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There is no exact information about the birth and death dates of Abdal Musa, one of the important names of the Bektashi sect. The influence of Abdal Musa, who undoubtedly left deep traces within the Bektashi sect, continued after his death. The manuscript containing the shaving man, which is the subject of our study, is registered in the Istanbul Metropolitan Municipality Atatürk Library with the catalog number OE_Yz_1056 297.7 BEK 1. The manuscript written in Nasih script is a Bektashi ritual. The section titled “This is the Erkân-ı Tıraş from Shah Abdal Musa Sultan Efendi” is a very short text. Although there is no record of who wrote the manuscript and on what date, it is possible to put forward some opinions based on the information contained in it. In the study, brief information about Abdal Musa’s life was given and an evaluation was made about the physical characteristics and content of the manuscript. The genealogy information given by el-Hâc Hasan, who we think is the author of the manuscript, also contains clues that will contribute to illuminating the period of Şahkulu Sultan Lodge in the early 19th century. Then, the implementation of the shaving ritual was discussed in accordance with the order conveyed in the manuscript, and the text was translated and evaluated.

Ventilatör ilişkili pnömoni (VİP), yoğun bakım ünitesindeki (YBÜ) en önemli enfeksiyonlardan biridir ve hastalarda mortalite ve morbidite artışına katkıda bulunur. Bu çalışmada Rheum ribes (Elazığ/Türkiye) ekstraktının VİP hastalarından elde edilen bakteri izolatları üzerinde antimikrobiyal etkilerini (agar kuyu difüzyonu, MİK testi) ve antioksidan kapasitesini (DPPH, FRAP ve metal şelatlama) değerlendirmeyi amaçladık. Analiz sonucunda R.ribes'in en yüksek antimikrobiyal etkisi 19.32 mm zon çapı ile Klebsiella pneumonia-2 (K.pneumonia) ve 18.45 mm zon çapı ile K.pneumonia-21 izolatında gözlendi. Bunların dışında Staph. aureus., K. pneumonia-20, K. pneumonia-16 ve Pseudomonas aeruginosa (P. aeruginosa) sırasıyla 18.32, 15.14, 14.56 ve 13.54 mm zon çapları ile tespit edildi. R. ribes ekstraktı K.pneumonia izolatları 16 ve 20'de 0,5 ppm'de %98,3 ve %94,88 inhibitör etki gösterirken, en yüksek izolatlar 21 ve 2'de %100 inhibitör etki göstermiştir. S. aureus %50,36 gibi yüksek bir inhibisyon etkisi göstermiştir. 0,25 ppm'de ve P. aeruginosa 0,5 ppm'de %82,82 oranında izole edilmiştir. Ayrıca DPPH, FRAP ve metal şelasyon analizleri güçlü bir antioksidan etki göstermiştir. Ribes ekstraktının antioksidan etkileri için demir iyonlarının (Fe2+) DPPH inhibisyon etkisi, FRAP analizi ve şelatlama aktivitesi değerleri sırasıyla %17.22, %1.18 ve %2.14 olarak belirlendi. Sonuç olarak, R. ribes ekstraktının patojenik bakteriler üzerindeki güçlü etkisi ve antioksidan kapasitesi belirlenmiş olup, in vivo ve klinik çalışmalarla faydalı özellikleri derinleştirilebilir.

Zeytinyağı, zeytin meyvesinden mekanik olarak elde edilen ve rafine edilmeden tüketilebilen en önemli bitkisel yağlardan biridir. Zeytinyağı, insan sağlığına faydalı olduğu bilinen yüksek oranda doymamış yağ asitleri ve antioksidan bileşikler içerir. Yeni üretilen zeytinyağı, zeytin posası parçacıkları ve sudan kaynaklanan mikro damlacıklar nedeniyle bulanık görünüme sahiptir. Bulanık görünüme neden olan katı partiküller ve su, bazı mikroorganizmaların canlılığını koruyabileceği bir ortam yaratır. Mikroorganizmaların bazıları zeytinyağının fiziko-kimyasal ve duyusal özelliklerini, yüksek enzimatik aktiviteleri sayesinde iyileştirirken, bazıları da zeytinyağının kalitesini bozar. Zeytinyağındaki mikroorganizma çeşitliliği, zeytin çeşidi, hasat yöntemi, işleme tekniği, depolama koşulları ve depolama süresi gibi faktörlere bağlı olarak değişebilir. Bu çalışmada zeytinyağında bulunan mikroorganizmalar ve bunların zeytinyağı kalitesine etkileri derlenmeye çalışılmıştır.

The Naples prognostic score (NPS) predicts patient survival in gastroesophageal cancer using parameters related to nutritional and inflammatory status. These parameters include risk factors for coronary endothelial dysfunction except for low total cholesterol. Therefore, we modified the score (mNPS) to include high cholesterol, a risk factor for coronary endothelial dysfunction. We aimed to evaluate the relationship between mNPS and the angiographic epicardial coronary slow flow phenomenon (CSFP). This retrospective study included 301 patients with coronary slow flow who underwent coronary angiography between 2018 and 2022. The mNPS parameters were calculated and the population was divided into three groups based on the calculated parameters. Angiographic findings were classified in the left anterior descending (LAD), circumflex (Cx), right coronary (RCA) arteries, and three coronary arteries together. Statistical analyses were performed to identify mNPS as predictors of a slow flow phenomenon. Participants were divided into mNPS Group 1 (n=63), mNPS Group 2 (n=201), and mNPS Group 3 (n=37). No significant differences were observed in age, gender, or medications among the mNPS groups. The RCA had a statistically significant association with mNPS groups for slow flow phenomenon (p=0.006). Considering all three coronary arteries, the association with mNPS groups was also significant (p=0.005). White blood cell and lymphocyte counts showed significant differences. Compared with group 1, group 3 had 4.11 times more coronary artery slow flow. Our study suggests that the mNPS, integrating nutritional and inflammatory parameters along with high cholesterol, holds promise as a potential predictor for the coronary slow flow phenomenon. This could impact risk stratification and clinical management in this patient group. [Med-Science 2023; 12(4.000): 1227-31]

Head trauma is a leading cause of mortality and morbidity in pediatric patients. The trauma itself leads to the activation of a biomolecular cascade of damage. Purinergic receptors and ATP release play an important role in the activation of astroglia, microglia, monocyte-macrophages, neutrophils, and T cells in this process. The systemic immune inflammation index can be easily calculated, cheap, only requires hemogram parameters, and does not include any subjective findings. Therefore, we believe that it could be a prognostic predictor and a diagnostic marker for pediatric head trauma cases. Our study was designed as a retrospective and single-center study. The study was conducted with pediatric patients who presented to the emergency department with isolated head trauma between June 15, 2022, and December 15, 2022. Demographic data, medical history, white blood count, platelet count, neutrophil count, systemic immune inflammation index (SIII), Glasgow Coma Score, and the presence of pathology on brain computed tomography were recorded on the case report form. The study was conducted with 112 cases. In cases with bleeding, the median value of GCS was significantly lower (p [Med-Science 2023; 12(3.000): 656-60]

In batch operation, most industries require engineers to maintain low hardness on the welded parts, particularly for low carbon steel. This article focuses on tungsten inert gas (TIG) welding performed on 0.90 mm of a C67 grade sheet by varying different welding parameters such as current, velocity, and temperature. Samples were collected from the tool side, mid-wall, and operator side for metallographic and micro-hardness examinations considering various parameters. Without post welding heat treatment (PWHT), the welded parts were quenched at room temperature, while with PWHT the welded parts were kept at 710 ℃ for 99 s after welding, and subsequently, the samples were cooled slowly by air at ambient temperature. An increase in hardness was registered in either the fusion zone or melted zone, with decrements in the heat affected zone (HAZ) for both procedures. When the the welding was performed without PWHT, a martensitic and bainitic microstructure was noticed in the melting zone (MZ) and HAZ, respectively. In contrast, a bainitic microstructure was observed in either the melting or heat affected zone in the welding with PWHT. Metallographic images revealed crack propagation when welding was performed without PWHT. A larger HAZ was noted in the welding sample with PWHT, and hardness was also relatively lower compared the samples without PWHT. There was no significant difference in hardness among the samples taken from tool side, mid-wall, and operator side for both procedures. Finally, the lowest microhardness (265 HV) was found in the MZ when the welding was carried out with PWHT employing a 90 A current and 10 mm/s velocity.

