Emphysematous pyelonephritis with left renal vein thrombosis-case report successfully treated by conservative methods

Presently emphysematous pyelonephritis is a rare but life-threatening disease, mostly seen in patients with urinary tract obstr uc- tion and diabetes mellitus. It is characterized by the production of gas and necrosis in the renal parenchyma, collecting systems, and perinephritic tissue. Radiologically, the Huang and Tseng classification is used to categorize the severity of the disease. Our case was 49 years old female pre- senting with unconsciousness, fever and bilateral Grade 3 lower extremity eodema one week after left percutaneous nephrolithotomy procedure because of urinary tract stone. Abdominal computerized tomography scan showed renal parenchymal and perinephritic tissue necrosis with the production of gas and renal vein thrombosis which was in accordance with Huang and Tseng classification Grade 3A. We treated our patient with the appropriate antibiotic, enoxaparin sodium, strict glycemic control, and supportive treatment without any surgical intervention or nephrectomy

Besin Alerjisi Olan 0-2 Yaş Çocukların Annelerinde Anksiyete ve Bakım Veren Külfetinin Değerlendirilmesi

Amaç: Besin alerjisi olan hastalar ve aileleri sağlıklı bireylere göre düşük yaşam kalitesi, anksiyete, depresyon ve strese sahip olup, ebeveynlerde bakım veren külfeti yüksektir. Çalışmamızda 0-2 yaş arası gıda alerjisi hastalarının annelerine eşlik edebilecek anksiyete bozukluğunun değerlendirilmesi ve gıda alerjisi olan hastaların annelerinde külfetin incelenmesi amaçlandı. Gereç ve Yöntem: Gıda alerjisi olan 0-2 yaş arası çocukların annelerine ve kontrol grubu olarak sağlıklı çocukların annelerine sosyodemografik veriler, Hastane Anksiyete ve Depresyon Ölçeği (HADÖ), Psikolojik Belirti Tarama Listesi (SCL 90-R) ve Zarit Bakıcı Yükü Ölçeği ile ilgili anket uygulandı. Bulgular: Çalışmaya gıda alerjisi olan 67 çocuk annesi ve sağlıklı çocuğu olan 74 anne alındı. Zarit Bakım Veren Külfet Ölçeği puanı, gıda alerjisi olan çocukların annelerinde sağlıklı çocukların annelerine göre anlamlı olarak daha yüksekti (p=0,018). Besin alerjisi olan çocukların anneleri, genel SCL 90-R ölçeğinde anlamlı olarak daha yüksek bir genel puana sahipti (p=0,045). Besin alerjisi olan çocukların annelerinde HADÖ puanı anlamlı olarak yüksekken, Hastane Depresyon Ölçeği puanında fark yoktu (sırasıyla p=0,045, p=0,825). Sonuç: Annelerin külfet, anksiyete, depresyon gibi duygusal durumlarının değerlendirilmesi ve besin alerjisi ile baş etmeye çalışma stratejileri ihmal edilebilir. Bu nedenle besin alerjisi olan özellikle küçük yaştaki çocukların annelerinin psikososyal destek gereksinimleri değerlendirilmeli ve gerekli yönlendirme sağlanmalıdır

Determination of some physicochemical properties of honeys from Tokat region and their compliance with the Turkish Food Codex

