Biochemical exploration of β-lactamase inhibitors

The alarming rise of microbial resistance to antibiotics has severely limited the efficacy of current treatment options. The prevalence of β-lactamase enzymes is a significant contributor to the emergence of antibiotic resistance. There are four classes of β-lactamases: A, B, C, and D. Class B is the metallo-β-lactamase, while the rest are serine β-lactamases. The clinical use of β-lactamase inhibitors began as an attempt to combat β-lactamase-mediated resistance. Although β-lactamase inhibitors alone are ineffective against bacteria, research has shown that combining inhibitors with antibiotics is a safe and effective treatment that not only prevents β-lactamase formation but also broadens the range of activity. These inhibitors may cause either temporary or permanent inhibition. The development of new β-lactamase inhibitors will be a primary focus of future research. This study discusses recent advances in our knowledge of the biochemistry behind β-lactam breakdown, with special emphasis on the mechanism of inhibitors for β-lactam complexes with β-lactamase. The study also focuses on the pharmacokinetic and pharmacodynamic properties of all inhibitors and then applies them in clinical settings. Our analysis and discussion of the challenges that exist in designing inhibitors might help pharmaceutical researchers address root issues and develop more effective inhibitors

Laparoskopik ve tek insizyon laparoskopik apendektominin prospektif karşılaştırma sonuçları

Laparoskopik apendektomi apandisit olgularının tedavisinde standart bir cerrahi yöntem olmuştur. Tek insizyon ile yapılan laparoskopik cerrahide (SILA) ise tek port kullanılması nedeniyle ameliyat sonrası ağrı daha az görülür ve kozmetik sonuçları ise daha iyidir. Bu avantajlar nedeniyle son yıllarda birçok konvansiyonel laparoskopik cerrahinin yerini almaya başlamıştır. Biz çalışmamızda merkezimizde gerçekleştirilen laparoskopik ve SILA apendektominin sonuçlarını değerlendirmeyi amaçladık. Ocak 2011 ile Mart 2012 tarihleri arasında kliniğimizde laparoskopik apendektomi (LA) ve tek insizyon laparoskopik apendektomi (SILA) yapılan hastalar yaş, cinsiyet, ameliyat süresi, hastanede kalış süresi, vücut kitle indeksi (VKİ), Alvarado skoru ve sayısal sözel ağrı skorları (SSAS) açısından prospektif olarak değerlendirilmiştir. Ameliyat sonrası hastalara 3.ayda Gastrointestinal Yaşam Kalitesi İndeksi (GIQLI) uygulanmıştır. 44 apandisit hastasına LA yapılırken, 30’una SILA tekniği uygulandı. Hastaların 36’sı (%48,6) kadın, 38’i (%51,3) erkek, ortalama yaş 37 (18-64) idi. Her iki grup arasında yaş, Alvarado skoru, şikayet süresi, serum lökosit ve CRP düzeyi, VKİ ve ASA skoru açısından istatistiksel olarak anlamlı fark saptanmadı. Ameliyat süresi laparoskopik grupta ortalama 63.41 dakika (30-150) ve SILA grubunda ortalama 54.33 dakika (15-120) olarak hesaplandı (p=0,146). Hastanede kalış süresi laparoskopik grupta ortalama 28.39 (13-102) ve SILA grubunda ortalama 25.23 (16-144) saatti (p=0,508). Tek komplikasyon LA grupta 1 (%2,3) hastada gözlenen mesane hematomu idi. LA grupta 12.saat SSAS skorları ortalama 2,62 (0-7) 1.hafta ortalama 2,52 (0-5) iken, SILA grubunda 12. saatte 3,43 (1-7), 1. haftada ise 2,9 (1-5) idi, iki grup arasında SSAS skorları açısından istatistiksel anlamlı farklılık gözlenmedi (12. Saat SSAS için P=0.131, 1. hafta SSAS için P=0.866). Ameliyat sonrası 3. Ayda bakılan GIQLI skorları açısından da her iki grup arasında istatistiksel anlamlı bir fark saptanmadı. SILA, apandisit olgularında uygulanabilecek güvenli bir cerrahi yöntem olmakla beraber konvansiyonel laparoskopik cerrahiye tek üstünlüğü daha iyi görsel kozmetik sonuçlarıdır

