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Hazardous waste management (HWM) deals with processing waste materials, and improper handling of this procedure might considerably harm human health and environment. It is crucial to employ the most appropriate treatment and disposal techniques while handling with waste materials as part of hazardous waste management so that potential problems can be minimized accordingly. Therefore, the weights of the criteria playing vital roles in solid waste management were determined by using AHP&MARCOS method, which is an integrated MCDM technique, and the most appropriate techniques to be employed in solid waste treatment and disposal were selected. The implementation took place in three phases; the first phase included brainstorming and literature review and the determination of the important criteria in the waste management (4 main and 12 sub-criteria) as well as the treatment (3) and disposal (7) methods to be employed; i.e, the alternatives. In addition, a decision-making group of 15 people was formed so that they could share their opinions based on their knowledge and experiences via the decision matrices while evaluating the alternatives according to the predetermined criteria. In the second phase, the decision matrices constructed based on the expert opinions were taken into consideration while determining weights/priorities of waste management criteria by employing AHP method. In the third phase, treatment and disposal methods were listed by using the decision matrices filled according to expert opinions, the weight values and the criteria. The criteria weights obtained by using AHP method revealed that “operation cost” was the criteria with the highest weight of importance while determining solid waste treatment/disposal methods. Similarly, among the obtained alternatives, the best solid waste treatment technique was found to be “physical treatment” and the best solid disposal technique “plasma arc”. The present study is different from similar studies in the literature since the selection of treatment and disposal method was performed separately for all hazardous solid wastes (healthcare waste, municipality solid waste, etc.) for the first time. Moreover, the obtained results were evaluated by undertaking comprehensive analyses (sensitivity and comparison). The findings obtained in the present study are expected to make valuable contributions to the literature.

Pituitary adenomas are a group of disease with broad different clinical characteristics and complications. We aimed to present the data of patients being followed in a single center and discuss the pituitary adenomas based on the literature. Two hundred and twenty patients followed at Department of Endocrinology and Metabolism, Medical School of Ondokuz Mayis University, were included into study. Clinical characteristics, laboratory findings and treatment modalities were examined retrospectively. 59% of patients were female and 41% were male. Mean age during the diagnosis was 43.7 years. Pituitary macroadenomas were 62% of all adenomas and 73% of pituitary adenomas were functional. Among the functional adenomas, the most frequently seen types were prolactin-secreting adenoma and growth-hormone secreting adenoma. Treatment options were surgical treatment (67%), medical treatment (20%) and radiotherapy (7%). Post-operative complications were developed in 27 (13.2%) of patients. In patients with non-functional adenoma, the cure after surgery was detected as 19.6% and the remission after the surgery was detected as 8.9%. In this study, the characteristics of the pituitary adenomas were found similar to the literature in general. The early diagnosis of the disease has a significant importance in terms of treatment and the response to the treatment.

Purpose To investigate the diagnostic and prognostic significance of the blood-count derived systemic immunoinflammatory parameters in patients with thyroid-associated ophthalmopathy (TAO). Methods In this retrospective case-control study, the blood-count parameters and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio, and systemic immune-inflammatory index (SII), thyroid peroxidase antibody, and anti-thyroglobulin antibody were evaluated in 46 patients with TAO and 46 matched controls. The associations of the immunoinflammatory parameters with clinical outcomes were analyzed among TAO patients. Results Significant differences were found in NLR, PLR, SII, and lymphocyte count between the controls and the TAO group (p < 0.05 for all). In logistic regression analysis, these inflammatory parameters did not have any prognostic effect on the clinical outcomes of the TAO (p > 0.05 for all). The patients, who needed systemic treatment due to any ocular involvement of TAO during the follow-up period, had significantly lower platelet count (p = 0.001) and PLR (p = 0.02) at the time of initial diagnosis when compared to the no treatment-needed group of the TAO patients. The initial platelet count was significantly associated with the subsequent steroid need due to TAO during the follow-up period (β = −0.02, p = 0.03). Conclusions NLR, PLR, and SII may serve as potential inflammatory markers in the identification of the TAO, although they have no evident prognostic significance in TAO. However, the relatively lower platelet count at initial diagnosis may be associated with the need for systemic therapy during the follow-up in patients with TAO.

