15 research outputs found
APPLYING EDAS AS AN APPLICABLE MCDM METHOD FOR INDUSTRIAL ROBOT SELECTION
No full textIn order to stay an actual competitor in today’s environment, it is essential for manufacturing organizations to make decisions promptly and correctly. In the real-time manufacturing decision making problems, some alternatives are more likely to be evaluated with respect to multiple conflicting criteria. Several multi-criteria decision-making (MCDM) methods have been available to help decision makers in choosing the best decisive course of actions. The aim of the study is to apply an efficient and relatively new method called Evaluation based on Distance from Average Solution (EDAS) as an applicable and useful MCDM method for robot selection problem (RSP). In order to examine the feasibility and effectiveness of the presented method, several numerical examples from the literature are considered. Comparing with other methods especially MCDM methods given in the literature for the industrial RSPs, the Spearman’s rank correlations analysis indicates that this method is capable of accurately ranking selected robots. © 2019 Yildiz Technical University. All Rights Reserved
Dede Korkut Kitabı'nda ikilemeler ve Almanca'da çevirisi
No full textBu çalışmanın amacı, Dede Korkut Kitabında saptanan ikilemelerin Almanca'ya çevirisini karşıtsal dilbilim bağlamında incelemektir. Bu incelemede Dede Korkut Kitabı ve Hendrik Boeschoten tarafından Almanca yapılmış çevirisi ele alınmaktadır. Eserdeki ikilemelerin ve çevirilerinin incelenmesi karşıtsal deyiş bilimi kapsamında yapılmaktadır. İkilemeler, genellikle bir ifadeyi vurgulamak ve ifadenin anlamını güçlendirmek için kullanılır. Çok belirgin bir dil bilimi olgusu olan ikilemeler, çoğunlukla kültürel, coğrafi veya tarihi bir geçmişe sahiptir. İkilemelerin bu özellikleri çevirmenin işini zorlaştırmaktadır. Orijinal metinde saptanan ikilemeler, bu çalışmada eşdeğerlik seviyesine göre sınıflandırılıp pragmatik bir bakış açısıyla değerlendirilmektedir. İkilemelerin Türkçe'den Almanca'ya çeviri olasılıkları bu yönde incelenip açıklanmıştır. Yapılan inceleme neticesinde elde edilen sonuç çok belirgindir. Karşılaştırmada esas alınan ikilemeler, anlam ve yapı bakımından tam, kısmi eşdeğer, eşdeğer olmayan ve sadece anlam bakımından benzer olarak dört başlıkta ele alınmıştır. Çalışma sonucunda elde edilen verilere göre tam eşdeğer çevrilebilen ikilemeler az sayıdadır. Aynı zamanda sadece anlam bakımından çevrilen ikilemeler ve kısmi eşdeğerlikte olan ikilemeler de çok azdır. Almanca karşılığı olmadığı için eşdeğeri olmayan ikilemeler çoğunluktadır. Bu sonuçlara göre ortaya çıkan şudur; çevirmen, özgün metindeki yapısal özelliklerin hakkını kısmen verebilmektedir. Hendrik Boeschoten çeviriyi, Almanca okuyanlar için net ve anlaşılır hale getirdiği gibi, tarihi, coğrafi ve kültürel unsurlara eşdeğerler bulmuş aynı zamanda Dede Korkut Kitabının olay örgüsünü de eksiksiz olarak okuyucuya aktarmıştır. Çeviri yapılan diller ve kültürler arasındaki mesafeden dolayı ikilemelerin yapısal bakımından tam eşdeğerliğini yakalamak çok güç bir uğraştır.In the context of contrastive linguistics, this article focuses on binomial pairs and their translation into German. For this concern, the Turkish heroic stories Dede Korkut and their translation of Hendrik Boeschoten into German were used. The study of the binomial pairs and their translation was done in terms of contrastive phraseology. Also called doublings, they serve mainly to increase and clarify, so they reinforce the used expression. Binomial