The impact of the COVID-19 pandemic and behavioral restrictions on electricity consumption and the daily demand curve in Turkey

The rapid spread of COVID-19 has severely impacted many sectors, including the electricity sector. The reliability of the electricity sector is critical to the economy, health, and welfare of society; therefore, supply and demand need to be balanced in real-time, and the impact of unexpected factors should be analyzed. During the pandemic, behavioral restrictions such as lockdowns, closure of factories, schools, and shopping malls, and changing habits, such as shifted work and leisure hours at home, significantly affected the demand structure. In this research, the restrictions and their corresponding timing are classified and mapped with the Turkish electricity demand data to analyze the estimated impact of the restrictions on total demand and daily demand profile. A modulated Fourier Series Expansion evaluates deviations from normal conditions in the aggregate demand and the daily consumption profile. The aggregate demand shows a significant decrease in the early phase of the pandemic, during the period March-June 2020. The shape of the daily demand curve is analyzed to estimate how much demand shifted from daytime to night-time. A population-based restriction index is proposed to analyze the relationship between the strength and coverage of the restrictions and the total demand. The persistency of the changes in the daily demand curve in the post-contingency period is analyzed. These findings imply that new scheduling approaches for daily and weekly loads are required to avoid supply-demand mismatches in the future. The long-term policy implications for the energy transition and lessons learned from the COVID-19 pandemic experience are also presented.

Carpal Tunnel Syndrome Surgery Anti-Adhesion Gel Is Effective?

PURPOSE OF THE STUDY The purpose of the current study is to assess the efficacy of anti-adhesion gel on the symptom severity and functional outcomes after mini incision open surgery for carpal tunnel syndrom (CTS). MATERIAL AND METHODS A total of 200 CTS patients (154 women, 46 men) were included in this study. Group I (n = 100; 78 women, 22 men) did not receive local administration of anti-adhesion gel, while anti-adhesion gel consisting of hyaluronic acid-carboxymethylcellulose (Seprafilm®, SanofiBiosurgery, Bridgewater, NJ, USA) was locally applied to patients in Group II (n = 100; 76 women, 24 men). All patients recruited in this study had received conservative treatment comprised of non-steroidal antiinflammatory drugs, steroid injection, replacement of vitamin B and stabilization with splints. Cases that did not benefit from these therapeutic options during one year were assigned as candidates for surgical treatment. RESULTS There was no significant difference between two groups in terms of mean age, gender distribution, preoperative and postoperative Boston questionnaire (BQ) scores, difference of BQ scores after the operation, and the presence of the disease on the left or right side. According to postoperative 1. Year results, there was no significant difference between two groups. CONCLUSIONS Results of the current study demonstrated that use of anti-adhesion gel during mini incision open surgery for CTS did not bring about significant advantages in terms of functional or symptomatic outcomes. Further, controlled trials on larger series are warranted to understand the beneficial effects of anti-adhesive materials during the surgical treatment of CTS. Key words: anti-adhesion gel, Boston questionnaire, carpal tunnel syndrome.

Do additional intramedullary elastic nails improve the results of definitive treatment with external fixation of open tibia fractures? A prospective comparative study

PURPOSE

External fixation has been associated with a high incidence of complications and poor outcomes due to the instability and difficulty in treating open tibia fractures. We use intramedullary (IM) elastic nails to supplement the external fixator. We compared the results of fractures treated by external fixation with and without IM-elastic nail.

HYPOTHESIS

The combination of external fixation with IM-elastic nails may be used as an alternative to solve problems due to the external fixators alone in open tibia fractures.

METHODS

Group 1 included prospectively 26 cases (15 males and 11 females, mean age 37.5 ± 12.4 years) treated with external fixation and IM-elastic nails, whereas group 2 consisted of 28 cases (23 males and five females, mean age 30.7 ± 14.0 years) treated with standard external fixation. Functional and bone results were made using the criteria proposed by ASAMI.

RESULTS

The mean follow-up period was 3.96 ± 2.0 years in group 1 and 3.32 ± 2.1 years in group 2. The mean duration to external fixation and mean time to union were significantly lower in group 1 (P<0.001). In addition, bone and functional results were significantly higher in group 1 (P<0.01), however, pin track infections were lower in group 1 (P<0.01).

