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Background The purpose of this study is to assess the incidence and clinical characteristics of adolescent tibial tubercle fractures (TTFs) during the COVID-19 pandemic by sharing our experiences. Methods Pediatric patients aged between 0 and 18 years old with confirmed diagnosis of TTFs who were treated at our center between April 2020 and May 2020 were included in the study. In addition to demographics, mechanism injury, treatment modalities, complications were also noted. Results Sixteen patients were included in the study. The mean age was 14.8 ± 0.9 years (range: 13–16 years). The mean BMI of patients was 26.3 ± 2.3 kg/m2 (range: 23.2–30.4 kg/m2). According to the BMI-for-age percentiles growth chart, eight patients (50%) were overweight, and eight patients (50%) were at a risk of being categorized as overweight. The most common cause for the injury was jumping due to basketball (50%). Twelve of 16 patients were treated operatively by open reduction and internal fixation. The remaining 4 patients were treated non-operatively with long leg cast. Conclusion The incidence of TTFs was 16 cases over about two months during the pandemic isolation period. Our results demonstrated that all adolescent TTFs occurred during periods when outdoor activities were permitted. This finding may be explained by sudden athletic activity after prolonged immobilization. We observed that all of our patients were male and either overweight or at risk of being overweight.

Objectives: Tuberculosis risk in solid-organ transplant recipients is more than the general population, although tuberculosis incidence has been reported to decrease 5% in the last decade in Turkey. In Turkey, solid-organ transplants started in 1975; however, routine pretransplant tuberculosis risk screening programs are still not established. Therefore, we conducted a meta-analysis of tuberculosis prevalence, clinical forms, and prognosis of tuberculosis in solid organ transplant recipients. Materials and Methods: We searched PubMed, Web of Knowledge, Google Scholar, EBSCOhost, and Scopus databases in English and Turkish Medical Index of Turkish Academic Network and Information Center, Turkish Citation Index, Turkish Medline, Central Thesis of ULAKBIM databases in Turkish (from inception until December 2018) for national and international reference lists of all relevant papers. We used standard methodological procedures (Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009). Results: We found 199 published studies in English and 26 in Turkish. After exclusion of noneligible studies, there were 10 retrospective research articles and 16 case reports. There were 148 (3.2%) tuberculosis cases with 4553 solid-organ transplant recipients (4031 renal, 522 liver). Of the tuberculosis cases, 50 (33.8%) were pulmonary, 21 (14.2%) were pulmonary and extrapulmonary, 13 (8.8%) were miliary, 27 (18.2%) were disseminated, and 37 (25.0%) were extra pulmonary tuberculosis cases involving a maximum of 2 organs. There were 19 cases (12.8%) of graft lost. Of the patients with tuberculosis, 34 (19.9%) died resulting from either tuberculosis or other reasons. Conclusions: In this meta-analysis, most of the centers did not perform pretransplant risk evaluations; every center had different clinical procedures and follow-ups. Tuberculosis prevalence in solid-organ transplant recipients differs according to study population. Case reports were mostly about extrapulmonary tuberculosis. All such patients should be followed-up by a standard regimen during pretransplant and posttransplant periods. Prospective studies should be considered.

Aims: The etiopathogenesis of Rheumatoid Arthritis (RA) is not clearly understood. However, the role of the cytokines play an important part in this mechanism. We aimed to bring a new approach to the concept of 'remission' in patients with RA. Background: RA is a chronic, autoimmune, inflammatory disease that involves small joints in the form of symmetrical polyarthritis and progresses with exacerbations and remissions. Pain, swelling, tenderness and morning stiffness are typical of the joints involved. Although it is approached as primary joint disease, a wide variety of extra-articular involvements may also occur. It is an interesting pathophysiological process, the exact cause of which is still unknown, with many environmental, genetic and potentially undiscovered possible factors in a chaotic manner. Objective: In this cross-sectional study, sedimentation rate (ESR), C- Reactive protein (CRP), Tumor necrosis factor (TNF)-α, soluble-TNF-α receptor (TNF-R), Interleukin (IL)-1B and IL-10 were measured in three groups which were healthy volunteers, patients with RA in the active period, and patients with RA in remission. Disease activity score-28 (DAS-28) was calculated in active RA and RA in remission. Methods: This study included 20 healthy volunteers, 20 remission patients with RA and 20 active RA patients. Venous blood samples were collected from patients in both healthy and RA groups. Results: RA group consisted 43 (71.6%) female and 17 (28.4%) male. Control group consisted 11 (55%) female and 9 (45%) male. TNF-R was significantly high only in the active group according to the healthy group (p=0.002). IL-10 was significantly high in active RA, according to RA in remission (p=0.03). DAS-28 was significantly high in active RA, according to RA in remission (p=0.001). : In the active RA group, ESR and TNF-R had a positive correlation (r:0.442; p=0.048). In the active RA group, there was also a positive correlation between TNF-R and CRP (r:0.621; p=0,003). Both healthy and active RA group had significant positive correlation between ESR and CRP (r: 0.481; p=0.032 and r: 0,697; p=0,001 respectively). Conclusion: TNF-R can be the main pathophysiological factor and a marker showing activation. TNF-R can be very important in revealing the effect of TNF on the disease and the value of this effect in the treatment and ensuring the follow-up of the disease with CRP instead of ESR in activation.

Background. Acute onset pain is one of the common reasons for cancer patients to present to the emergency department. In our study, we compared painkillers used in cancer patients admitted to the emergency department with pain complaints and their effectiveness and the superiorities of these painkillers in pain relief and their superiorities over each other. Materials and methods. The pain scores of the patients were asked at the time of admission by showing a visual analogue scale. Before treatment, pain scores were recorded. The patients were divided into four different groups according to the type of given treatment: non-steroidal anti-inflammatory drugs; opioid painkillers; paracetamol; paracetamol and opioid therapy. After the treatment, we asked which painkiller written in the treatment form was administered to the patient and recorded the pain score. Results. It was observed that the median pain score before and after treatment of the patients in all painkiller groups differed statically. When the median scores before and after treatment were compared according to drug types, no difference was found between the decrease in pain scores (p = 0.956 and p = 0.705, respectively). It was concluded that the pre-treatment and post-treatment median pain scores of patients who are using non-steroid anti-inflammatory drugs and opioids at home did not differ statistically (p = 0.063). Conclusions. The use of non-steroidal anti-inflammatory drugs, paracetamol or opioids was not found to be superior to each other in patients with acute severe cancer pain., Актуальність. Гострий біль є однією з найпоширеніших причин, через які пацієнти з раком можуть потрапляти до відділення невідкладної допомоги. У нашому дослідженні ми порівняли ефективність знеболювальних препаратів, що застосовуються в онкохворих, які надійшли до відділення невідкладної допомоги зі скаргами на біль, а також переваги цих засобів одного над одним. Матеріали та методи. Біль у пацієнтів оцінювали під час надходження за допомогою візуальної аналогової шкали. Перед лікуванням реєстрували оцінку болю в балах. Хворих розподілили на чотири різні групи за типом проведеного лікування: нестероїдні протизапальні препарати; опіоїдні знеболювальні; парацетамол; парацетамол з опіоїдною терапією. Після лікування ми запитували, яке знеболювальне отримував пацієнт, і реєстрували оцінку болю. Результати. Було відзначено, що середній показник болю до і після лікування хворих у всіх групах знеболювальних препаратів статистично відрізнявся. Коли середні показники до і після лікування порівнювали за типами препаратів, не було виявлено різниці в зменшенні показників болю (p = 0,956 і p = 0,705, відповідно). Зроблено висновок, що середній показник болю до і після лікування пацієнтів, які вдома використовують нестероїдні протизапальні препарати й опіоїди, статистично не відрізнявся (p = 0,063). Висновки. При використанні нестероїдних протизапальних препаратів, парацетамолу або опіоїдів не встановлено переваги жодного засобу над іншими в онко-хворих із сильними гострими болями.

Background/aim The aim of this study was to evaluate the value of PET Vascular Activity Score (PETVAS) during the follow-up of patients with Takayasu arteritis. Materials and methods Takayasu arteritis patients who underwent 18F-Fluorodeoxyglucose (FDG) PET imaging were evaluated retrospectively. In 8 patients both 1 and 2-hour imagings were also performed prospectively. For PETVAS, 9 arterial areas were scored between 0-3 according to the FDG uptake. Results Forty-six images of 34 patients were evaluated. PETVAS was higher in patients with clinically active disease (p=0.03) and in C-reactive protein (CRP) elevated group among clinically inactive patients (p=0.0015). PETVAS correlated with CRP (p=0.003, r=0.53) and erythrocyte sedimentation rate (p=0.005, r=0.41), whereas age, disease duration, immunosuppressive and glucocorticoid (GC) treatments were not associated with PETVAS. First vs 2nd-hour PETVAS was similar in patients who had both 1st and 2nd hour PET scans (p=0.67). Conclusion We observed higher PETVAS in patients with active disease and elevated acute phase reactants. Although scores in our study (performed at one-hour) were lower compared to the original PETVAS study performed at two hours, PETVAS seems to be a reliable tool to quantify FDG PET scores in routine practice.

