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Status epilepticus (SE) is a life-threatening emergency condition. In addition to well-known etiological factors, many rare causative factors have also been defined. Ecstasy (3,4-methylenedioxy-N-methylamphetamine) is an amphetamine derivative known to cause SE. Presently described is a case of recurrent SE in which ecstasy was an etiological factor.

OBJECTIVE: Quantification of stenosis, plaque morphology and surface characteristics by doppler sonography and prediction of plaque rupture risk are important for treatment options in ischemic stroke. OBJECTIVE: We evaluated the association of carotid plaque characteristics and the risk of recurrent ischemic stroke. METHODS: Carotid plaques were ultrasonographically evaluated within ten days in 79 acute anterior circulation ischemic stroke patients without source of cardiac emboli. The subsequent incidence of transient ischemic attack, minor and major stroke was investigated wtihin six months period. During follow-up, 20 strokes occurred. Logistic regression analysis was used to determine the relation between plaque morphology and recurrent stroke risk. RESULTS: Patients with an ulcerated plaque had an 8.7-fold higher risk of recurrent stroke than those without ulceration (p

POEMS syndrome (osteosclerotic myeloma) is a plasma-cell proliferative disorder and a combination of several organ system manifestations. The term POEMS is an acronym for polyneuropathy, organomegaly, endocrinopathy, monoclonal proteinemia and skin changes. Although the diagnostic criteria have been modified in time to cover those findings that are seen more frequently but are less specific to make a certain decision, the rare nature of the disease may also be associated with the fact that many patients present with symptoms or signs which are thought to be related to certain organ systems. Here we present a case of POEMS syndrome with almost complete visual loss, dyspnea and loss of sceletal muscle strength and their significant recovery after treatment

Multiple system atrophy (MSA) is an adult-onset, sporadic, progressive neurodegenerative disease. According to the consensus criteria, patients with MSA are clinically classified into cerebellar (MSA-C) and parkinsonian (MSA-P) subtype. Besides the poor response to levodopa, and the additional presence of pyramidal or cerebellar signs (ataxia) or autonomic failure as major diagnostic criteria, certain other clinical features known as ‘‘red flags’’ or warning signs may raise the clinical suspicion of MSA. Case report: A 67-year-old woman was admitted to our hospital due to inability to walk. Neurological examination revealed severe Parkinsonism with poor response to levodopa therapy, ataxia. Brain MR imaging showed severe atrophy of the cerebellum, pons, minimal cerebrum, and revealed cross section at the pons in the axial section. Mini-Mental State Examination (MMSE) was normal, Median SEP within normal limits but left Tibial SEP was longer than right side (right: 41, left: 44.2). Although sympathetic skin response of upper extremities was normal, the sympathetic skin responses of lower extremities were absent. RR interval study and a graded head-up tilt test were consistent with autonomic dysfunction. We report a patient with MSA because in clinical practice a case who fullfits all criteria is really rare.

Abstract This study assessed the connectedness between oil shocks and industry stock indexes in the United States (US). We consider the normal and extreme conditions across different frequency horizons, and the quantile time–frequency connectedness method is used to determine the tail risk contagion under different frequency horizons. Our results reveal that the short-term frequency connectedness significantly exceeds the long-term frequency connectedness. We also indicate that the connectedness in the lower and upper quantiles is greater than at the conditional mean. Importantly, oil risk shock is the biggest net transmitter of shocks to the US sectors in normal and extreme conditions, highlighting that oil risk shocks cause substantial variations in US sector stock returns in the short, medium, and long term. Finally, QAR(3) model demonstrates the significant impact of oil risk shocks on US sector stock returns during extreme and normal conditions. Therefore, our study underscores the role of asymmetry in the reaction of US sector stock returns to oil-related shocks, and we suggest that policies aimed at overcoming the adverse effects of oil shocks on stock markets and promoting financial stability should incorporate asymmetric features.

