Natural disaster insurance: public-private sector partnership

The public sector should intervene in the natural disaster insurance market in order to increase economic efficiency and social welfare. However the governments should not put at risk the sustainability of public finance by undertaking excessive financial risks. Therefore, public-private sector partnership practices in natural disaster insurance are on the agenda. Public-private partnerships can incorporate some of the advantages of both public insurance systems and private insurance systems. In such insurance systems, government guarantees, fiscal incentives, regulations and private sector expertise come together. The insurance systems established in public-private partnership sectors should be designed appropriately to ensure sustainability. A sustainable public-private insurance system should include mandatory participation, risk-based premiums, encouraging risk-mitigation activities, risk transfer mechanisms. NFIP, CEA, CATNAT, TCIP, CCS, JER are successful examples of public-private sector partnership. However, these insurance systems do not have all the features that a good insurance system should have

Anjiyotensin dönüştürücü enzim ve anjiyotensin II tip 1 reseptörü gen polimorfizmlerinin Trakya bölgesindeki Türk hastalarda görülen iskemik inme ile ilişkisi

Amaç: Bu çalışmanın amacı, Trakya bölgesinde yaşayan iskemik inme geçirmiş hastalarda ACE insersiyon/delesyon (I/D) ve AT1R (A1166C) gen polimorfizmlerinin sıklığını, vasküler risk faktörleri ve inme alt-grupları ile ilişkisini araştırmaktır. Hastalar ve Yöntemler: Çalışmaya 162 iskemik inme geçirmiş hasta ile 146 sağlıklı olgu alındı. İskemik inme hastaları, ORG 10172 Akut İnme Tedavisi (TOAST) kriterlerine göre büyük ve küçük damar hastalığı olarak inme alt gruplarına ayrıldı. ACE I/D polimorfizmi polimeraz zincir reaksiyonu (PZR), AT1R (A1166C) gen polimorfizmi ise PZR ve restriksiyon fragment uzunluk polimorfizmi (RFLP) yöntemleri kullanılarak yapıldı. Bulgular: Hasta grubundaki ACE I/D genotip dağılımı (DD=34.0%, ID=50.0%, II=16.0%), kontrol grubu ile karşılaştırıldığında (DD=34.3%, ID=49.7%, II=16.1%) fark bulunmadı. Ayrıca hasta grubundaki AT1R (A1166C) genotip dağılımları ile (AA=58.0%, CA=34.6% ve CC=7.4%) kontrol grubu ile karşılaştırıldığında (AA=60.1%, CA=35.7% ve CC=4.2%) anlamlı fark saptanmadı. Her iki inme alt grubu arasında ACE I/D ve AT1R (A1166C) polimorfizmlerinin dağılımı açısından farklılık bulunmadı. Sonuç: Çalışmamızda Trakya bölgesinde yaşayan insanlarda ACE I/D ve AT1R (A1166C) gen polimorfizmlerinin iskemik inme gelişmesinde genetik risk faktörleri olmadıkları belirlendi.Objectives: The aim of this study was to investigate the frequency of ACE insertion/deletion (I/D) and AT1R (A1166C) gene polymorphisms in ischemic stroke patients in Trakya region and the relation between these gene polymorphisms and stroke subtypes and vascular risk factors. Patients and Methods: The study involved 162 patients with ischemic stroke and 146 control subjects. Ischemic stroke patients were divided into large and small vessel disease subgroups according to ORG 10172 in Acute Stroke Treatment TOAST criteria. The ACE I/D polymorphism was investigated using polymerase chain reaction (PCR), and the AT1R (A1166C) polymorphism was identified using PCR and restriction fragment length polymorphism (RFLP) assay. Results: The ACE I/D genotype distribution in patients (DD=34.0%, ID=50.0%, II=16.0%) did not differ from those in controls (DD=34.3%, ID=49.7%, II=16.1%). The AT1R A1166C genotype distribution in patients (AA=58.0%, CA=34.6%, CC=7.4%) did not significantly differ from those in controls (AA=60.1%, CA=35.7%, CC=4.2%). There was also no difference among the stroke subgroups regarding the distribution of ACE I/D and AT1R (A1166C) polymorphisms. Conclusion: Our results show that ACE I/D and AT1R (A1166C) gene polymorphisms were not genetic risk factors for ischemic stroke in subjects in Trakya region

