Cell proliferation and apoptosis in canine oral papillomatosis.

This study was aimed at the evaluation of cell proliferation, p53 level and apoptotic index by immunohistochemical methods in canine oral papillomatosis. The study material comprised of tumor tissue samples taken from six dogs being admitted to the Pathology Department of Faculty of Veterinary Medicine, Kafkas University, Kars, Türkiye. Choice of immunohistochemical staining was avidin-biotin peroxidase method. Cases of canine oral papillomatosis, determined to have been caused by canine papillomavirus-1, were found to have a rather high cell proliferation index. Furthermore, all cases were immunohisto-chemically demonstrated to carry a mutant p53 gene. Despite the mutation of p53 gene, the shift in the Bax/Bcl-2 ratio of dogs diagnosed with tumor was in favor of the pro-apoptotic Bax gene. The apoptotic mechanism was determined to occur through both the caspase-dependent and caspase-independent pathways. While the lesions occupied the entire oral cavity in some cases, histopathologically, malignant transformation was not detected in any of the six cases.

The role of private healthcare sector actors in health service delivery and financing policy processes in low-and middle-income countries: a scoping review.

The expansion of the private healthcare sector in some low-income and middle-income countries (LMICs) has raised key questions and debates regarding the governance of this sector, and the role of actors representing the sector in policy processes. Research on the role played by this sector, understood here as private hospitals, pharmacies and insurance companies, remains underdeveloped in the literature. In this paper, we present the results of a scoping review focused on synthesising scholarship on the role of private healthcare sector actors in health policy processes pertaining to health service delivery and financing in LMICs. We explore the role of organisations or groups-for example, individual companies, corporations or interest groups-representing healthcare sector actors, and use a conceptual framework of institutions, ideas, interests and networks to guide our analysis. The screening process resulted in 15 papers identified for data extraction. We found that the literature in this domain is highly interdisciplinary but nascent, with largely descriptive work and undertheorisation of policy process dynamics. Many studies described institutional mechanisms enabling private sector participation in decision-making in generic terms. Some studies reported competing institutional frameworks for particular policy areas (eg, commerce compared with health in the context of medical tourism). Private healthcare actors showed considerable heterogeneity in their organisation. Papers also referred to a range of strategies used by these actors. Finally, policy outcomes described in the cases were highly context specific and dependent on the interaction between institutions, interests, ideas and networks. Overall, our analysis suggests that the role of private healthcare actors in health policy processes in LMICs, particularly emerging industries such as hospitals, holds key insights that will be crucial to understanding and managing their role in expanding health service access.

Cytokine profile in lambs naturally infected with sheeppox virus.

In this study, in order to reveal the immune response against the disease in naturally infected sheep with SPPV, the expressions of various pro- or anti-inflammatory cytokines such as tumour necrosis factor alpha (TNF-α), interferon gamma (IFN-γ), interleukin-1beta (IL-1ß), interleukin-2 (IL-2), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10) and interleukin-12 (IL-12) were evaluated immunohistochemically. The material of this study consisted of tissue samples taken from 24 sheep, which were brought as dead for routine histopathological examination to the Department of Pathology. Avidin-biotin-peroxidase method was used for immunohistochemistry. Characteristic pox lesions were observed in the skin, lungs and kidneys. In histopathological examinations, pox cells, which are very characteristic for the diagnosis of the disease, were observed in all three tissues. Capripoxvirus nucleic acid was detected in 8 of the 24 tissues. Samples were sequenced, and a phylogenetic tree was constructed with reference strains from GenBank. Strains from the study clustered with sheeppox virus references. In conclusion, the levels of pro-inflammatory cytokines such as TNF-α, IFN-γ, IL-1ß, IL-2, IL-8 and IL12 (Th1) were much more dominant compared to the levels of anti-inflammatory cytokines: IL-10 and IL-6 (Th2). This supported the fact that the cellular immune response is much more effective than the humoral immune response in sheeppox.

Insurance-based disparities in breast cancer treatment pathways in a universal healthcare system: a qualitative study.

