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Purpose: The aim of this paper was to investigate the relationship between the physical and subjective (observer) image quality metrics in digital chest radiography. Methods: Five digital radiography systems, four with indirect flat panel detector and one with storage phosphor-based computed radiography system, were used in the study. The physical image quality assessments were carried out using effective detective quantum efficiency (eDQE) metric and subjective performance of the digital radiography systems was evaluated in terms of inverse image quality figure (IQFinv) derived from the contrast-detail (CD) diagrams using CDRAD 2.0 phantom and CDRAD phantom analyzer software. All measurements were performed for different tube voltages (70, 81, 90, 102, 110, and 125 kVp) and polymethyl methacrylate (PMMA) phantom thicknesses. An anthropomorphic chest phantom and visual grading analysis (VGA) technique based on European image quality criteria for chest radiography were used for clinical image quality evaluation. Results: The Spearman correlation coefficients were calculated for the investigation of the correlation between physical image quality and clinical image quality. The results showed strong positive correlation between the physical and clinical image quality findings. The minimum correlation coefficient was 0.91 (p < 0.011) for IQFinv vs VGA scores and 0.92 (p < 0.009) for IeDQE vs VGA scores. Conclusions: Our results confirm that clinical image quality can be predicted with both physical assessments and contrast-detail detectability studies.

Coronavirus disease 2019 (COVID-19) is a contagious infection disease, which may cause respiratory, physical, psycological and generalised systemic dysfunction. The severity of disease ranges from an asymptomatic infection, mild illness, mild or severe pneumonia with respiratory failure, acute respiratory distress syndrome and/or death. COVID-19 affects the pulmonary system crucially. There is a lack of knowledge about the longterm outcomes of the disease and the possible sequeles and rehabilitation, as well. This clinical practice guideline includes pulmonary rehabilitation (PR) recommendations for adult COVID-19 patients and is developed in the light of the guides on the diagnosis and treatment of COVID-19 provided by World Health Organisation and Turkish Republic Ministery of Health, and recently published scientific literature, PR recommendations for COVID-19 regarding basic principles of PR. In this guideline, the contagiousness of COVID-19, recommendations on limited contact of patient with health care providers, and the evidence about possible benefits of PR were taken into consideration., Coronavirus Hastalığı 2019 (COVID-19) solunumsal, fiziksel, psikolojik ve yaygın sistemik işlev bozukluğuna yol açabilen bulaşıcı bir hastalıktır. Hastalığın ciddiyeti asemptomatik enfeksiyondan, hafif hastalık, pnömoni, ciddi pnömoni, akut solunum sıkıntısı sendromu, solunum yetmezliği ve ölüme kadar değişebilmektedir. COVID-19 solunum sistemi önemli şekilde etkilenmektedir. Hastalığın uzun dönem sonuçları ve muhtemel sekellerine ilişkin yeterli bilgi olmadığı gibi, rehabilitasyonu konusunda da henüz kanıt yoktur. Bu klinik uygulama rehberi erişkin COVID-19 hastaları için pulmoner rehabilitasyon önerileri içermektedir ve Dünya Sağlık Örgütü ile T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü tarafından hazırlanan COVID-19 tanı ve tedavi rehberleri, yakın zamanlı bilimsel yayınlar, uzman görüşü olarak yayınlanan COVID-19 için pulmoner rehabilitasyon önerileri ışığında ve pulmoner rehabilitasyonun temel prensipleri doğrultusunda hazırlanmıştır Bu öneriler geliştirilirken, COVID-19’un bulaşıcılığı, sınırlı sayıda personelin hasta ile teması ilkeleri ile pulmoner rehabilitasyonun sağlayacağı yararların düzeyi göz önünde bulundurulmuştur.

B-mode ultrasound is an essential part of radiological examinations due to its low cost, safety, and portability, but has the drawbacks of the speckle noise and output of most systems is two-dimensional (2D) cross sections. Image restoration techniques, using mathematical models for image degradation and noise, can be used to boost resolution (deconvolution) as well as to reduce the speckle. In this study, new single-image Bayesian restoration (BR) and multi-image super-resolution restoration (BSRR) methods are proposed for in-plane B-mode ultrasound images. The spatially correlated nature of the speckle was modeled, allowing for examination of two different models for BR and BSRR for uncorrelated Gaussian (BR-UG, BSRR-UG) and correlated Gaussian (BR-CG, BSRR-CG). The performances of these models were compared with common image restoration methods (Wiener filter, bilateral filtering, and anisotropic diffusion). Well-recognized metrics (peak signal-to-noise ratio, contrast-to-noise ratio, and normalized information density) were used for algorithm free-parameter estimation and objective evaluations. The methods were tested using superficial tissue (2D scan data collected from volunteers, tissue-mimicking resolutions, and breast phantoms). Improvement in image quality was assessed by experts using visual grading analysis. In general, BSRR-CG performed better than all other methods. A potential downside of BSRR-CG is increased computation time, which can be addressed by the use of high-performance graphics processing units (GPUs)., Scientific and Technological Research Council of Turkey (TUBITAK)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [2211-C]

Background . Platelet to lymphocyte ratio (PLR) has been demonstrated as a risk and prognostic marker in many of cardiovascular diseases. A relationship between PLR and severity of carotid stenosis has been shown. The aim of our study was to investigate the relationship between PLR and all cause mortality in patients with carotid arterial disease. Methods . This retrospective study included 146 patients who had been performed selective carotid angiography. Carotid stenosis were graded by the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. Platelet to lymphocyte ratio was calculated as the ratio of platelets to lymphocytes. The end point of the study was all-cause mortality. Results . During median follow-up of 16 months (0-65 months) 15 (10.3%) patients suffered all-cause mortality. 50 patients (34.2%) underwent carotid endarterectomy and 69 patients (47.3%) had non-carotid cardiac surgery. 38 patients (26.02%) had cerebrovascular events (stroke/transient ischemic attack) at admission. NASCET grades were not different between survivors and non-survivors. Non-survivors had significantly lower hemoglobin (Hb) levels (12.7 ± 1.6 g/dL vs. 13.7 ± 1.7 g/dL, p = 0.031) and they were older than survivors (74.2 ± 8.4 years vs. 68.6 ± 8.5 years, p = 0.029). Non-survivors had significantly higher PLR values compared with survivors (190.3 ± 85.6 and 126.8 ± 53.8, p = 0.017). In multivariate analysis, only PLR predicted all-cause mortality in patients with carotid artery stenosis. Conclusion . In our study, higher PLR was associated with increased all-cause mortality.

Introduction: Congenital afibrinogenemia is a rare autosomal recessive disorder characterized by bleeding that varies from mild to severe and by complete absence or extremely low levels of plasma and platelet fibrinogen. Hypofibrinogenemia is characterized by fibrinogen levels Objective: In this study, we analyzed fibrinogen beta chain gene mutations in Turkish afibrinogenemia and hypofibrinogenemia patients. Methods: We evaluated 20 afibrinogenemia and hypofibrinogenemia patients and 80 healthy controls. We have sequenced all exons of the FGB gene using the DNA isolated from the peripheral blood samples of patients and controls. Results and Conclusion: We found a nonsense mutation in exon 4 at nucleotide 630 that encoded serine amino acid, and in the same exon a missense mutation of T to C at nucleotide 647, resulting in a transition from leucine to proline (p.L198P) in a child with hypofibrinogenemia. These mutations have been shown for the first time in the same patient of Turkish descent. Furthermore, there was a novel heterozygous guanine-to-adenine nucleotide change in exon 3. This caused the change of arginine amino acid to threonine amino acid at position 136 (p.A136T) in a protein, which has not been described in the literature before.

Objective Fibrinogen-to-albumin ratio (FAR) is an inexpensive and easily measurable novel inflammatory index that has been found to be associated with atherosclerosis. In this study, we aimed to investigate the association between the FAR and coronary artery disease (CAD) severity in patients with stable CAD. Methods In total, 356 consecutive patients with CAD were classified into three groups, those with a low Synergy between percutaneous coronary intervention and the Taxus and Cardiac Surgery Study (SYNTAX) score (?22), those with an intermediate SYNTAX score (23? SYNTAX score ?32) and those with a high SYNTAX score (>32). Results We determined that there were significant differences in the mean age (P < 0.001), male gender (P = 0.008), serum fibrinogen (P = 0.03), low-density lipoprotein cholesterol (P < 0.001) and FAR (P < 0.001) among the SYNTAX score groups. A strong positive correlation was detected between FAR and SYNTAX score (r = 0.899; P < 0.001), and the cutoff level of FAR for high SYNTAX score was 82 (sensitivity of 82%, specificity of 88.3% and an area under the curve of 0.826). Conclusion The novel inflammatory index, FAR, is significantly associated with the severity of CAD in patients with stable CAD.

