Wickerhamomyces anomalus blood stream infection in a term newborn with pneumonia

WOS: 000422968000021PubMed ID: 29376586The incidence of invasive candidiasis is high in neonates admitted to neonatal intensive care unit and is associated with significant morbidity and mortality rates. Candida albicans is the most common fungal agent pathogenic to neonates but invasive fungal infections caused by uncommon fungi have increased in recent years. Wickerhamomyces anomalus is a very rare pathogen causing blood stream infection in neonates, which has reportedly caused only few cases in the literature. Here we report a case of blood stream infection caused by a fungal agent Wickerhamomyces anomalus in a term male infant

Arc magmatism as a window to plate kinematics and subduction polarity: Example from the eastern Pontides belt, NE Turkey

AbstractThe Eastern Pontides orogenic belt in the Black Sea region of Turkey offers a critical window to plate kinematics and subduction polarity during the closure of the Paleotethys. Here we provide a brief synthesis on recent information from this belt. We infer a southward subduction for the origin of the Eastern Pontides orogenic belt and its associated late Mesozoic–Cenozoic magmatism based on clear spatial and temporal variations in Late Cretaceous and Cenozoic arc magmatism, together with the existence of a prominent south-dipping reverse fault system along the entire southern coast of the Black Sea. Our model is at variance with some recent proposals favoring a northward subduction polarity, and illustrates the importance of arc magmatism in evaluating the geodynamic milieu associated with convergent margin processes

POTENTIAL PROTECTIVE ROLE OF SDF-1 AND CXCR4 GENE VARIANTS IN THE DEVELOPMENT OF DEMENTIA

Background: The aim of this study was to evaluate the role of polymorphisms of stromal cell-derived factor-1 (SDF-1) and chemokine receptor-4 (CXCR4) genes in dementia susceptibility in a Turkish population. Subjects and methods: The study group included 61 dementia patients, while the control group comprised 82 healthy individuals. Gene polymorphisms of SDF-1 3’A G801A (rs1801157) and CXCR4 C138T (rs2228014) were genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. Results: A significantly reduced risk for developing dementia was found for the group bearing an A allele for SDF-1 3’A polymorphism (p=0.009; x2=6.812; OR=0.626; 95%CI= 0.429-0.913). The frequency of the CXCR4 TT and TC genotype was significantly lower in patients with dementia compared to controls (p=0.028; x2=5.583; OR=0.215; 95%CI=0.05-0.914); (p=0.027; x2=4.919; OR=0.484; 95% CI= 0.246-0.955). Additionally, combined genotype analysis showed that the frequency of SDF1 GACXCR4 CC was significantly lower in patients with dementia in comparison with those of controls (p=0.049; OR=0.560; 95% CI= 0.307±1.020). Conclusions: Our study provides new evidence that SDF1 A and CXCR4 T alleles may be associated with a decreased dementia risk. The present study is important because to our knowledge, it is the first one to be conducted in a Turkish population to date, but we believe that more patients and controls are needed to obtain statistically significant results

Reappraisal of the transthoracic echocardiographic algorithm in predicting pulmonary hypertension redefined by updated pulmonary artery mean pressure threshold

BACKGROUND: Although an adopted echocardiography algorithm based on tricuspid regurgitation jet peak velocity and suggestive findings for pulmonary hypertension has been utilized in the non-invasive prediction of pulmonary hypertension probability, the reliability of this approach for the updated hemodynamic definition of pulmonary hypertension remains to be determined. In this study, for the first time, we aimed to evaluate the tricuspid regurgitation jet peak velocity and suggestive findings in predicting the probability of pulmonary hypertension as defined by mean pulmonary arterial pressure > 20 mm Hg and > 25 mm Hg, respectively. METHODS: Our study group was comprised of the retrospectively evaluated 1300 patients (age 53.1 ± 18.8 years, female 62.1%) who underwent right heart catheterization with different indications between 2006 and 2018. All echocardiographic and right heart catheterization assessments were performed in accordance with the European Society of Cardiology/European Respiratory Society 2015 Pulmonary Hypertension Guidelines. RESULTS: Although tricuspid regurgitation jet peak velocity showed a significant relation with mean pulmonary arterial pressure in both definitions, suggestive findings offered a significant contribution only in predicting mean pulmonary arterial pressure ≥ 25 mm Hg but not for mean pulmonary arterial pressure > 20 mm Hg. In predicting the mean pulmonary arterial pressure > 20 mm Hg, tricuspid regurgitation jet peak velocity and suggestive findings showed an odds ratio of 2.57 (1.59-4.14, P 3.4 m/s were associated with 70% and 84% probability of mean pulmonary arterial pressure > 20 mm Hg and 60% and 76% probability of mean pulmonary arterial pressure ≥ 25 mm Hg, respectively. CONCLUSIONS: In contrast to those in predicting the mean pulmonary arterial pressure ≥ 25 mm Hg, suggestive findings did not provide a significant contribution to the probability of mean pulmonary arterial pressure > 20 mm Hg predicted by tricuspid regurgitation jet peak velocity solely. The impact of the novel mean pulmonary arterial pressure threshold on the echocardiographic prediction of pulmonary hypertension remains to be clarified by future studies