A Case Report: Ictal Bradycardia in a Patient With Syncopal Attacks

DergiPark: 379060tmsjAims: Ictal bradycardia is characterized as the presence of bradycardia during the ictal discharge and mostly seen in left temporal zone originated seizures. It could lead to conditions such as syncope, asystole and severe injuries. With this case report, it is aimed to emphasize the importance of applying 24-hour video electroencephalographyelectrocardiography monitoring in patients with unexplained loss of consciousnes

Tip 2 diyabetik hastaların birinci derece yakınlarında total homosistein ve asimetrik dimetilargininin plazma düzeyleri

Amaç: Tip 2 diyabetik hastaların birinci derece yakınlarında, ailesinde diyabet öyküsü olmayan sağlıklı olgulara göre kardiyovasküler hastalıklar daha sık görülmektedir. Asimetrik dimetilarginin (ADMA) ve homosistein (Hcy) plazma düzeyleri kardiyovasküler hastalıklar ve endotel disfonksiyonuyla ilişkili göstergelerdir. Bu çalışmada, tip 2 diyabetik hastaların birinci derece yakınlarında ADMA ve Hcy plazma düzeyleri ile bu göstergelerle kardiyovasküler risk faktörleri arasındaki ilişkilerin incelenmesi amaçlandı. Hastalar ve Yöntemler: Dolaşımdaki ADMA ve Hcy düzeyleri 15 tip 2 diyabet hastasının birinci derece yakınında ve ailesinde diyabet öyküsü olmayan 15 kontrol olgusunda ölçüldü. Bulgular: Her iki grup arasında ADMA ve Hcy plazma düzeyleri açısından anlamlı farklılık saptanmadı (p>0.05). Asimetrik dimetilarginin plazma düzeyi tip 2 diyabetik olguların birinci derece yakınlarında, bel çevresi (p=0.02), açlık insülin düzeyi (p=0.03), insülin direnci (p=0.01), total kolesterol (p=0.04) ve HDL kolesterol (p=0.03) ile ilişkiliydi. Sonuç: Bu sonuçlara göre, kardiyovasküler risk faktörlerine sahip olan tip 2 diyabetik olguların birinci derece yakınlarında, ADMA plazma düzeylerinin doğrudan endotel disfonksiyonunun gelişimine katkıda bulunmadığını düşünmekteyiz.Objectives: Cardiovascular diseases are more common among first degree relatives of type 2 diabetic patients than healthy subjects without a family history of diabetes. Plasma asymmetric dimethylarginine (ADMA) and homocysteine (Hcy) levels are markers of endothelial dysfunction and cardiovascular disease. The objective of this study was to evaluate levels of ADMA, Hcy and their association with cardiovascular risk factors in first degree relatives of type 2 diabetic patients. Patients and Methods: The circulating ADMA and Hcy levels were measured in 15 first degree relatives of type 2 diabetic patients and 15 control subjects without a known family history of diabetes. Results: No statistically significant differences were found in plasma levels of ADMA and Hcy between the two groups (p>0.05). Plasma ADMA levels correlated significantly with waist circumference (p=0.02), fasting insulin levels (p=0.03), insulin resistance (p=0.01), total cholesterol (p=0.04) and HDL-cholesterol (p=0.03) levels in the first degree relatives of type 2 diabetic patients. Conclusion: These results suggest that plasma ADMA levels do not directly contribute to the development of endothelial dysfunction in first degree relatives of type 2 diabetic patients with cardiovascular risk factors

Obez hastalarda proinflamatuvar sitokinler ile fibrinolitik sistem arasındaki ilişki

