Retrospective comparison of hot forceps and hemoclip applications in upper gastrointestinal system bleeding

Giriş: Üst gastrointestinal kanama (ÜGİK), doktorlar tarafından en sık karşılaşılan acil durumlardan biridir. Yıllık insidans 100.000'de 133'tür. Peptik ülser hastalığı, tüm vakaların %31 ila %67'sinden sorumludur ve ÜGİK'nin en yaygın nedenidir. Bunun yanında diğer nedenler varis kanaması, eroziv hastalıklar, Mallory-Weiss yırtığı, Dieulafoy lezyonları, vasküler ektazi ve malignite olarak sıralanabilir. Tedavi genellikle asit baskılama ve endoskopik yöntemlerin kullanımına dayanır. ÜGİK tedavisinde kullanılabilecek endoskopik teknikler; enjeksiyon tedavisi, termal pıhtılaşma tedavisi, hemostatik klipsler, fibrin örtücü, argon plazma pıhtılaştırması ve bu sayılan tekniklerin herhangi biri ile epinefrin enjeksiyonu kombinasyonu yer almaktadır. Bununla birlikte, hangi yöntemin en iyi olduğuna ve seçim yöntemini oluşturması gerektiğine dair net bir kanıt yoktur. Endoskopistin kişisel tercihi, mevcut ekipman, lezyonun yeri ve özellikleri tedavi seçiminde rol oynar. Endoskopik HC, ÜGİK tedavisinde sıklıkla kullanılan mekanik bir tekniktir. Bu mekanik aparat kanayan lezyona ve periferik dokuya tutunarak tamponad ve hemostaz sağlar. Termal tedaviler ise vasküler yapılarda koagülasyon nekrozu ile daralma yaparak hemostaz sağlar. Üç ana tip termal temas cihazı vardır; çok kutuplu sondalar, ısıtıcı sondalar ve monopolar sondalar. Düşük maliyetli olan sıcak forseps (HF), monopolar hemostatik forsepse benzer şekilde çalışır. HF özellikle polipektomide ve endoskopik submukozal diseksiyonda (ESD) hemostaz sağlanmasında faydalıdır. Çalışmamızda ÜGİK tedavisinde HC ve HF'nin etkinliği ve maliyet etkinliğinin retrospektif karşılaştırmasını yaptık. Gereç ve Yöntem: Çalışma, Düzce Üniversitesi Eğitim Araştırma Hastanesi Gastroenteroloji ve İç Hastalıkları Anabilim Dalı'nda; Haziran 2017-Mart 2022 tarihleri arasında Gastroenteroloji ve İç Hastalıkları polikliniklerine başvuran hastalarla gerçekleştirildi. Hastalar araştırmaya katılmaya gönüllü olanlardan seçildi ve yazılı bilgilendirilmiş onam formu alındı. Üst gastrointestinal sistem kanaması olan hastalara endoskopi sırasında gereği halinde sıcak forseps veya hemoklip uygulamaları rutin olarak yapılmaktadır. Hastalar uygulanan endoskopik hemostatik yönteme göre iki gruba ayrıldı. HF grubu, sıcak forseps koagülasyon, HC grubu ise hemoklips uygulanan kişilerden seçildi. Primer hemostaz oranları, tekrarlayan kanama, transfüzyon gereksinimleri, hastanede kalış süreleri ve maliyetler iki grup arasında karşılaştırıldı. Acil servise ve/veya polikliniğe hematokezya ve/veya melena ve/veya hematemez nedeniyle başvuran hastalara gastroenterologlar tarafından tüm endoskopik prosedürler başvurudan sonraki 48 saat içinde gerçekleştirildi. Her hastada hemostaz yönteminin seçimi, kanamalı lezyonun konumuna, antiagregan ve antikoagülan kullanımına bağlı olarak, gastroenteroloğun kararına göre seçildi. Kalp hızı, kan basıncı ve hemoglobin düzeylerinin ilk stabilizasyonunu takiben 24 saat içinde, şok veya hemoglobin konsantrasyonlarında >2 g/dl azalma, taze hematemez veya melena yeniden kanamayı işaret eder olarak kabul edilmiştir. Bulgular: Hastaların demografik özellikleri açısından HC ve HF gruplarının karşılaştırma analizinde yaş ve cinsiyet homojendir. Her iki grupta işlem sonrası ilk 24 saatte hipotansiyon ve taşikardi gelişimi açısından yapılan karşılaştırma analizinde, anlamlı fark tespit edilmedi. HC ve HF tedavi gruplarında tekrarlayan kanama oranlarının arasında anlamlı fark bulunmadı. HC ve HF tedavi grupları arasında primer hemostaz oranları sırasıyla %83,33 ve %87,21 olarak saptandı (p=0,537). Her iki grupta hospitalizasyon süresi ortalama üç gün olarak tespit edildi (p=0,206). Maliyet açısından tedavi grupları karşılaştırıldığında, HC grubunda maliyet HF grubuna göre yüksek bulundu (p<0,001). Sonuç: Bu çalışma görece daha yeni olan HF tedavisinin HC kadar güvenli ve etkin olmasının yanı sıra maliyet etkinliği açısından