Anesthetic Management of a Pediatric Patient With Wilsons Disease

Wilsons disease, characterized by cirrhosis, extrapyramidal symptoms and Kayser-Fleischer corneal rings, is a rare hereditary disease of human copper metabolism. Clinical findings in Wilsons disease are complex and neurological symptoms such as tremor, dysarthria, rigid dystonia, seizures, psychiatric disorders, acute liver failure, chronic hepatitis or cirrhosis may develop. A 4-year-old male patient was operated for traumatic depressed skull fracture and intracerebral hematoma. He was diagnosed with Wilsons disease at the age of 2.5 years and treated with zinc sulphate and D-penicillamine. General anesthesia was induced with propofol, fentanyl, atracurium, and maintained with isoflurane, and oxygen. No complications were encountered during the operation or in the postoperative period. We concluded that general anesthesia can successfully be given to Wilsons disease patients using an anesthetic agent, the metabolism of which is least affected by the liver disease, one that induces least hepatic toxicity. By close follow-up of patients clinically and biochemically, it is possible to reduce the complication rates to a minimum

Work-life conflict experienced by Turkish women managers during the Covid-19 pandemic: A qualitative research

The changes in business life during the Covid 19 Pandemic had a significant effect on work-life balance of individuals, especially women as their roles at home and work have increased and the conflict between these roles has become more pronounced. Considering this fact, this research aimed to determine the conflicts and changes on the work-life balance of female managers during the Covid-19 pandemic. In this context, the research was carried out within the framework of workplace responsibilities, private life responsibilities, work-private life conflict, and the effects of the Covid-19 pandemic. This research was carried out in educational institutions of Turkey, through interviews with 16 married women employees who have children. The obtained data were classified following the main purpose of the research and content analysis, then coded and analyzed using the MAXQDA.The findings showed that the dominant factor in the pandemic period was Work-Life conflict and job responsibilities restricted private life responsibilities more. The fact that working at home decreases productivity, low productivity extends working hours, and the negative effects of technology increasing the workload have caused female managers, who are aware of their job responsibilities, to work more

