From disabled tourists to impaired cyborg tourists: What would it take to transform?

Despite the media reports and governments promoting tourism as a fundamental right for everyone, traveling is still not accessible for disabled people. This study has highlighted the need to make tourists with disabilities accessable for inaccessible destinations. Cyborg products in the form of technological implants can make tourists with disabilities accessable for inaccessible destinations. Since tourists with a mobility disability (TMD) will be one of the primary beneficiaries of technological implants, little is known about their acceptance of technological implants during traveling.Therefore, this study assesses the willingness of TMD to use technological implants during traveling through a qualitative research approach. The results from thematic analysis identified two main themes: the use of assistive devices during traveling with four sub-themes (freedom of traveling, physical and attitudinal barriers, cost, and additional assistance and battery issues), and drivers of impaired cyborg tourists with seven sub-themes (independence, improved well-being, convenience/ease of use, social inclusion, positive emotions, motivation, and other issues). The study contributed to the literature by introducing drivers of impaired cyborg tourists along with previously identified concepts. The results also provided implications for the stakeholders of the tourism industry.

Is thyroid-stimulating hormone a predictor of severity of carotid artery disease?

OBJECTIVE

The relationship between thyroid function and carotid artery stenosis in euthyroid patients is controversial. Therefore, we aimed at evaluating the relationship between the severity of carotid artery disease (CAD) and thyroid-stimulating hormone (TSH) levels in euthyroid patients.

PATIENTS AND METHODS

A total of 90 euthyroid patients with CAD were trichotomized into three groups based on CAD severity. Group 1 comprised patients who had one internal carotid artery with total stenosis and the other with more than 50% stenosis. In Group 2, patients had one internal carotid artery with total stenosis and the other with less than 50% stenosis. Group 3 comprised patients with less than 50% stenosis in both internal carotid arteries. Demographic data, complete blood count, biochemical parameters, and thyroid function parameters were compared between the groups.

RESULTS

No significant relationship was noted between the severity of CAD and demographic data and comorbidity rates. A comparison of the biochemical parameters revealed that TSH levels were significantly different between the groups. Post-hoc analysis showed that Group 1 and Group 3 differed significantly with respect to TSH levels (0.75 ± 0.37 IU/mL vs. 1.39 ± 1.00 IU/mL, p=0.002). A cut-off value of 0.65 yielded 46.67% sensitivity and 81.67% specificity, whereas a cut-off value of 0.70 yielded 53.33% sensitivity and 75.00% specificity. The area under the curve was 0.691 (95% CI, 0.576-0.806) (p=0.003).

CONCLUSIONS

TSH can be demonstrated to predict severe carotid artery disease. Therefore, the severity of CAD can be assessed using TSH levels.

The role of clean energy in the development of sustainable tourism: does renewable energy use help mitigate environmental pollution? A panel data analysis

The tourism industry has long been accused of being the major driver of global warming as a result of the size of the industry and its subsequent high energy consumption, most of which comes from sources that emit carbon dioxide. However, in spite of the criticism directed towards tourism due to its negative effects on the environment, there is a scarcity of research that has aimed to ascertain its impact on the environment, thus revealing the existence of a gap in the literature. The current study uses a dynamic GMM model for 38 OECD countries from 2008 to 2019 for the purpose of filling the gap in the literature by investigating the effects of tourism development on the environment, as well as ascertaining the role of renewable energy in mitigating environmental impact. Unlike past studies that have alluded to the fact that tourism development exacerbates the emissions of carbon dioxide and hence global warming, the current research shows that in the OECD countries, tourism does not have any significant link with greenhouse gas emissions. This is because OECD nations have long started to shift from the use of fossil fuels to renewable sources of energy that do not exacerbate greenhouse gas emissions. However, the current research concurs with the findings of past studies that renewable energy consumption significantly decreases greenhouse gas emissions. The use of renewable energy sources instead of fossil fuels should continue to be encouraged in all nations for the purpose of achieving the carbon neutrality goal of the United Nations.