Inflammatory bowel disease (IBD) is often diagnosed during the child-bearing years and 25% of women get pregnant for their first child after their IBD diagnosis. IBD disease can have significant effects on pregnancy in terms of adverse outcomes for mother and fetus. To achieve a healthy pregnancy, IBD patients have to be in remission before conception and need to continue their maintenance IBD treatment during pregnancy (except thalidomid and metothrexate). There is increasing evidence that anti-TNF used in the management of patients with IBD are safe with minimal risks in pregnancy. There is no recommendation in current IBD guidelines about biologic therapies other than anti-TNFs (vedolizumab, ustekinumab and tofacitinib)., İnflamatuvar bağırsak hastalığı (İBH) tanısı sıklıkla doğurganlık çağında konmaktadır, hatta kadın hastaların %25'i ilk gebeliğini İBH tanısı aldıktan sonra yaşamaktadır. İBH'nin anne ve fetüs advers olayları anlamında gebelik üzerinde ciddi etkileri bulunmaktadır. Sağlıklı bir gebelik yaşayabilmek için İBH'li hastalar konsepsiyon öncesi remisyonda olmalı ve gebelikleri boyunca idame tedavilerini (talidomid ve metotreksat hariç) kesmeden sürdürmelidirler. Antitümör nekrozis faktör (anti-TNF) ilaçların gebelikte minimum risk taşıdıkları ve güvenle kullanılabileceklerine dair kanıtlar artmaktadır. Anti- TNF dışı biyolojik ajanların (vedolizumab, ustekinumab ve tofasitinib).gebelikte kullanımı ile ilgili güncel İBH kılavuzlarında herhangi bir öneri bulunmamaktadır.

We read with great interest the paper on ‘A report of Hb Fontainebleau [α21 (B2) Ala > Pro] as a result of founder effect Phenomenon’ that appeared in a recent issue of the journal with great interest by Jalalia et al. However, although they discussed extensively the data on the very rare hemoglobin variant Fontainebleau (a 21(B2) Ala-Pro), they did not mention the existence of this variant in Turkish population.

Lower-extremity peripheral artery disease (LEAD) is associated with increased rates of mortality and morbidity. The aim of this study was to evaluate the associations among inflammatory and thrombotic markers and lower-extremity peripheral disease. A total of 280 patients were enrolled in this study. Of these patients, 152 patients had LEAD on peripheral angiography that was performed because of suspected lower-extremity peripheral disease based on history, physical examination, and non-invasive tests. The control group consisted of 128 patients without LEAD on peripheral angiography. Patients with LEAD were classified according to trans-atlantic inter-society consensus (TASC) II classification. Subsequently, patients in TASC A to B were defined as having mild to moderate peripheral artery disease, and those in TASC C to D were defined as having advanced peripheral artery disease. Thrombotic and inflammatory markers, such as the neutrophil-to-lymphocyte ratio (NLR), the high-sensitivity C (hs-C) reactive protein level, the monocyte-to-high-density lipoprotein-cholesterol ratio, the fibrinogen to albumin ratio (FAR), and whole-blood viscosity at high shear rate (HSR) and low shear rate (LSR), were evaluated in this population. The NLR, the monocyte-to-high-density lipoprotein-cholesterol ratio, the FAR, and whole-blood viscosity, both at a LSR and a HSR, were significantly higher in patients with lower-extremity peripheral disease compared with patients without lower-extremity peripheral disease. We determined that lower-extremity peripheral disease severity was correlated with the NLR, monocyte-to-high-density lipoprotein-cholesterol ratio, FAR, whole-blood viscosity at LSR, and whole-blood viscosity at HSR (r = 0.719, P =.004; r = 0.25, P =.008; r = 0.691, P =.002; r = 0.546, P

Objective: Left ventricular (LV) hypertrophy predisposes the myocardium to ischemia through several mechanisms. The LV mass index (LVMI) is used as a readily available and reliable measurement of LV hypertrophy. The LVMI can also be used to evaluate LV remodeling. The hypothesis of this study was that LV hypertrophy might augment coronary collateralization in patients with chronic total occlusion (CTO) and the aim was to research any association between LVMI and collateral formation in CTO. As a secondary goal, specific LV geometric types that might be associated with collateral presence were also investigated. Methods: A total of 305 patients with CTO were included and categorized into 4 groups based on Rentrop grade. Results: The LVMI demonstrated an incremental linear trend as the Rentrop grade increased. In the receiver operating characteristic curve, the likelihood that a cut-off value of 100.1 g/m2 would accurately differentiate patients with collaterals from those without collaterals was 75.8%, with 68.5% sensitivity and 68.6% specificity. A 1 gram/m2 increase in LVMI was associated with a 7.5% greater likelihood of collateral development. In addition, compared with normal geometry, the presence of eccentric hypertrophy was associated with 6.7 times higher odds of the presence of coronary collaterals. Conclusion: The results of this study indicated that a greater LVMI predicted coronary collateral presence. Furthermore, having an eccentric geometric type of hypertrophy increased the likelihood of coronary collaterals more than other geometries. This finding signified that in addition to LV wall thickness, the type of hypertrophy was also decisive in predicting collateral presence., Amaç: Sol ventrikül hipertrofisi, çeşitli mekanizmalar aracılığıyla miyokardı iskemiye yatkınlaştırır. Sol ventrikül kitle indeksi (SVKİ), sol ventrikül hipertrofisinin kolayca elde edilebilen ve güvenilir bir ölçümü olarak kullanılmaktadır. Ayrıca, sol ventrikül yeniden şekillenmesi bu parametre ile kategorize edilebilir. Bu çalışmada, kronik tam tıkanmalı (KTO) hastalarda sol ventrikül hipertrofisinin koroner kollateralizasyonu artırabileceği hipotezinde bulunduk ve SVKİ ile KTO’daki kollateral gelişimi arasındaki ilişkiyi araştırmayı amaçladık. İkincil hedef olarak, hangi spesifik sol ventrikül geometrik tipinin kollateral varlığı ile ilişkili olabileceğini belirlemeyi amaçladık. Yöntemler: Kronik tam tıkanmalı saptanan 305 hastayı dahil ettik ve dört Rentrop Grade grubuna sınıflandırdık. Bulgular: Sol ventrikül kitle indeksi, artan Rentrop gruplarına doğru doğrusal bir artış gösterdi. ROC eğrisinde, SVKİ için 100.1 g/m2 ’lik bir kestirim değerinin, kollateralleri bulunan hastaları bulunmayanlardan %68.5 duyarlılık ve %68.6 özgüllük ile doğru bir şekilde ayırdetme ihtimali %75.8’di. SVKİ’nİn bir gram/m2 ’lik artışı, %7.5’lik artmış kollateral gelişme olasılığı ile ilişkiliydi. Normal geometriye kıyasla, eksantrik hipertrofi varlığı 6.7 kat daha fazla koroner kollateral varlığı ihtimali ile ilişkiliydi. Sonuç: Bu çalışmada KTO’lu hastalarda artmış SVKİ’nın koroner kollateral varlığnı öngördürdüğünü gösterdik. Ayrıca, geometrik tipte bir eksantrik hipertrofi geometrisine sahip olmak koroner kollateralleri diğer geometrilere göre daha fazla artırmaktadır. Bu bulgu, sol ventrikül duvar kalınlığının yanı sıra, hipertrofi tipinin de, kollateral varlığını öngörmede belirleyici olduğunu göstermektedir.