Background: Amivantamab, an EGFR-MET bispecific antibody, is the first approved targeted therapy for patients with EGFR Ex20ins NSCLC after prior platinum-based chemotherapy—a population with historically poor outcomes before amivantamab approval. As antitumor activity in single-arm studies typically focuses on responders, the evaluation of outcomes in patients with stable disease (SD) as best response is of clinical interest. Patients and methods: Among 114 patients with post-platinum EGFR Ex20ins NSCLC in CHRYSALIS (NCT02609776; data cutoff: March 30, 2021), response was assessed by blinded independent central review via RECIST v1.1. Patients alive and receiving therapy at 12 weeks were grouped by response at this landmark: partial or complete response (PR+), SD, or progressive disease (PD). Progression-free survival (PFS) and overall survival (OS) by response cohort were determined using the Kaplan-Meier method; hazard ratios (HRs) and 95% confidence intervals (CIs) between response cohorts were calculated using Cox proportional hazards regression. Results: Among patients alive and receiving therapy at 12 weeks (n=107), 42 (39%) had PR+, 52 (49%) had SD, and 13 (12%) had PD. Among patients with PR+ and SD, median PFS was 12.2 and 7.0 months, respectively. A corresponding improvement in OS was observed in patients achieving PR+ (median: not reached; HR vs PD=0.21 [95% CI: 0.08–0.54]) and SD (median: 23.0 months; HR vs PD=0.33 [95% CI: 0.14–0.77]), relative to those with PD (median: 14.0 months). Conclusion: SD was observed in 49% of patients receiving amivantamab, with corresponding increases in OS that dramatically improved the prognoses of this patient population.

Introduction: Although various conservative and surgical treatment methods have been proposed, treatment options for patients with odontoid fractures remain controversial. This study was conducted to determine some demographic and radiological measurement parameters that can predict treatment options in patients with odontoid fractures. Materials and Methods: The patients were separated into the surgery (−) group (n = 9) and the surgery (+) group (n = 10). Patient data were recorded of age, gender, type of odontoid fracture, morphological measurement results obtained from computed tomography images, treatment regimens, duration of stay in the hospital, and mortality rate. In the operating room, a halo-vest corset or Philadelphia-type cervical collar was applied to the surgery (−) patients after the reduction of the fracture under fluoroscopy. Anterior odontoid lag screw fixation was performed on surgery (+) patients. Results: The amount of displacement of the fractured odontoid, the distance between the C1 vertebra and the odontoid process, the angle between the posterior wall of the odontoid process and the posterior wall of the clivus, the slip angle, and the anterior to posterior width of the spinal canal were not different between the groups. No difference was determined between the groups in respect of the amount of lateral displacement of the odontoid process in the spinal canal in the axial plane and the angle of the fractured odontoid process with the C2 vertebral body. Conclusion: This preliminary study showed that the demographic data and radiological measurement parameters analyzed in the present study could not be used as predictive markers either in decision-making for treatment modality or mortality risk.

Introduction: In this study, it is aimed to compare the long-term results of patients with short-segment instrumentation where screws were inserted into the fractured vertebra with those of patients with long-segment instrumentation applied by skipping the fractured vertebra and reveal the predictive markers in decision-making for screwing fractured vertebra. Methods: Patients were separated into two groups, namely, Group A (patients in which the fractured vertebra and vertebrae above and below the fractured vertebra were screwed (short-segment instrumentation, n=22) and Group B (patients in whom the fractured vertebra was not screwed, whereas two vertebrae above and below the fractured vertebra were screwed (long-segment instrumentation, n=27). Results: The presence of pedicle fracture, AOSpine Classification Scale score, the height of the fractured vertebra, vertebra height below the fractured vertebra, spinal canal diameter, and duration of stay in hospital were different between the groups, preoperatively (p

Çalışmamızın konusunu teşkil eden Der Beyân-ı Erkân-ı Tırâş ve İntisâb-ı Tarîk-ı Bektâşiyye başlıklı erkânnâme Hacı Bayram Veli Üniversitesi Türk Kültürü Açısından Hacı Bektaş-ı Veli Araştırmaları Uygulama ve Araştırma Merkezi kütüphanesinde B-311-183 arşiv numarasıyla ve Arnavutluk Erkanname adıyla kayıtlıdır. Aynı el yazısı ile kaleme alınmış olan eserin müellifi ya da müstensihinin kim olduğu ile ilgili bir bilgi bulunmamaktadır. Ayrıca hangi tarihte yazıldığına dair bir kayıt da yoktur. Başı ve sonu eksik olan eser Osmanlı Türkçesi ile yazılmıştır. Metin içerisinde Arapça ayet ve dualar ve kısa Farsça alıntılar yer almaktadır. Yazmanın 32b-35b varakları arasında yer alan Der Beyân-ı Erkân-ı Tırâş ve İntisâb-ı Tarîk-i Bektâşiyye adlı başlıkla başlayan bölümde Bektaşi tarikatına intisap eden kişilerin tıraş erkânı anlatılmaktadır. Bektaşi tarikatında tıraş erkânının uygulandığı çeşitli merasimler vardır. Bu merasimlerden bir tanesi de tarikata intisap eden kişilere uygulanan erkândır. Yazmada yer alan konu başlığından da anlaşılacağı üzere bu bölümde Bektaşi tarikatına intisap edenlerin tıraş erkânı anlatılmaktadır. Bu nedenle yazmanın bu bölümünün transkripsiyonu yapılarak, diğer tıraş erkânlarından ziyade tarikata intisap eden kişilere uygulanan tıraş erkânı değerlendirilmiştir. Doğal olarak çalışmamız sadece çeviri yazı çalışması değildir, Bektaşi tarikatındaki traş erkânı ve metnin içerik analizi hakkında araştırmayı da içermektedir. Der Beyân-ı Erkân-ı Tırâş ve İntisâb-ı Tarîk-i Bektâşiyye, kısa ve öz bir anlatımla ikrar vererek Bektaşi tarikatına girecek canın tıraş erkânını anlatmaktadır. Bektaşiliğe ait yazılı kaynakların gönümüz diline çevrilmesi önem arz etmektedir. Özellikle tıraş erkânı içeren bütün erkânnâmelerin günümüz diline çevrilmesi ortak ve farklı yönlerinin ortaya konulması açısından son derece önemlidir. Bu konu ile ilgili çalışmaların artması ortak ve farklı yönlerin ortaya konulmasına büyük katkı sağlayacaktır.

