The case of malignancy mimicking legionella pneumonia

Legionella pneumophila is a bacterium, which can grow inwater pipe networks and climate systems. Contaminationoccurs by aspiration of infected water or aerosol inhalation.It is usually presented with fever, bradycardia, andchange in mental status, hyponatremia, elevation of liverenzymes and deterioration of renal function. The definitediagnosis is established by detection of the antigens andcultivating in the culture medium. Also, malign lung tumorscan encounter with the same clinical findings, so lungcancer should be remembered in differential diagnosis.The patient hospitalized for the Legionella pneumophiladue to the physical examination and laboratory findingsduring the first evaluation in the emergency department.However, further examinations pointed to the cancer. Weaimed to emphasize the probability of malignant tumorsin terms of hyponatremia, increase in the liver enzymes,and failure in the renal functions, which were usually experiencedin emergency unit. J Clin Exp Invest 2013; 4(3): 390-392Key words: Legionella pneumophila, pneumonia, lung malignanc

“The Lolelaplap (Marshall Islands) in Us: Sailing West to East (Ralik→Ratak) to These Our Atolls (Aelon Kein Ad) Ad Jolet Jen Anij (Our Blessed Inheritance from God)”

This paper discusses the expansion of Oceania through a Marshallese indigenous lens as a focal point. It explains that decolonizing methodologies allows reclaiming of space for mental liberation and reassurement of constitutional rights. It highlights similar occurrences of decolonization practices meeting resistance in the 21st century all while strengthening the human right argument that no human deserves any less than their fellow human brothers and sisters. It argues that an indigenous imagery can only be viewed through an indigenous lens where the researches’ level of purity is retained and unfiltered. It nevertheless argues that Marshallese ethnolinguistics reveal the same cultural practices in America, Judeo-Christianity, and Oceania thus dictating the reality that “we are the same not withstanding one stays here and one there (Bedbedjin Bedbedjen, Bedbedjinma wot Kwe)”. It further explains the importance in these similarities and how Marshallese spirituality predates introduced American Judeo-Christianity despite the latter attempting to marginalize the former. It concludes by stating that Marshallese contributions on the global stage are rooted in that culture of love (IaKwe) which is echoed by the custom(s) revealing the significance of Marshallese validation academically, spiritually, economically, & socially to prevent institutionalized discrimination. This paper ends stating that the agency to know one’s self and how one should fit in the world, is a human right in itself and Marshallese are entitled to this sense of self worth through knowing thy self by thy self where real thinking takes place in one’s own mind as we all live our own lives

Does the Change in the Indications of Endoscopic Sinonasal Surgery Continue? Data between 1994-2018

Objective: Endoscopic sinonasal surgery (ESS) has changing over the years in parallel with the developments in endoscopy devices, video-imaging techniques, and surgical instruments. In the present study we investigated whether the indications of patients who underwent surgery over a period of 25 years have accommodated to these changes.Methods: We retrospectively evaluated 1173 patients who underwent surgery in our clinic from 1994 through 2007, and 954 patients who underwent surgery from 2008 through 2018. The patients were divided into three groups as follows: chronic rhinosinusitis with polyps (CRSwNP), chronic rhinosinusitis without polyps (CRSsNP), and others. The changes in the indications during the first 14 years and the following 11 years were compared, and the results were statistically evaluated.Results: A significant decrease was observed in the number of patients who underwent surgery following the diagnosis of CRSsNP (p<0.001). In addition, a statistically significant increase was found in CRSwNP (p<0.001) and other (p<0.001) indications.Conclusion: When ESS indications identified in our clinic were reviewed, it was observed that the increasing trend in CRSwNP rate in the first 14 years continued, there was a significant increase in non-CRS indications in the last 11 years, and there has been an increase in patients with fungal sinusitis, especially in this group

Türkiye akademik CAR-T hücre (ISIKOK-19) klinik çalışması ön raporu: Ürün karakterizasyonu ve klinik uygulama sonuçları

