Search

Turizmin nispeten yeni bir alt dalı olan arkeoturizm, son zamanlarda miras turizmine dönük artan ilgide önemli bir rol oynamaktadır. Dünyanın farklı bölgelerindeki kritik miras alanları, ev sahibi ülkelerde birçok kişi için iş fırsatı yaratmanın yanı sıra bu ülkelere büyük ekonomik girdi sağlayıcılar haline gelmiştir. Ancak, aynı şey Paleolitik Çağ'dan bu yana antik kültürlerin kesintisiz izlerini barındıran devasa bir alan olarak benzersiz olmasına rağmen, Anadolu (Asia Minor) için geçerli değildir. Uygun bir arkeoturizm planlaması ve çevre yönetimi, Türkiye’nin genel refahına katkıda bulunan, bölgenin kültürel, ekonomik ve bütüncül gelişiminin anahtarı olacaktır., Archaeotourism, a relatively new sub-branch, has played significant roles in the recently growing interest in heritage tourism. Critical heritage areas in different parts of the world have become great economic contributors to their host countries, generat-ing job opportunity for many. However, the same thing is not valid for Asia Minor alt-hough it is unique as a huge area to host continual traces of ancient cultures from the Palaeolithic Age. A proper archaeotourism planning and environment management can be the key to cultural, economic and integrational development of the region, contrib-uting to the overall wellbeing of Turkey.

Genotype distribution of hepatitis C virus (HCV) can vary over the years between different patient groups and regions. The prevalence of intravenous drug users (IVDU) is known to increase in our country, yet there are a limited number of studies investigating the distribution of HCV genotypes in this group. These data are essential for monitorization of the changes in HCV epidemiology. The present study aimed to evaluate the five-year results of HCV genotyping among patients infected with HCV related to IVDU and unrelated to drug use. Plasma samples of 720 patients (HCV antibody, HCV RNA positive), which were sent to our laboratory for HCV genotyping between January 2014-March 2019 were analyzed. HCV RNA extraction from plasma samples was performed in the automated-extraction system of EZ1 advanced (Qiagen, Germany) using the EZ1 virus mini kit v2.0 (Qiagen, Germany). Amplicons were obtained by amplifying the 5’NCR and core gene region in the Rotorgene 6000 real-time PCR (Qiagen, Germany) device with the HCV RNA real-time quantitative 2.0 (NLM, Italy) kit. For the genotyping, a commercial line probe assay (LIPA) based on in vitro reverse hybridization GEN-C2.0 kit (NLM, Italy) which can distinguish 1, 2, 3, 4, 6 genotypes and 1a, 1b, 2a/c, 2b, 3a, 3b, 3c, 3k, 4a, 4b, 4c/d, 4e, 4f, 4h, 5a, 6a/b, 6g, 6f/q, 6m, 7a subtypes of HCV, based on variations in the 5’-NCR and core regions was used. HCV genotype distribution of 266 IVDU (93.2%: male; median age: 25 ± 6.82) and 454 non-drug users (51.3%: male; median age: 56.5 ± 16.06) were examined. In order of frequency in the group with IVDU; genotype 1a, 3a, 1b, 4c/d, 2b, 4, 3 were observed and genotype 1, 2a/c and mixed genotype (1+3a) were detected in one patient. In the group without IVDU, in order of frequency; genotype 1b, 1a, 3a, 1, 2a/c, 4 were observed and genotype 2b, 4c/d, 5a, 6a/b, 6 and mixed genotype (3+4) were detected in one patient. Genotypes 1a and 3a were significantly higher in the IVDU group (p< 0.00001, p< 0.00001), while 1b was significantly higher in patients without IVDU (p< 0.00001). Genotypes 1a and 3a were more common in young men (p< 0.00001, p= 0.000163), while 1b was higher in middleaged women (p< 0.00001). The incidence of genotypes 1b (p= 0.021) and 3a (p= 0.012) was higher in foreign nationals than the Turkish patients. When the HCV genotype distribution was examined by years, it was observed that the percentages of genotype 1b and 1a were decreasing, while the percentage of genotype 3a was increasing. As a result, in this study, HCV genotype distribution among IVDU was observed to be different from the general population without IVDU. It was found that genotypes 1a and 3a were more common in the IVDU group. As in the other regions of our country, genotype 1b was found most frequently in the general population. Genotype 3a increases significantly compared to years. In our study, the determination of genotypes existing in different parts of the world may be due to the foreign nationals living in our city and our region is a tourism center. It is also necessary to investigate whether there is an increase in IVDU over the years.

