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Despite receiving little attention in the scientific literature, earthquakes are known to affect sleep patterns indirectly and can contribute to the development or worsening of sleep disorders. Earthquake-caused disruptions, such as structural damage, displacement, and unstable living conditions, create uncomfortable and anxious sleeping environments. Psychological factors such as fear, stress, and anxiety can contribute to sleep disruption. Physical injuries from earthquakes can disrupt sleep due to pain and discomfort. Additionally, infrastructure disruptions such as power outages and utility damage create uncomfortable or unsafe sleeping conditions. This review presents a comprehensive and systematic overview of the relationship between earthquakes and sleep health.

Objectives: To evaluate the incidence and severity of depression in patients with retinitis pigmentosa (RP). Materials and Methods: The Beck Depression Inventory (BDI) was administered to 74 patients with RP and 60 healthy controls. Biomicroscopic anterior segment and fundus examination, visual field, optical coherence tomography, and full-field electroretinography tests were performed in all cases. Variables were evaluated with bivariate, multiple linear, and ordinal logistic regression analyses. Results: The RP group included 40 (54%) male and 34 (46%) female patients, while the control group included 23 (38%) male and 37 (62%) female subjects. The patient group had a mean age of 39.20±12.4 years, median best corrected visual acuity (BCVA) of 0.10 decimal (1.0 logarithm of the minimum angle of resolution [logMAR]; range, 1.3-0.7 logMAR), and median visual field mean deviation (MD) score of -28.00 decibels (dB) (range, -1.00 to -34.00 dB). The median BDI score was statistically significantly higher in the patient group (19 points) than in the control group (12 points) (p

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular condition characterized by short-term vertigo attacks that significantly affect quality of life OBJECTIVES: Examine how well a single Epley maneuver worked in an outpatient setting for people with posterior canal benign paroxysmal positional vertigo (PC-BPPV) and whether they needed a second Dix-Hallpike maneuver. DESIGN: Prospective. SETTINGS: Otorhinolaryngology department of a tertiary care center. PATIENTS AND METHODS: Sociodemographic data, body mass index (BMI), and systemic disease history of 75 patients diagnosed with PC-BPPV were recorded, and their relationship with success rates after the modified Epley maneuver was analyzed. MAIN OUTCOME MEASURES: Detect cases that could not be repositioned with the diagnostic control Dix-Hallpike test performed 20 minutes after the modified Epley reposition maneuver in the same session in PC-BPPV patients. SAMPLE SIZE: 75 RESULTS: Of the 75 patients, 31 were male (41.3%), 44 female (58.6%) with a mean (standard deviation) age of 58.6 (15.9) years age, 54.6% had one or more chronic diseases. BMI was 30 mg/kg2 and above in 31 patients (41.3%). The modified Epley maneuver was successful in 77.3%. No significant relationship was found between additional diseases or BMI in the patient group in whom the maneuver was unsuccessful. CONCLUSION: The success rates of repositioning maneuvers in treating patients diagnosed with PC-BPPV are high. However, more than a single maneuver is required in some resistant patients. Second diagnostic and repositioning maneuvers performed in the same session will reduce multiple hospital admissions. While it is helpful to repeat the maneuver in the patient group where it was unsuccessful, other factors causing the failure should be investigated. LIMITATIONS: Lack of follow-up results of patients after 7-10 days.

Kutanöz mastositoz (KM), dermiste aşırı sayıda mast hücresi (MH)’nin varlığına göre kategorize edilen bir hastalık grubunu tanımlar. KM'li hastalar, sistemik mastositoz için tanı kriterlerini karşılamaz ve dermis dışında herhangi bir organ katılımı kanıtı göstermez. Bu makale tarih, prevalans ve sınıflandırmadan bahsettikten sonra kısaca MH aktivasyonunun farklı klinik özelliklerini ve tetikleyicilerini gözden geçirmekte ve son olarak güncel gözlemler ışığında çocuklarda KM yönetimini ayrıntılı olarak tartışmaktadır. KM'li hastalar, sıklıkla dermal lezyonlar üzerindeki baskılarla başlayan ve MH aracılığıyla meydana gelen semptomlardan muzdariptir. KM yönetimi, esas olarak MH tetikleyicilerinden kaçınma üzerine kuruludur. KM vakalarında tedavinin esasını anafilaksi gibi şiddetli sistemik reaksiyonlarda epinefrin otoenjektörlerinin elde mevcudiyeti ve semptomlar ortaya çıktığında antihistaminiklerin (H1/H2 histamin reseptör blokerleri) kullanılması oluşturmaktadır.

Abstract Background The initial idea of functional tissue replacement has shifted to the concept that injected cells positively modulate myocardial healing by a non-specific immune response of the transplanted cells within the target tissue. This alleged local modification of the scar requires assessment of regional properties of the left ventricular wall in addition to commonly applied measures of global morphological and functional parameters. Hence, we aimed at investigating the effect of cardiac cell therapy with cardiovascular progenitor cells, so-called cardiac induced cells, on both global and regional properties of the left ventricle by a multimodal imaging approach in a mouse model. Methods Myocardial infarction was induced in mice by ligation of the left anterior descending artery, the therapy group received an intramyocardial injection of 1 × 106 cardiac induced cells suspended in matrigel, the control group received matrigel only. [18F]FDG positron emission tomography imaging was performed after 17 days, to assess regional glucose metabolism. Three weeks after myocardial infarction, cardiac magnetic resonance imaging was performed for morphological and functional assessment of the left ventricle. Following these measurements, hearts were excised for histological examinations. Results Cell therapy had no significant effect on global morphological parameters. Similarly, there was no difference in scar size and capillary density between therapy and control group. However, there was a significant improvement in contractile function of the left ventricle – left ventricular ejection fraction, stroke volume and cardiac output. Regional analysis of the left ventricle identified changes of wall properties in the scar area as the putative mechanism. Cell therapy reduced the thinning of the scar and significantly improved its radial contractility. Furthermore, the metabolic defect, assessed by [18F]FDG, was significantly reduced by the cell therapy. Conclusion Our data support the relevance of extending the assessment of global left ventricular parameters by a structured regional wall analysis for the evaluation of therapies targeting at modulation of healing myocardium. This approach will enable a deeper understanding of mechanisms underlying the effect of experimental regenerative therapies, thus paving the way for a successful translation into clinical application.

Objectives:The full-field stimulus threshold (FST) test was developed to evaluate the efficacy and safety of treatments of hereditary retinal diseases. In this study we performed the FST test in patients with retinitis pigmentosa (RP) and compared the results with findings from other ophthalmological tests.Materials and Methods:The study included 51 intermediate and advanced RP patients and 21 normal subjects. All patients and controls underwent routine examination and ophthalmological tests including visual field, optical coherence tomography, full-field and multifocal electroretinography (mfERG), and FST tests. During FST testing, the perception thresholds of retina to the white, blue, and red FST were determined in decibels.Results:The mean age of the patients and the controls were 35.2 and 33.5 years, respectively. For all RP patients, no response was obtained on full-field ERG. All subjects were able to perform reliable FST tests. The mean values of visual acuity and central macular thickness were significantly lower and visual field mean deviation values were significantly higher in the RP group than the controls. When we evaluated the mfERG findings, the mean P1 wave amplitudes in all rings were significantly lower and the mean peak times were significantly longer in RP patients than controls. In comparisons of FST test results, the mean values for white, blue, red and the difference between blue-red thresholds were significantly lower in the RP group than the control group.Conclusion:The FST test is a fast and a reliable exam which can be done in subjects with poor visual acuity and reduced visual field. The results of this study confirm that the FST test can measure retinal sensitivity in severely affected RP subjects with flat flash ERG.

