Simplified Earthquake Analysis of Suspensi

This paper presents the finite element analysis of a suspension bridge subjected to earthquake ground motion using simplified models. For this purpose, two simplified models are considered. It is assumed that each element compose of the deck, cable and hangers in the first model. As second model, the elastic foundation analogy method is used. Also, actual bridge model is selected. Finite element earthquake analyses of the simplified and real bridge models are performed. One of the world's longest modern type suspension bridges, Fatih Sultan Mehmet Bridge, is selected as a numerical example. As ground motions, Kocaeli earthquake occurred on August 17, 1999 in Kocaeli, Turkey is chosen since it took place at the vicinity of the bridge. The response values obtained from simplified and actual bridge models are compared with each other

Infectious Complications of Induction Therapies in Kidney Transplantation.

Background: Cytomegalovirus (CMV) and BK virus (BKV) are post-transplant opportunistic viral infections that affect patientand graft survival. This study was designed to evaluate the risk of BKV nephropathy and CMV disease in kidneytransplant recipients who received induction therapy with ATG or basiliximab.Material/Methods: We retrospectively analyzed information on 257 adult patients who underwent kidney transplantation betweenJanuary 2007 and 2017. Patients were categorized into 3 groups according to the induction therapies. The primaryendpoint was the onset of CMV disease or biopsy-confirmed BKV nephropathy. The secondary endpointswere biopsy-proven rejection episodes, graft loss, loss to follow-up, and death.Results: We followed 257 patients for a median of 55.5 months. The incidence of CMV disease was significantly higherin the only ATG group compared to the group without induction treatment (p<0.001). There was no significantdifference in the incidence of BKV nephropathy among groups (p>0.05). The dosage of ATG (OR, 10.685; 95%CI, 1.343 5 to 85.009; P=0.025) was independent risk factor for death.Conclusions: This study demonstrated that a higher dosage of ATG in high-risk patients is associated with an increased riskof CMV disease and patient death, also, reducing the dosage may be a rational strategy for increasing graftand patient’s survival

Etiological agents of community-acquired pneumonia in adult patients in Turkey; a multicentric, cross-sectional study

This cross-sectional study was intended to investigate the etiology of community-acquired pneumonia (CAP) in adult patients receiving no prior antibiotic therapy. Etiological agents were identified in 137 (62.8%) of 218 patients, the most frequent being Streptococcus pneumoniae (14.7%), Mycoplasma pneumoniae (13.8%) and respiratory syncytial virus (10.1%). A single pathogen was detected in 50.9% of cases and mixed pathogens in 11.9%. Typical pathogens were determined in 35.8% of cases, atypical pathogens in 20.2% and viral pathogens in 20.6%. Chronic obstructive pulmonary disease was a common (42.7%) comorbidity. S. pneumoniae was the most common pathogen in adult patients with CAP. Atypical pathogens were more common in patients < 65 years old, M. pneumoniae being the most common in this age group. Our results suggest that initial empiric antibiotic treatment in patients with CAP should cover S. pneumoniae and M. pneumoniae in Turkey

Etiological agents of community-acquired pneumonia in adult patients in Turkey; a multicentric, cross-sectional study

This cross-sectional study was intended to investigate the etiology of community-acquired pneumonia (CAP) in adult patients receiving no prior antibiotic therapy. Etiological agents were identified in 137 (62.8%) of 218 patients, the most frequent being Streptococcus pneumoniae (14.7%), Mycoplasma pneumoniae (13.8%) and respiratory syncytial virus (10.1%). A single pathogen was detected in 50.9% of cases and mixed pathogens in 11.9%. Typical pathogens were determined in 35.8% of cases, atypical pathogens in 20.2% and viral pathogens in 20.6%. Chronic obstructive pulmonary disease was a common (42.7%) comorbidity. S. pneumoniae was the most common pathogen in adult patients with CAP. Atypical pathogens were more common in patients < 65 years old, M. pneumoniae being the most common in this age group. Our results suggest that initial empiric antibiotic treatment in patients with CAP should cover S. pneumoniae and M. pneumoniae in Turkey

Mortality Risk Factors among Critically Ill Children with Acute COVID-19 in PICUs: A Multicenter Study from Turkish Pediatric Critical COVID-19 and MIS-C Study Group

