Goal:
16 - Barış, Adalet ve Güçlü Kurumlar

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Barış, Adalet ve Güçlü Kurumlar Sürdürülebilir kalkınma için barışçıl ve kapsayıcı toplumlar tesis etmek, herkes için adalete erişimi sağlamak ve her düzeyde etkili, hesap verebilir ve kapsayıcı kurumlar oluşturmak. Barış, istikrar, insan hakları ve hukukun üstünlüğüne dayalı etkin yönetim olmadan, sürdürülebilir kalkınma olmasını bekleyemeyiz. Gittikçe artan ölçüde bölünmüş bir dünyada yaşıyoruz. Bazı bölgelerde barış, güvenlik ve refah sürekli iken, diğer bazı bölgelerde ise bitmek bilmeyen çatışma ve şiddet sarmalı var. Ancak bu, hiçbir şekilde kaçınılmaz sonuç değildir ve mutlaka çözümlenmelidir.

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PublicationOpen Access

Serum endocan levels in women with restless legs syndrome.

2015-11-19, CELIK, K, ÇıKRıKÇıOĞLU, MA, HALAC, G, KILIC, ERDEM, AYHAN, S, OZARAS, N, Karatoprak, CUMALİ, YILDIZ, KEMALETTİN, YILDIZ, RS, ZORLU, MEHMET, CAKIRCA, MUSTAFA, KıSKAÇ, MUHARREM, KILIÇ, ERDEM, YILDIZ, KEMALETTİN, ZORLU, MEHMET, KARATOPRAK, CUMALİ, ÇAKIRCA, MUSTAFA, KISKAÇ, MUHARREM

Background: Endocan is a recently introduced marker of endothelial dysfunction. The objective of this study was to compare serum endocan levels in patients with restless legs syndrome (RLS) and control subjects in order to elucidate whether RLS is associated with endothelial dysfunction. Methods: A total of 31 drug naïve female patients with RLS and 31 age- and BMI-matched women were included in the study. Patients with pathological or physiological conditions or with a history of medication use that could potentially influence endothelial functions were excluded, as well as those with alcohol or drug abuse history. The two groups were compared with routine blood tests and serum endocan levels. Results: Patients with RLS had lower serum endocan levels than the controls (P=0.037). There was a negative bivariate correlation between RLS severity score and serum endocan levels (r=-0.406, P=0.023). While white blood cell count was significantly higher in RLS group, 25-hydroxy vitamin D3, vitamin B12, transferrin saturation rate, and HDL-cholesterol were significantly lower. Creatininemia and diastolic blood pressure were also marginally insignificantly lower in RLS group. Due to the presence of differences between two groups in these variables, a linear regression analysis was performed that showed a positive association between endocan and creatininemia (β=0.310, P=0.022), and a negative association between endocan and RLS (β=-0.502, P,0.001). Conclusion: The results of this study seem to suggest that patients with RLS may have better endothelial functions when compared with the general population and that these patients may be better protected against atherosclerosis

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PublicationOpen Access

Insulin resistance in severe acne vulgaris

2015-01-01T00:00:00Z, Emiroglu, NAZAN, Cengiz, FATMA PELİN, KEMERIZ, Funda, EMİROĞLU, NAZAN, CENGİZ, FATMA PELIN

Introduction: Acne vulgaris is a pilosebaceous gland disease that usually affects people from puberty to young adulthood. It is seen especially on the face, neck, trunk and arms. Its severity differs from patient to patient and its pathogenesis is multifactorial. The main pathogenic factors of acne are high sebaceous gland secretion, follicular hyperproliferation, high androgen effects, propionibacterium acnes colonization and inflammation. Diet is always thought a probable reason for acne and many studies are done about acne and diet.

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PublicationOpen Access

QT interval changes in term pregnant women living at moderately high altitude

2016-09-01, BATMAZ, G., AKSOY, A., Aydin, SERDAR, Dane, B., AYDIN, SERDAR, KAHRAMAN AY, NURAY

Objective: This study aimed to compare the QT interval changes in women with term pregnancy living at moderately high altitude (1890 m in Erzurum, Turkey) with those of women living at sea level (31 m in İstanbul, Turkey). Materials and Methods: One‑hundred ten women (n = 55, for each group) with full‑term and single child pregnancies. Two different locations in that state were selected: İstanbul, Turkey, which is at 31 m above sea level (Group 1) and Erzurum, Turkey, at 1890 m above sea level (Group 2). Physicians from the two locations participated in the study. We estimated QTc, QTc Max, QTc Min, QT, and QTcd intervals. Results: Moderately high altitude group had significantly longer QT parameters (QTc, QTc Max, QTc Min, QT, and QTcd intervals) compared with sea level group (P < 0.01, for all). Conclusions: According to our results, QT interval changes occur in term pregnant women living moderately high altitude. These changes may be associated with pregnancy‑related cardiovascular complications in moderately high altitude.