BACKGROUND Defect treatment with tendon autograft in osteochondral lesions has been published in the literature with an experimental study in dogs. To demonstrate that it is possible to treat knee osteochondral lesions with the technique of autologous tendon transplantation. AIM To evaluate the clinical and radiological results of patients with knee osteochondral lesions who were treated with autologous tendon transplantation. METHODS Twenty patients (22 knees) with osteochondritis dissecans (OCD) lesions involving the knee were treated with autologous tendon transplantation between 2005-2018. All lesions were International Cartilage Repair Society grade IV. All patients were evaluated clinically at final follow-up with knee injury and osteoarthritis outcome score (KOOS); and radiologically with magnetic resonance observation and cartilage repair tissue (MOCART) and Kellgren-Lawrence (KL) classification. RESULTS A total of 20 patients (22 knees) with a mean age of 25.5± 6.8 years were included. The average defect size was 4.2 ± 2.1 cm2, and the average defect depth was 0.9 ± 0.4 cm. Total KOOS score was preoperatively 29.4 ± 5.5 and was later found to be 81.5 ± 5.9 after an average of 68.7 ± 37.7 mo follow-up. The mean MOCART score was 56.2 ± 10.7. Preoperatively, all of the patients had KL grades of 0–1; during the follow-up period, 80% of the patients showed no radiological progress of osteoarthritis. Patients with less than 4 cm2 lesion had statistically significantly better overall KOOS than patients whose more than 4 cm2 lesion, particularly in sport and quality of life subscales. CONCLUSION The autologous tendon transplantation is a single-step, safe, simple, cost-effective method for the treatment of knee OCD with satisfactory clinical and radiological outcomes, particularly in patients with less than 4 cm2 lesion.

Patienten mit Vorhofflimmern sind einem signifikant erhohten Risiko fur thromboembolische Ereignisse, insbesondere fur ischamische Schlaganfalle, ausgesetzt. Eine orale Antikoagulation reduziert dieses Risiko zuverlassig, ist jedoch aus unterschiedlichen Grunden nicht bei jedem Patienten einsetzbar und geht mit einer relevanten Erhohung des Blutungsrisikos einher. Alternativ bestehen zur Prophylaxe thromboembolischer Ereignisse bei Patienten mit Vorhofflimmern unterschiedliche Moglichkeiten eines Vorhofohrverschlusses. Anhand einer Ubersicht der aktuell verfugbaren Systeme zum Vorhofohrverschluss, eines Leitfadens zur Patientenauswahl und einer Zusammenfassung der aktuellen wissenschaftlichen Datenlage sollen die Moglichkeiten des interventionellen Vorhofohrverschlusses erlautert sowie die geeignete Patientenklientel charakterisiert werden. Fur Patienten mit Vorhofflimmern und relativer oder absoluter Kontraindikation einer oralen Antikoagulation stellt der interventionelle Verschluss des Vorhofohrs nach sorgfaltiger Patientenselektion eine sichere Alternative zum Schutz vor thromboembolischen Ereignissen dar. Die aktuell verfugbare wissenschaftliche Evidenz aus randomisierten, kontrollierten Studien ist gering. Umfangreiche Registerstudiendaten lassen dennoch einen eindeutigen Nutzen vermuten, wahrend die Ergebnisse mehrerer groser randomisierter, kontrollierter Studien in den kommenden Jahren erwartet werden.

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.

Bu çalışmada, deneysel florozis oluşturulmuş, korunma ve tedavi için vitamin C ve E uygulanmış ratlarda A- D ve E vitamin düzeylerinin belirlenmesi amaçlandı. Çalışmada materyal olarak, 1 aylık Wistar-Albino ratlar kullanıldı. Her biri 8 hayvandan oluşan 9 grup üzerinde çalışıldı. İçme suyu içerisinde hazırlanan sodyum florür (NaF) çözeltileri (150 mg/kg), çalışma süresince ad-libitum olarak uygulandı. Koruma grubuna, 150 ppm NaF içeren su ile birlikte 16 hafta/gün aşırı Vitamin C (100 mg/kg), Vitamin E (300 mg/kg) ve Vitamin C + Vitamin E (100 mg/kg + 300 mg/kg) uygulandı. Tedavi grubuna, 16 hafta süresince 150 ppm NaF içeren su, ad-libitum olarak verildikten sonra 4 hafta süresince normal içme suyu yanında; Vitamin C (100 mg/kg), Vitamin E (300 mg/kg) ve Vitamin C + Vitamin E (100 mg/kg + 300 mg/kg) uygulandı. On altı hafta sonunda ratlardan kan örnekleri alınarak serumları çıkarıldı. Serum Retinol, α-Tokoferol, Vitamin D3, düzeyleri HPLC ile belirlendi. Florozis grubunda tedavi ve koruma amaçlı vitamin C ve E uygulaması ile serum vitamin A ve vitamin D düzeylerinde bir değişikliğin olmadığı, ancak vitamin E seviyesinde azalma olduğu tespit edildi. Sonuç olarak, florozis olgularında hem korunmada hem de tedavide vitamin E verilmesinin etkili olduğu sonucuna varılmıştır., This study aimed to determine the vitamins A-D and E levels in rats with experimental fluorosis and in whom vitamins, C and E were administered for prevention and treatment. One-month-old Wistar-Albino rats were used as material in the study. Nine groups of 8 animals each were studied. Sodium fluoride (NaF) solutions (150 mg / kg) prepared in drinking water were administered ad-libitum during the study. Vitamin C (100 mg / kg), Vitamin E (300 mg / kg) and Vitamin C + Vitamin E (100 mg / kg + 300 mg / kg) were administered to the protection group with water containing 150 ppm NaF for 16 weeks / day. Water containing 150 ppm NaF was given ad-libitum for 16 weeks in the treatment group, and then Vitamin C (100 mg/kg), Vitamin E (300 mg/kg) and Vitamin C + Vitamin E (100 mg/kg + 300 mg/kg) were administered along with normal drinking water for 4 weeks. At the end of sixteen weeks, blood samples were taken from the rats and their serums were removed. Serum Retinol, α-Tocopherol, Vitamin D3 levels were determined by HPLC. In the fluorosis group, it was found that there was no change in serum vitamin A and vitamin D levels with the application of vitamins C and E for treatment and protection, but a decrease in vitamin E level. As a result, it was concluded that the administration of vitamin E is effective in both the prevention and treatment of fluorosis cases.

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.

Background We present a 76-year-old poly-morbid male patient suffering from severe ischemic mitral valve regurgitation. A hybrid approach was suggested by the heart team to treat his multifaceted cardiac pathologies. Methods At first percutaneous mitral valve repair with the mitraclip device was performed to reduce surgical risk. This was then followed by minimally invasive direct coronary artery bypass (MIDCAB). Results At day 20 Post mitraclip intervention the patient suffered gastrointestinal bleeding which needed argon plasma coagulation (APC)-therapy and multiple blood transfusions. Stage II of the hybrid procedure was executed on post-intervention day 34 by minimally invasive direct coronary artery bypass (MIDCAB) to left anterior descending artery (LAD). Seven days later the patient was discharged. Up to two years of follow-up, the patient is in stable condition, without recurrent cardiac symptoms. Conclusion Hybrid approach of percutaneous mitral valve repair followed by MIDCAB is an effective minimally invasive treatment for severe ischemic mitral valve regurgitation and coronary artery disease.

Background: Several factors that increase the risk of severe food-induced anaphylaxis have been identified. Objective: We aimed to determine the demographic, etiologic, and clinical features of food-induced anaphylaxis in early childhood and also any other factors associated with severe anaphylaxis. Methods: We carried out a medical chart review of anaphylaxis cases from 16 pediatric allergy and immunology centers in Turkey. Results: The data of 227 patients with 266 food-induced anaphylaxis episodes were included in the study. The median (interquartile range) age of the first anaphylaxis episode was 9 months (6‐18 months); 160 of these patients were boys (70.5%). The anaphylaxis episodes were mild in 75 cases (28.2%), moderate in 154 cases (57.9%), and severe in 37 cases (13.9%). The most frequent food allergens involved were cow's milk (47.4%), nuts (16.7%), and hen's egg (15.8%). Epinephrine was administered in only 98 (36.8%) of these anaphylaxis episodes. A logistic regression analysis revealed two statistically significant factors that were independently associated with severe anaphylaxis: the presence of angioedema and hoarseness during the anaphylactic episode. Urticaria was observed less frequently in patients who developed hypotension. In addition, confusion and syncope were associated with 25.9- and 44.6-fold increases, respectively, in the risk of concomitant hypotension. Conclusion: Cow's milk, nuts, and hen's egg caused the majority of mild and moderate-to-severe anaphylaxis episodes. The presence of angioedema and hoarseness in any patient who presents with a history of food-induced anaphylaxis should alert clinicians that the reaction may be severe. In addition, the presence of confusion, syncope, or stridor probably indicates concomitant hypotension.

