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Aim:Idiopathic peripheral facial paralysis [Bell’s palsy (BP)] is the most common cause of acute, one-sided facial paralysis, whose etiopathogenesis is currently unknown. However, inflammation is considered to play a role in etiopathogenesis. In this study, we examined the relationship between hematologic parameters and indices in children with BP.Methods:The study included 60 pediatric patients diagnosed with BP between December 2017 and May 2022 and 60 healthy controls of the same age and gender. The relationship between the patient and control cohorts and between the severity of the disease and inflammation markers was analyzed. Low-severe BP (House-Brackmann classification grade 2-3) and high-severe BP (House-Brackmann classification grade 4-5) were grouped. Complete blood count parameters and hematologic indices [neutrophil count/lymphocyte count (NLR), platelet count/lymphocyte count (PLR), monocyte count/lymphoid count (MLR), and platelet mass index] were recorded as inflammation markers.Results:55% of the patients had BP on the right side, 48.3% had grade 3, and 30.0% had grade 4 facial paralysis. Leukocyte, neutrophil, lymphocyte, monocyte, and platelet counts were significantly higher in the patient group than in the control group (p-values p

Objective: This study aimed to identify the most significant issues for the effective performance management of hospitals. Methods: Accordingly, seven indicators were selected based on the literature review results. An analysis was carried out using the Spherical fuzzy TOP-DEMATEL method to determine the most important ones among these criteria. Results: The main contribution of this study was that the prior indicators of effective performance management in the hospitals were identified. With the help of this issue, hospitals can take actions to improve performance without having too much costs. Moreover, the main methodological originality of this study is that a new decision-making model is proposed by the name of TOPDEMATEL. Conclusion: Effective supply chain is found as the best factor that affects the performance of the hospitals. Additionally, advanced technology also plays a key role in this framework. Nevertheless, qualified personnel criterion is on the last rank. Supply network refers to the process of providing medical supplies, medicines, equipment, and other resources for healthcare institutions. These resources are of great importance for the performance of hospitals as they are needed to deliver the service.

Malicious assaults and information leakage have grown in importance in practically every area of information and communication technology (ICT) in recent years. Enterprise ledger organization, preservation, security, and protection are all greatly aided by information security (IS). To maintain their positions in the market, industries must safeguard their data and other vital assets. The main goals of this paper’s systematic review, which covers the entire process of privacy protection and security, are to introduce cryptographic IS for Industry 5.0 (the Fifth Industrial Revolution) as a comprehensive solution that provides regulatory compliance and IS policies in addition to the industrial goals. The review covers the four main areas: 1) recognizing the need for frameworks to be developed for a secure Industry 5.0 lifecycle; 2) emphasizing security guidelines, procedures, and countermeasures for Industry 5.0; 3) applying control, access, and availability in real-time; and 4) proposing a futuristic architecture for industrial information security. Furthermore, the analysis of previously published state-of-the-art techniques is presented in this paper. These techniques survive with various limitations and challenges, including intercommunication exchange, fine-grained control access, and interconnectivity-related issues, which affect the adoption of an IS in industrial programs. At the end of this systematic review, we investigated a few open research problems and mentioned those that are involved in the design of cryptographic re-encryption enabled IS for future Industry 5.0 developments.

The objective of this study is to examine the relationship among different sources of renewable energy, role of technology, environment protection and economic growth. This study uses panel annual data set of selected BRICS countries from 1997 to 2019. This study uses the Augmented Mean Group (AMG) estimator, a second-generation estimator that takes slope homogeneity and cross-sectional dependence into consideration. For robustness, the Pooled Mean Group (PMG) estimator has also been utilized. The findings show that the use of renewable energy will rise as income inequality declines. The results of the analysis demonstrate a one-way causal association between income inequality and REC. This finding confirms that a reduction in income inequality will have a major impact on the adoption of renewable energy sources.

The purpose of this study is to identify priority criteria in green (net zero energy) building transformation. For this purpose, an analysis has been conducted for hospitals by considering new methodology. In this scope, firstly, 10 different indicators are selected with the help of literature examination. After that, by using this new methodology, the weights of these items are computed. The main contribution of this study is that a priority evaluation is conducted so that more critical indicators of green building transformations can be identified. Because of this issue, for financial sustainability, companies should firstly focus on more significant factors. Another important novelty of this study is that a new decision-making technique is generated. With the help of this issue, both problems in methodology can be solved and methodological originality can be achieved. The findings show that renewable energy usage is the most critical factor.

Abstract Background In childhood acute lymphocytic leukemia (ALL), relapse is most commonly seen in the bone marrow (10–20%), followed by the central nervous system (3–8%). Isolated skin relapse is very rare in ALL. We report an 8-year-old child presented with isolated skin relapse. Case presentation An eight-year-old female patient presented with swelling on the scalp 3 months after the completion of the ALLIC-BFM 2009 chemotherapy protocol administered due to the diagnosis of precursor B-cell (pre-B) ALL. Physical examination revealed a hard, painless, hyperemic, nodule-shaped lesion measuring 2 × 1 cm on the right parietal bone. Atypical hematopoietic cells with the prominent nucleolus, narrow cytoplasm, and immunohistochemically stained with CD 10, 19, 22, 79-a, and TdT were observed in the histopathological examination of the skin lesion. There was no blast in the bone marrow aspiration smear and cerebrospinal fluid. The patient was diagnosed with aleukemic leukemia cutis (LC) and pre-B ALL, presenting as an isolated relapse. Conclusion Aleukemic LC is a very rare finding after leukemia treatment. It may present with various cutaneous lesions, such as a papule, macule, plaque, nodule, palpable purpura, and ulcerative lesions. Leukemia cutis should be considered in the differential diagnosis of skin lesions developing during or after treatment in children with leukemia.

Background and objectives: The development of new therapeutic options to treat leukemia (therapies targeting chimeric antigen receptor [CAR] T cells) down-regulates markers expressed on the cell surface. Therefore, conventional immunophenotyping panels no longer make these antigens unreliable for identifying a B cell immunophenotype. In our study, we methodically compared multiparametric flow cytometry (FC) in bone marrow aspiration and immunohistochemical (IHC) analysis in bone marrow biopsy in childhood acute lymphoblastic leukemia (ALL). We sought to answer whether these two methods could be alternatives to each other in the diagnosis of leukemia. Material-Method: Twenty-eight patients diagnosed with ALL were included in the study. A Kappa test was performed between the expression rates of the antibodies studied in simultaneous FC and IHC studies in bone marrow aspiration and biopsy samples performed at the initial diagnosis. Results: Twenty-three of the patients were precursor B-ALL (BCP-ALL) and 5 were T-ALL. In the immunophenotyping of patients with BCP-ALL using FC and IHC, MPO, CD79A, CD14, CD3 expressions were the same, while CD19, CD7, CD117, CD33, CD 56, CD34 expressions were very good, good concordance for CD20 expressions and moderate for CD10 expressions. In immunophenotyping of patients diagnosed with T-ALL using FC and IHC, CD20, CD19, CD14, CD79a, MPO, CD22 expressions were the same and excellent agreement was found in terms of CD2, CD10, CD34 expressions. Conclusion: In cases where there are treatments that affect immunophenotyping, costly methods such as FC are not available, or bone marrow aspiration cannot be taken adequately, immunophenotyping with IHC can be safely performed in the diagnosis of pediatric ALL in bone marrow biopsy.

