DEATH, FREEDOM AND NARRATIVE THINKING: EXISTENTIAL ANALYTICS

In this thesis, I focus on the relation between individuals’ awareness of their mortality and freedom from a phenomenological perspective, which is based on making sense of our temporality with the tools of narrative thinking. I argue that this perspective will shed light on the neglected question, of how the awareness of the fact that every individual will die would have a bearing upon an individual’s freedom. In the first chapter, I argue that a linear understanding of time paves the way for the grand narratives, which eclipse the meaning of death and individual freedom. In the second chapter, I argue that Heidegger’s primordial conception of time is the proper way to see death as a phenomenon. This view is based on the distinction, I offer, between conceiving death as an event and an eventuality. I argue that, whereas conceiving death as an event reveals the temporal finitude of one’s existence; conceiving death as an eventuality discloses the finitude of possibilities at one’s disposal. In the fourth chapter, after introducing Berlin’s two conceptions of freedom in the third, I apply the negative conception of freedom in analysing individuals’ freedom with respect to the event of death and the positive conception respectively to the eventuality of death. This, firstly, leads me to discussing whether an immortal life-span would be a freer one, in the light of the suggestion of the negative conception that indexes the range of one’s freedom to the absence of external constraints and, secondly, whether the anxiety caused by the presence of death as an (ever-present) eventuality constrains one’s freedom, in the light of the suggestion of the positive conception that indexes one’s freedom to the presence of mechanisms which enable individuals to exercise control over their life. In the last chapter, I conclude that anxiety caused by the eventuality of death might actually constrain one’s freedom to a larger extent. I demonstrate that narrative thinking would be helpful to alleviate the influence of anxiety into a lesser degree and it might actually transform this potential constraint on a motivating factor for one’s authenticity

Is there a difference between normotensive and hypertensive patients in terms of blood parameters and cardiovascular diseases?

Objectives: It has been stated in various studies that there is a difference in some blood parameters between hypertensive and normotensive patients for a long time. Mean platelet volume (MPV), and red blood cell distribution width (RDW), have been studied in hypertensive patient groups in many studies. Hypertension is a classic risk factor for ischemic stroke and myocardial ischemia, as known. In our study, we examined whether there was a difference between hypertensive patient groups and normotensive patients in terms of blood parameters such as MPV and RDW, and the incidence of stroke and myocardial infarction.Methods: Blood samples and twenty-four-hour ambulatory blood pressure monitoring (ABPM) results of 552 patients admitted to our outpatient clinic with a pre-diagnosis of hypertension were retrospectively analyzed. According to ABPM results, we divided the study participants into four groups; dippers, non-dippers, extreme dippers, and normotansives. Complete blood count and biochemical test results were found in the database of our hospital for all patients and differences between groups were investigated.Results: One hundred seventy three normotensives (Group 1) (mean age, 47.4 ± 15.4 years), 210 non-dippers (Group 2) (mean age, 53.8 ± 15.8 years), 67 extreme dippers (Group 3) (mean age, 49.1 ± 15.9 years) and 102 dippers (Group 4) (mean age, 52.2 ± 12.5 years). Daytime mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) and night-time mean SBP and DBP were significantly different in groups (Group 1: 117 [90-193] mmHg and 71 [55-87] mmHg; Group 2: 137 [107-188] mmHg and 83 [107-188] mmHg; Group 3: 143 [115-193] mmHg and 88 [56-122] mmHg; and Group 4: 140.5 [116-173] mmHg and 76 [55-124] mmHg), p < 0.001; respectively. MPV and RDW levels were different in all four groups (p < 0.001). We found a significant difference in the rates of stroke and coronary artery disease between the four groups (p = 0.018 and p = 0.002, respectively). In the ROC curve analysis MPV had sensitivity of %77. 8 and specificity of 78. 1% for stroke when the cut-off value MPV was 9.25 (Area under curve: 0.808, 95% confidence interval: 0.726-0.889, p < 0.001).Conclusions: In our study, MPV and RDW levels and the rates of stroke and cardiovascular disease were significantly higher in non-dipper patients compared to other groups

