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Differences in clozapine metabolism across geographical regions in Turkiye
No full textObjective: The efficacy of clozapine is influenced by the pharmacogenetics of its metabolism, which can vary significantly among individuals. This study investigates regional variations in serum clozapine and norclozapine levels across Turkiye. Method: A retrospective analysis was conducted on 1,428 serum clozapine measurements from 328 patients treated at Hacettepe University Department of Psychiatry between 2014 and 2022. Patients were categorized based on their birthplaces and residential addresses into seven geographical regions ofTurkiye. Serum levels of clozapine and norclozapine were measured, and clozapine/norclozapine ratios were calculated. Linear mixed models were used to assess the effects of region, age, sex, and clozapine dose on therapeutic drug monitoring outcomes. Results: Significant regional differences were observed in serum norclozapine levels, with notably lower levels in the Eastern Anatolia Region (beta=-179.04, SE=49.7). No significant regional differences were found in serum clozapine levels or clozapine/ norclozapine ratios. Age (p=0.004) and clozapine dose (p<0.001) were positively associated with norclozapine levels, while sex showed no significant association. Conclusion: This study highlights inter-regional differences in clozapine metabolism within Turkiye, suggesting that regional factors may play a role in clozapine pharmacokinetics. These findings indicate that clozapine metabolism is influenced not only by genetic variability but also by a complex relationship of sociocultural factors. The results support the need for more personalized approaches to clozapine dosing and monitoring to enhance treatment efficacy, safety, and tolerability
Ophthalmologic and serologic predictors of positive minor salivary gland biopsy in suspected Sjögren's disease
No full textTo examine the relation between histopathology, ANA subtypes, and high-resolution dry eye analysis in treatment-naive patients evaluated for Sj & ouml;gren's disease suspicion in a referral center. Between October 2022 and December 2023, 231 patients who underwent minor salivary gland biopsies were included in the study. Patients were grouped according to their Chisholm and Mason (CM) biopsy scores. Non-invasive ocular surface evaluations and ANA subtype analysis, according to the International Consensus on ANA Patterns (ICAP), were also conducted. Meibomian gland (MG) atrophy was significantly higher (p 0.02) in the positive biopsy group (OR 1.02), although it was a weaker predictor than other parameters. Anti-SSA positivity was markedly correlated with positive biopsy results. However, subtype analysis did not show any significant correlation. In predicting CM scores > 2, ANA positivity was 2.1-fold, SSA positivity was 3.6-fold, Schirmer positivity was 12, fivefold, positive ocular OSS scores were fourfold, limbal redness, and NiBUT less than 10 s were 2.4-fold more significant determinant factors. Our results confirm that the Schirmer test and classical serologic markers are still irreplaceable. We believe that novel measurement techniques that enable faster, non-invasive analyses with advanced technology will facilitate the differential diagnosis of Sj & ouml;gren's disease in patients with dry eyes
YANGIN SONRASI PLANETSCOPE GÖRÜNTÜLERİNİ KULLANARAK YANMIŞ ORMAN ALANLARIN DERİN ÖĞRENME-TABANLI SEGMENTASYONU
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Nexus between Distributed Leadership, Meaningful Work and School Academic Optimism in Turkish Schools: A Multilevel SEM Analysis
No full textSchool academic optimism is an internal factor that plays an important role in a range of school outcomes. In recent years, there has been an increasing focus on the antecedents of school academic optimism. Previous studies have concluded that leadership has an important impact on school academic optimism. However, the holistic effect of distributed leadership and meaningful work on school academic optimism has not been sufficiently researched. Therefore, in the current study, we tested the model we had developed to explore the direct and indirect relations among distributed leadership, meaningful work, and school academic optimism both at the teacher level and school level. The data were gathered from 813 teachers working at 78 state primary schools located in 12 regions in T & uuml;rkiye. We used multilevel structural equation model analysis to test the model we had developed. The results show that meaningful work is a significant factor in the relationship between distributed leadership and school academic optimism. This result contributes to the literature that focuses on the antecedents of school academic optimism. Based on the study results, it is recommended to develop and implement policies that will strengthen schools and give school leaders more authority to produce effective outcomes
Evaluation of methodological and analytical approaches in assessing intra-individual serum progesterone variability on frozen embryo transfer day across hormone replacement therapy cycles.
No full textRe: Multiple spontaneous ruptures of the flexor digitorum profundus tendon of fingers in a child.
No full textDouble hit lymphoma masqueraded as clusters of crater-like nonhealing infectious skin lesions.
No full textQuantitative Assessment of the Distal Clavicle with Its Clinical Implications in Anatomical Reconstruction of the Coracoclavicular Ligament
No full textAim: Anatomical reconstruction of the coracoclavicular ligament has recently become popular in the treatment of acromioclavicular joint injuries. To perform this procedure correctly, the anatomy of the conoid tubercle and trapezoid line, which are the attachment sites of the coracoclavicular ligament, should be known accurately. Therefore, this study aimed to evaluate the distal clavicle along with morphometry of the conoid tubercle and trapezoid line. Material and Methods: In the present study, 77 human dry clavicles (39 right, 38 left) were examined using a digital caliper and digital thickness gauge. The clavicle length, thickness and width of the distal clavicle, morphometric features of the conoid tubercle, and trapezoid line were examined. Measurements were performed by two researchers independently. Results: The clavicle length was 138.37 +/- 10.69 mm. Supero-inferior thickness of the distal clavicle was 9.08 +/- 1.69 mm, and the antero-posterior width was 17.70 +/- 2.37 mm. Medio-lateral and supero-inferior dimensions of the conoid tubercle were 17.17 +/- 3.58 mm and 7.59 +/- 1.38 mm, respectively. The distance between the clavicle acromial end and the center of the conoid tubercle was 34.43 +/- 5.41 mm. Medio-lateral dimension of trapezoid line was 16.69 +/- 2.73 mm, and antero-posterior dimension was 9.61 +/- 1.80 mm. The distance between the clavicle acromial end and the center of the trapezoid line was measured as 18.15 +/- 2.80 mm. Conclusion: Accordingly, the tunnels for trapezoid and conoid ligaments should be created 18 mm and 34 mm medial from the clavicle acromial end, respectively. The measurements obtained in this study can be used as a guide for coracoclavicular ligament reconstruction
