A Practical and Safe Parameter for Determining Gestational Age: Transverse Cerebellar Diameter

INTRODUCTION: We aimed to investigate the role of transcerebellar diameter (TCD) on obstetric ultrasound for calculating the fetal gestational age METHODS: The women with a pregnancy of 18-25 weeks (according to date of the last menstrual period(LMP)) who underwent a obstetric ultrasound were included in the study. The biparietal diameter (BPD), femur lenght (FL) and trans-cerebellar diameter (TCD) were calculated and their correlation with the getastional age were examined with statistical analysis. RESULTS: Our study was conducted on 114 pregnant women. The mean age was 27 (+-5-17) and approximately 54% of them were between 21-22 weeks. The value of TCD in millimeters in transabdominal ultrasonography showed a strong positive correlation with LMP(r=0.916, p<0.001), BPD(r=0.939, p<0.001) and FL(r=0.880, p<0.001) at 18-25 weeks in indicating gestational age. As the gestational age increased, TCD also increased. In addition, the value of TCD in millimeters was the same as the gestational age in approximately 80% of all patients, especially when compared with BPD. DISCUSSION AND CONCLUSION: Because TCD calculation on obstetric ultrasound between 18-25 week of gestation is a safe and easy method for evaluating the general condition of fetüs, it may be added to BPD, FL calculation in the routine practise

The comparison of computed tomography densitometry and DEXA for diagnosis of osteoporosis

Aim: In this study, we aimed to compare DEXA and CT densitometry in the diagnosis of osteoporosis and to evaluate the contribution of Hounsfield Unit calculation to the diagnosis of osteoporosis. Also, we examined the bone mineral loss in osteoporosis by CT volumetry on lumbar vertebrae and femur neck. Materials and Methods: A total of 102 patients (51 females, 51 males) who underwent DEXA and CT densitometry on the same day were evaluated according to their measurements of lumbar vertebrae and femur neck. The DEXA T-scores and BMD values of L1-L2-L3-L4 vertebra bodies and femur neck were compared with CT densitometry HU values which were measured as the same regions. Also, CT volumetric measurements of vertebral bodies and femur neck were compared with DEXA results of the same regions. Results: A statistically significant correlation between DEXA results and CT HU values of lumbar vertebrae and femur neck was found as DEXA T-score and BMD value increase, CT HU value increased. CT HU values of patients which were classified according to WHO classification (osteoporosis, osteopenia, and normal density groups) were found to be statistically significantly different. We observed that an L1 vertebra corpus HU value < 161 and a femur neck HU value <96 suggest an increased risk of osteoporosis. As age increases, CT HU value statistically decreased. Also, we detected that DEXA T-score and BMD values of lumbar vertebrae and femur neck were correlated with CT volumetric measurements of these regions. Discussion: CT densitometry of lumbar vertebrae and femur neck may be an alternative method to DEXA for the diagnosis of osteoporosis. We suggest that a CT densitometry technique with a low-dose scan of an ideal region may be a promising modality for the diagnosis of osteoporosis

The Relationship of Markers With Carotid Artery Stenosis and Lesion Hardness: Superiority of C-Reactive Protein and Uric Acid

Background : Atherosclerosis is a disease that cholesterol plaque builds up inside arteries. The process of atherosclerosis starts when certain substances such as cholesterol, fats, and cellular waste products accumulate in the walls of arteries, and the immune system responds to these substances, triggering inflammation. Over time, this inflammation can cause the plaque to grow and harden, narrowing the artery and reducing blood flow. Carotid artery disease (CAD) is a conclusion of plaques in carotid artery. CAD can increase the risk of stroke, a potentially life-threatening condition that occurs when blood flow to the brain is interrupted. Objectives: The objectives of this study were to detect the association between carotid artery stenosis and inflammatory markers. Methods: This study was designed prospectively and included 109 and 100 patients having mild carotid stenosis and severe carotid stenosis, respectively. Further, 101 patients were included in the control group. The carotid ultrasonography was evaluated in all patients. After classifying the plaques into(severe stenosis) categories, they were also grouped into echogenicity plaques, namely, echolucent (soft) and echogenic (hard) plaques. Results: The uric acid (UA) values of the mild and severe stenosis groups were higher than that of the control group (P<0.01). The mean C-reactive protein (CRP) value was the highest in the severe stenosis group, and the lowest CRP value was found in the control group (P<0.01). A one-unit increase in UA could increase the risk by 2.203 times. The CRP value was higher in the soft lesion group without calcification than in the hard lesion group with calcification. Conclusion: Our findings demonstrated that age, UA, and CRP values were identified as predictors independent of each other in the development of carotid stenosis. Regarding plaque classification, our results identified CRP, mean platelet volume (MPV), white blood cell, and lymphocyte values as negative predictors. The findings of our study indicate that CRP and UA are valuable in predicting the severity of stenosis and the formation of soft plaque

Importance of the Factors for Hiring a University Lecturer: A Case Study at TIU Sulaymaniyah

