Global Location Selection for an Oral Health Center with a Sequential Method by SWARA&TODIM

The first step to take when a healthcare facility investment is planned is to choose the most appropriate facility location. This important selection process is a planning process that takes into account economic, ecological and environmental effects, and it is necessary for managers who are decision-makers at the establishment stage to carry out the settlement planning of their organizations using analytical methods. In this study, Stepwise Weight Assessment Ratio Analysis (SWARA) and Interative Multi-criteria Decision Making (TODIM) methods with a help of Weighted Aggregated Sum Product Assessment (WASPAS) step, which are among the multi-criteria decision-making techniques, have been applied to the solution of the location selection problem, which can be considered as the first step of health sector investments for an international dental clinic. Within the scope of the study, a multi-criteria decision-making model consisting of 4 main criteria, 17 sub-criteria and 6 alternative countries has been proposed. Alternative countries including Germany, Spain, Netherlands, England, Ireland, and Belgium were evaluated on the basis of criteria gathered under the headings of country structure, demographic structure of the country, cost and risk. By solving the proposed model with the proposed sequential method, Germany was found to be the most suitable location for such a dental health cente

THE RELATIONSHIP BETWEEN PHYSICAL PERFORMANCE LEVELS AND THE DIGIT RATIO OF

Amaç: Bu çalışmanın amacı; 35 yaş ve üstü master grupta yer alan atletlerin fiziksel ve fizyolojik özellikleri ile her iki elin parmak oranı arasındaki ilişki düzeyini saptamaktır. Gereç ve yöntem: İzmir Master Atletler Kulübüne üye olan 21 erkek ve 9 bayandan oluşan toplam 30 atlet üzerinde yapıldı. Sporcuların her iki ellerindeki işaret ve yüzük parmak uzunlukları dijital bir kumpas yardımıyla ölçüldü, daha sonra parmakların birbirine oranları belirlendi. Boy kilo ve vücut yağ oranları ölçüldü. Eldeki işaret parmağı, yüzük parmağından uzun olanlar östrojenin baskın olduğu grup, işaret parmağı yüzük parmağından kısa olanlar testosteronun baskın olduğu grup olarak tanımlandı. Fiziksel Performans testlerinden Maksimal oksijen kullanımı (VO2 Max), otur-uzan esneklik testi, dikey sıçrama testi, el-pençe kuvvet testi, sırt kuvvet testi uygulandı. Verilerin istatistiksel analizi SPSS 15.0 programında yapıldı. Bulgular: Çalışmada öncelikle parmak uzunluklarına göre östrojenin veya tes- tosteronun baskın olması açısından farklılık incelendi. Tüm sporcularda (n=30) sağ el parmak oranı (0,97 ± 0,04), sol el parmak oranı (0,96 ± 0,03) ve her iki elin parmak ortalaması (0,97 ± 0,03) olarak 1'in altında (testosteron hormonu baskın) bulundu. Master atletlerde fizyolojik ölçümlerle her iki eldeki parmak oranları karşılaştırıldı ve istatistiksel olarak anlamlı bir sonuç elde edilemedi. Sonuç: Bu çalışmada katılan tüm atletlerin el parmak oranlarının düşük bulunması, atletlerde parmak oranları açısından testosteron baskınlığı olduğunu ortaya koydu. An- cak master atletlerin fiziksel performans düzeyleri ile el parmak oranları arasında anlamlı ilişki olmaması, bu yaş grubunda testosteron baskınlığının fiziksel performansı direkt olarak etkilemediğini göstermiştir. Bu çalışmanın, ileriye dönük olarak, sporcu seçiminde var olan kriterlere yeni ve kolay bir ölçüm yöntemi olan parmak oranını katabileceği düşünülmektedir. SUMMARY Objective: The aim of this study is to determine the relationship between the effects of digit ratio and physical performance levels of master athletes. Material and method: The datas were collected from 30 master athletes from the members of İzmir Master athletes clup (n=21 males and n=9 females). The finger ratios in both hands by a caliper and digit ratio calculated. Heights and weights of athletes were measured and body fat ratio was calculated. When the index finger is longer than the ring finger, the group determined estrogen dominant digit ratio, when the ring finger is longer than the index finger, the group determined testosteron dominant digit ratio. The tests of physical performance, maximal using of oxygene (Max VO2), flexibility test, vertical jump test, hand-grip test and back-grip test were performed. The datas were evaluated statistically by SPSS 15.0 program. Results: In this study it was investigated that differences according to the estrogen or testosterone has been dominant on digit length, firstly. In all athletes (n=30), it was found the digit ratio under the level of 1 of the right hand (0.97 ± 0.04), left hand (0.96 ± 0.03) and the average both of hands (0.97 ± 0.03). Physiological measurements in the master athletes were compared with the fingers of both hands. and the results did not indicate the significant differences. Conclusion: In all athletes participating in this study were found lower rates of fingers, in terms of finger ratios, testosterone in athletes showed that dominance. However, ıt was no relation between physical performance level and finger ratio of master- athletes, testosterone dominance in this age group have not shown directly affect physical performance.We believe this study will contribute to the future studies as it introduces the digit ratio, which is a new and simple method of measurement