Bu çalışmada; bitki çeşitliliğinin oldukça fazla olduğu Tokat ili ve ilçelerinden temin edilen balların bazı fiziksel ve kimyasal özellikleri belirlenmiştir. 2019 ve 2020 yıllarında 12 ilçeden temin edilen (toplam 24 adet) çiçek balı örneklerinin Türk Standartları (TS) 3036 Bal Standardı ve uluslararası standartlarda kabul görmüş analiz metotları ile yapılan bazı fizikokimyasal, pestisit ve mineral analizleri sonuçlarının Türk Gıda Kodeksi (TGK) Bal Tebliği’ne (2020/7) uygunlukları incelenmiştir. Bal örneklerinde nem miktarı %13,0-20,0; serbest asitlik 26±0,12-48±0,16 meq/kg; elektriksel iletkenlik 0,33-0,86 mS/cm; Hidroksimetilfurfural (HMF) miktarı 0,05-8,69 mg/kg; prolin değeri 422,56-1222,56 mg/kg; diastaz sayısı 0,0-10,9; protein ve ham bal Δ13 C farkı-0.84-1.23; C4 şeker oranı %0,0-5,26; sakkaroz miktarı %0,30- 1,96; früktoz+glikoz miktarı %62,54-76,67; früktoz/glikoz oranı 0,98-2,62 olarak belirlenmiştir. Bal örneklerinde toplam üç numunede pestisit tespit edilmiştir. Bunlar triamenol+triadimefon, metrafenone, cypermethrin, boscalid, deltamethrin, kresoxim methyl olup üç örnekte sınır değerleri aşılmış olup, diğer örneklerde ise limit değerleri aralığındadır. Balların mineral içerikleri (mg/kg); çinko (Zn) 0,0-24,306; nikel (Ni) 0,0-2,906; krom (Cr) 0,0- 3,850; mangan (Mn) 0,0-4,660; bakır (Cu) 0,0-17,099; kurşun (Pb) içeriği 0,314-2,729 aralığında tespit edilmiştir. Örneklerin toplam fenolik madde miktarları 254,14-776,94 μg GAE/g bal; serbest radikali giderme aktivitesi 129,47-587,37 μg TE/g bal; katyon radikali giderme aktivitesi 93,33-1187,78 μg TE/g bal aralıklarındadır.In this study; some physical and chemical properties of honey taken from the districts of Tokat province, where plant diversity is quite high, were determined. Results of some physicochemical, pesticide, and mineral analyses conducted with Turkish Standards (TS) 3036 Honey Standard and internationally accepted analysis methods of flower honey samples (24 in total) obtained from 12 districts in 2019 and 2020 Turkish Food Codex (TGK) Honey Communique (2020/7) has been investigated for compliance. Moisture content in honey samples is 13.0-20%; total acidity 26 }0.12- 48 }0.16 meq/kg; electrical conductivity 0.33-0.86 mS/cm; the amount of hydroxymethylfurfural (HMF) 0.05-8.69 mg/kg; proline value 422.56-1222.56 mg/kg; diastase number 0.0-10.9; protein and raw honey Δ13 C difference -0.84-1.23; C4 sugar content 0.0-5.26%; amount of sucrose 0.30-1.96%; fructose+glucose amount 62.54-76.67%; fructose/glucose ratio was determined as 0.98-2.62. Pesticides were detected in a total of three samples in honey samples. These are triamenol+triadimefon, metrafenone, cypermethrin, boscalid, deltamethrin, and kresoxim methyl. In three samples, the limit values are exceeded, and in the other samples, the limit values are in the range. Mineral content of honey (in mg/kg); zinc (Zn) 0.0-24.306; nickel (Ni) 0.0-2.906; chromium (Cr) 0.0-3.850; manganese (Mn) 0.0-4.660; copper (Cu) 0.0-17.099; lead (Pb) content was determined in the range of 0.314-2.729. The total phenolic content of the samples was 254.14-776.94 μg GAE/g honey; free radical scavenging activity was 129.47-587.37 μg TE/g honey; cation radical scavenging activity was in the range of 93.33-1187.78 μg TE/g honey

Mikobakteriyel hastalıklara mendel duyarlılığı hastalarının genetik ve klinik profili; tek merkez deneyimi

