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Background Cardiopulmonary bypass (CPB) causes systemic oxidative stress response and endothelial damage in systemic organs. We investigated the effects of positive end-expiratory pressure (PEEP) and mechanical ventilation (MV) applications on oxidative stress in CPB. Methods Seventy-one patients were recruited and 60 completed the study. Randomized groups: MV off (Group 1); MV on, tidal volume (TV) at 3–4 mL.kg-1 (Group 2); MV on, TV at 3–4 mL.kg-1, PEEP at 5 cmH2O (Group 3), n = 20 in each group. As oxidative stress markers, we used glutathione peroxidase (GPx), total antioxidant status (TAS), total oxidant status (TOS), total and native thiol (TT, NT), malondialdehyde (MDA), and catalase. We also investigated the correlation between oxidative stress and postoperative intubation time. Results The postoperative GPx levels in Group 2 were higher than Group 3 (p = 0.017). In groups 2 and 3, TAS levels were higher postoperatively than intraoperatively (p = 0.001, p = 0.019, respectively). In Group 2, the TT levels were higher postoperatively than preoperatively and intraoperatively (p = 0.008). In Group 3, the postoperative MDA levels were higher than preoperatively (p = 0.001) and were higher than both postoperative levels of Group 1 and 2 (p = 0.043, p = 0.003). As the preoperative TAS (Group 2) decreased and the postoperative NT (Group 2) and catalase (Group 3) increased, the postoperative intubation time lengthened. Conclusion MV ( 3–4 mL.kg-1) alone seems to be the most advantageous strategy. Prolonged postoperative intubation time was associated with both increased NT and catalase levels.

Background/aim: Necrotizing enterocolitis (NEC) is a commonly seen life-threatening condition in newborns characterized by ischemic necrosis. This study aimed to investigate anakinras effects, an interleukin-1 receptor antagonist, on oxidative stress, inflammation, and tissue necrosis in an NEC rat model. Materials and methods: Forty Wistar albino pups were divided into four groups randomly as follows; group 1, control group; group 2, anakinra-treated control group; group 3, NEC group; and group 4, NEC and anakinra treatment group. The rats were given hyperosmolar formula feeding, and they were exposed to hypoxia after cold stress at +4 degrees C and oxygen in order to create the NEC model. On the 4th day of the experiment, the pups were decapitated, and the intestinal tissues were resected for biochemical and histopathologic examination. Results: Microscopic injury scores and apoptotic indexes were higher in group 3 than the control group (p < 0.001, p = 0.002, respectively), and there was a significant decrease after anakinra. Interleukin 18 and caspase-3 levels increased with NEC and decreased significantly after administration of anakinra (p = 0.006, p = 0.004, respectively). Malondialdehyde and glutathione peroxidase levels also increased compared with the control group (p = 0.019, p = 0.002, respectively). Conclusion: In this experimental study, we found that anakinra had antiinflammatory and antioxidant effects and was protective against intestinal injury and apoptosis.

Objectives: Arterial thrombo-embolic complications (ATEC) are still common during and after non-cardiac arterial procedures (NCAP) despite the administration of (a fixed bolus of) heparin. These ATEC could be due to existing individual differences in heparin sensitivity. The purpose of this study was to evaluate the feasibility and safety of an ACT guided heparin dose protocol and to evaluate if a more effective target ACT can be achieved during NCAP. Methods: In this multi-center prospective study, 194 patients undergoing elective and non-elective NCAP were enrolled and received heparin according to a heparin dose protocol which aimed to obtain a target ACT of 250 seconds (s.), measured by the Medtronic HMS Plus. Patients received a standardized bolus of 5 000 IU followed by additional boluses depending on the actual ACT. Primary outcome was the ACT value reached. Secondary outcomes were incidence of all ATEC and haemorrhagic complications. Results: The mean baseline ACT was 138 ± 17 s. The mean ACT five minutes after the initial heparin bolus of 5 000 IU was 197 ± 31 s. 48% of patients reached an ACT of 200 s. and six per cent of patients reached an ACT of 250 s. Additional dosages of heparin were administered in 72% of patients. With this ACT guided heparin protocol 86% of patients reached an ACT of 200 s. and 26% of patients reached an ACT of 250 s. A negative correlation was found between body weight and the ACT at T1 (p ˂ .001). ATEC and haemorrhagic complications occurred in 11.3% and 16.5% of patients. The lowest incidence of ATEC was found in patients with peak ACT between 200 and 250 s, namely 6.3%. Conclusion: This ACT guided heparin protocol proved to be feasible, safe and more patients reached an ACT > of 200 s. compared to a standardized heparin bolus of 5 000 IU. Further research is needed to investigate if ACT guided heparin administration could be preferable over not monitoring the anticoagulant effect of peri-procedural heparin and results in a lower incidence of ATEC, without an increase in haemorrhagic complications.

Pulmonary hemorrhage is an important cause of morbidity and mortality in premature infants. There are few studies on pulmonary hemorrhage and associated morbidities observed in premature. The aim of this study was to investigate the possible relationship between pulmonary hemorrhage and respiratory problems in premature infants.Premature infants aged 25-32 weeks who were born between January 2014 and January 2018 in the neonatal intensive care unit were included to the study. Of these premature infants, 28 were patients diagnosed as pulmonary hemorrhage and 56 were control cases with the same demographic characteristics without pulmonary hemorrhage. From the medical records of infants; clinical course characteristics such as duration of ventilation, duration of oxygen supplementation, hospital stay were detailed. The data was analyzed statistically.The duration of mechanical ventilation was significantly longer in the pulmonary bleeding group than in the control group (This study implicated that, pulmonary hemorrhage is related with respiratory morbidities in preterm infants such as BPD and prolonged respiratory support. At the same time, the other morbidities such as ROP prolonged hospitalization are higher in infants with pulmonary hemorrhage.In the follow-up of patients with pulmonary hemorrhage, defining respiratory problems and treatment and prophylaxis of comorbid conditions may be planned sooner.

In this study, different models were created to reduce bias by ensemble learning methods. Reducing the bias error will improve the classification performance. In order to increase the classification performance, the most appropriate ensemble learning method and ideal sample size were investigated. Bias values and learning performances of different ensemble learning methods were compared. AdaBoost ensemble learning method provided the lowest bias value with n: 250 sample size while Stacking ensemble learning method provided the lowest bias value with n: 500, n: 750, n: 1000, n: 2000, n: 4000, n: 6000, n: 8000, n: 10000, and n: 20000 sample sizes. When the learning performances were compared, AdaBoost ensemble learning method and RBF classifier achieved the best performance with n: 250 sample size (ACC = 0.956, AUC: 0.987). The AdaBoost ensemble learning method and REPTree classifier achieved the best performance with n: 20000 sample size (ACC = 0.990, AUC = 0.999). In conclusion, for reduction of bias, methods based on stacking displayed a higher performance compared to other methods.

A new type of coronavirus (COVID-19), detected at the end of December 2019 in Wuhan, China, can pass from person to person, spreading very quickly The COVID-19 outbreak has created stress among societies This study aims to evaluate the usability of Google Trends data in predicting and modeling the COVID-19 outbreak and the attitudes of different societies to it by using an infodemiological method The authors collected the search words related to coronavirus and their relative search volume (RSV) from 11 different countries affected by the COVID-19 outbreak from Google Trends A positive correlation was found between the trend rate of the words searched on the internet and the number of COVID-19 cases in countries related to the COVID-19 outbreak (p

Introduction: Benign Paroxysmal Positional Vertigo (BPPV) is a commonly encountered peripheral vestibular disorder. People exposed to massive earthquakes experience intense and long-term problem associated with dizziness. The purpose of our study is to investigate this relationship and to demonstrate the efficacy of the treatment modalities used in the management of patients with post-earthquake dizziness. Methodology: The study was carried out by examining the retrospective records of patients who presented with dizziness to the otorhinolaryngological outpatient unit before and after the Elazig earthquake that occurred on 24th Jan 2020. Parameters evaluated include patients’ age and gender, onset of dizziness, accompanying symptoms and comorbidities, videonystagmography (VNG) findings, pre- and post-treatment Visual Analogue Scale (VAS), Dizziness Handicap Inventory (DHI), and Hospital Anxiety and Depression Scale (HADS). Results: The number of patients who presented with dizziness to our outpatient clinic after the earthquake and were included in our study totaled 84. The number of patients who visited the outpatient clinic before the earthquake was identified to be 75. In the earthquake related group, while there was a statistically significant difference between residual symptoms (RS) and the need for repetitive repositioning maneuvers, there was no statistically significant difference detected for age, gender, and comorbidities. Also, no statistically significant difference was found in the pre- and post-treatment assessments of VAS, DHI, and HADS median values in the earthquake group. Conclusion: There was a remarkable increase in the number of patients presenting with dizziness in the early post-earthquake period. Management of these patients may differ from the classic BPPV. Residual symptoms appearing after performing repositioning maneuvers can be more commonly seen among these patients.