Coğrafya, uluslararası anlamda istihdam alanı oldukça geniş bir meslek olmasına rağmen Türkiye’de gerekli ilgi ve önemi kazanamamıştır. İlgili problem doğrultusunda bu araştırmanın amacı, koruma alanları kapsamında çalışan/çalışabilecek olan coğrafyacıların durumunu saptamak, gerçekten ihtiyaç duyulan bir mesleğin önemi ve gerekliliğine dikkat çekmektir. Araştırmada, nitel araştırma tasarımında kullanılan bir veri toplama tekniği olan yarı yapılandırılmış görüşme tekniği kullanılmıştır. Bu doğrultuda Balıkesir Doğa Koruma ve Millî Parklar Şube Müdürlüğü’nde çalışan kişilerle görüşme gerçekleştirilmiştir. Görüşmelerden elde edilen veriler MAXQDA 2024 programında analiz edilmiştir. Araştırma bulgularına göre 34 kod 4 alt tema altında, alt temalar ise 2 tema altında toplanmıştır. Araştırmanın ana temaları “empati ve doğa” ile “tekil ve kolektif etkileşim” şeklinde oluşturulmuştur. Kurumda coğrafyacıların istihdamına yönelik bir eğilimin olmadığı tespit edilmiştir. Doğa koruma faaliyetlerinde iyi yetişmiş coğrafyacıların çalışması ve çalıştırılması farklı ve bütüncül bir bakış açısı için oldukça gereklidir. Gelişmiş ülkelerde olduğu gibi Türkiye’de de doğa koruma faaliyetleri başta olmak üzere coğrafyanın önemsendiği ve coğrafyacının öncelikli olduğu bir istihdam ve çalışma sistemi geliştirilmelidir. Çünkü “Coğrafyacı mesleği diye bir şey yoktur; daha ziyade coğrafyacıların yaptığı birçok meslek vardır”.

Background It is unclear whether different exercise programs lead to an increase in the concentration of plasma Pentraxin3 (PTX3), an anti-inflammatory protein. This study aimed to investigate the effects of aerobic exercise (AE) and high-intensity interval training (HIIT) on plasma PTX3 levels in overweight and obese women. Method A total of 45 sedentary women aged between 32.26 ± 6.30 voluntarily participated in the study. The control group (CG, n = 15) was selected among normal-weight women. Women in the group of participants who partook in exercise consisted of overweight and obese women according to a random method, including the AE group (n = 15) and the HIIT group (n = 15). The AE session conducted was 50 min in duration and consisted of warm-up exercises (5 min), and primary exercises (40 min, basic aerobic-step exercises). HIIT consists of warm-up exercises (5 min), primary exercises (work intervals: 6−10 × 1 min (80–90% HRmax), rest intervals: 1 min (walk, 50% HRmax), 21–29 min running. The exercises were applied for three sessions/week for 12 weeks. Fasting blood samples were taken from all participants before and after exercise and their body composition was measured. Results As a result of two different 12-week exercises, serum PTX3 levels increased significantly by 47.53% in the AE group and 50.21% in the HIIT group (p .05). Also, no significant differences were found between the two types of exercises in terms of parameters. A significant negative correlation in the total sample was found between PTX3 with BMI, fat mass, LDL-C, and hsCRP. Conclusion The percentage change in PTX3 values was not different between exercise types, whereas PTX3 was increased with exercise, regardless of the type of exercise. It can be said that both aerobic and HIIT increase PTX3, VO2max levels and improve lipid metabolism in overweight and obese women.

