Acute transverse myelitis at the conus medullaris level after rabies vaccination in a patient with Behçet's disease

Case report: A 25-year-old man with Behçet's disease was admitted because of weakness of the lower limbs and difficulty in urination. He had received a rabies vaccination 2 months previous because he had been bitten by a dog. Findings: Clinical and laboratory findings supported acute transverse myelitis. A hyperintense lesion and expansion at the level of conus medullaris was detected on spinal magnetic resonance imaging. Conclusion: Although neurologic involvement is one of the main causes of mortality and morbidity in Behçet's disease, the factors that aggravate the involvement of the nervous system are still unclear. Vaccination may have been the factor that had activated autoimmune mechanisms in this case. To our knowledge, involvement of the conus medullaris in Behçet's disease after rabies vaccination has not been reported.Indications:For prevention of rabies in a patient who was bitten by a dog. Coexisting diseases: Behcet's disease, relapsing aphthous stomatitis and genital ulcerations.Patients:One 25-year-old male patient.TypeofStudy:A case report describing acute transverse myelitis at the conus medullaris level after Rabipur vaccination in a patient with Behcet's disease.AdverseEffects:1 patient developed acute transverse myelitis at the conus medullaris characterized by weakness of lower limbs, urinary retention, severe backache, difficulty with urination and defecation, hypoesthesia below the level of L1, absence of lower extremities vibratory and position senses, absence of deep tendon reflexes in the lower extremities, detrusor atony, and atrophy and fasciculations of the left leg muscles.AuthorsConclusions:Involvement of the conus medullaris in Behcet's disease after rabies vaccination has not been reported previously in the literature. The possibility of an activating factor (eg, vaccination) other than infection has never been mentioned in Neuro-Behcet syndrome. Understanding the activating factors may be helpful for the prevention of neurological involvement and is important for planning follow up and understanding the prognosis. Further reports and investigations are needed.FreeText:Tests: cerebrospinal fluid (CSF) leukocyte and protein level; muscle strength using Medical Research Council grade scoring; spine magnetic resonance imaging (MRI); vibratory and position senses; and deep tendon reflexes. The active substance of the rabies vaccine was an inactivated rabies virus.Results:Two months after the administration of the rabies vaccine, the patient experienced weakness of lower limbs which was preceded by severe backache for 12 hours and urinary retention. The weakness progressively worsened, and he began experiencing difficulty with urination and defecation. Muscle strength score was 2/5 at proximal left lower limb, 1/5 at distal left lower limb, 3/-5 at proximal right lower limb, and 1/5 at distal right lower limb. Atrophy and fasciculations of the left leg muscles were noted. There was hypoesthesia below the level of lumbar 1 (L1), and lower extremities demonstrated absence of vibratory and position senses. Absence of deep tendon reflexes was noted in the lower extremities, and plantar responses were extensor bilaterally. CSF examination revealed 110 leukocytes/mm3 with no microorganisms and elevated protein level (114 mg/dL). Spine MRI showed hyperintense lesion and expansion at the level of the conus medullaris. The patient was treated with methylprednisolone, azathioprine, and physiotherapy. He also required intermittent catheterization for urinary retention. After a year, a complete resolution of symptoms was observed and spinal MRI became normal.DosageDuration:Dosage not stated; given on the day of the bite and on the 3rd and 7th days thereafter

Evaluation of the awareness of the physicians on negligence and abuse of the elderly patients admitted to emergency department

Introduction: With the increase in the population of the elderly, the negligence and abuse of the elderly (NAE) is increasing at a great pace. Although the rates of NAE in the elderly admitted to emergency depart- ment (ED) is more than the estimated rates, the diagnosis and reporting of such cases are extremely rare. The primary aim of the present study is to evaluate the NAE status in the elderly admitted to ED, the awareness in ED physicians, the attitudes towards these cases and the knowledge levels in this field.  Methods: An electronic questionnaire form that was used as the data collection tool consisted of 19 ques- tions and 2 sections. To call for participation, the questionnaires used in the study were shared with the ED physicians in an online manner between December 2017 and April 2018. The data were analyzed with the SPSS 23.0 Windows computer program with definitive statistics.  Results: A total of 69.4% of the participants faced NAE and 30% did not report this; 79.8% of the partic- ipants stated that they had received training in this field and 9% stated that there was a screening test for the abuse of the elderly. A statistically significant difference was determined between those who received course training in this field and those who received training during medicine faculty education and specialist training.  Conclusions: In this study, it was observed that the NAE rates were more than the estimated rates in the elderly admitted to ED. It was understood that ED physicians did not have adequate knowledge in this field. A new curriculum is needed for the training and education in this field. 

