Mustafa Kemal University

Fosfomycin represents a last-line reserve antibiotic for the treatment of infections caused by multidrug-resistant (MDR) bacteria. Nevertheless, the advent of plasmid-mediated fosfomycin resistance among bacteria from humans and food animals incurs great concern. This study reports the detection and genomic portrait of the plasmid-mediated fosfomycin resistance gene, fosA4 , amid Escherichia coli from wild birds co-harboring plasmid-mediated tigecycline resistance gene , tet (X4), and colistin resistance gene, mcr-1 . A total of 100 samples from fecal droppings of wild birds in the urban parks in Faisalabad, Pakistan were subjected for the isolation and characterization of fosfomycin-resistant E. coli . The fosA4 gene was identified in 11 (11%) of the E. coli isolates, and all exhibited an MDR phenotype. Genome sequencing confirmed that all the fosA4 -positive isolates also co-harbored the mobile tigecycline resistance tet (X4) gene on a large MDR IncFII plasmid. One isolate PKF8 belonging to ST48 also co-carried the colistin resistance gene mcr-1 on the IncHI2 plasmid. To the extent of our knowledge, this is the first discovery of E. coli isolates in wild birds co-harboring the mcr-1 , fosA4 , and tet (X4) genes. The emergence of these pivotal antimicrobial resistance genes in wild birds native to South Asia with their close association to humans and animals is alarming. Our findings highlight the urgent need for further surveillance of bacterial resistance to last-resort antibiotics in the clinics, animal farming, and environment with the One Health approach. IMPORTANCE The global spread of the plasmid-mediated fosfomycin resistance gene fosA4 bearing Escherichia coli strains incurs a public health concern. However, research focusing on the pervasiveness of fosA4 -positive isolates in wild birds is still rare, and to the best of our knowledge, this is the first documentation from South Asia highlighting the concurrent presence of the fosA4 , mcr-1 , and tet (X4) genes within E. coli isolates recovered from fecal samples of wild birds in Pakistan. This co-existence of ARGs along with phylogenetic analysis revealed that MDR plasmids carried by E. coli isolates have the ability to spread horizontally between wild birds, food animals, and humans. Co-existence of fosA4 , tet (X4), and mcr-1 -carrying plasmids is worrying and warrants further investigation.

The pathogenesis of canine pyometra is multifactorial, involving hormonal imbalances, aberrant immune responses, and metabolic dysregulation includes lipid metabolism and oxidative stress. This study focuses on lipid metabolism and oxidative stress, revealing the key regulatory role of AMPK and PLIN2 in canine pyometra. Bitches with open cervix pyometra (n:8) and healthy bitches undergoing elective ovariohysterectomy (n:4) were enrolled to the study. In experiment one, the serum and tissue levels of Malondialdehyde (MDA) and Superoxide Dismutase (SOD) activity were assessed. Additionally, uterine histopathological analysis, AMPK and PLIN2 expressions were determined through immunohistochemistry. Furthermore, inflammation, oxidative stress, and lipid metabolism-related factors were evaluated using Western blot analysis. In experiment two, primary cell cultures were prepared from healthy uterine endometrial cells of the dogs in control group. Cultured canine endometrial epithelial cells were treated with lipopolysaccharide (LPS) along with oleic acid (OA) to induce an inflammatory response. Tissue and serum MDA and SOD levels were greater in dogs with pyometra. Accumulated lipid droplets were observed in the uterine tissue of bitches with pyometra. The phosphorylation of AMPK and the expression of PLIN2 significantly increased in the pyometra group. The expression of related lipid synthesis proteins such as ACC1, FASN, SREBP-1c, and PLIN2 was upregulated, while PPARα and PGC1α were downregulated in bitches with pyometra. In experiment two, activation of AMPK and PLIN2 not only restores the expression of PGC1α, but also effectively alleviates inflammation and oxidative stress. The role of lipid metabolism and oxidative stress in canine pyometra is elucidated, thus contributing to the pathogenesis of pyometra in dogs.