Generalist versus Abdominal Subspecialist Radiologist Interpretations of Abdominopelvic Computed Tomography Performed on Patients with Abdominal Pain and its Impact on the Therapeutic Approach

Introduction: Abdominal pain is one of the most common patient complaints in the emergency department (ED) and abdominopelvic computed tomography (ACT) scan plays an important role in evaluation of these patients. Objective: The aim of this study was to determine the differences between interpretations by generalist radiologists and abdominal subspecialist radiologists regarding the abdominopelvic computed tomography (ACT) of patients who were admitted to the Emergency Department (ED) and to investigate its effect on the patients’ therapeutic approach. Methods: The records of 16452 patients who were admitted to the emergency department with complaint of abdominal pain between January 2015 and April 2017 were reviewed, retrospectively. Out of these patients, 245 (1.5%) underwent ACT for differential diagnosis and among them, 137 (0.8%) patients had their ACT reports evaluated by generalist radiologists in 45 minutes and by abdominal subspecialist radiologist 8–12 hours later and were included in the study. Patients were divided into three groups according to the effect of ACT reports on the performed treatment. Group 1: no effect on planned treatment, group 2: minor effect on planned treatment, which did not result in a change in the treatment process and group 3: major effect on planned treatment approach, which resulted in a change in the treatment process. These changes included at least one of the two criteria: changing the indication of surgery from emergency surgery to elective surgery and/or discharge of the patient from the ED, when actually hospitalization was required. Results: Out of the 137 patients, 87 (63.5%) were male, 50 (36.5%) were female and the patients’ mean age was 56 (27-93) years. There were 117 (85.4%) patients in group 1, 15 (10.9%) patients in group 2, and 5 (3.7%) patients in group 3. We determined minor inconsistency between the reports in group 2 and major inconsistency in group 3. Patients in group 3 suffered from delayed surgical intervention due to inconsistency of the CT reports resulting in prolonged hospital stay and increased morbidity. In 17 patients (four patients in Group 1 and 13 patients in Group 2) treatment plan was changed due to CT results; and while surgical treatment was planned for them prior to CT scan, they were discharged with medical treatment after that and overtreatment was prevented. Conclusion: Contribution of abdominal radiologists to evaluation of ACT images in the ED would reduce the inconsistency in ACT reports and prevent the patients from receiving insufficient treatment or overtreatment

Simulation in manufacturing and business: A review

Copyright @ 2009 Elsevier B.V.This paper reports the results of a review of simulation applications published within peer-reviewed literature between 1997 and 2006 to provide an up-to-date picture of the role of simulation techniques within manufacturing and business. The review is characterised by three factors: wide coverage, broad scope of the simulation techniques, and a focus on real-world applications. A structured methodology was followed to narrow down the search from around 20,000 papers to 281. Results include interesting trends and patterns. For instance, although discrete event simulation is the most popular technique, it has lower stakeholder engagement than other techniques, such as system dynamics or gaming. This is highly correlated with modelling lead time and purpose. Considering application areas, modelling is mostly used in scheduling. Finally, this review shows an increasing interest in hybrid modelling as an approach to cope with complex enterprise-wide systems

Simulation of capacity expansion and sequencing alternatives for a sheet metal producer

We present a simulation case study carried out for a make-to-order aluminium sheet producer located in Istanbul, Turkey. We are concerned with a subsystem of the factory consisting of continuous casting, cold rolling, and annealing processes. Two simulation models are developed: (1) a combined model for studying the casting process only; (2) a discrete event model for comparing capacity expansion alternatives and order sequencing rules in the subsystem. Operational characteristics of the real system and past data are extensively analysed for modelling and validation purposes. Capacity expansion and sequencing alternatives are evaluated in an experimental design setting with the objectives of satisfying the demand, balancing the process loads, and keeping the work-in-process inventory under control