© 2022 Lippincott Williams and Wilkins. All rights reserved.Background: During the coronavirus disease 2019 (COVID-19) pandemic, the world has a large number of reported COVID-19 cases and deaths. Information on characteristics and mortality rate of pediatric intensive care unit (PICU) cases with COVID-19 remains limited. This study aims to identify the risk factors for mortality related to COVID-19 in children admitted to PICU. Methods: A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 44 PICUs in Turkey. Children who were 1 month-18-year of age with confirmed COVID-19 admitted to PICU were included in the study. Children with multisystem inflammatory syndrome and asymptomatic for COVID-19 were excluded. Results: Of 335 patients with COVID-19, the median age was 6.8 years (IQR: 1.2-14) and 180 (53.7 %) were male, 215 (64.2 %) had at least one comorbidity. Age and gender were not related to mortality. Among 335 patients, 166 (49.5%) received mechanical ventilation, 17 (5.1%) received renal replacement therapy and 44 (13.1 %) died. Children with medical complexity, congenital heart disease, immunosuppression and malignancy had significantly higher mortality. On multivariable logistic regression analysis, organ failure index [odds ratio (OR): 2.1, 95 confidence interval (CI): 1.55-2.85], and having congenital heart disease (OR: 2.65, 95 CI: 1.03-6.80), were associated with mortality. Conclusions: This study presents detailed data on clinical characteristics and outcomes of patients with COVID-19 admitted to PICU in the first pandemic year in Turkey. Our study shows that having congenital heart disease is associated with mortality. In addition, the high organ failure score in follow-up predict mortality

Etiological agents of community-acquired pneumonia in adult patients in Turkey; a multicentric, cross-sectional study Etiological agents of community-acquired pneumonia in adult patients in Turkey; a multicentric, cross-sectional study * TUCAP (Turkish Co

