Picadas de escorpião na Turquia: aspectos epidemiológicos e clínicos entre os anos de 1995 e 2004

The most important health-threatening scorpions found in Turkey are; Androctonus crassicauda, Leiurus quinquestriatus, Mesobuthus gibbosus and M. eupeus species, all of which belong to the Buthidae family. The epidemiological and clinical findings of scorpion stings in Turkey were evaluated between the years 1995 and 2004 based on data recorded in the National Poison Information Center (NPIC). A total of 930 cases were recorded. The cases mostly occurred in the month of July. The gender distribution was 50.22% female and 45.48% male. It was shown that the 20-29 age group presented more scorpion stings. Most of the stings occurred in Central Anatolia and Marmara regions of Turkey. Patients at the hospital showed signs of localized (pain, hyperemia, edema and numbness) and systemic effects (hyperthermia, nausea and vomiting, tachycardia, shivering and lethargy) but no lethality was notified. According to records, 33% of the poisoned patients were treated with antivenin in healthcare facilities.Os mais importantes escorpiões que comprometem a saúde na Turquia são: Androctonus crassicauda, Leiurus quinquestriatus, Mesobuthus gibbosus e M. eupeus, todos eles pertencentes à família Buthidae. Os achados clínicos e epidemiológicos da picada de escorpiões na Turquia foram avaliados no período entre os anos de 1995 a 2004 baseados em dados do Centro Nacional de Informações de Envenenamentos (NPIC). Foram registrados 930 casos que ocorreram principalmente no mês de julho. A distribuição por sexo foi 50,22% femininos e 45,48% masculinos. Demonstrou-se que o grupo etário de 20 a 29 anos apresentou maior número de picadas de escorpião. A maior parte das picadas ocorreu na Anatólia Central e na região de Marmara, na Turquia. Os pacientes hospitalizados mostraram sinais localizados (dor, hiperemia, edema e confusão mental) e sistêmicos (hipertermia, náusea e vômitos, taquicardia, arrepios de frio e letargia), mas não houve notificação de letalidade. De acordo com os prontuários 33% dos pacientes foram tratados com antiveneno nas unidades de saúde

Apocrine Fibroadenoma of the Perianal Region Associated with Perianal Fistula

A case of a 45 year-old woman who presented with a perianal fistula was reported. Histologically, the excised lesion showed features of apocrine fibroadenoma. In addition, the lesion had both glandular and stromal growth patterns and active chronic inflammation in the background. Malignant or benign counterparts of these types of lesions are widely described in literature. However fistula does not usually accompany and is very rare. Therefore, it is crucial for the pathologists and clinicians to be aware of such lesions. The relationship between apocrine fibroadenoma and perianal region was also discussed

Embolization of Ruptured Hepatic Hydatid Cyst to Pulmonary Artery in an Elderly Patient : Multidetector computed tomography findings

Pulmonary embolism due to hydatid disease is an unusual condition resulting from the rupture of a hydatic heart cyst or the opening of liver hydatidosis into the venous circulation. A 78-year old male patient complaining of dyspnea, cough and severe chest pain was admitted to our emergency department. A multidetector computed tomography of the chest revealed the presence of multiple nodules in both lungs especially in left and multiple hypodense filling defect in left main pulmonary artery and its branches. In addition, coronal reformatted multidetector computed tomography images also showed two hypodense cystic parenchymal masses on the left lobe of the liver with a cystic embolus in the right atrium. Pulmonary embolism should be kept in mind in patients who have hepatic hydatidosis if suddenly chest pain and dyspnoea occurs, especially in regions where hydatidosis is endemic

The effects of IgM-enriched immunoglobulin preparations in patients with severe sepsis [ISRCTN28863830]

INTRODUCTION: In this prospective, randomized controlled study, we aimed to evaluate the effect of IgM-enriched immunoglobulin treatment on progression of organ failure and septic shock in patients with severe sepsis. MATERIALS AND METHODS: Forty-two patients with severe sepsis were enrolled in the study. Patients in the study group (n = 21) received an intravenous immunoglobulin preparation (Pentaglobin(®)) in addition to standard therapy. Pentaglobin(®) therapy was commenced on the day of diagnosis of severe sepsis: 5 ml/kg per day Pentaglobin(®) (38 g/l IgG, 6 g/l IgM, and 6 g/l IgA) was infused over 6 hours and repeated for 3 consecutive days. Patients in the control group (n = 18) received standard sepsis therapy, but no immunoglobulin administration. Blood samples for procalcitonin (PCT) measurements were taken daily for 8 days. Severity of critical illness and development of organ failure were assessed by obtaining daily acute physiological and chronic health evaluation (APACHE) II and sequential organ failure assessment (SOFA) scores. RESULTS AND DISCUSSION: Procalcitonin levels showed a statistically significant decrease in the Pentaglobin(®) group (P < 0.001); however, an improvement in SOFA scores could not be demonstrated. Procalcitonin levels and SOFA scores did not change significantly in the control group. Septic shock incidence (38% versus 57%) and 28-day mortality rate (23.8% versus 33.3%) were found to be similar between the Pentaglobin(®) and control groups. The evaluation of serial APACHE II scores did not demonstrate a difference between Pentaglobin(®) and control groups either. CONCLUSION: Present data could not demonstrate any beneficial effects of polyclonal immunoglobulin preparation Pentaglobin(®) on organ morbidity, septic shock incidence and mortality rate in patients with severe sepsis

