INTRODUCTION: Kisspeptin (KP) and neurokinin (NK) are neuropeptides that govern the reproductive endocrine axis through regulating hypothalamic neuronal activity and pulsatile. Their critical role in reproductive health was first described by the demonstration of congenital hypogonadotropic hypogonadism and pubertal developmental anomalies following loss of function due to mutations in genes encoding the KP or NK signaling. This study aimed to investigate the efficacy of KP and NK, in mesenchymal stem cell (MSC)-based treatment of different origin, and examine the relationship of the expression of these genes with the passage number.
METHODS: Three adult rats (Rattus norvegicus) were used in our study. MSCs were obtained from bone marrow and adipose tissue of rats. The MSCs were analysed by flow cytometry using surface markers and RNA (ribonucleic acid) isolation was performed. Gene expressions of KP, NK and their receptors were investigated by real-time polymerase chain reaction (RT-PCR) and their relationship with the passages number was compared. Welch paired t-test was used to compare the expression of each gene at different passages. Statistical significance was accepted as 0.05 (p≤0.05).
RESULTS: The cultured bone marrow and adipose tissue cells were determined to be MSCs. When real-time PCR results of bone marrow-derived MSCs were evaluated, it was observed that kisspeptin receptor gene expression increased 14-fold in the sixth passage and 29-fold in the seventh passage compared to the fourth passage (p≤0.05). In the tachykinin gene, it was found that gene expression was almost completely suppressed in the fifth passage compared to the fourth passage (p≤0.05). In the tachykinin receptor gene, it was determined that gene expression was completely induced in the sixth passage, compared to the fifth passage (p≤0.05). When adipose tissue-derived MSC RT- PCR results were evaluated, it was observed that tachykinin receptor gene expression increased 15-fold, tachykinin gene expression increased 30-fold in the fifth passage, and KP receptor gene expression increased three-fold in the seventh passage compared to the fourth passage (p≤0.05).
DISCUSSION AND CONCLUSION: MSCs can be obtained from an easily available tissue such as bone marrow and adipose tissue is thought to shed light on the medical science for the future. In addition, it was concluded that the number of passages should be considered when analyzing the expressions of KP and NK genes, which have a very important role in the transition to puberty, and the number of passages should be selected by considering the gene expressions in the passage to be used.

INTRODUCTION: In the detection of colistin resistance in Klebsiella pneumoniae strains with multidrug resistance, automated systems give more erroneous results than the gold standard method, the liquid microdilution method. Comparative studies on the correct detection of colistin resistance by automated systems are limited in the literature. In this study; it is aimed to compare Vitek2 Compact and Phoenix automated systems by using liquid microdilution method in the determination of colistin susceptibility in K. pneumoniae strains isolated from various clinical specimens over a three-year period.


METHODS: Identification of K. pneumoniae strains was performed using conventional microbiological methods and automated bacterial identification systems which are Vitek2 (bioMérieux, MarcyL’Etoile, France) and Phoenix (Becton dickinson, M50, USA). Antibiotic susceptibility tests were also performed with the same devices. Colistin sensitivity was determined simultaneously with both automated methods and liquid microdilution method.


RESULTS: In our study, for the Vitek2 automated system, the Categorical Agreement (CA) ratio is 93.71%, the Very Major Error (VME) rate is 6.89%, and the Minor Error (ME) rate is 1.41%. For the Phoenix automated system, the CA ratio is 95.05%, the VME rate is 3.44%, and the ME rate is 1.51%.Vitek2; specificity is 86.10%, lambda value is 0.82, and kappa value is 0.83. For the Phoenix system, specificity is 88.20%, lambda value is 0.82, and kappa value is 0.87.


DISCUSSION AND CONCLUSION: In determining colistin susceptibility for K. pneumoniae, the Phoenix automated system was found to be more compatible with the reference method than the Vitek2 automated system, and more supportive multicenter studies are needed on this subject.