Amaç: Obez kişilerde proinflamatuar sitokinlerden TNF-? ve IL-6, fibrinolitik sistem parametrelerinden t-PA ve PAI-1 ve insülin direnci arasındaki ilişki araştırıldı. Hastalar ve Yöntemler: Çalışmaya obez (VKİ ?30 kg/m2) olarak değerlendirilen 54 kişi (41 kadın, 13 erkek; ort. yaş 33.5) ve obezite sorunu olmayan (VKİ <25 kg/m2) 30 kişi (19 kadın, 11 erkek; ort. yaş 22.3) alındı. Fibrinojen düzeyleri koagülometrik olarak ve TNF-?, IL-6, t-PA, PAI-1 düzeyleri ELISA yöntemiyle ölçüldü. Bulgular: Kontrol grubuyla karşılaştırıldığında, obez kişilerde fibrinojen (p<0.01), PAI-1 (p<0.001), TNF-? (p<0.01) ve IL-6 düzeyleri (p<0.001) anlamlı derecede yüksek, t-PA düzeyi (p<0.001) ve t-PA/PAI-1 oranı (p<0.001) anlamlı derecede düşük bulundu. Obezlerde TNF-? ile t-PA (p=0.007) ve t-PA/PAI-1 oranı (p=0.016) arasında ters ilişki saptandı. İnsülin direnci olan ve olmayan obez kişilerde parametreler arasında fark yoktu. Sonuç: Obezitede adipoz dokudan salgılanan özellikle TNF-? gibi inflamatuar sitokinlerin artması fibrinolizde azalmaya yol açar. Obez kişilerde görülen bu değişiklikler, insülin direncinden bağımsız olarak ateroskleroza neden olabilir.Objectives: The aim of this study was to investigate the relationship between proinflammatory cytokines (TNF-&amp;#945; and IL-6), and fibrinolytic system parameters (t-PA, and PAI-1) and insulin resistance in obese individuals. Patients and Methods: The study included 54 obese subjects (BMI &amp;#8805;30 kg/m2; 41 females, 13 males; mean age 33.5 years) and 30 non-obese healthy individuals (BMI &lt;25 kg/m2; 19 females, 11 males; mean age 22.3 years). Fibrinogen levels were measured by the coagulometric method and the measurements of TNF-&amp;#945;, IL-6, t-PA and PAI-1 were carried out by the ELISA method. Results: Compared with non-obese subjects, obese individuals had significantly higher fibrinogen (p&lt;0.01), PAI-1 (p&lt;0.001), TNF-&amp;#945; (p&lt;0.01), and IL-6 (p&lt;0.001) levels, and significantly lower t-PA level (p&lt;0.001) and t-PA/PAI-1 ratio (p&lt;0.001). We also found an inverse relationship between TNF-&amp;#945; and t-PA levels (p=0.007) and t-PA/PAI-1 ratio (p=0.016) in obese individuals. The presence or absence of insulin resistance did not affect proinflammatory cytokines and fibrinolytic system parameters in obese individuals. Conclusion: Our findings indicate increased inflammatory cytokine levels especially in TNF-&amp;#945; level, and decreased fibrinolysis in obese individuals. These changes may contribute to atherosclerotic process independent from insulin resistance in obesity

Wpływ dystrybucji tkanki tłuszczowej oraz wybranych adipokin na insulinooporność w stanie przedcukrzycowym