Hyponatremia is a potentially dangerous side effect of antidepressants. Almost every antidepressant can cause hyponatremia. Duloxetine-induced hyponatremia is a side effect that is usually seen in older women. In addition to advanced age and female sex; low body weight, presence of comorbid diseases are other important risk factors for the development of hyponatremia. In this case report we present a patient with depressive disorder who developed hyponatremia with duloxetine treatment which resolved immediately after the cessation of the medication with supportive electrolyte treatment. In our case, the resolution of hyponatremia with supportive electrolyte treatment in addition to the cessation of duloxetine reminds us about the importance of monitoring sodium levels both before and after antidepressant treatment in geriatric populations., Hiponatremi, antidepresanların potansiyel olarak tehlikeli bir yan etkisidir. Hemen hemen her antidepresan hiponatremiye neden olabilir. Duloksetin kaynaklı hiponatremi genellikle yaşlı kadınlarda görülen bir yan etkidir. İleri yaş ve kadın cinsiyetine ek olarak; düşük vücut ağırlığı, komorbid hastalıkların varlığı hiponatremi gelişimi için diğer önemli risk faktörleridir. Bu olgu sunumunda, ilacın kesilmesinden hemen sonra düzelen duloksetin tedavisi ile hiponatremi gelişen depresif bozukluğu olan bir hasta sunulmaktadır. Bizim olgumuzda, duloksetin kesilmesine ek olarak, hiponatreminin destekleyici elektrolit tedavisi ile çözülmesi bize geriatrik popülasyonlarda antidepresan tedavisinden önce ve sonra sodyum seviyelerinin izlenmesinin önemini hatırlatmaktadır.

Objective: To investigate the sociodemographic and clinical characteristics of patients admitted to an addiction center.Methods: The medical files of 4990 patients were analyzed retrospectively.Res...

ObjectiveThe aim of this study is to seek evidence for the validity and reliability of the Childbirth Trauma Index Scale, originally developed by Anderson for adolescents, among women in 18–45 age group.MethodTwo hundred twenty women who were in the postpartum period until 72 hours after birth were included in the study. In the study, the Impact of Events Scale was used to test the criterion validity of the Childbirth Trauma Index Scale, being adapted to Turkish.ResultsThe goodness of fit values obtained by the first level CFA (χ2 (19, N = 220) 91.75; p < .01; χ2/SD = 4.82; CMIN = 91.75; RMSEA = 0.132; CFI = .90; GFI = .90) shows that the proposed two-factor model is acceptable in accordance with the data.ConclusionBirth Trauma Index is recommended to be used as a data collection tool in postpartum clinics and primary health care services by health personnel in order to detect postpartum birth trauma.

Yeni koronavirüs hastalığı (COVID-19) pandemisi Aralık 2019'dan bu yana tüm dünyayı etkilemektedir. Pandemi sürecinde sağlık çalışanları COVID-19 ile mücadelede en önde savaşmaktadır ve birçok sağlık çalışanı bu mücadele sırasında hayatını kaybetmiştir. Pandeminin ön saflarında yer alan sağlık çalışanları bu dönemde yoğun ruhsal ve fiziksel stres altındadır. Pandemi dönemlerinde genel popülasyonda ve özellikle sağlık çalışanlarında psikiyatrik belirtiler ve hastalıklar artmaktadır. Özellikle tükenmişlik, depresyon ve anksiyete belirtileri önemli ölçüde artar. Bu olgu sunumunda, COVID-19 pandemisi sırasında semptomları başlayan, intihar düşüncelerinin eşlik ettiği depresyonu olan ve elektrokonvülsif terapi ile tam remisyona giren bir hekim sunulmaktadır. COVID-19 pandemisinin sağlık çalışanlarının ruh sağlığı üzerindeki etkileri bu olgu sunumu çerçevesinde tartışılmaktadır., Novel coronavirus disease (COVID-19) pandemic has been affecting the whole world since December 2019. During the pandemic, healthcare professionals are at the forefront of the fight against COVID-19, and many healthcare workers died during this fight. Healthcare workers, who are at the forefront of the pandemic, are under intense mental and physical stress along this period. This disease makes increase psychiatric symptoms for general population and especially in health professionals at pandemic conditions. In particular, the symptoms of burnout, depression, and anxiety have rised significantly. With this case report, we present a physician who had symptoms that started during the COVID-19 pandemic, had depression accompanied by suicidal thoughts, and went into complete remission with electroconvulsive therapy. The mental health effects of healthcare workers who have had COVID-19 are discussed within the frame of this case report.