Objectives During the COVID-19 pandemic, healthcare professionals are recommended to use PPE to prevent the transmission of disease. Healthcare workers who use N95 FFR, which has an important place, experience complaints such as headache and dizziness. In this study, we plan to find the cause of these complaints and aim to clarify whether they are associated with the use of N95 mask. Method Healthcare workers first put on a surgical mask for at least 1 h and a maximum of 4 h, this process was then repeated on another day with the same workers wearing N95 masks. After removing the mask, capillary blood gases were taken and a questionnaire was given. Results Thirty-four participants over the age of 18 were included in the study; 19 participants were female (56%) and 15 male (44%). The results of the capillary blood gas analysis after the use of surgical mask and N95 mask, respectively: pH: 7.43 ± 0.03; 7.48 ± 0.04 (p

Objective: In this study, it was aimed to determine whether the flora bacteria growing in blood cultures were infectious agents or only contaminants, for this purpose the hemogram parameters and other demographic characteristics of the patients were evaluated. Materials and Methods: We evaluated 11.579 blood culture results using the BacT/ALERT® microbial detection system. The skin flora bacteria was detected in the blood cultures during one year and the rates of infectious agents among these bacteria were investigated retrospectively. The blood culture results, which were accepted as true bacteremia and contamination were compared in terms of positive blood culture flask count and inflammation markers (white blood cell count, neutrophil ratio, lymphocyte ratio and C-reactive protein levels). Results: The total number of blood culture test was 11.579. Out of this number, 8205 (70.87%) was free of microbial growth and there was 3374 (29.13%) with microbial growth. 2609 (77.3%) of the positive cultures represented skin flora bacteria, 2510 (96.2%) of them were coagulase negative staphylococci. Only 50 (1.9%) of the flora bacteria were considered as infectious agents in terms of clinical and laboratory findings in addition to culture. A statistically significant correlation was found between true bacteremia and white blood cell (WBC) count and C-reactive protein (C-RP) levels (p

OBJECTIVE: The global impact of COVID-19 pandemic has gained momentum rapidly. People have little information about SARS-CoV-2 (Coronavirus). Internet has become a frequently used tool to obtain information in recent years, while YouTube is one of the popular sources of information with many videos on its platform. This study aims to identify the topics regarding Coronavirus that people learned about on YouTube. The videos about Coronavirus were also evaluated in terms of the reliability of their source of information. METHODS: In total, 160 videos on Coronavirus that had 500,000 or more views were analysed. The latent Dirichlet allocation method was used in the process of identifying the topics that were then compared in terms of video parameters. The reliability of the source of information provided by videos was assessed with a modified DISCERN tool. RESULTS: A proportion of 15.6 % of these videos had a scientific content, while 45 % of these videos were about the process entailed by the COVID-19 pandemic. In terms of video reliability, the difference between video types was found to be significant; videos with scientific content had more reliable sources of information (p

Purpose: Perioperative inadvertent hypothermia (PIH) is the decrease in core temperature below 36°C. We aimed to assess whether PIH develops in patients operated under local anesthesia (ULA) for vitreoretinal surgery in the operating room and investigate active warming efficacy. Methods: Seventy-two patients were divided into two groups: Group 1 contained unwarmed patients (n = 36), and Group 2, warmed patients (n = 36). The core temperatures, heart rate (HR), and mean arterial pressure (MAP) of the patients were measured at the beginning of surgery, after 20 min, 40 min, 1 h, at the end of the operation, and during the postoperative period. Results: PIH incidence was 44.6% in Group 1, whereas no hypothermia was observed in Group 2. Patient temperatures at 20 min (P = 0.001), 40 min (P < 0.001), 1 h (P < 0.001), the end of the operation (P < 0.001), and the postoperative period (P < 0.001) were significantly higher in Group 2 than in Group 1. Patient HRs at the end of the operation and during the postoperative period were significantly lower in Group 2 (P = 0.005) than in Group 1 (P < 0.001). The intraoperative 40th (P = 0.044) and 60th (P < 0.001) minutes, end of operation (P < 0.001), and postoperative MAP (P < 0.001) values of Group 1 were significantly higher than those of Group 2. Conclusion: PIH may develop in patients operated ULA, especially with a low ambient temperature. Actively warming may help prevent the harmful effects of PIH.

Objective: Atrial fibrillation (AF) is the most common form of arrhythmia in hemodialysis (HD) patients. Fragmented QRS (fQRS) morphology has been proposed as an ECG marker to predict the risk of paroxysmal AF in various conditions. In this study, we aimed to investigate the association between risk of AF development and P dispersion (Pd) and fQRS morphology in HD patients. Methods: After analyzing the 24-hour Holter recordings of the patients, they were divided into 3 groups as without atrial runs (WAR), short atrial runs (SAR), and silent paroxysmal atrial fibrillation episode (SPAFE). In ECGs taken before HD, the presence of fQRS morphology was investigated, and Pd was measured. Results: As a result of the analysis of the 24-hour Holter ECG recordings, it was determined that 12 of the 74 patients had SAR, while 6 had SPAFE. The duration of hemodialysis was significantly longer in the SPAFE groups than the WAR group (p=0.026). It was found that fQRS morphology could be an independent predictor of SAR (odds ratio=0.056; 95% CI, 0.006–0.548; p=0.013). The incidence of fQRS morphology was significantly higher in the SPAFE group than the WAR group (p=0.002). However, this significance did not continue in the multivariate analysis. Pd was similar between the groups. Conclusion: This retrospective study is the first study that investigated the association of fQRS morphology with SAR and SPAFE in HD patients, and it showed that fQRS morphology may be useful in distinguishing HD patients with a high AF risk.

BACKGROUND Violence is an important public health problem that threatens the peace of mind in health institutions as well as in many other sectors. In recent studies, it was stated that violence occurs more frequently in healthcare centers compared to other establishments. In terms of being exposed to violence, healthcare personnel is at 16 times more risk. Violence against healthcare employees has increased gradually in Turkey and the world; it's a serious occupational hazard to consider. AIMS The aim of our study was to analyze the situation about violence against physicians, to emphasize its importance, to shed light on preventive measures and to create programs and to raise awareness of violence against physicians. METHODS This descriptive study was conducted between October-December 2017. A link was sent to the participants to participate voluntarily through the social media platforms mostly used by physicians and they were asked to fill out a questionnaire. RESULTS 83.3% of the 948 physicians that participated have experienced at least one episode of violence so far. The most common type of violence was verbal. More than half of violent events occurred in hospitals. One-third of the physicians did nothing in the face of violence, more than half could not report this situation due to lack of time, only one-quarter of those who sought support received it. Only 23.7% of the perpetrators were punished, while physicians saw the lack of deterrent sanctions as the main cause of violence. While 90.2% of physicians feel occupational burnout, 81.6% thought that physicians can protect themselves through effective legislation against violence in healthcare. CONCLUSION The Law on Violence in Health should be enacted and put into practice as soon as possible.

Objectives Heparin has a non-predictable effect in the individual patient. The activated clotting time (ACT) is used to measure the level of anticoagulation after administration of heparin. To date, appropriate heparin dose protocols and corresponding therapeutic ACT values have not been established in non-cardiac arterial procedures (NCAP). The aim of this review was to study the use of ACT monitoring during NCAP, and whether an optimal ACT could be determined based on the fewest arterial thrombo-embolic complications (ATEC) and bleeding complications. Methods This systematic review was performed in accordance with the PRISMA Guidelines. A systematic search was conducted in MEDLINE, EMBASE, and the Cochrane database. Any associations were evaluated between peri-procedural ACT levels and ATEC and bleeding complications detected during the same admission as the primary procedure or during 30 day follow up. Also, heparin dose protocols, peri-procedural target ACTs, different ACT devices, protamine use and pre-, peri-, and post-procedural anticoagulation therapy were evaluated. Results In total, 21 studies with 3982 patients were included, on both open and endovascular NCAP. Four studies were primarily designed to correlate peak peri-procedural ACT with clinical outcomes; however, the definitions of the results and the clinical outcomes were too heterogeneous for analysis. There was major variability in all studied aspects of ACT measurement, heparin and protamine use, and in the type of procedures in the included studies. Overall methodological quality of the included studies was poor. No randomised controlled trials were found. Studies were at a high risk of bias. Conclusions This systematic review demonstrates a lack of data and no consensus in the literature concerning the optimal ACT, and the possible association with haemorrhagic complications and ATEC during NCAP.

