High altitude and blood pressure in children.

We aimed to evaluate the blood pressure of children who had similar demographic characteristics but lived at different altitudes. Blood pressure of the children attending primary schools in Izmir (sea level: n = 425) and Van (altitude: 1725 m, n = 291) were measured by mercurial sphygmomanometer for this study. They were similar with respect to age, sex, weight, height, and BMI. Mean age of the children was 10.51 +/- 0.87 years (range: 9 to 12 years), and 358 (50 percent) of them were female. Mean systolic blood pressure was significantly higher in the children living in Van than in the children living in Izmir (104.72 +/- 11.2 vs. 97.96 +/- 25.5 mmHg, respectively, p < .001). Similarly mean diastolic blood pressure was significantly higher in the children living in Van than in the children living in Izmir (63.98 +/- 9.3 vs. 59.91 +/- 10.0 mmHg, respectively, p < .001). When blood pressure was evaluated with regard to height percentile, the number of children with a blood pressure over 90 percentile were 19 (4.5 percent) and 48 (16.5 percent) for systolic blood pressure, and 25 (5.9 percent) and 37 (12.7 percent) for diastolic blood pressure among the children living in Izmir and Van, respectively (p < .001). Systolic and diastolic blood pressures were found to increase in parallel to the increase in body mass index in children living in Van (r = 0.358, p < .001 and r = 0.235, p < .001, respectively). However, blood pressures were not correlated to body mass index in children living in Izmir. A difference of 1700 m in altitude was associated with higher systolic and diastolic blood pressure levels in children with similar demographic characteristics, and at this altitude, body mass index and blood pressure showed a positive correlation

Diagnosis of comorbid migraine without aura in patients with idiopathic/genetic epilepsy based on the gray zone approach to the International Classification of Headache Disorders 3 criteria

BackgroundMigraine without aura (MwoA) is a very frequent and remarkable comorbidity in patients with idiopathic/genetic epilepsy (I/GE). Frequently in clinical practice, diagnosis of MwoA may be challenging despite the guidance of current diagnostic criteria of the International Classification of Headache Disorders 3 (ICHD-3). In this study, we aimed to disclose the diagnostic gaps in the diagnosis of comorbid MwoA, using a zone concept, in patients with I/GEs with headaches who were diagnosed by an experienced headache expert.MethodsIn this multicenter study including 809 consecutive patients with a diagnosis of I/GE with or without headache, 163 patients who were diagnosed by an experienced headache expert as having a comorbid MwoA were reevaluated. Eligible patients were divided into three subgroups, namely, full diagnosis, zone I, and zone II according to their status of fulfilling the ICHD-3 criteria. A Classification and Regression Tree (CART) analysis was performed to bring out the meaningful predictors when evaluating patients with I/GEs for MwoA comorbidity, using the variables that were significant in the univariate analysis.ResultsLonger headache duration (&lt;4 h) followed by throbbing pain, higher visual analog scale (VAS) scores, increase of pain by physical activity, nausea/vomiting, and photophobia and/or phonophobia are the main distinguishing clinical characteristics of comorbid MwoA in patients with I/GE, for being classified in the full diagnosis group. Despite being not a part of the main ICHD-3 criteria, the presence of associated symptoms mainly osmophobia and also vertigo/dizziness had the distinguishing capability of being classified into zone subgroups. The most common epilepsy syndromes fulfilling full diagnosis criteria (n = 62) in the CART analysis were 48.39% Juvenile myoclonic epilepsy followed by 25.81% epilepsy with generalized tonic-clonic seizures alone.ConclusionLonger headache duration, throbbing pain, increase of pain by physical activity, photophobia and/or phonophobia, presence of vertigo/dizziness, osmophobia, and higher VAS scores are the main supportive associated factors when applying the ICHD-3 criteria for the comorbid MwoA diagnosis in patients with I/GEs. Evaluating these characteristics could be helpful to close the diagnostic gaps in everyday clinical practice and fasten the diagnostic process of comorbid MwoA in patients with I/GEs

Meme kanseri ile ilişkili kol lenfödeminde mevcut son durum ölçütü skalalarının yanıt verilebilirliklerinin (responsiveness) araştırılması = Investigation of responsiveness of the outcome measurement scales in breast cancer related arm lymphedema