Objective: Mendelian susceptibility to mycobacterial disease (MSMD) is a subgroup of primary immunodeficiencies which develops with the Bacille Calmette–Guérin (BCG) vaccine or non-tuberculous mycobacterial infections. The clinical symptoms have a broad spectrum, from localized to disseminated infections. Materials and Methods: Herein, we performed whole-exome sequencing (WES) on 13 patients with MSMD phenotype. All variants were confirmed by Sanger sequencing. The mean age was 8.41 years (min 3 – max 14 years), and the mean age of symptom onset was 4.6 years in our cohort. Results: We found previously identified IFNGR1 (n=1), IFNGR2 (n=1), TYK2 (n=1), IL12RB1 (n=1), and CYBB (n=1) gene variants in nine patients. Our patients mostly suffered from lymphadenitis (61.5%), osteomyelitis (38%), and miliary tuberculosis (31%). All patients except one had had the BCG vaccination. Two patients developed BCGitis after vaccination. Three patients suffered from disseminated BCG infection (BCGosis). Conclusion: Our findings show the importance of molecular diagnosis in patients with severe infections as an approach for understanding the genetic basis of infectious diseases and deciding on treatment options. The deficiency of IFN-mediated immunity genes plays a crucial role in the pathogenesis of MSMD and must be considered in pediatric patients with BCGitis.Amaç: Mikobakteriyel hastalığa (MSMD) Mendel duyarlılığı, Bacille Calmette-Guérin (BCG) aşısı veya tüberküloz dışı mikobakteriyel enfeksiyonlarla gelişen primer immün yetmezliklerin bir alt grubudur. Klinik semptomlar, lokalize enfeksiyondan yayılmış enfeksiyona kadar geniş bir spektruma sahiptir. Gereç ve Yöntem: Bu çalışmada; MSMD fenotipli 13 hastada tüm ekzom dizileme (WES) yaptık. Tüm varyantlar Sanger dizileme ile doğrulandı. Bizim kohortumuzda ortalama yaş 8.41 yıl (en az 3 – en fazla 14 yıl) ve ortalama semptom başlangıç yaşı 4.6 idi. Bulgular: Dokuz hastada; IFNGR1 (n=2), IFNGR2 (n=1), TYK2 (n=1), IL12RB1 (n=1) ve CYBB (n=1) gen varyantları bulduk. Hastalarımızda en çok lenfadenit (%61,5), osteomiyelit (%38) ve miliyer tüberküloz (%31) mevcuttu. Biri hariç tüm hastalara BCG aşısı yapıldı. İki hastada aşılamadan sonra BCGitis gelişti. Üç hasta, yayılmış BCG enfeksiyonundan (BCGosis) muzdaripti. Sonuç: Bulgularımız, enfeksiyon hastalıklarının genetik temelinin anlaşılmasında ve tedavi seçeneklerine karar verilmesinde bir yaklaşım olarak ağır enfeksiyonlu hastalarda moleküler tanının önemini göstermektedir. IFN aracılı bağışıklık genlerinin eksikliği, MSMD’nin patogenezinde çok önemli bir rol oynar ve BCGitis’li pediatrik hastalarda düşünülmelidir

Concurrent Assay for Four Bacterial Species Including Alloiococcus Otitidis in Middle Ear, Nasopharynx and Tonsils of Children with Otitis Media with Effusion: A Preliminary Report

ObjectivesTo detect the prevalences of Alloiococcus otitidis, as well as Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis in children with chronic otitis media with effusion (OME) and to simultaneously investigate the colonization of these bacteria in the nasopharynx and palatine tonsils of these patients.MethodsThe study included 34 pediatric patients with OME, and 15 controls without OME. In the study group, A. otitidis, H. influenzae, S. pneumoniae, and M. catarrhalis were investigated in the samples obtained from middle ear effusions (MEE), nasopharyngeal swabs (NPS) and tonsillar swabs (TS), using multiplex polymerase chain reaction (PCR) and conventional culture methods. Only the samples obtained from NPS and TS were studied with the same techniques in the control group.ResultsA. otitidis was isolated only in MEE and only with multiplex PCR method. A. otitidis, S. pneumoniae, M. catarrhalis, H. influenzae were identified in 35%, 8.8%, 8.8%, and 2.9%, respectively, in 34 MEE. A. otitidis was not isolated in NPS or TS of the study and the control groups.ConclusionThe prevalence of A.otitidis is high in children with OME and A.otitidis doesn't colonize in the nasopharynx or tonsil

Prevalence of Helicobacter pylori in symptomatic patients and detection of clarithromycin resistance using melting curve analysis

