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Objective: Starting from the 1990’s minimally invasive methods such as endovenous laser ablation (EVLA), radiofrequency ablation (RFA), and ultrasound-guided foam sclerotherapy (UGFS) developed.Method: This study includes a total of 136 patients (81 women/55 men), of whom 22 (10 women/12 men) were treated with classic surgical stripping, 54 (32 women/22 men) with thermal ablation and 60 (39 women/21 men) with non-thermal ablation.Results: Twenty-two patients (10 women/12 men) were treated with surgical stripping. In one female patient a hematoma arose in the medial crural region postoperatively. A radiofrequency catheter (ThermoBLOCK TM) was used in the thermal ablation procedures in 54 patients (32 female/22 male). While permanent paresthesia occurred in one female patient after the procedure, temporary paresthesia occurred in 3 male patients postoperatively. Non-thermal ablation was performed in 60 patients (39 female/21 male). Even through a severe burning sensation was present in 6 patients (5 female/1 male) during the procedure, this symptom was only transient. In one of the patients, deep venous thrombosis (DVT) occurred at the level of the popliteal vein postoperatively at the sixth day.Conclusion: Even if thermal and non-thermal ablation and surgical procedures have the same pain decreasing rates, hematomas and a longer hospital stay are more frequent in surgical procedures., Amaç: 1990’lı yıllardan başlayarak endovenöz lazer ablasyon (EVLA), radyofrekans ablasyon (RFA) ve ultrason eşliğinde köpük skleroterapi (UGFS) gibi minimal invaziv yöntemler geliştirildi. Yöntem: Bu çalışma toplam 136 hastayı içermektedir (81 kadın/55 erkek) 22’ (10 kadın/12 erkek) klasik cerrahi stripping, 54’ (32 kadın/22 erkek) termal ablasyon ve 60’ (39 kadın/21 erkek) termal olmayan ablasyon ile tedavi edildi. Bulgular: Yirmi iki hasta (10 kadın/12 erkek) cerrahi stripping ile tedavi edildi. Bir kadın hastada operasyon sonrasında kruris medialinde hematom meydana geldi. 54 hastada (32 kadın/22 erkek) termal ablasyon işlemlerinde radyofrekans kateter (ThermoBLOCK TM) kullanıldı. Bir kadın hastada işlem sonrası kalıcı parestezi gelişti. 3 erkek hastada ameliyat sonrası geçici parestezi gelişti. 60 hastaya (39 kadın/21 erkek) termal olmayan ablasyon uygulandı. 6 hastada (5 kadın/1 erkek) işlem sırasında şiddetli yanma olmasına rağmen bu semptom geçiciydi. Bir hastada postoperatif altıncı günde popliteal ven düzeyinde derin ven trombozu (DVT) gelişti.Sonuç: Termal ve termal olmayan ablasyon ve cerrahi işlemler aynı ağrı azaltma oranlarına sahip olsa da cerrahi işlemlerde hematomlar ve hastanede daha uzun süre kalış daha sık görülür.

Objective: The auditory brainstem response (ABR) test has been widely used in childhood. Although it is a painless procedure, sedation can be needed in pediatric patients. Thus, this study aimed to evaluate safety and complications of sedation anesthesia applied in pediatric patients during ABR testing. Methods: Medical records of 75 children who underwent ABR testing between 2018 and 2020 were evaluated retrospectively in terms of applicability, safety, and complications of sedation anesthesia. Results: The ages ranged from 3 to 9 (mean 6.2) years. Comorbidity was detected in 20% (n = 15); 3 had multiple comorbidities, and the most common comorbidity was Down syndrome (4%). The drugs used in sedation anesthesia were midazolam in 81.3% (n = 61), a combination of propofol and ketamine in 14.7% (n = 11), and only propofol in 4% (n = 3) of the patients. An additional drug use was needed in 44% (n = 33). The mean procedure time was 40 (range 30–55) min. The mean anesthesia duration was 45 (range 35–60) min. The mean recovery time was 10 (range 5–15) min. Complications related to anesthesia developed in 4 (5.33%) of the patients; respiratory distress, agitation, cough, and nausea-vomiting were seen in one of the patients, respectively. Complications like bradycardia and respiratory or cardiac arrest were not seen at all. Conclusions: The complication rate of sedation anesthesia performed during ABR testing of pediatric patients is quite low. It may be more beneficial to use combinations of sedation drugs instead of using a single sedation drug. Although sedation anesthesia appears to be safe in general, the potentially life-threatening complications of sedative agents should be remembered, especially in children who have comorbidities.

Achillea ketenoglui H. Duman is an endangered species in Turkey. Its morphological, anatomical and palynological features were studied. Microphotographs of the cross sections of stem and root of this species are provided along with the detailed anatomical features and their morphological description with the help of drawings. Distribution and ecology of A. ketenoglui were determined and IUCN risk category was revised. Microphotographs of scanning electron and light microscope was studied, evaluated and discussed for their taxonomic use.

Aim: This article investigates the effects of two attacks and a failed coup attempt during 2016 on the tourist behavior. Foreign tourist data for the 2003-2019 period is analyzed to observe irregularities in Turkey’s national tourism income. Design / Research methods: Linear regression, multivariate regression and regression based static forecasting methods are applied for modeling the relationships. These models are supported with statistical tests. Conclusions / findings: Results on this study are in accordance with the current literature in the sense that conflicts in 2016 caused a shift in tourist behavior which in turn impaired the tourism industry in Turkey. Repercussions did not endure longer than expected and Turkish tourism recovered rapidly, only facing a serious loss due to the shift in tourism demand trend. Originality / value of the article: This study makes an addition to the terror and tourism literature, especially for the Mediterranean region and specifically for Turkey both of which are among the most popular tourist destinations worldwide. The aftermath of attacks and the coup attempt in Turkey during 2016 have not been researched before. The data and the outcomes presented sufficient evidence to infer on this issue.

