Drug Induced Thrombotic Microangiopathy with Certolizumab Pegol

Background: Certolizumab pegol is used to treat ankylosing spondylitis, Crohn’s disease, psoriatic arthritis, and rheumatoid arthritis. Unlike other monoclonal antibodies such as infliximab and adalimumab, certolizumab does not contain an Fc fraction and hence does not induce complement activation. In this report, we describe the case of a patient with thrombotic microangiopathy caused due to certolizumab pegol, with a brief description about the pathophysiological approach to thrombotic microangiopathy. Case Report: A-39-year-old man suffering from ankylosing spondylitis for the past 10 years presented with fatigue. He had been on certolizumab pegol treatment for 6 months, starting with 400 and 200 mg every 2 weeks. He had significant nonimmune hemolytic anemia and thrombocytopenia without a disseminated intravascular coagulopathy. Schistocytes were observed in more than 10% of the erythrocytes per field. Plasma exchange along with corticosteroid treatment was started. There was a dramatic improvement within a week, and after 10 sessions of plasma exchange, the patient was discharged on corticosteroids with a tapering plan. ADAMTS13 enzyme activity was determined to be normal. Conclusion: The development of drug-induced thrombotic microangiopathy may be either immune-mediated or dose-dependent toxicity-mediated Anti-drug antibodies and their immunological aspects are still unclear and yet to be elucidated

BİR TIP FAKÜLTESİ UYGULAMA VE ARAŞTIRMA HASTANESİNDE SERVQUAL METODU YARDIMIYLA SAĞLIK HİZMETİ ALAN MÜŞTERİLERİN BEKLENTİLERİNİN ANALİZİ

It is essential that the response of demand and expectations of customers in health care services given in a hospital. In this study, it is tried to measure patients (customers) satisfaction by using a model has been designed to determine the quality of service in a research and practice hospital in Konya. Servqual which is the common and efficient method in the way of measuring service quality is utilized. It is applied a questionarrie included 22 question in 5 dimensions at the 7 level of Likertscale.Sağlık hizmetlerinde, hizmet sunulan bir hastanede hizmeti alan müşterilerin talep ve beklentilerininkarşılanması esastır. Bu araştırmada bir üniversitenin tıp fakültesi uygulama ve araştırma hastanesinde ayakta tedavi hizmeti alan hastaların (müşterilerin) beklentileri analiz edilerek müşteri memnuniyeti ölçülmeye çalışılmıştır. Müşteri beklentilerinin analizinde, son yıllarda etkinbir şekilde kullanılan SERVQUAL (Service Quality)metodu kullanılmıştır.Müşterilerin hizmet algıları ile beklentilerinin arasındaki farkın irdelenmesi için yedili likert ölçeğinde beş boyutta ve 22 sorudan oluşan bir anket uygulanmıştır

A comparison of thoracic or lumbar patient-controlled epidural analgesia methods after thoracic surgery

BACKGROUND: We aimed to compare patient-controlled thoracic or lumbar epidural analgesia methods after thoracotomy operations. METHODS: One hundred and twenty patients were prospectively randomized to receive either thoracic epidural analgesia (TEA group) or lumbar epidural analgesia (LEA group). In both groups, epidural catheters were administered. Hemodynamic measurements, visual analog scale scores at rest (VAS-R) and after coughing (VAS-C), analgesic consumption, and side effects were compared at 0, 2, 4, 8, 16, and 24 hours postoperatively. RESULTS: The VAS-R and VAS-C values were lower in the TEA group in comparison to the LEA group at 2, 4, 8, and 16 hours after surgery (for VAS-R, P = 0.001, P = 0.01, P = 0.008, and P = 0.029, respectively; and for VAS-C, P = 0.035, P = 0.023, P = 0.002, and P = 0.037, respectively). Total 24-hour analgesic consumption was different between groups (175 +/- 20 mL versus 185 +/- 31 mL; P = 0.034). The comparison of postoperative complications revealed that the incidence of hypotension (21/57, 36.8% versus 8/63, 12.7%; P = 0.002), bradycardia (9/57, 15.8% versus 2/63, 3.2%; P = 0.017), atelectasis (1/57, 1.8% versus 7/63, 11.1%; P = 0.04), and the need for intensive care unit (ICU) treatment (0/57, 0% versus 5/63, 7.9%; P = 0.03) were lower in the TEA group in comparison to the LEA group. CONCLUSIONS: TEA has beneficial hemostatic effects in comparison to LEA after thoracotomies along with more satisfactory pain relief profile

