Risk factors and clinical characteristics of Stenotrophomonas maltophilia infections in neonates

BackgroundThe aim of this study was to review the risk factors and clinical, bacteriological, and epidemiological characteristics of Stenotrophomonas maltophilia infections in our neonatal intensive care unit.MethodsA retrospective matched case–control study was performed by comparing 23 cases of S maltophilia with 45 controls to identify the potential risk factors. To identify the case patients, the admission and medical records of patients in the neonatal intensive care unit and records from the Microbiology Department were reviewed between 2003 and 2008.ResultsSepsis in two neonates (9%), conjunctivitis in two neonates (9%), and ventilator-associated pneumonia in 19 (82%) neonates were determined. Invasive-procedures, exposure to aminoglycoside and carbapenem, total parenteral nutrition, histamine 2 blockers, exposure to steroids, cholestasis, and duration of hospitalization were significantly associated with S maltophilia infections (p<0.05). On multivariate analysis, invasive procedures (odds ratio, 18.81) and duration of hospitalization (odds ratio, 1.06) were determined to be the risk factors for S maltophilia infection. The most active antimicrobial agent was trimethoprim/sulfamethoxazole (87%) for S maltophilia infection, and the mortality rate was 17%.ConclusionsNeonatologists should avoid from unnecessary invasive procedures and broad-spectrum antibiotics to reduce S maltophilia infections. Invasive procedures should be finished in the shortest time possible. Agent/factor-specific antibacterial treatment should be administered. Patients being discharged as early as possible will also reduce infection frequency. Stenotrophomonas maltophilia should be considered in patients with high Stenotrophomonas infection risk factors

Early left ventricular functional alterations in patients with obstructive sleep apnea syndrome

Background: The knowledge regarding myocardial alterations in patients with obstructive sleep apnea syndrome (OSAS) in the absence of any known cardiovascular disorders including hypertension is limited. The aim of this study was to assess the early alterations of left ventricular (LV) functions caused by OSAS before the development of hypertension and other cardiovascular manifestations of OSAS.Methods: Eighty consecutive patients who underwent polysomnography (PSG) were enrolled in the study. Patients with hypertension, diabetes mellitus or any other known cardiac diseases were excluded from the study. Subjects were separated into two groups by their apnea/hypopnea index (AHI) (group 1: AHI &lt; 15, and group 2: AHI ≥ 15). Fourty-three patients with normal polysomnographic examination or mild OSAS (group 1) and 37 patients with moderate to severe OSAS (group 2) were compared. After PSG examination, LV functions were assessed by using the conventional and tissue Doppler echocardiographic methods.Results: The mean age was similar between the groups. The ratio of male patients was higher in group 2 (male/female: 31/12 in group 1 vs. 34/3 in group 2, p = 0.04). Body mass index was higher in group 2 (p = 0.05). Conventional echocardiography showed that interventricular septum thickness was 9.5 ± 1.1 mm in group 1, and 10.5 ± 1.4 mm in group 2 (p = 0.02). Mean left atrial diameter was 35.6 ± 4.1 mm in group 2, and 33.8 ± 3.1 mm in group 1 (p = 0.04). Ratio of early to late transmitral diastolic velocities was lower in group 2 (p = 0.01), indicating that impairment of diastolic function was more frequent in moderate to severe OSAS patients. Tissue Doppler echocardiography showed that early diastolic myocardial velocity was lower ingroup 2 (21.1 ± 5.6 cm/s in group 1 vs. 18.3 ± 5.3 cm/s in group 2, p = 0.01).Conclusions: Left ventricular diastolic dysfunction, LV hypertrophy and left atrial dilatationoccur in patients with OSAS even before the development of hypertension and other cardiovascular diseases