Takatsubo cardiomyopathy (TKM) is a table similar to the acute myocardial infarction seen in postmenopausal women, which is catecholamine discharge due to acute stress or coronary artery spasm. TKM is usually characterized by recurrent left ventricular failure and constitutes 1-3 % of suspected acute coronary syndromes. The most common symptoms are chest pain, syncope, dyspnea and abnormal ST and T (-) changes are frequently seen in ECG. In this case report, our anesthesia approach is presented in a 19-year-old pregnant with TKM who was operated on because of urgent cesarean section., Takatsubokardiyomiyopatisi (1) (TKM), sıklıkla postmenapozal kadınlarda görülen, akutstres sonrasında katekolamin deşarjına veya koroner arter spazmına bağlıgelişen, akut myokard infarktüsüne benzer bir tablodur. TKM genellikle geridönüşümlü sol ventrikül yetmezliği ile karakterizedir ve şüpheli akut koronersendromların %1-3’ünü oluşturur. En sık semptomlar göğüs ağrısı, senkop,dispnedir ve anormal ST ve T (-) değişiklikleri EKG’ de sıklıkla görülür. Buolgu sunumunda TKM’li acil sezeryan seksiyo nedeniyle operasyonuna alınmış 19yaşında gebedeki anestezi yaklaşımımız sunulmuştur.

Forecasting process may become cumbersome under erratic demand structures where no conventional methodology seems to provide plausible outcomes. The company investigated in this paper is subject to this condition and needs to forecast the workload in order to plan the indispensable process enhancement activities. Two parameters to be forecasted are the total production volume and the ratio of in-house production ratio with respect to the total production. The required forecasts for relatively regular structured in-house production to total production ratio were computed via static forecasting. The more important erratic structured total production volume forecasts were computed using FFT (Fast Fourier Transform) algorithm. Total production was further observed during the next year to check the reliability of the forecasts. The resulting respective MAPEs (Mean Absolute Percentage Errors) of approximately 11% (in-house ratio) and 14-22% (total production) were considered acceptable under the erratic demand structure.

Amaç: Karotis endarterektomi operasyonu genel anestezi ile uygulanabildiği gibi, bölgesel uygulanabilen; servikal rejyonel blok, lokal-rejyonel kombine anestezi ya da lokal infiltrasyon anestezisi altında yapılabilir. Bu çalışmada rejyonel blok uygulaması ile karotis endarterektomi uygulama deneyimlerimizi sunmayı amaçlıyoruz. Yöntem: Eylül 2020- Ocak 2022 tarihleri arasında karotis arterine endarterektomi operasyonu yapılan 61 hastanın cerrahi sonrası 30 gün süreyle erken dönem sonuçları retrospektif irdelenmiştir. Hastalara ait yaş, cinsiyet, risk faktörleri, şant kullanımı, operasyon süresi, nörolojik olaylar, mortalite ve morbidite değerlendirilmiştir.Bulgular: Toplam 61 hastanın verileri retrospektif olarak incelenmiştir. Hastalardan 15’i kadın, 46’sı erkekti. Ortalama yaş 61.6±9.1 (48-88) yıl olarak hesaplandı. Semptomatik hasta sayısı 51 idi. 10 hasta asemptomatik olup stenoz derecesi %70’in üzerindeydi. 11 hastada her iki tarafa endarterektomi uygulandı. Toplam olarak 72 karotis endarterektomi operasyonu gerçekleştirildi.Ortalama işlem süresi 77.6±19.7 dakika, karotis klemp süresi 29.4±11.5 dakika olarak hesaplandı. Taburcu edilen hiçbir hastada postoperatif ilk ay içinde majör nörolojik olay, kanama, enfeksiyon ya da ölüm ile karşılaşılmadı. Sonuç: Karotis endarterektomi operasyonu artan tecrübe ile birlikte rejyonel servikal blok altında güvenle gerçekleştirilebilir., Objective: Carotid endarterectomy can be performed under general anesthesia, regional cervical block, combined local-regional or local infiltration anesthesia. The aim of our research is to share our experience of patients who underwent carotid endarterectomy under regional cervical block.Methods: Between September 2020 and January 2020, a total of 61 patients who underwent carotid endarterectomy were examined retrospectively. The patients’ postoperative early results within the first 30 days were evaluated. Age, sex, risk factors, the usage of shunt, duration of the operation, neurological events, morbidity and mortality were all evaluated. Results: The data of 61 patients were analyzed retrospectively. Fifteen of the patients were female and forty-six were male. The mean age of the patients was calculated as 61.6±9.1(48-88) years. Fifty-one of the patients were symptomatic. Ten of the patients were asymptomatic, however they had a carotid stenosis of 70 percent or above. In 11 of the 61 patients, carotid endarterectomy was performed bilaterally, so a total of 72 carotid endarterectomies were performed in 61 patients. The mean duration of the procedure was 77.6±19.7 minutes, and the average time of a clamp on the carotid artery was 29.4±11.5 minutes. Major neurological events, bleeding, infections or death, were seen in none of the discharged patients within 1 month postoperatively. Conclusion: With increasing experience, carotid endarterectomy can be performed safely under regional cervical block.

Atomic absorption spectrometry facilitates the reliable determination of mineral content during pharmaceutical quality control of medicinal plants. In the present work, measurable amounts of Fe, Ca, Cu, K, Mg, Mn, Na and Zn were detected in the leaves and flowers of Hypericum origanifolium Willd. through atomic absorption spectrometry. Mean heavy metal content in the flowers and leaves of H. origanifolium was, in descending order, Ca > Mg > K > Na > Fe. Ca was present in higher concentrations in the flowers (11157.24 ppm) and leaves (20132.24 ppm) of titled plant. Our results reveal that flowers are less suitable as target plant parts for metal accumulation than leaves., Atomik absorpsiyon spektrometresi, tıbbi bitkilerin farmasötik kalite kontrolü sırasında mineral içeriğinin güvenilir bir şekilde belirlenmesini kolaylaştırmaktadır. Bu çalışmada, Hypericum origanifolium Willd'un yaprak ve çiçeklerinde atomik absorpsiyon spektrometresi ile ölçülebilir miktarda Fe, Ca, Cu, K, Mg, Mn, Na ve Zn bulunduğu tespit edilmiştir. H. origanifolium'un yaprak ve çiçeklerindeki ortalama ağır metal içeriği sırasıyla Ca> Mg> K> Na> Fe olarak belirlenmiştir. Kalsiyum, çiçek (11157,24 ppm) ve yapraklarda (20132,24 ppm) en yüksek konsantrasyonda tespit edilmiştir. Elde edilen sonuçlar çiçeklerin yapraklara kıyasla çok daha düşük seviyede ağır metal birikimi gösterdiğini ortaya koymaktadır.

