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Byline: D. Oguz (1), B. Ocal (1), U. Ertan (2), H. Narin (2), S. Karademir (1), F. Senocak (1) Keywords: Key words: Juvenile rheumatoid arthritis -- Diastolic functions -- Echocardiography Abstract: Cardiac involvement as pericarditis, myocarditis, and endocarditis is common in juvenile rheumatoid arthritis (JRA). Though there are many reports concerning systolic and diastolic functions of adults with rheumatoid arthritis, there are no studies on children with JRA. Thirty patients with JRA without any cardiac symptoms and 30 sex- and age-matched controls were included in the study. M-mode and pulsed-wave Doppler echocardiography were performed on each participant to assess the systolic and diastolic functions of the left ventricle. Left ventricular end-systolic diameter and volume were larger and ejection fraction and fractional shortening were decreased in the JRA group. Among the diastolic parameters, increased late flow velocity, decreased early flow velocity, and prolonged isovolumic relaxation time reflected an abnormal relaxation form of diastolic dysfunction. Mortality rate is increased in adults with rheumatoid arthritis, and ischemic heart disease is the leading cause of cardiovascular mortality. The abnormal relaxation form of diastolic dysfunction found in children with JRA is seen in ischemic heart disease. These children can therefore be candidates for ischemic heart disease in the future even though they are fully asymptomatic at present. In conclusion, children with JRA should be assessed for systolic and diastolic functions with serial echocardiography. In this way it may be possible to reduce the mortality and morbidity of the disease from cardiac causes. Author Affiliation: (1) Department of Pediatric Cardiology, Dr. Sami Ulus Children's Hospital, Ankara, Turkey, TR (2) Department of Pediatrics, Dr. Sami Ulus Children's Hospital, Ankara, Turkey, TR

One-time password (OTP) mechanisms are widely used to strengthen authentication processes. In time-based one-time password (TOTP) mechanisms, the client and server store common secrets. However, once the server is compromised, the client's secrets are easy to obtain. To solve this issue, hash-chain-based second-factor authentication protocols have been proposed. However, these protocols suffer from latency in the generation of OTPs on the client side because of the hash-chain traversal. Secondly, they can generate only a limited number of OTPs as it depends on the length of the hash-chain. In this paper, we propose a second-factor authentication protocol that utilizes Physically Unclonable Functions (PUFs) to overcome these problems. In the proposed protocol, PUFs are used to store the secrets of the clients securely on the server. In case of server compromise, the attacker cannot obtain the seeds of clients' secrets and can not generate valid OTPs to impersonate the clients. In the case of physical attacks, including side-channel attacks on the server side, our protocol has a mechanism that prevents attackers from learning the secrets of a client interacting with the server. Furthermore, our protocol does not incur any client-side delay in OTP generation.

This study was carried out to define different drip irrigation approaches on fruit yield and quality parameters of orange (Citrus sinensis cv. Valencia Late) trees during 2014-2016 at the private farm in Güzelyurt, Northern Cyprus. The amount of irrigation water was applied based on the total evaporation amount obtained from the Class A pan (Kcp1:1.25, Kcp2:1.00, Kcp3:0.75 and Kcp4:0.50) and experimental plots were irrigated when the total evaporation of Class A pan was about 35 ± 5 mm. It was determined that irrigation treatments affect yield, weight, length, width and juice of fruit, total soluble sugar, total acidity, pH and vitamin C content except for peel thickness. The average evapotranspiration values were 1343.5 mm for Kcp1, 1135.0 mm for Kcp2, 956.0 mm for Kcp3, and 787.3 mm for Kcp4 irrigation treatments. According to the average data of 2 years, yearly yield for Kcp1, Kcp2, Kcp3, and Kcp4 irrigation levels were 45.0, 47.1, 38.7, and 19.2 t ha-1, respectively. It is determined that Valencia Late can be irrigated by means of the volume of irrigation equivalent to 75% of Class A Pan in Güzelyurt region in Turkish Republic of Northern Cyprus.

