Çocuk ve sanal ortam

Son yıllarda çocukların bilgisayar ve internet ortamına dahil olmaları, elektronik medya cihazlarının giderek genişleyen çeşitliliği ile artmıştır. Çocuklar bu dünyayı; bilgiye erişim, iletişim, dijital oyunlar, sosyal medya kullanımı gibi alanlarda sıkça kullanmaktadır. Dünyada olduğu gibi ülkemizde de internet kullanan nüfusu giderek artan hızda çocuklar oluşturmaktadır. Bu kadar hızlı gelişen ve değişen bir ortama kendi yaşlarına özgü gelişim özellikleri olan çocukların uyum sağlaması bir takım zorluklar içerebilmektedir. Çocukların internet ve bilgisayar kullanımını kontrol etme ihtiyacı bir çok çalışmada araştırılmıştır. Hızla değişen sanal dünyaya uyum sağlamak güçlükler içermekte, bu yüzden çocukların ekran maruziyeti konusunda önemli ve hassas düzenlemeler belirli aralıklarla güncellenmelidir. Sanal dünyaya uyum sürecinde çocukların gelişimlerini desteklemek önemlidir. Ayrıca çocuklar, sanal dünyayı, fiziksel ve bilişsel yeteneklerine en az zararı olacak şekilde kullanmaları gerekmektedir. İnternet farklı yaş gruplarında farklı şekillerde kullanılmaktadır. Çocuğun sağlıklı bilişsel ve fiziksel gelişimi için, uygun süre ve içerikte kullanımı önerilmektedir. Özellikle okul öncesi dönemde internet ve bilgisayar kullanımının süre ve içerik olarak kontrolü önem taşırken, adölesan dönemde ebeveyn kontrolü daha önemli hale gelebilir. İnternetin aşırı kullanımı ve ayrı kalındığında yoksunluk bulgularının görülmesi olarak tanımlanan internet bağımlılığı en çok adölesan dönemde görülmektedir. Çocuğa yönelik kötü muamele olarak tanımlanan çocuk istismarı, gerçek hayatta olduğu kadar sanal dünyada da karşılaşılan bir sorundur. Bu durumu öngörmek ve bu durumdan çocuklarını korumak öncelikle ebeveynlerin sorumluluğundadır. İnternetin riskleri ön görülebildiğinde, internetin zararlı etkilerini önlemek mümkün olabilmektedir. Sağlıklı çocuk izleminde, klinisyenler çocuğun bilgisayar ve internet kullanımı sırasında karşılaşabileceği riskler konusunda ailelere bilgi vermeli ve bu konuda ailelerin bilgi ve farkındalıklarını artırmalıdır.The involvement of children in the virtual environment has been increased in recent years by the ever-expanding diversity of electronic media devices. Children often use this virtual world to access to information, in areas such as communication, digital games, and social media. The children are forming the population using the internet by the growing rate in our country similar to all over the world. It has some difficulties to accommodate to a fast developing and changing condition for the children who have age specific characteristics. The need to control the internet and computer usage of the children have been investigated in many trials. It has some difficulties to adapt to the rapidly changing virtual world, therefore the regulations about the screen exposure of children should be updated at definitive intervals. It is important to support the development of children during their adaptation to the virtual world. Also; the children should use the virtual world with minimum harm to their physical and cognitive abilities. The internet is used in different forms in different aged groups. Its use is recommended in an appropriate time and context for the cognitive and physical development of children. While the using period and content of internet and computer usage is important especially in the pre-school period, parental control for the adolescent period may carry out more importance. Internet dependence, which is defined as the overuse of the Internet and having absence findings in the case of separation, is seen mostly in adolescent period. Child abuse that is described as ill-treatment to the child is a problem in the virtual environment as well as in real life. Initially, parents have responsibility to foresee and to protect their children from this situation. It may be possible to prevent harmful effects of internet when the risks of the internet can be predicted. The clinicians should inform the parents regarding the risks of the computer and internet usage of the childen and increase the knowledge and awareness of the parents about that issue in healthy child follow-up visits

