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Introduction Bipolar Affective Disorder(BAPD) is characterized by variations in mood from elation and/or irritability to depression.Valproic acid(VPA) is indicated for the treatment of acute manic episodes in BPAD.The use of VPA can be limited by either loss or lack of efficacy or by adverse drug reactions. Stevens-Johnson syndrome(SJS) toxic epidermal necrolysis(TEN) are the rare but fatal cutaneous adverse drug reactions for VPA. Objectives We wanted to draw attention that drug induced bullous lesions which has been seen rarely in the literature caused by valproic acid in bipolar disorder. Methods We examined the side effects of valproic acid in one of our patients with bipolar affective disorder using our observations and laboratory tests. Results A 41 year old man was admitted to the our hospital with complaints of decreased amount of sleep, increased amount of speech, skepticism,irritability and dysphoric mood.The patient who was followed up with a diagnosis of BPAD for about 10 months,attempted suicide by taking lithium 2 days before his hospitalization.Considering that it was a mixed episode and the prophylactic effect of lithium was insufficient,VPA 1000 mg/day and Risperidone 2 mg/day treatment were started.Risperidone was increased to 4 mg/day because psychotic symptoms persisted.Valproic acid dose was increased to 1000 to 1500mg/day after the Valproic acid blood level reached 55.28 in the follow-ups.After 5 days 2 bullous lesions developed on the lower extremity of the patient.Routine laboratory investigations were within normal limits.When we consult the patient with the dermatologist;the dermatologist recommended that the lesion be fixed drug eruption and that valproic acid should be discontinued if possible.It was thought that the lesions of the patient who did not have dermatological disorders and did not describe insect bites,might be due to valproic acid. In addition to all these,the patient’s mother had pemphigus vulgaris.The patient’s valproic acid drug was discontinued and lithium was started.Risperidone treatment was continued.In the follow-ups,the patient’s bullous lesions regressed and no new lesion formation was observed. Image: Conclusions The differential diagnosis of bullous lesions at first may appear overwhelming.In this case traumatic bulla,Pemphigus vulgaris,drug induced bulla,Fixed drug eruption,Steven Johnson Syndrome were among our prediagnosis.Cutaneous drug eruptions associated with VPA can range from maculopapular eruption to severe Stevens-Johnson syndrome or toxic epidermal necrolysis.We were worried that the patient had SJS, but it remained only bullous lesions.We could not biopsy the patient lesions to understand the underlying cause but development of bullous lesions with the initiation of valproate and subsequent remission of the lesions with the discontinuation of the drug and subsequent course clearly suggests a causal relation between valproate and skin lesions. Disclosure of Interest None Declared

The helical array (with 10 atom %Cu) exhibits 3130 mAh g–1with 83% columbic efficiencyand retains 83% of its initial discharge capacity after 100th cycle.Homogeneously distributed interspaces between the helical arrays accommodatehigh volumetric changes upon cycling and copper atoms form a conductivenetwork to buffer the mechanical stress generated in the electrodewhile minimizing electrochemical agglomeration of Si. Also, ion assistanceis believed to enhance the density of the helices at the bottom thusincreasing the adhesion. [ABSTRACT FROM AUTHOR]

Objective: The obese-asthma phenotype has gradually increased in the last few years. We aimed to assess the differences between obese and non-obese patients with asthma., Methods: This research is a subanalysis of the Turkish Adult Asthma Registry (TAAR). Clinical presentation, disease control, severity, and demographics of obese and non-obese (normal-weight, overweight) patients were compared., Results: The obesity rate in TAAR was 32.2% ( n  = 619/1919; 18-83 years; 527 F/92 M). Patients with asthma and obesity had higher rates of childhood obesity, longer symptom duration, later onset of asthma, and more severe asthma. These patients were more likely to be female, older, less educated, and live in rural areas. Patients with obesity had more scheduled visits and emergency visits compared with non-obese patients, but similar asthma control, oral corticosteroid use, hospitalizations, intensive care unit admissions, and unscheduled visits. They also had a higher frequency of T2-high but lower frequency of possible T2-low phenotypes compared with normal-weight asthmatics. The risk of severe asthma in patients with obesity was 6.04 times higher for allergic than non-allergic patients and 3.58 times higher for the T2-high phenotype than for possible T2-low phenotypes. A one-unit increase in the asthma control test reduced the risk of severe asthma by 22%., Conclusions: A good definition of this phenotype is important to ensure that appropriate treatment strategies are implemented to achieve the control goal. We also believe that prevention of childhood obesity is an effective and pivotal strategy to achieve the goal of asthma control.