Genetic Diagnosis of Hereditary Hemorrhagic Telangiectasia: Four Novel Pathogenic Variations in Turkish Patients

Aims: Hereditary hemorrhagic telangiectasia is an autosomal dominant disorder characterized by telangiectasia, epistaxis, and vascular malformations. Pathogenic mutations were found in ENG, AVCRL1, SMAD4, and GDF genes. In this study, we present our database of patients with hereditary hemorrhagic telangiectasia regarding the phenotype-genotype relations and discuss two novel ENG gene pathogenic variations in two unrelated families. Methods: Next Generation Sequencing analysis was performed on the peripheral blood of nine patients with hereditary hemorrhagic telangiectasia in four unrelated families. All patients were diagnosed with hereditary hemorrhagic telangiectasia according to the Curaçao criteria. Data on treatment and screenings of visceral involvement were recorded from files. Results: We have found a pathogenic variation in either the ENG or ACVRL1 gene in each family. Two novel pathogenic variations in the ENG gene, including NM_000118.3 (ENG): c.416delC (p.P139fs*24) and NM_000118.3(ENG): c.1139dupT (p.Leu380PhefsTer16), were found in the same family. The NM_000020.2(ACVRL1): c.1298C>T (p.Pro433Leu) pathogenic variation in the ACVRL1 gene in our first family and a novel heterozygous likely pathogenic NM_000020.2(ACVRL1): c.95T>C (p.Val32Ala) variation was found in our second family. Seven of the nine patients were treated with thalidomide for controlling bleeding episodes. All patients responded to thalidomide. In one patient, the response to thalidomide was lost and switched to bevacizumab. Conclusion: In hereditary hemorrhagic telangiectasia, certain types of mutations correlate with disease phenotypes and with next generation sequencing methods. New pathogenic variations can be revealed, which might help manage patients with hereditary hemorrhagic telangiectasi

Thermal degradation of oriental beech wood impregnated with different inorganic salts

This study investigated the thermal properties of Oriental beech (Fagus orientalis) treated with (NH4)2HPO4, K2HPO4, NH4Cl and (NH4)2SO4 salts and their mixtures (1:1; w/w) aqueous solutions at 3% concentrations. The effects of different inorganic salts fire retardants on the thermal degradation characteristics of wood samples were evaluated by thermogravimetric analysis (TGA). Based on the TGA curve for untreated beech wood, weight loss takes place at three distinct steps. The impregnation of inorganic salts resulted in higher char yields and additional thermal degradation steps were identified. The highest char yield (80%) was obtained from (NH4)2HPO4-K2HPO4 mixture impregnated sample.  Salt mixtures containing phosphates ((NH4)2HPO4 and K2HPO4) have remarkable effects on thermal stability of beech wood, whereas NH4Cl salt lowered the decomposition temperatures and char yield. &nbsp

Could ratio of hemoglobin to red cell distribution width and ratio of absolute lymphocyte count to absolute monocyte count be a prognostic tool in newly diagnosed multiple myeloma patients?