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PublicationOpen Access

Female sexual distress in infertile Turkish women İnfertil türk kadınlarda cinsel sıkıntı

2015-12-01, AYDIN, SERDAR, KURT, Nihan, MANDEL, Selen, KAPLAN, Mustafa Arda, KARACA, Nilay, Dansuk, RAMAZAN, AYDIN, SERDAR, DANSUK, RAMAZAN

Objective: To evaluate the effect of infertility on sexual distress in women attending the infertility clinic. Materials and Methods: In a cross-sectional study we evaluated sexual distress among 88 women who attended the infertility clinic in our institute between January and June 2015. All women who were experiencing primary or secondary infertility during the study sampling were included in the sudy. Sexual distress was measured using the Female sexual distress scale-revised (FSDS-R), a cross-validated patient-reported outcomes measure. Correlations of FSDS-R with patient characteristics and laboratory measurements were calculated using Spearman’s rank correlation tests. Results: With the exceptions of the age of couples and serum anti-mullerian hormone (AMH) levels, no predictor of high sexual distress was found in the univariate analysis when comparing groups with regard to the FSDS-R cut-off score. The mean age of the sexually distressed women (33.6±5.8 years vs. 29.3±5.1 years) and their partners (35.4±4.8 years vs. 31.6±4.2 years) was significantly higher than those of the non distressed women, according to a FSDS-R score over 11 (p<0.05). The serum level of AMH was significantly lower in infertile women with high total sexual distress scores (1.4 vs. 7.6 ng/ mL (p<0.001)). Conclusion: In infertile women, age of woman, age of partner, and serum AMH levels are related with the hope of women to have a child despite an association with sexual distress. Serum AMH, which is perceived as necessary for fertility, had a significant inverse correlation with levels of sexual stress.

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PublicationOpen Access

Global overview of health systems oversight and financing for kidney care

2018-02-01, Bello, Aminu K., Alrukhaimi, Mona, Ashuntantang, Gloria E., Bellorin-Font, Ezequiel, Gharbi, Mohammed Benghanem, Braam, Branko, Feehally, John, Harris, David C., Jha, Vivekanand, Jindal, Kailash, Johnson, David W., Kalantar-Zadeh, Kamyar, Kazancioglu, RÜMEYZA, Kerr, Peter G., Lunney, Meaghan, Olanrewaju, Timothy Olusegun, Osman, Mohamed A., Perl, Jeffrey, Rashid, Harun Ur, Rateb, Ahmed, Rondeau, Eric, Sakajiki, Aminu Muhammad, Samimi, Arian, Sola, Laura, Tchokhonelidze, Irma, Wiebe, Natasha, Yang, Chih-Wei, Ye, Feng, Zemchenkov, Alexander, Zhao, Ming-hui, Levin, Adeera, KAZANCIOĞLU, RÜMEYZA

Reliable governance and health financing are critical to the abilities of health systems in different countries to sustainably meet the health needs of their peoples, including those with kidney disease. A comprehensive understanding of existing systems and infrastructure is therefore necessary to globally identify gaps in kidney care and prioritize areas for improvement. This multinational, cross-sectional survey, conducted by the ISN as part of the Global Kidney Health Atlas, examined the oversight, financing, and perceived quality of infrastructure for kidney care across the world. Overall, 125 countries, comprising 93% of the world's population, responded to the entire survey, with 122 countries responding to questions pertaining to this domain. National oversight of kidney care was most common in high-income countries while individual hospital oversight was most common in low-income countries. Parts of Africa and the Middle East appeared to have no organized oversight system. The proportion of countries in which health care system coverage for people with kidney disease was publicly funded and free varied for AKI (56%), nondialysis chronic kidney disease (40%), dialysis (63%), and kidney transplantation (57%), but was much less common in lower income countries, particularly Africa and Southeast Asia, which relied more heavily on private funding with out-of-pocket expenses for patients. Early detection and management of kidney disease were least likely to be covered by funding models. The perceived quality of health infrastructure supporting AKI and chronic kidney disease care was rated poor to extremely poor in none of the high-income countries but was rated poor to extremely poor in over 40% of low-income countries, particularly Africa. This study demonstrated significant gaps in oversight, funding, and infrastructure supporting health services caring for patients with kidney disease, especially in low- and middle-income countries.