Presents corrections to the paper, (Corrections to “A New Trend in Cryptographic Information Security for Industry 5.0: A Systematic Review”).

The COVID-19 pandemic has been rapidly raging. Suspending the services related to infertility and assisted reproductive techniques are among the measures taken to prevent the spread of the epidemic. Various guides and recommendations have been published by many national and international associations for this purpose. Recommendations foresee the completion of cycles that have already been initiated and require no new reproductive therapies to be initiated except for patients with a low ovarian reserve and those with a background of oncological disorders. The majority of couples whose treatment is suspended/postponed throughout this process have experienced intense stress, sadness, and anxiety. In addition, some of the patients do not have adequate coping skills. This article is designated as a literature review in order to provide information about the current emotional states of infertile couples throughout the COVID-19 pandemic and to guide the studies planned for their needs. Due to the fact that the subject is related to the pandemic, the years covered by the literature review were limited to 2019 and later. As a result of the literature review; 2 studies conducted in Turkey and 5 studies conducted abroad, examining the effects of COVID-19 on infertile couples, were included. The majority of studies revealed that suspending fertility treatments caused high levels of anxiety and stress in infertile couples. Providing psychological counseling services to couples through online platforms by health professionals is thought to enable couples to cope better with the situation.

Abstract This study defines key issues for sustainable healthcare policy in COVID-19 period. For this purpose, 9 different criteria that affect vaccine hesitancy are selected with the help of a detailed literature evaluation. A novel hybrid fuzzy decision-making model is developed using DEMATEL and TOPSIS based on q-Rung orthopair fuzzy sets. A comparative evaluation has also been performed using IF DEMATEL and PF DEMATEL. The results of all different methods are almost the same that indicates the reliability and coherency of the proposed model. The findings demonstrate that religion is the most critical factor that causes vaccine hesitancy. It is also defined that active population in daily life is the most important alternative. Developing countries should mainly focus on the actions regarding the religious issues to have sustainable healthcare policies in COVID-19 period. In this context, religious leaders can be released to the media and give information that the vaccine is not against religious rules. This has a significant contribution to convince people who are against the vaccine. Furthermore, these countries should also give priorities to the active population in daily life. Because this group supports the workforce in the country very seriously, it can be possible to increase the workforce in the country by completing the vaccination of this group that helps to boost economic development.

Purpose – This study was conducted to analyze the correlation between gender perception and infertility distress of infertile women. Design/methodology/approach – This was a descriptive-analytical study conducted with 255 women receiving treatment in the in vitro fertilization unit of a medical faculty hospital in Turkey. Study data were collected using sociodemographic questions as well as the Perception of Gender Scale (PGS) and the Infertility Distress Scale (IDS). Findings – It was found that the PGS mean score was 69.65 and the IDS mean score was 53.1. It was determined that there was a negative, moderate and significant correlation between gender perception and infertility distress levels of women in the infertility treatment process (r = −0.263, p < 0.001). Originality/value – As a result of the study, a negative, moderate, significant correlation was detected between gender perception and infertility distress.

Intensive chemotherapy can cause long-lasting immunosuppression in children who survived cancer. The immunosuppression varies according to the type of cancer, intensity of chemotherapy and age of the patient. A sufficient immune reconstruction when has been completed in childhood cancer survivors, the re-vaccination program can achieve sufficient antibody levels for some of the life-threatening vaccine-preventable infectious diseases. This study evaluates the serological status of pediatric acute lymphoblastic leukemia (ALL) cases before and after the intensive chemotherapy treatment. Antibodies against measles, mumps, rubella, varicella, hepatitis A and B were tested with the enzyme-linked immunosorbent assay (ELISA) method. Antibody titers were measured firstly at the leukemia diagnosis time when the chemotherapy was not started. The second evaluation of antibody titers was studied at 6 months after the cessation of chemotherapy for all patients. Forty-six patients with the mean age of 6.1 ± 4.5 years were participated in this study. Changing to seronegative after treatment was significantly different in measles, rubella, hepatitis A and hepatitis B (p

Aim:Acute rheumatic fever (ARF) is the most common cause of acquired heart disease especially in developing countries. This study is intended to evaluate the relationship between severity of cardiac involvement and hematological parameters in children diagnosed with carditis at the first episode of ARF.Methods:In this study, 45 children with carditis at the first episode of ARF and 30 healthy children of the same age and gender, between September 2015 and February 2019, were retrospectively reviewed. The data of the patients were recorded from the hospital automation system. Patients with acute rheumatic carditis (ARC) were grouped into two as mild (n=30) and moderate-severe ARC (n=15). Hemoglobin, red blood cell distribution width (RDW), leukocyte, neutrophil, monocyte, lymphocyte, platelet counts, neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), monocyte-to-lymphocyte ratio (MLR) were compared between control and all carditis patients, mild and moderate-severe carditis.Results:In ARC patients, hemoglobin and RDW values were statistically significantly lower (p

Purpose – This study was conducted to investigate the Social Physique Anxiety (SPA) level in adolescent and young women with polycystic ovarian syndrome (PCOS). Design/methodology/approach – This is a descriptive study. It was conducted in Turkey. The study was conducted from January 1, 2017 to December 31, 2017. It was completed with a total of 150 young women – 75 of them had PCOS and 75 of them were healthy. Study data were collected using demographic information form and Social Physique Anxiety Scale (SPAS). Findings – The study was found that the adolescent and young women with PCOS had higher subscales and total scores for total SPAS at a statistically significant level than healthy adolescent and young women (p < 0.05). Practice implication – The findings of this study may be used for planning and implementing interventions in health-care practice such as screening and early treatment of SPA of women with PCOS. Originality/value – It was found that PCOS in adolescent and young women increased the SPA level. In line with these results, health professionals must be particularly aware of the potential psychosocial and health needs of adolescent and young women with PCOS.

Purpose – This study aimed to examine the effect of causes of infertility related to gender differences on the distress level of women who were treated for infertility. Design/methodology/approach – This is a cross-sectional, descriptive study. The sample consisted of 314 women who were treated for infertility between September 2016 and June 2017. Data were collected as “Sociodemographic Characteristics Form” and “Infertility Distress Scale.” Findings – A statistically significant difference was found between the mean distress scores of the women for whom the reason for infertility was related to a female factor, and of the women for whom this reason was related to a male factor. Research limitations/implications – The situation should be determined with quantitative studies, and the reason for the differences should be determined with qualitative studies. Practical implications – Infertility nurses should develop a care plan that ensures that couples understand their feelings, and which enhances their mutual respect and partnership. Social implications – The study highlights the importance of cultural awareness in the care of infertile couples. Originality/value – The authors highlight some important aspects about the gender difference on women's distress level.

