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BACKGROUND: The endotracheal tube (ETT) contains a cuff that is placed in the trachea to prevent gas leakage and aspiration of secretions and gastric contents. However, patient positioning after intubation may cause ETT displacement and changes in cuff pressure. OBJECTIVES: Evaluate the effect of different patient positions on ETT cuff pressure in patients undergoing urological procedures in supine, prone, lateral flank, and lithotomy positions. DESIGN: Prospective and observational study SETTING: A university hospital in Turkey PATIENTS AND METHODS: Patients who underwent surgeries under general anesthesia in different patient positions were involved. After intubation (T0), the cuff pressure was checked with a manometer and adjusted to 25 cmH2O and continuously monitored. The cuff pressure was checked before (T1) and after achieving the final position (T2) and then at 5, (T3), 10, (T4), 15 minutes (T5) of the position, at the end of the procedure (T6) and before extubation (T7). At postoperative 2nd and 12th hours, the patients were interviewed for sore throat, hoarseness, and cough. MAIN OUTCOME MEASURES: The effect of different patient positions on the ETT cuff pressure. SAMPLE SİZE: 200 patients RESULTS: The cuff pressure increased significantly at T2 in the lithotomy, lateral flank, and prone groups (P

This study explores the valuation methods, accounting principles, and asset classification systems needed for accurate financial reporting in the Metaverse. The unique characteristics of virtual assets in the Metaverse pose challenges for traditional valuation methods and require the development of comprehensive and adaptable approaches. This study utilizes qualitative research methods, including in-depth interviews with accounting professionals in Bath and Bristol, UK. Fourteen accountants were selected based on their expertise in accounting and their understanding of the Metaverse. The findings reveal that effective governance, regulatory mechanisms, and community-driven protocols influence asset values in the Metaverse. It is shaped by factors such as engagement, scarcity, and competition. Tailored accounting principles should address legal recognition, accurate tracking, jurisdictional restrictions, and risk management. Compliance with regulations, transparent reporting, and collaboration with regulatory authorities are crucial, alongside integrating innovative technologies like blockchain for robust accounting practices.

Esra Ates Bulut,1 Suade Ozlem Badak,2 Huseyin Aksoy,3 Ayse Fadiloglu,4 Ahmet Turan Isik4 1Division of Geriatric Medicine, Department of Internal Medicine, Adana City Training and Research Hospital, Adana, Turkey; 2Division of Rheumatology, Department of Internal Medicine, Adana City Training and Research Hospital, Adana, Turkey; 3Department of Family Medicine, Adana City Training and Research Hospital, Adana, Turkey; 4Division of Geriatric Medicine, Department of Internal Medicine, Dokuz Eylul University, School of Medicine, Izmir, TurkeyCorrespondence: Ahmet Turan Isik, Email atisik@yahoo.com; ahmetturanisik@yahoo.comPurpose: Immunization is one of the main components of preventive medicine measures. Influenza, pneumococcal, tetanus, and shingles vaccines are recommended for older adults routinely. This study aimed to show the knowledge and attitudes of the physicians to older adults’ vaccination schemes.Patients and Methods: An electronic self-reported questionnaire was sent to physicians between March and July 2021 in Turkey. Sociodemographic characteristics, professional experience, area of expertise, and practice setting of the participants were recorded. As multiple-choice questions; the routinely recommended vaccines, and vaccines suggested in their daily practice before and after the COVID-19 pandemic were enquired.Results: A total of 435 participants were included in the study. 43.9% of the patients were primary family physicians, and 36.8% were internists. 63.4% of the participants had reported reviewing the National Vaccination Scheme. 94.5% of the medical doctors indicated that they had recommended any vaccination to their patients. 20.9% of the practitioners could select four or five of the routinely recommended vaccines. Reviewing the National Adult Vaccination Scheme and being an internist were positively related to predicting the recommended vaccines. The recommendation rates of influenza and pneumococcal conjugate (PCV13) were seen at 88% and 78%, respectively. Except for PCV13, recommendation rates of other routine vaccines were decreased after the pandemic.Conclusion: Awareness of routine vaccination schedules should be improved among health-care professionals, and reminders for immunization should be provided periodically in each health-care setting.Keywords: older adults, attitudes to vaccination, vaccine hesitancy, influenza, herpes zoster, preventive care