pairs are very specific linguistic phenomena and have mostly cultural, geographic or historical background. These characteristics of the binomial pairs do not make it easy for the translator. Out of the contrastive phraseological background, doublings identified in the source text are to be classified in terms of equivalence levels and elaborated from a pragmatic point of view. The possibilities of translating binomial pairs into German were accordingly examined and explained in this paper. The result of the analysis is a clear one. There are few fully, partially and purely semantically equivalent translations of the binomial pairs. Zero equivalent translations predominate in the classification. So the translator can only partially meet the formal function of the literary text. Especially, he meets the content-related function of heroes' narratives, in which he finds lyrical equivalents for historical, cultural and geographical expressions, just as he makes the plot clear and understandable for the German-speaking recipient. The holistic transfer of aesthetic function is difficult because of the distance between languages and cultures
ZUR ÜBERSETZUNG VOM TÜRKISCHEN NATIONALEPOS DEDE KORKUT / DEDE KORKUT HİKÂYELERİNİN ALMANCA ÇEVİRİSİ ÜZERİNE
No full textGegenstand dieses Artikels ist die Übersetzungskritik an der Übersetzung des türkischen Heldenepos Dede Korkut von Hendrik Boeschoten, im Hinblick auf den texttypologischen Ansatz von Katharina Reiβ. Das Heldenepos Dede Korkut gehört zu den wichtigsten gemeinsamen Schätzen der türkischen Welt. Wie sich im Folgenden zeigen wird, durchziehen kulturelle Elemente den ganzen Text und machen seine Bedeutsamkeit aus, stellen jedoch gleichzeitig auch ein großes Problem-Potential bei der Translation dar. Als Maßstäbe bei der Untersuchung galten: Äquivalenz, Adäquatheit, Korrektheit und Korrespondenz. Für die Evaluierung wurde die Realisierung der lexikalischen, semantischen, pragmatischen und stilistischen Instruktionen analysiert. Die Auswertung der deutschen Übersetzung zeigte, dass die Forderung an den 'formbetonten' Texttyp grundsätzlich beachtet wurde. Durch passende Äquivalente, so wie Erläuterungen und Fußnoten, ist es dem Übersetzer gelungen den Inhalt adäquat an den Zieltextleser zu bringen. Kleinere Auffälligkeiten, sowie mögliche Alternativen wurden ebenfalls ausgearbeitet.</p
ON THE GERMAN TRANSLATION OF THE TURKISH NATIONAL EPIC: DEDE KORKUT
No full textBu çalışmanın konusu, Dede Korkut hikâyelerinin Hendrik Boeschoten tarafından yapılan Almanca çevirisinin metin türü yaklaşımına göre incelenmesidir. Kahramanlık destanı Dede Korkut Türk dünyasının en önemli ortak değerlerinden sayılır. Çalışmada görüleceği gibi, metnin içeriği kültürel ögelerden oluşmakta ve bu durum çeviride büyük zorluklara neden olmaktadır. İncelemede eşdeğerlik, uygunluk, doğruluk ve yerindelik ölçütleri temel alınmıştır. Değerlendirme için sözcük, anlam, kullanım ve biçem eşdeğerliği çözümlenmiştir. Almanca çevirinin değerlendirilmesi sonucunda, biçim vurgulu metin türü özelliklerine dikkat edildiği, uygun eşdeğerlik yanında açıklama ve dipnotlarla içeriğin amaç dil okuruna başarılı bir biçimde aktarıldığı saptanmıştır. Bununla birlikte göze çarpan küçük çeviri sorunları ve olası seçenekler ele alınmıştır.This study analyzes the translation of Dede Korkut epic made by Hendrik Boeschoten with reference to text-typological approach. Heroic epic, Dede Korkut is regarded as one of the most important common values in Turkic world. As it will be observed during the study, the content