Necmettin Erbakan University

Coronavirus disease 2019 (COVID-19) and COVID-19-related multisystem inflammatory syndrome in children (MIS-C) is known to be a life-threatening health problem worldwide. The study investigates the potential relationship between asymmetric dimethylarginine (ADMA) levels and disease severity in such conditions. We conducted an observational, prospective study between July 2021 and January 2022. The study enrolled 98 patients diagnosed with COVID-19, 21 patients diagnosed with MIS-C, and 42 healthy individuals who served as a control group. The COVID-19 patients were further categorized into three subgroups based on their level of care: outpatients, those requiring hospitalization, and those requiring intensive care. The MIS-C patients formed a distinct fourth group. COVID-19 outpatients had a median ADMA level of 8097.0 ng/L (interquartile range: 6436.06–10840.0 ng/L), while those requiring hospitalization had a higher level of 13,195.60 ng/L (11,472.4–15,862.2 ng/L). Patients in intensive care exhibited the highest median ADMA level at 19,361.4 ng/L (15,596.65–23,367.9 ng/L). MIS-C patients also had elevated ADMA levels, with a median of 15,735.50 ng/L (13,486.6–20,532.5 ng/L). Receiver operating characteristic (ROC) curve analysis revealed that an ADMA level of 6135.15 ng/L could distinguish between patients and controls with 95% sensitivity, 100% specificity, 100% positive predictive value, and 87.5% negative predictive value. Conclusions: In conclusion, our study is the first to investigate ADMA levels in children with COVID-19 and MIS-C. We found that ADMA levels were significantly elevated in children with COVID-19 requiring intensive care and those with MIS-C, suggesting a potential role for ADMA as a biomarker of endothelial dysfunction in these populations. What Is Known: • Endothelial dysfunction is a determinant of poor prognosis in various cardiovascular diseases and plays a critical role in the pathogenesis of COVID-19 and MIS-C. • Asymmetric dimethylarginine (ADMA) is a well-known biomarker of endothelial dysfunction. Elevated levels of ADMA adversely affect vascular endothelial function by reducing nitric oxide production. What Is New: • It is the first to show that elevated ADMA levels in children with COVID-19 and MIS-C are associated with disease severity. • ADMA has been identified as a potential biomarker that can be used to assess the prognosis of COVID-19 and MIS-C in children and to predict the severity of the disease.

Purpose This study aims to identify anatomical variations inside and outside the maxillary sinus (MS), determine their prevalence and coexistence, and investigate their relationship with MS volume in individuals without MS pathology, using ImFusion Suite software. Methods Analysis of 330 paranasal CT scans obtained from the radiology archive (2018–2021) was performed using the ImFusion Suite program. Anatomical variations, including accessory ostium, Haller cells, ethmomaxillary sinus, concha anomalies, septa, and impacted teeth, were identified and their frequency of coexistence was determined. MS volume and nasal septum deviation (NSD) angle were measured. The relationship between MS volume and gender, as well as the impact of anatomical variations on MS volume, was analyzed. Statistical analyses were conducted using SPSS software. Results The most common anatomical variation was NSD (98%), while the least common was ethmomaxillary sinus (9.4%). Middle and inferior concha hypertrophy were more frequent in males, whereas concha bullosa and impacted teeth were more prevalent in females (p < 0.05). A normal anatomical appearance on CT scans was observed in only 2.1% of cases (3.5% in males; 1.1% in females), with a notable coexistence of multiple variations. MS volume was significantly higher in males (right: 16.79 ± 5.23 cm³; left: 16.39 ± 5.61 cm³) than in females (right: 14.44 ± 4.54 cm³; left: 14.59 ± 4.62 cm³) (p < 0.05). MS volume was significantly smaller when the NSD angle was ≥9° and larger in the presence of septa. Conclusion This study provides a comprehensive analysis of anatomical variations in the MS and their relationship with MS volume. The findings indicate that septa increase MS volume, while a higher NSD angle (≥9°) is associated with reduced MS volume. Other variations, including accessory ostium, Haller cells, and concha anomalies, showed no significant impact on MS volume. These results highlight the importance of detailed radiological evaluation in clinical and surgical planning.

The problem of segregation in urban spaces has been influential not only in the physical sense but also in social and class-related areas. Accordingly, in this study, it was aimed to examine the relationship between segregated urban spaces and gender, and an investigation was carried out on masculine and feminine identities reflected in spaces. It was determined that the parameter of safety and time of the day were the two most effective criteria on gender-based spatial segregation. It was also found that gender stereotypes shaped spaces, women were directly/indirectly excluded by the organization of space, they were alienated from public and semi-public spaces, patriarchal thought penetrated people’s mind maps, and feelings of worry, anxiety, and fear emerged in women who experienced stress in access to urban spaces.

