Myocardial Infarction in Children

Myocardial infarction (MI) is a clinical condition that develops associated with a sudden reduction or interruption of the blood flow of the vessels supplying the heart for various reasons. The electrocardiographic, echocardiographic and enzymatic diagnostic criteria of MI have been well defined in adults, in children there are some difficulties. Although seen more often in the presence of congenital heart disease (CHD), MI may also be seen in patients without CHD. Unlike atherosclerotic coronary artery disease in adult patients, ischaemia and infarct in children are often associated with coronary artery anomalies and CHD. In addition, congenital prothrombotic diseases, vasculitis, surgical or interventional procedures may also cause ischaemia and infarct. Subendocardial ischaemia, especially aortic stenosis characterised by hypertrophy in the left ventricle is often seen in hypertrophic cardiomyopathy or hypertensive patients. The most important risk factors in neonates and infants are the presence of CHD, coronary artery anomalies and perinatal asfixia. The most frequently seen causes of pediatric myocardial infarction (PMI) are abnormal left coronary artery originating from the pulmonary artery (ALCAPA) and Kawasaki disease. Another often seen cause of PMI is patients who underwent arterial switch operations

Comparison of the methods of fibrinolysis by tube thoracostomy and thoracoscopic decortication in children with stage II and III empyema: a prospective randomized study

Today, in spite of the developments in imaging methods and antibiotherapy, childhood pleural empyema is a prominent cause of morbidity and mortality. In recent years, it has been shown that there has been an increase in the frequency of pleural empyema in children, and antibiotic resistance in microorganisms causing pleural empyema has made treatment difficult. Despite the many studies investigating thoracoscopic debridement and fibrinolytic treatment separately in the management of this disease, there is are not enough studies comparing these two treatments. The aim of this study was to prospectively compare the efficacy of two different treatment methods in stage II and III empyema cases and to present a perspective for treatment options

Procjena aktivnosti sanacijske sječe nakon požara u mediteranskom području Turske

Various problems such as massive volume loss, erosion, degradation of water resources, and air pollution emerge after forest fire incidents. Thus, necessary forest operations should be quickly planned and implemented after forest fires so that afforestation activities can take place immediately to maintain forest vegetation in burned areas. The aim of this study was developing a Post-fire Action Planning (PFAP) model to minimize the time spent on salvage logging activities. PFAP model will assist decision makers for removing salvage timber in a timely manner after large scale forest fires, while considering economic and environmental constraints, and dealing with available employment conditions in local forest industry. The capabilities of this model were examined by standardizing the operational planning and developing a fast decision-making process. The model was implemented in Taşağıl Forest Enterprise Chiefs (FEC) of Antalya Forest Regional Directorate where the forests are sensitivity to fire at the first degree level and the second largest forest fire in the history of Turkish Forestry occurred in this area in 2008. The findings of PFAP model were compared with the data of actual salvage logging operation obtained from the FEC. The results indicated that using operational planning based PFAP model is capable of reducing total time spent on salvage logging operation by about 60%. Based on the forestry compartments of the study area, estimated durations of salvage logging operations were 15 to 75 days less than that of actual operations taken place in the field. Therefore, it is highly anticipated that using operational planning based PFAP model has great potential to provide economically and environmentally sound forest operations after forest fires.Nakon šumskih požara nastaju različiti problemi, kao što je velik gubitak drvne mase, erozije tla, degradacija pitkih izvora vode te onečišćenje zraka. Neophodno je kvalitetno i učinkovito isplanirati i implementirati potrebne šumske operacije nakon šumskog požara, kako bi se odmah moglo započeti s pošumljavanjem u svrhu održanja šumske vegetacije u izgorenim područjima. Cilj ovoga istraživanja je bio razvoj modela planiranja aktivnosti nakon požara, kako bi se smanjilo vrijeme utrošeno na aktivnosti sanitarne sječe. Model planiranja aktivnosti nakon požara pomoći će donositeljima odluka u pravovremenom uklanjanju saniranih debla nakon velikih šumskih požara, uzimajući u obzir ekonomska i ekološka ograničenja te rješavajući mogućnost zapošljavanja u lokalnoj drvnoj industriji. Mogućnosti ovoga modela provjerene su pomoću standardizacije operativnog planiranja i razvoja procesa brzog donošenja odluka. Model je implementiran u šumariji Taşağıl Regionalne uprave za šume Antalya, gdje su šume svrstane u prvi stupanj opasnosti od požara te se drugi najveći šumski požar u povijesti Turske uprave za šume dogodio upravo na ovome području 2008. godine. Rezultati ovoga modela uspoređeni su s podatcima stvarnih sanacijskih sječa dobivenih od šumarija. Rezultati su pokazali da se korištenjem operativnog planiranja temeljem modela planiranja aktivnosti nakon požara može smanjiti ukupno vrijeme utrošeno na sanacijske sječe za 60%. S obzirom na različite šumske odjeljke u istraživanome području, procijenjeno trajanje sanacijske sječe bilo je 15 do 75 dana kraće od stvarnih operacija na terenu. Prema tome, očekuje se da korištenje operativnog planiranja temeljem modela planiranja aktivnosti nakon požara ima velik potencijal u osiguravanju ekonomski i ekološki korisnih šumskih radova nakon šumskih požara