CONCLUSION

Our results showed the improvement in outcomes with IM-elastic nails: decreased duration of external fixation need and decreased bone healing delay. Therefore, this method may be a superior alternative for preventing complications related to external fixation in open tibia fractures.

LEVEL OF EVIDENCE

Level III: prospective comparative study.

Optimal effective doses of cabergoline and bromocriptine and valvular leasions in men with prolactinomas

OBJECTIVES

Prolactinoma is the most common pituitary adenoma, and dopamine agonists( BRC, and CAB) is the primary therapy. Recently, the increased prevalance of cardiac valvular disease in patients treated with DAs for Parkinson's disease has raised concerns about the safety of this drug in patients with prolactinoma. CAB and pergolide are frequently reported to cause valvulopathy, there are very few studies showing this side effect in BRC administiration which has less potent agonism of 5-HT2B receptors. Male patients who are known to have higher prevalance of macroadenomas compared to women. The dosage of DAs administered were rarely evaluated.

METHODS

We performed a retrospective chart to evaluate the medical management and treatment outcomes of male patients with macro/giant prolactinomas. We evaluated 22 patients with prolactinoma managed with DAs therapy alone for at least 1 year. All patients were followed for a mean of 61 months. Pretreatment echocardiographic examination were not available at that time.

RESULTS

None of them had any resistance or intolerance to DAs. The mean tumor shrinkage was 62%. In three patients the macroprolactinoma disappeared, in two patients the tumor shrinkage was 93% and 70%. The DAs therapy was discontinued in these patient. After a follow up neither MRI showed a recurrence or enlargement of the adenoma, nor prolactin levels showed any elevation. The echocardiography were performed at the last visit of each patient and no valvulopathy in any of the patients on DAs therapy were detected.

CONCLUSIONS

DAs are effective, and safe for valve morphology with mean cumulative doses of 155 mg CAB, and 7 301 mg BRC in patients with macroprolactinoma.

Anger and alexithymic characteristics of the patients diagnosed with insomnia: a control group study

The research was designed with a descriptive purpose to compare the alexithymic characteristics, trait anger and anger expression styles of those who are diagnosed with insomnia with those who are not. It was conducted with 96 patients who applied to Department of Sleep Disorders and were diagnosed with insomnia and 96 volunteers were not diagnosed with any psychiatric diagnosis and had not any sleep disorders in two Medical Faculty Hospitals in west of Turkey. Three types of forms were used to collect research data. The first form is the Sociodemographic Characteristics Form, the second one is The Toronto Alexithymia Scale and the third one is the Trait Anger-Anger Expression Scale. It was determined that the patients diagnosed with insomnia had displayed much more alexithymic characteristics than control group. Insomniac patients had higher level of anger and anger expression-in than the control group was found. In accordance with the findings, it is suggested that more comprehensive data should be obtained from the patients having sleeping problems and, that the nursing interventions on the patients' recognition, expression and anger management should be reflected on the nursing holistic care.

Spectral and photophysical studies on cruciform oligothiophenes in solution and the solid state

The photophysical and spectroscopic properties of a new class of oligothiophene derivatives, designated as cruciform oligomers, have been investigated in solution (room and low temperature) and in the solid state (as thin films in Zeonex matrixes). The study comprises absorption, emission, and triplet-triplet absorption spectra, together with quantitative measurements of quantum yields (fluorescence, intersystem crossing, internal conversion, and singlet oxygen formation) and lifetimes. The overall data allow the determination of the rate constants for all decay processes. From these, several conclusions are drawn. First, in solution, the main deactivation channels for the compounds are the radiationless processes: S(1) --> S(0) internal conversion and S(1) --> T(1) intersystem crossing. Second, in general, in the solid state, the fluorescence quantum yields decrease relative to solution. A comparison is made with the analogous linear alpha-oligothiophenes, revealing a lower fluorescence quantum efficiency and, in contrast to the normal oligothiophenes, that internal conversion is an important channel for the deactivation of the singlet excited state. Replacement of thiophene by 1,4-phenylene units in the longer-sized cruciform oligomer increases the fluorescence efficiency. The highly efficient generation of singlet oxygen through energy transfer from the triplet state (S(Delta) approximately 1) provides support for the measured intersystem crossing quantum yields and suggests that reaction with this may be an important pathway to consider for degradation of devices produced with these compounds.

