Return to Community Mental Health Centers after the Pandemic: A Qualitative Study on Turkish Patients' Subjective Experiences.

BACKGROUND: Community mental health centers (CMHCs) are important institutions for individuals with chronic mental illness. During the COVID-19 period, patients with mental health could not optimally access care in CMHCs. AIM: To explore the experiences of patients using a CMHC after its closure due to the COVID-19 pandemic. PATIENTS AND METHODS: This was a descriptive qualitative study that included 16 patients with mental disorders who regularly used CMHCs during the pre-pandemic period. Their data were collected between March 2022 and August 2022 using face-to-face, in-depth semi-structured interviews. All interviews were recorded and the content analysis method was used to analyze the data. RESULTS: The age range of the 16 study participants was 29-53 years with a mean age of 40.8 ± 6.5 years. Nine (56.3%) participants were men, and 7 (43.7%) were women. Ten (62.5%) participants had schizophrenia, whereas 6 (37.5%) had bipolar disorder. According to content analysis, the five main themes that emerged based on the statements of participants were the effects of change, difficulties experienced, support needs, coping experiences, and suggestions. The results showed that although patients using CMHCs are struggling with the adverse consequences of the pandemic process, they also have difficulty managing their diseases and daily life due to their inability to access psychosocial services in the CMHCs. CONCLUSION: The patients reported their negative experiences and need for support during the pandemic. The study highlights the need to adequately accommodate mental health services delivery during future pandemics that may impose movement restrictions.

Pigmented villonodular synovitis: Four pediatric cases and brief review of literature.

Pigmented villonodular synovitis (PVNS) is a rare benign disorder of a joint which affects its synovium, tendon sheaths and bursas. While most cases of PVNS are adult patients aged between 20-50 years, few afflicted children have also been reported. Clinical signs of PVNS are insidious and non-specific. Pain, swelling and stiffness are the major symptoms. Magnetic Resonance Imaging (MRI) is the best radiological method for diagnosis of PVNS, as the initial X-ray is normal in early phase of disease in most cases. Therefore, diagnosis is often delayed or confused with mechanical disorders, haemophilic arthropathy, tuberculosis, juvenile idiopathic arthritis (JIA), and other disorders. Four paediatric PVNS cases are being reported in this case series with the aim to highlight that PVNS should be considered in the differential diagnoses of chronic monoarthritis. Two of our cases were initially misdiagnosed as JIA and the remaining two as Familial Mediterranean fever (FMF). They did not respond to conventional anti-inflammatory treatment and eventually only benefited from surgery. These four cases emphasize that the radiologist and clinician should collaborate carefully while managing any child with monoarthritis to ensure that the diagnosis of PVNS is not missed.

Imaging of compositional gradients during in situ emulsification using X-ray micro-tomography.

The rate of emulsification in surfactant/oil/water systems is influenced by transport of chemicals and mixing of the fluid phases. In porous media applications, complex flow regimes are generated due to three-dimensional connectivity and irregular cross-sections of the pores facilitating the mixing for emulsification. The properties of the resulting emulsified phase depend on the interplay of flow, mixing and emulsification kinetics of the surfactant/oil/water system. Emulsification can be relatively quick. Direct visualization of the process and compositional gradients in three-dimensional pore space during flow requires imaging at few seconds time intervals. In this study, a flow unit was integrated in a synchrotron beamline-based fast X-ray computed micro-tomography set-up. Non-destructive three-dimensional visualization of multi phase flow inside a porous rock at flow conditions became viable. An oil saturated rock sample was first flooded with water, followed by surfactant solution to mobilize the remaining oil by miscible displacement. The sample was continuously imaged during injection; the scans were made at time intervals of 7-60 s. The presence of an emulsified phase in addition to the oil and the aqueous phases required a more advanced image processing workflow compared to the workflows used for the immiscible fluid systems. A newly developed image processing technique was adopted; the grey levels in the images were correlated with the local oil content in the emulsified fluid regions. The visual extractions of the pore space showed that the emulsification occurred within seconds. Compositional gradients were observed in the emulsified phase as the injected surfactant solution reached the remote locations in the pore space. While a significant fraction of the oil was displaced within few seconds, the compositional gradients persisted over several millimeter length for several minutes, illustrating a sequence of mobilization and solubilization of the oil phase. The ability to interpret such compositional gradients in real time in porous space brings capability to study interfacial phenomena in applications where in situ emulsification occurs under flow.