Evaluating the Effects of Improving Forest Road Standards on Economic Value of Forest Products

Forest roads are the key infrastructures that provide access to forest areas for sustainable management, protection, and utilization of forest resources. In order to benefit from the important functions of forest roads, they should be built in with adequate technical road standards. The road network with low technical standards require more frequent major repairs to ensure continues access to forest resources. In addition, only small trucks with low load capacity can move on the low standard roads. Furthermore, the low road standards limit the truck speed that increases vehicle travel time. These negative effects increase the transportation costs which are an important part of the timber production costs in Turkey. Thus, improving the road standards and developing forest transportation planning should be evaluated together in the most appropriate way. Large logging trucks with high load capacity are generally preferred for efficient transportation of wood-based forest products. In Turkey, large logging trucks, however, cannot operate on the most of the forest roads because insufficient technical road standards (road width, curve radius, surface materials, road structures) limit the maneuverability of large logging trucks. In this study, the objective is to determine the effects of improving forest road standards on total net profit of forest products by using the NETWORK 2000 program, a heuristic approach for solving forest transportation problems. Three Forest Enterprise Chiefs (FECs) located in Mustafakemalpaşa Forest Enterprise Directorate (FED) in Bursa Forest Regional Directorate were selected as the study area. The digital data layers for forest road network was generated by using ArcGIS 10.4 software. In the solution process, firstly, the optimum routes that minimize the transportation cost and maximize the total net profit of forest products on existing forest road networks were investigated for a truck type (15 ton) currently used in the region. In the second case, forest transportation was planned for the high load capacity truck (29 ton) moving on the forest roads with improved standards. In the first case, the transportation costs and annual major repair costs were considered in the calculation of the net profit of forest products, while one time cost of road improvement activities (i.e. road improvement construction, road structure installation, road surface construction) and annual maintenance costs were considered along with transportation costs in the second case. In both cases, the costs of other forest operations (i.e. felling, logging, etc.) were not considered since it was assumed that they do not vary with the forest transportation alternatives. As a result of the transportation plan developed for high load capacity truck, the annual transportation cost decreased by 46.85% comparing to the local logging trucks with low load capacity. Using improved road standards, the total road costs computed for the time period of 30 years (i.e. the average expected life cycle of forest roads) were reduced by 4.64%. The total net profit of forest products transported by using a high load capacity truck was 473 340 Euro more than that of using low load capacity truck on the existing forest road network. Thus, improving road standards might result in some additional costs in the road construction stage, but total net profit of forest products increase since transportation costs along with maintenance and repair costs considerably decrease in the long term

TURKISH JOURNAL of ONCOLOGY Gastrointestinal Stromal Tumors: A Single Center Experience