Ventilatör ilişkili pnömoni (VİP), yoğun bakım ünitesindeki (YBÜ) en önemli enfeksiyonlardan biridir ve hastalarda mortalite ve morbidite artışına katkıda bulunur. Bu çalışmada Rheum ribes (Elazığ/Türkiye) ekstraktının VİP hastalarından elde edilen bakteri izolatları üzerinde antimikrobiyal etkilerini (agar kuyu difüzyonu, MİK testi) ve antioksidan kapasitesini (DPPH, FRAP ve metal şelatlama) değerlendirmeyi amaçladık. Analiz sonucunda R.ribes'in en yüksek antimikrobiyal etkisi 19.32 mm zon çapı ile Klebsiella pneumonia-2 (K.pneumonia) ve 18.45 mm zon çapı ile K.pneumonia-21 izolatında gözlendi. Bunların dışında Staph. aureus., K. pneumonia-20, K. pneumonia-16 ve Pseudomonas aeruginosa (P. aeruginosa) sırasıyla 18.32, 15.14, 14.56 ve 13.54 mm zon çapları ile tespit edildi. R. ribes ekstraktı K.pneumonia izolatları 16 ve 20'de 0,5 ppm'de %98,3 ve %94,88 inhibitör etki gösterirken, en yüksek izolatlar 21 ve 2'de %100 inhibitör etki göstermiştir. S. aureus %50,36 gibi yüksek bir inhibisyon etkisi göstermiştir. 0,25 ppm'de ve P. aeruginosa 0,5 ppm'de %82,82 oranında izole edilmiştir. Ayrıca DPPH, FRAP ve metal şelasyon analizleri güçlü bir antioksidan etki göstermiştir. Ribes ekstraktının antioksidan etkileri için demir iyonlarının (Fe2+) DPPH inhibisyon etkisi, FRAP analizi ve şelatlama aktivitesi değerleri sırasıyla %17.22, %1.18 ve %2.14 olarak belirlendi. Sonuç olarak, R. ribes ekstraktının patojenik bakteriler üzerindeki güçlü etkisi ve antioksidan kapasitesi belirlenmiş olup, in vivo ve klinik çalışmalarla faydalı özellikleri derinleştirilebilir.

Objective(s): We aimed to investigate the levels of transient receptor potential melastatin (TRPM) gene expression, and the antioxidant and histopathologic effect of thymoquinone (Tmq) in the hepatic I/R rat model.Materials and Methods: Fifty Wistar rats were divided into 5 groups. Group 1: Control; Group 2: Sham; Group 3: Hepatic I/R (45 min/45 min); Group 4: Tmq (50 mg/kg); Group 5: Tmq+I/R (ten days before I/R at the dose of 50 mg/kg of Tmq). The hepatic I/R (45min/45min) model was performed at the portal vein and the hepatic artery with atraumatic vascular clamp in the ischemia groups. The liver tissues and blood samples that were taken at the end of the study were evaluated for histopathologic and biochemical analysis. Besides TRPM gene expression levels were determined in liver tissues. It was seen that cellular swelling, congestion, PNL, and apoptosis parameters statistically decreased in Tmq and Tmq+I/R groups in comparison with the I/R group in histopathological evaluation.Results: It was observed that biochemical parameters, AST, ALT, GGT, LDH, creatinine, and urea levels significantly increased in the I/R group as compared with, sham, Tmq, and Tmq+I/R groups. It was found that TRPM2,6,7,8 gene expression decreased significantly in Tmq+I/R groups as compared to the I/R group. Conclusion: We showed that thymoquinone can inhibit the entry of Ca+2 into the cell by decreasing TRPM2,6,7,8 gene expression. Based on our findings, we think that Tmq application in the treatment of liver diseases due to I/R damage may be important in terms of both ischemia and apoptosis and can also be used in the treatment of liver-related diseases.

Metal foam heat sinks are preferred in electronic cooling systems with their advantages such as superior properties in heat transfer, light weight and ability to mix the cooling fluid. It is very difficult to conduct extensive experimental studies with metal foam heat sinks due to the difficulty of production and high cost. In addition, due to the complex structure of metal foam heat sinks, difficulties may arise in the creation of numerical simulations. In the present study, various machine learning methods were used, taking into account the mean surface temperature values obtained by using metal foam heat sinks discretely placed in a partially open volume. The pore density of metal foam heat sink, Reynolds number, modified Grashof number and distance to aperture were taken as input parameters. When the results were examined, it was determined which of the inlet parameters were more effective on the mean surface temperature. It was determined that modified Grashof number was the most effective parameter on mean surface temperatures, but L was the weakest parameter. The models were ranked according to 3 different evaluation metrics. It was observed that the top three most successful machine learning algorithms were eXtreme gradient boosting, support vector machine and random forest.