Background: Spontaneous adverse drug reaction (ADR) reports prepared by healthcare professionals (HCPs) are the backbone of collecting post-marketing safety data. However, underreporting is a global problem creating health, economic, and ethical burden. Objectives: To determine the factors limiting ADR reporting rates from the HCPs' point of view. Methods: A questionnaire containing 43 questions evaluating sociodemographic characteristics, pharmacovigilance knowledge and activities, and prescription behaviors was prepared on "surveymonkey.com." The link was distributed mainly by professional organizations. Results: Although this survey aimed to reach all HCPs, most of the respondents were physicians and nurses. Of the 259 (69.6%) participants who encountered ADR at least once, only 105 (40.5%) reported ADR. The term "pharmacovigilance" was heard for the first time in this survey by 35.5% (n = 132) of the participants. Only 34.7% (n = 129) of the participants knew where to find the ADR reporting form, and 25.5% (n = 95) had previously filled the form and/or read it. Only 28.5% (n = 106) of the participants were aware of the ADR reporting and monitoring system of their institutions and related professionals. Almost all the participants agreed that pharmacovigilance and ADR reporting training are necessary. Conclusion: The main reason for underreporting is limited pharmacovigilance knowledge of HCPs. Training activities based on the needs and preferences of HCPs and close follow-up by authorities are the main steps to improve pharmacovigilance activities.

The aim of this study was to compare sleep problems among adolescents who attempted suicide and healthy adolescents who never attempted suicide. Adolescents who attempted suicide (study group, n = 103) and healthy adolescents (control group, n = 59) completed a questionnaire prepared by researchers including demographic factors. In addition, the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) were administered to both groups. The median age was 16 years and 73% were girls, in both groups. The study group had lower rate of attending to school (88.3% vs. 100%; p = 0.001), academic achievement (45.7% vs. 83.1%; p = 0.001), higher rate of smoking (37.9% vs. 13.8%; p = 0.001), socializing problems (31.1% vs. 3.4%; p = 0.001), and appetite changes (57.3% vs. 39.7%; p = 0.032) than controls. The rate of those with PSQI scores 6 or higher was 53.4% in the attempted suicide group and 37.3% in the control group (p = 0.048). Adolescents, classified as sleepy according to the ESS, did not differ significantly between the groups (p = 0.214). Adolescents who attempted suicide had poor sleep quality. It is crucial to examine the kinds of sleep problems adolescents who have attempted suicide have experienced. Among adolescents attending outpatient clinics with poor sleep quality, PSQI can be a useful screening tool. Those with high scores should be evaluated for suicide risk.

Objectives There is substantial evidence that the majority of cases of lower extremity peripheral artery disease are undetected. As a result, there is great interest in the detection of lower extremity peripheral artery disease through routine screening. However, routine screening of lower extremity peripheral artery disease is still debated. Methods In our cross-sectional study, we included 200 consecutive patients with symptoms suggestive of angina who were undergoing coronary angiography. Irrespective of intermittent claudication, we subsequently performed peripheral angiography to detect lower extremity peripheral artery disease. The predictors of lower extremity peripheral artery disease were analyzed, and the diagnostic utility of these predictors and their combinations were determined. Additionally, the determinants of the amount of radio-opaque material used and peripheral fluoroscopy time were investigated. Results The overall prevalence of lower extremity peripheral disease was 16%. Being older than 65 years, having coronary artery disease and smoking history remained significant predictors after adjusting for other well-known parameters. Having the combination of age ≥65 and smoking was associated with a positive predictive value of 50% (likelihood ratio 5.06), and having all of the predictors was associated with a positive predictive value of 100% (likelihood ratio >1000). Conclusions Routine screening for lower extremity peripheral disease patients undergoing coronary angiography may be useful in selected patients.

Aim: Since vitamin D deficiency is a growing problem worldwide, insufficient levels of vitamin D were reported in patients with spinal cord injury (SCI). It was stated that levels of vitamin D may be an indirect indicator of functional status in patients with SCI. The aim of this study was to investigate the relationship between vitamin D levels and mobilization, functionality, grip strength, and pulmonary function test parameters in patients with subacute SCI.Methods: Fifty-eight patients with subacute motor complete thoracic (T) and lumbar SCI injuries [46 males, 12 females; mean age 32.0 (11.2) years] were included. The time to complete the verticalization program on the tilt table without any orthostatic symptoms was considered as the ‘time of mobilization.’ Grip strength (GS) was measured using a dynamometer, pulmonary function test (PFT) parameters were measured using a spirometer, and functional status was measured using the Functional Independence Measure (FIM). For determining the levels of vitamin D, 25-hydroxy-vitamin D [25(OH)D] was measured and levels below 20 ng/mL were considered as deficiency. The patients were divided into two groups according to 25(OH)D levels, Amaç: D vitamini eksikliği dünya çapında büyüyen bir problem olduğundan, omurilik yaralanmalı (OY) hastalarda da yetersiz D vitamini seviyeleri bildirilmiştir. D vitamini düzeylerinin, OY hastalarda fonksiyonel durumun dolaylı bir göstergesi olabileceği belirtilmiştir. Bu çalışmanın amacı, subakut dönemdeki OY hastalarda D vitamini düzeyleri ile mobilizasyon, fonksiyonel durum, el kavrama gücü ve solunum fonksiyon testi (SFT) parametreleri arasındaki ilişkiyi araştırmaktır.Yöntemler: Subakut motor komplet torakal (T) ve lomber OY 58 hasta [46 erkek, 12 kadın; yaş ortalaması 32.0 (11.2) yıl] çalışmaya dahil edildi. Herhangi bir ortostatik semptom olmadan tilt masası ile vertikalizasyon programını tamamlama süresi “mobilizasyon zamanı” olarak değerlendirildi. El kavrama gücü dinamometre ile, SFT spirometre ile, fonksiyonel durum ise Fonksiyonel Bağımsızlık Ölçeği (FBÖ) ile değerlendirildi. D vitamini düzeylerini belirlemek için 25-hidroksi-vitamin D [25(OH)D] ölçümü yapıldı ve 20ng/mL’nin altındaki değerler eksiklik olarak değerlendirildi. Hastalar 25(OH)D seviyeleri

Amaç: Folat metabolik yolağı nükleotid sentezi ve DNA metilasyonu için gerekli olduğundan lösemi gelişimde önemli rol oynamaktadır. Folat eksikliği, DNA kırıklarına sebep olmaktadır. Bu yüzden folatla ilişkili polimorfizmler, çocukluk çağı akut lenfoblastik lösemisine (ALL) neden olabilmektedir. MTHFR (Metilentetrahidrofolat Redüktaz), DHFR (Dehidrofolat Redüktaz), CBS (Sistationin Beta Sentaz), TYMS (Timidilat Sentaz) ve RFC (Reduces Factor Carrier-1) bulunan değişimler, folat seviyesi ve DNA sentezini etkilediğinden dolayı, folat yolağında önemli role sahiptirler. Bu çalışmadaki amacımız, folat metabolik yolağı ile ilişkili olan RFC ve MTHFR genlerdeki polimorfizimlerin çocukluk çağı lösemisi üzerinde etkisi olup olmadığını araştırmaktır. Gereçler ve Yöntem: Çalışmaya Lösante Çocuk ve Yetişkin hastanesinde 103 akut lenfoblastik lösemi tanısı almış çocuk hasta dâhil edildi. RFC geni G80A ve MTHFR geni polimorfizmleri genotipleme işlemi RFLP (Restriction Fragment Length Polymorphism) ve Real Time PCR yöntemleri ile gerçekleştirildi. Bulgular: Genotip ve allel frekanslarının sonuçlarına göre, hasta ve kontrol grubu arasında herhangi bir istatistiksel farklılık görülmemiştir. RFC G80A ve MTHFR polimorfizmleri birlikteliği, ANOVA testi ile yapılan analiz sonucu istatistiksel olarak anlamlı bulunamamıştır (p> 0,05). Sonuç: Çalışmamız, Türk çocukluk çağı ALL hastalarında, RFC ve MTHFR polimorfizmlerle lösemi patogenezi arasındaki ilişkiyi tanımlayan ve frekansını tespit eden ilk tarama sonuçları olmasından dolayı önemlidir., Objective: Folate metabolic pathway plays a significant role in leukemogenesis because of its necessity for nucleotide synthesis and DNA methylation. Folate deficiency causes DNA damage. Thus polymorphisms of folate-related genes may affect the susceptibility to childhood Acute Lymphoblastic Leukemia (ALL). MTHFR (Methylenetetrahydrofolate Reductase), DHFR (Dihydrofolate reductase), CBS (Cystathionine ?-synthase), TYMS (Thymidylate Synthase) and RFC have an important role in folate pathway because of their activated variants modulate synthesis of DNA and levels of folate. In this study, we aimed to investigate whether polymorphisms in genes related to folate metabolic pathway influence the risk to childhood ALL. Materials and Method: The patient groups who were diagnosed with 103 childhood ALL at Losante Children and adult Hospital were included to the study. RFC G80A and MTHFR genotyping was performed by RFLP (Restriction Fragment Length Polymorphism) analysis and Real Time-PCR. Results: No statistical difference was observed among the patient and control group according to results of genotype and allele frequencies. The association of RFC G80A and MTHFR polymorphisms was not statistically significantly. Conclusion: Our study displays also importance because of the first screening results to identify association with the RFC and MTHFR polymorphisms in Turkish patients with childhood ALL and determination of the frequency in Turkish population.

