Vaccination in Individuals with Multiple Sclerosis – Part I

Multiple sclerosis (MS) is an autoimmune and demyelinating disease of the central nervous system. It is a chronic disease, and in the evaluation of all other health and vital processes, decisions should be made by considering the disease process and the drugs used by the patient. Since vaccination can be performed at every stage of life, from childhood to adulthood, immune system activity, except where it is characteristic of the vaccine, should be reviewed in patients with MS. In this review, the applications of different vaccines in individuals with MS are discussed in two separate sections

Clinical evaluation of microhybrid composites in noncarious cervical lesions: 24‑month results

Objective: To evaluate the clinical performance of two different microhybrid resin composites in noncarious cervical lesions (NCCLs) after 24 months.Subjects and Methods: Ninety‑seven NCCLs were restored with either TPH Spectrum (n = 48) or Filtek Z250 (n = 49) using an etch‑and‑rinse adhesive in 20 patients. The restorations were clinically evaluated using modified United States Public Health Service criteria for retention, color match, marginal discoloration, marginal adaptation, surface texture, anatomic form, postoperative sensitivity, and secondary caries. The restorations were assessed 1 week after placement (baseline) and after 6, 12, and 24 months. Restoration survival rates were calculated using the Kaplan– Meier procedure estimator, and a log‑rank test was used to compare the survival distributions (P < 0.05). Statistical analysis was undertaken using Pearson’s Chi‑square test and Fisher’s exact test to assess differences among the restorative materials (P < 0.05). Cochran’s Q‑test was employed for evaluating differences in the same restorative material between recall periods.Results: The retention rates were 100% at 6 months, 89.6% and 91.8% at 12 months, and 85.4% and 89.8% at 24 months for TPH and Z250, respectively. TPH showed a statistically significant difference in marginal discoloration between the baseline and 24 months results (P < 0.05). Both TPH and Z250 showed statistically significant differences in marginal adaptation between the baseline and 24 months results (P < 0.05).Conclusion: Over the 24‑month period, both microhybrid resin composites demonstrated acceptable clinical results in NCCLs.Key words: Clinical evaluation, microhybrid resin composites, modified United States Public Health Service criteria, noncarious cervical lesion

Batı ve Doğu toplumlarının Demokrasi algısında dinin/inanç sistemlerinin yeri

Until the Enlightenment, religion and belief systems, especially in western societies, were the sole source of every understandings related to social and moral values. There was not any significant change in this perspective till the French Revolution when new conceptions of modernity and the popular sovereignty emerged influentially. The perception of democracy based upon popular will, freedom from all kind of repressive governments and equality among citizens affected the belief system of all societies to a certain degree. In XIX. and  XX. centuries during which the idea of secular state understanding  became a part of political agenda and had a positive impact on western democracy. Nonetheless, the positive correlation between secularism and democracy could not be valid for all western societies. On the other hand, in the eastern societies where democracy conceived as the outcome of modernity and popular sovereignty, its role in the belief systems is still arguable. Moreover, the practices of democracy and how to implement democratic institutions in those societies is not apparent. Both in western and eastern societies, the belief systems have been affected by secularism and the content of relationship between secularism and religions is a vital factor in the formation and development of perception of democracy.Din ve buna bağlı inanç sistemleri, özellikle Batılı toplumlar açısından Aydınlanma Çağı’na kadar maddi ve manevi her olguya karşı geliştirilen bakış açılarının yegâne temelini oluşturmuştur. Bu durum, Fransız Devrimi sonrası modernleşme teorileri içerisinde gelişen kavramların ve “halk egemenliği” nosyonunun tüm dünya topluluklarını etkilemelerine kadar sürmüştür. Halkın kendi kendisini yönetmesi ve her türlü baskıcı olarak görülen iktidar şekillerine karşı “özgürlük” ve toplumdaki bireylerin “eşit” olduklarını vaaz eden “demokrasi” olgusu tüm dünya topluluklarının inanç sistemlerini belli oranlarda etkilemiştir. Özellikle sekülar ve laik devlet anlayışının geliştiği XIX. ve XX. yüzyıllarda Batılı toplumların demokrasiye bakış açısı bir hayli olumlu olmuştur. Ancak bu durumun tüm Batılı toplumları kapsayıp, kapsamadığı tartışmaya açık bir konu olduğu görülmektedir. Bunun yanı sıra bir modernleşme olgusu ve halk egemenliğinin bir tezahürü olarak Doğu toplumlarına sunulan demokrasinin, bu toplumların inanç sistemleri içerisinde günümüz anlamında anlaşılabilirliği ve nasıl uygulanmaya çalışıldığı da halen açıklığa kavuşturulabilmiş bir durum değildir. Günümüz anlamında Batı ve Doğu toplumlarının demokrasiye karşı geliştirmiş oldukları bakış açılarının, özellikle modern dönemde, kendilerini etkileyen inanç sistemlerinin sekülar anlayışlar çerçevesinde geçirmiş oldukları dönüşümlerle yakından alakalı bir durum olduğu muhakkaktır

