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In this work, we design a multisensory IoT-based online vitals monitor (hereinafter referred to as the VITALS) to sense four bedside physiological parameters including pulse (heart) rate, body temperature, blood pressure, and peripheral oxygen saturation. Then, the proposed system constantly transfers these signals to the analytics system which aids in enhancing diagnostics at an earlier stage as well as monitoring after recovery. The core hardware of the VITALS includes commercial off-the-shelf sensing devices/medical equipment, a powerful microcontroller, a reliable wireless communication module, and a big data analytics system. It extracts human vital signs in a pre-programmed interval of 30 min and sends them to big data analytics system through the WiFi module for further analysis. We use Apache Kafka (to gather live data streams from connected sensors), Apache Spark (to categorize the patient vitals and notify the medical professionals while identifying abnormalities in physiological parameters), Hadoop Distributed File System (HDFS) (to archive data streams for further analysis and long-term storage), Spark SQL, Hive and Matplotlib (to support caregivers to access/visualize appropriate information from collected data streams and to explore/understand the health status of the individuals). In addition, we develop a mobile application to send statistical graphs to doctors and patients to enable them to monitor health conditions remotely. Our proposed system is implemented on three patients for 7 days to check the effectiveness of sensing, data processing, and data transmission mechanisms. To validate the system accuracy, we compare the data values collected from established sensors with the measured readouts using a commercial healthcare monitor, the Welch Allyn® Spot Check. Our proposed system provides improved care solutions, especially for those whose access to care services is limited. [ABSTRACT FROM AUTHOR]

Hypertension is present in almost a third of Türkiye’s adult population. The Ministry of Health of the Republic of Türkiye in conjunction with the World Health Organization, rolled out a pilot primary health care model from February 2019 to 2020 to improve hypertension screening, management, and follow-up across the provinces of Erzincan, Çankırı and Uşak. The model was conducted in selected family health centers for one year and included multiple interventions – training of multidisciplinary primary care teams, implementation of evidence-based, standardised clinical guidelines related to monitoring and treatment of hypertension, clinical supervision and performance monitoring, and provision of health education to hypertensive individuals. Repeat surveys of population-based random samples of 975 patients were taken before (December 2018) and after (February 2020) model implementation to evaluate its effect on care delivery. There was an almost 6.5-fold increase in the measurement and subsequent recording of blood pressure compared to before model implementation (from 50 to 323). Blood pressure control improved to 58 % of measured individuals compared to 46 % of those measured at initial evaluation. The frequency of measuring risk factors and outcomes related to hypertension at least once a year increased for creatinine from 71 % to 79 %, fasting blood glucose from 70 % to 78 %, and tobacco use from 22 % to 31 %. Prescription of antihypertensive drugs increased from 49 % to 61 %. With improvements in hypertension-related care in all measures and across all regions, this primary healthcare model represents a potential paradigm for nationwide implementation.

Objective: To investigate the utility of simultaneous multi-catheter cryotherapy for the treatment of APs that were previously resistant to standard radiofrequency (RF) catheter ablation. Background: Catheter ablation is established in the treatment of accessory pathways (AP), with high rates of permanent procedural success with a single attempt. However, there are still instances of acute procedural failure and AP recurrences with standard RF and cryotherapy methods. Methods: Seven consecutive cases of pre-excitation syndromes with prior failed RF catheter ablation had the novel treatment. Cryotherapy was delivered using two 8 mm tip focal cryoablation catheters (Freezor® Max, Medtronic, Minneapolis, Minnesota, USA). Results: Accessory pathway localisation was septal in 5 cases, left posterolateral in 1, right lateral in 1. In all cases, ablation of the AP was acutely successful with no procedural complications. Median procedure and fluoroscopy durations were 199 and 35 min, sequentially. Median Procedure duration fell significantly in the second half of series (174 min) compared to the first half (233 min, P = 0.05). One patient had evidence of a recurring AP conduction with pre-excitation at 5-week follow up. After a median follow up of 66.8+-6.5 months, 6 out of 7 patients remained asymptomatic and free of pre-excitation. Conclusion: Simultaneous multi-catheter cryotherapy is feasible, safe and can provide definitive cure of accessory pathways that were previously resistant to standard radiofrequency ablation. Further study is required in the assessment of this novel form of advanced cryotherapy to treat complex and resistant arrhythmias.

