Crossing the Border Line: Interpreting Federal Drug Trafficking Statutes in United States v. Londono-Villa

Bu çalışmanın amacı koyunlarda phlorizin uygulamasının serum lipid profili ve oksidatif stres indikatörleri üzerine etkinliğini araştırmaktı. Çalışmada 10 adet laktasyonda ve gebe olmayan koyun kullanıldı. Phlorizin 100 mg/kg dozunda her koyuna derialtı yolla enjekte edildi. Çalışma öncesi ve sonrasında koyunların canlı ağırlık (CA) ve sırt yağı kalınlığı (SYK) ölçüldü. Çalışmadan önceki (0. saat) ve sonraki 12., 24., 48., 72. ve 120. saatlerde alınan kan örneklerinde hematolojik analizler ve lipid profilini içeren biyokimyasal parametreler ve oksidatif stres indikatörleri analiz edildi. Aynı saatlerde idrar örnekleri de analiz edildi. Histopatolojik muayene için, çalışmadan 24 saat önce ve sonra iki adet koyundan karaciğer biyopsi örnekleri alındı. Çalışma sonucunda, phlorizinin ortalama CA, SYK, total lökosit (WBC), insülin, glukoz, kan üre nitrojen (BUN), kreatinin, trigliserit (TG), alkalen fosfataz (ALP), laktat dehidrogenaz (LDH), total oksidan seviye (TOS) ve oksidatif stres indeksi (OSI) değerlerini önemli ölçüde azalttığı (p&lt;0.05) ve ortalama trombosit (PLT), hemoglobin (Hgb), esterleşmemiş yağ asitleri (NEFA) değerlerini ise önemli oranda artırdığı belirlendi (p&lt;0.05). İdrar örneklerinde proteinüri ve glikozüri tespit edildi. Histopatolojik muayenede, phlorizin uygulamasından sonra hepatositlerin sitoplazmalarındaki yağ vakuollerinin sayısında azalma görüldü. Bu çalışma koyunlarda phlorizinin antihiperglisemik, antihiperlipidemik ve antioksidan olarak önerilebileceğini gösterdi.The aim of this study was analyse the effect of phlorizin application on serum lipid prophile and oxidative stres indicators in sheep. Ten non-lactating and non-pregnant sheep were used in this study. Phlorizin was subcutanously injected at a dosage of 100 mg/kg to each animal. Body weight (BW) and subcutaneous fat thickness (SFT) were measured at the beginning and at the end of the study. Hematological, biochemical parameters including lipid prohile, and oxidative stress indicators were analysed in blood samples obtained before (0th hour) and 12., 24., 48., 72. and 120th hours after the study. Urine samples were analysed at the same time intervals. Liver biopsy materials were obtained from two sheep 24 hours before and after the study for histopathological examinations. Results indicate that phlorizin significantly decreased the mean BW, SFT, total leukocyte (WBC), insulin, glucose, blood urea nitrogene (BUN), creatinin, triglyceride (TG), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), total oxidative status (TOS) ve oksidative stres index (OSI) values (p&lt;0.05), and significantly increased the mean platelets (PLT), hemoglobin (Hgb) and non-esterified fatty acids (NEFA) values (p&lt;0.05). Proteinuria and glycosuria were determined in urine samples. Histopathological examinations revealed a progressive decrease in cytoplasmic lipid vacuoles of hepatocytes after phlorizin administration. This study suggests that phlorizin could be proposed as an antihyperglycemic, antihiperlipidemic and antioxidant agent in sheep.&nbsp;</p

Comparison of sociodemographic and clinical characteristics of unipolar and bipolar geriatric inpatients

Amaç: Bipolar bozukluk, toplumda %1 oranında görülen kronik bir hastalık olmakla beraber, yaşlılardaki yaygınlık oranı % 0.1 kadar düşüktür. Major depresyonun ise 70-85 yaşından sonra prevalans ve insidansı iki kat artmaktadır. Çalışmanın amacı, yatarak tedavi gören bipolar bozukluk(BB) ve unipolar depresyon(UD) tanılarıyla izlenen geriyatrik hastaların sosyodemografik ve klinik özelliklerinin araştırılmasıdır.Yöntem: Çalışmada Bakırköy Ruh ve Sinir Hastalıkları Hastanesi’nde yatmış olan, 65 yaş ve üzeri BB ve UD hastalarının sosyodemografik ve klinik özellikleri tıbbi kayıtları üzerinden karşılaştırılmıştır. Madde/ilaç, başka bir sağlık durumuna bağlı duygudurum bozukluğu tanısı olanlar ya da demans, deliryum tanısı olan hastalar çalışmaya dahil edilmemiştir. Bulgular: Tüm hastaların yaş ortalaması 69,3’tür. Çalışmaya dahil edilen 93 hastanın 51 tanesinde (%54,8) BB, 42 tanesinde(%45,2) UD tanısı bulunmaktadır. Hastalığın başlangıç yaşı BB için 41,33 iken UD için 59,21 bulunmuştur(p=0,000). UD hasta grubunun yatışındaki intihar fikri oranı %78,6 olup BB hasta grubununki %17,6’dır(p=0,000). UD grubundan 20(%47.6) kişi daha önce en az bir kere intihar girişiminde bulunmuşken bu sayı bipolar hasta grubunda 12(%23.5) olarak saptanmıştır(p=0,03). BB hastalarının ilaç uyumsuzluğu %51,0 iken UD hastalarında (%26,2) anlamlı derecede düşüktür (p=0,000). BB grubunun tedavisinde antipsikotikler (%100), depresyon hastalarına (%76,2) oranla daha sık kullanılmıştır(p=0,000). Sonuçlar: Yatarak tedavi görmüş unipolar ve bipolar geriyatrik hastalarda önemli klinik farklar saptanmıştır.Objective: Bipolar disorder (BD) is a chronic disease of 1% in the population although the prevalence in the elderly is low as 0.1%. The prevalence and incidence of major depression doubled after the age of 70-85. The aim of this study was to investigate sociodemographic and clinical characteristics of geriatric inpatients with bipolar disorder and unipolar depression (UD). Methods: In the study, demographic and clinical characteristics of 65 years and older patients with BD and UD who hospitalized in Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery were compared through medical records. Patients diagnosed with substance/medication-induced mood disorders, mood disorders due to another medical condition or dementia, delirium were excluded from the study. Results: The average age of patients is 69.3 years. The study included 93 patients; 51 patients (54.8%) are diagnosed BD, 42 of them (45.2%) are diagnosed UD. The age of onset was found 59.21 years for UD and 41.33 years for BD (p=0.000). Hospitalization ratio in the patients with suicidal ideation was 78.6% (n=33) in UD and 17.6% (n=9) in BD (p=0.000). While 20 of UD patients (47.6%) had suicide attempt at least once, 12 of BD patients (23.5%) attempted suicide before (p=0.03). The drug inadherence ratio in BB patients was found 51.0% (n=26), while it was significantly lower in UD patients (26.2%; n=11) (p=0.000). Antipsychotics were used in the treatment with 100% in BB group (n= 51) and 76.2% (n=32) in UD group (p=0.000). Conclusions: Important clinical differences were detected between geriatric unipolar and bipolar inpatients.Publisher's Versio