OBJECTIVE: The aim of this study was to compare the biomechanical properties of modified Kessler, Bunnell and Tsuge techniques in sheep Achilles tendon tear repaired using polyester and polydioxanone sutures which are also compared. METHODS: Sixty sheep Achilles tendons were cut transversely as a substitute for rupture and repaired using modified Kessler, Bunnell and Tsuge techniques with No. 2 braided polyester and monofilament polydioxanone sutures. Specimens were loaded to failure. Four biomechanical parameters – ultimate strength (US), strength to 2 mm gap (S2G), strength to 5 mm gap (S5G) and Young’s modulus (YM) – were recorded for statistical analysis. RESULTS: The Tsuge-Polyester group demonstrated the highest results regarding S2G (21.24±4.75 N) (p=.002) and S5G (38.91±7.45 N) (p=.002). According to YM, the Bunnell-Polyester group was the most superior (1929.9±512.28 kilopascal) (p=.009). In the repairs with the polydioxanone suture, Bunnell technique achieved the best purchase with regard to S2G (18.14±6.86 N) (p=.006) and S5G (35.69±13.49 N) (p=.015). The difference between the three repair techniques with the polydioxanone suture was statistically insignificant regarding US (p=.252) and YM (p=.338). Concerning the repairs with the polyester suture, the repair techniques demonstrated no statistically significant difference in terms of US (p=.195), S2G (p=.667), S5G (p=.689) and YM (p=.195). Regarding the mean S2G and S5G values, the polyester suture was significantly superior to the polydioxanone suture in modified Kessler repairs (S2G: p

Objective: Family physicians (FP) frequently encounter musculoskeletal system (MSS) disorders. Physicians, capable of making fine physical examination, are required for family health centers since diagnostic equipment is limited. Fine physical examination depends on adequate human anatomy (HA) knowledge. The aim of this study is to investigate the HA knowledge level on MSS among FP practicing in Kahramanmaras. Materials and Methods: This study was approved by institutional review board. 184 FP attended instructional seminars organized by City General Secretariat of Public Hospitals Association and 85 (46.1%) volunteered to be involved in the study. Volunteers were subjected to test including 20 multiple-choice questions on MSS anatomy. The test included four question groups (bone-ligament, muscle-tendon, nerve and vascular anatomy), each of which were comprised of five questions. The results were recorded and subjected to statistical analysis. Results: The average point of all volunteers was 8.1±3.2. According to question groups, average points were 3.0±1.0 for vascular, 2.4±1.3 for bone-ligament, 1.3±1.1 for muscle-tendon and 1.2±0.9 for nerve group with significant difference (p=0.001). Insignificant negative correlation was detected between reported duration of professional experience and received points considering question groups. Besides, there was no statistically significant difference between FP practicing in province and districts with regard to average points considering question groups. Conclusion: We believe further studies are required to evaluate knowledge level and interest of FP to HA. Besides, necessity for reinforcement of pre-graduate HA education and potentiality of postgraduate instructional seminars including practices for HA to improve health service quality and motivation of FP should be considered.Amaç: Aile hekimleri (AH) kas-iskelet sistemi (KİS) sorunları ile sık karşılaşmaktadır. Aile sağlığı merkezlerinde tanısal cihaz donanımının sınırlı olması nedeniyle iyi fizik muayene yapabilen hekimlere ihtiyaç duyulmaktadır. İyi fizik muayene yeterli Tıbbi Anatomi (TA) bilgisine dayanmaktadır. Çalışmamızda Kahramanmaraş’ta görev yapan AH’nin KİS üzerine TA bilgi düzeyinin araştırılması amaçlanmıştır. Yöntem: Çalışmamız yerel etik kuruldan onay almıştır. İl Kamu Hastaneler Birliği Genel Sekreterliği’nin düzenlemiş olduğu bilgi yenileme seminerlerine iştirak eden 184 aile hekiminden 85’i (%46,1) çalışmaya gönüllü olarak katıldı. Gönüllüler KİS anatomisi üzerine toplam 20 çoktan seçmeli sorudan oluşan teste tabi tutuldu. Test her biri beşer adet soru içeren dört soru grubundan (kemik-ligament, kas-tendon, sinir ve damar anatomisi) oluşuyordu. Sonuçlar kaydedildi ve istatistiksel değerlendirmeye tabi tutuldu. Bulgular: Tüm katılımcıların puan ortalaması 8,1±3,2 idi. Soru gruplarına göre puan ortalamaları yüksekten düşüğe doğru şu şekilde sıralanabilir: damar grubu 3,0±1,0; kemik-ligament grubu 2,4±1,3; kas-tendon grubu 1,3±1,1; sinir grubu 1,2±0,9. Soru grupları arasındaki farkın istatistiksel olarak anlamlı olduğu tespit edildi (p=0.001). Bildirilen mesleki tecrübe süreleri ile alınan grup puanları arasında anlamlı olmayan negatif yönlü bir ilişki saptandı. Ayrıca il merkezi ve ilçelerde görev yapan AH arasında, soru gruplarına göre puan ortalamaları açısından istatistiksel anlamlı fark saptanmadı. Sonuç: Daha ileri çalışmalarla AH’nin TA konusundaki bilgi düzeylerinin ve ilgilerinin değerlendirilmesinin gerekliliğine inanmaktayız. Ayrıca mezuniyet öncesi TA eğitiminin güçlendirilmesinin gerekliliği; pratik eğitimleri de kapsayan mezuniyet sonrası TA bilgi yenileme programlarının sağlık hizmetleri kalitesini ve AH’nin motivasyonunu artırması olasılığı göz önünde bulundurulmalıdır.

The aim of this study was to take ultrasonographic measurements of the length of the ligamentum flavum (LF), the LF-skin distance and the interspinous distance, which are critical for the application of neuraxial anaesthesia, with volunteers in the sitting position and with lateral tilt of the operating table at different angles to evaluate whether the target structures in neuraxial anaesthesia can be better visualised with the lateral tilt position and to determine whether or not these measurements change at different angles. The study included 29 volunteers. For the measurements, the operation table was first set into the neutral position and the length of the LF, the skin-LF distance and the interlaminar distance were measured at between L1-S1 spaces with a paramedian oblique sagittal approach with a linear ultrasound probe. Then the table was moved into 5°, 10° and 15° lateral tilt positions and the LF, LF-skin distance and the interlaminar distance were measured at the L1-S1 interspaces and recorded. At L2-3, L3-4, L4-5 and L5-S1 intervertebral interspaces, as the lateral tilt angle increased, so the measured LF length and interlaminar distance was determined to increase, this increase was statistically significant. In the ultrasonographic measurements of the skin-LF distance, at L3-4 and L4-5 intervertebral interspaces, there was a statistically significant increase. With lateral tilt applied to the table, there was determined to be an increase in ultrasonographic measurements of the LF length in the lumbar intervertebral interspaces. Therefore, for neuraxial blocks applied in the sitting position, the procedure may be facilitated with lateral tilt of the operating table.

BACKGROUND: The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines on hypertension management recommend new stage 1 hypertension thresholds (130-139/80-89 mmHg) for starting antihypertensive treatment. OBJECTIVE: To analyze the impact of the 2017 ACC/AHA guidelines on patients’ diagnoses within daily practice, in comparison with management using the 2018 European hypertension guidelines, regarding the new thresholds. DESIGN AND SETTING: Cross-sectional study conducted in a hypertension outpatient clinic at a tertiary-level public hospital. METHODS: The diagnosis of hypertension was defined separately using each guideline. The participants were patients who were attending the hypertension clinic, who were evaluated using the thresholds of two guidelines, based on cardiovascular risk factors, including age, gender, smoking status, diabetes mellitus, dyslipidemia, obesity, osteoporosis, chronic renal failure and family history of hypertension. RESULTS: After adapting the guidelines to the blood pressure values of our sample, 74.5% (n = 277) of the patients were diagnosed as hypertensive according to the blood pressure classification of the European Society of Cardiology (ESC) guidelines published in 2018, while 91.1% (n = 339) of the patients were hypertensive according to the new 2017 ACC/AHA guidelines. Multivariate regression analysis revealed that the significant demographic and cardiovascular risk factors associated with hypertension, based on the 2018 European Society of Hypertension (ESH)/ESC guidelines, were age (odds ratio, OR: 1.027; 95% confidence interval, CI: 1.001-1.054; P = 0.042), obesity (OR: 4.534; 95% CI: 1.830-11.237; P = 0.001) and family history of hypertension (OR: 2.199; 95% CI: 1.252-3.862; P = 0.006). CONCLUSIONS: The factors associated with the definition of hypertension may vary through changing the threshold values.