INTRODUCTION: Blood culture is the most commonly used method in the diagnosis of bloodstream infections and contributes to manage the treatment, take infection control measures and reduce mortality. Blood culture indicators are parameters that provide monitoring of preanalytical, analytical and postanalytical processes and determining what can be done to eliminate deficiencies and improve current situations. In this study, it was aimed to evaluate quality indicators according to health quality management system and to determine distribution of causative microorganisms in blood cultures of patients hospitalized in various clinics.
METHODS: A total of 6556 blood culture samples sent to microbiology laboratory between January 2020 and December 2022 were evaluated retrospectively. All data regarding quality indicators such as contamination rate in blood cultures, the rate of positive results, the number of blood cultures taken from a single bottle, the number of blood cultures taken from two or more sets, rate of incompatibility between Gram staining and final identification, rate of rejected samples and rate of false positive results were obtained by scanning through laboratory information management system. Blood culture bottles were incubated in automated blood culture device, bottles giving positive signals were cultured and identification and antimicrobial susceptibility tests were performed to isolated microorganisms by automated system.
RESULTS: Growth was detected in 534 (8.1%) of a total of 6556 blood cultures. The rates of samples detected to be contaminated and rejected were 1.8% and 0.7%, respectively. The higher rates of blood culture collection of two sets or more in pediatric intensive care unit (53.6%) and in pediatric wards (40.1%) showed a statistically significant difference compared to other services. It was observed that rates of single bottle collection (68.4%), contamination (33.3%), growth (49.3%) and rejection of samples (65.1%) sent from neonatal intensive care unit were higher than rates of samples sent from other clinics. The most frequently isolated microorganism was Methicillin-resistant Staphylococcus epidermidis (35.4%), followed by Methicillin-resistant Staphylococcus hominis (15.7%). While Klebsiella spp. (6.2%) was the most frequently isolated gram-negative bacteria, non-fermentative bacteria (2.3%) and Candida spp. (0.9%) were microorganisms rarely isolated from blood cultures.
DISCUSSION AND CONCLUSION: In this study, since the majority of patients are newborns and patients under one year of age, the higher rates obtained in quality indicators such as single-bottle blood culture collection reflects difficulties in collecting blood cultures from pediatric population. Even if contamination rates were found to be within ideal limits, laboratory-clinical cooperation is important in distinguishing between agents and contaminants.

INTRODUCTION: Occult HBV infection (OHI) can be defined as the presence of HBV DNA in the liver tissue of HBsAg negative individuals (with detectable or undetectable HBV DNA in the serum) by current sensitive tests, except window period of infection. This study was carried out to investigate isolated anti-HBc positivity and OHI, by using anti-HBc, HBV DNA PCR and anti-HBs, in the plasma samples of HBsAg negative donated blood.
METHODS: The one thousand and sixty three plasma samples of HBsAg, anti-HCV and anti-HIV negative blood which were donated between 19 March and 28 April 2010 stored at -80 ºC for one year in accordane with National Blood and Blood Products Guide, were included in the study. OHB was investigated by using anti-HBc and HBV DNA PCR in all plasma samples which were included in the study. In anti-HBc and/or HBV DNA PCR positive samples, anti-HBs investigation was conducted.
RESULTS: Anti-HBc positivity was detected in 87 (8.2%) donor plasma samples. The mean age of anti-HBc positive donors or isolated anti-HBc positive donors or anti-HBc/anti-HBs positive donors were; 30±11.5 years, 38±15.9 years and 28.8±10.4 years, respectively. Among all plasma samples included in the study; the rate of isolated anti-HBc positivity was 1.03% (n=11) and isolated anti-HBc positivity was seen significantly in older age, compared to anti-HBc positivity with anti-HBs positivity (p=0.047). As a result of this study, HBV DNA PCR positivity was not detected in any of the donor plasma samples.
DISCUSSION AND CONCLUSION: The rates of isolated anti-HBc positivity in blood donors admitted to our center was found lower than earlier studies conducted among blood donors in Turkey. In Turkey, although there is no legal obligation, Kızılay Regional Blood Centers have started to work on NAT in onated blood as of 1 November 2014. We suggest that large-scale studies to investigate the use of antiHBc and/or nucleic acid amplification tests in addition to HBsAg for screening of blood donors.

