased toward inhibiting CB1R-induced β-arrestin-2 ...

siprofloksasin kullanımı sonrasında gelişen enfeksiyöz komplikasyonların ve bu komplikasyonları kolaylaştıracak risk faktörlerini ortaya çıkarmaktır. Gereç ve Yöntemler: Ekim 2018 ve Ekim 2020 tarihleri arasında gerçekleştirilen toplam 281 TRİB olgunun tıbbi kayıtları retrospektif olarak incelendi. Olgular profilaktik antibiyotik kullanımına göre Grup 1 (siprofloksasin grubu, n=216) ve Grup 2 (fosfomisin grubu, n=65) olmak üzere ikiye ayrıldı. Ortalama yaş, vücut kitle indeksi (VKİ), prostat spesifik antijen (PSA) düzeyi, prostat hacmi (PV), histopatolojik tanı ve sistemik enfeksiyona neden olabilecek risk faktörleri incelendi. Hastaların enfeksiyöz komplikasyonları epididimit, prostatit, pyelonefrit ya da ürosepsis kategorilerinde değerlendirildi. Bulgular: Hastalardan Grup 1 ve Grup 2’ye ayrılanların sırasıyla; ortalama yaşı 64,9±10,8 ve 64,3±7,3 yıl, VKİ 26,6±4,6 ve 27,3±3,8; total PSA düzeyleri 12,3±26,2 ve 11,9±18,4 ng/mL; PV 62,6±80,6 ve 58,9±35,4 cc idi. Grup 1’de 171 (%79,2) hastada, Grup 2’de ise 60 (%92,3) hastada komorbidite saptanmadı. Grup 1’de 5 olguda (%2,3), Grup 2’de bir olguda (%1,5) olmak üzere toplam 6 olguda enfeksiyöz komplikasyon gelişti (%2,1) ve enfeksiyon oranı bakımından gruplar arasında fark gözlenmedi (p=0,21). İki grupta da yaş, VKİ, PV, PSA düzeyi gibi parametrelerle diabetes mellitus ve hipertansiyon gibi komorbiditeler febril komplikasyonları predispoze etmedi (R2=0,085 (Cox-Snell), R2=0,486 (Nagelkerke), p=0,051). Sonuç: TRİB profilaksisinde oral siprofloksasin ve fosfomisin uygulaması benzer enfeksiyöz komplikasyon oranlarına sahiptir. Siprofloksasine karşı antibiyotik direncinin artışı da dikkate alındığında, fosfomisin kabul edilebilir enfeksiyöz komplikasyon oranlarıyla tercih edilebilir bir ajan olarak öne çıkmaktadır

Background: In this study, we present our experiences with local injections of triamcinolone and prilocaine in patients diagnosed with Tietze syndrome. Methods: Between January 2016 and January 2019, a total of 28 patients (12 males, 16 females; median age: 33 years; range, 21 to 51 years) who were diagnosed with TS in our clinic were retrospectively analyzed. Triamcinolone hexacetonide and prilocaine hydrochloride were injected into painful joints. At first week, pain sensation of the patients was recorded using the Pain Rating Scale developed by the British Pain Society. Pain was also assessed at one, two, and three weeks after injections qualitatively and based on physical examination. Results: At one week, the pain severity before the local injection treatment was above average the pain-related discomfort rates, and the response was quite favorable after the treatment (p=0.005 and p=0.001, respectively). A statistically significant rating was observed for treatment response and success (p=0.003). Totally 75% of the patients experienced more than 70% reduction in pain level after the injection. Conclusion: Our treatment approach involving injection of a mixture of steroid and a local anesthetic provides a rapid relief from pain, irrespective of age, sex, or employment status in patients diagnosed with Tietze syndrome.

Objective: Cancer is the most common cause of death after cardiovascular diseases. Cisplatin used in most types of cancer produces neurotoxicity. In this study, we aimed to investigate the effects of pomegranate peel extract (1) in different doses, as potent antioxidants, on the prevention of neurotoxicity due to cisplatin, which is frequently used in cancer treatment. Methods: In our study, newborn rat cortex was used. 2 hours following the application of PPE at 200, 300 and 400 mg/mL, neurotoxicity was established by applying cisplatin in 50 and 100 µM concentrations. Results: In our study, cisplatin decreased cell viability in increasing doses, while PPE showed the best neuroprotective effect in high doses. Increased total oxidant capacity due to toxicity was significantly improved by PPE4. The antioxidant capacity decreased in the toxicity group showed improvement with the administration of PPE4. At the same time, increased TNF-α mRNA expression after cisplatin administration was significantly reduced with the administration of PPE4. The increased caspase 3 (CAS 3) and caspase 9 (CAS 9) mRNA expression due to cisplatin showed improvement with the administration of PPE4. Conclusion: These results indicated that PPE could inhibit cisplatin-induced neurotoxicity, and these effects may be related to anti-apoptotic and antioxidants activities.

