Numerical Analysis of Compound Biochemical Calcium Oscillations Process in Hepatocyte Cells

The hepatocyte cells regulate the wide range of liver function by moderating cellular activities such as lipid, protein metabolism, carbohydrate, and interact with other cells for proliferation and maintenance. In hepatocyte cells, the concentration of calcium uptake is quite extensive from various agonists such as activeG α ${G_\alpha}$ subunit, active phospholipase C, free calcium in the cytosol, and endoplasmic reticulum. The overproduction and degradation of calcium signals can cause homeostasis, liver inflammation, and liver diseases. The spatiotemporal behavior of calcium oscillation reveals the physiological role of these cellular entities in understanding the process of production and degradation. No computational attempt has been registered to date on the compound calcium regulation of these cellular entities including the memory of cells. Hence, the authors proposed a fractional order compartmental model that systematically simulates the exchange of calcium intake in cellular entities. The nonlinear equations of the rate of changes in the activeG α ${G_\alpha}$ subunit, active phospholipase C, free calcium in the cytosol, and endoplasmic reticulum are coupled to form a nonlinear fractional order initial value problem. The existence and uniqueness, stability analysis of the model is performed that validate the theoretical results and explore the dynamic behaviour of calcium oscillation in each compartment.

Transition dynamics between a novel coinfection model of fractional-order for COVID-19 and tuberculosis via a treatment mechanism

In this paper, a fractional-order coinfection model for the transmission dynamics of COVID-19 and tuberculosis is presented. The positivity and boundedness of the proposed coinfection model are derived. The equilibria and basic reproduction number of the COVID-19 sub-model, Tuberculosis sub-model, and COVID-19 and Tuberculosis coinfection model are derived. The local and global stability of both the COVID-19 and Tuberculosis sub-models are discussed. The equilibria of the coinfection model are locally asymptotically stable under certain conditions. Later, the impact of COVID-19 on TB and TB on COVID-19 is analyzed. Finally, the numerical simulation is carried out to assess the effect of various biological parameters in the transmission dynamics of COVID-19 and Tuberculosis coinfection.

Modeling the epidemic trend of middle eastern respiratory syndrome coronavirus with optimal control

Since the outbreak of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in 2012 in the Middle East, we have proposed a deterministic theoretical model to understand its transmission between individuals and MERS-CoV reservoirs such as camels. We aim to calculate the basic reproduction number ($ \mathcal{R}_{0} $) of the model to examine its airborne transmission. By applying stability theory, we can analyze and visualize the local and global features of the model to determine its stability. We also study the sensitivity of $ \mathcal{R}_{0} $ to determine the impact of each parameter on the transmission of the disease. Our model is designed with optimal control in mind to minimize the number of infected individuals while keeping intervention costs low. The model includes time-dependent control variables such as supportive care, the use of surgical masks, government campaigns promoting the importance of masks, and treatment. To support our analytical work, we present numerical simulation results for the proposed model.

Comprehensive Investigation of Thermal and Flow Features of Alloy Based Nanofluid Considering Shape and Newtonian Heating Effects via New Fractional Approach

The core purpose of this work is the formulation of a mathematical model by dint of a new fractional modeling approach to study the dynamics of flow and heat transfer phenomena. This approach involves the incorporation of the Prabhakar fractional operator in mathematical analysis to transform the governing system from a conventional framework to a generalized one. This generalized model evaluates the improvement in thermal efficacy of vacuum pump oil because of the inclusion of aluminum alloy nanoparticles. The flow of the under-observation nanofluid starts due to the combined effects of natural convection and the ramped velocity function at the boundary. Meanwhile, an analysis of the energy equation is conducted by taking the Newtonian heating mechanism into consideration. The characteristics of platelet-, brick-, cylinder-, and blade-shaped alloy nanoparticles are incorporated into the primary system using shape-dependent relations for thermal conductivity and viscosity. Both the classical and generalized models are solved to derive the exact solutions by first inserting some dimension-independent quantities and then operating the Laplace transform on the succeeding equations. These solutions are utilized for the development of graphical illustrations to serve the purpose of covering all features of the problem under consideration. Furthermore, changes in energy and flow functions due to the dominant influences of the relevant contributing factors are delineated with appropriate physical arguments. In addition, the numerical results of the skin friction coefficient and Nusselt number are displayed via multiple tables to analyze the disturbance in shear stress and discuss the contribution of the fractional parameters, the volume concentration of the considered nanoparticles, and the shape factor in the boost of the thermal potential of the considered nanofluid. The findings imply that aluminum alloy nanoparticles have the ability to produce a 44% enhancement in the thermal effectiveness of vacuum pump oil. Moreover, the flow velocity is reduced as the loading range of the nanoparticles rises.

Modelling and analysis of fractional-order vaccination model for control of COVID-19 outbreak using real data

In this paper, we construct the SV1V2EIR model to reveal the impact of two-dose vaccination on COVID-19 by using Caputo fractional derivative. The feasibility region of the proposed model and equilibrium points is derived. The basic reproduction number of the model is derived by using the next-generation matrix method. The local and global stability analysis is performed for both the disease-free and endemic equilibrium states. The present model is validated using real data reported for COVID-19 cumulative cases for the Republic of India from 1 January 2022 to 30 April 2022. Next, we conduct the sensitivity analysis to examine the effects of model parameters that affect the basic reproduction number. The Laplace Adomian decomposition method (LADM) is implemented to obtain an approximate solution. Finally, the graphical results are presented to examine the impact of the first dose of vaccine, the second dose of vaccine, disease transmission rate, and Caputo fractional derivatives to support our theoretical results.