Objective The aim of this retrospective case-control study was to analyze the effect of administering indomethacin after triggering final oocyte maturation in patients with poor ovarian response (POR) on the cycle cancellation rate due to premature ovulation (PO), the number of oocytes retrieved and the clinical outcomes of IVF cycles. Study Design A total of 214 patients with POR, diagnosed according to the Bologna criteria, who underwent fresh IVF cycle via flexible gonadotrophin-releasing hormone antagonist (GnRH-ant) protocol were enrolled in the study. The control group consisted of 100 patients, whereas the indomethacin group included 114 patients who received 100 mg rectal indomethacin administered twice within the same day (twelve hours apart) –starting at twelve hours after triggering. Cycle cancelation rates (CCR), number of oocytes retrieved (nOR), implantation rates (IR), biochemical pregnancy (BP) and clinical pregnancy loss rates (CPL), ongoing pregnancy rates (OPR) and live birth rates (LBR) were compared between the indomethacin and control groups. Results The CCR rate was significantly lower in the indomethacin group (1.8%) compared to the control group (1.8% vs %12%, p = 0.01). In the control group, those with cycle cancellation were older than those without cycle cancellation (mean age 42.2 ± 2.3 years vs. 39.36 ± 4.3 years, p = 0.001) and had lower anti-Mullerian hormone levels and lower antral follicle count (0.59 ± 0.2 ng/mL vs 0.79 ± 0.2 ng/mL, p = 0.001 and 4 ± 0.6 vs 5.7 ± 1.7, p = 0.001, respectively). In multivariable analysis, when the dependent variable in the logistic regression model was coded as the absence of cycle cancellation, it was observed that only indomethacin had a statistically significant effect on cycle cancellation (β = −1.931, standard error = 0.832, Exp(B) = 0.145, p = 0.020). nOR was higher in the indomethacin group than control group but the difference did not reach significance (p = 0.07). Moreover, the IR, OPR and LBR, BP and CPL values were similar in the indomethacin and control groups (p > 0.05). Conclusions Based on data from this study, it can be concluded that indomethacin reduces cycle cancelation due to PO in patients with POR –without compromising implantation and pregnancy rates. However, further randomized controlled trials with larger sample sizes are required to clarify the definitive effect of indomethacin in the treatment of patients with POR.

Background/aim Tumor necrosis factor-alfa (TNF-a) antagonists are extensively utilized in the treatment of inflammatory rheumatic diseases and also shown to be effective in Behcet’s disease (BD) patients with major organ involvement. In this study, we aimed to re- evaluate the incidence of tuberculosis (TB) infection after anti-TNFa treatments and to reveal the risk of TB in BD. Methods Data of patients who received anti-TNFa treatment between 2005 and 2018 were assessed retrospectively. Demographic features, TNF-a antagonist type/treatment time, tuberculosis skin test (TST) and QuantiFERON results, isoniazid prophylaxis status, and concomitant corticosteroid (CS) treatments were collected. Results A total of 1277 (male/female = 597/680; median age = 49 years) patients were treated with TNF-a antagonist for a median of 33 months (Q1:12, Q3:62). Thirteen (1%) patients developed TB during the follow-up period. Within 13 TB-positive patients, 7 of them had pulmonary, and 7 had extrapulmonary TB. Although, the median time of (month) TNF-a antagonist treatment was higher in TB-positive patients than negative ones, the difference was not statistically significant (48 and 33 months, respectively, p = 0.47). Similarly, TB-positive patients were treated with CSs more than TB-negative patients (80% vs. 60%). Time from the initiation of TNF-a antagonist treatment to the diagnosis of TB had a median of 40 months (Q1-Q3: 22-56). There was a statistically significant increase of TB development in BD patients than non-BD patients after TNF-a antagonists (7.5% vs. 0.8%, respectively, p = 0.007). When we combined our patients with the other series from Turkey, among 12928 patients who received TNF-a antagonists, TB was positive in 12 (3.9%) of 305 BD patients compared to 112 (0.9%) of 12623 non-BD patients (p < 0.00001). Conclusion Our results suggest a higher frequency of TB infections in BD patients with TNF-a antagonists. As biologic agents are increasingly used for major organ involvement in current practice for BD, screening mechanisms should be carefully implemented.

Objective: Guidelines suggest using bronchial provocation testing (BPT), which is hard to attain, in patients with asthma-like symptoms presenting with nondiagnostic spirometric tests. To eliminate the risk of over/underdiagnosing asthma, we aimed to evaluate the predictive value of not only fractional exhaled nitric oxide (FeNO) but also other easily accessible clinical indices for ruling in/out asthma. Materials and Methods: This retrospective study included adults presenting to our clinic with respiratory symptoms suggestive of asthma but with normal spirometric values and negative reversibility test, who underwent FeNO and methacholine BPT (MchBPT). Medical records were used to obtain descriptive characteristics, clinical history, allergy screening, eosinophils in peripheral blood, and spirometry. Results: Among 51 patients, 19 were diagnosed with asthma. Body mass index and blood eosinophils were significantly higher in patients with positive MchBPT (p=0.042 and p=0.037, respectively). No significant difference was found in other indices, including FeNO (p=0.293). Receiver operating characteristic curve analysis revealed the best diagnostic cutoff level for FeNO as 14 ppb and blood eosinophil as 150/μl for the prediction of positive MchBPT (with 63.16%-62.5% and 80%-61% sensitivity-specificity, respectively). These two indices were the only independent predictors of positive BHR, and the model of FeNO>14ppb combined with eos>150/μl showed 100% specificity with a 100% negative predictive value. Conclusion: Our results suggest using the combination of FeNO with blood eosinophil count as a rule-out test, adding a new step in the algorithmic diagnosis of asthma. This might avoid an unnecessary BPT procedure, reduce the risk of over/under-diagnosis of asthma, and hasten the correct diagnosis.

Introduction: Disability and decrease in the quality of life owing to the nature of schizophrenia are considered factors that predispose patients to parasitic infections. This study aimed to investigate intestinal parasites in schizophrenia and healthy volunteers with similar age-gender data and to contribute to the literature and/or clinical practice by determining the underlying cause of gastrointestinal complaints (such as side effects of psychiatric drugs or overlooked parasitic infection) in patients with schizophrenia. Methods: This case-control study included 30 patients with schizophrenia and 30 healthy volunteers. Their stool samples were examined for the presence of intestinal parasites primarily microscopically or serologically in cases requiring differential diagnosis. Results: The overall positivity rate of intestinal parasites was 25% (15/60). The difference between the intestinal parasite detection rates, which was 36.7% (11/30) in the schizophrenia group and 13.3% (4/30) in the healthy control group, was significant (odds ratio: 3.76; 95% confidence interval: 1.04-13.65; p

Background Turkey hosts the world’s largest refugee population of whom 3.5 million are Syrians and this population has been continuously growing since the year 2011. This situation causes various problems, mainly while receiving health-care services. In planning the migrant health-care services, for the policy makers of host countries, health literacy level of migrants is an important measure. Determination of health literacy level of Syrian refugees in Turkey would be supportive for planning some interventions to increase health-care service utilization, as well as health education and health communication programs. An “original health literacy scale” for 18–60 years of age Turkish literate adults (Hacettepe University Health Literacy Scale-HLS) was developed to be used as a reference scale in 2018. Since it would be useful to compare the health literacy levels of Turkish adults with Syrian adult refugees living in Turkey with an originally developed scale, in this study, it was aimed to adapt the HLS-Short Form for Syrian refugees. Methods This methodological study was carried out between the years 2019–2020 in three provinces of Turkey where the majority of Syrians reside. The data was collected by pre-trained, Arabic speaking 12 interviewers and three supervisors via a questionnaire on household basis. At first, the original Scale and questionnaire were translated into Arabic and back translated into the original language. The questionnaire and the Scale were pre-tested among 30 Syrian refugees in Ankara province. A total of 1254 refugees were participated into the main part of the study; 47 health-worker participants were excluded from the validity-reliability analysis. Confirmatory factor analysis (CFA) was performed. Cronbach’s alpha and Spearman–Brown coefficients were calculated. Results Of the participants, 52.9% was male; 26.1% had secondary education level or less; almost half of them had moderate economic level; 27.5% could not speak Turkish. The Cronbach’s Alpha was 0.75, Spearman–Brown Coefficient was 0.76; RMSEA = 0.073, CFI = 0.93, TLI = 0.92 and GFI = 0.95 for the Scale. The Cronbach’s Alpha was 0.76, Spearman–Brown Coefficient was 0.77; RMSEA = 0.085, CFI = 0.93, TLI = 0.91 and GFI = 0.95 for self-efficacy part. Conclusion In conclusion, the adapted HLS would be a reliable instrument to evaluate the health-literacy level of Syrian refugees living in Turkey and could allow for a comparison of the host country’s health literacy level to that of the refugees using the same scale.

Amaç: İlköğretim birinci sınıf öğrencilerinde, diş çürükleri ve diş çürüğü ileilişkili bazı etmenlerin incelenmesi amaçlanmıştır. Gereç ve Yöntem: Çalışmanın verileriMersin’in Toroslar ilçesinde 2008-2012 yılında yürütülen “Güçlü Dişler”projesinden alındı. Çalışmaya 41ilkokulun birinci sınıfında okuyan 4323öğrencinin 4010’unun verileri dâhil edildi. Öğrenciye ait sosyodemografiközellikler tanımlayıcı istatistiklerle özetlendi. Diş çürüğü ile ilişkiliolabilecek değişkenlerin araştırılmasında ki-kare, t-test, Linear by linearassociation ve lojistik regresyon testleri kullanıldı. İstatistiksel anlamlılıkdüzeyi α≤0.05 olarak kabul edildi. Bulgular:Çalışmaya alınan 4010 ilköğretim 1.sınıf öğrencisinin %79.5’i yedi yaşında ve%51.9’u erkekti. Öğrencilerden %48.4’ü daha önce hiç diş hekimine gitmemişti.Öğrencilerde; ortalama çürük diş sayısı süt dişlerinde 4.4±3.6 (dmf=4.49±3.6),kalıcı dişlerde 0.4±0.9 (DMF=0.42±1.0), toplam çürük sayısı ise ortalama 4.9(±3.5)’ti. Süt dişi çürüğü prevalansı erkeklerde (%85.8) kızlara (%82.8) göredaha fazla (p, Objective: Theaim of this study was to investigate the incidence of dental caries and relatedfactors in first year primary school students. Methods: The data of the study was taken from the “Strong Teeth”project conducted in 2008-2012 in Mersin, Toroslar district. The data of 4010out of 4323 students in the first year of 41 primary schools were included inthe study. Chi-square, t-test, linear by linear association and logisticregression tests were used to investigate the variables related to dentalcaries. Statistical significance level was accepted as α ≤0.05. Results: Of the 4010 primary schoolstudents included in the study, 79.5% were seven years old and 51.9% were male.48.4% of the students had never been to a dentist before. The mean number ofdecayed teeth was 4.4±3.6 (DMF=4.49±3.6) in primary teeth, 0.4±0.9(DMF=0.42±1.0) in permanent teeth, and the total number of caries was 4.9(±3.5). The prevalence of milk tooth decay was higher in boys (85.8%) thangirls (82.8%), while the prevalence of permanent tooth decay was higher ingirls (20.6%) than boys (17.6%) (p

