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Background: Optic neuritis, myelitis, and neuromyelitis optica spectrum disorder (NMOSD) have been associated with antibodies against myelin oligodendrocyte glycoprotein-immunoglobulin G (anti-MOG-IgG). Furthermore, patients with radiological and demographic features atypical for multiple sclerosis (MS) with optic neuritis and myelitis also demonstrate antibodies against aquaporin-4 and anti-MOG-IgG. However, data on the diagnosis, treatment, follow-up, and prognosis in patients with anti-MOG-IgG are limited. Aims: To evaluate the clinical, radiological, and demographic characteristics of patients with anti-MOG-IgG. Study Design: Multicenter, retrospective, observational study. Methods: Patients with blood samples demonstrating anti-MOG-IgG that had been evaluated at the Neuroimmunology laboratory at Ondokuz Mayıs University’s Faculty of Medicine were included in the study. Results: Of the 104 patients with anti-MOG-IgG, 56.7% were women and 43.3% were men. Approximately 2.4% of the patients were diagnosed with MS, 15.8% with acute disseminated encephalomyelitis (ADEM), 39.4% with NMOSD, 31.3% with isolated optic neuritis, and 11.1% with isolated myelitis. Approximately 53.1% of patients with spinal involvement at clinical onset demonstrated a clinical course of NMOSD. Thereafter, 8.8% of these patients demonstrated a clinical course similar to MS and ADEM, and 28.1% demonstrated a clinical course of isolated myelitis. The response to acute attack treatment was lower and the disability was higher in patients aged > 40 years than patients aged < 40 years at clinical onset. Oligoclonal band was detected in 15.5% of the patients. Conclusion: For patients with NMOSD and without anti-NMO antibodies, the diagnosis is supported by the presence of anti-MOG-IgG. Furthermore, advanced age at clinical onset, Expanded Disability Status Scale (EDSS) score at clinical onset, spinal cord involvement, and number of attacks may be negative prognostic factors in patients with anti-MOG-IgG.

Günümüz teknolojileri dikkate alındığında, dar toleranslarda çalışma gerektiren küçük ve kırılgan parçalarda, karmaşık geometrilerin işlenme zorluğunda kullanıma uygun ve yeni üretim teknolojileri olarak adlandırabileceğimiz Alışılmamış İmalat Yöntemleri (AİY) imalat alanında önemli bir yer almıştır. Bu çalışmada geliştirilen Karar Destek Sistemi (KDS) ile literatüredeki bilgi birikiminden yararlanarak, endüstriyel anlamda gerçek hayattaki kullanım alanlarında uygulanabilir nitelikte olan, hızlı ve dinamik karar verme, gerekirse hangi imalat sistemine yatırım yapma konusunda karar vericilere yardımcı olacak, veri iletişiminin olduğu, parametrik yapısı ile kriterlerin ve alternatiflerin değiştirilebileceği bir sistemin ortaya konulması planlanmıştır. Söz konusu KDS, kullanıcının arzu ettiği proses tipine göre ilgili verilerin girilmesi ile uygun filtrelemelerin yapılması sonrasında alternatif AİY’lerin sıralanması için Çok Kriterli Karar Verme Yöntemlerini uygulayarak kullanıcının karar vermesine yardımcı olmaktadır. KDS Python yazılım dili kullanılarak yazılmıştır.

Günümüzde alüminyum alaşımları hafif olması, yüksek dayanım sunması ve ekonomik olmaları gibi sebeplerle havacılık, otomotiv ve savunma sanayiinde yoğun olarak kullanılmaktadır. Bu çalışmada Al2024-T3 malzemesinin işlenmesinde elektro erozyon yöntemi kullanılarak, talaş kaldırma miktarı (TKM), takım aşınma miktarı (TAM) ve ortalama yüzey pürüzlülüğü (Ra) olarak sıralanabilecek performans yanıtları üzerinden sonuçlar elde edilmiştir. Yapılan deneylerde boşalım akımı (Ip), vurum süresi (Ton) ve vurum aralığı (Toff) parametrelerinin performans yanıtları üzerindeki etkileri incelenmiştir. Yapılan varyans analizi (ANOVA) sonucunda deney sonuçları üzerinde etkin parametrelerin sırasıyla Ton, Ip ve Toff olduğu tespit edilmiştir. Çalışmanın devamında performans yanıtlarını eniyileyecek parametre değerlerinin tespiti amacıyla bir optimizasyon çalışmasına da yer verilmiştir.

Abstract Background Changes induced by monosodium glutamate (MSG) can negatively impact milk production and secretion, among other adverse effects. This study aimed to investigate the effects of MSG consumption on receptor gene expression and quantification of hormones and receptors, as well as oxidative stress biomarkers and other lactogenic parameters in lactating animals. Twenty-four female Wistar rats, nine weeks of age, were randomly assigned to four groups, each containing six rats, at parturition. The rats in groups II, III, and IV were given varying doses of monosodium glutamate (MSG); while, group I was given distilled water and served as the control. The experimental period lasted two (2) weeks. Results The groups administered with MSG showed a significant decrease in mammary PRLR gene expression (p

Conducting comprehensive analyses to predict concrete compressive strength is crucial for enhancing safety in field applications and optimizing work processes. There is an extensive body of research in the literature focusing on predicting the mechanical properties of concrete, such as compressive strength. Summarizing the key contributions of these studies will serve as a guide for future research. To this end, this study aims to conduct a scientometric analysis of contributions that utilize machine learning (ML) models for predicting concrete compressive strength, assess these models, and provide insights for developing optimal solutions. Additionally, it seeks to offer researchers comprehensive information on prominent research themes, trends, and gaps in the literature regarding concrete compressive strength prediction. For this purpose, 2319 articles addressing the prediction of concrete compressive strength, published between 2000 and 19 August 2024, were identified through the Scopus Database. Scientometric analyses were conducted using VOSviewer software. The evaluation of relevant studies demonstrates that ML models are frequently used to predict concrete compressive strength. The advantages and limitations of these models are examined, with a particular emphasis on key considerations when working with complex datasets. A comprehensive analysis of ML models and their practical contributions to field applications distinguishes this study from existing research. This study contributes significantly to the literature by examining leading institutions, countries, authors, and sources in the field, synthesizing data, and identifying research areas, gaps, and trends in concrete compressive strength prediction. It establishes a strong foundation for the design of ML-supported, reliable, sustainable, and optimized structural systems in civil engineering, building materials, and the concrete industry.