Objective We aimed to compare the effectiveness of extended-release naltrexone (XR-NTX) implant and sublingual buprenorphine-naloxone (BUP-NX) in relapse prevention in opiate use disorder (OUD). Methods Medical records of 400 patients who were treated for OUD between 2016 and 2020 were retrospectively evaluated concerning sociodemographic and clinical characteristics and abstinence duration with either BUP-NX (192 patients) or XR-NTX (208 patients) as maintenance treatments. Results The median age of patients using BUP-NX was 25.00, and the median age of patients using XR-NTX was 25.50 (p = .785). The ratio of female patients in the BUP-NX group and the XR-NTX group was 7.3% (n = 14) and 6.7% (n = 14), respectively. A significantly higher abstinence time was observed in the BUP-NX group (median = 4 months) than in the XR-NTX group (median = 3 months) (p = .015). Liver function tests were within the normal ranges at the three time points, which were just before the beginning and in the first and third months of treatment. Conclusions These findings suggest that BUP-NX might be more effective than XR-NTX in preventing relapse in OUD and both drugs are safe for the liver. Prospective randomized studies are needed to replicate our results.

Ketiapin yaygın kullanılan, baş dönmesi, sedasyon ve metabolik yan etkiler gibi birçok yaygın yan etkisi olan bir antipsikotik ilaçtır. Bunlara ek olarak, ilacın bazı nadir yan etkileri de mevcuttur. Bunlar arasında ilaca bağlı interstisyel akciğer hastalığı (drug-induced interstitial lung disease, DI-ILD) çok az bilinmektedir. Bu olgu sunumunda ketiapin kullanımının akciğer yan etkilerini tartışmayı amaçladık. Elli dört yaşında erkek bir şizofreni hastasında ketiapin kullanımını takiben ortaya çıkan, nadir görülen bir yan etki olan interstisyel akciğer hastalığı olgusu sunulmaktadır. Olgumuzda, ketiapin tedavisinin başlamasından sonra ortaya çıkan ve ketiapin kesildikten sonra gerileyen akciğer bulguları nedeniyle DI-ILD düşünülmüştür. Klinisyenler, ketiapin kullanımının bir sonucu olarak ortaya çıkabilecek DI-ILD gibi nadir akciğer yan etkileri konusunda dikkatli olmalıdır.

Objectives: Idiopathic Parkinson's Disease (IPD) is a movement disorder that cause tremor, rigidity, bradykinesia, postural instability and deterioration quality of life. To assess the disease different scales can be used: The Unified Parkinson's Disease Rating Scale (UPDRS) for clinical severity, Parkinson's Disease Questionnaire (PDQ39) to assess quality of life, Beck Depression Scale (BD) for mood assessment and Hoehn Yahr Scale (HY) for clinical staging. The International Classification of Functioning, Disability and Health (ICF) is a classification to develop an international common language for the evaluation of the functionality and disability of patients. We aimed to compare validity and efficacy of ICF classification with other scales. Materials and Methods: Thirty-one patients with idiopathic Parkinson's disease were evaluated. PDQ39, UPDRS, Hoehn Yahr, Beck Depression Scale and 'Brief ICF core set for hand condition' which was recommended for Parkinson's disease were applied to patients. The brief ICF core set and other scales were compared and assessed if there was any correlation. For analyzes, the MedCalc Statistical Software version 12.7.7 programme was used. Results: The mean age of the IPD patients was 68.3 ± 6.9 years and 71% of them were female (22) and 29% were male (9). According to ICF codes, patients who have eight or more corrupted codes were recorded as 'major code impairment patients', and those with less than eight codes recorded as 'minor code impairment patients'. The total UPDRS score of major code impairment patients was 58.4 ± 29.8, while the mean score of minor code impairment patients was 21.2 ± 14.05. The PDQ39 score of major code impairment patients was 66.4 ± 24.1, while the mean score of minor code impairment patients was 19.3 ± 13.5. According to Hoehn Yahr stage, the ratio of stage 1 were higher in minor ICF patients. Conclusion: While assessing the functioning of the Parkinson's disease patients, we need comprehensive scales that include many parameters. The ICF coding system is an international system, which is very important to develop a common language. The significant correlation between ICF coding system and other scales in our Parkinson's patients, shows the validity of the coding system.