Ses kısıklığının ciddi pulmoner hipertansiyonu olan hastalarda pulmoner arter anevrizması ve sol ana koroner artere dıştan basıyı göstermedeki rolü

OBJECTIVE: Pulmonary artery (PA) enlargement is a common finding in patients with severe pulmonary hypertension (PH) and may be associated with extrinsic compression of the left main coronary artery (LMCA-Co) and/or compression of the left recurrent laryngeal nerve resulting in hoarseness named as Ortner syndrome (OS). In this study, we evaluated the diagnostic impact of OS in predicting the PA aneurysm and significant LMCA-Co in patients with PH. METHODS: Our study population comprised retrospectively evaluated 865 with PH confirmed with the right heart catheterization between 2006 and 2022. Patients underwent coronary angiography due to several indications, including the presence of a PA aneurysm on echocardiography, angina symptoms, or the incidental discovery of LMCA-Co on multidetector computed tomography. The LMCA-Co is defined as diameter stenosis ³ 50% in reference distal LMCA segment on two consecutive angiographic planes. RESULTS: The LMCA-Co and hoarseness were documented in 3.8% and 4.3% of patients with PH, respectively. Increasing PA diameter was significantly associated with worse clinical, hemodynamic, laboratory, and echocardiographic parameters. The receiver operating curves revealed that the PA diameter >41 mm was cutoff for hoarseness (AUC: 0.834; sensitivity 69%, specificity 84%, and negative predictive value 98%), and PA diameter >35 mm was cutoff for LMCA-Co >50% (AUC: 0.794; sensitivity 89%, specificity 58 %, and negative predictive value 99%). An odds ratio of hoarseness for LMCA-Co was 83.3 (95% confidence interval; 36.5-190, P < 0.001) with 3.2% sensitivity, 98.7% specificity, and 59% positive and 98% negative predictive values. CONCLUSION: In this study, a close relationship was found between the presence of hoarseness and the probability of extrinsic LMCA-Co by enlarged PA in patients with severe PH. Therefore, the risk of LMCA-Co should be taken into account in patients with PH suffering from hoarseness.Amaç: Pulmoner arter (PA) genişlemesi, şiddetli pulmoner hipertansiyonu (PH) olan hastalarda sık görülen bir bulgu olup Ortner sendromu (OS) adını alarak sol ana koroner arterin (LMCA) dıştan basısı ve/veya sol rekürren laringeal sinirin basısı ile sonuçlanarak ses kısıklığına neden olabilir. Bu çalışmada OS’nin PH hastalarında PA anevrizmasını ve anlamlı LMCA basısını öngördürmede tanısal etkisini değerlendirmeyi amaçladık. Yöntem: Çalışma popülasyonu, 2006 ve 2022 yılları arasında sağ kalp kateterizasyonu ile doğrulanan PH ile retrospektif olarak değerlendirilen 865 hastayı içermektedir. Hastalara, ekokardiyografide PA anevrizmasının varlığı, anjina semptomları veya çok kesitli bilgisayarlı tomografide tesadüfen LMCA basısı saptanması gibi endikasyonlarla invaziv koroner anjiyografi yapılmıştır. LMCA basısı, ardışık iki anjiyografik düzlemde referans distal LMCA segmentinde %50’nin üzerinde çap darlığı olarak tanımlanmıştır. Bulgular: LMCA basısı ve ses kısıklığı PH hastalarının sırasıyla %3.8 ve %4.3’ünde gösterilmiştir. Artan PA çapı daha kötü klinik, hemodinamik, laboratuvar ve ekokardiyografik parametrelerle anlamlı şekilde ilişkili bulundu. ROC eğrileri, 41 mm ve üzerindeki PA çap artışının ses kısıklığı için sınır değer olduğunu ortaya çıkardı (EAA: 0,834; duyarlılık %69, özgüllük %84, negatif öngörü değeri %98) ve PA çapının 35 mm ve üzerinde olması ise LMCA basısı için sınır değer olarak bulundu (EAA: 0,794; duyarlılık %89, özgüllük %58, negatif öngörü değeri %99). LMCA basısı için ses kısıklığının Odds oranı, %53,2 duyarlılık, %98,7 özgüllük, %59 pozitif ve %98 negatif öngörü değerleri ile 83,3 (%95 Güven Aralığı; 36,5 -190, P < 0,001) bulundu. Sonuç: Bu çalışmada şiddetli PH’lı hastalarda ses kısıklığının varlığı ile genişlemiş PA ile dıştan LMCA basısı olasılığı arasında yakın bir ilişki bulundu. Bu nedenle, ses kısıklığı şikayeti olan PH hastalarında LMCA basısı riski dikkate alınmalıdır