Purpose: The purpose of this study is to explore the effects of dihydrotestosterone (DHT) on lipopolysaccharide (LPS)-induced proinflammatory cytokine release in human ocular surface epithelial cells exposed to LPS and LPS-binding protein (LBP). Methods: Immortalized human corneal, conjunctival, and meibomian gland epithelial cells were cultured in keratinocyte-free medium. After confluency, they were exposed to a stratification medium Dulbecco's modified Eagle medium (DMEM)/F12 in the presence of fetal bovine serum and were exposed to vehicle, LPS + LBP, or DHT. Culture media were processed for multiplex-bead analysis of specific proinflammatory cytokines including interferon (IFN)-γ, tumor necrosis factor (TNF)-α, interleukin (IL)-2, IL-4, IL-8, IL-6, IL-10, IL-1β, vascular endothelial growth factor (VEGF)-A. Cytokine concentrations were compared by analysis of variance with Tukey post hoc testing. p < 0.05 was considered statistically significant. Results: The results are LPS + LBP-induced the secretion of IFN-γ, IL-6, IL-10, IL-1β, VEGF-A cytokines in corneal epithelial cells; TNF-α, IL-2, IL-8, IL-6, IL-1β, VEGF-A cytokines in conjunctival epithelial cells; and IL-8, IL-6, IL-1β, VEGF-A cytokines in meibomian gland epithelial cells. When these LPS + LBP-stimulated cells were exposed to DHT for 2 days, it was found that DHT suppressed the secretion of IL-6, IL-10, IL-1β, VEGF-A cytokines in corneal epithelial cells; TNF-α, IL-6, IL-1β, VEGF-A cytokines in conjunctival epithelial cells; and IL-6, IL-1β, VEGF-A cytokines in meibomian gland epithelial cells. Conclusion: LPS + LBP is shown to induce the secretion of certain proinflammatory cytokines from ocular surface and adnexal epithelial cells. DHT showed anti-inflammatory activity by suppressing some of those cytokines in these cell lines.

The COVID-19 pandemic, which originated in China and spread all over the world, continues to be a significant public health crisis. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are valuable parameters that can be evaluated in routine blood tests and provide information about the inflammation in many diseases. This study aimed to evaluate the effect of NLR and PLR on mortality. Methods. Our cross-sectional cohort study included patients who were hospitalized due to COVID-19 with positive polymerase chain reaction test results and patients whose test results were negative at the time of the first admission to the hospital, but whose computed tomography imaging was suspicious for COVID-19 and test results were found to be positive in repeated tests during their hospitalization. Prognosis of the hospitalization outcomes was investigated and discharge, hospital admission, intensive care unit (ICU) admission, and mortality data during the 30 days were recorded and the relationship between these parameters was evaluated. Results. The mean age of the patients was 57.5 ± 16.7 years. Cough was the most common symptom and was present in over half of patients. Almost one-third of patients (27.1%) had at least three symptoms at presentation. Both increased levels of NLR and PLR were observed to significantly predict the mortality of patients with COVID-19 (p5.49) and 43.5% and 81.9% for PLR, respectively (AUC: 0.622, cut-off>228.13). Conclusions. The present study has concluded that NLR and PLR are effective mortality predictors in patients infected with SARS-CoV-2.

Objective: Epistaxis is a common condition in the childhood age group. However, it is important to diagnose the underlying bleeding disorders in children presenting with this complaint. Simple methods to be used in primary health care are needed to determine whether patients have bleeding disorders. This study aims to evaluate patients presenting with epistaxis with the bleeding questionnaire and determine the diagnostic value of patients with symptomatic but normal hemostatic tests. Methods: Seventy-seven children with epistaxis were included in the study group and 20 healthy children in the control group. Pediatric Bleeding Questionnaire (PBQ) was used for evaluation. Results: In our study, 19.4% (n = 15) of the patients were diagnosed with bleeding diathesis (vWh: 10, rare factor deficiency: 5). The mean age at presentation was 8.99 ± 3.42 (3-17) years. Thirty-seven (48%) were girls and 40 were boys. In terms of PBQ epistaxis score, there was no statistically significant difference between those with and without bleeding diathesis. However, the overall score was not statistically different; it was higher in the group with bleeding diathesis. The cutaneous bleeding score was higher in the group with bleeding diathesis and there was a statistically significant difference. Conclusions: This study showed that bleeding scores can be used in patients with epistaxis who apply to primary health care institutions and patients with high overall scores and cutaneous bleeding scores should be directed to the hematologist for further research.Keywords: Epistaxis, bleeding diathesis, bleeding score

Background/aim Numerous studies show that cancer risk is reduced by consumption of soy-based foods containing genistein, but its effects on the glycogen synthase kinase-3 pathway (GSK-3) in ovarian cancer is unknown. Therefore, we tested the properties of genistein on inflammatory biomarkers and GSK-3 signaling pathways in the ovaries of old laying hens with ovarian cancer. Materials and methods A total of 300 laying hens were distributed into three groups as follows: group 1, animals fed a standard diet (comprising 22.39 mg of genistein/kg of diet); groups 2 and 3, animals fed a standard diet reconstituted with supplementation of 400 mg or 800 mg of genistein/kg of diet, respectively. Results Genistein modulated the inflammatory biomarkers by decreasing serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL- 6), interleukin-8 (IL-8), and vascular endothelial growth factor (VEGF) compared with control (p < 0.001). Moreover, it upregulated insulin receptor substrate-1 (p-IRS-1) and protein kinase B (p-AKT), but downregulated GSK-3α and β after treatment. It acts in a dose-dependent manner. Conclusion Genistein exhibited an anticancer effect by reducing proinflammatory biomarkers levels and inhibiting GSK-3 expression in the ovaries of old laying hens. It is a potential candidate in the chemoprevention and/or treatment of ovarian cancer.

Bu çalışma, deneysel olarak kronik florozis oluşturulan ratlarda vitamin C (vit C) ve E (vit E)'nin serum protein fraksiyonları üzerindeki etkilerini araştırmak amacıyla planlandı. Materyal olarak Wistar-Albino ratlar kullanıldı (Her biri 8 rat içeren, 8 grup). Deneme grupları; kontrol grubu, deneysel florozis grubu, koruma grupları (16 hafta boyunca, içme suyu içeren günlük 150 ppm NaF içeren içme suyu/ad-libitum ile birlikte vit C (100 mg / kg), vit E (300 mg / kg) ve vit C + vit E (100 mg/kg + 300 mg/kg)) ve tedavi grupları (16 hafta boyunca 150 ppm NaF içeren içme suyu/ad-libitum verildikten sonra tedavi amacıyla 4 hafta vit C (100 mg/kg), vit E (300 mg / kg) ve vit C + vit E (100 mg/kg + 300 mg/kg)) olarak oluşturuldu. Deneme sonunda kan örnekleri toplandı ve serumlar alındı. Bu örneklerde serum protein fraksiyonları selüloz-asetat elektroforezi ile belirlendi. Deneysel florozis grubunda total protein yüzde gram açısından, alfa-1’in önemli oranda azaldığı ve beta globülinlerin arttığı tespit edildi. Korunma ve tedavi amacıyla vitamin C, vitamin E ve vitamin C+vitamin E birlikte verildiği gruplarda, değişen bu değerlerin kontrol grubuna yaklaştığı görüldü. The aim of the present study was to investigate the effects of vitamins C (vit C) and E (vit E) on the serum protein fractions in rats with experimentally-induced chronic fluorosis. Wistar-Albino rats (male) were used as material (8 groups, each containing 8 rats). The experimental groups were control, protection groups (daily 150 ppm NaF containing drinking water for 16 weeks as ad-libitum, and, on alternate Vit C (100 mg/kg), Vit E (300 mg/kg) and Vit C+ Vit E (100 mg/kg + 300 mg/kg) for 16 weeks) therapy groups (daily 150 ppm NaF containing drinking water for 16 weeks as ad-libitum, then normal drinking water as ad-libitum, Vit C (100 mg/kg), Vit E (300 mg/kg) and Vit C + Vit E (100 mg/kg + 300 mg/kg) on alternate for 4 weeks). The end of experimental period, blood samples were collected and serums were obtained. Serum protein fractions in blood samples were determined with cellulose-acetate electrophoresis. Alpha-1 was significantly decreased and beta globulins increased in the experimental fluorosis group. In the groups in which vitamin C, vitamin E and combine combination of vitamin C and vitamin E were given for prevention and treatment, it was observed that these changing values approach to the control group.