  Introduction: The risk of developing insulin resistance and metabolic syndrome is particularly high in central obesity. In this study we evaluated the effects of fat distribution and some adipokines on insulin resistance in prediabetic patients. Material and methods: Eighty-seven age- and sex-matched patients were divided into three groups according to their 75-gram oral glucose tolerance test results as follows: impaired fasting glucose group, impaired glucose tolerance group, and normal glucose tolerance group. Fasting insulin levels were measured. Homeostatic model assessment of insulin resistance was calculated. Body fat mass measurements were assessed by bioelectric impedance analyser and abdominal fat thicknesses (subcutaneous, visceral, and preperitoneal) by ultrasonography. The fasting serum levels of several adipokines [adiponectin, leptin, resistin, vaspin, visfatin, retinol-binding protein-4 (RBP-4), tumour necrosis factor-alpha (TNF-alpha)] were measured by ELISA method. Results: The mean body mass index, fat mass measurements, and abdominal fat thicknesses of the groups were similar. There were no differences between groups in terms of the mean fasting insulin, vaspin, RBP-4, leptin, resistin, and TNF-alpha. In comparison of the prediabetic and normal groups, the levels of adiponectin (p &lt; 0.001) and visfatin (p &lt; 0.001) were lower in the prediabetic group. Furthermore, we found that high body mass index (p &lt; 0.01) and fat mass (p &lt; 0.01) and low adiponectin (p &lt; 0.05) levels have roles in the development of insulin resistance in the prediabetic group. Conclusions: We suggested that in the prediabetic period not only obesity but also decreased adiponectin levels play some role in the pathogenesis of insulin resistance. (Endokrynol Pol 2016; 67 (3): 277–282)    Wstęp: Ryzyko rozwoju insulinooporności i zespołu metabolicznego zwiększa się zwłaszcza u osób z otyłością centralną. W niniejszym badaniu oceniono wpływ dystrybucji tkanki tłuszczowej i wybranych adipokin na insulinooporność u osób ze stanem przedcukrzycowym. Materiał i metody: Osiemdziesięciu siedmiu chorych dobranych pod względem wieku I płci podzielono na 3 grupy w zależności od wyniku testu doustnego obciążenia 75 g glukozy: osoby z nieprawidłową glikemią na czczo, osoby z nieprawidłową tolerancją glukozy i osoby z prawidłową tolerancją glukozy. Zmierzono stężenie insulin na czczo. Do oszacowania insulinooporności zastosowano model homeostazy. Masę tkanki tłuszczowej oceniono za pomocą analizatora bioimpedancji elektrycznej, a grubość brzusznej tkanki tłuszczowej (podskórnej, trzewnej i przedotrzewnowej) zmierzono metodą ultrasonograficzną. Stężenie na czczo w surowicy kilku adipokin (adiponektyna, leptyna, rezystyna, waspina, wisfatyna, białko wiążące retinol-4 [RBP-4], czynnik martwicy nowotworów alfa [TNF-alfa]) zmierzono, stosując metodę ELISA. Wyniki: Średni wskaźnik masy ciała, masa tkanki tłuszczowej I grubość brzusznej tkanki tłuszczowej były podobne we wszystkich grupach. Nie stwierdzono różnic między grupami pod względem średniego stężenia insuliny na czczo ani stężeń waspiny, RBP-4, leptyny, rezystyny i TNF-alfa. W porównaniu grup ze stanem cukrzycowym i grupy z prawidłową tolerancją glukozy wykazano, że stężenia adiponektyny (p &lt; 0,001) i wisfatyny (p &lt; 0,001) były niższe u osób ze stanem przedcukrzycowym. Ponadto stwierdzono, że wysoki wskaźnik masy ciała (p &lt; 0,01) i duża masa tkanki tłuszczowej (p &lt; 0,01) oraz niskie stężenie adiponektyny (p &lt; 0,05) przyczyniają się do rozwoju insulinooporności u osób ze stanem przedcukrzycowym. Wnioski: Autorzy sugerują, że nie tylko otyłość, ale również obniżenie stężenia adiponektyny odgrywają pewną rolę w patogenezie insulinooporności w okresie przedcukrzycowym. (Endokrynol Pol 2016; 67 (3): 277–282)

Mean platelet volume and peripheral blood count response in acute ischemic stroke