Purpose – The impact of birth beliefs on pregnancy and delivery are universally recognized, but the factors that affect birth beliefs vary across regions depending on individual and cultural characteristics. This study aimed to determine women's birth beliefs and examine their associated factors. Design/methodology/approach – This cross-sectional study was conducted with 548 primiparas in the obstetrics clinic of a university hospital located in the Southeastern Anatolian Region of Turkey from February to June 2019. Descriptive characteristics, form and the Birth Beliefs Scale were used in data collection. To analyze the data, descriptive statistics, T-tests and ANOVA analyses were used. Findings – It was determined that factors such as age group, income level, any problems during pregnancy and preferred delivery mode statistically affected women's birth beliefs. Originality/value – Based on the findings from this study, healthcare personnel should provide training and consultation services to pregnant women starting from the prenatal period to help ensure a positive labor experience.

Introduction: Factor XIII deficiency is an extremely rare type among bleeding diathesis. In factor XIII deficiency, normal results of coagulation screening tests are expected. It usually does not cause spontaneous bleeding. Apart from bleeding diathesis, it may cause delayed wound healing and recurrent spontaneous abortions in women. Here, we present a 32-year-old case with severe congenital factor XIII deficiency who had an uncomplicated pregnancy and birth with regular replacement therapies. Case report: A 32-year-old patient with severe congenital factor XIII deficiency, who had a history of spontaneous abortion at the 11th week of her first pregnancy, applied to our center with a request for childbirth. It was learned that the factor XIII levels of the patient could not be measured, that she was using plasma-derived FXIII concentrate at a dose of 25 units/kg every time once a month, and in cases where this could not be obtained, 5 units/kg cryoprecipitate was given instead. After the completion of the pre-pregnancy assessments, starting 3 months before the planned pregnancy and continuing for the whole pregnancy and for 3 months after birth, 25 units/kg plasma-derived concentrate at a dose of 25 units/kg was applied each time and every two weeks, and in cases where this could not be provided, the follow-up was continued by applying cryoprecipitate at a dose of 5 units / kg instead. During this whole process, FXIII levels ranged between 70% and 100%. The patient, who developed an abortion risk due to decidual bleeding in the first trimester, was hospitalized and an additional 25 units / kg plasma-derived FXIII concentrate was administered and a parenteral dose of 30 mg / kg tranexamic acid was applied until the signs of decidual bleeding disappeared. An additional 50 units/kg dose of plasma-derived FXIII concentrate was administered to the patient 30 minutes before birth who had a planned delivery by cesarean section at 38 weeks of gestation, and 30 mg/kg parenteral tranexamic acid was administered for 7 days following the delivery. FXIII level was detected 50% in the child of a healthy, 3500-g born boy. The patient and her baby, who are in the first year after birth, are followed up without any complications, and prophylactic plasma-derived FXIII concentrate or cryoprecipitate is administered to the patient once a month. Discussion and Conclusion: Inherited bleeding diathesis lead to an increased risk of bleeding and abortion in obstetric patients. Factor XIII deficiency is an extremely rare type among them. FXIII has a role in angiogenesis as well as hemostasis. Therefore, wound healing and tissue repair are impaired in Factor XIII deficiency. The risk of premature separation of the placenta, miscarriage especially in the first trimester, and postpartum uterine bleeding are increased in FXIII deficiency. Tranexamic acid can be used safely in obstetric patients with bleeding diathesis. It may be possible to ensure that patients with factor XIII deficiency have an uncomplicated pregnancy and delivery with regular follow-ups, regular prophylactic factor preparations, plasma replacements if they are not found, and in cases of bleeding, with additional doses of factor preparations or plasma replacement applications with tranexamic acid.

Objectives: The aim of this study is to identify the epidemiological, clinical, and laboratory features of coronavirus disease 2019 (COVID-19) in children.Methods: A retrospective study was conducted by pediatric infectious disease specialists from 32 different hospitals from all over Turkey by case record forms. Pediatric cases who were diagnosed as COVID-19 between March 16, 2020, and June 15, 2020 were included. Case characteristics including age, sex, dates of disease onset and diagnosis, family, and contact information were recorded. Clinical data, including the duration and severity of symptoms, were also collected. Laboratory parameters like biochemical tests and complete blood count, chest X-ray, and chest computed tomography (CT) were determined.Results: There were 1,156 confirmed pediatric COVID-19 cases. In total, male cases constituted 50.3% (n = 582) and females constituted 49.7% (n = 574). The median age of the confirmed cases was 10.75 years (4.5–14.6). Of the total cases, 90 were younger than 1 year of age (7.8%), 108 were 1–3 years of age (9.3%), 148 were 3–6 years of age (12.8%), 298 were 6–12 years of age (25.8%), 233 were 12–15 years of age (20.2%), and 268 cases were older than 15 years of age (23.2%). The most common symptom of the patients at the first visit was fever (50.4%) (n = 583) for a median of 2 days (IQR: 1–3 days). Fever was median at 38.4°C (38.0–38.7°C). The second most common symptom was cough (n = 543, 46.9%). The other common symptoms were sore throat (n = 143, 12.4%), myalgia (n = 141, 12.2%), dyspnea (n = 118, 10.2%), diarrhea (n = 112, 9.7%), stomachache (n = 71, 6.1%), and nasal discharge (n = 63, 5.4%). When patients were classified according to disease severity, 263 (22.7%) patients were asymptomatic, 668 (57.7%) patients had mild disease, 209 (18.1%) had moderate disease, and 16 (1.5%) cases had severe disease. One hundred and forty-nine (12.9%) cases had underlying diseases among the total cases; 56% of the patients who had severe disease had an underlying condition (p < 0.01). The need for hospitalization did not differ between patients who had an underlying condition and those who do not have (p = 0.38), but the need for intensive care was higher in patients who had an underlying condition (p < 0.01). Forty-seven (31.5%) of the cases having underlying conditions had asthma or lung disease (38 of them had asthma).Conclusions: To the best of our knowledge, this is one of the largest pediatric data about confirmed COVID-19 cases. Children from all ages appear to be susceptible to COVID-19, and there is a significant difference in symptomatology and laboratory findings by means of age distribution.