The Coronavirus disease-2019 (COVID-19) in children is more likely to be asymptomatic or to have mild-to-moderate symptoms; however, severe cases have also been reported. A 10-year-old boy previously diagnosed with pontocerebellar hypoplasia presented with respiratory distress after 2 days of fever. He underwent tracheal intubation. He was COVID-19 positive. On day 10, a cystic area was observed in his chest radiography and thorax computer tomography also showed a thick-walled pulmonary abscess. Percutaneous empyema drainage was performed. On day 20, an open surgical tracheotomy was performed. On day 25, the percutaneous drainage catheter was removed. On day 55, he was discharged on the home ventilator and his chest radiography was normal. Children with COVID-19 may develop a pulmonary abscess secondary to superinfections during intensive care follow-up.

Objectives The incidence of cardiovascular disease is increased in patients with Behcet’s disease (BD). Proprotein convertase subtilisin/kexin type 9 (PCSK9) causes the acceleration of atherosclerosis. We aimed to investigate whether there is a relationship between PCSK9 with carotid artery intima-media thickness (cIMT), a marker of subclinical atherosclerosis, and BD disease activity. Methods Fifty-eight patients with BD and 58 age-, gender-, and body mass index (BMI)-matched healthy control subjects were included in the study. The disease activity of the patients was estimated. Individuals’ cIMT values were measured, and PCSK9 levels were studied. Results Patients with BD’ cIMT (0.51 ± 0.1 vs 0.41 ± 0.1 mm, p

Purpose: The aim of this study is to provide data about diagnosis, treatment, and results of the patients poisoned by drugs affecting the cardiovascular system. Materials and Methods: Patients aged 18 and over who applied to the emergency department with drug poisoning affecting cardiovasculer system were included in the study. The demographic data, drugs and doses, emergency treatment and the time of development of shock or bradycardia, treatment, antidotes and invasive procedures were recorded. Results: In our study twenty-five patients, 8 (32 %) male and 17 (68 %) female, were included. At the admission, 56 % (n=14) had hypotension, 8 % (n=2) had bradycardia, at the second hour 76 % (n=19) had hypotension, 16 % (n=4) had bradycardia. Within 6 hours after admission, 80 % (n=20) patients had hypotension, 28 % (n=7) patients had bradycardia at least once. Fifty-two percent (n=13) of the patients calcium, 36 % (n=9) glukagon, 32 % (n=8) lipid, 12 % (n=3) atropine, 20 % (n=5) positive inotropes were given. Conclusion: Lipid therapy produces positive results in patients who did not improve with calcium, glucagon and fluid therapy. Patients who received calcium channel blockers experienced more cardiogenic shock and bradycardia was more common in patients receiving beta-blockers.

Objective: Fragmented QRS (fQRS) has been shown to be related to coronary heart disease, heart failure, hypertension, cardiac arrhythmia, and metabolic syndrome. Although fQRS in lateral leads is shown to be associated with a poor outcome in patients with a known cardiac disease, the knowledge about the significance and prevalence of fQRS in inferior leads is scarce. This study aimed to investigate the prevalence and predictors of fQRS in inferior leads in healthy young men. Methods: A total of 1,155 men underwent electrocardiography (ECG), hepatic ultrasonography, and routine biochemical tests. A total of 210 eligible men with fQRS in inferior leads (group 1) and 770 eligible men without fQRS in inferior leads (group 2) were compared with each other in terms of clinical, demographic, and laboratory parameters. Results: The prevalence of fQRS in inferior leads was found to 21.4%. Body mass index (BMI), systolic blood pressure (BP), creatinine, and alanine aminotransferase levels; non-alcoholic fatty liver disease (NAFLD) percentage; and interventricular septum thickness (IVST) were significantly greater in group 1 than those in group 2. BMI, IVST, NAFLD, creatinine, ALT, and systolic BP were entered in a model of multiple regression analyses to predict fQRS, a dependent variable. NAFLD was the best independent predictor of fQRS (β=6.115, p=0.001). BMI (β=1.448, p=0.014) and IVST (β=1.058, p=0.029) were the other independent predictors of fQRS in inferior leads. Conclusion: This study demonstrated the association of fQRS in inferior leads with NAFLD, BMI, and IVST in young men.

Aim: The aim of this work, investigating the skin, lung, and bone marrow-related cancer prevalence and biochemical serum parameters of all these cancer patients. Materials and Methods: The skin, lung, and bone marrow cancer patient's biochemical serum data were examined retrospectively using a hospital information system. Results: Basal cell carcinoma patients number were recorded as 155 with 63%, squamous cell carcinoma patients number were enrolled in73 with 30% and malign melanoma patients number were noted as 10 with 4%. Skin cancers were recorded to be the most seen cancer type in 246 patients with 22% between 2013-2017 years. All types of cancer patient's numbers were calculated as 1134 between these years. The very common incidences of basal cell carcinoma and squamous cell carcinoma cancers were observed on the upper part of the body, respectively on the face-cheek, nose, ear, eyelid, and lip. In this study, there was seen a statistically significant difference between skin cancer patient’s serum glucose, aspartate aminotransferase, alanine aminotransferase, sodium, bilirubin direct, bilirubin total, creatinine, urea level, and control group serum parameters level, p lt;0.05. The lung cancer patient numbers were recorded as 119 with 10.4 %, bone marrow patients numbers were enrolled in 113 with 10%. Two cancer groups were statistically different in terms of 5-years survival. Log Rank X2 = 8.68, p = 0.003, p lt;0.05. Conclusions: We recorded that skin cancer types and regions on the upper parts of the body were more because of exposure to the sun. The lung cancer survival rate was lower than bone marrow cancer. Moreover, we strongly emphasized that measuring the biochemical serum parameters was statistically significant in the diagnosis of cancer patients.

Elçin Efendiyev, who is one of the leading figures of 20th century Azerbaijani literature, was born in Baku in 1943. This period is a period under the pressure of the Soviet administration, in which the literary works were written in line with the demands of the management, when the "socialist realism" movement was extremely influential. Elçin Efendiyev did not forget the children either, besides his works of different types. He went on contributing to their education and development by writing stories and nursery rhymes for children. In this study, firstly the life and literary personality of Elçin Efendiyev will be emphasized, then the stories written by Efendiyev for children will be analyzed with the method of "text oriented story analysis" and will be evaluated in terms of " child-appropriateness". Nineteen child stories, which are in the first volume of compilation of the ten volumes compilation titled Elçin – Seçilmiş Eserleri published by the author ''Çinar-Çap (Çınar Publishing House)'' in Azerbaijan, constitute the universe of the study

Introduction Functional healing of peripheral nerve injuries is still difficult. In this study, potential healing effects of thymoquinone and dexpanthenol in sciatic nerve compression injury (SCI) were investigated. Method: Twenty-four male Wistar albino rats which were applied compression injury to their sciatic nerves were randomly separated into four groups as following: “control” group contained six rats administered no pharmacological agent; “TMK” group consisted of six rats administered 10 mg/kg intraperitoneal thymoquinone once a day for one week; “DXP” group contained six rats administered 50 mg/kg intraperitoneal dexpanthenol once a day for one week; and “TMK–DXP” group consisted of six rats administered separately 10 mg/kg intraperitoneal thymoquinone and 50 mg/kg intraperitoneal dexpenthanol once a day for one week. Four weeks later from SCI, sciatic nerve function index (SFI) was applied before sacrifice of all rats, and then their crushed sciatic nerves were histopathologically examined, in terms of “Schwann cell count”, “axon and myelin degeneration”, “axon shape/size differences”, “fibrosis”, and “neovascularisation”. Results: “Schwann cell count” (p = 0.011), “axon and myelin degeneration” (p = 0.001), “axon shape/size differences” (p = 0.011), and “fibrosis and neovascularisation” (p = 0.026) scores were different between the control and TMK–DXP groups. SFI scores were different between the control and TMK groups (p = 0.002), between the control and TMK–DXP groups (p

