Usefulness of procalcitonin for diagnosis of sepsis in the intensive care unit

INTRODUCTION: The diagnosis of sepsis in critically ill patients is challenging because traditional markers of infection are often misleading. The present study was conducted to determine the procalcitonin level at early diagnosis (and differentiation) in patients with systemic inflammatory response syndrome (SIRS) and sepsis, in comparison with C-reactive protein, IL-2, IL-6, IL-8 and tumour necrosis factor-α. METHOD: Thirty-three intensive care unit patients were diagnosed with SIRS, sepsis or septic shock, in accordance with the American College of Chest Physicians/Society of Critical Care Medicine consensus criteria. Blood samples were taken at the first and second day of hospitalization, and on the day of discharge or on the day of death. For multiple group comparisons one-way analysis of variance was applied, with post hoc comparison. Sensitivity, specificity and predictive values of PCT and each cytokine studied were calculated. RESULTS: PCT, IL-2 and IL-8 levels increased in parallel with the severity of the clinical condition of the patient. PCT exhibited a greatest sensitivity (85%) and specificity (91%) in differentiating patients with SIRS from those with sepsis. With respect to positive and negative predictive values, PCT markedly exceeded other variables. DISCUSSION: In the present study PCT was found to be a more accurate diagnostic parameter for differentiating SIRS and sepsis, and therefore daily determinations of PCT may be helpful in the follow up of critically ill patients

Effects of different cavity‑disinfectants and potassium titanyl phosphate laser on microtensile bond strength to primary dentin

Aim: The aim of this in vitro study was to compare the effects of different cavity‑disinfectants and potassium titanyl phosphate (KTP) laser on microtensile bond strength to primary dentin. Chlorhexidine (CHX), propolis (PRO), ozonated water (OW), gaseous ozone (OG) and KTP laser were used for this purpose.Methodology: Twelve primary molar teeth were used in this study. One‑third of the teeth (from coronal portion) were removed to obtain flat surfaces. After applying the cavity‑disinfectants, an adhesive (prime and bond NT) was applied to dentin surfaces, and composite crowns were built up. One group received no pretreatment and was set as a control (CONT). Ten sticks were obtained from these samples and were stressed in tension until failure using a universal testing machine and the data were recorded.Results: The mean strength values (in MPa) of the sticks were OW (11.12) > KTP (9.58) > CHX (7.58) > PRO (7.42) > CONT (6.38) > OG (5.84) and OW showed significantly higher results than the other groups, except KTP group (P < 0.05).Conclusions: OW and KTP might be used safely without compromising the bond strength of restorative materials.Key words: Chlorhexidine gluconate, potassium titanyl phosphate lasers, microtensile bond strength, ozone, primary dentine, propoli

Ödeme Güçlüğüne Düşmüş İşveren Karşısında İşçi Hak ve Çıkarlarının Korunması Konusunda Türk Hukukunda Geçerli Olan Sistemin Uluslararası Normlara Uygunluğu Meselesi

Küreselleşmenin olumsuz etkilerinin görüldüğü alanların başında iş hukuku ve iflas hukuku gelir. İflas birçok etkisinin yanında en önemli etkisini işletme çalışanları üzerinde gösterir. Zira ödeme güçlüğü içine düşen işveren, genellikle en kolaylıkla ödemekten kaçınabileceği öğe olarak işçi ücretlerini görmektedir. Hakkında iflas kararı alınmış olmasa da aylarca çalıştıkları halde ücretlerini alamayan işçiler ve aileleri işverenden olan bu alacaklarını bilahare iflas masasına iflas alacağı olarak kaydettirseler de elde etmekte çok büyük sıkıntılar yaşamaktadır. Çalışmada bunun sebepleri ortaya konarak çözüm önerileri ve bu konuda ILO' nun 173 sayılı Sözleşmesi ve Gözden Geçirilmiş Avrupa Sosyal Şartı ile AB' nin bu konudaki direktifiyle konuya yaklaşımın ne olduğu ortaya konarak ülkemizde konuya ilişkin yapılanlar ve yapılması gerekenler ortaya konmuştur. Çıkış noktası çalışma hakkının bir temel insan hakkı olduğu ve korunması gereğinin iflas sürecinde de devam ettiğidir. Bu konuda gerek İş hukuku gerek iflas hukuku alanındaki anlayış ve düzenlemelerin bu anayasal sosyal hakkın korunması gereğini karşılayıp karşılamadığı ve bu konuda neler yapılması gerektiğine ilişkin varılan sonuç ortaya konacaktır. Çalışmamızda, konuya ilişkin uluslar arası belgelerdeki durum değerlen-dirilerek, Türk hukukunda geçerli sistem ortaya konacak ve bunun uluslar arası standartlara uygun olup olmadığı, bu konuda atılmış adımlarla atılması gereken adımların neler olabileceği üzerinde de durulacaktır

A General Outlook to Regenerative Pulp Therapy

Withing the last 10 years, the research regarding stem cell biology and tissue engineering has reaped many rewards in the field of dentistry. The goal of regenerative endodontic therapy is the regeneration of a healthy and functional pulp-dentin complex. With the development of successful materials such as mineral trioxide aggregate (MTA) and the use of the concept of tissue engineering, treating necrotic immature permanent teeth and stimulating the continuation of root-surrounding tissue formation has been made possible. Current stem cell research has also shown promising results and continues to show progress in the regeneration of dental and surrounding tissue. Since the ethical aspect of the use of stem cells is still in question, we have yet to see the potential of these materials in clinical practice. In this review, regenerative endodontic treatment prodedures, materials and developments are discussed in detail