Useful indicators and models for assessing erosion control ecosystem service in a semi-arid forest landscape

Forests provide a large array of ecosystem services (ESs) such as wood supply, extreme natural event prevention, and ecotourism opportunities. The quantitative characterization of ESs is a crucial but costly task for environmental managers. The aim of this study was to develop easily applicable models and indicators for assessing erosion control ES in a semi-arid landscape. In order to accomplish this, 107 randomly selected plots were visited for field measurements and topsoil sampling. Several parametric tests were then used to analyze the field data. The findings revealed that (i) normalized difference vegetation index (NDVI), (ii) cover management (C) factor of the Revised Universal Soil Loss Equation (RUSLE), (iii) soil organic matter content, (iv) canopy cover ratio, and (v) land use/land cover (LULC) types could be used as useful performance indicators of erosion control ES. Two regression models were developed based on these indicators and compared to RUSLE results for the study area. Using the first model, we were able to estimate the soil protection performance of different LULC types by NDVI at the pixel level (R²_adj = 0.90, p < 0.05). The second model estimated annual potential soil loss using NDVI and ground slope values (R²_adj = 0.57, p < 0.05). Based on the ES indicators framework, a practical approach was proposed in this study for rapid assessment of the soil erosion problem without running RUSLE. Thus, environmental managers are expected to make well-informed landscape planning decisions and improve their ES provision application capabilities at a reduced cost.

Electronic field effect detection of SARS-CoV-2 N-protein before the onset of symptoms

As part of the efforts to contain the pandemic, researchers around the world have raced to develop testing platforms to detect the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes the Coronavirus disease 2019 (COVID-19). Within the different detection platforms studied, the field effect transistor (FET) is a promising device due to its high sensitivity and fast detection capabilities. In this work, a graphene-based FET which uses a boron and nitrogen co-doped graphene oxide gel (BN-GO gel) transducer functionalized with nucleoprotein antibodies, has been investigated for the detection of SARS-CoV-2 nucleocapsid (N)-protein in buffer. This biosensor was able to detect the viral protein in less than 4 min, with a limit of detection (LOD) as low as 10 ag/mL and a wide linear detection range stretching over 11 orders of magnitude from 10 ag/mL-1 μg/mL. This represents the lowest LOD and widest detection range of any COVID-19 sensor and thus can potentially enable the detection of infected individuals before they become contagious. In addition to its potential use in the COVID-19 pandemic, our device serves as a proof-of-concept of the ability of functionalized BN-GO gel FETs to be used for ultrasensitive yet robust biosensors.

Ameliorative Effects by Hexagonal Boron Nitride Nanoparticles against Beta Amyloid Induced Neurotoxicity

Alzheimer’s disease (AD) is considered as the most common neurodegenerative disease. Extracellular amyloid beta (Aβ) deposition is a hallmark of AD. The options based on degradation and clearance of Aβ are preferred as promising therapeutic strategies for AD. Interestingly, recent findings indicate that boron nanoparticles not only act as a carrier but also play key roles in mediating biological effects. In the present study, the aim was to investigate the effects of different concentrations (0−500 mg/L) of hexagonal boron nitride nanoparticles (hBN-NPs) against neurotoxicity by beta amyloid (Aβ1-42) in differentiated human SH-SY5Y neuroblastoma cell cultures for the first time. The synthesized hBN-NPs were characterized by X-ray diffraction (XRD) measurements, scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Aβ1-42-induced neurotoxicity and therapeutic potential by hBN-NPs were assessed on differentiated SH-SY5Y cells using MTT and LDH release assays. Levels of total antioxidant capacity (TAC) and total oxidant status (TOS), expression levels of genes associated with AD and cellular morphologies were examined. The exposure to Aβ1-42 significantly decreased the rates of viable cells which was accompanied by elevated TOS level. Aβ1-42 induced both apoptotic and necrotic cell death. Aβ exposure led to significant increases in expression levels of APOE, BACE 1, EGFR, NCTSN and TNF-α genes and significant decreases in expression levels of ADAM 10, APH1A, BDNF, PSEN1 and PSENEN genes (p < 0.05). All the Aβ1-42-induced neurotoxic insults were inhibited by the applications with hBN-NPs. hBN-NPs also suppressed the remarkable elevation in the signal for Aβ following exposure to Aβ1-42 for 48 h. Our results indicated that hBN-NPs could significantly prevent the neurotoxic damages by Aβ. Thus, hBN-NPs could be a novel and promising anti-AD agent for effective drug development, bio-nano imaging or drug delivery strategies.

Fractional order modelling of omicron SARS-CoV-2 variant containing heart attack effect using real data from the United Kingdom

In this study, a new approach to COVID-19 pandemic is presented. In this context, a fractional order pandemic model is developed to examine the spread of COVID-19 with and without Omicron variant and its relationship with heart attack using real data from the United Kingdom. In the model, heart attack is adopted by considering its relationship with the quarantine strategy. Then, the existence, uniqueness, positivity and boundedness of the solution are studied. The equilibrium points and their stability conditions are achieved. Subsequently, we calculate the basic reproduction number (the virus transmission coefficient) that simply refers to the number of people, to whom an infected person can make infected, as R 0 = 3.6456 by using the next generation matrix method. Next, we consider the sensitivity analysis of the parameters according to R 0 . In order to determine the values of the parameters in the model, the least squares curve fitting method, which is one of the leading methods in parameter estimation, is benefited. A total of 21 parameter values in the model are estimated by using real Omicron data from the United Kingdom. Moreover, in order to highlight the advantages of using fractional differential equations, applications related to memory trace and hereditary properties are given. Finally, the numerical simulations are presented to examine the dynamic behavior of the system. As a result of numerical simulations, an increase in the number of people who have heart attacks is observed when Omicron cases were first seen. In the future, it is estimated that the risk of heart attack will decrease as the cases of Omicron decrease.