Background: Tetranucleotide Short Tandem Repeats (STRs) for human identification and common use in forensic cases have recently been used to address the population genetics of the North-Eastern Mediterranean area. However, to gain confidence in the inferences made using STRs, this kind of analysis should be challenged with changes in three main aspects of the data, i.e. the sizes of the samples, their distance across space and the genetic background from which they are drawn.Aim: To test the resilience of the gradients previously detected in the North-Eastern Mediterranean to the enlargement of the surveyed area and population set, using revised data.Subjects and methods: STR genotype profiles were obtained from a publicly available database (PopAffilietor databank) and a dataset was assembled including >7000 subjects from the Arabian Peninsula to Scandinavia, genotyped at eight loci. Spatial principal component analysis (sPCA) was applied and the frequency maps of the nine alleles which contributed most strongly to sPC1 were examined in detail.Results: By far the greatest part of diversity was summarised by a single spatial principal component (sPC1), oriented along a SouthEast-to-NorthWest axis. The alleles with the top 5% squared loadings were TH01(9.3), D19S433(14), TH01(6), D19S433(15.2), FGA(20), FGA(24), D3S1358(14), FGA(21) and D2S1338(19). These results confirm a clinal pattern over the whole range for at least four loci (TH01, D19S433, FGA, D3S1358).Conclusions: Four of the eight STR loci (or even alleles) considered here can reproducibly capture continental arrangements of diversity. This would, in principle, allow for the exploitation of forensic data to clarify important aspects in the formation of local gene pools., Italian Ministry of Justice [CUP E81J10001270005]

Introduction Transcranial magnetic stimulation (TMS) is a noninvasive technique for investigating cortical physiologic functions in the brain. In this study, the effects of continuous theta burst stimulation (cTBS) on motor evoked potential (MEP) parameters in patients with idiopathic generalized epilepsy (IGE) were investigated. Materials and methods Fifteen patients with IGE were included. Motor threshold (MT) and cortical silent period (CSP) were determined before cTBS application. Next, cTBS was applied to the dominant (left) hemisphere M1 hand area as the first application. After 1 day, cTBS was applied first to the left M1 hand area and then to the right lateral cerebellar area as the second application. Parameters were again determined after the applications. Results There was no difference in resting MT values before and after cTBS application (p > 0.05). Although CSP increased after stimulation (p < 0.05), it was not significantly different between applications (p > 0.05). Conclusion For patients with epilepsy, cTBS is a safe technique when applied at a low intensity. The inhibitory effect of cTBS, a noninvasive technique, on cortical excitability in patients with IGE was determined using MEP parameters. The effect lasted at least 1 h. To our knowledge, this is the first study to assess the effect of cTBS on cortical excitability in patients with IGE. Our findings indicate that cTBS decreases cortical excitability in patients with IGE.

Objective: Ankaferd hemostat (Ankaferd Blood Stopper®, ABS)- induced pharmacological modulation of essential erythroid proteins can cause vital erythroid aggregation via acting on fibrinogen gamma. Topical endoscopic ABS application is effective in the controlling of gastrointestinal (GI) system hemorrhages and/or infected GI wounds. Escherichia coli O157:H7, the predominant serotype of enterohemorrhagic E. coli, is a cause of both outbreaks and sporadic cases of hemorrhagic colitis. The aim of this study is to examine the effects of ABS on 6 different Shiga toxigenic E. coli serotypes including O26, O103, O104, O111, O145, and O157 and on other pathogens significant in foodborne diseases, such as Salmonella Typhimurium, Campylobacter jejuni, and Listeria monocytogenes, were also assessed. Materials and Methods: All strains were applied with different amounts of ABS and antimicrobial effect was screened. S. Typhimurium groups were screened for survival using the fluorescence in situ hybridization technique. Results: The relative efficacy of ABS solutions to achieve significant logarithmic reduction in foodborne pathogens E. coli O157:H7 and non-O157 serogroups and other emerging foodborne pathogens is demonstrated in this study. ABS has antibacterial effects. Conclusion: Our present study indicated for the first time that ABS may act against E. coli O157:H7, which is a cause of thrombotic thrombocytopenic purpura, hemolytic-uremic syndrome, and hemorrhagic colitis. The interrelationships between colitis, infection, and hemostasis within the context of ABS application should be further investigated in future studies., Amaç: Ankaferd hemostat (Ankaferd Blood Stopper®, ABS) gamma fibrinojene etki ederek eritroid agregasyonuna neden olan farmakolojik modülasyondur. Topikal endoskopik ABS uygulaması gastrointestinal (Gİ) kanamalarda ve enfekte Gİ yaralarında etkili olmaktadır. Escherichia coli O157:H7, en sık karşılaşılan enterohemorajik Escherichia coli tipi olup sporadik veya salgınlar şeklinde hemorajik kolitin önemli bir etkenidir. Bu çalışmanın amacı ABS ile 6 farklı Shiga Toksijenik Escherichia coli serotipi (O26, O103, O104, O111, O145 ve O157) ve diğer önemli gıda kaynaklı patojenlerden Salmonella, Campylobacter ve Listeria monocytogenes üzerine etkisi değerlendirilmiştir. Gereç ve Yöntemler: Tüm patojenler hazırlanarak ABS’nin farklı miktarları uygulanmış ve antimikrobiyel etki izlenmiştir. Salmonella canlılığı floresan in situ hibridizasyon tekniği ile izlenmiştir. Bulgular: ABS uygulamalarının sadece Escherichia coli O157 ve nonO157’ler üzerine değil aynı zamanda diğer patojenlerde de logaritmik azalma tetiklediği izlenmiştir. Bu çalışmada ABS ile farklı patojenler üzerine antibakteriyel etki gözlemlenmiştir. Sonuç: Bu çalışma özellikle trombositopenik purpura, hemolitik üremik sendrom ve hemorajik kolit yönünden önemli Escherichia coli O157:H7’nin üzerine ABS’nin antimikrobiyel etkisi olduğunu belirleyen ilk çalışmadır. ABS uygulamalarının kolitis, enfeksiyon ve hemostaz ilişkisi daha ileri seviyede araştırılmalıdır.

