FACTORS ASSOCIATED WITH SUICIDE ATTEMPTS IN PATIENTS WITH BIPOLAR DISORDER TYPE I

Background: The aim of this study is to identify the risk factors that are associated with suicide attempts in patients with bipolar disorder type I. Subjects and methods: This cross-sectional study was conducted with inpatients and outpatients with BD type I. Patients who met the study inclusion criteria (n=91) were evaluated in terms of sociodemographic variables, history of childhood trauma, comorbidity of adult attention deficit hyperactivity disorder and posttraumatic stress disorder, and the course of the disease. The patients were divided into two groups: those with a history of suicide attempts and those without a history of suicide attempts. The parameters of the study groups were compared with t and chi-square tests as appropriate. Logistic regression was used to identify the predictors of suicide attempt. Results: Logistic regression analysis of the study parameters suggested that the number of major depressive episodes (odds ratio: 7.18; 95% confidence interval: 1.84-28) and history of emotional neglect (odds ratio: 1.83; 95% confidence interval: 1.15- 2.90) were significant predictors of suicide attempt in patients with BD. Conclusion: In BD type I patients with a history of suicide attempts, the number of depressive episodes and emotional neglect, a subtype of childhood traumas, were the most remarkable risk factors. Considering the frequency of depressive episodes during the course of the disease and assessing traumas including those in childhood may help predict future suicide attempts in patients with BD

ELEVATED NEUTROPHIL/LYMPHOCYTE RATIO IN PATIENTS WITH SCHIZOPHRENIA

Background: Inflammatory mechanisms are reported to play important roles in the pathophysiology of schizophrenia. The neutrophil–lymphocyte ratio (NLR) is a simple and easily accessible indicator of the systemic inflammatory response. Our goal was to investigate whether NLR was higher in patients with schizophrenia than in healthy comparison subjects similar in age, sex, and body mass index. Subjects and methods: In this multicenter cross-sectional study, we analyzed 156 non-obese patients with schizophrenia and 89 healthy control subjects for complete blood count. The Brief Psychiatric Rating Scale was used to determine the severity of clinical pathology. Results: The mean±SD NLR of patients with schizophrenia was significantly higher than that of healthy controls (2.6±1.1 vs. 1.9±0.6, respectively, p0.05). Conclusions: Our findings suggest that NLR levels are increased in physically healthy, non-obese, patients with schizophrenia when compared with physically and mentally healthy individuals. To our knowledge, this is the first study that demonstrated the association between NLR and schizophrenia

Assessment of subjective sleep quality in iron deficiency anaemia

Objectives: We aimed to assess the effect of anemia on subjective sleep quality in patients with iron deficiency anemia (IDA). Methods: One hundred and four patients diagnosed with IDA and 80 healthy individuals, who are gender and age matched, were included in the study. All participants were requested to fill 3 forms: a socio-demographic form (age, gender, marital status, income level and educational status), hospital anxiety and depression (HAD) scale and pittsburgh sleep quality index (PSQI). Results: According to the HAD scale, the average anxiety score was found 9.24\ub14.37 in patients and 7.58\ub1 4.07 in controls. And, the average depression score was 7.53\ub14.10 in patients and 6.41\ub12.74 in controls. The total sleep quality score was 6.71\ub13.02 in patients and 4.11\ub11.64 in controls. There was a statistically significant difference in terms of anxiety, depression and sleep quality scores. Linear regression analysis showed no association between anxiety and depression with poor sleeping. Conclusion: IDA affects sleep quality irrespective of psychological symptoms such as depression and anxiety

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Kamu otoritesi müdahalesi çerçevesinde evlenmenin hükümsüzlüğü

