EVALUATION OF THE CASES WITH TUBOOVARIAN ABSCESSES

Amaç: Kliniğimizde Tuboovarian Abse nedeniyle cerrahi operasyon uygulanan hastalarınretrospektif olarak araştırılarak, klinik ve laboratuar sonuçlarını, uygulanan tedaviyöntemlerini ve gelişen komplikasyonlarını incelemektir.Gereç ve yöntem: Ocak 2003 - Mart 2007 tarihleri arasında tuboovarian abse tanısıile opere edilen 39 hasta retrospektif olarak incelendi. Hastaların klinik ve laboratuarsonuçları, uygulanan operasyon yöntemleri ve gelişen komplikasyonlar kaydedildi.Bulgular: Hastaların %71,7'si multipardı. Hastaların başlıca şikayetleri pelvik ağrı(%92,3) ve ateş (%69,6)'idi. Rahim içi araç kullanımı prevelansı %48,7, son 6 ay içindegeçirilmiş intrauterin veya intraabdominal operasyon prevelansı %33,3 ve pelvikinflamatuar hastalık prevelansı %28,2 olarak saptandı. Klinik bulgu olarak; %69,2 hastada38,3ËšC üzerinde ateş, %64,1 hastada lökositoz, %92,3 hastada yükseksedimentasyon hızı, %89,7 hastada C-reaktif protein yüksekliği tespit edilmiştir. Doğurganlığınıkorumak isteyen hastalara abse drenajı uygulandı. TOA drenajı yapılan hastalarınoranı %71,8 idi. Kullanılan rezektif cerrahi yöntemler arasında; total abdominalhisterektomi oranı (%12,8), unilateral salpingoooferektomi oranı (%10,3), bilateralsalpingoooferektomi oranı (%5,1) saptandı. Hastaların 5'inde (%12,8) intra-operatifkomplikasyon olarak barsak hasarı gelişirken, 4 hastada (%10,3) postoperatif komplikasyonolarak yara yeri enfeksiyonu ve atelektazi gelişti.Sonuç: TOA'yi takip eden yüksek morbidite ve azalmış fertilite oranları nedeniyle erkentanı ve cerrahi müdahale oldukça önemlidir.Objective: The aim of study is retrospective evaluation of the clinical and laboratoryresults, the treatments and complications in patients who were managed for tuboovarianabscess (TOA) clinic in our department.Materials and method: The records of 39 patients who has operated with thediagnosis of tuboovarian abscess between January 2003 and March 2007 were studiedretrospectively. The patients clinical and laboratory results, operational methods appliedand the complications raised were recorded.Results: 71.7% of the patients were multipar. The main complaints of the patientswere pelvic pain (92.3%) and fever (69.6%). Prevelance of intrauterine device (IUD)usage, intrauterin or intraabdominal operations applied in the last 6 months, previouspelvic inflamatuary disease (PID) were as 48.7%, 33.3 %, 28.2%. As clinical andlaboratory signs; in 69.2 % of patients high axillary fever (>38.3ºC), in %64.1 of patientsleukocytosis, in 92.3 % of patients high sedimentation rate and in 89.7 % of patientshigh C-Reactive Protein (CRP) detected. For the patients who would like to preservereproductivity; TOA abscess drainage is applied with a ratio of 71.8%. As resectivesurgery methods that were applied; total abdominal hysterectomy ratio was 12.8 %,unilateral salphingoophorectomy ratio was 10.3 %, bilateral salphingoophorectomy ratiowas 5.1%. Intraoperative complications were observed in 5 (12.8%) patients (bowelinjury) where as postoperative complication were observed in 4 (10.3%) patients(wound enfection and atelectasia).Conclusion: Due to minimizing decreased fertility and high morbidity following TOA; itis important for the women health to apply early diagnosis and early surgery

Simultaneous Determination of Cyclosporine A, Tacrolimus, Sirolimus, and Everolimus in Whole-Blood Samples by LC-MS/MS

Objectives. Cyclosporine A (CyA), tacrolimus (TRL), sirolimus (SIR), and everolimus (RAD) are immunosuppressive drugs frequently used in organ transplantation. Our aim was to confirm a robust sensitive and selective liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for determination of CyA, TRL, SIR, and RAD in whole-blood samples. Materials and Methods. We used an integrated online solid-phase extraction-LC-MS/MS system and atmospheric pressure ionization tandem mass spectrometry (API-MS/MS) in the multiple reaction monitoring (MRM) detection mode. CyA, TRL, SIR, and RAD were simultaneously analyzed in whole blood treated with precipitation reagent taken from transplant patients. Results. System performance parameters were suitable for using this method as a high-throughput technique in clinical practice. The high concentration of one analyte in the sample did not affect the concentration of other analytes. Total analytical time was 2.5 min, and retention times of all analytes were shorter than 2 minutes. Conclusion. This LC-MS/MS method can be preferable for therapeutic drug monitoring of these immunosuppressive drugs (CyA, TRL, SRL, and RAD) in whole blood. Sample preparation was too short and simple in this method, and it permits robust, rapid, sensitive, selective, and simultaneous determination of these drugs