Harun Muayad Said,1 Derya Kaya,2,3 Idil Yavuz,4 Fatma Sena Dost,2,3 Zekiye Sultan Altun,5 Ahmet Turan Isik2,3 1Department of Molecular Medicine, Graduate School of Health Sciences, Dokuz Eylul University, Izmir, Turkey; 2Unit for Brain Aging and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey; 3Geriatric Science Association, Izmir, Turkey; 4Department of Statistics, Dokuz Eylul University, Faculty of Science, Izmir, Turkey; 5Department of Basic Oncology, Oncology Institute, Faculty of Medicine, Dokuz Eylul University, Izmir, TurkeyCorrespondence: Ahmet Turan Isik, Unit for Brain Aging and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey, Tel +90 232 412 43 41, Fax +90 232 412 43 49, Email atisik@yahoo.comPurpose: Idiopathic normal pressure hydrocephalus (iNPH) is the leading reversible cause of cognitive impairment and gait disturbance that has similar clinical manifestations and accompanies to major neurodegenerative disorders in older adults. We aimed to investigate whether cerebrospinal fluid (CSF) biomarker for Alzheimer’s disease (AD) may be useful in the differential diagnosis of iNPH.Patients and Methods: Amyloid-beta (Aß) 42 and 40, total tau (t-tau), phosphorylated tau (p-tau) were measured via ELISA in 192 consecutive CSF samples of patients with iNPH (n=80), AD (n=48), frontotemporal dementia (FTD) (n=34), Lewy body diseases (LBDs) (n=30) consisting of Parkinson’s disease dementia and dementia with Lewy bodies.Results: The mean age of the study population was 75.6± 7.7 years, and 54.2% were female. CSF Aβ42 levels were significantly higher, and p-tau and t-tau levels were lower in iNPH patients than in those with AD and LBDs patients. Additionally, iNPH patients had significantly higher levels of t-tau than those with FTD. Age and sex-adjusted multi-nominal regression analysis revealed that the odds of having AD relative to iNPH decreased by 37% when the Aβ42 level increased by one standard deviation (SD), and the odds of having LBDs relative to iNPH decreased by 47%. The odds of having LBDs relative to iNPH increased 76% when the p-tau level increased 1SD. It is 2.5 times more likely for a patient to have LBD relative to NPH and 2.1 times more likely to have AD relative to iNPH when the t-tau value increased 1SD.Conclusion: Our results suggest that levels of CSF Aβ42, p-tau, and t-tau, in particularly decreased t-tau, are of potential value in differentiating iNPH from LBDs and also confirm previous studies reporting t-tau level is lower and Aβ42 level is higher in iNPH than in AD.Keywords: Alzheimer’s disease, beta-amyloid 42, phosphorylated tau, Tau, frontotemporal dementia, Lewy body diseases, cerebrospinal fluid, biomarker, Parkinson’s disease dementia, dementia with Lewy body, differential diagnosis

To comprehend the perspectives of school and university mentors in evaluating practicum experiences based on educational reform, this study aimed to investigate the feedback, within the framework of pedagogical content knowledge, provided by two cooperating teachers and a university supervisor to preservice teachers. Observation and document were used for data collection. Data collected within the context of the Teaching Practice course were analyzed deductively, considering the components of pedagogical content knowledge. Findings showed that although feedback given by mentors was positive or corrective, specific changes suggested by mentors about the preservice teachers' teaching practices were rather corrective. Although mentors' feedback seems to be concentrated in the fields of 'instructional strategies and representation' and 'pedagogy,' the majority of feedback provided in other PCK components points out those mentors focused on student learning within the knowledge of 'student understanding'. Feedback indicated that mentors especially attached importance to students' understanding of the subject and active participation in the learning, which are the goals of a science teaching program. The other aims of teaching based on inquiry and students' self-responsibilities in learning seemed to be in the background. Although mentors' feedback pointed out some differences in the categories of curriculum and assessment, they were consistent in general.