Thalassemia is the most frequently seen monogenetic disorders around the world that is inherited as a recessive single-gene disease, resulting from mutations in α-or β-globin gene clusters. In this study Beta Thalassemia Intermedia, Beta Thalassemia Minor, Sickle Cell Disease patients and the healthy control individuals both incidence and serum parameters were examined and analyzed retrospectively between 2015-2017 from Public Health information system. Beta Thalassemia Intermedia, Beta Thalassemia Major, Beta Thalassemia Minor and Sickle Cell Disease patient groups incidences were evaluated on the basis of their HPLC analysis. Patients and control groups serum parameters levels were analyzed from their autoanalyzer results. These serum biochemical tests datas were controlled and taken from Siirt Public Health Centre information system. In each year, there were recorded approximately 12 Beta Talassemia patients, 2 Beta Thallassemia Major patients, 340 Beta Thalassemia Minor patients and 33 Sickle Cell Disease patients.Beta Thalassemia Intermedia patients serum parameters levels were compared with Beta Thalassemia Minor Patients serum parameters and control group serum levels. There were seen statisticaly significant difference between Beta Thalassemia Intermedia patients serum ast, albumin, creatine, amylase, phosphor, iron, iron binding capacity, total protein, sodium, bilirubin direct, bilirubin total, LDH level and control serum parameters levels, p [Med-Science 2020; 9(3.000): 708-13]

Abstract Background Management of warfarin-associated major haemorrhage in prosthetic valve diseases is difficult as there is a fine line between haemorrhage and thrombosis. An individual’s propensity towards thrombosis, such as pregnancy, makes this situation even more complicated. Cases like these are very rare in the literature. Case presentation A 26 weeks pregnant, gravida two, para one, 35-year-old patient with prosthetic aortic and mitral valves presented to an external emergency clinic with clouding of consciousness. Her international normalised ratio(INR) was 8.9 at presentation. Brain MRI revealed a left subdural haematoma with no significant mass effect. Warfarin treatment was discontinued. On the second day of follow-up, she was referred to our centre for further evaluation of her clinical deterioration. She was haemodynamically stable on admission to the intensive care unit and followed up with a stable condition until the fourth day when she developed right eye drop and subsequent loss of consciousness. Her haematoma was surgically evacuated, and her condition improved. Eventually, she and a healthy newborn were discharged. Conclusion Intracranial haemorrhage during pregnancy is a relatively rare complication that requires a multidisciplinary management plan. Although the thrombogenic risk is high, it is vital to complete a reversal of warfarin anticoagulation in pregnant women with major bleeding.

Purpose: Despite advances in spinal biomechanic research, surgical techniques, and rehabilitation processes, no significant improvement has been identified in the treatment of spinal cord injury (SCI) and neurological recovery. Aim of the Study: This study was designed to investigate the potential therapeutic effects of methylprednisolone and levetiracetam on SCI. Materials and Methods: In this study, 42 male Wistar Albino rats, each weighing 300–350 g, were separated into three main groups: control group, acute and subacute stage groups. With the exception of the control group, a T7-8 dorsal laminectomy was performed on the spinal column of the rats. A temporary vascular aneurysm clip was then applied to the spinal cord for 1 min to create SCI and methylprednisolone or levetiracetam was administered intraperitoneally to all except the control and SHAM control groups. The damaged spinal cord was removed for histopathological and biochemical examinations. Results: Both pharmacological agents were determined to have improved the histopathological architecture in damaged neural tissues during the acute period of SCI, but could not sustain this activity in the subacute period. Neither pharmacological agent affected the biochemical data in the acute nor subacute stages. Conclusions: Both pharmacological agents showed histopathological healing effects in injured tissues during the acute phase of SCI in this rat model but these effects could not be sustained in the subacute period. No effect on biochemical data was seen in either the acute or subacute period. There is a need for further advanced studies to determine the effects of levetiracetam on the healing processes in SCI.

Background: Although age, comorbidity, duration and severity of symptoms, slippage degree, and flexion-extension slipping stability during X-ray imaging are effective in making a surgical decision in patients with spondylolisthesis, these factors are rarely based on definitive evidence. The aim of this study was to determine the efficacy of clinical, radiological and biochemical findings in surgical decision making in these patients. Materials and Methods: Patients’ data including age, gender, degree and type (i.e. degenerative or isthmic) of the spondylolisthesis, urinary incontinence, neurogenic claudication were recorded. Radiological imaging studies (lumbar dynamic X-ray, computed tomography, magnetic resonance imaging), serum glucose, C-reactive protein and erythrocyte sedimentation rate values of the patients obtained during hospital admissions were evaluated. Results: Forty patients were followed conservatively and 12 patients were treated surgically. Degenerative spondylolisthesis was seen in 22 patients. Nine patients had neurogenic urinary incontinence and 19 patients had neurogenic claudication. When the patients were divided into two groups with and without surgical treatment, the presence of the pars defect, slipping distance in a neutral position and slipping distance in flexion position was significantly different between groups. A positive correlation was found between pars defect and surgical treatment. Likelihood ratio test results revealed that the presence of pars defect, neurogenic claudication and neurogenic urinary incontinence could be the best parameters in decision making the surgical treatment. Conclusion: The presence of pars defect, neurogenic claudication and urinary incontinence could be the best parameters that may help the surgeon to make the surgical treatment decision.

Amaç: Bu çalışmanın amacı prognozlarını etkileyen faktörleri belirlemeye yönelik olarak servikal dislokasyon tespit edilen hastaların tedavi sonuçlarını incelemektir..Gereç ve Yöntem: Bu çalışmada servikal dislokasyon nedeniyle opere edilen hastaların yaş, cinsiyet, dislokasyon sebebi, “Japanese Orthopedic Association (JOAS)” ölçeği puanı, dislokasyon gelişen omurga seviyesi, faset kilitlenmesi, spondilolistesiz derecesi, cerrahi tedavi bilgileri, yoğun bakım ünitesine (YBU) ve hastane tedavi bilgileri ve hastaneden ayrılış nörolojik düzeylerine ait bilgiler (Modifiye Rankin Skalası, mRS) geriye dönük incelendi.Bulgular: Çalışmaya alınan 13 hastada dislokasyonun çoğunlukla faset kırığına ikincil C5-6 ve C6-7 segmentlerinde oluştuğu görüldü. Çoğu hastada (9 tane) anterior yaklaşımla omurga stabilizasyonu yapıldığı, hastaların %50 kadarında çok seviyeli stabilizasyon uygulandığı saptandı. Korelasyon analizi sonunda JOAS puanları düşük olduğunda spinal şok gelişme olasılığının, ventilatör desteği ihtiyacının, YBU kalma süresinin ve mRS puanlarının artabileceği öngörüldü. Spondilolistezis derecesi arttığında stabilizasyon uygulanan omurga sayısının, ventilatör desteği ihtiyacının, YBU ve hastanede kalma süresinin artabileceği düşünüldü. Spinal şok gelişen hastalarda ventilatör desteği ihtiyacının artabileceği, YBU ve hastanede kalma sürelerinin uzayabileceği ve mRS puanlarının artabileceği varsayıldı. Sonuç: Çalışma sonunda yapılan cerrahi girişimin türünün prognoza etkisinin olmadığı; buna karşılık düşük JOAS puanlarının, spinal şok gelişmesinin, ventilatör desteği verilmesinin, uzun süre yoğun bakım ünitesinde kalmanın hastaların prognozunu kötü etkileyebileceği öngörüldü.