BACKGROUND/AIM: The COVID-19 pandemic has created a long period of stress for people worldwide and has significantly affected sleep duration. The pandemic revealed new stress factors that are likely to affect sleep. Uncertainty is a factor that leads to anxiety and depression, which affects sleep. It should also be noted that reductions in sleep quality rather than sleep duration are associated with negative consequences on mental health. This study aims to investigate online that how this situation affected university students. MATERIALS AND METHODS: This research, with a descriptive study design, was conducted in Turkey between June 01, 2021 and July 30, 2021. The sample included 604 people who accepted voluntary participation, chosen by the random selection method. In the study, sociodemographic information form, Pittsburgh sleep quality index (PSQI), morningness–eveningness questionnaire scale (MEQ Scale), Beck depression inventory (BDI), and Beck anxiety inventory (BAI) were used as data collection tools. Pearson correlation analysis was utilized to examine the relationship between the scales. Multiple regression analysis was performed to investigate the role of morningness–eveningness, anxiety, depression, and insomnia severity on sleep quality. RESULTS: Sleep quality was negatively correlated with morningness–eveningness scores (r = –0.32, P < 0.01), and positively and significantly related with anxiety (r = 0.43, P < 0.01), depression (r = 0.40, P < 0.01) and insomnia severity (r = 0.55, P < 0.01). According to regression coefficients, while anxiety (β = 0.041, P < 0.001) and insomnia severity scores (β = 0.226, P < 0.001) positively predicted sleep quality, depression did not predict it significantly (β = 0.009, P > 0.05). A significant difference was found in sleep quality according to morning, evening, and intermediate types (F = 27.401, P < 0.001). CONCLUSION: Events related to the COVID-19 pandemic are associated with reduced sleep quality in connection with increasing negative moods. Considering the importance of sleep for a healthy life, efforts should be made to raise awareness about this issue and to provide psychological help to affected individuals.

Introduction: Platelet indices such as the mean platelet volume (MPV) and platelet distribution width (PDW) have been reported to have a diagnostic value in some cancer types and inflammatory diseases. In this study, the platelet indices and serum lactate dehydrogenase (LDH) levels were investigated in children with reactive lymph node hyperplasia and lymphoma.Methods: In total, 102 children were enrolled in this study. Overall, 30 healthy children and 72 children, who had undergone excisional lymph node biopsy between October 2011 and 2016, were enrolled this study. File records were retrospectively reviewed.Results: Histopathologically, 50 (69.4%) of the 72 patients were diagnosed with reactive lymph node hyperplasia, and 22 (30.5%) were diagnosed with lymphoma. Of the cases diagnosed with lymphoma, 15 (68%) were those of Hodgkin’s lymphoma and 7 (32%) were those of non-Hodgkin’s lymphoma. There was no difference between the patients diagnosed with reactive lymph node hyperplasia and those with lymphoma in terms of leukocyte counts, MPV and PDW values, and serum LDH levels (p>0.05, for all). The serum LDH levels of both groups were statistically significantly higher than those of the control group (p

Clear cell sarcoma of the kidney (CCSK) is an uncommon renal neoplasm of childhood. It represents between 2% and 9% of all pediatric renal tumors, and generally arises before the age of 5 years. It often mimics other pediatric renal tumors. Presently described is the case of a 7-year-old girl who presented with complaints of vomiting and abdominal pain. Abdominal ultrasonography revealed a right renal mass, and the patient developed a renal hematoma a few hours after admission. The patient underwent a nephroureterectomy with a provisional diagnosis of Wilms tumor; however, histopathological examination of a specimen revealed CCSK. CCSK is similar to Wilms tumor in terms of the typical age of appearance and clinical and histopathological features, but the treatment method and prognosis are different. Therefore, the differential diagnosis is very important. This case was presented to draw attention to a rare presentation of clear cell sarcoma. CCSK should be kept in mind in the differential diagnosis of a renal mass.

Introduction: The failure of infertility treatment leads to individual, familial, and social problems. The objective of this study was to evaluate the effectiveness of the nursing care program based on Watson’s "Theory of Human Caring" on anxiety and distress caused by coping when the treatment fails. Methods: This study randomized controlled trial study was conducted from April to November 2012, with 86 Turkish women with infertility (intervention group: 45, control group: 41). Follow-up of 32 infertile women, who failed infertility treatment from intervention group, and 35 infertile women, who failed infertility treatment from control group, continued for another four weeks. Data were collected through Spiel Berger’s State/Trait Anxiety Inventory, Distress Scale, and Ways of Coping Questionnaire. The analyses of data were conducted using SPSS ver 13. Results: The intervention and control groups significantly differed in terms of anxiety, distress, and coping levels. The intervention group’s mean anxiety score decreased by thirteen points and distress by fourteen points (in a positive direction). The intervention group’s mean positive coping style score increased. Whereas a negative increase was observed in the control group’s values depending on the failure of the treatment. Conclusion: Watson’s theory of human caring is recommended as a guide to nursing patients with infertility treatment to decrease levels of anxiety and distress, and to increase the positive coping style among infertile women.

Globalleşen dünyada işletme sahipleri ve örgütler yöneticiden çok lidere ihtiyaç duymaktadırlar. Yapılan araştırmalar, işletmeyi geleceğe taşıyan kişilerin liderler olacağını göstermektedir. Liderler bireylerin içindeki güçleri farklı yöntemlerle harekete geçirebilirler. Liderler öncelikle örgütün vizyonunu çalışanların değerleriyle uyumlu bir biçimde, onların değerleriyle çelişmeyen bir biçimde ifade etmekte ve vizyonun nasıl hayata geçirileceğine dair kararları çalışanlarla paylaşmaya özen göstermektedirler. Günümüz örgütleri özellikle de iş çevresi sürekli ve radikal değişimlerle kendini göstermektedir. Böyle değişken bir ortamda örgütler, yöneticileri olduğu kadar, tüm üyelerinin öğrenme potansiyellerini artırmak, günün gereklerine uygun bilgi ve beceriyle donatmak zorunda hissetmektedirler. Bu aşamada liderlik devreye girmekte ve çalışanları denetim mekanizmalarıyla bir yöne doğru itmek yerine, temel ihtiyaçlarını belirlemelerine, bu ihtiyaçları karşılamak için gereken enerjiyi kendilerinde hissetmelerine yardımcı olmaktadır. Bu çalışmada genel olarak liderliğin tanımı, sorumlulukları, misyon ve vizyon ile liderlik arasındaki ilişki, liderlik davranış tipleri (tarzları) üzerine odaklanmıştır. Ayrıca bir liderin ne gibi özelliklere sahip olması gerektiği anlatılarak, yaratıcı liderliğin günümüz örgütleri için önemi vurgulanmıştır. Bu amaçla, araştırma kısmında lider görünümlü bir kişiyle yapılan görüşme, sonuçları itibariyle değerlendirilip yorumlanarak, liderlik tarzlarının sadece teorik temelde kalmaması vurgulanmaya çalışılmıştır. Görüşme yapılan kişinin katkıları ile örnekler verilerek liderlik tarzları somut biçimde ele alınmaya çalışılmış, yaratıcı liderlik ile de ilişki kurulmuştur.