DETERMINATION OF OPTIMUM SELECTIVE FLOTATION CONDITIONS OF KOYULHISAR Pb-Cu-Zn ORE BY GUM ARABIC

Bu çalıĞ¢mada, Sivas-Koyulhisar yöresinden temin edilen Pb-Cu-Zn kompleks cevherinin gang bastırıcı olarak Gum Arabic kullanılarak selektif flotasyonla zenginleĞ¢tirilmesinde optimum flotasyon koĞ¢ulları belirlenmeye çalıĞ¢ılmıĞ¢tır. Deneylerde kullanılan Koyulhisar Pb-Cu-Zn kompleks cevherinin %6.54 Pb, %1.45 Cu ve %7.47 Zn tenörlü olduğu kimyasal analiz ile tespit edilmiĞ¢tir. Selektif flotasyonun ilk kademesinde Pb, ikinci kademesinde Cu ve üçüncü kademesinde ise Zn kaba konsantresi eldesinde en uygun flotasyon koĞ¢ulları belirlenmiĞ¢tir. Elde edilen kaba konsantreler daha sonra temizleme flotasyonlarına tabi tutulmuĞ¢tur. Selektif flotasyonla kazanılan Pb, Cu ve Zn kaba konsantrelerinin tenör değerleri sırasıyla; %24.33 Pb, %15.10 Cu ve %41.43 Zn, konsantre verim değerleri ise sırasıyla %93.45, %78.52 ve %89.57'dir. Deneyler sonucunda bu cevherin selektif flotasyonu için belirlenen optimum koĞ¢ullar: Pb kaba flotasyonu için; pH=8, 600 gr/ton Gum Arabic, 40 gr/ton NaCN, 600 gr/ton ZnSO4, 120 gr/ton KAX, 90 gr/ton 2 Etil Hekzanol, köpük alma süresi 5 dakika, Cu kaba flotasyonu için; pH=8, 400 gr/ton Gum Arabic, 20 gr/ton NaCN, 800 gr/ton ZnSO4, 100 gr/ton Na2Cr2O7, 60 gr/ton KAX, 40 gr/ton 2 Etil Hekzanol, köpük alma süresi 5 dakika, Zn kaba flotasyonu için; pH=11, 400 gr/ton Gum Arabic, 60 gr/ton NaCN, 80 gr/ton Na2Cr2O7, 250 gr/ton CuSO4, 100 gr/ton KAX, 90 gr/ton 2 Etil Hekzanol, köpük alma süresi 5 dakika, olarak bulunmuĞ¢tur. Kaba konsantrelerin temizleme flotasyonuna tabi tutulmasıyla elde edilen Pb, Cu ve Zn nihai konsantrelerinin tenörleri sırasıyla; %69.26 Pb, %29.52 Cu ve %58.14 Zn, konsantre verim değerleri ise %72.33, %66.16 ve %75.65'dir. In this study, optimum flotation conditions for Koyulhisar Pb-Cu-Zn ore was determined using by Gum Arabic as depressant. Ore sample's grade is 6.54% Pb, 1.45% Cu and 7.47% Zn from chemical analysis. The most suitable conditions were fixed for Pb, Cu, and Zn rough flotation in first, second and third stage respectively and cleaning experiments were carried out for each of these concentrates. The grade of Pb, Cu and Zn rough concentrates are 24.33% Pb, 15.10% Cu and 41.43% Zn were obtained with recoveries 93.45%, 78.52% and 89.57% respectively. The optimum conditions for selective flotation are below: Pb rough flotation: pH=8, 600 gr/ton Gum Arabic, 40 gr/ton NaCN, 600 gr/ton ZnSO4, 120 gr/ton KAX, 90 gr/ton 2 Etil Hekzanol, flotation time 5 min. Cu rough flotation: pH=8, 400 gr/ton Gum Arabic, 20 gr/ton NaCN, 800 gr/ton ZnSO4, 100 gr/ton Na2Cr2O7, 60 gr/ton KAX, 40 gr/ton 2 Etil Hekzanol, flotation time 5 min. Zn rough flotation: pH=11, 400 gr/ton Gum Arabic, 60 gr/ton NaCN, 80 gr/ton Na2Cr2O7, 250 gr/ton CuSO4, 100 gr/ton KAX, 90 gr/ton 2 Etil Hekzanol, flotation time 5 min. The grades of concentrates after cleaning flotation 69.26% Pb, 29.52% Cu and 58.14% Zn were obtained with recoveries 72.33%, 66.16% and 75.65% respectively

Chronic Intermittent Hypoxemia in Patients with Obstuctive Sleep Apnea Syndrome Causes Reduction of Peripheral Nerve Motor Fibers (Unit Number)

Objective:Obstructive Sleep Apnea syndrome (OSAS) is a chronic intermittent hypoxic process. In this study, we aimed to investigate electrophysiologically the changes in number of skeletal muscle motor unit due to chronic intermittent hypoxemia in cases followed up with the diagnosis of OSAS.Materials and Methods:According to the apnea-hypopnea index (AHI), patients divided into two groups (group 1: AHI 0.5). Maximum M mean area of nerve medianus was 50.8±20.4 (16.1-121.7) in group 1 and 48.6±20.05 (10.5-111.4) in group 2 (p=0.55). The mean MUNE values were 155.3±41.17 (46.6- 251.7) in group 1 and 127.7±40.2 (22.8-235) in group 2 (p<0.00).Conclusion:The MUNE method demonstrates that chronic intermittent hypoxemia during sleep causes reduction of the motor unit number in OSAS patients and is an independent risk factor for subclinical polyneuropathy