A new mathematical modelling and parameter estimation of COVID-19: a case study in Iraq

<abstract> <p>Mathematical modelling has been widely used in many fields, especially in recent years. The applications of mathematical modelling in infectious diseases have shown that situations such as isolation, quarantine, vaccination and treatment are often necessary to eliminate most infectious diseases. In this study, a mathematical model of COVID-19 disease involving susceptible (S), exposed (E), infected (I), quarantined (Q), vaccinated (V) and recovered (R) populations is considered. In order to show the biological significance of the system, the non-negative solution region and the boundedness of the relevant biological compartments are shown. The endemic and disease-free equilibrium points of the model are calculated, and local stability analyses of these equilibrium points are performed. The basic reproduction number is also calculated for the relevant model. Sensitivity analysis of this number is studied, and it has been pointed out which parameters affect this number and how they affect it. Moreover, using real data from Iraq, the model parameters are estimated using the least squares curve fitting method, and numerical simulations are performed by using these estimated values. For the solution of the model, the Adams-Bashforth type predictive-corrective numerical method is used, and with the help of numerical simulations, several predictions are achieved about the future course of COVID-19.</p> </abstract>

Extinction and stationary distribution of a stochastic COVID-19 epidemic model with time-delay

We reformulate a stochastic epidemic model consisting of four human classes. We show that there exists a unique positive solution to the proposed model. The stochastic basic reproduction number R0s is established. A stationary distribution (SD) under several conditions is obtained by incorporating stochastic Lyapunov function. The extinction for the proposed disease model is obtained by using the local martingale theorem. The first order stochastic Runge-Kutta method is taken into account to depict the numerical simulations.

Investigation of interactions between COVID-19 and diabetes with hereditary traits using real data: A case study in Turkey

In the present paper, interactions between COVID-19 and diabetes are investigated using real data from Turkey. Firstly, a fractional order pandemic model is developed both to examine the spread of COVID-19 and its relationship with diabetes. In the model, diabetes with and without complications are adopted by considering their relationship with the quarantine strategy. Then, the existence and uniqueness of solution are examined by using the fixed point theory. The dynamic behaviors of the equilibria and their stability analysis are studied. What is more, with the help of least-squares curve fitting technique (LSCFT), the fitting of the parameters is implemented to predict the direction of COVID-19 by using more accurately generated parameters. By trying to minimize the mean absolute relative error between the plotted curve for the infected class solution and the actual data of COVID-19, the optimal values of the parameters used in numerical simulations are acquired successfully. In addition, the numerical solution of the mentioned model is achieved through the Adams-Bashforth-Moulton predictor-corrector method. Meanwhile, the sensitivity analysis of the parameters according to the reproduction number is given. Moreover, numerical simulations of the model are obtained and the biological interpretations explaining the effects of model parameters are performed. Finally, in order to point out the advantages of the fractional order modeling, the memory trace and hereditary traits are taken into consideration. By doing so, the effect of the different fractional order derivatives on the COVID-19 pandemic and diabetes are investigated.

Health sector engagement on the implementation of SDGs in Turkey

Turkey is a country with major environmental and climate threats, so implementing the SDGs offers significant potential to improve people's health and well-being. The Turkish government aims to take a voluntary approach to SDGs. In Turkey's 2019 report, SDG-3 on Good Health and Well-being, which is coordinated by the Ministry of Health, was promoted as one of the goals with the most progress. Non-communicable diseases (NCD) have become the main cause of death; in Turkey, the share of NCDs in total disease burden was 69.7% in 2002, and rose to 82% in 2017. In the light of the latest Lancet findings, it is clear that the NCDs burden will increase further with climate change, thus the link between health and climate should be strengthened in SDG implementation. Turkey's latest Climate Change Action Plan 2011-2023 offers an opportunity for the health sector to do so (and thus also advancing the implementation of SDG-13). To strengthen the Turkish health sector's capacity to engage on the implementation of SDGs and other relevant climate and environment policies, HEAL, HASUDER (the Association Of Public Health Specialists) and Kocaeli University, Department of Public Health launched a network in April 2020, called “Health Collaboration on Climate Change and Environment Project (CISIP)”. The project, which is financed by the EU, will organise a range of webinars, trainings, materials and facilitate exchanges for better evidence-based and health promoting policy-making. So far, these three organisations/institutions have engaged with more than 30+ different health organisations that are keen to work on the environment, climate and health intersections. The presentation will share some lessons learnt from recent CISIP activities and discuss the opportunities and challenges for the implementation of SDGs 3 and 13 in Turkey.

Antenatal care access and concerns of pregnant women during pandemic: a population-based study

Background

The COVID-19 pandemic continues to burden the health of vulnerable populations such as pregnant women. It has been estimated that antenatal care coverage has been decreased with workforce, supplies, demand, and access reductions during the outbreak in some countries. The study aimed to investigate the health care access and concerns of pregnant women during the pandemic.

Methods

This cross-sectional study was conducted among 331 pregnant women in one district of Istanbul (Üsküdar) and a random sampling method was applied. The data was collected between November 22nd and December 18th 2020 by telephone interview after verbal consents were taken from the participants. Chi-square and multiple logistic regression analyses were performed. The study was approved by the Bahcesehir University Institutional Ethics Board.