Should coronary catheter laboratories be used in the treatment of ischemic stroke? Endovascular treatment in acute ischemic stroke performed by interventional cardiologists

OBJECTIVE

The aim of this study was to investigate the technical success and in-hospital outcomes of endovascular thrombectomy (ET) in acute ischemic stroke (AIS) patients performed by interventional cardiologists.

PATIENTS AND METHODS

ET for AIS provides fast, effective and safe recanalization. Insufficient number of catheter laboratories for stroke interventions and experienced interventional neurologists are limiting the widespread application of such a promising treatment method.

RESULTS

123 patients with AIS and eligible for ET were evaluated retrospectively. 65 patients were female (52.8%) and the mean age of the patients was 71.5 ± 11.9 years. Most of the patients had a middle cerebral artery (MCA) occlusion (112 patients, 91%). Successful recanalization (thrombolysis in cerebral infarction grading 2b or higher) was achieved in 109 patients (88.6%). Access site complication was observed only in 3 patients (2.4%). Intracranial bleeding was observed in 17 patients (13.8%) and only 8 of them were symptomatic (6.5%). In-hospital death occurred in 19 patients (15.4%). The initial National Institutes of Health Stroke Scale (NIHSS) was 16.8±3.3 (median 18) which improved significantly to 10.4±7.2 (median 11) at 24 hours (p<0.001). Dramatic neurologic improvement was observed in 60 of 123 patients (48.8%). The modified rankin score of the patients was significantly lower at discharge compared to admission (4.2±0.7 vs. 2.9±2, p<0.001).

CONCLUSIONS

ET in AIS can be performed safely with high success rates by trained interventional cardiologists within the stroke team. Until the number of stroke centers is sufficient, endovascular treatment of AIS can be supported by experienced interventional cardiologists.

Insufficient decontamination in Sewage treatment plants induce the risk of artificial selection of extended-spectrum β-lactamase producing Escherichia coli

Quantitative data about extended-spectrum beta-lactamase producing E. coli (ESBLEC) in the wastewaters are scarce, especially in developing countries. These data could be useful to raise awareness about the potential risk of spreading ESBLEC strains in the community. Water samples were collected weekly over a 10-week period, from one urban sewage treatment plant (STP), one rural STP and one hospital complex's wastewater (HWW) in Turkey. Mean E. coli and ESBLEC loads were determined for each sampling point. For the 580 ESBLEC isolated, antimicrobial resistance profiles, phylogenetic grouping, presence of common beta-lactamese-typesand integrons were studied using PCR. The mean ESBLEC ratio was accounted for 0.58%, 0,12%, 1.53% of the total E. coli in urban, rural untreated wastewater and HWW, respectively. These values were higher for the outlets. The mean number of different antimicrobial classes to which the strains were resistant was highest in urban STP (4.0± 1.6). The antimicrobial resistance ratios of ESBLEC strains isolated from HWW were observed to be in between those of urban and rural STPs. The most common phylogenetic group was C composing (29.7%) and the most susceptible strains belonged to phylogroup B1. Wastewater treatments without sufficient decontamination, resulting in artificial selection of ESBLEC might lead to public health risk as these strains reach communities through environment. To avoid such risks and protect the human health as well as the environment, well-established decontamination measures imposing barriers against this artificial selection should be implemented.

Bismuth nitrate-promoted disproportionative condensation of indoles with cyclohexanone: a new-type azafulvenium reactivity of indole

The bismuth nitrate-promoted disproportionative condensation of indoles with cyclohexanone in one pot, to yield C3-cyclohexyl substituted indoles and 1,3-di(1H-indol-3-yl)benzene derivatives is reported for the first time.

Comparison of the factors affecting neurological outcome in out-of vs in-hospital cardiac arrest cases

OBJECTIVE

To determine the differences between the factors such as return of spontaneous circulation positivity, duration of cardiopulmonary resuscitation, and cardiac rhythm at first arrival affecting neurological outcomes in cardiac-arrest cases.

