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Aim: Several imaging techniques are in use for diagnosis and risk assessment in patients with suspected stable coronary artery disease (S-CAD). Measurement of global longitudinal strain (GLS) by two-dimensional speckle tracking (2D-STM) is a more accurate and reliable technique compared to transthoracic echocardiography. It provides a quantitative measure of left ventricular function. The aim of this prospective study was to determine the relationship between resting layer-specific longitudinal strain values and severe coronary lesions in patients with suspected S-CAD. Materials and Methods: A total of 242 patients with suspected S-CAD were included in this study. They were scheduled for elective coronary angiograph. Patients were divided into two main groups: with (n=117) and without severe coronary artery disease (CAD) (n=125). Layer-specific GLS values were compared between groups as mid-myocardial, endocardial and epicardial layers, using 2D-STM. Results: This study showed that GLS values of all layers were significantly lower in patients with severe CAD compared to controls (p

Aim: Management of patients with heart failure and implanted cardioverter defibrillators (ICDs) is as important as ICD placement. Inappropriate shocks and factors affecting mortality are the factors determining management. Appropriate intervention and detection improve the quality of life of patients. We aimed to investigate the complaints, medication use, electrocardiography findings, symptoms, laboratory findings and body mass index affecting mortality in patients with pacemaker/ICD dysfunction who presented to the emergency department. Materials and Methods: Our study is a single-center, prospective, observational cohort. It included patients aged 18 years and older with pacemakers of both genders who gave their consent between 09/01/2022 and 09/01/2023. Results: Ninety-one patients were included. The mean age was 65.02±13.71 years and 61 (67.0%) were male. The most common diseases were hypertension (86.8%) and congestive heart failure (76.9%). The most commonly used drugs were beta blockers (70.3%) and antiplatelet agents (59.3%). ICD shock rates were higher in men and those with dyspnea did not experience inappropriate ICD shocks. There was a significant correlation between in-hospital mortality and systolic blood pressure (BP), diastolic BP, partial oxygen saturation (sPO2) and potassium (K) levels. Conclusion: We found that ICD shock rates were higher in men and in patients without diabetes mellitus. The incidence of infection due to pacemaker/ICD use was low. We found that ICD patients with low partial sPO2 and hypotensive patients had a worse prognosis. We found that K levels above 4.65 mEq/L were associated with increased mortality.

Aim: ST-elevation myocardial infarction (STEMI), is a common cause of morbidity and mortality. Emergency departments (ED) have a very important role in the management of these patients. Prediction of mortality in STEMI is decisive in establishing therapeutic management to improve outcomes. This study aims to investigate whether triage in emergency departments early warning score (TREWS), modified early warning scoring, national early warning score2 (NEWS-2), and rapid emergency medicine score (REMS) scoring systems are as effective as thrombolysis in myocardial infarction (TIMI), Portuguese registry of acute coronary syndromes (ProACS), and Canadian acute coronary syndrome (C-ACS) in predicting the prognosis in patients diagnosed with STEMI. Materials and Methods: Patients presenting to a tertiary emergency service in a single center between 01.07.2021 and 30.06.2022 and diagnosed with STEMI were prospectively analyzed. The mortality prediction performances of the patients’ measured scores in the first 24 hours and 30 days were evaluated. Results: A total of 213 patients who met the criteria were included in the study. When the area under the curve values for the first 28-day mortality diagnosis were examined, the NEWS-2 [0.713 (0.574-0.852), p

Abstract This research examines the reliability, validity, and usefulness of the Jump Power application by comparing it with the reliable and validated Optojump photoelectric cell system in measuring squat jump (SJ) and countermovement jump (CMJ) in professional athletes. Twenty-two soccer players volunteered to participate in the research. The participants were the players of the U21 team in the 1st League. All athletes were subjected to SJ and CMJ tests. Jump Power app and Optojump data were acquired simultaneously during SJ and CMJ. Trial procedure was performed on three separate occasions (Session 1, Session 2, and Session 3), with 48 h intervals to examine the reliability of the data from session to session. For reliability analysis, coefficients of variation percent (%CV). Jump power app reliability values CV% is below 5%. In the validity analysis, significant differences were observed between the Optojump photoelectric cell system and the Jump Power App for SJ and CMJ. In conclusion, this study revealed that the Jump Power app is a reliable but not valid tool to measure vertical jumps in soccer players.

Bupivacaine is frequently used in daily practice for local anesthesia. The cardiotoxic and arrhythmic effects of bupivacaine are known. Acute allergic attacks and electrocardiographic changes associated with bupivacaine have not been reported in the literature. Kounis syndrome presents with the clinical picture of acute myocardial infarction following an acute allergic attack. Coronary angiography was planned for the patient, who had a known coronary artery bypass graft, with the diagnosis of unstable angina pectoris. After subcutaneous bupivacaine injection applied to the radial area, severe chest pain and electrocardiography changes occurred. No acute occlusive lesion was detected in coronary angiography. In this article, bupivacaine-associated kounis syndrome will be presented.

This paper discusses the implementation of the Whole Communities-Whole Health (WCWH) initiative, which is a community-based, longitudinal cohort study. WCWH seeks to better understand the impact of location on family health and child development while also providing support for families participating in the study. Implementing a longitudinal study that is both comprehensive in the data it is collecting and inclusive in the population it is representing is what makes WCWH extremely challenging. This paper highlights the learning process the initiative has gone through to identify effective strategies for implementing this type of research study and work toward building a new model for community-engaged research. Through iterative testing following the Plan-Do-Study-Act model, three main strategies for implementation were identified. These strategies are (1) creating a data collection schedule that balances participant burden and maintains temporality across data types; (2) facilitating multiple opportunities for qualitative and quantitative input from faculty, families, and nonparticipant community members; and (3) establishing an open-door policy for data analysis and interpretation. This paper serves as a guide and provides resources for other researchers wanting to implement a multidisciplinary and community-based cohort study.

Background This study aimed to assess the prevalence of erectile dysfunction and identify associated factors among male patients with hypertension. Methods A cross-sectional descriptive study was conducted. Data were gathered from 223 individuals aged 18 and above, solely diagnosed with hypertension. Information was collected through face-to-face questionnaires, personal identification forms, and the 5-question version of the International Sexual Function Index Scale. Results Among the participants, 81.6% exhibited erectile dysfunction, with a mean total score of 18.72 ± 3.60 on the 5-question version of the International Index of Erectile Function Questionnaire, indicating a mild level of dysfunction. Older age, smoking, lower educational attainment, and use of beta blockers were associated with higher levels of erectile dysfunction (p

Objective: This study aimed to evaluate the effects of developments in neonatal units over time by comparing the results of the last 15 years of our unit with recent reliable international data. Methods: This study uses data from preterm infants and very-low-birth-weight infants enrolled in the Vermont Oxford Network (VON) system in a standard way. Our unit’s 15-year data (from 2005 to 2020) and VON data (for 2018) were compared in 3 subgroups of gestational age (

Objective: Foramen magnum meningiomas (FMMs) are rare but challenging for neurosurgeons to remove because of their anatomic location where vital neuro-vascular structures exist. The difficulties encountered by a neurosurgeon during the surgery and important points during management of complications are underlined, which may help guide young neurosurgeons. Methods: In this report, management of FMMs are provided in 7 patients who underwent surgical treatment between 2012 and 2022. In this small series, 4 women and 3 men were included. Mean age was 54.28 ± 13.61 years with a mean follow-up of 45.71 ± 40.18 months. Results: Although gross total removal was achieved in all patients 3 showed complication (42.8%) during follow-up period. One showed recurrence. Conclusions: Gross total removal in grade 1 FMM does not guarantee total cure, and strict follow-up is mandatory. We conclude that anterior or anterolaterally located FMMs can be safely removed by midline suboccipital subtonsillar approach. More importantly, every possible complication before surgery should be discussed in detail with the patients and/or their next of kin in order to avoid compensation lawsuits, which is a devastating problem among surgeons all over the world.