Hydrogenated derivatives of hexacoordinated metallic Cu2Si monolayer.

Herein, we carried out first-principles calculations based on density functional theory to investigate the effects of surface functionalization with hydrogen atoms on structural, dynamical and electronic properties of Cu2Si monolayer. Pristine Cu2Si, a metallic monolayer, has a planar hexacoordinate structure. Calculations revealed that the most favorable position of a single H atom on the Cu2Si monolayer is at the top of a Si site. Derivatives of Cu2Si monolayer with various H concentrations were investigated, and by performing phonon calculations, it was found that there are three stable hydrogenated structures. Specific heat of these monolayers was found to increase with the hydrogen concentration at temperatures higher than 100 K. Electronically, the hydrogenated derivatives of Cu2Si monolayer preserve the metallic character.

Association Between Vitamin D Receptor Polymorphism and Familial Mediterranean Fever Disease in Turkish Children.

Familial Mediterranean fever (FMF) is an autosomal recessive, inherited autoinflammatory disease characterized by recurrent, self-limited attacks of fever, and inflammation of serosal surfaces. The aim of our study was to determine a possible relationship between Vitamin D receptor (VDR) gene polymorphisms and the risk of children with FMF. We investigated VDR FokI (rs10735810), TaqI (rs731236), BsmI (rs1544410), and ApaI (rs7975232) polymorphisms in 50 children with FMF and 150 age-matched healthy control subjects. This study was performed by polymerase chain reaction-based restriction fragment length polymorphism. There was no significant difference between patients and controls for VDR FokI, TaqI, BsmI, and ApaI genotypes and alleles (p > 0.05). Results need to be supported by further investigations that define haplotype patterns for VDR gene polymorphisms in a larger group and different ethnic groups of FMF patients.

Rapid integrated rheo-optical and polarized Fourier-transform infrared spectrometry measurement system for polymer films undergoing chemo-mechanical changes.

The design and performance of a multisensory instrument to track physical and chemical changes of thin polymer films (typically 5 µm < thickness < 100 µm) subjected to thermal and mechanical treatments are described in this paper. For the first time, real-time measurements of spectral birefringence, true stress, true strain, and temperature are integrated together with ultra-rapid-scan polarized FT-IR spectrometer (URS-FT-IR) to investigate the relationships between true mechanical measures and structural features at different length scales. The rheo-optical properties (birefringence-true stress-true strain) are collected at a rate of 10 data points∕s and URS-FT-IR data are collected at a rate of 300 complete spectra∕s. The IR dichroism measurement is performed by exposing the sample to non-polarized IR beam in transmission mode with two mutually perpendicular polarizations, parallel and perpendicular to the stretching direction, received by detector unit. This design allows to analyze both polarizations simultaneously wavenumbers in the range of 500 cm(-1)-4000 cm(-1). Controlled processing parameters include air speed, air temperature, stretching rate, stretching ratio, stretch cycling, and holding times; while simultaneously measuring optical retardation, sample width, temperature, load cell, and both parallel and perpendicular IR spectra. Calibration and performance of this instrument is demonstrated with several film samples. These are: A polystyrene standard, an atactic polystyrene (homo-polymer), a polyurethane (consists of hard and soft segments) for physical changes during uniaxial deformation, and a polyamic acid during imidization reaction. This measurement system is particularly useful in unraveling molecular level details of complex physical and chemical events that take place during very fast deformation schemes (uniaxial stretching, retraction, relaxation, annealing, etc.) relevant to industrial processes. These include specific orientation behavior of each phase, block or filler, crystallization, relaxation and orientation state. It is also suited to track reaction rates and products in polymers undergoing thermal or photo curing.

Real-time measurement system for tracking birefringence, weight, thickness, and surface temperature during drying of solution cast coatings and films.