A novel composed index to evaluate the right ventricle free-wall adaptation against ventricular wall stress in acute pulmonary embolism

Background: Pulmonary embolism severity index and simplified pulmonary embolism severity index have been utilized in initial risk evaluation in patients with acute pulmonary embolism. However, these models do not include any imaging measure of right ventricle function. In this study, we proposed a novel index and aimed to evaluate the clinical impact. Methods: Our study population comprised retrospectively evaluated 502 patients with acute pulmonary embolism managed with different treatment modalities. Echocardiographic and computed tomographic pulmonary angiography evaluations were performed at admission to the emergency room within maximally 30 minutes. The formula of our index was as follows: (right ventricle diameter × systolic pulmonary arterial pressure-echo)/(right ventricle free-wall diameter × tricuspid annular plane systolic excursion). Results: This index value showed significant correlations to clinical and hemodynamic severity measures. Only pulmonary embolism severity index, but not our index value, independently predicted in-hospital mortality. However, an index value higher than 17.8 predicted the long-term mortality with a sensitivity of 70% and specificity of 40% (areas under the curve = 0.652, 95% CI, 0.557-0.747, P = .001). According to the adjusted variable plot, the risk of long-term mortality increased until an index level of 30 but remained unchanged thereafter. The cumulative hazard curve also showed a higher mortality with high-index value versus low-index value. Conclusions: Our index composed from measures of computed tomographic pulmonary angiography and transthoracic echocardiography may provide important insights regarding the adaptation status of right ventricle against pressure/wall stress in acute pulmonary embolism, and a higher value seems to be associated with severity of the clinical and hemodynamic status and long-term mortality but not with in-hospital mortality. However, the pulmonary embolism severity index remained as the only independent predictor for in-hospital mortality

Remembering the Occam’s Razor: Could simple electrocardiographic findings provide relevant predictions for current hemodynamic criteria of pulmonary hypertension?

Background: We evaluated the predictive value of electrocardiographic (ECG) findings for pulmonary hemodynamics assessed by right heart catheterization (RHC). Methods: Our study population comprised 562 retrospectively evaluated patients who underwent RHC between 2006 and 2022. Correlations between ECG measures and pulmonary arterial systolic and mean pressures (PASP and PAMP) and pulmonary vascular resistance (PVR) were investigated. Moreover, receiver operating characteristic (ROC) curve analysis assessed the predictive value of ECG for pulmonary hypertension (PH) and precapillary PH. Results: The P-wave amplitude (Pwa) and R/S ratio (r) in V1 and V2, Ra in augmented voltage right (aVR), right or indeterminate axis, but not P wave duration (Pwd) or right bundle branch block (RBBB) significantly correlated with PASP, PAMP, and PVR (P 0.16 mV, Ra in aVR > 0.05 mV, QRS axis > 100° and R/Sr in V1 > 0.9 showed the highest area under curve (AUC) values for PAMP > 20 mm Hg. Using the same cutoff value, Ra in aVR, Pwa, QRS axis, and R/Sr in V1 showed highest predictions for PVR > 2 Wood Units (WU). Conclusion: In this study, Pwa, Ra in aVR, right or indeterminate axis deviations, and R/Sr in V1 and V2 showed statistically significant correlations with pulmonary hemodynamics, and Ra in aVR, R/Sr in V2 and V1, QRS axis, and Pwa contributed to variance for PASP, PAMP, and PVR, respectively. Moreover, Pwa, Ra in aVR, QRS axis, and R/Sr in V1 seem to provide relevant predictions for PH and precapillary PH

Asymmetric aldol addition of alpha-azido ketones to ethyl pyruvate mediated by a cinchona-based bifunctional urea catalyst

The first asymmetric synthesis of ethyl 4-aryl-3-azido-2-hydroxy-2-methyl-4-oxobutanoates via a cinchona organocatalyst induced aldol addition of alpha-azido ketones to ethyl pyruvate has been developed. The coupling reaction under optimized conditions was carried out to furnish tetrafunctionalized synthons with enantioselectivities of up to 91:9 and enriched diastereoselectivities of up to 95:5 (syn:anti)

Broad cerebral infarct in a term neonate

WOS: 000216262100007Neonatal cerebral infarct is a very rare entity and such infarcts could regress as a transient event or result in severe neurological injuries such as hemiplegic cerebral palsy. Here, we report a case of cerebral infarct in a term male infant presenting with convulsions within the first day of life. Difficulty at birthmight be one of the uncommon reasons of the infarcts. In this case, dystocia is supposed to be one of the associated events. The neurological deterioration was transient and no neurological deficit was noticed at 7 months after birth. The majority of neonates with large infarcts have a poor prognosis. Early imaging in this population may lead to prompt diagnosis, timely neuroprotection, rehabilitation, and improved outcome