In this study, 15 Hamdani sheep and 4 rams belong to Research Center o( University of Yüzüncü Yıl were used as research material. Using spectrophoiometric tecnique the whole blood sample and plasma were analysed for the determination of the levels of glutathione, ceruloplasmin, Cu, Ca and P. In addition, haematocrit was determinated by using microhaematocrit technique. Animals having over 25 mg/dl glutathione were designated as high glutathione type (GSHH). Values of GSHH. GSHh, ceruloplasmin, Cu, Ca, P and haematocrit in Hamdani sheep were 30.8 ± 1.7 mg/dl, 11.88 ± 2.2 mg/dl, 12.68 ± 0.87 mg/dl, 75 ±23 (g/dl. 6.71 ± 0.4 mg/dl, 14.74 ± 0.63 mg/dl, % 33 ±0.37, respectively. These values in Hamdani rams also were 32.8 mg/dl, 22 ± 0.25 mg/dl, 12 ± 2.9 mg/dl, 91±40 (g/µdl, 9,45 ± 2.1 mg/dl, 5.69 ± 1.7 mg/dl and % 36.7 ± 1.3, respectively. Statisticaly positive correlation was found between Cu and ceruloplasmin concentration of plasma (p

The aim o! this study ts to determine o! the effect of supplemental zinc on the concentration of the oxidation products of nilnc oxide and antioxidant vitamins in chicken serum. Chicken were divided into three experimental groups and one control group, each group containing seven chicken. The experimental groups were treated supplement zinc (125, 500, 1000 ppm). The concentration of nitric oxide oxidation products and antioxidant vitamins in the serum of zinc treated chicken were analysed with spectrophotometry ally. Nitrate (ppm), nitrite (ppm), vitamin E (mg/dl), vitamin C (mg/dl) concentrations ol experimental groups 1.. 2., 3. and control group were found : 6.16, 6.41, 13.16, 7.38, 1.09, 1.20, 1,30, 1.78; 0.121, 0,326, 0.247. 0,313: 0.927, 1.682. 1.204, 1.323 respectively. Nitrite levels of control groups was found higher than experimental groups l.and 2 (p

Introduction and Objectives: Vascular endothelial growth factor (VEGF) inhibitors are widely used in oncology and ophthalmology. Although these agents have been shown to increase the risk of cardiovascular events in systemic use, the effect of local applications is unclear. In our study, we aimed to investigate the effects of anti-VEGF agents on left heart functions after intravitreal injection using speckle tracking echocardiography., Methods: In this prospectively designed study, 44 patients who were going to start intravitreal anti-VEGF treatment were included in the study. Patients were evaluated with speckle tracking echocardiography before the first anti-VEGF administration and at three months of anti-VEGF treatment., Results: Global longitudinal strain (GLS) values at three months were lower in the patients who participated in the study and this was statistically significant (-18.77±2.17, -18.60±2.01, p=0.001). Also, there was a statistically significant decrease in the mean values of GLS (GLS4CH) obtained from apical four space image, GLS (GLSAPLAX) obtained from apical long axis image and GLS (GLS2CH) obtained from apical 2 space image at month 0 and month 3 (-19.08±2.39, -18.93±2.26, p=0.004; -18.81±2.29, -18.60±2.12, p=0.001; -18.44±2.31, -18.27±2.12, p=0.013, respectively)., Conclusion: The slight decrease in GLS in our study suggests that the use of intravitreal anti-VEGF agents may have cardiac effects., (Copyright © 2024 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Purpose: To evaluate dry eye parameters, corneal topographic features, corneal densitometric changes, and anterior segment parameters in patients receiving systemic isotretinoin treatment., Methods: This prospective cross-sectional study included 66 eyes of 33 patients who were started on oral isotretinoin therapy for severe acne vulgaris. All patients were evaluated in terms of ocular surface tests such as tear break-up time (TBUT) and Schirmer-1 and were asked to fill in the ocular surface disease index (OSDI) questionnaire. Corneal densitometric and topographic measurements were obtained using the Scheimpflug imaging system., Results: The mean age of the patients was 19.9 ± 1.6 years, and 21 (63.6%) of the participants were female. The mean OSDI score was significantly higher in the third month than before treatment (20.05 ± 19.38, vs. 26.96 ± 22.94, p = 0.00, respectively). The mean values of the TBUT test were significantly lower in the third month than before treatment (9.06 ± 4.40 sec, vs. 10.71 ± 4.61 sec, p = 0.02, respectively). Mean scores of the Schirmer 1 test showed no statistically significant difference between before treatment and the third month (16.08 ± 8.40 mm, vs. 16.08 ± 8.50 mm, p = 1, respectively). There was no statistically significant difference between before treatment and the third month in the majority of the densitometry measurements in concentric zones. However, the difference tended to be significant between the groups concerning posterior zone 0-2 mm (11.01 ± 0.85 GSU vs. 10.62 ± 0.89 GSU, p = 0.006 ). The RMS LOAs (front), RMS Total (Total), RMS LOAs Total (Total), RMS HOAs Total (Total), K max , CCT, and CoV values were significantly higher in the third month than before treatment ( p  < 0.05 for all)., Conclusions: The dermatology specialists should be aware of the ocular complications of systemic isotretinoin therapy. Therefore, a complete ophthalmologic examination for the prompt apprehension and management of ocular involvement is essential in patients under isotretinoin therapy to increase ocular comfort and adherence to the therapy.

Introduction: No safe detectable level of lead (Pb) exists in the blood of children. Until recently, U.S. Centers for Disease Control and Prevention (CDC) guidelines designated a blood lead level (BLL) ≥ 5 μg/dL as an elevated BLL (EBLL). For the State of Kansas, early childhood blood lead burdens lack reporting in the literature., Methods: Secondary analysis was conducted of passively reported EBLL rates ≥ 5 μg/dL among children ages 0 - 5 years at the zip code-level in Kansas during 2005 to 2012. Data weights using corresponding population estimates were applied to produce statewide outcomes., Results: Statewide estimates of annual testing coverage in Kansas among children ages 0 - 5 years were low (9.7%). Approximately 17,000 children ages 0 - 5 years developed an EBLL ≥ 5 μg/dL each year in Kansas with a 6.9% statewide EBLL rate compared to the national rate of 3.2% for the corresponding years. Significant variations in EBLL rates were found between suburban zip codes compared to urban, urban cluster, or rural at 3.1%, 7.2%, 8.8%, and 10.0%, respectively. Among the worst outcomes in EBLL rates was observed for zip codes in southeast Kansas (13.5%) and rural areas with < 500 persons (15.1%)., Conclusions: Young children in Kansas had twice the risk of developing an EBLL ≥ 5 μg/dL compared to the national rate, while higher rates consistently were seen outside of the suburbs and particularly in more rural and less populated areas. At-risk children and troubled areas of toxic lead exposure in the State of Kansas require increased recognition with improved targeting and interventions., (© 2022 The University of Kansas Medical Center.)

Purpose: To determine the association of monocyte-to-high-density lipoprotein ratio (MHR) and neutrophil-to-lymphocyte ratio (NLR) with diabetic macular edema (DME) and early anti-VEGF treatment response., Material Methods: This was a retrospective and cross-sectional study conducted with 143 patients with diabetes mellitus (53 diabetic retinopathy with DME, 38 diabetic retinopathy without DME, and 52 without diabetic retinopathy)., Results: 13.9 was the best cutoff value to predict DME for MHR, and 2 was for NLR (59% and 75% sensitivity and 81% and 59% specificity, respectively). Logistic regression analysis showed that NLR≥2 and MHR≥13.9 were significantly associated with DME prediction. However, neither NLR≥2 nor MHR≥13.9 was associated with central retinal thickness(CRT) or best corrected visual acuity(BCVA) outcomes after anti-VEGF treatment. On the other hand, increased NLR was associated with inferior CRT outcomes., Conclusion: MHR and NLR were simple and cost-effective biomarkers to predict DME. Moreover, higher NLR may contribute to poor CRT outcomes.

