Fenotypowe podgrupy zespołu policystycznych jajników mają różne objawy wewnątrznerkowej oporności

Objective: The polycystic ovary syndrome (PCOS) is known to be related with increased metabolic and cardiovascular risks. Various phenotypic subgroups of PCOS have been proven to have metabolic and endocrine disorders with varying degrees of severity. However, intra-renal vascular resistance, which is an indirect indication ofatherosclerosis, remains unknown in PCOS subgroups. In this study we examined whether PCOS subgroups have different intra-renal resistance symptoms. Material and Methods: 98 PCOS patients (diagnosed according to the Rotterdam criteria) 30 controls were ncluded in the study. The diagnosis of PCOS was established in the presence of at least two of the following criteria: 1- oligo and/or amenorrhea (OM); 2- clinic and/or biochemical signs of hyperandrogenism (HA); 3- polycystic ovarian morphology (PCO) detected by transvaginal ultrasonography. 37 patients (Group 1) met all three criteria (HA+OM+PCO), 29 patients (Group 2) met two of the criteria including hyperandrogenism (HA+OM or HA+PCO) and the remaining 32 patients (Group 3) had no hyperandrogenism but fulfilled the other two criteria; PCO+OM. Renal Doppler ultrasonography and hormonal/ biochemical analyses were carried out. The first outcome measure was designated as the differences in the renal resistive index (RRI) values of the groups, and the second outcome measure was designated as the relation of RRI with the insulin resistance and lipid profile. Results: In Group 1, the RRI and the homeostasis model assessment of insulin resistance (HOMA-IR) values were significantly higher than in Group 3 and controls (P < 0.031, P < 0.001, respectively, after adjusting for age and BMI). The RRI and HOMA-IR values in Group 3 were similar to those of the control group. It was determined that RRI has a positive correlation with HOMA-IR (r=0.784, PCel pracy: Zespół policystycznych jajników jest związany ze zwiększonym ryzykiem metabolicznym i sercowonaczyniowym. Fenotypowe podgrupy w obrębie zespołu PCO charakteryzują się zaburzeniami metabolicznymi i endokrynnymi o rożnym stopniu nasilenia. Jednak wewnątrznerkowa oporność naczyniowa, która jest pośrednim wykładnikiem miażdżycy, pozostaje nieznana w podgrupach zespołu PCO. W badaniu ocenialiśmy czy podgrupy zespołu PCO mają rożne objawy wewnątrznerkowej oporności. Materiał i metoda: do badania włączono 98 pacjentek z zespołem PCO (zdiagnozowanym według kryterium z Rotterdamu) oraz 30 pacjentek kontrolnych. Rozpoznanie zespołu PCO postawiono na podstawie obecności przynajmniej dwóch z poniżej wymienionych kryteriów: 1-oligo i/lub amenorrhea (OM); 2-kliniczne lub biochemiczne objawy hiperandrogenizmu (HA); 3-policystyczny obraz jajnikow (PCO) w przez pochwowym badaniu ultrasonograficznym. Grupę 1 stanowiło 37 pacjentek, które spełniły wszystkie kryteria diagnostyczne (HA+OM+PCO), grupa 2 to 29 pacjentek z dwoma kryteriami, w tym kryterium hiperandrogenizmu (HA+OM lub HA+PCO), pozostałe 32 pacjentki to grupa 3 – bez hiperandrogenizmu ale z dwoma pozostałymi kryteriami; PCO+OM. Przeprowadzono badanie dopplerowskie nerek i hormonalno-biochemiczną ocenę. Jako pierwszą zmierzono różnicę pomiędzy grupami w indeksie oporu nerkowego (RRI), następnie oceniono związek pomiędzy RRI a insulinoopornością i profilem lipidowym. Wyniki: W grupie 1, RRI i wskaźnik oceny insulinooporności (HOMA-IR) były istotnie wyższe niż w grupie 3 oraz kontrolnej (

The relationship between thyroid autoimmunity and poor response to ovarian stimulation in in vitro fertilization women with infertility