Gastric intramucosal pH is stable during titration of positive end-expiratory pressure to improve oxygenation in acute respiratory distress syndrome

BACKGROUND: Optimal positive end-expiratory pressure (PEEP) is an important component of adequate mechanical ventilation in acute lung injury and acute respiratory distress syndrome (ARDS). In the present study we tested the effect on gastric intramucosal pH of incremental increases in PEEP level (i.e. PEEP titration) to improve oxygenation in ARDS. Seventeen consecutive patients with ARDS, as defined by consensus criteria, were included in this clinical, prospective study. All patients were haemodynamically stable, and were not receiving vasopressors. From an initial level of 5 cmH(2)O, PEEP was titrated at 2 cmH(2)O increments until the partial arterial oxygen tension was 300 mmHg or greater, peak airway pressure was 45 cmH(2)O or greater, or mean arterial blood pressure decreased by 20% or more of the baseline value. Optimal PEEP was defined as the level of PEEP that achieved the best oxygenation. The maximum PEEP was the highest PEEP level reached during titration in each patient. RESULTS: Gastric mucosal pH was measured using gastric tonometry at all levels of PEEP. The thermodilution technique was used for measurement of cardiac index. Gastric mucosal pH was similar at baseline and at optimal PEEP levels, but it was slightly reduced at maximum PEEP. Cardiac index and oxygen delivery remained stable at all PEEP levels. CONCLUSION: Incremental titration of PEEP based on improvement in oxygenation does not decrease gastric intramucosal perfusion when cardiac output is preserved in patients with ARDS

Balancing Exploration Ratio in Reinforcement Learning

The 11th Annual MOVES Research and Education Summit, July 12-14, 2011. SESSION #5: Agents and Combat Modeling. Moderato

Balancing exploration and exploitation in agent learning

Controlling the ratio of exploration and exploitation in agent learning in dynamic environments is a continuing challenge in applying agent-learning techniques. Methods to control this ratio in a manner that mimics human behavior are required for use in the representation of human behavior in simulations, where the goal is to constrain agent-learning mechanisms in a manner similar to that observed in human cognition. The Cultural Geography (CG) model, under development in TRAC Monterey, is an agent-based social simulation. It simulates a wide variety of situations and scenarios so that a dynamic ratio between exploration and exploitation makes the decisions more sensible. As part of an attempt to improve the model, this thesis investigates enhancements to the exploration-exploitation balance by using different techniques. The work includes design of experiments with a range of factors in multiple environments and statistical analysis related to these experiments. As a main finding from this research, for small environments and for short runs techniques based on subjective utility give better results, while for long runs techniques based on time obtain higher utilities than other techniques. In more complex and bigger environments, a combined technique performed better in long runs.http://archive.org/details/balancingexplora109455468Approved for public release; distribution is unlimited

A law enforcement perspective to intelligence failure in mass casualty terrorist attacks by global jihadist movements: a comparative study of terrorist attacks of September 11, 2001 and November 15-20, 2003

This study aims to explain, from a law enforcement perspective, the extent to which five factors—policy/bureaucratic obstacles, organizational problems, defects in intelligence cycle, lack of international intelligence sharing, and the capabilities of perpetrators—contribute to intelligence failure in mass casualty terrorist attacks. In an attempt to find answers to a set of probing questions based on the five factors mentioned above, the study which examines intelligence failure in two mass casualty terrorist attacks by global jihadist movements applies existing theories of and knowledge on intelligence failure to case studies of two mass casualty terrorist attacks: the 9/11 attacks in 2001 and the Istanbul bombings in 2003. The core findings of the study suggest that while some specific problems in the intelligence community, particularly structural problems and lack of information sharing can result in intelligence failure, government policies against terrorism (perception of threat, implementation of policies) and toward intelligence units (adequate funding, guidance, and oversight of the intelligence agencies) as well as the capability of perpetrators and the lack of international intelligence sharing also play an important role in intelligence failure. On the other hand, whether such attacks are inevitable remains questionable. Even if governments implement right policies and intelligence agencies do their best, the capacity and the willingness of terrorists and terrorist organizations can facilitate success of such attacks. Given the fact that intelligence failures are not rare events, even if particular instances could have been avoided, the general phenomenon cannot. The study has implications for reorganization of intelligence agencies, understanding of the global terrorism threat posed by jihadist movements and the role of law enforcement intelligence in countering transnational terrorism.Ph. D.Includes bibliographical referencesIncludes vitaby Ozcan Ozka