Aim: Today, spinal cord injury (SCI) can be rehabilitated but cannot be treated adequately. This experimental study was conducted to investigate possible beneficial effects of methylprednisolone and parecoxib in treatment of SCI. Materials and methods: Forty-eight male Wistar albino rats were assigned into CONTROL, acute (MP-A, PX-A, and PXMP-A), and subacute (MP-S, PX-S, and PXMP-S) stage groups. Then, to induce SCI, a temporary aneurysm clip was applied to the spinal cord following T7-8 laminectomy, except in the CONTROL group. Four hours later parecoxib, methylprednisolone, or their combination was administered to rats intraperitoneally except CONTROL, SHAM-A, and SHAM-S groups. Rats in the acute stage group were sacrificed 72 h later, and whereas rats in the subacute stage were sacrificed 7 days later for histopathological and biochemical investigation and for gene-expression analyses. Results: Parecoxib and methylprednisolone and their combination could not improve histopathological grades in any stage. They also could not decrease malondialdehyde or caspase-3, myeloperoxidase levels in any stage. Parecoxib and methylprednisolone could decrease the TNF-α gene expression in subacute stage. Methylprednisolone could increase TGF-1β gene-expression level in acute stage. Conclusion: Neither of the experimental drugs, either alone or in combination, did not show any beneficial effects in SCI model in rats.

Purpose: Peridural fibrosis which could occur after the spinal surgery could adhere neural tissue closely and may cause to neural entrapment symptoms and require surgical reintervention. Aim of the study: Present study was designed to reduce occurrence of peridural fibrosis in rat laminectomy model by using biophysical barriers called hyaluronic acid (HAS) dural barrier, activated polyethylene glycol and polyethylene imine (PEG) dural barrier, and platelet-rich plasma (PRP). Materials and methods: In this study, 2 of 26 male Wistar albino rats (325–350 g body weight), which were not included into study groups were sacrificed by removing their total blood and their blood was used for preparation of PRP, and remaining rats were randomly delivered into four groups called SHAM, HAS, PEG, and PRP groups. Then L3-4-5 laminectomy was performed to all animals and experimental agents were administered to the selected groups mentioned above. Spinal colons of all animals were removed gross total after 6-week period and investigated histopathologically. Additionally, real-time-polymerase chain reaction was used to obtain collagen type I and type III, transforming growth factor-1β, and tumor necrosis factor-α gene expressions. Results: All results demonstrated that polyethylene glycol and polyethylene imine dural barrier and PRP could decrease peridural fibrosis formation efficiently in rat. Conclusion: Present study results suggested that to reduce or block formation of peridural fibrosis, either polyethylene glycol and polyethylene imine dural barrier or PRP could be used effectively in human subjects after they will be closely investigated in future studies.

Background Today, there is a need for new and independent additional advanced markers that can predict the prognosis of meningioma patients, postoperatively. The present study aimed to find out postoperative short-term prognostic markers in patients with meningioma using their demographic data and routine blood biochemistry findings evaluated preoperatively. Methods The Glasgow Coma Scale (GCS), and Glasgow Outcome Scale (GOS) scores of the patients were recorded. Additionally, preoperatively obtained serum glucose, C-reactive protein (CRP), sodium, potassium, creatinine, blood urea nitrogen, aspartate aminotransferase (AST), alanine aminotransferase, and hemoglobin level values, platelet, leukocyte, neutrophil, lymphocyte, eosinophil, basophil, and monocyte count results, erythrocyte sedimentation rate (ESR), neutrophil-lymphocyte ratio, platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) values were evaluated. Results In the present study, 23 operated patients with meningioma World Health Organization (WHO) grade 1 (17 females, 6 males) were included. Correlation test results revealed that the GCS score, platelet count, and serum potassium level values could directly predict the short-term prognosis of these patients. Additionally, these test results suggested that the lymphocyte, monocyte, and eosinophil count values, PLR, LMR, ESR, serum glucose, CRP, and AST level values could be indirect markers in predicting the short-term prognosis. However, likelihood ratio test results revealed that only monocyte count value, LMR value, and serum CRP level value could be the markers for prediction of the short-term prognosis. Conclusion At the end of the present study, it was concluded that the monocyte count value, LMR value, and serum CRP level value could be the best markers in predicting the short-term prognosis of the operated meningioma patients.

Objectives: The effect of routine blood biochemistry parameters on the short-term prognosis of patients with chronic subdural hematoma (CSDH) has not been evaluated in literature before. In this study, it was aimed to establish markers for determination of short-term prognosis using data of patients who were operated for CSDH. Methods: During admission to hospital, data of patients including age, sex, antiaggregan and/or anticoagulant drugs usage, comorbidity, Glasgow Coma Scale (GCS) and Glasgow Outcome Scale scores were evaluated. Location and thickness of CSDH were recorded using brain CT or MR images. Blood leukocyte, neutrophil, lymphocyte, eosinophil, basophil, platelet count results, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio results, activated prothrombin time and INR values, serum glucose, aspartate aminotransferase, alanine aminotransferase, C-reactive protein, sodium, potassium, blood urea nitrogen and creatinine level values were also recorded. Patients were divided into two groups according to CSDH located “unilaterally (n=19)” and “bilaterally (n=12)”. In addition, patients with unilateral CSDH were divided into two groups as CSDH located at the "right hemisphere (n=6)” and "left hemisphere (n=13)". Results: It was concluded that short-term prognosis of patients with unilateral or bilateral CSDH was similar. Correlation analysis showed no correlation between short-term prognosis and demographic, clinical and laboratory findings. However, Likelihood Ratio test revealed that GCS score could be a biomarker in order to predict short-term prognosis of these patients, albeit weak (X2=6.138, p=0.046). Conclusion: It was thought that GCS scores could be effective in predicting short-term prognosis in patients with CSDH but routine biochemistry laboratory parameters could not predict short-term prognosis of these patients.

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive disease of pulmonary hypertension (PH) as a consequence obstructive of pulmonary arteries with thromboembolism. Augmented pulmonary vascular resistance and pulmonary artery pressure (PAP) can ultimately lead to the right ventricular dysfunction, which leads to adaptive and maladaptive changes. Right ventricle (RV) remodeling can cause clinical deterioration and RV failure. Aims and Objectives: We aimed to evaluate the RV functions with a new diagnostic modality 2-deoxy-2-(18F)-fluoro-D-glucose (FDG)-positron emission tomography (PET) in patients with CTEPH. Materials and Methods: We included 53 patients diagnosed with CTEPH who were planned to have pulmonary thromboendarterectomy (PEA) and did not have any contraindication for cardiac PET/computed tomography (CT). We performed transthoracic echo, cardiac PET/CT, 6-minute walk distance (6-MWT), and right heart catheterization 1 week before PEA surgery. Results: The patients divided into two groups according to RV/left ventricle (LV) FDG-PET uptake ratio, RV/LV ≤1, and RV/LV >1. Six-MWD was significantly higher in the RV/LV ≤1 group (P = 0.005). Pro-BNP was considerably higher in the RV/LV >1 group (P = 0.041). Conclusion: The present study aims to demonstrate the RV/LV FDG-PET uptake ratio could be used in the noninvasive diagnostic method in diagnosing, treatment strategy, and clinical follow-up in patients with CTEPH.