Examination of problem solving and problem posing skills of foreign teacher candidates in mathematics: The sample of Siirt University

Matematik öğretimi, öğrencilere alıştırmalardan açık uçlu problemlere ve keşif durumlarına kadar geniş bir yelpazedeki problemleri ve problem durumlarını keşfetme fırsatı verir. Problem çözme, basitçe, onu çözmeye çalışırken bir problemle başa çıkma sürecinin tamamını ifade eder. Problem kurma, yeni problemlerin ve matematiksel soruların üretilmesi, belirli bir problemi çözme sürecinde çözüm için daha erişilebilir kılmak için problemlerin yeniden formüle edilmesidir. Çalışmanın amacı, alternatif değerlendirme yaklaşımına dayalı Polya (1997) tarafından belirtilen dört aşamadan oluşan (problemi anlama, çözüm için plan hazırlama, planı uygulama, değerlendirme) ve bu kategorilere ek olarak problem kurma kategorisinin yer aldığı Baki (2008) tarafından geliştirilen aşamalı puanlama ölçeği kullanılmıştır. Aşamalı puanlama ölçeği ile yabancı uyruklu öğretmen adaylarının problem çözme süreçlerini ve problem kurma becerilerini incelemektir. Çalışmada nitel araştırma yaklaşımı benimsenmiştir. Araştırmanın katılımcılarını Siirt Üniversitesi Eğitim Fakültesi Matematik Eğitimi Anabilim Dalında öğrenim gören 8 yabancı uyruklu öğretmen adayı oluşturmaktadır. Katılımcıların belirlenmesinde amaçlı örnekleme yöntemi kullanılmıştır. Veri toplama aracı olarak araştırmacılar tarafından MEB ders kitaplarından yararlanılarak hazırlanan üç problem kullanılmıştır. Araştırmada katılımcıların problem çözme ve problem kurma davranışları ayrı ayrı incelendiği için Baki (2008) tarafından geliştirilen aşamalı puanlama ölçeği tercih edilmiştir. Elde edilen verilerin analizinde betimsel analiz tekniği kullanılmıştır. Çalışma sonucunda katılımcıların en yüksek performansı problemi anlama kategorisinde, en düşük performansı ise değerlendirme ve problem kurma kategorisinde gösterdikleri tespit edilmiştir. Problemi anlama, plan hazırlama ve planı uygulama kategorilerinde yabancı uyruklu öğretmen adaylarının orta düzeyin üstünde başarılı olduğu tespit edilmişken, değerlendirme ve problem kurma kategorilerinde başarısız oldukları sonucuna ulaşılmıştır.Teaching mathematics gives students the opportunity to explore a wide range of problems and problem situations, from exercises to open-ended problems and exploration situations. Problem solving simply refers to the entire process of dealing with a problem while trying to solve it. Problem posing is the generation of new problems and mathematical questions, the reformulation of problems to make them more accessible for solution in the process of solving a particular problem. The aim of the study is to examine the problem-solving processes and problem-posing skills of expat teacher candidates with the gradual scoring scale, which consists of four stages (understanding the problem, preparing a plan for the solution, applying the plan, evaluating) based on the alternative assessment approach, as stated by Polya (1997). Qualitative research approach was adopted in the study. The participants of the study are 8 foreign teacher candidates studying at the Department of Mathematics Education at the Siirt University Faculty of Education. Purposive sampling method was used to determine the participants. In this study, three problems prepared by the researchers using the MEB textbooks were used as data collection tools. Since the problem-solving and problem-posing behaviors of the participants were examined separately in the study, the progressive scoring scale developed by Baki (2008) was used. Descriptive analysis technique was used in the analysis of the obtained data. As a result of the study, it was determined that the participants showed the highest performance in the category of understanding the problem, and the lowest performance in the category of evaluation and problem posing. While it was determined that foreign teacher candidates were successful above the medium level in the categories of understanding the problem, preparing a plan and implementing the plan, it was concluded that they were unsuccessful in the evaluation and problem posing categories