Results

The median age of the participants was 30 years, the median gestational age was 24 weeks. Among the participants 9.6% were previously diagnosed with COVID-19, 15.8% had a chronic disease, 48.2% were nulliparous and 18.6% had a high-risk pregnancy. The frequency of having concern for their own health was 70.7%, for their children's health was 73,0%, for going to visits in healthcare facilities was 81.0% and for giving birth during the pandemic was 83.0%. Also, 17.1% did not go to antenatal visits because of the COVID-19 concerns. According to the logistic regression analysis, women who had chronic disease had higher concerns about their own health; women who had chosen to go to hospitals for antenatal care visits had higher concerns about children's health and giving birth, and women who had concerns about going to health facilities during the COVID-19 pandemic were less likely to go to family health centers.

Conclusions

Our results suggest that the concerns related to the pandemic among pregnant women are at significant levels. Measures should be taken to ensure that antenatal care services are not interrupted throughout the current pandemic.

Key messages

Significant concern levels were detected among pregnant women in our sample.

Measures should be taken to ensure to maintain uninterrupted antenatal care services.

The Scale of Evaluating Instruction in Pandemic Process: Development, Validation, and Reliability

The study aims to develop a scale for determining student views on distance instruction, hybrid instruction, and back-to-school process after the pandemic. The study data were obtained from 442 students. EFA and CFA were performed to determine the scale‘s construct validity. Moreover, to decide the data collection tool‘s reliability, item analysis was conducted and internal consistency coefficients were estimated. Based on the results obtained from the validity and reliability analysis of the scale, it can be said that the Scale of Evaluating Instruction in Pandemic Process (SEIPP) is valid and reliable.

Modeling and analysis of COVID-19 epidemics with treatment in fractional derivatives using real data from Pakistan

Coronaviruses are a large family of viruses that cause different symptoms, from mild cold to severe respiratory distress, and they can be seen in different types of animals such as camels, cattle, cats and bats. Novel coronavirus called COVID-19 is a newly emerged virus that appeared in many countries of the world, but the actual source of the virus is not yet known. The outbreak has caused pandemic with 26,622,706 confirmed infections and 874,708 reported deaths worldwide till August 31, 2020, with 17,717,911 recovered cases. Currently, there exist no vaccines officially approved for the prevention or management of the disease, but alternative drugs meant for HIV, HBV, malaria and some other flus are used to treat this virus. In the present paper, a fractional-order epidemic model with two different operators called the classical Caputo operator and the Atangana-Baleanu-Caputo operator for the transmission of COVID-19 epidemic is proposed and analyzed. The reproduction number R 0 is obtained for the prediction and persistence of the disease. The dynamic behavior of the equilibria is studied by using fractional Routh-Hurwitz stability criterion and fractional La Salle invariant principle. Special attention is given to the global dynamics of the equilibria. Moreover, the fitting of parameters through least squares curve fitting technique is performed, and the average absolute relative error between COVID-19 actual cases and the model's solution for the infectious class is tried to be reduced and the best fitted values of the relevant parameters are achieved. The numerical solution of the proposed COVID-19 fractional-order model under the Caputo operator is obtained by using generalized Adams-Bashforth-Moulton method, whereas for the Atangana-Baleanu-Caputo operator, we have used a new numerical scheme. Also, the treatment compartment is included in the population which determines the impact of alternative drugs applied for treating the infected individuals. Furthermore, numerical simulations of the model and their graphical presentations are performed to visualize the effectiveness of our theoretical results and to monitor the effect of arbitrary-order derivative.

A five-step protocol for estimating forest cover and rate of change in the New York City watershed

New York City drinking water quality depends on retention of forest cover in its Catskill Mountains watersheds, yet multiple published analyses of temporally approximate satellite imagery derived no definitive nor agreed upon quantification of either forest cover in the watershed, or, more importantly, its rate of change over time. The objective of this work was to reduce uncertainty surrounding these estimates. We developed a five-pronged protocol that included (1) creation of a 1975-2002 time-series of land use/land cover (LULC) using Cross-Correlation Analysis (CCA); (2) a corrective post classification logic-based algorithm to correct for illogical transitions; (3) a probability-based stratified random sample accuracy assessment; (4) joint probability calculations of the "true" 2002 class proportions; and (5) verification of quantities of our LULC classification, and those of other researchers, versus the statistically derived true proportions. The estimated true percent of forest cover as of 2002 is 72%, far less than that reported by other studies, even with a net reforestation between 1975 and 2002. This protocol is an enhancement over previous LULC monitoring methods. Its more robust estimates of both historic trends and 2002 forest cover reveal information that is vitally important to monitoring and managing future water quality for the nation's largest city.

Relationship between insulin resistance, hs-CRP, and body fat and serum osteoprotegerin/RANKL in prediabetic patients

BACKGROUND

Receptor activator of nuclear factor-κB ligand (RANKL) and osteoprotegerin (OPN) are soluble members of the tumor necrosis factor superfamily. Growing evidence suggest that there is link between inflammation, insulin resistance and OPG, soluble RANKL (sRANKL). We aimed to ascertain whether OPG and sRANKL levels are altered in prediabetic subjects and there is association between OPG/sRANKL and metabolic parameters.

METHODS

Forty prediabetic subjects and 40 age- and BMI-matched controls were recruited for this cross-sectional study. Circulating OPG, sRANKL were measured using ELISA. Anthropometric and metabolic parameters were also determined.

RESULTS

Circulating sRANKL (97.74±17.67 vs. 55.00±11.19 pg/mL, P=0.010) and OPG (261.54±74.55 vs. 159.23±52.91 pg/mL, P=0.020) levels were found to be significantly higher in diabetic subjects compared with control subjects. There was a positive correlation between sRANKL and OPG. sRANKL also positively correlated with BMI, insulin resistance marker HOMA-IR, inflammatory marker hs-CRP. Logistic regression analyses revealed that the odds ratio was increased for prediabetes in subjects with having elevated sRANKL levels.

