Background Shunt systems are used to provide cerebrospinal fluid drainage in the treatment of hydrocephalus. Recently, antibiotic-impregnated shunt systems are used to prevent colonization in the ventriculoperitoneal catheters. Methicillin-resistant Staphylococcus aureus (MRSA) is the most common causative microorganism of shunt infections. The aim of the study is to investigate effects of several substances on MRSA biofilms in the ventriculoperitoneal catheters. Methods The present study consists of mainly eight groups (each has two subgroups as antibiotic-impregnated and nonantibiotic-impregnated catheters). In addition, each group contains six molds using MRSA strains. In this study, daptomycin (DAPT) (2 mg/ml), vancomycin (VAN) (10 mg/ml), linezolid (LIN) (2 mg/ml), N-acetylcysteine (NAC) (6 mg/ml), and various combinations of these substances were used to evaluate the treatment against MRSA using scanning electron microscope (SEM) images and microbiological enumeration. Results The colony count in the antibiotic-impregnated samples significantly decreased compared to nonantibiotic-impregnated samples in the MRSA, MRSA + DAPT, and MRSA + LIN groups ( p < 0.01), respectively. Conversely, the colony count in antibiotic-impregnated samples significantly increased compared to nonantibiotic-impregnated samples in NAC + DAPT and NAC + VAN groups ( p < 0.01), respectively. Conclusions The results showed that the use of antibiotic-impregnated catheters has a significant impact on the prevention of infection whereas the combination of NAC and DAPT showed better antibiofilm and antibacterial effects than other combinations on the prevention and treatment of nonantibiotic-impregnated catheter infections.
Background Plantar fasciitis (PF) is the most common cause of heel pain. Previous work has shown promising results regarding platelet-rich plasma (PRP) injections for the treatment of PF. The aim of this study is to prospectively compare the efficacy of PRP and autologous blood injections in a randomized anonymized patient group to treat PF. Methods PF patients who failed at least 6 weeks of noninvasive conservative treatment aged between 40 and 65 years were recruited to be in the study. Patients were randomly assigned into group A (PRP) or group B (autologous blood). Injections were performed under ultrasonographic guidance in a double-anonymized manner. The groups were compared according to preinjection and postinjection health-related quality of life (HRQoL) scores measured with Foot and Ankle Disability Index (FADI) and visual analog scale (VAS). Intragroup comparative analysis was also performed at different time points. Independent t tests and repeated measures analyses of variance were used for statistical analysis, with P <.05 set for statistical significance. Results Group A (PRP) included 30 (19 female, 11 male) patients with mean age 52.2 ±6.3; group B (ABI) included 30 (20 female, 10 male) patients with mean age 52.7 ± 6.5. Both groups had similar body mass index ( P = .719). No injection-related complications were recorded. After treatment, both groups had improved FADI and VAS scores compared to the baseline. Although the mean HRQoL scores were higher in the PRP group, there was no significant difference between the 2 groups ( P VAS = .589; P FADI = .742). Conclusion Participants with plantar fasciitis improved statistically significantly after either PRP or ABI injections compared with baseline HRQoL scores, with no significant differences seen between the groups. Level of Evidence Level I, prospective randomized double-anonymized clinical comparative study.
Multisystem inflammatory syndrome in children (MIS‐C) is rare, however, severe hyperinflammatory condition in children generally weeks after acute SARS‐CoV‐2 infection. A subset of MIS‐C patients is presented with severe heart failure. We hereby report 8‐year‐old girl presenting acute severe left ventricular failure. Various medical treatments including inotropic agents and drugs related to SARS‐CoV‐2 infection and MIS‐C were applied. However, venoarterial extracorporeal membrane oxygenation (ECMO) was needed to be performed. Due to unsuccessful attempts for ECMO weaning, left ventricular assist device was implanted to the patient with temporary right ventricular support from ECMO.