Pressure-derived collateral flow index: a strong predictor of late left ventricular remodeling after thrombolysis for acute myocardial infarction

OBJECTIVE

Despite proved efficacy of pressure-derived collateral flow index in determining microvascular dysfunction in patients with acute myocardial infarction, its role in prediction of left ventricular remodeling at long term has yet to be demonstrated. In this study, we investigated the relationship between quantitatively assessed microvascular dysfunction by using intracoronary pressure wire and late left ventricular remodeling.

PATIENTS AND METHODS

The study population consisted of 28 patients with first acute myocardial infarction. They were treated with fibrinolytic therapy. The inclusion criteria were thrombolysis in myocardial infarction grade II-III flow in infarct-related artery and all destined for stent implantation. Cardiac catheterization and stent implantation were performed in mean of 3.3 days after acute myocardial infarction. During the stent implantation procedure, the pressure-derived collateral flow index was measured by using intracoronary pressure wire. Control angiograms were performed at 6+/-2 months. Echocardiographic left ventricular volume indexes were measured at discharge, at 6 months and at 1 year. Changes in left ventricular volumes from baseline to 1 year were followed.

RESULTS

Left ventricular end-diastolic volume index at 1 year correlated significantly with the pressure-derived collateral flow index (r=0.69, P<0.01). A significant correlation was also observed between the change in left ventricular end-diastolic volume index from baseline to 1 year and the pressure-derived collateral flow index (r=0.65, P<0.01). The most important predictor of 1-year left ventricular remodeling was the pressure-derived collateral flow index (P<0.0001), and collateral circulation (P=0.03).

CONCLUSION

The pressure-derived collateral flow index is a powerful independent predictor of 1-year left ventricular dilatation. Given its simplicity of measurement, and correlation with microvascular obstruction and left ventricular outcome at long term, the pressure-derived collateral flow index may provide useful and valuable estimates of clinical outcomes after acute myocardial infarction.

Increased plasma malondialdehyde and protein carbonyl levels and lymphocyte DNA damage in patients with angiographically defined coronary artery disease

We investigated the oxidative modifications of lipids, proteins and DNA, three potential molecular targets of oxidative stress, in 30 patients with angiographically defined coronary artery disease (CAD) and 30 healthy control subjects. In addition, we examined relationships between these oxidative modifications and the severity of vascular lesions in patients with CAD. Malondialdehyde (MDA) and protein carbonyl (PC) levels, as well as ferric reducing antioxidant power (FRAP), were measured in the plasma. DNA damage was evaluated as single strand breaks (SSBs), formamidopyrimidine glycosylase (Fpg) and endonuclease III (E-III)-sensitive sites by the comet assay in DNA isolated from lymphocytes. MDA and PC levels increased, but FRAP values decreased, in patients as compared to controls. However, these values did not vary with the number of affected coronary vessels and were not correlated with Duke score, a parameter of the severity of vascular lesions in patients with CAD. We also found that lymphocyte DNA damage (SSBs, Fpg and E-III sites) were increased in patients. Although there were no significant differences in SSBs values in patients grouped according to affected vessel number, Fpg and E-III sites increased. We also detected significant correlations between Duke scores and SSBs and Fpg sites. Serum cholesterol, triglyceride and LDL-cholesterol levels were found to increase, but HDL-cholesterol levels decreased in CAD patients, but these lipids were not correlated with Duke scores. The results of this study reinforce the presence of increased combined oxidative modifications in lipid, protein and DNA in patients with CAD. However, lymphocyte DNA damage seems to be a more reliable assay than MDA and PC determinations to detect the severity of vascular lesions in patients.