Derya Kaya,1 Ali Ekrem Aydin,2 Ahmet Turan Isik1 1Unit for Brain Aging and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey; 2Department of Geriatric Medicine, Sivas State Hospital, Sivas, TurkeyCorrespondence: Derya KayaUnit for Brain Aging and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylül University, Balçova, Izmir 35340, TurkeyTel +90 232 412 43 41Fax +90 232 412 43 39Email deryakaya29@gmail.comPurpose: Essential tremor (ET) is the most common movement disorder in which dysautonomia symptoms can be present. We aimed to evaluate the presence of orthostatic hypotension (OH) and its relationship with the clinical features.Patients and Methods: Forty-four elderly patients with ET and 118 healthy elderly controls were included. OH was assessed via the head-up tilt table test and defined, according to the change in position, as a drop of at least 20 mmHg in systolic blood pressure and/or 10 mmHg in diastolic blood pressure. Tremor severity was evaluated using the Fahn-Tolosa-Marin Tremor Rating (FTMTR) Scale. All patients underwent geriatric comprehensive assessment.Results: There were no differences between the controls and patients with ET regarding age and gender. The mean age was 72.8± 6.1, the mean disease duration 19.1± 13.5 years and the mean FTMTR score was 30.9± 17.1 in patients with ET. The frequency of OH at the 1st minute in patients with ET was higher than in controls (31.8% vs 17.8%, p=0.046). Furthermore, the frequency of jaw tremor in patients with OH was higher than in those without OH (35.7% vs 6.7%, p=0.025). About 28.6% of ET patients with OH had orthostatic symptoms.Conclusion: We demonstrated that ET patients, particularly those with jaw tremors, had OH and that most of them were asymptomatic. Therefore, in order to protect patients from complications related to OH, it would be appropriate to evaluate OH in the follow-up and treatment of elderly patients with ET.Keywords: essential tremor, orthostatic hypotension, head-up tilt table test, jaw tremor, elderly

Abstract Background and objectives: It is suggested that 38-45% of patients experience preoperative anxiety. We observe that patients undergoing living donor nephrectomy suffer from anxiety. Preoperative anxiety may complicate a patient’s recovery from anesthesia and postoperative pain control. This study investigates the preoperative anxiety rate and its effect on anesthetic recovery and postoperative pain in patients undergoing donor nephrectomy. Methods: Forty-eight individuals undergoing living-related renal donor nephrectomy were included in this analytic prospective observational cohort study. Their preoperative anxiety was measured with the STAI-I and STAI-II inventories. The relationships between anxiety scores with data regarding demographics, recovery from anesthesia, and postoperative pain scores were investigated. Results: The findings were remarkable in that the anxiety scores of living renal donors were significantly correlated with their recovery variables, which are spontaneous respiration time, sufficient respiration time, extubation time, and PACU discharge time (p < 0.01). Anxiety scores were significantly positively correlated with the pain scores of the 30th minute, 1st, 2nd, 4th, 8th, 12th, 24th hours, and the total amounts of analgesic administered in 24 hours (p < 0.05). A significantly negative correlation was also determined between anxiety scores and patients’ satisfaction. Conclusion: Our study showed that patients undergoing living-related donor nephrectomy with high anxiety levels had late recovery times and high postoperative pain scores. Thus, determining those patients with high preoperative anxiety level is crucial to providing patients with satisfactory emerging from anesthesia and the control of their postoperative pain during donor nephrectomy.

Ahmet Turan Isik,1 Derya Kaya,1 Esra Ates Bulut,1 Ozge Dokuzlar,1 Pinar Soysal2 1Unit for Aging Brain and Dementia, Department of Geriatric Medicine, School of Medicine, Dokuz Eylul University, Izmir, Turkey; 2Department of Geriatric Medicine, Bezmialem Vakif University, Faculty of Medicine, Istanbul, TurkeyCorrespondence: Ahmet Turan IsikUnit for Brain Aging and Dementia, Department of Geriatric Medicine, School of Medicine, Dokuz Eylul University, Balcova, Izmir 35340, TurkeyTel +90 232 412 43 41Fax +90 232 412 43 49Email atisik@yahoo.comPurpose: Elderly patients with iNPH (idiopathic normal pressure hydrocephalus) might be potentially high-risk surgical patients. Our purpose was to investigate the outcome of serial removal of cerebrospinal fluid (CSF) in the patients with iNPH who refused to have the ventriculoperitoneal or lumboperitoneal shunt surgery or had contraindications to them.Patients and methods: There were 42 patients, with a median age of 78 years. Recurrent CSF removal was performed when the patients had deteriorated gait which was defined as >10% pre-removal change on the average of two walking trials during timed up and go (TUG). All the patients underwent mini-mental status examination (MMSE), frontal assessment battery (FAB), Stroop test, Tinetti Performance Oriented Mobility Assessment (POMA), TUG and nine-hole peg test (NHPT) with the dominant hand, before and after CSF removal.Results: Thirty-five patients had two CSF removal procedures with a mean interim period of 7.4 months ranging from 1.5 to 35 months. Thirteen patients had three CSF removal procedures. The mean TUG scores were decreased after the first, second and third procedures (p