Objective: Hypoglycemia is a serious adverse effect of hydroxychloroquine (HCQ) which is very rare in non-diabetic patients. This case report describes a non-diabetic patient without any other chronic diseases, who experienced mild hypoglycemia related to HCQ used for COVID-19 treatment.Methods: All etiologies causing hypoglycemia were investigated and a 72-hour fast test was performed.Results: A 34-year-old male patient was admitted to our hospital with a high fever, cough, and chest pain. The result of his COVID-19 PCR test was positive. He received HCQ for 10 days for the treatment of COVID-19 infection. He experienced fatigue, dizziness, severe headache, weakness and feeling of hunger after discontinuation of HCQ during his isolation at home. Before COVID-19 infection, he never experienced hypoglycemia symptoms. He did not have a history of chronic diseases, drug use, alcohol consumption, or smoking. A 72-hour fasting test was performed. He complained about headache and weakness during the 72-hour test period. The PG level was determined as 49 mg/dl during these symptoms. Concurrent insulin and C-peptide levels were

Objective Our study aims to evaluate the patients’ immunity regarding childhood vaccination after leukemia treatment and determine the vaccines that require additional doses. Methodology Sixty-six patients who were followed up with the diagnosis of ALL and AML between 2013 and 2016 were included in our study. The patient's gender, age at diagnosis, leukemia type, leukemia risk groups, vaccination status before chemotherapy (CT) and serologies of hepatitis A, hepatitis B, varicella, measles, rubella, mumps at the end of CT were recorded. Results At the end of the treatment, loss of protective antibody response against hepatitis A (47.4%), hepatitis B (68.2%), varicella (64.2%), measles (45.5%), rubella (43.9%), and mumps (50%) vaccines were shown. Loss of protective antibodies against hepatitis A (66.7%), hepatitis B (100%), varicella (100%), measles (100%), rubella (91.7%), and mumps (91.7%) in high-risk ALL patients was higher than patients in standard-intermediate risk ALL. Conclusion Loss of humoral immunity against hepatitis A, hepatitis B, varicella, MMR was shown in patients with leukemia at the end of the treatment. Due to the significant decrease in hepatitis B and MMR protective antibodies in the high-risk group, we recommend patients with leukemia who have completed chemotherapy to be vaccinated with hepatitis B vaccine three months and MMR vaccine six months after the treatment.

The aim of this study is to evaluate the association between seven important H. pylori virulence factors and antibiotic resistance in patients with gastritis. H. pylori strains isolated from 33 patients with gastritis were examined. Antimicrobial susceptibilities were tested by GenoType® HelicoDR (Hain Life Science, Germany) test kit and RT-PCR. The virulence-factors were determined using conventional PCR. 39% of patients were resistant for clarithromycin and 27% of patients were resistant for fluoroquinolone. 15% of patients were resistant to both clarithromycin and fluoroquinolone. The H. pylori vacA m1/s2 genotype was the most frequent allelic combination. Patients were possessed the vacA s1, m1 (6.1%); s1, m2 (6.1%); s2, m1 (15.1%); and s2, m2 (3.0%) genotypes. 94% of patients with gastritis were positive for H. pylori napA gene. Also, there were no dupA gene-positive gastritis patients. There was no significant correlation between the vacA, cagA, oipA, hpaA, babA, napA, dupA, ureA, ureB virulence genes, clarithromycin, and fluoroquinolone resistance. Herein, we report that the relationship between the H. pylori napA gene and gastritis. Although we found a correlation between H. pylori virulence factor and clinical outcome, there is a need for further studies to enlighten the relation between H. pylori virulence genes and antibiotic resistance.