of the study includes cultural elements and this makes its translation more difficult. In this analysis, our basic criteria are some parameters such as equivalence, adequateness, correctness and correspondence. In our evaluation, lexical, semantic, pragmatic and stylistic equivalence are taken into account. After having evaluated its German translation, it has been concluded that form-stressed text type has been paid attention. And moreover, its content has been transmitted to the readers of the target language with the usage of suitable equivalents as well as footnotes and explanations succesfully. In this evaluation, some of the translation mistakes and their alternatives are also dealt with
On the German translation of the Turkish national epic: Dede Korkut
No full textGegenstand dieses Artikels ist die Übersetzungskritik an der Übersetzung des türkischen Heldenepos Dede Korkut von Hendrik Boeschoten, im Hinblick auf den texttypologischen Ansatz von Katharina Rei?. Das Heldenepos Dede Korkut gehört zu den wichtigsten gemeinsamen Schätzen der türkischen Welt. Wie sich im Folgenden zeigen wird, durchziehen kulturelle Elemente den ganzen Text und machen seine Bedeutsamkeit aus, stellen jedoch gleichzeitig auch ein großes Problem-Potential bei der Translation dar. Als Maßstäbe bei der Untersuchung galten: Äquivalenz, Adäquatheit, Korrektheit und Korrespondenz. Für die Evaluierung wurde die Realisierung der lexikalischen, semantischen, pragmatischen und stilistischen Instruktionen analysiert. Die Auswertung der deutschen Übersetzung zeigte, dass die Forderung an den 'formbetonten' Texttyp grundsätzlich beachtet wurde. Durch passende Äquivalente, so wie Erläuterungen und Fußnoten, ist es dem Übersetzer gelungen den Inhalt adäquat an den Zieltextleser zu bringen. Kleinere Auffälligkeiten, sowie mögliche Alternativen wurden ebenfalls ausgearbeitet.Bu çalışmanın konusu, Dede Korkut hikâyelerinin Hendrik Boeschoten tarafından yapılan Almanca çevirisinin metin türü yaklaşımına göre incelenmesidir. Kahramanlık destanı Dede Korkut Türk dünyasının en önemli ortak değerlerinden sayılır. Çalışmada görüleceği gibi, metnin içeriği kültürel ögelerden oluşmakta ve bu durum çeviride büyük zorluklara neden olmaktadır. İncelemede eşdeğerlik, uygunluk, doğruluk ve yerindelik ölçütleri temel alınmıştır. Değerlendirme için sözcük, anlam, kullanım ve biçem eşdeğerliği çözümlenmiştir. Almanca çevirinin değerlendirilmesi sonucunda, biçim vurgulu metin türü özelliklerine dikkat edildiği, uygun eşdeğerlik yanında açıklama ve dipnotlarla içeriğin amaç dil okuruna başarılı bir biçimde aktarıldığı saptanmıştır. Bununla birlikte göze çarpan küçük çeviri sorunları ve olası seçenekler ele alınmıştır.This study analyzes the translation of Dede Korkut epic made by Hendrik Boeschoten with reference to text-typological approach. Heroic epic, Dede Korkut is regarded as one of the most important common values in Turkic world. As it will be observed during the study, the content of the study includes cultural elements and this makes its translation more difficult. In this analysis, our basic criteria are some parameters such as equivalence, adequateness, correctness and correspondence. In our evaluation, lexical, semantic, pragmatic and stylistic equivalence are taken into account. After having evaluated its German translation, it has been concluded that form-stressed text type has been paid attention. And moreover, its content has been transmitted to the readers of the target language with the usage of suitable equivalents as well as footnotes and explanations succesfully. In this evaluation, some of the translation mistakes and their alternatives are also dealt with