Introduction Fertilin β is a sperm surface protein that can mediate sperm-egg membrane interaction. This study was conducted to determine whether the expression of fertilin β after intrauterine insemination (IUI) in donors with normal parameters after standard semen analysis is related to low success rate or failure of fertilization. Methods We examined the sperm of 30 male donors who have normal as controls, oligozoospermia, and unexplained infertility as the clinically indication for IUI. Fertilin β has been labeled with the ADAM2 antibody by indirect immunofluorescence (IF) assay. To evaluate the reproducibility of the test, we selected four sperm samples scale of 0 to +++ according to the distribution of fluorescence label. Results The results were highly correlated with the corrected total cell fluorescence (CTCF) (Rp = 0.9972, P < 0.05). We suggest that the relationship between infertility and fertilin β may be due to the distribution of this protein on the sperm surface. Male partners of couples with unexplained infertility showed a low distribution of fertilin β by a decrease of the fluorescence signal in the IF labeling (scale of +++ by 7.4 ± 10.32%, P < 0.0001, ±SD). Discussion Abnormal fertilin β function may be a potential mechanism that could lead to fertilization failure.
Objective: To observe the necessity and usefulness of follow-up Magnetic Resonance Imaging (MRI) and Computed Tomography Imaging (CTI) after RFA of osteoid osteoma. Study design: A descriptive study. Place and duration of study: Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey, between May 2015 and January 2020. Methodology: Patients, who underwent CT-guided RFA for osteoid osteoma treatment, were followed-up both clinically and radiologically. MRI was recommended between the third and sixth months and CTI at 12th month or later for follow-up. All the pre and post-treatment radiological images were evaluated retrospectively. Radiological recovery was noted in three categories as complete/almost-complete, partial, and minimal-no recovery according to the healing of pre-treatment radiological findings. Results: One-hundred and thirty-one patients with at least one follow-up CT or MRI were included. All had technically and clinically successful RFA treatments. Of 131 patients, 64.1% had CTI and 82.4% had MRI follow-up. In follow-up images, complete/almost-complete-recovery was observed in 70.2%, partial recovery in 26.7%, and minimal recovery in 3.1% of the cases. Re-ablation therapies were applied in 2 cases in this study due to pain recurrence after three months of successful treatments. Conclusion: Radiological follow-up is beneficial for the evaluation of outcome after RFA of osteoid-osteoma. At least one follow-up MRI may be helpful for the assessment of healing or recurrence. Follow-up CTI may not be needed unless planning a re-ablation. Key words: Osteoma osteoid, Radiofrequency ablation, Tomography, Magnetic resonance imaging.
Objective: To compare dosimetric and radiobiological terms of modified dynamic conformal arc therapy (mDCAT) and volumetric modulated arc therapy (VMAT) techniques using different flattening-filter free (FFF) energies in patients with single adrenal metastasis. Methods: In this study, plans were prepared for 10 patients drawing on the mDCAT and VMAT techniques with 6MV-FFF and 10MV-FFF energies. Target volume doses, biological effective doses (BED), quality indices, Monitor Unit (MU), number of segments, beam-on time and critical organ doses were compared in the plans. Results: Plans with the significantly lower gradient index (GI) and conformity index (CI) values were obtained with 6MV-FFF energy VMAT planning (p < 0.05). The higher values were obtained for dose to 95% of internal target volume (ITVD95), ITVD95-BED10 with 10MV-FFF energy VMAT planning, whereas lower results were obtained for high dose spillage (HDS%) values (p < 0,05). With 10MV-FFF energy, HDS% values were 21.1% lower in VMAT plans and 5.6% lower in mDCAT plans compared to 6MV-FFF energy. Plans with approximately 50% fewer segments were obtained in mDCAT plans than VMAT plans (p < 0,05). Beam-on time values with mDCAT was 1.84 times lower when 6MV-FFF energies were analyzed, and 2.11 times lower when 10MV-FFF was analyzed (p < 0,05). Additionally, when 6MV-FFF and 10MV-FFF energies were examined, MU values with mDCAT were 2.1 and 2.5 times lower (p < 0,05). In general, the smaller the target volume size, the greater the differences between MU and beam-on time values mDCAT and VMAT. Conclusions: The study results implied that VMAT enabled to offer significantly more conformal SBRT plans with steeper dose fall-off beyond the target volume for single adrenal metastasis than the mDCAT, which attained at the cost of significantly higher MU and beam-on times. Especially with 10MV-FFF energy mDCAT plans, low-dose-bath zones can be reduced, and shorter-term treatments can be implemented with large segments. In adrenal gland SBRT, higher effective doses can be achieved with the right energy and technique, critical organ doses can be reduced, thus increasing the possibility of local control of the tumor with low toxicity.