Volume CXIV, Number 4, November 7, 1996

Objective: Turner syndrome (TS) is a chromosomal disorder caused by complete or partial X chromosome monosomy that manifests various clinical features depending on the karyotype and on the genetic background of affected girls. This study aimed to systematically investigate the key clinical features of TS in relationship to karyotype in a large pediatric Turkish patient population.Methods: Our retrospective study included 842 karyotype-proven TS patients aged 0-18 years who were evaluated in 35 different centers in Turkey in the years 2013-2014.Results: The most common karyotype was 45,X (50.7%), followed by 45,X/46,XX (10.8%), 46,X,i(Xq) (10.1%) and 45,X/46,X,i(Xq) (9.5%). Mean age at diagnosis was 10.2±4.4 years. The most common presenting complaints were short stature and delayed puberty. Among patients diagnosed before age one year, the ratio of karyotype 45,X was significantly higher than that of other karyotype groups. Cardiac defects (bicuspid aortic valve, coarctation of the aorta and aortic stenosis) were the most common congenital anomalies, occurring in 25% of the TS cases. This was followed by urinary system anomalies (horseshoe kidney, double collector duct system and renal rotation) detected in 16.3%. Hashimoto's thyroiditis was found in 11.1% of patients, gastrointestinal abnormalities in 8.9%, ear nose and throat problems in 22.6%, dermatologic problems in 21.8% and osteoporosis in 15.3%. Learning difficulties and/or psychosocial problems were encountered in 39.1%. Insulin resistance and impaired fasting glucose were detected in 3.4% and 2.2%, respectively. Dyslipidemia prevalence was 11.4%.Conclusion: This comprehensive study systematically evaluated the largest group of karyotype-proven TS girls to date. The karyotype distribution, congenital anomaly and comorbidity profile closely parallel that from other countries and support the need for close medical surveillance of these complex patients throughout their lifespa

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

Design, Performance, and Calibration of the CMS Hadron-Outer Calorimeter

The CMS hadron calorimeter is a sampling calorimeter with brass absorber and plastic scintillator tiles with wavelength shifting fibres for carrying the light to the readout device. The barrel hadron calorimeter is complemented with an outer calorimeter to ensure high energy shower containment in the calorimeter. Fabrication, testing and calibration of the outer hadron calorimeter are carried out keeping in mind its importance in the energy measurement of jets in view of linearity and resolution. It will provide a net improvement in missing \et measurements at LHC energies. The outer hadron calorimeter will also be used for the muon trigger in coincidence with other muon chambers in CMS

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

Current Approaches To Waste Polymer Utilization And Minimization: A Review

Scheme The mass production of polymer products, in particular plastics, and their widespread use depending on the inherent advantages they have, make these materials ironically a threat to life on Earth. Polymer recycling is being considered as one of the most widely accepted remedies to the threat of growing amounts of plastic waste by both the public and scientists. In practice, recycling is associated with many difficulties, such as problems related to separation, sorting and cleaning operations, lack of fiscal subsidies, instability of selective garbage separation programs, high transport and electricity costs, etc. Still, a large section of society and the authorities agree on the necessity and importance of recycling to protect the environment, and natural habitats and resources for future generations in a balanced manner to conserve raw materials, and to reduce energy consumption, municipal solid waste production and greenhouse gas emission. The recycling effort is almost endless in itself and includes a variety of approaches such as refurbishing, mechanically reshaping, chemically treating, thermally utilizing, etc. Some novel approaches such as application in carbon capture or synthesis of carbon nanostructures from the plastic waste are among the new process technologies of recycling. From traditional and promising polymer waste utilization approaches, this review will highlight sustainable methods to reduce impacts of plastic waste on the environment. (c) 2018 Society of Chemical IndustryWoSScopu

Collagen/Beta-Tricalcium Phosphate Based Synthetic Bone Grafts via Dehydrothermal Processing

Millions of patients worldwide remain inadequately treated for bone defects related to factors such as disease or trauma. The drawbacks of metallic implant and autograft/allograft use have steered therapeutic approaches towards tissue engineering solutions involving tissue regeneration scaffolds. This study proposes a composite scaffold with properties tailored to address the macro- and microenvironmental conditions deemed necessary for successful regeneration of bone in defect areas. The biodegradable scaffold composed of porous beta-tricalcium phosphate particles and collagen type I fibers is prepared from a mixture of collagen type-I and β-tricalcium phosphate (β-TCP) particles via lyophilization, followed by dehydrothermal (DHT) processing. The effects of both sterilization via gamma radiation and the use of DHT processing to achieve cross-linking were investigated. The impact of the chosen fabrication methods on scaffold microstructure and β-TCP particle-collagen fiber combinations were analyzed using X-ray diffractometry (XRD), scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC), and microcomputerized tomography (µ-CT). Electron spinning resonance (ESR) analysis was used to investigate free radicals formation following sterilization. Results revealed that the highly porous (65% porosity at an average of 100 µm pore size), mechanically adequate, and biocompatible scaffolds can be utilized for bone defect repairs

