Demographic Characteristics of Syrian Patients Having Died in Hospital

Objective: Our study aims at reviewing the demographic characteristics of Syrian patients who presented to a state hospital in Sanliurfa, where the largest immigrant camp is located, and subsequently died.Material and Methods: Syrian patients who died after presenting to a state hospital in Sanliurfa between 2011-2015 were retrospectively analyzed. Patients’ age, gender, trauma status, reasons of death, and place of death (inside or outside the hospital) were examined in detail.Results: The study included a total of 1866 Syrian citizens who after being admitted to hospital were declared dead at the state hospital in Sanliurfa between 2011 and 2015. Of the patients, 43.7% (n=816) were female. The mean age of the patients was 61.16 ± 23.6 years (%95 CI: 60.08 - 62.23). Comparing the patients according to reasons of their death, while the groups varied depending on age, gender and traumatic injury (p<0.001, p=0.047, p<0.001, respectively), no difference was obtained between the groups according to presence of a firearm injury (p=0.290).Conclusion: There is no significant difference between in-hospital deaths and emergency service deaths of traumatic Syrian patients

The Hidden Though Flourishing Justification of Intellectual Property Laws: Distributive Justice, National Versus International Approaches

Bu çalışmada, Gökkuşağı alabalıklarında enfeksiyonoluşturan Ichthyophthirius multifiliis’infarklı bölgelerden izole edilmiş saha suşlarının genotipik yapıları temelindeimmundominant özellik gösteren rekombinant immobilizan antijenlerini(i-antijen) kodlayan genlerin bakteriyel ekspresyon sistemine klonlanarakeksprese ve karakterize edilmeleri, antijenik profillerinin ortaya çıkarılmasıve aşı adayı olabilecek rekombinant antijenlerin elde edilmesi amaçlanmıştır.&nbsp;Çalışmada 2018 ve 2019 yıllarının Temmuz ve Ağustos ayları arasında Gökkuşağıalabalığı yetiştiriciliğinin yoğun yapıldığı Samsun, Rize, Kayseri, Elazığ,Burdur, Antalya ve Muğla illerinde bulunan işletmeler ziyaret edilerek balıkpopülasyonları üzerinde saha araştırmaları yürütülmüş ve I. multifiliis ile enfekte bulunan balıklardan ilgili protokolleregöre izolasyon gerçekleştirilmiştir. Laboratuvara uygun solüsyonlar ve soğukzincir altında intikal ettirilen örneklerden cDNA ve gDNA izolasyonlarıgerçekleştirilmiştir. I. multifiliis i-antijengen lokusunun amplifikasyonu amacıyla optimum primer dizaynı için ön çalışmalaryürütülmüş ve hedef gen bölgeleri uygun amplifikasyon koşullarında PCR’daçoğaltılmıştır. Elde edilen amplikonlar agaroz jel üzerinden saflaştırılmıştır.Multiple gen lokusu sekanslarının belirlenebilmesi amacıyla ilgili pürifiyeamplikonlar pJET 1.2 plazmit vektörüne CloneJET PCR cloning kit (Thermo FisherScientific) kullanılarak klonlanmış ve katı besi yerinde belirlenenkolonilerden rekombinant plazmid DNA izolasyonları gerçekleştirilmiştir. Rekombinantplazmidler spesifik primerlerle çift yönlü olarak sekanslanmış vekromotogramlar De Novo Assemble üzerinden işlenerek hedef insert sekanslarvektör plazmid DNA’sı içerisinden çıkarılmış ve konsensüs sekanslar eldeedilmiştir. İlgili primerlerin i-antijen gen lokusu içerisinde çoğalttığı fragmentlerinbelirlenebilmesi amacıyla PCR ürünleri ayrıca yeni nesil dizileme teknolojisi (NGS)kullanılarak işlenmiş ve elde edilen dizilimlerin gen veri tabanlarındakimevcut tüm i-antijen gen lokusları ile filogenetik ilişkileri araştırılmıştır.Tüm bu araştırmalar sonucu