Pamukkale Üniversitesi Hastaneleri

OBJECTIVE: To determine causes of death, estrogen toxicity, and hyperprolactinemia in a murine model of systemic lupus erythematosus (SLE). METHODS: Female New Zealand Black x New Zealand White (NZB x NZW) mice were implanted with ethinyl estradiol, 17 beta-estradiol, or empty capsules (controls). RESULTS: Estrogen-treated mice developed striking hyperprolactinemia and died prematurely with genitourinary complications. CONCLUSION: Implanted estrogens, including 17 beta-estradiol in a dose reported previously to stimulate SLE, contribute to premature death in NZB x NZW mice, through toxic effects. Estrogen therapy increases the level of prolactin, an immunostimulatory hormone.

The aim of this study was to evaluate the effect of different surface finishing processes on the color stabilities of lithium disilicate glass-ceramics, zirconia-reinforced lithium silicate ceramics, and resin nanoceramics after artificial ageing. MATERIALS AND METHODS. 216 samples were prepared from 3 different CAD/CAM materials (LAVA Ultimate, IPS e.max CAD, VITA Suprinity) with A1 HT color at a size of 14 12 mm and a thickness of 0.5 0.05 mm. Color measurements of the samples were performed with a spectrophotometer using color parameters and CIE Lab color system on a gray backing between baseline color and after 5000 cycles of artificial ageing in 4 stages (i.e. the first measurement before the treatment, the second measurement after polishing, the third measurement after cement application, and the fourth measurement after artificial ageing). The results were evaluated using the Variance analysis and Fisher's LSD test. RESULTS. Resin nanoceramics (LU) exhibited higher color change values than zirconia-reinforced lithium silicate (VS) and lithium disilicate (EC) ceramics after artificial ageing. Manual polishing and glazing resulted in similar color change for LU and VS (P>.05). In the EC group, glazing provided statistically different results as compared to the manual polishing and control groups (P<.05). Among the ceramic groups, color change values of the subgroup, which was treated by glazing, of the zirconia-reinforced lithium silicate (VS) and lithium disilicate (EC) samples were below the clinically acceptable level (E < 3.5). CONCLUSION. The lowest color change for all stages was observed in Vita Suprinity.

PURPOSE: The purpose of this study was to determine the point prevalence (PP) of general pressure injuries (PIs), hospital-acquired PIs, PI-related risk factors, and PI preventive interventions performed by nurses. DESIGN: Descriptive, multicenter, prospective, analytical study. SUBJECTS AND SETTING: The sample comprised 5088 patients cared for in 13 hospitals in 12 geographic regions of Turkey. Data were collected between November 5, 2018, and July 17, 2019. METHODS: The study was carried out in 2 stages. First, nurses who collected data were trained in the diagnosis of PI, risk assessment, staging, and prevalence studies, and informed about the purpose and methods of the study, including data collection. Second, nurses and researchers who had received training related to data collection for this study conducted a PP study for PIs in their inpatient clinics using the ASSIST II method. The PI Prevalence Study Tool and the Braden Scale for Predicting Pressure Sore Risk were also used during data collection. RESULTS: The PP of general PIs was 9.5%; the prevalence of PIs with hospitalization in intensive care units was 43.2%; medical device-related pressure injuries prevalence was 10.7%. We found that 65.1% of the PIs were acquired after hospital admission. CONCLUSIONS: Similarities exist between PI prevalence in Turkey and reported PI prevalence rates worldwide. However, the prevalence of nosocomial PIs related to intensive care units and the prevalence of all nosocomial injuries were higher than rates previously reported. Based on results, there is a need to develop strategies to reduce the prevalence of nosocomial PIs.

PURPOSE: The purpose of this study was to explore the opinions of nurses regarding their knowledge of and perceived responsibility for providing ostomy care. SUBJECTS AND SETTING: The target population of this descriptive study was staff nurses working in an acute care hospital in Ankara, Turkey. METHODS: Data were collected by a questionnaire that included 2 sections. The first section queried descriptive information about the nurses, the perceived responsibility for providing ostomy care for patients. The second section included 54 items that focused on knowledge about stoma care. RESULTS: Evaluating the answers of the nurses to all statements in general (54 propositions), the median value of the "I do not know/false" answers (27.50) was observed to be close to the median value of the "true" answers (26.5). These results indicated that the staff nurses' knowledge of ostomy care was not at the desired level. Responses from section 2 indicated that nonspecialty practice staff did not consider stoma care as their responsibility. Factors that influenced knowledge of ostomy care were number of years working as a nurse, level of education, level of reviewing professional literature on ostomy care, and participation in scientific meetings on the subject. CONCLUSIONS: Study findings reveal that knowledge level of nonspecialty nurses about intestinal stoma care is inadequate, and most staff nurses did not consider themselves responsible for stoma care.

