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Rail transit systems, one of the important public transportation (PT) systems, are widespread in large cities to satisfy passengers or commuters for their daily trips. However, rail transportation (RT) investments are costly, and the budgets are minimal. Thus assessing RT systems in big cities play a crucial role in deciding on the best RT investment. In this study, for the first time, a two-stage fuzzy set is used among the multi-criteria decision-making (MCDM) studies in the area of transportation. The proposed method is a unique technique integrating the Analytic Hierarchy Process (AHP) and Vise Kriterijumska Optimizacija I Kompromisno Resenje (VIKOR) techniques with an extension of Pythagorean fuzzy sets. In this manner, datasets from the observations of three rail lines in Antalya, one of the largest cities in Turkey, are applied to the proposed method. Fuzzy Analytic Hierarchy Process (FAHP), a commonly used MCDM method, is used to weighting four main criteria and thirteen sub-factors. AHP is strengthened by interval-valued Pythagorean fuzzy numbers (IVPFNs). The Fuzzy VIKOR (FVIKOR) approach is then applied for the prioritization of three rail line alternatives. Results are achieved by analyzing not only real RT service observations, also actual RT expenditures or costs. Consequently, the uncertainty in results is thus minimized. Outcomes of the case study reveal the most serviceable RT line in the city evaluating the main criteria, namely economy, comfort, environment, and safety. Therefore, the proposed approach methodologically contributes to adopting a new insight into the integration of MCDM methods with fuzzy set. [ABSTRACT FROM AUTHOR]

Objective: Coronavirus disease-2019 (COVID-19), which caused a big outbreak, was first detected in Wuhan, China on 31st of December, 2019, and began to spread all over the world rapidly. The first case in Turkey was detected on the 11th of March, 2020. This study aims to calculate time-dependent (TD) reproduction number (Rt) using three different serial interval values in the late phase of the COVID-19 pandemic for Turkey. Material and Methods: TD model was used for estimation of reproduction number. For the serial interval of the coronavirus, the serial interval values of 4±2.5 and 6±3 days were used together with the severe acute respiratory syndrome and Middle East respiratory syndrome serial interval mean of 8±3.6. Gamma distribution was used for serial interval estimates. The bootstrap method with 1,000 simulations was used for all reproduction number confidence interval estimates. Results: Using 8±3.6, 6±3 and 4±2.5 serial interval values, the mean reproduction number (Rt) calculated for Turkey with the TD model was 2.06 (1.92-2.21), 1.70 (1.58-1.81), and 1.39 (1.30- 1.48), respectively. The confidence intervals of the reproduction number values calculated for Turkey range from 1.30 (lowest) to 2.21 (highest). Conclusion: According to the TD model results, from the first day when the pandemic started in Turkey to the 32nd (11th of April 2020) and 33rd (12th of April 2020) days, the Rt value decreased below 1 and the outbreak started to demonstrate a breaking point. Lower Rt in Turkey compared to the other epicenters of the world may indicate that Turkey was quicker in implementing preventive measures much earlier than the other countries. [ABSTRACT FROM AUTHOR]

Aim: Doppler echocardiography has become the standard imaging modality for diastolic function and provides pathophysiological insight into systolic and diastolic heart failure. In this study, we aimed to obtain normal echocardiographic Doppler parameters of healthy Turkish population. Methods: Among 31 collaborating institutions from all regions of Turkey, 1154 healthy volunteers were enrolled in this study. Predefined protocols were used for all participants during echocardiographic examination and The American Society of Echocardiography and European Association of Cardiovascular Imaging recommendations were used for echocardiographic Doppler measurements. Results: A total of 967 healthy participants were enrolled in this study after applying exclusion criteria. Echocardiographic examination was obtained from all subjects following predefined protocols. Mitral E wave velocity and E/A ratio were higher in females and decreased progressively in advancing ages. E wave deceleration time and A wave velocity were increased with aging. Assessment of tissue Doppler velocities showed that left ventricular lateral e′, septal e′, and septal s′ were higher in younger subjects and in females. E/e′ ratio was increased progressively with advancing decades. Right ventricular e′ and s′ were decreased but a′ was increased with increasing age. Septal e′ lower than 8 cm/s was 1.9% in the fifth decade and 13.7% in ages older than 50 years. The E/e′ ratio greater than 15 (and also 13) was not found. Conclusion: This study, for the first time, provides echocardiographic reference ranges for normal cardiac Doppler data in healthy Turkish population which will be useful in routine clinical practice as well as in future clinical trials. [ABSTRACT FROM AUTHOR]