This study aims to examine the effect of augmented reality-assisted programming education supported by participatory design on the basic and computational thinking skills of preschoolers. In the study, a pretest-posttest single-group semi-experimental design, which is one of the quantitative research methods, was used. The study group of the research consists of 61 students studying in kindergarten in the 2021-2022 academic year. 48% of the students are boys and 52% are girls. The implementation process took nine weeks. In the first part of the research, the CodeLimbel application was developed by conducting a five-week participatory design study with two groups. In the second part of the study, the programming training prepared by the researcher was applied to all groups for four weeks. The "Basic Skills Scale", "TechCheck" scale, and "Student Interview Questions" developed by the researcher were used as data collection tools. It was found that augmented reality-supported programming education had a statistically significant effect on students' computational thinking and basic skills. It was observed that all of the students who participated or did not participate in the participatory design study were interested and excited about programming education with augmented reality applications.

Ahmet Turan Isik Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Balcova, Izmir, TurkeyCorrespondence: Ahmet Turan IsikDepartment of Geriatric Medicine, School of Medicine, Dokuz Eylul University, Geriatri Bilim Dalı Dokuz Eylul Universitesi Tıp Fakultesi, Balcova 35340, Izmir, TurkeyTel +90 232 412 4341Fax +90 232 412 43 49Email atisik@yahoo.comAbstract: The pandemic of the Covid-19 virus has become the main issue all over the world. In its current form, the disease is more severe in geriatric cases and individuals with chronic disease, even causing death. In older adults and atypical presentations, testing strategies for Covid-19, potential drug interactions of experimental Covid-19 therapies, and ageism are important issues in the course of the disease. Therefore, health-care professionals should be aware of these, and screening policies for Covid-19 should also include atypical presentations with or without classical symptoms of the illness in older adults. Furthermore, evaluation of individuals > 65 years of age from a geriatrician’s perspective is very important, because Covid-19 is severe and fatal in seniors.Keywords: Covid-19 infection, pandemic, older adults, atypical presentation

Neziha Erken,1 Fatma Sena Dost Gunay,1 Pinar Soysal,2 Ahmet Turan Isik1 1Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey; 2Department of Geriatric Medicine, Bezmialem Vakif University, Faculty of Medicine, Istanbul, TurkeyCorrespondence: Ahmet Turan IsikUnit for Brain Aging and Dementia, Department of Geriatric Medicine, School of Medicine, Dokuz Eylul University, Izmir, Turkey Tel +90 232 412 43 41Fax +90 232 412 43 49Email atisik@yahoo.comAbstract: Chemobrain is one of the problems that may arise during or after treatment and there is currently no specific treatment for this condition. Our case was a 76-year-old female patient who presented to our clinic with complaints of forgetfulness that did not affect daily living activities for the last year. Breast cancer was diagnosed in 2013 and she has been receiving anastrozole treatment for 6 years after local mass excision surgery and radiotherapy. After a comprehensive geriatric evaluation, cognitive impairment due to systemic cancer therapy was detected and treatment was started with Theracurmin 90 mg twice a day therapy. After 3-months of Theracurmin therapy, she had no cognitive improvement during the follow-up. This case report demonstrated that Theracurmin treatment may be a new option for chemobrain.Keywords: chemobrain, Theracurmin, elderly, cognitive impairment, cancer

Pinar Soysal,1 Nicola Veronese,2,3 Ferhat Arik,4 Ugur Kalan,4 Lee Smith,5 Ahmet Turan Isik6 1Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey; 2National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy; 3Department of Geriatric Care, Ortho Geriatrics and Rehabilitation, E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genova, Italy; 4Department of Internal Medicine, Geriatric Center, Kayseri Education and Research Hospital, Kayseri, Turkey; 5The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK; 6Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey Aim: Mini Nutritional Assessment-Short Form (MNA-SF) is used to assess nutritional status in older adults, but it is not known whether it can be used to define frailty. This study was aimed to investigate whether or not MNA-SF can identify frailty status as defined by Fried’s criteria. Methods: A total of 1,003 outpatients (aged 65 years or older) were included in the study. All patients underwent comprehensive geriatric assessment. Frailty status was evaluated by Fried’s criteria: unintentional weight loss, exhaustion, low levels of activity, weakness, and slowness. One point is assigned for each criterion, and frailty status is identified based on the number of points scored: 0 points, not frail; 1–2 points, pre-frail; ≥3 points, frail. A total score of MNA-SF 11 indicates malnutrition, risk of malnutrition, and no malnutrition, respectively. Results: Of the 1,003 outpatients (mean age 74.2±8.5 years), 313 participants (31.2%) were considered frail and 382 (38.1%) pre-frail. Among frail and pre-frail patients, 49.2% and 25.1% were at risk of malnutrition and 22.0% and 1.6% were malnourished, respectively. MNA-SF with a cut-off point of 11.0 had a sensitivity of 71.2% and a specificity of 92.8% for the detection of frail participants, and with a cut-off point of 13 had a sensitivity of 45.7% and a specificity of 78.3% for the detection of pre-frailty. The area under the curve for MNA-SF was estimated to be 0.906 and 0.687 for frailty and pre-frailty, respectively. Conclusion: MNA-SF can be useful for frailty screening in older adults. Keywords: malnutrition, frailty, nutritional status, pre-frailty