HC'den üstün olduğunu göstermiştir. Bu bağlamda HF tedavisi uygun endikasyonda ÜGİK hastalarında kullanılabilir. Bu konuda daha geniş hasta sayısına sahip, prospektüs ve çok merkezli çalışmalara ihtiyaç vardır. Anahtar Kelimeler: Gastrointestinal kanama, sıcak forseps, hemoklips, endoskopiIntroduction: Upper gastrointestinal bleeding (UGIB) is one of the most common emergencies encountered by physicians. The annual incidence is 133 per 100,000. Peptic ulcer disease is responsible for 31% to 67% of all cases and is the most common cause of UGIC. In addition, other causes can be listed as variceal bleeding, erosive diseases, Mallory-Weiss tear, Dieulafoy lesions, vascular ectasia and malignancy. Treatment is generally based on acid suppression and the use of endoscopic methods. Endoscopic techniques that can be used in the treatment of UGIB; injection therapy, thermal coagulation therapy, hemostatic clips, fibrin sealant, argon plasma coagulation, and epinephrine injection combined with a different technique. However, there is no clear evidence as to which method is best and should constitute the method of choice. The endoscopist's personal preference, available equipment, location and the characteristics of the lesion play a role in treatment selection. Hemoclip (HC) and thermal therapy, alone or in combination with injection therapy, have been shown to prevent recurrent bleeding and surgical intervention more effectively than injection therapy alone. Endoscopic HC is a mechanical technique frequently used in the treatment of UGIB. This mechanical apparatus provides hemostasis by attaching to the bleeding lesion and peripheral tissue. Thermal treatments provide hemostasis by providing thermal vascular constriction. There are three main types of thermal contact devices; multipolar probes, heating probes and monopolar probes. The low-cost hot forceps (HF) work similarly to the monopolar hemostatic forceps. HF is particularly useful in providing hemostasis in polypectomy and endoscopic submucosal dissection (ESD). In this study, we performed a retrospective comparison of the efficacy and cost-effectiveness of HC and HF in the treatment of UGIB. Material and Method: The study was carried out in Düzce University Training and Research Hospital, Department of Gastroenterology and Internal Medicine; between June 2017 and March 2022. The patients were selected from those who volunteered to participate in the study and a written informed consent form was obtained. During endoscopy, hot forceps or hemoclip applications are routinely applied to patients with upper gastrointestinal bleeding, if necessary. The patients v were divided into two groups according to the endoscopic hemostatic method applied. The HF group was selected from people who underwent hot forceps coagulation, and the HC group was selected from people who underwent hemoclips. Primary hemostasis rates, recurrent bleeding, transfusion requirements, hospital stay and costs were compared between the two groups. All endoscopic procedures. Results: Demographic characteristics of the patients were similar betten the groups. The rates of hypotension and tachycardia in the first 24 hours after the procedure, şaş statistically not significant between the groups. There was no significant difference between the rates of recurrent bleeding in the HC and HF treatment groups. Primary hemostasis rates between HC and HF treatment groups were 83.33% and 87.21%, respectively (p=0,537). In both groups, the average hospitalization time was three days (p=0,206). The cost was higher in the HC group compared to the HF group (p<0,001). Conclusion: This study showed that the relatively newer HF therapy is as safe and effective as HC, as well as being superior to HC in terms of cost effectiveness. In this context, we recommend HF treatment in patients with UGIC in appropriate indications. We believe that our study will shed light on new research on this subject. Keywords: Gastrointestinal bleeding, hot forceps, hemoclips, endosco