Historically, women are perceived to have been relegated to the second fiddle positions in social schema, especially in cultures where patriarchy predominates. Since the Industrial Revolution in England, women have taken it upon themselves to liberate their kind in all facets of human engagements. This determination, therefore, necessitated the proliferation of various groupings for women’s liberation. One crucial means adopted for achieving this objective is to acquire Western education, a potent strategy often used to break barriers of real and perceived oppression by men. They ‘wrestle’ power from men and now take charge of most aspects in which men hitherto reigned supreme. This study was spurred by the trend of female students leading in academic performance in public and school examinations. A survey of the academic performance of Fountain University students for four years was carried out with a specific focus on gender performance. Senior Secondary School Certificate examination results, final results of graduating students, library attendance and Students’ Disciplinary Committee reports were examined. Interview sessions were conducted with six (6) parents (IDIs) and five (5) school officials (KIIs). These were complemented with ten (10) Focus Group Discussions (FGDs) with students. Radical Feminist Theory was employed to provide explanations on the study’s findings, which were content analysed.

Introduction: The development of immune checkpoint inhibitors is considered one of the most important advances in cancer treatment. Pembrolizumab is an immune checkpoint inhibitor against programmed death-1 (PD-1) receptors that has demonstrated antineoplastic activity against various malignancies, including non-small cell lung cancer, melanoma, and triple-negative breast cancer. Pembrolizumab is associated with numerous adverse reactions including mucosal and cutaneous reactions referred to as immune-related adverse events. These events can impact patient quality of life and lead to dose reduction or discontinuation of the medication. A comprehensive understanding of pembrolizumab’s toxicities is crucial for the initiation of treatment. Case Presentation: We present the case of a 27-year-old man with stage IVB thymic carcinoma with a bulky anterior mediastinal mass, bilateral jugular, bilateral peritracheal, and bilateral cardiophrenic lymphadenopathies, and a small pericardial effusion. He received pembrolizumab IV every 3 weeks for 53 cycles over 39 months. The patient developed bleeding oral lesions approximately 38 months after treatment with pembrolizumab. Conclusion: The patient’s pembrolizumab treatment was not interrupted and the perioral rash ultimately improved after treatment with steroids.

Kurşun asit akülerde çevrim ömrü ızgara kalınlığı, ızgara malzemesi, plaka hamur kimyasalı gibi çeşitli faktörlere bağlı olarak değişmektedir. Bu faktörlerin akü performansına olan etkileri önemli bir araştırma konusudur. Bu çalışmada plaka yapısında sülyen ve/veya kostikli asit kullanımının, tanecik yapısının, plaka kalınlığının, ızgara yapısında kullanılan antimuanın ve kalsiyumun etkileri açıklanmaya çalışılmıştır. Birçok değişkenin etkisinin incelendiği bu makalede çok ölçütlü karar verme yöntemi olan MOORA yöntemi kullanılarak kurşun asit akü bileşenlerinde yapılacak değişikliklerle akü performansının iyileştirilmesi amaçlanmıştır. Çalışma sonuçları daha yüksek oranlı 4BS tanecikli iç yapıya sahip plakaların 3BS tanecik yoğunluklu iç yapıya sahip plakalara kıyasla akü performansında artış sağladığını göstermiştir. Ayrıca ızgara yapısında katkı maddesi olarak Kalsiyum (Ca) yerine Antimuan (Sb) kullanımının kurşun asit akülerin iç direncinde düşüşe sebep olduğu ve bu sayede çevrim ömrünün artmasını sağladığı belirlenmiştir. Çalışma sonunda en iyi performans değerlerini veren kombinasyonun iç yapı analizleri yapılmış ve geleneksel kurşun asit akülerle kıyaslanmış, iç yapıda yapılacak değişiklikler ile akü iç direncinin azaltılabileceği ortaya konulmuştur. En iyilenen gruba ait SEM analizlerinde 3BS faz içeriğinin ağırlıkça %53 olduğu ve bazik sülfat taneciklerine ait boyut dağılımının 0,6 µm ile 2,27 µm aralığında bulunduğu tespit edilmiştir. Başlangıç grubuna ve en iyi sonuçları veren gruba ait çevrim test sonuçlarına göre 105 Ah değerinde %11,3, 150 Ah değerinde %12,3 ve 180 Ah değerinde %5,4 oranında bir iyileştirme elde edilmiştir.

Bu çalışmanın amacı, ortaokul 8. sınıf öğrencilerinin verilen metinlerden hareketle hazırladıkları soruları Yenilenmiş Bloom Taksonomisi’nin bilişsel süreç basamaklarına göre incelemektir. Çalışmada, temel nitel araştırma deseni kullanılmıştır. Araştırmanın çalışma grubunu 2022-2023 eğitim-öğretim yılı ikinci döneminde Aksaray, Antalya, İstanbul, İzmir ve Kütahya illerinde bulunan devlet ortaokulları arasından rastgele belirlenen okullarda öğrenim görmekte olan 400 sekizinci sınıf öğrencisi oluşturmaktadır. Çalışman verilerini toplama sürecinde doküman incelemesinden faydalanılmıştır. Öğrencilerden verilen metinlerden hareketle bir ders saati içerisinde 6 adet soru hazırlamaları istenmiş ve bu sorular, Yenilenmiş Bloom Taksonomisi’nin bilişsel süreç boyutlarına göre değerlendirme yapmaları için 3 alan uzmanının görüşüne sunulmuştur. Çalışma kapsamında öğrencilerden ve alan uzmanlarından elde edilen verileri tanımlanabilmek amacıyla betimleyici analiz tekniklerinden faydalanılmış ve verilerin daha iyi anlaşılması amacıyla da frekans analizi kullanılmıştır. Araştırma sonucunda öğrencilerin hazırladıkları soruların büyük oranda alt düzey bilişsel basamakta yer aldığı; öğrencilerin üst düzey bilişsel basamakta soru hazırlamakta problem yaşadıkları sonucuna ulaşılmıştır.

INTRODUCTION: Menarche is the endpoint of a sequence of maturational events of female puberty. The timing of menarche is a strongly heritable trait. However, secular trends suggest that lifestyle and environmental factors are important. To assess the trend in age at menarche (AAM), and its associated factors in İstanbul over the last 12 years. METHODS: A cross-sectional study was carried out between March and April 2022 on schoolgirls aged 9-18 years. A predesigned and self-administered questionnaire was filled out anonymously by the students. The data of AAM was included in the statistical analysis if the time of AAM is remembered in both months and years. A probit model was used to calculate the median AAM. The findings were compared with those from a study performed 12 years ago in the same region of İstanbul. RESULTS: Among 9000 girls to whom the questionnaire was distributed, 1749 (19.5%) responded. The median AAM of 1374 girls whose AAM information was considered valid was 12.04 years (95% confidence interval: 12.01-12.13), 0.7 years lower than was reported 12 years ago (p