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Highlights • Industrial container and drum cleaning (ICDC) wastewater characterization was done. • The concentrations of pollutants in ICDC wastewater have very variable structure. • Fenton-like process and combined coagulation/oxidation processes have been studied. • All methods were suitable for the removal of COD, BOD, TOC, TP, and of some metals. • Fenton-like process is a favorable system for modification of existing system. Abstract Industrial container and drum cleaning (ICDC) facilities generated complex wastewater which have organic/inorganic compounds, acids, alkalis, metals, dyes, asbestos, PCBs, chemical cleaning solutions or textile auxiliary chemicals. Treatment of such these wastewaters containing all these pollutants is also very difficult. It is required that the wastewater chemical oxygen demand (COD) is below 1500 mg/L to treat in a centralized wastewater treatment facility in Thrace Region, Turkey. In this study the characterization of ICDC industrial wastewater and treatment alternatives of this wastewater using Fenton-like (FL) process, acidic coagulation-flocculation + H 2 O 2 /UV-C (CF + H 2 O 2 /UV-C) and acidic coagulation-flocculation + S 2 O 8 2− (CF + S 2 O 8 2−) processes have been studied. The existing treatment system already has a biological treatment system after coagulation-flocculation system and couldn't be operated effectively in spite of all the efforts. We have studied processes that can be integrated into the coagulation-flocculation (CF) process used in the existing wastewater treatment plant. According to characterization study, COD values were in the range of 4584–18125 mg/L. The COD of the wastewater used in treatment experiments were 11,853 mg/L. According to the results FL and CF + S 2 O 8 2− systems were suitable for the COD discharge standards specified for the centralized wastewater treatment plant. The optimum conditions of FL process were 0.8 g/L for FeCl 3 and 45 g/L for H 2 O 2 and COD was measured as about 1500 mg/L at these doses. The optimum conditions of CF + S 2 O 8 2− system were determined as 0.64 g/L FeCl 3 for CF and 15 g/L H 2 O 2 doses. At these dosages the highest COD removal efficiency was achieved to 68% after 5 h. All methods used were suitable for the removal of COD, biochemical oxygen demand (BOD), total organic carbon (TOC), total phosphorus (TP) and of some metals. Considering the integration into the existing treatment system and applicability, it is concluded that the FL process is most favorable. [ABSTRACT FROM AUTHOR]