Thrombocytopenia complicating the clinical course of leptospiral infection

Leptospirosis can present with a wide clinical spectrum, and haematological manifestations are often apparent. We retrospectively analysed platelet counts in 49 patients with leptospirosis. Forty-three patients (87.8%) had thrombocytopenia. Mean baseline platelet counts rose from 69 x 10(9)/l to 151 x 10(9)/l following treatment. Haemorrhagic episodes were observed in 11 patients. Platelet nadir was 29 x 10(9)/l in the group experiencing bleeding and 64 x 10(9)/l in the remainder. Six patients died due to bleeding and one due to sepsis. Thirty-six patients (73.5%) had acute renal failure; their means platelet count was 46 x 10(9)/l. Liver enzyme levels were elevated in all patients. Thrombocyte count, liver enzyme levels and bilirubin levels were significantly correlated. Forty-three (87.8%) patients showed signs of sepsis; mean thrombocyte count was 46 x 10(9)/l in these patients, and 133 x 10(9)/l in those without sepsis. Multiple organ involvement and fulminant disease is usually associated with renal failure and/or thrombocytopenia in leptospirosis.

[Pilot study for the registration of acute myocardial infarction in the Liège area (Belgium)]

BACKGROUND

In 1998, a permanent registry of myocardial infarction was developed in the Liège area (Belgium) to provide updated, exhaustive and validated data on the morbidity and mortality from cardiovascular causes, to define the patients' profile, to identify myocardial infarction therapeutic strategies and to complete and make comparisons with data collected in other parts of the country through methodologically identical registers.

METHODS

All acute coronary events lethal or non lethal among individuals from both genders aged from 25 to 69 years and living in the area were registered according to the methodology developed for the MONICA project (Multinational Monitoring of Trends and Determinants in Cardiovascular Diseases) of WHO. The three main selected data sources were: death certificates, general practitioners and cardiologists, hospitals. The events were categorised according to symptoms, cardiac enzymes, electrocardiogram, history of chronic ischaemic heart disease and necropsy findings.

RESULTS

The coronary-event rates were 283/100,000 in men and 102/100,000 in women. The case fatality rate, 28 days after the onset of the symptoms, was 30.6% for men and 36.2% for women, and 77.5% of deaths occurred in the first 24 hours after the onset of the symptoms.

CONCLUSION

The development of a myocardial infarction register at a regional level requires the involvement of all health professionals dealing with that pathology. Such register has valuable public health interests, providing exhaustive and validated data on the pathology and its evolution as well as useful information for improving therapeutic strategies and developing adapted preventive measures.

Metronidazole-induced encephalopathy in a uremic patient: a case report

A variety of neurologic disorders may develop in patients with chronic renal failure. Drug toxicity must be thought of in the differential diagnosis of these disorders. We report a case with renal failure developing serious neurotoxicity after metronidazole use.

Effects of different surface treatment methods on the bond strength of composite resin to porcelain

In this study failures of composite resin/ porcelain interfaces under shear loading were examined. Porcelain firing were made onto metal cylinders and porcelain surfaces were roughened with burrs or treated with hydrofloric acid gel and/ or sandblasted with a Microetcher. Two silane coupling agents were used in five groups, each of which had 22 samples. All of the treated samples were restored with a hybrid-type composite resin. Then each group was divided into two subgroups according to storage times of 24 h and 30 days. After thermocyling the samples which were stored for 30 days, all of the groups were subjected to shear force at the composite resin/porcelain interface until fracture occurred. The results showed that there were differences both in the 24-h and 30-day storage period bond strengths between the various surface treatment methods. The samples treated with all three of the Microetcher, hydrofloric acid and silane exhibited the highest shear bond values after 24 h storage, followed by the microetched/silane and the hydrofluoric acid/silane groups (F: 570.31, P: 0.00). After 30 days, the highest mean shear bond strength values were again with samples treated by all three processes. The storage period and thermocycling decreased the bond strength of samples, however, there was a significant difference among groups (F: 1388-55, P: 0.00). Silane pre-treatment of porcelain was important as the mean bond strength of sandblasted/etched specimens were significantly lower than the other groups which were treated mechanically, in 24 h. Sandblasting seems to have little effect on the bonding. The comparison of 24-h and 30-day samples have also significant difference (F: 91.4376, P: 0.00).

Misrepresentation of authorship by applicants to pediatrics training programs

PURPOSE

To determine whether applicants to pediatrics residency and fellowship programs misrepresented authorship of publications.

METHOD

The authors sampled 1995 applications to the University of Washington School of Medicine's pediatrics residency program and pediatrics pulmonary fellowship program. They submitted all publications claimed in the submitted applications to extensive efforts to authenticate both their existence and authorship.