Objectives: To report visual and anatomical outcomes following two- or four-quadrant partial-thickness sclerectomy and sclerotomy surgery to treat nanophthalmos (NO)-related uveal effusion (UE)., Materials and Methods: Consecutive patients with NO-related UE were treated with four-quadrant or two-quadrant (for those with associated glaucoma) partial-thickness sclerectomy and sclerotomy surgery. Axial length, extent of UE, preoperative, postoperative, and final best corrected visual acuity (BCVA), time to retinal reattachment, and rates of retinal reattachment and recurrence were noted., Results: Fourteen eyes of 10 patients with NO-related UE were operated. Retinal detachment (RD) involved mainly the peripheral retina in 7 (50%) eyes, macula in 2 eyes (14.2%), both macula and peripheral retina in 4 eyes (28.6%), and the whole retina in 1 eye. Eleven eyes had four-quadrant surgery, and 3 eyes with associated glaucoma had two-quadrant surgery. External subretinal drainage was performed in one patient who had total RD. The mean preoperative logMAR BCVA of 1.50±0.53 increased significantly to 0.92±0.49 after surgery (p=0.002). Resolution of RD could be achieved with two-quadrant surgery in only 1 of 3 eyes. In the other 2 eyes, retinal reattachment was achieved after a secondary surgery for the remaining two quadrants to complete four-quadrant sclerectomy. Final outcome was total reattachment of the retina in 11 eyes (78.6%), partial reattachment in 1 eye (7.1%), and recurrence of macular detachment in 2 (14.3%) eyes., Conclusion: Quadrantic partial-thickness sclerectomy and sclerotomy surgery seems effective for treating UE in eyes with NO. Twoquadrant surgery may be tried for mild UE associated with glaucoma to preserve the superior quadrants for future possible glaucoma surgeries, but secondary surgery for the superior quadrants may be needed. External drainage of subretinal fluid may be an option in severe cases to achieve quicker resolution.

There is no safe detectable level of lead (Pb) in the blood of children. Blood lead levels (BLLs) at ages 6-24 months ≥2 μg/dL result in lost grade school intelligence quotient (IQ) points at ages 5-10 years. Black children continue to have the highest BLLs in the United States. Therefore, we examined currently undetermined racial/ethnic disparities in anticipated IQ points and associated lifetime earnings lost to early childhood blood lead. We conducted secondary analysis of infants with blood lead (in μg/dL) measured at ages 12-24 months by the cross-sectional National Health and Nutrition Examination Survey (NHANES) during 1999 to 2010. Nationally-representative estimates were produced using weighted simulation model. A total of 1241 infants were included from the NHANES sample (52% male; mean [SD] age, 18.5 [3.5] months; 25% Black [non-Hispanic], 42% Hispanic [any race], 5% Other/Multiracial, and 29% White [non-Hispanic]) after excluding 811 without BLL determinations. For national outcomes, Black infants experienced approximately 46-55% greater average estimated loss of grade school IQ points from blood lead than Hispanic or White infants (-1.78 IQ points vs. -1.15 and -1.21 respectively) with similar disparities in costs to expected lifetime earnings (-$47,116 USD vs. -$30,393 and -$32,356 respectively). Our estimated nationwide costs of IQ points lost to BLLs during this 12-year period totaled $554 billion ($46.2 billion/year), in which blood lead <5 μg/dL accounted for 74% of this total burden. We report two aspects of the substantial national costs attributable to lead exposure in just the second year of life alone, which disproportionately impact predominately African-American Black infants from continuing legacies of environmental racism in lead exposure. Our findings underscore the remarkably high costs from recognized hazards of blood lead even at the lowest levels and the importance of primary prevention regarding childhood lead exposure., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Introduction: Pseudoexfoliation syndrome (PEX) is a disease characterized by the accumulation of fibrillary material in the extracellular matrix in the eye and many tissues. Myocardial involvement occurs as in other storage diseases. Speckle tracking echocardiography is a quantitative echocardiography modality that enables the detection of subclinical changes that cannot be detected by standard echocardiographic evaluation. In this study, we aimed to evaluate potential subclinical myocardial dysfunction in PEX patients by speckle tracking echocardiography., Methods and Results: The study group consisting of 29 cardiac asymptomatic pseudoexfoliation syndromes and 30 healthy volunteers were included in this case-control cross-sectional study. Detailed echocardiographic evaluations and strain analyses of all participants were performed. Concerning standard echocardiographic parameters, there was only a marginally significant difference between the two groups in the e' mean wave, and it was lower in the PEX group than the control group (0.07 ± 0.03, 0.10 ± 0.08, respectively, P = .06). However, in strain echocardiography, the global longitudinal strain (GLS) value was observed to be significantly lower in the PEX group than the control group (-17.02 ± 2.02, -19.29 ± 2.26, respectively P < .001). GLS was observed to be an independent predictor in the multivariable logistic regression model made to determine independent predictors of PEX syndrome (OR = 0.59, CI = 0.418-0.832, P = .003)., Conclusion: Subclinical myocardial involvement in PEX syndrome, in which standard echocardiographic techniques are blinded, can be detected by the strain echocardiography. PEX causes deterioration in the deformation parameters of the left ventricle. Systemic involvement should not be forgotten in patients with PEX and cardiac functions should be monitored., (© 2021 Wiley Periodicals LLC.)

