KORONER ARTER HASTALIĞININ BELİRLEYİCISI OLARAK PENIL DOPPLER ULTRASONOGRAFİ İLE SAPTANAN KAVERNOZ ARTER STENOZU: OLGU SUNUMU

An association between Coronary Artery Disease (CAD) and Erectile Dysfunction (ED) has been described. We aimed to show that cavernous artery stenosis may be an important predictor of a silent but serious CAD. A 56-year-old man who had moderate ED was evaluated for risk factors. He had several vascular risk factors for ED and CAD including age, smoking, hypertension, hyperhomocysteinemia and hyperlipidemia. His penile colour Doppler ultrasonography revealed multiple stenotic area in the right cavernous artery. His treadmill exercise test showed significant changes. Then, coronary angiography was performed and it showed the patient had doublevessel CAD. Findings of atherosclerotic plaques in cavernosal arteries with penile Doppler ultrasonography may be address subclinical coronary artery stenosis in patients with ED. Koroner arter hastalığı ile erektil disfonksiyon arasındaki ilişki belirgindir. Bu yazıda kavernozal arter darlığının sessiz fakat ciddi koroner arter hastalığını gösterebileceğinin ortaya konulması amaçlandı. Orta şiddette erektil disfonksiyon yakınması olan 56 yaşındaki hasta risk faktörleri açısından değerlendirildi. Hastanın yaş, sigara, hipertansiyon, hiperhomosisteinemi ve hiperlipidemi olmak üzere çok sayıda vasküler risk faktörü vardı. Penil Doppler ultrasonografide sağ kavernozal arterde çok sayıda darlık saptandı. Treadmill egzersiz testinde belirgin değişiklikleri olan hastanın yapılan koroner anjiografisinde iki damarda stenoz saptandı. Erektil disfonksiyonlu hastalarda penil Doppler ultrasonografi ile kavernozal arterlerde saptanan aterosklerotik plaklar subklinik koroner arter hastalığı habercisi olabilir

Circadian blood pressure rhythm in normotensive offspring of hypertensive parents

Background: The aim of this study was to explore the circadian blood pressure (BP) rhythm using ambulatory BP monitoring (ABPM) in normotensive children with a family history of essential hypertension. Methods: Group 1 consisted of children with hypertensive mothers and/or fathers (n = 20), Group 2 consisted of children with hypertensive grandparents (n = 20), and Group 3 consisted of children with normotensive parents (n = 20). All participating children underwent a 24-h ABPM and echocardiography. Results: Significantly higher systolic burden was found in children with hypertensive parents (p < 0.05) and grandparents (p < 0.05) compared to controls. Ambulatory BP measurements had a higher daytime systolic BP in Group 1 compared to controls (p < 0.05). While left ven­tricular (LV) posterior wall thickness was similar in Group 1 and Group 2, it was significantly higher in both of these groups compared to the controls. The LV mass index (LVMI) was signifi­cantly higher in Group 1 than in controls (p < 0.05). However, diastolic BP was significantly higher in dippers compared to non-dippers (p < 0.05). LV posterior wall thickness, interven­tricular septum thickness and LVMI were significantly higher among non-dippers compared to dippers (p < 0.05). In children with a family history of hypertension, a positive correlation between nocturnal systolic BP and LVMI was found, and increasing nocturnal BP values were associated with increasing LVMI (p < 0.01). Conclusions: In children with a family history of hypertension, target-organ damage may precede the clinical detection of hypertension, and in those with a nocturnal non-dipper status, a more marked effect on LVMI may occur

An examination upon troubled assets selling to asset management companies in participation banking in Turkey and method proposals

MUSTAFA TEVFİK KARTAL* Marmara Üniversitesi CÜNEYT HAKAN DEMİR İstanbul ÜniversitesiBu çalışma konvansiyonel bankalarda sıkça uygulanan sorunlu kredilerin varlık yönetim şirketlerine devredilmesinin Türkiye’de katılım bankaları tarafından kullanılmasına yönelik değerlendirme yapmak için hazırlanmıştır. Konu mevzuat ve fıkıh hükümleri açısından ele alınmıştır. Çalışma sonucunda katılım bankalarının sorunlu kredilerini varlık yönetim şirketlerine devretmesinde bankacılık mevzuatı ve İslami bankacılık ilkeleri açısından bir engel bulunmadığı belirlenmiştir. Sorunlu kredilerin varlık yönetim şirketlerine satılmasına yönelik belirli bir mal karşılığında veya belirli bir menfaat karşılığında alacağın satılması olmak üzere iki model önerilmiştir. Katılım bankaları önerilen yöntemlerden birini kullanarak varlık yönetim şirketlerine sorunlu kredilerini satabileceklerdir. Böylece katılım bankalarının aktif kalitesi, karlılık, büyüme, sektör payı gibi birçok göstergesinde iyileşme sağlanabilecektir. Katılım bankalarının sorunlu kredilerinin varlık yönetim şirketlerine devrine ilişkin model öneren çalışma bulunmadığından yapılan çalışma bu yönüyle öncü bir çalışma olma özelliği taşımaktadır.This paper was prepared to make a conceptual evaluation about troubled credits transferring to asset management companies, which is used by conventional banks frequently, by participation banks in Turkey. The subject dealt with from aspects of regulations and Islamic banking principles. As a result of study, it was determined that there is no obstacle to prevent participation banks from transferring troubled credits to asset management companies. Two models as selling assets in return a good or an interest are proposed related transferring troubled assets to asset management companies. Participation banks can transfer troubled credits to asset management companies by using any of the methods which were stated in the study. Hence, so many indicators of participation banks such as asset quality, profitability, growth, industry share could be enhanced