karakterize edilen i-antijen genlerinin ekspreseettiği proteinlerin rekombinant olarak eldesi için çalışmalargerçekleştirilmiştir. Aşı adayı potansiyeli olabilecek bazı lokusların bakteriyelekspresyon sistemine aktarımı için kodon optimizasyonları yapılarak pET-32a(+)ekspresyon plazmid DNA’sına (Novagen) klonlanması gerçekleştirilmiştir. Eldeedilen rekombinant plazmitler E. colikompotent BL21(DE3) hücrelerine transforme edilerek optimum koşullardaekspresyon çalışmaları yürütülmüş ve ekspresyon etkinliği SDS-PAGE ve WesternBlot analizleri ile belirlenmiştir. Eksprese edilen rekombinant i-antijenproteinleri afinite kromotografi kulanılarak saflaştırılmış ve immunreaktiflikleri Western Blot analizleri ile tespit edilmiştir.&nbsp;Çalışmada,Elazığ, Rize ve Muğla illerinde ziyaret edilen işletmelerdeki Gökkuşağıalabalıklarında deri ve solungaçlarından hazırlanan preparatların mikroskobikincelemeleri ile I. multifiliisenfeksiyonunun yaygın olduğu görülmüştür. İlgili bölgelerden elde edilen I. multifiliis suşlarına ait cDNA vegDNA izolatlarının i-antijen gen lokusunun dizayn edilen pirmerlerle PCR’daamplifiye edilmesi sonucu 1200-1300 bp büyüklüğünde amplikonlar saptanmıştır.Pürifiye amplikonların klonlanması sonucu ilgili izolatlara ait açık okumaçerçevesi (ORF) sekanslarının analizinde birbirleriyle %38,3-58,8 arasındafarklılık gösteren 4 farklı i-antijen izoformu tespit edilmiştir. Bu izoformlararasında bir antijenik lokusun (ImulTR1-iant) her üç ildeki alabalıkpopülasyonlarından izole edilen I.multifiliis suşlarında da var olduğu NGS analizlerinde görülmüştür.ImulTR1-iant ORF sekansı ayrıca Amerika Birleşik Devletleri’nde alabalıklardanizole edilmiş bir i-antijen izoformuyla %83,3 identiklik gösterirken, diğertespit edilen izoformlara ait sekansların GenBank veri tabanında mevcuti-antijen sekanslarından oldukça farklı olduğu belirlenmiştir. Araştırmadarekaombinant i-antijen eldesi için yaygın belirlenen ImulTR1-iant izolatıüzerinden analizler yürütülmüştür. Bu izoformu kodlayan gen bölgesinin 1263bpbüyüklüğünde olduğu ve ORF’nin 420 amino asitten teşekkül ettiğibelirlenmiştir. ORF amino asit sekanslarının in-slico analizlerde 42,552 kDabüyüklüğünde bir proteini eksprese ettiği, bu proteinin sitoplazmik olduğu vetransmembran bölge içermediği tespit edilmiştir. Ayrıca ilgili ORF sekansıiçerisinde uzunluğu 7-22aa arasında değişen 21 antijenik bölge olduğubelirlenmiştir. Kodon optimizasyonu yapılmış olan ImulTR1-iant izoformuna ait pET-32a(+)rekombinant plazmitinin E. colikompotent BL21(DE3) hücrelerine transformasyonu ve ekspresyonu sonrasındayapılan SDS-PAGE analizlerinde in-silico analiz sonuçlarına paralel olarakyaklaşık 43kDa’luk protein jel üzerinde görüntülenmiştir. İlgili rekombinantprotein afinite kromotografide HisTrap FF crude (GE Healthcare) kolonlarıkullanılarak saflaştırılmış ve pürifiye rekombinant antijenin immun-reaktifliğiWestern-Blot analizleriyle gösterilmiştir.&nbsp;ErciyesÜniversitesi Bilimsel Araştırma Projeleri Birimi tarafından TOA-2017-7742 kodnumarasıyla desteklenen bu çalışma ile Türkiye’de gökkuşağı alabalıklarındasorun oluşturan ve ekonomik kayıplara yol açan I. multifiliis suşlarına karşı biyoteknolojik aşı geliştirilmesinoktasında aşı adayı olabilecek immobilizan antijenler üzerine özgün veriler sağlanmıştır.Elde edilen aşı adayı rekombinant antijenlerin etkinliğini ortaya koymanoktasında laboratuvar ve saha şartlarında immunizasyon ve çelınç enfeksiyondenemeleri için yeni proje çalışmaları planlanmaktadır.</style