Gastric perforation in an extremely low birth weight infant recovered with percutaneous peritoneal drainage

Neonatal gastric perforation is an uncommon but life-threatening condition, which is mainly encountered in premature infants. Primary surgical repair is the principal mode of the treatment. Gastric perforation in neonates improving with percutaneous peritoneal drainage alone has not been described previously. Therefore, an extremely low birth weight infant is presented herein in order to emphasize that gastric perforation may improve with percutaneous peritoneal drainage alone. Isolated gastric perforations in newborn infants may be improved with percutaneous peritoneal drainage alone without need for primary surgical repair

Regional Difference in Disease Burden Among Patients with Psoriatic Arthritis: A Multi-Center Study

Annual Meeting of the American-College-of-Rheumatology/Association-of-Rheumatology-Professionals (ACR/ARP) -- NOV 08-13, 2019 -- Atlanta, GA[Anstract Not Available]Amer Coll Rheumatol,Assoc Rheumatol Profes

Real-world efficacy and safety of Ledipasvir plus Sofosbuvir and Ombitasvir/Paritaprevir/Ritonavir +/- Dasabuvir combination therapies for chronic hepatitis C: A Turkish experience

Background/Aims: This study aimed to evaluate the real-life efficacy and tolerability of direct-acting antiviral treatments for patients with chronic hepatitis C (CHC) with/without cirrhosis in the Turkish population.Material and Methods: A total of 4,352 patients with CHC from 36 different institutions in Turkey were enrolled. They received ledipasvir (LDV) and sofosbuvir (SOF)+/- ribavirin (RBV) ombitasvir/paritaprevir/ritonavir +/- dasabuvir (PrOD)+/- RBV for 12 or 24 weeks. Sustained virologic response (SVR) rates, factors affecting SVR, safety profile, and hepatocellular cancer (HCC) occurrence were analyzed.Results: SVR12 was achieved in 92.8% of the patients (4,040/4,352) according to intention-to-treat and in 98.3% of the patients (4,040/4,108) according to per-protocol analysis. The SVR12 rates were similar between the treatment regimens (97.2%-100%) and genotypes (95.6%-100%). Patients achieving SVR showed a significant decrease in the mean serum alanine transaminase (ALT) levels (50.90 +/- 54.60 U/L to 17.00 +/- 14.50 U/L) and model for end-stage liver disease (MELD) scores (7.51 +/- 4.54 to 7.32 +/- 3.40) (p<0.05). Of the patients, 2 were diagnosed with HCC during the treatment and 14 were diagnosed with HCC 37.0 +/- 16.0 weeks post-treatment. Higher initial MELD score (odds ratio [OR]: 1.92, 95% confidence interval [CI]: 1.22-2.38; p=0.023]), higher hepatitis C virus (HCV) RNA levels (OR: 1.44, 95% CI: 1.31-2.28; p=0.038), and higher serum ALT levels (OR: 1.38, 95% CI: 1.21-1.83; p=0.042) were associated with poor SVR12. The most common adverse events were fatigue (12.6%), pruritis (7.3%), increased serum ALT (4.7%) and bilirubin (3.8%) levels, and anemia (3.1%).Conclusion: LDV/SOF or PrOD +/- RBV were effective and tolerable treatments for patients with CHC and with or without advanced liver disease before and after liver transplantation. Although HCV eradication improves the liver function, there is a risk of developing HCC.Turkish Association for the Study of The Liver (TASL