Amaç: Ortalama trombosit hacminin (OTH) trombosit aktivitesinin iyi bir göstergesi olduğu, vasküler hastalıklarda arttığı bildirilmektedir. Bu çalışmada akut iskemik inmede, inme alttipleri ile OTH'nin ilişkisinin araştırılması amaçlandı. Hastalar ve Yöntemler: Çalışmada ORG 10172 çalışması TOAST kriterlerine göre büyük (n=43) ve küçük (n=59) damar hastalığı olarak alttiplendirmesi yapılan, akut iskemik inme geçiren 102 hastanın OTH değerleri, yaş ve cinsiyet eşleştirilmiş 48 sağlıklı birey ile karşılaştırıldı. Ortalama trombosit hacminin inme alttipleri, inme şiddeti ve diğer hematolojik parametreler (trombosit sayısı, platekrit, hemoglobin, hematokrit, eritsosit sayısı, ortalama korpusküler hacim, lökosit, nötrofil, lenfosit, monosit sayıları) ile ilişkisi araştırıldı. Bulgular: İnme altgrupları ve kontrol grubu arasında OTH değerleri açısından fark tespit edilmezken, OTH ile inme şiddeti ve diğer hematolojik parametreler arasında da ilişki saptanmadı (p>0.05). Büyük damar hastalığı olanlarda, küçük damar hastalığı olanlara ve kontrollere göre lökosit ve nötrofil sayısında artışın anlamlı olarak daha fazla olduğu görüldü (p<0.005). Nötrofil sayısında artış inme şiddeti için bir risk faktörü olarak belirlendi (?=0.362, p=0.01, OR=1.437, CI %95 0.02-0.08). Sonuç: Ortalama trombosit hacmi akut iskemik inmede anlamlı bir değişikliğe uğramamakta olup, lökosit ve nötrofil sayısında artış, özellikle büyük damar hastalığı alttipi ve inme şiddeti için iyi bir göstergedir.Objectives: Mean platelet volume (MPV) is a marker of the platelet activity and is reported to increase in vascular diseases. The aim of the study is to investigate the relationship between MPV and the subtypes of acute ischemic stroke. Patients and Methods: The patient group consisted of 102 acute ischemic stroke patients who were divided into the large vessel (n=43) and the small vessel (n=59) disease subgroups. Their MPV values were compared with those of 48 age/sex-matched healthy individuals. The relationship of MPV with the subtypes and severity of stroke, and other hematological parameters (platelet count, platecrit, hemoglobin, hematocrit, erythrocyte count, mean corpuscular volume, leukocyte, neutrophil, lymphocyte, monocyte) was further investigated. Results: No difference was found in terms of MPV values between the patient subgroups and control group, and no relation was found between MPV and stroke severity and other hematological parameters (p&gt;0.05). A significant increase in the leukocyte and neutrophil count was seen in patients of the large vessel disease group when compared with the small vessel disease and control group (p&lt;0.005). Neutrophil count is found to be a risk factor for the stroke severity (&amp;#946;=0.362, p=0.01, OR=1.437, CI %95 0.02-0.08). Conclusion: No significant change in MPV was seen in acute ischemic stroke. High leukocyte and neutrophil levels are markers for the large vessel disease subtype and severity of ischemic stroke

Contribution of Long Term Video Eeg Monitoring to Diagnosis of Epilepsy Patients

DergiPark: 378980tmsjAims: Data obtained by the patient’s anamnesis and interictal routine EEG are sometimes not satisfactory for achieving a correct diagnosis of epilepsy. It is considered that some of the treatment resistant epilepsy patients are such kind of cases. In the present study, the contribution of long term video EEG monitoring (VEM) to treatment in the treatment resistant epilepsy patients was investigated. Methods: Twenty-nine cases were enrolled into the study, and the epilepsy diagnosis and classification were re-evaluated. The ratio of cases who needed a change of treatment after the new diagnosis and classification was calculated. Results: A significant difference was seen in the diagnosis, classification and treatments (34,5%, 44,8%, 37,8%, respectively) before and after long-term VEM. Conclusion: Long term VEM seems to be an important tool in re-evaluation of treatment resistant epilepsy patients and in achieving the correct diagnosi

Management of endocrine surgical disorders during COVID-19 pandemic: expert opinion for non-surgical options