Objective: To compare the sedative and physiological effects of intranasal (IN) and intramuscular (IM) delivery of detomidine in calves., Study Design: Prospective, randomized experimental study., Animals: A total of 20 healthy calves, aged 15.6 ± 4.2 days old, with body masses ranging from 40 to 60 kg., Methods: Calves were randomly assigned to be administered detomidine (0.03 mg kg -1 ) by either IN or IM route. The onset of sedation, duration of sedation and sedation score (SS) were recorded. Heart rate (HR), peripheral arterial hemoglobin oxygen saturation (SpO 2 ), noninvasive systolic and diastolic arterial pressures (SAP and DAP, respectively), respiratory rate (f R ) and rectal temperature (RT) were measured immediately before drug delivery (baseline), at 10 (T 10 ), 15 (T 15 ), 20 (T 20 ) and 30 (T 30 ) minutes after drug delivery. Calves underwent disbudding at T 25 . Comparisons between groups for physiological variables were performed with an independent t-test. Duration of sedation and SS were assessed with a Mann-Whitney test., Results: Onset of sedation was 6.8 ± 2.3 (mean ± standard deviation) and 14.1 ± 6.6 minutes in groups IM and IN, respectively (p = 0.005). Duration of sedation was 32.5 (26-65) [median (range)] and 33 (26-52) minutes in groups IM and IN, respectively (p = 0.622). SS was significantly higher in the IM group than the IN group at T 15 (p = 0.015) and T 20 (p = 0.039). HR was significantly higher with IN than with IM at T 20 (p = 0.022). RT was significantly lower in IN than in IM at T 30 (p = 0.020). f R , SpO 2 , SAP and DAP did not differ significantly between groups., Conclusions and Clinical Relevance: The IN delivery of detomidine resulted in a slower onset of sedation compared with IM injection, although the duration of sedation did not differ between the two treatments., (Copyright © 2024 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.)

Aims: To understand factors influencing nurse manager retention or intention to leave, develop a preliminary theoretical model and identify strategies and interventions for workforce planning., Design: Systematic review update of literature with integrated design of mixed research synthesis., Methods: We included peer-reviewed articles examining factors influencing retention or intention to leave for front-line, middle or patient care nurse managers. Authors independently screened articles for inclusion and assessed included articles for quality. We adhered to a convergent synthesis approach., Data Sources: Nine databases included MEDLINE, EMBASE, PsychINFO, CINAHL Plus with Full Text, ERIC, Health Source Nursing/Academic Edition, Scopus, ProQuest Dissertations and Theses and LILACS in January 2023., Results: Thirty-five studies published between 1990 and 2022, 22 quantitative and 13 qualitative or mixed methods, were included. 155 factors influencing nurse manager retention, intention to stay, or turnover were reported. Job satisfaction was most frequently examined (n = 7), followed by factors such as empowerment (n = 3), decision-making (n = 3) and resilience (n = 2). We developed a preliminary theoretical model demonstrating staff relations and leadership, organizational and job characteristics, socio-demographics, personal characteristics, well-being and nurse manager relationship with work influence managers' intention to stay or to leave., Conclusions: Nurse managers who were empowered, satisfied with their work, received constructive feedback and found meaning in their roles showed greater intent to stay., Implications for the Profession And/or Patient Care: Nurse administrators can ensure managers are provided with authority to make decisions that promote autonomy. Work cultures that allow for regular meaningful constructive feedback from staff and leaders may contribute to nurse managers feeling valued., Impact: Understanding factors that influence job retention or intention to leave may help nurse managers and their supervisors identify areas for strategy and intervention design to ensure sustainability of this workforce., Reporting Method: PRISMA 2020 Guidelines., Patient or Public Contribution: No patient or public contribution., (© 2024 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Background: In the postacute phase of coronavirus disease-2019 (COVID-19), survivors may have persistent symptoms, lung function abnormalities, and sequelae lesions on thoracic computed tomography (CT). This new entity has been defined as post-COVID interstitial lung disease (ILD) or residual disease., Aims: To evaluate the characteristics, risk factors and clinical significance of post-COVID ILD., Study Design: Multicenter cross-sectional analysis of data from a randomized clinical study., Methods: In this study, patients with persistent respiratory symptoms 3 months after recovery from COVID-19 were evaluated by two pulmonologists and a radiologist. post-COVID ILD was defined as the presence of respiratory symptoms, hypoxemia, restrictive defect on lung function tests, and interstitial changes on follow-up high-resolution computed tomography (HRCT)., Results: At the three-month follow-up, 375 patients with post-COVID-19 syndrome were evaluated, and 262 patients were found to have post-COVID ILD. The most prevalent complaints were dyspnea (n = 238, 90.8%), exercise intolerance (n = 166, 63.4%), fatigue (n = 142, 54.2%), and cough (n = 136, 52%). The mean Medical Research Council dyspnea score was 2.1 ± 0.9, oxygen saturation was 92.2 ± 5.9%, and 6-minute walking distance was 360 ± 140 meters. The mean diffusing capacity of the lung for carbon monoxide was 58 ± 21, and the forced vital capacity was 70% ± 19%. Ground glass opacities and fibrotic bands were the most common findings on thoracic HRCT. Fibrosis-like lesions such as interlobular septal thickening and traction bronchiectasis were observed in 38.3% and 27.9% of the patients, respectively. No honeycomb cysts were observed. Active smoking [odds ratio (OR), 1.96; 95% confidence interval (CI), 1.44-2.67), intensive care unit admission during the acute phase (OR, 1.46; 95% CI, 1.1-1.95), need for high-flow nasal oxygen (OR, 1.55; 95% CI, 1.42-1.9) or non-invasive ventilation (OR, 1.31; 95% CI, 0.8-2.07), and elevated serum lactate dehydrogenase levels (OR, 1.23; 95% CI 1.18-1.28) were associated with the development of post-COVID ILD. At the 6-month follow-up, the respiratory symptoms and pulmonary functions had improved spontaneously without any specific treatment in 35 patients (13.4%). The radiological interstitial lesions had spontaneously regressed in 54 patients (20.6%)., Conclusion: The co-existence of respiratory symptoms, radiological parenchymal lesions, and pulmonary functional abnormalities which suggest a restrictive ventilatory defect should be defined as post-COVID-19 ILD. However, the term “fibrosis” should be used carefully. Active smoking, severe COVID-19, and elevated lactate dehydrogenase level are the main risk factors of this condition. These post-COVID functional and radiological changes could disappear over time in 20% of the patients., Competing Interests: Conflict of Interest: The authors declare that they have no conflict of interest.