IntroductionAs useful tools for clinical decision-making, diagnostic tests require careful interpretation in order to prevent underdiagnosis, overdiagnosis or misdiagnosis. The aim of this study was to explore primary care practitioners’ understanding and interpretation of the probability of disease before and after test results for six common clinical scenarios.MethodsThis cross-sectional study was conducted with 414 family physicians who were working at primary care in Istanbul via face-to-face interviews held between November 2021 and March 2022. The participants were asked to estimate the probability of diagnosis in six clinical scenarios provided to them. Clinical scenarios were about three cancer screening cases (breast, cervical and colorectal), and three infectious disease cases (pneumonia, urinary tract infection, and COVID-19). For each scenario participants estimated the probability of the diagnosis before application of a diagnostic test, after a positive test result, and after a negative test result. Their estimates were compared with the true answers derived from relevant guidelines.ResultsFor all scenarios, physicians’ estimates were significantly higher than the scientific evidence range. The minimum overestimation was positive test result for COVID-19 and maximum was pre-test case for cervical cancer. In the hypothetical control question for prevalence and test accuracy, physicians estimated disease probability as 95.0% for a positive test result and 5.0% for a negative test result while the correct answers were 2.0 and 0%, respectively (p

Background: The burden of tuberculosis (TB) in Nigeria remains high, and diagnosis in children, a challenge. We aimed to document yield from Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) as a mode of diagnosis for children and the variables associated with a positive result. Methods: This was a retrospective review of TB treatment cards of children aged 0–15 years managed from January 2017 to December 2021 across six public tertiary institutions in Nigeria. The data obtained were analyzed using the descriptive and inferential statistics. Statistical significance was set at P < 0.05. Results: Of 1489 children commenced on TB treatment, 1463 (97.9%) had sufficient data for analysis the median age of study participants was 60 months (interquartile range [IQR]: 24, 120), and 814 (55.6%) were males. Xpert MTB/RIF test was performed in 862 (59%) participants and MTB was detected in 171 (19.8%) participants, of which 6.4% (11/171) had RIF resistance reported. The use of Xpert MTB/RIF rose from 56.5% in 2017 to 64% in 2020 but fell to 60.9% in 2021. We found that older age (> 10 years), the presence of pulmonary TB (PTB), and a negative human immunodeficiency virus (HIV) status were associated with positive Xpert MTB/RIF tests (P = 0.002, 0.001, and 0.012, respectively). Conclusion: The utilization of Xpert MTB/RIF in children increased in the years before the COVID-19 pandemic. Factors associated with MTB detection by Xpert MTB/RIF include older age, the presence of PTB, and a negative HIV status. Clinical and radiological evaluation continues to play vital roles in the diagnosis of childhood TB in Nigeria.

Abstract. Introduction: Past research has shown that psychological and behavioral factors, including anxiety, fear, and preventive behaviors, are related to well-being outcomes during the COVID-19 pandemic. Yet little is known about the simultaneous effects of those factors in predicting satisfaction with life among vaccinated people. Methods: This cross-sectional study is among the first to examine whether COVID-19 anxiety, fear of COVID-19, and preventive behaviors predicted satisfaction with life among the vaccinated general public in Turkey. Participants were 1,017 Turkish adults (69.71% female; mean age = 36.28, SD = 10.83 years) who completed online self-reported questionnaires. Results: Results showed that increased levels of anxiety and fear of COVID-19 significantly predicted reduced satisfaction with life over and above the effects of sociodemographic and clinical factors. Discussion: The findings suggest the importance of tailoring and implementing interventions focusing on the improvement of the well-being of people during the pandemic.

IntroductionFever is both a sign of various diseases (chief of which are infectious in nature) and an adverse effect of certain interventions (e.g. vaccines, drugs) in the pediatric population. It elicits anxiety among caregivers and healthcare professionals alike resulting in non-evidence based practices, adverse medication administration events, waste of scarce resources and overutilization of health facilities. The determinants of these practices among caregivers in the domiciliary contexts have not been well characterized in developing settings.MethodsWe assessed the knowledge and practices of childhood fever and their determinants among caregivers in domiciliary settings in Northern Nigeria using a 41-item questionnaire between August 2020 and February 2021.ResultsThe questionnaire is reliable (knowledge: Cronbach's Alpha = 0.689; practice: Cronbach's Alpha = 0.814) and collected data on a total of 2,400 caregiver-child pairs, who participated in the study. Over two-third (68.3%; 1,640) of the caregivers expressed fever phobic tendencies. Paracetamol was the most commonly used medication and constituted 31.3% of medication administration adverse events reported by the caregivers. Only one out of every six knowledgeable caregivers engaged in evidence-based home childhood fever management practices (7% vs. 41.6%) with being a primary caregiver [Knowledge: odd ratio (OR): 2.81, 95% CI: 0.38; 5.68; p value: 0.04; Practice: OR: 1.65, 95% CI: 0.09; 7.33; 0.02] and having a child/children aged ≤3 years (knowledge: OR: 7.03, 95% CI: 4.89; 9.67, p value: 0.003; practice OR: 3.11, 95% CI: 1.27; 8.59, 0.007) determining both the knowledge and practices of childhood fever management in a household.ConclusionsThe knowledge and practice of childhood fever management among caregivers were sub-optimal with being a primary caregiver and having a child/children aged ≤3 years being the significant determinants of each domain. These gaps underscore the dire need for targeted strategies aimed at improving childhood fever management by educating caregivers.

For materials with high ductility, malleability and conductivity, temperature will have significant impact on the material properties. This is especially true for pure elemental metals which have a wide range of applications due to their ultrahigh strengths. Recently, the study of damage mechanism at the nano- and micro level has attracted a significant interest and research. However, the current understanding of deformation mechanisms in nanocrystalline metals in relation to atomic structure and behavior is insufficient. In this study, atomistic simulation of uniaxial tension at nano-scale was performed at a fixed rate of loading (500 ms^-1) on some nano-crystalline face centered cubic metals (Al, Cu, and Ni), to study the nature of tensile deformation at different temperatures using the embedded-atomic method (EAM) potential function. The simulation results show a rapid increase in the stress up to a maximum value followed by a sharp drop when the nanocrystal fails by ductile dislocation. The drop in the stress-strain curves can be attributed to the rearrangement of atoms to a new or modified crystalline structure. Additional simulations were run to study the effects of temperature on the stress-strain curve of nano-crystals. The result shows that increasing temperature weakens the ductility of these nanomaterials. In this investigation, the strain corresponding to yielding stress is observed to be lower with increasing temperature. Finally, the evolution of crystalline microstructure during the entire tensile process was investigated. The atomistic simulation result of tensile deformation at nanoscale obtained in this study agree with plasticity phenomenon observed in macroscale.

Anadara granosa are one of the benthic organisms that are frequently reported because contained heavy metals because of water pollution. This is because A. granosa is a feeder filter so that accumulates heavy metals in its body. Reduce the levels of heavy metals with activated charcoal from coconut shells in the absorbance process using the depuration method. It is re-optimized with the use of nano-active charcoal. The goal was to determine the effect of concentrations of nano-active charcoal from coconut shells on the heavy metal content of A. granosa. Stages of this reserch, namely charcoal activation, ultrasonication, SEM testing, blood shell depuration, and heavy metal testing. Based on the results of the Scanning Electron Microscope (SEM) Test it is known that the charcoal particles are sized 10-9 nm. The types of heavy metals found included hydrargyrum (Hg) 0.0009 mg/kg, cadmium (Cd) 0.62 mg/kg, and plumbum (Pb) 1.82 mg/kg. Heavy metals with lowest content is found in P5 (active charcoal concentration of 15% of the sample weight) of mercury (Hg) 0.0002 mg/kg; cadmium (Cd) 0.1 mg/kg; and lead (Pb) 0.373 mg/kg. This shows that the higher concentraion of activated charcoal given, the lower heavy metal content.