Study design This was a retrospective observational study. Objective The objective of the study was to evaluate the spinal and extraspinal factors responsible for pulmonary dysfunction in adolescent idiopathic scoliosis patients. Summary of background data Development of thoracic deformity due to scoliosis results with the restrictive ventilatory pattern and the reduced pulmonary function. To prevent pulmonary function deterioration, it is imperative to understand which factors are causing the restrictive lung disease in adolescent idiopathic scoliosis patients. Materials and methods An online database search was conducted in a hospital computerized archive between 2008 and 2018 years. Cobb angle of >30 degrees, Lenke type 1 and 2 patients treated in a single spine unit were included. Coronal and sagittal Cobb angle, bending correction rate for evaluation of flexibility, Risser score, apical vertebra rotation (AVR), and pulmonary function test of patients were obtained. Results There was a moderate negative correlation between forced expiratory volume in the first second, forced vital capacity, and AVR. There was no correlation between forced expiratory volume in the first second and forced vital capacity with age, sex, Cobb angle, Risser score, kyphosis, and bending correction rate. Conclusions When considering the results of the current study and the other studies in the literature there is not any strong correlation between the features of scoliotic curvature and respiratory functions. In the current study, 52 (72.22%) of 72 patients with moderate to severe scoliosis had mild to severe respiratory dysfunction. Considering the age-related physiological respiratory loss, to evaluate the necessity of surgical treatment in patients with moderate and severe scoliosis, especially in patients with high AVR, the respiratory functions of the patient should also be evaluated. Level of evidence Level III.

Aim: This study aims to determine the prognostic value of the Glasgow Prognostic Score (GPS) and fibrinogen to albumin ratio (FAR) in patients with COVID-19. Methods: Electronic database records of 400 patients with COVID-19 were retrospectively analyzed and the initial levels of CRP, albumin, fibrinogen values were recorded. The ground-glass opacities (GGO) and consolidations were evaluated on thorax CT. Hospital mortality and the need for intensive care unit (ICU) transfer were determined as adverse outcomes. Results: It was determined that 345 patients (86.25%) were discharged while 31 patients (7.75%) were transferred to ICU in addition to 24 patients who died (6%). The rates of deaths and transfers to ICU were significantly increased in GPS 2 group compared to both GPS 0 and 1 groups. Additionally, increased FAR was observed in patients who died and transferred to ICU compared to the discharged patients. The FAR was significantly increased in patients with diffuse GGO. Logistic regression analysis indicated that FAR ≥144.59 and the presence of GPS 2 were independent predictors of the adverse outcomes in COVID-19 patients. Conclusion: Our results demonstrated that the GPS and FAR could possess a predictive value for adverse outcomes in patients with COVID-19.

Giriş: Kına, doğu kültürlerinde saç boyası ve dövme olarak uzun yıllardır kullanılmaktadır. Parafenilendiamin (PPD), kınaya eklenen bir çeşit aromatik amindir. PPD eklendiğinde oluşan formülasyonun oldukça toksik olduğu bilinmektedir. Olgu sunumu: Burada intihar amaçlı kına alımı sonrası PPD'ye bağlı yaygın anjiyoödem, rabdomiyoliz ve akut böbrek yetmezliği ile acil servise başvuran 16 yaşında bir kadın hasta sunuldu. Hastaya şiddetli solunum sıkıntısı nedeniyle acil trakeotomi yapıldı ve hasta yoğun bakımda mekanik ventilatöre bağlanarak takip edildi. Sonuç: PPD intoksikasyonu hayatı tehdit eden bir durumdur ve PPD intoksikasyonu için spesifik bir antidot yoktur. Hayat kurtarıcı olduğu için hastaya erken müdahale şarttır., Introduction: Henna, has been applied in eastern cultures for many years, as a hair dye and tattoo. Paraphenylenediamine (PPD) is a kind of aromatic amine added to henna. The formulation formed when PPD added known to be highly toxic. Case report: Here, a 16-year-old female patient admitted to an emergency clinic with severe angioedema, rhabdomyolysis, and acute renal failure caused by PPD after henna ingestion for suicidal purposes, was presented. An emergency tracheotomy was performed to the patient because of severe respiratory distress, and the patient was followed up by connecting to the mechanical ventilator in intensive care.Conclusion: PPD poisoning is a life-threatening condition, and there is no specific antidote for PPD intoxication. Early intervention to the patient is essential because it is life-saving.

Objective: In this study, we aimed to analyze the TURKMI registry to identify the factors associated with delays from symptom onset to treatment that would be the focus of improvement efforts in patients with acute myocardial infarction (AMI) in Turkey. Methods: The TURKMI study is a nation-wide registry that was conducted in 50 centers capable of 24/7 primary percutaneous coronary intervention (PCI). All consecutive patients (n=1930) with AMI admitted to coronary care units within 48 hours of symptom onset were prospectively enrolled during a predefined 2-week period between November 1, 2018, and November 16, 2018. All the patients were examined in detail with regard to the time elapsed at each step from symptom onset to initiation of treatment, including door-to-balloon time (D2B) and total ischemic time (TIT). Results: After excluding patients who suffered an AMI within the hospital (2.6%), the analysis was conducted for 1879 patients. Most of the patients (49.5%) arrived by self-transport, 11.8% by emergency medical service (EMS) ambulance, and 38.6% were transferred from another EMS without PCI capability. The median time delay from symptom-onset to EMS call was 52.5 (15-180) min and from EMS call to EMS arrival 15 (10-20) min. In ST-segment elevation myocardial infarction (STEMI), the median D2B time was 36.5 (25-63) min, and median TIT was 195 (115-330) min. TIT was significantly prolonged from 151 (90-285) min to 250 (165-372) min in patients transferred from non-PCI centers. The major significant factors associated with time delay were patient-related delay and the mode of hospital arrival, both in STEMI and non-STEMI. Conclusion: The baseline evaluation of the TURKMI study revealed that an important proportion of patients presenting with AMI within 48 hours of symptom onset reach the PCI treatment center later than the time proposed in the guidelines, and the use of EMS for admission to hospital is extremely low in Turkey. Patient-related factors and the mode of hospital admission were the major factors associated with the time delay to treatment., Turkish Society of Cardiology from AstraZeneca, Statistical analyses were conducted by Omega CRO, Ankara, Turkey. The electronic case report form and the data capture program (OpenClinica LLC and collaborators, Waltham, MA, USA) hosted were by Omega CRO, Ankara, Turkey. TURKMI registries are investigator-initiated trials and sponsored by the Turkish Society of Cardiology, which received major, unrestricted funding from AstraZeneca for this project. The funder had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

GİRİŞ ve AMAÇ: İnsan İmmun Yetmezlik Virüsü (HIV) ölümcül seyredebilen AIDS (Acquried-immunodeficiency syndrome) olarak tanımlanan hastalığa neden olmaktadır. Bu çalışmada anti HIV/1-2 testi reaktif saptanan olguların doğrulama sonuçlarının incelenmesi, hatalı pozitif ELISA sonuçlarının önüne geçebilmek için uygun eşik değerin belirlenmesi amaçlanmıştır.YÖNTEM ve GEREÇLER: Çalışmamızda XXX Hastanesi Laboratuvarı’ na Temmuz 2017–Eylül 2019 tarihleri arasında gönderilen anti-HIV/1-2 sonuçları retrospektif olarak değerlendirildi. Serumda Anti- HIV/1-2 antikorları 4. Kuşak ELISA testi olan Elecsys HIV combi PT ( Roche, Almanya) ile çalışıldı. Reaktif örnekler, Ulusal AIDS Doğrulama Merkezi’ne gönderildi. Örnekler burada başka bir 4. Kuşak ELISA testi olan Vıdas HIV duo ultra (bioMerıeux, Fransa) kullanılarak tekrar çalışıldı. Reaktif örnekler doğrulama için antikor saptayan hızlı HIV doğrulama testlerinden olan Geenius HIV-1/2 Supplemental Assay (Bio-Rad, Fransa) ile çalışıldı. Doğrulama testi pozitif örnekler HIV enfeksiyonu olarak değerlendirildi. ELISA testi ile reaktif saptanıp doğrulama sonucu negatif olan örneklerde akut HIV enfeksiyonu varlığını tespit etmek için artus HI virus-1 QS RGQ RT-PCR (Qiagen, Almanya) kiti kullanılarak Rotor-Gene Q cihazı (Qiagen, Almanya) ile HIV RNA çalışıldı. BULGULAR: Reaktif sonuca sahip 60 örnek tespit edildi. Doğrulamaya gönderilen 60 reaktif örneğin 7’ si (%11.6) pozitifti. Yanlış reaktif saptanan en yüksek ELISA değeri 24,09 S/CO iken gerçek reaktif en düşük ELISA değeri 16,78S/CO olarak görüldü. ELISA ile reaktif saptanıp doğrulama testi negatif olan örneklerin hiçbirinde HIV-RNA pozitifliği saptanmadı.TARTIŞMA ve SONUÇ: Sonuç olarak, ülkemiz gibi düşük HIV prevalansına sahip toplumlarda, tarama testlerinin pozitif prediktif değeri oldukça düşmektedir. Her merkezin kendi tarama testinin eşik değerlerini belirlenmesi hatalı reaktif sonuçların önüne geçecektir. Ancak bu durumda akut HIV enfeksiyonlarının gözden kaçabileceği de unutulmamalıdır.