Global warming, as the world came across, is a global problem from that it must prevent and struggle with decisiveness. The countries, which had recently become combating with global warming, have made a lot of progresses to overcome the problem. In this study, it is aimed to appraise Turkish tax system in terms of the taxes that are applied to combat with the global warming. The findings on the tax amendments show that Turkey has not direct tax applications to combat with the global warming, but some indirect tax amendments. As those existing amendments are not directly related to reduce the gas releases but other purposes, Turkey needs to resume its agendas on green tax policies and make immediate amendments in the tax legislation so as to integrate its tax systems to international tax regulations. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the relationship between nephrolithiasis and vitamin D receptor (VDR) gene BsmI (rs1544410), ApaI (rs7975232), TaqI (rs731236), Tru9I (rs757343) and FokI (rs2228570) polymorphisms in a study group from the Turkish population.Materials and Methods: Ninety-eight patients with calcium oxalate kidney stones and 70 controls were enrolled in this study. Five polymorphisms of the VDR gene were studied using the Polymerase Chain Reaction Restriction Fragment Length Polymorphism (PCR-RFLP) method.Results: For all polymorphisms, genotype frequencies were in line with Hardy-Weinberg equilibrium in the patients and controls. For the BsmI polymorphism, allele frequency distribution was found to differ significantly between the patients and the controls (P < .05). The "B" allele was found to increase the risk of nephrolithiasis by approximately 1.5-fold (odds ratio = 1.55, 95% confidence interval: 1.00-2.40; P = .048). However, we did not find any statistically significant differences in the allele and genotype frequencies for the ApaI, TaqI, Tru9I and FokI polymorphisms. Proportionally, the "BAt" and "baT" haplotypes were more common than other haplotypes in the cases and controls, respectively. For the haplotypes of the BsmI and TaqI polymorphisms, the "bT" haplotype frequency was found to be common in both the patients and the controls. However, we did not find statistically significant differences between the cases and the controls for either the BsmI / ApaI / TaqI or the BsmI/TaqI haplotypes. Moreover, no relationship was identified between family history and development of stone disease.Conclusion: The "B" allele of the BsmI polymorphism of the VDR gene may increase stone development risk. Further investigations are needed to improve our knowledge regarding the genetic factors affecting urinary stone development. [ABSTRACT FROM AUTHOR]

Objective: Peripartum Cardiomyopathy (PPCM) is a life-threatening, rare disorder that occurs during the late stages of pregnancy or the early postpartum period. The ARTEMIS (A RegisTry of pEripartuM cardIomyopathy in Turkish patientS) aims to investigate the clinical characteristics and outcomes of PPCM in Türkiye, providing insights into its management within this specific population., Methods: The ARTEMIS registry retrospectively enrolled patients diagnosed with PPCM within the last five years at 44 cardiology centers across Türkiye. Eligible participants were women over 18 years old, diagnosed with PPCM and without other known cardiac pathology. Data collected included demographic information, clinical presentation, diagnostic modalities, treatment regimens, and outcomes., Results: The study included 293 patients, predominantly between 25 and 35 years old. The majority presented with symptoms such as dyspnea and palpitations, diagnosed postpartum via echocardiography. A low use of advanced diagnostic imaging was noted, relying primarily on echocardiography for evaluation. Common treatments included beta blockers (97.8%), angiotensin-converting enzyme (ACE) inhibitors (71.3%), and in severe cases, bromocriptine (6.9%). The study highlighted a mortality rate of 5.1%, with surviving patients often requiring continued management for heart failure. Diagnostic challenges and variations in treatment responses were noted, reflecting the complexity of PPCM diagnosis and care., Conclusion: The ARTEMIS registry provides valuable insights into the management of PPCM in Türkiye, highlighting the need for targeted educational programs for healthcare providers and patients. It also underscores the importance of national registries in understanding and improving outcomes for rare diseases like PPCM.

Objective: To determine the outcomes of retrograde ıntrarenal surgery (RIRS) and its complications in  both young and elderly patients., Study Design: An observational study., Place and Duration of Study: Departments of Urology, University of Health Sciences, Ankara Research and Training Hospital, Ankara, and Çorum Hitit University, Çorum, Turkey from April 2019 to January 2020., Methodology: Patients with kidney stones up to 3 cm in maximal diameter on computarised tomography (CT) scan, were divided into two groups according to age (<60 vs. ≥60 years ). RIRS was performed. Demographics, clinical data, and complications were recorded and compared., Results: Mean age of 78 patients was 52.47 ±13.28 years. There were no significant difference in gender, American Society of Anesthesiology (ASA) scores, operation time, number of multiple sessions, success rates of outcome and complication rates between groups. At the end of the first session, stone-free rates were 91.1% vs 87.9% in younger and elderly groups, respectively; while, after the second session, all patients were stone-free in both groups. Fever, hematuria (macroscopic, more than 24 hours), and perirenal hematoma were the observed complications. Postoperative hematocrit levels significantly decreased without any need of transfusion; there were significant differences in the preoperative and postoperative creatinine levels ( p=0.002) in the older group., Conclusion: RIRS is a safe and effective method for treating kidney stones up to 3 centimeter diameter in all age groups. Although hemorrhagic events are mostly clinically unremarkable, there is a risk of renal function impairment in older (≥60 years) patients. Preoperative hydration and postoperative close follow-up is important. Key Words: Retrograde ıntrarenal surgery, Elderly, Effectiveness, Safety.