L-alanine and β-alanine are important biological molecules and have zwitterion structure. In this study, L- alanine and β-alanine’s microscopic protonation constants and thermodynamic parameters (enthalpy, entropy, and free energy changes) for the proton–ligand systems of L-alanine methyl ester, β-alanine and β-alanine methyl ester have been determined at 5; 20; 35 °C, in ACN-water (25% ACN and 50% ACN (v/v)) mixtures at constant ionic strength of 0.1000 mol L–1 NaClO4 by potentiometric method. The results shown that, L-alanine and β-alanine’s microscopic protonation constants generally tend to decrease with temperature rise and their protonation reactions in ACN-water mixtures generally favor enthalpy-driven.
This study aims to compare the depression levels and the frequency of domestic violence cases with the parameters that can alter those levels and frequencies. Studies on people living in quarantine conditions at home during the Covid 19 Pandemic show that violence has increased. However, the literature shows lack of similar studies in Turkey. Therefore, it is necessary to carry out a research on the connection between domestic violence, depression level and the Covid-19 pandemic. The sample group consists of 689 people living in different cities of Turkey. To collect the data Demographic Information Form, Covid 19 Pandemic Information Form and Beck Depression Inventory were employed. The rate of the participants who stated that violence, anger and arguments increased in the family is 28%. The rate of those who stated that they were exposed to emotional violence during this process is 11.5%. The mean depression level of all participants included in the study is 14.05. The findings show that the level of depression and domestic violence cases increased during the Covid process. It is a necessity to develop long-term inclusive approaches and policies to prevent the increased domestic violence during an epidemic and to improve the psychological health of people.
The neoliberal structural adjustment policies in Turkey moved on to a new phase with the Health Transformation Program (HTP) that came into effect in 2003. In this study, 5,002 people, who used the services of the public hospitals in Istanbul, participated in a face-to-face survey to find out the impact of the HTP on the public's understanding of the welfare state and also the impact on their opinions over the healthcare services offered by the state. The data were classified into two topics: First, the transformation of the welfare state and second, the adequacy of the public healthcare services. Interestingly, the participants took a much more explicit stance against the neoliberal transformation of the welfare state than against the adequacy of the public healthcare service provision. The primary purpose of this research was to expose this paradox.
Aim: This study aimed to present the short- and long-term results of Demirtas two-step treatment model in patients with obstructed-hydronephrotic kidneys functioning below 10%, and before deciding on nephrectomy, to evaluate whether this method can contribute to the accurate assessment. Material and methods: This prospective study included patients with unilateral renal obstruction and renal parenchymal loss assessed by computed tomography and whose renal function was found to be below 10% in Tc-99m-dimercaptosuccinic acid. In the first step, percutaneous nephrostomy (PCN) was performed. Two weeks later, the second step was performed, in which patients were offered nephrectomy (if renal function was <10%) or etiology-based treatment (if renal function was ≥10%). Results: Thirty-eight patients were included in the study, comprising 20 (52.6%) men and 18 (47.4%) women with a mean age of 51.3±16.8 years. Mean baseline renal function was 6.0%, which increased to 10.8% two weeks after PCN (p=0.001). Renal function increased to above 10% in 20 (52.6%) out of 38 patients. Of these, 17 patients underwent etiology-based treatment and baseline, two-week, and 12-month renal function levels were 7.0%, 17.5%, and 18.8%, respectively (p<0.001). Conclusion: Demirtas two-step treatment model introduced in the present study can be recommended as a standard treatment modality in unilaterally obstructed kidneys functioning below 10% ability.
This study aims to point out the correlation between photobiomodulation (PBM) targets and effects and management of temporomandibular disorders (TMDs) pain using diode lasers with infrared wavelengths ranging from 780 up to 980 nanometers (nm). A systematic search of multiple electronic databases was done to identify the clinical trials published between 1st January 2010 and 18th December 2021. The included studies were limited to human subjects who had TMD pain, involving two genders with age > 18 years, and were treated with PBM using a diode laser (780–980 nm) as a non-pharmacological therapy to decrease the intensity of the pain associated to TMDs. The risk of bias for included studies was assessed using the Cochrane RoB tool (for randomized studies). The methodologic quality was rated using the Delphi list. The findings suggest that PBM is an effective tool in alleviating TMDs’ pain and increasing the range of movement in patients with Axis 1 of TMDs. However, TMDs’ pain related to underlying pathology cannot be solely treated by PBM. The causative factors must be treated first. Studies displaying the highest quality Delphi score may represent a suggested PBM therapy protocol to follow for TMDs pain management.
