A golden ratio for foramen magnum: an anatomical pilot study

Background: The foramen magnum (FM) is an important landmark because of its close relationship to key structures such as the brainstem and spinal cord, an extension of the medulla oblongata. Because of the similarity in their shape, the existence of a relationship between cranial length and anteroposterior diameter of the FM, and between cranial width and transverse diameter of the FM may reveal the magnificent harmony of the skull and FM. Based on this idea, we investigated the existence of this harmony in skulls that we used in our study. Materials and methods: In this study, 60 adult dry skulls belonging to the Turkish population were examined. The anteroposterior and transverse diameters of the foramen magnum and the length and width of the skull were measured. Measurements were made directly on the skull using a digital sliding caliper. New indices and ratios were applied with those measurements. Results: Our study suggests that FM width and FM length could be estimated by using the cranial length and cranial width measurements in the skull by accepting the mean of these coefficients (4.62) as the golden ratio. The average of the coefficients of cranial width to FM width ratio [4.62 ± 0.35 (95% CI: 4.52-4.70)] and the average of the coefficients of cranial length to the FM length ratio [4.62 ± 0.50 (95% CI): 4.49-4.76)] were found to be equal to each other. In order to check the accuracy of this hypothesis, FM width and FM lengths were estimated with the help of new equations. Conclusions: In the present study, the ratio between the anteroposterior and transverse diameters of both FM and the cranium was estimated at 4.62, indicating a magnificent harmony between cranial and subcranial structures. With this ratio, it is easy to estimate FM's size based on simple cranial measurements

Assessment of the requisites of microbiology based infectious disease training under the pressure of consultation needs

<p>Abstract</p> <p>Background</p> <p>Training of infectious disease (ID) specialists is structured on classical clinical microbiology training in Turkey and ID specialists work as clinical microbiologists at the same time. Hence, this study aimed to determine the clinical skills and knowledge required by clinical microbiologists.</p> <p>Methods</p> <p>A cross-sectional study was carried out between June 1, 2010 and September 15, 2010 in 32 ID departments in Turkey. Only patients hospitalized and followed up in the ID departments between January-June 2010 who required consultation with other disciplines were included.</p> <p>Results</p> <p>A total of 605 patients undergoing 1343 consultations were included, with pulmonology, neurology, cardiology, gastroenterology, nephrology, dermatology, haematology, and endocrinology being the most frequent consultation specialties. The consultation patterns were quite similar and were not affected by either the nature of infections or the critical clinical status of ID patients.</p> <p>Conclusions</p> <p>The results of our study show that certain internal medicine subdisciplines such as pulmonology, neurology and dermatology appear to be the principal clinical requisites in the training of ID specialists, rather than internal medicine as a whole.</p

Integrase Strand Transfer Inhibitors (INSTIs) Resistance Mutations in

Objectives: Integrase strand transfer inhibitor (INSTI) is a new class of antiretroviral (ARV) drugs designed to block the action of the integrase viral enzyme, which is responsible for insertation of the HIV-1 genome into the host DNA. The aim of this study was to evaluate for the first time INSTI resistance mutations in Turkish patients.Methods: This study was conducted in Turkey, between April 2013 and April 2015 using 169 HIV-1-infected patients (78 ARV naive patients and 91 ARV-experienced patients). Laboratory and clinical characteristics of ARV naive and ARV-experienced patients were as follows: gender (M/F): 71/7 and 80/11, median age: 38 and 38.4; median CD4+ T-cell: 236 and 216 cells/mm3, median HIV-1 RNA: 4.95+ E5 and 1.08E+ 6 copies/ml. Population-based seqeunces of the reverse transcriptase, protease, and integrase domains of the HIV-1 pol gene were used to detect HIV-1 drug resistance mutations.Result: INSTI resistance mutations were not found in recently diagnosed HIV-1-infected patients. However, ARV-experienced patients had major resistance mutations associated with raltegravir and elvitegravir; the following results were generated: F121Y, Y143R, Q148R and E157Q (6/91 - 6.6%).Conclusions: The prevalence of INSTI resistant mutations in ART-experienced patients suggested that resistance testing must be incorporated as an integral part of HIV management with INSTI therapies

Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update)

The International Working Group on the Diabetic Foot (IWGDF) has published evidence‐based guidelines on the prevention and management of diabetic foot disease since 1999. This guideline is on the diagnosis and treatment of foot infection in persons with diabetes and updates the 2015 IWGDF infection guideline. On the basis of patient, intervention, comparison, outcomes (PICOs) developed by the infection committee, in conjunction with internal and external reviewers and consultants, and on systematic reviews the committee conducted on the diagnosis of infection (new) and treatment of infection (updated from 2015), we offer 27 recommendations. These cover various aspects of diagnosing soft tissue and bone infection, including the classification scheme for diagnosing infection and its severity. Of note, we have updated this scheme for the first time since we developed it 15 years ago. We also review the microbiology of diabetic foot infections, including how to collect samples and to process them to identify causative pathogens. Finally, we discuss the approach to treating diabetic foot infections, including selecting appropriate empiric and definitive antimicrobial therapy for soft tissue and for bone infections, when and how to approach surgical treatment, and which adjunctive treatments we think are or are not useful for the infectious aspects of diabetic foot problems. For this version of the guideline, we also updated four tables and one figure from the 2016 guideline. We think that following the principles of diagnosing and treating diabetic foot infections outlined in this guideline can help clinicians to provide better care for these patients