[No abstract available]

[No abstract available]

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Artificial intelligence (AI) is increasingly being used in life sciences. While decreasing the time and cost to bring a new drug to market, AI will increase the efficacy, safety and accuracy of the new drug. The cost of clinical research will decrease and in turn, this will positively affect health economics. AI is being used in designing clinical trials, selecting study population, monitoring effectiveness and safety, data collection, and analysis. Use of personal data, handling the incidental findings, and informing the patients that will benefit from these findings, are some of the issues that AI use needs proper regulation and ethical approach. Moreover, limited access of vulnerable populations to technology may cause limited access of this population to the advantages of precision medicine that is highly evolved by AI, and increase inequalities profoundly. In conclusion, AI applications brings many problems that must be handled and regulated meticulously., Yapay zekâ (YZ) hayatın tüm alanında olduğu gibi, gün geçtikçe artan hız ve kapsamda sağlık bilimlerinde de uygulanmaktadır. YZ doğru aday molekülünün hızlı, güvenli ve etkili biçimde hastaya ulaşma sürecini hızlandıracağı gibi, klinik araştırma harcamalarını da azaltacak, dolaylı olarak bu sağlık ekonomisine de yansıyacaktır. YZ, klinik araştırma tasarımı, doğru araştırma popülasyonunun seçimi, ilaç etkililik ve güvenliliğinin izlenmesi, veri toplama ve analizi gibi araştırmanın birçok basamağında kullanılmaya başlanmıştır. Fakat, bu hızlı gelişmeye yasal ve etik düzenlemeler aynı hızda ayak uyduramamaktadır. Hasta veya sağlıklı gönüllülerin kişisel verilerinin kullanımı, bu veriler kullanılarak elde edilecek tesadüfi bilgilerin bundan faydalanacak kişilere ulaştırılmasının ve bu bilgiye göre tedavi ve/veya koruyucu hekimlik uygulamalarının nasıl değişeceği başlıca sorunlardır. Dezavantajlı grupların özellikle teknolojik erişimlerin kısıtlı olması nedeniyle YZ'nın kişiselleştirilmiş tıp alanında sağladığı gelişmelerden faydalanamamasına ve eşitsizliklerinin derinleşmesine neden olabilir. Sonuç olarak, klinik araştırmalarda YZ kullanımı her aşamada titizlikle ele alınması ve düzenlenmesi gereken çok sayıda sorunu barındırmaktadır.

[No abstract available]

[No abstract available]

Superficial Musculo-Aponeurotic System (SMAS) is a network of collagen fibers, elastic fibers and fat interconnecting facial muscles and dermis. Subcutaneous morphology of face is more organized than subcutaneous layer of any part of body. SMAS has distinctive features in forehead, parotid region, zygomatic region, temporal region, cheek, infraorbital region, nasolabial fold, and lower lip. Because SMAS is a key feature for either percutaneous and surgical aesthetic interventions, neurovascular structure embedded in this tissue must be well known. Radiologic views were enrolled from the archive system of radiology department. Images of 50 patients were randomly selected. (29 ale, 21 female). Age width of the participants was in between 18 and 78 years (mean age 40.34± 15.32). Thickness of SMAS for each region is measured. Continuity of the tissue was followed between the junctions of the regions in a proper sequence with MR images. Thickness of SMAS in the zygomatic region was measured in 50 patients and mean value was 0.12 mm. Left and right side measures were compared between genders and no statistical difference between gender groups was found. Correlation between measures and age was analyzed statistically and no correlation was found. A radiologically and clinically neglected tissue: SMAS deserves more attention because of its continuous course interconnecting distinct regions of face and acting as a functional unit for the expressions. Age and gender related changes in SMAS morphology studied in healthy individuals by means of radiology provides an important contribution to the literature.

[No abstract available]

Background: Hematuria is an important and common sign of urinary system diseases in children. Careful assessment is needed for definitive diagnosis and appropriate management. In this study we aimed to investigate the demographic and clinical characteristics of patients who were admitted to our pediatric nephrology clinic with hematuria and to determine the features that will guide the diagnosis. Methods: Medical charts of 370 patients who were referred to our clinic in a period of four years with gross or microscopic hematuria were evaluated retrospectively. Demographical data, clinical and laboratory findings, imaging modalities and diagnosis of the patients were investigated. Findings: Of the patients 195 (52.7 %) were boys and 175 (47.3%) were girls and the majority of the patients were in the age group of 6-10 years. Major presenting feature was red colored urine (64.1 %). Non-glomerular causes were found to be significantly higher among patients with macroscopic hematuria (p=0.002). Acute poststreptococcal glomerulonephritis formed the majority of glomerular hematuria and urinary system infections formed the majority of non-glomerular hematuria causes respectively. Conclusions: This study suggests that a careful history, detailed physical examination and clinical evaluation may elucidate the etiology in the majority of the patients with hematuria. Advanced imaging modalities and renal biopsy are indicated only in selected cases., Amaç: Hematüri çocuklarda üriner sistem hastalıklarının önemli bir bulgusudur. Altta yatan ciddi hastalıkların belirtisi olabileceğinden ayırıcı tanı için dikkatli bir değerlendirme ve iyi bir klinik yaklaşım gerektirmektedir. Bu çalışmada pediatrik nefroloji kliniğimize hematüri nedeni ile başvuran hastaların demografik ve klinik özelliklerinin incelenmesi ve tanıya yol gösterecek özelliklerin belirlenmesi amaçlandı. Hastalar ve Yöntem: Bu çalışma, kliniğimizde makroskopik ve/veya mikroskopik hematüri nedeniyle izlenmiş olan 370 hastanın dosyası retrospektif olarak değerlendirilerek gerçekleştirildi. Hastaların demografik verileri,l aboratuar sonuçları ve klinik bulguları, görüntüleme tetkikleri ve nihai tanıları araştırıldı. Bulgular: Hastaların 195’i (%52.7) erkek, 175 (%47.7)’si kızdı ve çoğunluğu 6-10 yaş grubunda yer almaktaydı. Hastaların 234 ‘ü (%63.2) makroskopik hematüri ile başvururken , 44’ünde (%15.3) glomerüler hematüri saptandı. Makroskopik hematüri grubunda non-glomerular nedenler anlamlı olarak yüksek bulundu. Glomerüler hematüri nedenleri arasında ülkemizde halen yaygın olarak saptanan akut poststreptokokkal glomerülonefrit (APSGN), non glomerüler nedenlerden de üriner sistem enfeksiyonu en yüksek oranda görülen hastalıkları oluşturmaktaydı. Tartışma: Bu çalışma dikkatli bir öykü, ayrıntılı fizik muayene ve klinik değerlendirme ile hematüri ile başvuran hastaların büyük çoğunluğunda etiyolojinin aydınlatılabileceğini göstermektedir. İleri görüntüleme tetkikleri ve renal biyopsi sadece seçilmiş vakalarda endikedir.

Artificial intelligence (AI) is being used in determining new drug candidate molecules, new targets, personalization of the treatment, increasing the compliance, and monitoring efficacy and safety of treatments. By AI, it is possible to ensure the medication is taken and reached the target tissue and treatment success and compliance increases, especially in chronic diseases. Moreover, AI applications can determine the advers effects of high-risk treatments such as opioid analgesics at a very early stage. However, AI algorithms mostly depend on an extended analysis of both personal and population data, and the success of these algorithms increases with the increasing number of datum that can be handled. Thus, it is essential to consider ethical aspects of the handling of, rights to use, and sharing the personal data and to bring legislative regulations for the use of AI in health sciences promptly., Yapay zekânın (YZ) ilaç adayı molekülün ve yeni tedavi hedeflerinin belirlenmesinden, tedavinin bireyselleştirilmesine, ilaç tedavisine uyuncun artırılmasından, etkililik ve güvenliliğin takibine kadar çok farklı alanlarda kullanılmaktadır. İlaçların 'akıllı' hale getirilmesi ile alındığının ve hedef dokuya ulaştığının garantilenmesi, giyilebilir biyosensörler ile yaşamsal bulguların takibi, tüberküloz ve kronik diğer hastalıklar gibi uzun süre tedavi gerektiren durumlarda tedavi başarı şansını artırmakta, depresyon gibi hastalıklarda hastanın yüz ifadesi, sosyal davranışları gibi parametrelerle tedavi uyuncu değerlendirilmekte veya opioid analjezikler gibi yüksek riskli tedavilerde advers etkiler erken dönemlerde saptanabilmektedir. Bu uygulamalarda hastanın kapsamlı tıbbi ve diğer bireysel verilerinin ele alınması ile birlikte o tedavinin hedef kitlesine ait veriler de değerlendirilir. Veri sayısı arttıkça YZ'nın kullandığı algoritmaların başarı şansı ve keskinliği artar. Dolayısı ile kişisel verilerin ele alınması ve kullanım hakları, paylaşımı gibi alanlar başta olmak üzere, YZ'nın kullanıldığı sağlık hizmetleri ve ilaç tedavisine erişimde eşitsizlik yaratabilecek durumların etik ve yasal olarak düzenlenmesine yönelik adımlar hızla atılmalıdır.