DergiPark: 486447 trakyasobed Organizational learning ability is defined as a series and a set oforganizational tasks and skills that authorize the organization to use itsknowledge and experience based on the experience and knowledge gained, and touse this information as it grows and when knowledge is needed. The concept oforganizational learning ability aims to find and correct mistakes inenterprises, to execute in-house routines, to fix problems that are found orseen, to create information and idea diversity, to be renewed continuously. Theorganizational learning ability and the sub-dimensions that affect theperformance of the enterprises, which have a big share in profitability,branding and sustainability, have been examined in depth and the literaturethat has been acquired has been investigated by the academicians who researchin this issue and the models they have introduced. In this phase, the relationand the differences with the learning organization which is another conceptwhich is discussed further are discussed. The ability of organizationallearning and organizational learning has emerged as a new concept in ourcountry and the issue has not yet been recognized. In this study; the effect oforganizational learning capacity on task and contextual performance has beenexamined. Within the scope of the survey, the questionnaire was distributed to550 people who work in the hospitals that accept to participate in the surveyamong the private hospitals operating in the Istanbul province of Europe and525 people were returned. The survey results were coded and analyzed with thehelp of SPSS and AMOS programs. As a result; Organizational learning capacity,together with its sub-dimensions, was found to positively affect jobperformance and sub-dimensions. Örgütsel öğrenme yeteneği kavramı, işletmelerin içerisinde hatayı bulmave düzeltme, işletme içi rutinleri yürütme, bulunan veya görülen problemleridüzeltme, bilgi ve fikir çeşitliliği oluşturma, devamlı iyiye doğru yenilenmeyiamaçlamaktadır. İşletmelerin performansına etki eden, dolayısıyla karlılığınınartmasında, markalaşmasında ve sürdürülebilirliğinde büyük pay sahibi olanörgütsel öğrenme yeteneği ve bu kavramı oluşturan alt boyutları derinlemesineincelenmiş olup edinilen literatür taraması ile şimdiye değin bu konudaaraştırma yapan akademisyenler ve meydana getirdikleri modeller incelenmiştir.Bu safhada başkaca ele alınan bir diğer kavram olan öğrenen örgüt ile ilişkisive farkları ele alınmıştır. Örgütsel öğrenme ve örgütsel öğrenme yeteneğiülkemizde yeni bir kavram olarak karşımıza çıkmış olup önemi henüz kavranamamışbir konudur. Bu çalışmada; örgütsel öğrenme yeteneğinin görev ve bağlamsalperformansa etkisi incelenmiştir. Araştırma kapsamında hazırlanan anketİstanbul ili Avrupa Yakasında faaliyet gösteren özel hastaneler içinden,araştırmaya katılmayı kabul eden hastanelerde çalışan 550 kişiye anketdağıtılmış olup 525 kişiden geri dönüş sağlanmıştır. Anket sonuçları SPSS veAMOS programları yardımıyla kodlanmış ve analize tabi tutulmuşlardır. Sonuçolarak; örgütsel öğrenme kapasitesi alt boyutları ile birlikte iş performansıve alt boyutlarını pozitif olarak etkilediği görülmüştür.

Despite several alternatives for cellular iron influx, the only mechanism for cellular iron efflux is ferroportin mediated active transport. In cases of ferroportin dysfunction, iron accumulates in the cell and causes ferroptosis. Hepcidin suppresses ferroportin levels and inflammatory activation increases hepcidin production. Mild inflammation in schizophrenia and bipolar disorder may alter hepcidin and ferroportin.The study included a total of 137 patients aged 18-65 years, 57 diagnosed with schizophrenia and 80 with bipolar disorder, according to the DSM-IV diagnostic criteria, and a control group (HC) of 42 healthy individuals. Biochemical analyses, thyroid function tests, hemogram, serum iron level, iron-binding capacity, and ferritin levels were examined. Serum levels of hepcidin and ferroportin were measured with enzyme-linked immunosorbent assay (ELISA) method.A statistically significant difference was determined between the groups in terms of the serum ferroportin levels (F = 15.69, p 0.001). Post-hoc analyses showed that the schizophrenia group had higher ferroportin levels than in the bipolar group (p 0.001) and HCs (p 0.001). Hepcidin levels did not differ between the groups. Chlorpromazine equivalent doses of antipsychotics correlated with ferroportin levels (p = 0.024).Ferroportin levels were increased in the schizophrenia group, although iron and hepcidin levels were within normal ranges. Antipsychotics may alter the mechanisms which control ferroportin levels. Further studies are needed to examine the relationships between antipsychotics and iron metabolism for determination of causal relationship.