DIAGNOSIS AND TREATMENT OF DIABETIC FOOT ULCERS

Diyabetik ayak ülserleri diyabetin sık görülen ve ciddi bir kronik komplikasyonudur. Diyabetikayak ülserleri diyabetik hastalarda önemli bir morbidite ve mortalite nedenidir. Diyabetikayak ülserlerinin izlem ve tedavisi periferik arter hastalığı, nöropati, travma ve enfeksiyongibi ilişkili nedenler doğrultusunda bireyselleştirilmelidir. Cerrahi ve cerrahi dışı temel yarabakımı prensipleri bu yaraların etkin bir şekilde iyileşmesinde vazgeçilmez bir unsurdur.Ayak ülseri oluşumunun önlenmesi de tedavisi kadar önemlidir ve diyabetin bu ciddikomplikasyonuna karşı en ekonomik yaklaşımıdır. Bu yazıda diyabetik ayak ülserleri nedenlerive patofizyolojisi birlikte incelenmiş, klinik değerlendirme ve tedavi seçenekleri gözdengeçirilmiştir.Diabetic foot ulcers are common and serious chronic complications of diabetes. They are animportant cause of mortality and morbidity. The management of diabetic foot ulcers shouldbe individualized according to the causes of the ulcer such as peripheral arterial disease,neuropathy, pressure trauma, and infection. Basic principles of wound care, includingsurgical and nonsurgical components, are essential to effective healing of these wounds.Prevention of foot ulceration is also important, and the most cost-effective strategy formanaging this serious complication of diabetes. In this article, we performed a review ofdiabetic foot ulcers in terms of its causes, pathophysiology, clinical approach andmanagement

Öğretmen Adaylarının Matematiğe Karşı Tutumlarının İncelenmesi

Bu çalışmada öğretmen adaylarının matematiğe karşı tutumlarının bazı değişkenler açısından incelenmesi amaçlanmıştır. Bu amaçla, araştırmanın örneklemi Atatürk Üniversitesi, Kazım Karabekir Eğitim Fakültesi, Ortaöğretim Matematik Öğretmenliği (N=93) ve İlköğretim Matematik Öğretmenliği (N=148) bölümlerinde öğrenim gören toplam 241 öğretmen adayı olarak belirlenmiştir. Araştırmada veri toplama aracı olarak literatürden elde edilen \"Matematiğe Karşı Tutum Ölçeği\" kullanılmıştır. Elde edilen veriler istatistiksel olarak (ANOVA) analiz edilmiştir. Bulgular, öğretmen adaylarının öğrenim gördükleri bölümler açısından matematiğe karşı tutumlarında anlamlı düzeyde bir farklılık olduğunu ortaya koymaktadır. Aynı zamanda, analiz sonuçları cinsiyet ve sınıf düzeyi arasında önemli düzeyde bir etkileşimin olduğunu göstermektedir. Çalışmanın sonuçları derse karşı olan tutumun önemi açısından tartışılmıştır

Transcatheter closure of extracardiac fontan fenestration in a cyanotic patient

Fontan operation is the connection of the systemic venous return to the pulmonary arteries, performed in patients with single ventricle physiology. The Fontan circuit is commonly fenestrated because of early postoperative risks such as high systemic venous pressure and low cardiac output. As it causes progressive cyanosis and increased risk of paradoxical embolism in the follow-up period, occlusion of these fenestrations is generally suggested. Successful closure of extracardiac Fontan fenestration with atrial septal occluder in a 10-year-old girl is reported herein. To our knowledge, this is the first such report from Turkey

Asymmetrical dimethylarginine and severity of erectile dysfunction and their impact on cardiovascular events in patients with acute coronary syndrome