Purpose: The aim of this study was to evaluate the efficacy of adrenomedullin on damage associated with cisplatin ototoxicity created in an experimental animal model.Materials and Methods: A total of 32 Wistar Albino rats were separated into 4 groups of 8. To the rats in Group 1 (control), 1% acetic acid was administered intraperitoneally and intratympanically, to Group 2, cisplatin (10mg/kg/2 days) + intratympanic acetic acid, to Group 3, cisplatin + intraperitoneal adrenomedullin (12 µg/kg) and to Group 4, cisplatin +0.1- 0.3ml intratympanic adrenomedullin (12 µg/kg). The drugs were administered on the first 5 days and signal-to-noise ratio (SNR) measurements of the auditory brainstem response (ABR) and distortion product otoacoustic emissions (DPOAE) were made on days 0, 5 and 15. The rats were sacrificed and serum and ear tissue samples were taken for histopathological examination and examination of oxidative stress levels.Results: A statistically significant difference was determined in the cisplatin+intratympanic adrenomedullin group in the Auditory brain-stem response (ABR) measurements on days 0, 5 and 15 . In the Distortion product-evoked otoacoustic emission (DPOAE) measurements, the between-day differences at 16000 frequency in the cisplatin + intraperitoneal adrenomedullin group were accepted as statistically significantConclusion: Adrenomedullin, which is a strong vasodilator and antioxidant, was found to have a protective effect against cisplatin ototoxicity in the cochlea.

Summary Objective The aim of this study was to determine nodules using newly developed software with a computer-assisted visual process technique for the calculation of size. The effects of the ratios of nodule base and width were evaluated with voice acoustic analysis. Methods A total of 72 patients with pediatric vocal nodule were evaluated. Nodules were marked with the ImageJ News program on photographs obtained from the video recordings in the videostroboscopic examination and classified according to the Shah et al scale. Segmentation was applied automatically. The ratios were taken as base of nodule/width and base of nodule/vocal cord. In the voice acoustic analysis, basic frequencies (mean F0), jitter (local %), shimmer (local %), and harmonicity (mean harmonics-to-noise [mean HNR]) were evaluated. Results A statistically significant negative correlation was determined between the mean F0 value and the nodule base/width ratio (P = 0.042, r = −0.240). A negative statistically significant relationship was determined between jitter (%) and vocal nodule base/width (P = 0.009, r = −0.305). A statistically significant positive correlation was determined between mean HNR and vocal nodule base/width (P = 0.034, r = 0.324). In discriminant analysis, correct classification of the Shah et al scale degrees of the classifying variables was 73.6%. Conclusion Through collaboration with the biomedical engineering department, the results of this study determined new ratios in patients with pediatric vocal nodule. In voice acoustic analysis, the mean F0 was more affected by the width of the nodule, mean HNR was affected by the length of the base of the nodule, and jitter (%) was affected by the width of the nodule.

Introduction Sulcus vocalis (SV) subtypes are difficult to diagnose. Non-invasive techniques are sometimes not feasible in the diagnosis. The study aims to demonstrate the effectiveness and applicability of objective and subjective voice analysis combined with videolaryngostroboscopic examination (VLS) in the diagnosis of SV types. Material and Methods This is a retrospective study that includes patients who presented to Phoniatric outpatient clinic with complaints related to voice and diagnosed with SV on VLS examination between 2017-2020. The SV type was determined based on VLS findings and the patients were categorized into respective groups. Between- and within-group assessment of objective and subjective voice analysis of SV types was conducted. Results 47 patients were included in the study; Type I, Type II, Type III SV patients were 16, 17, and 14 in number, respectively. Fundamental frequency (F0) and Shimmer (%) values were significantly high in Type II and III SV cases, whereas the Maximum Phonation Time (MPT) was significantly low. GRBAS, Voice Handicap Index -10 (VHI-10), Reflux Symptom Index (RSI) scores were statistically significantly high in pathological SV and Voice Related Quality of Life (V-RQOL) scores were low. A moderate correlation between VHI-10 and V-RQOL and between RSI and V-RQOL was detected. Conclusions Objective and subjective voice analysis in Type II and III SV show a significant difference compared to Type I SV. The use of objective and subjective voice analysis combined with VLS examination can be helpful in the diagnosis of SV types.

Objectives Acupuncture is one of the oldest therapeutic interventions in the world for the treatment of pain, musculoskeletal diseases, and inflammation. This study aimed to investigate the effect of acupuncture on pain and IL-17 and IL-23 levels in the treatment of endovenous ablation. Methods The study was a randomized controlled trial. Patients were divided into group C (Control, n = 35) and group A (Acupuncture, n = 35). Group A patients were treated with acupuncture 24 h preoperatively. Follow-up checkups were conducted intraoperatively, postoperatively, and on the third day. Results There was no difference between men; there was a difference between women. Visual analog scale score was lower in group A at the intraoperative third and fifth minutes (0.00 vs. 1 and 0.00 vs. 0.5). Analgesic consumption was lower in group A at the end of third day ( p = 0.024). Postoperative IL-17 levels were higher than preoperative levels in group A (23.58 vs. 19.33). Postoperative IL-23 levels were lower than preoperative levels in group A (13.66 vs. 29.51). Group C showed increased postoperative IL-23 levels (28.81 vs. 33.51). Preoperative IL-17 and postoperative IL-23 levels were lower in group A than in group C (19.33 vs. 27.69 and 13.66 vs. 33.51). Although no difference was observed between group A and group C in preoperative saphenous vein diameter, postoperative saphenous vein diameter was smaller in group A ( p = 0.008). Saphenous vein diameter was smaller on day 3 in group A than in group C ( p = 0.043). Conclusion Acupuncture is effective on acute pain and level of IL-23 in the treatment of endovenous ablation using cyanoacrylate.

Background. Pain aggravates the autonomic response to stress and raises neuroendocrine stress hormone levels. We compared the effects of propofol and sevoflurane on postoperative pain and neuroendocrine stress hormones. A prospective, randomized, and controlled trial was conducted with 60 patients. Methods. We randomly allocated patients to groups P (remifentanil/propofol, n = 30) and S (remifentanil/sevoflurane, n = 30). Preoperative blood samples were taken to measure serum adrenocorticotropic hormone (ACTH), corticotropin-releasing hormone (CRH), glucagon, cortisol, aldosterone, and prostaglandin E2 (PGE2) levels. Intraoperatively and postoperatively, clinical parameters were monitored at different time points. The hormone levels were again measured in the follicular fluid and blood postoperatively. Result. Demographic data were similar. The preoperative serum aldosterone levels were significantly higher in group P ( p = 0.001 ). Preoperative and postoperative serum ACTH, glucagon, cortisol, and PGE2 levels were significantly different in group P ( p = 0.009 , p = 0.004 , p = 0.029 , and p = 0.002 ); serum ACTH, glucagon, and PGE2 levels increased while serum cortisol levels decreased postoperatively. In group S, serum CRH and aldosterone levels, both increased in the postoperative period compared to the preoperative ( p = 0.001 , p = 0.006 ). Postoperatively, glucagon and PGE2 levels were both higher in group P than group S ( p = 0.019 , p = 0.015 ). In postoperative follicular fluid, glucagon and PGE2 levels were higher in group P, while cortisol levels were higher in group S ( p = 0.001 , p = 0.007 , and p = 0.001 ). Conclusion. The effects of anesthetic agents were different. In group P, in the preoperative and postoperative evaluation, ACTH, glucagon, and PGE2 increased postoperatively, while cortisol decreased. In group S, aldosterone and CRH increased postoperatively. Glucagon and PG E2 were higher in group P than S, postoperatively.