Introduction. Diabetes is a very common public health problem. Diabetic foot is a complication of diabetes and can cause significant foot problems. Diabetic foot wounds are a significant problem with serious consequences for both patients and healthcare systems. Aim. Our aim in this research was to determine the knowledge and practice levels of diabetic patients regarding diabetic foot care. Materials and Methods. The research was conducted in a cross-sectional descriptive design. Research data were collected from April 2022 to July 2022. The sample was diabetic patients (n=200). A form was used to determine the sociodemographic characteristics of the patients and their knowledge and practice levels regarding diabetic foot care. Results. Diabetic foot care knowledge level was found to be low in 60.5% of the patients. Additionally, it was determined that 62.5% of the patients had low diabetic foot application. A statistically significant difference was found between the patients' level of knowledge about diabetic foot and their gender, education level, profession, income, place of residence, and whether there is a health center or hospital close to where they live.A statistically significant difference was found between the patients' diabetic foot practice level and their level of education, profession and residence (p

Objective:There is a need for new treatment options for treating Leishmaniasis, since there is no standard treatment scheme with few side effects. Sonodynamic therapy (SDT) is also a candidate to be one of these options. SDT is a treatment method based on the simultaneous combination of low-intensity ultrasound and a sonosensitizer, and the generation of reactive oxygen species in cells in the presence of molecular oxygen. Sonosensitizer, ultrasound, and molecular oxygen individually, these components are not toxic, but when combined form cytotoxic reactive oxygen species In this study, we evaluated the effect of rose bengal (RB)-mediated SDT on Leishmania tropica (L. tropica) promastigotes.Methods:SDT was performed using different concentrations of RB (20, 40, and 80 μM) and ultrasound at a frequency of 1 MHz with an intensity of 1, 1.5, and 2 W/cm2 for 10, 20, and 30 min.Results:Incubation with different RB concentrations applied alone had no effect on L. tropica promastigotes. Ultrasound application time for L. tropica promastigotes alone was determined as 10 min. Ultrasound application intensity showed more significant results at 2 W/cm2. It was determined that the number of promastigotes was lower than that of the control group after 10 min of exposure to ultrasound at 2 W/cm2 at 1 MHz frequency for 10 min with RB (80 μM). Morphologically, round, swollen, atypical forms of the parasite with indistinguishable nuclei are observed, but typical narrow cell body forms have also been detected.Conclusion:These results showed that RB-mediated SDT on L. tropica could be a candidate treatment approach. This approach can be used for both superficial and deeply located lesions. This study emphasized the biophysical mechanisms, ultrasound exposure strategies, reliability and difficulties in the clinical practice of RB-mediated SDT on L. tropica promastigotes.

Objective:In this study, it was aimed to retrospectively evaluate the anti-Toxoplasma IgG, IgM and avidity index results of patients who were requested for Toxoplasma serology in our hospital between 01.01.2017 and 31.12.2021.Methods:Anti-Toxoplasma antibodies are studied with Abbott Architect İ2000 SR device that using the chemiluminescent microparticle immunoassay method (CMIA), according to the company's recommendations. The age, gender, nationality, sending clinic/polyclinic, and pregnancy status information of patients were scanned from the hospital system.Results:In the five-year period between 2017 and 2021, 29.58% of anti-Toxoplasma IgG tests requested from 12694 patients and 0.94% of anti-Toxoplasma IgM tests sent from 12546 patients were found positive. It is striking that the number of test requests is higher in women. IgG positivity is highest in women in the age group of 30-39 (9.97%), and in men in the age group of 60-69 (6.97%). IgM positivity is higher in both women and men in the 20-29 age group (0.48% and 0.38%, respectively). Anti-Toxoplasma IgG was positive in 27.78% and IgM in 0.64% of the pregnant women. IgG positivity in Turkish and Syrian pregnant women were determined as 25.88%; 47.10% and IgM positivity as 0.49% and 1.83%, respectively, and the difference was statistically significant (p

Objective: Nutritional status assessment, dysphagia evaluation and enteral feeding decision are important determinants of prognosis in acute neurovascular diseases. Materials and Methods: NöroTek is a point prevalence study conducted with the participation of 87 hospitals spread across all health sub regions of Turkey conducted on 10-May-2018 (World Stroke Awareness Day). A total of 972 hospitalized neurovascular patients [female: 53%, age: 69+-14; acute ischemic stroke in 845; intracerebral hematoma (ICH) in 119 and post-resuscitation encephalopathy (PRE) in 8] with complete data were included in this sub-study. Results: Gastrostomy was inserted in 10.7% of the patients with ischemic stroke, 10.1% of the patients with ICH and in 50% of the patients with PRE. Independent predictors of percutaneous endoscopic gastrostomy (PEG) administration were The National Institutes of Health Stroke Scale score at admission [exp (β): 1.09 95% confidence interval (CI): 1.05-1.14, per point] in ischemic stroke; and mechanical ventilation in ischemic [exp (β): 6.18 (95% CI: 3.16-12.09)] and hemorrhagic strokes [exp (β): 26.48 (95% CI: 1.36-515.8)]. PEG was found to be a significant negative indicator of favorable (modified Rankin's scale score 0-2) functional outcome [exp (β): 0.032 (95% CI: 0.004-0.251)] but not of in-hospital mortality [exp (β): 1.731 (95% CI: 0.785-3.829)]. Nutritional and swallowing assessments were performed in approximately two-thirds of patients. Of the nutritional assessments 69% and 76% of dysphagia assessments were completed within the first 2 days. Tube feeding was performed in 39% of the patients. In 83.5% of them, tube was inserted in the first 2 days; 28% of the patients with feeding tube had PEG later. Conclusion: The NöroTek study provided the first reliable and large-scale data on key quality metrics of nutrition practice in acute stroke in Turkey. In terms of being economical and accurate it makes sense to use the point prevalence method.

Aim:Inconsistent results were reported in studies on the relationship between pneumothorax and meteorological condition. We investigated whether meteorological variables increase the incidence of pneumothorax application in a region of Turkey with intense southwestern winds.Materials and Methods:The study was conducted retrospectively using the hospital records of patients diagnosed with spontaneous pneumothorax (SP) at the emergency department or thoracic surgery outpatient clinics between January 2016 and December 2018. The admissions were grouped according to the month and seasons. Meteorological data, including daily mean temperatures (°C), atmospheric pressure (millibars), moisture (%), and wind (m/s), were obtained from the local meteorological directorate. The meteorological data on the days with and without SP were compared.Results:Total 264 patients diagnosed as pneumothorax included to this study. Of the patients, 27 (10.2%) were female, and 237 (89.8%) were male. The mean age was 36.71±17.95 years (between 18-92). Of these patients, 185 (70.0%) had primary SP, while 79 (29.9%) had secondary SP (SSP). During the study period, lower atmospheric pressure, humidity and higher °C were detected in July, August and September (

Aim: The study aimed to compare the biomechanical stability and strength of the tension band wiring method used to treat mayo 2A olecranon fractures with Kirschner (K)-wire or cannulated screw configurations. Material and Methods: A total of 24 anatomical ulna models (Sawbones Model 1004, Pacific Research Laboratories, Vashon Island, WA) used in the study were divided into two equal groups of 12, tension band fixation with K-wire (Group 1) and tension band fixation with cannulated screw (Group 2), and groups were compared. The mechanical comparison was performed with a universal measuring machine (Shimadzu Autograph 50 kN; Shimadzu Corp). Results: Fixation methods comparison (K-wire/cannulated screw) were the main factors that determined the stability and the strength of the internal fixation. The median flexion strength of Group 1 was 107.92 (range, 94.22-121.72) N, and that of Group 2 was 109.67 (range, 105.07-113.86) N. The median varus strength of Group 1 was 100.02 (range, 83.24-102.18) N, and that of Group 2 was 76.32 (range, 68.44-78.43) N. Varus strength and stiffness were significantly higher in the K-wire group than in the cannulated screw group (both p values were

Purpose: The aim of this study is to assess how NIRS values changed with cross-clamp (CC) duration in carotis endarterectomy (CEA) surgeries. Materials and Methods: The study included 30 patients. Before induction of general anesthesia, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (SpO2), and regional oxygen saturation(rSO2) values were recorded as right and left sides. The same parameters were recorded before the carotid CC, at the 3rd, 5th, and 10th minutes of the carotid CC, and at the 1st and 5th minutes after the cross-clamp removal postoperatively. Results: When the rSO2 values of the study participants were measured at different times, there was a significant difference (p

Abstract Global control of hookworm infections relies on periodic Mass Drug Administration of benzimidazole drugs to high-risk groups, regardless of infection status. Mutations in the isotype-1 β-tubulin gene have been identified in veterinary nematodes, resulting in structural changes and reduced drug-binding. In Ghana, previous studies have demonstrated significant variability in albendazole effectiveness among people infected with the hookworm Necator americanus, although the mechanisms underlying deworming response have not been defined. Using hookworm egg samples from a cross-sectional study in Ghana, we developed a multiplex amplicon deep sequencing (MAD-seq) method to screen genomic regions encapsulating putative drug-resistance markers in N. americanus isotype-1 β-tubulin gene. Three single nucleotide polymorphisms (SNPs) corresponding to resistance-associated mutations (F167Y, E198A, F200Y) within the coding region of the isotype-1 β-tubulin gene were characterized using MAD-seq in 30 matched pre- and post-treatment samples from individuals with persistent infection following therapy. Post-sequence analysis showed that the highest mean alternative nucleotide allele at each PCR amplicon was 0.034% (167amplicon) and 0.025% (198/200amplicon), suggesting minimal allelic variation. No samples contained the F167Y SNP, while one contained low-frequency reads associated with E198A (3.15%) and F200Y (3.13%). This MAD-seq method provides a highly sensitive tool to monitor the three putative benzimidazole resistance markers at individual and community levels. Further work is required to understand the association of these polymorphisms to treatment response.

Abstract Purpose There are rising concerns about titanium hypersensitivity reaction regarding dental endosseous implants. This review aims to summarize and compare the validity and reliability of the available dermatological and laboratory diagnostic tests regarding titanium hypersensitivity. The following PICO design was used: In Patients with titanium dental implants (P) does epicutaneous testing (ECT) (I), compared to lymphocyte transformation test (LTT) or Memory Lymphocyte Immunostimulation Assay (MELISA) (C) detect hypersensitivity reactions (O)? A literature search was performed including all studies dealing with this topic. Studies regarding orthopedic implants were excluded. Methods Three databases (MEDLINE PubMed, Cochrane Library, SciELO) were screened for suitable studies and an additional manual search was also performed. Literature regarding hypersensitivity reactions in orthopedic implants, hypersensitivity reactions regarding implants not related to dental or maxillofacial surgery, animal studies and in vitro studies were excluded. A quality assessment of all selected full-text articles was performed. Randomized, controlled trials were evaluated with the Cochrane Risk of Bias Tool I. Cohort studies were assessed according to the New Castle–Ottawa Scale and case series according to Moga et al. (Development of a quality appraisal tool for case series studies using a modified Delphi technique. 2012). Results 10 studies were included in the quantitative synthesis and available for the endpoint diagnostics of intolerance reactions to titanium dental implants: 2 clinical studies, 7 cohort studies and 1 case series. The potential for bias (internal validity) for these studies was overall rated as high. Conclusions The study of the available literature regarding ECT and MELISA or LTT in patients with suspected titanium hypersensitivity showed inconsistent results in terms of reliability and validity and thus, those tests should be regarded cautiously. There is strong evidence that titanium hypersensitivity in dental implants is associated with innate immunity: unspecific pro-inflammatory responses due to particle induced hyperreactivity of macrophages or toxicological responses especially towards nanoparticles rather than activation of the adaptive immune system. Therefore, tests detecting allergies do not seem expedient and inflammatory clinical signs should be regarded as leading parameters. Graphical Abstract

Delirium is a complex neuropsychiatric syndrome characterized by an acute onset of cognitive, attention, disorientation and change in the level of consciousness. Delirium is a serious health problem that is common at all ages and medical conditions in many places from the emergency department to the operating room. Delirium symptoms can develop within hours or days and last longer than a month. Nurses have important roles in diagnosing delirium and managing the process with evidence-based practices in patient care. Delirium screening and diagnostic measurement tools used for delirium risk classification and diagnosis should be used by nurses who care for the patient day and night. High mortality in the delirium table, a long stay in the intensive care unit or in the hospital lead to high maintenance costs. The prevalence rates of delirium in patients with Covid-19 have increased. The triggering factors that cause delirium in the Covid-19 pandemic may be social distance and social isolation, deep sedation practices, high fever, prolonged mechanical ventilation, delayed extubation due to aerosol propagation anxiety, inadequate pain assessment, psychological perceptions (mass death), multiple organ dysfunctions. It is known that the application of the ABCDEF (Assessing Pain, Both Spontaneous Awakening and Breathing Trials, Choice of Drugs, Delirium monitoring/management, Early exercise/mobility, and Family Empowerment) care package is effective in the management of delirium. It is recommended to use the ABCDEF care package for delirium management in Covid-19 patients. In this review, evidence-based practices are included in the prevention of delirium and nursing care in the coronavirus (SARS-CoV-2) pandemic affecting the whole world. (JNNN 2022;11(2):74–82).

