Giant biventricular thrombi presenting with acute myocardial infarction

AbstractBiventricular thrombi secondary to anterior myocardial infarction is very rare. We present a patient with giant biventricular thrombi subsequent to an old anterior wall myocardial infarction, and devastating consequences, including acute pulmonary artery and femoral artery embolism. We introduce a unique case report with demonstrative and illustrative images

Evaluation of personality features and mental state of keratoconus patients

Objectives: Keratoconus (KCN) is a disorder that usually appears during adolescence and progressively reduces visual acuity. KCN may lead to differences in personality features as a result of vision loss and the numerous clinical examinations and treatment methods used from a young age. The aim of this study was to better understand the psychological characteristics of KCN patients and to define possible correlations between corneal topographic parameters and psychological state. Methods: A total of 59 KCN cases were included in the study group and were compared with 65 age- and sex-matched healthy individuals. All of the participants underwent a routine ophthalmic examination that included corrected distance visual acuity (CDVA), biomicroscopy, and fundoscopy. The KCN patients were evaluated busing Scheimpflug corneal topography. Psychiatric evaluations were performed using the Eysenck Personality Questionnaire Revised-Short Form (EPQ), the Self-Confidence Scale, the Maudsley Obsessive-Compulsive Inventory (MOCI), and the Beck Depression Inventory (BDI). Results: The mean age of the case and control groups was 23.98±5.7 years and 25.82±5.4 years, respectively. The KCN cases had significantly higher EPQ neuroticism subscale scores; higher MOCI subscale scores, with the exception of the doubting subscale; and higher BDI scores. Analysis of the KCN duration revealed a positive correlation with the checking and slowness subscales of the MOCI, however, there was no significant correlation between the psychometric scale scores, corneal topographic parameters, and CDVA. Conclusion: A substantially asymmetrical course and a relatively long period for KCN to result in severe vision loss might explain the lack of correlations between psychological parameters and visual acuity. Nonetheless, the apparent effect of vision loss on emotional distress cannot be disregarded; the day-to-day progressive loss of visual acuity and multiple, costly interventions may initiate or contribute to a depressive mood in KCN patients. A vicious depressive cycle and the exhaustion of long-term coping mechanisms might be underlying factors for the higher neuroticism scores seen among KCN patients. Both the personality traits and mental state of KCN patients demonstrate distinguishing properties; clinicians working with these patients should consider their mental state in addition to other factors in order to achieve better treatment outcome

Comparative Analysis of Deep Learning Architectures for Breast Cancer Diagnosis Using the BreaKHis Dataset

Cancer is an extremely difficult and dangerous health problem because it manifests in so many different ways and affects so many different organs and tissues. The primary goal of this research was to evaluate deep learning models' ability to correctly identify breast cancer cases using the BreakHis dataset. The BreakHis dataset covers a wide range of breast cancer subtypes through its huge collection of histopathological pictures. In this study, we use and compare the performance of five well-known deep learning models for cancer classification: VGG, ResNet, Xception, Inception, and InceptionResNet. The results placed the Xception model at the top, with an F1 score of 0.9 and an accuracy of 89%. At the same time, the Inception and InceptionResNet models both hit accuracy of 87% . However, the F1 score for the Inception model was 87, while that for the InceptionResNet model was 86. These results demonstrate the importance of deep learning methods in making correct breast cancer diagnoses. This highlights the potential to provide improved diagnostic services to patients. The findings of this study not only improve current methods of cancer diagnosis, but also make significant contributions to the creation of new and improved cancer treatment strategies. In a nutshell, the results of this study represent a major advancement in the direction of achieving these vital healthcare goals.Comment: 7 pages, 1 figure, 2 table

Clinical utility of EDACS-ADP in patients admitted with chest pain to an emergency department

BACKGROUND: Acute coronary syndrome (ACS) is a common cause of mortality and morbidity. An ACS diagnosis can be made with electrocardiogram (ECG) and cardiac markers. However, despite medical advances, 2–5% of ACS patients are undiagnosed and discharged from emergency departments (EDs) because clinicians often find it difficult not only to diagnose and treat high-risk patients but also to define nonemergency diseases or safely discharge healthy patients. Risk stratification can be prevented, and inappropriate diagnosis and treatment protocols can be identified. The ED Assessment of Chest Pain Score-Accelerated Diagnostic Protocol (EDACS-ADP) scoring system, developed to identify patients with chest pain but at low risk for a major adverse cardiac event (MACE), is the first score based on clinical data from emergency medicine.   OBJECTIVES: This study investigates the usability of EDACS-ADP in Turkey.   MATERIALS AND METHODS: This is a prospective observational study of 392 patients. The primary outcome was a major adverse cardiovascular event (MACE) within thirty days.   RESULTS: A total of 116 MACEs occurred in 65 (16,6%) patients during a one-month follow-up. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+ LR), and negative likelihood ratio (–LR) values of the EDACS-ADP score for the evaluation of 30-day MACE rate in patients who admitted with chest pain for two months were as follows: 96.9%, 64.5%, 35.2%, 99.1%, + LR: 2.73, and –LR: 0.05.   CONCLUSION: Most of these patients were classified by the EDACS-ADP as low risk and suitable for discharge. The 30-day MACE rate of development was significantly low (0.9%) and acceptable in patients grouped as low risk