Mehmet Şefik (Aker) Bey: Activities in the Dardanels and Galician Fronts and in the Turkish National Strugple (1915-1922)
No full textAlbay Şefik Aker'in faaliyetlerini konu alan bu çalışmamızda amacımız, Türk İstiklal Harbi'nde, Türkiye Cumhuriyeti'nin Kuruluşu yolunda büyük hizmetleri olan ancak tarihin tozlu raflarında kaybolmuş bu şahsiyetin Türkiye Cumhuriyeti tarihindeki hak ettiği yerini ortaya koymaktı. Albay Şefik Aker, Harp Okulu'ndan 1896 da teğmen olarak mezun oldu. 1896 yılında başlayan Osmanlı-Yunan Savaşı'na katıldı. Bu savaşta sergilediği başarılardan dolayı üsteğmenlik rütbesini atlayarak yüzbaşı oldu. İtalyanların Trablus'a asker çıkartması üzerine Debre'de İtalyanlara karşı savaşan yerel halkla beraber savaştı. Balkan devletlerinin birleşerek Osmanlı Devleti'ne savaş açması üzerine başlayan I. Balkan ve II. Balkan Savaşları'nda bulundu. I. Dünya Savaşı'nın başlamasıyla İtilaf Devletlerince açılan Çanakkale Cephesinde Arıburnu mevkiinde 27'nci Alay Komutanı olarak bulundu. Bu mevkide İtilaf Devletleri'nden İngiltere'ye ait Anzak Birliklerinin 24 Nisan 1915 tarihindeki kara çıkarmasına kumandanı olduğu 27. Alay ile beraber ilk müdahalede bulundu. Anzakların püskürterek sahile geri çekilmesini sağladı. Mustafa Kemal (Atatürk) Bey'in Liman Paşa tarafından Anafartalar Kumandanı olarak atanmasından sonra Mustafa Kemal Bey, makamını 19'uncu Tümen kumandanı olarak vekaleten Şefik Bey'e bıraktı. Şefik Bey, bu makamda Çanakkale Cephesi kapanana kadar kaldı. Avusturya-Macaristan'ın Galiçya'da Ruslar karşısında aldığı mağlubiyetler sonrasında Almanya, Osmanlı Devletinden asker yollamasını talep etti. Bu talep üzerine Osmanlı Devleti tarafından oluşturulan 15. Kolorduya bağlı, 19. Fırka kumandanı olarak Galiçya Cephesi'ndeki muharebelere katıldı. Şefik Bey, bu cephede Ruslara karşı kazanılan başarılarda katkıda bulunmasından dolayı Almanya, Avusturya-Macaristan ve Osmanlı Devleti tarafından madalyalar aldı. Yarbay rütbesinden albaylığa yükseltildi. Galiçya Cephesi'nden sonra İzmir Asker Alma Dairesi'ne atanan Şefik Bey, Mondros Mütarekesi'nin imzalanmasından sonra işgale uğrayan Aydın, Antalya ve yörelerinde 57'nci Fırka Kumandanı olarak bulundu. Millî Mücadelenin başlamasından sonra ise bu bölgede işgale karşı Kuvâ-yı Milliye gruplarının oluşmasında ve desteklenmesinde katkıda bulundu. Şefik Bey, İtalyanların 57. Fırka mıntıkasında yapmaya çalıştığı işgalleri kabullendirme çalışmalarına ve yeni yerleri işgal amacıyla yaptığı keşiflere müdahalede bulunarak engelledi. Aydın'ın ve Nazilli'nin Yunanlılardan geri alınmasından sonra aldığı tedbirlerle olası taşkınlıkların önüne geçti. Şefik Bey, Denizli Hadisesi olarak bilinen ve Sökeli Ali Efe ile arkadaşlarının öldürülmesi sonrasında Denizli'ye gelen Demirci Mehmet Efe ve adamlarının intikam almalarını engellemeye çalıştı. Denizli halkını olası kötü gelişmelerden, Denizli'yi de yakılmaktan kurtardı. Şefik Bey, 1920 tarihinde Konya ayaklanması nedeniyle teşkil edilen Takip Müfrezesi'nin başında ve Millî Savunma Bakanlığı'nın Antalya'da İtalyanlardan silah ve cephane tedarikine ait işlerde görevlendirildi. 1921'de Antalya ve Çevresi Komutanlığını yaptı. Millî Mücadelenin 1918-1922 yılları arasını kapsayan mütareke döneminde mücadele eden Şefik Bey, yeni kurulan Türkiye Cumhuriyeti'nde çeşitli görevler üstlendikten sonra 25 Şubat 1931'de emekliye ayrıldı. Emeklilik zamanlarında hatıralarını yazarak geçiren Şefik Bey, 6 Şubat 1964'te vefat etti.
