The impact of low molecular weight heparin on obstetric outcomes among unexplained recurrent miscarriages complicated with methylenetetrahydrofolate reductase gene polymorphism

Objectives: The association between methylenetetrahydrofolate reductase gene polymorphisms and unexplained recurrent miscarriage is elusive. The recommendations for improving pregnancy outcomes in these patients keep changing based on the available evidence. The aim of this study is to analyze the impact of low molecular weight heparin on obstetric outcomes of recurrent miscarriage patients complicated with methylenetetrahydrofolate reductase gene polymorphism. Material and methods: We reviewed medical records of 121 patients with a history of recurrent miscarriage complicated by methylenetetrahydrofolate reductase gene polymorphisms, retrospectively. From among them, 68 patients were treated only with folic acid and iron. The remaining 53 patients were treated with folic acid, iron and prophylactic doses of low molecular weight heparin. The subsequent pregnancy outcomes of these patients were noted. Results: The live birth rate was higher in patients with anticoagulant therapy than in patients without anticoagulant therapy (48.5% vs. 69.8%, respectively, p: 0.015) and the congenital anomaly rate was lower in anticoagulant therapy group (17.6% vs. 3.8%, respectively, p: 0.022). The other obstetric outcomes were found to be similar between the two groups. Conclusions: The current study demonstrated that low molecular weight heparin improved the live birth rates among unex­plained recurrent miscarriage patients complicated with methylenetetrahydrofolate reductase gene polymorphisms. How­ever, the routine use of low molecular weight heparin did not improve the late pregnancy complications in these selected patients in the eastern region of our country. Further studies are needed to discriminate the effect of anticoagulation on the live birth rate of each of methylenetetrahydrofolate reductase gene polymorphism type

Peripheral blood levels of cellular and humoral immunity parameters in esophageal and gastric cancer patients

Aim: To evaluate parameters of cellular and humoral immunity in gastric and esophageal cancer patients. Material and methods: In this study, we recruited 40 patients with newly diagnosed esophageal cancer (20 of them) or stomach cancer (20 of them) and 20 healthy individuals of similar age as a control group. In the study and control groups we measured CD3, CD4, CD8, CD19, CD4/CD8 ratio and the ratio of natural killer cells using the flow cytometer device. Results were evaluated with factorial analysis of variance and Duncan test. Results: The CD3 and CD8 ratios were significantly higher in patients with esophageal cancer (p = 0.012, p = 0.003, respectively) and the ratio of NK cells was significantly higher in patients with stomach cancer (p = 0.001) when compared to the control group. The ratio of CD19 was significantly lower in the two cancer groups (p = 0.031). There were no significant differences in the ratio of CD4 and CD4/CD8 between the groups. No correlation between the stage of cancer and the ratio of CD cells was detected. Discussion: In conclusion, understanding of the cancer immunology of esophageal and stomach cancer will provide insight into the pathogenesis of the cancer Therefore, further and extensive cancer immunology studies should be conducted to understand the nature of the upper gastrointestinal tract cancers

Tip 2 Diyabetli Bir Hastada Linagliptine Bağlı Lokalize Ağrılı Döküntü

The number of patients with type 2 diabetes using dipeptidylpeptidase-4 (DPP-4) inhibitors is increasing across the world.Although this class of antidiabetic medications is generallysafe and associated with less side effects compared to otheroral antidiabetic medications, they could also cause some sideeffects such as skin rashes. Herein we report a case of type 2diabetes patient who developed a painful maculopapular rashinduced by linagliptin, a widely used DPP-4 inhibitor.A localized painful maculopapular rash developed on thepalmar faces of the patient’s hands almost 1 day after theinitiation of the drug. The patient was using intensive insulintherapy before linagliptin was started. There was no eruptionon the other body parts except the palmar faces of the hands.Following the discontinuation of the drug, the rash disappearedin about four days. The patient had no history of urticaria anddid not use an ACE inhibitor. As far as we know, this is the firstcase report of a skin rash induced by linagliptin in the Turkishliterature. This case report highlights a rare and lesser knownside effect of linagliptin, a new member of DPP-4 inhibitors.Dipeptidil peptidaz-4 (DPP-4) inhibitörleri kullanan tip 2 diyabet hastalarının sayısı dünya genelinde artmaktadır. Bu antidiyabetik ilaç sınıfı genelde güvenli olmakla birlikte diğer oral antidiyabetik ilaçlarla karşılaştırıldığında daha az yan etki ile ilişkili olsa da, deri döküntüleri gibi bazı yan etkilerle ilişkili olabilirler. Burada yaygın olarak kullanılan bir DPP-4 inhibitörü olan linagliptin ile indüklenen ağrılı makülopapüler döküntü gelişen tip 2 diyabetli bir hastayı sunuyoruz. Linagliptin başlandıktan 1 gün sonra hastamızın ellerinin palmar yüzünde lokalize ağrılı makülopapüler bir döküntü gelişti. Linagliptin başlanmadan önce hasta intensif insülin tedavisi altındaydı. Vücudun diğer bölgelerinde herhangi bir döküntü yoktu. Linagliptin kesildikten sonra 4 gün içerisinde döküntü kayboldu. Hastanın ürtiker öyküsü yoktu ve Anjiyotensin dönüştürücü enzim inhibitörü kullanmıyordu. Bildiğimiz kadarıyla bu, Türk literatüründe Linagliptine bağlı deri döküntüsü geliştirdiği rapor edilen ilk olgudur. Bu olgu sunumu, DPP-4 inhibitörlerinin nadir görülen ve daha az bilinen bir yan etkisini vurgulamaktadır