Background: The inappropriate and excessive use of antibiotics during the coronavirus pandemic has become an important issue., Objective: Our primary aim is to ascertain the attitudes of physicians toward the antibiotics prescribing for the treatment of COVID-19 in Turkey. Our secondary aim was to identify factors affecting to physicians' decisions regarding antibiotic therapy for the treatment of COVID-19 and risk factors associated with antibiotic overprescribing., Methods: It was a multicenter cross-sectional survey. Physicians from 63 different cities were invited to survey through social media (Facebook, Instagram, WhatsApp). Data were collected from respondents through an online questionnaires during November-December 2021., Results: The survey was completed by 571 participants from 63 cities. Pulmonologists comprised the majority (35.20%), followed by internal medical specialists (27.85%) and general practitioners (23.29%). The rates of participants who started empirical antibiotics in the outpatient, ward, and ICU (intensive care unit) were 70.2%, 85.5%, and 74.6%, respectively. When the practice of prescribing antibiotics by physicians for the treatment of COVID-19 in outpatients was compared according to the healthcare setting (primary, secondary, tertiary care hospitals) no significant difference was found. Sputum purulence (68.2%) was recognized as the most important factor for the decision of antibiotic therapy, followed by procalcitonin levels (64.9%) and abnormal radiological findings (50.3%). The most prescribed antibiotics were respiratory quinolones. (48%, 65.9%, 62.7% outpatient, ward, ICU respectively) CONCLUSIONS: In this study, we found that physicians frequently had irrational attitudes toward antibiotic prescription to COVID-19 patients, including those with minor diseases. Our findings underline that the necessity of particular, workable interventions to guarantee the prudent use of antibiotics in COVID-19., (© 2024. The Author(s).)

Objective: This study aimed to compare rectal temperature (RT) with temperatures measured in the pinna, cornea, medial canthus, gingiva, metacarpal pad and axillary region of cats in a home environment., Animals Studied: Five healthy mixed-breed cats (two females and three males) owned by a veterinarian were used., Procedures: All temperature measurements were conducted by the owner by using an infrared camera in the same room and initiated with the pinna, followed by the cornea, medial canthus, gingiva and metacarpal pad. Subsequently, axillary temperature (AT) and RT were recorded by a digital thermometer, respectively. The time taken for a single AT and RT measurements was recorded., Results: The average measurement time for RT was 17.34 ± 0.89 s, with a range of 8-32 s, whereas AT measurements took an average of 46.72 ± 1.16 s, with a range of 29-69 s. AT emerged as a superior alternative measurement site compared to others, exhibiting the lowest bias and the highest proportion of readings within the limits of clinical agreement. The mean difference between RT and AT, with 95% limits of agreement for the differences, was -0.26 (-1.13 to 0.61)., Conclusions: Anatomical regions were not all interchangeable with the rectum for assessing body temperature (BT), with AT recording the highest level of agreement with RT. When RT is not possible, AT could be considered as an alternative for monitoring BT in clinically healthy cats that live in a home environment., (© 2024 The Authors. Veterinary Medicine and Science published by John Wiley & Sons Ltd.)

This compilation covers emergency medical management lessons from the February 6 th Kahramanmaraş earthquakes. The objective is to review relevant literature on emergency services patient management, focusing on Koenig's 1996 Simple Triage and Rapid Treatment (START) and Secondary Assessment of Victim Endpoint (SAVE) frameworks. Establishing a comprehensive seismic and mass casualty incident (MCI) protocol chain is the goal. The prehospital phase of seismic MCIs treats hypovolemia and gets patients to the nearest hospital. START-A plans to expedite emergency patient triage and pain management. The SAVE algorithm is crucial for the emergency patient secondary assessment. It advises using Glasgow Coma Scale, Mangled Extremity Severity Score, Burn Triage Score, and Safe Quake Score for admission, surgery, transfer, discharge, and outcomes. This compilation emphasizes the importance of using diagnostic tools like bedside blood gas analyzers and ultrasound devices during the assessment process, drawing from 6 February earthquake research. The findings create a solid framework for improving emergency medical response strategies, making them applicable in similar situations., Competing Interests: None declared., (Copyright: © 2024 Turkish Journal of Emergency Medicine.)

