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BACKGROUND: Early intervention services play a crucial role in the prevention and management of Autism Spectrum Disorder (ASD). With the increasing prevalence of ASD, understanding the specific needs of mothers and their children is essential for the development of effective interventions and support systems. METHODS: This interview study examines the early intervention service needs of Turkish mothers with children aged 2-6 who have been diagnosed with ASD. Semi-structured in-depth interviews were conducted with nine mothers. Thematic analysis was carried out following the guidance and six steps procedures described by Braun and Clarke. FINDINGS: The study's findings reveal six distinct themes that encompass the needs expressed by the participating mothers: 1) psychological support needs, 2) social support needs, 3) financial support needs, 4) strengthening the family, 5) government-based enhancement, and 6) the need for social awareness. DISCUSSION: The findings underscore the significance of comprehensive early intervention services tailored to address the needs of mothers. The stressors associated with the impact of ASD on families are highlighted, aligning with Guralnick's framework. The findings emphasize the need for holistic intervention programs and stress the importance of collaborative relationships among parents, educators, and service providers. APPLICATION TO PRACTICE: The practical implications of this study benefit healthcare professionals, policymakers, educators, and stakeholders. The emphasis lies in aligning interventions with the ASD needs of both mothers and children, ultimately aiding in the development of effective policies and the enhancement of the quality of care for individuals with ASD in Turkey.
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Transtorno do Espectro Autista , Criança , Feminino , Humanos , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/terapia , Transtorno do Espectro Autista/psicologia , Turquia , Mães/psicologia , Pais , Pesquisa QualitativaRESUMO
This work demonstrates an additive and hydrogen-free 2-step lignin-first fractionation in flow-through. First, solvolytic delignification renders lignin liquors with its native chemical structure largely intact; and second, ß-zeolite catalytic depolymerization of these liquors leads to similar monomer yields as the corresponding 1-step fractionation process. Higher delignification temperatures lead to slightly lower ß-O-4 content in the solvated lignin, but does not affect significantly the monomer yield, so a higher temperature was overall preferred as it promotes faster delignification. Deposition of Pd on ß-zeolite resulted in a bifunctional hydrogenation/dehydration catalyst, tested during the catalytic depolymerization of solvated lignin with and without hydrogen addition. Pd/ß-zeolite displays synergistic effects (compared to the Pd/γ-Al2O3 and ß-zeolite tested individually and as a mixed bed), resulting in higher monomer yield. This is likely caused by increased acidity and the proximity between the metallic and acid active sites. Furthermore, different ß-zeolite with varying SAR and textural properties were studied to shed light onto the effect of acidity and porosity in the stabilization of lignin monomers. While some of the catalysts showed stable performance, characterization of the spent catalyst reveals Al leaching (causing acidity loss and changes in textural properties), and some degree of coking and Pd sintering.
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OBJECTIVE: We aimed to investigate the relation of NT-pro BNP level and left ventricular ejection fraction with premature ventricular complex burden. PATIENTS AND METHODS: A total of 94 patients with PVC burden > 5% (age 45.9+12.9 years, 53 males, 41 females) were included in the study. The primary outcome was PVC burden % and main prognostic factors were LVEF% and NT-Pro BNP level. Gender, age, DM, HTN, presence of symptoms, symptom duration and heart rate were used as adjustment predictor variables. We created four different linear multivariable models to compare performance measures of prognostic factors: Model-1 has gender, age, DM, HTN, symptoms and heart rate, while LVEF has been added in addition to model-1 in model-2. Model-3 included NT-Pro-BNP alongside model-1 variables, while model-4 included both LVEF and NT-Pro-BNP variables in addition to model-1 variables. Accordingly, we compare the performance (R2, likelihood ratio X2) of models. RESULTS: The median PVC burden was 18% (IQR; 11-27). When model-1 consisting of gender, age, DM, HTN, presence of symptoms, symptomS duration and heart rate and model-2 consisting of LVEF in addition to variables of model-1 were compared, it was observed that both LRX2 and R2 values improved (likelihood ratio test p-value=0.013). Model-1 compared with model-3 which consisting of NT-pro BNP in addition to variables of model-1, and it was observed that both LRX2 and R2 values improved (likelihood ratio test p-value=0.008). However, when compared to model-1, the most significant improvement was observed in both LRX2 and R2 values in model-4 consisting of model-1 plus NT-Pro-BNP and LVEF (likelihood ratio test p-value <0.001). CONCLUSIONS: We determined that NT-pro-BNP levels and LVEF could predict PVC burden in patients. Higher levels of NT-pro-BNP and lower LVEF values were associated with increased PVC burden.