Objective: This study aims to evaluate data from coronavirus disease-2019 (COVID-19) patients with neurological manifestations hospitalized in the intensive care unit (ICU). Materials and Methods: The study included data from COVID-19 patients with neurological manifestations hospitalized in ICU. Patients’ demographic characteristics, risk factors, laboratory results, treatment methods, mechanical ventilation methods, use of non-invasive techniques to meet O2 requirements, clinical outcome at discharge and after three months, and mortality rates were evaluated. Results: The study included 25 patients. Mean age of the patients was 66.76±12.93. Fifty two percent of the patients were male. Of the patients 96% had a positive polymerase chain reaction test, and 92% had lung involvement. The comorbidities of the patients were hypertension (48%), diabetes mellitus (28%), coronary artery disease (28%), cerebrovascular disease (20%), cancer (20%), and chronic obstructive pulmonary disease (12%). Seventy two percent of the patients presented with stroke. Of the patients %12 presented with encephalopathy, whereas patients with epilepsy and myasthenia gravis accounted for 8%. Patients’ average length of stay in ICU was 13.16±12.44 days. Pressure-synchronized intermittent mandatory ventilation mode was used in 56% of patients. Number of intubation days was 9.5±12.26. All patients were treated with favipiravir and antiaggregant, 92% with steroids and antibacterial therapy, 52% with antiaggregant, 20% with plasma therapy, 8% with cytokine filter and immunoglobulin therapy, and 4% with monoclonal antibody therapy. During hospitalization, mortality rate was 48%, good clinical outcome rate was 36%. Conclusion: The rates of poor clinical outcomes are seen to be high during in-hospital treatment and follow-up of COVID-19 patients presenting with neurological symptoms, as well as at discharge.

Genomic surveillance has emerged as a critical monitoring tool during the SARS-CoV-2 pandemic. Wastewater surveillance has the potential to identify and track SARS-CoV-2 variants in the community, including emerging variants. We demonstrate the novel use of multilocus sequence typing to identify SARS-CoV-2 variants in wastewater. Using this technique, we observed the emergence of the B.1.351 (Beta) variant in Linn County, Oregon, USA, in wastewater 12 days before this variant was identified in individual clinical specimens. During the study period, we identified 42 B.1.351 clinical specimens that clustered into 3 phylogenetic clades. Eighteen of the 19 clinical specimens and all wastewater B.1.351 specimens from Linn County clustered into clade 1. Our results provide further evidence of the reliability of wastewater surveillance to report localized SARS-CoV-2 sequence information.

Abstract Background Cushing’s syndrome (CS) is associated with an hypercoagulable state and an increased risk of venous thromboembolism (VTE). Evidence-based guidelines on thromboprophylaxis strategies in patients with CS are currently lacking. We aimed to map the current clinical practice for thromboprophylaxis management in patients with CS across reference centers (RCs) of the European Reference Network on Rare Endocrine Conditions (Endo-ERN), which are endorsed specifically for the diagnosis and treatment of CS. Using the EU survey tool, a primary screening survey, and subsequently a secondary, more in-depth survey were developed. Results The majority of the RCs provided thromboprophylaxis to patients with CS (n = 23/25), although only one center had a standardized thromboprophylaxis protocol (n = 1/23). RCs most frequently started thromboprophylaxis from CS diagnosis onwards (n = 11/23), and the majority stopped thromboprophylaxis based on individual patient characteristics, rather than standardized treatment duration (n = 15/23). Factors influencing the initiation of thromboprophylaxis were ‘medical history of VTE’ (n = 15/23) and ‘severity of hypercortisolism’ (n = 15/23). Low-Molecular-Weight-Heparin was selected as the first-choice anticoagulant drug for thromboprophylaxis by all RCs (n = 23/23). Postoperatively, the majority of RCs reported ‘severe immobilization’ as an indication to start thromboprophylaxis in patients with CS (n = 15/25). Most RCs (n = 19/25) did not provide standardized testing for variables of hemostasis in the postoperative care of CS. Furthermore, the majority of the RCs provided preoperative medical treatment to patients with CS (n = 23/25). About half of these RCs (n = 12/23) took a previous VTE into account when starting preoperative medical treatment, and about two-thirds (n = 15/23) included ‘reduction of VTE risk’ as a goal of treatment. Conclusions There is a large practice variation regarding thromboprophylaxis management and perioperative medical treatment in patients with CS, even in Endo-ERN RCs. Randomized controlled trials are needed to establish the optimal prophylactic anticoagulant regimen, carefully balancing the increased risk of (perioperative) bleeding, and the presence of additional risk factors for thrombosis.

Introduction:This study aims to determine the experiences and opinions of physicians on informed consent practices, to research their awareness of their legal responsibilities, and to provide solutions to the problems encountered in practice.Methods:This research is a descriptive field study. One hundred and eighty-four physicians working in a state hospital in İstanbul participated in this study between January 15 and February 15, 2018. The questionnaire form was used as a data collection tool. After the participants were informed about the purpose and method of the research, their consent was obtained, and they were asked to fill in the questionnaire forms. The analysis of the data was performed using the SPSS 18.00 program. The significance level was accepted as p

To evaluate diagnostic performance of Neutrophil/lymphocyte ratio (NLR), Platelet to lymphocyte ratio (PLR) and platelecrit in the first and third trimester in preeclampsia. This was a single center case control study conducted between January 2015 and January 2021. Patients diagnosed with preeclampsia were assigned as study population. The preeclamptic patients were assigned into two groups based on gestational weeks at diagnosis. Patients diagnosed before 34th gestational weeks were categorized as early preeclampsia and whereas patients diagnosed after 34th gestational weeks as late preeclampsia. Receiver operating characteristics curve was used to assess diagnostic value of first and third trimester NLR, PLR and platelecrit in preeclampsia. Detection rate of each variable was assessed for a 10% false positive rate. NLR in the first trimester have highest sensitivity of 30 % at a 90 % specificity to detect early preeclampsia. The area under curve (AUC) for NLR was 0.742 respectively. The best cut off for 1st trimester NLR was 4.98. PLR and platelecrit yielded low diagnostic performance. NLR in the first trimester has a moderate predictive performance for early preeclampsia. PLR was not different in preeclamptic cases and controls and platelecrit yielded a low diagnostic performance for preeclampsia. [Med-Science 2022; 11(1.000): 148-53]