INTRODUCTION: Female mosquito species belonging to Culex sp. are important infectious disease vectors in terms of disease transmission. Ecdysis plays an important role in mosquito development. In mosquitoes, the integument consists of a single layer of ectodermal cells and the cuticle layer secreted by them. Among the insect growth regulators (IGR) and some bio insecticides recommended by the World Health Organization for use in larval control, diflubenzuron (DFB) is among the most used commercially. DFB has been defined as a chitin synthesis inhibitor because it negatively affects cuticle formation in insects. DFB inhibits chitin synthesis, altering the composition of the cuticle and causing anomalies in the storage of chitin in the endocuticle, thereby preventing the proper occurrence of molting in the integument. In this study, it was aimed to determine the changes occurring in the cuticles of third and fourth instar mosquito (Culex pipiens) larvae treated with DFB at the macroscopic and histologic levels and to reveal possible abnormalities.
METHODS: The best results in mosquito control are obtained with larvae control. For this reason, DFB was applied at a rate of 2.5mg per m2 to the water-filled container containing the third and fourth larval stages of C. pipiens, and to ecdysis behavior of the larvae followed for 2-3 days. DFB-treated and non-DFB-treated (control) C. pipiens larvae of the same stages were compared in detail, examined and macroscopically photographed. In addition, 5-6 µm cross-sections were taken from the control and treatment groups mosquito larvae, which were fixed as a total using Bouin fixative, following routine histological steps. Preparations were made by staining Pollak’s trichrome and Heidenhain’s Azan-Mallory process, then detailed observation and photographed.
RESULTS: Macroscopic abnormalities were determined in the larvae of both treatment stages. Histologically, it was observed that the cuticle was thin and there were fat body accumulations under the epidermal cell layer just below it.

DISCUSSION AND CONCLUSION: As a result, it has been determined both morphologically and histologically that DFB, one of the chitin synthesis inhibitors, negatively affects cuticle formation during ecdysis that occurs during growth in mosquitoes.

INTRODUCTION: COVID-19 vaccines are at the forefront of the most important protective factors in the fight against the epidemic, but there are different attitudes towards the vaccine. Vaccine literacy indicates the capacity of individuals to obtain, process and understand basic health information and services to make sound health decisions about vaccines. This study aimed to evaluate the vaccination literacy level of Çankırı province and to determine the factors affecting vaccination literacy.
METHODS: The research is a cross-sectional type research. The population of the research consists of individuals aged 18 and over who are registered to the family health center located in Çankırı province and all districts. In this study, a questionnaire was used as a data collection tool. The survey consists of two parts. In the first part, there are 12 questions, including socio-demographic characteristics. In the second part, there is the COVID-19 vaccine literacy scale. Research data was collected between 01.12.2021 and 31.01.2022. The determined sample was allocated in the research was used in proportion to the district population and 400 people were reached. The data were analyzed in the SPSS 25.0 package program.
RESULTS: COVID vaccine literacy level in Çankırı province was determined as medium level (2.80±0.53). In the study, when the COVID-19 vaccine status and the COVID-19 vaccine literacy levels were examined, the literacy level was found to be higher in the individuals who were vaccinated Although the COVID-19 vaccine literacy levels are lower in districts with a high elderly population, no statistically significant difference was observed and in accordance with the literature, it was found to be lower in the older age group than in other groups. In the study, when the COVID-19 vaccine status and the COVID-19 vaccine literacy levels were examined, the literacy level was found to be higher in the individuals who were vaccinated and showed similar results with other studies.
DISCUSSION AND CONCLUSION: Vaccination, one of the most important methods of combating infectious diseases and is necessary for public health. Vaccination has increasingly become more important for protection against COVID-19, which has emerged as an important health problem in recent years. Within the scope of the fight against pandemics, the vaccination literacy level should be increased, especially in elderly individuals aged 65 and over, and it is evaluated that disease rates and deaths will be reduced by increasing vaccination rates.