METHODS

This study was conducted at the Malatya State Hospital, Malatya, Turkey, from January to December 2014, and comprised patients who had received cardiopulmonary resuscitation. Patients were divided into two groups; in-hospital cardiac arrest and out-of-hospital cardiac arrest. The groups were compared in terms of gender, age, initial rhythm, cardiopulmonary resuscitation durations, cardiopulmonary resuscitation results (exitus, return), return of spontaneous circulation rates observed after cardiopulmonary resuscitation, and neurological outcome responses of the cases in which return of spontaneous circulation was observed. SPSS 22 was used for data analysis.

RESULTS

Of the 321 cases, 88(27.41%) were in-hospital and 233(72.59%) were out-of-hospital cardiac arrest cases. Besides, 189(58.9%) of the patients were men and 132(41.1%) were women with an overall mean age of 67.21±15.25 years (range: 18-98 years). Moreover, 16(18.2%) in-hospital cases and 47(20.2%) out-of-hospital cases had shockable rhythms at the time of arrival. Cardiopulmonary resuscitation was applied to 74(23%) patients for less than 20 minutes and to 247(76.9%) for more than 20 minutes. Return of spontaneous circulation positivity was recorded in 134(41.7%) patients, of whom 62(70.5%) were in-hospital and 72(30.9%) were out-of-hospital cases. Moreover, 19(5.9%) patients were discharged with good neurological outcome. In cases where cardiopulmonary resuscitation was applied for less than 20 minutes, return of spontaneous circulation positivity was present in 43(100%) in-hospital and 31(100%) out-of-hospital cases. Return of spontaneous circulation positivity and good neurological outcome rate of the patients having shockable rhythms was 48(76.2%) and 8(12.7%), respectively.

CONCLUSIONS

Return of spontaneous circulation positivity, favourable neurological outcome response and survival rates were significantly higher among in-hospital cardiac arrest cases.

Is ischemia modified albumin a disease activity marker for inflammatory bowel diseases?

BACKGROUND AND AIM

We aimed to identify ischemia-modified albumin (IMA) levels in inflammatory bowel disease (IBD) and IBD subgroups, and to examine its relation with disease activity index.

METHODS

Sixty-eight patients with IBD (35 ulcerative colitis [UC] and 33 crohn disease [CD]) and 65 healthy volunteers were included in the study. Rachmilewitz scoring system (endoscopic activity index [EAI]) was used to determine UC activity, and as for CD activity, CD activity index (CDAI) scoring was used. IMA measurement was performed with ELISA kit.

RESULTS

Ischemia-modified albumin levels in IBD, UC, and CD groups were comparably higher than the control group (37.7 ng/mL vs 42.4 ng/mL vs 36.4 ng/mL vs 21.8 ng/mL, respectively; P < 0.05). In IBD group, a positive correlation was identified between IMA level and CRP (r = 0.325, P = 0.011), EAI(r = 0.302, P = 0.020), and CDAI (r = 0.311, P = 0.013). In stepwise regression model; it was identified that IMA(OR = 1.496; P = 0.016) and CRP(OR = 3.457; P = 0.015) are predictors of IBD in comparison with the control group. In linear regression model, it was identified that risk factors such as log(IMA) and log(CRP) were independent predictors of log(CDAI) and log(EAI) levels.

CONCLUSION

This is the first study showing that IMA levels in IBD were determined higher in comparison with the control group. Moreover, IMA being a predictor for IBD and being positively correlated with disease activity indexes were determined for the first time in the study. In accordance with these results, it is possible to say that IMA in IBD might be related with the pathogenesis of disease and correlated with the severity of the disease.