To the best of our knowledge, no other studies investigated acute myocardial infarction patients’ beliefs and knowledge level after the discharge education. The aim of the study was to investigate the effectiveness of planned discharge education on the beliefs and knowledge levels of CVD risk factors, medication compliance, dietary compliance, and individual follow-up in patients with acute myocardial infarction (AMI). A double-blind randomized controlled study was carried out with 100 AMI patients. All participants were randomly assigned to the intervention (n = 50) and control groups (n = 50). The first evaluation of all participants in both groups was on the day of discharge. Both groups were re-evaluated after 4 weeks. Patients’ beliefs on medication, diet, and individual monitoring were assessed by the Beliefs about Medication Compliance Scale (BMCS), the Beliefs about Dietary Compliance Scale (BDCS), and the Beliefs about Individual Follow-up Scale (BIFS), respectively. The knowledge of CVD risk factors was questioned with the Cardiovascular Disease Risk Factors Knowledge Level (CARRF-KL) Scale. The mean age of the patients was 59.10 ± 9.38 years in the intervention group and 58.86 ± 9.19 in the control group. After the planned discharge education, beliefs and knowledge levels of CVD risk factors, medication compliance, dietary compliance, and individual follow-up were significantly increased compared with the control group. Planned discharge education had a positive effect on the knowledge level of cardiovascular diseases risk factors, drug compliance, nutritional compliance, and individual follow-up in patients with acute myocardial infarction.

We study a real-life problem in which a nurse is required to check upon patients she is responsible for either by home visits or phone calls. Due to the large number of patients and their varying conditions, she has to select carefully which patients to visit at home for the upcoming days. We propose assigning priorities to patients according to factors such as the last visit time and the severity of their condition so that the priorities of unvisited patients increase exponentially by day. The solution to this problem should simultaneously specify which patients to visit on each day of the planning horizon, as well as the sequence of the visits to the selected patients on each day that obeys patients’ time window requests. The objective is to maximize the total priority of the visited patients primarily and to minimize the total traveling time secondarily. After having observed the computational limits of an exact formulation, we develop an Adaptive Large Neighborhood Search (ALNS) algorithm and a matheuristic to generate near-optimal solutions for realistic-sized instances. We measure the quality of both algorithms by computing the optimality gaps using upper bounds generated by Lagrangean relaxation. Tests on real-life data show that both algorithms yield high quality solutions, but the matheuristic outperforms ALNS in large instances. On the other hand, the ALNS algorithm provides very short running times, while the running times of the matheuristic increase exponentially with problem size.

This work studies the jitter buffer management algorithm for Voice over IP in WebRTC. In particular, it details the core concepts of WebRTC’s jitter buffer management. Furthermore, it investigates how jitter buffer management algorithm behaves under network conditions with packet bursts. It also proposes an approach, different from the default WebRTC algorithm, to avoid distortions that occur under such network conditions. Under packet bursts, when the packet buffer becomes full, the WebRTC jitter buffer algorithm may discard all the packets in the buffer to make room for incoming packets. The proposed approach offers a novel strategy to minimize the number of packets discarded in the presence of packet bursts. Therefore, voice quality as perceived by the user is improved. ITU-T Rec. P.863, which also confirms the improvement, is employed to objectively evaluate the listening quality.