The fact that patients with severe mental disorders are deprived of social skills and professional pursuits to sustain their lives imposes a burden of care on both their families and the society. Considering that the rehabilitation of individuals with this disease will alleviate the care burden of families and governments, community-based mental health services have been started to be provided in Community Mental Health Centers (CMHC). The aim of this study is to reveal the participation rate of patients receiving service from CMHC in rehabilitation programs and to determine the effect of this participation on hospitalizations and cost-effect. In the study, the file data of 550 patients who were enrolled in a CMHC, followed up between 2014 and 2018, and participated in the rehabilitation program for at least one year, were retrospectively analyzed in statistical analysis. Patients; 44.9% schizophrenia, 39.5% Bipolar Affective Disorder, 11.5% Psychosis, 4.2% Schizoaffective disorder followed up with diagnosis. In the study, the mean duration of the disease was 19.59 ± 9.87, and the age of onset of the disease was 24.18 ± 9.56. The patients are followed by CMHC for an average of 33.77±14.68 months. The mean number of cigarette smokers per day (n=289) was 28.30 ± 16.23. of patients while 48.5% receive only medical treatment in CMHC 51.5% benefit from rehabilitation activities. The 5-year average number of hospitalization days before and after rehabilitation and the costs to the state of the patients were also examined. The number of hospitalization days before rehabilitation decreased from approximately 17 days to 7 days for a patient. The average cost of a patient to the state decreased from 1940 TL to 752 TL. CMHC are very important in order to increase the effectiveness of mental health services and reduce the burden and costs of care due to diseases. [Med-Science 2022; 11(1.000): 377-81]

COVID-19 pandemic significantly affects the mental health of the personnel working in the frontline of the healthcare system. The present study aimed to determine the prevalence of anxiety and risk factors in people who served in the emergency health system during the COVID-19 pandemic. The study was designed as a cross-sectional online survey conducted on healthcare staff working in emergency services throughout the country between May 15 and June 15, 2020. The questionnaire form consisted of two parts. The first part included sociodemographic questions (13 questions), while the second part consisted of 20 questions found in STAI (State-Trait Anxiety Inventory) anxiety. Multivariate logistic regression analysis was performed to identify the potential risk factors for anxiety symptoms in the participants. Relationships between risk factors and their consequences were stated as rates (ORs) and 95% CI. A total 1014 completed the survey. Among the respondents, 54.3% male, 41.3% 1829 age group, 60.4% married, 44.9% doctors, and 63.4% working in the city center. Analysis showed that anxiety triggering factors included being a female (OR, 1.50; 95% CI, 1.131.99; p = 0.004), working as an emergency medical technician (OR, 7.42; 95% CI, 1.0950.53; p = 0.041), large family (OR, 1.69; 95% CI, 1.062.70; p = 0.041), few children (OR, 1.28; 95% CI, 0.842.15; p = 0.068), and working in the town center (OR, 1.43; 95% CI, 1.061.93; p = 0.017). Our results showed that the anxiety level is high for a significant portion of the emergency staff during the pandemic and that risk-enhancing factors exist in their home and work lives during this period. It is important to carry out supportive administrative studies aimed at reducing stress and anxiety levels, especially for the health staff working in the frontline during the pandemic. [Med-Science 2022; 11(1.000): 20-4]

Pressure injuries are a serious medical problem that both negatively affects the patient's quality of life and results in significant healthcare costs. In cases where a patient doesn’t receive appropriate treatment and care, death may result. Nurses play critical roles in the prevention, care, and treatment of pressure injuries as members of the healthcare team who closely monitor the health status of the patient. Today, the use of artificial intelligence is becoming more prevalent in healthcare, as in many other areas. Artificial intelligence is a method that aims to solve complex problems by using computers to mathematically simulate the way the brain works. In this article, we compile and share information about a deep learning model developed for the detection and classification of pressure injuries. Deep learning can operate on many types of data. Convolutional Neural Networks (CNN) prefer images because they can handle 2D arrays. In this case, the images, annotated according to the National Pressure Injury Advisory Panel pressure injury classification system, have been fed into a deep learning model using CNN. The developed CNN model has a 97% success in detecting and classifying pressure injuries, and as more images are collected and fed into the CNN, the prediction accuracy will increase. This deep learning model allows for the automatic detection and classification of pressure injuries, an indicator of health outcomes, at an early stage and for quick and accurate intervention. In this context, it is expected that the quality of nursing care will increase, the prevalence of pressure injury will decrease, and the economic burden of this health problem will decrease.

Background: Changes in hematological parameters play a role in the pathogenesis of coronavirus disease 2019 (COVID-19). We aimed to investigate the significance of neutrophil-lymphocyte ratio (NLR) and hematologic parameters in determining the severity of COVID-19. Methods: This retrospective cross-sectional study was conducted on adult patients diagnosed with COVID-19 in two pandemic hospitals between 01, April, and 01, July 2020. Using the COVID-19 diagnostic criteria of the world health organization (WHO), the patients were divided into two groups as severe and non-severe. Demographic and clinical characteristics, white blood cell (WBC), neutrophil, lymphocyte and platelet counts, and NLR of all patients were examined at the first admission. Multivariate analyzes were performed to determine the independent predictive data and ROC analysis to test the diagnostic accuracy of the hematological parameters. Results: Of the 381 patients included in the study, 42 (11%) had severe COVID-19 infection. While the mean NLR was 7.61±7.48 in patients with severe COVID-19, the mean NLR of non-severe patients was 2.97±2.37 (95% CI: 2.294 to 6.984, p

Enterobius vermicularis is one of the parasitic diseases involved in the etiology of acute appendicitis. Appendiceal diverticulitis is a rare clinical condition that often presents with the clinical manifestations of acute appendicitis. A 57-year-old woman was admitted to the emergency department with complaints of abdominal pain and loss of appetite. The patient, whose physical examination and imaging modalities were compatible with acute appendicitis, was hospitalized. An explorative laparotomy showed findings consistent with acute appendicitis, and an appendectomy was performed. No problem was seen during the postoperative follow-up of the patient, and she was discharged with healing. The examination of the pathology specimen revealed the coexistence of appendiceal diverticulitis and E. vermicularis. Although many cases of acute appendicitis due to E. vermicularis infestation have been reported, the coexistence of appendiceal diverticulitis with E. vermicularis has not been reported in the literature. Histopathological confirmation was vital as the necessary anthelmintic treatment was prescribed to the patient and her close contacts, averting the spread of infection.

Abstract BACKGROUND Stigmatization, which emerges depending on the sexual behavior of young individuals, leads to negative health and social outcomes, such as shame, social marginalization, violence, and mental health morbidity. Objective: This study aimed to examine the correlation between the level of sexual and reproductive health stigma and gender perception in female university students. DESIGN AND SETTING: This descriptive cross-sectional study was conducted at the Faculty of Health Sciences of a university in Turkey. METHODS: The data of this study were collected from digital media between July and October 2020 from a study population of 385 students. The data were collected using the Personal Information Form, including the socio-demographic characteristics of students, the Sexual and Reproductive Health Stigmatization Scale in Young Women and the Perception of Gender Scale. Descriptive statistics, independent samples t-test, analysis of variance, and Pearson’s correlation test were used to assess the data. RESULTS: It was determined that there was a negative correlation between the Sexual and Reproductive Health Stigmatization Scale in Young Women and the Perception of Gender Scale (r = -0.173, P = 0.001). CONCLUSION: It was determined that as the gender perception in the young women who participated in the study increased, the sexual and reproductive health stigmatization level decreased. The sexual and reproductive health stigmatization levels of the participants were at an above average level, and gender perception was at a medium level.