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Função Ventricular Esquerda , Complexos Ventriculares Prematuros , Masculino , Feminino , Humanos , Adulto , Pessoa de Meia-Idade , Volume Sistólico/fisiologia , Biomarcadores , Peptídeo Natriurético Encefálico , Fragmentos de PeptídeosRESUMO
OBJECTIVE: Obesity is a serious public health problem associated with excessive food intake. Regulation of food intake in highly organized organisms is under the control of a large number of orexigenic and anorexigenic molecules. Therefore, the main purpose of this study has been to determine the relationship between obesity and some of the circulating orexigenic and anorexigenic peptides that have a role in appetite control and to determine whether the concentrations of these molecules differ according to blood groups. PATIENTS AND METHODS: The study included 400 individuals of whom 100 were obese women, 100 obese men, 100 healthy men and 100 healthy women. Obese women and men were divided into 4 groups, according to their blood groups. In the control group, healthy women and healthy men were similarly divided into 4 blood groups. Each blood group within the groups, therefore, had 25 participants. RESULTS: When leptin, nesfatin-1, obestatin and neuropeptide-Y, ghrelin and galanin levels of the control group and obese participants were compared, regardless of blood groups, leptin, nesfatin-1, obestatin and neuropeptide-Y were significantly higher, whereas only the ghrelin levels were significantly lower in obese patients. When the amounts of these hormones were measured according to gender, the situation was similar. When leptin, nesfatin-1, obestatin and neuropeptide-Y values of the control and obese participants' blood groups were compared with each other; these hormones were high in all blood groups; however, leptin levels in A blood group, nesfatin-1 levels in AB and O blood group, obestatin levels in AB blood group, neuropeptide-Y levels in A, B, AB blood groups were significantly higher. When the ghrelin levels of the blood groups in the control group and obese participants were compared, it was only significantly lower in the AB blood group. The ghrelin levels in the other blood groups of the obese individuals were again low, but not significantly so. When the distribution of hormones according to gender was evaluated, a situation parallel to the above results was recorded. CONCLUSIONS: Leptin, nesfatin-1, obestatin and neuropeptide-Y and galanin levels of obese individuals were significantly higher than the control values, whereas the ghrelin values were significantly lower regardless of blood groups. Also, these hormones in blood partly varied with ABO blood groups. These different concentrations of hormones in ABO blood groups might be related with stimulation or suppression of appetite in human. However, further studies in other ethnic groups are needed to confirm these results.
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Sistema ABO de Grupos Sanguíneos , Obesidade/sangue , Orexinas/sangue , Feminino , Galanina/sangue , Grelina/sangue , Humanos , Leptina/sangue , Masculino , Neuropeptídeo Y/sangueRESUMO
Brucellosis is a worldwide zoonosis, that can still be classified as endemic despite its ancient origins which causes economic losses and public health problems. Although effectively controlled by vaccination in animals, there is currently no vaccine for use in humans. Outer Membrane Proteins (OMP) that play an active immunogenic and protective role in the Brucellae family. OMP19 is present in all Brucella species as a surface antigen and is a potent immunogen responsible for Brucellosis intracellular infection. For this reason, the study was aimed to be used safely as a potential recombinant vaccine candidate against all Brucella infections, especially in humans and pregnant animals. This study evaluated a Brucella lipoprotein antigen, i.e. 19 kilodalton (kDa) outer membrane protein (OMP19), which was amplified and cloned into the pETSUMO vector system. The immunogenic power of the purified recombinant OMP19 antigen against brucellosis was compared with that of OMP19 (Raybiotech Inc, USA) in a mouse model and the obtained rOMP19 antigen was found to be similar to the commercially available recombinant protein.