Coronavirus disease 2019 (COVID-19) is a contagious infection disease, which may cause respiratory, physical, psychological, and generalized systemic dysfunction. The severity of disease ranges from an asymptomatic infection or mild illness to mild or severe pneumonia with respiratory failure and/or death. COVID-19 dramatically affects the pulmonary system. There is a lack of knowledge about the long-term outcomes of the disease and the possible sequelae and rehabilitation. This clinical practice guideline includes pulmonary rehabilitation (PR) recommendations for adult COVID-19 patients and has been developed in the light of the guidelines on the diagnosis and treatment of COVID-19 provided by the World Health Organization and Republic of Turkey, Ministry of Health, recently published scientific literature, and PR recommendations for COVID-19 regarding basic principles of PR. In this guideline, the contagiousness of COVID-19, recommendations on limited contact of patient with healthcare providers, and the evidence about possible benefits of PR were taken into consideration., NA

[No abstract available]

[Abstract Not Available]

Blood group types are associated with coronary artery disease. However, data are scarce about the impact of blood group types on coronary collateral circulation. In this study, we aimed to investigate the relationship between the blood group types and coronary collateral circulation. Two hundred and twelve patients who underwent coronary angiography in our department and had a stenosis of ≥ 90% in at least one major epicardial vessel were included in our study. Collateral degree was graded according to Rentrop-Cohen classification. After grading, patients were divided into poor coronary collateral circulation (Rentrop grade 0 and 1) and good coronary collateral circulation (Rentrop 2 and 3) groups. The ABO blood type of all participants was determined. The incidence rates of O blood group type were significantly higher in the good coronary collateral group compared to the poor collateral group (37.9% vs 17.1%, P < .001). The O type blood group was an independent predictor of good coronary collateral circulation (odds ratio = 1.83, 95% confidence interval = 1.56-6.18, P = .015). Coronary collateral circulation is associated with blood group types. The O blood group predicts good coronary collateral development among patients with coronary artery disease.

In this article, we present a case of a 47-year-old male patient presenting with an insidious onset of hip pain and loss of range of motion. The patient was initially treated conservatively to no avail. Detailed investigations included magnetic resonance imaging of the left hip which revealed a synovitis. Blood results were unremarkable apart from moderately raised inflammatory markers. Differential diagnoses of both intra- and extra-articular hip pain were ruled out and the patient treated for a preliminary diagnosis of psoriatic arthritis for a total of six months. Persistent pain resulted in a re-visit of the diagnosis and further clinical evaluation. This time, an X-ray of the hip revealed calcification at the joint. A computed tomography followed and revealed synovial thickening and intra-articular calcification. A biopsy was consistent with primary synovial chondromatosis (SC). Open synovectomy was performed approximately one year after the onset of symptoms. This case emphasizes the importance of re-visiting initial evaluations and diagnoses when faced with a difficult case of persistent hip pain so to avoid misdiagnosis and unnecessary pharmacological treatment. In view of its rarity and diagnostic challenges, future work on SC should concentrate on gathering data which can be used to produce a diagnostic algorithm.

[No abstract available]

Summary: Background: Written informed consent forms (ICFs) are important for ensuring that physicians disclose core information to patients to help them autonomously decide about treatment and for providing substantial evidence for the surgeon in case of a legal dispute. This paper aims to assess the legal and ethical appropriateness and sufficiency of the contents of ICFs designed for several elective surgical procedures currently in use in Turkish hospitals. Methods: One hundred and twenty-six forms were randomly selected and were analyzed for 22 criteria. The results were compared using the Fisher’ exact test, and 95% confidence intervals were calculated. Results: More than 80% of ICFs contained information about the risks of the proposed treatment, the diagnosis of the patient, and the patient's voluntariness/willingness, as well as a designated space for the signatures of the patient and the physician and a description of the proposed treatment. Some ICFs were designed for obtaining blanket consent for using patients' specimens. Conclusions: The ICFs for general elective surgery contain many deficiencies regarding disclosure of information, and there is significant variation among primary healthcare providers. Unrealistic expectations regarding the surgery or the post-operative recovery period due to insufficient information disclosure may lead patients, who experience post-surgical inconveniences, to file lawsuits against their surgeons. Although all ICFs, regardless of their institution, are generally insufficient for defending hospital administrations or surgeons during a lawsuit, ICFs of private hospitals might be considered better equipped for the situation than those of state or university hospitals. However, further research is needed to show if private hospitals have lower lawsuit rates or better lawsuit outcomes than state or university hospitals in Turkey. Keywords: Informed consent, General surgery, Malpractice, Medical ethics

[No abstract available]

[No abstract available]

Background/Aims: The aim of the present study was to analyze the diagnostic accuracy of serum eosinophilic cationic protein (ECP) for eosinophilic esophagitis (EoE) and the correlation of ECP with clinical, histopathological, laboratory, and endoscopic features of EoE. Materials and Methods: Fifteen patients with EoE and 14 healthy controls were included in the study. Demographic parameters were recorded. EoE Endoscopic Reference Score (EREFS) was calculated according to endoscopic features, and esophageal biopsies were obtained by a single experienced endoscopist in a patient group. Serum ECP levels (mu g/mL), absolute eosinophil count (U/mm(3)), and maximum peak of eosinophils/high-power field in esophageal biopsies were analyzed. Results: The median age of all participants was 33.0 (min-max: 18-46) years. There were 27 (93.1%) male patients. Serum ECP level was significantly higher in patients with EoE than in healthy volunteers (20.4 vs. 8.8, p

Aim: Shoulder pain and disability is a complication that can be seen frequently after implantable cardioverter defibrillator (ICD) implantation. The aims of this study were to determine the causes of shoulder problems and related factors in patients with ICD implantation and to investigate the effects of shoulder problems on quality of life and psychological status. Material and Methods: A total of ninety-four consecutive patients (average age 59.38±10.75 years) who admitted to ICD follow up clinic were included in the study. Patients who had shoulder problems were referred to our physical therapy and rehabilitation outpatient clinic for further evaluation. The Shoulder Pain and Disability Index (SPADI), Short Form-36 (SF-36) and The Hospital Anxiety and Depression Scale (HADS) were used as the clinical assessment scales. Results: Thirty-nine (41.5%) patients had shoulder complaints. The patients were divided into two groups according to presence of shoulder problem. The statistical analysis revealed no significant differences between the groups in terms of the socio-demographic and clinical characteristics. None of these characteristics was demonstrated as a risk factor for the development of shoulder problem (p>0.05). There were significantly lower SF-36 subgroup scores and higher HADS depression and anxiety scores in patients with shoulder complaints. The SPADI scores also showed significant correlations with shoulder pain VAS score, several subgroups of SF-36 and HADS scores (p

Periodic fever syndromes are generally autoinflammatory diseases. Autoinflammatory diseases are disorders of the innate immune system and characterized by unprovoked and uncontrolled inflammation. This review focuses on pathogenesis, clinical properties, diagnosis and treatments of these ilnesses, which include periodic fever, aphthous stomatitis, pharyngitis and adenitis (PFAPA); tumor necrosis factor receptor-associated periodic syndrome (TRAPS); Mevalonate kinase deficiency/Hyperimmunglobulin D syndrome (MKD/HIDS); cryopyrin-associated periodic syndrome (CAPS). Although it is not an autoinflammatory disease, cyclic hematopoiesis (CH) will also be included in this review since it is one of the causes of periodic fever., Tekrarlayan ateş sendromları, genellikle inflamasyonun sınırlandırılmasındaki bozukluklar nedeniyle ortaya çıkan otoinflamatuar hastalıklardır. Otoinflamatuar hastalıklar, doğal immun sistemin bozukluklarıdır ve herhangi bir uyarı olmaksızın oluşan inflamasyonun kontrölsüz şekilde devam etmesi ile karakterizedir. Bu derlemede, tekrarlayan ateş ile seyreden otoimmun hastalıklardan periyodik ateş, aftöz stomatit, farenjit ve servikal lenfadenit sendromu (PFAPA); Tümör nekrozis faktor reseptor ilişkili periyodik sendrom (TRAPS); Mevalonat kinaz eksikliği/Hiperimmunglobulin D sendromu (MKD/HIDS); kriyopirin ilişkili periyodik sendromlar (CAPS) ile otoinflamatuar bir hastalık olmamasına rağmen tekrarlayan ateş tablosuyla seyreden siklik hematopoez (CH) 'in patogenezi, klinik özellikleri, tanı ve tedavi yaklaşımları gözden geçirilecektir.