Outcome expectations are a multidimensional construct encompassing physical, social, and self-evaluative components, significantly influencing adults’ exercise behaviors. The study aimed to develop and validate a Turkish version of the ‘Multidimensional Outcome Expectations for Exercise Scale’ (MOEES) and assess its reliability in adults with cardiovascular disease (CVD). This cross-sectional validation included 150 participants. The MOEES was translated into Turkish, ensuring cultural and linguistic appropriateness, and reviewed by 15 healthcare professionals. Participants’ demographic data were collected, and they completed the MOEES, International Physical Activity Questionnaire (IPAQ), and Tampa Scale for Kinesiophobia-Heart (TSK-H) twice, 15 days apart. The internal consistency of the MOEES was excellent, with a Cronbach’s Alpha of 0.919. Test-retest reliability showed high intraclass correlation coefficients (ICC) for the physical (0.924), self-evaluative (0.921), and social (0.929) subscales. Confirmatory factor analysis (CFA) indicated an excellent fit (X²/df = 1.782, GFI = 0.908, AGFI = 0.856, CFI = 0.962, RMSEA = 0.072, NFI = 0.918, SRMR = 0.052). Strong correlations were found between MOEES sub-dimensions and IPAQ total and TSK-H scores (p < 0.01), confirming the scale’s validity. The Turkish MOEES is a reliable tool for evaluating physical, social, and self-evaluative outcome expectations regarding exercise in CVD patients, making it suitable for clinical and research applications.

Blueberry leaf mottle virus (BLMoV) is a highly destructive agent in blueberry production, and entire crop can be lost in some cultivars. In this study, 316 samples from several provinces of Türkiye were tested by both ELISA and RT-PCR using virus-specific primers. Results showed that 1.26% of the tested plants were infected by DAS-ELISA, whereas 2.50% of the samples were infected by RT-PCR for BLMoV. Although multiple alignments of nucleotide sequences with corresponding sequences from GenBank showed 93.6–98.2% identity with the two BLMoV isolates available in the GenBank from the USA, identity range was 94.5–100% between Turkish isolates. To our best of knowledge, this is the first report of BLMoV on blueberry in Türkiye and outside of North America and Canada.

Introduction Care for patients in the intensive care unit (ICU) must support all body systems. However, ICU nurses often focus on life‐threatening conditions, giving less attention to other critical areas such as eye care. Objective This study aims to determine ICU nurses' knowledge, attitudes and practices regarding eye care. Method This descriptive study was conducted in Türkiye between 1 June 1 2024, and 15 August 2024. The sample included 210 nurses actively working in ICU settings, and data were collected using the snowball sampling method. An online survey was administered, which included demographic information and the ‘Eye Care Clinical Competence Questionnaire’ Statistical analysis was performed using SPSS 22.0. The normality of the data was assessed using kurtosis and skewness tests, and appropriate analysis methods were selected. Results The average age of the participants was 32.48 ± 7.45 years, with 78.1% being female and 77.1% holding a bachelor's degree. Female nurses and those with intensive care nursing certification had significantly higher eye care clinical competency scores. Additionally, nurses working in Neonatal ICU's scored higher in knowledge and attitude sub‐dimensions compared to other ICUs. Nurses who received in‐service training and used protocols for eye care had higher competency scores. A total of 37 nurses (17.6%) stated that the obstacles to performing eye care were the perception that eye care is less important compared to other problems. Nurses with an ICU nursing certificate had significantly higher Eye Care Clinical Competence Questionnaire total scores ( p = 0.002), attitude sub‐dimension ( p = 0.049) and practice sub‐dimension ( p = 0.004) total scores. Conclusion The clinical competency levels of ICU nurses in eye care improve with post‐graduation education, the use of protocols, and updated information. Thus, it is recommended that standard protocols be developed and training programmes for eye care practicesbe expanded. Implications for the Profession and/or Patient Care It was determined that intensive care nurses had limited knowledge about eye care and that a standard eye care practices were not performed. In order to increase the competence of intensive care nurses in eye care, this subject should be included in continuing evidence‐based practice education, in‐service training and certification programs and integrated into practices. Educational initiatives and policy advancements will enhance nurses' clinical competencies in eye care and promote patient safety. Impact This study determined the knowledge, attitudes and practices of intensive care nurses regarding eye care, as well as the influencing factors. It was found that nurses had limited knowledge about eye care but had good attitudes. Having certification and education for intensive care nurses improve clinical competence and attitudes in eye care. Reporting Method STROBE checklist was followed for reporting in the study. Patient or Public Contribution Nurses working in the intensive care unit participated in this study.