This paper describes the design and performance of a new instrument to track temporal changes in physical parameters during the drying behavior of solutions, as well as curing of monomers. This real-time instrument follows in-plane and out-of-plane birefringence, weight, thickness, and surface temperature during the course of solidification of coatings and films through solvent evaporation and thermal or photocuring in a controlled atmosphere. It is specifically designed to simulate behavior of polymer solutions inside an industrial size, continuous roll-to-roll solution casting line and other coating operations where resins are subjected to ultraviolet (UV) curing from monomer precursors. Controlled processing parameters include air speed, temperature, initial cast thickness, and solute concentration, while measured parameters are thickness, weight, film temperature, in-plane and out-of-plane birefringence. In this paper, we illustrate the utility of this instrument with solution cast and dried poly (amide-imide)∕DMAc (Dimethylacetamide) solution, water based black paint, and organo-modified clay∕NMP (N-Methylpyrrolidone) solution. In addition, the physical changes that take place during UV photo polymerization of a monomer are tracked. This instrument is designed to be generic and it can be used for tracking any drying∕swelling∕solidification systems including paper, foodstuffs such as; grains, milk as well as pharmaceutical thin paste and slurries.

A fast real time measurement system to track in and out of plane optical retardation/ birefringence, true stress, and true strain during biaxial stretching of polymer films.

An instrumented and highly integrated biaxial stretching system was designed and constructed to obtain true stress, true strain, and optical behavior of polymeric films during biaxial stretching. With programmable drive motors, any form of temporally varying biaxial deformation profiles, including linear, exponential, logarithmic as well as cyclic, can be applied to a square-shaped films. This machine allows the investigation of mechano-optical behavior of films under profiles captured in industrial processes. To overcome the edge effects, the samples are painted with a dot pattern that is imaged using a high speed video capture system. This system accurately determines the locations of the each dot matrix in subsequent images acquired and calculates the true strains in both directions. The in-plane optical retardation is determined using spectral birefringence method that uses polarized white light and optical spectrometer in the optical train. This is carried out automatically at less than 10 nm in retardation resolution with the light beam passing through the symmetry center of the sample. Out of plane retardation is measured with an identical optical train tilted 45° to the plane of the film with its light beam going through the same spot on the sample as 0° beam. The true stress and birefringences are calculated with the determined instantaneous thickness of the film. With this system, the stress optical behavior of PET's is determined up to very large deformation levels at moderate to high deformation rates. Beyond the initial linear stress optical behavior, these films exhibit sudden positive deviation from linearity and this start of nonlinearity was directly associated with the stress induced crystallization.

Health-related quality of life of school-age children with familial Mediterranean fever.

OBJECTIVES: To describe and compare the parent proxy-reported and child self-reported physical and psychosocial HRQOL of school age children who have FMF with healthy peers. METHODS: The Pediatric Quality of Life Inventory 4.0 (Peds QL 4.0) Generic Core Scales was used to measure HR-QOL. Fifty-one patients and 81 healthy peers were enrolled in the study. Patients were grouped according to their ages as : 1) Children (8-12 years) and 2) Adolescents (13-18 years). An accompanying parent completed the parent proxy-report of the Peds QL 4.0. RESULTS: Peds QL scores of children (8-12 years) with FMF were significantly lower than healthy peers for physical and psychosocial functioning for both child self-report and parent proxy-report. The parent proxy-report and child self-reported Peds QL scores of adolescent patients (13-18 years) with FMF were lower than the healthy group for physical, emotional and school functioning; however no significant difference was detected regarding the social functioning. Adolescents with FMF had significantly higher social scores when compared to the younger age group (8-12 years) with FMF, 92.6 +/- 8.5 and 82.2 +/- 17.6, respectively (p=0.028). The scores of physical, emotional and school functioning were similar in both groups (p=0.73, p=0.93, and p=0.028). Correlations among child self-report subscales and proxy-report subscales were all significant and varied from moderate to high. CONCLUSION: This study suggested that assessment of HRQOL has potential clinical implications for the healthcare needs of children and adolescents with FMF. Given the degree of reported impairment in their health-related quality of life, individualized counseling and interventions are needed.

Clinicopathologic features and prognostic significance of lung tumours with mixed histologic patterns.