Exact solution of circular vertical curves

Geçki düşey geometrisinde, iki doğru parçasını birleştirmek için daire yayı veya 2. derece parabolü kullanılmaktadır. Uygulamada, dairesel düşey kurblara ilişkin kırmızı kot ve kilometre hesaplarında kolaylık amacı ile bazı kabuller yapılarak yaklaşık çözümler uygulanmaktadır. Bir ulaştırma yapısının uygulama projesi, yapının tüm niteliklerini kapsar. Bu niteliklerin en önemlilerinden biri olan “geçki düşey geometrisi”, ulaştırma yapısının gerçek (hatasız) düşey geometrisini temsil eder ve sayısal olarak kilometreler, kırmızı kotlar ve kırmızı çizgi eğimleri ile ifade edilir. Söz konusu sayısal büyüklükleri hata dereceleri bakımından üç ana gruba ayırmak mümkündür: Birinci gruptaki büyüklükler, hesap kolaylığı bakımından yuvarlak sayı seçilirler. İkinci gruptakilerin sayısal inceliği boy kesit çiziminin ölçeğine bağlıdır. İkinci gruptaki büyüklüklerin hataları küçüktür. Üçüncü gruptaki büyüklükler ise, bir hesap işlemi sonunda üretildiklerinden hataları diğer gruptakilerden daha büyüktür. Günümüzde demiryolları ve yüksek standartlı kara yolları için, hesapla bulunan kilometrelerin ve proje kotlarının varsayımlardan kaynaklanan hatalardan arındırılmış mm inceliğinde değerler kabul edilebilir hata sınırları içinde hesaplanmalıdır. Günümüzde bilgisayar teknolojisinin gelişmesi ile birlikte bu yaklaşık çözümlerin önemi kalmamıştır.  Ayrıca demiryolları ve yüksek standartlı kara yolları için, hesapla bulunan kilometre ve kırmızı kotların mm inceliğinde değerler olması gerekmektedir. Bu nedenle dairesel düşey kurbların çözümünde kesin çözümün kullanılması daha uygun olacaktır. Bu yazıda düşey kurbların (daire ve 2. derece parabol) kesin çözümlerine ilişkin formüller türetilmiş ve çözümü anlatılmıştır. Örnek olarak alınan bir geçkide düşey geometriye ait ana ve ara noktaların kilometrelerinin ve kırmızı kotlarının, yaklaşık ve kesin hesapları yapılarak aradaki farklar gösterilmiştir. Anahtar Kelimeler: Düşey kurb, geçki, daire, parabol, düşey geçki tasarımı.  In the vertical geometry of the routes, circular curves or 2nd degree parabola are used for joining two straight lines.  In practice, the approximate solutions are used with the aim of simplifying the calculation of heights and kilometers of circular vertical curves. A transportation practice project covers all properties of the structure. One of the most important properties named "vertical geometry of the route" represents real geometry (with no errors) and is expressed by kilometers, elevations and gradients digitally. Those digital values can be divided into the tree parts by means of error levels: Group 1- The values chosen by creator (designer/drafter) with defined criteria (usually, radiuses of vertical circular curves or the lengths of parabolas in horizon plate, entry and exit gradients of back and forward tangents, kilometers of essential points of vertical curve (EPVC) which consist of beginning of vertical curve (BVC), end of vertical curve (EVC) and point of vertical intersection (PVI). Group 2- The values measured by means of graphically. Group 3- The values determined by calculation. The values in the second group are chosen as rounded numbers in order to simplify the computations. The numbers of the digits of the values in the second group are determined based on the scale of the longitudinal section.  In most cases, the scale of the longitudinal section is 1:1000 thus the chainage values of the tangent points are obtained within the precision of 0.25 to 0.5 meters. The values in the group one are free of error while the second group values consist small errors. In third group, since the values in the third group are the products of a computation they have more errors according to the other two groups. In most textbooks the computation of vertical geometry is being thought without taking the errors introduced by omitting and assumptions into account. These errors are mainly introduced by not carrying out the computations using enough degrees of a formula which is in a series form or assuming that slope distances can be used as plane distances (Umar and Yayla 1994; Müller, 1984). The main reason of these assumptions is due to the limitations of the computations before 70s. Nowadays these limitations are over come by means of new computation techniques and instruments. And the computations can even be executed easily by a hand calculator. The results of exact computations of circular and parabolic vertical curves are described. The basic concepts of the subject should be summarized prior to calculations. 1) The vertical geometry is designed by using the longitudinal section of horizontal geometry (original surface). All vertical geometry related calculations are to be carried out on a vertical plane defined by K, H perpendicular coordinate system.2) K axis shows the chainages. The points located on the same vertical line naturally will have the same chainages. All distances used in the calculations must be in horizontal plane.3) H shows the point heights. All distances used in the calculations must be in vertical plane. 4) All computations are carried out in stages. The number and the quality of the input values obtained as 1st, 2nd and 3rd group values should be good enough to achieve an unique solution for the stage calculation of a vertical geometry. If the number and the quality of the values are not suitable, the calculations can not be done.  In case of having the number of the initial data more than required number, the obtained results are different depending on the calculation method used. The contradictions adverting to the real value concept as a result of these computations must be prevented. The both methods, approximate solution and the exact solution, were applied to the profile data of sag and crest vertical curves to point out differences between two methods and the initial data. Two points are taken as an initial data on every curve and straight line for each. Nowadays, approximate solutions are not necessary due to the recent developments in computer technology. In addition, for the railroads and high standard roads the level of calculation precision should be in millimeter. For these reasons, the exact solutions are more suitable instead of approximate solutions. In this paper, equations of exact solution of vertical curves are evaluated and the solutions are explained. Differences of project heights and kilometers obtained from approximate and exact solutions are having been shown on a sample route. Keywords: Circular curves, route, circle, parabola, circular route design

