January 1958

My dear Brother: It does not require a great stretch of the imagination for me to hear you mutter: Didn\u27t I get one of these yellow sheets only a month ago? Why doesn\u27t he get back to work instead of cluttering up my mail? Well, thereby hangs a tale. A few weeks ago I spent an illuminating, and somewhat dismaying, evening with brother Theophilus in the Middle West. He has a good congregation of about five hundred members. It is an average parish, with the usual complement of saints and sinners, with the lines between them shifting back and forth. Theophilus has worked hard and the Lord of the Church has blessed his hands and his voice

Is it a typical crosstalk: Need for re-implantation?

AbstractWith constantly evolving technology and an ever-increasing number of patients with pacemakers, clinicians will encounter various pacemaker malfunctions in their practice. While some of these issues can be solved even by using only the pacemaker׳s mode settings, others require re-intervention; neglecting a pacemaker׳s malfunction without full investigation threatens the patient׳s life. In this report, we describe a patient with a dual-chamber pacemaker with neglected or unresolved dyssynchronization that occurred 2 years after implantation

The minority buildings in İzmit

Osmanlı İmparatorluğu’nda Tanzimat’ın ilanından önce gayrimüslimler belli kısıtlamalara göre yapı inşa edebilmekteydiler.  Tanzimat’ın getirdiği eşitlik ilkesinin bu kısıtlamaları kaldırması, gayrimüslimlere ait yapıların inşa faaliyetlerini de arttırmıştır. 16. yüzyılın ikinci yarısından itibaren İzmit nüfusu içerisinde sayıları çoğalan gayrimüslimlere ait gerek sivil gerekse sosyal yapılar, kentteki yapı repertuarının önemli bir bölümünü oluşturmaktadır. Bu makalede İzmit’teki gayrimüslimlere ait geleneksel yapıların Tanzimat sonrasındaki yeniden inşa süreçleri, dönemin koşulları bağlamında ele alınmış, bunlara 19. yüzyılda Osmanlı topraklarında etkili olan misyoner örgütlerce veya kentteki yabancılarca inşa edilen yapılar da dahil edilmiştir.  Bu bağlamda yayınlanmış kaynakların yanı sıra Başbakanlık Osmanlı Arşivi ve Osmanlıca kent haritalarının yardımıyla İzmit’te toplam 10 yapı tespit edilebilmiştir. Yalnızca ikisi günümüzde de mevcut olan bu yapıların geneli, kentte gayrimüslimlerin yoğun olarak yaşadıkları alanlarda inşa edilmiştir. Yalnızca Rumlara ait Pandeleimom Manastırı, kentin 19. yüzyıldaki yerleşim alanı dışında kalmaktadır. Tanzimat dönemi sonrasında İzmit’te gayrimüslimlere ait sosyal yapılarda yapılacak onarım ve yeniden inşa faaliyetlerine ilişkin Başbakanlık Osmanlı Arşivi belgelerinde özgün projeleri tespit edilen 6 yapının projeleri kentteki yerel mimarlarca hazırlanmıştır. Fakat görsellerini tespit ettiğimiz yapılardan anlaşıldığı üzere, bu projelere uygulama aşamasında her zaman bağlı kalınmamıştır.  19. Yüzyılın sonu ve 1912 yılları arasında yeniden inşa edilen veya projeleri yapılan yapılarda, bu zaman aralığında geçerli olan Neo-Gotik, Neo-Klasik, I. Ulusal Mimari üslupları tercih edilmiştir. Anahtar Kelimeler: İzmit, Tanzimat mimarisi, Azınlık yapıları, Misyoner yapıları. Izmit that is located at the end of the gulf with the same name at the east of the Marmara Sea was established in the Hellenistic period with Nicomedia name. Izmit became an important coastal town through the advantage of its strategic location and maintained its characteristic as being one of the important cities of Anatolia after going under the Ottoman Authority in 1337. In the historical sources, it was mentioned that the local people from the Greeks were allowed to stay in the city after the conquest, if so desired. The Jews and the Armenians were added on the population of the city starting from the second half of the 16th century. By the time of progress, the number of the non-Moslems who constitute a significant portion of the population of the city shows variances in the different dated data. According to the figures provided by Cuinet at the end of the 19th century regarding the ethnical and religious distribution of the population of Izmit,  the minorities 12.625 while the Moslems were 12.365 out of the approximate city population of  25.000. On the other hand, in 1914 there were 3.500 Armenians, 950 the Greeks and 250 Jews in the total city population of 15.410. Genarally the minority populations in the city were living in the locations that were outside of the Moslem locations. Physically, in the Izmit city that consists of the linear expansion flat area between the sea and the hill at the north, the Moslem locations were observed expanding from the slopes of the hill at the north towards the east. In the city, the Armenians were located in the west of the city, the Greeks were located in the area covering the coast and the upper side of the railway in the southeast of the city, the Jews was located in the east of the old bazaar named as Hanlarici. A considerable amount of churches, synagogues and educational establishment belonging to the non-Moslem population in the city comprise the significant part of the building repertoire of the city. But those buildings making themselves apparent in the physical appearance of the city have started by the same rights given to the Moslems and non-Moslems in the Tanzimat Imperial Order in 1839. As throughout the Empire, an increase in the building activities belonging to the minorities was also observed in Izmit after the removal of the restrictions on the building after the Tanzimat. While the traditional buildings belonging to the local minorities constitute their new building activities, the rest were the buildings constructed upon the effects of the increased missionary studies on the Ottoman land in the 19th century. Miniority buildings in Izmit, that are no more present in the city with the exception of two, were determined in the old city maps located in the Saraybahce Municipality and in the documents in the Ottoman Archives of the Prime Ministry. Only 10 buildings were determined at the end of the study related to the subject. It was understood that the three of these buildings were constructed by the missionary organizations. Two of these  buildings  belonging to the Armenians. One of these was accepted as the Surp Asdvadzadzin Church that was told to be in Izmit in the resources was the building within the Armenian settlement boundaries in the old city maps. The building that has the phrase of the "Armenian Nation School" name in the same Armenian settlement boundaries should be the Armenian Nation School that was permitted for its renovation in 1911 according to the archive documents. In Izmit, 3 religious buildings belonging to the Greek was determined. One of those is Pandeleimon Monastery that was first constructed in the 4th century outside of the city is in the west of the city. The church belonging to the Greeks in the center of the city is the Aya Vasil Church that was permitted for its renovation in 1888. Another religious building belonging to the Greek is Metropolitan House. In the city, there are one synagogue and one school belonging to the Jews. It was observed that the buildings of which some of their genuine drawings were met in their permission requests were designed in accordance with the effectual architectural styles of the period. For example, the plan of the Metropolitan House was designed in the Neoclassical style in 1898. In the school building plans of 1911-1912 periods, the effects of the I. Ulusal Mimari understanding style were felt. It was understood that these plans prepared by the public or private local architects, but prepared plans were not always applications. Keywords: Izmit, Tanzimat architecture, Minority buildings, Missionary buildings.

The Relationship between Extremity Volume with Pain, Sensation and Grip Strength After Breast Cancer Surgery

Amaç: Üst ekstremite hacmindeki artış meme kanseri cerrahisi sonrasında görülen en yaygın komplikasyonlardan biridir ve üst ekstremite fonksiyonlarını olumsuz etkileyebilmektedir. Bu çalışmanın amacı meme kanseri cerrahisi sonrası, üst ekstremite hacmi ile ağrı, duyu ve kavrama kuvveti arasındaki ilişkileri araştırmaktı. Gereç ve Yöntem: Çalışmaya 44-73 (54,00/50,50-62,00 yıl) yaş arası, meme kanseri tanısı sonrası cerrahi ve onkolojik tedavi almış ve son tedavisini en az üç ay önce tamamlamış 49 katılımcı dahil edildi. Üst ekstremite hacmi Frustum yöntemi ile hesaplandı, ağrı Görsel Analog Skala ile sorgulandı, duyu Semmes-Weinstein Monofilament Testi ile değerlendirildi ve kavrama kuvveti hand-held dinamometre ile ölçüldü. Bulgular: Etkilenen ekstremitede, etkilenmeyen ekstremiteye göre kavrama kuvveti daha düşük (p<0,001) ve ekstremite hacmi daha yüksekti (p<0,001). Üst ekstremite hacmi ile birinci parmak ucunda duyu kaybı arasında (p=0,036) ve üst ekstremite hacmi ile hipotenar bölge duyu kaybı arasında (p=0,036) pozitif yönde düşük orta derecede ilişkiler tespit edildi. Sonuç: Bu çalışmanın sonuçlarına göre meme kanseri cerrahisi sonrası üst ekstremite hacmindeki artış üst ekstremite duyusu ile ilişkili, bununla birlikte, ağrı veya kas kuvveti ile ilişkili değildir. Meme kanseri cerrahisi sonrasında sıklıkla görülen üst ekstremite hacmindeki değişikliklerin ilişkili olduğu faktörler önleme ve tedavi sürecine yön verme açısından akılda tutulmalıdır

COVID-19 Disease and Pulmonary Physiotherapy

Aralık 2019’da, Çin’in Wuhan kentinde ortaya çıkan ve Dünya Sağlık Örgütü’nün pandemi olarak ilan ettiği COVID-19, hastaların temel olarak respiratuar, kardiyovasküler, nörolojik ve kas-iskelet sistemlerini etkilemektedir. Vakaların %15’i şiddetli, %5’i ise ventilasyon ve yaşam desteği gerektiren çok şiddetli klinik tablo ile izlenmektedir. COVID-19 hastaları, bu etkiler sebebiyle hastalığın stabil olduğu erken dönemden itibaren pulmoner rehabilitasyona ihtiyaç duymaktadır. Solunum fizyoterapisi, pulmoner rehabilitasyonun önemli komponentlerinden biridir. Bu derlemede güncel literatür eşliğinde, COVID-19 hastalarının hastane süreci ve taburculuklarında uygulanabilecek solunum fizyoterapi yöntemleri ve uygulamalar sırasında dikkat edilmesi gereken noktalar ele alınmıştır. COVID-19, which was appeared in Wuhan, China in December 2019 and declared by the World Health Organization a pandemic, affects patients’ respiratory, cardiovascular, neurological, and musculoskeletal systems. 15% of the cases are severe and 5% are followed by a very severe clinical condition that requires ventilation and life support. COVID-19 patients need pulmonary rehabilitation from the early stage on when the disease is stable due to these negative effects. Respiratory physiotherapy is one of the important components of pulmonary rehabilitation. In this review, respiratory physiotherapy methods which can be applied to patients during the treatment inhospital and after the discharge, and points to be considered in the application of these methods are discussed

Comparison of Physical Fitness of University Students with and without Regular Physical Activity and Exercise Habits: Preliminary Study

Amaç: Düzenli fiziksel aktivite ve egzersiz alışkanlığının çok sayıda fizyolojik yararı olduğu bilinmesine rağmen, genç yetişkinlerde fiziksel uygunluğa etkisi net değildir. Bu çalışmanın amacı düzenli fiziksel aktivite ve egzersiz alışkanlığı olan ve olmayan üniversite öğrencilerinin sağlıkla ilişkili fiziksel uygunluk parametrelerinden kardiyorespiratuar endurans ve vücut kompozisyonlarının karşılaştırılmasıdır. Gereç ve Yöntem: Çalışmaya 16’sı erkek toplam 29 üniversite öğrencisi (ortalama yaş; 20.4 ± 1.5 yıl) katıldı. Öğrencilerin demografik özellikleri ve kardiyovasküler risk faktörleri sorgulandı. Fiziksel aktivite ve egzersiz alışkanlıkları kaydedildi. Haftada en az 3 kez orta şiddette fiziksel aktivite yapan öğrenciler düzenli fiziksel aktivite ve egzersiz alışkanlığı olan grup olarak belirlendi. Fiziksel uygunluk değerlendirmesinde, vücut kompozisyonu; beden kütle indeksi, bel kalça oranı ve biyoelektriksel impedans analizi kullanılarak, kardiyorespiratuar endurans ise UKK 2 km Yürüme Testi ile değerlendirildi. Bulgular: Çalışmaya katılan öğrencilerin 15’inde (%51,7) düzenli fiziksel aktivite ve egzersiz alışkanlığı vardı. Düzenli fiziksel aktivite ve egzersiz alışkanlığı olan ve olmayan öğrencilerin vücut kompozisyonları benzer bulundu (p>.05). Düzenli fiziksel aktivite ve egzersiz alışkanlığı olan grubun yürüme testini bitirme süresi daha kısa ve maksimal oksijen tüketimi daha yüksekti (p<.05). Sonuç: Düzenli fiziksel aktivite ve egzersiz alışkanlığı olan üniversite öğrencilerinde kardiyorespiratuar endurans değerleri düzenli fiziksel aktivite ve egzersiz alışkanlığı olmayanlara göre daha yüksektir. Üniversite öğrencileri sağlığı geliştirici düzenli fiziksel aktivite ve egzersiz alışkanlığı kazanmaları doğrultusunda bilgilendirilmeli ve bu alışkanlığı arttırmaya yönelik programlara yönlendirilmelidir.Objective: Although it is known that regular physical activity and exercise habits have numerous physiological benefits, its effect on physical fitness in young adults is not clear. The aim of this study is to compare the cardiorespiratory endurance and body composition of university students, which is a health-related physical fitness parameter, with and without regular physical activity and exercise habits. Material and Method: A total of 29 university students, 16 of them were male (mean aged 20.4 ± 1.5 years) participated in the study. Demographic characteristics and cardiovascular risk factors were questioned. Physical activity and exercise habits were recorded. Students with moderate physical activity at least 3 times per week were identified as having regular physical activity and exercise habits. For physical fitness assessment, body composition was evaluated by body mass index, waist hip ratio, and bioelectrical impedance analysis, and cardiorespiratory endurance was evaluated by UKK 2 km Walk Test. Findings: Of the 29 students who participated in the study, 15 (51.7%) had regular physical activity and exercise habits. The body composition of groups was similar (p>.05). The group with regular physical activity and exercise habits had shorter duration of running and higher maximal oxygen consumption (p<.05). Conclusion: Cardiorespiratory endurance of university students with regular physical activity and exercise habits are higher than those without exercise habits. University students should be informed about health promoting regular physical activity and exercise habits and should be directed to habitenhancing programs