Phytochemical composition of ethyl acetate fraction and total phenolic content, in vitro antioxidant, anti-inflammatory, antimicrobial activities of petroleum ether, chloroform, ethyl acetate and n-butanol fractions of the ethanol extract obtained from the subaerial parts of Scorzonera pygmaea Sibth. & Sm. (Asteraceae) were investigated. Nine compounds; scorzopygmaecoside (1), scorzonerol (2), cudrabibenzyl A (3), thunberginol C (4), scorzocreticoside I (5) and II (6), chlorogenic acid (7), chlorogenic acid methyl ester (8), 3,5-di-O-caffeoylquinic acid (9) were isolated and identified using spectroscopic methods. All substances were isolated for the first time from this species. Compounds 1 and 2 are new. The fractions showed high antioxidant capacity correlated with their phenolic content and no significant antimicrobial activity against tested bacteria and fungi. COX inhibition test was used to evaluate the anti-inflammatory activity and all the fractions showed low inhibition in comparison with indomethacin.

Background Preoperative smoking cessation is commonly advised in an effort to improve postoperative outcomes. However, it remains unclear for how long smoking cessation is necessary, and even whether a brief preoperative period of abstinence is helpful and well tolerated. Objective We evaluated associations between various periods of preoperative smoking cessation and major morbidity and death. Design Retrospective cohort analysis. Setting Adults who had noncardiac surgery at the Cleveland Clinic Main Campus between May 2007 and December 2013. Patients A total of 37 511 patients whose smoking history was identified from a preoperative Health Quest questionnaire. Of these patients, 26 269 (70%) were former smokers and 11 242 (30%) were current smokers. Of the current smokers, 9482 (84%) were propensity matched with 9482 former smokers (36%). We excluded patients with American Society of Anesthesiologists' physical status exceeding four, patients who did not have general anaesthesia, and patients with missing outcomes and/or covariables. When multiple procedures were performed within the study period, only the first operation for each patient was included in the analysis. Main outcome measures The relationship between smoking cessation and in-hospital morbidity/mortality. Results The incidence of the primary composite of in-hospital morbidity/mortality was 6.9% (656/9482) for all former smokers; the incidence was 7.8% (152/1951) for patients who stopped smoking less than 1 year before surgery, 6.3% (118/1977) for 1 to 5 years, 7.2% (115/1596) for 5 to 10 years and 6.9% (271/3457) for more than 10 years. Conclusion Smoking cessation was associated with reduced in-hospital morbidity and mortality which was independent of cessation interval.

Detailed morphological investigation on the pollen of two Turkish Euphorbia species (E. kotschyana Fenzl. and E. stricta L.) was carried out under light microscope and SEM. Pollen grain microphotographs of examined taxa have been taken from preparates which were made by Wodehouse and Erdtman techniques in LM. Type of the pollen grains of studied taxa have determined as tricolporate and spheroidae shape. Ornamentation is tectate-rugulate according to the Wodehouse and Erdtman methods. For E. kotschyana P/E= 1.22 (W), 0.98 (E), Exine 2.91 µm (W), 2.76 µm (E). For E. stricta, pollen grains measured as P/E= 0.89 (W), 0.94 (E), Exine 2.32 µm (W), 2.59 µm (E)

In this study, detailed morphological investigation on the pollen of two Turkish Gagea species (G. glacialis and G. fibrosa) was carried out under light microscope and SEM. Pollen grain microphotographs of examined taxa have been taken from preparates which were made by Wodehouse and Erdtman techniques in LM. According to this analysis, Pollen ornemantetion of investigated taxa are identified as reticulate for Gagea glacialis, microreticulate for G. fibrosa. For G. glacialis mono sulcate, subprolate P/E= 0.76 (W), 0.8 (E), Exine 1.3 µm (W), 1.366 µm (E). For G. fibrosa, pollen grains measured as mono sulcate, subprolate P/E= 0.78 (W), 0.73 (E), Exine 1.316 µm (W), 1.25 µm (E)

The anti-inflammatory effects of statins have been suggested to relieve postoperative pain. This retrospective study tested the association between the perioperative routine use of statins in therapeutic doses, and opioid requirements and pain scores, after hip replacement surgery.With IRB approval, data was obtained for adult patients who had elective hip replacement surgery under spinal anaesthesia at Cleveland Clinic between 2005 and 2015. Patients were compared using a joint hypothesis framework. We used the inverse probability of treatment weighting method to control for observed confounding factors (a total of 26).We included 611 statin users and 780 non-statin users. Pain score during the initial 72 h after surgery was 0.07 higher (95% CI: -0.02, 0.17) in statin users (noninferiority test in both directions P0.001). The estimated ratio of geometric means in the cumulative i.v. morphine equivalent opioid consumption was 1.01 (95% CI: 0.93, 1.10) for statin vs non-statin users (noninferiority test P=0.001 in the hypothesized direction and0.001 in the other direction) during the initial 72 h after surgery. The statin and non-statin patients were deemed equivalent on postoperative opioid consumption and pain score.This is the first large retrospective clinical study that investigates the effects of statin use on postoperative pain and opioid consumption. We observed no difference between statin users and non-users during the initial 72 h after hip surgery. Our findings do not support the routine use of statins as part of an analgesic regimen.

Nausea and vomiting seen within the post-operative recovery room or 24 hours following the operation remain one of the most common complications in the postoperative period. Nausea and vomiting decrease the patient's postoperative satisfaction, which may lead to complications, such as aspiration of gastric contents, dehydration, electrolyte imbalance, hemorrhage, it may also bring about economic losses, prolongs recovery time and length of hospital stay. Therefore, in the preoperative process, it is very important to investigate the risks correctly for each patient concerning postoperative nausea and vomiting and to identify and apply risk-reducing pharmacological and non-pharmacological treatment methods. In this review, the importance of postoperative nausea and vomiting, risk factors, strategies to reduce risks and the treatment algorithm used in prophylaxis are presented. © 2020, Turkish Society for Radiation Oncology.

In this study, passive edge filter design was implemented by using I-6, I-25, M-5, M-12 erbium-doped fibers. For this purpose, first the highest bandwidth and the steepest slope regions of the erbium-doped fibers were determined in the simulation environment. The experimental setup was realized by using the most appropriate lengths of erbium-doped fibers found in the simulation study. For I-25 erbium-doped fiber, an edge filter with a bandwidth of 32.8 nm and a slope angle of 50.77 degrees was obtained.