Non-communicable diseases (NCDs) are a leading health and development challenge worldwide. Since 2015, WHO and the United Nations Development Programme have provided support to governments to develop national NCD investment cases to describe the socioeconomic dimensions of NCDs. To assess the impact of the investment cases, semistructured interviews and a structured process for gathering written feedback were conducted between July and October 2022 with key informants in 13 countries who had developed a national NCD investment case between 2015 and 2020. Investment cases describe: (1) the social and economic costs of NCDs, including their distribution and projections over time; (2) priority areas for scaled up action; (3) the cost and returns from investing in WHO-recommended measures to prevent and manage NCDs; and (4) the political dimensions of NCD responses. While no country had implemented all the recommendations set out in their investment case reports, actions and policy changes attributable to the investment cases were identified, across (1) governance; (2) financing; and (3) health service access and delivery. The pathways of these changes included: (1) stronger collaboration across government ministries and partners; (2) advocacy for NCD prevention and control; (3) grounding efforts in nationally owned data and evidence; (4) developing mutually embraced ‘language’ across health and finance; and (5) elevating the priority accorded to NCDs, by framing action as an investment rather than a cost. The assessment also identified barriers to progress on the investment case implementation, including the influence of some private sector entities on sectors other than health, the impact of the COVID-19 pandemic, and changes in senior political and technical government officials. The results suggest that national NCD investment cases can significantly contribute to catalysing the prevention and control of NCDs through strengthening governance, financing, and health service access and delivery.

BackgroundThe increasing population of older adults has led to a rise in the demand for health care services, with chronic diseases being a major burden. Person-centered integrated care is required to address these challenges; hence, the Turkish Ministry of Health has initiated strategies to implement an integrated health care model for chronic disease management. We aim to present the design, development, nationwide implementation, and initial performance results of the national Disease Management Platform (DMP). ObjectiveThis paper’s objective is to present the design decisions taken and technical solutions provided to ensure successful nationwide implementation by addressing several challenges, including interoperability with existing IT systems, integration with clinical workflow, enabling transition of care, ease of use by health care professionals, scalability, high performance, and adaptability. MethodsThe DMP is implemented as an integrated care solution that heavily uses clinical decision support services to coordinate effective screening and management of chronic diseases in adherence to evidence-based clinical guidelines and, hence, to increase the quality of health care delivery. The DMP is designed and implemented to be easily integrated with the existing regional and national health IT systems via conformance to international health IT standards, such as Health Level Seven Fast Healthcare Interoperability Resources. A repeatable cocreation strategy has been used to design and develop new disease modules to ensure extensibility while ensuring ease of use and seamless integration into the regular clinical workflow during patient encounters. The DMP is horizontally scalable in case of high load to ensure high performance. ResultsAs of September 2023, the DMP has been used by 25,568 health professionals to perform 73,715,269 encounters for 16,058,904 unique citizens. It has been used to screen and monitor chronic diseases such as obesity, cardiovascular risk, diabetes, and hypertension, resulting in the diagnosis of 3,545,573 patients with obesity, 534,423 patients with high cardiovascular risk, 490,346 patients with diabetes, and 144,768 patients with hypertension. ConclusionsIt has been demonstrated that the platform can scale horizontally and efficiently provides services to thousands of family medicine practitioners without performance problems. The system seamlessly interoperates with existing health IT solutions and runs as a part of the clinical workflow of physicians at the point of care. By automatically accessing and processing patient data from various sources to provide personalized care plan guidance, it maximizes the effect of evidence-based decision support services by seamless integration with point-of-care electronic health record systems. As the system is built on international code systems and standards, adaptation and deployment to additional regional and national settings become easily possible. The nationwide DMP as an integrated care solution has been operational since January 2020, coordinating effective screening and management of chronic diseases in adherence to evidence-based clinical guidelines.

The roles of the integrins, alpha2beta1 and alpha3beta1, in keratinocyte intercellular adhesion (ICA) were investigated. The monoclonal antibody (mAb), P1B5, stimulated ICA in the cell cultures used by a heterophilic integrin reaction. It also induced an interaction between mAb-immobilized alpha3beta1 and alpha2beta1 in culture. However, a basal interaction was observed in affinity-purified integrins that was not enhanced by P1B5 treatment. Cells transfected with alpha2 complementary DNAs produced a similar interaction with alpha3beta1 that was also unaffected by P1B5.

