Mikofenolat mofetil ile remisyon sağlanan steroide dirençli otoimmün hemolitik anemi

Autoimmune hemolytic anemia (AIHA) is a disease that is seen in 1/10.000 people and characterized by forming antibodies against red blood cells and degradation of these red blood cells in reticuloendothelial system. Even autoimmune diseases can accompany, it is seen usually idiopathic. Paleness due to anemia, jaundice, tachycardia, darkening in urine color, hepatosplenomegaly are frequently seen clinical findings. Clinically normochrome and normocytic anemia, reticulocytosis, polychromasia in peripheral smear, spherocytes, indirect hyperbilirubinemia and increased lactate dehydrogenase are seen. Direct coombs test is the diagnostic test. Steroids are the first line drugs in treatment. The dosage and the treatment duration is formed according to patient's clinical situation. The treatment is checked by complete blood count, reticulocyte and Coombs test. Immunosuppressor treatments are given to patients that don't respond to treatment in 4-6 weeks or less patients who has recurrence at the time of decreasing the treatment dosage of corticosteroids. In few patient, that did not respond steroids, immunosuppressive treatments are used. Here, we present a patient, who is diagnosed with AIHA that we couldn't manage remission by steroid treatment, and no response to rituxumab as an immunosuppressor, but treated successfully with microphenolat mofetil

A new hematologic predictor of major adverse events after cardiac surgery: red cell distribution width to lymphocyte ratio

Background The perioperative risk factors that cause severe morbidity and prolongation of postoperative hospital stay after cardiac surgery should be determined. Various scores have been used to predict morbidity and mortality. Preoperative blood counts are considered potential biomarkers of inflammation and oxidative stress. Inflammatory and immune imbalances may have a significant impact on postoperative adverse events. The present study aimed to investigate the association and potential predictive properties of red cell distribution width/lymphocyte ratio (RLR) for major adverse events in adult patients who underwent coronary surgery with cardiopulmonary bypass. Methods After approval from the ethics committee, pre- and post-operative data of 700 patients were obtained from the electronic database of the hospital, intra- and post-operative anesthesia, and intensive care unit follow-up charts. We performed a stepwise multiple logistic regression analysis to investigate the association of RLR with major adverse events in adult patients who underwent coronary surgery with cardiopulmonary bypass. Results Among 700 patients, 47 (6.7%) had major adverse events after surgery. Multivariate logistic regression analysis showed that age (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.03–1.12; P < 0.001), mean platelet volume (OR, 1.49; 95% CI, 1.07–2.06; P = 0.017), and RLR (OR, 1.21; 95% CI, 1.02–1.43; P = 0.026) were significantly associated with major adverse events. Conclusions RLR indicates the balance between inflammatory and immune responses. Therefore, it can be used to predict adverse events following coronary surgery

Investigation of antibacterial activities of ethanol and methanol extracts of some marine algae species on yersinia ruckeri

Bu çalışmada Liagora ceranoides (Rhodophyta), Halopteris scoparia (Ocrophyta), Padina pavonica (Ocrophyta) ve Sargassum vulgare (Ocrophyta) alglerinin etanol ve metanol ekstraktlarının hasta gökkuşağı alabalığı (Oncorhynhus mykiss)’ndan izole edilen Yersinia ruckeri suşları üzerine antibakteriyel aktiviteleri değerlendirilmiştir. Ayrıca, suşların çeşitli antibiyotiklere duyarlılıkları da çalışılmıştır. Balıklardan izole edilen suşlar fenotipik testler, API 20E hızlı tanı kiti ve PZR sonuçlarına göre Yersinia ruckeri olarak tanımlanmıştır. Çalışmada L. ceranoides, H. scoparia, P. pavonica ve S. vulgare makroalglerinin metanol ekstraktlarının Y. ruckeri’ye karşı antibakteriyel etki göstermediği bulunmuştur. P. pavonica’nın etanol ekstraktı Y. ruckeri’ye karşı düşük antibakteriyel aktivite göstermiştir. L. ceranoides, H. scoparia ve S. vulgare makroalglerinin etanol ekstraktlarının bakteriye karşı antibakteriyel aktivite göstermediği tespit edilmiştir. Antibiyogram test sonuçlarına göre suşların ampisilin, flumekuin, oksitetrasiklin ve trimetoprime duyarlı oldukları bulunmuştur. Suşlar eritromisine karşı orta derecede direnç göstermiştir. Sonuç olarak, alglerin antibakteriyel aktiviteye sahip olduklarının bildirilmesine karşın her alg türünün antibakteriyel aktivite gösteremeyeceği anlaşılmıştır.In this study, antibacterial activities of extracts of Liagora ceranoides (Rhodophyta), Halopteris scoparia (Ocrophyta), Padina pavonica (Ocrophyta) and Sargassum vulgare (Ocrophyta) on Yersinia ruckeri strains isolated from sick rainbow trout (Oncorhynhus mykiss) were evaluated. Also, susceptibilities of the strains against various antibiotics were studied. The strains isolated from the sick fish were identified as Yersinia ruckeri according to the results of the phenotypic tests, the API 20E rapid diagnostic kit and PCR. In the study, it was found that the methanol extracts of L. ceranoides, H. scoparia, P. pavonica and S. vulgare did not show antibacterial activity against Y. ruckeri. The ethanol extract of P. pavonica showed low antibacterial activity against Y. ruckeri. The ethanol extracts of L. ceranoides, H. scoparia and S. vulgare macroalgae did not show antibacterial activity against the bacterium. According to the results of the antibiogram test, it was found that the strains were sensitive against ampicillin, flumequine, oxytetracycline and trimethoprime. The strains showed intermediate resistance against erythromycine. In conclusion, although it was reported that algae had antibacterial activities, it was understood that every algae species could not exhibit antibacterial activity