Preeclampsia increases the risk of cardiovascular mortality and morbidity both during pregnancy and long term after the labor by causing cardiac changes that may lead to atrial and ventricular arrhythmias.We aimed to investigate noninvasive predictors of atrial and ventricular arrhythmias and cardiac structural changes in preeclampsia.The study included 34 preeclampsia patients as the study group and 33 healthy pregnant women as the control group. The presence of fragmented QRS morphology, P dispersion, QT dispersion, Tp-e/QTc ratio, inter- and intra-atrial electromechanical delay, left ventricular mass index was evaluated in the groups by 12 lead- ECG and standard and tissue Doppler echocardiography.Left ventricular mass index and relative wall thickness, and E/Em ratio was significantly higher in preeclampsia. Inter- and intra-atrial electromechanical delay and Tp-e were prolonged, and P dispersion, QT dispersion, and Tp-e/QTc ratio were increased significantly in patients with preeclampsia. In addition, fragmented QRS morphology was seen in 76.5% of patients with preeclampsia while it was present in only 27.3% of the control group (Preeclampsia causes significant cardiac structural and electrocardiographic alterations that may increase the risk of atrial and/or ventricular arrhythmias. A more thorough and earlier cardiac assessment and closer follow-up of these patients would be useful to avoid further complications.

WOS: 000461832600001, PubMed: 30892416, OBJECTIVE: In this study, the relationship between osteoporotic vertebral fractures and 9041 Guanine/Adenine and 3673 Guanine/Adenine polymorphisms related to the vitamin K epoxide reductase complex subunit-1 (VKORC1) gene in postmenopausal women with osteoporosis was investigated. METHOD: DNA was isolated from blood samples collected from 150 women with postmenopausal osteoporosis. Genotyping of the two polymorphic regions (9041 Guanine/Adenine and 3673 Guanine/Adenine) in VKORC1 was performed using polymerase chain reaction-restriction fragment length polymorphism analysis. The presence of radiographic fractures among the 150 patients was ascertained by using the Genant method. RESULT: At least one fracture was detected in 98 patients, and no fracture was observed in 52 patients on radiological images. We found no association between the 9041 Guanine/Adenine (p=0.283) and 3673 Guanine/Adenine (p=0.232) polymorphisms of the VKORC1 gene and the development of secondary postosteoporotic fractures in our study. CONCLUSION: There was no relationship between osteoporotic vertebral fracture and VKORC1 gene polymorphism in a postmenopausal Turkish population., Research Foundation of Eskisehir Osmangazi University Turkey [201211D08], This study was supported by the Research Foundation of Eskisehir Osmangazi University Turkey (Project No: 201211D08). No potential conflict of interest was reported.

We suppose that apigenin may inhibit the cellular process of sepsis-induced lung injury, which is considered to be a major cause of morbidity and mortality, and may improve inflammation and oxidative stress. The aim of this study was to investigate the potential protective effect of apigenin in a rat model of polymicrobial sepsis. Eight groups consisting of a total of 64 female Wistar albino rats were used for this study. Pro-inflammatory (TNF-α, IL-1-β, IL-6) and anti-inflammatory (TGF-β, IL-10) cytokine levels were measured with the enzyme-linked immunosorbent assay technique, oxidant/antioxidants parameters were measured using the spectrophotometric method and Bax and Caspase-3 immunohistochemical methods. TNF-α, TGF-β, IL-1β, and IL-6 levels significantly increased in the sepsis-induced group than in the control groups, while IL-10 levels decreased. Lipid peroxidase (LPO), an oxidative stress marker, increased, while the antioxidant defense parameters of superoxide dismutase (SOD), catalase (CAT) activities, glutathione (GSH) levels decreased. Although Bax and Caspase-3 immunoreactivity and H score levels significantly increased in the sepsis group, significant decreases were found in the groups treated with apigenin. In conclusion, we are of the opinion that apigenin treatment improves lung injury by inhibiting oxidative stress and inflammatory cell damage.

Objective: This study aims to determine the family physician’s level of awareness on vertigo. The approaches of family medical practitioners and ENT physicians on vertigo-diziness was determined, as well as the knowledge on most common vertigo-causing diseases and the diagnostic and therapeutic approaches of these diseases were contrasted. Methods: 352 physicians including 160 ENT physicians and 192 family physicians were included in the survey study. This study was conducted in the form of an online survey using “google forms” open web page. The questionnaire study was completed by specialist physicians, lecturers and actively working medical residents with more than 1 year of professional experience. Participants were asked to fill in a 34-item questionnaire involving sociodermographic information, the definition of vertigo, the commonest vertigo-causing diseases, the treatment of these diseases and their willingness for educationon vertigo. Results: Concerning the questionnaire item “what is the first disease that comes to mind when vertigo is mentioned?”, 95% of ENT physicians responded benign paroxysmal positional vertigo (BPPV) and 3% of them mentioned Meniere’s disease as their answer while 53% of the family physicians answered BPPV and 35% of them chose Meniere’s disease. 31% of ENT physicians and 63% of family physicians stated that they usually order blood tests to the patients presenting with vertigo complaint. The reply to the question “what is the basic treatment of BPPV” was repositioning maneuvers in 96% of ENT physicians and 71% of family physicians. The rate of performing repositioning maneuvers on patients with BPPV is 97% in ENT physicians and 29% in family medical doctors. Conclusions: The most crucial conclusion of this study is that family physicians participating in the questionnaire need more education about the distinction between vertigo and dizziness and some fundamental points about peripheral vertigo-causing diseases. At this point, we think that organizing courses on vertigo for family physicians will be beneficial in this regard.

TROP2 is a glycoprotein which is expressed in carcinomas rather than normal tissues and associated with poor prognosis. Immunohistohemical TROP2 staining was determined to be useful for diagnosing papillary thyroid carcinoma (PTC). In this study, we aimed to find out relationship between TROP-2 expression and the diagnosis of PTC, and clinico pathological parameters. This retrospective study was conducted on 270 cases (145 malignant and 124 benign). All histopathological parameters were re-evaluated blindly. We used 3 different scores for positivity for TROP2 expression (TES: Total estimation score, 5%, IRS:Immunoreactive score). Sensitivity was respectively according to TES, 5%and IRS; 55.5%, 54.1%, 51.4%. Specificity was 98.4% in all different scores. TROP2 positivity was correlated with older age in 5% score and TES. Absence of encapsulation, presence of infiltrating spreading, perineural invasion, extra thyroidal extension, tall cell and/or hobnail differentiation were associated with TROP2 expression in three different scores. Presence of lymphatic invasion was correlated with TROP2 positivity in 5% score and IRS. TROP2 expression was inversely proportional to follicular variant PTC and tumour size in 5% score. TROP-2 is a marker for aggressive behaviour rather than detecting malignancy, but if it stained and not malignant, it may also have potential for determining precursor lesion that demands further studies. Additionally, in 3 different scores, TES was most sensitive, but most variable that had correlation with TROP2 was seen at 5% score.

Objective: Our goal was to compare the operative and postoperative effects of del Nido cardioplegia (DN group) and blood cardioplegia (BC group) performed in cardiac surgery. Methods: A total of 83 patients were included, separated into DN group and BC group. The operative and postoperative effects of the two groups were compared for the first 24 hours until extubation. The operative and postoperative complete blood count (CBC), biochemical values and clinical parameters were compared. Results: The first control activated clotting time (ACT) levels in DN group patients were lower (P=0.003) during the operation. The amount of cardioplegia in DN group were lower than that in BC group (P=0.001). The pump outflow and postoperative lactate level of DN group were lower than those of BC group (P=0.005, P=0.018, respectively), as well as the amounts of NaHCO3 (P=0.006) and KCl (P=0.001) used during the operation. The same occurred with the first monocytes (Mo) and mean corpuscular volume (MCV) levels in the postoperative intensive care unit (P=0.006, P=0.002). However, the first glucose level and the eosinophil (Eo) level were higher in DN group (P=0.011, P=0.047, respectively). Conclusion: In the operative evaluation, the amount of cardioplegia, the first ACT levels, the pump outflow lactate level and the amounts of NaHCO3 and KCl in DN group were lower. In postoperative evaluation, measured level of lactate, Mo and MCV in DN group were all lower; their glucose and Eo levels were higher.