Our aim in this study is a lost figure in the dusty shelves of history to reveal the place that he deserves in the history of the Republic of Turkey which is about the activities of Colonel Şefik Aker, in the Turkish War of Independence, the great services towards the establishment of the Republic of Turkey. Colonel Sefik Aker graduated from the War College in 1896 as a lieutenant. He participated in the Ottoman-Greek War that began in 1896. He became a Captain by skipping the rank of Lieutenant for his accomplishments in this war. He fought with local people against the Italians when the Italians' troops landed in Tripoli. He was in the Balkan Wars I. and II, upon of the Balkan states joined the war on the Ottoman Empire. With the start of World War I, he was found as the 27th Regiment Commander in Arıburnu on the Çanakkale Front which was opened by the Entente States. In this location, the 27th Regiment, which he was the commander, he made the first intervention with the Anzac Units belonging to the Allied Powers on the land landing on 24 April 1915. He repelled the Anzac and retreat them to the coast. After Mustafa Kemal Atatürk was appointed as the Commander of Anafartalar by Liman Pasha, Mustafa Kemal left his office to Şefik Bey as the deputy commander of the 19th Division. Şefik Bey stayed in this office until the Çanakkale Front was closed. After Austria-Hungary defeated by the Russians in Galicia, Germany demanded from Ottoman Empire to send the troops. Upon this request, he participated in the battles of the Galician Front as the commander of the 19th Devision, which belonged to the 15th Corps formed by the Ottoman State. He received medals from Germany, Austria-Hungary and the Ottoman Empire for his contribution to the achievements against the Russians on this front. He was promoted from Lieutenant Colonel to Colonel. After the Galician Front, Sefik Bey who was appointed to the Izmir Recruitment Office, was occupied as a Commander of the 57th Division in Aydın, Antalya and its region after the signing of the Armistice of Mondros. After the start of the National Struggle, he contributed to the formation and support of the National Forces against the occupation in this region. Şefik Bey, intervened and prevented the Italians trying to do invasion of occupations acceptance in the area of the 57th Division districts and the discoveries in order to occupy new places. After taking back Aydın and Nazilli from Greeks he took precautions against any possible undesired events in these areas. Şefik Bey tried to prevent Demirci Mehmet Efe and his men wo came to Denizli tried to take the revenge of murder of Sökeli Ali Efe and his friends and as it was known Denizli event. He saved the people of Denizli from possible bad events and Denizli from being burned. Şefik Bey, in 1920, he was assigned at the head of the tracing union, which was formed due to the Konya uprising and work for the Ministry of Defense in Antalya to supply of weapons and ammunition from Italians. In 1921, he was the commander of Antalya and its environs. Şefik Bey, who fought during the period of the Turkish National War between 1918-1922, he retired at February 25, 1931 after he held various positions of the newly founded Republic of Turkey. Şefik Bey, who spent his retirement writing his memories and died on 6 February 1964
Yerbilimleri dergisi’nde (2015, 36 (2), 61-80) yayımlanmış olan “Karçal Dağları’nda kaya buzulu oluşumları” başlıklı makale ile ilgili tartışmaya yanıt
No full textThis article, was written in response to the criticism of our article “Rock Glacier Formations in the Karçal Mountains” published in Geoscience journal in the 2nd volume of the 36th issue. This article is to classification of the rock glaciers and identification of their geographical features which were recognized during the observations in the field work on the Karçal Mountains. In this context, based on a work by Gürgen and Yeşilyurt in 2012, authors argues that the formations mentioned by us are debris covered glaciers. This judgement is based on field obser- vations of previous studies. So there has never been a debate on whether these