INTRODUCTION: Due to the secondary metabolites, edible plants have been a recent focus in the literature for their biotherapeutic effects and functional food potentials. Discovering the aromatic bioactive components of plants consumed as food is of great importance in an ethnobotanical vision. In this context, the study investigated Helichrysum arenarium L., Origanum sipyleum L., Plantago major L., and Rumex spp. species both in vitro and in silico.
METHODS: The volatile composition and identification of these plants were determined using carboxen-polydimethylsiloxane / solid-phase microextraction (CAR-PDMS/SPME) fiber with gas chromatography/mass spectrometry (GC/MS) method. Moreover, the antioxidant activities of the plants were determined using a 2,2′-diphenyl-1-picrylhydrazyl (DPPH) radical and β-carotene-linoleic acid assays. To determine their antioxidant activities and inhibitory effects on oral cancer, molecular docking analysis was conducted. Also, ADMET (absorption, distribution, metabolism, elimination and toxicity) properties were identified, the presence of carcinogenic and mutagenic components was investigated, and their potentials for various diseases were revealed through PASS (prediction of activity spectra for substances) analysis.
RESULTS: The results indicate that the plants exhibit a rich profile of volatile bioactive compounds, with the highest bioactive compound content found in Rumex spp. Compared with other plants, Helichrysum arenarium was found to have the highest antioxidant potential and in silico anticancer potential. Additionally, it was determined that the various volatile compounds of the plants could have protective effects on the gastrointestinal system and could be used particularly for stomach complaints.This investigation shows that these plants may have pharmaceutical and dietary potential as functional foods.


DISCUSSION AND CONCLUSION: This investigation shows that these plants may have pharmaceutical and dietary potential as functional foods.

INTRODUCTION: The aim of this study was to investigate the attitudes and field experiences of primary health care workers on vaccine refusals.
METHODS: This descriptive study was conducted with a total of 201 people (inclusion rate: 91.4%) including doctors, midwives, nurses and other healthcare professionals in all units (including district health directorates, Healthy Living Centres) of Mardin Provincial Health Directorate. A questionnaire form and antivaccination scale were used to collect the data. Descriptive data are shown with numbers and percentages. It was used to Mann Whitney U test to evaluate the relationships between the total and sub-dimension scores of the scale, demographic and vaccination practice variables.
RESULTS: 5.0% of healthcare workers supported vaccine refusal, and 15.4% had vaccine hesitation. The most commonly reported reason for concern about vaccination was not finding vaccine ingredients safe. Almost all participants have experienced vaccine refusal for childhood (99.0%) and COVID vaccines (99.5%). The total score of the vaccine opposition scale was higher in males (median 30 (24-54)) than in females (median 25 (22-32)), in physicians (median 27 (23-47)) than in other employees (median 25 (22-35)), in those who were against vaccines/experienced hesitation (median 58 (45-73)) than in those who were not, and in those who did not find vaccines safe (median 75 (64-83)) than in those who found them safe (median 25 (22-32)) (p<0.05).
DISCUSSION AND CONCLUSION: It has been revealed that healthcare workers are faced with a high rate of vaccine refusal/hesitancy within the scope of immunization services in the region, they are experiencing a significant level of hesitancy about vaccination and they need training on this subject.

