Comparative Effectiveness of Guidelines for the Management of Hyperlipidemia and Hypertension for Type 2 Diabetes Patients

Background: Several guidelines to reduce cardiovascular risk in diabetes patients exist in North America, Europe, and Australia. Their ability to achieve this goal efficiently is unclear. Methods and Findings: Decision analysis was used to compare the efficiency and effectiveness of international contemporary guidelines for the management of hypertension and hyperlipidemia for patients aged 40-80 with type 2 diabetes. Measures of comparative effectiveness included the expected probability of a coronary or stroke event, incremental medication costs per event, and number-needed-to-treat (NNT) to prevent an event. All guidelines are equally effective, but they differ significantly in their medication costs. The range of NNT to prevent an event was small across guidelines (6.5-7.6 for males and 6.5-7.5 for females); a larger range of differences were observed for expected cost per event avoided (ranges, $117,269-$157,186 for males and $115,999-$163,775 for females). Australian and U.S. guidelines result in the highest and lowest expected costs, respectively. Conclusions: International guidelines based on the same evidence and seeking the same goal are similar in their effectiveness; however, there are large differences in expected medication costs. © 2011 Shah et al

Noncomparabilities & Non Standard Logics

Many normative theories set forth in the welfare economics, distributive justice and cognate literatures posit noncomparabilities or incommensurabilities between magnitudes of various kinds. In some cases these gaps are predicated on metaphysical claims, in others upon epistemic claims, and in still others upon political-moral claims. I show that in all such cases they are best given formal expression in nonstandard logics that reject bivalence, excluded middle, or both. I do so by reference to an illustrative case study: a contradiction known to beset John Rawls\u27s selection and characterization of primary goods as the proper distribuendum in any distributively just society. The contradiction is avoided only by reformulating Rawls\u27s claims in a nonstandard form, which form happens also to cohere quite attractively with Rawls\u27s intuitive argumentation on behalf of his claims

Recent status and fate of the north-eastern Mediterranean monk seal populations.

The endangered Mediterranean monk seal (Monachus monachus) is represented by approximately 350-450 individuals in Eastern Mediterranean waters in the form of small, fragmented and isolated groups. The North-eastern Mediterranean coast of Turkey being the host to one of the last continuously breeding populations, has vital importance for the survival of the species. Small populations inhabiting this region have been studied extensively for the last 25 years. The recent surveys showed that fragmented populations are still exposed to severe threats as a consequence of anthropogenic impacts. Therefore, in this study we focused on three previously documented populations in the southern coast of Turkey to update their status by utilizing photo-identification method, to estimate the size of the populations with Champan modification, to elucidate the dispersal among populations and to test the impact of dispersal on the survival of the populations through population viability analysis (PVA). Within this context, 20 caves were monitored with infrared camera-traps between the years 2015 and 2018. 37 individuals were identified and the overall population size estimate was 37 ± 5 (95% CI) seals. Among them were three adult females mobile between Western and Central groups which makes the mobility range of seals almost six times larger than previously documented in the same region. When compared to former studies, mortality rates increased whilst fecundity rates decreased. The results of the PVA analysis showed that populations have higher chance of survival in the case of dispersal. However, both isolated and dispersed populations have failed to survive within the next 100 years. Moreover, PVA models were easily affected by carrying capacity which highlights the importance of breeding caves. Therefore, continuity of monitoring studies focusing on threats and establishing Marine Protected Areas considering the suitable seal habitats and mobility of seals has vital importance for the future of the specie

The Distribution and Antimicrobial Susceptibility Profiles of Etiologic Agents Isolated From Bacteremia Episodes Among Immunocompromised Patients

Objective: Bacteremia is the leading cause of morbidity and mortality among immunocompromised patients. The aim of this study is to evaluate the etiology of bacteremia and the antibiotic susceptibilities of etiologic agents among immunocompromised patients followed up from January 1, 2012 to July 30, 2013. Methods: Immunocompromised patients, both inpatient and outpatient treated in our hospital, were followed prospectively. The definition of "immunocompromised patients" consisted of solid organ (kidney, liver) transplantation recipients and hemato-oncologic malignancy patients with a history of chemotherapy in the previous month before bacteremia. Results: This prospective study comprised of 167 bacteremia episodes of 130 consecutive immunocompromised patients. The most isolated group of bacteria was Gram-negative bacteria. Escherichia coli was the most commonly (30.8%) isolated bacteria and the second was coagulase-negative staphylococci (15.1%). Fifty one percent of the E. coli isolates were extended-spectrum beta-lactamasepositive. Acinetobacter baumannii was the second most common bacteria of Gram-negative agents and the ratio of multiple drug-resistant (MDR) isolates among Acinetobacter isolates was 73%. Conclusions: Gram-negative bacteria are the most common causative agents of bacteremia in immunocompromised patients in our hospital. The rising ratio of MDR A. baumannii is a striking problem which causes difficult-to-treat infections