The role of soluble tumor necrosis factor like weak inducer of apoptosis and interleukin-17A in the etiopathogenesis of celiac disease: A cross-sectional study

Our aim in this study was to determine soluble tumor necrosis factor (TNF)-like weak inducer of apoptosis (sTWEAK) and interleukin-17A (IL-17A) levels in celiac disease, and their association with the gluten diet and autoantibodies. Eighty patients with celiac diagnosis and 80 healthy control individuals with similar age, gender and body mass index to the patient group were included in the study. Serum sTWEAK and IL-17A levels were measured by the serum enzyme-linked immunosorbent assay kit. The median IL-17A (117.5 pg/mL vs. 56.7 pg/mL; P = 0.001) level in celiac patients was higher than in the control group, while the median sTWEAK (543 pg/mL vs. 643 pg/mL; P = 0.016) level in patients was determined to be lower. In the patient group, patients who complied with the gluten diet had a lower level of median IL-17A (98.1 pg/mL vs. 197.5 pg/mL; P = 0.034) and a higher level of sTWEAK (606 pg/mL vs. 522.8 pg/mL; P = 0.031) than those who did not adhere. Furthermore, the IL-17A level was higher and the sTWEAK level was lower in celiac patients with positive antibody than those with negative antibody. A positive correlation was determined among anti-gliadin antibody IgA, anti-gliadin antibody IgG, anti-tissue transglutaminase IgG levels and the IL-17A level, and a negative correlation was determined with the sTWEAK level. In celiac disease, the sTWEAK and IL-17A levels differ between patients who cannot adapt to the gluten diet and who are autoantibody positive, and patients who adapt to the diet and are autoantibody negative. We believe that sTWEAK and IL-17A are associated with the inflammation in celiac pathogenesis.

Comparison of thiol/disulphide homeostasis parameters in patients with COPD, asthma and ACOS

OBJECTIVE

Chronic obstructive pulmonary disease (COPD), asthma and asthma-COPD overlap syndrome (ACOS) are obstructive pulmonary disorders with different manifestations. Status of oxidation in tissues is important in obstructive pulmonary disorders. Smoking, acute exacerbations of COPD and asthma were associated with a marked imbalance in oxidant or antioxidant status due to increased oxidative stress in tissues and blood. Oxidative conditions may cause a reversible formation of mixed disulphides among protein thiol groups. The aim of this study was to compare parameters related with thiol/disulphide homeostasis in patients with COPD, asthma and ACOS.

PATIENTS AND METHODS

Patients (n= 135, 69 females, 66 males) who were referred with a diagnosis of COPD, asthma or ACOS were included in the study. Thiol/ disulphide homeostasis parameters in blood were analysed by a newly established method that measures the exact thiol/ disulphide status in the body.

RESULTS

The patients with COPD, asthma or ACOS were similar for demographic parameters other than age and number of cigarettes smoked. Measured thiol/disulphide homeostasis parameters were similar among these patient groups. When these biochemical measurements were adjusted for age and number of cigarettes by using regression analysis, similarity for thiol/disulphide homeostasis parameters among patient groups persisted.

CONCLUSIONS

To best of our knowledge, this is the first study to compare thiol/disulphide homeostasis parameters in COPD, asthma and ACOS patients. Similarity of thiol/disulphide homeostasis parameters among these patient groups supports the current view of Dutch hypothesis that COPD, asthma and ACOS share similar pathophysiological features but display different clinical manifestations.

Late-Onset BK Viruria in Renal Transplant Recipients

BACKGROUND

Most cases of BK virus (BKV) infections emerge within the 1st years of kidney transplantation. We aimed to determine the prevalence of late-onset BKV infection and whether there are any differences between risk factors in early and late BKV infections.

METHODS

In this single-center retrospective study, we reviewed 300 kidney transplant recipients that were under regular follow-up and selected recipients with BKV infection and recorded associated risk factors, connection with immunosuppression, and responses to modification of treatment.

RESULTS

BKV was detected within the 1st 5 years after transplantation in 20 patients (6.6%, group 1) and after 5 years in 15 patients (5.0%, group 2). There were no significant differences between the 2 groups regarding age, sex, sex mismatches, donor type, BKV elimination time, serum creatinine, and estimated glomerular filtration rate at the times of BKV detection and last follow-up visit. In group 1, 2 recipients had biopsy-proven BKV-associated nephropathy (BKVAN), 3 recipients had BK viruria and viremia without BKVAN (biopsy proven), and 15 recipients (75%) had only BK viruria. In group 2, all of the patients had only BK viruria. In this group, on detection of BK viruria and immediate modification of immunosuppressive regimens prevented BK viremia.