Amaç: Bu çalışmanın amacı meme kanseri ile ilişkili lenfödemde mevcut son durumölçütü skalalarının yanıt verilebilirliklerinin karşılaştırılmasıdır.Gereç ve Yöntem: Çalışmaya mastektomi sonrası lenfödem gelişen 40 hasta dahiledildi ve kompleks dekonjestif tedavi faz 1 dört hafta boyunca uygulandı. Hastalaratedavi öncesi ve sonrası Lenfödem Yaşam Etki Ölçeği (LLIS), LenfödemFonksiyonellik, Yetersizlik ve Sağlık Sorgulaması (Lymph-ICF), Yaşam KalitesiÖlçeği-Kol (LYMQOL), Hasta Fayda İndeksi (PBI), Avrupa Kanser Araştırma veTedavi Teşkilatı Yaşam Kalitesi Ölçeği (EORTC-QLQ-30), Meme Kanserine ÖzgüYaşam Kalitesi Ölçeği (EORTC-QLQ-BR-23) ve Kısa Form 36 (SF-36) uygulandı.Bulgular: LLIS, Lymph-ICF, LYMPQOL ve EORTC-QLQ-BR 23 (cinsel işlev vecinsel haz dışında) tedavi sonrası skorun tedavi öncesi skora kıyasla çok yüksekdüzeyde anlamlı olduğu belirlendi (p<0,0001). SF-36 tedavi sonrası skorlarda tedaviöncesine kıyasla (sağlığın genel algısı dışında) anlamlı fark belirlendi. Total skoruhesaplanabilen ölçeklerden iki sonuç ölçütü en büyük etki büyüklüğünü gösterdi:LYMQOL (d=-0,88; SRM=-0,38; GI=-0,36), VAS gerginlik (d=0,88; SRM=0,41;GI=0,7). Total skoru hesaplanamayan ölçeklerde üç sonuç ölçütü en büyük etkibüyüklüğünü gösterdi: EORTC-QLQ-BR23 kola bağlı sorunlar, saç dökülme kaygısıve sistemik tedavi yan etkileri (d=1,35; SRM= 0,46; GI=0,41), (d=1,15; SRM=0,47;GI=0,44), (d=1,10; SRM=0,47; GI=0,43).Sonuç: Total skoru hesaplanabilen ölçeklerden LYMQOL ve VAS gerginlik; totalskoru hesaplanamayan ölçeklerden EORTC-QLQ-BR23 kola bağlı sorunlar, saçdökülme kaygısı ve sistemik tedavi yan etkileri alt ölçekleri meme kanseri ile ilişkililenfödemde yanıt verilebilirliği en yüksek son durum ölçütleridir--------------------Objective: The aim of this study is to compare the responsiveness of the scales of theend state criteria in breast cancer-associated lymphedema.Materials and Methods: Forty patients who developed post-mastectomylymphedema were included in the study and complex decongestive therapy wasadministered for four weeks in phase 1. Lymphedema Life Impact Scale (LLIS),Lymphedema Functioning, Disability and Health Questionnaire (Lymph-ICF), Qualityof Life Scale-Arm (LYMQOL), Patient Benefit Index (PBI), European Organizationfor Cancer Research and Treatment Life before and after treatment Quality of LifeScale (EORTC-QLQ-30), Breast Cancer Specific Quality of Life Scale (EORTCQLQ-BR-23) and Short Form 36 (SF-36) were applied.Results: The post-treatment score of LLIS, Lymph-ICF, LYMPQOL and EORTCQLQ-BR23 (excluding sexual function and pleasure) was found to be significantlyhigher than before (p<0.0001). Significant difference was determined in SF-36 posttreatment scores compared to before (except healthchange). For those whose totalscore could be calculated, two outcome measures showed the largest effect size:LYMQOL (d=-0.88; SRM=-0.38; GI=-0.36), VAS tension (d=0.88; SRM=0.4;GI=0.7). For those whose total score could not be calculated, three outcome measuresshowed the greatest effect size: EORTC-QLQ-BR23 arm-related problems, hair lossanxiety, and systemic treatment side effects (d=1.35; SRM=0.46; GI=0.41), (d=1.15;SRM=0.47; GI=0.44), (d=1.10; SRM= 0.47; GI=0.43).Conclusion: LYMQOL and VAS strain; The EORTC-QLQ-BR23 arm-relatedproblems, hair loss anxiety and systemic treatment side effects subscales, among thescales whose total score cannot be calculated, are the most responsive end-state criteriain breast cancer-related lymphedema