Purpose The COVID-19 pandemic brought unprecedented conditions for overall health care systems by restricting resources for non-COVID-19 patients. As the burden of the disease escalates, routine elective surgeries are being cancelled. The aim of this paper was to provide a guideline for management of endocrine surgical disorders during a pandemic. Methods We used Delphi method with a nine-scale Likert scale on two rounds of voting involving 64 experienced eminent surgeons and endocrinologists who had the necessary experience to provide insight on endocrine disorder management. All voting was done by email using a standard questionnaire. Results Overall, 37 recommendations were voted on. In two rounds, all recommendations reached an agreement and were either endorsed or rejected. Endorsed statements include dietary change in primary hyperparathyroidism, Cinacalcet treatment in secondary hyperparathyroidism, alpha-blocker administration for pheochromocytoma, methimazole +/- beta-blocker combination for Graves' disease, and follow-up for fine-needle aspiration results of thyroid nodules indicated as Bethesda 3-4 cytological results and papillary microcarcinoma. Conclusion This survey summarizes expert opinion for the management of endocrine surgical conditions during unprecedented times when access to surgical treatment is severely disrupted. The statements are not applicable in circumstances in which surgical treatment is possible

The effects of pulsed electromagnetic field treatment in pain due to diabetic polyneuropathy

Amaç: Diyabetik periferik nöropati, diyabetin en sık görülen ve özürlülüğe neden olan komplikasyonudur. Nöropatik ağrı sıklıkla çoklu farmakolojik tedaviye dirençlidir ve bu ajanların yan etkileri kullanımlarını sınırlar. Nöropatik ağrı tedavisinde farklı alternatif tedaviler araştırılmaktadır. Nonfarmakolojik tedavilerin sistemik yan etkileri düşüktür. Bu rasgele seçilmiş, plasebo kontrollü çalışmada, dirençli diyabetik nöropatik ağrıda puls elektromanyetik alan tedavisinin etkinliği araştırıldı. Hastalar ve Yöntemler: Çalışma, rasgele ayrılan, 25 puls elektromanyetik alan tedavisi (PEMF) ve 25 plasebo grubunda olmak üzere 50 hastayla tamamlandı. Tedavi grubundaki hastaların her iki ayağına on ardışık gün ve günde 1 saat PEMF uygulandı. Olguların tedaviden önce, sonra ve 6. haftadaki kontrollerinde vizüel analog skala ve nöropatik ağrı skala değerlendirmeleri yapıldı. Elektronöromiyografi tetkikleri, tedaviden önce ve 6. hafta kontrollerinde değerlendirildi. Bulgular: Çalışmanın sonucunda, vizüel analog skala ile yapılan ağrı değerlendirmesinde tedavi sonunda %53, kontrol değerlendirmesinde %67 iyileşme saptandı. Nöropatik ağrı skalası farklı verilerinde saptanan düzelme, tedavi grubunda plasebo grubuna göre istatistiksel olarak anlamlıydı. Sinir ileti hızı çalışmalarında iki grup verileri arasında anlamlı istatistiksel fark saptanmadı. Sonuç: Puls elektromanyetik alan tedavisi, ağrı skorları ve polinöropati semptomları üzerindeki olumlu etkileri ile diyabetik nöropatik ağrı tedavisinde alternatif bir seçenek olarak düşünülebilir.Objectives: Diabetic polyneuropathy is the most common and disabled complication of diabetes mellitus. Pharmacological treatment of diabetic neuropathy is limited because of the side efects of the drugs, used in the treatment of diabetic neuropthy. Alternative treatments are also used in diabetic neuropathy. Systemic side effects of non-pharmacological treatment modalities are rare. We evaluated the value of pulsed electromagnetic field treatment in patients with pain due to diabetic polyneuropathy. Patients and Methods: Symptomatic 95 patients were included in the study, and from these patients, 25 patients were randomized in pulsed electromagnetic field treatment group and 25 patients were randomized in placebo group. Pulsed electromagnetic field device was applied over both feet of the patients for one hour a day (during 10 days). Visual analog scale and neuropathic pain scale of all patients were performed before and after treatment and 6th week. Electroneuromyography was also performed before treatment and 6th week. Results: Improvement of pain determined by visual analog scale was 53% after treatment and 67% six weeks later. The improvement of visual analog scale scores were statistically significant in study group when compared with control subjects. Conclusion: The pulsed electromagnetic field may be an alternative treatment modality in diabetic patients with neuropathic pain