OBJECTIVES: To investigate the effects of valproic acid on vestibular symptoms and electronystagmography (ENG) findings in patients with migraine-related vestibulopathy. METHODS: Thirty-seven patients with migraine (13 with vertigo, 13 with dizziness, and 11 without vestibular symptoms) were included in the study. Slow-released valproic acid (500 mg/d) was given for 3 months. Frequency of headache and vestibular symptoms in the first, second, and third months of the therapy were recorded and compared with the pretreatment values. The ENG findings were also evaluated before and 2 months after the therapy. RESULTS: We determined that prophylactic low-dose valproic acid decreased the frequency of headache and vestibular symptoms, although it does not cause any statistically meaningful change in ENG findings. CONCLUSIONS: Valproate can be used satisfactorily for patients with migraine who have vestibular complaints. Ineffectiveness of valproic acid on ENG findings can be clarified by the permanent effect of migraine on the vestibular system.

Ten cases of primary upper small-intestinal lymphoma associated with alpha-chain protein in serum were discovered in a prospective study of the sera of patients with immunoproliferative small-intestinal disease (IPSID). Patients were mostly young males presenting with abdominal pain, weight loss, and diarrhea and showing laboratory evidence of carbohydrate, fat, and vitamin B12 malabsorption and hypoalbuminemia. The more frequently encountered pathologic abnormality was a diffusely nodular jejunal mucosa produced by a plasmacytic infiltrate of variable cell maturity involving a varible depth of small bowel wall with or without involvement of the mesenteric or para-aortic-lymph node complex and, in one instance, the liver. A less frequent picture included circumferential ulcerative and constrictive transmural tumors of the upper small intestine produced by a malignant lymphoma with involvement of abdominal lymph nodes. Small-intestinal surface epithelial abnormalities, a dense mantle of mature plasma cells overlying the lymphoma, a pronounced follicular lymphoid hyperplasia adjacent to and at distances from the lymphoma were other features of note in our IPSID cases associated with alpha-chain protein.

O presente trabalho objetivou, através do método de Valoração Contingente (VC) ou Disposição a Pagar (DAP), quantificar monetariamente os benefícios indiretos advindos do "Bosque Alemão", na cidade de Curitiba-PR, bem como caracterizar o perfil socioeconômico do usuário e discutir os atrativos do local. A pesquisa, realizada entre dezembro/97 e fevereiro/98, também teve como objetivo realizar um estudo piloto para refinar e avaliar o método proposto para uso posterior no levantamento dos benefícios gerados nos demais parques e bosques da cidade. Os resultados mostram que 62,1% dos entrevistados estão dispostos a pagar um valor de entrada para a manutenção das áreas verdes em Curitiba. Considerando o total de entrevistados (dispostos e não dispostos a pagar) esta média foi de R$1,21, sendo o valor anual agregado dos benefícios gerados pelo Bosque Alemão de R$ 29.040,00. O perfil do usuário foi composto por classe média (renda familiar média de aproximadamente R$ 2.600,00), com um alto grau de importância atribuído aos parques e áreas verdes urbanas, elevado grau de instrução (43,2% com nível superior) e grande fluxo de turistas (33,7%). Os parques urbanos foram apontados como a principal fonte de recreação nos finais de semana (43,2%) devido, principalmente, à necessidade de contato com a vegetação, e considerado como um investimento importante por 100,0% dos entrevistados. O método (VC) mostrou-se eficiente para a determinação do valor monetário dos benefícios ambientais em áreas urbanas, embora subestime o valor total. Para a melhor captação deste valor sugere-se que sejam efetuadas adaptações metodológicas pertinentes. Contingent Valuation In The Economic Appraisal Of Urban Green Areas Abstract This paper had as objective to quantify indirect benefits from the urban park called "Bosque Alemão”, in the city of Curitiba-PR, Brazil, using the method of Contingent Valuation (CV) or Willingness to Pay, and also to obtain socioeconomic data from the users as well. This research was carried out between December/97 and February/98, and had the initial objective to perform a preliminary study in order to refine a methodology for future application in measuring benefits generated in other parks of the city. The results show that 62,1% of the interviewed users are willing to pay an admission value destined for the maintenance of green areas in Curitiba. Considering total interviews (willing and not willing to pay), the average admittance value was of R$1,21, with an annual value of generated benefits of R$ 29,040.00. The users profile was mostly made of middle class individuals (average familiar income of approximately R$ 2.600,00), who attributed a high degree of importance to parks and urban green areas, and who had a higher degree of education (43,2% with an undergraduate degree) and also a relatively good flow of tourists (33.7%). The urban parks had been pointed as the main source of recreation in weekends (43.2%) demanded mostly for contact with vegetation, and considered as an important investment for 100.0% of the interviewed users. The methodology (CV) was considered efficient in obtaining monetary values of environmental benefits in urban areas, although it may underestimate them. In order to obtain a better estimation of those values it was suggested that adaptations in the methodology should be made when pertinent.