Outcomes of high-risk breast lesions diagnosed using image-guided core needle biopsy: results from a multicenter retrospective study

PURPOSEThe clinical management of high-risk lesions using image-guided biopsy is challenging. This study aimed to evaluate the rates at which such lesions were upgraded to malignancy and identify possible predictive factors for upgrading high-risk lesions.METHODSThis retrospective multicenter analysis included 1.343 patients diagnosed with high-risk lesions using an image-guided core needle or vacuum-assisted biopsy (VAB). Only patients managed using an excisional biopsy or with at least one year of documented radiological follow-up were included. For each, the Breast Imaging Reporting and Data System (BI-RADS) category, number of samples, needle thickness, and lesion size were correlated with malignancy upgrade rates in different histologic subtypes. Pearson’s chi-squared test, the Fisher–Freeman–Halton test, and Fisher’s exact test were used for the statistical analyses.RESULTSThe overall upgrade rate was 20.6%, with the highest rates in the subtypes of intraductal papilloma (IP) with atypia (44.7%; 55/123), followed by atypical ductal hyperplasia (ADH) (38.4%; 144/375), lobular neoplasia (LN) (12.7%; 7/55), papilloma without atypia (9.4%; 58/611), flat epithelial atypia (FEA) (8.7%; 10/114), and radial scars (RSs) (4.6%; 3/65). There was a significant relationship between the upgrade rate and BI-RADS category, number of samples, and lesion size Lesion size was the most predictive factor for an upgrade in all subtypes.CONCLUSIONADH and atypical IP showed considerable upgrade rates to malignancy, requiring surgical excision. The LN, IP without atypia, pure FEA, and RS subtypes showed lower malignancy rates when the BI-RADS category was lower and in smaller lesions that had been adequately sampled using VAB. After being discussed in a multidisciplinary meeting, these cases could be managed with follow-up instead of excision

The frequency of Duchenne muscular dystrophy/Becker muscular dystrophy and Pompe disease in children with isolated transaminase elevation: results from the observational VICTORIA study

IntroductionElevated transaminases and/or creatine phosphokinase can indicate underlying muscle disease. Therefore, this study aims to determine the frequency of Duchenne muscular dystrophy/Becker muscular dystrophy (DMD/BMD) in male children and Pompe disease (PD) in male and female children with isolated hypertransaminasemia.MethodsThis multi-center, prospective study enrolled patients aged 3–216 months with serum alanine transaminase (ALT) and/or aspartate transaminase (AST) levels &gt;2× the upper limit of normal (ULN) for ≥3 months. Patients with a known history of liver or muscle disease or physical examination findings suggestive of liver disease were excluded. Patients were screened for creatinine phosphokinase (CPK) levels, and molecular genetic tests for DMD/BMD in male patients and enzyme analysis for PD in male and female patients with elevated CPK levels were performed. Genetic analyses confirmed PD. Demographic, clinical, and laboratory characteristics of the patients were analyzed.ResultsOverall, 589 patients [66.8% male, mean age of 63.4 months (standard deviation: 60.5)] were included. In total, 251 patients (188 male and 63 female) had CPK levels above the ULN. Of the patients assessed, 47% (85/182) of male patients were diagnosed with DMD/BMD and 1% (3/228) of male and female patients were diagnosed with PD. The median ALT, AST, and CPK levels were statistically significantly higher, and the questioned neurological symptoms and previously unnoticed examination findings were more common in DMD/BMD patients than those without DMD/BMD or PD (p &lt; 0.001).DiscussionQuestioning neurological symptoms, conducting a complete physical examination, and testing for CPK levels in patients with isolated hypertransaminasemia will prevent costly and time-consuming investigations for liver diseases and will lead to the diagnosis of occult neuromuscular diseases. Trial RegistrationClinicaltrials.gov NCT04120168

Lojistik sektörünün uluslararası alanda dijitalleşme süreci ve türkiye'ye etkileri

