USA v. Eric Esposito

USDC for the Eastern District of Pennsylvani

The frequency and costs of intravitreal therapy agents in retinal diseases

Background: The aim of this study is to analyze the numbers and the economic burden of intravitreal anti-VEGF agents and intravitreal dexamethasone (IVD) implants administered to patients with diabetic retinopathy (DR), age-related macular degeneration (AMD) and retinal vein occlusion (RVO). Material and methods: The retrospective case-control study included 1525 patients diagnosed with DME, neovascular AMD and RVO, and received intravitreal anti-VEGF and IVD between January 2016 and December 2018. Intravitreal anti-VEGF administration was performed within the framework of the Pro Re Nata (PRN) regimen. The prices of anti-VEGF agents and IVDs were calculated on the average of the prices in the relevant year. Results: The total number of intravitreal injections in 3 years was 5864. During the 3-year follow-up, on average,ranibizumab (Lucentis) was applied 3.56 ± 2.25 times, alfibercept (Eylea) was applied 3.31 ± 2.16 times, and IVD(Ozurdex) was applied 1.70 ± 0.83 times. The anti-VEGF numbers in 2016, 2017 and 2018 were 1997, 1801, 2066,respectively. In total, the 3-year drug cost was 3,587,812.44 USD. Conclusions: The economic burden of intravitreal anti-VEGF and IVD treatment for retinal diseases is so important to developing countries such as Turkey. The economic burden created by anti-VEGF agents and IVDs in Turkey will reduce in a serious sense, and the legal concerns of physicians will decrease thanks to the decision taken by the Turkish Medicines and Medical Devices Agency (TMMDA)

The frequency of refractive errors required to be corrected in childhood among Turkish children

Background: The aim of this study is to investigate the distribution of refractive errors needed to be correct in childhood. Material and methods: Children applied and received glasses prescriptions were recruited. Age, gender, spherical, cylindrical error, and spherical equivalent (SE) were noted. The refractive errors were classified as myopic, hyperopic and cylindrical errors according to the SE and prescriptions. Cylindrical errors were subdivided into myopic, hyperopic. Children were classified into 4 groups. Group 1, 2, 3 and 4 composed of children whose ages were between 0–5, 6–10, 11–15 and 16–18 years, respectively. Results: There were 846 children in group 1, 3931 in group 2, 5948 in group 3, 3896 in group 4, and a total of 14621 children. The rates of myopia and hyperopia were 72.4% and 27.6%. Myopic and hyperopic astigmatism were found in 29.1% and 11.3% of children. Myopia, myopic astigmatism increased with age (p < 0.05). The hyperopia rate decreased with decreasing age (p < 0.05). The frequency of myopia, myopic astigmatism was higher in both male and female children (p < 0.05). The rate of myopia was higher in females (p < 0.05). There was no statistically significant difference in terms of cylindrical value between genders. The statistically significant difference was found in terms of mean SE among all groups and a negative correlation was present between age and mean SE. A lower negative correlation was stated between age and cylindrical value. Conclusion: Corrected myopic and myopic astigmatism errors were higher than hyperopic refractive errors. The prevalence of myopia increased by age and was higher in females. The need for glasses was highest in children whose age range was between 11 and 15 years

Textile Wastes: Status and Perspectives

The world population has grown tremendously in the past few decades, and the same period also witnessed improvements in living standards in general. These two developments have augmented the consumption of textiles, which in turn increased textile production. Global production of all apparel and textile fibers amounted to more than 110 million tons annually, leading to the generation of high amount of textile wastes. In order to ensure sustainability and reduce environmental impacts in the textile and apparel sector, utilizing a circular economy model is of utmost importance. Recycling of textile waste is a requirement for the implementation of a circular model. This study presents a general evaluation of management of textile wastes, in terms of ensuring sustainability and minimizing environmental impacts

Hypogammaglobulinemia Prevelance in Children with Atopic Dermatitis and the Relationship Between Immunoglobulin Levels and Eczema Severity