ABSTRACT BACKGROUND: Gastrointestinal (GI) bleeding is an important cause of mortality and morbidity among geriatric patients. OBJECTIVE: To investigate whether the shock index and other scoring systems are effective predictors of mortality and prognosis among geriatric patients presenting to the emergency department with complaints of upper GI bleeding. DESIGN AND SETTING: Prospective cohort study in an emergency department in Bursa, Turkey. METHODS: Patients over 65 years admitted to a single-center, tertiary emergency service between May 8, 2019, and April 30, 2020, and diagnosed with upper GI bleeding were analyzed. 30, 180 and 360-day mortality prediction performances of the shock index and the Rockall, Glasgow-Blatchford and AIMS-65 scores were evaluated. RESULTS: A total of 111 patients who met the criteria were included in the study. The shock index (P < 0.001) and AIMS-65 score (P < 0.05) of the patients who died within the 30-day period were found to be significantly different, while the shock index (P < 0.001), Rockall score (P < 0.001) and AIMS-65 score (P < 0.05) of patients who died within the 180-day and 360-day periods were statistically different. In the receiver operating characteristic (ROC) analysis for predicting 360-day mortality, the area under the curve (AUC) value was found to be 0.988 (95% confidence interval, CI, 0.971-1.000; P < 0.001). CONCLUSION: The shock index measured among geriatric patients with upper GI bleeding at admission seems to be a more effective predictor of prognosis than other scoring systems.

Hydrogels are widely used materials in biomedical, pharmaceutical, cosmetic, and agricultural fields. However, these hydrogels are usually formed synthetically via a long and complicated process involving crosslinking natural polymers. Herein, we describe a natural hydrogel isolated using a ‘gentle’ acid treatment from the girdle of a chiton species (Chiton articulatus). This novel hydrogel is shown to have a proliferative effect on mouse fibroblast cells (cell line, L929). The swelling capacity of this natural hydrogel was recorded as approximately 1,200% in distilled water, which is within desired levels for hydrogels. Detailed characterizations reveal that the hydrogel consists predominantly (83.93%) of protein. Considering its non-toxicity, proliferative effect and swelling properties, this natural hydrogel is an important discovery for material sciences, with potential for further applications in industry. Whether the girdle has some hydrogel activity in the living animal is unknown, but we speculate that it may enable the animal to better survive extreme environmental conditions by preventing desiccation.

Introduction:Video head impuls test (vHIT) is used in the diagnosis of vestibular dysfunction. There is no study conducted on vHIT application and its results on children in our country. Our study aimed to examine vHIT tests in children with normal hearing function and to determine normal value ranges.Methods:This study was made up of a total of 78 children under 16 years of age with normal hearing function. All children received vHIT and the values found were recorded.Results:Of the 78 children participating in the study, 44 (56.4%) were boys and 34 (43.6%) were girls. There was no significant difference in the results of vHITs between the ages of 4-6, 7-9 and 10-12 in terms of mean left lateral, right lateral, left anterior, right posterior, left posterior and right anterior values (p>0.05 for each). However, in the analysis performed by combining 4-12 age groups, there was a significant difference between the ages of 4-12 and 12 years in terms of left posterior mean values (p=0.012).Conclusion:When the findings of our study and combined reports were evaluated, it was observed that normal vestibuloocular reflex gain values should be determined in the paediatric population by the vHIT method. We consider that, paediatricians may use the findings of our study as guide for the evaluation of vestibular function in children. Extensive studies are needed to ensure that the normal value ranges reach a higher level of reliability.

Objective:In present times, malaria remains an infectious disease with a high mortality rate in some regions of the world. It is predicted to preserve its importance as a disease in the future because of the traveling human populations from malaria-endemic African countries into the regions where malaria has been eradicated. The objective of this study is to evaluate the increasing imported malaria cases in the Turkish Republic of Northern Cyprus.Methods:In this study, we investigated 13 patients who were diagnosed with malaria between 2016 and 2019. We clinically evaluated all the cases. More importantly, we made the diagnosis of these patients by Giemsa-stained thin and thick blood smears, rapid malaria antigen tests, and genotyping (only for five patients) by real-time polymerase chain reaction. Additionally, we evaluated patients with malaria in terms of age, gender, and seasons.Results:In the diagnosed malaria cases, 11 (84.4%) of them were male and 2 (15.6%) were female. There was no significance between malaria infection and gender (p=0.358). Plasmodium falciparum, Plasmodium vivax, and Plasmodium ovale infection were detected in ten patients (76.9%), two (15.4%) patients, and one (7.7%) patient, respectively. There was a significant increase (p=0.003) in the malaria cases in 2019 (n=9). The seasonal comparison revealed that malaria infections are most common in autumn (8/13, 61.5%).Conclusion:Despite the eradication of malaria in Turkish Republic of Northern Cyprus, the rising number of recently imported cases increases the risk of emerging local cases. Malaria infection should be immediately suspected, particularly, in foreign patients who travel from the malaria-endemic region and present with symptoms such as fever and shivering if the laboratory findings especially detect thrombocytopenia.

Aim:Intervertebral disc degeneration (IVDD) is caused by several genetic and environmental factors. Aggrecan is the major component of intervertebral disk matrix proteoglycan with multiple functional domains. The aim of this study was to investigate the possible association between ACAN (coding aggrecan) gene variable number tandem repeat (VNTR) polymorphism and susceptibility to IVDD.Methods:Two hundred and sixty subjects participated in this study. The disease group comprised 150 patients diagnosed with symptomatic IVDD. The control group consisted of 110 healthy subjects. The ACAN gene VNTR region was analyzed using the polymerase chain reaction (PCR) method.Results:The most common allele in the patient and the control group was 27 repeat allele (49% and 34.55%, respectively). Allele 26 was more frequent in males compared to females (p=0.030). Allele 21 and 23 were more common in ones living in rural areas (p=0.030) while allele 27 was the most frequent in ones living in urban areas (p

Fever negatively affects the recovery of the brain following neurosurgical operation and prolongs the length of stay in the neurosurgery intensive care unit. Accordingly, it is necessary to deliver nursing care as indicated by the evidence regarding the management of fever in neurosurgical patients. The management of body temperature requires teamwork. Each healthcare professional in the team should select appropriate cooling methods, provide an acceptable cooling rate, manage shivering, and monitor the patient closely, with a multidisciplinary perspective. In this context, the present article discusses the causes of fever, its incidence, treatment and care practices for neurosurgical patients and proposes evidence-based recommendations for practice upon the review of the international guidelines. (JNNN 2020;9(2):80–85)