CONCLUSIONS

Routine screening of renal transplant recipients for BKV was indicated not only during the 1st 5 years, but also for the full follow-up period after transplantation.

Diastolic dysfunction and contrast-induced nephropathy in patients undergoing coronary angiography

OBJECTIVES

It has been demonstrated that decreased left ventricular ejection fraction (LVEF) is associated with an increased risk of contrast-induced nephropathy (CIN). In this study, we aimed to assess whether there is a relationship between left ventricular (LV) diastolic dysfunction and renal function decline after coronary angiography (CAG).

PATIENTS AND METHODS

The study consisted of two groups: group I, patients with normal diastolic function; group II, patients with cardiac symptoms and abnormal diastolic function. Serum creatinine (Crea) and glomerular filtration rates (GFR) were measured before and after 48 h of CAG.

RESULTS

After the procedure, serum Crea values were higher in group II compared with group I (p = 0.051). Postprocedural 48-h GFR values determined by Cockcroft-Gault and Modification of Diet in Renal Disease (MDRD) equations were lower in group II compared with group I (p = 0.016 and p = 0.003, respectively). Delta (Δ) ΔCrea and ΔGFR determined by the Cockcroft-Gault and MDRD equations were statistically higher in group II than in group I (p = 0.005, p = 0.052, p = 0.030). The presence of higher age (p = 0.025), E/E' lateral ratio (p = 0.030), and left atrial volume index (p = 0.05) were independent predictors of worsening renal function.

CONCLUSION

The presence of diastolic dysfunction may play a role in determining the risk of CIN in patients with normal LVEF.

Effect of boron addition on injection molded 316L stainless steel: mechanical, corrosion properties and in vitro bioactivity

The research was investigated the effect of boron additions on sintering characteristics, mechanical, corrosion properties and biocompatibility of injection molded austenitic grade 316L stainless steel. Addition of boron is promoted to get high density of sintered 316L stainless steels. The amount of boron plays a role in determining the sintered microstructure and all properties. In this study, 316L stainless steel powders have been used with the elemental NiB powders. A feedstock containing 62.5 wt% powders loading was molded at different injection molded temperature. The binders were completely removed from molded components by solvent and thermal debinding at different temperature. The debinded samples were sintered at different temperature for 60 min. Mechanical property, microstructural characterization and electrochemical property of the sintered samples were performed using tensile testing, hardness, optical, scanning electron microscopy and electrochemical corrosion experiments. Sintered samples were immersed in a simulated body fluid (SBF) with elemental concentrations that were comparable to those of human blood plasma for a total period of 15 days. Both materials were implanted in fibroblast culture for biocompatibility evaluations were carried out. Results of study showed that sintered 316L and 316L with NiB addition samples exhibited high mechanical and corrosion properties in a physiological environment. Especially, 316L with NiB addition can be used in some bioapplications.

Scorpion sting: eclampsia

Scorpion stings are common in many regions of the world, particularly in rural areas. While most of the stings are harmless and tend to be milder, some stings rarely have severe clinical course, including neurological, cardiovascular and respiratory system complications. Although there are many studies in the literature related to the scorpion sting, data on effects of scorpion stings in pregnant woman are very little. The authors have not come across any case report of eclampsia as a complication of scorpion sting. With this study, the authors aimed to discuss a scorpion sting lead to an unexpected complication, eclampsia.

Prolonged bleeding due to a medicinal leech bite: another treatment method, primary suture

Medicinal leeches have been used in the treatment of many diseases for thousands of years. A 25-year-old man presented to our emergency department with bleeding from right and left side of his neck. He had applied leeches 10 h previously to both sides of his neck to treat acne. The bleeding was not controlled by applying pressure with sterile gauze upon the wounds. Homeostasis was achieved by primary suture under local anaesthesia. Prolonged bleeding can be seen following medical leech application. In such cases, bleeding can be controlled by primary suture.