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PublicationOpen Access

The Effect of Intraspinal Bupivacaine versus Levobupivacaine on the QTc Intervals during Caesarean Section: A Randomized, Double-blind, Prospective Study

2014-03-01T00:00:00Z, Dogan, Zafer, Yildiz, Huseyin, Akcay, Ahmet, Coskuner, Ismail, ARIKAN, DENİZ CEMGİL, Silay, Emin, Akbudak, Ilknur H., Kaya, Hakan, ÖKSÜZ, HAFİZE

The aim of this study was to describe whether or not spinal anaesthesia with bupivacaine versus levobupivacaine has any effects on the QTc interval during caesarean section. Sixty healthy pregnant women scheduled for elective caesarean section were randomized to spinal anaesthesia with either bupivacaine (the bupivacaine group) or levobupivacaine (the levobupivacaine group). ECG recordings were performed prior to spinal anaesthesia at baseline (T1), 5min. after spinal anaesthesia, but before uterine incision (T2), and after skin closure (T3). QT intervals were calculated and corrected with the patients- heart rate according to the Bazett formula. Compared with baseline values, mean maximum QTc intervals at T2 and T3 were significantly longer in the levobupivacaine group, but only at T2 in the bupivacaine group. In addition, compared with the bupivacaine group, the QTc maximum interval at T3 was significantly longer in the levobupivacaine group. At T2, the QTc maximum intervals were longer than baseline in both groups. By the end of the surgery, the prolongation of the QTc interval had disappeared in the bupivacaine group but not in the levobupivacaine group.

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PublicationOpen Access

Global access of patients with kidney disease to health technologies and medications: findings from the Global Kidney Health Atlas project

2018-02-01, Htay, Htay, Alrukhaimi, Mona, Ashuntantang, Gloria E, braum, branko, gharbiğ, mohammed benghanem, Feehally, John, Harris, David C, KAZANCIOĞLU, RÜMEYZA, KAZANCIOĞLU, RÜMEYZA

Access to essential medications and health products is critical to effective management of kidney disease. Using data from the ISN Global Kidney Health Atlas multinational cross-sectional survey, global access of patients with kidney disease to essential medications and health products was examined. Overall, 125 countries participated, with 118 countries, composing 91.5% of the world's population, providing data on this domain. Most countries were unable to access eGFR and albuminuria in their primary care settings. Only one-third of low-income countries (LICs) were able to measure serum creatinine and none were able to access eGFR or quantify proteinuria. The ability to monitor diabetes mellitus through serum glucose and glycated hemoglobin measurements was suboptimal. Pathology services were rarely available in tertiary care in LICs (12%) and lower middle-income countries (45%). While acute and chronic hemodialysis services were available in almost all countries, acute and chronic peritoneal dialysis services were rarely available in LICs (18% and 29%, respectively). Kidney transplantation was available in 79% of countries overall and in 12% of LICs. While over one-half of all countries publicly funded RRT and kidney medications with or without copayment, this was less common in LICs and lower middle-income countries. In conclusion, this study demonstrated significant gaps in services for kidney care and funding that were most apparent in LICs and lower middle-income countries.

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PublicationOpen Access

Global capacity for clinical research in nephrology: a survey by the International Society of Nephrology

2018-02-01, Okpechi, Ikechi G., Alrukhaimi, Mona, Ashuntantang, Gloria E., Bellorin-Font, Ezequiel, Gharbi, Mohammed Benghanem, Braam, Branko, Feehally, John, Harris, David C., Jha, Vivekanand, Jindal, Kailash, Johnson, David W., Kalantar-Zadeh, Kamyar, Kazancioglu, RÜMEYZA, Levin, Adeera, Lunney, Meaghan, Olanrewaju, Timothy Olusegun, Perkovic, Vlado, Perl, Jeffrey, Rashid, Harun Ur, Rondeau, Eric, Salako, Babatunde lawal, Samimi, Arian, Sola, Laura, Tchokhonelidze, Irma, Wiebe, Natasha, Yang, Chih-Wei, Ye, Feng, Zemchenkov, Alexander, Zhao, Ming-hui, Bello, Aminu K., KAZANCIOĞLU, RÜMEYZA

Due to the worldwide rising prevalence of chronic kidney disease (CKD), there is a need to develop strategies through well-designed clinical studies to guide decision making and improve delivery of care to CKD patients. A cross-sectional survey was conducted based on the International Society of Nephrology Global Kidney Health Atlas data. For this study, the survey assessed the capacity of various countries and world regions in participating in and conducting kidney research. Availability of national funding for clinical trials was low (27%, n = 31), with the lowest figures obtained from Africa (7%, n = 2) and South Asia (0%), whereas high-income countries in North America and Europe had the highest participation in clinical trials. Overall, formal training to conduct clinical trials was inadequate for physicians (46%, n = 53) and even lower for nonphysicians, research assistants, and associates in clinical trials (34%, n = 39). There was also diminished availability of workforce and funding to conduct observational cohort studies in nephrology, and participation in highly specialized transplant trials was low in many regions. Overall, the availability of infrastructure (bio-banking and facilities for storage of clinical trial medications) was low, and it was lowest in low-income and lower-middle-income countries. Ethics approval for study conduct was mandatory in 91% (n = 106) of countries and regions, and 62% (n = 66) were reported to have institutional committees. Challenges with obtaining timely approval for a study were reported in 53% (n = 61) of regions but the challenges were similar across these regions. A potential limitation is the possibility of over-reporting or under-reporting due to social desirability bias. This study highlights some of the major challenges for participating in and conducting kidney research and offers suggestions for improving global kidney research.