CONCLUSIONS

Increased sRANKL and OPG levels were associated with prediabetic subjects. sRANKL and OPG may play a role in the pathogenesis of diabetes as well as metabolic disturbance.

Brachial artery protected by wrapped latissimus dorsi muscle flap in high voltage electrical injury

High voltage electrical injury can disrupt the vascular system and lead to extremity amputations. It is important to protect main vessels from progressive burn necrosis in order to salvage a limb. The brachial artery should be totally isolated from the burned area by a muscle flap to prevent vessel disruption. In this study, we report the use of a wrap-around latissimus dorsi muscle flap to protect a skeletonized brachial artery in a high voltage electrical injury in order to salvage the upper extremity and restore function. The flap wrapped around the exposed brachial artery segment and luminal status of the artery was assessed using magnetic resonance angiography. No vascular intervention was required. The flap survived completely with good elbow function. Extremity amputation was not encountered. This method using a latissimus dorsi flap allows the surgeon to protect the main upper extremity artery and reconstruct arm defects, which contributes to restoring arm function in high voltage electrical injury.

Determination of gamma radioactivity levels and associated dose rates of soil samples of the Akkuyu/Mersin using high-resolution gamma-ray spectrometry

In this study several soil samples were collected from the Büyükeceli district where Turkey's first nuclear power plant will be built and radioactivity concentrations of (226)Ra, (232)Th, (40)K and (137)Cs were determined by gamma spectrometry using a high-purity germanium detector. The measured activity concentrations in soil samples ranged from 9.8 ± 0.7 to 258.6 ± 15.8, 11.7 ± 0.9 to 85.6 ± 5.0, 173.8 ± 2.1 to 1949.5 ± 14.7 and 0.4 ± 0.1 to 72.2 ± 2.2 Bq kg(-1) for (226)Ra, (232)Th, (40)K and (137)Cs, respectively. Findings are in good agreement with the published results of neighbouring areas. The absorbed gamma dose rate (D) in air and the annual effective dose of soil samples were calculated to be 80.2 nGy h(-1) and 98.3 mSv y(-1), respectively. The results show that the radiation hazard in the Büyükeceli district is insignificant. The data presented in this study would be very useful to determine the future effects of the nuclear power plant to the environment.

Gold nanoparticle loaded phytosomal systems: synthesis, characterization and in vitro investigations

A novel liposomal formulation was synthesized by encapsulating both gold nanoparticles (AuNPs) andCalendula officinalisextract as AuNP-phytosomes and AuNP-phytosomes were characterized and used atin vitroinvestigations.

An unusual cause of hoarseness: hydatid cyst of the thyroid

Hydatid cyst is a parasitic infestation that is distributed world-wide. It may be found in nearly any part of the body, most often in the liver and the lungs, but occasionally in other structures such as the thyroid gland. Thyroid gland is very rarely involved by this parasitic infection even in Turkey where the echinococcal disease is endemic. In this article we report a very rarely encountered case of thyroid cyst revealed by hoarseness, and underwent subtotal thyroidectomy and diagnosed as primary hydatid cyst disease by histological studies.

The effect of concurrent androgen deprivation and 3D conformal radiotherapy on prostate volume and clinical organ doses during treatment for prostate cancer

In this study, we investigated the shrinking effect of concurrent three-dimensional conformal radiotherapy (3D-CRT) and androgen deprivation (AD) on prostate volume, and its possible impact on the dose received by the rectum and bladder during the course of 3D-CRT. The difference between the prostatic volumes determined on pre-treatment planning CT (PL-CT) and post-treatment CT (PT-CT) following a 3D-CRT course was assessed in 52 patients with localised prostate carcinoma. The changes in mean prostate volume when compared with PL-CT and PT-CT-based measurements were assessed. The pre- and post-treatment mean prostate volumes for the whole study population were 49.7 cm(3) and 41.0 cm(3) (p _ 0.02), respectively. The study cohort was divided into two groups depending on the duration of neoadjuvant androgen deprivation (NAD): 23 patients (44.7%) were designated as "short NAD" (< or =3 months; SNAD) and the remaining 29 (55.3%) as "long NAD" (>3 months; LNAD). Patients on SNAD experienced a significantly greater reduction in prostate volume compared with those on LNAD (14.1% vs 5.1%; p _ 0.03). A significant increase in rectum V(40-60) values in PT-CT compared with PL-CT was demonstrated. LNAD patients had significantly higher rectal V(50-70) values at PT-CT compared with the SNAD group. There was a significant decline in V(30)-V(75) bladder values in PT-CT compared with PL-CT in the SNAD group. In conclusion, a higher prostate volume reduction during 3D-CRT was demonstrated when RT planning was performed within 3 months of NAD. However, this reduction and daily organ motion may lead to an unpredictable increase in rectal doses.

Severe vitamin D deficiency in chronic renal failure patients on peritoneal dialysis

The aim of this study was to evaluate the prevalence of vitamin D deficiency in chronic renal failure (CRF) patients on peritoneal dialysis (PD) and to correlate the findings with various demographic and renal osteodystrophy markers.

METHOD

This cross-sectional, multicenter study was carried out in 273 PD patients with a mean age of 61.7 +/- 10.9 years and mean duration of PD 3.3 +/- 2.2 years. It included 123 female and 150 male patients from 20 centers in Greece and Turkey, countries that are on the same latitude, namely, 36-42 degrees north. We measured 25(OH)D3 and 1.25(OH)2D3 levels and some other clinical and laboratory indices of bone mineral metabolism.