AbstractBackground:Clarithromycin is often a component of combination therapies for Helicobacter pylori eradication; however, increases in resistance rates have decreased the success of the treatment.Objective:This study was designed to determine the prevalence of H pylori infection in symptomatic patients and to detect clarithromycin resistance rates using melting curve analysis.Methods:Patients scheduled for upper endoscopy at the Endoscopy Unit of the Department of Gastroenterology, Duzce University, Medical Faculty Hospital, Konuralp/Duzce, Turkey, were assessed for enrollment in the study. Two pairs of gastric biopsy specimens (antrum and corpus) were obtained from each study patient. Histopathologic examination, rapid urease test, culture, and polymerase chain reaction (PCR) of the specimens were used to identify H pylori infection. Clarithromycin resistance was detected using melting curve analysis.Results:Seventy-five patients (41 women, 34 men; mean [SD]age, 42.6 [14.5] years [range, 17–70 years]) were included in the study. Using histopathology and rapid urease test, H pylori was detected in 40 (53.3%) of the 75 specimens. H pylori was detected using PCR in 40 (53.3%) specimens and by culture in 10 (13.3%) specimens. The specificity and sensitivity of PCR and culture were interpreted by comparing them with the results of histopathologic examination and urease tests. The specificity and sensitivity of PCR were 68.6% and 72.5%, respectively, and the specificity and sensitivity of culture were 97.1% and 22.5%, respectively. Of the 40 isolates, 21 (52.5%) were susceptible to clarithromycin, 12 (30.0%) were resistant, and a mixed susceptibility pattern was detected in 7 (17.5%) specimens. H pylori isolates from 19 (79.2%) of the 24 patients who had formerly used clarithromycin showed clarithromycin resistance.Conclusions:The prevalence of H pylori infection was 53.3% for the symptomatic patients in this study, and 47.5% of the isolates showed clarithromycin resistance using melting curve analysis. The PCR-based system used in this study was accurate for the detection of H pylori infection as well as clarithromycin susceptibility testing directly in biopsy specimens

Impaired IL-23-dependent induction of IFN-gamma underlies mycobacterial disease in patients with inherited TYK2 deficiency

Human cells homozygous for rare loss-of-expression (LOE) TYK2 alleles have impaired, but not abolished, cellular responses to IFN-alpha/beta (underlying viral diseases in the patients) and to IL-12 and IL-23 (underlying mycobacterial diseases). Cells homozygous for the common P1104A TYK2 allele have selectively impaired responses to IL-23 (underlying isolated mycobacterial disease). We report three new forms of TYK2 deficiency in six patients from five families homozygous for rare TYK2 alleles (R864C, G996R, G634E, or G1010D) or compound heterozygous for P1104A and a rare allele (A928V). All these missense alleles encode detectable proteins. The R864C and G1010D alleles are hypomorphic and loss-of-function (LOF), respectively, across signaling pathways. By contrast, hypomorphic G996R, G634E, and A928V mutations selectively impair responses to IL-23, like P1104A. Impairment of the IL-23-dependent induction of IFN-gamma is the only mechanism of mycobacterial disease common to patients with complete TYK2 deficiency with or without TYK2 expression, partial TYK2 deficiency across signaling pathways, or rare or common partial TYK2 deficiency specific for IL-23 signaling.ANRS Nord-Sud ; CIBSS ; CODI ; Comité para el Desarrollo de la Investigación ; Fulbright Future Scholarshi

Differential cross section measurements for the production of a W boson in association with jets in proton–proton collisions at √s = 7 TeV

Measurements are reported of differential cross sections for the production of a W boson, which decays into a muon and a neutrino, in association with jets, as a function of several variables, including the transverse momenta (pT) and pseudorapidities of the four leading jets, the scalar sum of jet transverse momenta (HT), and the difference in azimuthal angle between the directions of each jet and the muon. The data sample of pp collisions at a centre-of-mass energy of 7 TeV was collected with the CMS detector at the LHC and corresponds to an integrated luminosity of 5.0 fb[superscript −1]. The measured cross sections are compared to predictions from Monte Carlo generators, MadGraph + pythia and sherpa, and to next-to-leading-order calculations from BlackHat + sherpa. The differential cross sections are found to be in agreement with the predictions, apart from the pT distributions of the leading jets at high pT values, the distributions of the HT at high-HT and low jet multiplicity, and the distribution of the difference in azimuthal angle between the leading jet and the muon at low values.United States. Dept. of EnergyNational Science Foundation (U.S.)Alfred P. Sloan Foundatio

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good