Green financial products have emerged that can benefit economic actors in financing green initiatives to promote renewable energy and enable carbon neutrality. Against this backdrop, the study examines the impact of green bonds (GBs) on carbon dioxide (CO2) emissions and renewable electricity generation (EG) in China and the USA, the leading countries in terms of GB issuance and CO2 emissions. To this end, the study conducts a disaggregated-level analysis by applying novel nonlinear quantile methods between January 2, 2019, and July 31, 2023. The results demonstrate that at higher quantiles; (i) GBs mainly have a dampening impact on CO2 emissions from the transportation sector in China and the USA; (ii) GBs have a stimulating impact on solar and wind EG in China; (iii) GBs have a diminishing impact on all types of EGs in the USA. Thus, GBs have an impact on carbon neutrality and renewable energy, which differs by quantiles, sectors, and EG sources. Accordingly, various policy implications are discussed in terms of further contributions of GBs to carbon neutrality and renewable energy in China and the USA.

This study was carried out to determine the performance of four peach × almond hybrids and one Prunus cerasifera × almond hybrid rootstock in low chilling areas of the eastern Mediterranean region of Türkiye. In this study, the ‘Crimson Baby’ nectarine and the ‘Flored’ peach cultivars were grafted on the peach–almond hybrids Garnem, GF-677, Patrones-Arda, and Rootpac-40® and the plum–almond hybrid Rootpac-R® rootstock in October 2016 and were planted in the research area in October 2017. During the first three bearing years, the earliness, yield, and fruit quality characteristics of the budded cultivars varied depending on the rootstock and growing season. Rootpac-40®, Rootpac-R®, and Patrones-Arda rootstocks advanced harvest time 2–3 days compared to GF-677 and Garnem rootstocks. The lowest tree vigor was induced by Rootpac-40® for both cultivars, with 32 and 41% reductions in trunk cross-sectional area (TCSA) for ‘Crimson Baby’ and ‘Flored’, respectively, compared to GF-677. The largest fruits were obtained from the Rootpac‑R and Rootpac 40 rootstocks for the ‘Flored’ cv., and were obtained on Garnem and Patrones-Arda rootstocks for the ‘Crimson Baby’ cv. The cumulative yield was markedly greater for the Rootpac-R® rootstock in both cultivars. The highest yield efficiency was detected on Rootpac-R® for ‘Crimson Baby’ and on Rootpac-40® for ‘Flored’. According to 3‑year averages, the highest fruit weight was obtained on GF-677 and Garnem rootstocks for ‘Crimson Baby’ and on Rootpac-R® and Rootpac-40® for ‘Flored’. The highest fruit soluble solids content was observed in Rootpac-40® for both cultivars. These results showed that new Prunus rootstocks such as Rootpac-R® and Rootpac-40® could be the best option for the growing conditions, resulting in better yield performance and fruit quality than those of the Garnem and GF-677 rootstocks.