BACKGROUND: The influence of healthcare system factors on treatment pathways for breast cancer has been studied extensively in lower-middle-income countries (LMICs), but in upper-middle-income countries (UMICs), this area is understudied. This article focuses on the experiences of breast cancer patients in Türkiye, a UMIC with a universal healthcare system. It explores variations in treatment pathways based on the type of health insurance provider (private or state). METHODS: The study uses an exploratory qualitative method based on in-depth interviews with 12 breast cancer patients. The inclusion criteria were Turkish nationality, female gender, and having received treatment from a private hospital within one year of the interview. A purposeful sampling strategy was employed to recruit patients who had either social health insurance only or who had private health insurance in addition to their social health insurance. A two-stage thematic analysis of the interview data was conducted. First, we examined whether the type of insurance provider makes a difference in treatment pathways; we then identified healthcare system factors that explain these differences. RESULTS: The study revealed two distinct pathways to treatment. These differ in terms of financial protection, service coverage, and patients' sense of equity. Patients with private insurance reported easy access to timely and comprehensive treatment. Those without, however, had to navigate complicated routes to treatment; they generally had to resort to seeking treatment from more than one hospital. We found two healthcare system factors that explained the differences: a failure to fully enforce the mandates of the state's social health insurance in the private hospital sector and growing reliance on private insurance to gain access to essential services. CONCLUSIONS: Based on data from the Turkish case, we conclude that healthcare system factors are indeed influential in shaping treatment pathways for breast cancer in UMICs with universal healthcare. These factors include a failure to fully enforce the mandates of the state's social health insurance programme in the private hospital sector and a growing reliance on private insurance to gain access to essential services. We note that this contrasts dramatically with the situation in LMICs, where the main factors are low-quality care and shortages of medical staff, medicines, and technologies.

Evaluation of the relationship between inflammatory reaction and interleukins in ovine pulmonary adenocarcinomas.

In this study, it was aimed to investigate the association between inflammatory reaction of tumoral microenvironments with interleukin responses in ovine pulmonary adenocarcinomas (OPAs). Material of the study consisted of 26 sheep lung tissue samples being brought to the Pathology Department for routine diagnosis. Cases were collected between years 2009 - 2021; pre-diagnosis was based on clinical symptoms, anamnesis and gross lesion of the lungs. These tissues were designated in two groups as control (n = 6) and OPA (n = 20) groups. Choice of immunohistochemical staining was avidin-biotin peroxidase method. Reverse transcription polymerase chain reaction (RT-PCR) was used to confirm Jaagsiekte sheep retrovirus from paraffin-embedded tissues. On gross examination of OPAs, lesions seen were mostly in the caudal lobes of the lung, 1.00 - 2.00 cm in diameter as gray-white consolidated foci and in microscopic observation, tumor cells showed acinar, papillary or mixed growths. No expressions of interleukin (2 and 8) were observed in the control group. All OPAs cases were positive for interleukins (2 and 8) expressions. A total of eight tissue samples were detected as positives through RT-PCR. In conclusion, in this study, it was determined that interleukin-2 and interleukin-8 were produced from tumor microenvironment elements, especially tumor-associated macrophages, and these interleukins showed pro-inflammatory effects. Interleukins and the inflammatory reaction may promote the development of OPA.

The effects of the degree of pleural invasion on survival in patients with non-small cell lung cancer undergoing surgical resection.

Background: The aim of this study was to evaluate the degree and size of pleural invasion in non-small cell lung cancer patients and to compare its relationship with the survival time. Methods: Between January 2008 and June 2019, a total of 164 patients (143 males, 21 females; median age: 64.65 years; range 39 to 92 years) who underwent surgical resection with a diagnosis of non-small cell lung cancer and who were found to have pleural invasion histopathologically were retrospectively analyzed. The control group consisted of 105 patients (95 males, 10 females; median age: 61.7 years; range, 32 to 82 years) who underwent surgical resection but who were not found to have pleural invasion histopathologically during the same time period. Survival time was compared between the groups. Results: Median survival was 52 months in the group with pleural invasion, while it was 70.6 months in the group without pleural invasion. In the pleural invasion group, the patients who underwent sublobar resection had shorter survival. The degree of pleural invasion (p=0.028), advanced age (p=0.022), and lymph node involvement (p=0.011) were found to be poor prognostic factors for survival. Conclusion: In non-small cell lung cancer patients, the increase in the degree and size of pleural invasion is negatively correlated with the survival time and this is thought to be associated with advanced disease stage.