Moderate hypothermia (e.g., 34.5 °C) causes surgical site infections, but it remains unknown whether mild hypothermia (34.6 °C-35.9 °C) causes infection. Therefore, the objective of this study was to evaluate the relationship between intraoperative time-weighted average core temperature and a composite of serious wound and systemic infections in adults having colorectal surgery over a range of near-normal temperatures.Retrospective, single center study.The operating rooms of the Cleveland Clinic Foundation from January 2005 to December 2014.Adult patients having colorectal surgery at least 1 h in length who received both general anesthesia and esophageal core temperature monitoring.Time weighted average intraoperative core temperature.Our primary outcome was a composite of serious infections obtained from a surgical registry and billing codes. Average intraoperative esophageal temperatures and the composite of serious 30-day complications were assessed with logistic regression, adjusted for potential confounding factors.A total of 7908 patients were included in the analysis. A 0.5 °C decrease in time-weighted average intraoperative core temperature ≤ 35.4 °C was associated with an increased odds of serious infection (OR = 1.38, P = .045); that is, hypothermia below 35.4 °C progressively worsened infection risk. Additionally, at higher core temperatures, the odds of serious infection increased slightly with each 0.5 °C increase in average temperature (OR = 1.10, P = .047).Below 35.5 °C, hypothermia was associated with increased risk of serious infectious complications. Why composite complications increased at higher temperatures remains unclear, but the highest temperatures may reflect febrile patients who had pre-existing infections. Avoiding time-weighted average core temperatures35.5 °C appears prudent from an infection perspective, but higher temperatures may be needed to prevent other hypothermia-related complications.

Background Childhood and adolescent obesity increased in recent decades, and caregivers face an increasing number of obese pediatric surgical patients. Some clinical and pharmacogenetic data suggest that obese patients have altered pain sensitivity and analgesic requirements. Objective To test the primary hypothesis that increased BMI in pediatric patients is associated with increased pain during the initial 48 postoperative hours. Secondarily, we tested whether BMI is associated with increased opioid consumption during the same period. Design Retrospective single-center cohort study. Setting Pediatric surgical wards in a tertiary medical center. Patients A total of 808 opioid naive patients aged 8 to 18 years having elective non-cardiac surgery with hospital stay of at least 48 h in the Cleveland Clinic between 2010 and 2015. Interventions None. Measurements Using U.S. Centers for Disease Control definitions for childhood weight classifications, we retrospectively evaluated the association between body mass index (BMI) percentile and time-weighted average pain scores and opioid consumption. We used multivariable linear regression to test for an association with postoperative pain scores, and multivariable gamma regression to test for an association with postoperative opioid consumption (in mg morphine equivalents Kg−1). Results BMI was not associated with postoperative pain after general, orthopedic, or neuro-spinal surgeries. Pain increased by 0.07 [98.75% CI: (0.01, 0.13), Padj Conclusion We found no clinically important increase in pain scores or opioid consumption in association with higher BMI in patients 8 to 18 years of age recovering from elective non-cardiac surgery.

L-Karnitinin vücutta, kas dokusunun önemli bir elemanıdır. Zayıflama ve egzersiz performansını arttırıcı etkisinden dolayı özellikle genç erişkinlerde son 30 yılda popüler bir ilaç olmuştur.İlaç olarak kullanıldığında, aşırı dozlarında ciddi istenmeyen etkileri ortaya çıkmaktadır. Biz bu olgu sunumunda, L-Karnitin kullanımına bağlı nörolojik yan etkiler gelişen bir hastada yoğun bakımdaki tedavi yaklaşımımızı sunduk., L-Carnitine is an important element of muscle tissue. Because of slimming and developing exercise performance, it has become a populer drug especially for young adults in last 30 years. When used as a medicine, serious adverse effects are emerging in overdoses. In this case report we presented our treatment approach in a patient with developing neurological side effects related to L-Carnitine used in intensive care unit.

Phytochemical composition of ethyl acetate fraction and total phenolic content, in vitro antioxidant, anti-inflammatory, antimicrobial activities of petroleum ether, chloroform, ethyl acetate and

Acetaminophen is effective for acute surgical pain, but whether it reduces persistent incision pain remains unknown. We tested the primary hypothesis that patients given perioperative acetaminophen have less incisional pain three months after surgery. Our secondary hypotheses were that patients randomized to acetaminophen have less postoperative pain and analgesic consumption, and better functional recovery at three months.140 patients having abdominal hysterectomy were randomly assigned to: 1)intravenous acetaminophen (4 g/day for 72 postoperative hours); or, 2) saline placebo. The primary outcome was incisional pain visual analog scale (VAS) at three months after surgery. The secondary outcomes were (1, 2) postoperative VAS scores while laying and sitting and (3) total patient-controlled intravenous tramadol consumption during the initial 24 hours, (4) DN4 questionnaires and (5) SF-12 at three months after surgery.The persistent incisional pain scores at three months were significantly lower in acetaminophen (median [Q1, Q3]: 0 [0, 0]) as compared with saline group (0 [0, 1]) (P = 0.002). Specifically, 89%, 9%, and 2% of acetaminophen patients with VAS pain score at three months of 0, 1, and 2 or more, as compared with 66%, 23%, and 10% in the saline group (odds ratio: 2.19 (95% CI: 1.33, 3.59), P = 0.002). Secondly, postoperative pain scores both laying and sitting were significantly lower in the acetaminophen group. Acetaminophen group had significantly better DN4 score and mental health related but not physical health related quality of life.Our results suggest that acetaminophen reduces the risk and intensity of persistent incisional pain. However, there are other mechanisms by which acetaminophen might reduce persistent pain.Anesthesia, acetaminophen, Persistent surgical pain, Postoperative acute pain.L’acetaminofene (paracetamolo) è efficace nel trattamento del dolore chirurgico acuto, ma non è noto se riduce il dolore persistente delle incisioni. Abbiamo esaminato una prima ipotesi che la somministrazione perioperatoria dell’acetaminofene riduce il dolore dell’incisione tre mesi dopo l’interventi. Le nostre ipotesi secondarie erano che pazienti randomizzati al paracetamolo avessero minore dolore postoperatorio e minore consumo di analgesici, e migliore recupero funzionale a tre mesi. Sono state utilizzate 140 pazienti sottoposte ad isterectomia per via addominale, suddivise a random e in doppio cieco tra un gruppo sottoposto alla somministrazione endovenosa per 72 ore nel postoperatorio di 4 g/die di paracetamolo, ed un secondo gruppo trattato con semplice placebo (soluzione fisiologica). Come controllo primario è stata usata la scala analogica visiva (VAS) del dolore incisionale a tre mesi dopo l’intervento. Il controllo secondario sono stati la VAS del dolore 1) in posizione sdraiata, 2) in posizione seduta, 3) il consumo totale di tramandolo endovena richiesto dalla paziente nelle prime 24 ore dall’intervento , 4) il questionario Diagnostico del Dolore Neuropatico (DN4), e 5) il questionario sullo stato di salute SF-12 a tre mesi dopo l’intervento chirurgico . Risultati: il punteggio del dolore persistente a tre mesi a livello dell’incisione è significativamente inferiore nel gruppo trattato con paracetamolo (in media [Q1, Q3]: 0 [0, 0]) a paragone col gruppo trattato con placebo (0 [0, 1]) (P = 0.002). Più specificamente 89%, 9%, e 2% delle pazienti trattate con paracetamolo hanno presentato un punteggio 0, 1 e 2 o più nel VAS del dolore a tre mesi, a paragone col 66%, 23%, e 10% delle pazienti trattate con placebo (rapporto di probabilità : 2.19 (95% CI: 1.33, 3.59), P = 0.002). secondariamente i punteggi del dolore postoperatorio sia in posizione sdraiata che seduta sono stati sifgnificativamente inferiori nel gruppo trattato con paracetamolo. Questo gruppo ha presentato un DN4 significativamente migliore e correlata ad un migliore DF-12, ma non una qualità di vita correlata alla salute fisica. Da questi risultati si conclude che il paracetamolo riduce richio ed intensità del dolore persistente a livello dell’incisione chirurgica. Però esistono altri meccanismi con cui il paracetamolo potrebbe ridurre il dolore persistente.