Strain relatedness in gram-negative bacteremia: Cause or contamination?

Aim: Bloodstream infections are a major cause of mortality, 25% of which are associated with gram-negative bacteremia. To avoid the inappropriate use of antibiotics, it is important to differentiate the bacteremia from contamination. In general, gram-positive bacteria were more likely to be contaminants than gram-negative-bacteria. There is little information in the literature concerning the epidemiology of gram-negative bacteria isolated from sequential blood cultures. Therefore, we aimed to examine the molecular epidemiology of gram-negative bacteria isolated from sequential blood cultures. Material and Methods: A total of 56 patients (112 samples and strains) with two or more sequential positive blood cultures for gram-negative bacteria with the same antibiogram were included in the study. Pulsed-field gel electrophoresis (PFGE) and arbitrarily primed PCR (AP-PCR) were performed for the determination of strain relatedness. Results: While PFGE analysis demonstrated relatedness in 6 isolates, AP-PCR demonstrated 9 relatedness in 112 isolates. Discussion: The results of our study suggest that, although the possibility of contamination is very low in gram-negative bacteremia, this can still take place, as shown in sequential blood cultures with the same antibiogra

Polyclonal outbreak of bacteremia caused by Burkholderia cepacia in the intensive care unit

Aim: Burkholderia cepacia is a multidrug-resistant, opportunistic pathogen of humans and outbreaks of infection in hospitals have been described. In this study, we aimed to report an outbreak in patients without cystic fibrosis or chronic granulomatous disease involving different species of Burkholderia cepacia. Material and Methods: A small outbreak of nosocomial Burkholderia cepacia complex occurred in a 6-bed intensive care unit. We isolated Burkholderia cepacia from blood cultures of the patients admitted to our intensive care unit. All isolates from patients and the environment were identified by standard microbiological techniques and VITEK system. Antibiotic susceptibility testing was performed using Kirby Bauer's disk diffusion method and the VITEK system Results: All isolates exhibited identical patterns of antibiotic susceptibility and all isolates were sensitive to trimethoprim-sulfamethoxazole, ceftazidime and meropenem. The isolates were typed using pulsed-field gel electrophoresis using the restriction enzymes XbaI and SpeI. Accordingly, while 4 strains were similar, one was different. Discussion: The experience from this outbreak reminded us of the importance of outbreak investigation in such small outbreaks and keeping the health care workers educated and constant attention on this issue. The results of this study emphasized once again the necessity to maintain our sensitivity to the basic principles of sanitation and to raise our awareness of such outbreaks

Distribution and antimicrobial susceptibilities of stenotrophomonas maltophilia strains ısolated from various clinical samples: an 8-year study