The effect of 3-methylcholanthrene and butylated hydroxytoluene on glycogen levels of liver, muscle, testis, and tumor tissues of rats

This study examined the effects of separate and combined applications of 3-methylcholanthrene, a polycyclic aromatic hydrocarbon and potent carcinogenic agent, and butylated hydroxytoluene, the antioxidant food additive, on the glycogen levels of liver, muscle, testis, and tumor tissues in rats. Adult male Wistar albino rats weighing 100-110 g at 8 weeks of age were used in this study. This study consisted of a control group (n = 9) and 3 different experiment groups in which rats were chronically treated with 3-methylcholanthrene (n = 9) or butylated hydroxytoluene (n = 11) or a combination of these agents (n = 14). Rats were intraperitoneally injected with a 200 mg kg(-1) dose of butylated hydroxytoluene and a 40 mg kg-1 dose of 3-methylcholanthrene. At the end of the 26-week experimental period, tissues of rats killed via cervical dislocation were placed in 10% trichloroacetic acid for glycogen determination. Our results showed that the administration of 3-methylcholanthrene, butylated hydroxytoluene, and 3-methylcholanthrene + butylated hydroxytoluene caused statistically significant changes in the glycogen levels of liver, muscle, and testis tissues, and glycogen was stored in tumor tissue

Hellenistic pottery from rural settlements in the light of Nif Dağı excavations

Nif (Olympos) Dağı, günümüzde İzmir İli, Torbalı, Buca ve Kemalpaşa İlçeleri’nin ortak sınırında, Antik dönemde ise Smyrna (İzmir) Körfezi’nin hemen doğusunda, İonia ve Lydia Bölgeleri’nin sınırları içerisinde yer almaktadır. İlk bilimsel kazı çalışmaları, 2006 yılında Prof. Dr. Elif Tül Tulunay başkanlığında başlatılmış olup günümüzde halen sistemli olarak devam etmektedir. Tez çalışmasının ana konusunu oluşturan Hellenistik Dönem’e ait bölgesel özellik gösteren keramikler, Nif (Olympos) Dağı Araştırma ve Kazı Projesi kapsamında kazısı yapılarak tamamlanan ya da devam eden Ballıcaoluk yerleşmesi ile Karamattepe ve Dağkızılca nekropollerinden ele geçirilmiştir. Söz konusu dönemde, Attik keramiklere alternatif olarak üretildiği düşünülen bu yöre kırsalındaki bölgesel özellik gösteren keramikler, ithal örnekler ile farklı özelliklere sahip olduğu tespit edilmiştir. Bu keramiklerin gerek hamur gerekse astar özellikleri bakımından ithal örneklerden hemen ayırt edilmesi önemli bir kriter olup kendine özgü formları, tipolojik özellikleri ve bezeme anlayışı da diğer belirleyici unsurlar arasında yer almaktadır. Nif Dağ'ındaki kırsal kesim yerleşmelerinin, keramik kültrünü incelemek adına yapılan bu tez çalışmasında toplam 200 adet parça ve tam keramik örneği incelemeye alınmıştır. Buluntu çeşitliliğine göre; Batı Yamacı Stilinde Keramikler, Batı Yamacı Taklidinde Yapılan Keramikler, Kabartmalı Kâseler, Kantharoslar, Tabaklar, İçe Dönük Kenarlı Kâseler, Sosluklar, Dirsekli Kâseler, Dışa Dönük Kenarlı Kâseler, Üçgen Ağız Profilli Kâseler, Dışa Çekik Kenarlı Kâse, Akhamenid Kâse, Kaideler, Unguentariumlar, Amphoriskoslar, Testiler, Yonca Ağızlı Testiler, Mykeler, Kraterler, Depolama Kapları, Pişirme Kapları, Amphoralar, Kremasyon Kapları, Kapaklar, Tymiaterion ve Kandiller şeklinde keramik grupları yer almaktadır. Anahtar Kelimeler: Hellenistik Dönem, Nif (Olympos) Dağı, Ballıcaoluk, Karamettepe, Dağkızılca, KeramikNif (Olympos) Mountain is located in the common borders of Torbalı, Buca and Kemalpaşa Districts of Izmir Province. The first scientific excavations were started under the chairmanship of Prof. Dr. Elif Tül Tulunay in 2006 and still continues systematically today. The potteries which one got regional features of hellenistic period an also the main subject of the thesis study, were recovered from the Ballıcaoluk settlement and Karamattepe and Dağkızılca necropolises which were excavated or continued under the scope of Nif (Olympos) Mountain Research and Excavation Project.In the said period, it is determined that the ceramics of this region which is thought to be produced as an alternative to Attic pottery has different characteristics with imported samples. Distinguish of this pottery from their paste and slip features from their imported examples is imporatant criteria and their own forms and typological features and view of deceration are their determining factor. In this thesis study, which is aimed to investigate the pottery culture of Nif Mountain rural settlements, a total of 200 pieces and full ceramic samples were examined. According to the variety of finds; West Slope Tecnique potteries, West Slope made of imitation potteries, moldmade relief bowls, cantharoi, Plates, echinus bowls, small bowls (sauces), bowls with angular profile, outturned rim bowls, the profile of mouth triangle bowls, flaring rim bowls, Achaemenid bowl, bases, unguentaria, amphoriskoi, jugs, myke, oinochoe, crater, storage vessels, cooking vessels, amphoras, cremation vessells, lids, thymiaterion and candles the ceramis groups is located. Keywords: Hellenistic Period, Nif (Olympos) Mountain, Karamattepe, Ballıcaoluk, Dağkızılca, Pottery