LOJİSTİK SEKTÖRÜNÜN ULUSLARARASI ALANDA DİJİTALLEŞME SÜRECİ VE TÜRKİYE’YE ETKİLERİ Bilişim sistemleri ve dijital faaliyetler uluslararası ticaret aşamalarında yol haritası niteliğindedir. Tedarik zinciri yönetiminde yer alan lojistik sektörü de teknolojinin sağladığı yönlendirmelere ve değişim sürecine dahil olmuştur. Endüstri 4.0’ın lojistiğe temas etmesi, sektörde verimli alanlarının çoğalmasına sebep olmaktadır. Hammadde üretiminden nihai noktaya teslimine kadar geçen süreçler, kapsamlı bir faaliyet alanı içermektedir. Global anlamda rekabet avantajı sağlanabilmesi adına, lojistik şirketlerinin dijital tüm sistemlere aşina olması gerekmektedir. Uluslararası taşımacılıkta, yükün hareket halinde olmasından ziyade; depolama, stok, gümrük işlemleri ve ürün iadesine kadar uzanan operasyon ağı söz konusudur. Yapay zeka ve akıllı robotların özellikle depo yönetiminde kullanımı; işlemlerdeki hata oranlarını azaltarak, firmalara hız ve takip konularında destek sağlamaktadır. Lojistikte çok paydaşlı bir sistem yapısı mevcuttur. Bu hususta blockchain teknolojisi de veri hakimiyeti, şeffaflık ve iş birliğine çözüm sunar boyuttadır. Sektörde ise denemeleri gerçekleştirilmiş olup, önem verilen konular arasında yer almaktadır. Dünyada var olan bilişim sistemlerinin ve teknolojik yeniliklerin doğal sonucu olarak, ülkemizde de endüstri 4.0 etkisi yaşanır durumdadır. Geleneksel iş yapma modellerinin yeni çağın sunduğu dijital sisteme uyumlu hale getirilmesi; sürdürülebilir süreçlere, global anlamda rekabet gücüne ve iş gücü yönetimine katkı sağlar niteliktedir. -------------------- DİGİTALİZATİON PROCESS IN INTERNATIONAL LOGISTICS INDUSTRY AREA AND IMPACTS ON TURKEY Information systems and digital activities serve as a roadmap for international trade. The logistics sector in supply chain management has also been involved in the direction and change process provided by technology. Industry 4.0's contact with logistics leads to the proliferation of productive areas in the sector. Processes from raw material production to final delivery include a comprehensive field of activity. In order to gain a competitive advantage globally, logistics companies should be familiar with all digital systems. In international transport, rather than moving the cargo; This includes a network of operations ranging from storage, inventory, customs clearance and product returns. The use of artificial intelligence and intelligent robots, especially in warehouse management; By reducing the error rates in transactions, it provides support to companies in speed and follow-up issues. There is a multi-stakeholder system structure in logistics. Blockchain technology provides data domination, transparency and collaboration. In the sector, trials have been carried out and are among the issues that are given importance. As a natural consequence of the information systems and technological innovations in the world, the effect of industry 4.0 is also experienced in our country. Adapting traditional business models to the digital system offered by the new age; contributes to sustainable processes, global competitiveness and workforce management

Management of renin-angiotensin-aldosterone inhibitors and other antihypertensives and their clinical effects on pre-anesthesia blood pressure

Background Blood pressure fluctuations appear more significant in patients with poorly controlled hypertension and are known to be associated with adverse perioperative morbidity. In the present study, we aimed to determine the effects of antihypertensive drug treatment strategies on preanesthetic operating room blood pressure measurements. Methods A total of 717 patients participated in our study; 383 patients who were normotensive based on baseline measurements and not under antihypertensive therapy were excluded from the analysis. The remaining 334 patients were divided into six groups according to the antihypertensive drug treatment. These six groups were examined in terms of preoperative baseline and pre-anesthesia blood pressure measurements. Results As a result of the study, it was observed that 24% of patients had high blood pressure precluding surgery, and patients using renin-angiotensin-aldosterone system inhibitors (RAASI) had higher pre-anesthesia systolic blood pressure than patients using other antihypertensive drugs. Patients who received beta-blockers were also observed to have the lowest pre-anesthesia systolic blood pressure, diastolic blood pressure, and mean blood pressure, compared to others. Conclusions Recently, whether RAASI should be continued preoperatively remains controversial. Our study shows that RAASI cannot provide optimal pre-anesthesia blood pressure and lead to an increase in the number of postponed surgeries, probably due to withdrawal of medication before the operation. Therefore, the preoperative discontinuation of RAASI should be reevaluated in future studies

The Cytotoxic Effects of Humic Acid on Human Breast Cancer Cells

Breast cancer is the most common cancer among women and in order to create alternative treatments different types of in vivo and in vitro studies have used various plant-based therapeutic agents. Humic acid (HA) induces apoptosis and has various pharmacological properties including anti-inflammatory and anti-proliferative effects. In our study, we examined the cytotoxic effects of HA at concentrations of 5, 10, 20, 50 and 100 μg/mL in human breast adenocarcinoma MCF-7 cell line for 24 and 48 h. By using MTT method, it has been found out that HA 100 g/mL had cytotoxic effect on human breast adenocarcinoma MCF-7 cell line at both 24 and 48 h; also found out that the effective dose of HA at the same time (24 and 48 h) was 50 μg/mL. The results of our study will shed light on the development of alternative therapeutic approaches in the treatment of cancer by evaluating the cytotoxic effect of HA