Assessment of Turkey’s Harmonization Process to the European Union Environmental Policies

1970’li yıllarda Roma Kulübü tarafından başlatılan çevre konusundaki farkındalık, AB’de sürekli olarak gelişen bir sürecin başlangıç noktasını oluşturmuştur. Sonraki süreçte çevreyle ilgili alınması gereken önlemler ve uygulanması düşünülen politikalar, anlaşmalar, strateji belgeleri ve Çevre Eylem Programları kapsamında somutlaştırılmıştır. Türkiye, çevre konusunu öncelikle kalkınma planları çerçevesinde ele almıştır. Kalkınma planlarının gelişme sürecinde, Türk çevre politikalarının AB politikalarına uyumu çalışmanın ana konusunu oluşturmaktadır. Bu çerçevede ilk olarak Türkiye ve AB mevzuat olarak karşılaştırılmıştır. Daha sonra ekonomik açıdan kamu ve özel sektörün çevresel koruma, harcamalar ve yatırımları da karşılaştırılmış ve bu doğrultuda Türkiye’nin çevre politikalarına uyum sürecindeki son durumu değerlendirilmiştir. Buna göre Türkiye’nin AB’ye çevre politikaları açısından uyumu için daha ulaşılabilir politikalar belirlemesi ve hayata geçirmesi gerektiği sonucuna varılmıştır

Assessment of Turkey’s Harmonization Process to the European Union Environmental Policies

1970’li yıllarda Roma Kulübü tarafından başlatılan çevre konusundaki farkındalık, AB’de sürekli olarakgelişen bir sürecin başlangıç noktasını oluşturmuştur. Sonraki süreçte çevreyle ilgili alınması gereken önlemler veuygulanması düşünülen politikalar, anlaşmalar, strateji belgeleri ve Çevre Eylem Programları kapsamındasomutlaştırılmıştır.Türkiye, çevre konusunu öncelikle kalkınma planları çerçevesinde ele almıştır. Kalkınma planlarının gelişmesürecinde, Türk çevre politikalarının AB politikalarına uyumu çalışmanın ana konusunu oluşturmaktadır. Buçerçevede ilk olarak Türkiye ve AB mevzuat olarak karşılaştırılmıştır. Daha sonra ekonomik açıdan kamu ve özelsektörün çevresel koruma, harcamalar ve yatırımları da karşılaştırılmış ve bu doğrultuda Türkiye’nin çevrepolitikalarına uyum sürecindeki son durumu değerlendirilmiştir. Buna göre Türkiye’nin AB’ye çevre politikalarıaçısından uyumu için daha ulaşılabilir politikalar belirlemesi ve hayata geçirmesi gerektiği sonucuna varılmıştır.In the 1970s, awareness of the environment initiated by the Club of Rome has been the starting point of acontinuous process developing within the EU. In the next process, the measures to be taken and considered policies tobe implemented about environment are objectified by in the framework of agreements, strategy papers andEnvironment Action Programmes.Turkey, primarily approaches environmental issues within the framework of development plans. In thedevelopment process of development plans, the adaptation of Turkish environmental policies to the EU policies is themain purpose of the study. In this context, firstly Turkey and EU was compared in terms of legislations. Then thepublic and private sector’s environmental protection expenditures and investments was compared in terms ofeconomy, and in this sense, Turkey’s recent situation in adaptation process to environmental policies have beenassessed. Accordingly, it is concluded that Turkey needs to determine and adopt more accessible policies to beharmonized with the EU in terms of environmental policies

Comparison of clinical and laboratory features and treatment options of 237 symptomatic and asymptomatic children infected with SARS-CoV-2 in the early phase of the COVID-19 pandemic in Turkey

Since the first report of COVID-19 in December 2019, little is known about therapeutic usage of hydroxychloroquine in pediatric patients with COVID-19. We retrospectively retrieved data for SARS-CoV-2 PCR positive pediatric patients from 20 hospitals in 8 different cities in Turkey. We obtained patients' epidemiological, clinical, laboratory features and drugs used for treatment of COVID-19. 237 nasopharyngeal swab SARS-CoV-2 PCR positive children were included into the study from March 26 to June 20, 2020. The mean age of asymptomatic children (118±62 months) was found to be higher than that of symptomatic children (89±69 months). Symptomatic children had a significantly lower mean lymphocyte count and higher mean CRP, D-dimer value, procalcitonin and LDH than asymptomatic children in univariate analysis. Out of 156 children, 78 (50%) children received Hydroxychloroquine-containing regimen, 15 of them were treated with hydroxychloroquine + azithromycin + oseltamivir, 44 were treated with hydroxychloroquine + azithromycin and 21 were only treated with hydroxychloroquine. Among the 156 patients who received medical treatment, 90 (58%) patients had pre and/or post-treatment ECG performed upon them. However, none of them either reported ECG abnormalities or a need for discontinuation of hydroxychloroquine because of adverse drug reaction