Introduction: Cerebral venous and sinus thrombosis (CVST) may lead to cerebral edema and increased intracranial pressure; besides, ischemic or hemorrhagic lesions may develop. Intracerebral hemorrhages occur in approximately one-third of CVST patients. We assessed and compared the findings of the cerebral hemorrhage (CH) group and the CVST group. Materials and Methods: In the VENOST study, medical records of 1,193 patients with CVST, aged over 18 years, were obtained from 35 national stroke centers. Demographic characteristics, clinical symptoms, signs at the admission, radiological findings, etiologic factors, acute and maintenance treatment, and outcome results were reported. The number of involved sinuses or veins, localizations of thrombus, and lesions on CT and MRI scans were recorded. Results: CH was detected in the brain imaging of 241 (21.1%) patients, as hemorrhagic infarction in 198 patients and intracerebral hemorrhage in 43 patients. Gynecologic causes comprised the largest percentage (41.7%) of etiology and risk factors in the CVST group. In the CH group, headache associated with other neurological symptoms was more frequent. These neurological symptoms were epileptic seizures (46.9%), nausea and/or vomiting (36.5%), altered consciousness (36.5%), and focal neurological deficits (33.6%). mRS was ≥3 in 23.1% of the patients in the CH group. Discussion and Conclusion: CVST, an important cause of stroke in the young, should be monitored closely if the patients have additional symptoms of headache, multiple sinus involvement, and CH. Older age and parenchymal lesion, either hemorrhagic infarction or intracerebral hemorrhage, imply poor outcome.

BACKGROUND To see the relationship of early admission parameters with the type of stroke and/or with the 30-days mortality from this disease. METHODS Stroke patients at their early hyperacute phase (n = 180) were enrolled in this study (156 ischemic strokes and 24 hemorrhagic strokes). Blood levels of C-reactive protein (CRP), testosterone, and estradiol were determined at admission, before any specific intervention. Patients' clinical data, including the above-mentioned laboratory parameters, were compared between the above two stroke types (in total and between sexes). RESULTS The mean age of the patients was 69.55 ± 12.03 years old (69.92 ± 11.94 years old in ischemic stroke and 67.12 ± 12.54 years old in hemorrhagic stroke). Serum estradiol levels of both males of ischemic stroke and females of hemorrhagic stroke patients were significantly higher than the females of the ischemic stroke. Serum CRP levels of both females and males of the hemorrhagic group were higher than their peers of the opposite group. Early admission serum CRP level ≥ 0.74 mg/dL in males helped predict hemorrhagic stroke while a serum estradiol level ≥ 14.07 ng/mL helped predict the same type of stroke in females. CONCLUSIONS Our study results show that simple early laboratory measures (such as CRP and estradiol) may help in the early phase management of stroke. Further studies are needed to confirm our findings.

Atlas projects and phylogeographic studies provide detailed information of great value on key species; distribution maps of the species are the primary input for establishing hotspots, conservation, and management plans. Krüper's Nuthatch (Sitta krueperi) is endemic to Anatolia, Lesvos Island, and the Caucasus region. We surveyed more than 1400 point counts in Turkey and Greece, covering most of its global distribution in its potential habitat, coniferous forestland, during the breeding season. The geographical information system was used for preparing the distribution maps and depicting the hotspots for Krüper?s Nuthatch. The population density of Krüper?s Nuthatch in all of Turkey was 10.25 ± 0.33 birds km−2−2, which was significantly higher than on Lesvos Island (1.94 ± 0.79 birds km−2−2) (P < 0.001). We found a negative correlation between the population density of the species and longitude. These results showed that the western part of the study area had higher densities than the eastern part. In conclusion, we recommend that the Beydağları Mountains and the Aladağlar Mountains in southern Turkey, and the Ilgaz Mountains and/or Kartalkaya Mountains in northern Turkey should be considered hotspots and preserved for the conservation of the species. Furthermore, the Beydağları Mountains should be considered as an Important Bird Area for Krüper's Nuthatch due to high population density and genetic diversity.

Internet has become an important source of health information that enables people to access a large portion of medical information. Cyberchondria is defined as behavior seeking information about health from the Internet. It can be mentioned as an internet-mediated version of hypochondriasis. It is emphasized that health anxiety is at the forefront in the etiology. Information pollution on the Internet is an important risk factor. There are no diagnostic criteria. It is not included in the DSM classification. Although there are various assessment scales, the most commonly used assessment tool is the Cyberchondria Severty Scale. It is a psychometric scale with 34 questions to measure the level of cyberchondria. Psychoeducation is the main approach in the treatment and no specific pharmacological treatment has been defined., İnternet tıbbi bilgilerin büyük bir kısmına insanların erişimini sağlayan önemli bir sağlık bilgi kaynağı haline gelmiştir. Siberkondria, hipokondriyazın dijital bir versiyonu olan, bir kişinin sağlığına ilişkin kaygı ile beslenen ve bu belirli kaygıyı güçlendiren çevrimiçi sağlıkla ilgili bilgi arayışı olarak tanımlanmaktadır. Son dönemde giderek sıklığı artmaktadır. Etyolojisinde sağlık kaygısının ön planda olduğu vurgulanmaktadır. Çevrimiçi bilgi kirliliği önemli bir risk faktörüdür. Tanı kriterleri henüz oluşturulmamış olup, tek değerlendirme aracı Siberkondri Şiddet Ölçeği’dir. Siberkondria düzeyini ölçmeye yönelik 34 soruluk 2014’te geliştirilmiş psikometrik bir ölçektir. Tedavisinde ise temel yaklaşım psikoeğitim olup belirli bir farmakolojik tedavi tanımlanmamıştır.