BACKGROUND: The trauma mortality rate is higher in the elderly compared with younger patients. Ageing is associated with physiological changes in multiple systems and correlated with frailty. Frailty is a risk factor for mortality in elderly trauma patients. We aim to provide evidence-based guidelines for the management of geriatric trauma patients to improve it and reduce futile procedures. METHODS: Six working groups of expert acute care and trauma surgeons reviewed extensively the literature according to the topic and the PICO question assigned. Statements and recommendations were assessed according to the GRADE methodology and approved by a consensus of experts in the field at the 10th international congress of the WSES in 2023. RESULTS: The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage, including drug history, frailty assessment, nutritional status, and early activation of trauma protocol to improve outcomes. Acute trauma pain in the elderly has to be managed in a multimodal analgesic approach, to avoid side effects of opioid use. Antibiotic prophylaxis is recommended in penetrating (abdominal, thoracic) trauma, in severely burned and in open fractures elderly patients to decrease septic complications. Antibiotics are not recommended in blunt trauma in the absence of signs of sepsis and septic shock. Venous thromboembolism prophylaxis with LMWH or UFH should be administrated as soon as possible in high and moderate-risk elderly trauma patients according to the renal function, weight of the patient and bleeding risk. A palliative care team should be involved as soon as possible to discuss the end of life in a multidisciplinary approach considering the patients directives, family feelings and representatives desires, and all decisions should be shared. CONCLUSIONS: The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage based on assessing frailty and early activation of trauma protocol to improve outcomes. Geriatric Intensive Care Units are needed to care for elderly and frail trauma patients in a multidisciplinary approach to decrease mortality and improve outcomes.

Extrapulmonary nontuberculous mycobacteria (NTM) infection potentially affects any organ; lymph nodes, skin, and soft tissue are the most commonly affected (1,2). The severity of disease varies considerably from uncomplicated lymphadenitis [...]

Esra Ates Bulut,1 Pinar Soysal,2 Ahmet Turan Isik1 1Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey; 2Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey Background: Geriatric syndromes are complex clinical manifestations that are not an isolated disease in older adults and have common risk factors within themselves. The syndromes are significant causes of mortality, morbidity, and increased health care costs. Objective: To determine the frequency of geriatric syndromes such as malnutrition, dementia, depression, falls, polypharmacy, urinary incontinence, pressure ulcer, sarcopenia, and frailty in community-dwelling older adults. Methods: A total of 2,816 patients, who applied to geriatric outpatient clinic and were evaluated by comprehensive geriatric assessment, were included in this cross-sectional retrospective study. Falls in the last year and urinary incontinence were recorded. Polypharmacy was accepted as concurrent use of more than four drugs. Diagnosis of dementia and depression was defined according to Diagnostic and Statistical Manual of Mental Disorders Fifth Edition diagnostic criteria. In addition, frailty and sarcopenia were evaluated according to Fried’s physical frailty scale and European Working Group on Sarcopenia criteria, respectively. Results: The frequency of polypharmacy was 54.5%, urinary incontinence 47.6%, malnutrition 9.6%, depression 35.1%, dementia 21.6%, falls 33.6%, sarcopenia 31.7%, and frailty 28.3%. When all the participants were divided into three groups (60–69, 70–79, ≥80 years), all syndromes were significantly increased with age, except for depression. While 20% of cases in 60–69 years age group did not have any syndromes, 48% of cases in ≥80 years had more than four syndromes simultaneously. Conclusion: The frequency and coincidence of geriatric syndromes, except for depression, increases with age. Therefore, clinicians other than geriatricians taking care of older people should be aware of these syndromes as well as their treatment mechanisms. Keywords: geriatric syndromes, frailty, sarcopenia, dementia, malnutrition