Objective: This study investigates the cross-sectoral spillover effect and the contribution of the volatility index (VIX) in the transmission of shocks in the Fragile Five (Brazil, India, Indonesia, South Africa, and Turkey). Research Design & Methods: We focused on the role played by the various sectors of the economy (Energy, Financials, Industrials, Basic Materials, and Real Estate) and the VIX in the crisis propagation, i.e. whether they act as sources, transmitters or receivers of financial stress, following the time-varying parameter vector autoregression (TVP-VAR) approach. The study also highlights the dynamic evolution of contagion across time. Findings: We identified the financial sector (essentially the largest in terms of market value) as a strong net transmitter. Another relatively strong net transmitter was the industrial sector (medium-sized). Basic Materials (medium-sized) and Real Estate (the smallest in terms of market value) essentially acted as net receivers. In all the countries surveyed, Energy (medium-sized sector) and the VIX were identified as net receivers. We found that the bidirectional spillover between the VIX and sectoral indices was weak in all countries under investigation. Our observations on the VIX behaviour can be associated with the fundamentals, such as the US/the Fragile Five equity market mutual exposures, but we opted for the neutrality of the relationship between the VIX and sectoral indices. The average Total Connectedness Index (TCI) in the Fragile Five turned out to be relatively low. We also observed that sharp increases in the TCI were associated with market tensions, both country-specific and global. Implications & Recommendations: Our conclusions can help formulate economic policy goals and increase the efficiency of portfolios with exposures in the Fragile Five countries. Risk transmitters such as the financial and industrial sectors should be closely watched by regulators and investors with exposures to risk takers, i.e. sectors such as Energy, Basic Materials, and Real Estate. Sharp increases in the TCI related to market tensions should be a warning signal when formulating economic policy goals and building investment strategies. Determining the role of fear indices in the spillover mechanism, including the VIX, requires additional in-depth empirical studies. Contribution & Value Added: Our contribution to the literature is threefold. Primarily, to our knowledge, it is the first study to provide insights into the linkages between the different sectors of the Fragile Five economies and the volatility index. Secondly, unlike the vast majority of previous work focused on sectoral linkages in selected groups of emerging economies taken as a whole, we draw common conclusions for the Fragile Five based on observations of their individual economies, which helped to reduce the number of generalizations. Thirdly, through the inference process, we identified some interesting correlations that could be a starting point for further research.

Abstract Background Unstable femoral neck fractures with medial calcar defects are difficult to manage. The optimal fixation methods for these fractures have been a subject of ongoing debate among orthopedic surgeons. In this study, three different fixation techniques for vertical, medial defected femoral neck fractures were compared. Methods In this study, a biomechanical analysis was conducted to compare three fixation methods: cannulated screws (Group 1), cannulated screws combined with a medial buttress plate (Group 2), and intramedullary nails (Group 3). Synthetic composite bone models representing vertical collum femoris fractures with medial calcar defects were used. Each group consisted of seven specimens, and, to maintain consistency, a single surgeon performed the surgical procedure. Biomechanical testing involved subjecting the specimens to axial loading until failure, and the load to failure, stiffness, and displacement values were recorded. Normality was tested using the Shapiro–Wilk test. One-way ANOVA and Tukey’s HSD post hoc test were used for comparisons. Results The difference in the load to failure values was statistically significant among the groups, with Group 2 exhibiting the highest load to failure value, followed by Group 3 and Group 1. Stiffness values were significantly higher in Group 2 than in the other groups. Displacement values were not significantly different between the groups. Fracture and displacement patterns at the point of failure varied across the groups. Conclusion The results of this study indicate that fixation with a medial buttress plate in combination with cannulated screws provides additional biomechanical stability for vertical femoral neck fractures with medial calcar defects. Intramedullary nail fixation also demonstrated durable stability in these fractures. These findings can be used to better understand current management strategies for these challenging fractures to promote the identification of better evidence-based recommendations.