Familial Mediterranean Fever (FMF) is a genetic autoinflammatory disease primarily affecting populations in the Mediterranean region. The pathogenesis of FMF and the roles of various molecules remain unclear. Adropin, a protein encoded by the Energy Homeostasis-Associated Gene (ENHO), is involved in energy metabolism and inflammation. This study aimed to explore the relationship between ENHO expression, Adropin levels, and FMF, examining their correlations with disease characteristics. This study included 30 patients clinically diagnosed with FMF and 35 healthy controls. The ENHO expression in peripheral blood mononuclear cells was assessed using a qRT-PCR, and the serum Adropin levels were measured via ELISA. The ENHO expression was significantly elevated in the FMF patients compared to the controls (p = 0.0007), while no significant differences were observed in the serum Adropin levels between the groups (p = 0.81). A correlation analysis revealed a negative association between the ENHO expression and age (r = −0.47, p = 0.009), whereas the serum Adropin levels were positively correlated with age, disease onset, and diagnostic delay (p < 0.05). No significant associations were found between the ENHO expression and Adropin levels or FMF clinical features. These findings suggest that increased ENHO expression may play a role in FMF pathophysiology, potentially as a compensatory mechanism. The correlation between Adropin levels and disease onset indicates a potential protective role. Further studies are needed to confirm these findings.

Paving a sustainable development road for countries by harmonizing economic development and ecological sustainability has become one of the significant tasks for policymakers. To this end, green investments (GI) have gained significance for supporting economic activities while preventing environmental deterioration. However, the former literature provides limited evidence of whether GI is an effective tool for promoting sustainable development. Therefore, the main objective of this study is to investigate how GI, proxied by renewable energy investments (RENI), impacts sustainable development proxied by load capacity factor (LCF) in the Nordic Countries, namely Denmark, Finland, and Sweden, from 2008 M1 to 2020 M6 by using novel Wavelet Transform Coherence (WTC) and Quantile‐on‐Quantile regression (QQR) as a baseline estimator. Quantile regression (QR) is also used to check for robustness. Empirical results of the WTC method show a time‐ and frequency‐based interaction between GI and LCF in Nordic states. The QQR estimation shows that GI can improve and promote sustainable development in Denmark and Finland. At the same time, GI may not have the desired impact on sustainable development in Sweden. QR estimation results imply that the obtained findings are robust. Therefore, promoting GI could be an efficient way to promote sustainable development in Denmark and Finland.

Purpose Priapism is a condition characterized by a prolonged erection lasting over four hours, either independent of or following sexual stimulation. The primary treatment goal for ischemic and non-ischemic priapism is timely and appropriate intervention to preserve erectile function and penile length. This study aims to evaluate the management of recurrent ischemic priapism in SCD patients in an endemic region and compare it with ischemic priapism of other etiologies. Methods Patients who were admitted to our hospital with a diagnosis of priapism between January 2010 and June 2024 were retrospectively screened. Patients were divided into two groups as ischemic priapism due to SCD and ischemic priapism due to other etiologies; the characteristics of the patients, treatment management and penile prosthesis requirement were compared. Results A total of 40 ischemic priapism patients were included in the study; 20 of them had sickle cell disease and the other 20 had priapism cases due to different etiologies. In the SCD priapism group, the rate of comorbidity and previous history of priapism were significantly (p < 0.05) higher than in the other etiologies of priapism group. Similarly, in the SCD priapism group, the hospital admission time and the rate of fibrosis findings in MRI (magnetic resonance) were significantly (p < 0.05) higher than in the other priapism groups. The penile prosthesis implantation rate in the SCD priapism group was found to be significantly (p < 0.05) higher than in the other priapism group. Conclusions This study explored the association between ischemic priapism, SCD, and other etiologies, focusing on treatment approaches and penile prosthesis necessity. Early intervention and patient awareness are essential in SCD-related priapism to prevent complications. Thus, educational programs are recommended to enhance symptom recognition and prompt medical attention.