Background and Objectives. The coronary slow flow (CSF) is an angiographic finding characterized by delayed opacification of nonobstructive epicardial coronary arteries. Chronic inflammation has been suggested to be mainly responsible for the underlying mechanism of CSF. The systemic immune-inflammation index (SII) is a relatively novel inflammation-based biomarker, derived from counts of peripheral neutrophils, platelets, and lymphocytes, and has been shown to predict clinical outcomes in various malignancies and cardiovascular diseases. The aim of this study is to evaluate the relationship between SII and CSF. Methods. A total of 197 patients (102 patients with CSF; 95 patients with normal coronary flow) were included in this retrospective study. Clinical and angiographic characteristics of patients were obtained from hospital records. Results. Patients with CSF had higher SII, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte (PLR), and high-sensitivity C-reactive protein (hsCRP) levels compared with the control group. Body mass index (p=0.022, OR 1.151, 95% CI 1.121–1.299), low-density lipoprotein (p=0.018, OR 1.028, 95% CI 1.005–1.052), hsCRP (p=0.044, OR 1.161, 95% CI 1.004–1.343), and SII (p877 in ROC curve analysis (p

By this study we aimed to determine the frequency of smoking of physicians, whether they evaluate their patients in terms of smoking, and their traits of 5A step method use in an attempt to provide consultancy service to their patients. The research is a descriptive study. The size of the minimum sample was determined to be 251. The survey constituted of sections which examined demographic features and the implementations of the physicians on smoking cessation and 5A practices. Twenty one percent of the physicians stated to smoke every day, 8% of them stated to smoke occasionally. Considering the familiarity with 5A practices for those cases willing to quit smoking, 20.1% of the physicians stated to be familiar, and 79.9% of them stated not to be familiar. When the 5A practices according to the specialists of the physicians are considered, while pulmonology physicians have scored significantly the highest average point. The vast majority of physicians dont know the implication 5A and dont applicate the implications. [Med-Science 2019; 8(1.000): 81-7]

Summary: Background: Many studies have been conducted about the existence of obesity paradox in cardiovascular diseases. But, there is limited data on elderly patients. The aim of this study is to explore the existence of the “obesity paradox” and effect of obesity in periprocedural outcomes in patients presenting with acute myocardial infarction (AMI). Methods: This study involved elderly patients (≥65 years) who admitted our clinic with AMI and treated for acute STEMI between April 2011 and November 2014. Patients were divided into two groups according to their body mass index (BMI [kg/m2]) and a BMI>30 kg/m2 was accepted as obese. We compared angiographic, electrocardiographic, echocardiographic data and in-hospital mortality between two groups. Results: A total of 127 patients were included in the study and obese (BMI>30 kg/m2) patients comprised 27.3% (47) of all AMI patients. Analysis of the acute coronary angiographic data revealed that the number of significant coronary lesions was higher in non-obese group (p:0.04). The last TIMI-3 rate was higher in the obese group (%91.5 vs %79.2, p:0.05), whilst corrected TIMI frame count was lower (26 ± 13 vs 32 ± 14, p:0.01). In multivariate analysis, the number of lesions was correlated with obesity (OR 0.47, 95%CI 0.37–0.99, p:0.04). Conclusion: In our study, obesity was associated with better coronary flow after percutaneous coronary intervention and the number of lesions was lower in obese patients compared to non-obese elderly patients treated for STEMI. Our results were consistent with the phenomenon of “the obesity paradox”. Keywords: elderly, obesity paradox, myocardial infarction

With this study, we aimed to determine the defensive medical practices of the physicians of different academic title and seniority, who are performing their duty in MalatyaAfter the approval from the ethical committee had been received, our study was conducted by performing surveys and face-to-face interviews with the practitioners, specialists, family practitioners and academicians working in the State and University hospitals as well as Private Hospitals in the city of Malatya. 234 physicians were asked to answer 19 questions regarding the defensive medical practices within the survey. 87% of the research sampling was reached. 176 (75,2%) of these physicians are male, whereas 58 (24,8%) of them are female. The mean age of the women who participated in the research is 38,9. It turned out that the physicians working in the state hospitals as well as private hospitals had referred to defensive medical practices more than those working in the university hospitals (P=0.026), and that the professors and associate professors had avoided the patients with the risk of filing a suit in temrs of medical malpractice less than the specialists and medical practitioners (p=0,003). In conclusion, it was determined that as the degree of professional experience, academic title and seniority in the physicians increased, the rate of defensive medical practices seemed to decrease. [Med-Science 2017; 6(2.000): 270-5]