Therapeutic plasma exchange in hypertriglyceridemic patients

Background/aim: High triglyceride (TG) levels are associated with increases in atherosclerotic cardiovascular disease (CVD), hepatic steatosis, and pancreatitis. Acute pancreatitis is a condition with high mortality. Therapeutic plasma exchange (TPE) in the treatment of hypertriglyceridemic pancreatitis (HTGP) is a rapid and effective treatment modality. in this study, the results of TPE were evaluated and the frequency of lipoprotein lipase (LPL) mutation in these patients was determined. Materials and methods: TPE was performed in 31 patients with HTGP at the Adult Therapeutic Apheresis Center. Results: A TG level under 500 mg/dL was achieved by applying apheresis at a median of 2 times (IQR 2–2, min 1, max 6) in the 31 cases. LPL mutation was detected in 8 (25.8%) of the 31 hypertriglyceridemia cases. When TG levels before and after TPE were evaluated, the mean TG level before TPE was significantly higher (3132 ± 1472 mg/dL) than the mean TG level afterwards (948 ± 465 mg/dL, P < 0.001). This result represented a decrease of 69.7% TG after TPE. Conclusion: TPE is a safe, fast, and effective treatment modality in experienced centers

Health-related quality of life in patients with bronchiolitis obliterans

Introduction Bronchiolitis obliterans (BO) is mainly caused by infections and hematopoietic stem cell transplantation (HSCT). This study aimed to investigate the health-related quality of life (HRQOL) of children with BO compared to the healthy children and also to assess the HRQOL according to the etiology. Methods Postinfectious (group 1) and post-HSCT BO (group 2) patients and healthy children were included in the study. HRQOL was assessed by the Short Form-36 (SF-36) and St George's Respiratory Questionnaire (SGRQ). Correlations between demographic and clinical characteristics, pulmonary function tests, high-resolution chest tomography scores, and HRQOL were assessed. Results Thirty-seven postinfectious and post-HSCT BO patients and 34 healthy children were included in the study. Mean age was 13.8 +/- 0.7 years. Mean forced vital capacity and forced expiratory volume(1)were 60.7 +/- 2.7% predicted, and 49.8 +/- 3.1% predicted, respectively. The SF-36 scores were lower in BO patients compared to healthy children (P < .01). Patients with better lung functions had higher SF-36 scores, but lower SGRQ. The number of inhaled therapies, acute exacerbations, hospitalizations were inversely correlated with SF-36. A positive correlation was found between these parameters and total SGRQ scores (r = .507,P = .02;r = .409,P = .12;r = .326,P = .049, respectively). SF-36 scores were better in group 1 for subscales of physical role functioning and social role functioning compared to group 2. (P = .01,P = .01, respectively). Conclusion The HRQOL of patients with BO measured by SF-36 was low compared to healthy children. SF-36 scores were more affected in post-HSCT BO patients. HRQOL of children with chronic lung disease should be taken into consideration in the management of these patients

Health‐related quality of life in patients with bronchiolitis obliterans

Introduction Bronchiolitis obliterans (BO) is mainly caused by infections and hematopoietic stem cell transplantation (HSCT). This study aimed to investigate the health-related quality of life (HRQOL) of children with BO compared to the healthy children and also to assess the HRQOL according to the etiology. Methods Postinfectious (group 1) and post-HSCT BO (group 2) patients and healthy children were included in the study. HRQOL was assessed by the Short Form-36 (SF-36) and St George's Respiratory Questionnaire (SGRQ). Correlations between demographic and clinical characteristics, pulmonary function tests, high-resolution chest tomography scores, and HRQOL were assessed. Results Thirty-seven postinfectious and post-HSCT BO patients and 34 healthy children were included in the study. Mean age was 13.8 +/- 0.7 years. Mean forced vital capacity and forced expiratory volume(1)were 60.7 +/- 2.7% predicted, and 49.8 +/- 3.1% predicted, respectively. The SF-36 scores were lower in BO patients compared to healthy children (P < .01). Patients with better lung functions had higher SF-36 scores, but lower SGRQ. The number of inhaled therapies, acute exacerbations, hospitalizations were inversely correlated with SF-36. A positive correlation was found between these parameters and total SGRQ scores (r = .507,P = .02;r = .409,P = .12;r = .326,P = .049, respectively). SF-36 scores were better in group 1 for subscales of physical role functioning and social role functioning compared to group 2. (P = .01,P = .01, respectively). Conclusion The HRQOL of patients with BO measured by SF-36 was low compared to healthy children. SF-36 scores were more affected in post-HSCT BO patients. HRQOL of children with chronic lung disease should be taken into consideration in the management of these patients

Pediatric flexible bronchoscopy in the intensive care unit: A multicenter study

Introduction Flexible bronchoscopy (FB) is frequently used for assessment and treatment of patients with respiratory diseases. Our aim was to investigate the contribution of FB to diagnosis and therapy in children admitted to the intensive care units (ICU) and to evaluate the safety of FB in this vulnerable population. Methods Children less than 18 years of age who underwent FB in the five neonatal and pediatric ICUs in Istanbul between July 1st, 2015 and July 1st, 2020 were included to the study. Demographic and clinical data including bronchoscopy indications, findings, complications, and the contribution of bronchoscopy to the management were retrospectively reviewed. Results One hundred and ninety-six patients were included to the study. The median age was 5 months (range 0.3-205 months). The most common indication of FB was extubation failure (38.3%), followed by suspected airway disease. Bronchoscopic assessments revealed at least one abnormality in 90.8% patients. The most common findings were airway malacia and the presence of excessive airway secretions (47.4% and 35.7%, respectively). Positive contribution of FB was identified in 87.2% of the patients. FB had greater than 1 positive contribution in 138 patients and 80.6% of the patients received a new diagnosis. Medical therapy was modified after the procedure in 39.8% and surgical interventions were pursued in 40% of the patients. Therapeutic lavage was achieved in 18.9%. There were no major complications. Conclusion Flexible bronchoscopy is a valuable diagnostic and therapeutic tool in neonatal and pediatric ICUs and is not associated with major complications