A 51-year-old male presented with dysarthria and weakness on his left side. In his history, he had an operation due to aortic coarctation 13 years ago, and 5 years ago, he had a transient ischemic attack along with difficulty in speaking. During his neurological examination, he was conscious, cooperative, and oriented. Mild dysarthria and left hemiparesis were seen (4/5, 4/5). He smoked at least one cigarette packet per day for 30 years. Vascularization was performed only by narrowed right vertebral artery on cranial and cervical magnetic resonance angiography. He had a mild increase in his left hemiparesis during his stay in the hospital (2/5, 4/5). A stent had been inserted into his right vertebral artery during digital subtraction angiography. In his last neurological examination, he was conscious, cooperative, and oriented. We started prasugrel (10 mg/day) and acetylsalicylic acid (300 mg/day) for his mild dysarthria and mild hemiparesis. In this case, we explain that although there was three-vessel occlusion and narrowing in the right vertebral artery, the patient’s neurologic status was not too bad due to collateral circulation around the cerebral arteries. This showed us the importance of collateral circulation between cerebral arteries.

A challenging problem in the field of avian ecology is deriving information on bird population movement trends. This necessitates the regular counting of birds which is usually not an easily-achievable task. A promising attempt towards solving the bird counting problem in a more consistent and fast way is to predict the number of birds in different regions from their photos. For this purpose, we exploit the ability of computers to learn from past data through deep learning which has been a leading sub-field of AI for image understanding. Our data source is a collection of on-ground photos taken during our long run of birding activity. We employ several state-of-the-art generic object-detection algorithms to learn to detect birds, each being a member of one of the 38 identified species, in natural scenes. The experiments revealed that computer-aided counting outperformed the manual counting with respect to both accuracy and time. As a real-world application of image-based bird counting, we prepared the spatial bird order distribution and species diversity maps of Turkey by utilizing the geographic information system (GIS) technology. Our results suggested that deep learning can assist humans in bird monitoring activities and increase citizen scientists&rsquo, participation in large-scale bird surveys.

Introduction Current evidence suggests that pro-inflammatory cytokines, particularly tumor necrosis factor alpha (TNF-α) may play an important role in the pathophysiology of bipolar disorder (BD). Our study aims to compare BD patients and controls in terms of serum TNF-α, soluble tumor necrosis factor receptor 1 and soluble tumor necrosis factor receptor 2 (sTNF-R1, sTNF-R2) levels in different phases of BD. Methods Eighty-three patients with BD type 1 (27 manic, 22 depressive and 34 euthymic) and twenty-nine healthy controls were included in the study. Serum levels of TNF-α, sTNF-R1, sTNF-R2 levels were evaluated with ELISA kit. Results Levels of sTNF-R1 were showed a statistically significant difference between groups. Levels of sTNF-R1 were higher in depression or mania patients than euthymia patients and control subjects. A statistically significant difference in the serum level of sTNF-R1 between patients in acute episode (mania and depression) group and stabile (patients in euthymic episode and controls) group was found in logistic regression analysis. The probability of having acute episode increased threefold for each unit increase in serum level of sTNF-R1. There was no statistically significant difference between the mean serum values of TNF-α and sTNF-R2 between the groups. Conclusions sTNF-R1 production was different between acute episode patients and controls or stable BD patients. The result of this study confirms that TNF-R1 may be a state marker representing disease activity for BD.

Objective In this study, the aim was to evaluate the lower extremity muscle strength in patients with chronic venous insufficiency using an isokinetic dynamometer. Methods The study comprised a group of 36 lower extremities of 23 patients diagnosed with chronic venous insufficiency and a control group of 40 lower extremities of 20 patients who did not have chronic venous insufficiency. In the diagnosis and evaluation of chronic venous insufficiency, photoplethysmography was used to evaluate the venous return circulation time. Visual Analog Scale scoring was applied to define the level of pain of the patients. Muscle strength measurements were made in all the lower extremities by using an isokinetic dynamometer. Results A statistically significant difference was detected between the groups in terms of the muscle strength parameters in the ankle plantar flexion, and knee flexor and extensor muscles. However, no statistically significant difference was found between the groups in the ankle dorsiflexion muscle strength parameters. A significant difference was determined in the ratio of ankle dorsiflexion/plantar flexion muscle strength between the mild, moderate and severe venous insufficiency groups. A statistically considerable negative correlation was found between the Visual Analog Scale scores and the photoplethysmography results. According to the Visual Analog Scale results, as the degree of venous insufficiency increased, so did the level of pain. Conclusion Impaired lower extremity muscle strength was observed in chronic venous insufficiency patients. Although the current study was consistent with literature in respect of impaired calf muscle strength, this finding was also seen in the thigh muscles. Furthermore, we concluded that if venous insufficiency becomes more severe, impaired calf muscle strength becomes more evident.