With worldwide use of oral rehydration solutions, the treatment of acute diarrhea does not pose much of a problem. However, chronic diarrhea is still harmful, especially for the growth and development status of the children. Between January 1993 to December 1996, patients who suffered from chronic diarrhea for more than one month duration and admitted to Dr. Sami Ulus Children's Hospital were evaluated for epidemiological and etiologic factors. Seventy consecutive patients were evaluated. The mean age was 40.8 months and 52% were males. Malnutrition was detected in 80% of cases. Etiologic factors included celiac disease 30%, cow milk allergy 17%, bacterial and parasitic factors 26%, cystic fibrosis 10% and postinfectious gastroenteritis 10%. Eosinophilic gastroenteritis, chronic nonspecific diarrhea, pseudo-obstruction, neurofibromatosis and inflammatory bowel disease were rarely detected. Celiac disease and cow milk allergy were implicated as the most common causes of chronic diarrhea. The vicious cycle of faulty nutrition, malnutrition and infection and postinfectious enteropathy were also significant factors in the etiology of chronic diarrhea. It may be considered that cow milk protein prick test, sweat test, immunologic tests and mucosal biopsies should be performed for the definite diagnosis of chronic diarrhea. [ABSTRACT FROM AUTHOR]

This study is a descriptive cross-sectional study and aims to determine the satisfaction level, and the factors that affect this level in adults who benefit from the family medicine services in Malatya city center. 10 people from each center, in total 383 people were randomly selected from the 39 Family Health Centers in Malatya city center and were contacted for the study in the 2014 March-June period. The European General Practitioners or European Patients Evaluate General/Family Practice (EUROPEP) Scale has been used in the study. In the statistical analyses, the Mann-Whitney U was used for the data that did not suit the normal distribution, and the Student t and the One Way Anova tests were used for those which suited the normal distribution; and the p0.05). When the average points received from the scale in terms of satisfaction levels of the family medicine services are considered, the adults who are very satisfied with the services have received significantly more points than the other groups (p [Med-Science 2015; 4(4.000): 2721-31]

The appropriate size, accurate alignment and correct positioning of transcatheter aortic valves (TAVIs) at the point of deployment are emphasized as key factors in placement and fixation of the devices. Presence of a sigmoid left ventricular septum in the patient is one of the important limitations of TAVIs, especially with the Edwards- Sapien Valve (ESV), due to the risk of aortic embolization of the prosthesis. In cases of a pronounced sigmoid septum, transapical implantation of the ESV or the usage of a Medtronic CoreValve (MCV) is generally recommended. However, severe left ventricular hypertrophy and sigmoid septum are also risk factors for the development of conduction disturbances with the usage of MCV. The depth of implantation of MCV within the left ventricular outflow tract and larger or significantly oversized prostheses have also been reported as important predictors of permanent pacemaker (PPM) requirement after MCV implantation. Thus, recent reports indicate that there may be less need for a PPM if a high implantation technique is used to place the MCV at a short implantation depth. In this report, we present the high implantation technique under rapid pacing during transcatheter aortic MCV implantation in a surgically high-risk aortic stenosis patient with sigmoid left ventricular hypertrophy and a large aortic annulus.

Complex ostium secundum type atrial septal defect (ASD) is a definition used for large (stretched diameter over 26 mm with deficient rim) or multiple ASDs or multifenestrated septum or ASDs with redundant and aneurysmal septal rims. Compared to simple defects, transcatheter ASD closure with Amplatzer septal occluder (ASO) is relatively challenging in these cases, and different techniques have been defined to increase procedure success. We report three adult patients with complex ostium secundum type ASDs that were closed with ASO device using three different techniques. The first case was a 36-year-old female patient with complaints of dyspnea, palpitation and fatigue. A complex ostium secundum type ASD was diagnosed, and the defect was closed with a 36 mm ASO device using a left upper pulmonary vein technique. The second case was a 47-year-old female patient with complaints of dyspnea and palpitation. A large and complex ASD was detected, and the defect was closed with a 28 mm device using a left atrial roof technique supported by non-inflated balloon. The third case was a 40-year-old female patient who presented with complaints of dyspnea and palpitation. Complex ASD was diagnosed, and the defect was closed with a 32 mm device using a partially inflated balloon technique. In large and complex ASDs, the classical implantation technique of an ASO device may fail at any time. The knowledge and application of different techniques that orient the left atrial disc parallel to the septum may increase the procedure success and decrease complications.

Aim. Mesenchymal stem cells (MSCs) isolated from human bone marrow (hBM) and adipose tissue (hAT) are perceived as attractive sources of stem cells for cell therapy. The aim of this study was to compare MSCs from hBM and hAT for their immunocytochemistry staining and resistance to in vitro apoptosis. Methods. In our study, we investigated the antiapoptotic ability of these MSCs toward oxidative stress induced by hydrogen peroxide (H2O2) and serum deprivation. Results were assessed by MTT and flow cytometry. All experiments were repeated a minimum of three times. Results. Flow cytometry and MTT analysis revealed that hAT-MSCs exhibited a higher resistance toward H2O2-induced apoptosis (n=3, hBM-hAT viability H2O2 58.43±1.24–73.02±1.44, P