Melen havzası yüzeysel sular, yeraltı suları ve sedimentlerinde metal kirliliğinin araştırılması

06.03.2018 tarihli ve 30352 sayılı Resmi Gazetede yayımlanan “Yükseköğretim Kanunu İle Bazı Kanun Ve Kanun Hükmünde Kararnamelerde Değişiklik Yapılması Hakkında Kanun” ile 18.06.2018 tarihli “Lisansüstü Tezlerin Elektronik Ortamda Toplanması, Düzenlenmesi ve Erişime Açılmasına İlişkin Yönerge” gereğince tam metin erişime açılmıştır.Metaller insan sağlığı ve ekosistem için gerekli yapıtaşı olmasına karşın ciddi problemlere sebep olabilecek potansiyele de sahiptirler. Metallerin ekosistemde canlı ve cansız faktörler üzerinde taşınımı-etkileşimi ve risk potansiyeli her geçen gün daha çok önemle üzerinde durulmaktadır. Kirlilik ve risk değerlendirmeleri genel olarak su kaynağı olan havzalar bazında ele alınmaktadırlar. Bu çalışmada Türkiye’nin en önemli havzalarından olan ve etkisi milyonlarca insan ve canlı sistemini kapsayan Melen Havzası metallerinin ayrıntılı olarak yüzeysel su, yeraltı suyu ve sedimentlerde derişimleri ve kirlilik değerlendirmeleri yapılmıştır. İlk defa bu üç bileşen için ve yirminin üzerinde metalin izlenmesi havza bazında yapılmıştır. Metallerin yanında temel su kalitesi parametreleri de izlenmiştir. Metallerin mekânsal ve mevsimsel düzeyleri ve birbiriyle etkileşimleri ortaya konulmuştur. Havzanın metal kirliliği yönünden çok ekstrem kirliliğinin olmadığı fakat bazı parametrelerinin dönemsel ve mekânsal olarak uluslararası kabul edilebilir değerlerin üzerinde olduğu gözlenmiştir. Havza için en riskli metallerin arsenik, mangan ve çinko olduğu, yağışlı dönemin daha riskli olduğu görülmüştür. Yüzeysel su ve sediment metalleri yönünden Asar deresi ve Büyük Melen Nehrinin yerleşim yerinden sonra ki bölümleri en riskli bölgeler bulunmuşlardır. Melen Havzasının başarılı havza yönetim modeliyle metal kirlenmesinin kontrol edilebileceği ve önemli bir içme suyu kaynağı olduğu tespit edilmiştir.Although metals are constituents required for human health and ecosystem, they have potentials which would cause serious problems. Transportation-interaction of metals on animate and inanimate factors within ecosystem and risk potential are discussed with more and more attention every passing day. Pollution and risk evaluations are generally considered in the basis of basins which are water resources. In this study, surface water, groundwater and concentration in sediments and pollution evaluations of Melen Basin which is one of the most important basins in Turkey and whose effect covers millions of people and living beings was done. For the first time these three components and more than twenty metals were analyzed on the basis of basin. Basic water quality parameters were also analyzed apart from metals. Spatial and seasonal levels of metals and their interaction were presented. It was observed that the basin does not have an extreme pollution in the sense of metal pollution but, some of the parameters are above international acceptable values in seasonal and spatial sense. It was determined that the most risky metals for the basin are arsenic, manganese and zinc. It was observed that rainy period is more risky than arid period in the sense of metal pollution. Parts which are located following the settlement place of Asar stream and Büyük Melen River were found to be the most risky regions in the sense of surface water and sediment metals. It was determined that Melen Watershed can be controlled against metal pollution with a successful watershed management model and can be used as an important resource for drinking water for a long time

Comparison of metoprolol and tramadol with remifentanil in endoscopic sinus surgery: a randomised controlled trial