Background and objective: The aim was to investigate the effects of Turkish classical music on pain and oxidative stress in patients undergoing oocyte pick-up. Methods: The study was a randomized, controlled trial. The groups included Group NM (Non-Music), control group; Group PM, which comprised patients who listened to music before the operation; and Group CM, which comprised patients who listened to music both before and during the operation. Blood was drawn prior to the operation to measure the oxidative stress values. Pain, hemodynamic parameters, oxidative stress values were assessed postoperatively. Results: The number of patients requiring additional propofol was higher in Group PM than in Groups NM and CM (p = 0.003). The postoperative Visual Analog Scale (VAS) score were lower in Groups PM and CM than in Group NM (p = 0.001, p = 0.007) in the 1st and 60th minutes. The postoperative VAS score was lower in Group CM than in Group NM (p = 0.045) in the 5th minute. The postoperative additional analgesic requirements were lower in Groups PM and CM than in Group NM (p = 0.045). The postoperative blood glutathione peroxidase values were significantly higher in Groups PM and CM than in Group NM (p = 0.001). The postoperative catalase values were significantly higher in Groups PM and CM than in Group NM (p = 0.008 and p < 0.001). The preoperative malondialdehyde values were significantly lower in Groups PM and CM than in Group NM. The preoperative nitric oxide values were higher in Groups PM and CM than in Group NM (p < 0.001), whereas the postoperative nitric oxide values were lower in Groups PM and CM than in Group NM (p < 0.001). Conclusion: Turkish classical music has beneficial effects on pain and oxidative stress in oocyte pick-up patients. Resumo Justificativa e objetivo: O objetivo deste estudo foi investigar os efeitos da música clássica turca sobre a dor e o estresse oxidativo em pacientes submetidas a aspiração folicular. Método: Estudo randomizado controlado. Os grupos foram: grupo controle NM, sem música; Grupo PM, com pacientes que ouviram música antes da cirurgia; e Grupo CM, com pacientes que ouviram música antes e durante a cirurgia. Foi coletado sangue antes da cirurgia para avaliar os valores de estresse oxidativo. Dor, parâmetros hemodinâmicos e valores de estresse oxidativo foram avaliados após a cirurgia. Resultados: O número de pacientes que necessitaram de propofol adicional foi mais alto no Grupo PM do que nos grupos NM e CM (p = 0,003). A pontuação da Escala Visual Analógica (EVA) pós-operatória foi mais baixa nos Grupos PM e CM do que no Grupo NM (p = 0,001; p = 0,007), no 1° e 60° minutos. A pontuação da EVA pós-operatória foi mais baixa no Grupo CM do que no grupo NM (p = 0,045) no 5° minuto. A necessidade de analgesia pós-operatória adicional foi mais baixa nos Grupos PM e CM do que no Grupo NM (p = 0,045). Os valores pós-operatórios de glutationa peroxidase no sangue foram significantemente mais altos nos Grupos PM e CM do que no Grupo NM (p = 0,001). Os valores pós-operatórios de catalase foram significantemente mais altos nos Grupos PM e CM do que no Grupo NM (p = 0,008 e p≤ 0,001). Os valores pré-operatórios de malondialdeído foram significantemente mais baixos nos grupos PM e CM do que no Grupo NM. Os valores pré-operatórios de óxido nítrico foram mais altos nos grupos PM e CM do que no Grupo NM (p≤ 0,001), ao passo que valores pós-operatórios de óxido nítrico foram mais baixos nos grupos PM e CM do que no Grupo NM (p≤ 0,001). Conclusão: Música clássica turca exerce efeito benéfico sobre a dor e estresse oxidativo em pacientes na aspiração folicular.

Introduction: Schizophrenia is typically diagnosed through interviews with patients and their relatives. Thus, molecular biomarkers for this mental illness have recently become a hot topic for research. Oxidative stress and antioxidant parameters, such as catalase (CAT), superoxide dismutase (SOD) and malondialdehyde (MDA), have been investigated in schizophrenia; however, no studies have been conducted on the diagnostic performance of oxidative parameters. The goal of the present study is to examine the serum levels of SOD, CAT and MDA and to test the diagnostic performance of MDA in patients with schizophrenia. Methods: Thirty patients with schizophrenia and 30 healthy gender– and age-matched controls were included in our study. Symptom severity in the patient group was rated using the Positive and Negative Syndrome Scale (PANSS). Results: The serum levels of MDA, SOD and CAT were found to be significantly increased in patients with schizophrenia compared to the control group. A receiver operating characteristic curve showed a cut-off point of 2.72 nmol/ml for the MDA diagnostic measure. No significant correlation was found (p>0.05) between MDA, SOD and CAT activity and PANSS scores or the chlorpromazine equivalent and clinical characteristics. Conclusion: In summary, we found higher serum levels of SOD, CAT and MDA in patients with schizophrenia compared to healthy controls. MDA is considered a very good diagnostic lipid peroxidation marker, and further studies should be done to test its validity in patients with schizophrenia.

BACKGROUND Endothelial dysfunction (ED) is associated with high cardiovascular disease burden in hemodialysis (HD) patients. Vasohibin-1, an endothelium-derived angiogenesis inhibitor, is essential for endothelial cell survival, therefore it may be a promising marker of ED. We aimed to investigate whether vasohibin-1 levels are associated with ED markers in HD patients. METHODS Fifty HD patients and 30 healthy controls were included in the study. As markers of ED, endothelium-dependent flow-mediated dilatation (FMD), carotid intima-media thickness (CIMT), and pulse wave velocity (PWV) were examined. Serum vasohibin-1 levels were measured with ELISA. RESULTS Serum vasohibin-1 levels were low (387.7 ± 115.7 vs 450.1 ± 140.1 P = .02), FMDs' were impaired (6.65 ± 2.50 vs 10.95 ± 2.86 P

Objective: We aimed to investigate the protective effect of adrenomedullin (ADM) on cerebral tissue of rats with cerebral ischemia/reperfusion (I/R) injury. Methods: Thirty-two Wistar rats were randomized into four groups (n=8). In the I/R Group, bilateral common carotid arteries were clamped for 30 minutes and, subsequently, reperfused for 120 minutes. In the ADM Group, rats received 12 µg/kg of ADM. In the I/R+ADM Group, bilateral common carotid arteries were clamped for 30 minutes and, subsequently, the rats received 12 µg/ kg of ADM. Then, reperfusion was performed for 120 minutes. The Control Group underwent no procedure. Blood and brain tissue samples were collected for biochemical and histopathological analysis. Serum malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GPx) were analysed. Brain tissue was evaluated histopathologically and neuronal cells were counted in five different fields, at a magnification of ×400. Results: Brain MDA in I/R Group was significantly higher than in ADM Group. Brain GPx and SOD in I/R+ADM Group were significantly higher than in I/R Group. The number of neurons was decreased in I/R Group compared to the Control Group. The number of neurons in I/R+ADM Group was significantly higher than in I/R Group, and lower than in Control Group. Apoptotic changes decreased significantly in I/R+ADM Group and the cell structure was similar in morphology compared to the Control Group. Conclusion: We demonstrated the cerebral protective effect of ADM in the rat model of cerebral I/R injury after bilateral carotid artery occlusion.

OBJECTIVES Nesfatin-1 is an antiiflammatory, antiapoptotic, and anorexigenic peptide that has many roles in cardiomyocyte metabolism and viability. Inflammation plays an important role in the pathogenesis of atherosclerosis. In this study, we aimed to evaluate the alterations in serum nesfatin-1 levels of the patients undergoing coronary artery bypass operation due to atherosclerotic coronary artery disease. MATERIALS AND METHODS The study included 49 patients (30 men, 19 women) undergoing coronary artery bypass surgery. Serum nesfatin-1 levels were measured from venous blood samples of the patients collected before and three months after the operation. The relationship of nesfatin-1 levels with accompanying conditions was also analyzed. RESULTS Nesfatin-1 levels at third month, postoperatively, were significantly higher than preoperative nesfatin-1 levels of the patients (41.94±13.90 pg/ml and 27.06±8.01pg/ml, respectively; p

Raftlin is a large, major lipid raft protein of cell membranes. Raftlin levels have not been previously examined in patients with obstructive sleep apnea (OSA). Our study aimed to evaluate the changes in raftlin, interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor alpha (TNFα) values from the preoperative state to the third month postoperatively in patients undergoing expansion sphincter pharyngoplasty for OSA. Of 60 patients, 10 patients had mild OSA (AHI 5–14), 10 moderate (AHI 15–29), 10 severe (AHI ≥ 30), and 30 with AHI < 5 formed a control group. Preoperatively and at 3 months post-operatively, IL-6, IL-8, TNFα, and raftlin values were measured. Preoperatively, mean raftlin levels were 914.4 ± 62.7 pg/mL for controls, 910.0 ± 42.5 pg/mL in mild, 1000.5 ± 63.3 pg/mL in moderate, and 1386.3 ± 101.4 pg/mL in severe groups, with moderate and severe groups significantly elevated compared to controls (p < 0.001). Preoperatively to 3 months post-operatively, raftlin levels decreased significantly in each OSA group (p < 0.05). Levels of IL-6, IL-8 and TNFα followed similar patterns at baseline and after surgical intervention. Raftlin levels at the third postoperative month decreased significantly compared with preoperative levels in parallel with other markers of inflammation.