Phylogenetic analysis of West Nile virus: first report of lineage 1 in donkey in Turkey.

West Nile virus (WNV), a member of the Flaviviridae, is a major arbovirus that causes West Nile fever. Previous data showed the prevalence of the WNV serologically and molecular in Turkey, and the presence of lineage 1 in horses and humans has been reported. This is the first notification of partial phylogeny of WNV detected in donkeys in the northeast of Turkey (on the Iranian border). Blood serum samples collected from 25 donkeys without clinical symptoms were tested by RT-PCR. Sequence analysis of the sample detected as positive was performed. Multiple sequence alignments of reference sequences taken from GenBank were performed using the ClustalW method using the MEGA6 program. Partial nucleotide sequences of the capsid gene coding region revealed that the strains are closely related to viruses of lineage 1, clade 1a. According to the phylogenetic tree, the TUR/Igdir/donkey strain was included in the same cluster as the strain (KJ958922) previously obtained from horses in Turkey and the strain (GQ851658) from the Central African Republic. This study is the first report to show the circulation of WNV lineage 1 in donkeys in Turkey.

Rethinking Universal Health Coverage: A qualitative study of patient organisation perspectives on the Turkish health-care system.

Universal health coverage (UHC) has been elevated to the status of a global policy target, but this was at the expense of losing its aspirational meaning. As a case in point, Turkey has been one of the countries that has achieved UHC, according to the technocratic definition. This article employs a combination of deductive and inductive thematic analysis methods to explore patient organisation (PO) perspectives on the Turkish health-care system based on 26 respondent interviews from 19 POs in Istanbul. Highlighting the inadequacy of the technocratic definition of UHC, the article maintains that an analysis of PO perspectives opens the way for a nuanced and bottom-up assessment of essential service coverage and financial protection by identifying elusive gaps in both dimensions that would otherwise be lost in generalist evaluations. The findings also underline the importance of keeping intact the UHC's aspirational element to enable POs to participate in the politics of priority setting in health care.

A contextual policy analysis of a cash programme in a humanitarian setting: the case of the Emergency Social Safety Net in Turkey.

The Emergency Social Safety Net (ESSN) programme, which was launched in 2016, has become the central element of the humanitarian response to the plight of Syrian refugees in Turkey and an instrument of European migration control policies. This paper offers a contextual analysis of this European Union-funded cash assistance scheme by examining the modes of interaction between its major assumptions and the broader humanitarian response in the context of Turkey. It finds that the ESSN comes with compromises on humanitarian principles and standards, amplifies the protection and assistance divide, and fails to address the realities of Turkey with respect to the country's housing and labour markets and weak protection framework. The paper concludes that a more inclusive approach to eligibility and higher transfer payments can contribute to the addressing of assistance needs provided that cash support is combined with robust protection programming and the implementation of sector-specific projects and policies.

Effects of several production methods on technological, textural and sensorial properties of emmer (Triticum turgidum ssp. dicoccum) bulgur.

In recent years, the interest in primitive wheat species including emmer (Triticum turgidum ssp. dicoccum) wheat and their characteristics have increased due to natural food trends. Bulgur is a nutritious and healthy product with long shelf life, produced from hard wheat species without the need for any additives. The basis of this study was to reveal the potential for bulgur production by the six production methods, combinations of three cooking (traditional, autoclave, microwave) and two drying (hot-air, microwave) methods of emmer wheat. In addition to some physical, chemical and technological properties of emmer wheat, yield, color, cooking time and textural and sensorial properties of the bulgur samples were investigated and statistically significant differences (p < 0.05) were recorded among the bulgur samples. Autoclave cooking had a negative effect on color and got the lowest sensorial acceptability scores. Microwave drying increased fine bulgur formation and shortened the cooking time. The volume and weight increase indexes were increased more than hot-air drying thanks to physical effects of microwave drying on the structure. According to the texture analysis results, microwave cooking increased the adhesivity, and microwave drying increased hardness and springiness. In conclusion, emmer wheat have great potential for bulgur production, and traditional cooked + hot air dried samples had better bulgur properties in overall.

Temporomandibular Joint Dysfunction and Impaired Stomatognathic Alignment: A Problem Beyond Swallowing in Patients With Stroke.