Abstract Background Medical education requires the implementation of different teaching methods and strategies for future doctors to achieve broad learning objectives. This wide range of methods and strategies includes the use of Information Technologies. For a long time, there was a call for a change in medical education for blending new teaching approaches to lessen medical students’ class time. The COVID-19 pandemic then sped up the transition to the new way of medical education and classroom lectures were quickly moved to a virtual environment. We expect that these changes will continue, and online learning will be one of the main teaching strategies in medical education. Therefore, educational experiences during the COVID-19 pandemic will improve our understanding of online learning and will help to develop blended medical school curricula in the future. For this reason, we aimed to determine students’ overall satisfaction with their online learning experience and to define the main factors affecting students’ satisfaction with their online learning program at Cerrahpaşa Medical Faculty. Methods A cross-sectional survey study was conducted to determine medical students’ overall satisfaction with online learning methods and to identify factors associated with positive and negative satisfaction levels. A questionnaire, consisting of 24 questions to collect demographic characteristics, factors associated with online education experience and overall satisfaction levels was developed and distributed to 1600 medical students. Multivariable linear regression analysis was used to determine the factors associated with positive and negative satisfaction levels. Results Regression analysis showed that being familiar with online teaching techniques (β = 0.19, 95% CI [0.07, 0.30], faculty members’ higher online teaching skill levels (β = 0.42, 95% CI [0.32, 0.51], interactive online teaching approaches (β = 0.54, 95% CI [0.41, 0.67], having a personal workspace (β = 0.43, 95% CI [0.19, 0.67], and a self-reported longer attention span (β = 0.75, 95% CI [0.57, 0.92] were associated with higher overall satisfaction with online learning. The occurrence of technical problems (β = -0.19, 95% CI [-0.26, -0.12] was associated with lower overall satisfaction. Conclusions Higher online teaching skills of faculty members, use of interactive approaches, students’ familiarity with online teaching techniques, provision of a personal workspace, and self-reported longer attention spans positively contributed to higher levels of student satisfaction with online learning. Considering the increasing significance of online educational methods, our study identified key components that affect students’ level of satisfaction. This information might contribute to the development of online educational programs in the future.

Aim: Coronary artery disease (CAD) is a pathological process characterized by atherosclerotic plaque accumulation in the epicardial arteries. Inflammation and high lipid levels play a role in pathological changes in atherosclerosis. Besides traditional risk factors, genetic factors such as single nucleotide polymorphism (SNPs) can be involved in disease process. In this study, we aimed to evaluate the effects of oxidized low density lipoprotein receptor 1 (OLR1) 3’UTR188C>T gene polymorphism, C-reactive protein (CRP), and lipid status in patients with coronary artery bypass grafting (CABG). Materials and Methods: The study population consisted of 109 CAD patients who had undergone CABG, and 127 healthy controls. The OLR1 3’UTR188C>T polymorphism was genotyped using PCR-RFLP technique. Serum CRP, high-density lipoprotein-cholesterol (HDL-C), and low-density lipoprotein-cholesterol (LDL-C) levels were measured with an automatic biochemistry analyzer. Results: The distribution of the OLR1 3’UTR188C>T genotypes and alleles did not differ significantly between CAD patients with CABG and controls. Serum CRP levels were increased in patients compared to the control group (pT polymorphism may not be involved in susceptibility to atherosclerosis. However, traditional risk factors in atherosclerosis such as smoking, alcohol consumption, family history, hypertension, diabetes mellitus, and circulating CRP levels were increased in our CABG population. The evaluation of OLR1 3’UTR188C>T and different OLR1 SNPs may be useful for their single and combined effects in atherosclerosis.

Aim: Laparoscopic inguinal hernia surgery is performed in many centers today. Mesh fixation is an important step in this procedure. In this study, we aim to show our results in total extraperitoneal repair of inguinal hernias using absorbable tuckers and n-butyl cyanoacrylate glue for mesh fixation. Materials and Methods: All surgeries were performed by a single surgeon. The surgeries were performed in Private Erdem Hospital İstanbul and Al Zahra Hospital Dubai between January 2015 and February 2022. Mesh fixation of the patients was applied in a randomized manner using absorbable tucker and glue. The patients were compared in terms of postoperative visual pain score (VAS), opioid need, length of hospital stay, duration of surgery, presence of recurrence and chronic pain. Results: A total of 226 patients were operated. Absorbable tucker were used for mesh fixation in 138 patients, and glue was used in 88 patients. The age and gender distribution of the patients were similar in both groups. No patient had any major complications or mortality during or after surgery. There was no conversion to open surgery. Operation time was similar in both groups. In the glue group, VAS was found to be significantly lower at the 8th hour after surgery. There was also a significant reduction in opioid requirement in the same group. The same-day discharge rate in the glue group was statistically significantly higher than in the absorbable tucker group. All patients were followed up for at least six months. Recurrence was observed in two patients (one patient in each group). The number of patients with chronic pain was significantly higher in the absorbable stapler group than in the other group. Conclusion: The use of glue for mesh fixation in laparoscopic extraperitoneal inguinal hernia repair is a safe method. Fixation with glue is clearly advantageous comparing to absorbable tuckers in terms of postoperative pain, early discharge, and chronic pain.

The promising results of transcatheter aortic valve replacement (TAVR) over the past two decades indicate an expansion of the patient cohort toward patients with intermediate or low surgical risk. Since some complications of TAVR have already been minimized, subclinical leaflet thrombosis (SLT) has gained importance in recent years. SLT is manifested by a thrombotic layer on the prosthetic leaflets that gradually reduces leaflet motion. The resulting decrease in functionality of the TAVR causes a need for re-intervention. The origin of SLT and approaches to prevent SLT are still unexplored. For this reason, we have developed an in silicomodel that can be used during the design development process of TAVR devices to estimate the thrombosis risk of the implant. Based on passive scalar transport, hemodynamic metrics are used to quantify platelet activation and aggregation which are associated with the formation of thrombosis. In conjunction with a numerical simulation model considering the fluid-structure interaction between the blood mimicking fluid and the TAVR implanted in an aortic root, the thrombosis risk can be modeled. The simulation model can be used to calculate the three-dimensional flow structures within the native sinus and neo-sinus and also provides the ability to derive metrics to assess the risk of thrombosis. We demonstrated that this in silicomodel is a time-effective tool to assess thrombosis risk in TAVR product development.

Biofluid mechanics play an important role in the study of the mechanism of cardiovascular diseases and in the development of new implants. For the assessment of hydrodynamic parameters, experimental methods as well as in-silico approaches can be used, such as particle image velocimetry (PIV) and Deep Learning, respectively. Challenges for PIV are the optical access to the region of interest, and time consumption for measuring and post-processing analysis in particular for three dimensional flow. To overcome these limitations state-of-the-art deep learning algorithms could be utilized to augment spatially coarse resolved flow fields. In this study, we demonstrate the use of Physics Informed Neural Networks (PINN) to augment PIV measurement data. To demonstrate a combined workflow, we investigate the flow of a Newtonian fluid through a simplified aneurysm under laminar conditions. Generation of synthetic PIV particle images of a single measurement plane and the corresponding PIV vector calculations were performed as the basis for the PINN algorithm. Based on the Navier-Stokes equations the PINN reconstructs the entire 3D flow field and pressure distribution inside the aneurysm. We observed qualitative agreements between ground through data and PINN predictions. Nevertheless, there are substantial differences in the quantitative, locally resolved comparison of the flow metrics, despite the generally tendency for the PINN algorithm to correctly augment the flow field.

Severe aortic valve stenosis has been successfully treated with minimally invasive transcatheter aortic valve replacement (TAVR) for more than 20 years. The therapy is applied to an increasing cohort of patients. Nevertheless, paravalvular leakage (PVL) remains one of the main complications after TAVR implantation reducing safety and efficacy of the implant. To improve TAVR performance, virtual patient cohorts can be used to generate a significant amount of data with biologically varying conditions comparable to clinically realworld data. For this purpose, in silico models need to be established which are used to evaluate the possible occurrence of PVL. When establishing in silico models, the question between simplification to reduce computational effort and still valid information from the model must always be clarified. Thus, we investigated the comparability between steadystate and transient PVL measurements as an input parameter for simulations in virtual cohorts. A clinically established TAVR was implanted into different annulus models and tested in a steady-state back-flow test bench and in a pulse duplicator system. As a result, leakage rates were compared and assumptions for the in silico models were derived. Although the trend of PVL is comparable in steady-state and transient conditions, absolute values differ making it difficult to extract generalized assumptions. Especially when PVL increased, e.g. in a larger implantation diameter or in an imperfect annulus, the variation also increased up to 50% of the measured value.