A newborn with moderate hemophilia A with severe intracranial and extracranial hemorrhage: A case report

Intracranial hemorrhage among term newborns is a rare clinical condition with high morbidity and mortality. Although major bleeding is relatively uncommon, the incidence of intracranial hemorrhage in hemophilic children is higher during the first few days of life than at any other stage in childhood, which relates to the trauma of delive ry. Here, we reported a newborn case diagnosed with moderate hemophilia A, without the presence of a positive family history of hemophilia and presenting with intracranial and extracranial hemorrhage and we aimed to emphasize that the early diagnosis and replacement therapy carries an essential importance

Surgical Treatment of Osteopetrosis-Related Femoral Fractures: Two Case Reports and Literature Review

Osteopetrosis is a rare hereditary disease which is characterized by increased bone density. Bone resorption is insufficient or fails due to the osteoclast defect in osteopetrosis. Half of the patients are asymptomatic and diagnosed incidentally or based on the presence of fracture. Adult onset osteopetrosis usually presents with hip and proximal femoral fractures. Internal fixation can be performed; however, technical challenges may be experienced due to increased bone density. As in other fractures, nonunion or varus malunion of these fractures may occur. Although rare, osteopetrosis may complicate treatment of fractures in such patients. In this study, we aimed to present two new cases of ADO type II with an osteopetrotic femoral fracture along with the clinical and radiological findings in the light of a comprehensive literature review. Orthopaedics surgeons should be aware of intraoperative technical difficulties and possible postoperative complications during the follow-up period. Investigation would be beneficial for the diagnosis of osteopetrosis such the patient with fractures who has minor trauma history and increased bone density in radiography

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

IAS/TMS 10 Standardı Çerçevesinde Bilanço Tarihinden Sonra Meydana Gelen Mali Nitelikteki Olayların Değerlendirilmesi ve Bir Öneri

anemonFinasal tablolar, işletlemerin mali nitelikteki gerçekleşmelerinin özeti niteliğindedir. İşletmeler performanslarını, kredi teminlerini, ödeyecekleri vergi tutarlarını finansal tablolara yansıyan değerler üzerinden takip etmektedirler. Yatırımcılar başta olmak üzere işletmeden bilgi bekleyen tüm paydaşlar da işletmede üretilen mali tablolara bakarak ihtiyaç duydukları bilgiye ulaşmayı hedeflemektedir. Yatırımcı davranışları şirketlerin ürettiği finansal tablolara göre şekillenmektedir. Esasen mali tablolarla devlet tahsil edeceği vergiyi bilmekte, şirket finansal başarısını mukayese etme imkanı bulmakta, yatırımcılar da finansal enstrümanlar arasında yatırım kararı alma aşamasında ihtiyaç duydukları finansal verilere ulaşmaktadır. Uluslararası Muhasebe Standartları, finansal raporlamanın nasıl olacağı hakkında oldukça kapsamlı standartlar içermektedir. Ülkemizde Türkiye Muhasebe Standartları olarak isimlendirilen bu standartlarla hedeflenen finansal raporlama kalitesinin arttırılmasıdır. Dönemsellik kavramı gereği, sonsuz kabul edilen işletme ömrü, vergiye konu olan rakamların netleşmesi, işletme performansının ortaya çıkarılması gibi durumlardan dolayı belirli periyotlara ayrılmak durumunda kalmaktadır. Belirli bir tarihte işletmenin varlık ve kaynaklarının resmedildiği bilanço da genellikle yılın son gününde dönem sonu bilanço adıyla üretilmektedir. Bilanço tarihinden sonra meydana gelen mali nitelikteki olayların nasıl ele alınıp değerlendirileceği Ias/Tms 10 Standardında ele alınmaktadır. Çalışmada Ias/Tms 10 Standardı kapsamlı olarak ele alınarak Borsa İstanbul’da Faaliyet gösteren şirketlerden standardın anlaşılabilirliğine katkı sunması için örnek uygulamalar gösterilecektir.The financial statements are a summary of the financial realizations of the businesses. Businesses monitor their performance, loan receipts, and the tax amounts to be paid over the values reflected in the financial statements. All stakeholders, especially investors, who are waiting for information from the enterprise, aim to reach the information they need by looking at the financial statements produced in the enterprise. Investor behavior is shaped according to the financial statements produced by the companies. Essentially, the government knows the tax to be collected with the financial statements, the company has the opportunity to compare its financial success, and the investors reach the financial data they need during the investment decision process among financial instruments. International Accounting Standards contain very comprehensive standards about how financial reporting should be. The aim of these standards, which are called as Turkish Accounting Standards in our country, is to increase the quality of financial reporting. Due to the concept of periodicity, it has to be divided into certain periods due to situations such as the life of the enterprise, which is considered indefinite, the clarification of the taxable figures, the revealing of the operating performance. The balance sheet, in which the assets and resources of the enterprise are depicted on a certain date, is usually produced on the last day of the year under the name of the end-of-period balance sheet. How to handle and evaluate financial events that occur after the balance sheet date is discussed in the Ias/Tms 10 Standard. In the study, Ias/Tms 10 Standard will be discussed comprehensively and sample applications from companies operating in Borsa Istanbul will be shown to contribute to the intelligibility of the standard.101703