Abstract Objective: To inform strategies aimed at improving blood pressure (BP) control and reducing salt intake, we assessed educational inequalities in high blood pressure (HBP) awareness, treatment and control; physician’s advice on salt reduction; and salt knowledge, perceptions and consumption behaviours in Eastern Europe and Central Asia. Design: Data were collected in cross-sectional, population-based nationally representative surveys, using a multi-stage clustered sampling design. Five HBP awareness, treatment and control categories were created from measured BP and hypertension medication use. Education and other variables were self-reported. Weighted multinomial mixed-effects regression models, adjusted for confounders, were used to assess differences across education categories. Settings: Nine Eastern European and Central Asian countries (Armenia, Azerbaijan, Belarus, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkey and Uzbekistan). Participants: Nationally representative samples of 30 455 adults aged 25–65 years. Results: HBP awareness, treatment and control varied substantially by education. The coverage of physician’s advice on salt was less frequent among participants with lower education, and those with untreated HBP or unaware of their HBP. The education gradient was evident in salt knowledge and perceptions of salt intake but not in salt consumption behaviours. Improved salt knowledge and perceptions were more prevalent among participants who received physician’s advice on salt reduction. Conclusions: There is a strong education gradient in HBP awareness, treatment and control as well as salt knowledge and perceived intake. Enhancements in public and patient knowledge and awareness of HBP and its risk factors targeting socio-economically disadvantaged groups are urgently needed to alleviate the growing HBP burden in low- and middle-income countries.

Giriş: Cerrahi müdahale geçirecek hastaların %60-80’inin ameliyat öncesinde sürece yönelik korku hissettikleri ve korkunun cerrahi süreci olumsuz etkilediği bilinmektedir. Yaşanılan bu korku hastaların öğrenme gereksininmlerini de etkilemektedir. Amaç: Bu araştırma cerrahi müdahale geçirecek hastaların yaşadığı korku ile öğrenim gereksinimleri durumları arasındaki ilişkiyi belirlemek amacıyla yapıldı. Yöntem: Araştırma, Eylül 2018- Ocak 2019 arasında Batı Karadeniz bölgesinde yer alan bir üniversite hastanesinin genel cerrahi kliniğinde ameliyat olmak için kabul edilen hastalar üzerinde yapıldı. Verilerin toplanmasında “Hasta Tanılama Formu”, “Hasta Öğrenim Gereksinimleri Ölçeği” ve “Cerrahi Korku Ölçeği” kullanıldı. Bulgular: Araştırmaya katılanların %85.6’sının 18-65 yaş aralığında olduğu, %43.2 'sinin lise eğitim düzeyinde, %57.6 ‘sının kronik hastalığının bulunmadığı saptandı.Ameliyat öncesinde hastaların hasta öğrenim gereksinimleri puanı ile sosyodemografik özellikleri arasındaki ilişkinin incelendiği analiz sonuçlarına göre yaş, eğitim düzeyi, kronik hastalık durumu değişkenleri ile hasta öğrenim gereksinimleri ölçeği puanı arasında anlamlı ilişki saptandı (p

Background and objectives: An important Non-Communicable Disease risk factor, hypertension (HT), is highly prevalent and controlled HT rates are not sufficient which increases the risk of developing premature deaths. The purpose of the study is to evaluate differences in all-cause and cardiovascular-related mortality according to HT status by using national data from Chronic Diseases and Risk Factors Survey in Turkey (2011–2017). Materials and Methods: Cox regression models were used to estimate hazard ratios (HR) for predicting the all-cause and cardiovascular system-related mortalities. Median follow-up period was 6.2 years. Results: Among individuals with HT, 41.8% was untreated, 30.1% received treatment and had controlled blood pressure, and 28.1% were under treatment but had uncontrolled BP levels. The hazard for mortality among treated & uncontrolled hypertensive participants was significantly higher for all-cause (HR = 1.32, 95% CI = 1.06–1.65), cardiovascular (HR = 2.11, 95% CI = 1.46–3.06), heart disease (HR = 2.24, 95% CI = 1.46–3.43), and Coronary Heart Disease mortality (HR = 2.66, 95% CI = 1.56–4.53) compared to normotensive participants. Conclusions: Individuals with HT who were treated but do not have controlled blood pressure in Turkey had a significantly increased risk of Cardiovascular Disease and all-cause mortality. Along with studies investigating the causes of uncontrolled blood pressure despite initiation of treatment, support should be provided to patients in cases of non-adherence to antihypertensive medication or life change recommendations.