This article discusses processes in the state related to regulation, organization and control, which essentially form the subject of administrative control. The purpose of the exposition is to define the sources which cause deviations and create problems for the subjects authorized by the state to exert control, based on an analysis of the interaction of the factors: authority, competence and success. As the executive, the local self-government, the prosecutor's office and the justice system stand out among them, the tasks related to the pledged have a specific character. Each source which is identified and reviewed acquires features of the state, interpreted as sovereign and simultaneously subject to a specific area, in properly initiated state control systems. The idea of the exposition is to present the author's point of view, revealing certain characteristics of the subjects in question, so that the system of general and administrative control in particular can seek solutions for the elimination of the identified weaknesses in the functioning of the particular systems and more generally in its work by extending the scope of powers delegated or exercised by it.

BACKGROUND: Myeloid differentiation primary response 88 (MYD88) is a common adaptor protein that is responsible for signaling from several receptors; mutations in this gene may play a role in the pathogenesis of lymphoma. AIM: We aimed to determine the MYD88 L265P mutation frequency, the level of MYD88 expression, and their associations with clinicopathological parameters in mature B-cell non-Hodgkin lymphomas (NHLs). METHODS: A total of 68 patients were included in the study. The presence of the MYD88 L265P mutation was analyzed by real-time polymerase chain reaction and direct sequencing. MYD88 protein expression was evaluated by immunohistochemistry (IHC) using two different scoring systems. RESULTS: MYD88 L265P mutation was present in eight (18.6%) diffuse large B-cell lymphoma (DLBCL) patients. We also observed a significant association between the loss of MYD88 expression and advanced stage in both mature B-cell NHL and DLBCL according to the first IHC scoring systems (p=0.015 and p=0.024, respectively). An association was also seen between MYD88 overexpression and low clinical risk in both mature B-cell NHL and DLBCL according to the second IHC scoring system (p=0.027 and p=0.024, respectively). CONCLUSIONS: The L265P mutation may be helpful for understanding the pathogenesis of immune-privileged site-associated DLBCLs. The presence of the mutation, together with its protein overexpression, could also be used as a prognostic marker in advanced stage DLBCLs.

The article examines the relationship between the socio-economic categories "strategy" and "small business", which are the key factors for the success of the economic system in Bulgaria. The aim of the project is to reveal and prove the prospects for improvement of the small business through the rational application of strategies. The purposeful decomposition of the goal is related to tasks revealing the evolution of the "strategy" category and finding opportunities to interact with the processes that drive small businesses. The accumulation of evidence is based on a principle basis, while the registered trends based on analyses are synthesized. On this basis, the expose is committed to substantiating the main thesis of development, which states that the application of strategies and strategic thinking in the development of the small business phenomenon is an important factor for its stable development and appropriate improvement.

OBJECTIVE: To examine the effects of computer usage on the musculoskeletal system discomforts (MSD) of Turkish university students, the possible risk factors and study implications (SI). METHODS: The study comprised a total of 871 students. Demographic information was recorded and the Student Specific Cornell Musculoskeletal Discomfort Questionnaire (SsCMDQ) was used to evaluate musculoskeletal system discomforts. RESULTS: The neck, lower back and upper back areas were determined to be the most affected areas and percentages for SI were 21.6%, 19.3% and 16.3% respectively. Significant differences were found to be daily computer usage time for the lower back, total usage time for the neck, being female and below the age of 21 years (p<0.05) had an increased risk. CONCLUSIONS: The neck, lower back and upper back areas were found to be the most affected areas due to computer usage in university students. Risk factors for MSD were seen to be daily and total computer usage time, female gender and age below 21 years and these were deemed to cause study interference.