Background/aim: In many studies, shock indices have proven to be good tools for predicting mortality. In the present study, burn shock index (BSI), percentage of total body surface area burned (TBSA%) multiplied by shock index; burn modified shock index (BMSI), TBSA% multiplied by modified shock index; burn age shock index (BASI), TBSA% multiplied by age shock index; burn rivers shock index (BrSI), TBSA% multiplied by rivers shock index; burn rivers shock index multiplied by Glasgow Coma Scale score (BrSIG) were examined in burn patients. We defined these burn shock indices for the first time. This study aimed to evaluate the effectiveness of shock indices and burn shock indices in predicting mortality in burn patients., Materials and Methods: This study examines retrospectively of burn patients admitted to the emergency department of Dicle University Hospital between January 2010 and December 2022. The patients' vital signs were obtained at the time of presentation to the emergency department, and shock indices were calculated. The effectiveness of shock indices in predicting mortality was compared., Results: A total of 2445 patients were included in the study. Of the patients, 1793 were pediatric, and 652 were adults. BSI (AUC: 0.872, 95% confidence interval (CI): 0.812-0.931, p < 0.001) had the highest area under the curve (AUC) value in predicting mortality in children. The optimal cut-off value for BSI in children was 21.79 and its was sensitivity 83.05%, specificity 79.64%, positive predictive value (PPV) 12.19%, negative predictive value (NPV) 99.28%. In adults, BASI had the highest value of AUC (AUC: 0.936, 95% CI: 0.887-0.984, p < 0.001). The optimal cut-off value for BASI in adults was 62.5 and its sensitivity was 86.49%, specificity was 91.71%, PPV was 38.55%, and NPV was 99.12%., Conclusion: Shock indices are easy to calculate and effective in predicting mortality in burn patients admitted to the emergency department. Among the shock indices in the study, BSI was the best in predicting mortality in children, and BASI was the best in adults., Competing Interests: Conflict of interest: There is no conflict of interest between the authors., (© TÜBİTAK.)

Introduction: National data on asthma characteristics and the factors associated with uncontrolled asthma seem to be necessary for every country. For this purpose, we developed the Turkish Adult Asthma Registry for patients with asthma aiming to take a snapshot of our patients, thereby assigning the unmet needs and niche areas of intervention., Methods: Case entries were performed between March 2018 and March 2022. A web-based application was used to record data. Study outcomes were demographic features, disease characteristics, asthma control levels, and phenotypes., Results: The registry included 2053 patients from 36 study centers in Turkey. Female subjects dominated the group ( n  = 1535, 74.8%). The majority of the patients had allergic ( n  = 1158, 65.3%) and eosinophilic ( n  = 1174, 57.2%) asthma. Six hundred nineteen (32.2%) of the patients had obese asthma. Severe asthma existed in 670 (32.6%) patients. Majority of cases were on step 3-5 treatment (n: 1525; 88.1%). Uncontrolled asthma was associated with low educational level, severe asthma attacks in the last year, low FEV 1 , existence of chronic rhinosinusitis and living in particular regions., Conclusion: The picture of this registry showed a dominancy of middle-aged obese women with moderate-to-severe asthma. We also determined particular strategic targets such as low educational level, severe asthma attacks, low FEV 1, and chronic rhinosinusitis to decrease uncontrolled asthma in our country. Moreover, some regional strategies may also be needed as uncontrolled asthma is higher in certain regions. We believe that these data will guide authorities to reestablish national asthma programs to improve asthma service delivery.

Background: Shock index (SI) is the ratio of heart rate (HR) to systolic blood pressure (SBP); modified SI (MSI) is the ratio of HR to mean arterial pressure; age SI (ASI) is age multiplied by SI; reverse SI (rSI) is the ratio of SBP to HR; and rSIG is rSI multiplied by Glasgow Coma Scale Score (rSIG). Studies have proven that shock indices are good tools in predicting mortality. This study aimed to evaluate the sensitivity of the shock indices SI, MSI, ASI, rSI, and rSIG in predicting mortality in burn patients., Methods: This is a retrospective cross-sectional study. The vital signs of the patients were recorded and their shock indices were calculated at the time of emergency department admission. The effectiveness of the shock indices SI, MSI, ASI, rSI, and rSIG in predict-ing mortality was compared in the burn patients included in the study RESULTS: A total of 913 patients were enrolled. rSIG and MSI were the shock indices with the highest area under the curve (AUC) values in predicting mortality in the burn patients. The AUC values of rSIG and MSI were 0.829 (95% CI: 0.739-0.919, P<0.001) and 0.740 (95% CI: 0.643-0.838, P<0.001), respectively., Conclusion: Vital signs are easily recorded and shock indices are easily calculated at the time of admission of burn patients to the emergency department; they also effectively predict mortality. rSIG and MSI are the best mortality predictors among the shock indices examined in this study.

Colorectal cancer (CRC) is one of the leading causes of cancer-linked deaths globally. The determination of biomarkers is important in the prognosis and treatment of CRC. Previous studies emphasized the relationship between hypoxia and CRC in humans, and there is strong evidence that this process is strongly related to HIF-1. KDM3A is a histone demethylase that could directly bind to HIF-1α, a subunit of HIF-1. This study aimed to reveal whether the expression level of the KDM3A gene could be used as a predictor of CRC. The expression levels of HIF-1α, KDM3A , and Epithelial-Mesenchymal Transition (EMT) genes were evaluated by qRT-PCR in leukocyte samples of 50 CRC patients in different stages and 50 healthy controls. HIF-1α and KDM3A expression levels were significantly higher in the CRC group, compared to the controls. Slug and ZEB-1 genes, the mesenchymal markers, showed the same significance pattern between groups. We acquired 0.664 AUC with 54% sensitivity and 85.4% specificity for separating controls from CRC patients by using the KDM3A expression levels in ROC analysis. This data support that KDM3A could be a novel supplementary biomarker in diagnosis of CRC, which could be noninvasively detected in circulation., Competing Interests: Declaration of Interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article., (© 2022 Polat D. et al., published by Sciendo.)