RESULTS

Among the 404 pediatrics residency program applications studied, 147 claimed authorship of publications; 29 (19.7%) of these contained at least one unverifiable publication. Of the 401 publications claimed in the 147 applications, 41 (10.2%) could not be confirmed. Among 31 fellowship applications, 14 claimed publications. At least one citation was unverifiable for each of the 14 applications. Of the total 77 publications claimed, 31 (40%) could not be confirmed.

CONCLUSION

Misrepresentation occurs on graduate medical education applications; solutions are needed to address this problem.

Comparison of four different denture cushion adhesives--a subjective study

Four cushion adhesives (Fittydent I; Fittydent II, introduced as an advanced formula; Protefix; and Seabond) were compared clinically through patients subjective evaluations. Maxillary dentures of 32 patients were relined and the mandibular dentures were scored by Kapur index before the application of different treatments. The cushion adhesives were used only with the existing mandibular prosthesis. The four treatments were applied to the patients in groups of 8 by allocating each group randomly to one of the four sequences of treatments determined by latin square design. Each patient took each treatment only once. The adhesives were applied by the authors as recommended by the manufacturers. Patients used each material for 24 h and, through a questionnaire, they evaluated the seven following aspects of each different cushion material: retention, duration of retention, effects on ability to chew, effects on other oral functions, cleansing of dentures, cleansing of gums, and an overall evaluation of materials. Both Fittydent products significantly improved denture retention and the ability to chew. The patients who expressed 'much better' chewing with Fittydent products, had mandibular dentures rated poor or fair.

Translocation of ricin A-chain into proteoliposomes reconstituted from Golgi and endoplasmic reticulum

Translocation to the cytosol is an essential and rate-limiting step in the cytotoxicity of the potent plant toxin ricin. In an attempt to study the mechanism of ricin A-chain translocation in a cell-free assay, we have partially purified Golgi and endoplasmic reticulum from Jurkat cells by discontinuous sucrose gradient fractionation. The membranes of the organelle fractions were solubilized by the addition of sodium cholate and reconstituted into proteoliposomes by dialyzing out the detergent. The resulting vesicles supported cell-free translocation of RTA (as assessed by an enzyme protection assay) at a rate which was linearly dependent on the concentration of the vesicle preparation. Ricin B-chain (RTB) neither translocated into the vesicles, nor increased the efficiency of RTA translocation. Liposomes prepared from purified phospholipids were not capable of supporting RTA translocation. Furthermore, protease treatment of concanavalin A adsorption of proteins from lysates prior to vesicle reconstitution resulted in abrogation of the translocation process, suggesting that the protein components of organelle membranes are required for RTA translocation. Reconstitution of translocation-competent proteoliposomes from detergent-solubilized membranes of endoplasmic reticulum- and Golgi-enriched fractions provides a convenient cell-free system to study the mechanism of RTA translocation.

Degradation of ricin A chain by endosomal and lysosomal enzymes--the protective role of ricin B chain

We investigated the role of intracellular processing of ricin A chain (RTA) by proteolytic enzymes on the expression of its ribosome inhibitory activity. Endosomal and lysosomal proteases extracted from Jurkat cells and purified cathepsins B, D and G were incubated with RTA, resulting in generation of a 28-kDa fragment by proteolytic cleavage. This process was reminiscent of the nicking of Pseudomonas exotoxin and Diphtheria toxin by intracellular proteases to produce functionally active toxin fragments. However, the ribosome inhibitory activity of the purified 28-kDa fragment of RTA was 11,000-fold less than that of native RTA, suggesting that such cleavage is not an essential step in the cytotoxic activity of the toxin. Addition of ricin B chain (RTB) in degradation assays resulted in the protection of RTA from proteolytic activities of lysosomes and cathepsins. However, RTB did not protect another RNA acting protein, RNAase; nor did excess amounts of unlabeled RTA or IgG protect labelled RTA from degradation, suggesting that the protective effect of RTB was specific to its interaction with RTA. Such a protective role for RTB may partially account for the higher toxicity of immunotoxins (ITs) containing whole ricin compared to ITs containing only RTA.