Introduction: Cardiometabolic syndrome (CMS), as a bunch of metabolic disorders mainly characterized by type 2 diabetes mellitus (T2DM), hypertension, atherosclerosis, central adiposity, and abdominal obesity triggering androgen deficiency, is one of the most critical threats to men. Although many significant preclinical and clinical findings explain CMS, new approaches toward common pathophysiological mechanisms and reasonable therapeutic targets are lacking. Aim: To gain a further understanding of the role of androgen levels in various facets of CMS such as the constellation of cardiometabolic risk factors including central adiposity, dyslipidemia, insulin resistance, diabetes, and arterial hypertension and to define future directions for development of effective therapeutic modalities. Methods: Clinical and experimental data were searched through scientific literature databases (PubMed) from 2009 to October 2019. Main Outcome Measure: Evidence from basic and clinical research was gathered with regard to the causal impact and therapeutic roles of androgens on CMS. Results: There are important mechanisms implicated in androgen levels and the risk of CMS. Low testosterone levels have many signs and symptoms on cardiometabolic and glycometabolic risks as well as abdominal obesity in men. Clinical Implications: The implications of the findings can shed light on future improvements in androgen levels and add potentially predictive risk for CMS, as well as T2DM, abdominal obesity to guide clinical management in the early stage. Strengths & Limitations: This comprehensive review refers to the association between androgens and cardiovascular health. A limitation of this study is the lack of large, prospective population-based studies that analyze the effects of testosterone treatment on CMS or mortality. Conclusion: Low testosterone levels have several common features with metabolic syndrome. Thus, testosterone may have preventive role in the progress of metabolic syndrome and subsequent T2DM, abdominal obesity, and cardiovascular disease and likely affect aging men's health mainly through endocrine and vascular mechanisms. Further studies are necessary to evaluate the therapeutic interventions directed at preventing CMS in men.Kirlangic OF, Yilmaz-Oral D, Kaya-Sezginer E, et al. The Effects of Androgens on Cardiometabolic Syndrome: Current Therapeutic Concepts. Sex Med 2020;8:132–155.

Objectives:To investigate the prevalence of strabismus in families of a proband with accommodative, partial accommodative, or infantile esotropia (IET), and to evaluate the mode of inheritance and the role of consanguineous marriages in this prevalence.Materials and Methods:Families of probands with comitant strabismus were invited to participate in the study. The family members of 139 subjects with accommodative esotropia (AET), 55 with partial accommodative esotropia (PAET), and 21 with IET agreed to participate. Detailed family trees were constructed. The first- and second-degree relatives were invited for a complete ophthalmological examination, and 518 individuals from 168 families were evaluated. The role of consanguinity, the presence of tropia, phoria (≥8 PD), microtropia, and hypermetropia (≥3.00 D) among first- and second-degree relatives were analyzed.Results:A non-Mendelian pattern was found in 49 families (23%), an autosomal dominant pattern in 39 families (18%), and an autosomal recessive pattern in 6 families (3%). The prevalence of consanguineous marriages among parents of probands was 18.1%, 22.6%, and 14.3% in the AET, PAET, and IET groups, respectively (p=0.652). The prevalence of strabismus in first-degree relatives was 58.9%, 45.5%, and 38.1%, respectively (p=0.07). The prevalence of microtropia in probands’ siblings was significantly higher in the AET group (p=0.034).Conclusion:Sporadic cases and non-Mendelian inheritance were more frequent than autosomal recessive inheritance. Autosomal recessive inheritance was found not to be frequent in consanguineous marriages. The prevalence of strabismus and microtropia was significantly higher in families of esotropia cases than in the general population.

Objectives:Granular corneal dystrophies (GCD) are characterized by small, discrete, sharp-edged, grayish-white opacities in the corneal stroma. Among the genes responsible for the development of GCD, the most strongly related gene is transforming growth factor beta-induced (TGFBI), located in the 5q31.1 locus. Studies show that R124H in exon 4 and R555W in exon 12 are hot-spot mutations in the TGFBI gene that lead to GCD development. In this study, we aimed to investigate these two hot-spot mutations in exons 4 and 12 of the TGFBI gene and other possible mutations in the same regions, which code important functional regions of the protein, in Turkish families with GCD1 and to determine the relationship between the mutations and disease and related phenotypes.Materials and Methods:The study included, 16 individuals diagnosed with GCD type 1 (GCD1), 11 of these patients’ healthy relatives, and 28 unrelated healthy individuals. DNA was obtained from peripheral blood samples taken from each individual and polymerase chain reaction was used to amplify target gene regions. Genotyping studies were done by sequence analysis.Results:The R124S mutation in exon 4 of TGFBI was not detected in the patients or healthy individuals in our study. However, all individuals diagnosed as having GCD1 were found to be heterozygous carriers of the R555W mutation in exon 12 of TGFBI. This mutation was not detected in healthy family members or control individuals unrelated to these families. In addition, we detected the silent mutation F540F in exon 12 and c.32924 G>A substitution in an intronic region of the gene in a few patients and healthy individuals.Conclusion:Our study strongly supports the association of GCD1 with R555W mutation in exon 12 region of the TGFBI gene, as reported in the literature.

Objective:Meglumine antimoniate (Glucantime®) and Sodium stibogluconate (Pentostam®) are used for the treatment of cutaneous leismaniasis in Turkey. There is a reported resistance to these drugs in recent years. The aim of the present study was to compare the in vitro sensitivities of resistant Leishmania isolates against Amphotericin B, Miltefosine, Meglumine Antimoniate, Paromomycin and Sodium Stibogluconate.Methods:Five Leishmania isolates of patients with cutaneous leishmaniasis, who showed no clinical recovery despite two consecutive meglumine antimoniate treatments, which were stored in the Parasite Bank in Manisa Celal Bayar University Medical Faculty were selected. They were genotyped with Real-Time PCR using specific primers and probes to ITS1 region. Drug resistance levels of each Leishmania isolate were analysed for Amphotericin B, Miltefosine, Meglumine Antimoniate, Paromomycin, and Sodium Stibogluconate at concentrations of 500, 250, 125, 50, 25 μg/mL with XTT method and hemocytometer.Results:It was observed that the resistant Leishmania tropica isolates showed no resistance to Amphotericin B, and were sensitive to Miltefosine, Sodium Stibogluconate, Paromomycin and Meglumin Antimonate, respectively. In addition, Leishmania tropica (MHOM/AZ/1974/SAF-K27) isolate of the control group could stay viable in none of the drug concentrations of five agents in the study.Conclusion:It was determined that none of the selected resistant L. tropica isolates showed resistance to Amphotericin B and that was also shown statistically (p

Objective:Leishmania tropica (L. tropica) and Leishmania infantum (L. infantum) are the species causing cutaneous Leishmaniasis (CL) in Turkey. There was a wave of immigration due civil war in Syria in 2011. Migration from Syria, where CL is endemic, to other countries is thought to affect the number of CL cases and species diversity. The aim of the study was to typify the samples of CL positive, pre-migration and post-migration Turkish patients and importe (Syrian) patients whose smears were found in the archive and to reveal the difference of CL species before and after migration in Hatay.Methods:Smears of a total of 150 patients (50 Turkish patients before migration, 50 Turkish patients after migration and 50 Syrian patients) which had been prepared with dermal scraping, stained with Giemsa and determined as CL positive by microscope examination were included in the study. DNA isolation of selected preparations was performed and GZ-PZR analysis with ITS-1probe was performed for species determination.Results:L. infantum/donovani was detected in 40 (80%), L. tropica in 8 (16%), and L. major in 2 (4%) of the samples belonging to pre-immigration Turkish patients. L. infantum/donovani was detected in 28 (56%), L. major in 3 (6%) and L. tropica in 19 (%38) of the samples belonging to post-immigration Turkish patients. L. infantum/donovani was detected in 2 (4%), L. major in 1 (2%) and L. tropica in 47 (94%) of the samples belonging to Syrian patients.Conclusions:It was observed that in local cases in Hatay before immigration, L. infantum/donovani was the common species that caused CL and that after immigration L. tropica began to raise and that L. major was more encountered than before. It was concluded that Syrians coming to Hatay may have caused diversity in the Leishmania species which were the causative agents of CL, and that further research was needed on the subject.