The Dual Pandemics of COVID-19 and Obesity: Bidirectional Impact

: The severe acute respiratory syndrome coronavirus&nbsp;2 (SARS-CoV-2), responsible for the COVID-19 pandemic, has been shown to disrupt many organ systems in the human body. Though several medical disorders have been affected by this infection, a few illnesses in addition may also play a role in determining the outcome of COVID-19. Obesity is one such disease which is not only affected by the occurrence of COVID-19 but can also result in a worse clinical outcome of COVID-19 infection. This manuscript summarizes the most recent evidence supporting the bidirectional impact of COVID-19 and obesity. It highlights how the&nbsp;presence of obesity can be detrimental to the outcome of COVID-19 in a given patient because of the mechanical limitations in lung compliance and also by the activation of several thrombo-inflammatory pathways. The sociodemographic changes brought about by the pandemic in turn have facilitated the already increasing prevalence of obesity. This manuscript highlights the importance of recognizing these pathways which may further help in policy changes that facilitate appropriate measures to prevent the further worsening of these two pandemics

Correction to: New-Onset Diabetes Mellitus in COVID-19: A Scoping Review

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A longitudinal study on lung disease in dental technicians: What has changed after seven years?

Objectives: The aim of this 7-year follow-up study was to determine respiratory changes in dental technicians. Material and Methods: In our region, in the year 2005, 36 dental technicians were evaluated with a cross-sectional study on respiratory occupational diseases, and in 2012 we evaluated them again. Inclusion of information on respiratory symptoms and demographic features questionnaires was applied. Pulmonary function tests (PFT) were performed. Chest X-rays (CXR) were evaluated according to the ILO-2000 classification. For the comparisons of the technicians' findings in 2005 and 2012, data analyses were performed with the Wilcoxon test in addition to descriptive statistical procedures. Results: In 2012, 19 out of the 36 technicians continued to work in the same place, so we were able to evaluate their findings. The prevalence of respiratory symptoms in dental technician was as follows: dyspnea 7 (37%), cough 6 (32%), and phlegm 5 (26%). According to ILO classifications in 2005, among the 36 technicians, 5 (13.8%) had pneumoconiosis. At the end of 7 years, there were 9 pneumoconiosis cases among the 19 remaining technicians (47%). Thus, there was a statistically significant progression on the profusion of the radiologic findings (p < 0.005). Also there was a significant worsening on spirometric findings (p < 0.05). Conclusion: In dental technicians, a determination of both radiologic and functional progressions at the end of 7 years demonstrate that the primary and secondary preventive measures are necessary for these workplaces. Workplaces must be regularly controlled for worker health and hygiene

Temperature Effects Explain Continental Scale Distribution of Cyanobacterial Toxins

Insight into how environmental change determines the production and distribution of cyanobacterial toxins is necessary for risk assessment. Management guidelines currently focus on hepatotoxins (microcystins). Increasing attention is given to other classes, such as neurotoxins (e.g., anatoxin-a) and cytotoxins (e.g., cylindrospermopsin) due to their potency. Most studies examine the relationship between individual toxin variants and environmental factors, such as nutrients, temperature and light. In summer 2015, we collected samples across Europe to investigate the effect of nutrient and temperature gradients on the variability of toxin production at a continental scale. Direct and indirect effects of temperature were the main drivers of the spatial distribution in the toxins produced by the cyanobacterial community, the toxin concentrations and toxin quota. Generalized linear models showed that a Toxin Diversity Index (TDI) increased with latitude, while it decreased with water stability. Increases in TDI were explained through a significant increase in toxin variants such as MC-YR, anatoxin and cylindrospermopsin, accompanied by a decreasing presence of MC-LR. While global warming continues, the direct and indirect effects of increased lake temperatures will drive changes in the distribution of cyanobacterial toxins in Europe, potentially promoting selection of a few highly toxic species or strains.Peer reviewe

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

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 middle-income 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 low-income 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 low-income, 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

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