The aim of this study is to evaluate the efficacy of supervised structured exercise programme in post stroke patients with temporomandibular joint dysfunction (TMJD). 30 post stroke patients diagnosed as TMJD according to "diagnostic criteria for temporomandibular disorders" (DC/TMD) were included for the study. A structured exercise programme including active and active-assisted range of motion (ROM) exercises for neck and temporomandibular joint (TMJ), chins tuck exercises, breathing and relaxing exercises and posture exercises were performed. Cervical ROMs including flexion, extansion, lateral flexion and rotation, Mann assessment of swallowing ability (MASA) and mini mental state exam (MMSE) scores, maximal mouth opening (MMO) and craniomandibular index (CMI) of the patients compared at baseline, 1st and 6th month after supervised rehabilitation procedure. All parameters were significantly improved both in 1st and 6th month evaluation. At 6th month evaluation, the cervical ROMs of the patients improved from severe to mild restriction (p = 0.001), the mean MASA score of the patients improved from moderate to mild swallowing disorder (p = 0.001), mean MMSE score of 30 patients was accepted as normal (p = 0.001), mean MMO of the patients was 56.00 ± 4.84 mm and mean CMI was 0.16 ± 0.05 indicating that the patients had a "mild" limitation in mouth opening and "mild" dysfunction in TMJ (p = 0.001 respectively). Our structured supervised exercise programme improves swallowing quality by establishing proper stomatognathic alignment and TMJ function.

Ultrasonographic Measurement of Talar Cartilage Thickness in Patients With Cerebral Palsy.

OBJECTIVE: Foot deformities are one of the most common musculoskeletal problems in children with cerebral palsy (CP). These deformities affect the walking ability and function of the patients. Talar cartilage is the hyaline joint cartilage of the tibiotalar joint that plantarflexes and dorsiflexes of the ankle. The aim of this study was to determine whether talar cartilage thickness was affected in children with ambulant diplegic CP. DESIGN: Forty patients with diplegic CP (19 boys, 21 girls) and 40 age-, sex-, and weight-matched healthy control subjects (20 boys, 20 girls) were included in the study. The demographic and clinical characteristics of the patients, including age, sex, and body mass index, were recorded. Patients were classified using the Gross Motor Function Classification System. A 12-MHz linear probe was used for ultrasonographic cartilage measurements at the tibiotalar joint according to European Musculoskeletal Ultrasound Study Group (EURO-MUSCULUS) and the Ultrasound Study Group in Physical and Rehabilitation Medicine (USPRM) scanning protocols. RESULTS: Mean talar cartilage thickness was significantly decreased in the CP group compared with the healthy control group (P < 0.001). There was a significant negative correlation between Gross Motor Function Classification System levels and talar cartilage thickness measurements (P < 0.001, Tb = -0.695). CONCLUSION: This study demonstrates that patients with CP have a thinner talar cartilage compared with healthy control subjects.

Acupuncture plus night splint for quality of life and disability in patients with carpal tunnel syndrome: a randomized controlled trial.

BACKGROUND: Carpal tunnel syndrome (CTS) is a common condition caused by pressure on a nerve in the wrist. This study aimed to evaluate the effects of acupuncture plus night splinting on quality of life, function and pain in patients with CTS. METHODS: This research is a prospective randomized, single-center trial. Acupuncture and night splinting was applied two times a week for five weeks, while the control group received night splinting only. Outcomes measured were Quality of life (Nottingham Health Profile, NHP), function (Boston Carpal Tunnel Questionnaire) and pain (visual analogue scale, VAS). RESULTS: At the end of the treatment, the acupuncture plus splinting group showed morereduction in the pain level than the splinting group (p = 0.007). The change in the pain subscale of the NHP was significantly reduced in the acupuncture plus night splinting group than the night splinting group (p = 0.001). The change in sleep and physical activity subscale of the NHP score failed to show the significant differences between the two groups. The functional scores also failed to show the signficant differences between the two groups. CONCLUSION: The effect of acupuncture plus night splinting may show significant reduction on pain but failed to show significant differences compared with night splinting in patients with CTS. Further studies with larger sample size may confirm the findings.

What Happens to Swallowing Muscles after Stroke?: A Prospective Randomized Controlled Electrophysiological Study.