Abstract Altitude is an important ecological factor that significantly affects essential oil content, yield and composition. In this study, conducted to examine the effects of altitude on essential oil content and composition of O. majorana, plant samples were collected from the southern region of Türkiye at the beginning of flowering period from seven different altitudes (766 m, 890 m, 968 m, 1079 m, 1180 m, 1261 m and 1387 m) at 100 m intervals. The highest percentage of essential oil (6.50%) obtained by hydro-distillation was determined at 766 m altitudes. The GC–MS analyses revealed that low altitude affected some essential oil components positively. The linalool ratio, which is the major component of the essential oil of O. majorana species, was the highest at 766 m (79.84%) altitudes. Borneol, linalool oxide, trans-linalool oxide, caryophyllene, a-humulene, germacrene-D and bicyclogermacrene components yielded high values at 890 m altitudes. Thymol and α-terpineol, which have an important place in the essential oil composition, increased at 1180 m altitudes; a-terpinene, cis-sabinene hydrate, terpinene-4-ol and carvacrol increased at 1387 m altitudes.

Henoch-schönlein purpurası (HSP), çocukluk çağının non-trombositopenik palpabl purpura ile seyreden ve en sık görülen sistemik vaskülitidir. HSP cilt tutulumu, artrit, renal ve gastrointestinal sistem tutulumu ile karakterizedir. Böbrekler, kolon, eklemler gibi bazı organlarda gelişen vaskülit sonucu palpe edilebilen purpura, karın ağrısı, artrit ve böbrek hastalığı (proteinüri) görülür. Hastalar döküntü (palpable purpura), karın ağrısı, eklem şişliği ve/ya ağrısı (artrit) şikayetleri ile başvurur. HSP genellikle viral enfeksiyonlar, ilaçlar ve böcek ısırığı gibi antijenik bir stimulus ile tetiklenir. Burada purpurik döküntü ile seyreden hastalıklarla kolaylıkla karışabilen ve farklı tanılar konulabilen HSP’ li beş yaşında bir kız olgu sunulmaktadır. Purpurik döküntü ile başvuran hastalarda travma öyküsü varlığında, travmaya sekonder purpura vs. düşünülsede vaskülit benzeri değişik hastalıklarla karşılaşılabileceği akılda tutulmalıdır.

Objective:Our aim in this study was to examine whether critically ill patients with coronavirus disease-2019 (COVID-19) achieved the targeted calories (ATC) while being treated in the intensive care unit (ICU) and their relationship with the modified nitric score (mNUTRIC) and mortality.Materials and Methods:The patients were categorized into two cohorts based on the attainment of the intended caloric intake during their stay in the ICU: the ATC group and the not achieved target calorie (NATC) group. A comparative analysis was conducted on the mNUTRIC scores, as well as the ICU and hospital mortality rates, between these two groups.Results:The number of patients in the ATC group was 59 (63.4%) and the number of patients in the group that could NATC was 34 (36.6%). mNUTRIC scores on admission were 3 (2-4) in the ATC group and 5 (4-6) in the NATC group. In multivariate regression analysis, a mNUTRIC score of 5 and higher (p

Purpose: Antenatal care, one of the strategies aimed at protecting maternal and child health, is to monitor the mother by trained health personnel at regular intervals throughout pregnancy. This study aimed to evaluate the prenatal care service use of pregnant women who attend Kartal Dr. Lütfi Kırdar City Hospital Gynecology and Obstetrics Polyclinics. Materials and Methods: The sample universe of this cross-sectional study was pregnant women attending Kartal Dr. Lütfi Kırdar City Hospital Gynecology and Obstetrics Polyclinic between 01.08.2020-01.09.2020. The questionnaire developed by the researchers was applied to the participants by face-to-face interview technique. Results: All the participants (n=403) received at least one prenatal care service from a health institution. 73.4% (n=296) of the pregnant women received prenatal care, which is required according to their weeks of gestation quantitatively. The highest rate of physical examination in antenatal care follow-ups was fetal heart rate, while the lowest rate was the cardiac auscultation and edema examination rates of the pregnant woman. Conclusion: It was seen that all of the pregnant women received antenatal care at least once, but the number of prenatal care follow-ups required in accordance with their gestational weeks was still not at the desired level. For this reason, there is a need for a study to determine the factors that prevent compliance with the follow-ups and to carry out the ideal four follow-ups of all pregnant women.

Objective Still’s disease is more frequently observed in the paediatric context, but a delayed onset is not exceptional both in the adulthood and in the elderly. However, whether paediatric-onset, adult-onset and elderly-onset Still’s disease represent expressions of the same disease continuum or different clinical entities is still a matter of controversy. The aim of this study is to search for any differences in demographic, clinical features and response to treatment between pediatric-onset, adult-onset and elderly-onset Still’s disease.Methods Subjects included in this study were drawn from the International AutoInflammatory Disease Alliance Network registry for patients with Still’s disease.Results A total of 411 patients suffering from Still’s disease were enrolled; the disease occurred in the childhood in 65 (15.8%) patients, in the adult 314 (76.4%) patients and in the elderly in 32 (7.8%) patients. No statistically significant differences at post-hoc analysis were observed in demographic features of the disease between pediatric-onset, adult-onset and elderly-onset Still’s disease. The salmon-coloured skin rash (p=0.004), arthritis (p=0.009) and abdominal pain (p=0.007) resulted significantly more frequent among paediatric patients than in adult cases, while pleuritis (p=0.015) and arthralgia (p

Background Different patient clusters were preliminarily suggested to dissect the clinical heterogeneity in Still’s disease. Thus, we aimed at deriving and validating disease clusters in a multicentre, observational, prospective study to stratify these patients.Methods Patients included in GIRRCS AOSD-study group and AIDA Network Still Disease Registry were assessed if variables for cluster analysis were available (age, systemic score, erythrocyte sedimentation rate (ESR), C reactive protein (CRP) and ferritin). K-means algorithm with Euclidean metric and Elbow plot were used to derive an adequate number of clusters.Results K-means clustering assessment provided four clusters based on means standardised according to z-scores on 349 patients. All clusters mainly presented fever, skin rash and joint involvement. Cluster 1 was composed by 115 patients distinguished by lower values of age and characterised by skin rash myalgia, sore throat and splenomegaly. Cluster 2 included 128 patients identified by lower levels of ESR, ferritin and systemic score; multiorgan manifestations were less frequently observed. Cluster 3 comprised 31 patients categorised by higher levels of CRP and ferritin, they were characterised by fever and joint involvement. Cluster 4 contained 75 patients derived by higher values of age and systemic score. Myalgia, sore throat, liver involvement and life-threatening complications, leading to a high mortality rate, were observed in these patients.Conclusions Four patient clusters in Still’s disease may be recognised by a multidimensional characterisation (‘Juvenile/Transitional’, ‘Uncomplicated’, ‘Hyperferritinemic’ and ‘Catastrophic’). Of interest, cluster 4 was burdened by an increased rate of life-threatening complications and mortality, suggesting a more severe patient group.

Abstract Importance Healthcare concepts for chronic diseases based on tele-monitoring have become increasingly important during COVID-19 pandemic. Objective To study the effectiveness of a novel integrated care concept (NICC) that combines tele-monitoring with the support of a call centre in addition to guideline therapy for patients with atrial fibrillation, heart failure, or treatment-resistant hypertension. Design A prospective, parallel-group, open-label, randomized, controlled trial. Setting Between December 2017 and August 2019 at the Rostock University Medical Center (Germany). Participants Including 960 patients with either atrial fibrillation, heart failure, or treatment-resistant hypertension. Interventions Patients were randomized to either NICC (n = 478) or standard-of-care (SoC) (n = 482) in a 1:1 ratio. Patients in the NICC group received a combination of tele-monitoring and intensive follow-up and care through a call centre. Main outcomes and measures Three primary endpoints were formulated: (1) composite of all-cause mortality, stroke, and myocardial infarction; (2) number of inpatient days; (3) the first plus cardiac decompensation, all measured at 12-months follow-up. Superiority was evaluated using a hierarchical multiple testing strategy for the 3 primary endpoints, where the first step is to test the second primary endpoint (hospitalization) at two-sided 5%-significance level. In case of a non-significant difference between the groups for the rate of hospitalization, the superiority of NICC over SoC is not shown. Results The first primary endpoint occurred in 1.5% of NICC and 5.2% of SoC patients (OR: 3.3 [95%CI 1.4–8.3], p = 0.009). The number of inpatient treatment days did not differ significantly between both groups (p = 0.122). The third primary endpoint occurred in 3.6% of NICC and 8.1% of SoC patients (OR: 2.2 [95%CI 1.2–4.2], p = 0.016). Four patients died of all-cause death in the NICC and 23 in the SoC groups (OR: 4.4 [95%CI 1.6–12.6], p = 0.006). Based on the prespecified hierarchical statistical analysis protocol for multiple testing, the trial did not meet its primary outcome measure. Conclusions and relevance Among patients with atrial fibrillation, heart failure, or treatment-resistant hypertension, the NICC approach was not superior over SoC, despite a significant reduction in all-cause mortality, stroke, myocardial infarction and cardiac decompensation. Trial registration ClinicalTrials.gov Identifier: NCT03317951.