Healthcare workers are the group with the highest risk of COVID-19 transmission. The illness of healthcare workers poses a risk to patients admitted to the hospital, colleagues and households besides their own health. In this study, it was aimed to determine the risk assessment and the factors associated with risk status of an university hospital healthcare workers after risky COVID-19 contact. The data of the descriptive study were obtained from 773 follow-up records of 555 healthcare workers who applied with COVID-19 risky contact between 06.04-10.05.2020. Employees who were positive for RT-PCR evaluated as "patients" and others as "risky contact". Risk assessment was classified as no risk, low, medium and high risk contact according to the "Algorithm of Assessment of Health Workers with COVID-19 Contact" of the Ministry of Health. The relationship between the risk levels of the participants and their demographic and workplace characteristics and their usage of personal protection were evaluated. Mean, standard deviation, percentage, chi-square and ANOVA tests were used in the analysis of the data. The average age of the healthcare workers was determined as 34.4 ± 7.6 years. It was determined that 56.2% of those who had contact were female, 62.9% were married and 17.5% had an additional disease. It was determined that 45.6% of the risky contacts were nurses, 18.4% were supportive personnel and 16.9% were doctors. While 46.5% of the contacts were found as medium, 28.0% low, 17.1% high risk and 8.4% risk free. 38.2% of risky contacts occurred while working in internal/surgical clinics. While 66.0% of the employees had risky contact during patient care and treatment, 25% had risky contact with colleagues in social settings. High-risk contact was higher in social relations between employees. The source of the contact was a colleague in 73.2% of the employees. The average age of high-risk employees was smaller than those of low-risk. While 54.5% of the employees wore surgical masks during contact, 67.8% of the patients did not have a mask. Of 555 employees followed, 37 (6.7%) were diagnosed as COVID-19; 48.6% of the patients were nurses and 18.9% were doctors. It was determined that 48.6% of the healthcare workers were working in the COVID-19 service, outpatient clinic or intensive care unit at the time of diagnosis. The source of the infection was thought to be a colleague in 51.6% of the patients. COVID-19 was more common in nurses and doctors. It was determined that risky contact also occurred in services other than the units where COVID-19 patients were treated and risky contact often took place while providing healthcare to the patients and during social relations between the employees. Unprotected contact of the employees with each other in the workplace was identified as an important risk source. Inadequate use of personal protective equipment by healthcare workers led to an increase in medium and high risk contacts. The use of masks by patients and their relatives during the health service delivery and the proper use of personal protective equipment by healthcare professionals will reduce the risk. With the physical improvement of the rest areas of the employees and the arrangement of the breaks, the risky contact between colleagues in the social areas will be reduced.

Background In acute myocardial infarction complicated by cardiogenic shock the use of mechanical circulatory support devices remains controversial and data from randomized clinical trials are very limited. Extracorporeal life support (ECLS) - venoarterial extracorporeal membrane oxygenation - provides the strongest hemodynamic support in addition to oxygenation. However, despite increasing use it has not yet been properly investigated in randomized trials. Therefore, a prospective randomized adequately powered clinical trial is warranted. Study Design The ECLS-SHOCK trial is a 420-patient controlled, international, multicenter, randomized, open-label trial. It is designed to compare whether treatment with ECLS in addition to early revascularization with percutaneous coronary intervention or alternatively coronary artery bypass grafting and optimal medical treatment is beneficial in comparison to no-ECLS in patients with severe infarct-related cardiogenic shock. Patients will be randomized in a 1:1 fashion to one of the two treatment arms. The primary efficacy endpoint of ECLS-SHOCK is 30-day mortality. Secondary outcome measures such as hemodynamic, laboratory, and clinical parameters will serve as surrogate endpoints for prognosis. Furthermore, a longer follow-up at 6 and 12 months will be performed including quality of life assessment. Safety endpoints include peripheral ischemic vascular complications, bleeding and stroke. Conclusions The ECLS-SHOCK trial will address essential questions of efficacy and safety of ECLS in addition to early revascularization in acute myocardial infarction complicated by cardiogenic shock.

Objective:This study aims to review the parameters affecting tumour recurrence, tumour progression and cancer survival of patients with low-grade non-muscle invasive bladder cancer.Materials and Methods:We retrospectively reviewed 262 patients with primary, low-grade Ta bladder cancer. Recurrence was defined as the occurrence of a new tumour in the prostatic urethra or bladder. Tumour progression was defined as confirmed high-grade Ta, all T1 or carcinoma in situ, upper tract recurrence or progression to T2. The associations between factors that affect recurrence and progression were analysed.Results:Tumour recurrence and progression occurred in 119 (45.4%) and 25 (9.5%) patients during follow-up (median follow-up: 50.9±36.3 months), respectively. Univariate and multivariate analyses demonstrate that smoking, multiple tumours and large tumours (3 cm3 cm) and smoking were risk factors for recurrence and progression. Prevention of smoking and routine cystoscopic examination are essential in bladder cancer.

In some cases of sexual assault that are not reported to judicial authorities within a certain time, it is important to detect and identify seminal stains on laundered fabrics. In this study, we aimed to reveal the effect of the time from staining to laundering on the detectability and identification of seminal stains on laundered clothes. A total of 180 pieces of fabric (four different colours and five different types) were stained with seminal fluids, and three different lag times (12 hours, 1 week and 1 month) from staining to laundering were used. Three different laundering protocols were applied to these fabrics after staining. The built-in camera of the Mobile Multispectral UV-VIS-IR Imaging System® was used to take photos (1260 in total) of the stains with seven different wavelength and filter options, and the obtained images were evaluated. The Seratec® PSA Semiquant test was used to analyse the presence of prostate-specific antigen (PSA) in the seminal stains laundered after different lag times. We observed that in examining with the forensic light source (FLS) system, the time from staining to laundering affected the detectability of seminal stains on pieces of cloth. The best fluorescence was obtained in the examination of semen-stained fabric with FLS, particularly when the fabric was not laundered for one month after staining. On the other hand, the time from staining to laundering had a more limited effect on PSA test positivity than on the results of the examination with FLS.

Objectives To evaluate the functional and anatomical results of patients with non-infectious intraocular inflammation (IOI) following intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection for the treatment of neovascular age-related macular degeneration (nAMD). Materials and methods The medical records of patients receiving anti-VEGF treatment for nAMD between January 2015 and March 2019 were retrospectively analyzed. Preoperative and postoperative routine ophthalmological examinations, central macular thickness, duration of inflammation, and follow-up time of the patients with non-infectious IOI following anti-VEGF injection were recorded. Results Non-infectious IOI was determined in 13 eyes (11 eyes with aflibercept, 2 eyes with ranibizumab) of 1,966 patients who received a total of 12,652 anti-VEGF (4,796 aflibercept and 7,856 ranibizumab) injections. IOI was detected after a mean of 7 injections (2-12 injections). All eyes had both anterior chamber reaction (Tyndall +1/+3) and vitritis (grade 1-3). None of the patients had pain, hypopyon, or fibrin reaction. Visual acuity progressed to baseline levels within 28.3 days. Vitritis continued with a mean of 40 days. All patients recovered with topical steroid therapy. In 11 eyes, injection of the same anti-VEGF agent was continued. No recurrence of IOI was observed in any patients. Conclusion Non-infectious IOI following intravitreal anti-VEGF injection typically occurs without pain, conjunctival injection, hypopyon, or fibrin and responds well to topical steroid therapy. Visual acuity returns to baseline levels within weeks according to the severity of inflammation.

Vincristine (VCR), which is a key component of chemotherapy, is important for survival. VCR is associated with a well-known side effect, including neurotoxicity. The aim of this study was to evaluate the features of vincristine-induced peripheral neuropathy (VIPN) and the effectiveness of pyridoxine plus pyridostigmine therapy in children with acute lymphoblastic leukemia. The WHO and NCI CTCAE neurotoxicity scorings were used to evaluate VIPN at diagnosis, in the first month, and after the third month of the treatment. The clinical features of 23 patients having acute lymphoblastic leukemia with VIPN during the period of July 2013–February 2016 were prospectively evaluated. The mean age was 72.8 ± 51.6 months, and 26.1%, 56.5%, and 17.4% were in standard, moderate, and high-risk groups, respectively. Neuropathy frequently occurred at induction (82.6%) and reinduction (17.4%) of the protocol. Drop foot (82.6%), leg pain (82.6%), and difficulty in walking (82.6%) were observed. The mean total cumulative dose of neuropathy occurrence was 5.6 ± 2.03 mg/m2. Our study showed that both the WHO and NCI CTCAE scorings were significantly improved via pyridoxine plus pyridostigmine therapy. The WHO and NCI CTCAE scorings may be used for evaluating neuropathy at diagnosis and follow-up of neurotoxicity with treatment. Pyridoxine plus pyridostigmine therapy may be an effective option in the treatment of VIPN.

