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Acute decompensation is defined as the development of ascites, bleeding due to portal hypertension, jaundice, or hepatic encephalopathy in the presence of known or unknown chronic liver disease. Acute-on-chronic liver disease is defined as a clinical entity reflecting acute worsening in liver function along with extrahepatic organ failure with significantly higher 28-day mortality. In the common pathogenesis, severe systemic inflammation and portal hypertension and varying degrees of reaction to these conditions play a major role. Triggering factors act as accelerators in the development of acute decompensation and acute-on-chronic liver failure. The extrahepatic organ failure in acute-on-chronic liver failure is mainly due to tissue hypoxia due to decreased perfusion and cellular edema. The number of organ failure in acute-on-chronic liver failure is considered to be the most important prognostic indicator. Liver transplantation remains the most appropriate treatment option for selected patients, even though supportive therapies based on the severity of the disease and the clinical findings that have developed are at the forefront.

Introduction: P wave axis is one of the most practical clinical tool for evaluation of cardiovascular disease. The aim of our study was to evaluate the P wave axis in electrocardiogram (ECG), left atrial function and association between the disease activity score in patients with systemic lupus erythematosus (SLE). Methods: Standard 12-lead surface ECGs were recorded by at a paper speed of 25 m/s and an amplifier gain of 10 mm/mV. The heart rate (HR), the duration of PR, QRS, QTd (dispersion), the axis of P wave were measured by ECG machine automatically. Results: The P wave axis was significantly increased in patients with SLE (49 ± 20 vs. 40 ± 18, P=0.037) and the disease activity score was found positively correlated with P wave axis (r: 0.382, P=0.011). The LA volume and the peak systolic strain of the left atrium (LA) were statistically different between the groups (P=0.024 and P=0.000). The parameters of the diastolic function; E/A and E/e’ were better in the control group than the patients with SLE (1.1 ± 0.3 vs. 1.3 ± 0.3, P=0.041 and 6.6 ± 2.8 vs. 5.4 ± 1.4, P=0.036, respectively). Conclusion: P wave axis was found significantly increased in patients with SLE and positively correlated with SELENA-SLEDAI score. As the risk score increases in patients with SLE, P wave axis changes which may predict the risk of all-cause and cardiovascular mortality.

Abstract Background Cigarette smoking affects the pharmacodynamic and pharmacokinetic behavior of many drugs and causes deterioration of pulmonary mechanics. We have evaluated the effect of cigarette smoking on washout time after one minimum alveolar concentration-h (1 MAC-h) of sevoflurane anesthesia. Methods We investigated the washout time of sevoflurane in 30 non-smoking and 30 healthy cigarette smoking (≥20 cigarettes/day for>1 year) ASA I-II physical status patients, aged 18-63 years, who were candidates for otorhinolaryngologic elective surgery under 1MAC-h standardized sevoflurane anesthesia. At the end of the surgery, the sevoflurane vaporizer was turned off and the time taken for the sevoflurane concentration to decrease to MAC-awake (0.3) and 0.1 MAC levels were recorded. In addition, the ratio of the fractions of inspired concentration (Fi) and expired concentration of sevoflurane (Fexp) at 1 MAC and Fexp of sevoflurane at 0.1MAC were recorded. The patients were mechanically ventilated during the washout time. Results We found no difference between the 2 study groups with regard to washout time of sevoflurane. The times of 1MAC down to MAC-awake (106 ± 48 sec in non-smokers vs 97 ± 37 sec in smokers, p > 0.05) and down to 0.1MAC (491 ± 187 sec in non-smokers vs 409 ± 130 sec in smokers, p > 0.05) were similar. Similarly, there were no significant differences in the ratios of Fi/Fexp at 1MAC (1.18 in non-smokers vs. 1.19 in smokers, p > 0.05) and Fexp of sevoflurane at 0.1MAC (0.26 in non-smokers vs. 0.25 in smokers, p > 0.05). Conclusions Washout time of 1MAC-h sevoflurane anesthesia is not appear to be effected by cigarette smoking in patients without significant pulmonary disease.

The purpose of this study is to explore whether there is a statistically significant difference between the ideas of university administrators and faculty members regarding how strictly Educational Performance Indicators for Educators (EPIE) should be monitored in the educational process. The responses of university directors were compared with those of faculty members, and the responses of public universities were compared to those of private universities. Improving the quality of education depends on the performance of teachers. Determining the objective indicators that measure the performance levels of teachers is necessary for maintaining quality assurance. In order for a university to maintain high standards, administrators and faculty members must cooperate with each other. The twelve point EPIE Index used in this study contains three components and nine indicators. No statistically significant relationship was found between the average component scores of university administrators and faculty members, and no statistically significant relationship was found between the average component scores of public and private universities. However, a statistically significant relationship was found between two factors from EPIE's self-appraisal scores. The model and data do not match the conceptual structure of the three components in the EPIE. Thus, further studies and analyses should be conducted. It was found that most faculty members think like academicians from private universities, and most university directors think like academicians from public universities.

Objective: Our aim is to investigate the effect of vitamin D deficiency on treatment success of cervical interlaminar epidural steroid injection (ILESI) in patients with cervical disc herniation-related chronic radiculopathy. Patients and Methods: Fifty patients who had neck and unilateral extremity pain and received cervical ILESI were included. The patients were divided into two groups according to their serum 25 (OH) D levels as Group 1 (>20 ng/mL) and Group 2 (<20 ng/ mL). Clinical and demographic data, magnetic resonance imaging (MRI) scans, pre-procedural laboratory tests, and pain scores were recorded. The patients were assessed before procedure and at three and six months after procedure. Results: Mean serum 25(OH)D level was 29.49±10.9 in Group 1 and 12.06±3.49 in Group 2, indicating a statistically significant difference (p<0.001). A significant improvement in pain scores was observed in both groups at six months of follow-up (p<0.001). Treatment success rates were significantly lower in vitamin D-deficient group at three months (p=0.024), while there was no significant difference between the groups at six months. Conclusions: Vitamin D level is a factor affecting short-term treatment success in patients undergoing cervical ILESI. [ABSTRACT FROM AUTHOR]

This study was conducted to analyse reaction time, psychomotor speed and concentration parameters in individuals who had previously been infected with COVID-19 and to compare these parameters with those of the control group. The study recruited 56 individuals previously diagnosed with COVID-19 with PCR and 56 healthy individuals. COVID-19-related information and sociodemographic characteristics of the participants were recorded. Light Trainer Exercises System (Model LTV2, Türkiye, 2017) was used for the evaluation of reaction time, while the d2 attention test was used for the evaluation of concentration performance. Psychomotor speed percentage (p<0.05) and achievement score percentage (p<0.05) of individuals who had COVID-19 were found to be statistically significantly lower than those of the control group. In terms of reaction time performance, when compared with the control group, upper extremity reaction time (p<0.001) and lower extremity reaction time (p<0.001) values were found to be statistically significantly longer in the COVID-19 group. The results showed that when compared with the control group with the same age group, the participants between the ages of 18 and 26 who had previously been infected with COVID-19 were negatively affected in terms of reaction time and psychomotor speed parameters. [ABSTRACT FROM AUTHOR]