This study aimed to explore the relationship between internal assessment (IA) and external assessment (EA) scores of the high school students in the International Baccalaureate Diploma Program (IBDP). Methods: Simple linear regression analysis was conducted to explore to what extent the IA scores predict the EA scores in the Turkish, English, Physics, Chemistry, Biology and Mathematics courses. Findings: The quantitative analysis revealed that only a small percentage of the variation in IBDP EA scores can be explained by the model containing only IA scores in the IBDP standard level (SL) and high level (HL) courses. Furthermore, the correlation coefficient was utilized to explain the degree to which the IA scores are associated with the EA scores. This analysis revealed that there is a moderate relationship between IA and EA in HL English and SL biology course, but a weak relationship between IA and EA in SL and HL biology, chemistry, mathematics, physics, English (only SL) and Turkish courses. Value: This research highlights some important implications for educators about the consistency and reliability of IA as a tool for forming a final mark in the IBDP assessment and the role the IA plays in predicting the students’ general academic achievement.

PURPOSETo evaluate the image quality and tumor morphology depiction ability of high resolution (HR) diffusion- weighted imaging (f-DWI) in comparison to conventional DWI (c-DWI) and dynamic contrast- enhanced magnetic resonance imaging (DCE-MRI) in the primary breast cancer setting.METHODSThe f-DWI, c-DWI, and DCE-MRIs of 160 malignant breast masses were evaluated retrospectively by two independent radiologists. Data on image quality [sharpness, distortion, and perceived signalto- noise ratio (SNR)], apparent diffusion coefficient (ADC) value, lesion size, and tumor morphology (shape, margin, and internal pattern) obtained on f-DWI, c-DWI, and DCE-MRI were compared. Consistency between the readers and imaging methods for morphological parameters was analyzed.RESULTSThe ADC values measured on f-DWI were significantly lower than those measured on c-DWI for both readers (P < 0.001 for each), whereas mean lesion size was significantly larger in c-DWI than in f-DWI and DCE-MRI for both readers (P < 0.001 for each). Higher consistency values were obtained for f-DWI compared with c-DWI when correlated with DCE-MRI for each morphological parameter. The least distorted images were obtained using DCE-MRI compared with c-DWI and f-DWI for both readers, whereas the highest distortion scores were obtained using c-DWI. Sharpness and perceived SNR scores were rated as significantly higher for f-DWI and DCE-MRI images compared with c-DWI by both readers (P < 0.001 for all). The concordance between c-DWI and DCE-MRI was fair to slight (κ = 0.15 to 0.41), whereas concordance between f-DWI and DCE-MRI was significantly better (κ = 0.68 to 0.87) for each reader and for all morphological parameters (P < 0.001). The highest concordance between the readers was achieved in margin assessment (κ = 0.87 to 0.89) regardless of the MRI method, followed by shape and internal pattern parameters (κ = 0.63 to 0.79).CONCLUSIONThe results demonstrated that f-DWI produces higher-quality images than c-DWI, enabling the morphological features to be identified in similar detail to that offered by HR DCE-MRI. Accordingly, f-DWI, as a method that highly correlates with DCE in determining the morphological characteristics of breast cancers, seems to have potential in the evaluation of breast tumors in patients for whom the use of contrast media is contraindicated.

Tryptase test can be used as a clinical marker of mast cell activation. The present study is was aimed to identify variations in serum tryptase levels and their possible relationships with allergic reactions to protamine in low-risk patients undergoing cardiac bypass surgery. Thirty patients according to American Society of Anesthesiologists physical status III who underwent cardiac bypass surgery were enrolled. This prospective, non-randomised, clinical study was conducted in an operating room. Venous blood samples for tryptase measurements were obtained from cardiac bypass surgery patients upon admission to the operating room and immediately before and 30 min after the initiation of protamine administration. Signs of allergic reactions were recorded and management steps based on rapid effect response-based clinical assessments for diagnosis and treatment decisions during protamine administrations were described. Serum tryptase levels and clinical signs of allergic reactions, primarily mean arterial pressure (MAP), were recorded. Serum tryptase levels increased significantly and progressively during the bypass procedure (study power, 80%; sample size, 28; power of analysis, 99.8% with α=0.05); however, tryptase levels did not reach a sufficiently high level to confirm an allergic reaction. The MAP and heart rate decreased in 50% of the patients. Although tryptase increased significantly when compared with baseline levels, protamine-associated increases were not significant and failed to provide an unequivocal indication of an allergic response to protamine.