ResumoJustificativaHistoricamente, as guerras e seus desafios afligem a humanidade. Na Síria, lesões graves ocorreram devido às armas de fogo e explosivos usados na guerra entre as forças governamentais e civis durante um período de mais de dois anos.Materiais e métodosO estudo incluiu 364 pacientes, admitidos no Hospital da Universidade Mustafa Kemal da Faculdade de Medicina (Hatay, Turquia) e submetidos à cirurgia. Os sobreviventes e não sobreviventes foram comparados quanto ao local e tipo da lesão e número de transfusões administradas. A taxa de mortalidade encontrada neste estudo também foi comparada àquelas relatadas em outras guerras civis.ResultadosA média de idade foi de 29 (3‐68) anos. Os principais locais de lesão incluíram extremidades (56,0%), cabeça (20,1%), abdome (16,2%), estruturas vasculares (4,4%) e tórax (3,3%). Os tipos de lesões incluíram ferimento de arma de fogo (64,4%), lesão causada por explosão (34,4%) e ferimentos diversos (1,2%). A taxa de sobrevivência foi de 89,6%, enquanto a taxa de mortalidade foi de 10,4%. Observou‐se uma diferença significativa entre as taxas de mortalidade neste estudo e aquelas relatadas para as guerras civis da Bósnia e Líbano; e a diferença ficou extremamente significativa quando comparada com as taxas de mortalidade relatadas para as guerras civis do Vietnã e do Afeganistão.ConclusãoDentre as lesões relacionadas à guerra, a maior taxa de mortalidade foi observada em lesões de cabeça‐pescoço, abdome e vasculares. Acreditamos que a maior taxa de mortalidade na Guerra Civil da Síria, em comparação com as guerras da Bósnia, Vietnã, Líbano Afeganistão, se deva ao fato de os civis terem sido vistos como alvo direto durante a guerra.AbstractBackgroundWars and its challenges have historically afflicted humanity. In Syria, severe injuries occurred due to firearms and explosives used in the war between government forces and civilians for a period of over 2 years.Materials and methodsThe study included 364 cases, who were admitted to Mustafa Kemal University Hospital, Medicine School (Hatay, Turkey), and underwent surgery. Survivors and non‐survivors were compared regarding injury site, injury type and number of transfusions given. The mortality rate found in this study was also compared to those reported in other civil wars.ResultsThe mean age was 29 (3–68) years. Major sites of injury included extremities (56.0%), head (20.1%), abdomen (16.2%), vascular structures (4.4%) and thorax (3.3%). Injury types included firearm injury (64.4%), blast injury (34.4%) and miscellaneous injuries (1.2%). Survival rate was 89.6% while mortality rate was 10.4%. A significant difference was observed between mortality rates in this study and those reported for the Bosnia and Lebanon civil wars; and the difference became extremely prominent when compared to mortality rates reported for Vietnam and Afghanistan civil wars.ConclusionAmong injuries related to war, the highest rate of mortality was observed in head–neck, abdomen and vascular injuries. We believe that the higher mortality rate in the Syrian Civil War, compared to the Bosnia, Vietnam, Lebanon and Afghanistan wars, is due to seeing civilians as a direct target during war.

Objective: Monitored anesthesia care is the combination of local anesthetics and intravenous anesthetics drugs for sedation and analgesia. The aim of this prospective, randomized double blinded study was to compare intraoperative and postoperative effects of dexmedetomidine and ketamine infusion in patients scheduled for lower extremity surgery under epidural anesthesia, Amaç: Monitörize anestezi bakımı, sedasyon ve analjezi için lokal ve intravenöz anesteziklerin kombinasyonudur. Bu prospektif, randomize çift kör çalışmanın amacı, epidural anestezi altında alt ekstremite cerrahisi geçirecek hastalarda intravenöz deksmedetomidin ve ketamin kullanımının intraoperatif ve postoperatif etkilerinin karşılaştırılmasıdır.Yöntem: Çalışmaya alt ekstremite cerrahisi planlanan, 18-80 yaşları arasında ve ASA I-II grubuna giren 60 hasta dahil edildi. Standart monitörizasyonun ardından, tüm hastalara epidural kateter uygulandı ve 14 ml 0.5% bupivakain ile anestezi uygulandı. Aynı anda; Grup I’deki olgulara 0.9%NaCl; Grup II’deki olgulara 0.5 mcg/kg/sa deksmedetomidin ve Grup III’deki olgulara 0.5 mg/kg/sa ketamin intravenöz infüzyonu başlatıldı. Operasyon sonunda (0), 30. dk 1, 2, 4, 8, 12, 24, 48. saatlerde: hemodinamik ölçümler, solunum sayısı, oksijen saturasyonu, sedasyon ve ağrı skorları kaydedildi. Postoperatif dönemde hasta kontrollü epidural analjezi yöntemi uygulandı. Epidural anestezik tüketimi ve yan etkiler postoperatif 24 ve 48. saatlerde kaydedildi.Bulgular: Cerrahi blok düzeyine ulaşma zamanı, periferik oksijen satürasyonu, solunum sayısı, cilt ısısı, idrar ve kanama volümü, enfeksiyon oranları ve yan etkiler benzerdi. Operasyon esnasında 45 - 105. dak arasında sistolik ve diyastolik basınçlar deksmedetomidin grubunda düşüktü (p

