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Item Securing sustainable funding for viral hepatitis elimination plans(WILEY, 2020-01-01) Hatzakis, Angelos; Lazarus, Jeffrey V.; Cholongitas, Evangelos; Baptista-Leite, Ricardo; Boucher, Charles; Busoi, Cristian-Silviu; Deuffic-Burban, Sylvie; Chhatwal, Jagpreet; Esmat, Gamal; Hutchinson, Sharon; Malliori, Minerva-Melpomeni; Maticic, Mojca; Mozalevskis, Antons; Negro, Francesco; Papandreou, George A.; Papatheodoridis, George V.; Peck-Radosavljevic, Markus; Razavi, Homie; Reic, Tatjana; Schatz, Eberhard; Tozun, Nurdan; Younossi, Zobair; Manns, Michael P.The majority of people infected with chronic hepatitis C virus (HCV) in the European Union (EU) remain undiagnosed and untreated. During recent years, immigration to EU has further increased HCV prevalence. It has been estimated that, out of the 4.2 million adults affected by HCV infection in the 31 EU/ European Economic Area (EEA) countries, as many as 580 000 are migrants. Additionally, HCV is highly prevalent and under addressed in Eastern Europe. In 2013, the introduction of highly effective treatments for HCV with direct-acting antivirals created an unprecedented opportunity to cure almost all patients, reduce HCV transmission and eliminate the disease. However, in many settings, HCV elimination poses a serious challenge for countries' health spending. On 6 June 2018, the Hepatitis B and C Public Policy Association held the 2nd EU HCV Policy summit. It was emphasized that key stakeholders should work collaboratively since only a few countries in the EU are on track to achieve HCV elimination by 2030. In particular, more effort is needed for universal screening. The micro-elimination approach in specific populations is less complex and less costly than country-wide elimination programmes and is an important first step in many settings. Preliminary data suggest that implementation of the World Health Organization (WHO) Global Health Sector Strategy on Viral Hepatitis can be cost saving. However, innovative financing mechanisms are needed to raise funds upfront for scaling up screening, treatment and harm reduction interventions that can lead to HCV elimination by 2030, the stated goal of the WHO.Item Is Functional Improvement Always Correlated with Symptomatic Improvement in Children with Attention-Deficit/Hyperactivity Disorder Managed with Oros Methylphenidate? A Prospective Open-Label Naturalistic Follow-Up Study(AVES, 2020-01-01) Tarakcioglu, Mahmut Cem; Caliskan, Yasin; Kadak, Muhammed Tayyib; Aliyev, Nilufer Okumus; Aksoy, Umut Mert; Tufan, Ali Evren; Gundogdu, Ozlem Yildiz; Memik, Nursu Cakin; Weiss, Margaret D.Background: To investigate the relationship between symptomatic improvement and functional improvement in children with attention deficit hyperactivity disorder (ADHD) who were being treated with OROS methylphenidate. Methods: Parents evaluated the severity of ADHD symptoms on the Turgay-DSM-IV ADHD/Disruptive Behavior Disorders Scale (T-DSM-IV). They assessed functioning on the Weiss Functional Impairment Rating Scale - Parent Form (WFIRS-P), and the Pediatric Quality of Life Inventory (PedsQL) was used to assess quality of life. Clinicians rated global outcome on the Clinical Global Impressions Scale (CGI). Response was measured in terms of the following criteria: a 20\% change in symptoms, a CGI-I score that was much improved (2) or very much improved (1), or an improvement of 0.25 (the minimally important difference) on the WFIRS. Improvement in quality of life was defined as >= 20\% change in PedsQL score. Results: Sixty-three children completed the study. After 12 weeks, 77.7\% of patients met the a priori criteria for treatment response rate. Among patients who exhibited improvement in symptoms, 42.9\% also showed improved functioning. Among those who showed improved functioning, 95.5\% showed improvement in symptoms. Of patients who showed improvement in symptoms, 34.6\% percent also showed improvement in quality of life. Of those who showed improvement in quality of life, 94.4\% also showed improvement in symptoms. Conclusions: Evaluation of changes in functional improvement, quality of life improvement, and symptom improvement during ADHD treatment enables clinicians to identify individuals whose functional impairment/quality of life persists despite symptom improvement. On that basis, additional treatment interventions can be organized for those individuals.Item Turkish Neonatal Society guideline on prevention and management of bronchopulmonary dysplasia(TURKISH PEDIATRICS ASSOC, 2018-01-01) Arsan, Saadet; Korkmaz, Ayse; Oguz, SunaScientific and technological advances in perinatology and neonatology have led to an increased rate of survival and decreased incidences of various neonatal morbidities. However, the incidence of bronchopulmonary dysplasia has remained almost the same for years in very-low-birth-weight preterm