Objective: Controlled hypotension is commonly induced during functional endoscopic sinus surgery to limit mucosal bleeding. This may be detrimental to elderly patients and patients with arterial stenosis. The aim of this pilot study was to determine if a normotensive anaesthetic technique with sufficient analgesia and without profound vasodilation may reduce intraoperative bleeding and incidence of adverse haemodynamic effects associated with vasodilation and variable rate continuous infusions. Methods: In this double-blind randomised controlled trial in a tertiary care centre, a total of 88 patients were randomised to receive intravenously either 0.1 mg kg?1 metoprolol and 1 mg kg?1 tramadol following anaesthesia induction (MT group) or a bolus dose of 0.5 ?g kg?1 remifentanil following anaesthesia induction, followed by 0.25-0.5 ?g kg?1 min?1 remifentanil infusion (R group). The primary outcome was quality of surgical field and incidence of adverse haemodynamic effects. The secondary outcomes were time to achieve intraoperative bleeding score <3, bleeding rate and changes in cerebral regional oximetry. Results: A total of 105 patients were recruited, in which 88 were randomised. The median intraoperative bleeding score was similar (1, interquartile range: 1-1, p=0.69). The mean bleeding rate was lower in the MT group, although the difference was not significant (p=0.052, 95% CI 0 to 8.8). Hypotension, bradycardia and cerebral desaturation in the MT group were not observed compared to hypotension in 3 (7%), bradycardia in 18 (41%) and cerebral desaturation in 2 (5%) patients in the R group (p=0.241, p<0.001, p=0.474, respectively). Conclusion: Providing sufficient analgesia and eliminating stress response can provide stable heart rate and good surgical field with no need for additional hypotension. This normotensive technique may be useful in patients with stenotic arteries or ischaemic organ diseases

A comparative analysis of preoperative tympanometry and intraoperative findings in patients otitis media with effusion

Otitis media with effusion is one of the most commonly encountered diseases by otolaryngologists. Hearing loss is the most common symptom, particularly affecting academic performance in school-age children. Therefore, establishing an accurate diagnosis is crucial. The primary diagnostic method is an otoscopic ear examination. Tympanometry is the most frequently used technique for diagnosis. In this study, we aimed to compare the results of tympanometric examinations with intraoperative findings. Our study included a total of 126 patients with a diagnosis of chronic otitis media with effusion and a decision for surgery, comprising 224 ears that were followed by our clinic. All patients underwent at least one myringotomy. Ventilation tubes were inserted in cases of glue ear. Preoperative physical examination and tympanometry results were compared with intraoperative findings. Of the 126 patients, 81 were male. The mean age was 5.3 years (range: 2-15). Preoperatively, 135 ears exhibited Type B tympanogram, and 89 ears exhibited Type C tympanogram. The rate of tube insertion was statistically significant in cases with type B tympanogram. Additionally, the tube insertion rate was determined to be 32.5% in cases with Type C tympanograms. In conclusion, diagnosing effusive otitis media is a crucial matter. While physical examination is the most important diagnostic tool, it may sometimes be insufficient. Tympanometry is a highly useful method for improving the diagnostic rate of this condition

Effects of Harvesting Stages and Additives on the Chemical Composition, Fermentation Quality and Relative Feed Value of Soybean Silages Varieties

In this study, the chemical composition, silage fermentation quality and relative feed value of soybean silages varieties, namely Adasoy (A), Derry (D) and Yeşilsoy (Y), with Pioneer11C33 (I), molasses (M) and cracked wheat (W) additives at the three harvesting stages, i.e., full flowering (R2), full pod (R4) and full seed (R6) stages, were determined. It was observed that the A and D varieties were the best silage materials for the production of good quality silage in terms of both nutrient contents such as DM and CP and fermentation criteria such as LA and BA concentrations during the R4 and R6 harvest periods. Molasses and cracked wheat additives significantly improved the fermentation qualities of all soybean varieties (P&lt;0.05), but the fermentation effect of the inoculant on silages was less than that of molasses and cracked wheat. The harvesting of soybean varieties in the full seed and applying molasses or cracked wheat as an additive optimally improves silage characteristics and results in well-preserved silage