Colorectal injuries are one of the most common causes of mortality in war. Mainstay treatment of these injuries include primary repair or stoma creation.Clinical data of the patients were evaluated retrospectively. Time from injury to hospital admission, method of treatment, the colorectal area affected, injury severity score ISS, hemodynamic instability, and mortality rate were determined.Of the 61 patients included in the study. Mean time from injury to hospital admission was 160±19 minutes. The injury was in the right colon in 24 patients 39.3%, in the left colon in 18 29.5%, and in the rectum in 19 31.2% patients. Median ISS value of 61 patients was 16, IQR 5. Mortality and complication rates were higher in patients with hemodynamic instability and stoma requirement was also higher in this group p0.05. Total mortality occurred in 15 24.5% patients. Of these, 10 66.6% patients had hemodynamic instability.Hemodynamic instability is the most important factor affecting the mortality and the treatment method in wartime colorectal injuries.We believe that in victims of war with colorectal injuries, surgical intervention before the development of hemodynamic instability may reduce the rate of mortality and stoma requirement.Colorectal injury, Firearm injury, Hemodynamic instability, Stoma.Le lesioni traumatiche del colon-retto rappresentano una delle più comuni cause di mortalità in guerra e l’elemento fondamentale del trattamento consiste nella riparazione immediata della lesione o la confezione di un ano artificiale. Lo studio consiste nella revisione retrospettiva dei dati clinici di pazienti di questo genere. Sono stati valutati l’intervallo tra l’evento traumatico e il ricovero in ospedale, il tipo di trattamento adottato, la sede anatomica della lesione colorettale, la gravità dell ISS Injury Severity Score, l’instabilità emodinamica, e l’incidenza della mortalità. La casistica consta di 61 pazienti, con intervallo medio dal trauma al ricovero di 160±19 minuti. In 24 pazienti 39,3% si trattava di lesione del colon destro, in 18 pazienti 29,5% del colon sinistro, ed il 19 31,2% di lesioni del retto. l valore medio dell’ISS nei 61 paqzienti era 16 IQR 5. La mortalità e l’incidenza di complicazioni sono risultate più elevate bei pazienti con instabilità emodinamica, e nello stesso gruppo p0,05 la necessità di esecuzione di una stomia. La mortalità totale ha riguardato 15 pazienti 24,5% sul totale, e 10 di essi 66,6% presentavano instabilità emodinamica. Dall’analisi risulta che l’instabilità emodinamica è il fattore più importante connesso con la mortalità, insieme con il tipo di trattamento da adottare nelle lesioni colorettali da causa bellica. Riteniamo dunque che nelle vittime di guerra per lesioni colorettali l’intervento chirurgico eseguito prima dell’insorgenza dell’istabilità emodinamica può rifdurre sia l’incidenza della mortalità che la necessità della stomia.

WOS: 000440995500004, Veronica ersin-yucelii (subg. Pentasepalae, Plantaginaceae) is described and illustrated as a new species. It grows on marble rocks and screes, in one single site in Central Anatolia (Eskisehir Province), at elevations from about 1700 to 1820 metres above sea level. Diagnostic features are also given to enable comparison with the most similar species, V. caespitosa Boiss. and V. multifida L., especially regarding the indumentum, habit, inflorescence, bracts, seeds and leaves. The geographical distribution of the new species is mapped. Notes about its ecology and conservation status are also presented., Eskisehir Osmangazi University Scientific Research Projects Commission [2010/029], We are grateful to PhD. Angelo Troia, as well as an anonymous referee, for useful comments on drafts of the manuscript. Also we would like to thank PhD. Angelo Troia and Burcu Sezer for revising the language of the manuscript. This study was supported by Eskisehir Osmangazi University Scientific Research Projects Commission [Project name: "Flora of vascular plants, mosses, lichen and some vascular plants pollen morphology determination studies and ethnobotanical properties in Gunyuzu (Eskisehir)", Project number: 2010/029].

Turkey is one of the new centers of attraction for healthcare tourism with increasing efforts for improvement at policy making level. In link with the specific targets for healthcare tourism income set by the government, this study aims to analyze historical data of healthcare tourism income of Turkey over 2002-2015 and provide future forecasts. Both annual and quarterly healthcare tourism income data are analyzed to investigate the share of healthcare tourism income in aggregate tourism income and to search for seasonal effects. Results indicate that relying on the high correlation between aggregate tourism and healthcare tourism income, healthcare tourism income can be presented and forecasted as a percentage of annual tourism income. Seasonality is observed for the aggregate tourism income, where it is also present for healthcare tourism income between 2002 and 2009. It is also found that Turkey has an upward trend in health and aggregate tourism income.