Amaç: Bu çalışmada, intrakranial kanaması olan hastaların rutin laboratuvar bulgularını inceleyerek prognozu belirlemeye yönelik bir algoritma oluşturulması amaçlandı.Gereç ve Yöntem: İntrakranial kanama ile takip edilen ve cerrahi tedavi uygulanan hastalar spontan subaraknoid kanama, spontan intraserebral hematom ve subdural hematom grupları olarak üç gruba ayrıldı. Daha sonra cerrahi öncesi ve sonrası ölçülen serum sodyum, potasyum, C-reaktif protein değerleri ve kan lökosit ve nötrofil düzeyi sonuçları karşılaştırıldı. Bulgular: Yirmi sekiz hasta (10 kadın, 18 erkek) çalışma kapsamına alındı. Tüm parametreler açısından gruplar arasında fark görülmedi Ancak intraserebral hematom grubunda postoperatif lökosit sayılarının preoperatif değerden yüksek olduğu; subraknoid kanama grubunda postoperatif sodyum düzeyinin preoperatif değerden yüksek olduğu saptandı. Buna ek olarak, subaraknoid kanama grubunda Glasgow Çıkış Ölçeği puanları ile preoperatif, preoperatif ve postoperatif sodyum değerleri arasında negatif korelasyon bulundu. Subdural hematom grubunda Glasgow Çıkış Ölçeği ve preoperatif C-reaktif protein değerleri arasında negatif korelasyon olduğu tespit edildi.Sonuç: Sonuç olarak subaraknoid kanamalarda ameliyat öncesi ve sonrası ölçülen serum sodyum değerlerinin; spontan intraserebral hematomlarda ise yaş, Glasgow Koma Ölçeği, ameliyat öncesi ve sonrası ölçülen CRP değerlerinin ve subdural hematomlarda ameliyat öncesi ölçülen CRP değerlerinin ve prognozu belirlemede birer belirteç olabileceği düşünüldü.

Bovine testicular hyaluronidase (BTH) is a very important enzyme in industrial field, cancer studies and in many animal applications. In this study, it was investigated whether amniotic fluid of Romanov sheep could be used as an alternative new substrate source for BTH enzyme. As a result of the study, the BTH activity was found as 9.187 U mL-1 with commercially available hyaluronic acid (HA), while the BTH activity of 35 different amniotic fluids was found between 1.604-18.659 U mL-1. No information was reported on whether the amniotic fluids of the Romanov breed sheep were a source of substrate for the BTH enzyme due to the HA content. It was thought that amniotic fluid of the Romanov breed sheep could be a new HA source, as the BTH activity calculated using the commercial HA and the BTH activities obtained using amniotic fluid were very close.

During the pandemic, school districts have adopted hybrid schedules to continue the education of the students while maintaining social distance. In a hybrid schedule, students in the same classroom are usually divided into two groups and students only in the same group can physically attend class together two days a week. School districts do not take preferences of the students/parents over the days they would like to come to school into account during this procedure. In this paper, we propose a solution that divides students into groups based on their preferences. Our solution respects the number of classrooms initially reserved for each grade and enables possible efficiency gains by swapping classrooms across grades. Moreover, when there are two alternative schedules provided for students, our solution is immune to preference manipulations.

A 56-year-old female patient was admitted with a history of pain during neck movements after cervical injury. Computerized tomography scan revealed type II odontoid fracture and fusion anomaly between C2 and C3 vertebrae. At surgery, the anteroinferior part of C2 vertebra corpus could not be reached; therefore, transodontoid screw was advanced from C3 vertebra toward odontoid process. At follow-up examination, the complaints of the patient had recovered, and fracture line was completely fused. Advancing screw from C3 to odontoid process via anterior cervical approach could be thought an alternative treatment option in the patient with short neck caused from vertebra fusion anomaly and/or obesity.

Background: Total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI), nitric oxide (NO), zinc (Zn), copper (Cu) levels, paraoxonase (PON1), arylesterase (ARES) activities, and biochemical changes were studied on sheep with cystic echinococcosis. Methods: The materials were taken from 2-3 yr old sheep slaughtered in Van Province, Turkey in 2017. Before the slaughter, blood samples were collected from the healthy sheep, while various organs of animals were examined for hydatid cysts after the slaughter. Thirty sheep were protoscolex positive, hydatic group, while 30 sheep that did not have any pathological lesions in organ examinations were accepted as the control group. TOS levels, PON1 and ARES activities, and Zn levels were determined by commercial kits, while Cu levels were determined by atomic absorption spectrophotometer. The collected data were then statistically analyzed. Results: Serum TOS and OSI levels were significantly higher in sheep with cystic echinococcosis compared to the control group (P

Yapay antikorlar olarak da bilinen aptamerler, farklı boyutlardaki hedef moleküllere, yüksek ilgi ve seçicilik ile bağlanan ve geçtiğimiz 30 yıl içerisinde çok farklı sensör uygulamalarında başarıyla kullanılan yakalama elemanlarıdır. Aptamerlerin bir organizmada üretilen antikorlar yerine laboratuvar ortamında üretilebilmesi, çoğaltılma ve saflaştırma aşamasının kolay olması ve sonsuz konfigürasyonda üretilebiliyor olması gibi eşsiz avantajları vardır. Askeri, çevresel, gıda güvenliği ve tıbbi uygulamalarının yanı sıra, adli bilimlerde de aptamerlerin kullanılması kaçınılmazdır. Bu makalede, aptamerlerin adli bilimlerde uygulamalarına yönelik örnekler verilmiştir. Literatürde, çok sayıda uygulama olması nedeniyle bu makalede, adli bilim ve adli tıpta sensörler için kokain ve adli bilim için parmak izi belirlemesi uygulamaları örnek olarak verilmiştir.

Machine learning (ML) has the potential to significantly aid medical practice. However, a recent article highlighted some negative consequences that may arise from using ML decision support in medicine. We argue here that whilst the concerns raised by the authors may be appropriate, they are not specific to ML, and thus the article may lead to an adverse perception about this technique in particular. Whilst ML is not without its limitations like any methodology, a balanced view is needed in order to not hamper its use in potentially enabling better patient care.

In this study, 9-benzylidene-9H-fluorene-substituted urea (5a–p) and thiourea derivatives (5q–v) were synthesized and their inhibitory effects on the activity of human carbonic anhydrase (hCA) I and II were evaluated. hCA I and II were purified from human erythrocytes using a Sepharose 4B-L-tyrosine-sulphanilamide affinity column. All the synthesized compounds inhibited the activity of the hCA I and II isoenzymes. Among the synthesized compounds, 5f was found to be the most active (IC50 = 21.4 μM) for inhibition of hCA I and 5s was the most active (IC50 = 25.3 μM) for inhibition of hCA II.

Takotsubo cardiomyopathy (TTC) is a rare clinical syndrome and is associated with intense emotional and physical stress. It has been demonstrated that TTC may be triggered by sepsis, however there is no data relation between type 1 diabetes mellitus (DM), subacute sclerosing panencephalitis (SSPE) and TTC. We present a patient with TTC who was previously diagnosed SSPE and type 1 DM and was admitted to emergency service with sepsis which is triggered by aspiration pnomonia. [Med-Science 2018; 7(2.000): 441-2]

Ebubekir Hâzim Tepeyran had educated in Niğde was one of the most important statesman and litterateur. He was born in Niğde and died in 5 June 1947. He was governor of Musul, Bağdat, Hicaz, Beyrut and Hüdavendigar. He was mayor of İstanbul in March-July 1909 and he was also Chamberlain internist in 1920.Mr. Ebubekir Hâzim's work, in 1944 the first edition of his memories was published that told about the experiences of school in his primary school is based on our study. District schools were primary schools which were established for following Seljuklu and other İslamic states' tradition in Ottoman State. These schools were called mahalle school or sıbyan school by public and they were operated through foundations. They were in every districts and villages. They were generally built next to the mosque.Local schools were described negatively in Ebubekir Hâzim Bey' memories. They were neglected through Euorapan education system beginning with reform, they were effort to keep alive a tradition at the second half of the XIX. century. Like all institution which completed its task, they waited death by leaving them alone. An understanding of Westernization brought, like all institutions belongs to old times, local schools were seen of evil and negativity as a reason, as a nightmare for the new generations.In Mr. Ebubekir Hâzim's memories and other people' remembrances of a flogging, and held with the concept of local schools of education is lagging behind the age, seem to have another function in maintaining the tradition. In our report,we will try to present, based on Mr. Ebubekir Hâzim's memories, both local schools' progress and their declines against institutions of modern education along with the westernization process.