OBJECTIVE Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumor of the gastrointestinal (GI) tract. The aim of this retrospective study was to explore the characteristics, prognostic factors, and treatment results of GIST cases. METHODS Clinical and pathological data of 35 GIST patients at our center between 2002 and 2015 were reviewed. RESULTS Total of 18 (51.4%) were women and 17 (48.6%) were men, with median age of 54 years. Common site of tumor was stomach (48.6%). Abdominal pain (37.1%) was common clinical symptom. Risk group distribution was 8.6% low, 31.4% intermediate, and 60% high-risk cases. Mean follow-up period of the patients was 34 months. Low-risk GIST can be treated with surgery alone. Recurrence was observed in only 1 of 10 patients who received adjuvant treatment. All 6 patients in whom metastasis was determined were in high-risk group, and 4 of them had liver metastasis. Metastasis was not detected in any of the patients who had <5 mitoses per 50 high-power field (HPF), but in 5 of 12 patients who had >10 mitoses per 50 HPF, metastasis was determined. Metastasis did not correlate with site or size of tumor, but was related to high mitotic rate (p=0.015). Median overall survival of the patients was 79 months. CONCLUSION Low-risk GIST can be treated with surgery alone. Imatinib therapy significantly improves survival of high-risk or advanced-stage GIST patients. Metastasis did not correlate with site or size of tumor, but correlation with high mitotic rate was observed

The comparison of local tumor control after microwave ablation, surgical resection and combined treatment for colorectal liver metastases

Aim. We aimed to compare the local therapeutic efficiency of microwave ablation (MWA), surgical resection, and combined treatment, assess the outcomes, and identify predictive factors for local treatment response in colorectal liver metastases (CLMs). Methods. From March 2013 to September 2019, a total of 54 patients with 302 CLMs were enrolled in this retrospective study. Eleven patients (20.4%) were treated with MWA, 9 patients (16.7%) with surgery, and 34 patients (63%) with the combined method. Univariate and multivariate analyses were performed to investigate overall survival (OS) and hepatic progression-free survival (HPFS) using the Cox proportional hazard regression model. The logistic regression analysis was used to identify the predictive factors for the local treatment response. Results. Total treatment response was achieved in 46.3% (n=25) of the patients. Local tumor progression was seen in 7.4% (n=4) of the patients, and the rate of intrahepatic distal recurrence was 46.3% (n=25). There were no significant differences in HPFS and OS between the three groups (p=0.56 and 0.90, respectively). Younger age

Rehabilitation for Addicted Patients: Erenköy BAHAR Model

Rehabilitation is any action taken on an individual who has lost their physical or mental capabilities due to a disease or accident to recover their health or improve their capabilities in physical, mental, psychological, social and economic terms within their limitations. Rehabilitation application is divided into medical, social, occupational and psychiatric rehabilitation categories. Main purpose of rehabilitation application for addicted patients is the cessation of drug use in order to begin dealing with the psychological, legal, economic, social and physical damages done of the patients. The purpose of this study is to share several rehabilitation models applied on addicted patients of several countries, and to provide up-to-date knowledge on the development of rehabilitation models applied on addicted patients in our country with a relatively topical application example. In the practice of rehabilitation for addicted patients, we share the capacity and procedural operations, two years of research data and the experiences of what we believe is an important model for our country, the Erenköy Bağımlı Hastalar İçin Rehabilitasyon (BAHAR) Center’s model, for their individualized and integrated approach in recovery. The Center’s rehabilitation programs are cascaded into adaptation program, 0 to 3, 3 to 6, and 6 to 12 months long programs. In Erenköy BAHAR Center, patients’ recoveries in medical and spiritual sense were observed; and positive developments in social standing, family relations and occupational and social roles were recorded. It is seen that this center’s treatment methods for addiction are crucial for individual’s general wellbeing and functionality recovery, thus giving rise to the thought of establishing similar centers in our country. In conclusion, rehabilitation for addicted patients in our country is an emerging field and it requires more effort