A Novel Label-Free Optical Biosensor Using Synthetic Oligonucleotides from E. coli O157:H7: Elementary Sensitivity Tests

SiO2-TiO2 thin films for use as fiber optic guiding layers of optical DNA biosensors were fabricated by the sol-gel dip coating technique. The chemical structure and the surface morphology of the films were characterized before immobilization. Single probe DNA strands were immobilized on the surface and the porosity of the films before the hybridization process was measured. Refractive index values of the films were measured using a Metricon 2010 prism coupler. On the surface of each film, 12 different spots were taken for measurement and calculation of the mean refractive index values with their standard deviations. The increased refractive index values after the immobilization of single DNA strands indicated that immobilization was successfully achieved. A further refractive index increase after the hybridization with target single DNA strands showed the possibility of detection of the E. coli O157:H7 EDL933 species using strands of 20-mers (5′-TAATATCGGTTGCGGAGGTG -3′) sequence

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Economic analysis of iron and steel industry in Turkey

YÖK Tez ID: 419135Demir çelik sektörü, dünya ekonomisini büyük ölçüde ve doğrudan etkilemektedir. Tüm ülkeler için ekonomik kalkınmanın dayanağı güçlü bir demir çelik sanayiine sahip olmaktan geçmektedir. Çünkü demir çelik sektörü birçok endüstriyel alana girdi sağlamaktadır. Dolayısıyla birçok alana girdi sağlayan bir sektör, ne kadar güçlü olursa ona bağlı olan diğer sektörlerde o kadar güçlenecektir. Ayrıca güçlü bir demir çelik sektörü, diğer sektörler için hızlı ve daha ucuz girdi temini avantajı sağlamaktadır. Ulusların gelişmişlik düzeyi önceleri kişi başına ham demir çelik tüketim miktarıyla ölçülmekteydi. Fakat günümüzde gelişen teknolojiyle birlikte ham çelik tüketimi kadar nihai çelik tüketimi de önem kazanmıştır. Dünyada ham ve nihai çelik tüketim değerleri ilerleyen bölümlerde incelendi ve inceleme sonucu hem ham hem de nihai çelik üretim ve tüketim miktarlarının sürekli artış gösterdiği gözlenmiştir. Dolayısıyla gerek artan nüfus gerekse gelişen teknolojiye bağımlı olarak, demir çelik ürünlerine olan talep giderek artmaktadır. Sürekli tüketimi artan demir çelik sanayi ürünleri, gün geçtikçe insan hayatının vazgeçilmezi haline gelmeyi başarmıştır. Gelişen teknolojiyle birlikte zaman içinde değişiklik gösteren tüketici taleplerini karşılamak için, sektör çok parçalı bir yapıya bürünmüştür. Demir çelik sektöründe mevcut üretim sistemini değiştirmenin ve sektöre yeni giriş maliyetlerinin çok yüksek olmasından dolayı, oluşan parçalı yapıyla baş edebilmek için sektörde birleşmeler ve şirket evlilikleri gerçekleşmiştir. Sektörde hızla artan tüketici talebine bağımlı olarak önceleri çelik fiyatlarında artışlar görülse de zaman içerisinde üreticilerin mevcut karlılığı görüp kapasitesini artırma eğilimine gitmesi rekabeti artırmış ve fiyatların düşmesine sebep olmuştur. Fiyatlarda yaşanan düşüşün üretimi etkilememesi için özellikle 2008 sonrası üreticiler, mal farklılaştırmasına gitmiş ve piyasaların uzun mâmüle doyması sonucu yassı ve vasıflı ürün üretimine yönelmişlerdir.Iron and steel industry, affects the world economy directly and greatly. The basis for economic development for all countries is having a strong steel industry. Becasue the iron and steel sector is providing inputs for many industrial areas. Therefore, a sector which is providing inputs for many industrial areas, how strong it will be, the other sectors which are depending on it will be as strong as it is. Also, a strong iron and steel sector, provides advantage on cheaper and faster input supply for the other sectors. The level of development of nations previously been measured by consumption of crude steel per capita. But today, with evolving technology consumption of finished steel has gained importance as consumption of crude steel. In the following sections, the World crude and finished steel consumption values and encountered tables showed that crude and finished steel consumptions are increasing continuously. Hence, the demand for iron and steel products is increasing depend on growing population and evolving technology. Constantly increasing consumption of iron and steel industry products has managed to become indispensable for human life, everyday. By the developing technology, by the time the industry has taken a very fragmented structure to meet consumer demand which is changing over the time. Because of changing existing production systems and due to the very high costs of newly entry to industry, in the iron and steel industry mergers and acquisitions and takeovers took place to cope with fragmented structure. Previously, although steel prices were increasing depending on the rapidly growing consumer demand in the sector, by the time competition has increased and prices has decreased because of current profitability on the sector has seen by producers and they have increased their production capacity. In order to do not affected by the decreased prices, the producers chose to product differentiation and couse of demand is getting low for long products in the market, producers have turned to produce flat and special steel products, especially after 2008