Dünyada ve Türkiye’de vadeli işlemler piyasası ve Türkiye buğday piyasası üzerine bir inceleme

ÖZETTürkiye'de 1900'lü yılların başında uygulanmaya başlayan borsacılık faaliyetleri aradan bir asır geçmesine rağmen uluslararası rekabet avantajını yakalayamamıştır. Sermaye piyasaları gelişmiş olan ülkelerde spot piyasaların yanında vazgeçilmez bir unsur olarak nitelendirilecek vadeli işlem piyasalarının oluşturulmasında oldukça geç kalınmıştır.Gelişmiş olan ülkelerin ticaret borsaları sürekli olarak gelişme halindedirler. Özellikle tarımsal gelişimini tamamlanmış ülkelerde borsalar emtia bazında ihtisaslaşmaya giderken Türkiye'de ihtisas borsacılığı kurulamamıştır. Gelişmiş ülkelerde ticaret borsacılığı emtia piyasalarında etkin bir rol oynamaktadır. Tarım ürünlerinin fiyatları rasyonel ve gerçekçi bir şekilde oluşmaktadır. Aynı başarı Türkiye'de sağlanamamıştır. Ülkemiz tarım ürünleri alanında oldukça önemli bir potansiyele sahiptir. Bu potansiyel tarım ürünlerinde vadeli işlem piyasalarının önemini daha da arttırmaktadır. Vadeli İşlem ve Opsiyon Borsası'nın kurulması ve faaliyete geçmesi ile Türk finansal piyasası önemli bir ilerleme gerçekleştirmiştir. Ancak bu piyasaların emtia piyasalarında başarılı olabilmesinin önünde altyapıdan tarım politikalarına kadar birçok problem bulunmaktadır. Bu çalışmada Türkiye'de ve Dünyada vadeli işlemler piyasasının genel durumu incelenmiş, buğdaya dayalı vadeli işlem sözleşmelerinin uygulanabilirliği mevcut tarım politikaları göz önünde bulundurularak incelenmeye ve tartışılmaya çalışılmıştır.Çalışma toplam beş bölümden oluşmaktadır. Birinci bölümde vadeli işlem kavramı ve tarihçesi anlatılmıştır. İkinci bölümde vadeli işlem piyasalarının işleyişi ve fonksiyonları, ayrıntılı olarak incelenmiştir. Üçüncü bölümde Türkiye'de ve Dünya’da buğday piyasası, dördüncü bölümde buğdaya dayalı vadeli işlemler piyasası ve Türkiye'de uygulanabilirliği incelenmiştir. Beşinci bölüm sonuç ve önerilerden oluşmaktadır.ABSTRACTExchange activities which have been carried out since the beginning of the 1990s has not yet get the international competition advantage even though it has been almost a century. Turkiye has been fairly late to form the futures markets that have been qualified as the indispensable factor as well as the spot markets in the countries with the developed capital marketsCommodity exchanges in the developed countries are in a constant development process. In the countries which completed particularly agricultural development while the exchanges specialize in commodity base, in our country there has not yet been formed specialized commodity exchanges. Commodity exchanges are taking an effective part in the commodity markets in developed economies and so the prices of agricultural products are formed in a more realistic and a rational way. Same achievements could not be affected in our country. Our country has a great potential with its agricultural products. This great potential appreciates the value of the futures markets in agricultural products in Turkey.Turkish financial markets have made a great headway since the Turkish Derivative Exchange has been formed and started its operations. On the other hand, there are a lot of factors ranging from agricultural policies up to infrastructure that will effect the achievement of the futures markets in a negative way. In this study the applicability of the transaction markets on the wheat has been tried to examine by considering the agricultural policies in Turkey.Study consists of five parts including the history of derivative markets, futures, forward and option contracts , derivative markets in the world, derivative markets in Turkiye and Turkish Derivative Exchange, Turkish agricultural policies and the applicability of the derivative markets on wheat, conclusion and advises