Investigation of the moderator effect of job stress on the relationship between cyberloafing and employee performance: a research on health sector

Bu araştırmanın amacı iş stresinin, sanal kaytarma ve işgören performansı ilişkisi üzerinde anlamlı bir etkisinin olup olmadığını belirlemektir. Bu amacı gerçekleştirmek için “Sanal Kaytarma”, “İşgören Performansı” ve “İş Stresi Ölçekleri” Balıkesir ilinde kamuda görevli 402 sağlık çalışanına uygulanmıştır. Toplanan veriler üzerinde frekans analizi, faktör analizi, güvenilirlik analizi, normallik testi, korelasyon analizi ve regresyon analizi testleri uygulanmıştır. Korelasyon analizi sonucuna göre sanal kaytarma, işgören performansı ve iş stresi arasında anlamlı ilişkilerin olduğu tespit edilmiştir. Regresyon analizi sonucunda iş stresinin, sanal kaytarma ve işgören performansı ilişkisi üzerinde düzenleyici etkisinin olduğu tespit edilmiştir. Yöneticiler ve yapılacak araştırmalar için önerilerde bulunulmuştur. Araştırmanın bulgularının literatüre ve uygulayıcılara katkı sağlayacağı düşünülmektedir.The aim of this study is to determine whether job stress has a significant effect on the relationship between cyberloafing and employee performance. With this aim, “Cyberloafing”, “Employee Performance” and “Job Stress” scales were applied 402 public health employees in Balıkesir. Frequency analysis, factor analysis, reliability analysis, test for normality, correlation analysis, and regression analysis were applied on the collected data. According to the correlation analysis, it was found that there were significant relationships between cyberloafing, employee performance and job stress. As a result of the regression analysis, it was found that job stress has a moderator effect on the relationship between cyberloafing and employee performance. Managerial and further research implications are provided. It is thought that the findings of this study can contribute to both literature and applicators

A case of primary gastric choriocarcinoma and a review of the Turkish literature:An extremely rare carcinoma of the stomach

Primary choriocarcinoma of the stomach is an extremelyrare and highly malignant tumor. A 60 years old man visitedanother hospital for the chief complaint of the stomachacheand black stools. A large ulcero-vegetative tumoroccupying the gastric body and antrum was seen in theupper gastrointestinal endoscopy. It was diagnosed asgastric adenocarcinoma by endoscopic biopsy. The patientadmitted to our hospital for treatment. The patientwas assessed as a gastric adenocarcinoma complicatedwith hemorrhage. In the exploration, it was observed thatthe mass arising from gastric body was invaded the transversecolon and pancreas. The lymphadenopaties in theceliac axis were conglomerated and had invaded the celiacvessels. A subtotal gastrectomy and an extended righthemicolectomy were performed for palliation. In pathologicalfindings, typical characteristics of two cell pattern consistingof syncytiotrophoblasts and cytotrophoblasts wereobserved. The tumor consisted of only choriocarcinoma.For the definite diagnosis of choriocarcinoma, immunohistochemi-cal tests were performed. Beta-HCG andEMA staining were positive. The patient was invited forcontrol because of gastric choriocarcinoma three weekslater surgery. His serum beta-HCG level was 458 mIU/mL(normal range, <0.5 mIU/mL). For the differantiation fromthe primary choriocarcinoma in the testis or mediastinum,testicular ultrasonography and chest CT were performed.Abnormal findings were not detected in the tests, so itwas diagnosed as primary gastric choriocarcinoma. Thepatient refused chemotherapy. Three months later, hehad inguinal lymphadenopaties and multiple metastasesin lung. He died 5 months after surgery because of respiratoryfailure