Aim Substance abuse and concomitant infections are important causes of morbidity and mortality. Yet, the number of epidemiological studies regarding infectious diseases in people with substance abuse are limited in our country. In this study, the aim was to investigate the frequency of illegal alcohol and substance use in an Alcohol and Drug Research, Treatment and Training Centres (AMATEM) clinic in Turkey as well as the HBsAg, anti-HBs, anti-HCV, and anti-HIV parameters between the years of 2016-2021. Material and Method HBsAg, anti-HBs, anti-HCV, and anti-HIV tests were conducted using the ELISA technique in 6881 alcohol and substance use disorder (ASUD). Urine samples from ASUD’s were analyzed for alcohol, cannabis, and cocaine metabolites. The results were evaluated retrospectively. Results All of the 6881 ASUD’s were male with a mean age of 32.18±9.66 years. Of the 6881 ASUD’s included in the study, 4107 (59.7%) were opioid addicts; 1479 (21.5%) were mixed drug addicts; 897 (13%) were alcohol addicts; and the rest were addicts with other types of substance use. The mean age of the alcohol users was 45.33±13.03 and the mean age of opioid users was 29.90±7.13. The percentage of opioid addiction in 2016 was 71.2% which dropped to 28.7% in 2021. Meanwhile, the percentage of alcohol addiction was 13.6% in 2016 and increased to 21.4% in 2021; and the percentage of mixed drug use was 8.7% in 2016 and increased to 36.8% in 2021. HBsAg-positivity in opioid users (56.7%) was higher compared to cannabis users (2.6%) and mixed drug users (22.3%). Anti-HCV positivity of opioid users (69.4%) was found to be higher compared to alcohol (9.4%), cannabis (2%), and mixed drug (16.2%) users, and this finding was statistically significant (p=0.0001). Anti-HBs positivity of opioid users (63.1%) was found to be higher compared to alcohol (9.9%), cannabis (3%), and mixed drug (21%) users, and this finding was statistically significant (p=0.0001). Anti-HIV was determined negative in all ASUD’s. The highest rates of HBsAg, anti-HCV and anti-HBs positivity were found in the 26-30 years of age. Conclusion These findings indicate a high prevalence of intravenous substance abuse in the 26-30 years age group in our region as well as the high HBV and HCV rates in this patient group.

Amaç: Bu çalışmada 0-24 ay arası çocuklarda ön fontanel (ÖF) kapanma zamanı ve boyutlarını değerlendirmeyi amaçladık. Bu çalışmanın ikincil amacı ise ÖF boyutu ve subaraknoid mesafe genişliği arasındaki ilişkinin araştırılmasıdır. Gereç ve Yöntemler: Bu çalışmada Ocak 2020 ve Ekim 2021 tarihleri arasında hafif kafa travması nedeniyle bilgisayarlı tomografi (BT) çekilen olguların görüntüleri retrospektif olarak değerlendirildi. 3D BT görüntüleri üzerinde ön fontanel kapanması (ÖFK) değerlendirildi ve açık olanlarda ÖF alanı ölçüldü. Aksiyal BT görüntülerde subaraknoid mesafe ölçümleri gerçekleştirildi. Bulgular: Hafif kafa travması nedeniyle BT çekilen 602 çocuk çalışmaya dahil edildi. 0-24 ay arasında her aylık yaş grubunda 23-25 olgu mevcuttu. K/E oranı 284/317 idi. Radyolojik olarak 0-6 ay arası, klinik olarak 0-2 ay arası ÖFK izlenmedi. Klinik ÖFK 3. ayda başlayıp 13. ayda % 66’ya 15. ayda % 90’ın üzerine, radyolojik ÖFK ise 7. ayda başlayıp, 16. ayda % 65’e ve 24. ayda % 84’e ulaşmıştır. Ortalama ÖF alanı doğumdan 2. aya kadar artmış, 3-9 aylarda azalan dalgalı bir seyir göstermiş ve 9. aydan 2 yaşa kadar ise giderek azalmıştır. ÖF alanı ile subaraknoid mesafe genişliği arasında ilişki saptanmadı (r:0,229, p

Objective: The spread of coronavirus disease-2019 (COVID-19) worldwide has caused sudden and dramatic changes in our daily routines and work lives. Healthcare workers tried to adapt to the pandemic process, protecting patients, themselves, and their families from COVID-19 infection. Our study explains the early psychological effects of the COVID-19 pandemic on healthcare professionals working in the front line in intensive care units and operating rooms. Materials and Methods: This cross-sectional type of study was conducted face-to-face with 125 medical personnel working on the front line in the COVID-19 intensive care unit (ICU) during the pandemic. The beck depression inventory and perceived stress scale were used in our study to measure the depression and stress levels of worker healthcare care. Results: 73.6% of the participants were female, 52.8% were nurses, and 28% were working in a pandemic ICU. The mean age was 34.17±7.72. Compared to the low-stress group, the high-stress group consisted of females with a statistically significantly higher frequency. Conclusion: Unfortunately, history indicates that pandemics are inevitable and that we must help each other in these difficult times. Understanding early signs of the stress factors of healthcare workers can be helpful in protecting them from posttraumatic disorder. During this period, social distancing was the key to slowing down the transmission of the virus, but it led to increased health sector employees’ increased anxiety. Understanding the early signs of healthcare workers’ signs of anxiety and depression can protect them from serious health problems such as burnout syndrome and posttraumatic stress disorder.

Computational fluid dynamics (CFD) has enormous potential for the development of novel cardiovascular implants. In particular, the evaluation of the thrombogenic potential of implants is gaining importance. For this purpose, the numerical model must represent the essential properties of the real system, i.e., an implant in the human blood circulation, in a suitable form. Due to its complexity, the model building process is crucial for the successful application of the model. Currently, there is no structured guideline for the application of numerical flow simulation to which model developers can refer. Based on NASA and ASTM, we present key aspects of the model building process using CFD for stent flow as an example.

The implantation of a transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis improves pathologic blood flow through the aortic valve, but still alters hemodynamics in comparison to a healthy native aortic valve. The hemodynamic characteristics of TAVR are associated with hypo-attenuating leaflet thickening and prosthetic leaflet thrombosis, which may reduce the durability of TAVR. For this reason we developed a numerical model to identify pro-thrombotic regions of TAVR based on the velocity field. In silico models have already been proven to be an effective tool for device optimization in other medical device applications. However, when using an in silico model, it is important to validate the model assumptions with experimental data or analytical solutions to confirm the accuracy of the model. In this study, we present an approach to validate a complex numerical Fluid Structure Interaction (FSI) model used to simulate leaflet kinematics and flow in the vicinity of a TAVR. Based on the recommendation of ISO 5840 (2021), a combined validation of the kinematic and fluid dynamic parameters was performed for this purpose. The leaflet kinematic was investigated via high-speed recordings and evaluated based on the Geometric Orifice Area (GOA). The velocity field of the TAVR was determined experimentally using Particle Image Velocimetry (PIV). The evaluation of the GOA showed a good agreement of the in silico model with the in vitro data for the systolic duration. The occurring velocities were qualitatively compared during peak systole for three planes and showed similar flow characteristics. The maximum velocity was 1.1 m/s in the in vitro and in silico model. Based on the results, it can be assumed that the numerical FSI model of the TAVR can be used for thrombosis risk assessment.