Background The effect of inspiratory muscle training (IMT) applied along with function in Hypertension (HT) patients is uncertain. In this study, it was to determine the effectiveness of functional IMT (F-IMT) on functional lower and upper exercise capacity, mobility, peripheral and respiratory muscle strength, blood pressure, fatigue, physical activity, and quality of life (HRQoL) in HT patients. Methods Prospective, randomized controlled, assessor-blinded, parallel three-armed trial. Forty-five patients with HT were divided into F-IMT group (IMT with 50% maximal inspiratory pressure (MIP)/4 weeks + exercise and IMT with 50% MIP/4 weeks, n = 15), IMT group (MIP 50%, n = 15) and control group (CG, breathing exercises, n = 15). 6-min walking test (6-MWT), 6-min pegboard ring test (6PBRT), 1-min sit to stand test (1STS), mobility, peripheral muscle strength, MIP, maximal expiratory pressure (MEP), systolic& diastolic blood pressure (SBP, DBP), fatigue, physical activity, and HRQoL were evaluated before and after 8 weeks of training. Results Increases in 6-MWT were higher in F-IMT (p < 0.001). 6PBRT, 1STS, quadriceps femoris strength were improved and SBP reduced in F-IMT and IMT than CG (p < 0.001). Mobility, handgrip, HRQoL, and physical activity level increased within groups (p < 0.05). MIP increased within F-IMT and IMT; MEP, fatigue, DBP improved only within F-IMT (p < 0.05). Conclusions F-IMT is more effective in enhancing exercise capacity, reducing fatigue and DBP, and improving MEP. Both IMT and F-IMT show similar benefits for upper extremity exercise capacity, quadriceps femoris strength, SBP, and MIP. Mobility, HRQoL, and physical activity levels are increased with F-IMT, IMT, and breathing exercises. Trial registration ClinicalTrials.gov Identifier: NCT06343246 (03/29/2024).

Purpose Osteotoxicity, a common consequence of Methotrexate (MTX) therapy, significantly compromises bone health by inducing oxidative stress and disrupting bone remodeling. This study examines the protective effects of Tempol, a nitroxide compound with antioxidant properties, against MTX-induced osteotoxicity. Methods Osteocyte-like MLO-Y4 cells were cultured and treated with Tempol and MTX to evaluate changes in apoptotic mediators, MAPK signaling pathways, and oxidative stress parameters. Results MTX treatment significantly increased caspase-3 activity and Bax expression while decreasing Bcl-2 levels, thereby creating a pro-apoptotic environment. It also activated stress-related pathways by elevating JNK and ERK activities. Conversely, Tempol effectively countered these effects by restoring the balance of apoptotic mediators, downregulating MAPK activation, and enhancing Total Antioxidant Status (TAS). Additionally, Tempol reduced Total Oxidant Status (TOS) and improved the activities of superoxide dismutase (SOD) and glutathione peroxidase (GPx). Conclusion These findings highlight Tempol’s potential to mitigate oxidative stress and apoptosis linked to MTX therapy, supporting its use as an adjunctive treatment to protect bone health in patients undergoing MTX therapy. Emphasizing Tempol’s clinical implications as a protective agent reinforces the urgency for further research into its long-term effects on cellular viability and bone integrity in the context of chemotherapy.

Fibropapillomatosis (FP) is a panzootic and neoplastic disease. In the current study, we aimed to characterize a tumour‐like mass and reveal spirorchid‐like parasitic eggs in the ocular tissues of Caretta caretta turtles. In this study, seven ocular tissue samples, including six eye/eyelid tissues taken from Loggerhead turtles (C. caretta) with healthy‐looking animals and one tumour‐like ocular mass obtained from a C. caretta turtle with a clinical lesion, were used as study material. Unilateral spirorchid‐like parasite eggs were detected in the tissue samples of only two healthy‐looking animals. The characterization and identification of a tumour‐like mass were performed using histopathology, PCR and immunohistochemistry, respectively. Unilateral corneal scarring, spirorchid‐like parasite eggs and papilloma virus by PCR were detected in the ocular tumour‐like mass evaluated as fibropapilloma. However, in immunohistochemical staining, Ki‐67, p16, pan‐cytokeratin, vimentin and herpesvirus showed positive staining, whereas p53 showed negative staining. Koilocytosis was observed in some cells. Our findings indicate that papillomavirus, herpesvirus and spirorchid‐like parasite eggs may have a predisposing role in the occurrence of FP. This study provides the first research data on spirorchid‐like parasite eggs and FP in loggerhead turtles (C. caretta) in the Mediterranean Sea in Türkiye.