Lung tumours with a mixed histologic pattern are rare. We evaluated the clinicopathologic features and prognosis of lung tumours with mixed histology and compared them with the tumours which have single histology. The study group consisted of 39 patients with a mixed histologic pattern and a control group consisted of 41 patients with a single histology on the consecutive surgical specimens. In the study group three types of tumour were identified: adenosquamous carcinoma, combined neuro-endocrine tumours and biphasic tumours. The combined neuro-endocrine tumours were further divided into small cell carcinoma (SCLC)+non-neuro-endocrine carcinoma (NNEC), SCLC+large cell neuro-endocrine carcinoma (LCNEC) and LCNEC +NNEC. Clinicopathologic characteristics, stage and survival rates were evaluated retrospectively and compared with the tumours showing single histology. There was no significant difference in mean age, sex, smoking history, asbestos exposure and tumour size between the study and control groups (p > 0.05). Among adenosquamous carcinomas advanced stage (IIIa or IIIb) (p = 0.004), vascular invasion (p = 0.04) and parietal pleural involvement (p = 0.012) was significantly more evident than in the single histology group. Among combined neuro-endocrine tumours, advanced stages (p = 0.002) and vascular invasion (p = 0.003) were more evident than in the single histology group. Two- year survival rates were 60% for the single histology group, 39% for the adenosquamous group and 25% for the combined neuro-endocrine tumour group (p = 0.0002). Tumours with mixed histology are rarely seen in the lung. Among these tumours adenosquamous carcinoma and combined neuro-endocrine tumours present more aggressive clinico-pathologic behaviour than tumors with a single histology.

Malignity-like peritoneal tuberculosis associated with abdominal mass, ascites and elevated serum Ca125 level.

Peritoneal tuberculosis (TB) is similar to ovarian cancers with respect to clinical, radiological laboratory findings. In this report, we present 10 TB cases with malignity pre-diagnosis based on the presence of ascites, pelvic mass, abdominal lymph nodes and elevated Ca125. The mean age of the cases was 29 +/- 14.4 years (18-63). Eight cases were associated with ascites, and the mean adenosine deaminase (ADA) value in ascitic fluid was 130.37 +/- 92.2. All cases had elevated levels of serum Ca125. In 6 cases, we identified lung pathologies based on chest radiography. Diagnoses were made based on diagnostic laparotomy in four cases, laparoscopy in two cases, percutaneous needle biopsy in two cases, and clinical evaluation in two cases. Anti-TB treatments lasted 12 months. Serum Ca125 levels normalised in the 3rd month of treatment. In the differential diagnosis of ascites and high serum Ca125 levels, tuberculosis should be considered in patients from developing countries.

Co- and counter-current spontaneous imbibition into groups of capillary tubes with lateral connections permitting cross-flow.

A model for co- and counter-current imbibition through independent capillaries has already been developed and experiments conducted to verify the theory [E. Unsal, G. Mason, N.R. Morrow, D.W. Ruth, J. Colloid Interface Sci. 306 (2007) 105]. In this paper, the work is extended to capillaries which are connected laterally and in which cross-flow can take place. The fundamental pore geometry is a rod in an angled round-bottomed slot with a gap between the rod and a capping glass plate. The surfaces of the slot, rod and plate form capillaries and interconnecting passages which have non-axisymmetric cross-sections. Depending on the gap size either (i) a large single meniscus, (ii) two menisci one on each side of the rod, or (iii) three menisci, one between the rod and the glass additional to the ones on each side can be formed. A viscous refined oil was applied to one end of the capillaries and co-current and counter-current spontaneous imbibition experiments were performed. The opposite end was left open to the atmosphere for co-current experiments. When the gap between the rod and the plate was large, the imbibing oil advanced into the tubes with the meniscus in the largest capillary always lagging behind the two menisci in the other two smaller capillaries. For counter-current imbibition experiments the open end was sealed and connected to a sensitive pressure transducer. In some experiments, the oil imbibed into the smaller capillaries and expelled air as a series of bubbles from the end of the largest capillary. In other experiments, the oil was allowed to imbibe part way into the tubes before counter-current imbibition was started. The meniscus curvatures of the capillaries have been calculated using the Mayer and Stowe-Princen method for different cell slot angles and gap sizes using a value of zero for the contact angle. These values have been compared with actual values by measuring the capillary rise in the tubes; agreement was very close. A model for co-current and counter-current imbibition has also been developed. The significance of this model is that some hydraulic/capillary properties are common for both co-current and counter-current imbibition. The experiments give an illustration of behavior expected in a real porous material and verify the importance of the 'perfect cross-flow' modification to the 'bundle of parallel tubes' model.