Purpose: This study aimed to identify an easy-to-apply biomarker by correlating visual evoked potential (VEP) with optical coherence tomography angiography (OCTA) results in multiple sclerosis (MS). Methods: Our study was planned prospectively. Patients with MS were divided into two groups, VEP prolonged group 1 and VEP normal group 2. Age-matched and gender-matched healthy individuals (group 3) were included as the control group. Vascular density (VD) of the optic nerve head (ONH) and radial peripapillary capillaries (RPCs) were measured and recorded by OCTA. The optic nerve damage of patients was measured and recorded with a VEP device. Results: Thirty-two eyes were included in group 1, 50 eyes were included in group 2, and 51 healthy eyes were included in group 3. In terms of visual acuity, group 1 was significantly lower than the other groups (P < 0.001). Regardless of the prolongation of p100 latency in patients with MS, whole image, inside disc ONH VD and in the same sectors in RPC VD were found to be significantly lower than the control group (P < 0.05). Retinal nerve fiber layer thickness was found to be significantly lower in group 1 than in group 2 and group 3 (P < 0.05). There was a significant correlation between low ONH VD and RPC VD and prolonged VEP P100 (P < 0.05). Conclusion: VEP measurements can be correlated with OCTA measurements in patients with MS and can be used as a biomarker to determine the degree of optic nerve damage.

Background In 2013, Marshfield Clinic Health System (MCHS) implemented the Dragon Medical One (DMO) system provided by Nuance Management Center (NMC) for Real-Time Dictation (RTD), embracing the idea of streamlined clinic workflow, reduced dictation hours, and improved documentation legibility. Since then, MCHS has observed a trend of reduced time in documentation, however, the target goal of 100% adoption of voice recognition (VR)-based RTD has not been met. Objective To evaluate the uptake/adoption of VR technology for RTD in MCHS, between 2018–2020. Methods DMO data for 1,373 MCHS providers from 2018–2020 were analyzed. The study outcome was VR uptake, defined as the median number of hours each provider used VR technology to dictate patient information, and classified as no/yes. Covariates included sex, age, US-trained/international medical graduates, trend, specialty, and facility. Descriptive statistics and unadjusted and adjusted logistic regression analyses were performed. Stata/SE.version.17 was used for analyses. P-values less than/equal to 0.05 were considered statistically significant. Results Of the 1,373 MCHS providers, the mean (SD) age was 48.3 (12.4) years. VR uptake was higher than no uptake (72.0% vs. 28.0%). In both unadjusted and adjusted analyses, VR uptake was 4.3 times and 7.7 times higher in 2019–2020 compared to 2018, respectively (OR:4.30,95%CI:2.44–7.46 and AOR:7.74,95%CI:2.51–23.86). VR uptake was 0.5 and 0.6 times lower among US-trained physicians compared to internationally-trained physicians (OR:0.53,95%CI:0.37–0.76 and AOR:0.58,95%CI:0.35–0.97). Uptake was 0.2 times lower among physicians aged 60/above than physicians aged 29/less (OR:0.20,95%CI:0.10–0.59, and AOR:0.17,95%CI:0.27–1.06). Conclusion Since 2018, VR adoption has increased significantly across MCHS. However, it was lower among US-trained physicians than among internationally-trained physicians (although internationally physicians were in minority) and lower among more senior physicians than among younger physicians. These findings provide critical information about VR trends, physician factors, and which providers could benefit from additional training to increase VR adoption in healthcare systems.

Amaç: Bu çalışmada, pnömoni ve üst solunum yolu enfeksiyonu (ÜSYE) kliniği ile başvuran şüpheli COVID-19 hastaları arasındaki PCR testi pozitifliğinin ilişkisinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Ondokuz Mayıs Üniversitesi Hastanesi pandemi kliniğine COVID-19 şüphesiyle yatırılan 80 hastanın kayıtları retrospektif olarak incelendi. COVID-19 şüphesi ile yatırılan 80 hasta, Toraks BT (Bilgisayarlı Tomografi) sonucu ve semptomları değerlendirilerek ÜSYE ve pnömoni olarak iki gruba ayrıldı. Hastalara çekilen Toraks BT görüntüleri, deneyimli iki radyolog tarafından değerlendirildi. BT bulguları, tipik görünüm, belirsiz görünüm, atipik görünüm ve pnömoni için negatif olarak sınıflandırıldı. Hastaların, demografik özellikleri, ek hastalıkları, temas öyküsü, verilen tedavi, geliş semptomları ve laboratuvar değerleri kaydedildi. Bulgular: Çalışmada 80 hastanın verileri incelendi. Normal BT bulguları ve ÜSYE semptomları olan 29 hasta (%36.3) ve BT’de tipik COVID-19 pnömonisi bulguları olan 51 hasta (%63.7) olduğu gözlendiYapılan analiz sonucunda PCR pozitifliğine etki eden faktörler incelenmiş ve analiz sonucunda ÜSYE olanların pnömoni olanlara göre PCR test sonucunun pozitif çıkma riskinin 6,6 kat daha fazla olduğu tespit edilmiştir. Nefes darlığı olmayanların olanlara göre pozitif çıkma riski de 6,5 kat fazla bulunmuştur ). Sonuç: Üst solunum yolu semptomları ile başvuran hastalarda PCR testleri negatif olsa da COVID-19 pnömonisiyle uyumlu tipik Toraks BT bulguları varsa hastalara tekrar test yapılmalı ve bulaş riskini en aza indirmek için gerekli önlemler alınmalıdır.

Background and objectivesAlthough several repurposed antiviral drugs have been used for the treatment of COVID-19, only a few such as remdesivir and molnupiravir have shown promising effects. The objectives of our study were to investigate the association of repurposed antiviral drugs with COVID-19 morbidity.MethodsPatients admitted to 26 different hospitals located in 16 different provinces between March 11–July 18, 2020, were enrolled. Case definition was based on WHO criteria. Patients were managed according to the guidelines by Scientific Board of Ministry of Health of Turkey. Primary outcomes were length of hospitalization, intensive care unit (ICU) requirement, and intubation.ResultsWe retrospectively evaluated 1,472 COVID-19 adult patients; 57.1% were men (mean age = 51.9 ± 17.7years). A total of 210 (14.3%) had severe pneumonia, 115 (7.8%) were admitted to ICUs, and 69 (4.7%) were intubated during hospitalization. The median (interquartile range) of duration of hospitalization, including ICU admission, was 7 (5–12) days. Favipiravir (n = 328), lopinavir/ritonavir (n = 55), and oseltamivir (n = 761) were administered as antiviral agents, and hydroxychloroquine (HCQ, n = 1,382) and azithromycin (n = 738) were used for their immunomodulatory activity. Lopinavir/ritonavir (β [95% CI]: 4.71 [2.31–7.11]; p = 0.001), favipiravir (β [95% CI]: 3.55 [2.56–4.55]; p = 0.001) and HCQ (β [95% CI]: 0.84 [0.02–1.67]; p = 0.046) were associated with increased risk of lengthy hospital stays. Furthermore, favipiravir was associated with increased risks of ICU admission (OR [95% CI]: 3.02 [1.70–5.35]; p = 0.001) and invasive mechanical ventilation requirement (OR [95% CI]: 2.94 [1.28–6.75]; p = 0.011).ConclusionOur findings demonstrated that antiviral drugs including lopinavir, ritonavir, and favipiravir were associated with negative clinical outcomes such as increased risks for lengthy hospital stay, ICU admission, and invasive mechanical ventilation requirement. Therefore, repurposing such agents without proven clinical evidence might not be the best approach for COVID-19 treatment.