Objective: Chimeric antigen receptor T (CAR-T) cell therapies have already made an impact on the treatment of B-cell malignancies. Although CAR-T cell therapies are promising, there are concerns about commercial products regarding their affordability and sustainability. In this preliminary study, the results of the first production and clinical data of an academic CAR-T cell (ISIKOK-19) trial in Turkey are presented. Materials and Methods: A pilot clinical trial (NCT04206943) designed to assess the safety and feasibility of ISIKOK-19 T-cell therapy for patients with relapsed and refractory CD19+ tumors was conducted and participating patients received ISIKOK-19 infusions between October 2019 and July 2021. The production data of the first 8 patients and the clinical outcome of 7 patients who received ISIKOK-19 cell infusions are presented in this study. Results: Nine patients were enrolled in the trial [5 with acute lymphoblastic leukemia (ALL) and 4 with non-Hodgkin lymphoma (NHL)], but only 7 patients could receive treatment. Two of the 3 participating ALL patients and 3 of the 4 NHL patients had complete/ partial response (overall response rate: 72%). Four patients (57%) had CAR-T-related toxicities (cytokine release syndrome, CAR-T-related encephalopathy syndrome, and pancytopenia). Two patients were unresponsive and had progressive disease following CAR-T therapy. Two patients with partial response had progressive disease during follow-up. Conclusion: Production efficacy and fulfillment of the criteria of quality control were satisfactory for academic production. Response rates and toxicity profiles were also acceptable for this heavily pretreated/refractory patient group. ISIKOK-19 cells appear to be a safe, economical, and efficient treatment option for CD19+ tumors. However, the findings of this study need to be supported by the currently ongoing ISIKOK-19 clinical trial.Amaç: Kimerik antijen reseptör T (CAR-T) hücre uygulamaları B-hücreli malignitelerin tedavisinde etkili olmaktadır. CAR-T hücre uygulamalarının sonuçları umut vaadedici olsa da, ticari CAR-T ürünlerinin yükek maliyetleri nedeniyle ulaşılabilirlik açısından ciddi sorunlar yaşanmaktadır. Bu ön raporda, Türkiye’deki ilk akademik CAR-T hücre çalışmasının üretim ve klinik uygulama sonuçları sunulmuştur. Gereç ve Yöntemler: Relaps refrakter CD 19+ hematolojik maligniteli hastalarda ISIKOK-19 T-hücre tedavisinin güvenliği ve etkinliğini değerlendirmek amacıyla yürütülen klinik çalışmaya (NCT04206943) Ekim 2019-Temmuz 2021 tarihleri arasındaki hastalar dahil edilmiştir. Bu raporda ilk 8 hastanın üretim bilgileriyle, ISIKOK-19 hücre infüzyonu yapılan 7 hastanın klinik sonuçları sunulmuştur. Bulgular: Çalışmaya toplam 9 hasta dahil edilmiştir (5 akut lenfoblastik lösemi [ALL] ve 4 non-hodgkin lenfoma [NHL]), ancak sadece 7 hastaya hücre infüzyonu yapılabilmiştir. Hücre infüzyonu alan 3 ALL hastasından 2’sinde ve 4 NHL hastasının 3’ünde tam/kısmi cevap gözlenmiştir (toplam yanıt oranı %72). Dört hastada (%57) CAR-T ilişkili toksisite (sitokin salınım sendromu, immün efektör hücre ilişkili nörotoksisite sendromu ve pansitopeni) tespit edilmiştir. İki hastada ise CAR-T hücre uygulaması sonrası cevapsızlık ve progresif hastalık izlenmiştir. Kısmi cevap veren hastalardan 2’sinde de takip sırasında progresif hastalık tespit edilmiştir. Sonuç: Akademik CAR-T üretimimiz, üretim etkinliği ve kalite kontrol kriterlerinin tam olarak karşılanması açısından tatmin edici sonuçlara sahiptir. Çalışmaya dahil edilen hastaların tedavi yükü hesaba katıldığında tedaviye cevap oranı ve toksisite profili açısından da sonuçlar kabul edilebilir düzeydedir. Bu sonuçlarla, ISIKOK-19 hücrelerinin güvenli, ekonomik ve etkili bir tedavi seçeneği olduğu düşünülebilir. Ancak bu ön sonuçların halen devam eden ISIKOK-19 klinik çalışmasıyla desteklenmesi beklenmektedir

Life history characteristics of a potential invasive Ponto-Caspian goby, Neogobius fluviatilis in natural lakes from its native range (Black Sea region of Turkey)

To fill the gap in and provide baseline knowledge for developing increased understandings of the factors driving the invasiveness of the Ponto-Caspian gobiid Neogobius fluviatilis, their life history traits (as somatic growth and reproduction) were studied in three natural freshwater lakes in its native range. These populations were characterised by slow somatic growth rates, being the slowest reported across all of their native and non-native ranges. Ages were recorded to seven years old. Across the three lakes, there was considerable variability in their sex ratios and reproductive traits (including length at maturity and fecundity at length and age), revealing considerable inter-population variability. These data thus suggest N. fluviatilis has considerable plasticity in the expression of their life history traits, with this plasticity argued as a key factor in facilitating their ability to establish and invade new waters following introductions

Çoklu travmalı olgularda kalp etkilenmesinde etkili faktörler ve travma şiddeti ile ilişkisi