Bloodstream Infections among Solid Organ Transplant Recipients: Eight Years’ Experience from a Turkish University Hospital

Background: Bloodstream infections (BSI) are frequently seen after solid organ transplantation. The incidence of bloodstream infections differs among the types of transplantation. The microbiological features and antimicrobial resistance patterns change from centre to centre. Aims: To evaluate the incidence and spectrum of aetiological agents of bloodstream infections among solid organ transplantation recipients. Study Design: Retrospective descriptive study. Methods: Medical records of solid organ transplant recipients in the period between January 1st 2004 and August 15th 2012 were assessed retrospectively. The study population comprised 927 (64 heart, 556 kidney, 307 liver) consecutive recipients. Bloodstream infections were divided into three groups according to the onset time of bloodstream infections after transplantation: early, mid-term and late. The incidence and microbiological features of bloodstream infections were evaluated. Results: The number of bloodstream infection episodes was 317 in 191 recipients which was distributed as 228 (72%) in liver, 70 (22%) in kidney and 19 (6%) in heart transplantation. Ninety-eight 98 (30.9%) of the episodes were diagnosed within the early period, 134 (42.3%) within the mid-term and 85 (26.8%) in the late period. Early and mid-term bloodstream infections were seen statistically more often in liver than in kidney or heart transplantation (p=0.01 and p=0.031, respectively). Late bloodstream infections were also common in liver transplant recipients which was not statistically significant (p=0.229). Conclusion: Liver transplant recipients are at the highest risk for developing BSI after transplantation in early, mid-term and late periods

Yayılımın Nesli Tehlike Altındaki Akdenz Fokunun Küçük Popülasyonlarının Devamlılığı Üzerindeki Etkisinin Anlaşılması

Akdeniz foku (Monachus monachus) Phocidae ailesinin en nadir bulunan üyesi olup, IUCN tarafından 2015 yılına kadar nesli kritik derecede tehlike altında olan türler arasında kabul edilmekteydi. Son dönemde yapılan çalışmalarda sayılarının dünya üzerinde 600-700 birey ile temsil edildiği ve bunların 400 kadarının Akdeniz’de bulunduğu belirlenmiştir. Bu türün son yaşam alanlarından biri olan Türkiye; uluslararası anlaşmalara imza atarak türü ve türün yaşam alanlarını koruma sorumluluğunu almıştır. Önemli olan habitatların kaybı ve artan ölüm oranları, türün ülkemizdeki geleceği açısıdan kaygı vericidir. Önceki yıllarda yapılan çalışmalarla tüm Kuzeydoğu Akdeniz için kuluçkalık konumunda olduğu ortaya çıkan Taşeli kolonisinden çevreye olan yayılımın tespiti türün bölgedeki geleceği açısından çok önemlidir. Bu sebeple Antalya ve Hatay bölgesindeki olası yaşam alanlarını tespit ederek bu alanlardaki mevcut ve olası tehditleri belirlenecek, fotokapanlarla birey tespiti yaparak, bölgeler arasındaki ilişkinin ortaya çıkarılacak ve mevcut veriler güncellenerek, yaşamsallık analiziyle popülasyonun geleceği hakkında yorum yapılacaktır

Varicella-Zoster Virus Activates Inflammatory Cytokines in Human Monocytes and Macrophages via Toll-Like Receptor 2

The pattern recognition receptor Toll-like receptor 2 (TLR2) has been implicated in the response to several human viruses, including herpes simplex viruses (types 1 and 2) and cytomegalovirus. We demonstrated that varicella-zoster virus (VZV) activates inflammatory cytokine responses via TLR2. VZV specifically induced interleukin-6 (IL-6) in human monocytes via TLR2-dependent activation of NF-κB, and small interfering RNA designed to suppress TLR2 mRNA reduced the IL-6 response to VZV in human monocyte-derived macrophages. Unlike other herpesviruses, the cytokine response to VZV was species specific. VZV did not induce cytokines in murine embryonic fibroblasts or in a mouse cell line, although VZV did activate NF-κB in a human cell line expressing a murine TLR2 construct. Together, these results suggest that TLR2 may play a role in the inflammatory response to VZV infection