Purpose: This study aimed to compare the effects of bubble-blowing (active distraction) and cartoon watching (passive distraction) techniques on pain, anxiety, and fear during venipuncture in children aged 6-8 years., Design and Methods: This experimental study randomly assigned 56 children aged 6-8 years to cartoon watching or bubble-blowing groups. The child, parent, and researcher assessed pain using the Wong-Baker FACES Pain Rating Scale, anxiety using the Children's State Anxiety Scale, and fear using the Children's Fear Scale. The study data were analyzed using the Chi-square tests and independent Sample t-tests., Results: The groups were similar in clinical and demographic characteristics. The scores on pain, anxiety, and fear during the procedure were lower in the cartoon watching group than in the bubble-blowing group (pain t(47) = 2.638, p = .013; anxiety t(47) = 2.358, p = .023; and fear t(47) = 2.784, p = .008)., Conclusion: This study revealed that cartoon watching as a passive distraction method was more effective in reducing pain, anxiety, and fear during venipuncture in children aged 6-8 years compared to bubble-blowing as an active distraction method., Practice Implications: The cartoon watching technique, which is affordable, easy to access, and effective (in reducing pain, anxiety, and fear), can be safely used during venipuncture in children aged 6-8 years., Competing Interests: Declaration of Competing Interest Authors declare no competing interests., (Copyright © 2022 Elsevier Inc. All rights reserved.)

In this article, Early Career Task Force Group members of the Turkish Thoracic Society summarize the European Respiratory Society 2020 virtual congress. Current developments in the field of respiratory diseases were compiled with the addition of sessions specific to coronavirus disease 2019 this year. Almost all of the congress sessions were examined, and the important and striking results of the congress were highlighted. Congress sessions were attended by expert researchers, and the prominent messages of each session were highlighted in short summaries. They were then grouped under relevant titles and ranked in order of meaning and relation. It was finalized by a team of researchers.

Objective: Investigate imaging follow-up patterns and assessment of malignancy rate of BI-RADS 3 lesions in women younger than 30 years., Methods: We retrospectively reviewed consecutive studies between January 1, 2013 and January 1, 2015 with BI-RADS 3 assessment in women <30 years. Lesion size, follow-up rate, and biopsy rate were recorded. Completion of 24-month imaging follow-up or biopsy determined the endpoint. Statistical analysis of follow-up rates and biopsy timing was performed., Results: Of 2525 BI-RADS 3 lesions, 278 were identified in 215 women <30 years. Fifty-two (24%) women underwent a biopsy which was more frequently done at patient request than for lesion growth [33 (63.4%) versus 19 (36.5%), P <.01]. The odds of having biopsy upfront was significantly higher in lesions >2 cm in diameter (OR: 4.4 [95% CI 2.1-9.4], P <.01). The malignancy rate in our cohort was 0% (95% CI 0-1.7%). Of the 188 women expected for follow-up imaging, 58 (30%) were lost to follow-up, while 103 (55%) had 6-month follow-up, 74 (39%) 12-month follow-up, and 56 (30%) 24-month follow-up., Conclusions: BI-RADS 3 lesions identified in our cohort had high biopsy rates and low compliance with no cancers. Our findings suggest that probable fibroadenomas in young women may only warrant abbreviated short-term follow-up at 6-months., (© 2021 American Institute of Ultrasound in Medicine.)

Rationale and Objectives: To identify the outcomes of stereotactic vacuum-assisted large bore biopsies performed on sonographically-occult non-calcified mammographic lesions (NCL)., Materials and Methods: In an IRB-approved retrospective study, we reviewed all NCL that underwent stereotactic biopsy from January 1, 2014 to December 31, 2017 at our institution, comparing patient age, lesion type, size and location with pathology outcome (benign, high-risk or malignant) using Wilcoxon-Mann-Whitney or Fisher's exact tests as appropriate. Multivariable logistic regression models were developed to decrease benign biopsies in our cohort with diagnostic performance assessed using receiver operating characteristic curve and area under the curve (AUC)., Results: Of 222 biopsied lesions in 213 patients, 79.3% (176/222) were benign, 5.9% (13/222) malignant, and 14.9% (33/222) high-risk. NCL were less likely to be malignant compared to calcifications biopsied in the same period [5.9% vs 19.0% (243/1279), p < 0.001]. All 42 asymmetries and 33 architectural distortions were benign, while 8.7% (4/46) of masses and 8.9% (9/101) of focal asymmetries were malignant. Cancers were associated with older age (mean 65.2 vs 52.7 years, p < 0.001), smaller size (mean 9.5 mm vs 15.5 mm, p < 0.01), and concurrent breast cancer (p < 0.01) compared to benign/high-risk lesions. Multivariable logistic regression model using patient age >50 years, lesion type, and size <15 mm had a high diagnostic performance [AUC=0.89, 95%CI (0.83, 0.94)], and yielded the highest PPV [0.24; 95%CI (0.13, 0.38)], and highest number of avoided, unnecessary biopsies (172/209, 82%)., Conclusion: NCL biopsied under stereotactic guidance have low cancer yield (5.9%). A multivariate model integrating age, lesion size and type could potentially help avoid unwarranted biopsies in our cohort., (Copyright © 2020 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Objectives: This study aimed to evaluate pain management practices in the emergency departments (EDs) in Turkey and to evaluate the prevalence and etiologies of oligoanalgesia to identify possible improvement strategies., Methods: This multicenter cross-sectional observational study was conducted in 10 tertiary care hospitals in Turkey. Patients who were admitted to the ED with pain chief complaints were included in the study. Both patients and physicians were surveyed with two separate forms by the research associates, respectively. The patient survey collected data about the pain and the interventions from the patients' perspective. The pain was evaluated using the Numerical Rating Scale. The physician survey collected data to assess the differences between study centers on pain management strategies and physician attitudes in pain management., Results: Ten emergency physicians and 740 patients (male/female: 365/375) enrolled in the study. The median pain score at admission at both triage and ED was 7 (interquartile range: 5-8). The most frequent type of pain at admission was headache ( n = 184, 24.7%). The most common analgesics ordered by physicians were nonsteroidal anti-inflammatory drugs ( n = 505, 67.9%), and the most frequent route of administration was intramuscular injection ( n = 396, 53.2%). About half of the patients ( n = 366, 49.2%) received analgesics 10-30 min from ED admission. The posttreatment median pain score decreased to 3 ( P < 0.001). About 79.2% of patients did not need a second analgesic administration ( n = 589), and opioid analgesics were the most frequently administered analgesic if the second application was required. Physicians prescribed an analgesic at discharge from the ED in 55.6% of the patients ( n = 414) and acute pain was present in 7.5% ( n = 56) of the patients., Conclusion: Our study on the pain management practices in the EDs in Turkey suggested that high rate of intramuscular analgesic use and long emergency room stay durations are issues that should constitute the focus of our quality improvement efforts in pain management., Competing Interests: Conflicts of interest Emergency Medicine Association of Turkey, where all authors are members to, holds the responsibility of this research which is funded by Abdi İbrahim Pharmaceuticals in which authors have no business or financial interests., (Copyright: © 2021 Turkish Journal of Emergency Medicine.)