Türkiye'nin ilk diyetisyenleri ve Türkiye'de diyetisyenliğin tarihçesi

Ankara : İhsan Doğramacı Bilkent Üniversitesi İktisadi, İdari ve Sosyal Bilimler Fakültesi, Tarih Bölümü, 2016.This work is a student project of the The Department of History, Faculty of Economics, Administrative and Social Sciences, İhsan Doğramacı Bilkent University.by Öztürk, İbrahim Mert

MDP monomer içeren adeziv sistemlerin rekabeti: Makaslama bağ dayanımlarının karşılaştırılması

Amaç: Bu in - vitro çalışmanın amacı MDP monomeri içeren üç farklı self- etch adeziv sistemin makaslam a bağ dayanımınlarını değerlendirmektir. Materyal ve Metod: Bu çalışma için atmış adet çekilmiş insan üçüncü molar dişl eri kullanlmıştır. Dişler bir elmas kesme diski yardımıyla ve su soğutması altında kron boylarının orta üçlülerine kadar kesilmiştir. Kesilen dişler rastgele üç gruba ayrılmıştır (n20). Ultradent Bonding Jig yardımıyla ve üç farklı MDP içeren self-etch ad eziv sis tem kullanılarak restorasyonlar yapılmıştır (2,30 mm çap ve 3mm yükseklik). Sonrasında örnekler test cihazına alınmış ve makaslama bağlanma değerleri ölçülmüştür. Bulgu lar: 1. Ve 2. Grup restorasyonlar, 3. Gruba göre anlamlı derecede daha yüksek ma kaslama bağ değeri gösterdi. (p0.05). Bunun yanında 1. Grubun 2. Gruba göre nispeten daha yüksek bağ değeri gösterdiği saptandı. Sonuç: Bu in -vitro çalışmanın sonuçlarına göre, bütün grupların optimal bağ değerlerigösterdiği saptandı. Ancak 1 . ve 2. Gruplar 3. Gruba oranla anlamlı derecede daha iyi bağlanma değerleri gösterdi.Aim: The aim of this in vitro study was to evaluate the shear bond strengths of three MDP monomer containing self-etch adhesive system s. Material and method: Sixty human third molars were used for the study. The teeth were sectioned with a low -speed diamond disk saw under water coolant to expose mid -coronal dentin. The teeth were randomly divided into three groups( n20). The restoration s (2.30mm diameter and 3mm heigh) builded with using three different MDP containing adhesive systems by aid of Ultradent Bonding Jig. After that, the specimens were placed in a universal testing machine and the shear bond strength was measured at a crosshe ad speed of 1 mm/min. Result : Group 1 and 2 showed significantly higher bond strength than group 3(p0.05) in spite of group 1 showed slightly higher bond strength values than group 2. Conclusion: Within the limitations of this in -vitro study, all groups showed optimal results but first and second adhesives showed significantly higher values than third group

Evaluation of whole blood thiamine pyrophosphate concentrations in critically ill patients receiving chronic diuretic therapy prior to admission to Turkish intensive care units: A pragmatic, multicenter, prospective study

Background/Objectives: Thiamine plays a pivotal role in energy metabolism. The aim of the study was to deter-mine serial whole blood TPP concentrations in critically ill patients receiving chronic diuretic treatment before ICU admission and to correlate TPP levels with clinically determined serum phosphorus concentrations.Subjects/Methods: This observational study was performed in 15 medical ICUs. Serial whole blood TPP concen-trations were measured by HPLC at baseline and at days 2, 5 and 10 after ICU admission. Results: A total of 221 participants were included. Of these, 18% demonstrated low TPP concentrations upon admission to the ICU, while 26% of participants demonstrated low levels at some point during the 10-day study period. Hypophosphatemia was detected in 30% of participants at some point during the 10-day period of observation. TPP levels were significantly and positively correlated with serum phosphorus levels at each time point (P < 0.05 for all).Conclusions: Our results show that 18% of these critically ill patients exhibited low whole blood TPP concen-trations on ICU admission and 26% had low levels during the initial 10 ICU days, respectively. The modest correlation between TPP and phosphorus concentrations suggests a possible association due to a refeeding effect in ICU patients requiring chronic diuretic therapy.Erciyes University Scientific Research Committee [THD-2020- 10295]; Turkish Society of Clinical Enteral & Parenteral Nutrition (KEPAN)Erciyes University Scientific Research Committee (THD-2020- 10295) and Turkish Society of Clinical Enteral & Parenteral Nutrition (KEPAN) to KG

