The evaluation of the effects of different doses of intravenous ascorbic acid administration on anemia, oxidative stress, malnutrition and inflammation markers in stable hemodialysis patients receiving erythropoietin therapy with normal or increased ironload

Potent bir anti-oksidan olan ve hemodiyaliz (HD) hastalarında eksikliği bildirilen askorbik asit (AA), demir (Fe) metabolizmasının çeşitli basamaklarına olumlu etkileri nedeniyle Rekombinant insan eritropoietin (rHuEPO) alan hastalarda adjuvan tedavi olarak önerilmektedir. Son dönemdeki yayınlarda r-HuEPO tedavisine refrakter HD hastalarında haftada 2-3 kez 100- 500 mg intravenöz (İV) AA uygulamasının eritropoez üzerine olumlu ancak r-HuEPO dozuna farklı etkilerinin olduğu gösterilmiştir. Yüksek ferritin seviyelerinin Fe salınımına yol açarak oksidatif strese (OS) neden olduğu, anti-oksidan etkisi konsantrasyon bağımlı olduğu bildirilen AA’in belli fizyolojik koşullarda ferritinden Fe salınımına yol açarak pro-oksidan olarak davranabileceği belirtilmektedir. AA uygulamasına yeterli r-HuEPO cevabı alınamayan olgularda, AA’in anti-oksidan etkisinden çok pro-oksidan etkisinin sorumlu olup olmadığı değerlendirilmemiştir. Farklı dozlarda AA tedavisinin normal ve yüksek ferritin düzeylerine sahip HD hastalarında oksidan veya anti-oksidan olarak hareket edip etmediğine dair literatürde bir çalışma yoktur. Bu çalışmada normal veya yüksek ferritin düzeylerine sahip HD hastalarında düşük ve yüksek doz AA’in yavaş infüzyonunun OS, eritropoez, malnütrisyon ve inflamasyon üzerine etkilerinin değerlendirilmesi amaçlanmıştır. Uludağ Üniversitesi Tıp Fakültesi İç Hastalıkları ABD. Hemodiyaliz Ünitesi’nde düzenli HD uygulanmakta olan 49 hastanın 29’u bu çalışmaya alınmış, bir hasta kan transfüzyonu nedeni ile çalışmadan çıkarılmıştır. Hastalar ferritin düzeylerine göre (<800 ng/ml veya ≥ 800 ng/ml) iki gruba ayrılmışlardır. Dört aylık takipten sonra hastalara 4’er ay süre ile 100 ve 500 mg yavaş infüzyon İV AA uygulaması yapılmıştır. Düşük ve yüksek doz İV AA uygulaması sonrasında hemoglobin, hematokrit, transferrin saturasyonu, serum Fe düzeylerinde, r-HuEPO ve Fe dozlarında iyileşme sağlanamamıştır. Düşük doz İV AA uygulaması ferritin düzeyinde artışa, yüksek doz AA ise ferritinde azalmaya yol açmıştır. Her iki doz AA uygulaması da lipid peroksidasyonunu arttırmıştır. 100 mg AA sonrasında anti-oksidan sistemde belirgin azalma olurken 500 mg İV AA uygulaması ile sistemde hafif düzelme gözlenmiştir. Her iki doz İV AA tedavisinin de malnütrisyon ve inflamasyon belirteçlerine etkisi gösterilememiştir. Sonuç olarak; 500 mg İV AA uygulaması 100 mg AA uygulamasına göre Fe depolarını azaltmada daha etkin olmasına rağmen AA tedavisi fonksiyonel Fe kullanımında ve r-HuEPO dozunda iyileşme sağlamamıştır. Literatürdeki diğer çalışmalarla benzer olarak AA düşük dozda pro-oksidan olarak etki ederken yüksek dozda anti-oksidan olarak hareket