Biological studies have shown that macrophages play a dual role in cancer dynamics. Through the secretion of different factors, they can modulate the tumor microenvironment and directly interact with tumor cells. Active macrophages, more precisely tumor‐associated macrophages (TAM), can secrete substances that increase the proliferation and survival of tumor cells, thus promoting tumor growth. This study explores the dynamic interactions between tumor carcinogenesis and macrophage activation through a newly developed mathematical model using the Caputo sense fractional operator. The main focus is to analyze the influence of macrophage polarization on tumor progression and cancer development. To precisely capture the dynamic behavior of macrophage‐tumor interactions, the model is verified for qualitative analysis. The fixed points of the model are obtained and their stability analysis is carried out. It is started by explaining the essential components of the model and then assuring its mathematical reliability. The Adams–Bashforth–Moulton method (ABM) is also discussed to show its applicability and efficiency for the numerical results of the developed model. The findings shed light on cancer progress, potential analyses, and the influence of public information. The outcome of the study offers a more detailed understanding of possible treatment targets by highlighting the delicate balance between macrophage pro‐ and anti‐tumor effects. The outcomes might improve public health policy, healthcare budget apportionment, and contest tumors and related infections. Further, it improves the understanding of tumor‐immune system interactions and lays the solid basis for cancer treatment research. Finally, numerical simulations make our outcomes more significant.

Science, technology, engineering, and mathematics (STEM) literature has provided an examination of demographic variables for understanding career interest. However, in addition to these variables, there is a research gap on the impact of experiences within STEM, which are related to self-efficacy, stereotypes, and sense of belonging as it pertains to career interest. Based on this, the predictors of STEM career interest of high school students (n = 507) were investigated. The results of the study showed that STEM experiences, math and science self-efficacy, and sense of belonging in STEM were positive predictors of STEM career interest. However, gender or socioeconomic status does not significantly predict STEM career interests. In addition, stereotypes regarding STEM were a negative predictor of STEM career interest. Based on the results, implications for strengthening the STEM pipeline are drawn.

Oral administration of terbinafine hydrochloride for the treatment of superficial mycoses in the targeted skin area may require high concentrations due to first-pass metabolism and intensive plasma protein binding. To address these challenges, this study aimed to fabricate hydrogel patches for localized delivery of terbinafine hydrochloride. The patches were developed using methacrylic acid and 2-hydroxyethyl methacrylate monomers through a free radical polymerization technique. Infrared spectroscopy, field emission scanning electron microscopy, and time-dependent swelling tests were performed to examine the physicochemical, structural, and morphological characteristics of hydrogel patches. Hydrogels exhibit interconnected highly porous structures suitable for drug loading and controlled release. Biocompatibility was assessed through in vitro cytotoxicity and comet assays, showing no significant cytotoxic or genotoxic effects on human embryonic kidney cells, even at high extract concentrations. Terbinafine was loaded into biocompatible hydrogels with different monomer ratios, and it was found that both the loading content (from 3.84 to 5.83%) and the entrapment efficiency (from 26.63 to 41.45%) increased as the methacrylic acid composition increased. These patches can release the drug at higher concentrations depending on their methacrylic acid content while retaining the drug's inhibitory action on yeast microbiological growth. These findings suggest that the developed hydrogel patches could serve as efficient platforms for topical antifungal therapy following further clinical studies. Graphical abstract

Fetal health anxiety during pregnancy is considered one of the most common and intense types of anxiety experienced. This study was conducted to determine the relationship between fetal health anxiety, spiritual well-being, and perceived social support levels in hospitalized pregnant women with high-risk pregnancies. This descriptive study was carried out between March and August 2024 with 175 pregnant women diagnosed with high-risk pregnancies in the obstetrics department of a medical faculty hospital in Türkiye. Data were collected using a descriptive characteristics form, the fetal health anxiety inventory (FHAI), the three-factor spiritual well-being scale (SWBS), and the multidimensional perceived social support scale (MSPSS). Hospitalized women with high-risk pregnancies reported low levels of fetal health anxiety and high levels of perceived social support. It was found that pregnant women with higher educational levels and those using medication regularly had higher perceived social support levels. It was determined that the anomie subdimension of the SWBS significantly differed based on pregnancy status, while the transcendence and harmony with nature subdimensions showed significant differences based on income level. An increase in the harmony with nature score resulted in a 0.282-unit increase in the perceived social support score (β = 0.282; p = 0.005). Similarly, an increase in the anomie subdimension score led to a 0.211-unit increase in the fetal health anxiety score (β = 0.211; p = 0.005). Health professionals, in addition to providing medical interventions in high-risk pregnancies, can offer holistic care by strengthening spiritual care and social support networks.