Digital Media and Children

Today, digital media occupies an important place in human life and children live in this technological environment. Exposure to excessive and inappropriate digital media content, especially in early childhood, when brain development is important, has negative effects both in childhood and adulthood. Excessive and poor quality digital media use has been found to be associated with early effects such as sleep problems, negative self-regulation skills, cyberbullying, psychological disorders, and adult diseases such as obesity and cardiovascular disease. In the light of these data, the American Academy of Pediatrics does not recommend screen use for children before 18 months, except for video chat. It is important for parents to choose quality content in the use of digital media, to be a role model for their children, to guide them and to keep in touch with their children while using the screen

Metastatik safra yolu kanseri olan yaşlı hastalarda optimal tedavi yaklaşımları ve prognostik faktörler

Introduction: There is a lack of evidence of the outcomes in elderly patients advanced stage biliary tract cancer due to the patients aged over 65 years are less than 25% in many prospective trials. We designed a retrospective multicenter study to evaluate the factors affecting treatment and survival in elderly patients with advanced-stage biliary tract cancer. Materials and methods: A total of 116 patients with advanced stage biliary tract cancer aged ≥65 years were included, and the treatment responses, survival, and toxicity rates were evaluated with respect to age groups Results: There was no significant difference between age and response to treatment, survival, or toxicity. The median progression-free survival and overall survival were 5.3, and 11.8 months respectively. Multivariate analysis indicated that ECOG PS (p<0.001 CI95% 1.5-3.7) and PNI (p<0.001 CI 95% 0.14-0.41) were significant independent prognostic factors for PFS. The independent prognostic factors for OS were choice of frontline regimen, NLR and PNI (p=0.007 CI 95% 0.71 – 0.94, p=0.006 CI 95% 1.2 – 3.1, p=0.001 CI 95% 0.35 – 0.91, respectively). Discussion: This study confirms the general prognostic relevance of inflammatory parameters and the importance of frontline treatment in elderly patients with advanced-stage biliary tract tumors. Additionally, getting older does not indicate that treatment will be avoided or that they will have a worse prognosis and suffer from more toxicities.Giriş: 65 yaş üzeri hastaların klinik çalışmaların %25’inden daha azını oluşturması nedeniyle biliyer sistem kanseri olan ileri yaş hastaların yönetimi konusunda kanıt eksiği bulunmaktadır. Bu amaçla, metastatik safra yolu kanseri tanılı yaşlı hastalarda tedaviyi ve sağkalımı etkileyen faktörleri değerlendirmek için retrospektif çok merkezli bir çalışma tasarladık. Gereç ve yöntemler: Çalışmaya 65 yaş ve üzeri, ileri evre safra yolu kanseri tanısı almış, 116 hasta dahil edildi ve yaş gruplarına göre tedavi yanıtları, sağkalım ve toksisite oranları değerlendirildi. Bulgular: Median yaşa göre gruplandırılıdğında; yaş ile tedaviye yanıt, sağkalım, toksisite arasında anlamlı bir fark bulunmadı. Tüm populasyonda medyan progresyonsuz sağkalım (PSK) ve genel sağkalım (GSK) sırasıyla 5.3, 11.8 aydı. Multivariate analizde, PSK için bağımsız prognostik faktörler preformans durumu(ECOG PS) (p<0.001 CI95% 1.5-3.7) ve Prognostik nutrisyonel indek (PNI) (p<0.001 CI 95% 0.14-0.41) olarak bulundu. GSK için ise bağımsız prognostik faktörler, birinci sıra tedavi seçimi, Notrofil Lenfosit oranı (p=0,007 CI %95 0,71 – 0,94) ve PNI (p=0,001 CI %95 0,35 – 0,91) olarak bulundu. Tartışma: Metastatik safra yolu kanseri olan yaşlı hastalarda prognozu etkileyen temel faktöreler inflamatuar parametreler ve birinci basamakta seçilen kemoterapi rejimidir. İleri yaş ile sağkalım, toksiste profili ve tedavi toleransı farklılık göstermemektedir