Objectives: To investigate the effects of the COVID-19 pandemic on the treatment course of neovascular age-related macular degeneration (nAMD) patients who received anti-VEGF injection therapy with real-life data., Methods: This retrospective study consisted of 116 eyes of 106 patients. Ophthalmic examination, assessment of best-corrected visual acuity (BCVA), optical coherence tomography (OCT) findings and data of last two visits before restrictions (V-2 and V-1) and the first visit (V0) after the release of national lockdown and subsequent visits (V1 and Vlast) were recorded. The lockdown period was determined by the time interval between March 11 and June 1, 2020., Main Results: The injection interval before V-1 was significantly longer than the interval after V0 (2.56±0.9 vs. 2.14±0.8 months, P=0.02). While the median central macular thickness (CMT) was significantly increased at V0 compared to V-1 [274(132-711) vs. 238(136-628), P<0.001], the median CMT was significantly lower at V1 compared to V0 [256 (136-591) vs. 274(132-711), P=0.003]. The median BCVA was 0.67(0.1-1.1) logMAR at V-1 and significantly worsened to 0.78 (0.1-1.2) logMAR at V0 (P=0.003). Although the median BCVA improved to 0.69 logMAR (0.1-1.2) at Vlast, the difference did not reach statistical significance compared to V0 (P=0.08)., Conclusion: Treatment delay due to the COVID-19 pandemic cause progression of nAMD and visual impairment. To plan more frequent anti-VEGF treatments and visits may be an appropriate approach until the disease stabilizes. However, it should be kept in mind that despite the improvement in OCT findings, the desired success in VA could not be achieved in the short term., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Background: To evaluate the retinal vascular changes and foveal avascular zone area in patients with unilateral blunt ocular trauma using optical coherence tomography angiography., Methods: This retrospective study consisted of 50 traumatized and 50 contralateral sound eyes of the patients with blunt ocular trauma. The foveal avascular zone area, choriocapillaris flow area, foveal, parafoveal, and perifoveal vessel densities in both superficial capillary plexus and deep capillary plexus and central macular thickness were evaluated., Results: There were no significant differences between traumatized and sound eyes in the foveal avascular zone area (p:0.36), choriocapillaris flow area (p:0.43), central macular thickness (p:0.67), and in vessel densities of superficial capillary plexus over all regions (p > 0.05 for all). However, the vessel densities of deep capillary plexus were significantly lower in traumatized eyes (p < 0.05 for all)., Conclusion: Optical coherence tomography angiography demonstrated a significant decrease in retinal deep capillary plexus vessel density of the eyes effected by blunt ocular trauma, even with no evident findings on fundus examination or structural spectral domain-optical coherence tomography changes., (Copyright © 2020 Elsevier B.V. All rights reserved.)

There is no safe detectable level of lead (Pb) in the blood of young children. In the United States, predominantly African-American Black children are exposed to more Pb and present with the highest mean blood lead levels (BLLs). However, racial disparity has not been fully examined within risk factors for early childhood Pb exposure. Therefore, we conducted secondary analysis of blood Pb determinations for 2841 US children at ages 1-5 years with citizenship examined by the cross-sectional 1999 to 2010 National Health and Nutrition Examination Survey (NHANES). The primary measures were racial disparities for continuous BLLs or an elevated BLL (EBLL) ≥5 µg/dL in selected risk factors between non-Hispanic Black children ( n = 608) and both non-Hispanic White ( n = 1208) or Hispanic ( n = 1025) children. Selected risk factors included indoor household smoking, low income or poverty, older housing built before 1978 or 1950, low primary guardian education <12th grade/general education diploma (GED), or younger age between 1 and 3 years. Data were analyzed using a regression model corrected for risk factors and other confounding variables. Overall, Black children had an adjusted +0.83 µg/dL blood Pb (95% CI 0.65 to 1.00, p < 0.001) and a 2.8 times higher odds of having an EBLL ≥5 µg/dL (95% CI 1.9 to 3.9, p < 0.001). When stratified by risk factor group, Black children had an adjusted 0.73 to 1.41 µg/dL more blood Pb ( p < 0.001 respectively) and a 1.8 to 5.6 times higher odds of having an EBLL ≥5 µg/dL ( p ≤ 0.05 respectively) for every selected risk factor that was tested. For Black children nationwide, one in four residing in pre-1950 housing and one in six living in poverty presented with an EBLL ≥5 µg/dL. In conclusion, significant nationwide racial disparity in blood Pb outcomes persist for predominantly African-American Black children even after correcting for risk factors and other variables. This racial disparity further persists within housing, socio-economic, and age-related risk factors of blood Pb outcomes that are much more severe for Black children., Competing Interests: The authors declare that they have no competing interests.

Purpose: To describe the long-term anatomical and functional results of surgery for retinal detachment (RD) associated with stage 4 retinopathy of prematurity (ROP) and patient and surgery-related factors affecting postoperative success., Design: Retrospective case series at a single tertiary referral paediatric vitreoretinal practice., Methods: One hundred and twenty-one eyes of 82 infants (40 female/42 male) who underwent lens-sparing vitrectomy (LSV) or lensectomy with vitrectomy surgery for stage 4A and 4B ROP at Gazi University Department of Ophthalmology between 2011 and 2016 were enrolled in this study. Patient characteristics including gestational age, birth weight, gender, stage of ROP at presentation, preoperative treatment (laser, anti-vascular endothelial growth factor (VEGF) or combined), anatomical and functional outcome and complications were recorded. The effect of birth weight, gestational age, presence of plus disease, preoperative treatment status, surgically induced posterior hyaloid detachment, postoperative vitreous haemorrhage and iatrogenic retinal tear formation on anatomical and functional results was evaluated., Results: 61.2% of the eyes were stage 4A and 38.8% were stage 4B ROP. The mean follow-up was 24.5 months. 18.2% of the eyes had no preoperative treatment. Anatomical success was 86.5% for stage 4A and 68.1% for stage 4B at the first year, 91.7% for stage 4A and 69.4% for stage 4B at the second year, and 95.8% for stage 4A and 57.9% for stage 4B at the third year. Functional success was 85.1% for stage 4A and 65.9% for stage 4B at the first year, 89.6% for stage 4A and 61.1% for stage 4B at the second year, and 87.5% for stage 4A and 57.8% for stage 4B at the third year. The mean visual acuity was 1.12±0.34 logarithm of the minimum angle of resolution (logMAR) for stage 4A and 1.34±0.32 logMAR at the 3-year follow-up duration (p>0.05). There was preoperative plus disease in 59.5% of the eyes. Subsequent retinal surgeries were required in 17.4% of the eyes. Presence of plus disease and absence of preoperative treatment, iatrogenic retinal tear formation and postoperative vitreous haemorrhage were found to have significant negative effects, while surgical induction of posterior hyaloid detachment and sparing the lens intraoperatively affected the anatomical and functional results positively., Conclusions: Surgery for stage 4 ROP-associated RD resulted in encouraging anatomical and functional outcomes and the results are even better in eyes with preoperative (laser/anti-VEGF) treatment, LSV and surgically induced posterior hyaloid detachment., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Kawasaki disease (KD) primarily affects children <5 years of age (75%-80%) and is currently the leading cause of acquired heart disease in developed nations. Even when residing in the West, East Asian children are 10 to 20 times more likely to develop KD. We hypothesized cultural variations influencing pediatric mercury (Hg) exposure from seafood consumption may mediate ethnic KD risk among children in the United States. Hospitalization rates of KD in US children aged 0-4 years (n = 10,880) and blood Hg levels in US children aged 1-5 years (n = 713) were determined using separate US federal datasets. Our cohort primarily presented with blood Hg levels <0.1 micrograms (µg) per kg bodyweight (96.5%) that are considered normal and subtoxic. Increased ethnic KD risk was significantly associated with both increasing levels and detection rates of blood Hg or cadmium (Cd) in a linear dose-responsive manner between ethnic African, Asian, Caucasian, and Hispanic children in the US (p ≤ 0.05). Increasing low-dose exposure to Hg or Cd may induce KD or contribute to its later development in susceptible children. However, our preliminary results require further replication in other ethnic populations, in addition to more in-depth examination of metal exposure and toxicokinetics.