Co-current and counter-current imbibition in independent tubes of non-axisymmetric geometry.

Experiments that illustrate and quantify the basics of co- and counter-current spontaneous imbibition have been conducted in a series of simple model pore systems. The fundamental pore geometry is a rod in an angled round-bottomed slot with the rod touching a capping glass plate. The capillaries thus formed by the surfaces of the slot, rod and plate do not have circular cross-sections but more complicated geometric structures with angular corners. The tubes formed at each side of the rod connect at both ends. A viscous, refined oil was applied from one end. For co-current experiments, the opposite end was left open to the atmosphere and oil imbibed into both tubes. For counter-current experiments the opposite end was sealed and connected to a sensitive pressure transducer. Oil imbibed into the smaller capillary and expelled air as a series of bubbles from the end of the larger capillary. Bubble snap-off was observed to be rate-dependent and occurred at a lower curvature than that of the cylindrical meniscus that just fits inside the tube. Only the corners of the larger capillary filled with oil during counter-current imbibition. Meniscus curvatures were calculated using the Mayer and Stowe-Princen method and were compared with actual values by measuring the capillary rise in the tubes; agreement was close. A simple model for co-current and counter-current imbibition has also been developed and the predictions compared with the experimental results. The model results were in agreement with the experiments. The experiments demonstrate that the capillary back pressure generated by the interfaces and bubbles in counter-current imbibition can slow the process significantly.

Factors influencing sputum smear and culture conversion time among patients with new case pulmonary tuberculosis.

Sputum smear and culture conversion are important indicators for the effectiveness of treatment and the infectivity of the patient. The aim of this study was to identify the factors influencing both sputum smear and culture conversion time among patients with new case pulmonary tuberculosis (TB). The study was conducted in a reference hospital in Turkey in which 737 patients with pulmonary TB were hospitalised between January 2000 and 2005. We evaluated 306 (193 men and 113 women) human immunodeficiency virus-negative patients diagnosed with new case pulmonary TB. Factors associated with both sputum smear and culture conversion time (days) were investigated. Patients with diabetes mellitus (DM), cavitary disease, radiologically extensive disease had longer sputum smear and culture conversion time than the other groups. In addition, old age, male sex, smoking and thrombocytosis were found to be significantly associated with sputum smear conversion time. In the logistic regression analysis, the presence of DM and extensive disease were determined as independent factors associated with persistent sputum smear and culture positivity at the end of 2 months. The presence of DM and extensive disease were found to be independent risk factors influencing both sputum smear and culture conversion time in pulmonary TB. Sputum smear and culture examinations should be considered together to assess the poor prognosis.

Relationship between embryo quality and aneuploidies.

Many high-grade embryos selected for transfer according to their morphological evaluation were detected to have chromosomal abnormalities after aneuploidy screening for infertility by preimplantation genetic diagnosis (PGD). The aim of this study was to detect if there is any correlation between embryo quality and genetic status. The chromosomal status of the day three embryos was studied by multicolour fluorescence in-situ hybridization for chromosomes 13, 18, 21, X and Y. PGD was performed on 132 patients for 1107 embryos. The correlation between embryo quality and aneuploidy was analysed. The analysis showed that a large proportion of normal embryos (50.7%, n = 280) were grade I. In addition, a considerably high proportion of aneuploid embryos (36.1%, n = 83) were evaluated as grade I. There was a significant relationship between PGD results and embryo grades (P = 0.001). Of the 69 polyploid embryos, 21.7% were grade I and 37.8% were grade II. Of the 83 haploid embryos, 27.8% were grade I and 34.9% were grade II. Euploidy was positively related to morphological grade of embryo (P = 0.001). It was also possible for chromosomally abnormal embryos to have a good developmental potential, and they could be selected for embryo transfer unless the PGD procedure was applied.

Potential role of interleukin 6 in reactive thrombocytosis and acute phase response in pulmonary tuberculosis.