The efficacy of the antibiotic trimethoprim, which inhibits bacterial dihydrofolate reductase (DHFR), is limited by the rapid emergence of resistant bacteria. Here, Manna et al. show that 4’-desmethyltrimethoprim inhibits DHFR and a common TMP-resistant variant, and impedes evolution of antibiotic resistance by selecting against the emergence of this variant.

Background: World Health Organization (WHO) reported COVID-19 as a pandemic, on March 11th, 2020. The quick and accurate diagnosis is crucial to provide the appropriate treatment and isolation process. Immunity against COVID-19 is essential for disease control. There is scant information about antibody response and disease severity. In this study, we aimed to investigate the relationship between clinical severity and COVID antibody response. Methods: Hospitalized PCR (n=10) and/or radiologically (n=31) proven 35 COVID-19 patients were included in the study. The blood samples were collected at least eight days after the onset of symptoms and studied by using the COVID-19 IgG/IgM Rapid Test. Patients were divided as mild (n= 14), severe (n=12) and critical (n=9) according to COVID-19 disease severity. The results were compared among the groups. Results: A total of 35 COVID-19 patients’ (mean age: 54.65±16.51 years, Male/Female: 23/12) rapid test results were compared according to clinical severity. A significant correlation was observed between disease severity and IgG results in both PCR positive (p=0.007) and whole patients (p=0.026). The positive IgG ratio was significantly low in the mild patient group while it was higher in severe and critical patients. Conclusions: Our study reveals that the greater antibody response occurs with the more serious COVID-19 disease. The application of the rapid test, in addition to PCR, may be used as a clue to foresee the clinical progression. These tests not only have an important role in diagnosis with PCR tests but also are associated with disease severity.

This paper aims to see the extent of the impact of Covid-19 on the implementation of education at SMP PGRI-9 Percut Sei Tuan. The learning process in schools is the best public policy tool as an effort to increase knowledge and skills, but with the presence of the Covid-19 outbreak, the Indonesian education world needs to follow a path that can help school conditions in an emergency, thus the same thing was felt by SMP PGRI-IX Percut. Sei Tuan, schools need to force themselves to use online media. However, the use of technology is not without problems, there are many variances of problems that hinder the effectiveness of learning with online methods. Variants of problems that arise due to covid-19 in hampering the implementation of the effectiveness of learning at SMP PGRI-IX Percut Sei Tuan are the limitation in the author's research. The author conducts a search in the form of interviews with school objects in completing and perfecting this paper, while the intended interview objects are; principals, teachers, and parents of students who are in SMP PGRI-9 Percut Sei Tuan

Hypercalcemia is an ominous development in the course of malignancy associated with a mean survival of only several months. A majority of cases of hypercalcemia are related to humoral hypercalcemia of malignancy (HHM), where hypercalcemia is caused by increased levels of circulating parathyroid hormone-related protein (PTHrP). Mainstay treatments in the management of HHM are intravenous fluids, intravenous bisphosphonates, and subcutaneous denosumab, although hypercalcemia oftentimes recurs despite these efforts. We present a case of advanced non-small cell lung cancer with PTHrP-mediated hypercalcemia that proved resistant to standard therapy. A trial of oral cinacalcet was initiated and improved calcium levels for 2 months despite a progressive rise in PTHrP and prior to subsequent disease progression. Based on the current body of literature, we propose that this calcium-lowering effect of cinacalcet occurs due to a potential effect on renal calcium excretion.

Background and Objective: While insufficient sleep remains an under-recognized public health issue across the globe, there is paucity and heterogeneity of data regarding its cardiometabolic and haemoinflammatory implications. We, therefore, aimed to evaluate the impact of chronic sleep restriction on cardiometabolic and haemoinflammatory parame-ters in rats. Materials and Methods: 16 male Wistar rats (aged 8-10 weeks) were randomly assigned into equal control or sleep restriction groups. Gentle handling was used to induce sleep restriction for six weeks. Fasting weight and blood sugar were obtained and lipids were analyzed using their respective Randox kits. Malondialdehyde (MDA) levels and catalase (CAT) and superoxide dismutase (SOD) activities were assayed. Full blood count and CD4+ T cell count were deter-mined using automated analyzer. Data were analyzed using Student’s t-test, with level of significance set at P ≤ 0.05, via SPSS software. Results: Chronic sleep restriction caused significant initial weight loss, increase in feed consumption, and percentage in-crease in fasting blood sugar (FBS) (32% vs. 15%). We also noted the triglyceride-glucose (TyG) index of sleep-restricted rats to be significantly higher (6.22) than that of controls (5.62). In addition, a significant reduction in monocyte count, monocyte-lymphocyte ratio (MLR), and absolute CD4+ cell count among the sleep-restricted rats was observed. Conclusion: Our findings have provided objective evidence that, over the course of 6 weeks, 5 hours of sleep re-striction had caused body weight gain, hyperglycaemia, insulin resistance, and impairment in immunoinflammatory status; hence, it could be a risk factor for developing cardiometabolic syndrome and immune-related disorders.