OBJECTIVES: This study aims to compare the efficacy of existing training models for acquisition of arthroscopic skills and to investigate the most effective training method or combination of methods for residents. MATERIALS AND METHODS: A total of 100 fifth-year students from medical school (40 males, 60 females; mean age 23.7 years; range, 22 to 33 years) volunteered to participate in the study and were randomly divided into five education groups (E1-5): group E1 (trained on bench-top simulator), group E2 (read surgical technique), group E3 (read surgical technique and watched surgical video), group E4 (watched surgical video only), and group E5 (control group). After completion of the pre-training, each student was individually asked to perform an arthroscopy practice. A checklist containing the tasks to be performed was given to students and students were asked to complete the tasks on the checklist in five minutes. RESULTS: In group E1, the mean rate of successful achievement of tasks was significantly higher than other groups in both knee and shoulder arthroscopy models. Rate of each task was statistically similar for groups E2, E3, E4 and E5. In group E1, mean durations for completion of tasks in both arthroscopy models were significantly shorter than other groups. There was no statistically significant difference in terms of gender between those who successfully completed the tasks in both arthroscopy models. CONCLUSION: A basic arthroscopic bench-top simulator may be a low-cost and effective training method to increase arthroscopic skill levels in resident training compared to traditional methods.

GİRİŞ ve AMAÇ: Bu çalışma, tip I diabetes mellituslu (T1DM) çocukların,hastalığa uyumunda eğitimin ve sosyal desteğin etkisi değerlendirmek amacıylayapılmıştır. YÖNTEM ve GEREÇLER: Bir üniversite hastanesinin Çocuk EndokrinolojiPolikliniği’nde T1DM tanısı ile izlenen 8-13 yaş grubu 23 hasta alınmıştır.Veriler, Tanıtıcı Bilgi Formu, Çocuklar için Sosyal Desteği DeğerlendirmeÖlçeği (Ç-SDDÖ), DM Bilgi formu ile toplanmıştır. Veriler, bilgisayar ortamındatanımlayıcı istatistikler sayı-yüzde ve tekrarlı ölçümlerde Wilcoxoneşleştirilmiş iki ölçek testi kullanılarak değerlendirilmiştir.BULGULAR: Hastaların eğitim ve sosyal destek girişimleri sonrası toplam sosyaldestek puan ortalamalarında artış olduğu görülmektedir (p&amp;amp;lt;0.05). Ayrıcaeğitim faaliyetlerinden sonra tip 1 diabetli hastaların, diabet bilgisi puandüzeylerinin arttığı belirlenmiştir (p&amp;amp;lt;0.05). TARTIŞMA ve SONUÇ: Hemşirelerin ve ekip üyelerinin, T1DM’lu hastalara, sosyaldestek programları, eğitim faaliyetleri yürütmesi, akran destek çalışmalarındateknolojinin kullanılması önerilmiştir.Türkçe Kısa Başlık: diyabetli çocukların hastalığa uyumu

This work is an attempt for a brief analysis of the new "Strategy for the development of higher education in the Republic of Bulgaria for 2021 -2030" and is searching for an answer to the new challenges facing the education system. Searching and finding the right solutions in this direction does not only require specific skills and competencies, but also sufficient experience, information and knowledge in this direction. This challenge cannot and should not be the action of just one person, but of a group of scientists, researchers and politicians with a sufficiently high level of expertise that would contribute to the development of an objective and accurate action plan.

Kentlerin gelişimine yön veren planlama çalışmalarında olası tehlikelerin yeterince dikkate alınmıyor olması afet duyarlı mekansal gelişme ihtiyacını daha kritik bir hale getirmektedir

The content of the material reveals that the main purpose is to establish the place and role of control principles in creating modern patterns of model managerial thinking such as the Balanced Scorecard. It is for this reason that the process of creating a balanced scorecard and revealing specific control principles in its gradual development is the subject of analysis. Tracking the chronology in the process has made it possible to ascertain in more general terms why the Balanced Scorecard model is gaining more popularity and, more specifically, to see how increasing the perimeter of modular impact predetermines the transformation of the scorecard into a universal methodology for precise and effective, management control.