Introduction: Thyroid autoimmunity (TAI) is the most common autoimmune disorder. Patients with TAI are usually euthyroid, and the presence of anti-thyroid peroxidase (anti-TPO) in patients with or without thyroid dysfunction is associated with infertility, recurrent embryo implantation failure, and early pregnancy loss. We aimed to investigate the relationship between low ovarian reserve, pregnancy outcomes, and TAI. Material and methods: This retrospective cohort study was conducted in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) patients between 2010 and 2018. All patients (n = 1400) for whom thyroid autoantibody testing was requested were detected. A study group was formed from patients with anti-TPO positivity (n = 363). The control group (n = 555) comprised euthyroid anti-TPO negative patients matched to the study group regarding age and body mass index (BMI). Results: Mean serum TSH value was 2.35 ± 1.70 mIU/mL in anti-TPO-positive patients and 1.81 ± 1.2 mIU/mL in controls, and the difference was significant (p &lt; 0.05). Total dose of gonadotropins used in ovulation induction in anti-TPO-positive and control patients were 3000 IU and 2700 IU, respectively, and the difference was statistically significant (p &lt; 0.05). The number of metaphase 2 oocytes was significantly lower in the anti-TPO-positive group (p &lt; 0.05). Embryo transfer number and embryo grade were significantly lower in the anti-TPO-positive group (p &lt; 0.01). Poor ovarian response was significantly higher in anti-TPO-positive patients (40%) as compared to anti-TPO-negative controls (30%) (p &lt; 0.01). Clinical pregnancy rate was significantly lower in the anti-TPO-positive group (29.2%), as compared to the antibody-negative group (38.4%) (p &lt; 0.01). Conclusions: There are controversial data regarding the impact of antithyroid antibodies on ovarian reserve and pregnancy outcome after IVF treatment. The results of this study indicate that there was a relationship between TAI and poor ovarian response, and that TAI adversely affects IVF outcomes. Further investigations are required to explore the mechanism behind these effects

The effect of renin-angiotensin blockers on COVID-19 related mortality: A tertiary center's experience

Background: The first reports on coronaviruse disease 2019 (COVID-19) revealed an exaggerated mortality rate in hypertensive patients. In this regard, concerns about angiotensin-converting enzyme (ACE) inhibitors’ and angiotensin-receptor blockers’ (ARBs) have been aroused. Our aim in this study was to evaluate the potential bad outcome effect of hypertension and anti-hypertensive therapy on COVID-19. Methods: 183 patients with polymerase-chain-reaction (PCR)-proven COVID-19, who were admitted to our hospital and consulted to cardiology department between 15th of March and 15th of April 2020 were included. Data were recruited from hospital records. Results: Thirty-two out of 183 patients with COVID-19 died in hospital. Hypertension incidence was not statistically different between patients who survived and died (76 [50.3%] vs 19 [59.4%, p = 0.352]). Although the usage rate of ACEI were similar among groups, ARB usage rate was significantly higher in patients who died than survived (11 [34.4%] vs 23 [15.2%], p = 0.011). Binary regression analysis showed an association between ARBs and mortality (OR: 0.032, 95% CI 1.045–2.623, p = 0.032). Conclusion: Our study confirmed previous concerns regarding a potential harmful effects of ARBs on COVID-19 related mortality.Kontext: První zprávy o onemocnění koronavirem v roce 2019 (coronavirus disease 2019, COVID-19) ukazovaly na zvýšenou mortalitu jedinců s hypertenzí, což vyvolalo obavy ohledně užívání inhibitorů angiotenzin konvertujícího enzymu (ACEI) a blokátorů receptoru AT1 pro angiotenzin II (ARB). Cílem naší studie bylo posoudit možnost nepříznivého vlivu onemocnění covid-19 na závažnost hypertenze a účinnost antihypertenzní léčby. Metody: Do studie bylo zařazeno 183 pacientů s onemocněním covid-19 prokázaným PCR testem, kteří byli v období od 15. března do 15. dubna 2020 přijati do naší nemocnice a následně odesláni na kardiologickou kliniku. Údaje byly získány z nemocničních záznamů. Výsledky: Celkem 32 ze 183 pacientů s onemocněním covid-19 zemřelo v nemocnici. Incidence hypertenze se mezi pacienty, kteří přežili a zemřeli, statisticky významně nelišila (76 [50,3 %] vs. 19 [59,4 %]; p = 0,352). I když podíly pacientů užívajících inhibitory ACE byly v obou skupinách podobné, léčiva ze skupiny ARB užívalo statisticky významně více pacientů, kteří zemřeli, než těch, kteří přežili (11 [34,4 %] vs. 23 [15,2 %]; p = 0,011). Binární regresní analýza prokázala souvislost mezi užíváním ARB a mortalitou (OR: 0,032; 95% CI 1,045–2,623; p = 0,032). Závěr: Naše studie potvrdila původní obavy týkající se možných škodlivých účinků lékové skupiny ARB na mortalitu v souvislosti v onemocněním covid-19

Nepotism, employees’ competencies and firm performance in the tourism sector: A dual multivariate and Qualitative Comparative Analysis approach