Morphological, biochemical, and molecular evaluation of genetic diversity in different plum genotypes (Prunus domestica L.)

Plums have recently played a significant role in agriculture with their high fiber content, vitamins, and antioxidant substances. In addition to being consumed as fresh fruit worldwide, it is grown commercially in dried form or as various processed additives. In this study, the variation among plum genotypes growing naturally in the garden borders of Suşehri, Koyulhisar, and Akıncılar districts of Sivas province, located in the Kelkit Valley, Türkiye, was investigated using morphological, biochemical and molecular analyses. In terms of morphological characteristics, genotype E9 stood out as having the highest values in terms of fruit weight (25.92 g), fruit width (33.11 mm), and fruit height (34.70 mm). According to the results of biochemical analysis, statistically significant differences were found in total biochemical contents. Genotype E19 has 327.01 mg GAE/100 g for total phenolic content, genotype E11 with 109.98 mg QE/100 g for total flavonoid content, genotype E5 with 48.70% for total antioxidant value, and genotype E9 with 44.54 mg cyn-3-gluc/100 g for total anthocyanin content were the highest values. To determine the genetic diversity of plums at a molecular level, 10 different ISSR primers were used, and a total of 80.00 scorable bands were obtained. 67.00 of the bands obtained were polymorphic. According to the unweighted pair group method with arithmetic mean (UPGMA) method, the similarity index ranged between 0.69 and 0.99, and two different main groups were formed in the dendrogram. Genotypes 21 and 22 were in the first group. Genotypes E6 and E7 were the closest genotypes with a similarity index 0.99. Five of the 10 different inter simple sequence repeat (ISSR) primers had 100% polymorphism, and eight had 80% or more polymorphism. It is thought that the results obtained in plum genotypes can guide researchers to understand the characteristics of plum species and to integrate the appropriate genetic material or trait of interest into modern plant breeding programs

The Effect of PGPR Applications on Bioactive Content and Fruit Characteristics of Different Apple Scion–Rootstock Combinations

In modern apple growing, plant and pomological characteristics as well as physiological behaviors of genotypes may vary according to the rootstock, changing growth ecology, and applications of biological control agents. The aim of this research is to determine the effects of rhizobacteria application on the biochemical substances (contents of total phenolics, total flavonoids and total anthocyanin and antioxidant activity) in fruits. This study was carried out on seven standard apple cultivars (‘Scarlet Spur’, ‘Red Chief’, ‘Fuji’, ‘Jeromine’, ‘Galaxy Gala’, ‘Granny Smith’ and ‘Golden Reinders’) grafted on M9 and MM106 rootstocks. Within the scope of the study, nitrogen + phosphorus solvent rhizobacteria were applied to each tree three times in 15 days in the spring period. On the other hand, in the study, the effects of rhizobacteria application on the biochemical contents of the fruits differed according to scion–rootstock combinations and these provided generally significantly positive contributions. Considering the fruit color data, the highest result was obtained from hue angle with 122.41 on ‘Granny Smith’ grafted to MM106 rootstock. According to the phenolic compound analysis, the highest phenolic compound content was epicatechin with 15.77 mg/kg, determined on ‘Scarlet Spur’ grafted to M9 rootstock. The highest positive contribution was 5.5% in total phenolic content, 4.5% in total flavonoid content, 3.3% in total anthocyanin content, and 5.7% in antioxidant activity. According to the results of this study, it has been determined that bacteria have positive effects on different fruit properties, but results may change with climate, growing conditions, environment and soil properties