The aim of the study was to demonstrate the effect of blood electrolytes on the voice in chronic hemodialysis patients. The study included a total of 59 hemodialysis patients. Pre- and post-dialysis voice recordings were performed. In the analysis of vocal acoustic parameters, fundamental frequency (F0), jitter, shimmer, the noise-to-harmonics ratio (NHR), and F0 minimum and F0 maximum were measured. The Voice Handicap Index-10 (VHI-10), and maximum phonation time (MPT) were evaluated. For perceptual evaluation, the GRBAS scale was used. The duration of dialysis (years) and changes in weight during dialysis were recorded for each patient. From venous blood samples, measurements were taken of hemoglobin (Hb), albumin, Na+, K+, creatinine, uric acid, phosphorus, Ca++, and parathormone. The difference in the pre and post-dialysis values of F0, shimmer, NHR and MPT were found to be statistically significant (p = 0.001). The only variable determined to have an effect on the change in F0 values was uric acid, and the change in the F0 values was statistically significant (p = 0.009). The only variable determined to have an effect on the change in shimmer values was sodium, and the change was statistically significant (p = 0.034). The only variable determined to have an effect on the change in NHR values was creatinine, and the change in the NHR values was statistically significant (p = 0.028). Hb and the duration of dialysis were determined to have a statistically significant effect on the change in MPT values (p = 0.001). The results showed that uric acid was the agent creating a reduction in vocal cord vibration, the agent increasing the difference between vibration waves was Na+, and creatinine increased the NHR rate. The effect of these variables can be considered important in the understanding of vocal cord physiology.

Objectives: The aim of this study was to find out the effect of training on dimensions of spleen, kidney and liver in licensedfootball players.Methods: The study group consisted of 53 licensed male football players and 52 male non-athlete controls. The visceral organmeasurements were evaluated by ultrasonography. Independent samples t test and linear regression analysis were used for statisticalanalysis.Results: The mean age was 22.11±3.36 years in footballers and 22.71±3.92 years in controls. The spleen’s transverse axis length(4.89±0.52 cm) and liver’s anteroposterior length (11.9±2.35 cm) were significantly higher in the footballers compared to thecontrols (4.42±0.65 cm and 10.39±1.9 cm; p

Purpose Fuelled by the latest scandals at Siemens, VW or Walmart, there is a lively debate on the role of compliance and ethics programmes. Unlike large corporations, small and medium-sized enterprises (SMEs) arguably tend to underestimate their significance and lag behind. Hence, the purpose of this paper is to shed light on the process of introducing compliance codes and its effects on employee acceptance and performance. Design/methodology/approach In line with the qualitative methodology, the authors conducted 12 in-depth interviews with German SME employees which the authors evaluated with the qualitative content analysis. Findings As for the major contribution, results indicate the emergence of a lack of understanding, anger, anxiety and operational performance losses – both at the individual and the corporate level – especially when employees feel uninvolved in the initial introduction stadium. Originality/value Practicing managers may benefit from the recommendation to facilitate staff involvement at earlier stages. As for theory advancement, the authors draw on Kotter’s (2007) long surviving “Eight Steps Change Management Model” and find significant support for shifting the spotlight of attention towards the first four phases. The authors discuss the original value of the research, admit limitations and illuminate some promising future research trajectories.

During the wash-in period in low flow anaesthesia (LFA), high fresh gas flow is used to achieve the desired agent concentration. In this study, we aimed to evaluate the safety of fixed 1 L/min fresh gas flow desflurane anaesthesia in both the wash-in and maintenance periods in patients including the obese ones. 104 patients undergoing surgery under general anaesthesia were included. After endotracheal intubation, fresh gas flow was reduced to 1 L/min and the desflurane vaporizer was set at 18%. The time from opening the vaporizer to end-tidal desflurane concentration reaching 0.7 MAC was recorded (MAC 0.7 time). Throughout the surgery, hemodynamic variables, FIO2, MAC and BIS values were observed. MAC 0.7 time, BIS and MAC values at the start of surgery, number of adjustments in vaporizer settings, desflurane consumption were recorded. The average MAC 0.7 time was 2.9 ± 0.5 min. MAC and BIS values at the start of the surgery were 0.7 (0.6-0.8) and 39 ± 8.5 respectively. No individual patient had a BIS value above 60 throughout the surgery. Hemodynamic variables were stable and FIO2 did not fall below 30% in any patient. The number of adjustments in vaporizer settings was 56. Average desflurane consumption was 0.33 ± 0.05 mL/min. We demonstrated that LFA without use of initial high fresh gas flow during the wash-in period is an effective, safe and economic method which is easy to perform.

Introduction: While concentric left ventricular hypertrophy (cLVH) predominates in non–dialysis-dependent chronic kidney disease (CKD), eccentric left ventricular hypertrophy (eLVH) is most prevalent in dialysis-dependent CKD stage 5 (CKD5D). In these patients, the risk of sudden death is 5× higher than in individuals with cLVH. Currently, it is unknown which factors determine left ventricular (LV) geometry and how it changes over time in CKD5D. Methods: Data from participants of the CONvective TRAnsport Study who underwent serial transthoracic echocardiography were used. Based on left ventricular mass (LVM) and relative wall thickness (RWT), 4 types of left ventricular geometry were distinguished: normal, concentric remodeling, eLVH, and cLVH. Determinants of eLVH were assessed with logistic regression. Left ventricular geometry of patients who died and survived were compared. Long-term changes in RWT and LVM were evaluated with a linear mixed model. Findings: Three hundred twenty-two patients (63.1 ± 13.3 years) were included. At baseline, LVH was present in 71% (cLVH: 27%; eLVH: 44%). Prior cardiovascular disease (CVD) was positively associated with eLVH and s-blocker use inversely. None of the putative volume parameters showed any relationship with eLVH. Although eLVH was most prevalent in non-survivors, the distribution of left ventricular geometry did not vary over time. Discussion: The finding that previous CVD was positively associated with eLVH may result from the permanent high cardiac output and the strong tendency for aortic valve calcification in this group of long-term hemodialysis patients, who suffer generally also from chronic anemia and various other metabolic derangements. No association was found between eLVH and parameters of fluid balance. The distribution of left ventricular geometry did not alter over time. The assumption that LV geometry worsens over time in susceptible individuals, who then suffer from a high risk of dying, may explain these findings.

Objective: Although there are adult vaccination schemes in our country, there are serious deficiencies in the way that doctors direct the patients to this vaccination, but also patients have to make and demand these vaccinations. The aim of our study is to identify the shortcomings in this area and draw a roadmap for what arrangements should be made in terms of physicians and patients in order to increase adult immunization rates in primary care. Method: We conducted a two-phase, multicentered, descriptive clinical trial between October and December 2017. The first phase of the trial was carried out with patients from 3 Family Health Centers in Antalya, Istanbul and Osmaniye. Patients to be interviewed were selected voluntarily among Family Health Center’s applicants. The second phase of the trial was carried out with health workers, who were participated to trial from 26 different provinces of Turkey. In the process, a questionnaire of 19 questions was applied to primary health care workers by the internet. Results: 490 patients were included in the study. There was a significant difference between gender, age, education level and guideline follow-up and vaccination status of patients [p < 0.05]. 794 primary health care workers participated in the survey. There was a statistically significant difference between gender, age groups, education and follow-up of guidelines and vaccination status [p < 0.05]. Conclusion: As a result of the studies including our study about adult vaccination, only 10% - 20% of the targeted groups in adults can be vaccinated. However, just like in childhood during adulthood, vaccinations protect individuals from diseases and provide economic benefits. Firstly, the knowledge level of physicians on adult immunization should be updated with in-service trainings, they should first be convinced to vaccinate because they are in risk group and then they should be recommended vaccination to patient to increase the vaccination rates.

Determining the structure of words in the text for the operations such as automated information extraction and text summarization of the text is essential. In computers, textual analysis to define the type of the word is considered as a vital advantage. Defining the types of words provides an estimate of the sequence of words in the sentence. In this article, estimating types of Turkish words is provided by developing a Hidden Markov Model and a Bayesian-based new model. In this model, an algorithm is developed which separates the suffixes of the words and grouping the words by counts of characters that suffixes of the words receive. A text composed of 584 Turkish words is used for the testing the dependability of the model. The model has achieved a high success rate in predicting the types of Turkish words.