Role of tobacco exposure in the course of COVID-19 disease and the impact of the disease on smoking behavior

Background The effect of COVID-19 on smoking behavior is not fully known. Studies evaluating the link between smoking and COVID-19 have controversial results. This study aims to evaluate patients' smoking status with COVID-19 and the effect of COVID-19 on smoking behavior. Methods Data were collected from 150 COVID-19 patients with a positive polymerase chain reaction test for SARS-CoV-2 between 11 March 2020 and 15 May 2020 in Rize, Turkey. Patients were interviewed by phone calls 2 months after their recovery. After 9 months, a follow-up was performed for those who quit smoking. Results Of the participants, 19 (12.7%) were current smokers before the COVID-19 diagnosis, and 15 (78.9%) of them stated that they quit smoking after their diagnosis. After nine months of follow-up, 11 of those 15 participants (57.8%) sustained abstinence. Conclusion Smoking cessation rates are high in people with COVID-19. Besides, the frequency of sustaining abstinence in the long term was also high in these individuals. The COVID-19 pandemic should be viewed as an open opportunity to strengthen and prioritize smoking cessation activities

Normal over rezervi olan ve long protokol uygulanan İVF hastalarında rekombinant fsh ve yüksek derecede saflaştırılmış hmg kullanımının gebelik sonuçlarına etkisinin karşılaştırılması]

Objective: Gonadotropins used in controlled ovarian stimulation have been increasing in number. Beside the recombinant preparations such as rec-FSH, rec-LH and h-hMG human-derived preparations have entered the market. We decided to compare the effects of rec-FSH and HP-hMG with GnRHa on embryo quality and pregnancy outcome in women undergoing an IVF cycle. Material and Methods: In this study, data of 87 patients who had applied to our center from 2007 to 2008 and who had met all inclusion criteria, were analyzed. The patients underwent controlled ovarian hyperstimulation with HP-hMG, rec-FSH following down-regulation with a GnRHa in a long protocol, selected according to determined criteria and acquired embryo via IVF transfer. Results: Of the 87 patients, 44 were stimulated with rec-FSH and 43 with HP-hMG. Distribution of infertility causes was similar between the groups. Duration of gonadotropin administration (p=0.677, Student's t-test) and the total dose of gonadotropin received (p=0.392, Student's t-test) were similar between the two groups. The fertilization rate of the rec- FSH group was significantly higher than the HP-hMG group (p=0.001, Mann-Whitney U test). No significant differences were observed between the study groups in biochemical, clinical and ongoing pregnancy parameters. Conclusion: The higher oocyte yield with rec- FSH does not result in higher quality embryos. LH activity in combination with FSH activity positively affected the oocyte and embryo maturation. Therefore, when we consider the clinical and ongoing pregnancy rates there is no inferiority of HP-hMG in controlled ovarian stimulation