are ice bearing rock glaciers or debris covered glaciers due to not having a different methodology than this study. Because the purpose of the aforementioned study was to investigate the erosion and deposition patterns of glaciation in Pleistocene. However, the author makes his assessment only by using the remote sensing method based on a previous work. That is why it is inevitable for his assessment to contain some shortcomings and errors. There is no doubt that these are rock glacier formations as described in publication. In the region, there are, of course, some new debris covered or naked cirque glaciers. Nevertheless, the focus of this work is rock glaciers; therefore, actual glacier formations are taken out of this work. Specified as periglacial formations in the international arena, rock glaciers are also assessed by us in this context. As stated in the international arena rock glaciers form of periglacial, authors also assessed in this context. © 2015, Hacettepe Universitesi Yerbilmleri. All rights reserved
Ahmet Hamdi Tanpınar’ ın “19’ uncu asır Türk edebiyatı tarihi” adlı kitabının söz varlığı
No full text06.03.2018 tarihli ve 30352 sayılı Resmi Gazetede yayımlanan “Yükseköğretim Kanunu İle Bazı Kanun Ve Kanun Hükmünde Kararnamelerde Değişiklik Yapılması Hakkında Kanun” ile 18.06.2018 tarihli “Lisansüstü Tezlerin Elektronik Ortamda Toplanması, Düzenlenmesi ve Erişime Açılmasına İlişkin Yönerge” gereğince tam metin erişime açılmıştır.Bir dilin sözvarlığını ortaya koyan kitaplara sözlük denir. Sözlüklerin de temel birimi kelimedir. Sözlükler bir dildeki sözlük birimi olan kelimelerin tümünün ya da bir bölümünün tanımlarını, söylenişlerini, kullanımlarını ve dilbilgisine dair sınıflarını gösterir. Bu bakımdan sözlükleri genel ve özel sözlükler olmak üzere iki sınıfa ayırmak mümkündür.Bir dili kullananlar tarafından ortaya konan en güzel, en beliğ, en seçkin ifade tarzlarını o dilin edebi metinlerinde bulmak mümkündür. Bu bakımdan dili konuşanlar arasında edebiyat ve sanat adamlarının eserleri ön plana çıkmaktadır.XX. yüzyılın büyük sanat, edebiyat ve bilim adamlarından Ahmet Hamdi Tanpınar'ın ?19. Asır Türk Edebiyatı Tarihi? adlı eserinin söz varlığı üzerine hazırlanan bu çalışma üç bölümden oluşmaktadır. Bunlardan birincisinde kendisi hakkında hazırlanan çalışmalardan derlediğimiz Ahmet Hamdi Tanpınar'ın hayatını, şahsiyetini ve eserlerini tanıtan bilgiler yer alır. İkinci bölümde sözlükbilim, sözlük türleri ve yazar-sanatçı sözlükleri hakkında bilgi verilmiştir. Üçüncü bölüm ise ?19. Asır Türk Edebiyatı Tarihi?nin dizinli söz varlığını içerir.Bu dizinde metindeki kelimelerin hangi satırda, hangi çekim ekleriyle ve kaç kez tekrarlandığını verdik. Çalışmanın sonuna da bir kelimenin hangi satırda geçtiğinin görülebilmesi maksadıyla özel olarak hazırlanmış numaralandırılmış dizin metnini koyduk.A dictionary of the language of the book is called sözvarlığını revealed. Is the basic unit of dictionary words. Dictionaries of words in a language interface unit, the whole or a part of the definition, pronunciation, usage, and shows the class of grammar. In this respect the general dictionaries and special dictionaries is possible to divide into two classes.Posed by those who use a language best, most eloquent, the most exclusive styles of expression of the language is to be found in literary texts. In this respect, the language spoken among the works of literature and art, he has come to the fore.XX. century's great art, literature and science from childhood, memories of the man "19 Century Turkish Literature "for his work on the vocabulary consists of three parts of this study was prepared. The first of them preparing their own studies say about the life of our childhood, memories, şahsiyetini includes information that identifies and works. In the second part of lexicography, dictionaries, dictionary types, and gives information about the author-artist. The third section, "19 Century Turkish Literature "with the directory that contains the assets.Which of these words in the line of text in the index, which has been repeated many times and have given their suffixes. What line of work at the end of a word that can be seen through a specially crafted in order to put the text of the numbered directories