Objective: The aim of this study was to examine the bacterial growth of the attendants’ hands and to determine the difference between the hospitalized and non-hospitalized attendants’ hands’ bacterial growth. Materials and Methods: In this study, the samples taken from the hands of attendants who were accompanying the hospitalized patients were examined. As a control group attendants who were not hospitalized was chosen. The samples were taken from the attendants’ hands and between the fingers using the swap which was wetted by steril serum physiological. Samples were inoculated to bood agar (BA) and eosine methylene blue agar (EMB) immediately. Inoculated plates were incubated 24-48 hours at 370C and growth was evaluated. Growth was identified using colony morphology, Gram stain, catalase and oxidase reaction. Catalaz positive bacteria were investigated for beta hemolysis, colony morphology on BA, Gram stain and microscopic appearance. Growth characteristics of Gram-negative bacilli on EMB and microscopic appearance were determined. All samples were identified by Vitec II. Results: All participants were women and their average age were 28.93±6.09 (min=18, max=45). It was determined that the rate of bacterial growth was 10% in case group and there was not growth in control group. The difference was statistically insignificant (χ² = 5.263, p = 0.056). Conclusions: In conclusion, the bacterial growth on 10% of participants’ hands in case group is an important and remarkable result. Being at the border of statistical difference between the two groups suggest that similar studies should be conducted with a larger sample group. Bangladesh Journal of Medical Science Vol.20(2) 2021 p.263-267

Objective To develop the readiness for hospital discharge scale for mothers and fathers with a premature infant hospitalised in the neonatal intensive care unit and to test the validity and reliability of this scale. Study design A cross-sectional study. Place and duration of study Sakarya University Education and Research Hospital, Sakarya, Turkey, from February to June 2020. Methodology This study was conducted with 136 mothers and 133 fathers, who met the inclusion criteria and agreed to participate in the study. After the content validity of the scale was evaluated, the exploratory and confirmatory factor analysis, reliability analysis (Cronbach Alfa) and test-retest reliability were performed. Results As a result of the factor analysis, items of the mother form and the father form were reduced to 22 and 20, respectively from the scale with 25 items. The confirmatory factor analysis fit indexes were calculated as χ²/df: 1.666, SRMR: 0.0598 in mothers and χ²/df: 2.110, SRMR: 0.0692 in fathers. The Cronbach's Alpha values were 0.911 for mothers and 0.948 for fathers. The test-retest intraclass correlation coefficient was observed as 0.835 for mothers and 0.942 for fathers. Conclusion In line with the validity and reliability analyses, it was determined that the mother and father forms of the readiness of the parents of premature infants hospitalised in the NICU for the discharge of infants and home care scale were valid and reliable scales for measuring parents' readiness for discharge. Key Words: Parent, Premature, Neonatal intensive care units, Scale, Development, Reliability and validity.

Purpose: To detect the presence of urotensin-2 (U-II) in the aqueous humor and evaluate the relationship between aqueous humor level and systemic diseases and pupil size. Methods: The study include...

