Benefits of dexmedetomidine during noninvasive mechanical ventilation in major abdominal surgery patients with postoperative respiratory failure

ObjectiveThe efficacy of non-invasive mechanical ventilation (NIMV) on the postoperative ARF is conflicting and the failure rate of NIMV in this patient population is high. In our study, we hypothesized that the use of dexmedetomidine during NIMV in major abdominal surgical patients can reduce NIMV failure without significant side affect.MethodsMedical records of patients who underwent major abdominal surgery, admitted to our general surgery intensive care unit (ICU), developed postoperative ARF, received NIMV (with oro-nasal mask) and dexmedetomidine infusion were enrolled in this study. The infusion rate was adjusted to maintain a target sedation level of a Richmond Agitation-Sedation Scale (RASS) (−2)–(−3). The sedation was stopped when NIMV was discontinued.ResultsA total of 60 patients, 42 (70.0%) male, and 18 (30.0%) female, with a mean age of 68 ± 11 years were included in the study. The mean APACHE II score was 20 ± 6. Dexmedetomidine was infused for a median of 25 h (loading dose of 0.2 mcg/kg for 10 min, maintained at 0.2–0.7 mcg/kg/h, titrated every 30 min). RASS score of all study group significantly improved at the 2 h of dexmedetomidine initiation (+3 vs. −2, p = 0.01). A targeted sedation level was achieved in 92.5% of patients. Six (10.0%) patients developed bradycardia and 5 (8.3%) patients had hypotension. The mean NIMV application time was 23.4 ± 6.1 h. Seven (11.6%) patients experienced NIMV failure, all due to worsening pulmonary conditions, and required intubation and invasive ventilation. Fifty-three (88.3%) patients were successfully weaned from NIMV with dexmedetomidine sedation and discharged from ICU. The duration of NIMV application and ICU stay was shorter in NIMV succeded group (21.4 ± 3.2 vs. 29.9 ± 6.4; p = 0.012).ConclusionOur study suggests that dexmedetomidine demonstrates effective sedation in patients with postoperative ARF during NIMV application after abdominal surgery. Dexmedetomidine can be considered safe and capable of improving NIMV success

A Glance Into Healthcare Delivery During COVID-19 Pandemic: A Survey Among Turkish Medical Doctors

The coronavirus 2019 (COVID-19) pandemic had an enormous impact on healthcare delivery globally. We conducted a cross-sectional online survey in Turkey to evaluate the impact of COVID-19 on healthcare services in Turkey. A 35-item anonymized online survey was completed by HCPs (medical doctors, MD) who continued their clinical practice during the COVID-19 pandemic in Turkey, regardless of their specialties or degrees. Overall, 209 HCPs participated in the study. Forty-two percent of the participants stated that their current workload intensity has been increased compared with the pre-pandemic era. More than half of the participants (54.6%) were using telemedicine services during their clinical practice, however, the effectiveness of telemedicine for first-time patients and follow-up patients was rated as low. The majority of participants (59.3%) reported that during the peak period of the pandemic, they encountered only a small variety of cases, other than COVID-19. Fifty-two percent of the participants agreed that they occasionally had patients who received misdiagnosis in the first admission due to the suspicion of a possible COVID-19 infection predominating the diagnostic process (eg., not excluding COVID-19 even though the PCR test is negative). For the distribution of possible late-diagnosed diseases, 25.8% of HCPs selected chest diseases, followed by infectious diseases, heart diseases, and cancer. In general, participants agreed that there was an increase in the negligence in the follow-up of various diseases and/or complication rates due to COVID-19 pandemic. Sixty percent of the HCPs agreed that HCPs are being much more rigorous to diagnose/treating COVID-19 than other important diseases. Fifty-seven percent of the participants stated that the diagnosis and follow-up of chronic diseases are affected, while 57.9% of the HCPs stated that some diseases that show similar signs and symptoms as COVID-19 are not diagnosed correctly during COVID-19 pandemic. Findings from this study emphasize that COVID-19 pandemic has significantly caused delayed diagnoses and interruption in the management of chronic diseases, and also increased the risk of missing out the diagnosis of non-COVID-19 diseases. The study genuinely aims to yield the floor to a permanent improvement in post-pandemic clinical management and it also shows the need for a focused approach in distinct areas of medical care. Policymaking is required to drive changes to better support HCPs in Turkey