Docetaxel combined with oral etoposide as second-line treatment for advanced gastric carcinoma after failure of platinum- and fluoropyrimidine-based regimens
No full textBackground. Platinum, antracyline, and fluoropyrimidine combination chemotherapy has been widely used as a first-line treatment for advanced gastric cancer (AGC). In the present study, we determined the efficacy and the safety of docetaxel and oral etoposide as second-line combination chemotherapy after failure of commonly used combination regimens in AGC. Methods. Patients with histologically proven gastric cancer and measurable metastatic disease received docetaxel 75 mg/m2 as a 1-h intravenous infusion on day 1, and oral etoposide 50 mg/m2 once daily on days 1-5, every 3 weeks until disease progression or unacceptable toxicities. Results. Between June 2006 and September 2008, 32 patients, of median age 60 years (range 32-77 years) were included in the study. Overall response rate was 9.4% and 31.3% of patients achieved a stable disease. Median progression-free survival was 3 months (95% CI, 2.5-3.5). Median overall survival was 6 months (95% CI, 3.8-8.2) with 16.9% 1-year survival rate. Grade 3-4 toxicities included neutropenia (28.8%), febrile neutropenia (18.8%), thrombocytopenia (3.1%), nausea and vomiting (15.6%), diarrhea (9.4%), and mucositis (6.2%). Conclusion. Docetaxel and oral etoposide combination was moderately effective and safe in appropriately selected AGC patients after failure of platinum- and fluoropyrimidine-based combination regimens. © The Author(s), 2010
Diagnosis, Treatment, Prevention, and Rehabilitation of Diabetic Foot Ulcers and Infections: Turkish Consensus Report, 2024 Diyabetik Ayak Yarası ve İnfeksiyonunun Tanısı, Tedavisi, Önlenmesi ve Rehabilitasyonu: Ulusal Uzlaşı Raporu, 2024
No full textDiabetic foot ulcers and infections are considered significant health problems worldwide. Turkish Society of Clinical Microbiology and Infectious Diseases Study Group for Diabetic Foot Infections (DAİÇG) prepared a consensus report in 2015 regarding the diagnosis, treatment, and prevention of diabetic foot (DF) ulcers and diabetic foot infections (DFI) in national circumstances. Subsequently, in 2023, representatives assigned through collaboration with relevant national specialty associations reviewed the literature and international guidelines on the pathogenesis, microbiology, assessment and grading, treatment, prevention and control, offloading, post-amputation rehabilitation; identified questions that needed to be addressed, and updated the Consensus Report with answers to these questions. The information in this report is intended to assist healthcare professionals caring for diabetic patients. Some of the answers in the report are listed as follows: 1) Many factors cause DF ulcers, with the main causes being sensorimotor polyneuropathy and the development of peripheral arterial disease (PAD). 2) In a patient with a DF ulcer, the infection should be considered if other causes are ruled out and there are at least two local inflammatory signs, such as purulent discharge or erythema, edema, warmth, pain, tenderness, and induration at the ulcer site. In these cases, the severity of the infection is described as mild, moderate, or severe depending on the depth of the ulcer, its width, and the presence of systemic signs of infection. 3) The causative agents in DFI vary depending on whether the infection is acute or chronic and the severity of the infection. Superficial DFIs that develop in patients with cellulitis and with no previous antibiotic use are mostly caused by aerobic Gram-positive cocci (staphylococci, streptococci). 4) Deep and chronic infections and/or infections of patients that have received previous antibiotic treatment are generally polymicrobial (Gram-positive cocci + Gram-negative rods). 5) The classification of the Infectious Diseases Society of America (IDSA)/International Working Group on the Diabetic Foot (IWGDF) can be used to assess the severity of DFI. 6) According to this classification, severe and certain special cases of DFI should be hospitalized for treatment. 