This review provides an overview of current applications of deep learning methods within breast radiology. The diagnostic capabilities of deep learning in breast radiology continue to improve, giving rise to the prospect that these methods may be integrated not only into detection and classification of breast lesions, but also into areas such as risk estimation and prediction of tumor responses to therapy. Remaining challenges include limited availability of high-quality data with expert annotations and ground truth determinations, the need for further validation of initial results, and unresolved medicolegal considerations. KEY POINTS: • Deep learning (DL) continues to push the boundaries of what can be accomplished by artificial intelligence (AI) in breast imaging with distinct advantages over conventional computer-aided detection. • DL-based AI has the potential to augment the capabilities of breast radiologists by improving diagnostic accuracy, increasing efficiency, and supporting clinical decision-making through prediction of prognosis and therapeutic response. • Remaining challenges to DL implementation include a paucity of prospective data on DL utilization and yet unresolved medicolegal questions regarding increasing AI utilization.

Purpose: To compare the outcomes of microcalcifications recalled on full-field digital (FFDM) and FFDM and combined tomosynthesis (Combo) to synthetic (SM) screening mammograms., Method: We reviewed medical records, radiology, and pathology reports of all patients found to have abnormal calcifications requiring further evaluation on mammography screening at our institution between 11/1/2016-11/1/2018 and collected patient demographics, calcification morphology and distribution, and mammography technique (SM, FFDM, or Combo). We used biopsy pathology or at least 1-year imaging follow-up to establish overall diagnostic outcome (benign or malignant). Fisher's exact test was used to compare validation rates at diagnostic work-up, BI-RADS category, and final outcome of calcifications identified on each screening technique. T-test was used for continuous variables., Results: Of 699 calcifications in 596 women recalled, 176 (30%) of 596 were from SM and 420 (70%) FFDM/Combo. There was a significantly higher rate of calcifications unvalidated at diagnostic work-up for SM compared to FFDM/Combo (0.8% vs. 10%, p < 0.0001). SM calcifications were more likely to receive BI-RADS 2/3 at diagnostic work-up compared to FFDM/Combo ones (55% vs. 42%, p = 0.003). Of 346 (49%) calcifications that underwent biopsy, 88 (25%) were malignant (36% of SM vs. 22% of FFDM/Combo, OR:0.5 [95% CI: 0.3, 0.8] p = 0.01). Of 622 lesions with established diagnostic outcome, there was no difference between having an overall benign or malignant outcome between SM and FFDM/Combo (17% vs. 13%, OR: 0.8 [95% Cl: 0.5, 1.2] p = 0.27)., Conclusions: Synthetic tomosynthesis screening results in a higher rate of false positive and unvalidated calcification recalls compared to FFDM/Combo., (Copyright © 2020 Elsevier B.V. All rights reserved.)