Antifungal activity of some Sternbergia taxa: effects on germ tube and biofilm formation

Natural products are rapidly becoming the primary sources of novel antimicrobial agents, as resistance to existing antimicrobial agents is increasing. Apart from determining the antimicrobial activity of natural products, it is also important to understand their effects on the virulence factors of microorganisms. This study aimed to determine the antimicrobial activity of Sternbergia species prevalent in Turkey and investigate their role in the inhibition of germination tube and biofilm formation, both of which are known to be important virulence factors of Candida albicans. The antimicrobial activities of the plant extracts were evaluated using bore-plate and broth microdilution method. The extracts’ capacity to inhibit the formation of the germ-tube was also evaluated. The findings of our study revealed that Sternbergia lutea, Sternbergia vernalis possessed antimicrobial activities, with MIC values ranging between 0.048 mg/mL and 0.39 mg/mL. The highest antimicrobial activity was observed against Candida dubliniensis (0.048 mg/mL). While evaluating the inhibition of fungal germination activities, S. vernalis extract (at a concentration of 0.09 mg/mL) was found to be the most effective against C. albicans ATCC 90028 strain. The results also indicated that S. vernalis extracts at sub-MIC levels inhibited germ tube formation and modulated the tail-length of germinated cells, both of which are important virulence factors of C. albicans. Furthermore, the inhibition of biofilm-formation was also investigated, and it was found that two Sternbergia spp. extracts at or below MIC levels inhibited biofilm formation

Turkish Standardization of Wechsler Adult Intelligence Scale- Revised (WAIS-R): Pilot Study

The aim of this study was to gather data for the pilot study of Wechsler Adult Intelligence Scale-Revised (WAIS-R). The Turkish translation of WAIS-R was individually administered to 134 adults (67 males, 67 females), from three socioeconomic groups (SES) between ages 16-70. The results of the statistical analysis showed that there were modifications in the item difficulties of the Information, Picture Completion, Comprehension, Picture Arrangement, Vocabulary and Block Design sub-scales. The results of the analysis of variance indicated that the main effect of SES and age were statistically significant on most of the sub-scales. On the other hand the main effect of sex was statistically significant on the sum of raw scores of Information and Arithmetic sub-scales, in favor of males. Moreover the interaction effect of age and SES was significant only on the raw score of the Digit Symbol sub-scale. No other interaction effect was significant on other sub-scales. The Spearman-Brown, Cronbach Alpha coefficients and inter- correlations calculated were very high and significant, indicating that the internal consistency of the Turkish WAIS-R is high. The suggestions for the future standardisation study were discussed in the light of the findings of this pilot study

Maternal Deaths and Their Causes in Ankara,Turkey, 1982-2001

This study was carried out to determine the incidence and causes of maternal deaths about a 20-year period at the Zekai Tahir Burak Women's Health Education and Research Hospital (ZTBWHERH), Ankara, Turkey. All maternal deaths from January 1982 to July 2001 were reviewed and classified retrospectively. Using a computer-generated list, 348 patients admitted to the Labour Department of ZTBWHERH during 1982-2001 were selected as controls. Medical records were reviewed for demographic data, history of antenatal care, route of delivery, referral history, and perinatal mortality. Cases and controls were compared, and standard tests were used for calculating odds ratio (OR) and 95% confidence interval (CI) for the association of demographic and delivery characteristics. During this period, there were 174 maternal deaths and 430,559 livebirths, giving a maternal mortality ratio of 40.4/100,000 livebirths. The mortality rate declined from 85.1/100,000 in 1982 to 11.6/100,000 in 2001. One hundred thirty (74.7%) deaths were due to direct obstetric causes and 24 (13.7%) were abortion- related, while 20 (11.4%) were due to indirect obstetric causes. The most common cause of direct obstetric deaths was pre-eclampsia/eclampsia, followed by obstetric haemorrhage and embolism. Abortion-related sepsis and haemorrhage, anesthesia-related deaths, obstetric sepsis, acute fatty liver of pregnancy, and ectopic pregnancy accounted for other causes of deaths. Cardiovascular disease was the leading indirect cause of death. Referral, lack of antenatal care, and foetal death at admittance were associated with 8-, 3-, and 6-fold increased risk of maternal mortality respectively (OR 8.89, 95% CI 5.7- 13.8; OR 3.74, 95% CI 2.5-5.5; OR 6.38, 95% CI 3.1-13.1). Although maternal mortality ratios have declined at the hospital, especially in the past five years, the rate is still high, and further improvements are needed. The problem of maternal mortality remains multifactorial. Short-term objectives should be focused on improving both medical and administrative practices. Improving the status of women will necessarily remain a long-term objective