Background: Light at night (LAN) threatens metabolic health by delaying our sleep timing and allowing us to eat at odds with our circadian clocks. Circadian research interests are majorly focused on jet lags, shift work, and the non-24-h days. Since exposure to LAN, sleep loss, and late night eating are common scenarios of modern-day circadian rhythm disruption, developing an animal model that better mirrors these scenarios and investigation of their diabetogenic potentials is a research priority. Materials and Methods: Over the course of 6 weeks, we developed chronic LAN exposure (LAN), sleep restriction (SR), abnormal feeding (AF), rural social jetlag (RSJ), night shift work (NSW), and urban social jetlag (USJ) models, using male Wistar rats. Gentle handling was used to induce SR, while LAN was instituted using a customized light rack system. Circadian and blood glucose rhythms were, respectively, determined using 4 hourly temperature and blood glucose measurements. Statistical analysis was done using SPSS V20.0 and ÒCosinor SoftwareÓ. The data were summarized using mean ± standard deviation as well as MESoRs, amplitudes, and acrophases. Statistical significance was considered as P ≤ 0.05. Results: Our findings have revealed a significantly (P < 0.01) higher average nocturnal glucose (126 mg/dL) and temperature (36.53°C) rhythms compared to diurnal glucose (108 mg/dL) and temperature (35.50°C) rhythms in the controls rats. All the developed models are noted to have a distorted light: dark glucose and temperature rhythms with acrophases of the core body temperature in controls, RSJ and USJ models occurring at 08:16 pm, 2:43 pm, and 7:48 pm local time, respectively. The vector components of the phase changes revealed 5 h phase delay in the LAN model and 28 min, 1 h, and 4.5 h phase advancements among the USJ, AF, and SR models, respectively. These indicate circadian disruption and blood glucose dysrhythmia among the SR, AF, LAN, RSJ, USJ, and NSW models. Conclusion: Our findings have suggested the circadian disruptive and diabetogenic nature of our widespread modern-day social behaviors.

Amaç: Bu çalışmanın amacı, akut iskemik inmeli hastalarda NIHSS ile repolarizasyon parametreleri arasındaki ilişkiyi araştırmak.Gereç ve Yöntem: Çalışmaya akut iskemik inme geçiren 97 hasta (erkek,42; kadın,55; yaş, 65 ± 16) alındı. 17 hasta çalışmadan çıkarıldı. NIHSS skoruna göre hastalar iki gruba ayrıldı (Grup 1, NIHSS skor

Purpose: The aim of this study is to investigate the relationship between myocardial function assessed by tissue Doppler imaging myocardial performance index (TDI-MPI) and National Institutes of Health Stroke Scale (NIHSS) score in patients with acute ischemic stroke. Materials and Methods: The study comprised 128 patients (males, 55; females, 73; 68 ± 19 years) with acute ischemic stroke. 20 patients were excluded. Patients were divided into two groups based on the calculated NIHSS score (Group 1, NIHSS score < 16; Group 2, NIHSS score ≥ 16). Demographic, clinical, and laboratory data for all patients were collected. Cardiac function was evaluated by transthorasic echocardiography within 48 hours of admission to the neurology care unit.Results: There were no significant differences among demographic parameters of patients. Tissue Doppler myocardial performance index was significantly higher in Group 2 patients than in Group 1 patients (0.62±0.28 vs 0.46±0.16).Conclusion: Our results suggest that TDI-MPI is associated with stroke severity on admission in patients with acute ischemic stroke. TDI-MPI is an indicator of global myocardial dysfunction with a different from LVEF. TDI-MPI, which includes both systolic and diastolic time intervals to assess the global cardiac dysfunction.

The present work is concerned with an analytical study of entropy generation in viscous, incompressible fluid in an inclined channel with porous walls. The solution of the governing equations were obtained in closed form. The expression for the irreversibility ratio was also obtained and the results were presented graphically and extensively discussed for different values of the dimensionless parameters. The result indicates that wall inclination enhance entropy generation.

Introduction: In 2019, we investigated the profile of the cases and controls and the determinants of pertussis transmission in Kebbi State, Northwestern Nigeria, to inform better immunization and surveillance strategies. Methods: Community-based unmatched case–control study and review of the 2019 pertussis routine surveillance data in the affected settlements in the state were conducted. A total of 52 suspected cases of pertussis and 107 control from two local government areas in Kebbi State were recruited. Data were analyzed using descriptive and inferential statistics. Results: The highest attack rate was observed among between 1- and 4-year age group followed by children less than 1-year old, and the least attack rate was among those above 15 years. The overall attack rate and the case fatality rate were 2.10% and 0.10%, respectively. A higher attack rate was observed among women, whereas the case fatality rate was more among males. From the community survey, we observed that the cases were less likely to have pertussis vaccination history (adjusted odds ratio = 0.28, 95% confidence interval = 0.11–0.74) compared with the controls. Knowing pertussis prevention methods were found protective for pertussis transmission (adjusted odds ratio = 0.14, 95% confidence interval = 0.04–0.45). Conclusion: This study showed the vulnerability of children under 5 years, especially under 1 year, to vaccine-preventable diseases in rural populations, where “real” immunization coverage is sub-optimal, and the dominant socio-demographic factors are supportive of disease transmission. We found immunization and knowledge of the preventive measures to be protective against pertussis outbreaks. Therefore, routine immunization services must be intensified to improve coverage and prevent future pertussis outbreak(s).

Penelitian ini bertujuan mengidentifikasi kekuatan, kelemahan, peluang dan ancaman kemudian menentukan strategi pembelajaran Pendidikan Agama Kristen di PPA IO-0497 Benyamin Oebufu. Penelitian ini menggunakan metode kualitatif dengan pendekatan deskriptif serta analisis data menggunakan analisis SWOT. Langkah-langkah dalam penelitian ini adalah observasi dan studi literatur, identifikasi dan perumusan masalah, pengumpulan data, pengolahan data, pembahasan serta penarikan kesimpuan. Subyek dalam penelitian ini sebanyak 6 orang yang terdiri dari 2 orang badan pengurus dan 4 orang mentor. Hasil penelitian menunjukkan bahwa PPA IO-0497 Benyamin Oebufu memiliki 11 kekuatan, 8 kelemahan, 6 peluang dan 6 ancaman. Hasil matrix space analysis menunjukkan posisi strategi pembelajaran PAK di PPA IO - 0497 Benyamin Oebufu berada dalam wilayah Kuadran I, artinya strategi bertumbuh sangat dimungkinkan karena kekuatan lebih besar dari kelemahan dan peluang lebih besar dari ancaman. Strategi pembelajaran PAK di PPA IO-0497 Benyamin Oebufu adalah integrasi pembelajaran dengan Firman Tuhan, menerapkan pembelajaran Alkitab berbasis teknologi yang kreatif dan menarik, membangun komunitas rohani tumbuh bersama, mengadakan diklat peningkatan kompetensi bagi mentor serta melakukan pastoral konseling bagi anak dan orang tua.

Bu çalışmanın amacı, Proje Tabanlı Öğrenme Yaklaşımının (PTÖY) ortaokul öğrencilerinin yazma becerilerine ve yazma kaygılarına etkisini araştırmaktır. Çalışmanın yöntemi ön test-son test kontrol gruplu yarı deneysel desendir. Araştırma, İstanbul ili Kağıthane ilçesinde bulunan Cengizhan Ortaokulunda 2016-2017 eğitim-öğretim yılında 7. sınıfta öğrenim gören 100 öğrenci üzerinde yürütülmüştür. Deney gruplarında PTÖY’nin aşamaları takip edilirken kontrol gruplarında mevcut Türkçe Dersi Öğretim Programı’nın aşamaları takip edilmiştir. Deneysel çalışma 10 hafta sürmüştür. Verilerin toplanmasında araştırmacılar tarafından geliştirilen Yazılı Anlatım Becerisi Dereceli Puanlama Anahtarı, Yazma Kaygısı Ölçeği, Kişisel Bilgi Formu ve Proje Değerlendirme Ölçeği kullanılmıştır. Araştırma sonucunda, öğrencilerin yazılı anlatım becerisi başarı puanlarının deney grupları lehine anlamlı ve daha yüksek olduğu tespit edilmiştir. Ayrıca deney ve kontrol gruplarındaki öğrencilerinin yazma kaygısı puanlarının deney grupları lehine istatistiksel olarak anlamlı düzeyde değiştiği sonucuna ulaşılmıştır. Bu sonuçlara göre Türkçe derslerinde PTÖY’nin uygulanmasının, öğrencilerin yazma becerisini geliştirmede ve yazma kaygılarının giderilmesinde etkili olduğu söylenebilir.