RESULTS

Of these 273 patients 92% (251 patients) had vitamin D deficiency i.e. serum 25(OH)D3 levels less than 15 ng/ml, 119 (43.6%) had severe vitamin D deficiency i.e., serum 25(OH)D3 levels, less than 5 ng/ml, 132 (48.4%) had moderate vitamin D deficiency i.e., serum 25(OH)D3 levels, 5-15 ng/ml, 12 (4.4%) vitamin D insufficiency i.e., serum 25(OH)D3 levels 15 - 30 ng/ml and only 10 (3.6%) had adequate vitamin D stores. We found no correlation between 25(OH)D3 levels and PTH, serum albumin, bone alkaline phosphatase, P, and Ca x P. In multiple regression analyses, the independent predictors of 25(OH)D3 were age, presence of diabetes (DM-CRF), levels of serum calcium and serum 1.25(OH)2D3.

CONCLUSION

We found a high prevalence (92%) of vitamin D deficiency in these 273 PD patients, nearly one half of whom had severe vitamin D deficiency. Vitamin D deficiency is more common in DM-CRF patients than in non-DM-CRF patients. Our findings suggest that these patients should be considered for vitamin D supplementation.

Aspergillus pneumonia in renal transplant recipients at a medical center in Turkey

Pulmonary aspergillosis is a devastating disease. Early diagnosis allowing early treatment may improve the prognosis. However, this goal remains difficult to achieve. When the diagnosis is confirmed, it is often already too late. Despite antifungal treatment, the mortality rate is high. Patients with immunosuppression show a high mortality rate. We present five patients of ages ranging between 34 and 43 years who displayed aspergillus pneumonia between 1991 and 2000. All patients received cyclosporine, azathioprine, and prednisone for maintenance immunosuppressive therapy. Their ages ranged from 34 to 43 years with the onset of infection between 1 to 25 months posttransplant. In all cases, the infection was localized to the lungs. Standard methods of fungal culture and identification were used. No coinfections with tuberculosis or other fungi or bacteria were identified. Three cases were successfully treated but two patients showed deterioration despite appropriate therapy and died. Among patients with solid organ transplantation, lung, liver, and renal transplant patients are at the highest risk of developing aspergillus lung infections. A high degree of awareness and efforts for early diagnosis and therapy may improve the poor prognosis.

Lessons learned from the catastrophic Marmara earthquake: factors influencing the final outcome of renal victims

BACKGROUND

During catastrophic earthquakes, crush syndrome is the second most frequent cause of death after the direct impact of trauma. The Marmara earthquake, which struck Northwestern Turkey in August 1999, was characterized by 639 crush syndrome victims with acute renal problems. The factors influencing their final outcome have been the subject of this study.

PATIENTS/METHODS

Within the first week of the disaster questionnaires asking about 63 clinical and laboratory variables were sent to 35 reference hospitals that treated the victims. Information obtained by means of these questionnaires, including the factors with a potential influence on outcome, was submitted to analysis.

RESULTS

Overall mortality rate was 15.2%. In univariate analysis, nonsurvivors were older (p = 0.048); the highest mortality rates were observed among the victims coming from the closest cities to the reference hospitals. Admission within the first 3 days of the disaster (p = 0.016), with oliguria (p = 0.042), lower figures for blood pressure (p < 0.001), platelets (p = 0.004) and serum albumin (p = 0.005) were associated with mortality. Also, higher body temperature (p = 0.013) and serum potassium (p < 0.001) as well as suffering from thoracic or abdominal traumas, extremity amputations and medical complications other than renal failure (for all 4: p < 0.0001) in addition to need of dialysis support (p = 0.015) and mechanical ventilation (p < 0.0001) indicated higher risk of death. In the multivariate analysis, age (p = 0.030, OR = 1.02), presence of disseminated intravascular coagulation (p = 0.001, OR = 4.49), abdominal trauma (p = 0.012, OR = 4.05) and amputations (p = 0.010, OR = 2.81) were predictors of mortality. Dialyzed patients were characterized by higher mortality rates than nondialyzed victims (17.2% versus 9.3%, p = 0.015).

CONCLUSION

Outcome of the renal victims of catastrophic earthquakes is influenced by the type of trauma, comorbid events and complications observed during the clinical course as well as epidemiological features such as age, distance to reference hospitals and time lapse between disaster and admission to reference hospitals.

Serum levels of leptin and proinflammatory cytokines in patients with gastrointestinal cancer

The aim was to investigate the serum levels of leptin, TNF-alpha, IL-1 beta, IL-6, insulin, and growth hormone in patients with upper gastrointestinal cancer and cachexia. A total of 39 patients with various advanced stage (stage IV) gastrointestinal malignancies were enrolled. These cancer patients were divided into two groups according to the presence or absence of cachexia. Fifteen healthy adults were recruited as the control group. Body mass index (BMI; kg/m2) was calculated. Serum leptin, tumour necrosis factor (TNF)-alpha interleukin (IL)-1 beta, interleukin (IL)-6, growth hormone, insulin, glucose, triglyceride, total protein, albumin, erythrocyte sedimentation rate, and CRP were measured. In both cancer groups (cachectic and non-cachectic) body mass index and serum leptin levels were lower than controls (p < 0.001). Serum IL-1 beta, IL-6, and growth hormone levels were higher in both cachectic and non-cachectic groups than those of controls (p < 0.05). Serum TNF-alpha level in non-cachectic group was also significantly higher than in control group (p < 0.01). There is no significant difference between three groups in terms of insulin resistance as assessed by HOMA index. Our results showed that some proinflammatory cytokine levels were increased and leptin level was decreased due to upper gastrointestinal cancers. Increased cytokine levels may lead to decreased food intake and caused a weight loss.