Identifying Clinical Characteristics of Hypoparathyroidism in Turkey: HIPOPARATURK-NET Study

Hypoparathyroidism is an orphan disease with ill-defined epidemiology that is subject to geographic variability. We conducted this study to assess the demographics, etiologic distribution, treatment patterns and complication frequency of patients with chronic hypoparathyroidism in Turkey. This is a retrospective, cross-sectional database study, with collaboration of 30 endocrinology centers located in 20 cities across seven geographical regions of Turkey. A total of 830 adults (mean age 49.6 ± 13.5 years; female 81.2%) with hypoparathyroidism (mean duration 9.7 ± 9.0 years) were included in the final analysis. Hypoparathyroidism was predominantly surgery-induced (n = 686, 82.6%). The insulting surgeries was carried out mostly due to benign causes in postsurgical group (SG) (n = 504, 73.5%) while patients in nonsurgical group (NSG) was most frequently classified as idiopathic (n = 103, 71.5%). The treatment was highly dependent on calcium salts (n = 771, 92.9%), calcitriol (n = 786, 94.7%) and to a lower extent cholecalciferol use (n = 635, 76.5%) while the rate of parathyroid hormone (n = 2, 0.2%) use was low. Serum calcium levels were most frequently kept in the normal range (sCa 8.5–10.5 mg/dL, n = 383, 46.1%) which might be higher than desired for this patient group. NSG had a lower mean plasma PTH concentration (6.42 ± 5.53 vs. 9.09 ± 7.08 ng/l, p < 0.0001), higher daily intake of elementary calcium (2038 ± 1214 vs. 1846 ± 1355 mg/day, p = 0.0193) and calcitriol (0.78 ± 0.39 vs. 0.69 ± 0.38 mcg/day, p = 0.0057), a higher rate of chronic renal disease (9.7% vs. 3.6%, p = 0.0017), epilepsy (6.3% vs. 1.6%, p = 0.0009), intracranial calcifications (11.8% vs. 7.3%, p < 0.0001) and cataracts (22.2% vs. 13.7%, p = 0.0096) compared to SG. In conclusion, postsurgical hypoparathyroidism is the dominant etiology of hypoparathyroidism in Turkey while the nonsurgical patients have a higher disease burden with greater need for medications and increased risk of complications than the postsurgical patients. © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature

INEFFICACY OF DAPSON TREATMENT IN A PATIENT WITH ERYTHEMA DYSCHROMICUM PERSTANS

Eritema diskromikum perstans gövde, ekstremiteler, yüz ve boyunda simetrik dağılım gösteren, asemptomatik ve yavaş ilerleyen kül grisi renginde maküllerle karakterize nadir görülen, benign, kronik ve idiyopatik bir pigmentasyon bozukluğudur. Bu hastalıkta tamamen etkili olan bir tedavi seçeneği henüz mevcut değildir. Birçok tedavi seçeneğinin denendiği görülmüş, ancak klofazimin ve dapson dışındaki tedavilerin büyük çoğunluğunun etkisiz olduğu bildirilmiştir. Burada dapson tedavisine yanıtsız EDP'lu 36 yaşında bir erkek olgu sunulmaktadır Erythema dyschromicum perstans is an uncommon, benign, chronic, idiopathic pigmentary disorder characterized by asymptomatic, slowly progressive, ashy-gray macules over the trunk, extremities, face and neck with symmetrical distribution. No consistently effective treatment is yet available for this disease. Many therapeutic options have been tried, but the majority of them have been ineffective except clofazimine and dapson. Herein, we report a 36-year-old male of EDP who did not response to dapson treatment