Diagnosis and surgical treatment of hepatic hydatid disease

In this report, 226 patients with hydatid disease admitted to the Surgical Department of Erciyes University (Kayseri) and Sişli Etfal Hospital (Istanbul) in Turkey between 1978 and 1990 were reviewed retrospectively. 102 patients (45.1%) were male and 124 (54.9%) female. The most frequent symptom was right upper abdominal pain (66%). The most frequent signs were hepatomegaly (43.8%) and palpable mass (39%). 167 patients (73.9%) were examined with ultrasonography which has a diagnostic value of 94%. Preoperative complications were infection of cyst (7%), intrabiliary rupture (3.5%) and anaphylactic shock (0.4%). Patients were operated on by various techniques; omentoplasty (101), external drainage of residual cavity (64), marsupialization (25), capitonnage (15), introflexion (10), pericystectomy (6), and hepatic resection (5). Main postoperative complications were wound infection (12%) and biliary fistula (2.6%). Total mortality rate was 1.8% in this series.

Regulation of natural killer cell production in bone marrow of mice: no evidence for negative feedback control

The possible presence of a negative feedback control mechanism regulating natural killer (NK) cell production in the bone marrow of B6 mice was investigated by depleting NK cells with a single intravenous injection of anti-ASGM1 antibody. At times ranging from 1 to 21 days following injection, the response of the bone marrow cells to this depletion was assessed by measuring both NK activity against YAC-1 target cells in a 51Cr assay and the frequency of NK precursors by limiting dilution analysis. For comparison, measurements of lytic activity were also done in the peripheral blood and spleen. Anti-ASGM1 injection resulted in a depletion of mature NK cell activity in all compartments tested as expected, as well as the depletion of NK precursors from the bone marrow. Clearance of the anti-ASGM1 from the circulation of recipient mice was biphasic. More than 99% of the antibody was eliminated in the first 4 min, while the remaining 0.24% had a half-life in the serum of 6 days. Bone marrow was able to produce new lytic NK cells which were detectable between days 6 and 10 after depletion. The bone marrow of the NK cell-depleted mice did not show an 'overshoot' (compensatory increase) in NK cell production through day 21 after depletion. It therefore appears that the NK cell production in the bone marrow is independent of the activity of the peripheral NK cell pool.

Diagnosis and surgical treatment of hepatic hydatid disease

In this report two hundred and twenty six patients with hydatid disease were admitted to the Surgical Department of Erciyes University (Kayseri) and Sişli Etfal Hospital (Istanbul) between 1978 and 1990 and reviewed retrospectively. One hundred and two patients (45.1%) were male and 124 (54.9%) female. In the patients with hydatid cysts the most frequent symptom was right upper abdominal pain (66%). The most frequent signs were hepatomegaly (43.8%) and palpable mass (39%). One hundred and sixty seven patients (73.9%) were examined with ultrasonography which has a diagnostic value of 94%. Preoperative complications were infection of cyst (7%), intrabiliary rupture (3.5%) and anaphylactic shock (0.4%). All patients were operated on by using various surgical techniques; omentoplasty (101), external drainage of residual cavity (64), marsupialization (25), capitonnage (15), introflexion (10), pericystectomy (6), and hepatic resection (5). The main postoperative complications were wound infection (12%) and biliary fistula (2.6%). The total mortality rate was 1.8% in this series.

Diagnostic peritoneal lavage in blunt abdominal trauma

A prospective study to determine the reliability of diagnostic peritoneal lavage in blunt abdominal trauma was carried on during the 11 year period January 1978 to February 1989. Abdominal injury was correctly diagnosed by peritoneal lavage in 1,275 of 1,305 patients (97.7%). In the present study the charts of these patients were reviewed. Of the 555 patients in whom peritoneal lavage was positive and who underwent laparotomy, only 396 patients had an intraabdominal injury that required operation according to our new criteria for the treatment of blunt abdominal trauma. Sixty of the 555 patients had minor injuries that were treated conservatively. The remainder had either little (n = 78) or no (n = 21) intra-abdominal damage except a small amount of free blood about 20 ml in the peritoneal cavity. Diagnostic peritoneal lavage is accurate (97.7%) in detecting free blood in the abdominal cavity. On the other hand, it results in a high percentage of unnecessary laparotomies (28.6%). Patients with blunt abdominal trauma in whom peritoneal lavage shows the presence of blood should be investigated further to reduce the number of unnecessary laparotomies.