Cardiovascular disease is one of the major causes of mortality in anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). Metabolic syndrome (MetS) is associated with increased cardiovascular risk in the normal population. However, MetS in AAV has not been adequately investigated. We aimed to determine MetS prevalence and associated factors in AAV patients. Thirty-seven AAV patients and 42 healthy controls were enrolled. MetS was determined by International Diabetes Federation (IDF) and National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII) criteria. The relationship between clinical features of AAV and MetS was also investigated. MetS was significantly higher in AAV patients than controls by NCEP-ATPIII (51.4% vs. 26.2%, p 0.022) and IDF (62.2% vs. 35.7%, p 0.020). When AAV patients with MetS were compared to those without, there were significant differences in age, CRP, GFR and NT-pro-BNP. Age [58 (13) vs. 50 (8) years p: 0.028], CRP [4.0 (3.6) vs. 3.2 (1.0) mg/l, p 0.021] and NT-pro-BNP [173.5 (343.7) vs. 106.0 (103.0) pg/ml, p 0.013] were significantly higher in AAV patients with MetS than those without; GFR was significantly lower [38 (46) vs. 83 (51) ml/min/1.73 m2, p 0.004]. ROC curve analysis showed NT-pro-BNP > 58.0 ng/ml predicted MetS with 87.1% sensitivity and 46.7% specificity (Area under curve: 0.71, CI 0.536–0.902, p 0.041). Multivariate analysis revealed age [OR (95% CI): 1.180 (1.010–1.370), p 0.039] and NT-pro-BNP > 58 pg/ml [OR (95% CI): 5.5 (1.02–30.1) p 0.047] were independent predictors of MetS in AAV patients. MetS is significantly higher in AAV patients than controls and is associated with age and NT-pro-BNP. Screening and treating MetS may improve prognosis in AAV patients.

Ilkay Koca Kalkan,1 Gozde Koycu Buhari,1 Hale Ates,1 Buket Basa Akdogan,1 Ozlem Erdem Ozdedeoglu,1 Kurtulus Aksu,1 Ferda Oner Erkekol2 1Department of Immunology and Allergy, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey; 2Division of Immunology and Allergy, Department of Chest Diseases, Ankara Yıldırım Beyazıt University School of Medicine, Ankara, TurkeyCorrespondence: Ilkay Koca KalkanDepartment of Immunology and Allergy, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Sanatoryum Cad, Keçiören, Ankara 06280, TurkeyTel +90 505 3117710Fax +90 312 3552110Email ilkay.koca@gmail.comPurpose: Local anesthetics (LA) are widely used and adverse drug reactions (ADR) occur in 2.5– 10%, but hypersensitivity reactions are rare (ranging between 0% and 4.3%). Risk is so overestimated causing too many allergy clinic referrals. There are limited and also conflicting results over the management of LA allergy. We aimed to find out who should be referred to an allergy clinic for a LA allergy testing, to define the subjects with an increased risk of LA allergy and to assess the need for testing for identifying alternative LA.Patients and Methods: We performed a retrospective study of patients referred to our clinic for diagnostic workup of LA hypersensitivity from 2006 to 2020.Results: In our cohort of 398 patients, tests were positive in 14 (3.52%) of them. Personal history of ADR with LA was the only independent risk factor for positive test (RR=4.007, p=0.033). Presence of generalized cutaneous symptoms and hypotension during past reaction were independent predictors of positive test (RR=9.043, p=0.021 and RR=10.445, p=0.038, respectively). The negative predictive value of intradermal test at dilution of 1:100 for immediate-type reaction was high (97.56%). Also, we demonstrated cross-reactivity within the amide-group LAs and co-occurrence of immediate- and delayed-type reactions.Conclusion: Only patients with an LA-induced ADR should be referred to an allergy clinic. History of generalized cutaneous symptoms and/or hypotension during the reaction may define subjects with an increased risk of LA allergy. A stepwise test procedure may start with skin tests especially for these patients with increased risk factors. In presence of LA allergy, alternative LA should always be confirmed by performing a challenge test.Keywords: intradermal tests, local anesthetics, drug hypersensitivity, skin tests, risk factors, prick tests

Severe acute respiratory syndrome coronavirus-2 is an important infectious agent that was first detected in China, causing the pandemic and death of thousands of people. Although the clinic of this disease, called coronavirus disease-19 (COVID-19), is variable, cytokine storm and different mechanisms can cause increased mortality as a result of progressive and serious clinical presentations. Since it belongs to a well-known group of viruses, researchers have gained momentum after the isolation and the identification of the features of the virus. Although specific drugs began to be developed, the first potential candidate drugs were drugs such as broad-spectrum antibiotics, antiviral agents, anti-parasitic agents, and interferon, which were planned to be used with similar indications before pandemic. Trials on all steps such as prophylactic and supporting therapies, as well as care for critically ill patients and vaccine investigation studies are still ongoing. The drugs used in the light of the guidelines were frequently updated and some changes were made as a result of reports on side effects and efficacy evaluations. Especially in some drug combinations, side effects like prolonged QT interval, drug-drug interactions, and restrictions on the use of some drugs in the pediatric age group or pregnancy limit the specific, evidence-based and reliable treatment. Although there are many drugs in the trial phase for COVID-19 treatment, the most promising and most effective drugs are discussed and summarized under the light of national guidelines and clinical evidences with all aspects of the literature.

Objectives: The pathophysiology of isolated coronary artery ectasia (CAE) involves atherosclerosis and inflammation. Eosinophils and lymphocytes have been found to play a significant role in inflammation, atherosclerosis and endothelial dysfunction. Many studies have explored the relationship between isolated CAE and systemic inflammation. However, there are no data regarding the relationship between eosinophil-to-lymphocyte ratio (ELR) and isolated CAE. Therefore, this study analysed the relationship between ELR and isolated CAE. Methods: All patients who underwent coronary angiography between January 2009 and June 2018 were investigated retrospectively. Of 16 240 patients, 232 patients with isolated CAE (141 males) and 247 age- and gender-matched control subjects (130 males) with normal coronary angiography (NCA) were enrolled in this study. Baseline demographic and laboratory data were obtained from the hospital database. The severity of isolated CAE was determined according to the Markis classification, vessel count and diffuseness of ectasia. Results: Patients with angiographic isolated CAE had significantly elevated white blood cell (WBC) and eosinophil counts and ELR values compared to patients with NCA [8.11 ± 1.75 vs 7.49 ± 1.80 × 109 cells/l, p < 0.0001; 0.22 (0.13-0.32) vs 0.19 (0.12-0.28) × 109 cells/l, p = 0.02; 0.11 (0.06-0.17) vs 0.08 (0.05-0.12), p < 0.0001. The ELR value for Markis I was significantly higher than for Markis IV (p = 0.04), and three-vessel isolated CAE was significantly higher than onevessel isolated CAE (p = 0.04). Additionally, the ELR value for diffuse ectasia (Markis class I, II and III) was significantly higher compared to focal (Markis class IV) ectasia (p = 0.02). In receiver operating characteristics (ROC) analyses, it was determined that an ELR value > 0.099, measured in isolated CAE patients at application, had a predictive specificity of 60.3% and a sensitivity of 56.5% (area under the curve: 0.604, 95% confidence interval: 0.553-0.655, p < 0.0001). Conclusions: Patients with isolated CAE had higher blood eosinophil counts and ELR. Furthermore, the ELR was significantly correlated with severity of isolated CAE. These findings demonstrate that ELR may have a significant role in the aetiopathogenesis of isolated CAE. WOS:000587657400003 Q4

Behçet’s disease (BD) is a systemic and inflammatory disorder that is mainly present along the ancient Silk Road, from the Mediterranean Sea to East Asia. A wide range of prevalence figures (0.1–420/100,000) have been reported for BD, also among Turkish populations of similar genetic background living in different countries. Recently, a decline in the incidence of BD and a change of the disease spectrum to less-severe manifestations have been reported from Japan and Korea, two genetically homogenous, affluent populations with limited immigration. It was hypothesized that a decline in infectious diseases, especially dental/periodontal infections, associated with the improvement in oral health, could be a part of these changes in the disease expression. Further epidemiological studies in other populations might demonstrate whether there is a worldwide similar trend and may provide a better understanding of the triggering factors for the onset and course of BD.

Objective: we have conducted this study to evaluate clinical and laboratory findings and to gather and evaluate information that would be useful in clinical practice, such as demographics, joint involvement patterns, laboratory anomalies, treatments applied, and responses obtained in patients diagnosed with gout. Methods: in our study, the demographic, clinical, and laboratory characteristics of 94 patients diagnosed with gout were evaluated. The patients were re-evaluated with regard to their clinical and laboratory findings at the end of the 1st and 3rd months, their responses to the treatment were observed, and where necessary, new treatment adjustments were made. Results: seventy-nine (84%) of the patients were men, and 15 (16%) were women. The ages of the patients ranged between 22 and 86 years with the average age being 57.5 years. The joint involvement during a gouty arthritis attack was most frequently observed in the 1st metatarsophalangeal joint (87.2%), followed by the ankle joint (26.9%), and the knee joint (23.7%). The joint involvement pattern was evaluated to reveal that the acute monoarticular arthritis was observed in 87 patients (93.5%), followed by acute oligoarticular arthritis coming in second in terms of frequency (26.9%). An average attack was determined to last 10.7 days, and the average number of attacks in a year was 2.69. In our study, the colchicine treatment in 24 of our patients, in whom it was determined during the admission and follow-up process that they have not had gouty arthritis attack in the past 3 months, was stopped. Five (20.8%) patients whose colchicine treatment was stopped later developed gouty arthritis attacks, and the colchicine treatment was restarted. On the other hand, 10 out of 38 patients (26.3%), who have either been continuing or had never been on colchicine treatment, were observed to experience a gouty arthritis attack during their 1st and 3rd month check-ups. Conclusion: In patients with gout, it is recommended that the related diseases, as well as the triggering factors (alcohol, drug use, and dietary effect), be determined, the necessary lifestyle changes be made, and the treatments started., NA

Background/aim: In this study, our objective was to evaluate the mortality in geriatric hip fracture patients who were operated within 48 h after admission or after the 48thh. Materials and methods: A total of 194 patients who had undergone surgery for hip fracture between 2016 and 2018 were retrospectively evaluated. Patient information was obtained from the hospital’s database using the ICD codes 81.52, 82.00–82.09, and 82.10. Radiological examination reports were collected from the patient files. Information on mortality was obtained from the Death Notification System of the Turkish Ministry of Health. First-year mortality rates of patients operated within 48 h (Group 1) and those operated at 48–96 h (Group 2) were compared.Results: The mean duration between admission to the hospital and surgical intervention was 33.90 ± 1.95 h (3–96 h). The mean total hospitalization time was 7.29 ± 1.53 days (2–36 days). Of the patients, 62 (32%) died within one year after the operation. The mean survival times for patients operated ≤48 h or >48 h were 8.47 ± 1.90 and 6.57 ± 2.59 months, respectively (Z = 1.074, P = 0.283). There was no significant correlation between survival time and the time delay before the operation (r = –0.103, P = 0.153). Additionally, the Cox regression analysis, including age (years), ASA (grade 3 vs. 2), time to operation (h), and days spent in the ICU, demonstrated no significant independent effect of the time to operation on survival (P = 0.200).Conclusion: Although shortening the time to surgery may have some rationale, we did not find any difference in patients operated before 48 h compared to 48–96 h concerning mortality.