Fabrication of a multi-layered decellularized amniotic membranes as tissue engineering constructs

As a promising approach in tissue engineering, decellularization has become one of the mostly-studied research areas in tissue engineering thanks to its potential to bring about several advantages over synthetic materials since it can provide a 3-dimensional ECM structure with matching biomechanical properties of the target tissue. Amniotic membranes are the tissues that nurture the embryos during labor. Similarly, these materials have also been proposed for tissue regeneration in several applications. The main drawback in using amniotic membranes is the limited thickness of these materials since most tissues require a 3D matrix for an enhance regeneration. In order to prevent this limitation, here we report a facile fabrication methodology for multilayered amniotic membrane-based tissue constructs. The amniotic membranes of Wistar albino rats were first decellularized with the physical and chemical methods and utilized as scaffolds. Secondly, the prepared decellularized membranes were sutured to form a multilayered 3D structure. Within the study, 7 groups including control (PBS), were prepared based on physical and chemical decellularization methods. UV exposure and freezing techniques were used as a physical decellularization methods while hypertonic medium and SDS (sodium dodecyl sulfate) protocols were used as chemical decellularization methods. The combinations of both protocols were also used. In groups, A was the control and group B was applied just UV. In group C was applied UV and freezing. In addition to UV and freezing, in group D was applied hypertonic solution while group E was applied SDS (0.03 %). In group F was applied UV, freezing, hypertonic solution and SDS (0.03 %). In group G was applied UV, hypertonic solution, SDS (0.03 %) and freezing, respectively. Based on the histological and quantitative analyses, F and G groups were found as the most efficient decellularization protocols in rat amniotic membranes. Then, group F and G decellularized amniotic membranes were used to form scaffolds and thus-formed matrices were further characterized in vitro cell culture studies and mechanical tests. Cytotoxicity analyses performed using MTT showed a good cell viability in F and G groups scaffolds. The percentage viability rate was higher in G group (81.3 %) compared to F (75.33 %) and also cell viability in G group was found more meaningful according to p value which was obtained 0.007. Cellular adhesions after in vitro cell culture and morphology of scaffolds were evaluated by scanning electron microscopy (SEM). It was observed that the cells cultivated in equal amounts of tissue scaffolds were higher in the F compared to that observed in group G. The mechanical testing with 40 N force revealed 0.77 mm displacement in group F while it was 0.75 mm in group G. Moreover, according to forcecontrolled test, 2.9 mm displacement of F group and 1.2 mm displacement of G group was measured. As a result, this study shows that the multilayered decellularized amniotic membrane scaffolds support cell survival and adhesion and can form a flexible biomaterial with desired handling properties

Study on Cost-Efficient Carbon Aerogel to Remove Antibiotics from Water Resources

Because of pharmaceutical-emerging contaminants in water resources, there has been a significant increase in the antibiotic resistance in bacteria. Therefore, the removal of antibiotics from water resources is essential. Various antibiotics have been greatly studied using many different carbon-based materials including graphene-based hydrogels and aerogels. In this study, carbon aerogels (CAs) were synthesized from waste paper sources and their adsorption behaviors toward three antibiotics (hygromycin B, gentamicin, and vancomycin) were investigated, for which there exist a limited number of reports in the literature. The prepared CAs were characterized with scanning electron microscopy, transmission electron microscopy, X-ray photoelectron spectroscopy, and micro-computerized tomography (mu-CT). According to the mu-CT results, total porosity and open porosity were calculated as 90.80 and 90.76%, respectively. The surface area and surface-to-volume ratio were found as 795.15 mm(2) and 16.79 mm(-1), respectively. The specific surface area of the CAs was found as 104.2 m(2)/g. A detailed adsorption study was carried out based on different pH values, times, and analyte concentrations. The adsorption capacities were found as 104.16, 81.30, and 107.52 mg/g for Hyg B, Gen, and Van, respectively. For all three antibiotics, the adsorption behavior fits the Langmuir model. The kinetic studies showed that the system fits the pseudo-second-order kinetic model. The production of CAs, within the scope of this study, is safe, facile, and cost-efficient, which makes these green adsorbents a good candidate for the removal of antibiotics from water resources. This study represents the first antibiotic adsorption study based on CAs obtained from waste paper.Publisher's Versio