Objective: Natriuretic peptide levels at initial presentation and especially discharge levels have been identified as powerful predictors for long term outcomes in patients with decompensated heart failure. However, changes in natriuretic peptides levels during therapy in predicting clinical outcomes remains to be established. The aim of this study was to evaluate whether changes in natriuretic peptide levels in response to heart failure therapy with inotropic support in patients hospitalized with acute decompensated heart failure may have a role in predicting long-term outcomes. Material and Method: The study population consisted of 44 patients hospitalized for the management of decompensated heart failure with NYHA class IV, left ventricular ejection fraction, Amaç: Akut kalp yetersizliği ile hastaneye kabul edilen olgularda gerek hastaneye kabul sırasındaki gerekse tedavi sonrası hastaneden çıkış dönemindeki natriüretik peptid düzeylerinin prognozun güçlü öngördürücüsü olduğu bilinmektedir. Ancak tedaviye alınan nörohormonal yanıtın bir göstergesi olan natriüretik peptid düzeylerindeki azalma oranının prognostik önemi açık değildir. Bu çalışmanın amacı, akut dekompanse kalp yetersizliği olgularında pozitif inotropik desteği de içeren kalp yetersizliği tedavisi ile natriüretik peptid düzeylerinde sağlanan değişimin uzun dönem prognostik rolünü değerlendirmekti. Gereç ve Yöntem: Akut dekompanse kalp yetersizliği kliniği ile hastaneye yatışı yapılan, fonksiyonel kapasitesi NYHA III-IV, sol ventrikül ejeksiyon fraksiyonu 0,05). Ölen olguların hastaneye kabulündeki NT-proBNP düzeyleri, yaşayan olgulara göre hem tüm grupta (sırasıyla 25.905±3.251 ve 11.684±2.022 pg/mL, p

Familial Mediterranean fever (FMF) is a hereditary autoinflammatory disorder characterized by recurrent attacks of fever and serosal inflammation. It occurs most frequently in the East Mediterranean region. It is generally an autosomal recessive disease and develops due to the mutations in the MEFV gene. It has self-limiting attacks with abrupt onset lasting for 12-72 hours. The main symptom is fever and usually accompanied by abdominal pain, joint manifestations, chest pain and erysipelas-like skin rash. The diagnosis relies on mainly clinical findings and molecular analysis of MEFV gene provides genetic confirmation. The most important complication of the disease is amyloidosis type AA that is the main cause of mortality and morbidity though its frequency decreased due to the therapeutical advances. The main drug of treatment in FMF is colchicine. Anti IL-1 treatment was shown to be effective in a few patients that are resistant to colchicine. The prognosis of FMF is very good in compliant patients providing a high quality of life., Ailesel Akdeniz ateşi (AAA) tekrarlayan ateş ve serözit ataklarıyla karakterize herediter, otoinflamatuar bir hastalıktır. Daha çok doğu Akdeniz kökenli toplumlarda görülen AAA genellikle otozomal resessif kalıtılmakta ve MEFV (MEditerranean FeVer) genindeki mutasyonlar sonucu gelişmektedir. Ataklar genellikle ani başlar, 12-72 saat sürer ve kendiliğinden geçer. Ateş hastalığın en önemli bulgusudur ve beraberinde sıklıkla karın ağrısı, eklem bulguları, göğüs ağrısı ve erizipel benzeri döküntüler görülebilir. Tanı esas olarak klinik bulgularla konulur ve MEFV geninin moleküler analizi ile genetik olarak doğrulanır. En ciddi komplikasyonu önemli bir mortalite ve morbidite nedeni olan tip AA amiloidoz olup tedavideki geişmeler nedeniyle görülme sıklığı çok azalmıştır. Tedavide ilk başlanacak en etkin ilaç kolşisindir. Kolşisine dirençli çok az sayıdaki hastada ise anti IL-1 ilaçların fayda sağladığı gösterilmiştir. Tedaviye uyumlu hastalarda prognoz çok iyidir ve genellikle yaşam kalitesi yüksek, normal bir yaşam sürerler.

Background: Left ventricular aneurysm (LVA) is an important complication of acute myocardial infarction. In this study, we investigated the role of N-Terminal pro B type natriuretic peptide level to predict the LVA development after acute STsegment elevation myocardial infarction (STEMI). Methods: We prospectively enrolled 1519 consecutive patients with STEMI. Patients were divided into two groups according to LVA development within the six months after index myocardial infarction. Patients with or without LVAs were examined to determine if a significant relationship existed between the baseline N-Terminal pro B type natriuretic peptide values and clinical characteristics. A p-value < 0.05 was considered statistically significant. Results: LVA was detected in 157 patients (10.3%). The baseline N-Terminal pro-B type natriuretic peptide level was significantly higher in patients who developed LVA after acute MI (523.5 +/- 231.1 pg/mL vs. 192.3 +/- 176.6 pg/mL, respectively, p < 0.001). Independent predictors of LVA formation after acute myocardial infarction was age > 65 y, smoking, Killip class > 2, previous coronary artery bypass graft, post-myocardial infarction heart failure, left ventricular ejection fraction < 50%, failure of reperfusion, no-reflow phenomenon, peak troponin I and CK-MB and NT-pro BNP > 400 pg/mL at admission. Conclusions: Our findings indicate that plasma N-Terminal pro B type natriuretic peptide level at admission among other variables provides valuable predictive information regarding the development of LVA after acute STEMI.

[No abstract availeble]

Objective: The aim of our study was to compare plasma vitamin D levels between patients with breast cancer-related lymphedema (BCRL) and healthy population, and also to investigate the effects of socio-demographic and clinical factors and lymphedema severity on vitamin D levels. Materials and Methods: Eighty patients with BCRL [mean age 55.5±8.9 (36-81)] and age- and sex-matched 80 healthy controls [mean age 53.7±7.4 (32-70)] who were not on calcium or vitamin D supplementation were included in the study. Socio-demographic and clinical characteristics of the subjects were questioned. Plasma 25-Hydroxyvitamin D3, calcium, phosphorus, alkaline phosphatase (ALP), and parathormone (PTH) levels were evaluated. Lymphedema was classified as stage 0, I, II, or III. Results: The mean duration of lymphedema was 23.5±13.8 months. Comparisons revealed lower vitamin D levels and higher PTH and ALP levels in patients with BCRL than healthy controls. As a result of multivariate regression analysis, a significant relationship was revealed between vitamin D levels and age, breast cancer stage, and disease duration in patients with BCRL. Vitamin D levels were significantly lower and PTH levels were significantly higher in stage 3 lymphedema patients compared to stage 1. Conclusion: Vitamin D levels were detected lower in patients with lymphedema than healthy controls. Although vitamin D levels were found to be lower in patients with severe lymphedema, the multivariate regression analysis revealed that the severity of lymphedema does not have a significant effect on vitamin D levels., Amaç: Çalışmamızın amacı meme kanseri ile ilişkili lenfödem (MKİL) ve sağlıklı popülasyondaki hastalarda plazma D vitamini düzeylerini karşılaştırmak ayrıca sosyo-demografik ve klinik faktörlerin ve lenfödem şiddetinin D vitamini düzeylerine etkilerini tespit etmekti. Gereç ve Yöntem: MKİL’li 80 hasta [yaş ortalaması 55,5±8,9 (36-81)] ve kalsiyum ya da Vitamin D tedavisi altında olmayan 80 yaş ve cinsiyet uyumlu sağlıklı kontrol [yaş ortalaması 53,7±7,4 (32-70)] çalışmaya alındı. Olguların sosyo-demografik ve klinik özellikleri sorgulandı. Plazma 25-Hydroxyvitamin D3, kalsiyum, fosfor, alkalen fosfataz (ALP), parathormon (PTH) düzeyleri değerlendirildi. Lenfödem evre 0, I, II veya III olarak sınıflandırıldı. Bulgular: Ortalama lenfödem süresi 23,5±13,8 aydı. MKİL’li hastalarda sağlıklı kontrollere oranla daha düşük D vitamini düzeyleri ve daha yüksek PTH ve ALP düzeyleri saptandı. Çok değişkenli regresyon analizi sonucunda, MKİL hastalarında D vitamini düzeyleri ile yaş, meme kanseri evresi ve hastalık süresi arasında anlamlı bir ilişki olduğu ortaya çıkarıldı. Evre 3 lenfödem hastalarında, evre 1’e kıyasla D vitamini düzeyi daha düşük ve PTH düzeyi anlamlı olarak daha yüksekti. Sonuç: D vitamini düzeyleri lenfödemli hastalarda sağlıklı kontrollere oranla daha düşük saptanmıştır. Şiddetli lenfödemi olan hastalarda D vitamini düzeylerinin daha düşük saptanmasına rağmen, çok değişkenli regresyon analizi lenfödem şiddetinin D vitamini düzeyleri üzerinde anlamlı bir etkisi olmadığını ortaya koymuştur.