Assessment of the Prevalence of Pulp Stones in a Sample of Turkish Central Anatolian Population

Objective. The aim of this study was to determine the prevalence of pulp stones (PS) in a Turkish dental patient population with respect to sexes and dental localization in relation between sex and this anomaly. Materials Methods. A retrospective study was performed using bitewing radiographs of 814 patients ranging in age from 15 to 65. All data (age, sex, and location) was obtained from the files. These patients were analyzed for pulp stones. Descriptive characteristics of sexes, jaws, and dental localization were recorded. The Pearson chi-squared test was used. Results. Of the patients, 462 (56.8%) were female and 352 (43.2%) were male. Sixty (12%) had one or more teeth that contained pulp stones. Pulp stones were identified in 518 (63.6%) of the subjects and in 2391 (27.8%) of the teeth examined. Pulp stone occurrence was significantly more common in the females than in males. With the increasing of age, the prevalence of pulp stones increased. Molars had statistically more pulp stones than premolars. Pulp stones were significantly more common in the maxilla compared with mandible. Conclusion. Prevalence of pulp stones in Turkish population was 27.8% but further larger-scale studies are required to assess its prevalence in the general population to compare it with other ethnic groups

A Rare Cardiac Anomaly in Absent Pulmonary Valve Syndrome with Tetralogy of Fallot

Heart failure and cardiomegaly are observed in patients with absent pulmonary valve syndrome with tetralogy of Fallot (TOF), unlike in those with TOF alone. Additional cardiac anomalies can also be seen in these patients, although not frequently. In our case, we found that the right and left pulmonary arteries were disconnected (the main pulmonary artery continued only with the right pulmonary artery and the left pulmonary artery originating from patent ductus arteriosus). In this paper, we wanted to remember other cardiac anomalies associated with absent pulmonary valve syndrome with tetralogy of Fallot

Inappropriate antimicrobial use in Turkish pediatric hospitals: A multicenter point prevalence survey

Objectives: Although well-defined principles of rational antimicrobial use are available, inappropriate prescribing patterns are reported worldwide. Accurate information on the usage of antimicrobials, including factors associated with and influencing their use, is valuable for improving the quality of prescription practices. Methods: In this cross-sectional point prevalence survey, data on patients hospitalized in 12 different children's hospitals were collected on a single day. Appropriateness of prescription was compared between the types of antimicrobials prescribed, indications, wards, and presence of/consultation with an infectious disease physician (IDP). Results: A total 711 of 1302 (54.6%) patients evaluated were receiving one or more antimicrobial drugs. The antimicrobial prescription rate was highest in pediatric intensive care (75.7%) and lowest in the surgery wards (37.0%). Of the 711 patients receiving antimicrobials, 332 patients (46.7%) were found to be receiving at least one inappropriately prescribed drug. Inappropriate use was most frequent in surgery wards (80.2%), while it was less common in oncology wards (31.8%; p < 0.001). Respiratory tract infection was the most common indication for antimicrobial use (29.4%). Inappropriate use was more common in deep-seated infections (54.7%) and respiratory infections (56.5%). Fluoroquinolones were used inappropriately more than any other drugs (81.8%, p = 0.021). Consultation with an IDP appears to increase appropriate antimicrobial use (p = 0.008). Conclusions: Inappropriate antimicrobial use remains a common problem in Turkish pediatric hospitals. Consultation with an IDP and prescribing antimicrobial drugs according to microbiological test results could decrease the inappropriate use of antimicrobials

Survival results according to Oncotype Dx recurrence score in patients with hormone receptor positive HER-2 negative early-stage breast cancer: first multicenter Oncotype Dx recurrence score survival data of Turkey