There is an increasing interest in the effects of preoperative anxiety on the course and outcomes of surgical treatments and also in the studies about the anxiety-decreasing interventions. The present study aims to identify the relationship between the preoperative anxiety level of the individuals prior to aesthetic surgery operations such as nose, ear, eyelid, and mammoplasty and religious rituals such as performing prayers, fasting, and going to pilgrimage. The frequency of performing the religious rituals was identified through a questionnaire. The questionnaire included questions about the religious rituals such as performing prayers, going to a pilgrimage, and fasting as well as questions about sociodemographic features such as gender, age, and education level of the patients. Preoperative anxiety level was measured using the "Anxiety Specific to Surgery Questionnaire." The nonparametric Mann-Whitney U test was used for the scale score comparisons of the two independent groups. The scale score comparisons of more than two groups were performed using the Kruskal-Wallis test. The relationships between age and scale scores were analyzed using the Spearman's correlation coefficient. The study involved 117 patients who were planned to undergo an aesthetic surgery operation. The scale scores were significantly different according to the pilgrimage groups (p = 0.004). The scale scores were significantly different according to the level of fasting (p = 0.022). No significant differences were found between the scales scores of the groups who reported the frequency of performing prayer as never, sometimes or five times (p = 0.515). In conclusion, the present study found that Muslim people who performed religious rituals more often experienced less preoperative anxiety levels in plastic surgeries, which indicates that the belief level is an effective factor in preoperative anxiety levels. The findings of the present study indicate that patients' beliefs and worship practices should be taken into consideration by doctors, operating room personnel, and even all health workers in order to decrease the anxiety levels of patients who will undergo surgery.

Objective: We aimed to determine nutritional status and related factors among schoolchildren in Çorum, Central Anatolia, Turkey., Design: Schoolchildren's height and weight were measured to calculate BMI and BMI Z-scores. Height, weight and BMI Z-scores were analysed and nutritional status classified according to the WHO., Setting: Central Anatolia, Turkey.ParticipantsSchoolchildren aged 5-17 years (n 1684) participated in study., Results: Of children, 4·2% were stunted, 6·9% thin, 13·8% overweight and 6·6% were obese. Proportions of stunting, thinness and overweight/obesity were significantly higher in children aged &gt;10 years (78·6, 75·0 and 64·9%, respectively) than in those aged ≤10 years (21·4, 25·0 and 35·1%, respectively; all P &lt;0·001). Median (range) birth weight and breast-feeding duration in children with stunting (2750 (1400-3600)g; 10 (0-36) months) were significantly lower and shorter, respectively, than those of normal height (3200 (750-5500)g; 15 (0-72) months) and tall children (3500 (2500-4900)g; 18 (0-36) months; P &lt;0·001, &lt;0·001, 0·011 and 0·016, respectively). The same relationship was observed in thin children (3000 (1000-4500)g; 12 (0-36) months) compared with normal-weight (3200 (750-5500)g; 15 (0-72) months) and overweight/obese children (3300 (1200-5500)g; 16 (0-48) months; P=0·026, &lt;0·001, 0·045 and 0·011, respectively)., Conclusions: Overweight and obesity are health problems that must be addressed in schoolchildren. Adolescents also have a risk of double malnutrition. Promoting normal birth weight and encouraging long duration of breast-feeding are important to support normal growth in children.