A 70-year-old man was admitted to our hospital with acute stroke. He had a history of hypertension with trandolapril-verapamil 4/240 mg per day therapy. He had confusion and right-sided hemiplegia. Diffusion magnetic resonance imaging revealed an ischemic lesion on the left middle cerebral artery territory. After receiving intravenous (iv) recombinant tissue plasminogen activator (r-tPA) infusion, he developed tongue swelling. With standard anti anaphylactic medication tongue swelling disappeared. Termination of iv r-tPA may not be required in some tongue swelling cases. Timing of angioedema, circumstances under which iv r-tPA is administered and the severity of relevant respiratory problems may be helpful in the decision of termination or continuation of iv r-tPA administration.

Background Intravenous tissue plasminogen activator (IV tPA) was shown to be an effective treatment for acute ischemic stroke (AIS). According to stroke guidelines, there is no need to wait for the complete blood count (CBC) and coagulation test results before application of IV alteplase if there is no suspected coagulation disorder. In this study, a patient with AIS and thrombotic thrombocytopenic purpura (TTP) symptoms during thrombolytic treatment was presented. Case A 33-year-old male patient was admitted at the 2.5th hour of AIS symptoms onset with right hemiparesis and sensorimotor aphasia. Cranial computed tomography (CT) and diffusion magnetic resonance imaging did not reveal any abnormality. In his medical history, the patient did not have any contraindication for thrombolytic treatment. To avoid delays to thrombolytic therapy, blood samples were taken, and after that, IV bolus alteplase treatment was applied. During maintenance treatment, agitation and vomiting developed. The result of blood samples showed less than 26,000 mm3 platelet count and maintenance therapy was stopped. In control cranial CT, there was no hemorrhage. In the laboratory examination; anemia, low platelet count; increased indirect bilirubin, lactate dehydrogenase (LDH) levels were found, and fever was 38.4°C. Schistocytes were observed in peripheral blood smear and the patient was diagnosed as TTP. Conclusions Stroke guidelines recommend not to wait for the results of CBC and coagulation tests before IV tPA treatment in patients who do not have any history of coagulopathy disorder. If possible, before applying IV tPA we may wait for the results of coagulation and CBC tests, keeping in mind the diseaes with high mortality such as TTP.

Objective: The aim of this study is to retrospectively compare the efficacy of long acting naltrexone (XR-NTX) and oral naltrexone (O-NTX) treatment in alcohol use disorder patients. Methods: In the study, retrospective data including sociodemographic characteristics, treatment continuation rates, mean treatment duration (duration of abstinence) and liver function test results were scanned from the medical records and then analyzed in a group of 16 patients and a group of 27 patients who were put on XR-NTX and O-NTX treatments, respectively. Results: 87.5% (14 patients) of the XR-NTX treatment group and 88.9% (24 patients) of the O-NTX treatment group com-prised of male patients. The mean age in the XR-NTX group was 41.31±10.26 years; whereas it was 42.14±9.07 in the O-NTX group. Fourteen patients in the XR-NTX (87.5%) and 15 patients (55.6%) in the O-NTX group returned for control after the first admission. Thus, treatment compliance was significantly higher in the XR-NTX group than in the O-NTX group. Conclusion: An increase in treatment compliance with XR-NTX treatment was observed in the study. This study may suggest that XR-NTX is more efficient than O-NXR in the treatment of alcohol use disorder. Thus XR-NTX treatment may be a good alternative for patients with alcohol use disorder to stay on treat-ment for a longer time.