Knowing the distribution of gossypol glands in cotton will help to improve advanced cultivars with great economic return. The aim is to compare cotton genotypes for the number and the distribution of gossypol glands found in different plant parts and to determine the genotypes which contain more gossypol glands in their vegetative parts but little or none in their seeds. The intensity and the greatness of the gossypol amount is an important part of defending against plant insects and diseases. Randomized complete block design with two replications was applied at the Agricultural Research Institute of Kahramanmara? during 2006-2007. Thirty seven cotton genotypes belonging to Gossypium hirsutum L. species were the plant material. The number of gossypol glands on stem, boll walls (carpels), leaves and seeds were visually counted and ranged from 0 to 142 per cm2 for stem, 0 to 135 per cm2 for leaf, 0 to 85 per cm2 for boll wall and 0 to 16 per mm2 for embryo (kernel). Number of gossypol glands varied for the genotypes and years but this variance was too low in some genotypes. Genotypes �Acala Royale�, �Acala Prema�, �Deltaopal� and �Carmen� had relatively more gossypol glands on their vegetative parts but less in their seed. Measured parameters were positively and significantly correlated to each other. Correlations for number of gossypol glands between stem and leaf (r=0.77**), boll wall (r=0.65**) and seed (r=0.32**) were significant.

Background. The primary purpose of this study was to investigate adult-child caregiver burden in heart failure (HF) patients. Secondary purpose of the study was to identify the possible influencing factors for caregiver burden and depressive symptoms in a young adult-child caregiver group. Methods. A total of 138 adult-child caregivers and 138 patients with HF participated in this study. Caregivers’ burden, depressive symptoms, and anxiety levels were assessed by using Zarit Caregiver Burden Scale (ZCBS), Beck Depression Inventory, and State-Trait Anxiety Inventory, respectively. Results. The mean ZCBS scores of the female caregivers were significantly higher than male caregivers. Approximately one-third of the adult-child caregivers had at least mild depressive symptoms. Caregivers with higher depressive symptoms had higher levels of caregiver burden. There were positive correlations between caregiving time, severity of depressive symptoms, and perceived caregiver burden. There was a negative correlation between education level of caregivers and perceived caregiver burden. Age, socioeconomic level, and marital status of patients were affecting factors for depressive symptoms in caregivers. Among caregiver characteristics, gender, marital status, and ZCBS scores seem to influence the depression in caregivers. Conclusions. The study findings suggest significant levels of burden and depressive symptoms even in adult-child caregivers of HF patients.

Aim: In this study, research was conducted to determine the meat consumption preferences of academician veterinarians by conjoint analysis. Materials and Methods: A total of 69 veterinarians, who are working in a veterinary faculty of a public university in Bursa Turkey, participated in this study. Survey method was used as a data collection tool in the research. In the survey conducted in March-April 2014, two levels were determined for each of the health, taste, and hygiene qualities, and orthogonal experimental design was used. With the help of orthogonal experimental design, seven plancards were created and presented to the veterinarians who participated in the survey form. Participants were asked to give sequence numbers to the plancards that were created for four types of meat (poultry meat, beef, mutton, and turkey meat). Importance values were calculated for all meat types studied. Results were evaluated separately according to gender and history of cardiovascular disease presence. Results: The results of the questionnaire applied to the participants showed that health is the most important attribute for all meat types whereas related to the variety of meat, hygiene and taste ranking varied according to gender and family history of cardiovascular disease presence. Conclusion: In this study, it is planned to present a comprehensive study for four meat types by examining how the health, taste and hygiene factors of the veterinarians who have high-level knowledge in terms of animal production and animal health evaluate the meat consumption preferences.

Aims: Despite the substantial progress in the management of diabetes mellitus (DM), chronic kidney disease (CKD) remains one of the most common complications. Although uncommon, diabetic emergencies [diabetic ketoacidosis (DKA), hyperosmolar hyperglycaemic state (HHS)] can still occur in stage 4 and 5 CKD, at times with less typical clinical manifestations due to the altered pathophysiology, presence of chronic metabolic acidosis and effect of haemodialysis on glycaemic control and metabolic parameters. The purpose of this article is to review the current literature and provide recommendations for the diagnosis and treatment of DKA, euglycaemic DKA and HHS in people with advanced CKD., Methods and Results: Guidance on the management of diabetes-related emergencies mainly focuses on individuals with preserved renal function or early-stage CKD. Existing literature is limited, and recommendations are based on expert opinions and case reports. Given the clinical need for amended guidelines for this population, we are proposing a management algorithm for DKA and HHS based on clinical and metabolic parameters., Conclusions: In this review article, we propose treatment algorithms for diabetes-related hyperglycaemic emergencies in people with advanced CKD. Further research is needed to validate our proposed algorithms., (© 2024 Diabetes UK.)

Background: Severe mental illnesses (SMIs), including schizophrenia, bipolar affective disorder, and major depressive disorder, are associated with an increased risk of physical health comorbidities and premature mortality from conditions including cardiovascular disease and diabetes. Digital technologies such as electronic clinical decision support systems (eCDSSs) could play a crucial role in improving the clinician-led management of conditions such as dysglycemia (deranged blood sugar levels) and associated conditions such as diabetes in people with a diagnosis of SMI in mental health settings., Objective: We have developed a real-time eCDSS using CogStack, an information retrieval and extraction platform, to automatically alert clinicians with National Health Service Trust-approved, guideline-based recommendations for dysglycemia monitoring and management in secondary mental health care. This novel system aims to improve the management of dysglycemia and associated conditions, such as diabetes, in SMI. This protocol describes a pilot study to explore the acceptability, feasibility, and evaluation of its implementation in a mental health inpatient setting., Methods: This will be a pilot hybrid type 3 effectiveness-implementation randomized controlled cluster trial in inpatient mental health wards. A ward will be the unit of recruitment, where it will be randomly allocated to receive either access to the eCDSS plus usual care or usual care alone over a 4-month period. We will measure implementation outcomes, including the feasibility and acceptability of the eCDSS to clinicians, as primary outcomes, alongside secondary outcomes relating to the process of care measures such as dysglycemia screening rates. An evaluation of other implementation outcomes relating to the eCDSS will be conducted, identifying facilitators and barriers based on established implementation science frameworks., Results: Enrollment of wards began in April 2022, after which clinical staff were recruited to take part in surveys and interviews. The intervention period of the trial began in February 2023, and subsequent data collection was completed in August 2023. Data are currently being analyzed, and results are expected to be available in June 2024., Conclusions: An eCDSS can have the potential to improve clinician-led management of dysglycemia in inpatient mental health settings. If found to be feasible and acceptable, then, in combination with the results of the implementation evaluation, the system can be refined and improved to support future successful implementation. A larger and more definitive effectiveness trial should then be conducted to assess its impact on clinical outcomes and to inform scalability and application to other conditions in wider mental health care settings., Trial Registration: ClinicalTrials.gov NCT04792268; https://clinicaltrials.gov/study/NCT04792268., International Registered Report Identifier (irrid): DERR1-10.2196/49548., (©Dipen Patel, Yamiko Joseph Msosa, Tao Wang, Julie Williams, Omar G Mustafa, Siobhan Gee, Barbara Arroyo, Damian Larkin, Trevor Tiedt, Angus Roberts, Richard J B Dobson, Fiona Gaughran. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 05.04.2024.)