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Brucella melitensis , Brucelose , Doenças dos Roedores , Humanos , Feminino , Camundongos , Gravidez , Animais , Brucella melitensis/genética , Brucella melitensis/metabolismo , Proteínas da Membrana Bacteriana Externa/genética , Proteínas da Membrana Bacteriana Externa/metabolismo , Brucelose/prevenção & controle , Brucelose/veterinária , Antígenos de Bactérias , Clonagem Molecular , Camundongos Endogâmicos BALB CRESUMO
Electrical storm is a life-threatening medical emergency that requires immediate diagnosis and treatment. It can remain a clinical challenge despite anti-arrhythmic drugs and catheter ablation therapies. Autonomic modulation techniques have gained increased recognition in the treatment of refractory electrical storm cases. In our case, we present a patient with recurrent ventricular tachycardia/fibrillation episodes one week after a myocardial infarction. Patient's arrhythmia was refractory to antiarrhythmic drugs and hemodynamical status was unstable, thus catheter ablation under temporary mechanical circulatory support was the initial strategy. Ventricular fibrillation episodes relapsed 48 h after catheter ablation and we proceeded with autonomic modulation treatment options. Bilateral stellate ganglion blockade was performed under ultrasound guidance using bupivacaine. Sinus bradycardia was present and no ventricular arrhythmias were detected on post-procedure ECG. Stellate ganglion blockade was complemented with video-assisted thoracoscopic cardiac sympathetic denervation. After the last procedure, patient remained on sinus rhythm, was hemodynamically stable and extubated successfully.
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Bloqueio Nervoso Autônomo , Ablação por Cateter , Taquicardia Ventricular , Bupivacaína , Eletrocardiografia , Humanos , Gânglio Estrelado , Taquicardia Ventricular/cirurgia , Resultado do TratamentoRESUMO
AIM: End-stage renal disease is a disease in which the kidney is not able to perform its functions. Kidney transplantation is the most effective treatment and cost-effective modality of renal replacement therapy for patients with end-stage renal disease. However, the most important problem in end-stage renal disease patients is the unpredictability of immunologic response after transplants. In this study, it was aimed to investigate the possible association between the interleukin 2 (IL-2) expression level and an organ rejection or rejection episode. MATERIALS AND METHODS: Lymphocytes were isolated from peripheral blood obtained from 21 end-stage renal disease-diagnosed patients prior to transplant and at the sixth month after transplant. CD4+ T cells were separated from lymphocytes by the magnetic cell-sorting method. The purity of these cells were controlled by a flow cytometer. After total RNA isolation from CD4+ T cells, IL-2 was examined by the real-time polymerase chain reaction (RT-PCR) method. RESULTS: Among nonrejection patients (n = 18), the IL-2 expression level decreased in 12 patients in post-transplant time, and 3 of these were statistically significant (P < .05). The level was the same in 1 of 18 patients; it increased in 5 patients, and 1 of them was significant (P < .05). The IL-2 expression level also increased in 3 patients who had a rejection episode, and the increase was statistically significant in 2 samples (P < .05). CONCLUSION: When the patients were evaluated individually, it was observed that there might be a relationship between IL-2 expression levels in CD4+ T cells and rejection episodes. The clinical data of the patients, the immunosuppressive therapies, and post-transplant evaluation of cytokines should be considered together.
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Linfócitos T CD4-Positivos/imunologia , Rejeição de Enxerto/imunologia , Interleucina-2/sangue , Transplante de Rim , Adulto , Biomarcadores/sangue , Feminino , Rejeição de Enxerto/sangue , Humanos , Interleucina-2/imunologia , Falência Renal Crônica/cirurgia , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Adequate tissue removal must be performed for symptom relief following reduction mammoplasty. However, this is not always possible in patients with gigantomastia because the pedicle is planned wider and the breast cannot be sufficiently reduced to prevent compromising the blood supply to the pedicle. To maximize blood circulation to the nipple-areola complex in our patients, the pedicle was planned to include the internal thoracic artery branches coming from both the second and third interspaces and the intercostal artery branches coming from the fourth and fifth intercostal spaces. METHODS: A total of 185 patients underwent reduction mammoplasty with the superomedial pedicle- and septal perforator-based technique. The mean weight of excised tissue was 928.77 g from the right breast and 899.92 g from the left, whereas the mean distance of nipple-areola transfer was 11.52 cm on the right breast and 11.27 cm on the left. RESULTS: Complications developed in 11 patients (5.94%): hematoma occurred in three patients, partial loss of areola and fat necrosis in five patients, and wound dehiscence in three patients. CONCLUSIONS: The pedicle included vessels of both superomedial and septum origin without any disruption in circulation. Consequently, the blood supply of the nipple-areola complex was preserved. Furthermore, in cases where the pedicle was long, intercostal perforators were identified and the pedicle was narrowed thoroughly; thus, the breast was reduced to the desired volume while minimizing the risk of complications. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Mama/anormalidades , Hipertrofia/cirurgia , Mamoplastia/métodos , Satisfação do Paciente , Retalho Perfurante/transplante , Retalhos Cirúrgicos/transplante , Adulto , Mama/cirurgia , Estudos de Coortes , Estética , Feminino , Humanos , Mamoplastia/efeitos adversos , Mastectomia Subcutânea/métodos , Pessoa de Meia-Idade , Retalho Perfurante/irrigação sanguínea , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Prognóstico , Estudos Retrospectivos , Medição de Risco , Retalhos Cirúrgicos/irrigação sanguínea , Resultado do Tratamento , Cicatrização/fisiologiaRESUMO
BACKGROUND: Sternum is one of the skeleton parts which have frequently congenital anomalies and variations are commonly used by researchers in determining sex. We evaluated the morphological characteristics and sex-related changes of the sternum in adult individuals using multidetector computed tomography in our study. MATERIALS AND METHODS: Two hundred adults (103 female and 97 male) aged between 18 and 87 years were evaluated. Utilising the morphological characteristics of the sternum based on the multislice images; length, width and the thickness of manubrium, length, width and the thickness of corpus sterni, total length of sternum, sternal angle, sternal index (SI), length of the xiphoid process, the thickness of xiphoid process, the number of indents of xiphoid process were measured and a total of 20 parameters were evaluated by adding age, height and weight to these variables. RESULTS: The mean length of the manubrium, the length of corpus sterni, the length of total sternum, SI, sternal angle were found in females 46.7 ± 5.1, 86.6 ± 9.7, 133.1 ± 1.1, 54.47 ± 10.0 and 163.75 ± 5.79; in males 51.2 ± 6,102.4 ± 13.3, 154.1 ± 13.1, 50.11 ± 10.02 and 162.21 ± 6.17, respectively. We found that Hyrtl's Law and SI did not provide adequate accuracy for sex determination in our patients. It has been detected that the length of the manubrium alone is not helpful for individual samples. Total length of the sternum was found to be more reliable than the length of the manubrium and the length of corpus sterni. We determined sternal cleft and sternal foramen as 0.5% and 3.5%, respectively. CONCLUSIONS: We suggest that the morphometric standards cannot be universally applied and can demonstrate individual differences. The standard rules must be implemented for every population.
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Tomografia Computadorizada Multidetectores , Anormalidades Musculoesqueléticas/diagnóstico por imagem , Caracteres Sexuais , Esterno/anormalidades , Esterno/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Ureteric stenosis (US) is the most common urologic complication after kidney transplantation. In this dual-center retrospective study we compared the efficacy and safety of open surgery versus interventional radiology for the management of US. METHODS: From 2009 to January 2016, US was treated by surgical revision in 22 (7.8%) out of 281 recipients at one center (group 1) and managed by percutaneous nephrostomy with antegrade nephroureteral stenting (PNAS) in 22 (14.2%) out of 155 recipients at the other center (group 2). RESULTS: Three patients in group 1 required reintervention and again were treated with open surgery. With a mean follow-up of 42.1 ± 38.7 months, graft function improved in all but one patients (95%). Three patients in group 2 were admitted with relapse of US not amenable to 2nd PNAS, and 2 of them were managed with surgery. These 3 and 2 other cases with improved graft function after PNAS lost their grafts and returned to hemodialysis. The remaining 17 patients (77%) still have functioning grafts. There was no statistically significant difference between the efficacy of PNAS and open surgery for the management of post-transplantation US. However; a benefit in favor of open surgery existed for type 2 urinary tract obstruction in terms of decreased reintervention rate and much better protection of the graft function and survival. CONCLUSIONS: Both interventional radiology and open surgery have acceptable efficacy rates in the management of ureteric complications after renal transplantation. Open surgery is a better treatment option for type 2 obstruction.