etmektedir. AA’in malnütrisyon ve inflamasyon üzerine etkisi bulunamamıştır. Vitamin C uygulamasının güvenilirliği ve etkinliği değerlendirmek için daha büyük hasta populasyonunda, randomize ve kontrollü çalışmalara ihtiyaç vardır.Ascorbic acid (AA), a potent antioxidant and known to be deficient in haemodialysis (HD) patients, is recommended as an adjuvant therapy to the patients receiving recombinant human erythropoietin (r-HuEPO) because of its’ positive effects on iron (Fe) metabolism at different levels. In recent reports, it is shown that in r-HuEPO refractory HD patients 2-3 times a week 100-500 mg intravenous (IV) AA administration has positive effects on erythropoiesis but different effects on r-HuEPO dosages . It is stated that higher ferritin levels causes oxidative stress (OS) by releasing Fe, under certain physiologic conditions AA, as its’ anti-oxidant effect is reported to be dose dependent, by releasing iron from ferritin acts as a pro-oxidant. In patients, not having adequate r-HuEPO response to AA administration, the responsibility of AA acting as a pro-oxidant rather than anti-oxidant is not being evaluated. There is no study reporting that different dosages of AA therapy acting as an oxidant or anti-oxidant in HD patients with normal and/or higher ferritin levels. In this study, it is aimed to evaluate the effects of slow infusion of low and high dose AA on OS, erythropoiesis, malnutrition and inflammation markers in HD patients with normal or higher ferritin levels. Twenty-nine patients of 49 patients, receiving regular HD at Uludag University Medical Faculty Internal Medicine HD Unıt, accepted to the study, a patient was excluded because of blood transfussion. Patients were divided into two groups according to their ferritin levels (<800 ng/ml or ≥ 800 ng/ml). They were followed for 4 months and then received slow infusion of 100 and 500 mg AA for 4 months for each. After low and high dose IV AA administration neither improved haemoglobin, hematocrit, transferrin saturation, serum Fe levels nor reduced r-HuEPO and Fe doses. As low dose IV AA administration caused increase in ferritin, high dose AA reduced ferritin levels. Both doses of AA administration increased lipid peroxidation. After 100 mg AA therapy anti-oxidant system significantly decreased, 500 mg IV AA administration improved the system. Also both doses had no effect on malnutrition and inflammation markers. In conclusion; although 500 mg IV AA administration is more effective than 100 mg AA in reducing the iron stores, AA therapy does not improve functional Fe usage or reduce r-HuEPO dose. As similar to the other studies, AA act as a pro-oxidant in lower dose and as an anti-oxidant in higher dose. AA has no effects on malnutrition and inflammation to evaluate the efficacy and safety vitamin C administration, randomised and controlled studies with higher population are needed