Background/aims: Celiac disease (CD) is an autoimmune enteropathy that develops in individuals with genetic susceptibility as a result of a permanent sensitivity to gluten found in grains. The prevalence of CD in Turkey is between 0.3% and 1%. However, the prevalence of CD in Çorum, a city in middle Anatolia in Turkey, is unknown. The purpose of this study was to identify the prevalence of childhood CD in Çorum and to detect patients with silent and atypical CD., Materials and Methods: The sample size was calculated using a stratified sampling method, to provide the sample number that would best represent this population. Screenings were conducted using rapid tissue transglutaminase IgA test kits., Results: A total of 1730 students were included in the study; 877 (50.6%) were female. Of students in the city center, 301 (34%) were in primary school, 299 (34%) were in secondary school, and 283 (32%) were in high school. As for towns, 847 (49%) students from 92 schools were included in the study. Eight children had positive screening results; 4 (50%) were female, and the average age was 11.6±3.4 (9-17) years. According to the celiac serology results and endoscopic duodenum biopsies, all children with positive screening results were diagnosed with CD. The prevalence of CD was found to be 0.46% in schoolchildren., Conclusion: Various studies in Turkey have reported a prevalence of CD between 0.6% and 0.9%, with 0.47% reported in a multicenter study. The present study identified CD prevalence as 0.46% (1 in 216) among children in Çorum, Turkey.

We aimed to investigate the relationship of religious beliefs and forgiveness in diabetic patients with various sociodemographic characteristics, emotional problems and glycaemic control. The study comprises 100 patients diagnosed with type 2 DM. We used a data collection form, the Scale of Forgiveness and Religiosity (SFR), Problem Areas in Diabetes Scale (PAID), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI) and the Audit of Diabetes-Dependent Quality of Life (ADDQoL). We also recorded blood glucose and HbA1c test results. A statistically significant relationship was determined only between the scores of the STAI-I and the religious belief scales (r = 0.198, p = 0.049). A statistically significant negative relationship was determined between the forgiveness scale points and the BDI (r = 0.326, p = 0.001), the STAI-II (r = 0.308, p = 0.002) and PAID (r = 0.313, p = 0.001) and a positive correlation with ADDQoL (r = 0.284, p = 0.004). To conclude, forgiveness by patient himself or others reduced the emotional problems which were experienced related to diabetes by reducing stress levels and could increase quality of life.

Objective: In this study, patients admitted with the diagnosis of Eisenmenger syndrome (ES) in a tertiary referral center were analyzed., Methods: The data of 20 consecutive patients (mean age: 27.6+1.8 years, 7 male and mean follow-up time: 35.6 ± 9.1 months) with ES were retrospectively analyzed. Demographic characteristics, symptoms, physical examination, laboratory and hemodynamic parameters were analyzed at the time of first admission., Results: The most frequent underlying heart diseases were ventricular septal defect (VSD) with complex congenital disease (n:8, 40%) and isolated VSD (n:7, 35%). 6-minute walking test distance was 347.9 ± 33.7 meters and 15 patients (75%) had a functional capacity of NYHA Class III, at the time of admission. ES was diagnosed with catheterization in all patients and mean systolic pulmonary arterial pressure measured by catheterization was 112 ± 6.8 mmHg. Pulmonary function tests, FVC (forced vital capacity), FEV1 (forced expiratory volume), FEV1/FVC values were respectively, 3.1 ± 0.4, 2.5 ± 0.4 L and 76.7 ± 3.3%. Metabolic tests were performed in all patients at the first visit. Mean VO2 max was 16.7 ± 1.0 ml / kg/min and VE/VCO2 rate was 53.9 ± 3.2%. Although PH and partial pressure of carbon dioxide levels were within normal range in blood gas analysis, oxygen saturation and partial pressure of oxygen levels were low., Conclusion: The most common underlying heart disease of ES patients is VSD. In this cases exercise capacity is restricted and this restriction is reflected in laboratory parameters.