Higher algebraic KK-groups and D\mathcal D-split sequences

In this paper, we use $\mathcal D$-split sequences and derived equivalences to provide formulas for calculation of higher algebraic $K$-groups (or mod-$p$ $K$-groups) of certain matrix subrings which cover tiled orders, rings related to chains of Glaz-Vasconcelos ideals, and some other classes of rings. In our results, we do not assume any homological requirements on rings and ideals under investigation, and therefore extend sharply many existing results of this type in the algebraic $K$-theory literature to a more general context.Comment: 20 page

TRH: Pathophysiologic and clinical implications

Thyrotropin releasing hormone is thought to be a tonic stimulator of the pituitary TSH secretion regulating the setpoint of the thyrotrophs to the suppressive effect of thyroid hormones. The peptide stimulates the release of normal and elevated prolactin. ACTH and GH may increase in response to exogenous TRH in pituitary ACTH and GH hypersecretion syndromes and in some extrapituitary diseases. The pathophysiological implications of extrahypothalamic TRH in humans are essentially unknown. The TSH response to TRH is nowadays widely used as a diganostic amplifier in thyroid diseases being suppressed in borderline and overt hyperthyroid states and increased in primary thyroid failure. In hypothyroid states of hypothalamic origin, TSH increases in response to exogenous TRH often with a delayed and/or exaggerated time course. But in patients with pituitary tumors and suprasellar extension TSH may also respond to TRH despite secondary hypothyroidism. This TSH increase may indicate a suprasellar cause for the secondary hypothyroidism, probably due to portal vessel occlusion. The TSH released in these cases is shown to be biologically inactive

Pica associated with iron deficiency or depletion: clinical and laboratory correlates in 262 non-pregnant adult outpatients

<p>Abstract</p> <p>Background</p> <p>There are many descriptions of the association of pica with iron deficiency in adults, but there are few reports in which observations available at diagnosis of iron deficiency were analyzed using multivariable techniques to identify significant predictors of pica. We sought to identify clinical and laboratory correlates of pica in adults with iron deficiency or depletion using univariable and stepwise forward logistic regression analyses.</p> <p>Methods</p> <p>We reviewed charts of 262 non-pregnant adult outpatients (ages ≥18 y) who required treatment with intravenous iron dextran. We tabulated their sex, age, race/ethnicity, body mass index, symptoms and causes of iron deficiency or depletion, serum iron and complete blood count measures, and other conditions at diagnosis before intravenous iron dextran was administered. We excluded patients with serum creatinine >133 μmol/L or disorders that could affect erythrocyte or iron measures. Iron deficiency was defined as both SF <45 pmol/L and TS <10%. Iron depletion was defined as serum ferritin (SF) <112 pmol/L. We performed univariable comparisons and stepwise forward logistic regression analyses to identify significant correlates of pica.</p> <p>Results</p> <p>There were 230 women (184 white, 46 black; ages 19-91 y) and 32 men (31 white, 1 black; ages 24-81 y). 118 patients (45.0%) reported pica; of these, 87.3% reported ice pica (pagophagia). In univariable analyses, patients with pica had lower mean age, black race/ethnicity, and higher prevalences of cardiopulmonary and epithelial manifestations. The prevalence of iron deficiency, with or without anemia, did not differ significantly between patients with and without pica reports. Mean hemoglobin and mean corpuscular volume (MCV) were lower and mean red blood cell distribution width (RDW) and platelet count were higher in patients with pica. Thrombocytosis occurred only in women and was more prevalent in those with pica (20.4% vs. 8.3%; p = 0.0050). Mean total iron-binding capacity was higher and mean serum ferritin was lower in patients with pica. Nineteen patients developed a second episode of iron deficiency or depletion; concordance of recurrent pica (or absence of pica) was 95%. Predictors of pica in logistic regression analyses were age and MCV (negative associations; p = 0.0250 and 0.0018, respectively) and RDW and platelet count (positive associations; p = 0.0009 and 0.02215, respectively); the odds ratios of these predictors were low.</p> <p>Conclusions</p> <p>In non-pregnant adult patients with iron deficiency or depletion, lower age is a significant predictor of pica. Patients with pica have lower MCV, higher RDW, and higher platelet counts than patients without pica.</p