7) Inflammatory markers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and procalcitonin can be useful in differentiating infection from colonization. 8) Before starting antibiotics in suspected DFI, a suitable tissue sample should be taken from the ulcer base by curettage or biopsy for culture. 9) A three-view plain X-ray of the foot should be taken initially as an imaging method for diagnosis. This can help detect infection and bone deformities, fractures, radiopaque foreign bodies, and gas formation in soft tissues. 10) Magnetic resonance imaging (MRI) is a sensitive and specific method for patients who do not respond to treatment or where osteomyelitis or deep soft tissue abscess is suspected. 11) Culture and a positive result in histopathological examination of the bone are accepted as the gold standard in diagnosing osteomyelitis. 12) To promote ulcer healing and salvage of the limb, it is necessary to perform urgent and aggressive debridement to remove dead and infected tissues, provide proper ulcer care, relieve the foot from pressure, administer appropriate antibiotic therapy, achieve metabolic control, diagnose and treat PAD, and restore foot function. 13) In cases of DFI and PAD coexistence, consultation with the relevant surgical specialty is essential for the planning and timing of surgical procedures, and it is also advisable to seek the opinion of a vascular surgeon for revascularization. Surgical management of DF ulcers can be analyzed in five sections: (a) Urgent ulcer intervention; abscess drainage and/or debridement, (b) surgical interventions for vascular pathologies, (c) ulcer closure interventions; reconstruction methods; graft and flap surgery, (d) reconstruction of bone and foot pathologies for ulcer prevention and treatment (Charcot foot deformity, Achilles lengthening, tenotomy, and osteotomies, etc.), (e) minor and major amputations when necessary. 14) Amputation may be a more appropriate choice when infected tissue cannot be completely cleaned with debridement, when the patient is bedridden or has a non-functional extremity, when it is believed that adequate revascularization cannot be achieved by orthopedic and plastic surgical interventions, in cases where reconstruction is nearly impossible, and in dialysis patients. 15) The goal of post-DFI reconstruction is to allow the ankle to reach a neutral position and to make the plantar surface of the foot have a balanced contact with the ground. 16) Selected ulcer care products can be used based on the characteristics of the ulcer to support and accelerate ulcer healing, reduce the risk of complications, ensure patient comfort during treatment, and improve quality of life. 17) DF ulcers often develop due to improper shoe selection during the structural and biomechanical changes, resulting in fluid accumulation and callus formation around bone surfaces. 18) Orthoses, which distribute pressure over the widest possible area, are the most effective means of reducing plantar pressure in the foot. 19) Hyperbaric oxygen therapy is beneficial in addition to revascularization and antibiotic therapy, which are the primary treatments for pathologies causing tissue hypoxia, such as ischemia, infection, and edema. 20) Negative pressure ulcer therapy is an additional adjunct method to conventional techniques, and it can contribute to the healing process with the correct indications. 21) In cases where the infection is under control, active osteomyelitis is absent, topical epidermal growth factor (EGF) can be used for Meggitt-Wagner ulcer classification grade 1-3, and intralesional EGF applications can be used for grade 3-4 in addition to standard treatments. 22) Preventive medical practices in people with diabetes, collaborative efforts of the patients, their families, and the medical team, and regular patient education are necessary to prevent DF ulcer development. In the event of DF ulcer development, interdisciplinary collaboration in moderate/severe infections is essential for early treatment and infection prevention