Successive developments in information technologies have brought important developments in the business world, one of which is e-commerce. Undoubtedly, consumers’ continuous adoption of online shopping, which has been specially accelerated as the result of the pandemic, is not likely to end or reduce after the Covid-19 passes, increasing volume and transaction in e-retailing make e-business more challenging. Under these circumstances, the most important requirement of sustainable development and profitability in e-business management is to retain loyal customers rather than one-time buyers. Hence, in an e-commerce setup, understanding the repurchase intention of consumers is essential in sustaining growth. Most previous studies have focused on one or two factors, ignoring the whole picture, depicting the most effective factors both e-satisfaction and e-repurchase intention. The main purpose of this study is to investigate the relationships between e-service quality, information quality, e-satisfaction, and e-repurchase intention by involving customer decision-making styles in the context. An online retailer, belonging to a large brick-and-mortar Turkish company was chosen to conduct the survey. Consequently, the data collected from the conveniently selected sample among the members of that e-retailer was used to test the research model using structural equation modeling. The results revealed efficiency, fulfillment, privacy, and information quality to influence both e-satisfaction and e-repurchase intention whereas after-sales e-services influencing e-satisfaction. Meanwhile, e-satisfaction mediates the relationship between the service quality of a website and e-repurchase intention. Furthermore, novelty and recreational shopping style attitude moderates the relationship between e-satisfaction and e-repurchase intention.
Increased opioid synthesis and release, and enhanced alpha-2 adrenoceptor signaling have been suggested to mediate repeated oxytocin-induced long-lasting effects including elevated pain threshold in rats. This study evaluated whether oxytocin pretreatment would influence development of dependence and tolerance to the nociceptive and body temperature responses to morphine and enhance effects of alpha-2 adrenergic agonist clonidine on nociceptive threshold, body temperature and morphine withdrawal signs. Rats injected subcutaneously with saline or 1 mg/kg oxytocin for 5 days were implanted with placebo or morphine pellets 24 h after the treatment period. Body temperature and nociception were assessed, with nociception determined via by hot plate and tail immersion tests, before and 4, 24 and 48 h after pellet implantation, and following a challenge dose of morphine. Withdrawal signs were determined after naloxone administration. Oxytocin produced analgesia, as evidenced by increased paw withdrawal latency in the hot plate test. Morphine increased body temperature and nociceptive threshold which declined over time. Morphine challenge could not demonstrate tolerance to the body temperature response. Analgesic tolerance was observed in the hot plate test in saline and in both tests in oxytocin pretreated rats. Naloxone-precipitated withdrawal appeared to be less severe in oxytocin pretreatment. Clonidine was ineffective on the withdrawal signs but decreased body temperature and increased tail flick latency in the tail immersion test in oxytocin pretreated animals. These results, while producing evidence for a hyperresponsiveness in alpha-2 adrenoceptors, provide contrasting effects on morphine tolerance and dependence, and their partial mediation by opioidergic and adrenergic activation in repeated oxytocin treatment.
Because of its fragile structure, tourism is a sector where tourist arrivals fluctuate, and competition is high. Tourism demand is changing rapidly according to many different factors. Most of the tourist arrivals to Turkey are from European countries. This paper analyzes the relationship between tourist arrivals from countries of origin and basic macroeconomic variables in the period between 2010-2020. The study, which uses the Autoregressive distributed lag (ARDL) boundaries testing approach, shows that tourist arrivals interact with key macroeconomic variables such as exchange rate and unemployment rate. This situation reveals the necessity of eliminating dependence on certain countries in the tourism sector and turning to different markets.