BACKGROUND: Stroke is the most frequent reason of neurological dysphagia Electrophysiological studies can be used to evaluate oral, pharyngeal and initial phase of esophageal phase. AIMS: This study aims to noninvasively evaluate mastication, mimic, and tongue muscles of stroke patients, which play an important role in the oral phase of swallowing process and compare them with healthy individuals. SETTING AND DESIGN: This study was conducted at the Physical Medicine and Rehabilitation Clinic of our hospital between January 2014 and December 2016. MATERIALS AND METHODS: Fifty-one patients who were admitted to our clinic with stroke and 51 healthy individuals were evaluated for the study. Demographic features of individuals were recorded. The swallowing intervals and motor action potentials (MAPs) of trigeminal, facial and hypoglossal nerves were measured. After four weeks of treatment schedule, patients were re-evaluated. STATISTICAL ANALYSIS: The Wilcoxon Signed Rank test, the Mann-Whitney U test and Fisher exact test were used in this study. RESULTS: The all swallowing intervals were found prolonged compared to the healthy controls (P < 0.05). The MAPs of the masseter, orbicularis oculi, and intrinsic tongue muscles were significantly lower in patient group (P < 0.05). After treatment, we found significant improvement for all parameters in patient group, but the swallowing intervals were still significantly prolonged, and MAPs of these muscles were still lower (P < 0.05). CONCLUSION: Although swallowing is examined as different phases, the process is complicated and should be evaluated totally. In post-stroke dysphagia, oral phase of swallowing process is as important as phayngeal phase and perioral, mastication, and tongue muscles are influenced even in an early period as a month.

Migraine in patients with fibromyalgia and outcomes of greater occipital nerve blockage.

OBJECTIVES: The aim of this study is to evaluate the efficacy of greater occipital nerve (GON) blockage in patients with migraine and fibromyalgia (FM) comorbidity. PATIENTS AND METHOD: 20 patients who were diagnosed as FM according to 2010 American College of Rheumatology (ACR) diagnostic criteria and migraine according to International Classification of Headache Disorers II criteria and did not recieve any medication or GON block for both disorders were included for the study. GON blocks were repeated every week in the first month and repeated montly for the following 2 months. The frequency and duration of the migraine attacks, pain severity with visual analogue scale (VAS), quality of life (QoL) with revised fibromyalgia impact questionnaire (FIQR) and migraine disability assesment questionnaire (MIDAS) before,1 st month and 3rd months after treatment were recorded and compared. RESULTS: 95% of 20 patients were female (n = 19) and 5% was male (n = 1). The affected site was left in 60% of the patients (n = 12) and 40% was right (n = 8). There was significant improvement in terms of all evaluation parameters both at 1 st month and 3rd months after treatment compared to the baseline. Likely, all parameters were significantly improved at 3rd month compared to the 1 st month. CONCLUSIONS: GON blockage reduces pain severity, headache frequency and duration and increases QoL in patients with migraine and FM comorbidity.

Application of multi pass high pressure homogenization to improve stability, physical and bioactive properties of rosehip (Rosa canina L.) nectar.

The effect of high pressure homogenization (HPH) on physical and bioactive properties of rosehip nectar was investigated. Rosehip nectar has a sedimentation problem while waiting on the market shelf during the sale, for solving this problem, nectars were passed 1, 2 and 3 times through 75, 100 and 125 MPa pressures. Mean particle size decreased as pressure and pass number increased (p < 0.05), whereas zeta potential did not change (p > 0.05). Microstructural images revealed that HPH treatment disrupted the cells and caused to release of cell materials to serum. HPH treatment increased the ΔE values (from 2.48 to 6.03). HPH treated samples showed no sedimentation during storage for 15 days. All samples showed shear thinning behavior and were characterized as weak gel network (G' > G″). Total phenolic content and ascorbic acid results were decreased by HPH treatments due to increasing outlet temperatures of product, however, antioxidant capacity of nectars increased after treatment due to increasing total carotenoid content. This study indicated that HPH treatment could solve the sedimentation problem during shelf life with minimally affecting bioactive and physical properties of rosehip nectar.

Effect of Primary Hypertension on Treatment Outcomes of Patients with Postmenopausal Osteoporosis: A 5 Year Follow Up Retrospective Study.