Elevated levels of heavy metals like cadmium (Cd) and manganese (Mn) are known to lead to oxidative damage-related oto-toxicity and decreased levels of chromium (Cr) and selenium (Se) are known to lead to oto-toxicity due to reduced anti-oxidant activity. The aim of the present study was to evaluate serum levels of Cd, Mn, Cr, and Se and their relationship with tinnitus. A total of 48 patients with tinnitus (Group 1) and 40 healthy controls (Group 2) were included in the study. All participants were applied audiology tests. Severity of tinnitus was measured with Tinnitus Severity Index Questionnaire (TSIQ) in group 1. Serum Mn, Cd, Cr, and Se measurements were done by using The Agilent ICP-MS system consisted of a 7700 coupled plasma mass spectrometry (ICP-MS). Serum Cd, Mn, and Cr levels were higher in group 1 and Se level was lower in group 1 than that of group 2. We may conclude that Cd, Mn, Cr, and Se levels could play an important role in etio-pathogenesis of tinnitus, and thereby supplementation or reduction of these elements could be considered as novel therapeutic goals.

Objectives This study aims to present our experience in the management of fractured femoral stems after primary and revision hip replacements by evaluating the clinical and radiographic characteristics and determining the effectiveness of the extraction methods. Patients and methods A total of 15 patients (5 males, 10 females; mean age 65.9 years; range, 49 to 87 years) who underwent revision hip replacement due to a fractured femoral stem between January 2005 and December 2019 were included in this retrospective study. The mechanisms and risk factors for failure as well as methods applied to extract fractured stem were analyzed through clinical and radiographic data. Results Nine patients had fractured cemented femoral stems, while six patients had fractured fully porous coated cementless revision stems. Lack of proximal buttress in distally fixed femoral stems was detected in 11 patients and identified as the predominant mechanism resulting in fracture. The proximal extraction method with conventional revision instrumentation, the cortical window technique, and extended trochanteric osteotomy (ETO) were used in three, seven, and five cases, respectively. Conclusion Our results demonstrated that the lack of proximal buttress is the most common reason for femoral stem fracture. Moreover, the proximal extraction method was mostly ineffective in fully porous femoral stems. A step-by-step approach should be considered for the extraction of a broken stem. The cortical window method can be considered as the second step if proximal extraction methods fail, and ETO should be considered at the last step if all techniques fail.

Background Patients scheduled for surgery after unsuccessful MitraClip® intervention present increasingly with multiple comorbidities, and they are often referred to the heart team to suggest the most appropriate intervention. The publication of successful results of initial patient cohorts treated with the MitraClip device has resulted in recruitment of more seriously ill patients, who otherwise would have been denied catheter-based/surgical treatment. There has been increasingly reports on conventional surgery after failed mitral valve repair with the MitraClip device. However, data on such procedures remain scarce and mostly focused on individual case studies. The inevitable increase in use of MitraClip, however, will raise the number of patients in need of surgery post MitraClip, making it imperative for surgeons to understand challenges and outcome data related with surgery in this patient cohort. We present our long-term institutional experience with surgery after MitraClip intervention in highest risk patients. Methods Eighteen patients underwent surgery of the mitral valve at our Institution between January 2015 and June 2020. These patients developed recurrent mitral regurgitation grade more than 2° at various intervals after MitraClip. Mitral valve repair was performed where possible and gross examination Valve/MitraClip were intra-operatively documented. Implanted MitraClip devices were analyzed histopathologically to evaluate the healing process and rule out inflammation. Regular patient follow-up was performed. Results Mean patient age was 74 (±9 years) and MitraClip implantation was performed at various tertiary institutions. Sixteen out of eighteen (16/18) patients received mitral valve replacement, whereas the remaining two patients received mitral valve repair and extracorporal membrane oxygenation, respectively. Four patients died of sepsis and intractable multi organ failure in-hospital. The remaining patients were discharged alive out of hospital to different rehabilitation centers. Follow-up was complete in all patients. Conclusions Surgery is demanding when patients require surgery for persistent or recurrent mitral regurgitation after MitraClip therapy and can be successfully implemented as a possible therapy option for selective cases as an interdisciplinary approach despite calculated high perioperative mortality risk. These patients should not be denied surgery outright.

Enerji temini ve maliyeti her geçen gün daha çok ön plana çıkmaktadır. Bununlabirlikte üretiminde ve tüketiminde çevreye olan etkileri de, maliyet ve teminikadar önemli hale gelmiştir. Bu yüzden mevcutenerji türlerine alternatif olarak rüzgâr, güneş, dalga gibi doğal vesürdürülebilir enerji kaynakları yerini almaya başlamıştır. Enerjikullanımındaki bu değişim, ahşap endüstrisine de yansımaktadır. Bu çalışmada, masif ahşabın kurutulması için ısı kaynağı olarak güneşenerjisini kullanan bir kurutma fırının kurutma performansı incelenmiştir. Bu kapsamdagüneş enerjisi bakımından nispeten önemli bölgelerden olan Muğla şehrinde yeralan güneş kolektörlü bir fırında, iki farklı kalınlıktaki Kızılçam kerestelerikurutulmuştur. Yapılan denemeler sonucunda; istenen sonuç rutubetine, büyükoranda kereste kalitesi korunarak ulaşılmıştır. Diğer yöntemlere oranla birazdaha uzun sürede kurutulmalarına karşın, en az %30 enerji tasarrufu sağlandığısöylenebilir. Sonuç olarak bu alanda kullanılan diğer enerji türleriylekarşılaştırıldığında, temiz bir enerji türü olan güneş enerjisi ile düşükmaliyetli ve kaliteli bir kurutma yapılabildiği görülmüştür., Energysupply and cost come to the forefront more with each passing day. However, theimpacts on the environment in the production and consumption have becomeimportant as cost and supply. Therefore, wind, solar, wave etc. began to taketheir place as natural and sustainable with being alternative energy sources.This change in energy use is also reflected in the wood industry.In this study, theperformance of drying kiln using solar energy as a heat source wasinvestigated. In this context, Red Pine lumbers with two different thicknessgroups were dried in a solar kiln located Muğla where is relatively importantregion about solar energy. The results showed that the desired final moisture contentswere achieved by substantially maintaining the lumber quality. Although thedrying duration a bit longer than other methods, it can be said that at least30% energy saving was provided. As a result, compared to other energy typesused in drying kilns, it has been seen that drying operations with low cost andgood quality can be performed with solar energy which can be described as aclean energy type.

Mitral regurgitation (MR) is the most prevalent valvulopathy in the USA and the second most prevalent valvulopathy in Europe. Despite excellent clinical results of surgical mitral valve repair (SMVR), transcatheter-based mitral valve repair (MVR) procedures emerged as a feasible treatment option for surgically inoperable or high-risk patients suffering from clinically relevant MR. The current study investigates the impact of device-induced coaptationwidth on the hydrodynamic performance of insufficient mitral valves (MV) during left ventricular (LV) systole. A non-calcified, pathological MV model (MVM) featuring a D-shaped MV annulus with an area of 7.6 cm2 and a flail gap in the A2-P2 region was employed in an experimental setup. Pressure gradient-volumetric flow rate (Δp-Q) relations were investigated for steady-state backward flow with transvalvular pressure gradients ranging from (0.75 ≤ Δp ≤ 177.36) mmHg. Glycerol-water mixture (36 % (v/v) glycerol in water) at 37 °C with a density of (1 098.2 ± 1.3) kg·m-3 and a dynamic viscosity of 3.5 mPa∙s was used as circulatory fluid. In order to determine the impact of the width of transcatheter MVR devices during LV-systole Δp-Q relations were investigated for three MVM-configurations: (i) MVM without MVR device, (ii) MVM with one MVR device and (iii) MVM with two MVR devices implanted in the A2-P2 region. The MVR devices were manufactured from steel sheets with a thickness of 0.2 mm and feature arm lengths of 9.0 mm and a width of 5.0 mm. The conducted investigations show that the implantation of MVR devices in the A2-P2 region prevents the manifestation of an A2-P2 flail gap and thereby effectively reduces the retrograde blood flow during the LV-systole by 13 % with one MVR device and 27 % with two MVR devices implanted. Thus, the application of two MVR devices with a combined device-induced width of 10 mm results in a better MR reduction than the implantation of one MVR device with a device-induced width of 5 mm.