Human resource management is one of the key departments at the organizations to improve employee abilities and skills based on the objectives of the companies. Accordingly, finding correct staff for the correct position is key responsibility for HRM to increase the competitive advantage of the organization. In this respect, this paper aims to investigate how HRM at the Tishk international university evaluates teaching staff for hiring. To understand this, we have organized a questionnaire and interviewed with the head of the departments of TIU. Results of the interviews have been evaluated through analytical hierarchy process (AHP). It has been observed that “knowledge in his/her field” is the most important factor for a lecturer to be hired TIU. Further, “Productive (writes article, does projects…etc)” is the second most important factor for the head of the departments at the university

Clinical utility of EDACS-ADP in patients admitted with chest pain to an emergency department

BACKGROUND: Acute coronary syndrome (ACS) is a common cause of mortality and morbidity. An ACS diagnosis can be made with electrocardiogram (ECG) and cardiac markers. However, despite medical advances, 2–5% of ACS patients are undiagnosed and discharged from emergency departments (EDs) because clinicians often find it difficult not only to diagnose and treat high-risk patients but also to define nonemergency diseases or safely discharge healthy patients. Risk stratification can be prevented, and inappropriate diagnosis and treatment protocols can be identified. The ED Assessment of Chest Pain Score-Accelerated Diagnostic Protocol (EDACS-ADP) scoring system, developed to identify patients with chest pain but at low risk for a major adverse cardiac event (MACE), is the first score based on clinical data from emergency medicine.   OBJECTIVES: This study investigates the usability of EDACS-ADP in Turkey.   MATERIALS AND METHODS: This is a prospective observational study of 392 patients. The primary outcome was a major adverse cardiovascular event (MACE) within thirty days.   RESULTS: A total of 116 MACEs occurred in 65 (16,6%) patients during a one-month follow-up. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+ LR), and negative likelihood ratio (–LR) values of the EDACS-ADP score for the evaluation of 30-day MACE rate in patients who admitted with chest pain for two months were as follows: 96.9%, 64.5%, 35.2%, 99.1%, + LR: 2.73, and –LR: 0.05.   CONCLUSION: Most of these patients were classified by the EDACS-ADP as low risk and suitable for discharge. The 30-day MACE rate of development was significantly low (0.9%) and acceptable in patients grouped as low risk

Kyphoplasty is not Superior to Vertebroplasty in Restoring Vertebral Height in the Long Term

Objective: The aim of this study was to evaluate whether kyphoplasty (KP) is superior to vertebroplasty (VP) in restoring spinal height in the long term. Methods: The study encompassed a cohort of 33 patients aged between 42 and 90 years, with a follow-up period of at least 5 years, who had undergone either KP (n=16) or VP (n=17) for the diagnosis of osteoporotic vertebral fractures at our institution. Clinical comparisons were conducted on the basis of Oswestry scores, EuroQol-5 Dimension (EQ-5D), and visual analog scale (VAS) scores, while radiological assessments were performed considering fractured vertebral height and local kyphosis angle values. Evaluations were conducted across preoperative, postoperative, and last control radiographs. Results: In both cohorts, the mean age was comparable, and there was no significant difference in the follow-up duration (p=0.126). Regarding radiological assessments during the early postoperative phase, KP patients exhibited a noteworthy enhancement in the anterior vertebral column height (mean, from 1.3471 mm to 2.0941 mm), middle vertebral column height (mean, from 1.3375 mm to 1.6437 mm), and local kyphosis angle improvement (mean, from 17.88° to 7.81°). However, the last control values demonstrated similar outcomes in both groups (KP patients: 1.4412 mm, 1.4063 mm, 13.69°; VP patients: 1.2813 mm, 1.3176 mm, 17.18°). In addition, there were no statistically significant differences in Oswestry scores, EQ-5D index, and VAS scores between the two groups. Conclusion: According to our study, KP appears to be an effective method in the early treatment of painful collapsed vertebral fractures, but it was not observed to be superior to VP in the long term

Eco-critical analysis of Tolkien's Legendarium from an environmental history perspective