BACKGROUND Acute ischemia/reperfusion (I/R) injury of skeletal muscle, an important mortality and morbidity cause, is associated with oxidative stress. Lycopene is a carotenoid pigment with potent antioxidant activity and is found in vegetables and fruits. This study aims to investigate the protective effects of lycopene against I/R injury in rat hind limb muscle model. METHODS Thirty-two Wistar-albino rats were randomly allocated to control, lycopene, I/R and I/R+lycopene groups. In lycopene and I/R+lycopene groups, the rats received 10 mg/kg/day lycopene orally for 15 days before the experiment. Dissection around abdominal aorta at the infrarenal level was performed in all rats under general anesthesia. The aorta was clamped at the infrarenal level in the I/R and I/R+lycopene groups for two hours. Then, reperfusion was allowed for two hours in these groups. Samples were obtained from the hind limb muscles of rats after sacrifice for biochemical and histopathological analyses. RESULTS Serum and tissue malondialdehyde and ischemia-modified albumin levels were significantly lower in the I/R+lycopene group compared to I/R group (p

ObjectiveTo present 18-month clinical results for internal compression therapy (ICT) applied percutaneously and as a novel method in the treatment of primary deep venous insufficiency.Material and MethodThirty patients diagnosed with isolated primary femoral vein (FV) insufficiency between October 2017 and February 2018 were included in the study. Pre-procedural femoral vein diameters and reflux durations were measured. CEAP classification and Venous Clinical Severity Score (VCSS) were recorded. Pre-procedural CEAP classifications were CEAP 4 in nine patients and CEAP 3 in 21. Quality of life assessments were carried out using a Chronic Venous Insufficiency Questionnaire (CIVIQ-2). FV diameters were then reduced, and valve coaptation was established with the percutaneous application of hyaluronic acid and cyanoacrylate injected adjacent to a valve with non coapting leaflets. Venous diameters and reflux duration were again measured immediately after the procedure. Patients were followed-up at months 1, 6, and 18, at which times all parameters were re-evaluated.ResultsEighteen of the 30 patients were women, and 12 were men. The mean duration of the procedure was 22.7 ± 2.9 (20–30) min. Patients’ FV diameters were 12.8 (11–14.7) mm before the procedure, 9.9 (9–11.5) mm immediately after, and also 9.9 (9–11.2) mm after 1.5 years (p ConclusionPreliminary investigation of the injection of cyanoacrylate and hyaluronic acid around one valve in an incompetent FV can result in improved hemodynamics, CEAP, VCSS and patient QOL at 18 months, without complications.

Objective Neonatal sepsis is a clinical condition that results in serious morbidity and mortality unless urgently diagnosed and treated. Obtaining the results of blood cultures to determine the causative agent in sepsis is a time-consuming process. The CRP/albumin ratio is an inflammatory marker that has started to be used in recent years. The aim of our study was to investigate the relationship between CRP/albumin and Gram-negative bacterial sepsis in neonates. Material and Methods This study was conducted on 112 premature neonates with sepsis. The patients were divided into two groups according to culture results as Gram-negative and Gram-positive bacterial sepsis. The laboratory and demographic features of the patients were obtained from the hospital records. A receiver operating characteristic curve was plotted to evaluate the predictive value of the CRP/albumin ratio for Gram-negative sepsis. Results CRP/albumin was significantly higher in the Gram-negative group (p 35.17, which had a specificity of 97% and sensitivity of 56% (AUC=0.839; 95% CI: 0.743-0.944; p

Objective: The aim of this study is to develop a valid and reliable measurement tool to determine the knowledge level of women about gynecologic cancer prevention. Methods: This study is of the methodological research type. The number of draft scale items in this study is 50. Women were taken to sample 10 times for each item (500 women) and pre-test was applied to 125 women which was 25% of the sample. The scale was re-applied to the first pre-test group after 3 weeks by test-retest method. The data were collected by using the Personal Information Form and Gynecologic Cancer Prevention Information Scale. The suitability of the data for factor analysis was investigated by the Kaiser-Meyer-Olkin coefficient and by Barlett's test of sphericity. In order to test the construct validity of the scale, exploratory and confirmatory factor analyses were performed. Results: Content validity index of the draft scale was 94%. Kaiser Meyer Olkin test value was 0.902 and the sample was found to be adequate and appropriate. On the other hand, the Bartlett test was obtained as X2=9542.07 p

Incidence of cancer is increasing in the developing countries such as Turkey. Screenings are important part of preventive medicine practices which can reduce deaths due to cancer. Our aim was to identify patient’s awareness and knowledge level of cancers and screenings and to create a road map of what we need to do to increase screening rates. This study was a descriptive type, and the research population was the patients between the age of 30 and 75, who went to 18 different Family Health Centres in different places in Turkey for any reason in July–September 2016. The survey was completed by face-to-face interview and consisted of 20 questions about the socio-demographic attributes, level of cancer and cancer screenings knowledge, causes of screening, and reasons for not doing. Screening rates was self-reported by patients. A total of 643 patients, 394 women (61.3%) and 249 men (38.7%), participated in the study. The average age was 45.67 ± 11.49. The most well-known cancer type was breast cancer (79%). Having no screening was high in general population (64.7%). Having a screening was statistically significantly higher in women, over 50 year olds group, divorced/widower group, housewives, primary school graduates, the group who have green-card (having very low or no income) as social security, and in the group who have a history of family member with cancer. 55.8% of patients received the information about screenings from healthcare professionals. The reasons for not having a screening were “not seeing themselves as under risk” (27.4%), not having knowledge (22.8%), and fear of the results (15%). First of all, the importance of cancer screening as an important part of the preventive health services should be understood by family doctors through in-service training. Then family doctors would share the information and experience, clear the lack of knowledge of them and by doing this rates of screening would increase.

Objectives: Gestational diabetes(GDM) is an importantdisease that should be diagnosed and treated early.Because GDM brings a numberof risks for the mother and the baby.These risks can be prevented bytreatment.Oral glucose tolerance test (OGTT) is used for diagnosis ofGDM.However,the number of pregnant women who don’t want to receive OGTT due tolack of information,environmental factors and media factors increaseconsiderably.Our aim in this study is to determine the frequency of those whodon't want to undertake OGTT,why they don't want to have them,and the factorsthat don't want,to find situations that may be a risk factor in GDM,toinvestigate the effects of media on our health ideas.Materials and Methods: The study wasperformed between May-July 2018 at Kahramanmaraş Sütçü İmam University pregnantclinic.All pregnant women older than 18 years of age were included in thestudy.Information was given to the pregnant women about the study and theconsent form was signed.A questionnaire with 37 questions related to OGTT andGDM including sociodemographic information was applied by face to faceinterview method.The categorical variables were expressed with statisticalparameters,frequency and percentage.The relationships between frequencydistributions were evaluated by chi-square and Fisher's exact test.Thestatistical significance level was accepted as p, Amaç: Gestasyonel diyabet (GDM), erken tanınıp tedavi edilmesigereken önemli bir hastalıktır. Çünkü GDM anne ve bebek için bir takım riskleride yanında getirmektedir. Tedaviyle bu riskler önlenebilmektedir. GDM’ninteşhisi için oral glikoz tolerans testi (OGTT) yapılmaktadır. Fakat bilgieksikliği, çevre faktörü ve medya faktörü gibi nedenlerle OGTT yaptırmakistemeyen gebelerimizin sayısı hatırı sayılır biçimde artmaktadır. Bizim buçalışma ile amacımız OGTT yaptırmak istemeyenlerin sıklığını, neden yaptırmakistemediklerini, istememelerindeki etkili faktörleri belirlemek; gestasyoneldiyabetes mellitus (GDM) açısından risk faktörü olabilecek durumları bulmak;medyanın sağlık fikirlerimize olan etkilerini araştırmaktır.Materyal vee Metot: ÇalışmaMayıs-Temmuz 2018 tarihleri arasında Kahramanmaraş Sütçü İmam Üniversitesi TıpFakültesi gebe polikliniğinde yapıldı. Çalışmaya katılmayı kabul eden 18yaşından büyük tüm gebeler dahil edildi. Gebelere anket ve çalışma hakkındabilgilendirme yapıldı ve onam formu imzalatıldı. Gebelere yüz yüze görüşmemetodu ile içerisinde sosyodemografik bilgiler, OGTT ve GDM ile ilgilisoruların da bulunduğu 37 soruluk anket uygulandı. Verilerindeğerlendirilmesinde kategorik değişkenlerde istatistik parametreleri, frekansve yüzde ile ifade edilmiştir. Gruplara göre frekans dağılımları arasındakiilişkiler Kikare testi ve Fisher exact testi ile değerlendirilmiştir.İstatistiksel anlamlılık p