Background: Pregnancy is one of the most important variables of women's life, causing psychological, biological and emotional changes. Objective: This study was carried out to determine the effect of pre-pregnancy body mass indexes (BMI) of pregnant women on their natal and postnatal anxiety levels. Methods: This descriptive and cross-sectional study was carried out in the gynecology and obstetrics clinic of a university hospital between 15 April and 15 May 2019. A total of 438 pregnant women who met the inclusion criteria and volunteered to participate in the study constituted the sample of the study. The data obtained using the questionnaire form consisting of 25 questions containing the introductory information of the pregnant women prepared by the researchers, and the ‘Concerns About perinatal and postnatal periods Scale’ were evaluated using the SPSS 22.0 statistical program. Number, percentage distribution, mean, standard deviation and Pearson correlation analysis were used in the analysis of data. Results: It was determined that the average age of 438 pregnant women participating in the study was 28.95 ± 5.39, the mean BMI before pregnancy was 24.07 ± 4.19 and the mean of the gestational week was 31.59 ± 8.90. In this study, it was concluded that the relationship between BMI before pregnancy and the “Anxiety of Inability to Receive Support from Their Husband After Birth” sub-dimension was statistically significant and the level of anxiety decreased as the BMI increased (p < .05). Conclusion: It has been determined that as pre-pregnancy BMI increases in expectant mother, the anxiety of not getting support from the spouse after birth decreases from the sub-dimensions of the Anxiety Regarding the Birth and Postpartum Period. There was no significant relationship between the other sub-dimensions of the scale and BMI. It suggested that the increase in weight gain may cause the pregnant women to need more support and this support may be provided by their spouses starting from the pregnancy period, which may have reduced postpartum fear., Giriş: Gebelik psikolojik, biyolojik ve duygusal değişimlere neden olan, kadın yaşamının en önemli değişkenlerinden birini oluşturmaktadır. Amaç: Bu çalışma, gebelik öncesi Beden Kitle İndeksi’nin (BKİ) gebelerin doğum ve doğum sonrası endişe düzeyini etkileme durumunu belirlemek amacıyla yapıldı. Yöntem: Tanımlayıcı ve kesitsel tipteki bu çalışma 15 Nisan- 15 Mayıs 2019 tarihleri arasında bir üniversite hastanesinin kadın hastalıkları ve doğum polikliniğinde yürütüldü. Araştırmanın örneklemini dahil edilme kriterlerine uygun, çalışmaya katılmaya gönüllü toplam 438 gebe oluşturdu. Araştırmacılar tarafından hazırlanan gebelerin tanıtıcı bilgilerini içeren 25 sorudan oluşan soru formu ile ‘Doğum ve Doğum Sonrası Döneme İlişkin Endişeler Ölçeği’ kullanılarak elde edilen veriler SPSS 22.0 istatistik programı kullanılarak değerlendirildi. Verilerin analizinde, sayı, yüzde dağılımı, ortalama, standart sapma ve Pearson korelasyon analizi kullanıldı. Bulgular: Araştırmaya katılan 438 gebenin yaş ortalaması 28.95 ± 5.39, gebelik öncesi BKİ ortalaması 24.07 ± 4.19 ve gebelik haftası ortalaması 31.59 ± 8.90 olarak belirlendi. Yapılan bu çalışmada gebelik öncesi BKİ ile ‘Doğum Sonrası Eşinden Destek Alamama Endişesi’ alt boyutu arasındaki ilişkinin istatistiksel olarak anlamlı olduğu ve BKİ arttıkça endişe düzeyinin azaldığı sonucu elde edildi (p < .05). Sonuç: Anne adaylarında gebelik öncesi BKİ’leri arttıkça Doğum ve Doğum Sonrası Döneme İlişkin Endişeler Ölçeği alt boyutlarından doğumdan sonra eşinden destek alamama endişesinin azaldığı saptandı. Ölçeğin diğer alt boyutları ile BKİ arasında anlamlı bir ilişki saptanmadı. Kilo alımındaki artışın gebelerde daha çok desteğe ihtiyaç duymasına neden olabileceği ve bu desteğin gebelik döneminden itibaren eşleri tarafından karşılanabilmesi nedeni ile doğum sonrası korkuyu azaltmış olabileceğini düşündürdü.

Background Only a few studies assessed the prevalence and the predictors of complementary and alternative medicine (CAM) use specifically in melanoma patients. The aim of this study was to assess the extent of CAM use in Turkish melanoma patients. Objective To assess the extent of CAM use and to compare sociodemographic and clinical characteristics between users and non-users in melanoma patients. Methods One hundred melanoma patients who were seen in outpatient clinics were included in a survey using questionnaire on CAM use. Results Twenty-seven patients used at least one type of CAM, the majority of which were herbs (73%). Turmeric (curcumin) was the most popular herb that was used alone or in conjunction with various other herbs (41%). Living in rural areas was significantly associated with CAM use (p = 0.02). The most common reason for CAM use was intent to cure of the disease (52%). The primary source of information about CAM was a close friend or a family contact (44%). CAMs were generally used together with conventional anticancer treatment modalities (64%) and they were ingested on a regular base (72%). CAMs could easily be acquired at regular herbal stores (88%). The patients experienced almost no adverse effects with CAM use; and most cases (71%) had confidence in CAM. About half of the patients consulted with their physicians about CAM use. Conclusion Minority, nearly one fourth of the melanoma cases used at least one type of CAM, the majority of which were herbs and turmeric (curcumin) was the most popular agent.

Diuretic volume reduction continues to be the mainstay of congestive heart failure (CHF) management globally. However, diuretic resistance is a critical topic that lacks standardized evidence-based management guidelines accounting for mechanisms of diuretic resistance, renal function, and co-morbidities. Major healthcare utilization consequences result from this. The authors herein reconcile the definition of renal functional decline with emphasis on biomarker-driven assessment. Novel goal-directed treatment approaches are reviewed including hypertonic saline, acetazolamide, sodium-glucose transporter inhibition, sequential nephron blockade and Elabela-APJ axis targeting are reviewed, as well as percutaneous visceral splanchnic sympathectomy (converting a volume-focused to a distribution-focused paradigm).