Varicella-Related Hospitalizations Among Immunocompetent and Immunocompromised Children in Pre-Vaccine Era: A Tertiary Care Center Experience in Turkey

Aim: Although varicella is a common, contagious, self-limited childhood disease, it can cause significant long-term sequelae and mortality in both immunocompetent and immunocompromised children. The aim of the present study is to identify and review varicella-related hospitalizations, admissions and complications of primary varicella infection among immunocompetent and immunocompromised children of a large unselected local population in a governmental institution. Materials and Methods: Demographic aspects, clinical features, microbiological findings, complications, managements and outcome of the patients hospitalized for varicella were analyzed retrospectively. Results: Among 100 such children, 66 were immunocompetent and 34 were immunocompromised. Secondary bacterial infection was the most common complication in both groups. The second most common complication in the immunocompetent group was neurological complications (21%) followed by varicella-zoster virus (VZV) pneumonia (2%). In the immunocompromised group neurological complications and VZV pneumonia were not observed. Hematological complications were seen in 5% of the immunocompetent patients and 6% of the immunocompromised patients. Mortality was seen in 2% in the study group, one patient in the immunocompetent and one in the immunocompromised group. Conclusion: Despite a common perception of varicella infection being highly contagious but harmless, complications requiring hospitalization are frequent, potentially serious and costly even in healthy children. Since varicella virus vaccine prevents most of the morbidity and mortality caused by primary varicella in children, prevention rather than the treatment will be the optimal approach

Comparison of tidos with m-chat for screening autism spectrum disorder

OBJECTIVES: Modified Checklist for Autism in Toddlers (M-CHAT) is widely used internationally to screen autism spectrum disorder (ASD). Three-item Direct Observation Screen (TIDOS) is a novel observational tool which may be used by physicians in a short time as a part of routine well-child visit. It includes the following: (a) Joint Attention, (b) Eye Contact, and (c) Response to Name. We aimed to compare the screening performance of TIDOS and M-CHAT for ASD. MATERIAL AND METHODS: A total of 1345 children aged 16–38 months were examined during well-child care visits at Social Pediatrics Department of Ankara University between May 2015 and May 2016. Five hundred and eleven of 1345 children aged 16—38 months whose parents approved informed consent were enrolled in this study to evaluate the performance of two screening tests: TIDOS and M-CHAT for ASD. The children whose screening tests were positive and controls whose tests were negative had undergone clinical evaluation for the diagnosis of ASD. Clinical evaluation was performed within 2 weeks of the initial M-CHAT, M-CHAT/F, or TIDOS screenings for screening positive children and within 3–9 months for screening randomly selected negative children. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of those tests were determined. RESULTS: ASD was diagnosed in 5 of the 511 children in a healthy child clinic of a university hospital with the prevalence of approximately 1%. All the children with ASD were boys. The growth parameters (including body weight, height, head circumference) did not have any properties. There were no consanguineous marriages among the parents of children with ASD. The ages of mothers and fathers of the children with ASD were in a range between 31–39 years and 31–46 years, respectively. The sensitivity for diagnosis of ASD was found to be 0.60 for both M-CHAT and M-CHAT/F tests. The specificity of M-CHAT and M-CHAT/F tests for diagnosis of ASD was found to be 0.96 and 0.97, respectively. PPV were found to be 0.14 and 0.18, respectively. The sensitivity for diagnosis of ASD was found to be 0.80 for TIDOS. Specificity and PPV in the diagnosis of ASD were found to be 0.99 and 0.80, respectively. NPV for all tests were above 0.99. CONCLUSION: The current study has demonstrated that TIDOS was more sensitive and had higher PPV than M-CHAT. TIDOS has required little time and might be easily combined to routine physical examination of toddlers attending 18- to 36-month well-child clinic visits