The effect of creative drama practices in mathematics on primary school students' problem solving strategies, achievement, self-concept and interaction patterns

Bu araştırmanın amacı, yaratıcı drama destekli matematik öğretim programının ve mevcut matematik dersi öğretim programının, ilköğretim öğrencilerinin matematik dersindeki başarısı, benlik kavramı ve problem çözme strateji kullanımı üzerindeki etkilerini ve yaratıcı drama gruplarındaki etkileşim örüntülerini incelemektir. Araştırmada kontrol gruplu, ön test ? son test, yarı deneysel araştırma modeli kullanılmıştır. Kontrol grubunda mevcut matematik öğretim programının ön gördüğü öğretim yöntemleri, deney grubunda ise yaratıcı drama yöntemleri kullanılmıştır. Araştırma, araştırmacının görev yaptığı orta sosyoekonomik düzeye sahip bir devlet ilköğretim okulunda gerçekleştirilmiştir. Deney ve kontrol grupları, okuldaki tüm 6. sınıflardaki öğrencilerden rastgele seçimle belirlenmiştir. Deney ve kontrol gruplarında 24'er katılımcı ile çalışılmıştır. Araştırmanın nitel verileri, derinlemesine görüşme protokolü video kayıtları ve ses kayıtları ile nicel verileri ise matematik dersi başarı testi ve benlik kavramı ölçeği ile toplanmıştır. Araştırmanın nicel verilerinin analizinde aritmetik ortalama, standart sapma ve tekrarlı ölçümler için ANOVA karşılaştırması kullanılmıştır. Nitel veriler olan video ve ses kayıtlarının analizinde kodlamaya gidilmiştir. Veriler kodlayıcı tarafından kodlanıp, kategorilere ayrılarak sınıflandırılmış ve çözümlemelerinde frekans ve yüzde hesabı kullanılmıştır. Araştırma sonucunda, yaratıcı drama destekli matematik öğretim programının, öğrencilerin matematik dersi başarısını arttırdığı ve benlik kavramı düzeylerinde olumlu yönde bir artışa neden olduğu saptanmıştır. Deney grubu öğrencileriyle yaratıcı drama destekli matematik öğreniminden sonra gerçekleştirilen görüşmelerde, ele alınan problem çözme stratejilerinin, her birinin kullanım frekansında bir artış gözlemlenmiştir. Yaratıcı drama uygulamalarının, ilköğretim ikinci kademe öğrencilerinin problem çözme strateji kullanımları üzerinde olumlu bir etkisi olduğu söylenebilir. Yaratıcı drama gruplarındaki etkileşim örüntülerine dair incelemeler sonucunda ?Fikir sunma? kategorisinin en sık, ?Kaygı duyma? kategorisinin ise en az kodlandığı saptanmıştır. The aim of this study is to analyze the practices of creative drama and current mathematics curriculum on elementary students' achievement in mathematics, self-concept, problem solving strategies and interactive patterns in creative drama groups. The quasi-experimental research design with a pre- and post-test and a control group was used in the study. Current mathematics curriculum teaching methods were used in the control group while creative drama techniques were used in the experimental one. The study was conducted in a middle socio-economic-status state school. The experimental group and the control group were chosen randomly among 6th graders. There were 24 participants in each group. The qualitative data was collected by using video records with interview protocols and voice records. The quantitative data was collected by using a mathematics achievement test and a self-concept scale. Arithmetic Mean, Standard Deviation and ANOVA for Repeated Measurements were used to analyze the quantitative data. Coding Technique was used to analyze the qualitative data in video and voice records. A coder coded and categorized the data, and frequencies and percentages were calculated to analyze the data. The results show that creative-drama-based mathematics program has a positive effect on the mathematics achievement and self-concept of students. In addition, creative drama techniques increase the entire the frequencies of students' use of problem solving strategies. It may be said that creative drama practices have positive effects on elementary students' problem solving strategies. According to the analyses of interactive patterns, ?Presentation of an idea? was the most frequently coded category whereas ?Feeling of anxiety? was the least frequently coded one

[The pilgrimage and the burden of pneumococcal disease in adults].

Pneumococcal disease is responsible for significant morbidity and mortality. All over the world, 1.6 million people die of pneumococcal disease every year; this estimate includes the deaths of 1 million children aged less than 5 years and the deaths of 600.000- 800.000 adults. The burden of pneumococcal disease is high in adults. Increasing age and the presence of comorbidity has a significant affected of the risk of developing the disease. During mass gatherings, such as pilgrimage individuals, is exposed to severe community-acquired pneumococcal infections. Individuals who has Streptococcus pneumoniae in nasopharynx, have the potential to infection and leave exposed to the risk of pneumococcal disease the other Individuals with sneezing, coughing or out of breath, given breath through droplets of these microorganisms. In the present review, the relationship of pneumococcal disease in adults and pilgrimage, vaccination strategies will be considered and then during a visit to Pilgrimate and Umrah pilgrims against the current vaccine recommendations will be summarised

Assessment of Lower Urinary Tract Symptoms and Sexual Function in Women with Metabolic Syndrome