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Transplante de Rim/efeitos adversos , Radiografia Intervencionista/métodos , Obstrução Ureteral/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Radiografia Intervencionista/efeitos adversos , Reoperação , Estudos Retrospectivos , Ureter/cirurgia , Obstrução Ureteral/etiologia , Procedimentos Cirúrgicos Urológicos/efeitos adversosRESUMO
OBJECTIVES: In ankylosing spondylitis (AS) patients, cardiac and vascular involvement may manifest as atherosclerosis and coronary artery disease. Systemic inflammation, oxidative stress, increased low-density lipoprotein (LDL) cholesterol and decreased high-density lipoprotein (HDL) cholesterol constitute a significant risk for atherosclerosis. This study investigated the relationship between carotid intima-media thickness (CIMT), LDL/HDL ratio, total oxidant status (TOS; an indicator of oxidative stress) and ischemic modified albumin (IMA; an ischemic marker in AS patients). PATIENTS AND METHODS: Sixty AS patients were diagnosed using the Modified New York Criteria; 54 age- and gender-matched participants were included as controls. CIMT, LDL/HDL ratio, TOS and IMA were measured using the most appropriate methods. RESULTS: IMA was higher in AS patients compared to controls (p < 0.0001). TOS was also increased in AS patients (p = 0.005); as was CIMT (p < 0.0001). The LDL/HDL ratio was also greater in AS patients compared to controls (p = 0.047). A positive correlation was found between CIMT and LDL/HDL ratio among AS patients. CONCLUSION: Elevated CIMT, IMA and TOS levels suggest an increased risk of atherosclerotic heart disease in AS patients. The LDL/HDL ratio was higher in AS patients compared to controls, and there was a correlation between LDL/HDL ratio and CIMT, albeit statistically weak. Therefore, the LDL/HDL ratio is not a reliable marker to predict atherosclerotic heart disease in AS patients.
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Aterosclerose/sangue , Aterosclerose/epidemiologia , Lipoproteínas HDL/sangue , Lipoproteínas LDL/sangue , Espondilite Anquilosante/epidemiologia , Adulto , Aterosclerose/diagnóstico , Biomarcadores/sangue , Comorbidade , Feminino , Humanos , Masculino , Prevalência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Albumina Sérica , Albumina Sérica Humana , Espondilite Anquilosante/diagnóstico , Turquia/epidemiologiaRESUMO
OBJECTIVES: Behcet's disease (BD) is a systemic vasculitis characterized by cardiovascular complications. Early diagnosis of these complications can reduce morbidity and mortality. Carotid artery intima-media thickness (cIMT) and the logarithmic value of triglyceride to high density lipoprotein ratio (atherogenic index of plasma, AIP) are good markers of atherosclerosis. The purpose of this study was to investigate whether AIP is a predictive marker of subclinical atherosclerosis in BD patients. PATIENTS AND METHODS: A total of 84 BD patients (60 male, 24 female) and 84 healthy control individuals (58 male, 26 female) were included in this study. cIMT measurements were made, and AIP values were calculated. RESULTS: cIMT (p < 0.001) and AIP (p < 0.001) values of the BD patients were higher than those of the control group. A strong independent relationship was found between the AIP value and cIMT (ß = 0.232, p = 0.018). In the subgroup analysis, the cIMT and AIP values of male BD patients were higher than those of female BD patients. CONCLUSION: Increased AIP and cIMT values can be a good marker for subclinical atherosclerosis in BD patients, especially in male BD patients.