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PublicationOpen Access

New Fetal Dose Estimates from F-18-FDG Administered During Pregnancy: Standardization of Dose Calculations and Estimations with Voxel-Based Anthropomorphic Phantoms

2016-11-01, Zanotti-Fregonara, Paolo, Chastan, Mathieu, Edet-Sanson, Agathe, Ekmekcioglu, Ozgul, Erdogan, EZGİ BAŞAK, Hapdey, Sebastien, Hindie, Elif, Stabin, Michael G., ERDOĞAN, EZGİ BAŞAK

Data from the literature show that the fetal absorbed dose from 18F-FDG administration to the pregnant mother ranges from 0.5E-2 to 4E-2 mGy/MBq. These figures were, however, obtained using different quantification techniques and with basic geometric anthropomorphic phantoms. The aim of this study was to refine the fetal dose estimates of published as well as new cases using realistic voxel-based phantoms. Methods: The 18F-FDG doses to the fetus (n = 19; 5-34 wk of pregnancy) were calculated with new voxel-based anthropomorphic phantoms of the pregnant woman. The image-derived fetal time-integrated activity values were combined with those of the mothers' organs from the International Commission on Radiological Protection publication 106 and the dynamic bladder model with a 1-h bladder-voiding interval. The dose to the uterus was used as a proxy for early pregnancy (up to 10 wk). The time-integrated activities were entered into OLINDA/EXM 1.1 to derive the dose with the classic anthropomorphic phantoms of pregnant women, then into OLINDA/EXM 2.0 to assess the dose using new voxel-based phantoms. Results: The average fetal doses (mGy/MBq) with OLINDA/EXM 2.0 were 2.5E-02 in early pregnancy, 1.3E-02 in the late part of the first trimester, 8.5E-03 in the second trimester, and 5.1E-03 in the third trimester. The differences compared with the doses calculated with OLINDA/EXM 1.1 were +7%, +70%, +35%, and -8%, respectively. Conclusion: Except in late pregnancy, the doses estimated with realistic voxelwise anthropomorphic phantoms are higher than the doses derived from old geometric phantoms. The doses remain, however, well below the threshold for any deterministic effects. Thus, pregnancy is not an absolute contraindication of a clinically justified 18F-FDG PET scan.

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PublicationOpen Access

Hemodialysis Experience of a Large Group of Syrian Refugees in Turkey: All Patients Deserve Effective Treatment

2019-01-01, Gursu, MELTEM, ARICI, MUSTAFA, Ates, Kenan, Kazancioglu, RÜMEYZA, Yavas, Pinar Guneser, Öztürk, Murat, ALTUN, BÜLENT, Arinsoy, Turgay, GÜRSU, MELTEM, KAZANCIOĞLU, RÜMEYZA

Background/Aims: Refugee dialysis is a worldwide growing dilemma with limited experience. This report presents the largest hemodialysis (HD) patient registry data of Syrian refugees in Turkey. Methods: Demographic, clinical, laboratory, and dialysis practice data of 345 Syrian HD patients during one year were collected and analyzed. Results: There were 345 prevalent Syrian HD patients at the end of 2016. Majority of the patients were placed in the Southeast Anatolian Region. The majority of the patients (74.8%) are in the age range of 20-64 years. Dialysis vintage in Turkey is less than 12 months in 20.8% and less than one month in 29.3% of patients. The vascular access was arteriovenous fistula in the majority of patients (72.5%). Kt/V is over 1.7 in 57%, serum albumin is above 35 g/L in 65.8% and hemoglobin level is more than 100 g/L in %65.2 of the patients. The ratio of patients with serum phosphorus level of 1.13-1.77 mmol/L was 56.2%. Twenty Syrian HD patients (14 male, 6 female) died within the year 2016 and annual mortality rate was 5.7%. Conclusion: This study with the largest number of Syrian refugees undergoing maintenance hemodialysis showed good dialysis practices, acceptable values for dialysis adequacy and biochemical parameters along with lower mortality compared to native HD population of Turkey. Longer follow up will enrich the knowledge related to care of refugee population in all over the world.