The impact of university investments on urban sprawl in Southwest Ankara Region

Yüksek Lisans TeziKentsel mekân dinamik bir yapıda olup sürekli değişim göstermektedir. Kent, yaygın, parçalı, dağınık ve sınırsız bir gelişim gösteriyorsa alan yazınında buna "kentsel yayılma" denmektedir. Üniversite kurmak gibi büyük yatırım kararları nüfusun, ekonomik faaliyetlerin ve kamu hizmetlerinin coğrafi mekânda dağılışına etki etmektedir. İdari ve akademik çevrelerde üniversitelerin kente etkileri gündem oluşturan, sıkça tartışılan ve üzerinde çalışılan bir konu halini almıştır. Üniversiteler, "komşu çevre" olarak adlandırılan alanların aktifleşmesinde ve canlandırılmasında önemli aktörlerdir. Bu tezin amacı kentsel alanın yayılması üzerinde üniversite yatırımlarının etkisini araştırmaktır. Bu bağlamda tez kapsamında Ortadoğu Teknik Üniversitesi, Hacettepe Üniversitesi Beytepe Yerleşkesi, İhsan Doğramacı Bilkent Üniversitesi, Başkent Üniversitesi Bağlıca Yerleşkesi, Atılım Üniversitesi, Ufuk Üniversitesi Dr. Rıdvan Ege Yerleşkesi ve Çankaya Üniversitesi Merkez Yerleşkesi'nin Güneybatı Ankara'nın yayılma sürecine etkileri incelenmiştir. Çalışma alanının seçilmesinde bölgenin tarihsel gelişimi ile kısa erimli ve tutarsız planlarla üretilen parçalı kentsel yapısı etkili olmuştur. Üniversite yerleşkeleri etrafındaki kentsel büyüme, farklı dönemlerdeki uydu görüntülerinin piksel tabanlı kontrollü sınıflandırılması ile elde edilen alan büyüklüklerinin karşılaştırılması yöntemi ile incelenmiştir. Yerleşkelerin öğrenci sayısı, yapılı alan büyüklüğü ve kent merkezine olan uzaklığı gibi çeşitli parametreler ışığında üniversitelere etki alanı çizilmiş ve araştırma, etki alanı içerisinde sürdürülmüştür. Sonuçlar tezin "üniversite yatırımlarının kentsel fonksiyonları, çevresinde toplama potansiyeli olduğu" savını destekler niteliktedir. Çalışmanın, kentsel işlev alanları ile kentsel yayılma olgusu arasındaki ilişkiyi sorgulayan araştırmacılar için yol gösterici olduğu ve kent formunun şekillenmesi ile ilgili sayısal yöntemlerle yapılan çalışmalar açısından örnek olabileceği düşünülmektedir. Çalışmaya farklı parametreler eklenerek alternatif yöntemlerle çalışma konusunun detaylandırılabileceği veya dönüştürülebileceği düşünülmektedir.Urban space has a dynamic structure and changes continuously. If the city shows a extensive, fragmented, dispersed and unlimited development, it is called "urban sprawl" in the literature. Large investment decisions, such as establishing a university, affect the geographical distribution of population, economic activities and public services. In administrative and academic circles, the effects of universities on the city has become an issue that is frequently discussed and studied. Universities are important actors in the activation and revitalization of areas called neighboring environments. The aim of this thesis is to investigate the effect of university investments on the spread of urban area. In this context, the effects of the Middle East Technical University, Hacettepe University Beytepe Campus, Ihsan Doğramacı Bilkent University, Baskent University Baglica Campus, Atılım University, Ufuk University Ridvan Ege Campus and the Cankaya University Merkez Campus on the spread process of Southwestern Ankara were examined. The historical development of the region and the fragmented urban structure produced by short-term and inconsistent plans were effective in selecting the study area. Urban sprawl around university campuses was measured by pixel-based controlled classification method. Then, urban developments in different periods were compared. In the light of various parameters such as the number of students, the size of the built area and the distance to the city center, the impact area for the universities was drawn and the research was carried out within the impact area. The results support the argument that the thesis has the potential to gather university investments around urban functions. It is thought that this study will help researchers questioning the relationship between urban function areas and urban sprawl phenomenon. The study can be an example in terms of the studies conducted with the numerical methods related to shaping the urban form. It is thought that working with alternative methods can be elaborated or transformed by adding different parameters