Aim:Dynamic changes in troponin levels have been shown to be effective indicators of acute injury and useful for distinguishing acute injuries from chronic injuries. This study investigates the role of the change in troponin I (TnI) values in the prediction of acute myocardial infarction (AMI) and its relationship with the findings of percutaneous coronary angiographies.Materials and Methods:The patients included here were divided into two groups: a group of patients with AMI and a group of patients without AMI. The patients diagnosed with AMI were subsequently divided into two subgroups as those with and without critical stenosis. The relative troponin change in these patients was calculated as the percentage of the difference between the first and second troponin measurements; the second measurement was taken two hours later after admission.Results:The receiver operating curve analysis revealed that increases of more than 83.18% in ΔTnI were significant predictors of AMI and critical stenosis [sensitivity 45.24%, specificity 89.67%, area under the curve (AUC)=0.698 (95% confidence interval (CI): 0.639-0.752, p=0.001), sensitivity 56.00%, specificity 87.92%, AUC value of 0.681 (95% CI: 0.620-0.738, p

Objectives:Hereditary retinal dystrophies are a rare group of diseases which are heterogeneous in genotype and phenotype and result in total blindness. One of the genetic defects that cause hereditary retinal dystrophy is mutation of the RPE65 gene. Genetic therapy studies in hereditary retinal dystrophies have increased in number recently, and important developments have been reported in these studies. Voretigene neparvovec-rzyl (Luxturna, Spark Therapeutics), a gene therapy drug for retinal dystrophy associated with RPE65 mutation, received Food and Drug Administration approval in 2017. This study aimed to investigate the frequency and clinical findings of patients with RPE65 gene defects, which may be amenable to genetic treatment.Materials and Methods:The data of patients diagnosed with hereditary retinal dystrophy who were followed up between 2017 and 2021 were retrospectively reviewed. Of these, 460 patients with genetic analysis results were included in the study. The clinical findings of patients with homozygous (biallelic) RPE65 mutation were screened.Results:RPE65 homozygous gene mutation was detected in only 11 of 460 cases (2.39%). Genetic results of the cases were presented in detail. The inheritance patterns of the cases were autosomal recessive. The demographic data and clinical findings were defined.Conclusion:RPE65 gene mutation is a very rare disorder. Genetic screening has gained importance with the emergence of gene therapy alternatives. New treatment methods are promising in cases for which there was no chance of a cure to date.

Background/Aim This study aimed to investigate the effects of oxygen therapy using a high flow nasal cannula (HFNC) on patients diagnosed with COVID-19 Acute Respiratory Distress Syndrome (C-ARDS) by utilizing electrical impedance tomography (EIT)-based parameters. Materials and Methods Oxygen therapy was administered to the patients at two different flow rates and two different positions: T0—baseline measurements were taken in the supine position before any therapy was initiated. T1—HFNC was administered in the supine position with a flow rate of 30 L/min. T2—HFNC was administered in the supine position with a flow rate of 50 L/min. T3—HFNC was administered in the prone position with a flow rate of 30 L/min. T4—HFNC was administered in the prone position with a flow rate of 50 L/min. EIT-based parameters (global inhomogeneity index (GI index), center of ventilation (CoV), regional ventilation delay index (RVD index), region of interest ratio (ROI ratio)), as well as respiratory and hemodynamic parameters of the patients, were recorded from the database. Results A total of twenty patients were included in this retrospective observational study. The mean age of the included patients was 64.3 ± 10.6 years. Statistically significant differences were observed in the measurements of GI index, CoV, RVD index, ROI ratio, PaO2/FiO2 ratio, respiratory rate, and mean arterial pressure parameters across different time intervals (p

Primer immün yetmezlik hastalık tipleri günümüzde bilindiği gibi 400 hastalığı geçmiş bulunmaktadır. Farkındalığın artması ve tanı yöntemlerinin gelişmesi ile nadir olarak görülmekten çıkmışlar ve sık görülen hastalıklar haline gelmeye başlamışlardır. Bu hastalıklara cilt bulguları açısından yaklaşmak ve tanımak bu derlemenin asıl amacıdır. Primer immün yetmezlik hastalıklarının 10 uyarıcı işaretlerinden ikisi cilt bulgularından olmakla beraber sadece (bakteriyel ya da fungal) enfeksiyöz cilt bulgularını düşündürtmektedir. Bunlardan ilki tekrarlayan derin cilt abseleri ve diğeri cilt üzerindeki persistan mantar enfeksiyonu (tinea / dermatofitoz) olmasıdır. Cilt bulgularının sık olarak primer immün yetmezlik hastalıklarında görüldüğü bilinmelidir. En sık enfeksiyonlara (bakteriyel) ait bulgular görünmesine rağmen, onu non-enfeksiyöz tipte immüno-alerjik bulgu olarak egzama (atopik dermatit) izler. İmmüno-alerjik olmayan bulgular ise epidermal displazi, telenjiektazi vb. belirtilerdir. Bu deri belirtileri, bazen ilk geliş bulgusu olabilir. Her zaman bu bulgular çok özgün olmayabilir. Bu cilt bulgularıyla beraber özellikle büyüme geriliği ya da çoklu sistem tutulumu varsa, yine bu cilt bulgusu rekurrent ve tedaviye dirençli (refrakter) ise mutlaka primer immün yetmezlik hastalığı düşünülmeli ve var olup olmadığı araştırılmalıdır.

Purpose:In our study, it was aimed to determine whether the disinfectant efficacy of 2% glutaraldehyde solution changes with the aging of the solution. Methods: In our study, metal obtained from k-wire, plastic obtained from serum sets, and glass balls were used to imitate metal, plastic, and glass materials found in surgical instruments. 20 of each material were contaminated with Klebsiella pneumoniae (K. pneumoniae), Staphylococcus aureus (S. aureus),Pseudomonas aeruginosa (P. aeruginosa), Escherichia coli (E. coli), and Yeast on the 1st, 14th, and 28th days of the solution. 10 of them were thrown into 2% glutaraldehyde solution in different glasses and kept in the solution for 15 minutes. Subsequently, materials were taken from the glasses using separate sterile forceps for each piece. The other 10 were washed with physiological saline solution for 1 minute. After the procedures, they were sent to the microbiology laboratory without waiting and inoculated on routine media, and Gram staining was performed simultaneously. The identification of strains was carried out by conventional methods. Results: No growth was detected on the 1st, 14th, and 28th days in all metal, plastic, and glass materials disinfected with 2% alkaline glutaraldehyde solution. In the control groups, growth rates were 53.3%, 50%, and 63.3%, respectively. Conclusions: If the guidelines and manufacturer's recommendations are followed in the preparation and use of 2% alkaline glutaraldehyde solution, it provides an effective disinfection without being affected by the aging of the solution.

INTRODUCTION: The aim of this study is to determine the effect of active and passive smoking on polycythemia in adolescents. METHODS: This study was retrospectively performed between January 2019 and October 2020 in 98 male patients aged 13-18 years who applied to the Department of Pediatric Hematology XXXXXXXXXXXXXXXX for polycythemia. The cases were divided into three groups as active smokers (23 patients), passive smokers (29 patients) and never smokers (46 patients). RESULTS: The frequency of smoking in the study group was found to be 23.4%. Carboxy Hemoglobin values of smoking patients were significantly higher. The hemoglobin values of active smokers were not found to be significantly different when compared with passive smokers and nonsmokers (p> 0.05). DISCUSSION AND CONCLUSION: The rate of smoking exposure was found to be high in patients who were followed up with polycythemia during adolescence (53%). This shows that active and passive smoking exposure during adolescence is an important cause of secondary polycythemia.

Aralık 2019 yılında Çin’in Wuhan şehrinde etiyolojisi bilinmeyen bir pnömoni salgını tüm dünyaya yayıldı. Bu salgın yeni tip koronavirüs olan Şiddetli Akut Solunum Sendromu Coronavirus 2 (SARS-CoV-2) olarak adlandırıldı ve hastalığa COVID-19 adı verildi. Dünya Sağlık Örgütü (DSÖ) tarafından global pandemi ilan edildi. COVID -19 hastalığında ateş, öksürük, krup, nefes darlığı, koku alamama gibi semptomların yanında gastrointestinal sistem hastalıkların (GİS) semptomları da bildirilmiştir. SARS-CoV-2, akciğerlerin alveolar epitel hücrelerinde bulunan ACE-2 reseptörlerine bağlanarak pnömoniye neden olur. Ayrıca sadece akciğer hücreleri değil bağırsak epitel hücrelerinin (özellikle enterositler) de ACE-2 reseptörlerini eksprese ettiği gözlenmiştir. Son zamanlarda COVID-19 hastalarının dışkı materyalinde de SARS-CoV-2 RNA izole edilmiştir. Bu durum COVID-19 ve GİS arasında bir ilişki olabileceğini göstermektedir. Şu anda, COVID-19 için kullanılan ilaç ve birden fazla aşı mevcuttur ancak aşı üretimi, aşının etkinliği, saklama koşulları ve taşınmasındaki aksaklıklardan dolayı viral yükü azaltmak için alternatif tedaviler araştırılmaktadır. Probiyotikler, belirli dozlarda insan sağlığı üzerine faydalı etkileri olan canlı mikroorganizmalar olarak tanımlanmaktadır. Bilimsel çalışmalar probiyotiklerin antiviral özelliğini ve genel bağışıklığı güçlendirici etkisini ortaya koymuştur. Bu derleme probiyotiklerin COVID-19 hastalığındaki rolünü, SARS-CoV-2 enfeksiyonu ve mikrobiyota arasındaki olası ilişkiyi tartışmayı amaçlamaktadır.