RAPD-PCR AND REAL-TİME PCR HRM BASED GENETIC VARIATION EVALUATIONS OF URTİCA DİOİCA PARTS, ECOTYPES AND EVALUATIONS OF MORPHOTYPES İN TURKEY

Urtica dioica is an ethnobotanically and medicinally important Complementary and Alternative Medicine (CAM) plant worldwide and in Turkey; 90 % of herbal CAM applications depend on it in Turkey. It has a wide range of habitats in nearly all continents. It is found in all three phytogeographical regions in Turkey (Euro-Siberian, Irano-Turanian, Mediterranean) with high adaptivity to heterogeneous geographies such as climate, soil types and altitudes. This fact in relation to the assessment of chemical constituents of the plant and combining with further genetic and morphological variation data can assist and enhance the works for the utility and reliability of CAM applications in effect and activity of this plant species. In this work we have made some preliminary experiments with novel approaches to reveal the ecotypes and genetic variation of mighty ecotypes of Urtica dioica from different phytogeographical regions of Turkey (Euro-Siberian and Mediterranean). The ecotypes have heterogeneity in both its parts (leaf, stem, root) as revealed by Random Amplified Polymorphic DNA-Polymerase Chain Reaction (RAPD-PCR) using random primers and High-resolution Melt (HRM) analysis using Urtica dioica specific primers and universal chloroplast DNA (cpDNA) primers and morphological traits such as phenolic contents and antioxidant capacities of plants’ leaf infusions as used in medicinal applications in Turkey. This work will contribute a lot for the development of molecular markers to detect the genetic variation and heterogeneity of Urtica dioica to further relate with expected phenotypes that are most useful and relevant in CAM applications

Discoidin domain receptor 1 as a promising biomarker for high-grade gliomas

Background: Two fundamental challenges in the current therapeutic approach for central nervous system tumors are the tumor heterogeneity and the absence of specific treatments and biomarkers that selectively target the tumor tissue. Therefore, we aimed to investigate the potential relationship between discoidin domain receptor 1 (DDR1) expression and the prognosis and characteristics of glioma patients. Materials and Methods: Tissue and serum samples from 34 brain tumor patients were evaluated for DDR1 messenger ribonucleic acid levels in comparison to 10 samples from the control group, and Kaplan-Meier survival analysis has performed. Results: DDR1 expression was observed in both tissue and serum samples of the patient and control groups. DDR1 expression levels in tissue and serum samples from patients were higher in comparison to the control group, although not statistically significant (P > 0.05). A significant correlation between tumor size and DDR1 serum measurements at the level of 0.370 was reported (r = 0.370; P = 0.034). The levels of DDR1 in serum showed a positive correlation with the increasing size of tumor. The results of the 5-year survival analysis depending on the DDR1 tissue levels showed a significantly higher survival rate (P = 0.041) for patients who have DDR1 tissue levels above cutoff value. Conclusions: DDR1 expression was significantly higher among brain tumor tissues and serum samples and its levels showed a positive correlation with the increased size of tumor. This study can be a starting point, since it investigated and indicated, for the first time, that DDR1 can be a novel therapeutic and prognostic target for aggressive high-grade gliomas

Vaccination in Individuals with Multiple Sclerosis – Part I

Multiple sclerosis (MS) is an autoimmune and demyelinating disease of the central nervous system. It is a chronic disease, and in the evaluation of all other health and vital processes, decisions should be made by considering the disease process and the drugs used by the patient. Since vaccination can be performed at every stage of life, from childhood to adulthood, immune system activity, except where it is characteristic of the vaccine, should be reviewed in patients with MS. In this review, the applications of different vaccines in individuals with MS are discussed in two separate sections