Fever is body temperature which is above the normal circadian rhythm. It's a biological response as secondary to the infection that occurs through the central nervous system to defend the body. Although fever is often associated with self-limiting viral infections in children, it may be a sign of life-threatening serious infections, so pediatricians worry as well as parents. It is important that the physician should have enough knowledge about the approach and the management of the fever as well as the the parents. For this reason, we have discussed the pathogenesis of pediatric fever as well as its management., Ateş, vücut ısısının olması gereken sirkandiyen ritim aralığının üstünde seyretmesi olup genellikle enfeksiyona sekonder olarak vücüdu savunmaya yönelik santral sinir sistemi aracılığılıyla oluşan biyolojik bir cevaptır. Çocuklarda sıklıkla kendini sınırlayan viral enfeksiyonların, bazen de yaşamı tehdit edebilen ciddi enfeksiyonların bir bulgusu olabileceği için ebeveynler kadar çocuk hekimlerini de endişelendirebilmektedir. Bu nedenle ebeveynlerin aydınlatılması'nın yanı sıra hekimin de ateşe yaklaşım ve ateşin yönetimi konusunda yeterince bilgiye sahip olması önemlidir. Bu nedenle pediatride ateş'i patogenezi yanısıra yönetimi ile de ele aldık.

Underreporting of adverse drug reactions (ADRs) is a global problem and the main reasons for not reporting ADRs are either failure to recognize an ADR or failure to report the recognized ADR, which can be prevented by efficient education and training. Thus, the content on pharmacovigilance and related subjects in the curricula of the medical schools was evaluated. The web pages of the 63 Turkish medical schools that provided online curricula were evaluated for the following subjects: pharmacovigilance, toxicology, rational pharmacotherapy, drug use in special populations, good prescription writing principles, and clinical pharmacology stage. The number of hours dedicated to these subjects and the year of the course during which these subjects were taught were recorded. Of the 63 medical schools, 41 (65.1%) provide pharmacovigilance course and 33 (52.4%) rational pharmacotherapy course for 0.5-2 hours, mostly during the 3rd year of education. Thirty of the medical schools (47.6%) had clinical pharmacology and rational pharmacotherapy stage covering personal-drug selection, and clinical pharmacology of organ-systems was mostly a five-day course during the 4th or 5th years of education. The time allocated for pharmacovigilance and related subjects in the curricula of medical schools is not sufficient for the students to acquire satisfactory knowledge on ADR and to influence their attitudes as physicians in the future. In order to improve this, more time and effort must be allocated by medical schools to pharmacovigilance and rational pharmacotherapy education, particularly during the later years of medical education., Advers ilaç reaksiyonlarının (AİR) yeterince bildirilmemesi küresel bir sorundur ve bildirmemenin temel nedenleri AİR'lerin fark edilmemesi veya fark edilse bile bildirilmemesidir. Bu durumun üstesinden ancak yeterli eğitim ile gelinebilir. Tıp fakülteleri ders programlarında farmakovijilans ve ilgili konuların varlığı bu nedenle değerlendirildi. Türkiye'de bulunan tıp fakültelerinin 63'ü web sayfalarında ayrıntılı ders programlarını paylaşmaktadır. Bu ders programları şu konuların varlığı açısından incelenmiştir: farmakovijilans, toksikoloji, akılcı farmakoterapi, özel popülasyonlarda ilaç kullanımı, iyi reçete yazma kuralları, klinik farmakoloji stajı. Bu konuların hangi sınıfta öğretildiği ve ne kadar süre ayrıldığı kaydedilmiştir. İncelenen 63 tıp fakültesinden 41'i (%65,1) farmakovijilans dersini ve 33'ü (%52,4) akılcı farmakoterapi dersini 0,5-2 saat süre ile ve genellikle 3. sınıfta sunmaktadır. Otuz (%47,6) okul genellikle 4 veya 5. sınıfta beş iş günü süren klinik farmakoloji ve akılcı farmakoterapi stajı vermektedir ve bu staj sırasında kişisel ilaç seçimi, organsisteme özgü ilaçların klinik farmakolojisi gibi konular kapsanmaktadır. Tıp fakülteleri eğitim programında farmakovijilans ve ilgili konulara ayrılan süre tıp öğrencisinin AİR ile ilgili tatmin edici düzeyde bilgi sahibi olması ve gelecekteki doktorlar olarak gerekli davranışı edinebilmeleri için yeterli değildir. Bu durumu düzeltmek için tıp eğitiminde farmakovijilans ve akılcı farmakoterapiye daha fazla zaman ve emek, özellikle tıp eğitiminin son yıllarında verilmelidir.

[No abstract available]

Deficiencies of Vitamin D (VitD) has been associated with coronary heart disease, hypertension and left ventricular hypertropy. However its effects on cardiac conduction system and atrial fibrillation (AF) predisposition have not been studied yet. In this study we aim to evaluate the effects of VitD on invasive electrophysiologic parameters and AF inducibility. Materials and Methods: This retrospective crosssectional study included 135 patients. Study population was divided into three group as VitD sufficient, VitD insufficient and VitD deficient according to baseline vitD levels. Patients’ invasive electrophysiologic parameters and induced AF episodes were recorded. Results: Corrected sinus node recovery time, baseline cycle length, atrial-His interval, His-ventricular interval and Wenckebach cycle length were lengthened in vitD deficient group but they didn’t reach statistical significance. The rate of AF inducibility was twice as likely in VitD deficient group than sufficient group, however, it also didn’t reach statistical significance. Conclusion: Baseline VitD levels were not associated with cardiac electrophysiologic parameters and AF inducibility. To demonstrate the role of VitD in cardiac conduction system and AF inducibility thoroughly, further studies such as addressing VitD replacement are warranted., Amaç: Vitamin D (vit D) eksikliği, koroner kalp hastalığı, hipertansiyon ve sol ventrikül hipertrofisi ile ilişkili bulunmuştur. Ancak kardiyak iletim sistemi ve atriyal fibrilasyon (AF) yatkınlığına etkisi henüz araştırılmamıştır. Bu çalışmada, VitD'nin invaziv elektrofizyolojik parametreler ve AF indüklenebilirliği üzerindeki etkilerini değerlendirmeyi amaçladık. Gereç ve Yöntem: Bu retrospektif kesitsel çalışma 135 hastayı içermektedir. Çalışma popülasyonu, temel vitD düzeylerine göre VitD yeterli, VitD yetersiz ve VitD eksikliği olmak üzere üç gruba ayrıldı. Hastaların invaziv elektrofizyolojik parametreleri ve uyarılan AF epizodları kaydedildi. Bulgular: Düzeltilmiş sinüs nodu iyileşme zamanı, bazal döngü uzunluğu, atriyal-His aralığı, His-ventriküler aralık ve Wenckebach siklus uzunluğu, vitD eksikliği olan grupta uzamış, ancak istatistiksel olarak anlamlı bulunmamıştır. AF indüklenebilirlik oranı, VitD eksikliği olan grupta, yeterli gruba göre iki kat daha fazlaydı., ancak istatistiksel olarak anlamlı değildi. Sonuç: Bazal VitD seviyeleri kardiyak elektrofizyolojik parametreler ve AF indüklenebilirliği ile ilişkili değildi. VitD'nin kardiyak iletim sistemindeki rolünü ve AF'nin indüklenebilirliğini tam olarak göstermek için VitD replasmanını da içeren daha ileri çalışmalar gereklidir.