ÖZETKAMU OTORİTESİ MÜDAHALESİ ÇERÇEVESİNDE EVLENMENİN HÜKÜMSÜZLÜĞÜÖzel Hukukta kural irade özgürlüğü olmakla birlikte, kişinin her türlü irade beyanına hukuk düzeninin mutlaka olumlu bir sonuç bağlaması düşünülemez. Zira, kişilerce ortaya konulan hukuki işlemler yürürlükteki hukukun aradığı şartlara uygun düştüğü ölçüde geçerlilik kazanır. Bu durum toplumu oluşturan ve onun devamlılığını sağlayan en küçük sosyal grup olaet birtakım özel düzenlemelere ve müdahalelere ihtiyaç duymuştur. Bu kapsamda, eksikliği evlenmenin yokluğuna neden olan kurucu unsurların varlığına rağmen, kanunun taraflarda ya da taraf iradelerinde aradığı niteliklerin bazıları gerçekleşmeden kurulmuş bir evlilik butlanla batıl bir evlenmedir. Bununla birlikte, eğer butlan sebepleri kamu yararı ve kamu düzeninin korunması düşüncesine dayanıyorsa mutlak butlan hali söz konusudur. Nihayetinde, tüm bu hususlar bir yana, olması gereken hukuk açısından mutlak butlan davası açma ve bu davayı takip etme görevinin Savcılık kurumundan alınması gerekmektedir. Çünkü, çoğu zaman mutlak butlan halleri nüfus müdürlükleri tarafından tespit edilmekte, Cumhuriyet Savcısı da nüfus müdürlüklerinin bildirimi üzerine harekete geçmektedir. Ayrıca, Cumhuriyet savcıları tarafından kendiliğinden harekete geçilerek veya ilgililer ya da üçüncü kişilerin tetiklemesiyle dava açıldığı ender görülmektedir. Öte yandan, daha önce de belirtildiği üzere adli görevleri yanında birçok idari görevleri de olan ve diğer Avrupa ülkelerine kıyasen muazzam bir işi yükü altında yıpranan Cumhuriyet Savcılarından belirtilen gerekçelerle bu davaların açılmasında ve bu davaların takibinde kanunun öngördüğü anlamda bir katkı beklemek mümkün değildir. Bu gerekçelerle, Cumhuriyet Savcıları'nın gerek bu davaları açmalarında gerekse bu davalara katılmalarında artık hiçbir hukuki ya da sosyal bir yarar yoktur. Anahtar Kelimele : Kamu Düzeni, Olması Gereken Hukuk SUMMARYİNTERFERENCE BY PUBLİC AUTHORİTYE ANDA THE FRAMEWORK OF THE İNVALİDİTY OF A MARRİAGEAs well as the rule is free discretion in private law, it shall not be considered that rule of law cannot certainly conclude positive conclusion to all kind of declaration of intention of the person. Because, the legal transactions which have set forth by the persons, become valid to the extent that it collocates to the conditions which current law needs become valid. Such situation is valid for prenuptial agreement which provides the establishment of family which is the smallest social group and which constitutes the society and provides the continuity. Because, state is a social contract and the family is the headstone of the society. With such reasons, the state has needed certain special arrangements and interventions for the purpose of protection of the family and so the maintaining public order. Within this scope, despite of existence of the founder elements whose lack causes absence of marriage, a marriage which has occurred without providing certain qualifications which the law seeks in the parties or declarations of the parties, is void marriage with nullity. On the other hand, if the nullity reasons are based on the thought of protection public order, there is an absolute nullity reason. Ultimately, apart from all such issues, the duty of public prosecutor to bring absolute nullity suit and follow the same should be taken with regard to de lege feranda. Because, mostly, absolute nullity grounds are designated by birth registration offices, the public prosecutors step into action upon the notice of birth registration offices. Furthermore, it is rarely seen that the public prosecutors bring suits by moving automatically or triggering by concerned or third persons. On the other hand, as it is mentioned before, it is not possible to wait contribution which the law stipulates from public prosecutors who have both judicial duties and many administrative duties and who are under enormous work load comparing with other European countries, in bringing such suits and following up the same for specified reasons.For such reasons, there is not any legal or social benefit that the public prosecutor either brings such suits or participates to the same.Keywords : Should Be Legal, Puplic Orde