Aim:Atopic dermatitis (AD) is the most common chronic skin disease of childhood. Although eczema may be a prominent finding in some primary immune deficiencies, there are very few studies conducted on the frequency of hypogammaglobulinemia in patients with eczema. In our study, we aimed to determine the frequency of hypogammaglobulinemia in patients with AD and the relationship between immunoglobulin levels and eczema severity.Materials and Methods:Patients between the ages of 0-18 years, who were diagnosed with AD between January 2015 and August 2018 in the Department Pediatrics Division of Pediatric Allergy and Immunology, Trakya University Faculty of Medicine, were included in the study. Hypogammaglobulinemia was defined as being less than -2 standard deviation of immunoglobulin A, M and G from normal values for age.Results:The median age of 117 patients included in the study was 11 months [interquartile range (IQR): 6.7-33 months], the median age of eczema onset was 3.5 months (IQR: 2-6 months), the median SCORingAtopicDermatitis at presentation was 13.8 (IQR): 5-32]. Thirty-six (30.8%) patients had low levels in one of the immunoglobulin isotypes and decreased levels of immunoglobulin A (IgA), M and G were found in 21 (17.9%), 18 (15.5%) and 23 (19.7%) patients, respectively. While there was no difference between mild and moderate-severe eczema groups in terms of age at presentation, age of onset of eczema, family history of allergic diseases, smoking exposure, aeroallergen sensitivity, food allergy, the number of patients having hypogammaglobulinemia, and the levels of IgA, M and G, a male predominance and higher number of eosinophils were observed in the moderate-severe eczema group.Conclusion:It is concluded that the evaluation of immunoglobulin levels independent of the severity of eczema is important for the distinction of primary immunodeficiency and the follow-up of patients in terms of transient hypogammaglobulinemia of infancy in patients with AD

Whole-genome sequencing and genome-scale metabolic modeling of Chromohalobacter canadensis 85B to explore its salt tolerance and biotechnological use

Salt tolerant organisms are increasingly being used for the industrial production of high‐value biomolecules due to their better adaptability compared to mesophiles. Chromohalobacter canadensis is one of the early halophiles to show promising biotechnology potential, which has not been explored to date. Advanced high throughput technologies such as whole‐genome sequencing allow in‐depth insight into the potential of organisms while at the frontiers of systems biology. At the same time, genome‐scale metabolic models (GEMs) enable phenotype predictions through a mechanistic representation of metabolism. Here, we sequence and analyze the genome of C. canadensis 85B, and we use it to reconstruct a GEM. We then analyze the GEM using flux balance analysis and validate it against literature data on C. canadensis. We show that C. canadensis 85B is a metabolically versatile organism with many features for stress and osmotic adaptation. Pathways to produce ectoine and polyhydroxybutyrates were also predicted. The GEM reveals the ability to grow on several carbon sources in a minimal medium and reproduce osmoadaptation phenotypes. Overall, this study reveals insights from the genome of C. canadensis 85B, providing genomic data and a draft GEM that will serve as the first steps towards a better understanding of its metabolism, for novel applications in industrial biotechnology

Residents and interns in the 3 university hospitals: their knowledge of and attitudes to drug allergy

Background: Previous studies revealed there are many gaps in the awareness and knowledge regarding the diagnosis and management of drug allergy (DA) among various health-care professionals. Objective: To assess the knowledge, attitudes, and practices towards DA among residents and interns of 3 university hospitals in the region of Trakya (Thrace), Turkey. Methods: A cross-sectional survey was conducted at university hospitals of 3 cities in the Trakya region: 1. Trakya University Medical Faculty, Edirne (n = 405), 2. Namik Kemal University Medical Faculty, Tekirdag (n = 114), and 3. Canakkale 18 Mart University Medical Faculty, Canakkale (n = 111). A Turkish questionnaire was developed based on previous published studies. Results: The majority of participants (67%) had not received education on DA as a separate subject during their medical education. Less than a third (28.3%) of all respondents were satisfied with their knowledge concerning patients with clinical signs of DA. Of the 6 knowledge questions on DA, the average score for the study was 3.51 out of 6 (58.5%). Residents had a higher knowledge score (3.93 +/- 1.1) compared with interns (3.05 +/- 1.2) (p < 0.001). The lowest percentage of correct answers were in response to questions on laboratory confirmation of drug-related anaphylaxis (14.5%) and the possibility of penicillin toleration in patients with a history of penicillin allergy (11.8%). The majority of participants (92%) believe that medical doctors should be educated in DA. There were no significant correlations between taking DA histories and the frequency during daily practice of encountering patients. Conclusion: Our study revealed that DA knowledge and attitudes are not at satisfactory level among respondents, and we concluded the importance and necessity of reinforcement of DA education in pre- and postgraduate education of medical doctors