Karaciğer ve böbrek yetmezlikli hastaların invaziv enfeksiyonlarında crp yanıtının değerlendirilmesi

Toplum ya da hastane kaynaklı enfeksiyonlar, hem gelismis hem de gelismekte olan ülkelerde mortalite ve morbitide nedeni olarak önemini hala korumaktadır. Enfeksiyonların tanı, teshisi ve takibi bazı özel durumlarda klinisyen için zor olabilmektedir. Kronik böbrek yetmezliği ve karaciğer sirozunda gerek hücresel, gerekse hümoral immünitenin baskılanmıs olması enfeksiyonlara yatkınlığı artırır. Bu hastalardaki artmıs intelökin (ĐL)-6 ve TNF (tümör nekroze edici faktör)-α sürekli enflamasyona neden olmakta araya giren enfeksiyon durumunda enfeksiyon tanısını zorlastırabilmektedir. Creaktif protein (CRP) enflamasyon ve enfeksiyon durumunda kan düzeyi artan pozitif akut faz reaktanıdır. CRP’nin %90’ı hepatosit endoplasmik retikulumunda sentezlenir. Karaciğer sirozunda CRP sentezinde azalma ve enflamasyon, kronik böbrek yetmezliğindeki bazal enflamasyon CRP takibinde klinisyenin bu grup hastalarda enfeksiyon tanı ve takibini zorlastırmaktadır. Çalısmamıza Baskent Üniversitesi Ankara Hastanesinde Ocak 1996 ile Haziran 2009 tarihleri arasında yatmıs ve invaziv enfeksiyon nedeniyle takip edilmis 48 karaciğer sirozu, 91 son dönem böbrek yetmezliği ve 93 kontrol (karaciğer ve böbrek yetmezliği olmayan) hastası olmak üzere toplam 232 hasta alındı. Enfeksiyon tanısı alan bu hastaların geriye dönük olarak antibiyotik baslanmadan önceki ilk CRP değeri CRP1, enfeksiyon dönemi takipteki en yüksek CRP değeri CRPmaks ve tedavi bitimindeki CRP değeri ise CRP2 olarak kaydedildi. CRP ile birlikte hastaların yası, cinsiyeti, takip edildiği tarih, eslik eden hastalıkları, enfeksiyon dönemi maksimum vücut sıcaklığı, kan beyaz küresi ve parçalı yüzdesi, albümin düzeyi, aldığı antibiyotikler, alınan kültürler ve üretilen mikroorganizmalar, böbrek ve karaciğer yetmezliğinde etyolojik nedenler kaydedildi. Böbrek yetmezlikli hastaların diyaliz tipi ve hemodiyalize girenlerin diyaliz yolu ile karaciğer sirozu olan hastaların Child-Pugh sınıflamasına göre skoru not edildi. Çalısma grupları arasında CRP1, CRPmaks ve CRP2 arasında anlamlı fark saptandı. Sırasıyla, p=0,001, p=0,001 ve p=0,042 idi. Kontrol, böbrek yetmezliği ve karaciğer sirozu için CRP1 sırasıyla ortalama; 111,4 (±104,0), 129,5 (±98,1), 61,8 (±65,6) CRPmaks; 188,3 (±112,7), 226,8 (±106,5), 91,6 (±69,2) ve CRP2; 53,4 (±52,2), 70,0 (±75,7), 39,2 (±43,5) olarak bulundu. Hasta gruplarında CRP yanıtını değerlendirmede bir diğer yol da CRP1 ile CRPmaks ve CRPmaks ile CRP2 arasındaki yüzde değisimleri saptamak idi. Hasta gruplarında CRP1 ile CRPmaks arasındaki yüzde değisimde anlamlı fark saptanmadı (p=0,764). Yani aynı oranda yanıt alınmaktaydı. Kontrol, böbrek yetmezliği ve karaciğer sirozunda değerler CRP1-CRPmaks sırasıyla 460,8 (±1144,1), 285,3 (±743,7), 296,3 (±638,1) idi. CRPmaks ile CRP2’nin yüzde değisimleri arasında hasta grupları arasında istatistiksel olarak anlamlı düzeyde fark bulundu (p=0,003). Her üç hasta grubunda da invaziv enfeksiyonların tanı ve takibinde CRP önemli bir belirteçtir. Özellikle karaciğer sirozundaki enfeksiyonlarda ihmal edilen bu belirtecin hastanın kliniği ve diğer laboratuvar bulguları değerlendirilerek daha sık takip edilmesini