Introduction: Increasing numbers of people admitted to hospital have diabetes and need specialist support. To date, there is no mechanism which can help teams estimate the number of health care professionals they need to provide optimal care for people with diabetes in hospitals., Methods: The Joint British Diabetes Societies (JBDS) for Inpatient Care Group organised a survey of specialist inpatient diabetes teams in the UK for current staffing and the perception of optimal staffing using mailing lists available through their representative organisations. The results were verified and confirmed by one-to-one conversations with individual respondents and discussed in multiple expert-group meetings to agree on the results., Results: Responses were received from 17 Trusts covering 30 hospital sites. Current diabetes specialist staffing level per 100 people with diabetes in hospital (Median, IQR) for consultants was 0.24 (0.22-0.37), diabetes inpatient specialist nurses was 1.94 (1.22-2.6), dieticians was 0.00 (0.00-0.00), podiatrists was 0.19 (0.00-0.62), pharmacists was 0.00 (0.00-0.37), psychologists was 0.00 (0.00-0.00). The teams also reported that for optimal care the total staff needed for each group (Median, IQR) was much higher; consultants 0.65 (0.50-0.88), specialist nurses 3.38 (2.78-4.59), dieticians 0.48 (0.33-0.72), podiatrists, 0.93 (0.65-1.24), pharmacists, 0.65 (0.40-0.79) and psychologists 0.33 (0.27-0.58). Based on the results of the survey, the JBDS expert group produced an Excel calculator to estimate staffing needs of any hospital site in question just by populating a few of the cells., Conclusion: Current inpatient diabetes staffing is much lower than needed in most Trusts who responded to the survey. The JBDS calculator can provide an estimate of the staffing needs of any hospital., (© 2023 Diabetes UK.)

Hyperosmolar Hyperglycaemic State (HHS) is a medical emergency associated with high mortality. It occurs less frequently than diabetic ketoacidosis (DKA), affects those with pre-existing/new type 2 diabetes mellitus and increasingly affecting children/younger adults. Mixed DKA/HHS may occur. The JBDS HHS care pathway consists of 3 themes (clinical assessment and monitoring, interventions, assessments and prevention of harm) and 5 phases of therapy (0-60 min, 1-6, 6-12, 12-24 and 24-72 h). Clinical features of HHS include marked hypovolaemia, osmolality ≥320 mOsm/kg using [(2×Na + ) + glucose+urea], marked hyperglycaemia ≥30 mmol/L, without significant ketonaemia (≤3.0 mmol/L), without significant acidosis (pH >7.3) and bicarbonate ≥15 mmol/L. Aims of the therapy are to improve clinical status/replace fluid losses by 24 h, gradual decline in osmolality (3.0-8.0 mOsm/kg/h to minimise the risk of neurological complications), blood glucose 10-15 mmol/L in the first 24 h, prevent hypoglycaemia/hypokalaemia and prevent harm (VTE, osmotic demyelination, fluid overload, foot ulceration). Underlying precipitants must be identified and treated. Interventions include: (1) intravenous (IV) 0.9% sodium chloride to restore circulating volume (fluid losses 100-220 ml/kg, caution in elderly), (2) fixed rate intravenous insulin infusion (FRIII) should be commenced once osmolality stops falling with fluid replacement unless there is ketonaemia (FRIII should be commenced at the same time as IV fluids). (3) glucose infusion (5% or 10%) should be started once glucose <14 mmol/L and (4) potassium replacement according to potassium levels. HHS resolution criteria are: osmolality <300 mOsm/kg, hypovolaemia corrected (urine output ≥0.5 ml/kg/h), cognitive status returned to pre-morbid state and blood glucose <15 mmol/L., (© 2022 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.)

Introduction: Glycaemic control associates with better outcomes for hospitalised patients. Whether GLP-1 receptor agonists (GLP-1 RA) are suitable and effective drugs for inpatients is unclear., Methods: A retrospective, single centre, observational study using data from the electronic health record. Patients admitted using GLP-1 RA as outpatients, from 2016 to 2019, were identified. Outcomes were compared to those admitted using twice-daily (BD) mixed insulin. Capillary glucose, medication use, creatinine, and demographic data were collected. As drugs may be discontinued/not administered in hospital, days when GLP-1 RA was administered were 'GLP-1 RA active' and, for insulin, 'insulin active'. The primary comparison was rate of hypoglycaemia (<4 mmol/L) and severe hypoglycaemia (<3 mmol/L). A logistic regression model examined variables for hypoglycaemia., Results: GLP-1 RA comprised n = 262 admissions and BD insulin n = 166. The 'insulin active' cohort (n = 957 patient days) had higher risk of hypoglycaemia than 'GLP-1 RA active' (n = 806 days); occurring on 14.7% of days; 95% confidence interval [CI] 12.6-17.1 versus 9.9% days; 95% CI 8.0-12.2; p = 0.002, and severe hypoglycaemia 4.0% of days (95% CI 2.8-5.4) versus 2.0% (95% CI 1.1%-3.2%; p = 0.005). Daily glucose (mean ± standard deviation) was 10.8 ± 5.2 mmol/L in insulin active versus 9.6 ± 4.7 mmol/L in GLP-1 RA active; p < 0.001. Insulin use, age, and acute admissions predicted hypoglycaemia. The odds ratio for hypoglycaemia was 2.15 times greater (95% CI, 1.14-4.08; p = 0.019) with insulin than with GLP-1 RA., Conclusions: GLP-1 RA provided better glycaemic control than BD mixed insulin and should be continued during hospitalisation unless there is a clear indication for cessation., (© 2022 John Wiley & Sons Ltd.)

The management of hyperglycemia in patients admitted to hospital is mainly based on insulin therapy. However, the positive and rapid effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on cardiorenal outcomes raises the possibility that they might confer benefits to hospitalized patients. In recent, well designed, randomized trials (SOLOIST-WHF and EMPULSE) recruiting inpatients with heart failure (HF), SGLT2i demonstrated the potential to improve survival and quality of life and reduce the number of HF events, time to first HF event, hospitalizations, and urgent visits for HF compared with placebo. They were also well tolerated, whereas incidence of diabetic ketoacidosis was low. In EMBODY, empagliflozin was shown to be protective against the deleterious effects of cardiac injury in patients with acute myocardial infarction. In DARE-19, the administration of dapagliflozin to inpatients with cardiometabolic risk factors and COVID-19 was based on the hypothesis that the anti-inflammatory properties of SGLT2i could alleviate organ damage. Although the findings did not reach statistical significance, the efficacy and safety profiles of the drug were encouraging. These promising findings in the field of cardiometabolic medicine set the stage for future research to explore whether the benefits of gliflozins can expand to inpatients with non-cardiometabolic disorders, including sepsis, cirrhotic ascites, and malignancies. The concept of inpatient use of SGLT2i has evolved greatly over the past few years. The latest evidence suggests that SGLT2i may be effective and safe in the hospital setting, provided patients are carefully selected and closely monitored. Real-world data will prove whether present hope about inpatient use of gliflozins will transform into future confidence., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)