Amaç: İnflamatuvar barsak hastalıkları (İBH) çevresel, genetik ve immün faktörlerin sebep olduğu düşünülen bir grup kronik ve inflamatuvar durum olarak tanımlanmaktadır. Tedavisinde başlıca antiinflamatuvar, immünsupresif ve sitotoksik ilaç kombinasyonları kullanılmaktadır. Fakat bu ajanların ciddi yan etkilerinden dolayı yeni tedavi yöntemleri bulmak için araştırmalar yapılmaktadır. Bu çalışmanın amacı dekstran sülfat sodium (DSS) ile indüklenmiş deneysel kolit modelinde Centella Asiatica (CA) ekstresinin etkinliğini araştırmaktır. Gereç ve Yöntem: Çalışmada 24 adet Wistar Albino rat üç eşit gruba ayrıldı. Grup 1' e (kontrol) sadece su verildi. Grup 2' ye (kolit) DSS' li içme suyu ve Grup 3'e (medikasyon grubu) 200mg/kg/gün CA ekstresi ve DSS' li içme suyu verildi. Deney sonunda kolonun histopatolojik incelemesi ve myeloperoksidaz (MPO), malonildialdehit (MDO), tümör nekroz factör alfa (TNF-?) ve interlökin-10 (IL-10) düzeyleri belirlendi. Bulgular: CA ekstratı veilen grupta kolit grubu ile kıyaslandığında TNF- ? düzeyi daha düşüktü ve İL 10 düzeyi daha yüksekti. MPO ve MDA düzeyleri kolit grubunda diğer gruplarla karşılaştırıldığında anlamlı düzeyde daha yüksek bulundu. (p, Background: Inflammatory bowel disease (IBD) is a group of chronic and inflammatory conditions that are considered to be caused by environmental, genetic, and immune factors. The treatment of IBD mainly involves combinations of anti-inflammatory, immunosuppressive, and cytotoxic agents. However, due to serious side effects of these agents, research is being performed to find new treatment methods. The aim of this study is to investigate the efficacy of Centella asiatica (CA) in the experimental colitis model. Materials and Methods: In this study, twentyfour rats were divided into 3 equal groups; control group (group 1) received only water and standard rat chow; colitis group (group 2) received water with dextran sulfate sodium (DSS); medication group (group 3) received water with DSS, and 200 mg/kg/day CA extract was administered Histopathologic examination of colon, concentrations of myeloperoxidase (MPO), malondialdehyde (MDA), tumor necrosis factor alpha (TNF-?), and interleukin-10 (IL-10), were determined.Results: The results indicated that the TNF-? level was lower and the IL-10 was higher in the rats administered with CA extract compared to the rats in the colitis group (p

Araştırma alanı Yunusemre Beldesi (Eskişehir) ve çevresini kapsamaktadır. Araştırma alanının tamamı Davis’in kareleme sistemine göre B3 karesinde yer almaktadır. Floranın belirlenmesi için 2012-2013 yılları arasında araştırma alanından 1900 damarlı bitki örneği toplanmıştır. Toplanan bitki örnekleri herbaryum tekniklerine uygun olarak preslenip kurutulmuştur. Floristik liste hazırlanırken APG III sistemi kullanılmıştır. Yapılan teşhisler sonucunda; 83 familya, 383 cins, 671 tür ve tür altı damarlı bitki taksonu tespit edilmiştir. Araştırma alanındaki bitki taksonları fitocoğrafik bölgelerine göre; % 20,72’si İran-Turan, % 9,39'u Akdeniz ve % 6,11’i Avrupa-Sibirya elementi olarak tespit edilmiştir. Çok bölgeli veya fitocoğrafik bölgesi bilinmeyenlerin oranı ise % 63,77’dir. Endemizm oranı % 17,59’dur. Tür ve tür altı seviyede 16 takson B3 karesi için yeni kayıttır.

In the current study, karyotypes of four taxa in the genus of Ornithogalum L. were examined. These taxa grow naturally in Eskisehir (Central Anatolia). Studies were carried out on somatic chromosomes, using the root tips squash technique and based on staining with acetic orcein stain, for the most actively dividing meristematic cells of the collected root tips. Their counts were based on chromosomes observed during mitotic division. For species included in the Ornithogalum L. (Asparagaceae) genus, O. montanum Cirillo has 2n = 14 with basic chromosome number x = 7; O. comosum L. has 2n = 20, basic chromosome number x = 10, O. pyrenaicum L. has 2n = 24, basic chromosome number x = 12; and O. sigmoideum Freyn & Sint. has 2n = 14, basic chromosome number x = 7; it was found that they have diploid chromosomes. O. montanum and O. sigmoideum chromosome numbers are 2n = 14 (diploid races), but their basic karyotypes are different, including chromosome size, and position of centromere. Mean chromosomal length of t...

The present study determines the morphological, anatomical, palynological, karyological, chorological features and conservation status of the rediscovered rare endemic Turkish taxon Cota fulvida (Grierson) Holub. (Asteraceae) after ca.110 years. C. fulvida distributes naturally in Golcuk Plateau (Turkmen Mountain), Eskisehir-Turkey. In the cross-sections of the root of C. fulvida, the pith was found completely covered by xylem cells. As to stem, it was observed that large parenchymatic cells were present in the pith of the stems. Leaves are equifacial and amphistomatious having amaryllis type of stomata. They are mesomorphic. Stomata are anisocytic. The results of the light and scanning electron microscope investigation revealed that the pollen grains of C. fulvida are tricolporatae, amb shape triangular, pollen shape spheroidal. Exine tectatae-echinate. The somatic chromosome number of C. fulvida was found to be 2n =18 without any satellite. It is considered "Critically Endangered" (CR) based on IUCN category. DOI: http://dx.doi.org/10.3329/bjb.v42i1.15869 Bangladesh J. Bot. 42 (1): 91-98, 2013 (June)

Onosma atila-ocakii sp. nova [Boraginaceae, Sect. Asterotricha (Boiss.) Gurke] is described and illustrated as a new species. It grows in a steppe on magnesite rocks in Eskisehir province (Central Anatolia, Turkey). Its description, photographs, and an identification key including related species (O. roussaei DC. and O. aucheriana DC.) are given. Diagnostic morphological and palynological characters of closely related species are compared and discussed. The characteristic features of indumentum and pollen structure are studied using a light microscope. The new species distinctly differs from related species because of its setose and adpressed retrorse–pilose indumentum, 2–3 rows of setules on foliar tubercles, 10–14 mm white petals and 2.1–2.6 × 1.7–2 mm dark brown nutlets. The International Union for Conservation of Nature threat category and observations on the ecology of the populations are noted. The distribution map of this new species and closely related species in Turkey is presented.

Kırka village is situated at northwest of central Anatolia on the Seyitgazi (Eskişehir)-Afyonkarahisar higway, 70 km to Eskişehir; 27 km to Seyitgazi. During fieldwork which was substantiated between 2009-2010, 860 plant specimens were collected. As a ressult of identification of specimens 462 taxa which belogn to 69 families and 287 genera were determined.457 of these taxa belong to Angiospermae and 5 of the taxa belong to Gymnospermae. 386 of Angiospermae taxa are Dicotylodonae and the other 71 taxa are Monocotylodonae.61 of identifed taxa are andemic for Turkey and endemism ratio is 13.20 %. According to the investigation top families of the in terms of the species number are Asteraceae 50, Fabaceae 42, Brassicaeceae 40, Lamiaceae 33, Poaceae 25, Caryophyllaceae 23, Liliaceae 27, Boraginaceae 18, Apiaceae 20, Scrophulariaceae 15, Ranunculaceae 14, Papaveraceae 10 and Rosaceae 8, and large genus of the in terms of species are Astragalus 10, Alyssum 10, Centaurea 9, Salvia 8, Silene, Veronica, Allium, Crocus and Covolvulus 6, Trifolium 5. According to the phytogeographical region, dispersion and the dispertion ratio are 16.45 % Irano-Turanian (76 taxa), 6.07 % Mediterrenean (31 taxa ), % 4.11 East Mediterrenean (19 taxa), 0,21 % East Mediterrenean (Mountain) (1 taxon), 0.21% Omni Mediterrenean (1 taxon), 6.49 % Euro-Siberian (30 taxa), % 1.70 Euxine (5 taxa) and % 64,71 multiregional or unknown (299 taxa).