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Doenças Assintomáticas/epidemiologia , Aterosclerose/sangue , Aterosclerose/epidemiologia , Síndrome de Behçet/sangue , Síndrome de Behçet/epidemiologia , Espessura Intima-Media Carotídea/estatística & dados numéricos , Triglicerídeos/sangue , Adulto , Aterosclerose/diagnóstico , Síndrome de Behçet/diagnóstico , Biomarcadores/sangue , Estudos de Casos e Controles , Causalidade , Comorbidade , Feminino , Humanos , Incidência , Lipoproteínas HDL/sangue , Masculino , Prognóstico , Reprodutibilidade dos Testes , Fatores de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Turquia/epidemiologiaRESUMO
AIM: Scrotal calcinosis is a rare and benign condition characterized by multiple calcific deposits occurring in scrotum and formed as nodules and lumps within scrotal skin with any systemic metabolic disorder. The so-called idiopathic scrotal calcinosis does not appear to be idiopathic, but rather a process of dystrophic calcification of epidermal cysts. Histological examination shows calcium deposites with in the dermis that may be surrounded with histiocytes and an inflammatory giant cell reaction. The aim of this paper was to detect dystrophic calcification of epidermal cysts and to take attention to the incorrect terminology of "idiopathic calsification". METHODS: This is a two-centered study of scrotal calcinosis with 17 cases, on which clinical and histopathological examinations were conducted. RESULTS: The patients we examined all had scrotal epidermoid cysts in varying stages of inflammation coexisted with scrotal calcinosis. Some cyts (52.9%) had intact epithelial walls, others (35.2%) showed rupture of their epithelial walls associated with the presence of keratin fibers and calcium granules in the surrounding dermis and all had naked calcium deposits lying in the dermis. CONCLUSION: The spectrum of the changes that we experienced in the histology, coupled with the normal values in the biochemical profile, shore up the theory of dystrophic calcification of epithelial cysts. During the time first these cysts become inflamed than rupture in the and calcium depocytes replase with the cysts.
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Calcinose/patologia , Cisto Epidérmico/patologia , Doenças dos Genitais Masculinos/patologia , Escroto/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Calcinose/diagnóstico , Cálcio/metabolismo , Doenças dos Genitais Masculinos/diagnóstico , Humanos , Inflamação/patologia , Queratinas/metabolismo , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Terminologia como Assunto , Adulto JovemRESUMO
INTRODUCTION: In Turkey, donation rates remained low despite the efforts of the Religious Affairs Supreme Council. We sought to determine theological perspectives and behaviors of clergy and theology students toward organ donation. METHODS: We conducted a systematic review and metaanalysis of observational studies. RESULTS: There were 2154 participants. Eighty-two percent stated Islam allows organ donation. Nineteen had organ donation card (<1%). Fifty-four percent were reluctant to donate organs themselves, 56% lacked sufficient knowledge. Twenty percent referred to school education and periodicals as the source of information. Sixty-nine percent were act as opinion leaders for organ donation. In curriculums of the Faculties of Theology, organ donation as a separate topic has not been found. No articles regarding organ donation have been published in theology journals in their 60-year publication history. CONCLUSIONS: A discrepancy exists between the resolutions of the Board of Religious Affairs and attitudes of clergy toward organ donation in Turkey. Theology faculties seem not to pay specific attention to this issue. The Directorate of Religious Affairs and the faculty of theology should meet at a common point immediately in terms of training programs and continuing education with strict audit in context of organ transplantation and donation.
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Atitude , Clero/ética , Currículo , Inteligência , Islamismo , Teologia/educação , Obtenção de Tecidos e Órgãos/ética , Humanos , Masculino , TurquiaRESUMO
INTRODUCTION: Contrary to TV programs projecting awareness about organ donation in society, concrete evidence exists about adverse influence of negative broadcasts on organ donation rates. We sought to determine the effect of mass media on public opinion toward organ donation and the efficacy of public campaigns and novel social media attempts on donation rates. METHODS: We conducted a systematic review of relevant literature and national campaign results. RESULTS: Hoaxes about brain death and organ transplantation adversely affect organ donation rates in both Western and Eastern societies. Scientifically controversial and exaggerated press conferences and institutional advertisements create mistrust in doctors, thus reducing organ donation. The overall effect of public education campaigns in promoting organ donation is a temporary 5% gain. Increments in organ donation rates is expected with novel applications of social media (Facebook effect). CONCLUSION: Communication, based on mutual trust, must be established between medicine and the media. Continuing education programs with regard to public awareness on organ donation should be conducted over social media.