THE FACTORS THAT AFFECT DEVELOPING ANAL FISSURE IN CHILDHOOD

Amaç: Anodermal yırtık ya da kesik olarak tanımlanan anal fissür oluşumunda konstipasyon başta olmak üzere birçok faktör etkilidir. Bu çalışmanın amacı anne sütüyle beslenmenin, defekasyonun, anal bölge temizliği ve bakımının anal fissür gelişimine etkisinin belirlenmesidir. Gereç ve yöntem: Bu çalışmaya İzmir Bornova Atatürk Sağlık Ocağı ve Celal Bayar Üniversitesi Tıp Fakültesi Pediatrik Gastroenteroloji Polikliniğine Ocak-Mart 2006 arasında başvuran yaşları 1-17 ay arası (ortalama  standart sapma 6,6  4,0 ay) 72 bebek (40 erkek 32 kız) alındı. Bunlar anal fissür saptanan ve saptanmayan bebekler olarak iki gruba ayrıldı. Bebeğin yaşı, beslenmesi, defekasyon ritmi, gaita kıvamı, doğumdan sonraki gaita çıkış zamanı, konstipasyon için tedavi görüp görmediği, önceki anal fissür öyküsü ve yıkanma sıklığı kaydedildi. Hazır bez kullanımı, anal bölge bakımı ve temizliğinde kullanılan ajanlar soruldu. Bebeklerin tümüne ayrıntılı anal bakı yapıldı. Bulgular: Anal fissürü olan grupta 29, olmayan grupta 43 bebek vardı. Anne sütü ile beslenme anal fissür gelişiminden koruyucu bulundu (eksponensiyel B = 0,11, %95 CI = 0,02 - 0,76). Defekasyon ritmi ve gaita kıvamı iki grup arasında anlamlı farklı olmasına karşın regresyon analizinde anlamlı farklı bulunmadı (sırası ile p=0,09 ve 0,29). Anal bölge temizliğinde ıslak mendil kullanımının anal fissür riskini anlamlı arttırdığı saptandı (eksponensiyel B= 11,0, %95 CI= 2,13 - 57,6). Önceki anal fissür öyküsü regresyon analizinde anlamlılığını yitirdi (eksponensiyel B= 4,34, %95 güven aralığı= 0,89 - 20,99). Regresyon analizi modeline alındığında yaştaki her 1 aylık artışın fissür riskini 1,4 kat arttırdığı bulundu. Doğumdan sonra ilk defekasyon zamanı, konstipasyon tedavisi, yıkanma sıklığı ve anal bölge bakımının her iki grup arasında anlamlı farklılık göstermedi. Sonuç: Anne sütü alımının anal fissür gelişimi riskini azalttığı, ıslak mendil kullanımının ise arttırdığı düşünülmüştür. Objective: Many factors especially constipation play a role in the development of anal fissure that is defined as anodermal tear or cut. The aim of this study was to evaluate the influence of breast feeding, defecation, anal hygiene and care on development of anal fissure. Material and method: The study included 72 children (40 males 32 females) aged 1-17 months (mean  standard deviation 6.6  4.0 months) who presented to Izmir Bornova Ataturk Health Center and Celal Bayar University Pediatric Gastroenterology Outpatient Department between January-March 2006. These were grouped into two as babies with and without an anal fissure. Age, nutrition, defecation rhythm, stool consistency, time of first defecation after birth, history of constipation treatment, history of previous anal fissure and bathing frequency were recorded. Use of diapers, agents used in anal care and hygiene were questioned. All the children had anal examination. Results: The anal fissure group included 29 babies whereas the one without anal fissure included 43 babies. Breast feeding was found to be protective against anal fissure development (eksponential B = 0.11, %95 confidence interval = 0.02-0.76). Defecation rhythm and stool consistency was not found to be significant in regression analysis although they were significantly different between the two groups (p=0.09 ve 0.29 respectively). Use of baby wipes for cleaning anal region was detected to increase risk of anal fissures significantly (eksponential B= 11.0, %95 CI= 2.13-57.6). Previous history of anal fissure lost its significance in regression analysis (eksponential B= 4.34, %95 confidence interval = 0.89-20.99). It was detected that increase of one month of age increased the risk of anal fissure development by 1.4 times. Time of defection after birth, bathing frequency and anal care was not significantly different between the groups. Conclusion: It was thought that the risk of anal fissure development decreased with breast feeding while it increased with the use of wet wipes

