THE NEW WEIGHTED INVERSE RAYLEIGH DISTRIBUTION AND ITS APPLICATION

In this study, a new weighted version of the inverse Rayleigh distribution based on two different weight functions is introduced. Some statistical and reliability properties of the introduced distribution including the moments, moment generating function, entropy measures (i.e., Shannon and R´enyi) and survival and hazard rate functions are derived. The maximum likelihood estimators of the unknown parameters cannot be obtained in explicit forms. So, a numerical method has been required to compute maximum likelihood estimates. Finally, the daily mean wind speed data set has been analysed to show the usability of the new weighted inverse Rayleigh distribution

Robust estimation of the location and the scale parameters of shifted Gompertz distribution

In this study, we consider the estimation of the location parameter  and the scale parameter  of the shifted Gompertz (SG) distribution. We obtain the closed form estimators of these parameters by using the modified maximum likelihood (MML) methodology originated by Tiku (1967). We also compare the efficiencies of these estimators with the well-known and widely used least squares (LS) and maximum likelihood (ML) estimators via Monte-Carlo simulation study in terms of bias, mean square error (MSE) and deficiency (Def) criteria. In addition, we evaluate the performances of the proposed estimators when the data contains the outliers or is contaminated. In other words, the robustness properties of the estimators are investigated. A real data set is analyzed to demonstrate the implementation of the estimation methods at the end of the study

Relationship between plasma osmolality and neutrophil/lymphocyte ratio in heart failure with reduced ejection fraction

Aim: Heart failure (HF), a progressive disease, is accompanied by chronic inflammation and changes in osmolality. The neutrophil-to-lymphocyte ratio (NLR) demonstrates a sys- temic inflammatory response in most diseases; however, the relationship between plasma osmolality and the systemic inflammatory response in HF patients is not yet clear. There- fore, we aimed to investigate the possible associations of NLR with plasma osmolality levels in patients with HF. Materials and Methods: The present study included 189 consecutive patients with chronic HF with an ejection fraction (EF) of <40%. They were classified into four groups based on admission plasma osmolality quartiles: hypo-osmolar (first quartile), normo- hypo-osmolar (second quartile), normo-hyperosmolar (third quartile), and hyperosmolar (fourth quartile). We evaluated the relationship between NLR, plasma osmolality, type-B natriuretic peptide (BNP), and the New York Heart Association (NYHA) functional class. Results: The hyperosmolar group had an increased NLR (p = 0.007). The presence of NYHA class 3–4 functional capacity, high-sensitivity C-reactive protein, and high osmo- lality were independent predictors of increased NLR. In correlation analysis, osmolality was significantly positively correlated with NLR (r = 0.201, p = 0.011). Conclusion: Higher NLR values may be associated with increased plasma osmolality, which may indicate an increased inflammatory status in the HF phenomenon

Role of sympathetic cotransmitter galanin on autonomic balance in heart failure: an active player or a bystander?

Objective: Galanin, a cotransmitter similar to neuropeptide Y (NPY), aggravates autonomic imbalance in systolic heart failure (HF) by attenuating vagal tonus after burst sympathetic activity. In animal HF models, galanin antagonists have improved cardiac function. To determine whether galanin is a promising therapeutic target in HF, we studied its concentrations in HF patients and evaluated its correlation with NPY, markers of humoral activity such as pro-BNP and copeptin, and echocardiographic parameters of HF severity. Methods: After recording demographic and echocardiographic characteristics of 87 individuals (57 HF patients and 30 control subjects), fasting serum concentrations of galanin, NPY, copeptin, and pro-BNP were determined. Results: Unlike pro-BNP, copeptin, and NPY, which were significantly elevated in HF patients (p<0.001, p<0.001, and p=0.001, respectively), galanin was similar in HF patients and control subjects (p=0.9). NPY correlated with the echocardiographic parameters of HF severity (r=-0.22, p=0.03 for EF; r=0.3, p=0.005 for Tei index of RV; r=-0.23, p=0.03 for TAPSE; and r=0.24, p=0.024 for E/e') and pro-BNP (r=0.22, p=0.046). NPY levels were also associated with beta blocker (BB) use, wherein BB significantly decreased NPY in both HF patients and control subjects. Galanin correlated with humoral biomarkers, pro-BNP and copeptin (r=0.39, p<0.001 and r=0.41, p<0.001, respectively). Although current smoking, BB therapy, pro-BNP, copeptin, and body mass index were associated with galanin in univariate analyses, the multiple linear regression model revealed that pro-BNP was the only significant determinant of galanin levels in HF patients. Conclusion: Our findings confirmed the role of NPY in autonomic balance and suggest that galanin is associated with the proadrenergic state, but its role in HF in humans remains unclear.Scientific Research Projects Fund of Namik Kemal University [NKUBAP.02.YL.16.046]This research was supported by the Scientific Research Projects Fund of Namik Kemal University (NKUBAP.02.YL.16.046)