INTRODUCTION: Neurofibromatosis type 1 (NF1) is a common yet complex neurogenetic disorder characterized by a highly variable clinical presentation, influenced by both genetic and environmental factors. While its genetic basis is well understood, the variability in symptoms among patients presents significant challenges for diagnosis and management. This study focuses on examining the differences in clinical features between sporadic and familial NF1 cases. Additionally, it evaluates the potential of machine learning techniques to predict sporadic NF1 cases based on clinical symptoms, offering insights into how computational approaches can complement traditional diagnostic methods.
METHODS: A retrospective analysis was conducted on the medical records of 241 NF1 patients, including 121 sporadic and 120 familial cases. The frequency of various clinical features, such as Lisch nodules, pseudoarthrosis, and hypertension, was compared between the groups. analysis of variance (ANOVA) was used to identify the most important features distinguishing sporadic cases from familial ones. Furthermore, multiple machine learning algorithms, including k-nearest neighbors, artificial neural networks, support vector machines, decision trees, and XGBoost, were employed to predict sporadic cases based on the identified features.
RESULTS: Among the machine learning models tested, the XGBoost algorithm demonstrated the highest predictive accuracy at 62.86%, indicating moderate reliability in identifying sporadic cases. Despite this limitation, the analysis revealed significant differences in clinical manifestations between the two groups. These differences suggest that shared genetic modifiers may play a critical role in shaping the observed genotype-phenotype relationship in NF1.
DISCUSSION AND CONCLUSION: This study represents the first detailed comparison of a broad spectrum of clinical symptoms between sporadic and familial NF1 cases. While machine learning models showed only moderate success in prediction, the findings provide valuable insights into the phenotypic variability of NF1 and underscore the importance of larger, more diverse datasets for improving predictive accuracy. These results hold significant potential for guiding personalized diagnostic and therapeutic strategies for NF1 patients.

INTRODUCTION: Clinical quality (CQ) describes the technical quality of healthcare services and explains how healthcare system affect patient outcomes. This study aims to assess CQ on the patient scale by using structure, process, and outcome measures in the context of coronary artery bypass graft (CABG) surgery.
METHODS: Network Data Envelopment Analysis NDEA) was used to assess the CQ levels of patients undergoing CABG. The structure, process, and outcome quality measures of CABG surgery which include clinical factors of the patient as well as the medical procedures, costs, inpatient days, and quality of life, are examined simultaneously. These variables are used to assess CQ and to determine the quality improvement points.
RESULTS: According to the results of NDEA three patients had the highest level of CQ. Detailed profiles were generated for CABG surgery and for patients with low-clinical quality levels. This research highlighted areas for quality improvement to maximize resource utilization and clinical efficiency.
DISCUSSION AND CONCLUSION: As a result of this study, CQ with the NDEA on a patient scale, encompassing the structure, process, and outcome quality measures across the entire healthcare cycle of CABG surgery and the analysis model demonstrated its potential as a useful tool for assessing and improving CQ. The intensive care unit and postoperative length of stay, the duration of cardiopulmonary-bypass and cross-clamp, and the use of fresh frozen plasma were identified as the areas requiring quality improvement. The study recommends creating disease-specific standard data packages including multiple quality measures for CQ assessment, and employing the NDEA method for further quality improvement studies.