Amaç: Hastane enfeksiyonları ve buna bağlı mortalitenin artması çoklu ilaç direncine sahip fırsatçı patojenleri her zamankinden daha fazla gündeme getirmiştir. Bunlar arasında yer alan stenotrophomonas maltophilia önemi giderek artan fırsatçı bir patojendir. Bu çalışmanın amacı,sekiz yıllık süre boyunca hastanemizde çeşitli klinik örneklerden izole edilmiş S. maltophilia izolatlarının dağılımını ve antimikrobiyal duyarlılıklarını araştırmaktır. Yöntemler: Ocak 2011-Aralık 2019 tarihleri arasında çeşitli klinik örneklerden izole edilen toplam 149 S. maltophilia suşunun antimikrobiyallere direnç oranları araştırıldı. Bakteri identifikasyonu ve antibiyotik duyarlılığı rutin konvansiyonel mikrobiyolojik yöntemler ve VİTEK 2 kompakt otomatize sistem (BioMerieux, France) ile yapılmıştır. Bulgular: S. maltophilia en sık yoğun bakım ünitelerinde izole edilirken 50 (%33,5), en az 1 örnekle ( %0,6) Kardiyovasküler cerrahi servisi, Pediatri servisinden izolasyon gerçekleşmiştir. Örneklerin 85’i (%57,) solunum yolu izolatları olurken (trakeal aspirat, lavaj, balgam), en az 1 örnek ( %0,6) ile plevra ve eklem sıvısı olmuştur. Karbapenemlere doğal direnç gösteren S. maltophilia’da levofloksasin direnci % 6 iken, trimetoprim/sulfametoksazol’de %12, seftazidim’de %45 olarak tespit edilmiştir. Tartışma ve Sonuç: Çalışmada saptanan yüksek direnç oranları nedeniyle, S. maltophilia suşlarının etken olduğu nozokomiyal enfeksiyonların tedavisinde mümkün olduğunca in vitro duyarlılık testlerinin yapılması gerekir. Bunun yapılamadığı durumlarda ise tedavi planlamasında trimetoprim-sulfametoksazol ve levofloksasin iyi birer tedavi seçeneğidir. Ayrıca tedaviye başlamadan önce kolonizasyon - etken ayrımı klinik bulgularda göz önünde tutularak birlikte karar verilmelidirObjective: Hospital infections which associated with increased mortality have brought opportunistic pathogens like Stenotrophomonas maltophilia, with multiple drug resistance into focus. The aim of this study was to investigate the distribution and antimicrobial susceptibility of S. maltophilia isolates obtained from various clinical samples in our hospital for a period of eight years. Method: Antimicrobial resistance rates of 149 strains of S. maltophilia isolated from various clinical samples between January 2011 and December2019 were investigated. Bacterial identification and antibiotic susceptibility were performed with routine conventional microbiological methods and the VITEK 2 compact automated system (BioMerieux, France). Results: While S. maltophilia was most frequently isolated in intensive care units, from a total of 50 samples (33.5%), the rate was 0.6% (1 sample) the cardio vascular surgery service and pediatrics services. 85 (57%) of the samples were respiratory tract isolates (tracheal aspirate, lavage, sputum) with at least 1 (0.6%) pleural and joint fluid. Among these isolates of S maltophilia, which shows natural resistance to carbapenems, resistance for levofloxacin was 6% and for trimethoprim/ sulfamethoxazole was 12%. Conclusion: Due to the high resistance rates observed in the study, in vitro susceptibility tests should be used as much as possible in the treatment of nosocomial infections caused by S. maltophilia strains. In cases where this is not possible and empirical treatment is required, trimethoprim-sulfamethoxazole and levofloxacin are reasonable treatment options. Also, before starting treatment, the separation between colonization and agent should be decided in accordance with the clinical findings

Naiv hepatit C enfeksiyonlu hastaların on-altı yıllık prognozu

Objectives: In this study, we aimed to evaluate the clinical course of treatment-naive patients infected with hepatitis C virus (HCV) who were followed up in various centers in Turkey. Materials and Methods: This was a retrospective study performed with the participation of 15 centers. Patients aged 18 years and older with HCV infection were included. Results: A total of 391 treatment-naive patients infected with HCV were included in this study. During the follow-up period, the final values of alanine aminotransferase, aspartate transaminase, and total protein were significantly decreased when compared to the initial values (p<0.001, p<0.001, and p=0.005, respectively). In the study group, 19.2% of the patients underwent liver biopsy and 4.1% underwent transient elastography (FibroScan). An increased histological activity index (HAI) score and fibrosis in the second biopsy were observed in one patient, only increased HAI in two patients and increased fibrosis in one patient, as shown on the FibroScan. In the 16 years of the study period, cirrhosis was radiologically detected in only one patient. Conclusion: Even if rapid progression is not observed, close monitoring of the clinical findings related to liver failure and fibrosis with invasive or non-invasive methods may be useful.Amaç: Bu çalışmada ülkemizin çeşitli merkezlerinde takip edilen naiv hepatit C virüs (HCV) ile enfekte hastaların klinik seyrini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Bu çalışma retrospektif olarak 15 merkezin katılımıyla gerçekleştirilmiştir. Çalışmaya 18 yaş üstü, HCV enfeksiyonu olan hastalar dahil edilmiştir. Bulgular: Çalışmada 391 tedavi-naiv HCV enfeksiyonlu hasta yer almıştır. Hastaların takip süresinde son alanine aminotransferase, aspartate transaminase ve total protein değerleri ilk düzeyine göre önemli düzeyde azalmıştır (sırasıyla p<0,001, p<0,001, p=0,005). Çalışma grubunda hastaların %19,2’sine karaciğer biyopsisi, %4,1’ine elastografi (FibroScan) uygulanmıştır. Takip esnasında bir hastada ikinci biyopside histolojik aktivite indeksi (HAI) ve fibroziste artma, iki hastada sadece HAI’da artma, birinde FibroScan ile fibrozis değerinde artma olduğu gözlenmiştir. Bir hastada 16 yıl içinde radyolojik olarak siroz saptanmıştır. Sonuç: Hızlı progresyon gözlenmemekle birlikte hastaların izleminde karaciğer yetmezliği ile ilgili klinik bulguların ve invaziv veya noninvaziv yöntemlerle fibrozisin yakın takibi yararlı olabilir

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