Nest temperatures and sex-ratio estimates of loggerhead turtles at Patara beach on the southwestern coast of Turkey

During the nesting period in 2000 and 2001 on Patara beach, total emergence and non-nesting emergence of loggerhead turtles (Caretta caretta), nest distribution, and nest distance from the sea were recorded . The main nesting seasons for sea turtles (family Cheloniidae) were during June and July. Loggerhead turtles comprised the majority of sea turtle emergence records; only two green turtle (Chelonia mydas) emergences were recorded. The small nesting population (52 and 53 nests in 2000 and 2001, respectively) of sea turtles on Patara beach was due to low hatching success resulting from a rise in seawater levels, owing to beach erosion, and the subsequent inundation of most nests. The temperatures of four nests and sand at different distances from the sea were measured with electronic temperature loggers, which recorded mean nest temperatures of 28.8–30.7 °C, with the mean temperature in the middle third of the incubation period from 28.5 to 31.0 °C. The mean temperatures, incubation periods, temperature during the middle third of the incubation period, and percentage of hatchling sexes were evaluated with respect to sand and nest temperatures. The results showed a female-dominated sex ratio, which was probably the result of predation of nests far from the sea and the seawater inundation of nests close to the sea, as the sand temperature was different at sites close and far from the sea.

A renal transplant recipient with pulmonary tuberculosis and visceral leishmaniasis: review of superimposed infections and therapy approaches

Visceral leishmaniasis (VL) is an acute or subacute disease that is almost invariably fatal if untreated. It is a rare disease in renal transplant recipients and frequently reported together with other infectious agents. A 39-year-old renal transplant patient was admitted to hospital for elective coronary surgery. In the post-operative period, he developed spiking fever and non-productive cough and his general condition deteriorated. While he was taking medication for non-specific pneumonia, a cavitary lesion occurred in his lung, and he had the diagnosis of pulmonary tuberculosis and antituberculous treatment was started. Despite treatment, his fever continued. As the patient developed pancytopenia and splenomegaly, a bone marrow aspiration was done. Evaluation of bone marrow aspirate indicated Leishmania parasites. He was successfully treated with a more intensive liposomal amphotericin (L-AmB). Complete cure was achieved during follow-up period of 10 months without clinical relapse. In the existence of fever and long-standing pancytopenia, VL should be suspected although the patient had another proved infection and did not live or visit an endemic area. L-AmB usage can be safely preferred for treatment of selected renal transplant recipients with VL as first-line therapy.

Serum potassium in the crush syndrome victims of the Marmara disaster

BACKGROUND

Hyperkalemia is a major cause of mortality in the patients who suffer from crush syndrome in the aftermath of major earthquakes. The aim of this study is to investigate the frequency and effects of hyperkalemia in the 639 victims of catastrophic Marmara earthquake that struck northwestern Turkey, in August 1999.

PATIENTS AND METHODS

Within the first week of disaster, questionnaires were sent to 35 reference hospitals that treated the victims. Information on serum potassium which was provided in 595 out of 639 questionnaires was submitted to analysis.

RESULTS

In the patients who were admitted within the first 3 days of the disaster (n = 401) serum potassium was 5.4 +/- 1.3 mEq/l, which was higher than in those admitted thereafter (n = 171) (4.5 +/- 1.1 mEq/l) (p = 0.02). Considering the whole series, males (p = 0.01), patients needing dialysis support (p < 0.001) and non-survivors (p = 0.001) were characterized by higher serum potassium at admission. Seventy patients' serum potassium was above 7 mEq/l, while 22 patients were hypokalemic (< 3.5 mEq/l). Admission potassium correlated with many clinical and laboratory variables indicating the severity of the trauma, and a logistic regression model with clinical and laboratory parameters upon admission, revealed potassium as the most significant predictor of dialysis needs in the victims admitted within the first 3 days (p = 0.008, OR = 3.33). Among the victims who were admitted to hospitals 1 week after the disaster, 8 had serum potassium levels above 6.5 mEq/l; among 4 of them were complicated by hyperkalemia even higher than 7.5 mEq/l. These findings undeline the importance of hyperkalemia during clinical course.

CONCLUSION

The most important and fatal medical complication in crush syndrome patients is hyperkalemia. Risk of fatal hyperkalemia continues even after hospitalization. Empirical therapy at the scene is indicated especially in male victims with severe soft tissue traumas. Early detection and treatment of hyperkalemia may improve the final outcome of renal disaster victims.

Survival analysis of the factors affecting in mortality in injured patients requiring dialysis due to acute renal failure during the Marmara earthquake: survivors vs non-survivors

BACKGROUND

We reviewed medical records of dialyzed patients admitted to our hospital after the Marmara earthquake and evaluated the factors affecting mortality in survivors and non-survivors according to the survival times.

PATIENTS AND METHODS

Crush syndrome (CS) was diagnosed in 110 patients. Dialysis treatment was initiated in 60 patients; 21 of all died. The patients were divided into 2 groups which consisted of 39 survivors (Group A, 25 male, 14 female, mean age: 31 +/- 2.2 years) and 21 non-survivors (Group B, 9 male, 12 female, mean age: 27 +/- 3.0 years). Victims treated by any form of renal replacement therapy, including daily or intermittant hemodialysis and/or continuous venovenous hemodiafiltration. Clinical and laboratory findings were recorded regularly. Statistical analysis was performed with Kaplan-Meier method, log rank test and Cox regression analysis for the survival functions.