A phytochemical-containing metal-organic framework: Synthesis, characterization and molecular simulations for hydrogen adsorption

keskin, seda/0000-0001-5968-0336; Demir, Selcuk/0000-0002-5719-7145; TOPCU, YILDIRAY/0000-0002-2095-6603; TOPCU, YILDIRAY/0000-0002-2095-6603WOS: 000349462500018As a result of involvement of all carboxylato/methoxo/oxo donor oxygen atoms of a phytochemical ferulic acid with zinc ions, a Zn-ferulate metal-organic framework (PhytoMOF-1), {[Zn-2(fer)(2)]}(n) is formed. the structure of PhytoMOF-1 was characterized by single crystal X-ray diffraction studies. PhytoMOF-1 contains channels with a considerable diameter of 15.1(1) x 17.2(1) angstrom. the total void volume of PhytoMOF-1 is similar to 3517 angstrom(3). N-2 adsorption/desorption analyses indicate that the PhytoMOF-1 is porous. Molecular simulations show that PhytoMOF-1 might store hydrogen. the luminescent properties of PhytoMOF-1 are quenched upon the adsorption of toluene and nitrobenzene. (C) 2014 Elsevier B.V. All rights reserved.OMV Gaz ve Enerji Limited Sirketi - Turkey; Ondokuz Mayis University - TurkeyOndokuz Mayis University [PYO.MUH.1905.11.002]This work was financially supported by OMV Gaz ve Enerji Limited Sirketi - Turkey and Ondokuz Mayis University - Turkey (PYO.MUH.1905.11.002). Prof. Dr. Stefanie Dehnen (generous support and helpful discussions) and Mr. Michael Marsch (help with X-ray diffraction studies) are gratefully acknowledged

Deneysel Multipl Skleroz Modelinde (DAE) MSCOV’un İyileştirici Etkilerinin Moleküler Mekanizmalarının Saptanması