Aralık 2019’da Çin’de başlayan SARS-CoV 2 enfeksiyonu olarak bilinen Coronavirüs pandemisi Dünya Sağlık Örgütü tarafından duyuruldu. Virüsü ile enfekte olan kişinin komorbiditesine göre mortalite oranları %6-10.5 arasında değişiklik gösteren SARS-CoV 2 bilinen üçüncü en yüksek patojeniteye sahiptir.1,2 Coronavirüs ailesine üye tek sarmallı bir RNA virüsüdür. İnsan hücresine anjiotensin dönüştürücü enzim 2 (ACE 2) reseptörü aracılığı ile giriş yapar. Renin anjiotensin sinyal yolağı, oksidatif stress ve hücre ölümü, sitokin fırtınası ve endotelyal disfonksiyon olmak üzere SARS-CoV-2 patogenezinde 4 majör yolak vardır.3 Patogenezin ve dolayısıyla semptomların gelişmesine neden olan bu yolaklar aynı zamanda mevcut tedavide kullanılan ilaçların da etki mekanizması açısından kilit noktadır. SARS-CoV-2’ye karşı etkili tedavi henüz geliştirilemediği için virüsün vücuda potansiyel giriş yollarını ve hastalığın oluşma mekanizmalarını bilmek enfeksiyonu önleme açısından büyük önem taşımaktadır.

Aim This study aimed to compare the Rotterdam and Helsinki computed tomography (CT) scoring systems for predicting the 30-day mortality after traumatic brain injury (TBI) in the geriatric population. Materials and Methods Patients aged ≥65 years presenting to the emergency department with trauma-related complaints were retrospectively scanned using International Classification of Disease codes, and patients with isolated head trauma examined using brain CT were included. Demographic data including age, gender, trauma mechanisms, Glasgow Coma Scale (GCS) score at the time of admission, light reflex information, intubation, and surgery status, and emergency department outcomes were recorded. Brain CT images were investigated to calculate the Rotterdam and Helsinki CT scores and the relationship between them was examined. Results Of the 890 included patients, 403 (45.3%) were male. Overall, 683 patients fell from a height of lt;1 m and 195 suffered injuries by hitting or direct impact. Further, the 30-day mortality rate was examined, revealing that 868 patients were alive and 22 patients died. Mortality rate was 3.7% for males and 1.4% for females. The Rotterdam and Helsinki CT scores and 30-day mortality was analyzed using receiver operating characteristic curve analysis, and the area under the curve was found as 0.564 and 0.603, respectively. The specificity of Rotterdam and Helsinki CT scoring systems in predicting 30-day mortality was 99.08% and 99.19%, respectively. Conclusion The use of CT scoring systems such as Rotterdam and Helsinki in the geriatric population presenting with TBI allows us to predict 30-day mortality.

Objective:To compare efficacy and safety of recombinant follicule stimulating hormone (r-FSH) and highly purified urinary FSH (HPuFSH) in polycystic ovary syndrome (PCOS) patients undergoing intracytoplasmic sperm injection (ICSI).Method:This was a prospective randomized study conducted at Kocaeli University Faculty of Medicine, Department of Obstetrics and Gynecology, in vitro fertizilization (IVF) Unit. A total of 91 PCOS patients undergoing ICSI were randomly assigned to receive either r-FSH (n=46) or HPuFSH (n=45) with a gonadotropin releasing hormone (GnRH) antagonist protocol. The main outcome measures were the number of mature oocytes retrieved, embryo quality, pregnancy rates, implantation rates.Results:The number of mature oocytes retrieved, fertilization rates, the number of cryopreserved embryos were significantly higher in r-FSH group (p=0.024, p=0.023, p=0.026 respectively) while the total dose of FSH used was significantly lower in the same group (p=0.023). Pregnancy rates, clinical pregnancy rates were higher in r-FSH group although not statistically significant (52.2% versus 35.6%, p=0.11, 37% versus 28.9%, p=0.41 respectively). Overall therapy costs per clinical pregnancy were associated with a 9.94% increase in r-FSH group whereas costs per pregnancy were not different between groups.Conclusion:r-FSH is superior than HP-uFSH in PCOS regarding fertilization rates, the number of mature oocytes retrieved and cryopreserved embryos, pregnancy rates although overall therapy costs per clinical pregnancy are higher.

Objective: This study was conducted to describe the current diagnosis and treatment strategies of patients admitted to the emergency department and diagnosed with acute renal colic. Material and Methods: In this study, an internet-based cross-sectional survey was administered to emergency medicine physicians. In addition to the participants’ demographic data, such as age and gender, years of experience in the emergency medicine department, and whether they were a specialist or resident, the survey also inquired about their choices of imaging methods, laboratory tests, analgesic medications, and intravenous fluids, and tendency to refer patients to a urologist for a consultation. Results: The median age of the 108 volunteers participating in the study was calculated as 31 (27 - 34.8) years and their years of experience as 4 (2-8) years. More than half (60.2%, n=65) of the participants were emergency medicine residents, while the remaining 39.8% (n=43) were emergency medicine specialists. The emergency medicine specialists and residents were compared in terms of the variables related to their approaches to patients presenting to the emergency department with a preliminary diagnosis of renal colic. The first choice of analgesic drugs was dichotomised as diclofenac and other non-steroidal anti-inflammatory drugs, with 34 (79.1%) of the specialists and 60 (92.3%) of the residents reporting diclofenac as their first choice, and there was a statistically significant difference between the two groups. Conclusion: In this study, the emergency medicine residents preferred diclofenac more than the emergency medicine specialists in primary care, although they had similar renal colic imaging methods preferences. Keywords: Acute renal colic, emergency medicine, kidney stone.

İmmunglobulin A vasküliti küçük damarlarda immun kompleks birikimi ile oluşan ve genellikle kendini sınırlayarak iyi seyir gösteren çocukluk çağının en sık vaskülittir. Bu çalışma ile kliniğimizde takip edilen immunglobulin A vasküliti tanılı hastaların klinik özelliklerini, seyirlerini, tedavilerini tanımlamak ve MEFV tetkik edilen hastaları detaylandırarak hastalık seyrine katkısı olup olmadığını ortaya koymaktır. Gereç ve Yöntemler Retrospektif olarak düzenlenen bu çalışma Ocak 2012 ile Haziran 2021 tarihleri arasında immunglobulin A vasküliti tanısı almış olguları içermektedir. Hastaların elektronik dosyalarından demografik, klinik, laboratuvar özellikleri, görüntüleme sonuçları ve tedavileri kaydedildi. Bulgular İmmunglobulin A vasküliti tanısı ile çalışmaya dahil olan 345 hastanın %42,30’ü kızdı. Hastaların medyan tanı yaşı 6,5 yıl (1-17,50). Şikayetlerin başladığı dönem mevsimlere göre %31,30 sonbahar, %28,70 ilkbahar, %27,50 kış ve %12,50 yaz oranlarında dağılmaktaydı. Tüm hastaların döküntüsü mevcuttu. Hastalık sürecinde %38,80 hastada kas iskelet, %35,70 hastada gastrointestinal, %7 hastada böbrek ve %8,10 hastada epididimal tutulum gelişti. MEFV taraması yapılan 54 hastanın 27 (%7,80)’sinde mutasyon pozitifti ve gruplar arasında cinsiyet, hastalık başlama yaşı, klinik tutulum ve tedavi parametreleri açısından anlamlı fark yoktu. Sonuç İmmunlobulin A vasküliti çocukluk çağının çoğunlukla iyi prognoza sahip vasküliti olmakla beraber bazı hastalarda ağır seyrederek sekel bırakabilmektedir. Kötü prognozu açıklayacak faktörler için çok merkezli prospektif çalışmalar gereklidir.