In this study, the effects of infill ratio, layer thickness, nozzle temperature, and raster angle on the flexural strength of polylactic acid material were investigated through microstructural analysis. A total of 10 different sample groups were produced, changing the parameters of the filling ratio (20, 40, 60, 80 %), layer thickness (0.15, 0.20, 0.25, 0.30 mm), nozzle temperature (210, 220, 230 °C), and raster angle (±45°, 0/90°). Three-point bending tests were conducted using the Shimadzu bending machine, and the results were used to calculate maximum bending stress, modulus of elasticity, and strain values. The results showed that the values of maximum bending stress and modulus of elasticity vary significantly with changes in layer thickness, filling ratio, nozzle temperature, and raster angle. The Scanning Electron Microscopy (SEM) images were obtained from the longitudinal cross-section of the samples in the failure area. The obtained images were used to identify the gaps between beads, voids, porosity, filament rapture, pull-out breakage, elongation, and necking patterns on the samples. The variations in flexural properties were verified by using SEM micrographs in the failure area.

Purpose The aim of this systematic review is to assess the environmental impact of urologic procedures and equipment (P), specifically comparing emissions and waste generation between single-use and reusable devices (I and C), while also exploring strategies for emission reduction and providing relevant recommendations for sustainable practices in urology. Methods The review registered to PROSPERO (ID: CRD42024576865) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search was conducted to identify studies addressing sustainability, carbon footprint, and environmental impact in urology. A total of 7714 records were initially identified, of which ten met the inclusion criteria. Study quality was assessed using the QUADAS scoring system to evaluate risk of bias and applicability concerns. Results Ten studies met the inclusion criteria, focusing on the environmental impacts of urologic devices and procedures (O). Single-use cystoscopes demonstrated lower carbon dioxide (CO2) emissions per procedure (2.41 kg) compared to their reusable counterparts (4.23 kg) but produced more waste (622 g). Reusable cystoscopes, while having a lower cumulative waste per-use, increased emissions due to energy-intensive reprocessing. For ureteroscopes, single-use devices generated less CO2 but significantly more solid waste. TURBT procedures had a high carbon footprint (131.8 kg CO2 per procedure), largely from single-use items and sterilization. Robotic prostatectomy produced a lower carbon footprint (47,313 g CO2) than laparoscopic methods, emphasizing the potential for energy-efficient techniques to reduce emissions in urology. Conclusion A hybrid approach in urology, focusing on improving sterilization processes and developing eco-friendly single-use alternatives, may provide a balanced approach toward sustainability.

The material footprint (MFP) is a critical issue due to the pressure on natural resources, environmental degradation, biodiversity loss, and increased greenhouse gas emissions. In the existing literature, the determinants and their impacts on the MFP of G7 countries have not been sufficiently examined. The aim of this study is to analyze the effects of material productivity, energy transition (ET), globalization, economic growth, financial development, and population on the MFP of G7 countries. Using annual data from 1983 to 2021, the panel cointegration technique and the Toda-Yamamoto causality test with Fourier function are applied. The results reveal that there are significant but variable causal relationships between the dependent and independent variables specific to each country. Panel cointegration estimates show that renewable energy, economic growth, financial development, and population have a positive effect on MFP, while material productivity, globalization, and the square of economic growth have a negative effect. These findings support the validity of the Environmental Kuznets Curve (EKC) hypothesis in the context of MFP. Our study provides policy recommendations to help G7 countries achieve a balance between environmental sustainability and economic growth.

The purpose of this phenomenographic study was to examine the different ways in which a group of research assistants who varied by university, department and gender understand the anger they feel towards the faculty members with whom they interact. Phenomenographic analysis was conducted on data obtained through face‐to‐face, semi‐structured interviews with 15 research assistants at two state universities in Turkey. The analysis revealed that the participants understood the anger at issue in six different ways: (1) ‘an emotion one feels when exposed to an injustice’, (2) ‘an emotion that diminishes work performance’, (3) ‘an emotion that should be kept under control’, (4) ‘an emotion that causes discomfort’, (5) ‘an emotion that pushes one to look for a solution’ and (6) ‘an emotion for which one develops resilience as one gains work experience’. Implications for future research and practise were also discussed based on the findings.