INTRODUCTION: Fixation is the basic step in the investigation of the tissues by light microscopy and affects the following steps. There are different fixation methods and different fixatives are used for this purpose. In this study, it was planned to examine which fixative gives the best result in the examination of the eye tissue. In terms of preserving tissue integrity, the study aimed to examine the effects of six different tissue preparation methods on eye structure.
METHODS: Six different tissue processings methods, different dehydrating agent (alcohol and acetone) and different fixatives (10% formaline, Bouin and 4% paraformaldehyde) were applied to 24 eye tissues taken from 12 female Wistar Albino rats. Sections taken from the obtained blocks were stained with hematoxylin and eosin dye and evaluated histomorphologically under the light microscope. The suitability of the different fixatives and dehydration agents applied to eye tissues and the differences that occur in the tissues are indicated.
RESULTS: The histological structure of rat eye samples was investigated in terms of the cornea, sclera, choroid, retina, iris and ciliary body. There was not any important difference among the groups. Accordingly, it was observed that all evaluated parameters generally gave similar results in terms of morphology when tissue integrity and all structures were considered in group I, group II, group III, group IV, group V, and goup VI. However, when the integrity of the eye tissues was evaluated, it was observed that the integrity of the histological layers in the eyeball was best preserved in the group IV Bouin fixative and acetone group. When the layers were examined individually between the groups, it was determined that the cornea, sclera, choroid and retina structures did not differ significantly.
DISCUSSION AND CONCLUSION: For optimal histomorphological examinations, the tissue preparation process is important to follow. The more successful this process is, the better the level of detail in the microscope will be and it will provide a suitable basis for basic histomorphological examinations. According to the findings of our study, we can recommend using Bouin as a fixative and acetone as a dehydrating agent in the eye tissue preparation process. Further studies are needed to generalize and improve the results of this study.

INTRODUCTION: Taenia multiceps is a cestode that lives in the small intestines of domestic and wild carnivores such as dogs, foxes and jackals. The larval stage of T. multiceps, Coenurus cerebralis, develops in the central nervous system. Parasite is usually in rural areas, and dog-sheep contact, including foxes and wild ruminants, is the most contagious area. It can be transmitted when farmers open the skulls of sick animals and feed the cysted tissues to dogs. The presence of the cyst results in typical neurological symptoms and, in most cases, leads to the death of the animal. Coenurosis caused by C. cerebralis is a parasitic disease that causes high economic losses in small ruminants. In this study; it was aimed to find C. cerebralis by molecular methods in nine of the samples found to have coenurosis.
METHODS: This study was conducted on 1200 sheep slaughtered in the Diyarbakır province between September 2022 and April 2023. Phylogenetic studies were conducted with nine of the 122 sheep considered positive.
RESULTS: Coenurus cysts were observed in 12 out of 122 animals (9.8%). Cysts of nine out of 12 sheep were genetically analyzed and confirmed as T. multiceps metacestodes by COX1 (cytochrome c oxidase subunit 1) gene sequence analysis. Accession numbers; OR239756, OR239757, OR239758, OR239759, OR239760, OR239761, OR239762, OR239763, OR239764. Similarities of these data with other strains in NCBI (National Center for Biotechnology Information) were compared.
DISCUSSION AND CONCLUSION: For a definitive identification of T. multiceps in Türkiye, further studies may be required using various molecular protocols on biological characteristics, long sequence genes in the mitochondrial and nuclear genome, other hosts and samples from different geographical regions to improve our understanding of the epidemiological distribution in Türkiye.