Investigation of the effects of neuromuscular electrical stimulation in the treatment of drooling in children with cerebral palsy

Amaç: Salya problemi serebral palsili (SP) çocuklarda fonksiyon bozukluğuna yol açan, çocukların bakımını zorlaştıran önemlibir problemdir. Çalışmamızda salya problemi olan SP’li çocuklarda Nöromusküler Elektrik Stimülasyonu (NMES) uygulamasınınsalya kontrolü, dilin itme refleksi ve yutma üzerindeki etkilerinin araştırılması hedeflenmektedir.Yöntem: Çalışmaya SP’li 40 çocuk dahil edildi ve rastgele yöntemle randomize olarak iki gruba ayrıldı (20 kontrol, 20 NMES).Tüm olgular; Kaba Motor Fonksiyon Sınıflandırma Sistemi (KMFSS), Dil İtme Refleksi Değerlendirme Skalası (DİRS), SalyaKontrol Problemi Sıklık ve Şiddeti Skalası (SKŞS), Salya Akış Oranının değerlendirilmesi için sünger testi ve yutma yeteneği içinSu Yutma Testi (SYT) ile değerlendirildi. Kontrol grubuna intraoral uyarı, orafasyal masaj, pasif dil hareketleri içeren oral motoregzersiz tedavi (OMET) programı, ev programı olarak verildi. NMES grubuna, ev programına ilave olarak haftada 2 seans, 4 haftaboyunca bilateral masseter, orbicularis oris ve suprahiyoidal kaslara 20 dakika düşük frekanslı NMES uygulandı.Bulgular: Tedavi sonrası grup içi karşılaştırmada salya akış oranlarının değerleri her iki grupta anlamlı (kontrol grubundap=0,030; NMES grubunda p<0,001) bulunurken, gruplar arası karşılaştırmada istatistiksel olarak anlamlı bir fark bulunmadı(p=0,617). Tedavi sonrası DİRS, SKŞS düzeyleri ve SYT değerleri her iki grupta grup içi ve gruplar arası değerlendirmelerarasında anlamlı bir fark bulunmadı.Sonuç: Salya problemi olan SP’li çocuklarda ev programına ek olarak yapılan NMES uygulamasının 4 haftalık uygulama sürecisonunda salya kontrolü, dilin itme refleksi ve yutma üzerindeki etkilerinin olmadığı görülmüştür.Purpose: Drooling is an important problem that causes dysfunction in children with cerebral palsy and makes it difficult for children’s care. In our study, we aimed to investigate the effects of Neuromuscular Electrical Stimulation (NMES) on saliva control, tongue thrust and swallowing in children with Cerebral Palsy (CP) with drooling problems. Methods: Fourty children with CP were included in the study and randomly divided into two groups (20 control, 20 NMES). All cases were assessed by using Gross Motor Function Classification System (GMFCS), Tongue Thrust Rating Scale (TTRS), Drooling Severity and Frequency Scale (DSFS), Swab test for salivation flow rate evaluation, and Water Swallowing Test (WST) for swallowing. Oral Motor Exercise Therapy (OMET) program including intraoral stimulation, orofacial massage, and passive tongue movements as a home program was given to the control group. The NMES group received a low frequency NMES for 20 minutes to be applied bilaterally to the masseter, orbicularis oris, and suprahyoidal muscles for two sessions per week for 4 weeks, in addition to the home program. Results: A significant difference was found in both groups in the evaluation of salivary flow rate (control group p=0.030; NMES group p<0.001) after the treatment. Comparing the groups, there was no significant difference in the analysis of saliva flow rates after the treatment (p=0.617). There were also no significant differences regarding to TTRS, DSFS and WST levels in both groups after the treatment. Conclusion: Among children with CP having drooling problems, NMES application with home exercise program did not have an effect on saliva control, tongue thrust, and swallowing after four weeks period

Existence of periodic solution for a tumor growth model with vaccine interaction

This paper is devoted to the study of existence of positive periodic solutions of a tumor-immune competition model with vaccine interaction. By using the continuation theorem of coincidence degree theory developed by Gains and Mahwin, we establish the sufficient conditions for the existence of periodic solutions

Effects of unsuitable discharge coefficient usage on marine outfall lifetime in design stage

Marine outfall constructions are commonly used for domestic wastewater discharge into marine environment. Outfall systems are designed and operated according to their working lifetimes. Outfall designs could be affected by many factors. The hydraulic performance of a diffuser pipe, which is the most important part of an outfall, depends on its correct hydraulic design and suitable practical operation. One of the principal design factors is the discharge coefficient that is determined as port (diffuser hole) type. There are a few sources for obtaining the values of discharge coefficient. One of these is the usage of experiment-based graphics, while the other is via the equations modeled from those graphics. The obtaining of discharge coefficient depends on very strict rules and equation-based discharge coefficients only find limited use in design stage. However, obtaining those coefficients by using the equations only is the commonly preferred way in practice, due to its simplicity. This situation may cause some differences from those expected in both design and practice stages. They even may cause the operation lifetime of the plant to be less than the aimed lifetime in its design