Diagnosis and treatment process of comorbid bipolar disorder in a patient diagnosed with autism: Case report

Depression is one of the main psychiatric comorbidity reported in individuals with autism spectrum disorder (ASD). However, some cases of bipolar disorder accompanying ASD have been reported. In the past, there was a tendency to attribute all psychiatric problems in autistic children and adults to autism itself. Nowadays, there is not only an increase in the number of studies on other medical conditions especially neurological conditions in ASD but also there is an increasing effort in defining the comorbide psychiatric disorders. Comorbid psychiatric conditions can make disease management difficult in cases of autism. The precise and reliable diagnosis of psychiatric disorders accompanying children and adolescents with autism is of great importance. More specific treatment options are possible when problematic behaviors are accepted only as a manifestation of comorbid psychiatric disorder from isolated behavior. In this case report, we aimed to present the diagnosis and management of an adolescent autism diagnosed patient and comorbid bipolar disorder

Diffusion tensor imaging and diffusion-weighted imaging on axillary lymph node status in breast cancer patients

PURPOSEThis article will examine the usefulness of diffusion tensor imaging (DTI) and diffusion-weighted imaging (DWI) on the assessment of axillary lymph nodes (ALN) of breast cancer patients.METHODSAxillary lymph nodes in 66 breast cancer patients were examined by DTI and DWI, and the largest lymph node with increased cortical thickness in axilla was selected. Morphological features, apparent diffusion coefficient (ADC), volume anisotropy, and fractional anisotropy values were measured by using a special software. Imaging findings and histopathological results were recorded.RESULTSMetastatic ALN were detected in 43 (65.1%) patients. Cortical thickness of the metastatic ALN was significantly higher than the non-metastatic ALNs (P < .001), and the long-axis-to-shortaxis ratio was significantly lower in metastatic ALNs (P < .001). There was a statistically significant difference between the ALN status and fatty hilum presence (P < .001). Apparent diffusion coefficient values of metastatic ALNs were statistically lower than those of non-metastatic ALNs (P < .001) using a cutoff value of 1.26 × 10−3 mm2 /s for b=500 ADC and 1.21 × 10−3 mm2 /s for b=800 ADC which had 97.7% sensitivity and 91.3% specificity. Fractional anisotropy and volume anisotropy values were significantly different between both groups. A cutoff value of 0.47 for b-500 fractional anisotropy had 83.7% sensitivity, 69.6% specificity 69.6% positive predictive value, and 83.7% negative predictive value. A cutoff value of 0.33 for b=500 volume anisotropy had 76.7% sensitivity, 78.3% specificity, 86.8% positive predictive value, and 64.3% negative predictive value.CONCLUSIONApparent diffusion coefficient value of metastatic ALNs was found to be significantly lower than those of non-metastatic ALN, and DTI metrics of metastatic ALN were found to be significantly higher than those of non-metastatic ALN. Overall, ADC had a better diagnostic performance than morphological features, fractional anisotropy, and volume anisotropy. Diffusion tensor imagingderived diffusion metrics may be used to complement breast magnetic resonance imaging in the future after further standardization of the imaging parameters

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Bioinformatic Studies on Autotransporter Secretion System and the Beta-Barrel Assembly Machinery of Gram-Negative Bacteria

This thesis investigates the classification of proteins into families and super-families based on similarities in their sequence. In this digital age, proteins are represented as a string of alphabetic letters, which can be analyzed using computer programs. The research was aimed at developing and optimizing computer-based techniques to find new members of a protein family, and to find common features of protein families. In particular, the studies investigated protein families shown to be important in the biology of antibiotic-resistant superbugs, with a view to providing new knowledge as foundation to develop new means to prevent life-threatening infections

Diabetes mellitus

Diabetes mellitus is an important health problem with a rapidly increasing incidence in the world. It is considered the epidemic of the century due to its high mortality and morbidity rates and increased socioeconomic burden. In addition, diabetes is a chronic disease that affects all aspects of the lives of individuals and their families and reduces the quality of life with both acute and chronic complications that require compulsory lifestyle changes. Individuals with diabetes need expert help in diabetes management throughout their lives. Providing glycemic control by encouraging the self-management of the diabetic individual with the "holistic care and interdisciplinary team approach" in achieving success in diabetes management constitutes the main goal. The role of the specialist health team and especially the nurses in the team in the fight against diabetes is very valuable. The effect of diabetes nurses has become increasingly important in preventing or delaying diabetes, in recognizing individuals at high risk in the early period, and in protecting diagnosed diabetics from chronic complications and maintaining their quality of life. © 2023 by Nova Science Publishers, Inc. All rights reserved

Emergency contraception: Knowledge and attitudes of Turkish nursing and midwifery students

Conclusion The nursing and midwifery students we assessed have a very insufficient knowledge of EC. Probably therefore, many are prejudiced against it. They should be much better acquainted with this modality of contraception since, after graduation, they will play an important role in the dissemination of information about EC in the population

Diagnostic Accuracy Comparison of Artificial Immune Algorithms for Primary Headaches

The present study evaluated the diagnostic accuracy of immune system algorithms with the aim of classifying the primary types of headache that are not related to any organic etiology. They are divided into four types: migraine, tension, cluster, and other primary headaches. After we took this main objective into consideration, three different neurologists were required to fill in the medical records of 850 patients into ourweb-based expert system hosted on our projectweb site. In the evaluation process, Artificial Immune Systems (AIS) were used as the classification algorithms. The AIS are classification algorithms that are inspired by the biological immune system mechanism that involves significant and distinct capabilities. These algorithms simulate the specialties of the immune system such as discrimination, learning, and the memorizing process in order to be used for classification, optimization, or pattern recognition. According to the results, the accuracy level of the classifier used in this study reached a success continuum ranging from 95% to 99%, except for the inconvenient one that yielded 71% accuracy

Determining type 2 diabetes risk factors for the adults: A community based study from Turkey

Aims: This study aimed to determine risk factors for type 2 diabetes among adults who were not diagnosed with diabetes. Methods: Adults were included in this study within the public activities performed on World Diabetes Day (n = 1872). Data were collected using the FINDRISC questionnaire and a short questionnaire. Results: Participants' mean age was 39.35 +/- 10.40. The mean FINDRISC score was 7.46 +/- 4.62, women's mean score was higher than that for men. The FINDRISC score indicates that 7.4% of the participants were in the highrisk group. Among participants, BMI value of 65.1% was 25 kg/m(2) and higher, waist circumference of 58% was over the threshold value; and 50.7% did not engage in sufficient physical activity. Of the participants, 9.5% had a history of high blood glucose, families of 38.9% had a history of diabetes. The mean FINDRISC score was in the slightly high category, 121 participants were found likely to be diagnosed with diabetes within ten years if no action was taken. Conclusions: It is recommended the risk screening studies to be conducted and the FINDRISC tool to be used in Turkey, where diabetes prevalence is increasing rapidly, to determine diabetes risks in the early period and to raise social awareness for diabetes. (C) 2018 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved