The frequency and costs of intravitreal therapy agents in retinal diseases

Background: The aim of this study is to analyze the numbers and the economic burden of intravitreal anti-VEGF agents and intravitreal dexamethasone (IVD) implants administered to patients with diabetic retinopathy (DR), age-related macular degeneration (AMD) and retinal vein occlusion (RVO). Material and methods: The retrospective case-control study included 1525 patients diagnosed with DME, neovascular AMD and RVO, and received intravitreal anti-VEGF and IVD between January 2016 and December 2018. Intravitreal anti-VEGF administration was performed within the framework of the Pro Re Nata (PRN) regimen. The prices of anti-VEGF agents and IVDs were calculated on the average of the prices in the relevant year. Results: The total number of intravitreal injections in 3 years was 5864. During the 3-year follow-up, on average,ranibizumab (Lucentis) was applied 3.56 ± 2.25 times, alfibercept (Eylea) was applied 3.31 ± 2.16 times, and IVD(Ozurdex) was applied 1.70 ± 0.83 times. The anti-VEGF numbers in 2016, 2017 and 2018 were 1997, 1801, 2066,respectively. In total, the 3-year drug cost was 3,587,812.44 USD. Conclusions: The economic burden of intravitreal anti-VEGF and IVD treatment for retinal diseases is so important to developing countries such as Turkey. The economic burden created by anti-VEGF agents and IVDs in Turkey will reduce in a serious sense, and the legal concerns of physicians will decrease thanks to the decision taken by the Turkish Medicines and Medical Devices Agency (TMMDA)

The frequency of refractive errors required to be corrected in childhood among Turkish children

Background: The aim of this study is to investigate the distribution of refractive errors needed to be correct in childhood. Material and methods: Children applied and received glasses prescriptions were recruited. Age, gender, spherical, cylindrical error, and spherical equivalent (SE) were noted. The refractive errors were classified as myopic, hyperopic and cylindrical errors according to the SE and prescriptions. Cylindrical errors were subdivided into myopic, hyperopic. Children were classified into 4 groups. Group 1, 2, 3 and 4 composed of children whose ages were between 0–5, 6–10, 11–15 and 16–18 years, respectively. Results: There were 846 children in group 1, 3931 in group 2, 5948 in group 3, 3896 in group 4, and a total of 14621 children. The rates of myopia and hyperopia were 72.4% and 27.6%. Myopic and hyperopic astigmatism were found in 29.1% and 11.3% of children. Myopia, myopic astigmatism increased with age (p < 0.05). The hyperopia rate decreased with decreasing age (p < 0.05). The frequency of myopia, myopic astigmatism was higher in both male and female children (p < 0.05). The rate of myopia was higher in females (p < 0.05). There was no statistically significant difference in terms of cylindrical value between genders. The statistically significant difference was found in terms of mean SE among all groups and a negative correlation was present between age and mean SE. A lower negative correlation was stated between age and cylindrical value. Conclusion: Corrected myopic and myopic astigmatism errors were higher than hyperopic refractive errors. The prevalence of myopia increased by age and was higher in females. The need for glasses was highest in children whose age range was between 11 and 15 years

The determınatıon of values added to nature and envıronment by classroom teachers

The individual in which the nature and the environment is a part. Nature has the power to renew itself with the mysterious structure, but the look and attitude of the people to nature present a threat in terms of future generations. The formation of this consciousness and making them gain should begin more from early ages. At this point classroom teachers become important. The values and attitudes towards nature and the environment of classroom teachers is also important in term of making students gain awareness. The aim of this qualitative research is to reveal classroom teachers’ perception of value that they add to the nature and the environment. In the study, phenomenological method of qualitative research methods to reveal the nature and the environment oriented perceptions is preferred. In the Scope of study, face to face interviews were conducted with 20 classroom teachers who work in the center of Isparta province and content analysis was performed to the collected data. Three specialists opionions have been consulted to ensure the reliability of the research Reliability was calculated using the formula of Miles and Huberman for this research and the reliability coefficient was calculated as 0.92. In light of the obtained findings, classroom teachers see nature as a living area and a source of peace, believe the need to keep the environment clean and to behave by acting consciously, think the love of nature is more about instinctive, adopt the need to be example to the students with their behaviors and believe that nature should be respected too, such as respect for human.Birey, içerisinde bulunduğu doğanın ve çevrenin bir parçasıdır. Doğa gizemli yapısı ile kendi kendini yenileyebilme gücüne sahiptir. Ancak insanların doğaya olan bakışı ve tutumu gelecek nesiller açısından tehdit oluşturmaktadır. Bu bilincin oluşması ve kazandırılması daha küçük yaşlardan itibaren başlamalıdır. Bu noktada sınıf öğretmenleri önemli hale gelmektedir. Sınıf öğretmenlerinin doğa ve çevreye yönelik sahip olduğu değer ve tutumlar öğrencilerine bilinç kazandırma açısından önemlidir. Araştırmanın amacı da sınıf öğretmenlerinin doğa ve çevreye yükledikleri değer algılarını ortaya koymaktır. Araştırmada, doğa ve çevreye yönelik algıları ortaya koyabilmek için nitel araştırma yöntemlerinden fenomenolojik yöntem tercih edilmiştir. Çalışma kapsamında Isparta il merkezinde görev yapmakta olan 20 sınıf öğretmeni ile yüz yüze görüşmeler gerçekleştirilmiş ve toplanan verilere içerik analizi yapılmıştır. Araştırmada veri toplama aracı olarak “Görüşme Formu” kullanılmıştır. Bu doğrultuda güvenirliği sağlamak amacıyla 3 uzman görüşüne başvurulmuştur. Güvenirlik, Miles ve Huberman’ın formülü kullanılarak hesaplanmış ve bu araştırma için ise güvenirlik katsayısı 0,92 olarak hesaplanmıştır. Elde edilen bulgular ışığında, sınıf öğretmenleri doğayı yaşam alanı ve huzur kaynağı olarak görmekte, çevreyi temiz tutarak ve bilinçli davranarak hareket etmek gerektiğine inanmaktadırlar. Ayrıca, sınıf öğretmenleri doğa sevgisinin daha çok içgüdüsel olduğunu, davranışlarıyla öğrencilerine örnek olunması gerektiğini belirtmektedirler. Nitekim sınıf öğretmenleri, insana duyulan saygı gibi doğaya da saygı duyulması gerektiğine inanmaktadırlar

Contribution of Endorectal Ultrasound, Magnetic Resonance Imaging and Positron Emission Tomography to Operation Strategy in Rectal Cancer

Objective:Colorectal cancer is the most common type of cancer in the gastrointestinal tract. Preoperative staging is important for applying appropriate treatment modalities. The role of endorectal ultrasonography (ERUS), magnetic resonance imaging (MRI) and positron emission-computed tomography (PET-CT) in rectal cancer patients was evaluated.Method:In this study, between October 2010-April 2012, 30 patients who were diagnosed as rectal cancer clinically and histopathologically were evaluated with ERUS, MRI and PET-CT preoperatively and results were compared with histopathologic findings.Results:Between October 2010-April 2012, 30 patients who were diagnosed as rectal cancer with biopsy in Bezmialem University Medical Faculty Hospital General Surgery Department were included in this study [20 male (66.6%), 10 female (33.3%) and their ages are 38-75 years old, 21 of them received neoadjuvant treatment and 9 of them did not received]. All patients were evaluated with MRI, ERUS and PETCT preoperatively. Rectal cancer patients who are primarily operated from rectal adenocarcinoma were included in this study. For T staging, preoperative MRI, ERUS and PET-CT staged 9 (31%), 12 (41%) and 12 (40%) of 30 patients accurately, respectively. For N staging, preoperative MRI, ERUS and PET-CT staged 15 (51%), 16 (55.1%) and 17 (56.6%) of 30 patients accurately, respectively. In comparison to other modalities, PET-CT did not yield a significant difference in staging and did not change operation strategy. PET-CT detected distant metastasis in 3 patients. One of them was liver and two of them were lung metastasis. Biopsies from mass predicted as lung metastasis did not result as metastasis. PET-CT has high rates of false positivity to detect distant metastasis. In statistical analysis, significant p-values for evaluation could not be obtained.Conclusion:Efficacy of routine use of PET-CT on staging, evaluation of T, N and extramesorectal spread could not be shown

Baş ve boyun bölgesinde çoklu metastaz yapmış solunum sıkıntısına yol açan dev karsinoma ex pleomorfik adenom

Carcinoma ex pleomorphic adenoma is a rare tumor that results from the carcinomatous transformation of a primer or recurrent pleomorphic adenoma. A 75-year-old male patient presented with a solid mass in his neck and respiratory failure. The patient had a 20-year history of this disease. A clinical examination revealed a solid and fixed mass with a number of lobules that fully pervaded the 2nd region on the left side of the neck, arising from the left parotid. Facial nerve functions were good. Furthermore, solid and mobile masses were identified in the frontal region, below the scalp, in the auricle of the left ear and the in left superficial layer of the sternocleidomastoid muscle. An oropharynx examination revealed that the left tonsil region had passed to the midline of the neck, pushing the uvula under the effect of the mass. In an MRI of the neck, the image involved the masticatory and parapharyngeal area that filled in the left parotid on the skull base, narrowed the Rosenmuller fossa on the left superior and obliterated significantly the air lumen on the oropharynx level. The mass extended to the hyoid bone in the caudal and to the bottom of skinto-skin in parotid region. The measurable size of the mass was 9 x 10 cm. The patient underwent a total parotidectomy and a left neck dissection in surgery, and in addition, other masses in the neck and the head were excised.Karsinoma ex pleomorfik adenom primer veya rekürren pleomorfik adenomun karsinomatöz transformasyonu olan nadir bir tümördür. Bu tümörlerin en yaygın klinik prezentasyonu parotis bezinde sert kitle olmasıdır. Bizim olgumuz boyunda kitle ve solunum sıkıntısı ile başvuran 75 yaşındaki erkek hastaydı. Hastanın 20 yıllık bir hikayesi bulunmaktaydı. Klinik muayenede sol parotisten kaynaklanan boynunun sol tarafında 2. bölgeyi de tamamen doldurmuş sert, fikse, çok sayıda lobüllü olan kitle mevcuttu. Fasyal sinir fonksiyonları salimdi. Ayrıca frontal bölgede, skalp altında, sol kulak aurikulasında ve sol sternokleidomastoid kas yüzeyelinde sert, mobil kitleleri mevcuttu. Orofarenks muayenesinde kitle etkisiyle sol tonsil loju uvulayı da iterek orta hattı belirgin bir şekilde geçmişti. Boyun MR’ında solda kafa tabanında, parotit alanı dolduran, süperiorda rosenmüller fossa seviyesinde, rossen müller fossayı soldan daraltan, orta hatta doğru uzanım gösteren, orofarenks düzeyinde hava lümenini belirgin derecede oblitere eden, mastikatör alan, parafarengeal alanı kaplayan parotis lojunda cilt-cilt altına doğruda uzanan, kaudalde hyoid kemik seviyesine kadar uzanan, ölçülebilen boyutu 9x10 cm boyutlarında T1 hafif hiperintens T2 hiperintens, lobüle konturlu, kontrast tutan solid kitle izlenmekteydi. Hastaya cerrahi olarak total parotidektomi ve sol boyun diseksiyonu uygulandı. Ayrıca baştaki ve boyundaki diğer kitleler de eksize edildi. Parotisteki kitle karsinoma ex pleomorfik adenom, baş ve boyun bölgesindeki çıkarılan diğer kitlelerin patolojik tanıları ise karsinoma ex pleomorfik adenom metastazı olarak rapor edildi. Lokal olarak agresif seyreden bu tümörlerin solunum sıkıntısna yol açacak şekilde boyutunun büyük olması, baş ve boyun bölgesinde yüzeyel olarak cildin hemen altında multiple metastazlara yol açması çok nadir olarak görülmektedir

Open Pit Mining Design of Silopi (Harbul-Uckardesler) Asphaltite Filon by Micromine Mining Design Software

Bu çalışma Silopi (Harbul-Üç Kardeşler) asfaltit filonunun Micromine Madencilik tasarım programı kullanılarak yatırımların ekonomikliğini belirleyen projelendirmeyi ve bunun ışığında açık işletme üretim yöntemi ile sahanın modellenmesini içermektedir. Projelendirme aşamasında günümüzde gelişmekte olan paket programların üç boyutlu modellemedeki başarısı, yatırımların daha doğru yapılması, uygun üretim yöntemlerinin uygulanması aşamasında risklerin minimize edilmesi daha kolay hale gelmiştir. Çalışma sonucunda Harbul ve Üçkardeşler Asfaltit filonlarının Micromine 11.0 programı ile modellemesi, rezerv hesaplamaları ve açık işletme dizaynı yapılmıştır.This study includes the project design which determines the economy of investments by using Micromine Mining design program for Silopi (Harbul-Üç Kardeşler) asphaltite filon (phylon) and modeling of the site with the open-pit production method. The success of today’s emerging packet programs on the three dimensional modeling, doing more accurate investments during the project design phase and minimizing the risks at the phase of the implementation of appropriate methods of production has become much easier. As a result of this study, modeling, reserve calculations and open pit design of Harbul and Üçkardeşler asphaltite filons have done by using Micromine 11.0 program

An Examination of the Relations Between Symptom Distributions in Children Diagnosed with Autism and Caregiver Burden, Anxiety and Depression Levels

High stress levels and impairment of physical/mental health in parents can delay early and effective intervention in autism. The purpose of this study was to examine relations between the clinical characteristics of children diagnosed with autism spectrum disorder (ASD) and caregiver burden, and anxiety and depression levels. Seventy cases under monitoring at the Namk Kemal University Medical Faculty Child and Adolescent Psychiatric Polyclinic with a diagnosis of ASD, and their principal caregivers, were included in the study. The Autism Behavior Checklist (ABC), Beck Depression Inventory (BDI), Beck Anxiety Inventory, and the Zarit Caregiver Burden Scale were completed. At multiple regression analysis, autism symptom severity and caregiver depressive symptom levels emerged as significant predictors of total caregiver burden scores. Only the ABC language subscale score had a determining effect on caregiver burden (r=0.51, r(2)=0.26, p=0.04). ABC body and object use subscale scores were identified as the symptom cluster affecting depression and anxiety scores (r=0.25, r(2)=0.06, p=0.03 and r=0.28, r(2)=0.08, p=0.01). Our findings show that ASD symptom severity and depressive symptoms in the caregiver are the most important factors giving rise to the caregiver burden, and that the main ASD symptom cluster affecting the caregiver burden was problems associated with language development. Better understanding of variables impacting on the caregiver burden will increase the quality of psychosocial services for caregivers

In vitro inhibition effect of some dihydroxy coumarin compounds on purified human serum paraoxonase 1 (PON1)

WOS: 000311310400015PubMed: 22971832Human serum paraoxonase 1 (PON1; EC 3.1.8.1) is a high-density lipoprotein associated, calcium-dependent enzyme that hydrolyses aromatic esters, organophosphates and lactones and can protect the low-density lipoprotein against oxidation. In this study, in vitro inhibition effect of some dihydroxy coumarin compounds namely 6,7-dihydroxy-3-(2-methylphenyl)-2H-chromen-2-one (A), 6,7-dihydroxy-3-(3-methylphenyl)-2H-chromen-2-one (B) and 6,7-dihydroxy-3-(4-methylphenyl)-2H-chromen-2-one (C) on purified PON1 were investigated by using paraoxon as a substrate. PON1 was purified using two-step procedures, namely ammonium sulphate precipitation and Sepharose-4B-l-tyrosine-1-naphthylamine hydrophobic interaction chromatography. The purified enzyme had a specific activity of 11.76 U/mg. The dihydroxy coumarin derivatives of A and B compounds inhibited PON1 enzyme activity in a noncompetitive inhibition manner with K (i) of 0.0080 +/- 0.256 and 0.0003 +/- 0.018 mM values, respectively. C compound exerted an uncompetitive inhibition of PON1 enzyme activity with K (i) of 0.0010 +/- 0.173 mM. Moreover, dihydroxy coumarin derivatives of A, B and C compounds were effective inhibitors on purified human serum PON1 activity with IC50 of 0.012, 0.022 and 0.003 mM values, respectively. IC50 value of unsubstituted 6,7 dihydroxy coumarin was found as 0.178 mM. The present study has demonstrated that PON1 activity is very highly sensitive to studied coumarin derivatives

Subsidence monitoring in Zonguldak Coal mining area with SAR interferometry

Zonguldak şehri Türkiye’ nin tek ve en büyük yeraltı taşkömürü maden alanı üzerine kurulmuştur. Bu bölgede 19. yüzyılın ortalarından bu yana taşkömürü madeni çıkarılmaktadır. Sürekli ve yoğun bir şekilde düzenlenen madencilik aktiviteleri nedeniyle yer yüzeyinde geniş alanları etkileyen yer yer çökmeler meydana gelmiştir. Bölgedeki çökmeler açısından birer risk unsuru olan yerleşimlerin varlığı bu alanlarda bulunmaları dolayısıyla büyük bir tehlike altındadır. Bu deformasyonların izlenmesinde klasik jeodezi yöntemleri yeterli olmamakta, uzun süreli ve sürekli ölçümler yapılamamaktadır. Bu çalışmada alternatif bir yöntem olarak doğrultu boyunca meydana gelen deformasyonun belirlenmesinde SAR interferometri (InSAR) yöntemi kullanılmıştır. 1993 ve 2001 yılları arasında alınmış Avrupa Uzaya Ajansı’na (ESA) ait 21 ERS 1/2 uydu görüntüleri kullanılmıştır. StaMPS yazılımı ile sabit saçıcılar (Persistent Scatterers: PS) tekniği kullanılarak Kozlu bölgesi şehir alanında ortalama yer değiştirme hızı 7-8 mm/yıl olarak belirlenmiştir. 7.5 yıl sonucunda ortaya çıkan zemin hareketi değeri ise 50-65 mm olarak belirlenmiştir.Zonguldak city was settled down on the largest and unique hard coal mining source of Turkey. Mining activities have been continued since the mid of 19th century. Constant and intense underground mining caused heavy damage on the Earth surface. Long term measurement of this subsidence is not sufficient with conventional geodetic methods. In this study we used SAR Interferometry (InSAR) as an alternative method. 21 Single Look Complex (SLC) ERS images are acquired between 1993 and 2001 for the process. Persistent Scatters Interferometry (PSI) implementation of StaMPS software is applied to extract deformation rate. In Kozlu town of Zonguldak deformation velocity is estimated 7-8 mm/year over urbanization. The analysis of 7.5 years of data indicates 50-60 mm ground subsidence in the region, which is computed using time series analysis