The impact of hybrid capture-based comprehensive genomic profiling on treatment strategies in patients with solid tumors

Objective: The development of bioinformatics and comprehensive genomic profiling (CGP) has provided insights into the ap-plicability and functionality of the genomic alterations (GA). In this study, we evaluated the impact of CGP on the treatment plan and outcomes in a significant number of patients. Material and Methods: We carried out a retrospective case-control study on 164 adult patients with advanced solid tumors from 15 oncology centers in Türkiye. Results: In all cases, CGP was performed within 23.8 [standard deviation (SD)±32.1] months of initial diagnosis. Non-small cell lung carcinoma, breast cancer, unknown primary carcinoma, colorectal carcinoma, and sarcoma were among the most common tumor types, accounting for 61.5% of all cases. CGP was performed immediately after the diagnosis of advanced cancer in 13 patients (7.9%). In 158 patients (96.4%), at least one GA was found as per the CGP report. Also, in the reports, the average tumor mutational burden (TMB) and GAs were 7.3 (SD±8.7) mut/Mb and 3.5 (SD±2.0), respectively. According to CGP reports, 58 patients had 79 evidence-based drug suggestions for their particular tumor type, whereas 97 patients had 153 evidence-based drug suggestions for another tumor type. After the primary oncologist interpreted the CGP reports, significant changes were made to the treatment of 35 (21.3%) patients. Conclusion: We strongly believe that in the future, high-TMB or other tumor-agnostic biomarkers will become much more afford-able, and CGP will serve as one of the major decision-making tools for the treatment of patients along with pathological, radiological or lab-oratory tests

Crizotinib efficacy and safety in patients with advanced NSCLC harboring MET alterations: A real-life data of Turkish Oncology Group

Crizotinib is a multikinase inhibitor, effective in non-small cell lung cancer (NSCLC) harboring mesenchymal-epidermal transition (MET) alterations. Although small prospective studies showed efficacy and safety of crizotinib in NSCLC with MET alterations, there is limited real-life data. Aim of this study is to investigate real-life efficacy and safety of crizotinib in patients with advanced NSCLC harboring MET alterations. This was a retrospective, multicenter (17 centers) study of Turkish Oncology Group. Patients' demographic, histological data, treatment, response rates, survival outcomes, and toxicity data were collected. Outcomes were presented for the study population and compared between MET alteration types. Total of 62 patients were included with a median age of 58.5 (range, 26-78). Major histological type was adenocarcinoma, and 3 patients (4.8%) had sarcomatoid component. The most common MET analyzing method was next generation sequencing (90.3%). MET amplification and mutation frequencies were 53.2% (n = 33) and 46.8% (n = 29), respectively. Overall response rate and disease control rate were 56.5% and 74.2% in whole study population, respectively. Median progression free survival (PFS) was 7.2 months (95% confidence interval [CI]: 3.8-10.5), and median overall survival (OS) was 18.7 months (95% CI: 13.7-23.7), regardless of treatment line. Median PFS was 6.1 months (95% CI: 5.6-6.4) for patients with MET amplification, whereas 14.3 months (95% CI: 6.7-21.7) for patients with MET mutation (P = .217). Median PFS was significantly longer in patients who have never smoked (P = .040), have good performance score (P < .001), and responded to the treatment (P < .001). OS was significantly longer in patients with MET mutation (25.6 months, 95% CI: 15.9-35.3) compared to the patients with MET amplification (11.0 months; 95% CI: 5.2-16.8) (P = .049). In never-smokers, median OS was longer than smoker patients (25.6 months [95% CI: 11.8-39.3] vs 16.5 months [95% CI: 9.3-23.6]; P = .049). The most common adverse effects were fatigue (50%), peripheral edema (21%), nausea (29%) and diarrhea (19.4%). Grade 3 or 4 adverse effects were observed in 6.5% of the patients. This real-life data confirms efficacy and safety of crizotinib in the treatment of advanced NSCLC harboring MET alteration