Aim:The aim of this study is to demonstrate the efficiency of non-invasive imaging method-MR proton density fat fraction (PDFF); ideal IQ sequence- on detecting the effects of bariatric surgery on liver and pancreatic fatty infiltration.Materials and Methods:Thirty-nine patients (25 females, 14 males) who underwent bariatric surgery between May 2016 and April 2017 were analyzed retrospectively in this study. Body mass index (BMI) and body weight (BW) values of all patients were noted one week before and one month after bariatric surgery, and meanwhile an unenhanced upper abdominal MR imaging was performed. Liver fat fraction (LFF), pancreas fat fraction (PFF), liver volume (LV) and craniocaudal length of liver (LL) were measured with MR-PDFF and T2 weighted images. Changes in all parameters after the surgery were recorded and the correlation of these changes with the change in LFF was analyzed.Results:At the end of first month of bariatric surgery, a significant decrease on mean values of LFF and PFF has been observed along with a decrease of LV, LL, BW and BMI (p

Background Currently, the most effective method in the fight against coronavirus disease 2019 (COVID-19) is vaccination against the disease. However, there are hesitations among society concerning the safety and side effects of COVID-19 vaccines. We aimed to determine the observed side effects that require an emergency room visit after taking the BNT162b2 and CoronaVac vaccines. Methods This prospective observational study was conducted with patients who presented to the emergency department due to vaccine-related complications after COVID-19 vaccination. The patients' symptoms at the time of presentation, time from vaccination to the onset of symptoms, and dose of the vaccine administered were determined. In addition, the demographic characteristics of the patients, whether they had a history of COVID-19 infection, and their vital signs at the time of presentation were recorded. The variables were compared according to the type of vaccine administered. Results The study included 182 patients who presented to the emergency department over a 6-month period. It was determined that 166 of these patients (91.2%) had received the BNT162b2 vaccine and 16 (8.8%) had received the CoronaVac vaccine. The majority of the patients did not have a history of COVID-19 infection (70.3%), and most presented to the hospital with complications after the second dose (61%). The onset of vaccine-related symptoms was mostly within 1 to 12 hours (39%). The majority of patients (97.8%) were discharged from the emergency department. The most common symptoms after vaccination were fatigue (n = 70), followed by muscle/joint pain (n = 52), headache (n = 33), and fever (n = 32). The rate of dizziness was found to be statistically significantly higher in the CoronaVac vaccine group than in the BNT162b2 vaccine group (p = 0.008). There was no statistically significant difference between the two vaccine groups in relation to the remaining symptoms (p > 0.005). Conclusion There were no serious complications related to the BNT162b2 or CoronaVac vaccine. The most common symptom after both vaccines was fatigue; therefore, the BNT162b2 and CoronaVac vaccines can be safely administered.

This study was conducted to examine the relationship between the levels of prospective preschool teachers’ self-efficacy beliefs in science education and learning styles. In this study, the correlational survey model was used. The sample of the research was composed of 193 (165 females, 28 males) prospective pre-school teachers studying in their first, second, third, and fourth year in a faculty of education of a state university located in the Black Sea in Turkey. Data were collected using the ‘Science Education Self-Efficacy Belief Scale’ developed by Riggs and Enochs (1990) and adapted into Turkish by Özkan et al. (2002) and ‘Kolb Learning Style Inventory’ developed by Kolb (1984) and adapted into Turkish by Evin Gencel (2007) in the spring semester of the 2019-2020 academic year. Descriptive and inferential statistics were used in the statistical calculations of the data in the study. As a result of the study, it was determined that these prospective pre-school teachers’ self-efficacy beliefs in science education were very high while their personal self-efficacy beliefs and result expectation sub-dimensions were at a high level. In addition, there is no statistically significant difference between prospective teachers' self-efficacy beliefs in science education, personal self-efficacy perception, and result expectation according to their learning styles. Based on the results obtained, to increase the success of prospective teachers in science and achieve desired goals in education, learning environments should be designed according to learning styles, and studies should be conducted to increase the quality of science education by making use of self-efficacy beliefs.