Familial mediterranean fever and glomerulonrphritis: a case report

Ailevi Akdeniz Ateşi ateş ve seröz zarların iltihabı ile ortaya çıkan tekrarlayan ataklar ile karakterize, otozomal resesif bir hastalıktır. En sık Musevi, Arap, Türk ve Ermenilerde görülür. Ailesel Akdeniz ateşinin en önemli ve prognozu belirleyen komplikasyonu böbrek tutulumudur. En sık böbrek tutulumu nedeni AA tipi amiloidozdur. Kolşisinin etkin ve yaygın kullanımı amiloidoz sıklığını eskiye nazaran azaltmıştır. Ülkemizde amiloidoz sıklığı kolşisin kullanmayanlarda %20-25 civarında olduğu bildirilmiştir. Ailevi Akdeniz Ateşi seyri sırasında nadir olarak glomerulonefrit gibi amiloidoz dışında böbrek patolojileri de görülebilmektedir. Burada Ailesel Akdeniz ateşi ve Membranaproliferatif glomerolonefrit birlikteliği görülen bir olgu sunuyoruz.Familial mediterranean fever is characterized by recurrent attacks of fever and polyserositis. Familial mediterranean fever is an autosomal recessive disease. Familial mediterranean fever is commonly seen in Jewish, Arab, Turkish and Armenian. The most important and prognosis-determining complication is kidney involvement. The most common cause of kidney involvement is AA type amyloidosis. Effective ad common use of colchicine decreased amyloidosis frequency when compared to before. It has been reported that frequency of amyloidosis in patients who don't use colchicine is around 20-25% in our country. During the course of familial mediterranean fever, renal pathologies such as glomerulonephritis can be seen other than amyloidosis. Here we present a patient with familial mediterranean fever and membranoproliferative glomerulonephritis

A CpG island promoter drives the CXXC5 gene expression

CXXC5 is a member of the zinc-finger CXXC family that binds to unmethylated CpG dinucleotides. CXXC5 modulates gene expressions resulting in diverse cellular events mediated by distinct signaling pathways. However, the mechanism responsible for CXXC5 expression remains largely unknown. We found here that of the 14 annotated CXXC5 transcripts with distinct 5 ' untranslated regions encoding the same protein, transcript variant 2 with the highest expression level among variants represents the main transcript in cell models. The DNA segment in and at the immediate 5 '-sequences of the first exon of variant 2 contains a core promoter within which multiple transcription start sites are present. Residing in a region with high G-C nucleotide content and CpG repeats, the core promoter is unmethylated, deficient in nucleosomes, and associated with active RNA polymerase-II. These findings suggest that a CpG island promoter drives CXXC5 expression. Promoter pull-down revealed the association of various transcription factors (TFs) and transcription co-regulatory proteins, as well as proteins involved in histone/chromatin, DNA, and RNA processing with the core promoter. Of the TFs, we verified that ELF1 and MAZ contribute to CXXC5 expression. Moreover, the first exon of variant 2 may contain a G-quadruplex forming region that could modulate CXXC5 expression

Diagnosis of systemic lupus erythematosus in a patient with generalized lymphadenopathy: a case report