The present study aimed to investigate the histological changes in the liver induced by cadmium and to determine the possible preventive effects of selenium on the detrimental effects of cadmium under light microscopy. Sixty adult male Wistar albino rats were divided into 4 groups as cadmium, selenium, cadmium+selenium, and control groups, each containing fifteen rats. After rats were given cadmium and selenium via gavage, their livers were removed following cardiac perfusion procedure on days 1, 6, and 28. After livers were fixated with 10% buffered neutral formalin and routine histological procedures were applied. Sections were stained with Hematoxylin-eosin (H&E) Massons trichrome, and periodical acid-Schiff (PAS) techniques. Results have shown that cadmium has caused hydropic degeneration in the liver, expanding in sinusoids and increases in foci of inflammation and activated Kupffer cells. In groups that were given only selenium, no obvious changes were observed in the liver except for mild expansion in the sinusoid. In groups that were given cadmium and selenium together, fewer histological changes were observed when compared with groups given only cadmium. These results revealed that selenium may exhibit a protective effect against the oxidative stress in the liver caused by cadmium. [Med-Science 2021; 10(2.000): 444-9]

Reduced graphene oxide (rGO) and graphene oxide (GO) are gaining popularity among many research areas. rGO synthesis is based on bottom-up production, which consists of two different stages: the oxidation of graphite and the reduction of GO. The properties of rGO structure are determined by GO used as raw material, reducing agents and the type of process. Different chemical agents are used to reduce GO to rGO and among these, hydrazine is known to be the strongest and effective, but the most toxic agent.In this study, the rGO structure synthesized using sulfur-containing sodium dithionite (Na2S2O4) was compared with the rGO structure synthesized by L-ascorbic acid (Vitamin C) agent in terms of layer number, elemental analysis and crystal structures, and It has been observed that Na2S2O4 may be a good is a good alternative. to reduce GO. GO was synthesized by Modified Improved Hummers method without using toxic sodium nitrate. The reduced products were examined by FTIR, XRD and SEM/EDS. Results showed that different reducing agents synthesized similar rGO-Na2S2O4 and rGO-LAA structures with 0.34 nm interlayer space also they included % 14.27 and %12.24 of oxygen respectively.

INTRODUCTION: The aim of this study is to investigate the demographic characteristics, mortality reasons and the factors that affect the mortality of the patients in general intensive care units. METHODS: In this study, 510 patients who were followed-up in our Intensive Care Units for one year and died were grouped according to age groups as Age≤18, 18

Giriş ve Amaç: Dünyada yaşlı nüfusun %50-60’ında vitamin D eksikliği vardır. Kritik hastalarda ise vitamin D eksikliğinin (25(OH)D lt;20ng/ml) prevalansı %70’i aşmaktadır. Bu çalışmada Yoğun Bakım Ünitesi(YBÜ)’nde takip ve tedavi edilen 65 yaş üstü; vitamin D verilen ve verilmeyen hastaların prognoz açısından karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Kasım 2014-Nisan 2015 tarihleri arası hastanemiz YBÜ ’de takip ve tedavi edilen hastaların kayıtları geriye dönük olarak incelendi. Enteral beslenen ve vitamin D desteği alan 20 hasta (Grup D), enteral beslenen ancak vitamin D desteği almayan 20 hasta (Grup K) arasında yoğun bakıma kabul sırasında(T1), 7.(T2) ve 15.(T3) günlerde ölçülen vitamin D, albümin, prealbumin, total lenfosit, CRP düzeyleri ve triceps kas kalınlığı açısından fark olup olmadığı değerlendirildi. Bulgular: İki grup demografik veriler açısından benzerdi. Grup D ile Grup K arasında T1,T2 ve T3 zamanlarında vitamin D düzeyleri, albümin- prealbümin düzeyleri, enfeksiyon oranları, mekanik ventilasyon süreleri, yoğun bakım yatış günü ve mortalite açısından istatistiksel olarak anlamlı bir fark saptanmazken T1 ve T2 zamanında total lenfosit(TLS) düzeyleri(p lt;0,05) vitamin D grubunda istatistiksel olarak anlamlı yüksek idi. Hastaların sadece T3 zamanında vitamin D ve diğer değişkenler ele alındığında ise APACHE II değerleri, MV gün, T3 albümin, T3 prealbümin ve T3 total proteinle istatistiki olarak anlamlı ilişki gözlendi. Sonuç: Çalışmamızda vitamin D verilen grupla verilmeyen grup arasında bazı değişkenlerde anlamlı fark gözlenmesi, prospektif ve daha fazla sayıda hasta ile yapılacak çalışmalar açısından yol gösterici olacağını düşünmekteyiz.