Kawasaki disease (KD) is a systemic vasculitis primarily affecting children < 5 years old. Genes significantly associated with KD mostly involve cardiovascular, immune, and inflammatory responses. Recent studies have observed stronger associations for KD risk with multiple genes compared to individual genes. Therefore, we investigated whether gene combinations influenced KD susceptibility or coronary artery lesion (CAL) formation. We examined 384 single-nucleotide polymorphisms (SNPs) for 159 immune-related candidate genes in DNA samples from KD patients with CAL (n = 73), KD patients without CAL (n = 153), and cohort controls (n = 575). Individual SNPs were first assessed by univariate analysis (UVA) and multivariate analysis (MVA). We used multifactor dimensionality reduction (MDR) to examine individual SNPs in one-, two-, and three-locus best fit models. UVA identified 53 individual SNPs that were significantly associated with KD risk or CAL formation (p < 0.10), while 35 individual SNPs were significantly associated using MVA (p ≤ 0.05). Significant associations in MDR analysis were only observed for the two-locus models after permutation testing (p ≤ 0.05). In logistic regression, combined possession of PDE2A (rs341058) and CYFIP2 (rs767007) significantly increased KD susceptibility (OR = 3.54; p = 4.14 x 10(-7)), while combinations of LOC100133214 (rs2517892) and IL2RA (rs3118470) significantly increased the risk of CAL in KD patients (OR = 5.35; p = 7.46 x 10(-5)). Our results suggest varying gene-gene associations respectively predispose individuals to KD risk or its complications of CAL.

Objective: The association between Kawasaki disease and autism has rarely been studied in Asian populations. By using a nationwide Taiwanese population-based claims database, we tested the hypothesis that Kawasaki disease may increase the risk of autism in Taiwan., Materials and Methods: Our study cohort consisted of patients who had received the diagnosis of Kawasaki disease (ICD-9-CM: 446.1) between 1997 and 2005 (N = 563). For a comparison cohort, five age- and gender-matched control patients for every patient in the study cohort were selected using random sampling (N = 2,815). All subjects were tracked for 5 years from the date of cohort entry to identify whether they had developed autism (ICD-9-CM code 299.0) or not. Cox proportional hazard regressions were then performed to evaluate 5-year autism-free survival rates., Results: The main finding of this study was that patients with Kawasaki disease seem to not be at increased risk of developing autism. Of the total patients, four patients developed autism during the 5-year follow-up period, among whom two were Kawasaki disease patients and two were in the comparison cohort. Further, the adjusted hazard ratios (AHR) (AHR: 4.81; 95% confidence interval: 0.68-34.35; P = 0.117) did not show any statistical significance between the Kawasaki disease group and the control group during the 5-year follow-up., Conclusion: Our study indicated that patients with Kawasaki disease are not at increased risk of autism.

Previously, we reviewed biological evidence that mercury could induce autoimmunity and coronary arterial wall relaxation as observed in Kawasaki syndrome (KS) through its effects on calcium signaling, and that inositol 1,4,5-triphosphate 3-kinase C (ITPKC) susceptibility in KS would predispose patients to mercury by increasing Ca(2+) release. Hg(2+) sensitizes inositol 1,4,5-triphosphate (IP3) receptors at low doses, which release Ca(2+) from intracellular stores in the sarcoplasmic reticulum, resulting in delayed, repetitive calcium influx. ITPKC prevents IP3 from triggering IP3 receptors to release calcium by converting IP3 to inositol 1,3,4,5-tetrakisphosphate. Defective IP3 phosphorylation resulting from reduced genetic expressions of ITPKC in KS would promote IP3, which increases Ca(2+) release. Hg(2+) increases catecholamine levels through the inhibition of S-adenosylmethionine and subsequently catechol-O-methyltransferase (COMT), while a single nucleotide polymorphism of the COMT gene (rs769224) was recently found to be significantly associated with the development of coronary artery lesions in KS. Accumulation of norepinephrine or epinephrine would potentiate Hg(2+)-induced calcium influx by increasing IP3 production and increasing the permeability of cardiac sarcolemma to Ca(2+). Norepinephrine and epinephrine also promote the secretion of atrial natriuretic peptide, a potent vasodilator that suppresses the release of vasoconstrictors. Elevated catecholamine levels can induce hypertension and tachycardia, while increased arterial pressure and a rapid heart rate would promote arterial vasodilation and subsequent fatal thromboses, particularly in tandem. Genetic risk factors may explain why only a susceptible subset of children develops KS although mercury exposure from methylmercury in fish or thimerosal in pediatric vaccines is nearly ubiquitous. During the infantile acrodynia epidemic, only 1 in 500 children developed acrodynia whereas mercury exposure was very common due to the use of teething powders. This hypothesis mirrors the leading theory for KS in which a widespread infection only induces KS in susceptible children. Acrodynia can mimic the clinical picture of KS, leading to its inclusion in the differential diagnosis for KS. Catecholamine levels are often elevated in acrodynia and may also play a role in KS. We conclude that KS may be the acute febrile form of acrodynia.

Recently, a single nucleotide polymorphism (SNP) of the inositol 1,4,5-triphosphate kinase C (ITPKC), rs28493229, was found to passively confer susceptibility for Kawasaki syndrome (KS) and subsequent coronary arterial lesions. This association is believed to be the result of defective phosphorylation of inositol 1,4,5-triphosphate (IP3), which releases calcium from intracellular stores, resulting from reduced genetic expression of ITPKC in carriers of the SNP. Reduced ITPKC activity would increase IP3 levels, and thus, increase calcium release. We hypothesized that an environmental agent which influences IP3-mediated calcium release is potentiated by the ITPKC SNP. This led us to an attractive candidate, thimerosal, an organomercurial medical preservative still used in several pediatric vaccines. Thimerosal is well-known to sensitize IP3 receptors via its induction of oxidative stress, resulting in enhanced release of intracellular calcium with distinctive consequences for various cell types. Dysregulated calcium signaling in T cells and other immune cells can result in autoimmunity, while hyperpolarization of vascular smooth muscle cells secondary to the stimulation of calcium-activated potassium channels can result in increased vascular permeability and arterial relaxation. We propose that ITPKC susceptibility in KS is related to its synergy with environmental triggers, such as thimerosal, which alter calcium homeostasis and promote oxidative stress. Therefore, carriers of the ITPKC SNP are more susceptible to thimerosal-induced autoimmunity and coronary arterial lesions observed in KS. This would explain why only a susceptible subset of children develops KS although pediatric thimerosal exposure is nearly universal due to vaccination. As was experienced with the infantile acrodynia epidemic, only 1 in 500 children developed the disease although pediatric mercury exposure was nearly ubiquitous due to the use calomel teething powders. This hypothesis also mirrors the current leading theory for KS in which a widespread infection only induces the disease in susceptible children. We conclude that KS may be the acute febrile form of acrodynia., (Copyright © 2012 Elsevier B.V. All rights reserved.)