Lenfadenopati (LAP), lenf dügümünün boyut ve karakterindeki anormallik olarak tanımlanır. Lenfadenopati neoplastik veya inflamatuar hücrelerin lenf nodunda çogalması veya lenf nodunu invazyonu sonucu olusabilir. Lenfadenopati genis bir hastalık tablosu sonucunda gelisebilir. Yaygın lenfadenopati sebepleri arasında enfeksiyonlar, otoimmun hastalıklar, malignensiler, histiyositozlar, depo hastalıkları, hiperplaziler ve ilaç etkilesimleri sayılabilir. Lenfadenopati etyolojisinde kollajen doku hastalıkları önemli yer tutmaktadır. En sık lenfadenopatiye neden olan otoimmun hastalıklar romatoid artrit, sistemik lupus eritematozis (SLE) ve Sjögren sendromudur. Bu olguda yaygın lenfadenopati nedeni ile arastırılan ve SLE tanısı alan bir olguyu sunduk. Lenfadenopati nedeniyle tetkik edilen hastalarda kollajen doku hastalıklarını ve özellikle de SLE'u göz önünde bulundurmamız gerektigini bu yazıda vurgulamak istedik.Lymphadenopathy (LAP) is defined as the abnormality in the size and character of lymph node. Lymphadenopathy emerges due to increase of inflammatory cells in lymph node or invasion of these cells in the lymph node. Lymphadenopathy may occur in any age group, in symptomatic or asymptomatic patients, and in a single site or at multiple sites. Causes of generalized lymphadenopathy include infections, autoimmune diseases, malignancies, histiocytoses, storage diseases, benign hyperplasia, and drug reactions. In LAP etiology, collagen tissue disorders hold an important place. The most common autoimmune causes of LAPare rheumatoid arthritis, systemic lupus erythematosus (SLE) and Sjogren syndrome. In this case, we presented a case which was investigated for generalized lymphadenopathy and diagnosed with SLE. SLE diagnosis should be considered in patients researched for lymphadenopathy etiology

Retrospective Analysis of Lymphangitis Carcinomatosa Regarding Primer Tumor Spectrum and Computer Tomography Features

INTRODUCTION: Lymphangitis carcinomatosis (LC) is used to describe the metastatic involvement of pulmonary lymphatic canals and perilymphatic connective tissue by primary tumor cells and commonly occurs secondary to primary tumors, mostly adenocarcinomas, originated from breast, lung, gastrointestinal system cancers. Common findings in lung computed tomography (CT) are interlobular septal thickening and increased reticular/reticulonodular density. In this study, we aim to present the primary tumor spectrum and most frequent computed tomography findings of patients with LC. METHODS: In this double-centered study 63 patients, who had lung CT examination due to prediagnosis of LC, were retrospectively investigated. 41 patients with final diagnosis of LC due to findings upon Positron emission tomography/Computed tomography (PET/CT), ultrasonography, CT scan, endoscopic, bronchoscopic and cytopathologic investigations and/or clinical manifestations are ultimately included RESULTS: In 41 patients with LC, lung in 11 cases, esophagus in 7 cases, colon in 6 cases, stomach in 4 cases, pancreas in 3 cases, breast in 2 cases, bladder in 2 cases, thyroid in 2 cases and singly larynx, kidney, prostate and bone marrow in 4 cases were respectively revealed as primary tumor origins. Most frequent lung CT findings were increased reticular/reticulonodular and nodular densities, thickenings of interlobular septa, mediastinal and hilar lymphadenopathies, pleural and/or pericardial effusions, atelectasis, ground-glass opacities. Extrapulmonary involvement was detected in 14 patients DISCUSSION AND CONCLUSION: LC occurs with metastatic involvement of pulmonary lymphatics in patients with primary malignancy, especially adenocarcinomas. In CT, the reticular, reticulonodular, and noduler pattern (most common pulmonary parenchymal changes) and mediastinal lymphadenopathies (LAP) are the most common findgs. Pulmonary CT examination is accepted as the most important radiological modality in diagnosis and follow up of LC