Serum Inflammatory Cytokines and Growth Factors in Patients with Sjögren’s Syndrome and Diabetes Mellitus

Abstract Background/ Aims: Sjögren’s syndrome (SS) and diabetes mellitus (DM) are common causes of dry eye disease (DED) and autologous serum is used when artificial tears are not sufficient. Our aim was to compare serum growth factor and inflammatory cytokine levels of SS and DM patients with the healthy individuals. Methods: Twenty-three SS patients (mean age 52.70±7.55 years), 25 DM patients (mean age 56.68±6.53 years), and 23 healthy subjects (mean age 51.70±9.14 years) were included in the study. After detailed ophthalmological examination, Schirmer test, tear break-up time (TBUT) and Ocular Surface Disease Index (OSDI) scores were measured. Serum levels of six different proinflammatory interleukins (IL), five growth factors, matrix metalloproteinase-9, and fibronectin were measured by immunoassay. One-way ANOVA or Kruskal-Wallis tests and Dunn-Bonferroni post hoc analysis were used for comparison and p&lt;0.05 was considered significant. Results: Schirmer test and TBUT were significantly lower in the SS group (2.08±1.72 mm/5 min and 3.08±2.08 s) than in the DR (10.24±4.63 mm/5 min and 4.20±3.09 s) and control groups (13.30±5.95 mm/5 min and 9.00±1.75 s) (p&lt;0.001). Among the parameters studied, mean serum IL-23 level was significantly higher in the SS group (156.66±207.94 pg/mL) than in the DM and control groups (73.48±95.91 and 69.59±105.39 pg/mL, respectively) (p&lt;0.05). Serum insulin-like growth factor 1 (IGF-1) level was lowest in DM patients (DM: 12.89±21.09, SS: 30.77±19.85, and control: 27.08±21.93 ng/mL) (p&lt;0.05). Sjögren’s syndrome disease activity index (ESSDAI) showed a negative correlation with TBUT and a positive correlation with IL-1, IL-2 and fibronectin (p&lt;0.005). Conclusions: Except IL-23 and IGF-1, the contents of serum obtained from patients with SS and DM are similar with the healthy individuals. Therefore, autologous serum seems to be a good option to replace deficient tear fluid in these subjects

Pyrin Modulates the Intracellular Distribution of PSTPIP1

PSTPIP1 is a cytoskeleton-associated adaptor protein that links PEST-type phosphatases to their substrates. Mutations in PSTPIP1 cause PAPA syndrome (Pyogenic sterile Arthritis, Pyoderma gangrenosum, and Acne), an autoinflammatory disease. PSTPIP1 binds to pyrin and mutations in pyrin result in familial Mediterranean fever (FMF), a related autoinflammatory disorder. Since disease-associated mutations in PSTPIP1 enhance pyrin binding, PAPA syndrome and FMF are thought to share a common pathoetiology. The studies outlined here describe several new aspects of PSTPIP1 and pyrin biology. We document that PSTPIP1, which has homology to membrane-deforming BAR proteins, forms homodimers and generates membrane-associated filaments in native and transfected cells. An extended FCH (Fes-Cip4 homology) domain in PSTPIP1 is necessary and sufficient for its self-aggregation. We further show that the PSTPIP1 filament network is dependent upon an intact tubulin cytoskeleton and that the distribution of this network can be modulated by pyrin, indicating that this is a dynamic structure. Finally, we demonstrate that pyrin can recruit PSTPIP1 into aggregations (specks) of ASC, another pyrin binding protein. ASC specks are associated with inflammasome activity. PSTPIP1 molecules with PAPA-associated mutations are recruited by pyrin to ASC specks with particularly high efficiency, suggesting a unique mechanism underlying the robust inflammatory phenotype of PAPA syndrome