INTRODUCTION: In conditions leading to hemorrhagic shock, the transfusion of erythrocyte concentrate (EC) may be necessary. The primary goal of transfusion is to reduce mortality caused by tissue hypoxia. In critically ill patients where time is of the essence, such as those with trauma or gastrointestinal bleeding, the administration of O Rh-negative EC without cross-matching can be life-saving. This study aims to evaluate the effectiveness of emergency O Rh-negative EC transfusion in patients with hemorrhagic shock by analyzing its impact on hemodynamic parameters, the need for surgical intervention, and patient outcomes. Additionally, it seeks to highlight the importance of O Rh-negative EC transfusion in gaining the necessary time for bleeding control.
METHODS: This retrospective study was conducted in the Emergency Department of a tertiary hospital between June 1, 2023, and June 1, 2024.The study included 95 patients aged 18 years and older who received O Rh-negative EC transfusion without cross-matching. The patients’ vital signs, complete blood count, biochemical and blood gas values, transfusion indications, surgical intervention rates, and 30-day mortality were recorded. In my hospital, the preparation of erythrocyte concentrate with a cross-match test takes an average of 60–90 minutes, whereas the preparation of O Rh-negative EC without cross-matching is completed in a significantly shorter time, approximately 5–20 minutes.
RESULTS: Among the patients, 72% (n=68) were male, and the most common indication for transfusion was trauma (69.5%), followed by gastrointestinal bleeding (24.2%). The most frequent trauma-related causes were liver injuries (n=20) and extremity injuries (n=17). Endotracheal intubation was performed in 64% of the patients, 63% underwent emergency surgery, and 82% were admitted to the intensive care unit. The mortality rate in the emergency department was 16%, while the overall mortality rate was found to be 56%. A significant relationship was found between mortality and systolic blood pressure, diastolic blood pressure, Glasgow Coma Scale score, and lactate levels (p=0.022, p=0.001, p<0.001, p<0.001). Additionally, higher International Normalized Ratio (INR) values and lower platelet counts were significantly associated with survival status (p=0.01, p=0.002).
DISCUSSION AND CONCLUSION: The transfusion of O Rh-negative EC was found to provide critical time before surgical intervention and improve survival in patients with trauma and gastrointestinal bleeding. It is suggested that initiating blood transfusion during the pre-hospital period may further reduce mortality rates. This study is expected to contribute to the establishment of a database for the appropriate and effective use of blood and blood products.

INTRODUCTION: Healthcare managers spend approximately 20% of their time addressing conflicts, which is common in this labor-intensive sector. While conflict is inevitable in healthcare, ensuring job satisfaction among healthcare workers and enhancing service quality are critical for the success of healthcare systems. Proper conflict management is essential to minimize its adverse effects on job satisfaction and support patients and workers.The study examined the relationship between job satisfaction and healthcare conflict levels among healthcare workers. It also evaluated how sociodemographic characteristics influence job satisfaction and conflict levels.


METHODS: This descriptive study was conducted with 276 healthcare workers employed at a tertiary public hospital. Data were collected via an online survey (Google Forms) with three sections: sociodemographic data, Job Satisfaction Scale, and Healthcare Conflict Scale. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) ensured validity, while Cronbach’s alpha assessed reliability. Due to non-normal distribution, Mann-Whitney U and Kruskal-Wallis H tests were used. Structural Equation Modeling (SEM) was performed.

RESULTS: The findings showed no statistically significant differences in job satisfaction based on sociodemographic characteristics (p>0.05). However, significant differences in healthcare conflict levels were observed based on age and years of professional experience (p<0.05). A weak positive correlation was also identified between job satisfaction and healthcare conflict levels (r=0.15, p=0.019).

DISCUSSION AND CONCLUSION: The study reveals a weak positive relationship between job satisfaction and healthcare conflict levels. While conflict levels were significantly influenced by age and professional experience, job satisfaction showed no significant sociodemographic variation. These findings highlight the need for further research to understand better the interplay between conflict and satisfaction in healthcare settings and to develop effective conflict management strategies.

Efflux systems are transport proteins that are crucial for bacteria in maintaining their internal environment and ensuring survival. Efflux pumps extrude a lots of harmful substrate that endogenous and exogenous from bacteria to the environment. These systems have gained considerable attention due to their role in drug resistance mechanisms, which has significant implications of infection disease. This review provides the main characteristics of efflux pumps in bacteria, including the structure of pumps and provides also a perspective to efflux pump inhibitors that nacavt antibiotic resistance. Efflux pump strongly related to biofilm infection and necessary to deliver quorum sensing signal molecules. Understanding the structure and function of efflux systems may provide valuable insights into the development of novel therapeutics for infectious diseases and combating drug resistance in bacteria. The rise of multidrug-resistant bacteria poses a serious threat to global public health. International authorities, such as the World Health Organization (WHO), recognize the urgent need for effective treatments against these resistant strains. With the potential exhaustion of current antibiotics, the WHO is leading multidisciplinary efforts to discover new antibiotics and increase the efficacy of existing ones. Efflux pump inhibitors have emerged as a promising approach to combat resistant bacteria by enhancing the effectiveness of existing antibiotics. While toxicity issues have hindered the clinical use of many efflux pump inhibitors, new strategies such as the discovery of novel agents or the use of bacteriophages show potential to overcome these obstacles. The main is to provide an overview of current approaches in efflux pump inhibitors to provide a solution to the treatment of multidrug resistant bacterial infections.