Harnessing Bacterial Extracellular Vesicle Immune Effects for Cancer Therapy

There are a growing number of studies linking the composition of the human microbiome to disease states and treatment responses, especially in the context of cancer. This has raised significant interest in developing microbes and microbial products as cancer immunotherapeutics that mimic or recapitulate the beneficial effects of host-microbe interactions. Bacterial extracellular vesicles (bEVs) are nano-sized, membrane-bound particles secreted by essentially all bacteria species and contain a diverse bioactive cargo of the producing cell. They have a fundamental role in facilitating interactions among cells of the same species, different microbial species, and even with multicellular host organisms in the context of colonization (microbiome) and infection. The interaction of bEVs with the immune system has been studied extensively in the context of infection and suggests that bEV effects depend largely on the producing species. They thus provide functional diversity, while also being nonreplicative, having inherent cell-targeting qualities, and potentially overcoming natural barriers. These characteristics make them highly appealing for development as cancer immunotherapeutics. Both natively secreted and engineered bEVs are now being investigated for their application as immunotherapeutics, vaccines, drug delivery vehicles, and combinations of the above, with promising early results. This suggests that both the intrinsic immunomodulatory properties of bEVs and their ability to be modified could be harnessed for the development of next-generation microbe-inspired therapies. Nonetheless, there remain major outstanding questions regarding how the observed preclinical effectiveness will translate from murine models to primates, and humans in particular. Moreover, research into the pharmacology, toxicology, and mass manufacturing of this potential novel therapeutic platform is still at early stages. In this review, we highlight the breadth of bEV interactions with host cells, focusing on immunologic effects as the main mechanism of action of bEVs currently in preclinical development. We review the literature on ongoing efforts to develop natively secreted and engineered bEVs from a variety of bacterial species for cancer therapy and finally discuss efforts to overcome outstanding challenges that remain for clinical translation

A Rare Cause of Back Pain after Pregnancy: Postpartum Osteoporosis and Treatment Approach

Pregnancy associated osteoporosis (PAO) is a rare disease characterized by multiple vertebral compression fractures, limitation of movement and severe back pain. A positive family history of PAO, decreased body mass index, sedentary life style, smoking, malnutrition and low calcium intake are among the risk factors of this disease. PAO should be considered in patients with back pain during pregnancy and postpartum period. As a specified therapy option is lack for PAO, discontinuation of lactation and the supplementation of calcium and vitamin D are the main steps of the treatment in patients who are planning to become pregnant in the future. The current data show that bisphosphonates should be avoided and teriparatide may be a treatment option in patients who are planning to become pregnant. In this case report, it was aimed to highlight the diagnosis and treatment approaches of PAO in a patient with back pain during postpartum period

An Unusual Case of Cushing’s Syndrome: Coexistence of Functional Pituitary and Adrenal Adenoma

A case of adrenocorticotropic hormone (ACTH)-independent Cushing’s syndrome, which develops in the course of ACTH-dependent Cushing’s disease, is presented in this report. A 47-year-old woman with a past history of surgery and gamma knife radiosurgery because of Cushing’s disease was admitted to the endocrinology clinic with weight gain and unregulated blood glucose levels. Hypercortisolemia was still persisting and diagnostic work-up indicated ACTH-independent Cushing’s syndrome. Along with the rare possibility of this coexistence, longstanding ACTH hypersecretion can play a role in functional transition of adrenal adenomas. Further studies are needed to clarify the underlying mechanisms

Bulgaristan göçmeni simitçi Murat Haydar Selimoğlu'nun hayatı

Ankara : İhsan Doğramacı Bilkent Üniversitesi İktisadi, İdari ve Sosyal Bilimler Fakültesi, Tarih Bölümü, 2018.This work is a student project of the Department of History, Faculty of Economics, Administrative and Social Sciences, İhsan Doğramacı Bilkent University.The History of Turkey course (HIST200) is a requirement for all Bilkent undergraduates. It is designed to encourage students to work in groups on projects concerning any topic of their choice that relates to the history of Turkey. It is designed as an interactive course with an emphasis on research and the objective of investigating events, chronologically short historical periods, as well as historic representations. Students from all departments prepare and present final projects for examination by a committee, with 10 projects chosen to receive awards.Includes bibliographical references (pages 15-16).by Abdürrahim Özer