Objectives To determine that perioperative ondansetron reduces the analgesic efficacy of acetaminophen. Design Randomized, double-blinded study. Patients 120 patients ASA I-II who underwent abdominal hysterectomy. Interventions All the patients were given 1g acetaminophen at skin closure. Patients were divided into two groups; ondansetron HCl (8mg, 2ml IV) (Group I, N=60) and saline (2ml IV) (Group II, N=60) at the skin closure. Measurement Postoperative pain scores (VAS) while resting in bed and sitting, total opioid consumption were noted. Main results Patients randomized to ondansetron had significantly worse pain scores upon arrival to the recovery unit [by 1.7 (99.7% CI: 0.75, 2.59) cm] and at 1h [by 1.3 (0.5, 2.1) cm] while resting in bed. Pain scores while sitting were also significantly greater in ondansetron group at arrival in PACU by 0.6 (99.7% CI: 0.1, 1.0) cm. Thereafter, pain scores did not differ significantly. Median total opioid (tramadol) consumption was 441 [Q1, Q3: 280, 578] mg in the ondansetron group and 412 [309, 574] mg in the placebo group, P=0.95. Conclusions Ondansetron significantly decreased the analgesic effect of acetaminophen during the initial postoperative period. Our results thus confirm that acetaminophen analgesia is partially mediated by serotonin receptors. However, the reduction was of marginal clinical importance and short-lived.

Objective International scientific publication productivity is a tangible indicator for the accuracy of scientific policies. The quality of scientific publications is not increasing despite the fast increase in the publication count in Turkey. The international publication activities of Turkish anaesthesia clinics have not been previously explored. Thus, we aimed to evaluate the high quality scientific productivity of Turkish anesthesia clinics within the last 10 years. Methods We searched for studies conducted by anaesthesiologists in Turkey within the last 10 years and published in journals listed under the medical subject categories of anaesthesiology and critical care using 'Thomson Reuters InCites' and PubMed databases. We recorded publication year, subject, method, citation count and origin of each paper and conducted descriptive analyses. Results There were 630 papers meeting our inclusion criteria. Among those, 525 (83%) were studies on anaesthesia, 66 (10%) were studies on critical care and 39 (6%) were studies on pain. The average citation count was 9.90. There were 376 controlled/randomized controlled trials, 98 observational studies, 66 laboratory studies, 64 case series/reports, 5 reviews and 21 letters to the editor. Studies were conducted by universities (82.4%), by training and research hospitals (15.56%), by state and military hospitals (0.63%) and by physicians in private practice (1.27%). Baskent University had the highest publication count, Istanbul University had the highest citation count and Trakya University had the highest publication count per faculty teaching staff. Conclusion The high-impact scientific productivity of Turkish anesthesia clinics is in a downward trend in the last 10 years, and the average citation count is lower than the global average.

In this study, Passive Edge Filter was designed using Erbium Doped Fiber. When this design was done, simulation was performed to monitor gain changes with respect to −5, −10, − 15, −20 dBm input signal power and varying lengths of I6 EDF which design by FibeCore company. As a result of the simulation, we have experimentally studied using the optimal EDF length of 20 m. As a result, a passive filter with a correlation coefficient of 0.99 with a bandwidth of approximately 21 nm was realized.

Epidermolizis Bülloza Distrofika (EBD) genetik geçişli, derinin frajilitesinde artış sonucu ortaya çıkan tekrarlayıcı büllerin oluşumu ile karakterize bir hastalıktır. Bu olgulara, anestezi gerektiren durumlarda mukoza ve ciltteki her işlem yeni lezyon oluşumuna neden olabileceği için minimal travmaya neden olunabilecek düzeyde dikkatli olunmalı ve noninvaziv monitörizasyon mümkünse tercih edilmelidir. Bu olgumuzda EBD tanısı konulmuş bir hastaya anestezi yaklaşımımız sunulmuştur.

Theresearch area includes Pazaryeri (Bilecik) and its enviroment, and it occurs inthe A2 and B2 square according to the grid system of P.H. Davis. To investigatethe flora, 2472 specimens have been collected during the field seasons of2013-2014. The specimens have been prepared according to the relevant herbariumtechniques. The floristic list follows the APG III. At the end of identificationsof the specimens 532 taxa belonging to 312 genera (61 family) have beendetermined. Phytogeographical distribution of the taxa are Irano-Turanian(9.09%), Mediterranean (12.50%) and Euro-Siberian (10.79%) with theirpercentage of. Pluriregional or phytogeographically unknown taxa is 67.61%. Theendemism ratio of the areas is 9,19%, Araştırma alanı Pazaryeri (Bilecik) ve çevresini kapsamakta olup Davis’inkareleme sistemine göre A2 ve B2 kareleri içinde yer almaktadır. 2013-2014yılları arasında araştırma alanından floranın belirlenmesi için 2472 adet bitkiörneği toplanmıştır. Toplanan bitki örnekleri herbaryum tekniklerine uygunolarak preslenip kurutulmuştur. Floristik liste APG III sistemi esas alınarakdüzenlenmiştir. Yapılan teşhisler sonucunda çalışma bölgesinde; 61 familya, 312cins, 532 tür ve tür altı damarlı bitki taksonu tespit edilmiştir. Araştırmaalanındaki bitki taksonlarının fitocoğrafik bölgelere dağılımı ise şöyledir; %9.09’u İran-Turan, % 12.50’i Akdeniz ve %10.79 Avrupa-Sibirya elementi. Çok bölgeliveya fitocoğrafik bölgesi bilinmeyenlerin oranı ise % 67.61’dir. Bölgedeki endemizm oranı %9,19’dur.