In breast cancer, undetected lymph node metastases can spread to distal parts of the body for which the 5-year survival rate is only 27%, making accurate nodal metastases diagnosis fundamental to reducing the burden of breast cancer, when it is still early enough to intervene with surgery and adjuvant therapies. Currently, breast cancer management entails a time consuming and costly sequence of steps to clinically diagnose axillary nodal metastases status. The purpose of this study is to determine whether preoperative, clinical DCE MRI of the primary tumor alone may be used to predict clinical node status with a deep learning model. If possible then many costly steps could be eliminated or reserved for only those with uncertain or probable nodal metastases. This research develops a data-driven approach that predicts lymph node metastasis through the judicious integration of clinical and imaging features from preoperative 4D dynamic contrast enhanced (DCE) MRI of 357 patients from 2 hospitals. Innovative deep learning classifiers are trained from scratch, including 2D, 3D, 4D and 4D deep convolutional neural networks (CNNs) that integrate multiple data types and predict the nodal metastasis differentiating nodal stage N0 (non metastatic) against stages N1, N2 and N3. Appropriate methodologies for data preprocessing and network interpretation are presented, the later of which bolster radiologist confidence that the model has learned relevant features from the primary tumor. Rigorous nested 10-fold cross-validation provides an unbiased estimate of model performance. The best model achieves a high sensitivity of 72% and an AUROC of 71% on held out test data. Results are strongly supportive of the potential of the combination of DCE MRI and machine learning to inform diagnostics that could substantially reduce breast cancer burden.

The novel coronavirus pandemic poses a major global threat to public health. Our knowledge concerning every aspect of COVID-19 is evolving rapidly, given the increasing data from all over the world. In this narrative review, the Turkish Thoracic Society Early Career Taskforce members aimed to provide a summary on recent literature regarding epidemiology, clinical findings, diagnosis, treatment, prevention, and control of COVID-19. Studies revealed that the genetic sequence of the novel coronavirus showed significant identity to SARS-CoV and MERS-CoV. Angiotensin-converting enzyme 2 receptor is an important target of the SARS-CoV-2 while entering an organism. Smokers were more likely to develop the disease and have a higher risk for ICU admission. The mean incubation period was 6.4 days, whereas asymptomatic transmission was reported up to 25 days after infection. Fever and cough were the most common symptoms, and cardiovascular diseases and hypertension were reported to be the most common comorbidities among patients. Clinical manifestations range from asymptomatic and mild disease to severe acute respiratory distress syndrome. Several patients showed typical symptoms and radiological changes with negative RT-PCR but positive IgG and IgM antibodies. Although radiological findings may vary, bilateral, peripherally distributed, ground-glass opacities were typical of COVID-19. Poor prognosis was associated with older age, higher Sequential Organ Failure Assessment score, and high D-dimer level. Chloroquine was found to be effective in reducing viral replication in vitro. Likewise, protease inhibitors, including lopinavir/ritonavir, favipiravir, and nucleoside analogue remdesivir were proposed to be the potential drug candidates in COVID-19 management. Despite these efforts, we still have much to learn regarding the transmission, treatment, and prevention of COVID-19.

Objective: To investigate if Neutrophil Gelatinase-associated Lipocalin can be used or not as a biochemical marker to determine the indications for emergency dialysis treatment., Methods: The study was conducted at the Emergency Department of Numune Taraining and Research Hospital, Ankara, Turkey, in 2012, and comprised 60 patients who had uraemic symptoms and abnormal laboratory tests, including elevated potassium, blood urea nitrogen, and creatinine level or lowered pH and bicarbonate. They were divided in to 2 equal groups as those having indication for dialysis (Group 1) and those not having such indications (Group 2). Relevant values, including that of Neutrophil Gelatinase-associated Lipocalin, were compared between the two groups. To assess the utility of Neutrophil Gelatinase-associated Lipocalin measurements at varying cut-off values to predict indications for dialysis, a conventional receiver operating characteristic curve was generated and the area under the curve was calculated. P < 0.05 was considered statistically significant., Results: The mean age of the 30 patients in Group 1 was 68.29 +/- 16.9 years, while in Group 2 it was 66.47 +/- 14.2 years (p < 0.65). The mean Neutrophil Gelatinase-associated Lipocalin level was 817.65 +/- 334.76ng/mL in Group 1 and 398.97 +/- 202.42 ng/mL in Group 2 (p < 0.001). The best cut-off level for Neutrophil Gelatinase-associated Lipocalin to predict emergency haemodialysis indication was 615 ng/mL with a sensitivity of 82% and a specificity of 80%, and the areas under curve was 0.84., Conclusion: Serum Neutrophil Gelatinase-associated Lipocalin level may be a determining parameter for indication of emergency haemodialysis.