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Conscientização , Meios de Comunicação de Massa , Opinião Pública , Rede Social , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/organização & administração , Humanos , TurquiaRESUMO
OBJECTIVE: Ankylosing spondylitis (AS) is a progressive chronic inflammatory disease mainly characterized by axial skeleton and sacroiliac joint involvement. We aimed to investigate the relation between neutrophil-to-lymphocyte ratio (NLR) and disease severity of AS and to explore its availability in clinical practice. METHODS: A total of 102 AS patients and 60 individuals who were age- and gender-compatible with the control group were included into the study. Patients were divided into 2 groups according to Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores. Patients with BASDAI scores < 4 were considered to be having mild disease activity, whereas those with scores ≥ 4 were considered to be displaying severe disease activity. Hemogram test during the diagnosis, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) and other laboratory values of the control group were recorded. RESULTS: NLR was observed to be higher in AS patients compared to the controls (2.47 ± 1.33 and 1.72 ± 0.47; respectively; p<0.0001). NLR was observed to be significantly higher in severe AS disease activity compared to the mild AS disease activity (2.72 ± 1.41, 2.20 ± 1.19; respectively; p = 0.001). NLR had statistical significant differences between mild disease activity compared to the controls (2.20 ± 1.19 and 1.72 ± 0.47, respectively; p = 0.263). There was a positive correlation between NLR and BASDAI (r = 0.193, p = 0.041). The performance of NLR evaluating the disease severity by Roc analysis had sensitivity of 69%, specificity of 54% (cut-off value 1.91), and AUC of 0.652 (95% Cl, 0.549-0.755) (p = 0.006). CONCLUSIONS: NLR may be a simple and inexpensive marker to indicate disease activity in patients with AS in daily clinical practice (Tab. 3, Fig. 3, Ref. 25).
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PURPOSE: The combination of taxanes and anthracyclines has proven efficacy in node-positive (N+) premenopausal primary breast cancer patients. Ovarian ablation is also associated with better survival outcomes in premenopausal hormone-receptor positive (HR+) patients. Therefore, this trial aims to determine the superiority of combined hormonal treatment of ovarian ablation with tamoxifen (TMX) versus TMX alone, in premenopausal N+, HR + patients receiving adjuvant chemotherapy (AC) with taxane and anthracycline. MATERIALS AND METHODS: Premenopausal women who had surgically removed breast cancer with histologically confirmed N + and HR+ were included in the trial. The AC consisted of six cycles of taxotere, adriamycin, cytoxan or taxotere, epirubicin and cytoxan with the completion of radiation therapy. Patients were randomly assigned to receive TMX 20 mg/day for 5 years or up to menopause or TMX 20 mg/day for 5 years plus goserelin (GOS) 3.6 mg injection per month for 2 years. The primary end point was disease-free survival (DFS). RESULTS: Between 2003 and 2011, 101 consecutive patients were allocated to TMX (51 patients) and TMX/GOS (50 patients) groups. The mean follow-up period was 52.4 ± 2.8 months. DFS was 43.0 ± 3.6 months versus 49.9 ± 4.22 months (P = 0.13) and overall survival was 51.1 ± 3.8 months versus 53.1 ± 4.2 months (P = 0.50) in the TMX and TMX/GOS groups, respectively. The results showed 9% absolute risk reduction with respect to DFS in favor of the TMX/GOS group. CONCLUSION: This study group was comprised of stage II and III disease patients with high nodal status. The TMX/GOS combination reduced absolute risk of developing first locoregional or distant relapse by almost 9%. Longer follow-up is required to justify this protocol for routine use.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Carcinoma Ductal de Mama/tratamento farmacológico , Carcinoma Lobular/tratamento farmacológico , Gosserrelina/administração & dosagem , Recidiva Local de Neoplasia/prevenção & controle , Tamoxifeno/administração & dosagem , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/secundário , Carcinoma Lobular/secundário , Quimioterapia Adjuvante , Ciclofosfamida/administração & dosagem , Intervalo Livre de Doença , Docetaxel , Doxorrubicina/administração & dosagem , Epirubicina/administração & dosagem , Feminino , Humanos , Pessoa de Meia-Idade , Pré-Menopausa , Estudos Prospectivos , Taxa de Sobrevida , Taxoides/administração & dosagem , Resultado do TratamentoRESUMO
BACKGROUND: The major renal involvement in Familial Mediterranean Fever (FMF) is the occurrence of amyloidosis that primarily affects the kidneys manifested by proteinuria and ending in death from renal failure. AIM: This study aims to investigate whether serum cystatin (cys-C) levels could be used as an early marker of renal involvement in FMF patients. PATIENTS AND METHODS: Forty-six patients with FMF during the attack period (AP), and 41 patients with FMF during attack-free periods (AFP), and 11 patients with FMF associated amyloidosis, and 38 healthy controls were enrolled in the study. We determined cys-C levels in the serum of FMF patients and healthy controls. RESULTS: Serum cys-C levels were significantly increased in patients with FMF and secondary amyloidosis, and serum cys-C is a more accurate and efficient marker for detecting renal involvement than estimated glomerular filtration rate (e-GFR) in patients with FMF. CONCLUSIONS: We propose a cutoff level of the serum cys-C of 876.5 pg/mL for screening renal involvement in patients with FMF, and amyloidosis should be strongly suspected when the serum cys-C reaches 1565.5 pg/mL.