Effect of protein sources on cardiovascular diseases

Kardiyovasküler hastalıklar ile diyet ilişkisini araştıran çalışmalar genellikle karbonhidrat ve yağ kaynaklarına odaklanmıştır. Bu çalışmadaki amaç, kardiyovasküler hastalıklara, diyetsel protein kaynaklarının etkilerini incelemektir. Hayvansal ve bitkisel protein kaynakları, (süt ve süt ürünleri, yumurta, et, tavuk, balık, baklagiller ve tahıllar) farklı besin matriksine sahip olmaları sebebiyle lipid metabolizmasına ve kardiyometabolik risklere farklı etki ederler. Kardiyovasküler hastalıkların beslenme tedavisinde, süt ürünleri, tam tahıllar, yağlı tohumlar, tavuk, balık ile meyve ve sebzelerin tüketimi arttırılırken; yağ içeriği yüksek olan hayvansal kaynaklı besinlerin, işlenmiş kırmızı et, rafine şeker içeren yiyecek ve içeceklerin tüketiminin kısıtlanması genel bir beslenme önerisidir. Güncel kanıtlar, bitkisel protein ağırlıklı beslenmeyi desteklemektedir.Studies investigating the relationship between cardiovascular diseases and diet have generally focused on carbohydrate and fat sources. The aim of this study is to examine the effects of dietary protein sources on cardiovascular diseases. Animal and plant protein sources (milk and dairy products, eggs, meat, chicken, fish, legumes and cereals) have different effects on lipid metabolism and cardiometabolic risks due to their different nutritional matrix. In the nutritional treatment of cardiovascular diseases, the consumption of dairy products, whole grains, oil seeds, chicken, fish, fruits and vegetables is increased; restriction of consumption of foods of animal origin with high fat content, processed red meat, refined sugar-containing foods and beverages is a general nutritional recommendation. Current evidence supports a plant-based diet

A Case of Gelastic Epilepsy Associated with Tuberosclerosis: Where is the Lesion Corresponding to Electroencephalography?

Summary Gelastic seizures are typically associated with hypothalamic hamartoma. Given the rarity of gelastic seizures, pathways for the motor and emotional aspects of laughter have been hypothesized but remain unclear. Only few case reports of patients with tuberous sclerosis complex who developed gelastic epilepsy have been reported. In this case study, we report a case of TS that presented itself mainly with dermatologic manifestations and without any neurological findings other than gelastic seizures. Ictal EEG revealed an active epileptic activity on the right fronto-temporal region. Clinical and laboratory findings were consistent with gelastic epilepsy that originated from temporal and extra-temporal lobes. Seizures were controlled using carbamazepine and levetiracetam polytherapy. In our case, there is no evidence of cortical and subcortical tubers, subependymal glial nodules, giant cell astrocytomas or aneurysm