AIM: To investigate the efficacy of primary hypertension (HTN) on the treatment prognosis of patients with postmenopausal osteoporosis (PMOP). METHODS: 45 patients who were diagnosed as PMOP with lumbar and/or femur neck bone mineral density screening (BMD) but have no history of PMOP treatment including calcium and vitamin D, have comorbid primary HTN and treated with a vasodilator antihypertensive drug at least a year were included to the study. Control group was constituted with 44 patients with PMOP at same age but have no comorbidity. Demographic features including age, height, weight, occupation, educational level menarche and menopause age, clothing style, daily intake of calcium, smoking and/or alcohol consumption, daily physical activity level, personal history of fragility fracture or in mother and duration of primary HTN diagnosis were recorded. Biochemical parameters were also recorded. Patients were treated with bisphosphonate, calcium and vitamin D and same parameters were evaluated at the end of first and fifth year. RESULTS: Demographic and disease characteristics were not different between groups before treatment (p > 0.05). In group analysis, there was significant improvement in lumbar and femur neck T scores of PMOP + HT and PMOP groups after 1 and 5 years of treatment compared to baseline (p < 0.05) Lumbar and femur neck T score variations between the baseline, first and fifth years of treatment were not significantly different in PMOP + HT and PMOP groups (p < 0.05). CONCLUSIONS: Although the results vary between populations, primary HTN does not have an impact on the prognosis of PMOP treatment in Turkish population.

The psychometric evaluation of the Turkish version of the Mann Assessment of Swallowing Ability in patients in the early period after stroke

Background/aim: The Mann Assessment of Swallowing Ability (MASA) is an efficient tool that allows physicians to determine the alertness, cooperation, and respiration of patients, which are important factors when assessing swallowing . This study aimed to translate the MASA into Turkish (T-MASA) and to assess its reliability and validity in patients during the early period after a stroke . Materials and methods: The scale was administered to 141 patients in the early period after a stroke. For reliability, both internal consistency (Cronbach's alpha and corrected item-to-total correlations) and interrater reliability were analyzed. The procedures were scored by two blinded independent expert observers. The validity was assessed using the convergent validity. The cut-off value of the T-MASA for dysphagia was accepted as 169 points. The correlation between the MASA and endoscopic evaluation was evaluated. Results: The T-MASA showed good internal consistency using Cronbach's alpha (0.899­0.901) and corrected item-to-total correlations. In addition, the intraclass correlation coefficient scores indicated excellent agreement. A significant moderate negative correlation was found between endoscopic evaluation and the T-MASA in terms of the presence of dysphagia (r: ­0.324, r: ­0.302, respectively, and both P = 0.001) Conclusion: Our results suggest that the Turkish version of the MASA is a valid and reliable instrument when determining dysphagia in patients in the early period after a stroke.

Turkish Standardization of Movement Disorders Society Unified Parkinson's Disease Rating Scale and Unified Dyskinesia Rating Scale.

BACKGROUND: Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and Unified Dyskinesia Rating Scale (UDysRS) were developed as standard tools to rate Parkinson's disease (PD) and drug-induced dyskinesias of PD. As these scales have become widely used, there is a need for translation to non-English languages. Here we present the standardization for the Turkish translations. METHODS: The scales were translated into Turkish and then back-translated to English. These back-translations were reviewed by the MDS team. After cognitive pretesting, movement disorder specialists from nine centers tested 352 patients for MDS-UPDRS, and 250 patients for UDysRS. Confirmatory factor analyses (CFAs) were used to determine if the factor structures for the reference standards could be confirmed in the Turkish data. The comparative fit indexes (CFIs) for the scales were required to be 0.90 or higher. Exploratory factor analyses (EFAs) were conducted to explore the underlying factor structure without the constraint of a pre-specified factor structure. RESULTS: For both scales, the CFIs were 0.94 or greater as compared to the reference standard factor structures. The factor structures were consistent with that of reference standards, although there were some differences in some areas as compared to the EFA of the reference standard dataset. This may be due to the inclusion of patients with different stages of PD and different cultural properties of raters and patients. CONCLUSIONS: These results demonstrate that the Turkish translations of MDS-UPDRS and UDysRS have adequate clinimetric properties. They are established as the official translations and can be reliably used in Turkish speaking populations.