BackgroundThe Oncotype Dx recurrence score (ODx-RS) guides the adjuvant chemotherapy decision-making process for patients with early-stage hormone receptor-positive, HER-2 receptor-negative breast cancer. This study aimed to evaluate survival and its correlation with ODx-RS in pT1-2, N0-N1mic patients treated with adjuvant therapy based on tumor board decisions.Patients and methodsEstrogen-positive HER-2 negative early-stage breast cancer patients (pT1-2 N0, N1mic) with known ODx-RS, operated on between 2010 and 2014, were included in this study. The primary aim was to evaluate 5-year disease-free survival (DFS) rates according to ODX-RS.ResultsA total of 203 eligible patients were included in the study, with a median age of 48 (range 26-75) and median follow-up of 84 (range 23-138) months. ROC curve analysis for all patients revealed a recurrence cut-off age of 45 years, prompting evaluation by grouping patients as ≤45 years vs. &gt;45 years. No significant difference in five-year DFS rates was observed between the endocrine-only (ET) and chemo-endocrine (CE) groups. However, among the ET group, DFS was higher in patients over 45 years compared to those aged ≤45 years. When stratifying by ODx-RS as 0-17 and ≥18, DFS was significantly higher in the former group within the ET group. However, such differences were not seen in the CE group. In the ET group, an ODx-RS ≥18 and menopausal status were identified as independent factors affecting survival, with only an ODx-RS ≥18 impacting DFS in patients aged ≤45 years. The ROC curve analysis for this subgroup found the ODx-RS cut-off to be 18.ConclusionThis first multicenter Oncotype Dx survival analysis in Turkey demonstrates the importance of Oncotype Dx recurrence score and age in determining treatment strategies for early-stage breast cancer patients. As a different aproach to the literature, our findings suggest that the addition of chemotherapy to endocrine therapy in young patients (≤45 years) with Oncotype Dx recurrence scores of ≥18 improves DFS

Trace metal surface water inflow and retention in different terms of the wetland

Wetlands are important ecosystems that provide biodiversity and buffer aquatic ecosystems. This study monitored the quality of surface water in the Efteni wetland system in Turkey, which is intertwined with the Melen River. Basic water quality parameters and 26 different trace elements were analysed by standard methods (USEPA method 200.7 and ISO 11885) using inductively coupled plasma in water samples taken from inflows, an internal lake and the outlet of the wetland in different seasons (before, during and after the flowering) in 2011. Trace element concentrations differed between tributaries flowing to and within the wetland. Natural attenuation was observed for health risk elements such as molybdenum, copper, nickel, boron and vanadium in all seasons. Most trace elements were observed at their lowest levels during the flowering period. These results confirm that the Efteni wetland acts as a retention zone and, due to its important location in the River Melen watershed, warrants protection

Transport of particle-associated elements in two agriculture-dominated boreal river systems

Transport of particulate pollutants in fluvial systems can contribute greatly to total loads. Understanding transport mechanics under different hydrological conditions is key in successful load estimation. This study analysed trace elements and physico-chemical parameters in time-integrated suspended sediment samples, together with dissolved and total concentrations of pollutants, along two agriculture- and peatland-dominated boreal river systems. The samples were taken in a spatially and temporally comprehensive sampling programme during the ice-free seasons of 2010 and 2011. The hydrochemistry and transport of particle-bound elements in the rivers were strongly linked to intense land use and acid sulphate soils in the catchment area, with arable, pasture and peat areas in particular being main diffuse sources. There were significant seasonal and temporal variations in dissolved and particulate fluxes, but spatial variations were small. Continuous measurements of EC, turbidity and discharge proved to be an accurate indicator of dissolved and particulate fluxes. Overall, the results show that transport of particle-bound elements makes a major contribution to total transport fluxes in agriculture-dominated boreal rivers. (C) 2013 Elsevier B.V. All rights reserved