Introduction: Coronary artery disease (CAD) and vascular erectile dysfunction (ED) are related to endothelial dysfunction. Elevated asymmetrical dimethylarginine (ADMA) levels and ED are common in patients with increased cardiovascular risk. Our aim was to investigate whether ADMA has a predictive role for major adverse cardiovascular events (MACE) in acute coronary syndrome (ACS). The secondary aim of this study was to investigate whether severity of ED predicts MACE in these patients. Material and methods: Follow-up data were available for severity of ED in 71 patients with ACS. Plasma ADMA levels were determined by ELISA in 57 patients. Erectile dysfunction was assessed by the International Index of Erectile Function-6 (IIEF-6) score. Major adverse cardiovascular events (reinfarction, all-cause hospitalisation, stroke and all-cause death) was evaluated after a median of 10 months. Results: Severe ED had no significantly increased hazard ratio for cardiovascular events compared with mild, mild to moderate, and moderate ED (0.259 [95% CI 0.041-1.6], p = 0.147; 0.605 [95% CI 0.095-3.8], p = 0.594; 0.980 [95% CI 0.233-4.1], p = 0.978; and 0.473 [95% CI 0.052-1.3], p = 0.508). The patients who had ADMA levels 0.32 mu mol/l had no significantly increased hazard ratio for cardiovascular events compared with patients who had ADMA levels < 0.32 mu mol/l (2.018 [95% CI 0.615-6.6], p = 0.247). Conclusions: Severity of ED and ADMA did not increase the risk of cardiovascular events in follow-up patients with ACS in our study. Larger prospective studies are necessary to evaluate whether ADMA predicts cardiovascular events in patients with ACS

Which Patients Can Benefit from Pillar Palatal Implant Procedure?

Objective:The aim of this prospective study is to determine which patients may benefit from pillar procedure as a treatment for snoring.Methods:A total of 37 patients (25 males and 12 females) with a history of snoring were implanted with 3 pillar palatal implants. Flexible fiberoptic examination was used to evaluate the upper airway, especially the retropalatal and retrolingual areas. Visual analog scale (VAS) and polysomnography were performed on before and 3rd months after the pillar procedure. The implantation was performed under local anesthesia.Results:The mean VAS score was reduced from 9.3±0.6 to 6.2±1.1 at the 3rd month. VAS scores of snoring intensity were reduced >50% in 24 of the patients (64.8%). The mean apnea-hypopnea index (AHI) was 11.7±2.3 before the implantation and was reduced to 8.4±1.6 at the 3rd month. VAS and AHI had a close relation with gender, body weight, and oropharynx class. There were no major complications, such as infection, extrusion, and major bleeding.Conclusion:Pillar procedure has a high success rate if it is done with appropriate patient selection, but overall effectiveness remains limited. Initial AHI and VAS values, oropharynx and tonsil position scores, and gender are important determinants of pillar procedure

Hearing stimulation of the pediatric patient with congenital aural atresia: surgical and audiological evaluation of 38 patients

The aim of this work is to stress the importance of and discuss the timing and options for the treatment of congenital aural atresia (CAA), including non-surgical alternative treatment modalities and amplification, and to report the audiological and surgical results of a series of patients. Thirty-eight children with CAA were evaluated with regard to hearing and anatomical anomalies accompanying CAA: the state of the ossicles and the facial nerve, postoperative complications and audiological results. The ages of the patients ranged between 4 and 18 years, with a mean of 10 years. All underwent surgical treatment; 32 had unilateral atresia, while 6 had bilateral atresia. The mean follow-up duration was 7 months. The facial canal was dehiscent in 36.8% of cases. In 70.2% cases, the malleus and incus were present as an ossicular mass, fixed and attached to the atretic bone. The stapes was normal in 97.3% of the patients; in 2.7% the suprastructure was deformed. The success rate, defined as an air-bone gap of 20 dB or less, was 63.1% in this series of patients. If atresia is bilateral, very early hearing stimulation to prevent the maldevelopment of children's speech and cognitive skills is of the utmost importance. In unilateral cases, surgery may be postponed until early adulthood, when the patient is able to make his/her own decision and cooperate in the treatment and postoperative aspects

Intensive Care Management of Critical and Severe SARS-CoV-2 Infection in Pregnancy: A Retrospective Observational Study

Objective: This study examined the clinical consequences of pregnancy coexisting with severe acute respiratory syndrome coronavirus 2 in the intensive care unit (ICU). Materials and Methods: The study was designed as a retrospective observational study. After the ethical approval of the local ethics committee, the study was conducted for a period when the number of young coronavirus disease-2019 (COVID-19) cases increased in our country. The patients enrolled in the study were pregnant/puerperal patients followed up in our third-level ICU. Results: The mean age of 35 pregnant women included in the study was 29.57±4.36 years. Twenty-one of the births (80.8%) were preterm births. Twelve (34.3%) patients received invasive mechanical ventilation (IMV), and 5 (41.7%) of these patients were deceased. Twenty-six (74.3%) underwent a cesarean section (C/S). There were 5 (14.3%) patients who needed extracorporeal membrane oxygenation and 3 (8.5%) patients who needed continuous renal replacement therapy. The 28-day neonatal mortality rate for 26 births was 3.8%. The maternal mortality rate in the ICU was 14.3%. Conclusion: The preterm birth rate was high in our pregnant patients followed up in the ICU with a diagnosis of COVID-19. Because of clinical and radiological progression in pregnant women, it is difficult to indicate any gestational week in which maternal outcomes are better to undergo C/S. IMV mortality is not higher than in non-pregnant patients, so endotracheal intubation should not be avoided in appropriate patients, whether pregnancy continues or not. The absence of fully vaccinated patients in the study group revealed the protective effect of vaccination during pregnancy