The COVID-19 pandemic, declared in 2020, has demonstrated the importance of surveillance activities in the pandemic response. Wastewater surveillance is a rapidly developing scientific discipline with the potential to monitor real-time data on geographic and temporal trends on a variety of subjects. It is successfully used in the elimination programs of infectious diseases such as poliovirus, norovirus, hepatitis A, aichivirus, influenza, illegal drug use follow-up and antimicrobial resistance surveillance in various countries. During the COVID-19 pandemic, the number of infected individuals and the prevalence of disease can be estimated by wastewater monitoring. It is thought that wastewater surveillance, which can be used for retrospective screening or early warning purposes, may also contribute to decision-making for public health interventions and monitoring spread of variants processes. SARS-CoV-2 monitoring studies in wastewater have revealed that there is a marked temporal correlation between the viral load detected in wastewater. However, there are important uncertainties and limitations on the subject due to the complexity of the methods and processes and the unique biological characteristics of SARS-CoV-2. There is no clear information on many subjects such as the viral load excreted in the feces at different stages of the infection and its relationship with the number of genes detected in the wastewater, the viral excretion time in the feces, the degradation rate of the viral RNA in the external environment and its persistence in the wastewater. It is recommended to develop hygiene and sanitation infrastructure and to ensure effective disinfection in treatment facilities against the potential risk of fecal-oral transmission. Also, World Health Organization (WHO) states that despite all the benefits of “wastewater surveillance”, which is one of the types of surveillance that can be used in the management of the COVID-19 pandemic, it can be used as a “complementary” rather than an “alternative” to clinical surveillance. When all these findings are evaluated together, it is thought that it would be more appropriate for our country to use financial resources and manpower for measures that have been epidemiologically proven to be effective in the fight against the pandemic, rather than wastewater surveillance. In this review, it is aimed to evaluate wastewater surveillance through examples, to reveal its possible benefits, possible problems and limitations on the subject, and to present recommendations.

Tuberculosis, a contagious and lethal disease, continues to be one of the most significant health problems worldwide. Currently, treatment with appropriate doses and combinations is effective; however, resistance to medication can develop due to factors such as low dosage, incorrect combinations, and patient abandoning treatment. As a result, resistance to a single drug may occur, as well as strains resistant to more than one drug. Resistance in bacteria occurs through gene transfer. However, mycobacteria develop resistance through spontaneous point mutations rather than gene transfer. Understanding the effect area of known drugs on mycobacteria is crucial for determining drug combinations and compatibility in treatment. The long duration of mycobacterial susceptibility tests delays both the initiation of treatment and the identification of resistance. Rapid molecular susceptibility tests have been developed to address this issue. Molecular drug susceptibility tests are rapid methods that can determine resistance quickly, detect the presence or absence of mutations in the relevant gene region, and exposes the resistance mechanism. However, molecular tests may sometimes result in cases where phenotypic resistance is not reflected despite genotypic resistance appearing to be present. Additionally, strains that are determined to be susceptible by molecular tests may exhibit phenotypic resistance. Given the potential challenges such as the long duration of tuberculosis treatment, patient abandonment, and disease relapse, the use of molecular tests provides significant benefits to clinicians. However, it is essential to verify the obtained results with classical antibiotic susceptibility tests. In conclusion, it is believed that the existence of new technologies and the use of classical drug susceptibility tests will allow for the understanding of drug effect-resistance mechanisms, influence the development of next-generation drugs in tuberculosis treatment, and enable the minimization of resistance development against new drugs.