Giriş ve Amaç: COVID-19, çocuklarda yetişkinlerle karşılaştırıldığında nispeten daha hafif klinik semptomlarla seyretmektedir. Bu çalışmada, tanı sırasında gözlenen hematolojik ve immünolojik değişiklikleri irdelemeyi amaçladık. Materyal ve Metod: Çalışmaya 22 (6 kız, 16 erkek) COVID-19 hastası alındı. Etik kuruldan onay alındı. COVID-19 hastalarında hematolojik parametreler olarak hemogram, protrombin zamanı (PT), aktive parsiyel tromboplastin zamanı (aPTT), fibrinojen, D-Dimer ve immünolojik parametre olarak flow sitometri ile lenfosit alt grupları çalışıldı. Bulgular: Hastaların medyan yaşı 8,1 (2,3-17,5) yıl idi. Elde edilen değerlerin, literatürdeki normal değerlerle kıyaslanabilmesi için hastalar yaş gruplarına ayrıldı. Medyan WBC sayısı 6.145 (3.137-11.000) /µL bulundu. Çocukların yaşı büyüdükçe beyaz küre sayısı azalma eğiliminde idi. Monosit sayıları açısından gruplar arası fark saptandı. Eozinofil, platelet/lenfosit oranı (PLR), PT, aPTT, fibrinojen, D-Dimer açısından gruplar arasında fark saptanmadı. Hastalarımızın 2-5 yaş grubunda olanlarda helper T hücreleri azalmış ve sitotoksik T hücreleri artmıştı. Buna bağlı olarak da CD4/CD8 oranı yaşa göre normalden düşüktü. Aynı oran düşüklüğü 16 yaş üzerindeki grupta da görüldü. Erişkin yaş grubuna yakın olan 16 yaş üstü grupta CD8 sayısı normale göre düşük bulundu. B hücre sayısı yaşı en küçük olan grupta azalmışken, en büyük grupta artmış bulundu. NK hücre sayıları da 16 yaş üstü grupta düşük bulunurken diğer yaş gruplarında normal veya artmış idi. Sonuç: Hemogram çalışıldığında basitçe elde edilecek platelet-lenfosit oranı (PLR) sitokin fırtınasının bir göstergesi olarak kullanılabilir ve çocuklarda CD8 aşırı ekspresyonu olmaması COVID-19 hastalığını neden erişkinlere oranla daha hafif geçirdiklerinin nedeni olabilir. NK hücrelerinin artışı da bu hastalıktan koruyucu mekanizmalardan biridir.

Body image problems are associated with several mental health problems: low self-esteem, depression, and eating disorders. This study aimed to determine the rate of impaired body figure perception and its relation with eating habits in Turkish adults. This cross-sectional study was carried with 446 participants. To determine body figure perception Stunkart Figure Scale was used. Dutch Eating Attitude Questionnaire was applied to determine the eating habits of all participants. Study data were analyzed with SPSS 21.0 package program. The concordance between Body Mass Index (BMI) and Stunkart Figure Scale was 66% (r=0,660; p=0,000). The concordance between BMI and Stunkart Figure scale gradually decreases from weak to morbidly obese. The mean scores obtained by the participants from the DEAQ showed that only external eating and restrictive eating behaviors of the participants are affected by the compliance with the scale (p =0,000; p=0,000 respectively). Concordance of body figure perception with actual BMI was good level in more than half of the participants and only extrinsic and restrictive eating behavior is affected by this concordance. Individuals need to make healthy evaluations about their bodies in terms of individual and public health to control weight gain.

ABSTRACT Aim: Whole body of computed tomography (WBCT) approach is increasingly being preferred by the clinicians over the traditional selected CT approach worldwide, not only for major trauma patients but even for minor trauma patients. Our aim was to determine the ratio of polytrauma patients in minor trauma patients imaged with WBCT and to determine demographical and clinical predictors of polytrauma. Methods: This retrospective-descriptive-study was conducted at the emergency department with patients older than 16 but had an injury severity scores of less than 16 and those who underwent WBCT trauma patients between January 2015 and December 2018. The presence of polytrauma, which defined presence of injury with an abbreviated injury scale score ≥2 according to tomography results in at least two body regions, was considered as the primary outcome of the study. Results: Total 3924 (ISS lt;16) patients’ data were enrolled in the study. Only in 278 of all patients (7.1%) polytrauma was detected. After the multi-logistic regression analysis, fall from height ( gt;3 meters), pedestrian struck, altered mental status (GCS lt;14), and male sex were found as significant predictor factors for presence of polytrauma. When created a model with these parameters, it was found that it had low diagnostic accuracy value as 0.6 (95%CI: 0.59 to 0.72). Conclusion: When considered only minor trauma patients with small polytrauma and mortality ratio, routine using of WBCT approach is not rational. The predictors found in our study can be used to develop a clinical decision rule in the future for minor trauma patients. ÖZET Amaç: Tüm vücut bilgisayarlı tomografi (TVBT) yaklaşımı, klinisyenler tarafından sadece majör travma hastaları için değil, hatta minör travma hastaları için de dünya çapında geleneksel seçilmiş BT yaklaşımına göre giderek daha fazla tercih edilmektedir. Amacımız, TVBT ile görüntülenen minör travma hastalarında çoklu travma hastalarının oranını belirlemek ve çoklu travmanın demografik ve klinik belirleyicilerini belirlemekti. Yöntemler: Bu retrospektif-tanımlayıcı-çalışma, acil serviste 16 yaşından büyük ancak injury severty skoru lt;16 olan ve Ocak 2015 ile Aralık 2018 tarihleri arasında, WBCT çekilmiş olan travma hastalarının verileri incelenerek yapıldı. En az iki vücut bölgesinde tomografi sonuçlarına göre abbreviated injury scale skoru ≥2 olan yaralanma varlığı çalışmanın birincil sonlanımı olarak belirlendi. Bulgular: Çalışmaya toplam 3924 hastanın verileri dahil edildi. Tüm hastaların sadece 278'inde (%7.1) çoklu travma tespit edildi. Çoklu lojistik regresyon analiz sonuçlarına göre, yüksekten düşme ( gt;3 metre), yayaya araç çarpması, değişen mental durum (GCS lt;14) ve erkek cinsiyet, çoklu travma varlığı için anlamlı değişkenler olarak bulundu. Bu değişkenlerle bir model oluşturulduğunda, bu modelin 0,6 (%95 CI: 0,59 ila 0,72) gibi düşük tanısal doğruluk değerine sahip olduğu bulunmuştur. Sonuç: Çoklu travma ve mortalite oranı küçük olan sadece minör travma hastaları düşünüldüğünde, TVBT yaklaşımının rutin kullanımı akılcı değildir. Çalışmamızda bulunan prediktörler, minör travma hastaları için gelecekte klinik bir karar kuralı geliştirmek için kullanılabilir.

Allergy to fruits and vegetables are the most frequent food allergies in adolescents and adults. The most common phenotypes of fruit and vegetable allergy are pollen-food allergy syndrome (PFAS) (oral allergy syndrome) and lipid transfer protein (LTP) syndrome. In PFAS, fruit and vegetable allergy is caused by a prime sensitization to labile pollen allergens, e.g. Bet v 1 or profilin, and yielding generally mild phenotype, is made of local oropharyngeal symptoms. However, LTP syndrome occurs from a sensitization to LTPs, which are stable plant food allergens, often resulting systemic allergic reactions and moreover anaphylaxis. Component-resolved molecular diagnosis is crucial in directing the treatment of these patients. Existing therapeutic policies involve prevention and salvage medication, including epinephrine, for life-threatening LTP allergic reactions. Allergen specific pollen immunotherapy is not found to be helpful to manage PFAS, nevertheless sublingual immunotherapy against LTPs appears to be an encouraging treatment. Here, an interesting patient having abdominal pain for a long period of time whom later diagnosed by us with PFAS is discussed under the light of recent literature.