ÖZET Despite recent advances in diagnosis, treatment and vaccination, community-acquired pneumonia (CAP) is still one of the most common infectious diseases worldwide. It remains a major cause of morbidity and mortality, and contributes significantly to excessive consumption of healthcare resources and related costs (1-4). In Turkey, a pneumonia rank 15 th among the 20 Etiological agents of community-acquired pneumonia in adult patients in Turkey; a multicentric, cross-sectional study 120 Tüberküloz most frequent acute and chronic diseases and is the 5 th leading cause of death (5). Despite the fact that a great number of microbial agents can cause CAP, often no specific etiological diagnosis is established at the time of initial treatment, and antimicrobial therapy is usually performed using an empiric approach in such patients (2). In order to administer micro-organism-guided treatment, it is necessary to determine the causative pathogens of CAP. The etiological agents of CAP may vary according to geographic area and patients´ underlying risk factors. Decisions on proper empiric antibiotic therapy will therefore depend on prospective epidemiological studies (3). Surveillance studies constitute an important tool for determining local and regional susceptibility patterns and guiding empiric antimicrobial therapy (6). The majority of studies that have investigated the microbial causes of CAP have been carried out with patients admitted to hospital. Only a few studies have been undertaken to determine the etiology of CAP in the ambulatory patient Only a few studies of the etiology of CAP have been performed in adult patients in an ambulatory setting in Turkey MATERIALS and METHODS Study Design Eight university hospitals from different geographical regions of Turkey between November 2003 and March 2005 were included in this multicentric, cross-sectional study. In selecting centers, the following features were sought: the ability to represent different geographical areas, the ability to perform the investigative procedures in the study protocol in an optimal manner, and facility in coordination. A Turkish Community-Acquired Pneumonia (TU-CAP) Study Group was coordinated under the Infectious Diseases and Clinical Microbiology and Chest Diseases and Tuberculosis departments of the Karadeniz Technical University Medical Faculty. TUCAP members belong to infectious diseases and clinical microbiology departments or chest diseases and tuberculosis departments in the study centers. The study was approved by the Institutional Ethical Committee, and written informed consent was obtained from all patients or their legal representatives before enrolment. Patients The study population consisted of adult CAP patients &gt; 17 years old and who attended an outpatient clinic at one of the study centers. Patients consisted of individuals living in urban as well as rural areas. All patients had clinical features and radiological findings compatible with CAP. CAP was defined as an acute illness associated with at least one of the following criteria; fever (&gt; 38°C) or hypothermia (&lt; 36°C), new cough with or without sputum production, pleuritic chest pain, dyspnea or altered breath sound on auscultation, plus a chest radiograph showing an opacity or new infiltrate consistent with pneumonia (11). CURB 65 score was used to determine disease severity (12). Patients with a diagnosis of immunosuppressive disorder, tuberculosis, health care associated pneumonia, aspiration pneumonia, antibiotic use in the last 48 hours, transferred from any health institution, hospitalization within the previous 2 weeks or pregnancy were excluded. Demographic and clinical data were collected by an investigator using a standardized questionnaire. In order to establish microbial etiology, sputum, nasopharyngeal aspirate, blood and urine samples were taken from the subjects. All samples were collected before the start of antibiotic therapy. Acute serum samples were collected on admission, and convalescent serum samples 2 and 4 weeks after initial diagnosis of CAP. Microbiological Evaluation Sputum and nasopharyngeal aspirate samples were investigated using Gram&apos;s stain and then cultured. Only sputum samples with &gt; 25 white blood cells and &lt; 10 squamous cells/per lowmagnification field (X10) were evaluated. Nasopharyngeal aspirate samples were also investigated for adenovirus, influenza A and B, parainfluenza viruses and respiratory syncytial virus Köksal İ, Özlü T, Bayraktar Ö, Yılmaz G, Bülbül Y, Öztuna F, Çaylan R, Aydın K, Sucu N, TUCAP Çalışma Grubu. 121 Tüberküloz Criteria for Etiological Diagnosis The following criteria were used to determine etiology: Cases that did not fulfil these diagnostic criteria were interpreted to be &quot;No etiology determined&quot;. Statistical Analysis The chi-square test was used. p&lt; 0.05 was regarded as statistically significant. RESULTS Two hundred ninety-two CAP patients were enrolled, of whom 218 were eventually analyzed. Seventy-four patients were excluded from analysis due to failure to obtain paired serum samples or to meet eligibility criteria, or else due to incomplete data. The mean age of enrolled patients was 57.5 ± 17.6. Ninety-four patients (43.1%) were older than 65. One hundred forty-seven patients were male and 71 female. All of patients had CURB-65 &lt; 2. One hundred forty-two of the 218 patients (65.1%) had at least one comorbidity. The main demographic characteristics of the patients were summarized Etiological agents of community-acquired pneumonia in adult patients in Turkey; a multicentric, cross-sectional study 122 Tüberküloz ve Toraks Dergisi 2010; 58(2): 119-127 Two pathogens were identified in 22 (10.1%) of the 26 patients with mixed pathogens and 3 pathogens in 4 (1.8%) patients. The most frequent combinations were a bacterial pathogen plus a viral pathogen. S. pneumoniae was determined in 9 patients with mixed pathogens. H. influenzae was the second most frequent bacteria