Single Centre Experience: Bening and Malign Hematological Patients with COVID-19

Introduction Coronavirus disease 2019 (COVID-19) were declared as pandemic by World Health Organization. With this study, we aimed to define our patients who were followed up with malign or benign hematological diagnoses and diagnosed with COVID-19; determine the distribution of this infection in patient groups and contribute to the literature by creating descriptive statistics with its clinical and demographic features. Patients and methods: It is planned to retrospectively examine patients with a history of COVID-19 who were followed up in Hematology Department of Dışkapı Yıldırım Beyazıt Training and Research Hospital with benign and malignant diagnoses. Results: 88 patients who had COVID-19 infection while being followed in our clinic due to hematological diseases were included in the study. 77 patients had been followed by hematologic malignancies and 11 patients had been followed by benign hematological disease.In the group with malignancy, COVID was found most frequently in patients diagnosed with Philadelphia chromosome negative myeloproliferative neoplasms (22%), nonhodgkin lymphoma (19%) and multiple myeloma (16%). ITP (64%) was the most common disease in patients with benign hematological disorder who had COVID history. 52 (67%) of the malignant cases and 8 (73%) of the bening cases were found to be followed up with the disease in remission. The all patient's most common symptoms at COVID-19 diagnosis were fever (77%), cough (70%) and weakness (65%). 45% of the patients were isolated at home, 48% were required hospitalization. 49% of patients had mild; 27% had moderate and 24% had severe COVID-19 infection. Almost all of the patients in the moderate and severe disease group were followed up in patients diagnosed with malignant hematological disease. 16 (18%) patients received mechanical ventilation and 16 (18%) patients was transferred intensive care unit. All of the patients who were intubated and needed intensive care were diagnosed with malignant hematological disease. 17 patients died due to COVID-19 infection. The mortality rate was 22% in patients with diagnosis of malignant hematological diseases, and 19% when all patients (malignant and bening) were included. Conclusion: In conclusion, the COVID-19 pandemic is a problem all over the world. Determining the course of the disease in certain diagnostic groups is important in the management of both the main disease and the COVID-19 infection. Therefore, the contribution of such recording studies to the literature is important and valuable

Clinical outcomes and treatment patterns of primary central nervous system lymphoma: Multicenter retrospective analysis

Objectives: Primary central nervous system lymphoma (PCNSL) is a rare malignant disease with poor prognosis. Its low incidence leads to challenges in decision-making for treatment. As a matter of fact, there is still no consensus on the appropriate treatment modalities. In this context, the objective of this study is to investigate and comparatively assess the efficacies of several treatment modalities in the treatment of PCNSL. Methods: Thirty-four patients diagnosed with PCNSL at 5 different hematology centers between 2007 and 2021 were included in the study. Patients’ data from all five centers were collected retrospectively. Since ibrutinib is not approved for this indication in Turkey, consent for off-label use of ibrutinib is obtained from each patient. Ethics committee ap-proval was obtained on June 9, 2021 with decision number 2021/18-05. Results: The median age of the patients was 59 (min.: 22, max.: 78) years. The male-to-female ratio was 1.26/1. Nineteen (55.9%) patients had Eastern Cooperative Oncology Group (ECOG) performance score of ≥2. Fifteen (44.1%) patients had normal lactate dehydrogenase (LDH) levels and only 14.7% of the patients had B symptoms at the time of diagnosis. Magnetic resonance imaging (MRI) revealed a single mass lesion in 14 (41.2%) patients. As an induction therapy, meth-otrexate-based regimen was administered in 29 (85.3%) patients. Only 14 of the 34 patients received 4 or more cycles of high-dose methotrexate (MTX). About 32.4% of the patients received radiation therapy (RT) during follow-up as a part of induction therapy. Five patients received only RT due to poor performance status. Ibrutinib was administered in 5 patients for refractory disease. It was determined that four or more cycles of MTX treatment increased progression-free survival (PFS) (p=0.031) and overall survival (OS) (p=0.012). Moreover, RT improved PFS (p=0.023). Considering that the complete response achieved by induction therapy influences long-term survival, achievement of the best response to the treatment regimens administered in combination with new agents may prolong survival (PFS: p=0.01, OS: p=0.023). Conclusion: The findings of this study indicate that the initial response to treatment is crucial. Additionally, it was found that high-dose MTX treatment should be administered for 4 cycles or more in order to achieve the best results. Furthermore, it was determined that ibrutinib monotherapy was well-tolerated in our patients with relapsed/refractory disease, with excellent clinical benefits. In conclusion, a combination therapy consisting of high-dose MTX, ibrutinib, and rituximab appears to be a promising initial treatment approach in appropriate patients