Otojen iliak kemikle greftlenen atrofik maksillanın 4 implant üstü zirkonyum sabit protezle rekonstrüksiyonu: Olgu sunumuPek çok vakada kemik rezorpsiyonunun fazla olması veya anatomik sınırlar nedeniyle ileri cerrahi uygulamadan implant destekli protezle sabit restorasyon yapmak zor olmaktadır. Bu olgu sunumunun amacı aşırı maksiller alveoler kret kaybı şikayeti olan ve sabit protetik restorasyon isteyen bir hastanın implant destekli sabit zirkon üst yapılı protez ile gerçekleştirilen tedavisini sunmaktır. Kliniğimize sabit protez ihtiyacı ile başvuran sistemik herhangi rahatsızlığı bulunmayan 61 yaşındaki hastanın klinik muayenesinde, maksillada sadece tek dişin olduğu ve mandibulada bilateral posterior dişsizlik olduğu görülmüştür. Genel anestezi altında iliak kemikten alınan kortikokansellöz kemik grefti ile maksillada alveoler kemik augmentasyonu ve bilateral maksiller sinüs greftleme yapıldı. Greft iyileşmesini takiben, maksillaya 4, sağ mandibula posterior bölgeye 2 ve sol mandibuler posterior bölgeye 1 adet olacak şekilde kemikiçi implantlar uygulandı.4 ay sonra maksilla ve mandibuladan alınan ölçüler sonrası zirkonyum üst yapılarla sabit protez uygulandı. Hastanın estetik ve fonksiyonel beklentileri tedavi sonrasında başarılı bir şekilde karşılandı. 1 yıllık takip sonucunda herhangi bir, biyolojik, estetik, fonksiyonel ya da biyomekanik komplikasyon gözlenmedi.

Rapid detection and phenotyping of pathogenic microbes is critical for administration of effective antibiotic therapies and for impeding the spread of antibiotic resistance. Here, we present a novel platform, rapid ultrasensitive detector (RUSD), that utilizes the high reflectance coefficient at high incidence angles when light travels from low- to high-refractive-index media. RUSD leverages a principle that does not require complex manufacturing, labeling, or processing steps. Utilizing RUSD, we can detect extremely low cell densities (optical density [OD] ≥ 5 × 10-7) that correspond to approximately 20 bacterial cells or a single fungal cell in the detection volume, which is nearly 4 orders of magnitude more sensitive than standard OD methods. RUSD can measure minimum inhibitory concentrations (MICs) of commonly used antibiotics against gram-negative and gram-positive bacteria, including Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli, within 2 to 4 h. Here, we demonstrate that antibiotic susceptibility tests for several pathogens can rapidly be performed with RUSD using both small inoculum sizes (500 cells/mL) and larger inoculum sizes (5 × 105 cells/mL) used in standard antibiotic susceptibility tests. We anticipate that the RUSD system will be particularly useful for the cases in which antibiotic susceptibility tests have to be done with a limited number of bacterial cells that are available. Its compatibility with standard antibiotic susceptibility tests, simplicity, and low cost can make RUSD a viable and rapidly deployed diagnostic tool.

In selecting the best mixed integer linear programming (MILP) formulation the important issue is to figure out how to evaluate the performance of each candidate formulation in terms of selected criteria. The main objective of this study is to propose a systematic approach to guide the selection of the best MILP formulation among the alternatives according to the needs of the decision maker. For this reason we consider the problem of “selecting the most appropriate MILP formulation for a certain type of decision maker” as a multi-criteria decision making problem and present an integrated AHP-TOPSIS decision making methodology to select the most appropriate formula­tion. As an example the proposed decision making methodology is implemented on the selection of the MILP formulations of the Capacitated Vehicle Routing Problem (CVRP). A numerical example is provided for illustrative purposes. As a result, the proposed decision model can be a tool for the decision makers (here they are the scientists, engineers and practitioners) who intend to choose the appropriate mathematical model(s) among the alternatives according to their needs on their studies. The integrated AHP-TOPSIS approach can simply be incorporated into a computer-based decision support system since it has simplicity in both computation and application. First published online: 09 May 2017

In this study, the effect of cooling rate on microstructure and mechanical properties of Al-Mg-Si (6063) alloys was investigated. In order to obtain different cooling rate, samples heat treated at 520 oC for 2 h and then cooled in furnace, sand, air, oil and water environments. A decrease in the cooling rate caused the growth of grains and precipitates as the strength of Al-Mg-Si alloys reduced. As a result, Al-Mg-Si alloy was found to change significantly the properties of strength and forming depending on the cooling conditions.

Bu çalışmada, soğuma hızının Al-Mg-Si (6063) alaşımından elde edilen numunelerin mikroyapı ve mekanik özelliklerine etkisi deneysel olarak araştırılmıştır. Farklı soğuma hızı elde edebilmek için numuneler 520 °C’de 2 saat solüsyona alındıktan sonra fırın, kum, hava, yağ ve su ortamlarında soğutulmuşlardır. Soğuma hızının düşmesi tane ve çökeltilerin büyümesine neden olarak Al-Mg-Si alaşımının dayanımını düşürmüştür. Çalışma sonucunda soğuma şartlarına bağlı olarak Al-Mg-Si alaşımının dayanım ve şekillenebilme özelliklerinde belirgin bir değişme olduğu tespit edilmiştir.