IntroductionHemoglobin/red cell distribution width (RDW) ratio (HRR) and lymphocyte-to-monocyte ratio (LMR) are two novel bio-markers associated with overall survival (OS) and prognosis in several types of cancers. The aim of this study is to investigate the value of HRR and LMR in newly diagnosed multiple myeloma (MM) patients. MethodsA total of 180 patients were included in this study. Patients diagnosed with MM between May 2013 and May 2019 at a single center were evaluated. HRR was calculated by dividing hemoglobin to RDW, both measured from the same sample. LMR was calculated by dividing absolute lymphocyte count (ALC) to absolute monocyte count (AMC). ResultsThe cutoff value for HRR was taken as 0.61, and the cutoff value for LMR was taken as 3.28. Patients were divided into low HRR, high HRR, low LMR, and high LMR groups. OS of the patients with low HRR was found lower compared with high HRR (36.7 months for low HRR and 53.2 months for high HRR, < 0.001). Also, OS was found lower in the low LMR group (39.4 months for low LMR and 51.7 months for high LMR, = 0.016). On multivariate analysis, low HRR and low LMR were predictive factors of OS (hazard ratio (HR) 2.08, 95% confidence intervals (CI) 1.31–3.03, and = 0.002 for low HRR; HR 1.47, 95% CI 0.92–2.29, and = 0.010 for low LMR). ConclusionCombining both HRR and LMR could be a prognostic biomarker and it reflects the status of the immune system in newly diagnosed MM patients

The Effect of Unilateral Posterior Transverse Cordotomy on Quality of Life of Patients with Bilateral Vocal Fold Paralysis

Objective:The aim of this study was to investigate the effect of unilateral transverse posterior cordotomy on the quality of life of patients with bilateral vocal fold paralysis.Methods:This study included 19 patients with bilateral vocal fold paralysis who underwent unilateral transverse posterior cordotomy between 2007 and 2012. Assessment of preoperative and postoperative quality of life of the patients was performed using the Short Form-36 (SF-36) quality of life survey.Results:The etiology of bilateral vocal fold paralysis was thyroid surgery in 18 patients. It was idiopathic in 1 patient. Cold knife was used in 12 patients and CO2 laser was used in 7 patients for posterior cordotomy. Acute upper airway obstruction developed in 1 patient who required tracheotomy. No other significant complications have been noted. We found a statistically significant improvement in all SF-36 subscale scores postoperatively (p<0.05).Conclusion:Unilateral posterior transverse cordotomy either by using cold knife or CO2 laser is a safe surgical procedure and improves the quality of life of patients with bilateral vocal fold paralysis

CD11b Expression in Acute Myeloid Leukemia is Associated With Hemostatic Complications and Response to Treatment

Aim:In our study, we aimed to investigate the effects of CD11b expression on myeloblasts on clinical course and prognosis in patients with AML.Materials and Methods:Data of 123 patients diagnosed with AML between 2014-2017 in Trakya University Faculty of Medicine, Department of Hematology, a tertiary referral hospital in the Trakya Region, were evaluated in a retrospective manner. The diagnosis of AML was based on WHO 2016 criteria of Myeloid Neoplasms.Results:Of the 123 patients in our study, 60 were female, and 63 were male. The mean age was 57.93 years. CD11b positivity was observed in 40 patients. Platelet counts were significantly lower in patients with CD11b positivity (p = 0.004). Likewise, D-dimer levels at presentation were higher in the CD11b positive patient group (p = 0.000). Regarding outcomes, patients with CD11b positivity were found to have lower rates of remission with first-line remission induction therapy (p = 0.003). There was no significant relationship between CD11b positivity and overall survival with Kaplan Meier survival analysis (8.5 months in CD 11b positive group, 12.1 months in negative group, p: 0.436).Conclusion:Our study demonstrated that patients with CD11b expression had lower remission rates with remission induction chemotherapy