Evaluating vaccine rejection during COVID-19 pandemic

Amaç: Aşılar, tıbbın insanlığa sağladığı en büyük başarılar arasında olup bugüne kadar milyonlarca kişinin yaşamını kurtarmıştır. Ülkemizde 2017 yılında 23 binden fazla aile aşı reddi talebinde bulunmuştur. Geçmişte salgın hastalıkların yıkıcı etkilerinin pek çok sosyal, coğrafi, ekonomik, kültürel etkilere yol açtığı gözlenmiştir. Bu çalışmada amacımız; COVID-19 pandemisi sırasında Türkiye’de normalleşme sürecinin başlaması sonrasında, geçmişte çocuklarına aşı yaptırmayan ebeveynler ile görüşerek aşı reddi oranlarında bir değişiklik olup olmadığını değerlendirmektir. Gereç ve Yöntemler: Kesitsel tipteki bu araştırmada aşı reddinde bulunan aileler telefon ile aranarak onayları alındıktan sonra anket çalışması gerçekleştirilmiştir. Görüşmeler, ülkemizde “normalleşme sürecinin” başlangıcı olan Haziran 2020 sonrasında gerçekleştirilmiş, ailelerin aşı reddine ilişkin görüşlerinin COVID-19 pandemisinden etkilenip etkilenmediği araştırılmıştır. Bulgular: Aşı reddinde bulunan 82 aile çalışmaya katılmayı kabul etmiş ve anket gerçekleştirilmiştir. Hepatit A aşısı ret oranının (%6,5) diğer aşılara göre yüksek, Hepatit B aşısı ret oranının (%2,1) ise diğer aşılara göre düşük olduğu belirlenmiştir. Aşı reddi için en sık sebep “içeriğine güvenmeme” (%43) olarak gözlenmiştir. Ailelerin tamamı COVID19 pandemisi kontrol önlemleri kapsamında normalleşme sürecine geçilmesi sonrasında da çocuklarına aşı yaptırmayı düşünmediklerini belirtmiştir. Çocuklarına aşı yaptırmayan ebeveynlere “COVID-19 aşısı olsa kendinize yaptırır mısınız” sorusu sorulduğunda %35,7’si olumlu yanıt vermişlerdir. Sonuç: Çalışmamızda COVID-19 pandemisi için ülkemizde normalleşme sürecine geçilmesi sonrasında ailelerin çocuklarına aşı yaptırma konusunda fikirlerinin değişmediği gözlenmiştir. Aşıların bireysel ve toplumsal faydaları düşünüldüğünde aşı ret oranlarını azaltmaya yönelik çalışmaların önemi ortaya çıkmaktadır.Aim: Vaccines are one of the most tremendous medical success in human history and have saved millions of people until this day. There are more than 23 thousand families who had rejected vaccines in our country in 2017. Outbreaks caused numerous social, geographic, economic, and cultural devastations in the past. This study aims to reveal the change in the ratio of people who refused vaccines after the COVID-19 pandemic. Material and Methods: This cross-sectional study was conducted via phone interviews with families who rejected vaccines by calling the people who refused to use vaccines after they agreed to join the study. The talks have been made after June 2020, which is also the starting of “normalization process” in our country. It is researched whether the patients' relatives' decisions have been changed during COVID-19.. Results: 82 families who refuse to vaccine their children accepted to join the study. Refusing rate for Hepatitis A (6.5%) vaccine was higher among other vaccines, and refusing rate for Hepatitis B (2.1%) vaccine was lower among all vaccines. Of the reasons for refusing vaccines, “Not trusting the substance” (43%) was higher than other causes. When it is asked parents, who refused to vaccines for their children “Do you use for yourself if a vaccine for a COVID-19 invented?” 37.7% of the participant gave an affirmative answer. Conclusion: At the end of our study, we concluded that the parents' thoughts about vaccines for their children have not changed after the pandemic of COVID-19. Taking direct, indirect, and protective effects of vaccines into consideration on individuals, the importance of studies about decreasing the refusal of vaccines becomes significant

Children in 2077: Designing Children’s Technologies in the Age of Transhumanism

What for and how will we design children’s technologies in the transhumanism age, and what stance will we take as designers? This paper aims to answer this question with 13 fictional abstracts from sixteen authors of different countries, institutions and disciplines. Transhumanist thinking envisions enhancing human body and mind by blending human biology with technological augmentations. Fundamentally, it seeks to improve the human species, yet the impacts of such movement are unknown and the implications on children’s lives and technologies were not explored deeply. In an age, where technologies can clearly be defined as transhumanist, such as under-skin chips or brain-machine interfaces, our aim is to reveal probable pitfalls and benefits of those technologies on children’s’ lives by using the power of design fiction