Assuntos
Amiloidose/diagnóstico , Cistatina C/sangue , Febre Familiar do Mediterrâneo/sangue , Nefropatias/diagnóstico , Adulto , Biomarcadores/sangue , Febre Familiar do Mediterrâneo/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Familial Mediterranean Fever (FMF) is an autosomal recessive disease characterized by short lived, febrile serosae inflammatory attacks. FMF has various effects in multiple systems and organs. AIM: In the present study, our aim was to evaluate adrenal steroidogenesis in female FMF patients. PATIENTS AND METHODS: There were 71 women in the study including 41 women with FMF and 30 women as healthy control group (HC group). Of 41 FMF patients, twenty were evaluated in attack period (AP-FMF group) whereas 21 of them were evaluated in attack-free period (AFP-FMF group). In all subjects; serum free testosterone, 17-OHP levels as hormones, IL-1 beta, TNF-alpha, IL-6, IL-18 as proinflammatory cytokines, CRP, fibrinogen, white blood cell (WBC) counts, and erythrocyte sedimentation rate (ESR) as acute phase reactants were measured in samples of venous blood taken in the morning before breakfast. RESULTS: Serum 17-OHP levels in AP-FMF group and AFP-FMF group were higher than in HC group (p < 0.001). A positive correlation was detected between serum levels of 17-OHP and IL-1 beta in FMF patients (p = 0.006; r = 0.486). There was no difference between FMF patients and HC group in terms of free testosterone levels (p > 0.05). CONCLUSIONS: Our results showed an increase in 17-OHP levels in FMF patients. These results may indicate that, regardless to the attack period adrenal steroidogenesis could be affected negatively in FMF patients.
Assuntos
17-alfa-Hidroxiprogesterona/sangue , Febre Familiar do Mediterrâneo/sangue , Testosterona/sangue , Adulto , Proteína C-Reativa/análise , Citocinas/sangue , Feminino , HumanosRESUMO
OBJECTIVE: This study evaluates the effect of enteric-coated mycophenolate sodium (EC-MPS) on patient and graft survivals, the incidence of rejection episodes, and graft function among de novo and maintenance renal transplant recipients. PATIENTS AND METHODS: This open label, multicenter, prospective, post-marketing observational study of 470 renal transplantation patients at 23 centers in Turkey includes 331 de novo patients whose mean age was 29.6 ± 13.2 years and 139 maintenance patients of 34.0 ± 13.0 years. The latter subjects had EC-MPS substituted for mycophenolate mofetil or added to the immunosuppressive therapy. Patients were followed for 12 months to evaluate graft function and treatment failure. RESULTS: The most common primary disease requiring transplantation was glomerulonephritis (24.3%). De novo and maintenance groups were similar in terms of overall rejection rates and acute rejection incidence whereas chronic rejection was evident only among the latter cohort (P < 0.001). Time to an acute rejection episode was significantly longer among maintenance rather than de novo patients (220.8 versus 18.7 months; P = 0.015). Overall, 12 and 36 month survival rates were 91.6 ± 1.3% and 86.9% ± 0.3% among subjects experiencing acute rejection versus 99.7 ± 0.2% and 50.3% for those displaying chronic rejection. Among maintenance group no deterioration of renal function was observed after conversion from mycophenolate mofetil to EC-MPS. The incidences of leukopenia, new-onset anemia, or liver dysfunction were similar between de novo and maintenance patients. Gastrointestinal discomfort was more prevalent among the maintenance group, reaching a significant level at the fourth visit (P < 0.05). EC-MPS dose reduction was required in only 16.7% of patients at visit, it was more frequent among the de novo group (17.9 versus 13.8%). CONCLUSION: EC-MPS was an effective adjunctive therapy for de novo as well as maintenance renal transplant recipients in the Turkish population due to a relatively low incidence of dose reductions necessitated by adverse events as well as with an increased likelihood of long-term graft survival.