Background: Studies on the impact of comorbidities on treatment responses in severe eosinophilic asthma (SEA) are limited. This study was a real-world investigation into how the presence or absence of nasal polyps (NP) and sensitivity to aeroallergens influence the outcomes of mepolizumab therapy. Methods: In this retrospective study, data obtained from patients with SEA and who received at least 6 months of mepolizumab treatment were analyzed. The patients were initially divided into two groups based on the presence of NPs. Within these two groups, the patients were further categorized into subgroups according to the presence of aeroallergen sensitivity (AE). Asthma-related outcomes in the resulting four groups were evaluated both before mepolizumab treatment and during the follow-up period. Results: Among the 36 patients with NPs, 14 (38.8%) had AE (NP+AE+), whereas 22 (61.2%) did not (NP+AE‐). Of the 35 patients without NPs, 17 (48.5%) had AE (NP‐AE+), and 18 (51.5%) did not (NP‐AE‐). The presence of NPs, independent of AE, was significantly associated with an increase in asthma exacerbations and oral corticosteroid (OCS) use before treatment (p < 0.001). In the NP+AE+ group, the baseline Asthma Control Test (ACT) score was lower, and the number of hospitalizations was significantly higher (p < 0.001). After mepolizumab treatment, all four groups showed significant reductions in asthma-related exacerbations, hospitalizations, and OCS use. Furthermore, ACT scores and pulmonary function test parameters significantly improved. There were limited differences in asthma improvements among the groups, with the NP+AE+ group showing a significant increase in ACT scores and a reduction in hospitalizations compared with the other groups (p < 0.001). Conclusion: Mepolizumab significantly reduced asthma exacerbations, hospitalizations, and OCS use in the patients with SEA with four different phenotypes. Analysis of these findings suggests that mepolizumab provides real-world benefits regardless of the presence or absence of NPs and AE.

Backround: Rapid drug desensitization (RDD) is commonly used for immediate drug hypersensitivity reactions (DHR) across various drugs. In delayed DHRs, the conventional approach is slow desensitization; however, limitations may arise due to drug-specific or disease-related factors. With the increasing role of targeted molecular drugs in delayed DHRs, data on the efficacy of RDD in these contexts remain scarce. Objective: This case series aims to explore the rationale and outcomes of RDD in managing delayed DHRs associated with targeted therapies. Methods: We analyzed data from patients referred to a tertiary university hospital's drug allergy outpatient clinic between January 2021 and April 2024. The subjects experienced delayed DHRs during treatment with targeted drugs and, subsequently, underwent RDD. Results: The drugs administered via RDD included bevacizumab, rituximab, daratumumab, lenalidomide, bortezomib, and carfilzomib. The index reactions included maculopapular eruptions (MPE), drug reaction with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP). Delayed breakthrough reactions were observed in four of seven patients. RDD with bortezomib was unsuccessful in all three patients, and delayed reactions were observed in all patients with severe cutaneous adverse reactions (AGEP and DRESS). Conclusion: Suggesting significant success of RDD for delayed DHRs induced by targeted therapies may be overly optimistic. Nevertheless, four of seven patients, including one with AGEP, were able to continue their treatment. Managing patients with advanced diseases and delayed DHR poses notable challenges. The risk to patient survival from withholding life-saving medication must be weighed against the risks of desensitization. The low sensitivity of skin tests and the critical waiting period complicate decision-making. Given the unique contribution of targeted agents in the treatment of severe, life-threatening diseases, further research on desensitization is warranted.

Objective Behçet's Disease (BD) may impair bone remodeling, increasing osteoporosis risk. This study evaluates mandibular trabecular bone fractal dimension (FD), mandibular cortical index (MCI), and temporomandibular joint (TMJ) degeneration in BD patients versus healthy controls. Materials and Methods A total of 106 panoramic radiographs, comprising 53 from BD patients and 53 from healthy individuals, were examined. Fractal analysis was performed using ImageJ software, selecting 50 × 50 pixel regions of interest (ROIs) from the gonial, interdental, and condylar areas. Degenerative changes in the TMJ, including osteophytes, sclerosis, surface flattening, erosion, and subchondral cysts, were recorded. Statistical analysis was conducted with SPSS v.21 (IBM, Armonk, USA), using a significance level of p < 0.05. Results The BD group exhibited significantly lower FD values compared to the control group (p < 0.05). Similarly, MCI scores differed significantly between the groups (p < 0.05). BD patients showed more pronounced radiological evidence of mandibular cortical resorption than controls. Additionally, degenerative changes in the TMJ were more prevalent among BD patients (p < 0.05). Conclusion Comprehensive evaluation of the mandibular cortex, trabecular bone, and TMJ is crucial in BD patients to effectively detect and monitor osteoporotic alterations. Clinical Significance BD patients may face considerable oral health challenges, such as jawbone deterioration and TMJ complications. Prompt diagnosis and treatment of these issues can enhance therapeutic outcomes and improve overall quality of life.