Amaç: Çalışma, yaşlı bireylerin ilaç uyumsuzluğu ile ilişkili ilaç kullanım davranışları ve bu davranışların sağlık okuryazarlığı düzeyi ile ilişkisini belirlemek amacıyla yapılmıştır. Gereç ve Yöntem: Çalışma tanımlayıcı-kesitsel tiptedir. Araştırmanın evrenini, Denizli’de bulunan iki Aile Sağlığı Merkezi’ne kesin kayıtlı olan 65 yaş ve üstü toplam 1654 kişi oluşturmuştur. Örneklem büyüklüğü, evrenin bilindiği durumlarda kullanılan formülle 282 kişi olarak hesaplanmış, 280 kişi örnekleme dahil edilmiştir. Araştırma verileri, Eylül 2016-Nisan 2017 tarihleri arasında herhangi bir nedenle aile sağlığı merkezine başvuran yaşlı bireylerden toplanmıştır. Veriler, yaşlıların Sosyo-Demografik Özellikleri ve Sağlık Durumu Tanılama Formu, Yaşlıların İlaç Kullanımına Yönelik Bilgi ve Davranışlarını Belirleme Formu ve Yetişkin Sağlık Okuryazarlığı Ölçeği kullanılarak toplanmıştır. İstatistiksel analiz için sayı, yüzde ve lojistik regresyon analizi kullanılmıştır. Bulgular: Yaşlı bireylerin en sık rastlanan ilaç uyumsuzluğu ile ilişkili ilaç kullanım davranışının ilaçlarını almayı unutma (%46.4) olduğu belirlenmiştir. Sağlık okuryazarlığı ölçeği puan ortalaması 11,75±3,97 olarak saptanmış ve orta düzeye yakın olarak değerlendirilmiştir. Yapılan lojistik regresyon analizi sonucunda düşük sağlık okuryazarlık düzeyi; ilaçları almayı unutma ve iyi hissettiğinde doktora sormadan ilacı bırakma davranışları için risk faktörü olarak belirlenmiştir. Sonuç: Düşük sağlık okuryazarlık düzeyi; ilaçları almayı unutma ve iyi hissettiğinde doktora sormadan ilacı bırakma davranışları için risk faktörü olarak belirlenmiştir. Bu sonuç doğrultusunda sağlık okuryazarlık düzeyi düşük yaşlı bireylerin özellikle ilaçları almayı unutma ve iyi hissettiğinde doktora sormadan ilacı bırakma davranışlarının ele alınması önerilebilir.&amp;nbsp;

BACKGROUND: Very few data are available for evaluating health-related quality of life among people with irritable bowel syndrome (IBS) and even fewer data are available in relation to anxiety and depression status among these patients. OBJECTIVES: To evaluate the quality of life, anxiety and depression status of patients with IBS. DESIGN AND SETTING: Observational cohort study conducted in a tertiary-care university hospital. METHODS: Patients who had recently been diagnosed with IBS and who had been followed up for IBS-specific treatment for at least three months were included. A quality of life (QoL) survey, the Beck Anxiety Index (BAI) and the Hamilton Depression Index (HAM-D) were applied to the patients. RESULTS: In total, 274 patients with IBS were included in the study cohort. These patients presented very high baseline scores for anxiety and depression, and very poor QoL results. CONCLUSION: Our study showed that IBS had a very high impact on these patients, regarding their anxiety and depression levels, alongside very poor results relating to quality of life.

Rapana&#x0D; venosa (damarlı rapa deniz salyangozu) Türkiye’de&#x0D; tüketilmeyen ancak Japonya’ya son yirmi beş yıldır ihraç edilen deniz ürünüdür.&#x0D; Bu çalışma, daha önce Japonya’da da tüketilmeyen deniz salyangozunun metalaşma&#x0D; sürecini ve üretim zincirini sosyolojik açıdan incelemektedir. Araştırma&#x0D; keşifseldir; veriler, döküman incelemesi, Sinop ve Samsun’da bulunan balık&#x0D; işleme fabrikalarında katılımcı olmayan gözlem ve fabrika sahipleri ve&#x0D; Tokyo’daki firma yöneticileriyle yapılan mülakatlar yoluyla toplanmıştır.&#x0D; Çalışma, küresel bağlantılar ve eşitsizliklerin son derece karmaşık hale&#x0D; geldiği yeni dünya düzeninde, deniz salyangozu ticaretinin Türkiye’deki yoksul&#x0D; üreticiyi Japonya’daki yoksul tüketiciye nasıl bağladığını irdelemektedir.&amp;nbsp;&amp;nbsp;

Veri madencilii, ham verilerden ok net olmayan, nceden bilinmeyen fakat potansiyel olarak kullanl bilginin elde edilmesidir. Bu da; kmeleme, veri zetleme, deiikliklerin incelenmesi, sapmalarn tespiti gibi belirli sayda teknik yaklamlar ierir