Treatment of brucellosis in a young child with trimethoprim/sulfamethoxazole anaphylaxis

SummaryBrucellosis is a common zoonotic disease throughout the world. Brucella spp. transmit to humans through contact with fluids of infected animals, especially sheep, cattle, and goats. It is also transmitted by ingestion of fluid-derived products of infected animals, such as unpasteurized milk and cheese. Brucella spp. changes pH level of intracellular environment, so the first treatment approach is to administer antibiotics that have activity in acidic conditions. Anti-brucellosis treatment regimens include doxycycline for children older than eight years old and rifampicin and trimethoprim/sulfamethoxazole (TMP-SMX) combination therapy for children under eight years old, which may be able to act intracellularly under acidic conditions. A TMP-SMX allergy causing anaphylaxis has been reported previously. No alternative anti-brucellosis treatments have been reported in the literature for patients under eight years old with a TMP-SMX allergy. Here, we report a case of a child with brucellosis and a TMP-SMX allergy who was under eight years old at the time of diagnosis and was successfully treated with rifampicin, ciprofloxacin, and gentamicin

Can the development of atrial fibrillation in patients with ischemic heart failure with low ejection fraction be predicted?

OBJECTIVE: Our aim is to determine the triggering factors of paroxysmal atrial fibrillation (PAF) in ischemic heart failure (HF) patients with low ejection fraction (EF). METHODS: Sixty patients were included in this study. Echocardiography and 24-hours Holter monitoring were performed after measurement of serum NT-pro BNP concentration. The patients were classified into two groups concerning the occurrence of PAF on Holter recordings. Biochemical and echocardiographic parameters of patients with and without PAF were compared. RESULTS: PAF was detected in 28 (46%) patients. Patients with PAF demonstrated higher NT-pro BNP levels, mitral and aortic regurgitation velocities, E/A, E/E', pulmonary capillary wedge pressure, pulmonary artery systolic pressure, left atrial volume and volume indices. NT-pro BNP was established as the predictor of PAF (OR=1.23, 95% CI: 1.08-1.42; p=0.001).ROC analysis showed an NT-pro BNP value of 2188 pg/mL as cut-off value with 68% sensitivity and 84% specificity [Area under the ROC curve (AUC)=0.826, CI 95%: 0.724-0.927; p<0.001]. CONCLUSION: The triggering factors for AF are increased intracardiac pressures, left atrial dilatation and increased wall tension. As an indicator of increased wall tension, elevated levels of NT-pro BNP predict the development of PAF

Evaluation of legislation about microbiologic examination in food handlers

Amaç: Çalışmamızın amacı, gıda alanında çalışanlarda portör muayenelerini düzenleyen mevzuatın incelenmesidir. Gereç ve Yöntem: Gıda alanında çalışanlar ile ilgili mevzuat metinleri, ulusal ve uluslararası literatür tarandı. Mevzuat ve internet üzerinden ulaşılabilen bilgi ve bulgular, bilimsel kanıtlar temelinde değerlendirildi. Konuyla ilgili mevzuat metinlerinin bilimsel kanıtlar ile değerlendirildiği, görüş ve önerilerin sunulduğu bir çalışmadır. Bulgular: Konuyla ilgili temel mevzuat Umumi Hıfzıssıhha Kanunu'dur(UHK). Sağlık Bakanlığı 2005 yılında bir genelge ile tetkikleri ve süreleri yeniden belirlemiştir. Portör muayenesi uygulamaları süregelirken; çıkartılan 663 sayılı Kanun Hükmünde Kararname(KHK)'de gıda ile uğraşan işyerlerinde hijyen uygulamaları ve eğitime önem verilmesi vurgulanarak sorumluluk işverene bırakılmıştır. Gıda kaynaklı infeksiyonlara neden olacak çok sayıda patojen mikroorganizma olmasına karşın yasal düzenlemeler, rutinde bu ajanların küçük bir kısmını incelememize olanak tanımaktadır. Güncel bilimsel yaklaşımlar, gıda çalışanlarında rutin tıbbi ve mikrobiyolojik incelemelerin yapılmasını önermemektedir. Son çıkan KHK'nin uygulanmasında sorun yaşanabileceği ve tamamlayıcı alt mevzuat düzenlemelerine gereksinim olduğu belirlenmiştir. Sonuç: Gıda hazırlama prosedüründe standardizasyon ve kontrol programlarının geliştirilmesi, hijyen eğitimleri verilmesi, erken uyarı sistemlerini kurulması ve belirti gösteren çalışanlara rutin tarama testlerinin uygulanması ile gıda kaynaklı infeksiyonların azaltılmasının sağlanması temel önerimizdir. Bu amaçla karar vericilerin, güncel bilimsel çalışma sonuçlarını dikkate alarak ivedilikle tamamlayıcı mevzuat çalışmalarına başlaması gerekmektedir.Introduction and Objective: Our study was planned to evaluate the Turkish legislation about microbiologic examination in foodhandlers. Material and Methods: National and international literature about legal regulations regarding foodhandlers in Turkey, were scanned. Legislation about microbiologic examination in foodhandlers and all documents were evaluated based on scientific evidence. This paper was designed to present the opinions and suggestions about this subject by evaluating the legislative texts on scientific evidence. Results: The main legislation is Law of Public Health. In 2005, Ministry of Health had made a circular and modified the analysis for food handlers and their frequency. While the applications of porter examination continues, by the decree law numbered 663 -indicating the importance of education and sanitation- this responsibility was given to the employers. Despite the presence ofvarious pathogenic microorganisms causing foodborne infections, the legal arrangements in our country allows the detection of only a small portion of these agents, by routine analysis. Current scientific approaches do not recommend routine medical and laboratory examination in food handlers. As some problems in daily practice can occur, last decree law about food handlers needs collateral legislation urgently. Conclusion: Our main recommendations are; to standardize the food preparation process, to give in training education, to establish early detection systems and to examine the routine laboratory analysis in symptomatic food handlers, to reduce the food borne infections. For this purpose, the governors have to start to work on complimentary legislation, considering the results of current scientific studies, urgently