12 yaşında kız hasta, ilk doz Pfizer-BioNtech aşısından yaklaşık 10 saat sonra yüzünde başlayan, saatler içinde gövdesine yayılan ürtiker plakları nedeniyle çocuk acil polikliniğine başvurdu. Hastaya feniramin maleat ve metilprednizolon uygulandı. Antihistaminik ile eve taburcu edildi. Hastanın lezyonlarının tekrar nüksetmesi ve rekürren acil başvurularının olması üzerine hasta hospitalize edildi. Feniramin maleat, metilprednizolon ve famotidin tedavisinin 2. gününde lezyonlar kayboldu ve tekrarlamadı. Ürtiker deri ve mukozalarda ani olarak ortaya çıkan, kabarık, kırmızı-pembe, kaşıntılı, ödemli, kısa sürede kaybolan plaklar ile karakterizedir. Şüpheli tetikleyiciler gıdalar, ilaçlar, enfeksiyonlar, fiziksel ve emosyonel stres, içerdiği antijenik yapılar ve stabilizörler nedeniyle aşılar olabilir. Literatürde Pfizer-BioNtech aşısı sonrası cilt reaksiyonları tanımlanmıştır. Literatürde tanımlanan vakaların daha çok yetişkin yaşta olduğu görülmektedir. Hastamız 12 yaşında adolesan bir çocuk olduğu için bu olgumuzla literatüre katkı sağlamak istedik.

Abstract Background Percutaneous coronary interventions (PCI) of bifurcation stenoses are both complex and challenging. Stenting strategies share that the stents’ side cells must be carefully explored and appropriately prepared using balloons or stents. So far, stent manufacturers have not provided any information regarding side-branch expansion capacity of their stent platforms. Aims Given that drug-eluting stent (DES) information regarding their mechanical capacity of side-branch expansion is not available, we aimed to evaluate contemporary DES (Orsiro, BIOTRONIK AG; Xience Sierra, Abbott Vascular; Resolute Integrity, Medtronic; Promus Premier Select, Boston Scientific; Supraflex Cruz, Sahajan and Medical Technologies) by their side-branch expansion behavior using in vitro bench testing. Methods In this in vitro study, we analyzed five commercially available DES (diameter 3.0 mm), measuring their side-branch expansion following inflation of different high-pressure non-compliant (NC) balloons (balloon diameter: 2.00–4.00 mm), thereby revealing the morphological characteristics of their side-branch expansion capacities. Results We demonstrated that all tested contemporary DES platforms could withstand large single-cell deformations, up to 4.0 mm. As seen in our side-branch experiments, DES designs consisting of only two connectors between strut rings did not only result in huge cell areas, but also in larger cell diameters following side-branch expansion compared with DES designs using three or more connectors. Furthermore, the stent cell diameter attained was below the balloon diameter at normal pressure. Conclusions We recommend that the expansion capacity of side-branches should be considered in stent selection for bifurcation interventions.

Intraocular lymphomas are among the rare malignancies that present with a wide variety of clinical manifestations. Differential diagnosis can be very troublesome due to its mimicking nature, insidious disease onset, and partial treatment response to steroids. The most important step in diagnosis is a high index of suspicion. Signs of the disease are now easier to detect using multimodal imaging techniques. In this case series, we reviewed the clinical characteristics of two women aged 70 and 71 years and a 72-year-old man with intraocular lymphoma and described their multimodal imaging findings in detail. Bilateral eye involvement was present in all three cases at our first ophthalmological examination. While the disease first presented with ocular involvement in two of the three cases, ocular involvement was detected seven years after initial heart involvement in one patient. All three patients had diffuse large B-cell lymphomas (one diagnosed with retinal biopsy, one with conjunctival biopsy, and the remaining with stereotactic brain biopsy). Intraocular lymphoma should be diagnosed and treated using a multidisciplinary approach, and we share our experience in this case series.

Objective: In this study aimed to determine the diagnostic efficiency of miR-21 and miR-34a serum levels in the discrimination of benign prostatic hyperplasia, chronic prostatitis, and prostate cancer. Materials and Methods: Blood samples were taken from 70 patients (25 benign prostatic hyperplasias, 10 chronic prostatitides, and 35 prostate cancer) who underwent prostate needle biopsy. After obtaining serum under suitable conditions, RNA isolation, cDNA synthesis, and qRT-PCR analysis were performed using Qiagen brand kits on Rotor-Gene® Q (Qiagen, Germany) device. -∆Ct values ​​were calculated using RNU6 as a reference gene for normalization. -∆Ct values ​​were used in all statistical calculations. Results: It was observed that miR-21 serum levels were upregulated in chronic prostatitis and cancer groups compared to benign prostatic hyperplasia and the difference between the groups was statistically significant (p = 0.021 and p = 0.001, respectively). The specificity and sensitivity of miR-21 and miR-21/miR-34a combination was calculated as 56% and 86%; 84% and 71% in discriminating benign prostatic hyperplasia and prostate cancer groups, respectively. Conclusion: In this study, it has been shown that miR-21 and miR-21/miR-34a combination has diagnostic performance that can be a biomarker candidate in diagnosing prostate cancer. In addition, the presence of a gradual increase in chronic prostatitis and prostate cancer at miR-21 levels compared to benign prostatic hyperplasia suggests that inflammation and cancer transformation processes taking place at the molecular level are also reflected in the circulating microRNA profile. Keywords: Prostate cancer, Prostatitis, Benign prostatic hyperplasia, MicroRNA, Diagnostic efficiency

Patients undergoing transcatheter aortic valve replacement (TAVR) may suffer severe clinical complications, caused by paravalvular leakage (PVL) which is defined as leakage between TAVR and aortic annulus. PVL is often facilitated by a severely calcified annulus. This limits the expansion of a self-expandable TAVR stent. To assess TAVR performance in terms of leakage, measurement of regurgitation fraction in a pathophysiological annulus is recommended according to ISO 5840. For this purpose, a configuration of a circular annulus with a calcification nodule has been proposed in the recently published ISO 5840. The impact of the proposed pathophysiological annulus model on the expansion of self-expandable TAVR stents and on the regurgitation fraction was investigated in this study. For this purpose, two commercially available selfexpandable TAVRs (Evolut R and Portico) were implanted in a calcified annulus model. Circular expansion of the TAVR stents was investigated based on μCT scans of the implanted TAVR. The calcification-induced area in which retrograde flow can occur during diastole was detected. These results were then compared with the experimentally determined regurgitation fraction obtained from pulse duplicator tests. The results of the μCT scans showed a continuous leakage area in the region of the annulus for the Evolut R compared to a locally larger leakage area of the Portico, which, however, reattaches to the annulus in the distal inflow region. The hydrodynamic measurements confirmed a smaller leakage in the pathological annulus for the Portico. In summary, it can be assumed that a continuous leakage area in the TAVR stent inflow region encourages the PVL of TAVR.

Mitral regurgitation (MR) is the second most frequent indication for heart valve surgery and catheter interventions. According to European and US-American guidelines, transcatheter mitral valve repair in general and transcatheter edge-to-edge repair (TEER) in particular may be considered as a treatment option for selected high-risk patients. However, the biomechanical impact of TEERdevices on the mitral valve (MV) has not yet been fully understood. To address this problem, a 3D-Fluid-Structure Interaction (FSI) framework utilizing non-linear Finite Element Analysis (FEA) for the MV apparatus and Smoothed Particle Hydrodynamics (SPH) for the pulsatile fluid flow was developed and validated against in vitro data. An artificial MV-model (MVM) with a prolapse in the A2-P2 region and a custom-made TEER device implanted in the A2-P2 region were used for the in vitro investigations. In accordance with ISO 5910, projected mitral orifice areas (PMOA), flow rates as well as atrial and ventricular pressures were measured under pulsatile flow conditions before and after TEER device implantation. For the FSI-model, the MVM geometry was reconstructed by means of microcomputed tomography in a quasi-stress-free configuration. Quasi-static tensile test data was utilized for the development of linear- and hyperelastic material models of the chordae tendineae and leaflets, respectively. The fluid flow was modelled assuming an incompressible, homogenous Newtonian behaviour. Time-varying in vitro transmitral pressure loading was applied as a boundary condition. In vitro investigations show that TEER device implantation in the A2-P2 region effectively reduces the regurgitation fraction (RF) from 55 % to 13 %. Moreover, the comparison of experimental and numerical data yields a deviation of 2.09 % for the RF and a deviation of 0.40 % and 6.47 % for the maximum and minimum PMOA, respectively. The developed FSI-framework is in good agreement with in vitro data and is therefore applicable for the characterization of the biomechanical impact of different TEER devices under pulsatile flow conditions.