Aim:The aim of this cross-sectional study was to investigate the perceptions of professional values and job satisfaction levels of pediatric nurses and their influencing factors.Materials and Methods:This study was conducted with 134 nurses working in the pediatric clinics of three hospitals in Turkey. Nurses’ Professional Values scale and Minnesota Job Satisfaction Questionnaire were used to collect the data.Results:It was found that the pediatric nurses had high professional values and that job satisfaction scores were moderate. It was further noted that pediatric nurses who were single, received their education in a nursing high school, had professional experience of 11-15 years in pediatric clinics, were working as clinical responsible nurse, and were working during the day shift regularly had higher scores of professional values. It was found that the job satisfaction of the pediatric nurses who were married, received their education in a nursing high school, had professional experience of 11-15 years in pediatric clinics, were working as clinical responsible nurse, and were working at day shift regularly, was significantly higher than the others. The results also indicated a positive and high correlation between pediatric nurses’ perception of professional values and job satisfaction levelsConclusion:It was concluded that promoting professional values among nurses would eventually result in increasing levels of job satisfaction. We believe this study provides substantial data in this particular field in Turkey and it is hoped that it may be used to guide nursing managers to design well-established and unbiased programs for pediatric nurses.

In times of environmental change species have two options to survive: they either relocate to a new habitat or they adapt to the altered environment. Adaptation requires physiological plasticity and provides a selection benefit. In this regard, the Western honeybee (Apis mellifera) protrudes with its thermoregulatory capabilities, which enables a nearly worldwide distribution. Especially in the cold, shivering thermogenesis enables foraging as well as proper brood development and thus survival. In this study, we present octopamine signaling as a neurochemical prerequisite for honeybee thermogenesis: we were able to induce hypothermia by depleting octopamine in the flight muscles. Additionally, we could restore the ability to increase body temperature by administering octopamine. Thus, we conclude that octopamine signaling in the flight muscles is necessary for thermogenesis. Moreover, we show that these effects are mediated by β octopamine receptors. The significance of our results is highlighted by the fact the respective receptor genes underlie enormous selective pressure due to adaptation to cold climates. Finally, octopamine signaling in the service of thermogenesis might be a key strategy to survive in a changing environment.

BackgroundNeurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome.MethodsWe conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models.ResultsWe included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67-82]), than encephalopathy (54% [42-65]). Intensive care use was high (38% [35-41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27-32]. The hazard of death was comparatively lower for patients in the WHO European region.InterpretationNeurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission.

To understand the genetic basis and selective forces acting on longevity, it is useful to examine lifespan variation among closely related species, or ecologically diverse isolates of the same species, within a controlled environment. In particular, this approach may lead to understanding mechanisms underlying natural variation in lifespan. Here, we analyzed 76 ecologically diverse wild yeast isolates and discovered a wide diversity of replicative lifespan (RLS). Phylogenetic analyses pointed to genes and environmental factors that strongly interact to modulate the observed aging patterns. We then identified genetic networks causally associated with natural variation in RLS across wild yeast isolates, as well as genes, metabolites, and pathways, many of which have never been associated with yeast lifespan in laboratory settings. In addition, a combined analysis of lifespan-associated metabolic and transcriptomic changes revealed unique adaptations to interconnected amino acid biosynthesis, glutamate metabolism, and mitochondrial function in long-lived strains. Overall, our multiomic and lifespan analyses across diverse isolates of the same species shows how gene–environment interactions shape cellular processes involved in phenotypic variation such as lifespan.

Choroidal neovascularization due to age-related macular degeneration (AMD) is currently treated successfully with anti-vascular endothelial growth factor (VEGF) intravitreal agents. Emerging evidence suggests that anti-VEGF treatment may potentially increase development of geographic atrophy. However, there is not yet direct proof of a causal relationship between geographic atrophy and use of anti-VEGF agents in neovaskuler AMD. The aim of this review is to discuss the evidence concerning the association between anti-VEGF therapy and progression of geographic atrophy.

OBJECTIVES Although vaccination has started, coronavirus disease 2019 (COVID-19) poses a continuing threat to public health. Therefore, in addition to vaccination, the use of supplements to support the immune system may be important. The purpose of this study was to synthesize evidence on the possible effect of low serum vitamin D levels (25[OH]D

Sol koroner arterin pulmoner arterden orijin alması (ALCAPA) nadir olmakla birlikte, ilk olarak 1866’da tarif edilen bir major konjenital kardiyak anomalidir. Sol koroner arterin direkt aortaya reimplantasyonu ve koroner arter baypas greftleme prosedürleri de dahil olmak üzere çok sayıda cerrahi teknik ikili koroner arteriyel sistem oluşturmayı amaçlamaktadır. Sol koroner arter nadir olarak non-facing pulmoner sinüsten köken alır ve bu nativ aortaya uzak mesafede bir bölge olduğu için, direkt reimplantasyonun teknik olarak oldukça zor olduğu cerrahi onarımdır. Bu vaka sunumunda, non-facing pulmoner sinus kökenli sol koroner arterin, otolog pulmoner arter duvarından tünel oluşturularak aortaya rekonstrüksiyonu cerrahi tekniği bir seçenek olarak sunulmuştur.

Son yıllarda ani kardiyak ölüm oranlarında artış görülmektedir. Günümüzde, implante edilebilir kardiyoverter defibrilatör (implantable cardioverter defibrilator, ICD) ani kardiyak ölümleri önlemede kullanılan bir cihazdır. Travma sonucunda cihazda birtakım problemler meydana gelebilmektedir. Kablo kırığı bu problemlerden biridir. Literatürde, künt travmaya bağlı ICD komplikasyonlarının, özellikle kablo kırığının oldukça nadir görüldüğü belirtilmektedir. Bu olgu sunumunda; eski eşi tarafından sol kolu çekilerek künt travmaya maruz kalan ve oluşan kablo kırığı nedeniyle uygunsuz şoklara maruz kalan kadın olgu medikolegal açıdan değerlendirildi. Olguda, göğse direkt bir travma olmadan, sol kolun çekilmesine bağlı olarak lead kırığı meydana gelmiştir. Hafif şiddetteki bir travmanın bile, yaşamsal tehlike oluşturabilecek, ciddi klinik sonuçlara neden olabileceğine dikkat çekmek amaçlandı.