RESULTS

APACHE II scores were 13.5 +/- 0.5 for Group A and 13 +/- 0.9 for Group B. Dialysis support was started to patients in Group A in a mean period of 2.8 +/- 0.2 days and in Group B in a mean period of 3.7 +/- 0.6 days after the earthquake (p > 0.05). The most frequent site of trauma was lower extremity (61.5%) and upper + lower extremities (23%) in Group A, and lower extremity (38.1%) and trunk + lower extremity (23.8%) in Group B. The frequencies of abdominal trauma, pelvic fracture and thoracic trauma in Group B were 23.8%, 19% and 14.2%, respectively. Multiple trauma was more frequent in Group B than in Group A (42.8% vs 2.5%). The rates of fasciotomy, amputation and surgery were similar in both groups. The frequency of sepsis was higher in non-survivors. In our center, the overall mortality rate was 8%, mortality rate in CS was 21% and in dialyzed patients it was 35%. Mortality was mainly associated with sepsis. Survival periods (52.3 +/- 4.0 days) in Group A were longer than in Group B (17.3 +/- 2.5 days). With Cox regression analysis, the parameters such as systolic hypotension on admission, female gender, high serum peak creatine kinase (> 20,000 U/l) and multiple trauma including thoracic and abdominal regions, were factors increasing risk of mortality.

CONCLUSION

As a result, sepsis, multiple trauma and severe crush injury were the main factors increasing mortality risk in dialyzed injuries after the earthquake.

Efficacy of losartan in patients with primary focal segmental glomerulosclerosis resistant to immunosuppressive treatment

OBJECTIVES

Angiotensin II may play an important role in the progression of renal disease. Currently, angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor antagonists are commonly used for renoprotection. To our knowledge, there is no study investigating this effect of angiotensin II receptor antagonists in patients with primary focal segmental glomerulosclerosis (FSGS) in the literature. The aim of this study was to evaluate the effects of losartan on proteinuria and renal function in patients with FSGS refractory to immunosuppressive treatment.

DESIGN

Twenty-three normotensive patients with FSGS proven through renal biopsy were included in the study. Thirteen of them, five men and eight women, were given losartan in a dose of 50 mg day(-1) during 12 months, and 10, four men and six women, were in the control group. Mean arterial blood pressure (MAP), 24-h urine protein excretion, serum total protein and albumin levels were determined just before the start of treatment as well as after 1, 6 and 12 months of the study. In addition, serum creatinine, creatinine clearance (CrCl), cholesterol and triglyceride levels were determined at the beginning and end of the study.

RESULTS

Age, gender and baseline levels of proteinuria, serum albumin, total protein, creatinine, CrCl and MAPs were similar in the two groups. Nephrotic range of proteinuria was present in five of 13 patients (38.4%) in the losartan group and in four of 10 patients (40%) in the control group. In the losartan group, 24-h proteinuria had decreased from 3.6 +/- 0.5 g to 2.3 +/- 0.5 g after 1 month, to 2.4 +/- 0.7 g after 6 months and to 1.9 +/- 0.7 g after 12 months. In the control group, a significant increase in proteinuria compared with the baseline value was noticed after 12 months. Proteinuria levels were significantly higher in the control group than in the losartan group after 6 and 12 months. Whilst total protein and albumin levels increased in the losartan group, they did not change significantly in the control group. The total protein levels after 6 and 12 months, and albumin levels after 6 months were significantly higher in the losartan group than in the control group. No significant change was observed between the baseline and the 12-month creatinine and CrCl levels of the groups when intra- and inter-group comparisons were made. Furthermore, serum cholesterol levels of the losartan group were reduced significantly. The changes in MAP values did not reach significant levels in either of the groups. There was no correlation between the percentage changes in MAP and in proteinuria of the losartan group after 12 months.

CONCLUSIONS

Angiotensin II receptor antagonists may be an alternative therapy in FSGS patients who are resistant to immunosuppressive therapy.

Endogenous granulocyte colony-stimulating factor (G-CSF) levels in chemotherapy-induced neutropenia and in neutropenia related with primary diseases

Granulocyte-colony stimulating factor (G-CSF) and granulocyte macrophage colony-stimulating factor (GM-CSF) are being administered to patients with neutropenia. However, little is known about the endogenous levels of both factors in these patients. We measured the endogenous G-CSF levels in patients with chemotherapy-induced neutropenia (n=15, study group A), in patients who had not received chemotherapy with neutropenia caused by a number of primary diseases (n=14, study group B) and in healthy volunteers (n=15, control group). Both the study groups and the control group did not show any clinical or laboratory findings of infection. The G-CSF levels were elevated in patients following chemotherapy and in patients who had neutropenia without chemotherapy, but the mean G-CSF levels in patients with chemotherapy-induced neutropenia were significantly higher than in patients with primary diseases. The levels of endogenous G-CSF were also higher in both neutropenic groups, compared to the control group. In conclusion, endogenous G-CSF levels in chemotherapy-induced neutropenia were significantly higher than non-chemotherapy related neutropenia and controls. This may be explained as G-CSF synthesizing bone marrow stromal cells may be more affected in primary disease related neutropenia than in chemotherapy induced neutropenia.

A family with IgA nephropathy and hereditary lymphoedema praecox

Immunoglobulin A (IgA) nephropathy is the most common primary glomerulonephritis worldwide. The pathogenesis is still unknown and treatment has not yet been established. Rarely it can be associated with other disorders. Its association with hereditary lymphoedema is not reported before. We report four patients, a 60-year-old father, his two sons and his daughter, with hereditary lymphoedema. The family had nine members and in four of them lymphoedema was evident. The other members had neither lymphoedema nor IgA nephropathy. This is the first report of IgA nephropathy in association with hereditary lymphoedema.