Multipl Skleroz (MS), hala etiyolojisi tam olarak bilinmemekle beraber genetik ve çevresel faktörler tarafından tetiklenen, immun bozukluğunun neden olduğu, merkezi sinir sisteminin kronik, enflamatuar ve demiyelizan bir hastalığıdır. Günümüzde MS tedavisi için kullanılan mevcut olan ilaçların kullanımları ile karşılaşılan sıkıntı, tam tedavi etmeni olmamaları ve yan etkilerden dolayı, MS için alternatif tedavi ajanlarının saptanması ve ilaç geliştirilmesi çalışmaları devam etmektedir. Bu kapsamda, projede öncelikle Capparis ovata bitkisinden elde edilen ekstre (MScov) veya Capparis ovata bitkisinden doğrudan elde edilen ekstreler çeşitli ekstraksiyon ve kromatografi teknikleri uygulanarak alt fraksiyonlar ve saf bileşikler elde edildi. Hem ana ekstre MSCov ile ve hem de alt fraksiyonlar ile multipl skleroz deneysel hayvan modeli olan DAE oluşturduğumuz CL57BL/6 farelerde, klinik skorlama, moleküler gen ifade değişkenlikleri, toksikolojik etki belirleme, histolojik ve immünohistokimyasal inceleme ve takipleri, tüm genom transkriptom analizleri gerçekleştirildi. Özellikle ana ekstre MSCov ile tedavi edilen DAE hayvanların hem klinik skorlar ve hem de moleküler gen ifade düzeyleri hastalığın kontrol hayvanlara benzer şekilde geri dönüştürüldüğünü teyit etti. Ayrıca histolojik ve immunühistokimyasal verilerimiz, DAE hayvanlarda tespit edilen miyelin tabakasındaki deformasyonların ve immünolojik tanıların, MSCov uygulaması ile büyük oranda iyileştirildiği ve immünreaktivitelerin kontrol skorlara yaklaştığını gösterdi. Bu ekstrenin olası yan etkilerini tanımlamak için yapılan toksikolojik gen profilleme çalışmalarımız MSCov?un 500 mg/kg/gün dozda güvenilir olduğunu, önemli bir yan etki oluşturmadığını destekledi. Bu verilerimiz Tüm genom transkriptom analizleri ile de teyit edildi. DAE hayvanlarda bağışıklık yanıtı ile ilgili yolaklarda ifade düzeyleri artan transkriptlerin MSCov uygulamaları ile tekrar baskılandığını gösterildi. Ancak elde edilen alt ekstrelerin hiç birisi ile ana ekstreye benzer sonuçlar elde edilemedi. Bu nedenle, MSCov ile gözlenen bu iyileştirici etkilerin içerdiği çok farklı bileşkenlerin pleiotropik etkileri olduğu; fraksiyonlama da birlikte pozitif etki oluşturan bileşkenlerin bir birinden ayrılması yada kompleks yapılarının bozulması nedeni ile etkilerinin kaybolduğu önerilmektedir. Capparis ovata bitkisinden yada ana MSCov ekstresinden proje kapsamında 8 bileşik [glukokapparin, ? -sitosterol, 5?,6?- epoksikolestan, 3?-ol, 5?,6?- epoksikolestan, 3?-ol, stigmast-5,22-dien-3?-ol, miristat, olean-12-en-28-ol, 3?-pentakosanoat (yeni), Bis -(3- metiloktil) fitalat (yeni), 1H-indol-, 2-hidroksi, 3-karboksilik asit (yeni)] saflaştırılmış ve karakterize edilmiştir. Bu bileşiklerin miktarları yeterli olmadığı için hayvan deneyleri yerine in vitro hücre kültüründe etkileri araştırılmıştır. Bu modellerde yapılan deneyler olean-12-en-28- ol, 3?-pentakosanoat bileşiğinin, hem immun baskılayıcı ve hem de miyelin oluşumunu tetikleyici etkiler göstermesi nedeniyle; MSCov ile gözlenen etkilerden sorumlu olabilecek, önemli bir terapötik ajan potansiyeli taşıdığı tespit edildi. Diğer bileşiklerin MS için etkin olma özellikleri oluşturmadığı saptandı. Sonuç olarak, proje ile önerilen hedefler başarı ile gerçekleştirildi ve patent dahil yeni araştırmalara temel oluşturacak çıktılar üretildi

The effects of amiodarone in ovarian injury due to oxidative stress and inflammation caused by ischemia-reperfusion

Objective Ovarian ischemia constitutes 2-3% of all gynecological emergencies. New-generation therapeutic agents need to be discovered, in addition to invasive interventions capable of reducing the risk of potential ovarian ischemia to a minimum and protecting against potential adverse outcomes. Aims To investigate the effects of amiodarone (AMD) on ischemia-reperfusion-induced oxidative stress and inflammation-induced ovarian damage. Methods The control group, received intraperitoneal (i.p.) injection of saline solution. The ischemia group (I-Group), was subjected to ischemia-induced injury without drug administration. The ischemia + AMD (50 mg/kg) group was subjected to ischemia injury and also received i.p. 50 mg/kg AMD prior to induction of ovarian ischemia. The ischemia-reperfusion (I/R group) was exposed to ischemia and reperfusion-induced injury without drug administration. The I/R + AMD (50 mg/kg) group underwent I/R injury together with i.p. administration of 50 mg/kg AMD prior to induction of ovarian I/R. The Sham + AMD group received intraperitoneal (i.p.) injection of 50 mg/kg AMD alone. In this study performed thiobarbituric acid reactive substances (TBARS), thiol (-SH), interleukin 1 Beta (IL-1 beta), interleukin 6 (IL-6), toll-like receptor 4 (TLR4) and nuclear factor-kappa B(NF-kappa beta). Results Increased oxidative stress and inflammation as a result of ovarian I and I/R application activated the cascade. AMD was not sufficient to reduce the oxidative stress and inflammation. TLR4 and NF-k beta, which were up-regulated by triggering oxidative stress and inflammation, were not regressed by the effects of AMD. Conclusions AMD, used as an antiarrhythmic agent, was found to be insufficient, despite its antioxidant and anti-inflammatory properties, to reduce the experimentally induced ovarian tissue damage