WOS: 000522673900009 Pheochromocytoma are the functional adrenal lesions originating from the chromaffin cells. For the cases of pheochromocytoma observed in multiple endocrine neoplasia Type 2 and Von Hippel syndrome, the bilateral adrenal glands are involved. In classical approach, total adrenalectomy is applicable on such masses while adrenal failure is almost inevitable. Lifelong cortisol and fludrocortisones replacement are necessary for the patients with adrenal failure while the rate of morbidity and mortality has significantly increased. With the introduction of the minimal invasive surgical approach, cortex sparing adrenalectomy has been brought forward for the adrenal tumors. The primary objective of the cortex sparing surgery is to prevent the lifelong replacement and the permanent adrenal failure after adrenalectomy. Therefore, it is particularly preferred in the case of genetic pheochromocytoma with bilateral adrenal involvement. However, in the case of the selected cases, it can also be applicable for adenoma producing aldostrerone and Cushing syndrome. The adrenal tumor will be completely removed and if sufficient tissue is reserved in the manner to preserve the cortex function, no long-term recurrence and adrenal failure is to be developed. Therefore, cortex-sparing surgery may be a good alternative to total adrenalectomy for the patients with small benign functional adrenal tumors or bilateral genetic pheochromocytoma.

Objectives: We sought to evaluate the possible correlation between serum vitamin D levels and exudative age-related macular degeneration (AMD). Methods: We conducted a cross-sectional study including 95 patients with exudative AMD and 95 healthy age-and sex-matched controls. The participants’ serum 25-hydroxyvitamin D3 (25(OH)D3) levels were measured, and the results were classified into three categories: deficient (< 20.0 ng/mL), insufficient (20.1–29.9 ng/mL), and sufficient (>30.0 ng/mL). We compared serum 25(OH)D3 levels between the two study groups and the AMD ratio between the patients with deficient serum 25(OH)D3 levels and those with levels in the sufficient and insufficient ranges. Results: The median 25(OH)D3 levels were significantly lower in patients with AMD compared to the control subjects (p = 0.042). The frequencies of patients with AMD among the vitamin D categories were statistically significant (p = 0.043). Subgroup analysis showed that the frequency of patients with AMD and deficient vitamin D levels was significantly higher than that found in the patients who had sufficient and/or insufficient ranges of vitamin D levels (55.0% vs. 36.0%, p = 0.043, respectively). Conclusions: Serum 25(OH)D3 levels may have an impact on the neovascular type of AMD. As 25(OH)D3 levels decrease, the frequency of AMD increases. © 2020, Oman Medical Specialty Board. All rights reserved.

Purpose To compare the central corneal thickness (CCT), intraocular pressure (IOP), and tear insulin-like growth factor 1 (IGF-1) levels between patients with acromegaly and a control group and to evaluate the possible effect of tear IGF-1 and duration of the disease on CCT and IOP. Methods We included 31 patients with acromegaly (study group) and 40 age- and sex-matched controls in the study. Patients with acromegaly were divided into 2 subgroups based on disease status (active/inactive). All participants underwent complete ophthalmologic evaluation including CCT and IOP values. Basal tear samples were collected from both groups and tear IGF-1 levels were measured. The CCT, IOP, and tear IGF-1 levels were compared between groups and subgroups and the association between tear IGF-I levels and ocular parameters (CCT, IOP) and disease duration were also evaluated. Results Central corneal thickness, IOP, and tear IGF-1 levels did not show a significant difference between study and control groups. We also did not find a significant difference in terms of CCT, IOP, or tear IGF-1 levels between subgroups of patients. Correlation analysis did not show an association between the duration of disease and tear IGF-1 levels with CCT or IOP. Conclusions There was no significant difference in tear IGF-1 levels between patients with acromegaly and controls. Additionally, there was no correlation between disease duration and tear IGF-1 levels with CCT or IOP levels. This lack of association may suggest that tear IGF-1 levels might not have an effect on CCT or IOP findings in patients with acromegaly.