Eber Lake Sub-Basın Groundwater Modelıng In Computer Support

This study is the province of Afyon, located within the boundaries of the basin north of Akarçay Mountains and south of Emir Sultan Mountains, 967 meters from the sea and the surrounding area, which includes Lake Eber. Eber lake and the surrounding groundwater flow modeling Groundwater Modeling System (GMS) program was created. Used in the model, and the borders of well logging, land topographic heights, hydrological and geological features of the land, whether there will be transferred to the program calculated. Eber lake located in a closed basin of our field work performed numerical modeling of groundwater budget was calculated. Three-dimensional modeling was carried out of the lake. Finite difference method, with the assumption that the study area and the steady flow of 2002 is modeled on the basis of hydrological observations. The modeling is based on the cross-section of land in any part of the underground water level is visualized. Groundwater as a result of the study of the results obtained will contribute to planning by providing information about the budget.Bu çalışma Afyon ili Akarçay havzası sınırları içinde bulunan kuzeyinde Emir Dağları ve güneyinde Sultan Dağları ve denizden 967 metre yükseklikte olan Eber gölü ve çevresini kapsamaktadır. Eber gölü ve çevresine ait yeraltı suyu akım modellemesi Groundwater Modeling System (GMS) programında oluşturulmuştur. Modelde kullanılacak kuyu logları ve kotları, arazinin topoğrafik yükseklikleri, arazinin hidrolojik ve jeolojik özellikleri, temin edilip hesaplanarak programa aktarılmıştır. Kapalı bir havza içinde bulunan Eber gölü çalışma alanımızın sayısal modelleme yapılarak yeraltı suyu bütçesi hesaplanmıştır. Gölün üç boyutlu modellemesi yapılmıştır. Çalışma alanı sonlu farklar yöntemiyle ve kararlı akım varsayımı ile 2002 yılı hidrolojik gözlemleri esas alınarak modellenmiştir. Yapılan modelleme üzerinde arazinin herhangi bir yerinden kesit alınarak yeraltı su seviyesi görselleştirilmiştir. Çalışmanın sonucu olarak elde edilen sonuçların yeraltı su bütçesi hakkında bilgi vererek planlamaya katkıda bulunacağı düşünülmektedir