OBJECTIVE: Reactive thrombocytosis is found in a number of clinical situations including infectious diseases such as pulmonary tuberculosis (PTB). To examine the possible role of interleukin (IL6) in reactive thrombocytosis and acute phase response in PTB this study measured serum IL6, C reactive protein (CRP), erythrocyte sedimentation rate (ESR), albumin concentrations in 62 PTB patients and 20 healthy volunteers. METHOD: PTB patients were divided into two groups based on thrombocyte counts. Twenty seven PTB patients with normal thrombocyte counts constituted group 1, 35 PTB patients with thrombocytosis constituted group 2, and 20 healthy volunteers constituted group 3. RESULTS: The median IL6 concentration of group 1 was 12.8 pg/ml (95% CI: 12.1 to 56.9 pg/ml) and group 2 was 40.6 pg/ml (95% CI: 67.1 to 168.7 pg/ml). The comparison of IL6 concentrations in the three groups was significant (p = 0.0001). Patients in group 1 had a higher concentration of CRP (p = 0.0001) and lower concentration of albumin (p = 0.002) than group 3 whereas group 2 had higher concentration of CRP (p = 0.003) and lower concentration of albumin (p = 0.002) than group 1. Serum IL6 concentrations were significantly correlated with thrombocyte counts (p = 0.004, r = 0.36), CRP (p = 0.007, r = 0.34), and albumin concentrations (p = 0.005, r = -0.34). IL6 concentrations were significantly correlated with the number of involved zones (p = 0.005, r = 0.35) and acid fast bacilli positivity (p = 0.03, r = 0.27). Patients in group 2 had weight loss (p = 0.004), fever (p = 0.038), and night sweats (p = 0.007) more frequently than group 1. Also, group 2 had more extensive radiological findings (involved zones p = 0.001, bilateral disease p = 0.0001, presence of cavity p = 0.02) than group 1. CONCLUSIONS: IL6 might play a contributory part in reactive thrombocytosis and acute phase response in PTB.

[Gastric pull-up in hypopharyngeal and cervical esophageal cancers]. / Hipofarenks ve servikal özofagus kanserlerinde gastrik pull-up.

OBJECTIVES: Gastric pull-up is a common technique in the reconstruction of gastrointestinal continuity following surgery for the primary esophageal and hypopharyngeal tumors with involvement of the esophagus. We evaluated the results of surgery in patients with cervical esophageal and hypopharyngeal cancers. PATIENTS AND METHODS: Eleven patients (4 women, 7 men; mean age 46 years; range 18 to 70 years) underwent surgery for hypopharyngeal and cervical esophageal epidermoid carcinoma. Surgery included pharyngolaryngoesophagectomy, subtotal thyroidectomy, and gastric pull-up in all patients. In addition, nine patients had radical neck dissection on the involved side and modified radical neck dissection on the contralateral side. One patient had bilateral radical neck dissection. Patients who were alive were followed-up for a mean period of 27 months (range 14 to 46 months). RESULTS: The one-, two-, and three-year survival rates were 54% (6/11), 36% (4/11) and 18% (2/11), respectively. Three patients died from early postoperative complications, two from organ failure due to locoregional recurrence (7th month) and to distant metastasis (11th month). CONCLUSION: Despite the small size of the study, the results favor the use of gastric pull-up in selected patients with cervical esophageal and hypopharyngeal cancers.

Assessment of protein-energy malnutrition in children with chronic arthritis.

Protein-energy malnutrition (PEM) has been estimated to occur in 10 to 50% of children with juvenile chronic arthritis (JCA). Thirty-eight children with JCA were evaluated and their nutritional status determined, and they were compared with 23 healthy sex and age-matched children as controls. A standardized, 9-parameter comprehensive nutritional assessment profile was used. The simple anthropometric measurements, height and weight for age, were abnormal in 30% and 27% of the patients, respectively. A detailed evaluation revealed that 71% had abnormal somatic protein stores, and that they also had significantly low levels of visceral protein stores, when compared to their healthy peers. The results were consistent with the fact that inflammation put the JCA patients at significant risk for developing complicated malnutrition and it might result in PEM without any obvious signs of malnutrition. A nutritional screening test would be very useful in detecting early PEM in children with chronic arthritis.