in mixed infections, in all cases together with a viral agent. Chronic obstructive pulmonary disease (COPD) was the most frequent comorbid factor, occurring in 42.7% of patients (93 out of 218). Other comorbidities were hypertension (29.8%), congestive heart failure (9.6%) and diabetes mellitus (8.7%). Seventy-eight pathogens were determined in 51 COPD subjects. The 4 most common pathogens were S. pneumoniae (27.4%), RSV (25.5%), H. influenzae (17.6%) and M. pneumoniae (17.6%). When the distribution of the microorganisms by age was evaluated, the most frequent pathogen in patients ≥ 65 was S. pneumoniae (17.0%), followed by RSV (13.8%) and M. pneumoniae (8.5%). In patients &lt; 65, the most frequent agent was M. pneumoniae (17.7%), followed by S. pneumoniae (12.9%), H. influenzae (7.3%) and RSV (7.3%). Pneumonia caused by Streptococcus spp. and P. aeruginosa was observed in individuals aged &gt; 65, though these agents were not encountered in subjects aged &lt; 65 (p= 0.016; p= 0.037). Pneumonia due to atypical agents was greater in subjects aged &lt; 65 (p= 0.034) ( DISCUSSION In this cross-sectional study conducted in Turkey, we determined etiology in 62.8% of patients with CAP. Levels of determination of the causative micro-organisms in CAP in the literature vary from 16% to 65% (13-27). In previous small studies in Turkey, the levels of etiological agents in pneumonia have been reported as, variously, 21% and 45.5 % of patients with CAP In our study, typical pneumonia agents were demonstrated in 35.8% of patients, atypical pneumonia agents in 20.2% and viral pneumonia agents in 20.6%. Mixed pneumonia agents were determined in 11.9% of patients. These proportions have been reported as 40%-54% for typical pathogens, 8%-63% for atypical pathogens and Köksal İ, Özlü T, Bayraktar Ö, Yılmaz G, Bülbül Y, Öztuna F, Çaylan R, Aydın K, Sucu N, TUCAP Çalışma Grubu. 123 Tüberküloz ve Toraks Dergisi 2010; 58(2): 119-127 4%-39% for mixed pathogens in different studies Major identifiable pathogens of CAP include S. pneumoniae, H. influenzae and atypical pathogens such as M. pneumoniae, C. pneumoniae and Legionella spp. In the present study, M. pneumoniae was the most frequent atypical pathogen and the second most frequent agent in the etiology of CAP. Some other studies have also reported M. pneumoniae as the most frequent atypical agent 124 Tüberküloz ve Toraks Dergisi 2010; 58(2): 119-127 nostic methods (28). The proportion of atypical pneumonia in other studies has varied from 8% to 63% We determined respiratory viral agents in 20.6% of patients. RSV has been determined as the third most frequent pathogen and the most common viral pathogen at all ages. In patients ≥ 65 it is the second most frequent agent. In recent years, RSV and other respiratory viruses have been detected more often in CAP patients due to use of new diagnostic methods. In different studies the level of respiratory virus has varied from 9% to 63% L. pneumophila was diagnosed in 2.3% of cases, which agrees with results obtained from previous studies (30). The incidence of Legionella spp. is reported to vary from 0.6% to 12.2% in sporadic CAP cases. A comprehensive study from Korea reported that L. pneumophila is one of the most common atypical pathogens of CAP around the world (28). Enterobacteriaceae (E. coli, K. pneumoniae) spp. and P. aeruginosa rarely cause CAP (30). In our study these pathogens were isolated as the least common microorganisms (1.8%, each). In our study, mixed pathogens were found in 11.9% of patients. Co-infection rates have been reported in 22.5%, 12.5%, 16%, 8.5% and 5.7% of CAP in other studies In CAP, the pattern of causative agents depends on age (33). Fifty-seven percent of the 218 patients in our study were younger than 65. In Turkey, the 15-64 age group represents 67% of the population (Turkish Statistical Institute, General Population Census and Economic Data, 2009). While S. pneumoniae was determined at the same rate in both groups, atypical pathogens were found less often in the elderly compared to younger patients. In elderly patients, the most frequent pathogen was S. pneumoniae (17.0%), followed by RSV (13.8%) and M. pneumoniae (8.5%). Viral pathogens have recently been increasingly diagnosed in elderly patients. In this study, as in others, M. pneumoniae was the most common pathogen in younger patients (30). Lim et al. reported atypical pathogen levels of 16% in elderly patients and 27% in younger patients (17). In this study COPD was the most important comorbidity. COPD has also been reported as the most common co-morbidity with CAP in other studies (30). The most important limitation in our study was the small number of CAP patients. Because university hospitals are tertiary referral centers, and because we excluded all patients who had received prior antibiotherapy, the number of CAP patients enrolled in this study was inevitably low. Köksal İ, Özlü T, Bayraktar Ö, Yılmaz G, Bülbül Y, Öztuna F, Çaylan R, Aydın K, Sucu N, TUCAP Çalışma Grubu. 125 Tüberküloz ve Toraks Dergisi 2010; 58(2): 119-127 Etiological agents of community-acquired pneumonia in adult patients in Turkey; a multicentric, cross-sectional study 126 Tüberküloz ve Toraks Dergisi 2010; 58(2): 119-127 In conclusion, a causative pathogen was demonstrated in 62.8% of patients with CAP. S. pneumoniae, M. pneumoniae and RSV were the 3 most frequent agents in adults with CAP in an ambulatory setting in this Turkish study. These results suggest that in patients with CAP in initial empiric therapy should cover S. pneumoniae and atypical pathogens. Our results showed that in the empirical treatment of CAP suggestions of the Turkish Thoracic Society consensus report are suitable and cover etiological agents of CAP for our country (34). Conflicts of Interest None of the authors had any financial or personal relationships with other individuals or organizations that might inappropriately influence their work during the submission process. ACKNOWLEDGEMEN