öneriyoruz. Community or hospital originated infections, both developed and developing countries as a cause of mortality and morbidity still maintains its importance. Diagnosis of infection, diagnosis and follow-up may be difficult for some special cases clinician. Chronic renal failure and liver cirrhosis to the cellular, as well as humoral immunity is suppressed susceptibility to infections increases. These patients have increased IL-6 and TNF-α continuous inflammation leads to infection between the cases entering the infection can make diagnosis difficult. C-reactive protein (CRP) inflammation and infection in the blood situation increasing the level of positive acute phase protein. CRP 90% of hepatocytes endoplasmic reticulm is synthesized. Decrease in the synthesis of CRP and inflammation in liver cirrhosis, chronic kidney failure clinicians in monitoring this group basal CRP in patients with inflammatory infection makes it difficult for the diagnosis and follow-up. Our study Baskent University Ankara Hospital January 1996 and June 2009 between lying and invasive infections due to liver cirrhosis, 48 were follow-up, 91 endstage renal disease and 93 controls (liver and kidney failure are not) patients have received a total of 232 patients. Infection of these patients retrospectively diagnosed as a head without antibiotics before the first CRP CRP1 value, following the infection period, the highest CRP value CRP value at the end of CRPmaks and treatment were recorded as the CRP2. CRP of patients with age, gender, follow the date of the accompanying diseases, infection period, the maximum body temperature, blood WBC and percentage of fragmented, albumin level, has received antibiotics, taken cultures and microorganisms are produced, kidney and liver failure etiologic factors were recorded. Renal failure and hemodialysis patients entering dialysis type via the dialysis of patients with liver cirrhosis according to Child-Pugh classification score was noted. Study groups between CRP1, CRP2, and no significant difference between CRPmaks detected. Respectively, p = 0.001, p = 0.001 and p = 0.042, respectively. Control, renal failure and liver cirrhosis respectively, the average for CRP1; 111.4 (± 104.0), 129.5 (± 98.1), 61.8 (± 65.6) CRPmax; 188.3 (± 112, 7), 226.8 (± 106.5), 91.6 (± 69.2) and CRP2; 53.4 (± 52.2), 70.0 (± 75.7), 39.2 (± 43.5) as found. An evaluation of the vii patient group, CRP response in other ways between CRP1 and CRP2 with CRPmax and percentage changes CRPmax was to determine. The patient group, the percentage difference between the max and CRP CRP1 significant difference was found (p = 0.764). That same percentage of responses were received. Control, renal failure and liver cirrhosis, respectively, in the values CRP1-CRP max 460.8 (± 1144.1), 285.3 (± 743.7), 296.3 (± 638.1), respectively. Among patients with CRPmax percentage change CRP2 among groups was statistically significant difference (p = 0.003). All three patient groups and follow-up also in the diagnosis of invasive infection, CRP is an important marker. Especially in liver cirrhosis, infections neglected this and other laboratory markers of the patient's clinical findings are assessed and recommend more frequent follow