Evaluation of the Coronary Angiography Results Performed at the Namık Kemal University Medical Faculty

Aim:In this study, we have tried to elucidate the influence of major cardiovascular risk factors such as age and gender on the prevalence of occlusive coronary artery disease (CAD) and define the prevalence of patients presenting with acute myocardial infarction(MI) or post-procedural MI in patients undergoing coronary angiography(CAG) at our center.Material and Methods:Five hundred consecutive CAG procedures carried out between may 2015 and july 2015 were retrospectively analysed in terms of demographic data (age, gender, prior sten tor coronary bypass procedure), angiographic characteristics (extense of CAD,number of occluded vessels, treatment and stent number),occurence of MI before or after the procedure.Results:In our study population (mean age 62.06±11.18 and 63% male) the rate of normal coronary arteries (NCA) was 14,6%, of nonocclusive CAD was 21,8%, of slow flow phenomenon was 3,8% and occlusive CAD was 59,8%. The mean age of patients with NCA was 56,1±10,5 years which was significantly lower than that of the patients with occlusive CAD (mean age 64±11,3) and nonocclusive CAD (mean age61±10) (p=0,000 and p=0,006 respectively). The patients with occlusive CAD were significantly older when patients with CAD were analysed.(p=0,026). Patients with NCA were more likely to be female (%74) while male gender was more common in patients with occlusive (71,2%) and nonocclusive(64,8%) CAD. Age did not effect the prevalence of presentation with MI. (p=0,11). There was no statisticaly significant difference in presentation with MI in terms of gender (p=0,287) but older women more commonly presented with MI when compared to men(p=0,015) and men experienced more thromboembolic complications after procedure when compared to women (p=0,011).Conclusion:The analysis of the KAG results showed that the prevalence of occlusive CAD is high among our patients. In the light of these data, more emphasis should be given to the primary prevention of cardiovascular diseases in our region

Systemic Immune-Inflammatory Index as a Determinant of Atherosclerotic Burden and High-Risk Patients with Acute Coronary Syndromes

Background: Systemic immune-inflammatory index (SII), which is derived from neutrophil, platelet and lymphocyte counts, represents the homeostatic balance among inflammatory, immune and thrombotic status. The systemic immune-inflammatory index is superior to indices such as neutrophil-lymphocyte ratio in predicting prognosis in various malignancies, while it is shown to predict future cardiac events better than traditional risk factors after coronary intervention. Objectives: Herein, we aimed to evaluate the relationship of the systemic immune-inflammatory index with atherosclerotic burden and in-hospital complications in acute coronary syndrome patients. Methods: The clinical outcomes, such as extent of myocardial damage, atherosclerotic burden, bleeding, acute kidney injury, duration of hospital stay and in-hospital mortality, were evaluated in a retrospective cohort of 309 consecutive acute coronary syndrome patients. The systemic immune-inflammatory index was calculated as (Platelet X Neutrophil)/Lymphocyte count on admission. Study population was categorized into tertiles with regard to systemic immune-inflammatory index. A p value of <0.05 was considered statistically significant. Results: The highest systemic immune-inflammatory index values were within ST elevation myocardial infarction patients (641.4 in unstable angina pectoris, 843.0 in non-ST elevation myocardial infarction patients and 996.0 in ST elevation myocardial infarction patients; p=0.004). Maximal troponin concentration (0.94 vs. 1.26 vs. 3; p<0.001), number of diseased vessels (1 vs. 2 vs. 2; p<0.001), the SYNTAX (synergy between percutaneous coronary intervention with taxus and coronary artery bypass grafting) score (9 vs. 14 vs. 17.5; p<0.001) and duration of hospital stay (2 vs. 2 vs. 3; p<0.001) also increased with increasing SIItertile (tertile1 vs. tertile 2 vs. tertile 3). Systemic immune-inflammatory index was an independent predictor of SYNTAX score (B: 0.232 [0.001 to 0.003]; p<0.001), extent of myocardial damage (B: 0.152 [0 to 0.001]; p=0.005) and duration of hospital stay (B: 0.168 [0.0 to 0.001]; p=0.003). Conclusions: This study has demonstrated that the systemic immune-inflammatory index, a simple hematological index, is a marker of atherosclerotic burden and longer hospital stay on well-known risk factors in high risk acute coronary syndrome patients