Fusarium graminearum is a phytopathogenic fungus causing head blight and crown rot diseases of cereals worldwide. The use of organisms with antagonistic effects against F. graminearum is one of the promising disease management strategies. In this study, the biocontrol agent potential of Trichoderma atroviride against F. graminearum was tested. The radial growth rate and the cell proliferation capacities of F. graminearum PH-1 treated with T. atroviride TR8 (FGvsTA) decreased in comparison to F. graminearum not treated with T. atroviride (FGc). The decrease in linear growth rate (LGR) and cytotoxicity values were as %50 and %45, respectively. Genomic template stability (GTS) and epigenetic alterations were investigated via RAPD and CRED-RA methods. GTS was recorded as 66.6%, and polymorphism % for MspI and HapII digested FGvsTA set were as 26% and 13.88%. In gene expression analysis, alterations in genes related to oxidative stress (cat), apoptosis-like process (mst20), and deoxynivalenol production (tri4) were revealed. While expression of gene mst20 was upregulated, downregulation in cat and tri4 expressions were recorded (p < 0.05). Fluorescence microscopy analysis, including acridine orange/ethidium bromide (Ao/Eb) and dichlorofluorescein diacetate (DCF-DA) also confirmed the presence of apoptosis and oxidative stress in FGvsTA. This is the first report with findings that T. atroviride could strongly affect F. graminearum growth in different ways, including physiological, genomics, epigenetics, oxidative stress, and apoptosis-like process levels.
Background: Bilateral shoulder instability and Bankart lesions are not rare and frequently require surgical treatment. Bilateral instability may be treated with either a single-stage, simultaneous bilateral Bankart repair or 2-stage surgery. Purpose/hypothesis: To compare simultaneous bilateral arthroscopic Bankart repair to 2-stage repair in terms of clinical outcomes and hospitalization costs. It was hypothesized that simultaneous repair would provide clinical outcomes similar to those of 2-stage Bankart repair while yielding lower hospitalization costs. Study design: Cohort study; Level of evidence, 3. Methods: Patients who underwent simultaneous bilateral arthroscopic Bankart repair (group 1) were matched by age, sex, and injury type to control patients who had unilateral Bankart repair (group 2). All patients were operated on by the same surgeon in the same institution between 2007 and 2017 and had a minimum follow-up duration of 24 months. Patients with inflammatory arthritis, metabolic/malignant disease, previous shoulder surgery, a glenoid bone loss ≥25%, or off-track Hill-Sachs lesion were excluded. The 2 groups were compared in terms of pre- and postoperative Western Ontario Shoulder Instability Index (WOSI) scores, hospitalization costs, complications, and recurrent instability. The hospitalization cost of group 2 was multiplied by 2 to create a projection of the estimated cost of 2 sequential unilateral Bankart repairs. Results: The study population comprised 48 patients (38 men [79.17%] and 10 women [20.83%]; mean age, 25.5 years at surgery and 22.75 years at first dislocation). Group 1 included 32 shoulders in 16 patients, while group 2 consisted of 32 shoulders in 32 patients. The mean hospitalization cost (in 2020 US dollars) was $26,010 ± $1455 for group 1 and $33,591 ± $1574 for group 2 (P < .001). Both groups had improved WOSI scores after surgery and achieved similar scores at the latest follow-up. There was 1 redislocation in each group (3.13%). No surgery- or anesthesia-related/medical complications were recorded in either group. Conclusion: For bilateral shoulder instability, clinical outcomes of simultaneous bilateral arthroscopic Bankart repair were similar to those of 2-stage repair; however, lower hospitalization costs were seen after simultaneous bilateral repair compared with 2-stage surgery.
The aim of this study was to evaluate the effect of vitamin D replacement in patients with lower urinary tract symptoms (LUTS)/erectile dysfunction (ED) who did not respond to tadalafil 5 mg treatment. Patients who applied to the Andrology Clinic with LUTS/ED between September 2017 and August 2020 and used 5 mg Tadalafil daily for treatment and did not benefit from treatment for 1 month were included in the study. Vitamin D levels of the patients were analysed and Vitamin D3 100,000 IU/week oral therapy was administered for a month to the patients with low levels of Vitamin D(<20 ng/ml).The values of the patients before and after Vitamin D replacement were compared. A total of 84 patients were included in the study. The mean age was 49.175 ± 11.63(28–70) years and the mean BMI was 25.93 ± 6.82(18.26–37.87). Testosterone levels of the examined patients were 3.45 ± 0.99 ng/ml. After 1 month of Vitamin D replacement + Tadalafil 5 mg/d treatment, the international index of erectile function–erectile function (IIEF‐EF) (pre‐treatment: 10.73 ± 6.12, post‐treatment: 24.18 ± 4.87; p = 0.001) and International Prostate Symptom Score (pre‐treatment: 9.12 ± 7.16, post‐treatment: 3.11 ± 1.08; p = 0.003) scores of the patients improved significantly. Evaluation of Vitamin D levels is important to improve treatment response, especially in patients who do not respond to PDE‐5 inhibitors.