School administrators organise several factors, such as the structure of the school, teachers, staff, students and parents to achieve educational objectives. Managing such a large-scale organization often involves addressing unexpected problems. School administrators face significant challenges in maintaining educational continuity following large-scale crises, such as the February 6, 2023, earthquakes in Türkiye. This study investigates the obstacles encountered by primary school administrators during the post-earthquake period. The research employs a qualitative design, gathering data through semi-structured interviews conducted with 18 school administrators affected by the earthquake disaster. The participants were school administrators working in primary schools located in the central districts of Hatay Province. The collected data were analysed using thematic analysis. The analysis identified various problems resulting from the earthquakes in the region, including the migration of families and students to different provinces, damage to school buildings, lack of internet access and educational materials, inequality in opportunities, and psychological challenges such as stress, anxiety, reduced motivation, and low morale. Additional concerns included uncertainty about the future, as well as difficulties related to accommodation, transportation, communication, teacher assignments, and access to teaching resources faced by school administrators and teachers. Furthermore, the study emphasizes the need to provide psychological support to school staff, students, and teachers; create safe educational environments; reorganize and enhance teaching materials; repair and reconstruct damaged school buildings; develop crisis management programs; and offer both financial and psychological support to affected families. These findings highlight the urgent need for improved disaster preparedness and post-disaster support systems within the educational sector. Keywords: disaster management in education, crisis management, educational challenges, educational disruption, school administration

The significant production of tea waste globally raises environmental concerns. Tea waste can be valorized by extractingits phytochemicals. In this study, the recovery of phenolic substances, flavonoids, and antioxidants from the black teawastes using two types of hydrogen-rich water (HRW): hydrogen bubbling and magnesium-water reaction (Mg water),besides ethanol/water (50/50, % vol), ethanol/Mg water (50/50, % vol), and pure water (control) was investigated. Thebest extraction yield was obtained for HRW (30.13%). The best levels of phenolics (TPC), flavonoids (TFC), and antioxi-dants (DPPH and ABTS) were found for HRW extracts, followed by ethanol/Mg water (50/50). The levels of TPC, TFC,DPPH, and ABTS increased by 193.05, 210.56, 49.21, and 86.60%, and by 59.70, 33.46, 28.66, and 58.25% when HRWand Mg water was used as a solvent instead of pure water, respectively, in the extraction. The maximum levels of phenolicacids (p-coumaric acid, chlorogenic acid, gallic acid) and flavonoids (rutin and epicatechin) were found in HRW extracts.Hydrogen extraction can be proposed as a sustainable method to extract phenolic substances from agri-food waste.

The purpose of the current work was to identify the levels of frailty, spiritual orientation, and death anxiety and the relationship between them in older adults with chronic illness. This descriptive, cross-sectional, and correlational study was conducted with 221 participants. Of the participants, 43.9% were frail. Considering the correlation between the scales, a positive moderate significant correlation was identified between the FRAIL Scale and the Death Anxiety Scale. In contrast, a negative moderate significant correlation was revealed between the Spiritual Orientation Scale, FRAIL Scale, and Death Anxiety Scale. When the mediator variable, death anxiety, was not included in the model, the total effect of spiritual orientation on death anxiety was significant. It was revealed that death anxiety mediated the relationship between spiritual orientation and frailty. Hence, it is recommended that spiritual care needs and death anxiety be evaluated in the assessment of patients’ frailty levels and patient care.