Acute coronary syndrome triggered by honeybee sting: a case report

A 56-year-old previously healthy man was admitted to our hospital with a severe chest pain that started shortly after being stung by a honeybee. He did not have any allergic symptoms and there was no cutaneous or respiratory evidence of allergy on physical examination. Electrocardiographic and biochemical markers were consistent with an acute coronary syndrome. Coronary angiography demonstrated a significant thrombotic lesion in the right coronary artery. Here, a rare and unexpected event is presented, the development of acute coronary syndrome after a bee sting.

Asthma in obese women: outcomes and factors involved

OBJECTIVE

It has been shown that the prevalence of asthma in obese people has increased in recent years. The aim of this study was to evaluate factors involved in the relationship between asthma and obesity in women,

METHODS

We evaluated serum leptin levels, fractional exhaled nitric oxide (FE(N0), asthma control (using theAsthma Control Test [ACT]), and presence of atopy in 41 obese women with asthma and 40 non-obese women with asthma. We also compared the relationship between body mass index (BMI) and these parameters between the 2 groups.

RESULTS

Serum leptin levels were significantly higher in obese asthmatics than in nonobese asthmatics (P < .05). In the obese group, leptin levels were positively correlated with FE(O) levels (r = 0.439, P = .004). Uncontrolled asthma (ACT score <20) was detected in 61% of women in the obese group compared to just 38% of those in the nonobese group (P = -.035). In atopic patients, total immunoglobulin E levels were positively correlated with leptin levels (r = 0.329, P = .038). When the 81 women were classified according to asthma control, high BMI was found to be the only significant factor that contributed to poor asthma control.

CONCLUSION

We have shown that serum leptin levels might have a role in poor asthma control in obese patients, and can conclude that obesity is an important factor in uncontrolled asthma.

Serum leptin concentration and advanced gastrointestinal cancers: a case controlled study

BACKGROUND

Serum leptin level is associated with appetite and energy expenditure in healthy individuals. We aimed to evaluate the serum leptin concentration and the other factors which may be associated with weight loss in patients with advanced gastrointestinal cancer.

METHODS

Forty-four patients with advanced gastrointestinal cancer (25 gastric and 19 colorectal cancer) and 25 healthy controls were enrolled. Serum leptin levels were measured as ng/ml via enzyme linked immuno-sorbent assay (ELISA) method in all subjects. The difference in serum leptin concentration between cancer and control group, the factor associated with its serum level and the relationship between serum leptin concentration and weight loss was evaluated.

RESULTS

Serum leptin concentration of cancer group was significantly lower than controls (p = 0.002). Female subjects had significantly higher serum leptin concentration than male subjects in control group (p = 0.01), while not in cancer group (p > 0.05). Serum leptin concentration was significantly related with gender in controls (p = 0.023, beta = 0.479), while no gender difference was observed in cancer group (p > 0.05). No relationship was found between serum leptin concentration and weight loss percentage in cancer group in linear regression analysis (p > 0.05). No significant difference was observed in serum leptin concentrations between colon and gastric cancer sub-groups (p > 0.05).

CONCLUSION

Independently from the site of gastrointestinal tract, serum leptin concentration in advanced gastrointestinal cancer is lower than controls and it is not a determinant factor in weight loss. In contrast to healthy subjects, gender does not effect the serum leptin concentration in patients with advanced gastrointestinal cancer.

Anti-Candida antibody levels in psoriasis vulgaris

Recent reports have suggested a role of Candida colonization of gut in psoriatic patients. In this study, intestinal yeasts and anti-candida immune response were investigated in 39 patients with psoriasis vulgaris. Anti-candida antibodies were determined by indirect haemagglutination (IHAT) and indirect immunofluorescence (IFAT) tests. Stool specimens showed 93pc C. albicans colonization but none of the patients showed clinical candidiasis. Four patients showed an increased IHAT titer and six patients showed an increased IFAT titer, the others were all in normal limits. Anti-Candida antibody titers did not correlate with PASI (Psoriasis area and severity index) scores.