Endometriozis, fonksiyonel endometrial dokunun uterin kavite dışında yerleşmesidir. En sık görülen tipi pelvik endometriozis olup, skar endometriozis oldukça nadirdir. Skar endometriozis çoğunlukla jinekolojik ameliyatları sezaryen ya da histerektomi takiben ortaya çıkar. Genellikle karın ön duvarda yerleştiklerinden ayırıcı tanıda mutlaka göz önünde bulundurulmalıdır. Olgularımız se- zaryen öyküleri olan 32, 21 ve 42 yaşlarında kadın hastalardır. Tüm hastaların skar yerlerinin sağında kitle mevcuttu ve boyutları yaklaşık 3 cm, 9 cm ve 1 cm idi. Kitleler endometriozis ön tanısıyla total eksize edildi. Histopatolojik tanıları endometriozis olarak rapor edildi. Biz, bu yazıda total cerrahi eksizyonla başarılı bir şekilde tedavi edilen sezaryen skarındaki üç adet skar endometriozis olgusunu sunduk

The lack of effective and well-tolerated therapies against antibiotic-resistant bacteria is a global public health problem leading to prolonged treatment and increased mortality. To improve the efficacy of existing antibiotic compounds, we introduce a new method for strategically inducing antibiotic hypersensitivity in pathogenic bacteria. Following the systematic verification that the AcrAB-TolC efflux system is one of the major determinants of the intrinsic antibiotic resistance levels in Escherichia coli, we have developed a short antisense oligomer designed to inhibit the expression of acrA and increase antibiotic susceptibility in E. coli. By employing this strategy, we can inhibit E. coli growth using 2- to 40-fold lower antibiotic doses, depending on the antibiotic compound utilized. The sensitizing effect of the antisense oligomer is highly specific to the targeted gene's sequence, which is conserved in several bacterial genera, and the oligomer does not have any detectable toxicity against human cells. Finally, we demonstrate that antisense oligomers improve the efficacy of antibiotic combinations, allowing the combined use of even antagonistic antibiotic pairs that are typically not favored due to their reduced activities.

In this study, a fuzzy multi-response standard ready-mixed concrete (SRMC) optimization problem is addressed. This problem includes two conflicting quality optimization objectives. One of these objectives is to minimize the production cost. The other objective is to assign the optimal parameter set of SRMC’s ingredient to each activity. To solve this problem, a hybrid fuzzy multi-response optimization and artificial neural network (ANN) algorithm is developed. The ANN algorithm is integrated into the multi-response SRMC optimization framework to predict and improve the quality of SRMC. The results show that fuzzy multi-response optimization model is more effective than crisp multi-response optimization model according to final production cost. However, the ANN model also gave more accurate results than the fuzzy model considering the regression analysis results.

Recurrent pyogenic cholangitis is endemic to South-east Asia but has been very rarely reported from natives of other parts of the world. A 43-years-old woman was presented with sepsis that had a history of recurrent epigastric pain and fever attacks. Her liver tests were unremarkable suggesting any hepatobiliary diseases. Recurrent pyogenic cholangitis and congenital extrahepatic biliary anomaly have been diagnosed after serial diagnostic and therapeutic procedures including endoscopic retrograde cholangiography, MR-cholangiography, percutaneous transhepatic cholangiography and finally left hepatectomy. She was cured completely following surgical treatment.

The increased number of mobile phone users has an impact on increasing electronic waste (E-Waste) without being offset by the act of product recovery management. Remanufacturing is one way to overcome this. Remanufacturing is a process to return used products to general aesthetics and operating standards.This paper aims to design a mobile phone remanufacturing process in Indonesia. Indonesia is a developing country where mobile usage is quite high. The mobile phones are chosen because it is one of the biggest e-waste takers of late. Several factories were visited in this study. This research uses a qualitative survey, which is carried out in mobile phone factories and service centers. From this research, a design has been made to remanufacture the process on mobile phones. The manufacturing plant verifies the design to obtain the input of the real constraints which will happen when the remanufacturing process is done. The steps in the process of remanufacturing are human machine interface & visual inspection, separation, disassembly, cleaning, inspection, sorting, reconditioning, reassembly, and final inspection.

Catatonia is a syndrome characterized by mutism, immobility, negativism, stereotypy, mannerisms, echophenomena, perseveration and passive obedience. The underlying causes can be psychiatric or may be associated with general medical status or neurological diseases. Additionally catatonia has two subtypes as malignant and nonmalignant catatonia. Main symptoms of malignant catatonia are hyperthermia and autonomic symptoms such as tachycardia, tachypnea and hyperhidrosis. It is important to make the diagnosis as early as possible for an appropriate medical treatment. Clinicians should be aware of the fatal outcome of the disease.

Ramsay Hunt Sendromu (RHS), fasyal sinir tutulumuna kulak çevresi ve/veya orofarenkste herpetik erüpsiyonların eşlik ettiği bir sendromdur. Fasyal paralizi geç ve sekelli düzelir. 90 yaşında erkek hasta başının sol yarısında saçlı deri, sol kulak aurikulası, çene ve boynu içine alan ağrı akabinde ortaya çıkan veziküller lezyonlar nedeniyle kliniğe kabul edildi. Öykü, klinik, ve laboratur verileri ışığında RHS olarak tanınan olguya intravenöz asiklovir ve steroid sağaltımı uygulandı. Fasiyal paralizinin tedaviye kısa sürede ve tam cevap verdiği gözlendi.

Servikosefalik Fibromusküler displazi çoğunlukla asemptomatiktir. Kadınlarda daha sık olup çoğunlukla rastlantısal olarak otopside ya da anjiyografide tanı konulur. Karotis arterin en sık ekstrakranial karotis arter bölgesinde saptanır. Şuur kaybı, sağ yan güçsüzlüğü yakınması ile kabul edilen, inme ön tanısı ile yatırılan 21 yaşındaki erkek hasta nörogörüntüleme bulguları ışığında servikosefalik fibromusküler displazi olarak tanınmıştır. Nadir görülen servikosefalik Fibromusküler displazin genç inmeli hastalarda inmenin bir nedeni olarak akılda tutulmalı ve ayırıcı tanıda dikkate alınmalıdır.

Ramsay Hunt Syndrome is a rare syndrome with symptoms facial paralysis accompanied by herpetic vesicles in oropharynx and ear side. Recovery from facial paralysis is generally late and with sequel. In the current case, a 90 year old man has been admitted to neurology clinics with symptoms of vesicular lesions in hairy skin, left ear auricula, chin and neck which developed after severe pain. His history, clinical and laboratory findings revealed that he had Ramsay Hunt syndrome which had been treated with intravenous acyclovir and steroid. Facial paralysis quickly responded to the treatment with full recovery. [Cukurova Med J 2013; 38(3.000): 479-481]

The course of cervicocephalic fibromuscular dysplasia is mainly asymptomatic. It is often found as an incidental finding on autopsy or angiography mostly in women and is commonly located in extracranial region of carotid artery. In the present article, we reported a 21 year-old man who has been initially accepted to our intensive care with a tentative diagnosis of cerebrovascular infarct after having symptoms of loss of consciousness and right hemiparesis. He later received a certain diagnosis of fibromuscular dysplasia after neuroimaging findings. This disorder should be considered in differential diagnosis of young stroke patients. [Cukurova Med J 2013; 38(2.000): 305-307]

Bu çalışmada ülkemizde 1987'den beri uygulanmal{ta olan Sürücü J(ursJarı üzerinde d urulmuştur. Çeşitli ülkelerdeki sürücü ehliyeti verme uygulanıalan da göz önünde bulundurularak, Sürücü Kurslarında verilen eğitiın ve bu uygulamanın verimliliği yapılan bir anket çalışması ışığında değerlendirilmeye çahşılmıştrr