Fiction, narrator and narrative techniques in Namık Kemal's pieces

Tiyatro; oyun, oyuncu, sahne, izleyici gibi çeşitli unsurlardan oluşan bir sanattır. Aynı zamanda dramatik metin, oyunculuk, sahneleme, sahne tasarımı, sahne giysisi, sahne müziği, ışıklama ve sahne tekniği öğelerinin tümünü birlikte içeren sanatsal etkinliktir. Kökeni antik çağlara dayanan tiyatronun edebi bir boyutu da vardır; belli bir zaman diliminde, seyirci karşısında sahnelenmek amacıyla yazılan piyesler tiyatronun edebi boyutunu oluşturmaktadır. Yaşadığı yıllarda topluma yarar sağlamayı amaçlayarak yazmış olduğu piyesleriyle ve sanatsal üretimiyle Namık Kemal, tiyatro alanında "öncü" bir yazardır. Batı etkisinde gelişim gösteren Türk tiyatrosunun ilk yazarları içinde yer alan Namık Kemal, tiyatro türüne ayrı bir önem vermiştir. Tiyatro tarihimizi tamamlayan kuramsal tiyatro bilgilerini de bizlere aktaran ilk kişi olan yazar, altı piyes yazmıştır. Vatan yahut Silistre (1873) yurtseverlik ve kahramanlık konulu bir piyestir. Zavallı Çocuk'ta (1873) görücü yoluyla evlenmeye karşı çıkmış ve bu tür evliliklerin doğurabileceği felaketleri anlatmıştır. Akif Bey'de (1874) saf, iyi niyetli, yurtsever bir deniz subayını anlatmıştır. Gülnihâl'de (1875) baskıya ve zulme karşı duyduğu tepkiyi dramatik bir biçimde dile getirmiştir. Celâlettin Harzemşah'ta (1876) ise Harzemşahlar Devleti'nin son hükümdarı Celâleddin Harzemşah'ın hayatını, kahramanlığını ve Moğollara karşı Türk-İslâm dünyasını korumak için giriştiği mücadele anlatılmıştır. Kara Bela (1910) ise saray hayatı ve entrikalarını konu almaktadır. Edebî eserlerin içeriğinin önemi kadar bu içeriğin sunuluş şekli de oldukça önemlidir. Yazarın olay ya da eylemleri birbirine bağlayarak oluşturduğu kurgu ve konunun sunumunda kullandığı anlatım teknikleri, edebî eserin içerik-biçim uyumunu yakalaması açısından değerlidir. Diyalog ve monologlar üzerine kurulu olan piyeslerde yazarların karakterlerin hareketlerini, ruh hâllerini, ses-ışık gibi bilgileri diyalogların dışında vermesi gerekmektedir. Bazen de okuyucu ve seyirci ile iletişim kuran, onlara oyun hakkında bilgiler veren bir kişiye ihtiyaç duymaktadır. Tiyatronun edebî boyutunu oluşturan piyeslerde yazar bu ihtiyacını gidermek için anlatıcıdan yararlanmaktadır. Çalışmamıza konu olan Namık Kemal'in tiyatro eserleri tezimizde giriş ve sonuç bölümleri hariç üç ana başlık altında incelenmiştir. Kurgu, anlatıcı ve anlatım teknikleri unsurların ele alınma biçimleri alt başlıklar altında değerlendirilmiştir. Çalışmamızın ikinci bölümünde Vatan yahut Silistre, Zavallı Çocuk, Gülnihâl, Celâleddin Harzemşah, Kara Bela ve Akif Bey "kurgu" bakımından incelenmiştir. Üçüncü bölümde bu eserler "anlatıcı" açısından incelenmiştir. Dördüncü bölümde ise aynı piyesler, "anlatım teknikleri" bakımından ele alınmıştır. Sonuç kısmında ise eldeki sonuçlar değerlendirilmiştir.Theatre is an art that consists of basic elements such as piece, actor, stage and audience. It is an artistic activity that includes all elements of dramatic text, acting, staging and stage design, dress, music, lighting and technique. Having its origins in ancient times, theatre has also a literary dimension; pieces written to be staged in front of the audience in a certain period of time constitute the very literary dimension of the theatre. With the pieces and artistic works produced with the aim of serving the society, Namık Kemal is a "pioneer" writer in the field of theater. Being one of the first writers of Turkish theater that evolved under the influence of the West, Kemal gave a special importance to the theater genre. He is the first person to convey the theoretical theater information that completes the Turkish theater history. Kemal wrote six pieces. His famous Vatan yahut Silistre (Homeland or Silistra) (1873) is a piece about patriotism and heroism. In Zavallı Çocuk (The Poor Child) (1873), Kemal opposed arranged marriage and described the disasters that such marriages can cause. In Akif Bey (Mr. Akif) (1874), he described a naive, well-intentioned, patriotic naval officer. In Gülnihâl (1875), he expressed his reaction to oppression and persecution in a dramatic way. In Celaleddin Harzemşah (1876), Kemal described Jalal al-Din Khwarazmshah's, the last ruler of the Khwarezmian Empire, life, heroism and struggle to protect the Turkish-Islamic world against the Mongols. In Kara Bela (Black Misfortune), the palace life and intrigues are told. In literary works, the way a content is presented is equally important as the content's importance. The fiction created by a writer by connecting events or actions and the narrative techniques used in the presentation of the subject are valuable in terms of capturing the content-form harmony of the literary work. In pieces based on dialogues and monologues, writers are supposed to give information such as the movements and moods of the characters or sound and light of the characters outside of the dialogues. Sometimes a person who communicates with the reader and the audience and gives them information about the piece might be needed. In the pieces that make up the literary dimension of the theatre, the writer uses the narrator to meet this need. Namık Kemal's theatrical works, which are the subject of our study, will be examined under three main headings, excluding the introduction and conclusion sections. The ways in which the elements to be examined will be handled will be evaluated under sub-headings. In the second part of our study, Vatan yahut Silistre, Zavallı Çocuk, Gülnihâl, Celâleddin Harzemşah, Kara Bela and Akif Bey will be examined in terms of "fiction." In the third part, these works will be examined in terms of "narrator." In the fourth part, the same pieces will be discussed in terms of "expression techniques." The results will be evaluated in the conclusion part