Complexes of trimethoprim (TMP), with Cu(II), Zn(II), Pt(II), Ru(III) and Fe(III) have been synthesized. Then, these complexes have been characterized by spectroscopic techniques involving UV-vis, IR, mass and (1)H NMR. CHN elemental analysis, electrochemical and thermal behavior of complexes have also been investigated. The electrochemical properties of all complexes have been investigated by cyclic voltammetry (CV) using glassy carbon electrode. The biological activity of the complexes has been evaluated by examining their ability to bind to calf-thymus DNA (CT DNA) with UV spectroscopy and cyclic voltammetry. UV studies of the interaction of the complexes with DNA have shown that these compounds can bind to CT DNA. The binding constants of the complexes with CT DNA have also been calculated. The cyclic voltammograms of the complexes in the presence of CT DNA have shown that the complexes can bind to CT DNA by both the intercalative and the electrostatic binding mode. The antimicrobial activity of these complexes has been evaluated against three Gram-positive and four Gram-negative bacteria. Antifungal activity against two different fungi has been evaluated and compared with the reference drug TMP. Almost all types of complexes show excellent activity against all type of bacteria and fungi. The morphology of the CT DNA, TMP, metal ions and metal complexes has been investigated by scanning electron microscopy (SEM). To get the SEM images, the interaction of compounds with CT DNA has been studied by means of differential pulse voltammetry (DPV) at CT DNA modified pencil graphite electrode (PGE). The decrease in intensity of the guanine oxidation signals has been used as an indicator for the interaction mechanism., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Background: Treatment of recent tuberculosis infection in children aged <2 years is essential, because of high risk of progression to disease, but diagnosis is hindered by the inaccuracy of the tuberculin skin test (TST). More-accurate T cell-based tests of infection could enhance diagnosis by optimizing interpretation of the TST results., Methods: A total of 979 child tuberculosis contacts in Istanbul underwent the TST and enzyme-linked immunospot assay. Using enzyme-linked immunospot test results as a reference standard, we assessed the effect of age and bacille Calmette-Guérin (BCG) vaccination on the sensitivity and specificity of the TST, and we computed the optimal TST cutoff points, using receiver operating characteristic curves., Results: With a TST cutoff point of >or=10 mm, the sensitivity of the TST was 66% for children aged <2 years, which was lower than that for older children (P= .006). Specificity was 75% for BCG-vaccinated children, compared with 92% for unvaccinated children (P= .001). Optimal cutoff points improved TST specificity for children with 1 BCG scar, with little loss of sensitivity. Despite the use of optimal cutoff points, TST sensitivity remained <70% for children aged <2 years, specificity remained <87% for BCG-vaccinated children aged >or=2 years, and overall accuracy was low for children with >1 BCG scar., Conclusions: Negative results of the TST cannot exclude tuberculosis infection for child tuberculosis contacts aged <2 years, which supports the use of preventive therapy regardless of the TST results for this age group. In children aged >or=2 years, the accuracy of the TST can be improved by adjustment of cutoff points for BCG-vaccinated children but remains poor for children with >1 BCG scar. This methodology can define optimal TST cutoff points for diagnosis of tuberculosis infection tailored to target populations.

The purpose of this study was to determine whether splenohepatopexy (SHP) or omental transposition (OP) could reverse the portal hypertension (PH) induced by portal vein ligation (PVL). Fifty-eight Wistar rats divided into four groups: in group A (22 rats) PH was produced by calibrated PVL. In group B (8 rats), SHP was performed. Group C animals (13 rats) underwent SHP and PVL. In group D (15 rats) both PVL and OP were done. In all of the rats, the portal pressures (PP) were measured before and after the production of PVL. For SHP, small areas on the spleen and liver capsula were stripped off, and these two areas were placed together. In group D, an omentum patch was tied on the prepared liver surface. Twelve weeks after surgery, the PP were measured again and portal angiography was done. The liver, omentum and spleen were histopathologically examined. In all of the groups, the PP after PVL were significantly higher than before PVL. Twelve weeks after surgery, the PP of SHP and OP groups were significantly lower than those with PVL alone. Angiographic study showed many collaterals between transposed tissue and liver. Histopathologically, the collaterals of animals with SHP or OP were found to be well developed to allow sufficient flow for PP reduction. Both SHP and OP may reverse the increased PP in PVL model of PH. In the future; these methods may be alternative techniques for PP reduction in human beings as well.

Reactive oxygen species (ROS) released by neutrophils have been suggested to play an important role in cancer development. Since the mechanisms underlying this effect in the respiratory tract are still unclear, we evaluated DNA damage induced by neutrophils in respiratory tract epithelial cells in vitro and in vivo. For in vitro studies, rat lung epithelial cells (RLE) were co-incubated with activated neutrophils, neutrophil-conditioned medium, or hydrogen peroxide. For in vivo studies, we considered the human nose as a target organ, comparing neutrophilic inflammation in the nasal lavage fluid with the oxidative DNA lesion 8-hydroxydeoxyguanosine (8-OHdG) in epithelial cells obtained by nasal brush. Our in vitro data show that human neutrophils are able to induce both 8-OHdG and strand breaks in DNA from RLE cells. Our data also suggest that DNA damage induced by neutrophils is inhibited when neutrophil-derived H2O2 is consumed by myeloperoxidase. In contrast, in the nose no association between neutrophil numbers and 8-OHdG was found. Therefore, it remains unclear whether neutrophils pose a direct genotoxic risk for the respiratory tract epithelium during inflammation, andmore in vivo studies are needed to elucidate the possible association between neutrophils and genotoxicity in the lung.

The epidemiological evidence that ambient exposure, including particulate matter (PM) is related to adverse health outcomes continues to mount. Inflammation and disease of the upper respiratory tract are commonly suggested as effects of ambient exposure. Therefore we studied both ambient exposure and nasal effects in a 4-months cross-sectional survey in Nordrhein-Westfalen (Germany). At 4 locations in 3 different cities ambient exposure to TSP (total suspended particles), O3, NOx and SO2 was derived from compliance measurements by governmental offices, and 884 subjects (501 mothers and 383 children, 6-7 years old) were screened using nasal lavage, with success rates of 90 and 75%, respectively. No differences in total cell counts or percentage of neutrophils were found between mothers or children from the 4 different locations, despite small but significant differences in ambient exposure to TSP, SO2, O3, and NOx during this period. A higher epithelial cell count in mothers and children from one city might be related to general higher ambient pollution in that location. Interestingly, total cells and interleukin-8 levels in children were higher than in mothers and possibly reflect their increased susceptibility to effects of air pollution. Future analysis will concentrate on temporal relations between inflammation and exposure, including individual risk factors such as allergy, smoking and the presence of disease.