Long-term Home Mechanical Ventilation of Children in İstanbul

OBJECTIVE: The aims of this multi-center study were to describe the characteristics of children receiving long-term home mechanical ventilation (HMV) in İstanbul and to compare the patients receiving non-invasive and invasive ventilation. MATERIAL AND METHODS: This cross-sectional multicenter study included all children receiving long-term HMV followed by admission to six tertiary hospitals. The data were collected between May 2020 and May 2021. Demographic data and data regarding HMV were collected from the patient charts. RESULTS: The study included 416 participants. The most common diagnoses were neuromuscular (35.1%) and neurological diseases (25.7%). Among the patients, 49.5% (n = 206) received non-invasive ventilation (NIV), whereas 50.5% (n = 210) received invasive ventilation. The median age at initiation was significantly younger in the invasive ventilation group than in the NIV group (10 vs. 41 months, P < 0.001). Most subjects in the NIV group (81.1%) received ventilation support only during sleep, whereas most subjects in the invasive ventilation group (55.7%) received continuous ventilator support (P < 0.001). In addition to ventilation support, 41.9% of the subjects in the invasive ventilation group and 28.6% in the NIV group received oxygen supplementation (P = 0.002). Within the last year, 59.1% (n = 246) of the subjects were hospitalized. The risk factors for hospitalization were invasive ventilation, continuous ventilatory support, oxygen supplementation, tube feeding, and swallowing dysfunction (P = 0.002, 0.009, <0.001, <0.001 and <0.001 respectively). CONCLUSION: Despite the increasing use of NIV in most studies, half of the study population received invasive ventilation. Patients receiving invasive ventilation were more likely to require continuous ventilator support and oxygen supplementation and were at increased risk of hospitalization

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Sığla yağının sinnamik asit ve alkollerinden elde edilen türevler

Ormanların kesilmesi ve aşırı üretim gibi sebeplerden günümüzde sığla ormanlarının miktarı çok düşmüştür. Sığla yağı, ağacın gövdesi kazınarak elde edilir. Bir zamanlar önemli bir ihraç maddesi olan sığla yağı günümüzde bu önemini kaybetmiştir. Kahverengimsi sarı renkte olup yarı sıvıdır. Acı bir tada ve sinnamik aside benzer bir kokuya sahiptir. % 35-40 civarındaki sinnamik asit, serbest ve ester halinde bulundurur. %1 civarında uçucu yağa sahip olan sığla yağı aynı zamanda % 60 civarında sitoresin denilen triterpen asitleri de içerir. Çalışmamızda sığla yağı, Muğla Orman Bölge Müdürlüğü, Köyceğiz Orman İşletmesinden sağlandı. Yağ içinde bulunan sinnamik asit esterleri alkollü KOH çözeltisi ile hidroliz edilerek potasyum sinnamat ve alkollere dönüştürülmüştür. Potasyum sinnamat asitlendirilerek oluşan sinnamik asit üzerinden metil ve etil esterlerine çevrilmiştir. Diğer parçalanma ürünü olan alkoller, asetat türevlerine dönüştürülmüştür. Bu oluşan esterler, 1H NMR ve IR ve GC/MS gibi değişik teknikler ile karakterize edilmiştir