Background. Hemostatic agents have the potential to improve clinical outcomes by decreasing postoperative drainage and the need for transfusions. Algan Hemostatic Agent is a polysaccharide-based hemostatic agent obtained from a mixture of six different herbs. The aim of this study is to investigate the clinical efficacy and safety of Algan Hemostatic Agent as a local hemostatic agent in coronary artery bypass operations. Methods. 28 subjects who underwent isolated coronary artery bypass graft surgery and met the inclusion criteria were included in this clinical study. Traditional methods (cautery, ligation, etc.) were used in the control group, whereas Algan Hemostatic Agent was added in the study group. A sponge soaked in Algan Hemostatic Agent liquid was lightly compressed to the bleeding area for 120 seconds. Results. Both groups were comparable in terms of preoperative demographic data and perioperative laboratory values. Drainage on the postoperative first day (650 ml vs 896 ml; p=0.381) and total drainage (817 ml vs 1210 ml; p=0.031) were found higher in the control group. Another significant difference was observed between the groups in terms of erythrocyte suspension utilization rate (1.14 U in the treatment group and 2.06 U in the control group, p=0.004). Algan Hemostatic Agent did not cause any complications during administration. Conclusion. In conclusion, Algan Hemostatic Agent has been found effective and safe in controlling bleeding during coronary artery bypass operations.
Background: Kidney transplant recipients have an increased risk of complications from COVID-19. However, data on the risk of allograft damage or death in kidney transplant recipients recovering from COVID-19 is limited. In addition, the first and second waves of the pandemic occurred at different times all over the world. In Turkey, the Health Minister confirmed the first case in March 2020; after that, the first wave occurred between March and August 2020; afterward, the second wave began in September 2020. This study aims to demonstrate the clinical presentations of kidney transplant recipients in the first two waves of the pandemic in Turkey and explore the impact of COVID-19 on clinical outcomes after the initial episode. Methods: Patients with COVID-19 from seven centers were included in this retrospective cohort study. Initially, four hundred and eighty-eight kidney transplant recipients diagnosed with COVID-19 between 1 March 2020 to 28 February 2021 were enrolled. The endpoints were the occurrence of all-cause mortality, acute kidney injury, cytokine storm, and acute respiratory distress syndrome. In addition, longer-term outcomes such as mortality, need for dialysis, and allograft function of the surviving patients was analyzed. Results: Four hundred seventy-five patients were followed up for a median of 132 days after COVID-19. Forty-seven patients (9.9%) died after a median length of hospitalization of 15 days. Although the mortality rate (10.1% vs. 9.8%) and intensive care unit admission (14.5% vs. 14.5%) were similar in the first two waves, hospitalization (68.8% vs. 29.7%; p < 0.001), acute kidney injury (44.2% vs. 31.8%; p = 0.009), acute respiratory distress syndrome (18.8% vs. 16%; p = 0.456), and cytokine storm rate (15.9% vs. 10.1%; p = 0.072) were higher in first wave compared to the second wave. These 47 patients died within the first month of COVID-19. Six (1.4%) of the surviving patients lost allografts during treatment. There was no difference in the median serum creatinine clearance of the surviving patients at baseline (52 mL/min [IQR, 47-66]), first- (56 mL/min [IQR, 51-68]), third- (51 mL/min [IQR,48-67]) and sixth-months (52 mL/min [IQR, 48-81]). Development of cytokine storm and posttransplant diabetes mellitus were independent predictors for mortality. Conclusions: Mortality remains a problem in COVID-19. All the deaths occur in the first month of COVID-19. Also, acute kidney injury is common in hospitalized patients, and some of the patients suffer from graft loss after the initial episode.
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