OBJECTIVE The objective of this study was to compare the effects of two drugs on motor performance and analgesic efficacy in a rat model. MATERIAL AND METHODS Rats were randomly divided into four groups as follows: propofol (600 μg/kg/min), dexmedetomidine (1 μg/kg/min), morphine (83 μg/kg/min) and control. The rats were placed on a rotating rod and tested at the slowest speed (5 rpm) and then at increasing increments from 5, 10, 15, 20, 25, 30, 35 to 40 rpm. The speed was set up again from 1 to 79 rpm within 4 and 10 min for the accelerod test, respectively. Pain reflexes in response to a thermal stimulus were measured at 0, 10, 20 and 60 min after the drug injection using the hot-plate test. RESULTS Dexmedetomidine injected rats showed an increased length of time compared to the propofol group at 20 rpm, 25 rpm, 35 rpm and 40 rpm speeds during the rotarod test. The latency times for the hot-plate test increased significantly for the propofol, at 0, 10 and 20 min compared to the control. At 10 min the latency times of the propofol group were longer than the dexmedetomidine group. CONCLUSIONS For long-term analgesic benefit propofol treatment seems to be better than the dexmedetomidine group. Dexmedetomidine may be preferable in day-case surgery and sedation applications in intensive care units as it provided a faster onset of recovery of motor coordination performance.

The heart rates (HRs) indicating the anaerobic threshold, which corresponds to a fixed blood lactate concentration of 4mmol/l (heart rate at the onset of blood lactate accumulation (HR-OBLA)); are predicted on the basis of the heart rate—work rate relationship during exercise performance. The predictor is a multi-layer perceptron (MLP). For training and testing, 225 male soccer players (mean age, 21.6±4.5 years) performed an incremental running test on a treadmill with 3-min runs and 30-s blood sampling sessions for lactate assessment. In addition to the treadmill test data, the ages, masses, heights, body mass indices, and playing positions of half of the subjects ( n=113) were used to train the MLP and the remaining 112 were used for external validation. The results showed that the HR values recorded in the last stages before exhaustion were strong predictors of HR-OBLA ( r=0.875; standard error of estimates, 4.17). Inclusion of other parameters did not improve the prediction rate. Although additional work is needed to generalize the method to training prescription, results suggest that a neural network is a promising non-invasive tool for accurately estimating the HR-OBLA from exercise test data.

The purpose of this study was to test the influence of custom-made mouth guards on strength and anaerobic performance of taekwondo athletes. The study included 21 (11 male and 10 female) trained subjects participating in taekwondo. Anaerobic power and anaerobic capacity, isokinetic quadriceps and hamstring strength, handgrip strength, isometric lower extremity and back strength, 20 m sprint time, squat and counter movement jumping height were measured in two randomized conditions: with or without custom-made (CM) mouth guards. No significant differences were observed between the two conditions (with or without CM mouth guards) in 20 m sprint time, jumping tests, handgrip strength, isometric leg or back strength. On the other hand, peak power and average power in Wingate Anaerobic Test and Hamstring Isokinetic Peak Torque significantly increased as a result of wearing mouth guard (P < 0.05). In conclusion, we can suggest that taekwondo athletes can use CM mouth guards without any negative effects on their strength and anaerobic performance.

According to a study performed between 2001 and 2003, the White-spectacled Bulbul is mainly distributed in the coastal Mediterranean region of Turkey and extends from Patara/Gelemis near Kas in the west to Turkoglu in Kahramanmaras province in the east. The vertical distribution extends from sea level to 1260 m in the non-breeding season. In the breeding season, the species has its highest density in the coastal area up to 400 m a.s.l. The highest nesting area was found at Belen in the Amanus Mountains at 740 m. The main areas of occurrence are the Antalya lowlands, the Cukurova and the coastal band of Hatay where dense populations are found. Low densitiy is found in particular in the areas of Ermenek (south-central Anatolia) and Nurdagi (southeastern Anatolia).

This study objective; a training hospital nurses who served in a review of patient safety in geometry applications health standards of quality (SKS) by comparing before and after that. October-November 2009 and October-november 2015 Im on a population of the training mission, namely hemsirelerdir. in this research, 390 nurse working for Better reliability, 95% and 5% by the deviation orneklemine research is 110 people. The random sampling method, the selected participants to get face-to-face survey method was employed. A study in the year 2009, 69.1 %, nurses 1-5 years, between 29.1 %, between 6-10 years, 1.8% is between 11-15 years. 89,1% ' i 40 hours and above. 90,9 % in direct interaction with patients is usually are located in. as previously reported in a number of events to Foods account for 52.7% of the as ever. As the degree of safety, 74,5 % appraised excellent, 21.8% gave a very good answer. In 2015, nurses in 50,9 %, between 1-5 years, 18.2% between i 6 - 10 years, from 12.7% of between 11-15 years, 18.2% between years 16-20 N?i . 65,5% ' i 40 hours and above. 100 % in direct interaction with patients is usually are located in. as reported in a number of events, %, 92,7% of noted as not at all. The degree of safety, as a reading of 84.5, 11.8 % has a very good answer. As a result great nurses in patient safety grades increased in value. frequency of Event report stated as close to zero.