Effect of premedication on hemodynamics and bispectral index in pediatric dental rehabilitation

Objectives: The aim of this study was to evaluate the effects of rectal midazolam premedicationon hemodynamic parameters and Bispectral Index Scale (BIS) values in children undergoinggeneral anesthesia (GA) for dental rehabilitation.Materials and Methods: Records of 30 children aged 2 to 7 years were retrieved and dividedinto 2 groups. Group 1 received midazolam 0.3mg/kg body weight rectally and group 2involved children who did not receive any presedative (control). Mean arterial blood pressure(MAP), heart rate (HR), oxygen saturation (SpO2), and BIS were evaluated for six times; beforelaryngoscopy(1); 1 min(2); 5 min(3); 10 min after nasotracheal intubation(4); at the time ofextubation (5) and at the time of recovery(6). Paired t-test was performed to analyze all data.p<0.05 was defined as statistically significant.Results: MAP and HR did not differ significantly between both groups before laryngoscopy(p>0.05) but increased significantly in control group 1 min after intubation (p<0.04). SpO2was in the normal range in both groups, which was statistically insignificant (p>0.05). The BISrecords of the midazolam group were slightly lower than the control group in general but thisdifference was insignificant (p>0.05).Conclusions: Midazolam premedication prior to GA induction resulted with lower MAP and HRthan the control group 1 minute after intubation whereas it did not alter BIS values remarkablyat all time intervals. Therefore, the midazolam sedation did not produce a significant change inreducing GA awareness in children undergoing GA for dental rehabilitation

The addition of droperidol or clonidine to epidural tramadol shortens onset time and increases duration of postoperative analgesia

Purpose: To compare tramadol alone and the combinations of either tramadol-clonidine or tramadol-droperidol with regard to analgesic and adverse effects. Methods: After Ethic's Committee approval and patient informed consent were obtained, epidural catheters were inserted preoperatively at the L3-4 interspace in 90 ASA physical status I-II adult patients undergoing lower abdominal surgery. Anesthesia was standardized. Patients were randomly assigned to one of three groups. Group I (T) patients received tramadol 75 mg, Group II (TD) patients received tramadol 75 mg plus droperidol 2.5 mg, and Group III (TC) patients received tramadol 75 mg plus clonidine 150 μg in a total volume of 10 mL administered as a single epidural injection in the postanesthesia care unit. The onset time of analgesia and duration of analgesia, visual analogue pain scores, sedation, nausea scores, vital signs and side effects were recorded. Results: Duration of analgesia was similar in both the TD and TC groups, and significantly longer than in the T group (P < 0.001). Group TC patients displayed a significant increase in sedation scores and decrease in blood pressure and heart rate when compared with other groups (P < 0.001). No adverse effects were observed in Group TD, while nausea scores were high in both the T and TC groups (P < 0.001). Pain score, respiration rate, and SpO2 values were similar in all study groups. Conclusion: We conclude that epidural tramadol in combination with droperidol or clonidine prolongs the duration of analgesia; however, droperidol appears to be a better alternative when adverse effects and antiemetic properties are taken into consideration

Observing change in teaching behavior through reflection

Ankara : The Institute of Economics and Social Sciences of Bilkent Univ., 1997.Thesis (Master's) -- Bilkent University, 1997.Includes bibliographical refences.This study investigated how teacher trainers and trainees observed changes in the teaching behavior of the trainees who attended a three-week pre-service training course. Determining the results of teacher training in terms of changes in teaching behavior has been a research theme of continuing importance and interest in the field of English Language Teaching. Since often such changes can not be observed directly, perceptions of trained teachers and teacher trainers are sometimes used as research probes. Past studies have shown that teachers perceive change as a result of attending teacher training programs. For example, Ozgirin's study (1996) examined to what extent participation in the DTEFLA training program changed teachers in terms of knowledge, skills, attitudes, awareness and performance. This study differs from Ozgirin's study in that it does not aim to observe changes in predetermined areas but tries to find out if change in teaching behavior of teachers who attended a pre-service course can be observed through reflection (by using the word "to observe" the intent throughout this study is to mean "to perceive"). This study was carried out in the following way. Three teacher trainers and five newly hired experienced and inexperienced teachers at the Middle East Technical University (METU), at the Department of Basic English (DBE) participated in this study. All of these teachers participated in a DBE pre-service training course taught prior to beginning their teaching at METU. Throughout this study, pre-service training and pre-service orientation are used interchangeably. This pre-service training course was presented according to a detailed written syllabus prepared before training began. The subjects were asked to review and reflect on the pre-service syllabus prepared by the trainers working at the department. The subjects were asked to reflect on the components of the syllabus and discuss them. Thus, data for this study was obtained primarily via think-aloud protocols (TAPs) based on syllabus reflection. How the trainers and the trainees observed change in the teaching behavior of the trainees based on the training items was determined from what they reported. Interviews were employed immediately after the TAPs to investigate further the issues which were not mentioned in the TAPs concerning how the trainees and the trainers observed change. Data obtained from the TAPs and the interviews were analyzed first by transcribing the TAPs and the interviews and then coding the transcriptions. The transcriptions were also coded by a second coder to achieve intercoder reliability. The results of the study show that change in the teaching behavior of the trainees can be observed through trainees' and trainers' reflecting on the pre-service syllabus. How they perceive change seems to be a way to observe changes in teachers as observing change directly is difficult. The results of the study indicate that in the following components of the syllabus change can be observed the most: Demo (of a lesson), Lesson Planning Preparing the Context (in presenting a new topic), Reflect Back Instructions, Vocabulary, Written Homework.Eröz, Nilgün SungurtekinM.S