The effects of vitamin B12 on the TLR-4/NF-κB signaling pathway in ovarian ischemia-reperfusion injury-related inflammation

Ovarian ischemia is a gynecological emergency case that occurs as a result of ovarian torsion. Oxidative stress and inflammation play central roles in the development of ischemia/reperfusion injuries. We investigated the effects of Vitamin B12, thought to possess antioxidant characteristics on oxidative stress and the toll-like receptor 4 (TLR-4)/nuclear factor kappa B (NF-κB) signaling pathway in the ovaries during ischemia-reperfusion. Forty-eight rats were randomly assigned into six groups and the groups are designed as follows: Control (C), Ischemia (I), Ischemia + Vitamin B12 (I + B12), Ischemia-Reperfusion (I/R), I/R + Vitamin B12 (I/R + B12) and Sham + Vitamin B12. Vitamin B12 was administered at a dose of 400 mcg/kg via the i.p. route once daily for three days before I/R procedure. Tissue interleukin-1β (IL-1β) and interleukin-6 (IL-6) and malondialdehyde (MDA) levels in ovarian tissue increased following I/R, while glutathione (GSH) levels decreased. Moreover, extensive congestion, edema, hemorrhage and defective follicle were observed. Both NF-κB and TLR-4 expression levels also increased in the group exposed to I/R. While GSH levels increased, IL-1β, IL-6, MDA, NF-κB and TLR-4 levels decreased with Vitamin B12 treatment. In addition, ovarian tissue without edema, mild congestion, and normal-appearing follicles were observed following Vitamin B12 administration. The findings showed that I/R in ovarian tissue resulted in significant tissue damage by increasing oxidative stress and inflammation. However, Vitamin B12 application was effective and alternative agent in reducing injury deriving from inflammation and oxidative stress developing in association with I/R in ovarian tissue

The protective effects of trimetazidine against ovary ischemia-reperfusion injury via the TLR4/Nf-kB signal pathway

Late diagnosis and treatment of ovarian ischemia can lead to worsening of ischemia, irreversible damage to ovarian functions and infertility. In this process, there is no approved medical treatment that can reduce the negative effects of ischemia and contribute positively to ovarian functions during reperfusion after detorsion. Rats were randomly assigned into one of six groups of eight animals each. The groups were designed as follows: The control group, The ischemia(I) group, The Ischemia + Trimetazidine (I + TMZ) (20 mg/kg) group, and The ischemia-reperfusion group (I/R). The Ischemia-Reperfusion + Trimetazidine (I/R + TMZ) (20 mg/kg) group, and The Sham + Trimetazidine (Sham + TMZ) (20 mg/kg) group. In this study performed thiobarbituric acid reactive substances (TBARS), total thiol (-SH), interleukin 1 beta (IL-1 beta), interleukin 6 (IL-6), toll-like receptor 4 (TLR4), and nuclear factor-kappa B(NF-kappa beta). Increased oxidative stress and inflammation were as a result of ovarian I and I/R application. Trimetazidine (TMZ), was sufficient to reduce the oxidative stress and inflammation. TLR4 and NF-kappa beta, which were upregulated by oxidative stress and inflammation, were regressed by TMZ. TMZ should be considered as a potential therapeutic agent in addition to surgery in the clinical treatment of ovarian torsion