Infertility and the provision of infertility medical services in developing countries

developing countrie

Akut myeloid lösemi hastalarında febril nötropenik atakların değerlendirilmesi

Aim: The most important cause of mortality in febrile neutropenic episodes (FNEs) which mature after chemotherapy s infections. Fever in neutropenic patients must be accepted as an infection and broad-spectrum empric antibiotherapy must be started immediately as a standard approach. The infection categories, isolated pathogen microorganisms, mortality ratios and antibiotherapy regimens in 236 FNEs which matured after chemotherapy have been examined retrospectively. Our goal was identification of infectious agents and to determine our treatment protocol. Materials and Methods: Our study includes 87 patients who were treated because of acute myeloid leukemia (AML) at Inonu University Turgut ;Ouml;zal Medicine Center Adult Hematology Clinic between 2002 and 2010. 236 FNEs were examined retrospectively. Infections of patients who met FNE criterias were categorized as microbiologic defined nfection (MDI), clinical defined infection (CDI) and fever of unknown origin (FUO). Physical examination and microbiological culture results were obtained from the records. Results: Fifty-three patients were male and 34 female. The mean age was 52.44 years. Fever was evaluated in 30.9% MDI, 40.3% CDI and 28.8% FUO categories. In FNEs, 19.9% efficient pathogen microorganisms were isolated from blood cultures. 51.1% of pathogens which were isolated from blood cultures were gram-positive, 40.4% were gram-negative bacteries and 8.5% were fungus. Pneumonia was detected 47.4% in 95 CDI episodes. The mean neutropenia duration was 13.33 days in all episodes, 16.69 in MDI, 13.09 in CDI and 10.04 days in FUO. Conclusion: If medical centers follow their infection agents closely and modify their empiric antibiotic treatment policies they can supply a useful additive for a better FEN management process.Amaç: Kemoterapiye bağlı febril nötropeni (FEN) gelişen hastalarda ölümlerin en önemli nedeni infeksiyonlardır. Bu nedenle nötropenik hastalarda ateş, aksi ispat edilinceye kadar infeksiyon olarak kabul edilip empirik geniş spektrumlu antibiyotik tedavisine hemen başlanılması gerekmektedir. Çalışmamızda kemoterapiye bağlı gelişen 236 FEN atağı; infeksiyon kategorileri, izole edilen patojen mikroorganizmalar, mortalite oranları ve uygulanan antibiyotik tedavileri açısından retrospektif olarak değerlendirildi. Merkezimizdeki infeksiyon etkenlerinin ve tedavi protokollerinin belirlenmesi amaçlanmıştır. Gereç ve Yöntem: Çalışmaya, İnönü Üniversitesi Tıp Fakültesi Turgut Özal Tıp Merkezi, Erişkin Hematoloji Kliniği’nde 2002 ile 2010 tarihleri arasında takip ve tedavisi yapılan 87 akut myeloid lösemi (AML) hastası alındı. 236 FEN atağı retrospektif olarak değerlendirildi. FEN kriterlerini karşılayan hastaların ataklarında infeksiyonlar mikrobiyolojik olarak tanımlanmış infeksiyon (MTİ), klinik olarak tanımlanmış infeksiyon (KTİ) ve nedeni bilinmeyen ateş (FUO) olarak kategorize edildi. Hastaların fizik muayene ve kültür sonuçları dosya kayıt sistemi ve mikrobiyoloji kayıtlarından elde edildi. Bulgular: Hastaların 53’ü erkek, 34’ü kadındı. Yaş ortalaması 52.44 yıl olarak bulundu. 236 FEN atağının %30.9’u MTİ, %40.3’ü KTİ ve %28.8’i FUO olarak kategorize edildi. Ataklarının %19.9’unda kan kültüründe etken patojen mikroorganizma izole edilirken, %80,1’inde izole edilmediği saptandı. Kan kültürlerinden izole edilen mikrorganizmaların %51.1’ini gram-pozitif bakteriler, %40.4’ünü gram-negatif bakteriler ve %8.5’ini ise fungal etkenlerin oluşturduğu saptandı. Klinik olarak dökümante edilen 95 ataktan %47.4’ünde pnömoni saptandı. Tüm ataklarlarda ortalama nötropeni süresi 13.33, MDİ’de 16.69, KTİ’de 13.09 ve FUO’da ise 10.04 gün olarak bulundu. Mortalite atak başına %8.5 olarak tespit edildi. Sonuç: Merkezimizde bakteriyemi etkeni olarak gram-pozitif mikroorganizmalar daha sık saptanmıştır. Her merkezin kendi infeksiyon etkenlerini yakından izleyip empirik antibiyotik tedavi politikalarını belirlemesi, FEN sürecinin daha iyi yönetilmesinde olumlu katkı sağlayabilir