© 2018 Elsevier Ltd The paper identifies the critical competencies affecting Egyptian travel agents’ performance while assessing the negative influence of nepotism on such competencies. To address this aim, the study uses a holistic dual approach employing a multivariate technique using Partial Least Squares Structural Equation Modelling (PLS-SEM) and a configuration method through a fuzzy-set Qualitative Comparative Analysis (fsQCA). Based on a sample of 500 travel agents’ employees, the results show that: (1) none of the competencies is sufficient to drive travel agents’ performance, (2) two distinct configurations of employee competencies are likely to result in high performance, and (3) nepotism has a direct negative influence on some of these competencies. The study holds important implications for both theory and practice

Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in 11 adult intensive care units from 10 cities of Turkey: Findings of the International Nosocomial Infection Control Consortium (INICC)

Purpose: To evaluate the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach on the reduction of ventilator-associated pneumonia (VAP) in adult patients hospitalized in 11 intensive care units (ICUs), from 10 hospitals, members of the INICC, in 10 cities of Turkey. Methods: A prospective active before-after surveillance study was conducted to determine the effect of the INICC multidimensional approach in the VAP rate. The study was divided into two phases. In phase 1, active prospective surveillance of VAP was conducted using the definitions of the Centers for Disease Control and Prevention National Health Safety Network, and the INICC methods. In phase 2, we implemented the multidimensional approach for VAP. The INICC multidimensional approach included the following measures: (1) bundle of infection control interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of VAP rates, and (6) performance feedback of infection control practices. We compared the rates of VAP obtained in each phase. A time series analysis was performed to assess the impact of our approach. Results: In phase 1, we recorded 2,376 mechanical ventilator (MV)-days, and in phase 2, after implementing the multidimensional approach, we recorded 28,181 MV-days. The rate of VAP was 31.14 per 1,000 MV-days during phase 1, and 16.82 per 1,000 MV-days during phase 2, amounting to a 46 % VAP rate reduction (RR, 0.54; 95 % CI, 0.42-0.7; P value, 0.0001.) Conclusions: The INICC multidimensional approach was associated with a significant reduction in the VAP rate in these adult ICUs of Turkey. © 2013 Springer-Verlag Berlin Heidelberg

Comparative Thermodynamic Analysis For An Absorption Refrigeration System On An Aluminum Profile Factory