infants. Although bronchopulmonary dysplasia is the leading cause of chronic respiratory morbidity in small preterms, no substantial improvement has been achieved in prevention and treatment strategies to date. Currently, postnatal very-low-dose corticosteroids, caffeine, and vitamin A seem to be the drugs of choice, and stem cell therapy appears to be the most promising treatment modality for the future. In this guideline, which was prepared by the Turkish Neonatal Society, recent evidence-based recommendations for the prevention and treatment of bronchopulmonary dysplasia are summarized.Item Treatment of Spasticity in Cerebral Palsy(GALENOS YAYINCILIK, 2016-01-01) Civelek, Gul Mete; Atalay, AyceThe cerebral palsy diagnosis is a clinical one and it includes motor development delay, abnormal muscle tone and hyperreflexia. Muscle weakness, spasticity, loss of coordination, the continuation of the primitive reflexes and non-developed normal motor control are often seen in children with cerebral palsy. Spasticity is the velocity dependent increase in the resistance against passive muscle stretching. Spasticity treatment program should be established after detailed evaluation of degree and effects. Treatments to achieve optimal muscle tone include physical therapy and rehabilitation program, oral and injectable medications and surgical treatments. In the treatment of spasticity, a personalized physical therapy and rehabilitation program including stretching exercises should be in the treatment plans, absolutely. There is no consensus regarding the optimal application of pharmacotherapy for the treatment of spasticity in cerebral palsy. Oral medications such as baclofen, benzodiazepine, tizanidine and dantrolene can be used for the treatment of generalized spasticity. Oral drugs have significant side effects such as sedation and cognitive deficits. Chemodenervation with perineural phenol or ethanol injection or intramuscular injection of botulinum neurotoxin A can be used as treatment of localized spasticity. It is shown that botulinum neurotoxin type A is safe and effective in reducing spasticity in children. Most commonly used surgical technique for the treatment of spasticity in cerebral palsy is selective dorsal rhizotomy and it can be applied to selected cases. Treatment options that are used in the treatment of spasticity in cerebral palsy are discussed in this review.Item In Vitro Efficacy of the Venome of Black Scorpion (Androctonus crassicauda) on Leishmania tropica Promastigotes(ANKARA MICROBIOLOGY SOC, 2021-01-01) Zeyrek, Fadile Yildiz; Toprak, Sahin; Okullu, Sinem Oktem; Gurses, Gulcan; Doni, Nebiye Yentur; Kurt, OzgurScorpion venom is a substance that shows strong neurotoxic effects with its complex protein content and thus plays an important role for the scorpion in catching and digesting the hunt. Human body stung by a scorpion can show life-threatening systemic effects in a short time, ranging from erythema, pain, edema and local fever to abdominal pain, nausea and vomiting, diplopia and even coma. Scorpion venome is known to possess antimicrobial activity, and some of its compounds have potent antibacterial and antifungal activities. Leishmaniasis is a common vector-borne parasitic infection caused by Leishmania sp. protozoa and can lead skin, mucosa and fatal internal organs involvement in patients. There is a need for new drugs in the treatment of leishmaniasis, because it has been documented lately that there is a growing resistance against antimonial compounds which have been used in its treatment for decades. Leishmania species are known to be susceptible to antimicrobial peptides that act as ion-channel inhibitors, which are known to be present in scorpion venome. In this study, it was aimed to investigate the anti-leishmanial activity of scorpion venome extract obtained from Androctonus crassicauda species in our country. In this context, Leishmania tropica promastigotes which were thawed from liquid nitrogen in our laboratory and first grown in NNN and then RPMI-1640 media, were exposed to different dilutions of the extract containing A.crassicauda venom and meglumine antimonate used in the standard treatment of leishmaniasis and the efficacies on the promastigotes were compared and measured in vitro. This was followed by XTT cell viability test, which assessed whether anti-leishmanial dose of the extract was lethal for human cells or not. Trials showed that the half maximal inhibitory concentration (IC50) values of the venome extract and meglumine antimoniate were 18.12 mu g/ml (17.33-18.94) and 8.411 mu g/ml (7.922-8.927), respectively. This preliminary study showed that scorpion venome can be lethal on L.tropica promastigotes in vitro, on relatively higher doses compared to meglumine antimonate. Next step will be to determine the anti-leishmanial proteins in the extract and thus to identify new drug candidates with more specific studies.