Objective:We aimed to investigate the importance of mean platelet volume (MPV) as a marker for the activation and severity of disease in patients with pulmonary sarcoidosis.Methods:The data of 84 patients diagnosed with pulmonary sarcoidosis in our clinic between 2011 and 2014 were evaluated retrospectively. Patients were divided into groups according to the activation status (active or in remission), acute or chronic disease, stage according to chest X-ray, and extrapulmonary involvement. The correlation of the initial MPV and ACE levels was evaluated.Results:Sixty-three of the patients were female, with an average age of 44 (38–52) years. Fifty-two of the patients (62%) were in stage 1, and 32 (38%) were in stage 2. The median ACE level was 59.6 (42.6–92), and the MPV level was 10.1 (9.7–10.7). Bronchoalveolar lavage was applied to 24 patients; all of these had predominant lymphocytes, and the median CD4/CD8 rate of the patients was 4.8 (3.2–12.5). A significant negative correlation was detected between ACE and MPV independently of the groups (p0.05 for all).Conclusion:According to our data, MPV is not a significant marker for inflammation or activation of disease and is not suitable for use as a diagnostic and follow-up indicator in pulmonary sarcoidosis.

Objective:Cadmium (CD), which is used for many industrial purposes, is a toxic agent. CD accumulates in the liver; therefore, exposure to toxic doses of Cd results in hepatic damage. Studies in rats have shown that CD induces apoptosis in hepatocytes. Curcumin is a natural compound isolated from Curcuma longa. It has a powerful anti-inflammatory affect and scavenges reactive oxygen radicals. Additionally, it has been shown to have an anti-apoptotic effect in a dose-dependent manner. The aim of the present study was to evaluate the effects of therapeutic doses of curcumin on Cd-induced hepatic apoptosis as well as hepatic biochemical and inflammatory changes in Sprague–Dawley rats.Methods:In this study, 24 female Sprague–Dawley rats (6 months old) were randomly assigned to four main groups (n=6): control, CD, CD +curcumin, and curcumin. At the end of the experiment, after collecting blood samples from the heart, the rats were sacrificed and their livers were removed for histopathological and biochemical examinations. The number of apoptotic cells, total anti-oxidant status, total oxidant status, and thiol and MPO levels were measured in liver tissue; interleukin-6 and procalcitonin levels were measured in sera.Results:Chronic CD administration induced apoptosis. The number of apoptotic cells was significantly increased in the Cd group (almost 2 fold) compared to that in the control group. However, in the CD+curcumin group, the number of apoptotic cells was significantly decreased (almost 2 fold) compared to that in the Cd group. However, there were no statistically significant differences.Conclusion:We suggest that curcumin protects the liver against toxin-induced apoptosis.

Background High blood pressure is still a challenge for emergency physicians to discern the patients that require further analysis to establish the existence of acute hypertensive target organ damage (TOD). The present study aimed to reveal that adropin levels are useful for detecting TOD in patients presenting with high blood pressure. Methods Patients presenting with a blood pressure of more than 180/110 mm Hg were enrolled into the study. After a resting period of 15 minutes, patients' blood pressures were measured thrice at 5-minute intervals while the patients were sitting on a chair, and the average of these measurements was accepted as the baseline value. Blood samples were obtained for either adropin levels or possible TOD during the emergency department admission. Results A total of 119 patients were included in the study. The mean systolic and diastolic blood pressures of study patients were 204.8 ± 23.2 and 108.3 ± 10.3, respectively, and 42% (n = 50) of the patients had TOD. Although the adropin levels were similar between the patients with or without TOD (TOD group = 195 pg/mL, interquartile range [IQR]: 178-201; no-TOD group = 196 pg/mL, IQR: 176-204 [P =.982]), it is significantly higher in normotensive patients (normotensive group = 289 pg/mL, IQR: 193-403) compared with the hypertensive ones (P