Çevre Tarihi insanlığın, toplumların ve devletlerin içerisinde yer teşkil ettikleri çevre ile etkileşimini ekoloji bilimi ve tarihi vesikalar ışığında inceleyen bir araştırma alanıdır. Eko-eleştiri ise kültür ve edebiyatın ekolojik perspektiften incelenmesine dayanan bir çalışma alanıdır. Bu çalışma çevre tarihi ve eko-eleştiri gibi araştırma alanlarını Tolkien Legendarium’u örneğinde buluşturmaktadır. 20. yüzyılın ilk yarısında İngiliz dilbilimci John Ronald Reuel Tolkien tarafından kaleme alınan Legendarium edebi niteliğinin yanı sıra kendi içerisinde binlerce yıllık bir tarih barındırmaktadır. Tolkien inşa ettiği Legendarium içerisine detaylı şekilde planlanmış bir coğrafya, jeolojik değişimler, toplumsal yapılar, diller, kültürler ve devletler yerleştirmiştir. Bu çalışma tüm bu oluşumların çevre ile ilişkisini konu edinmektedir. Bu araştırma çevre tarihi ve eko-eleştiri perspektiflerini Tolkien Legendarium’unu oluşturan eserlere uygulayarak bir analiz oluşturmaktadır. Bu kapsamda J.R.R. Tolkien’in Legendarium’u oluşturan metinleri analiz edilmeye çalışılmıştır. Bu açıdan bu çalışma Tolkien’in eserlerine odaklanmasıyla anlatı araştırmasının ve Tolkien’in eserlerindeki ekolojik bağlantıların derinlemesine açıklanmasıyla durum araştırmasının özelliklerini barındırmaktadır. Bu araştırma inşa edilirken Tolkien Legendarium’un belli bir dönemi yerine tüm zaman çizelgesi ele alınmıştır. Bundan dolayı bu araştırma uzun dönemli bir araştırmadır. Orta Dünya tarihi boyunca büyü, savaşlar ve sanayileşme gibi faaliyet alanlarının ekolojik boyutuna dair bulgulara sahip olan bu çalışma Orta Dünya’da doğaya yabancılaşıp onu değiştiren ve dönüştüren tüm unsurların yok olduğu sonucuna ulaşmaktadır.Environmental History is a research field that examines the interaction of humanity, societies and states with the environment in which they are located in the light of ecology and historical documents. Eco-criticism is a field of study based on the examination of culture and literature from an ecological perspective. This study brings together research areas such as environmental history and eco-criticism with the example of Tolkien Legendarium. Written by the English linguist John Ronald Reuel Tolkien in the first half of the 20th century, Legendarium has a history of thousands of years in addition to its literary quality. Tolkien placed a detailed planned geography, geological changes, social structures, languages, cultures and states into the Legendarium he built. This study deals with the relationship of all these formations with the environment. This research creates an analysis by applying the perspectives of environmental history and eco-criticism to the works that make up the Tolkien Legendarium. In this context, J.R.R. Tolkien's texts that make up the Legendarium have been tried to be analyzed. In this respect, this study has the characteristics of narrative research with its focus on Tolkien's works, and case study with an in-depth explanation of ecological connections in Tolkien's works. While constructing this research, the entire timeline of Tolkien Legendarium was considered instead of a certain period. Therefore, this study is a long-term study. This study, which has findings on the ecological dimension of fields of activity such as magic, wars and industrialization throughout the history of Middle-earth, concludes that all elements that alienated nature and changed and transformed it disappeared in Middle-earth

Assessement of the complications of ultrasound and fluoroscopy-guided placement of totally implantable venous access ports

© 2019, Yuzuncu Yil Universitesi Tip Fakultesi. All Rights Reserved.Totally implantable venous access systems are widely used in oncology; however, their complications are extremely common which, sometimes, require device removal, thereby, leading to delayed chemotherapy and infusion therapies. In this study, we aimed to investigate the immediate, early, and late complications of venous port implantation in our oncology patients. A total of 219 consecutive cancer patients (111 males, 108 females; mean age: 56.9 years; range: 1 to 81 years) were retrospectively analyzed between January 2013 and June 2014. A total of 220 ultrasound-and fluoroscopy-guided totally implantable venous port systems were implanted through the right or left internal jugular vein access. The mean follow-up was 83.7 (range: 2 to 410) days. Overall complication rate was 8.6% (19/220). Eight devices in seven patients were removed due to complications. Two ports were removed in one patient. The complications which required port removal were compromised port-related bloodstream infection (n=5), central venous thrombosis (n=3), and catheter thrombosis (n=1). No major complication or no mortality associated with the port implantation was seen during follow-up. Totally seven immediate complications including local hematoma (n=2), catheter tip retraction (n=2), pain (n=1), catheter loop formation (n=1), catheter malposition (n=1), two early complications (n=2; 1 wound dehiscence, and 1 wound infection), and 10 late complications including catheter-related blood stream infection (n=5), central venous thrombosis (n=3), catheter thrombosis (n=1), and tunnel hematoma (n=1) occurred. Low incidence of complications suggest ultrasound-and fluoroscopy-guided venous port implantation is a safe and reliable method for long-term venous acces

Uterin lipoleiomyoma : MR findings

BACKGROUND: Uterine lipoleiomyoma is a rare and specific type of leiomyoma. CASE REPORT: A 60-year-old postmenopausal woman presented with abdominal pain. Her pelvic ultrasound demonstrated a normal- sized uterus with a well- circumscribed, heterogeneous mass located in the anterior corpus. A pelvic MRI revealed a mass including hyperintense areas on T1-weighted images and hypointense on fat-suppressed T1-weighted images, compatible with lipoleiomyoma. CONCLUSIONS: Uterine lipoleiomyomas are often misdiagnosed pre-operatively and it is important to distinguish leiomyomas from other tumors for prevention from supererogatory surgery. Imaging plays an important role for the exact differentiation