Tez (Yüksek Lisans) -- İstanbul Teknik Üniversitesi, Enerji Enstitüsü, 2018Thesis (S.M.)--Massachusetts Institute of Technology, Dept. of Physics, [DATE]Bu tez çalışmasında alüminyum profil fabrikasına ait bir bileşik soğutma-ısı-güç üretim sisteminin soğutma çevrimi ele alınmıştır. Tek etkili soğurmalı soğutma sisteminin termodinamik modeli oluşturulmuş ve akış şeması ortaya konulmuştur. LiBr – H2O ikilisi kullanılan soğutma çevriminde soğutucu olarak su, soğurucu madde olarak LiBr kullanılmıştır. Buharlaştırıcıdan soğutmanın sağlandığı bu sistemde, alüminyum profil fabrikası içerisinde üretilen profillerin eloksal kaplamasının yapıldığı havuzları ve fabrika ortamını soğutmak amaçlanmıştır. Gaz motorunun atık egzoz gazlarından yararlanarak, kızgın buhar üreticide su ve lityum brömür birbirinden ayrılır ve soğutucu akışkan olan su kızgın buhar üreticiden kızgın buhar olarak çıkar. Yoğuşturucuda yoğuşan soğutucu akışkan olan su daha sonra kısılma vanasından geçerek basıncı düşürülür. Sonrasında buharlaştırıcıdan geçerek eloksal kaplamanın yapılacağı havuz için gerekli olan soğutma enerjisini aktararak soğurucuya girer. Soğurucuda lityum bromür tarafından soğurulan su ile fakir eriyik oluşur. Oluşan fakir eriyik, eriyik pompası yardımıyla kızgın buhar üreticisine doğru gönderilir. Varsa eriyik eşanjöründen geçen fakir eriyik kızgın buhar üreticisine girerek su ve lityum brömür birbirinden ayrılır. Kızgın buhar üreticisinden çıkan sudan arındırılmış LiBr ise zengin eriyik olarak adlandırılır ve kısılma vanasından geçip basıncı düşürülerek, soğurucuya girer ve burada suyla karışarak fakir eriyiği oluşturur. Bu şekilde çevrimin devamlılığı sağlanır. Tezin devamında LiBr – H2O ikilisinin kullanıldığı tek etkili soğutma çevriminin soğutma performans katsayısı hem eşanjörlü durumda hem de eşanjörün olmadığı durumda, EES (Engineering Equation Solver) programı ile hesaplanmıştır. Sonrasında eşanjörsüz sistem için her bir bileşenin tasarım parametreleri yani çalışma sıcaklıkları değiştirilerek, soğutma performans katsayısı tekrar hesaplanmıştır. Her bir eleman için sıcaklık ve soğutma performans katsayısı arasındaki ilişki grafikler ile gösterilmiştir. Bu yöntem ile optimum çalışma sıcaklıkları belirlenmeye çalışılmış ve verim hangi durumlarda daha fazla arttırılabilir bulunmuştur. Son olarak soğutucu akışkan olarak su yerine amonyak kullanılarak çevrimin soğutma verimi bir daha hesaplanmıştır. Çıkan sonuçlar karşılaştırılarak hangi ikilinin belirtilen sıcaklık değerlerinde daha verimli olacağı tesbit edilmeye çalışılmıştır. Bu karşılaştırma da yapıldıktan sonra en uygun çalışma şartları belirlenerek, kızgın buhar üreticisinde ihtiyaç duyulan ısı gücüne göre kataloglardan uygun gaz motoru seçilmiş ve çalışma sonlandırılmıştır.Energy sector has an important role to provide social and economic improvements for countries. Fossil fuels are used widely in the world and also in Turkey. Because of using fossil resources, negative environmental impacts continously increase. As a result of fossil fuel consumption, CO2 emissions are going up and climate change is observed around the world. Despite ever-growing energy demand depends on growing population and industral activities in Turkey, natural resources are limited. Accordingly, Turkey imports its energy raw materials. It means that Turkey is a country dependent on foreign supplies. Currently, our country is dependent to foreign oil with 98% and natural gas with 91%. Considering these dependencies, the importance of long term and effective planning increase significantly in the energy sector. If our country is considered to have limited energy sources, the project of minimizing the losses and increasing the efficiency during energy production and utilization has become more significant. Cogeneration, in other words combined heat and power generation systems, means that both heat and electricity production are made by a single energy source. Producing energy by the combined heat and power system is more efficient than conventional energy systems producing heat and electricity separately. Besides, establishing the cogeneration systems in the facility where it is used is important in terms of availability and economicy. Waste energy utilization is also another area to consider. In this direction, even the cogeneration systems with higher efficiency compared to conventional systems, some exhaust gas is released. Especially in summer times, absorbtion refrigeration systems can be used to benefit from waste heat for cooling. In the same way, if electricity, heat and cooling are produced from a single energy source this kind of systems are called trigeneration. There are two types of absorption cooling systems that are widely used in practice. These are systems using ammonia-water and lithium bromide-water solutions. The purpose of this thesis is evaluating the cooling load of the factory under consideration. This load is a design parameter for absorption refrigeration system. Specifying the working temperatures of cooling system components and carrying on thermal analysis of absorption cooling system by using stated data on EES (Engineering Equation Solver) software are also aimed. Once the coefficient of performance of the cooling cycle is calculated on EES programme, some design parameters are changed and calculated again on EES to find the most efficient system. In this study, a cooling cycle of the trigeneration system belongs to an aluminum extrusion rail factory is examined. Thermodynamic model of the single-effect absorption cooling system is created and thermodynamic flow scheme is shown. LiBr-H2O binary solution is used for absorption refrigerant system and water is used as refrigerant while LiBr used as absorbant. In this system, cooling process is made from evaporator. The energy of cooling is used in the pool which is made of anodic coating of aluminum extrusion rails in the factory in order to provide cooling and is used for air cooling in the factory. Cooling cycle of absorption refrigeration system runs through these stages; water and lithium bromide separate from each other in the generator. Water, which is refrigerant exits from generator as superheated vapor. After that, superheated water vapor comes to condenser and condenses there. Condensing water passes through the throttling valve and its pressure is reduced to minimum pressure of the cycle. After water enters to evaporator and transfer its cooling energy to the pool which is used to make of anodic coating, the refrigerant comes into the absorber. In the absorber, refrigerant water is absorbed by the lithium bromide and poor solution is constituted. This poor solution is pumped to the generator. If there is a heat exchanger in the system, the poor solution passes through the heat exchanger and water and lithium bromide are separated from each other in the generator. Dewatered LiBr in the generator is called rich solution and passes through throttling valve by reducing the pressure after exiting the generator. Then, it enters the absorber and there it becomes a mixture of refrigerant water again. Thus, the continuity of the cycle is ensured. The coefficient of cooling performance of the single-effect cooling cycle in which LiBr and water binary solution is used is calculated by EES for each system; with heat exchanger and without it. After that the working temperatures of each component for the system without heat exchanger are changed and coefficient of performance of the refrigeration system is analysed again. The relationship between temperature and coefficient of performance for each device is shown graphically and optimum working temperatures are specified with this method. Also, in which cases the efficiency can be increased more is investigated. An other important point for absorption cooling cycle is crystallization. Crystallization is a phenomenon in which a solid material dissolved in a solvent is precipitated and separated from the liquid under certain conditions. This phenomenon usually occurs at the exit of the generator and inlet of the absorber of cooling system because of the high temperature and low pressure values respectively. At high temperature rich solution exiting from generator may start to crystallize when it started cooling. Accordingly, it is very difficult to pump the mixture via the pump and the cycle can not be completed. As a result of this event, cooling process stops. Finally, ammonia is used as refrigerant in the cycle instead of water and accordingly the cooling performance of the system is estimated once again. Due to the low freezing point of ammonia, it is more suitable to work at temperatures below 0°C. This wide operating temperature and pressure range of ammonia makes the ammonia water fluid couple one of the most used pairs for absorption cooling systems. Also, due to its extreme volatility, it is much easier to separate the water from the generator. In this case, the design parameters are the same as before cases but due to the high volatility characteristic of the ammonia, the degree of dryness in the steps after the generator is entered as "1" to EES software because of the presence of vapour phase of ammonia. In the light of this information output of the analysis is compared and it is decided which binary solution is more efficient at the specified temperature values. After all these comparisons, by determining the most suitable working conditions, the appropriate gas engine is selected from the catalogs according to the heat power required by the generator and the study is terminated.Yüksek LisansM.Sc