An overview of the form of the city for throughout the history

Kent formu kavramı, günümüzde halen güncelliğini koruyan ve bilimsel literatürde tartışılan bir olgudur. Kent kavramının ortaya çıkışından itibaren çeşitli tarihsel süreçlerde kenti şekillendiren fiziksel, toplumsal, kültürel, ekonomik, politik ve idari faktörlerin incelendiği görülmektedir. Kenti şekillendiren ve sınıflandırılabilen etmenlerin yanı sıra teknolojik ve bilimsel gelişmeler ile birlikte kent olgusunun taşıdığı anlam ve boyutun değiştiği de görülmektedir. Zaman dizgesi içerisinde, ekonomik, politik, yasal-yönetsel, sosyo-kültürel alanlarda yaşanan değişim ve gelişmeler, bireylerin ihtiyaçlarının ve taleplerinin değişmesine neden olmaktadır. Bireylerin artan ve çeşitlilik arz eden talepleri ise; bu ihtiyaçlara cevap verebilecek mekânların yeniden üretimini beraberinde getirmektedir. Dolayısıyla tarih boyunca kent formunun biçimlenişinin; bireyin yaşam şeklinin değişmesi ve tüketim davranışlarının çeşitliliği ile ilgili olduğu ortadadır. Bu çalışmada soyut ve somut anlamları bünyesinde barındıran kent olgusu ve kent formunu etkileyen faktörler üzerine bilimsel yazın incelenmekte, farklı teorilerin karşılaştırmalı olarak değerlendirilmesi yapılmaktadır. Çalışmanın amacı; geçmişten günümüze tarihsel süreç içerisinde tartışılan kentsel form ile ilgili ortaya konulan teori ve uygulamaların farklı bakış açılarını irdelemek; bu teorilerin birbirleri ile çakışan ve çatışan argümanlarını ortaya koymaktır. Betimsel araştırma niteliği taşıyan bu çalışma kapsamında; farklı kentsel form tanım ve arayışlarından yola çıkarak, geleceğin kentleri için, kentsel forma dair ihtiyaç duyulan bakış açısına dair çıkarsamalarda bulunulmaktadırThe concept of urban form is a phenomenon that is currently being updated and discussed in the scientific literature. It is seen that the physical, social, cultural, economic, political and administrative factors that shape the city in various historical processes since the emergence of the concept of city are examined. In addition to the factors that shape and classify the city, along with technological and scientific developments, it is seen that the meaning and dimension of the urban phenomenon changed. Changes and developments in the economic, political, legal, administrative and socio-cultural fields within the time series cause people's needs and demands to change. The increasing and various demands of people; it brings with it the reproduction of the spaces that can respond to these needs. Therefore, throughout history, the formation of the urban form; it is about the change of the way of life and the diversity of consumption behaviors. In this study, the scientific literature on the urban phenomena and the factors affecting the urban form are examined and the different theories are evaluated comparatively. The aim of the study is to examine different aspects of the theories and practices that have emerged from the past on the urban form, is to present the overlapping and conflicting arguments of these theories with each other. Within the context of this descriptive study, it is possible to find out the urban form needed for the cities of the future, starting from the definitions and searches of different urban forms

Comparison of the value of immature retyculocyte and immature platelet in the diagnosıs of sepsis

© 2021 Japan Pediatric Society.Background: Sepsis is one of the causes of pre-treatment morbidity and mortality in the pediatric age group. In the present study, we investigated the place of the immature granulocyte percentage, (IG) immature reticulocyte fraction (IRF), and immature platelet fraction (IPF) in the diagnosis of sepsis. Methods: Complete blood count, C-reactive protein, (CRP) procalcitonin (PCT) and blood cultures were measured in 125 critical patients who were followed-up in the intensive care unit with the suspicion of sepsis and 65 healthy children between 2017 and 2019. In addition to the complete blood counts and routine parameters, IG, IRF, and IPF were examined in the patients. Results: When the critical patient group and the healthy control group were compared, it was found that the total number of leukocytes (white blood cells), neutrophil count, platelet count, CRP, PCT, IG, IRF, and IPF values were higher at statistically significant levels. When septic and non-septic patients were compared, it was found that the CRP, PCT,IGP, and IPF were higher at statistically significant levels in the septic patients. Conclusions: It was concluded that CRP, PCT, IG, and IPF were significant in determining sepsis and that PCT was the most sensitive and specific biomarker in these parameters. We believe that these parameters may be suitable for practical use in determining sepsis because they give faster results and suggest the diagnosis of sepsis

A Case of Abdominal Epilepsia Partialis Continua Occurring One Year after Ischemic Stroke

Epilepsia partialis continua is characterized by continuous clonic contractions of a certain area of the body. One of the most common causes of Epilepsia partialis continua in adults is cerebrovascular events. Other causes include meningoencephalitis, Rasmussen encephalitis, diabetic nonketotic hyperosmolar coma, central nervous system malignancies, tuberculosis, cerebral venous thrombosis, or idiopathic. A 70-year-old male patient was admitted to the emergency department with abdominal muscle contractions for about an hour. Neurodiagnostic imaging revealed an encephalomalasia area secondary to the area of the previous infarction in the left frontoparietal region. Focal motor findings were controlled within 5 min after the VPA (valproic acid) treatment at a dose of 15 mg/kg admission, and then the treatment was continued with 1500 mg/day Valproic acid. Here, we aimed to emphasize that myoclonic jerks confined to the abdominal region is a rare motor phenomenon and may be a feature of Epilepsia partialis continua, the history of stroke should be questioned in the etiology, and seizures can be controlled with IV Valproic acid treatment