Tekirdağ devlet hastanesi'ne başvuran gastroenteritli çocuklarda rotavirus ve adenovirus antijen varlığının araştırılması

Amaç: Çocuklarda infeksiyöz diyarenin sık etkenleri olan viral ajanların epidemiyolojisi ile ilgili bilgiler sınır- lıdır. Bu çalışmada Tekirdağ yöresinde rotavirus ve adenovirusa bağlı olarak gelişen gastroenteritlerin sıklığının araştırılması amaçlanmıştır. Gereç ve Yöntemler: Akut gastroenteritli çocukların dışkı örnekleri toplanmış ve Grup A rotavirus ve ade- novirus serotip 40-41 antijenleri açısından immunok- romatografik test (RIDA Quick, R-Biopharm, Almanya) ile taranmıştır. Sonuçlar yaşa dayalı gruplara ayrılarak değerlendirilmiştir. Buna göre gruplar; Grup A (0 - 2 yaş), Grup B (3-6 yaş) ve Grup C (7-15 yaş) şeklinde oluşturulmuştur. Bulgular: Dışkı örneklerinden 2135i rotavirus ve 2117si adenovirus varlığı açısından test edilmiştir. Örneklerden 222 (%10,4)sinde rotavirus ve 77 (%3,6)sinde adenovirus antijeni pozitif bulunmuştur. Tüm rotavirus pozitif olguların gruplara dağılımı ince- lendiğinde; Grup A, B ve Cde sırasıyla %63,7, %27,8, %8,5 (p<0,001) ve tüm adenovirus pozitif olguların gruplara dağılımı incelendiğinde ise Grup A, B ve Cde sırasıyla %40,3, %36,3, %23,4 (p=0,16) olarak bulunmuştur. Cinsiyetle ilişkili olarak her iki ajan açısından da anlamlı farklılık saptanmamıştır (p=0,38, p=0,31). Mevsimsel özellikler incelendiğinde rotavirus aralık ayında (n=44, %19,8), adenovirus ise temmuz ayında (n=21, %27,3) en sık olarak saptan- mıştır. Sonuç: Bulgularımız, rutin laboratuarlarda, infeksiyöz diyarelerin tanısında sıklıkla göz ardı edilen viral ajan- ların önemini bir kez daha ortaya koymaktadır.Objective: Viral agents are the frequent causes of infectious diarrhea in children, but little is known about their epidemiology in Turkey. With this study, we aimed to determine the frequency of gastroenteritis due to rotavirus and adenovirus in the Tekirdag region. Material and Methods: Stool specimens of children with acute gastroenteritis were collected and screened for Group A rotavirus and adenovirus serotype 40-41 antigens, with the immunochromatographic test (RIDA Quick, R-Biopharm, Germany) according to the rec- ommendations of the manufacturer. The results of the subjects were evaluated by examining groups based on the ages: Group A (0 months to 2 years), Group B (3-6 years) and Group C (7-15 years). Results: Of the stool samples, 2135 were tested for the presence of rotavirus and 2117 for adenovirus. 222 (10.4%) samples were positive for rotavirus and 77 (3.6%) were positive for adenovirus antigens. The distribution of rotavirus-positive cases in all the groups analyzed was 63.7%, 27.8%, 8.5% in groups A, B and C, respectively (p&lt;0.001) and the distribu- tion of adenovirus-positive cases in all groups ana- lyzed was 40.3%, 36.3%, 23.4% in groups A, B and C, respectively (p=0.16). No stastistical difference due to gender was obtained for any of the agents (p=0.38, p=0.31 Observation of seasonal variations of the agents showed a higher frequency of rotavirus in December (n=44, 19.8%) and adenovirus in July (n=21, 27.3%). Conclusion: Our results shows the importance of viraagents which are generally missed by routine diagnos- tic tests in identifying the causes of infectious diarrhea