The relationships between field dependent/independent cognitive styles and information & communication technologies based programs in gifted education

The research aims to investigate gifted students’ FD/FI cognitive styles and factors affecting them like preferring to take Information &amp; Communication Technologies-based courses at gifted children’s school. The study was carried out on two groups.  First group consisted of 52 students identified as gifted who are attending 6th and 7th grades at the Istanbul Science &amp;Art Center in Istanbul, Turkey,  the second group consisted of 38 students who are not identified as gifted and totally the study consists of 90 students. In order to collect data pertaining to this research, Group Embedded Figures Test (GEFT) was used to measure Field Dependence/Field Independence, (FD/FI).  According to the findings of the research, it has been observed that there is a significant difference between favored gifted students’ cognitive style scores and other students’ who are not identified as gifted. There is also a significant difference between in favor of Information&amp; Communication Technologies (ICT) based course taking gifted students’ cognitive style scores and other gifted students who are not taking ICT-based courses in Science and Art Center. In contrast to these, there is not a significant differences were found on cognitive styles in terms of gender and grade variants in both groups

Assessing the Kinesiophobia and Depression Status at Return to Sport Following Sport Related Injuries in Contact and Non-Contact Sports

Objective: The aim of this study is to examine the levels of kinesophobia and depression following sports injuries in physically contact and non-contact sports. Material and Methods: A total of 130 male athletes from 14 different sports, who were injured at least six months before were included in the study. Individuals participating in the study were interviewed by means of the Beck Depression Inventory and the Tampa Kinesiophobia Scale. Participants were also asked to complete a form to determine the injuries they had experienced. Results: There were no statistically significant differences between the physically contact and non-contact sport groups’ kinesiophobia and depression scores (p>0.05). There was no significant correlation between these two scores (r=0.27, p>0.05). Beck Depression Inventory scores following injuries that occurred in training and competition were significantly higher in physically contact sports than non-contact sports (

Examination Of Inequality Of Life Span By Using The Gini Coefficient In The Turkish Population For The Period 1990-2008

Objective: The aim of this study is to show that the Gini coefficient used in economics, particularly in exposing inequality in income levels can also be used in the field of health, especially for measuring inequality specific to any issue of concern. Based on life tables, this study uses the Gini coefficient in measuring the extent of inequality in years lived and shows the level of these inequalities in Turkey for the period 1990-2008. Material and Methods: Lorenz Curves were constructed by using data from life tables pertaining to years 1990, 2000, 2006 and 2008 as given by WHO database, Gini coefficients were calculated in measuring variability in length of life expectancies in general, for the male and female population and then used in examining reducing inequality over time. Results: Taking 1990 as the base year, life expectancy at birth has increased by 9.3 years by 2008 and inequality has decreased from 0.188 to 0.114 (by 39%) in the same period. Conclusion: In addition to the target of increasing life expectancy, the assessment of success in ensuring all individuals live up to average life expectancy should be conducted by using this measure of inequality.WoSScopu