The efficacy and safety of omalizumab in refractory chronspontaneous urticaria: Real-life experience in Turkey

Introduction: This study used real-world data to evaluate the effectiveness and reliability of omalizumab in treating recalcitrant chronic spontaneous urticaria in Turkish patients. Methods: Study data were collected retrospectively from eight tertiary-care hospitals in Turkey. This study included 132 patients with chronic spontaneous urticaria that were resistant to H1 antihistamine treatment in a dose up to four times the licensed dose and were treated with 300 mg/month of omalizumab for 6 months. Results: The mean weekly urticarial activity score (UAS7) after omalizumab treatment improved significantly compared to the pretreatment score (p <0.001). Treatment response was detected primarily in the 1st and 2nd months after treatment. No significant association was observed between omalizumab’s treatment effectiveness and disease-related parameters or laboratory data. The mean dermatology life quality index was 23.12 ± 6.15 before treatment and decreased to 3.55 ± 3.60 6 months after treatment (p <0.001). No side effects were reported in 89.4% (118) of the patients. Conclusion: This study showed that UAS7 decreased significantly and quality of life improved in omalizumab-treated patients. Moreover, treatment effectiveness was mainly observed in the first 2 months after treatment. However, no association was observed between omalizumab treatment effectiveness and disease-related parameters or laboratory data

Current barriers and recommendations on the diagnosis of transthyretin amyloid cardiomyopathy: a Delphi study

ObjectivesThis study has been conducted to investigate the non-invasive diagnostic journey of patients with a transthyretin amyloid cardiomyopathy (aTTR-CM) in Turkey, identify the challenges and uncertainties encountered on the path to diagnosis from the perspectives of expert physicians, and develop recommendations that can be applied in such cases.MethodsThis study employed a three-round modified Delphi method and included 10 cardiologists and five nuclear medicine specialists. Two hematologists also shared their expert opinions on the survey results related to hematological tests during a final face-to-face discussion. A consensus was reached when 80% or more of the panel members marked the “agree/strongly agree” or “disagree/strongly disagree” option.ResultsThe panelists unanimously agreed that the aTTR-CM diagnosis could be established through scintigraphy (using either 99mTc-PYP, 99mTc-DPD, or 99mTc-HMPD) in a patient with suspected cardiac amyloidosis (CA) without a further investigation if AL amyloidosis is ruled out (by sFLC, SPIE and UPIE). In addition, scintigraphy imaging performed by SPECT or SPECT-CT should reveal a myocardial uptake of Grade ≥2 with a heart-to-contralateral (H/CL) ratio of ≥1.5. The cardiology panelists recommended using cardiovascular magnetic resonance (CMR) and a detailed echocardiographic scoring as a last resort before considering an endomyocardial biopsy in patients with suspected CA whose scintigraphy results were discordant/inconclusive or negative but still carried a high clinical suspicion of aTTR-CM.ConclusionThe diagnostic approach for aTTR-CM should be customized based on the availability of diagnostic tools/methods in each expert clinic to achieve a timely and definitive diagnosis

Transitional ‘hospital to home’ care of older patients: healthcare professionals’ perspectives

Author's accepted version (postprint).This is an Accepted Manuscript of an article published by Wiley in Scandinavian Journal of Caring Sciences on 27/08/2020.Available online: https://onlinelibrary.wiley.com/doi/epdf/10.1111/scs.12904acceptedVersio