Objective To assess lower urinary tract symptoms and sexual function in premenopausal women with metabolic syndrome (MetS). Materials and Methods A total of 34 premenopausal patients over 18 years of age with MetS and who were admitted to our endocrinology clinic between September 2013 and April 2014 were included. Control group was consisted of 30 healthy controls chosen from the staff of the hospital. The sexual function, lower urinary tract symptoms and quality of life of the participants were evaluated by using Index of Female Sexual Function (IFSF), Urogenital Distress Inventory (UDI-6), and Incontinence Impact Questionnaire (IIQ-7), respectively. The scores of the patients were statistically compared with those of controls. Results The mean ages of the patient and control groups were 40.50±5.12 years and 38.17±2.12 years, respectively (p=0.09). The mean IFSF-total and all of the IFSF sub scales (except pain) in the patient group were significantly lower than those of the control group. The mean UDI-6 score of the patients was significantly higher than the controls (p=0.001). The mean IIQ-7 scores of the patients was higher than controls, however this increase was not statistically significant (p=0.11). Conclusion These findings showed that MetS affected adversely the sexual function of premenopausal women due to the fact that IFSF scores were found to be lower in women with MetS as compared to healthy controls. Moreover, IFSF score under the threshold values in patients showed that patients with MetS had sexual function disorder. These lower urinary tract symptoms in the patients with MetS did not affect the quality of life although the severity of lower urinary tract symptoms of patients with MetS was significantly worse than that in control group

İSKELETSEL SINIF 3 BİREYLERİN MANDİBULAR MORFOLOJİLERİNİN PANORAMİK RADYOGRAFİ İLE DEĞERLENDİRİLMESİ

Panoramik radyografiler ortodonti kliniğinde, ortodontik anomalilerin teşhis ve tedavi planlamasında sıklıkla kullanılmaktadır. Araştırmanın amacı; Sınıf 1 ve Sınıf 3 bireylerde panoramik radyografların, lateral sefalometrik radyograflarla ilişkisini incelemek ve panoramik radyograflarda ölçülen parametrelerle mandibulanın morfolojik özelliklerini ve farklılıklarını tanımlamaya çalışmaktır. Araştırma iskeletsel Sınıf 3 ANB° < 0 anomaliye sahip 53 birey ile iskeletsel Sınıf 1 0 < ANB

Combination treatment of bortezomib and epirubicin increases the expression of TNFRSF10 A/B, and induces TRAIL-mediated cell death in colorectal cancer cells

Colorectal cancer is one of the most common cancers worldwide, affecting the colon and rectum. A major problem in the treatment of colorectal cancer is acquired chemoresistance, including resistance against death receptor-induced apoptosis. Therefore, investigating new biomarkers for the treatment of the disease and sensitization strategies against TRAIL might be of high clinical importance. TNFRSF10A/B are known as death receptors for TRAIL-induced apoptotic cell death. In this study, we used multiple bioinformatic tools and experimental analyses to investigate the role of TRAIL receptors TNFRSF10A and TNFRSF10B in colorectal cancer. We also identified the potential effect of bortezomib and epirubicin in the induction of TRAIL-mediated apoptotic cell death. Here, we showed that TNFRSF10 A/B expressions are upregulated in various tumor types, including COAD, and its high expression is decreased with the different clinicopathological parameters in COAD. We also found an association between TNFRSF10 A/B expression and tumor molecular subtypes. We further detected the association between the expression of TNFRSF10 A/B and immune cell tumor infiltration, including B cells, CD8+ T cells, neutrophils and dendritic cells. In addition, we showed that combining bortezomib and epirubicin treatment leads to the upregulation of TNFRSF10 A/B in colorectal cancer cells in vitro. The increase in the expression of death receptors was correlated with higher active caspase-3 levels following the incubation of cells with recombinant TRAIL protein, which is a ligand for TNFRSF10 A/B receptors. Our results suggest that TNFRSF10 A/B may be a marker to differentiate tumor molecular subtypes in colorectal cancer. The expression of TNFRSF10 A/B may be associated with the recruitment of immune cells into tumors and the development of tumor suppression. The combination of bortezomib and epirubicin treatment might sensitize colorectal cancer cells to TRAIL-induced apoptosis via the upregulation of death receptor