The assessment of twin pregnancies delivered in our clinic: three-year experience

Objective: Twin pregnancies constitute 1–2% of all pregnancies. With the recent developments in assisted reproductive technologies, the incidence of multiple pregnancy has increased. Preterm labor is held responsible for the poor neonatal outcomes primarily. In our study, we aimed to assess fetal-maternal outcomes of twin pregnancies seen in our clinic. Methods: One hundred and thirty twin pregnancy cases out of 4241 pregnant women who delivered in our clinic between 01.01.2017 and 01.01.2020 were included in the study. The labor records of the patients were reviewed retrospectively and their data for age, week of gestation, delivery type, birth weight, fetal sex, chorionicity characteristics and laboratory parameters were recorded. Definitive statistics and SPSS 21.0 for statistical analyses were used to evaluate the data obtained from the study. The data were presented as mean ± SD (standard deviation). Results: The incidence of twin pregnancy was found 3%. In the ultrasonographic imaging evaluated during diagnosis, 27.7% of the cases were monochorionic and 72% of them were dichorionic. Of the pregnant women, 12.3% were at term and 87.7% were at preterm period. When the preterm fetuses were evaluated, 37.7% of 114 preterm fetuses were delivered at late preterm period, 29.2% of them at mid-preterm period and 20.8% at premature preterm period. The rates of treatment pregnancy (pregnancy provided by ovulation induction and assisted reproductive technologies) and spontaneous twin pregnancy were 20% and 80%, respectively. Mean maternal age was found 31.3. When evaluated in terms of maternal morbidity, preterm labor and premature rupture of membrane were the most common problems. Mean newborn weight was 1832g and 59.3% of the newborns had low birth weight and 21.8% of them had very low birth weight. While one fetus had transverse presentation in 12.5% of the patients, at least one fetus had breech presentation in 53.1% of the cases and 34.4% of the cases had head-head presentation. Conclusion: Twin pregnancies are characterized by the increased feto-maternal risks. Therefore, both antenatal and intrapartum management should be maintained diligently

The assessment of maternal deaths between 2015 and 2020 in Elazığ, Turkey

Objective: To determine the maternal deaths and the factors affecting them in our city. Methods: The maternal deaths occurred in our city between January 2015 and June 2020 were reviewed retrospectively. The review was conducted by checking “Maternal Death Registry Forms” of the Provincial Directorate of Health. In cases where additional data related with the cause of death were required, the relatives of the cases, associated family practitioner, The Council of Forensic Medicine or local authorities were contacted. The data of the cases including age, gravida, parity, abortion, delivery type, week of gestation during delivery, period of death and maternal deaths due to direct, indirect and incidental causes were recorded. Based on total live births and maternal deaths within 6.5 years, maternal mortality rate was found as the maternal death number per 100,000 live births. Descriptive statistics were used for the statistical analysis of the data. Results: A total of 46.618 live births occurred between 2015 and 2020 in Elazığ. The number of maternal deaths due to direct and indirect causes is 7, and maternal mortality rate was found 15.01/100,000. Hypertensive diseases during pregnancy (n=3, 42.8%), pulmonary embolism (n=1, 14.3%) and cerebral thrombosis (n=1, 14.3%) were among the natural causes of maternal deaths. Indirect cause for maternal death was cardiac diseases (n=2, 28.6%). When they were categorized according to the Three Delays Model, there were 3 death cases in the first delay model and 2 death cases in the third delay model, but there was no maternal death in the second delay model. Conclusion: Maternal death is an significant public health issue which develops due to the generally preventable causes and maintains its importance. The factors contributing to death should be paid attention in order to decrease maternal death rates