Endocan is a newly identified proteoglycan released from endothelium, stimulating angiogenesis and when increased, indicates endothelial activation (inflammation). Our aim was to examine the association between serum endocan levels and urine albumin-creatinine ratio (UACR).One hundred and thirty-seven patients with type 2 diabetes mellitus and normal serum creatinine who had no co-morbidities other than hypertension, diabetic nephropathy, retinopathy, or neuropathy were divided into normoalbuminuria (G1), microalbuminuria (G2), and macroalbuminuria (G3) groups and compared cross-sectionally regarding serum endocan levels.There were 55, 47, and 35 patients in G1, G2, and G3, respectively. The groups were comparable in terms of gender, age, duration of diabetes, diabetic neuropathy/retinopathy, fasting glucose, HbA1c, serum creatinine level, and eGFR. Patients in G3 had significantly higher blood pressure but lower serum albumin and endocan levels. UACR showed a negative bivariate correlation with serum endocan levels (r = -.282, p = .001). There was bivariate positive correlation between endocan and systolic blood pressure (r=.185, p = .030). In linear regression analysis, UACR was negatively correlated with endocan while positively correlated with systolic blood pressure, duration of diabetes, and platelet distribution width.Patients with macroalbuminuria had lower endocan levels, and increasing UACR was associated with decreasing serum endocan levels. Despite the occurrence of angiogenesis and glomerular hypertrophy in the early phase of diabetic nephropathy, ensuing significant renal injury over time may reduce the expression of endocan. Serum endocan levels may represent a novel marker for nephropathy progression.

Objective: The purpose of this study is to investigate the relationship of disease activity with Neutrophil-Lympho­cyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) and red blood cell distribution width (RDW). Methods: Seventy seven RA patients and 97 healthy sub­jects were examined retrospectively. People with chronic and systemic diseases were excluded from control group of the study. The disease activity scores (DAS 28) of pa­tient group, hematologic parameters and inflammation parameters of both groups were analyzed statistically us­ing independent t-test and spearman correlation test. Results: Age and gender was not found different be­tween groups. CRP and ESR levels were significantly higher in RA group (p

BACKGROUND/AIMS Acute pancreatitis (AP) is a life-threatening disease with a rising incidence. The aim of this study was to investigate the association between oxidative status, lymphocyte deoxyribonucleic acid (DNA) damage, and acute pancreatitis. MATERIALS AND METHODS A total of 45 patients with AP and 35 healthy controls were included in the study. We assessed pancreatic enzymes, oxidative stress, and lymphocyte DNA damage. The severity of AP disease was determined by the Harmless Acute Pancreatitis Score (HAPS) and Balthazar scoring systems. RESULTS In AP patients, lymphocyte DNA damage was significantly higher than in controls [49.84±25.48 arbitrary units (AU) vs. 28.80±13.98 AU, p

Objective The aim of this study was to assess the predisposition for atherosclerosis in patients with RLS through serum sLOX-1 (serum Lectin-Like Oxidized Low-Density Lipoprotein Receptor-1) measurements. Background Recent epidemiological studies have suggested an association of RLS with certain chronic conditions such as diabetes mellitus (DM), obesity, hypertension (HT), and hyperlipidemia. LOX-1 is expressed in endothelial cells, macrophages, and in smooth muscle cells under the effect of proatherogenic conditions. Methods This study was a prospective, cross-sectional, case-controlled. We measured the serum sLOX-1 levels in 37 restless legs syndrome patients and 38 controls. Results Serum sLOX-1 level was significantly lower in the patient group. The two groups were similar in glucose, HbA1c, creatinine, LDL cholesterol, TG, HDL, total protein, albumin, AST, ALT, GGT, ALP, HGB, HCT, MCV, transferrin saturation rate (TSR), ferritin, CRP, TSH, FT4, FT3, B12, and folic acid levels. Also the two groups were similar with respect to age at menarche, number of previous births, number of abortions and/or curettage, total duration of breastfeeding, percentage of patients in menopause, and age at menopause. Conclusion Our results may suggest a lower atherosclerotic risk among RLS patients as compared to the general population (Tab. 3, Ref. 33).

Generalized osteoporosis associated with gestation and lactation is a rarely-seen case, which is seen during the final period of gestation or right after birth/delivery. The etiology and pathogenesis are not fully known. The fact that the pre-existing osteoporosis may be aggravated by gestation, that it may stem from genetic susceptibility, or that it may even be random are still under discussion. The most commonly-seen symptom is particularly the short stature due to lumbar pain during the lactation period as well as the vertebral compression fractures. In this study, we aimed to draw the attention to this rare case seen in the patients applying to the clinic with the complaint of post-natal lumbar pain, by starting from the two cases whose diagnoses and treatments were performed in our clinic.