TEZ6134Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2006.Kaynakça (s.62-71) var.vi, 75 s. ; 29 cm.Trauma cases are frequently cause admission to emergency departments. Since multiple trauma effects a number of systems, and also increase the mortality rates, they should be investigated and considered as important trauma types. In this study, it is aimed to find out and compare effects of injury on cardiac affection via certain diagnostic procedures in multiple traumatized patients whose injury rate accounted by various trauma severity scores. In this respect, the relationship between trauma severity and cardiac affection were also evaluated. This prospective study has been approved by the medical faculty's ethical commitee. The study was performed between June 01th,2005 and August 31th, 2006. One hundred patients (over 15 years of age), having multiple trauma were taken in the scope of the study. After identifing trauma severity by using trauma severity scores such as ISS, GCS, RTS and C-RTS, cardiac affection was evaluated by biochemical and radiological diagnostic tests. SPSS 10 was used for statistical analysis. In examined time period, 78 (78%) male, 22 (22%) female, a total of 100 patients with a mean age of 33.2±15.4 (15-70) were included in the study. Out of all multiple traumatized patients, 92 (92%) were blunt trauma originated, of these 77 (77%) were due to traffic accidents. Thorax injuries were mostly accompanied by head-neck and extremity injuries. ECG was detected to be abnormal in 63 (63%) patients, 36 (36%) of these were sinus tachicardia. A total of 31 patients of which a great number (n=24) show ventricular function disorder, have abnormal ECHO signs. Nineteen cases whose trauma severity score were high resulted in death, and 14 of all deaths were secondary to traffic accidents. Out of all trauma scores, ISS was detected to be the best indicator of cardiac affection.Travma olguları ülkemizde acil servislere sık başvuru nedenlerindendir. Bunlar arasında çoklu travmalar; birçok organ sistemini etkilemesi yanında sakatlanma ve ölüm oranlarının yüksek olması nedeniyle üzerinde önemle durulması ve araştırılması gereken travma tipleridir. Çalışmamızda çeşitli travma şiddet ölçekleriyle zedelenme oranlarını belirlediğimiz çoklu travma hastalarında; bu şiddet oranlarının kalp etkilenimi üzerine etkilerini yardımcı tanı araçları ile birlikte değerlendirerek kıyaslamayı hedefledik. Böylece travma şiddeti ve kalp etkilenimi arasındaki ilişkiyi belirlemeye çalıştık. İleriye dönük olarak planlanan bu çalışma, fakülte etik kurul onayı alındıktan sonra Çukurova Üniversitesi Tıp Fakültesi Büyük Acil Servisine 1 Haziran 2005-31 Ağustos 2006 tarihleri arasında başvuran 15 yaşın üzerinde çoklu travmalı 100 hasta değerlendirilerek yapıldı. Hastalarda; ISS, GKS, RTS ve K-RTS gibi travma şiddet ölçekleri kullanılarak travmanın şiddeti belirlendikten sonra, biyokimyasal ve radyolojik tanı araçlarından faydalanılarak kalp etkilenimi değerlendirildi. İstatistiksel verilerin analizinde ""SPSS for Windows"" paket programının 10.0 nolu versiyonu kullanıldı. Çalışma süresince 78 (% 78)'i erkek, 22 (% 22)'si kadın ve ortalama yaşları 33,2±15,4 (15-70) olan 100 hasta çalışmaya dahil edildi. Çoklu travma hastalarının 92 (% 92)'sinin künt travma, bunlardan da 77 (% 77)'sinin trafik kazası sonucu olduğu belirlendi. Göğüs travması ile birlikte en sık görülen travma tipi baş-boyun ve ekstremite travması idi. Hastaların %63'ünde çoğunluğu sinüs taşikardisi (% 36) olan EKG bozukluğu görüldü. Çoğunluğunu ventrikül fonksiyon bozukluğunun (n=24) oluşturduğu anormal EKO bulguları ise vakaların 31'inde tespit edildi. Travma şiddeti yüksek olan 19 olgunun 14'ü trafik kazası nedeniyle hayatını kaybetti. Çoklu travma hastalarında kalp etkilenimini en iyi gösteren travma ölçeğinin ISS olduğu belirlendi. Sonuç olarak; çoklu travma hastalarında, direkt veya diğer sistemik etkiler nedeniyle kalp etkilenmesi olabilmektedir. Travma şiddeti yüksek olan çoklu travma hastalarında, kalp belirteçlerinin yüksek olması, anormal EKO ve EKG bulgularının tespit edilmesi, bu hastalarda kalp etkileniminin yüksek olduğunu düşündürmektedir. Yüksek travma şiddetine sahip çoklu travmalı hastalara, kalp etkilenimi olabileceği düşünülerek, kalp ritm bozukluğu ve hemodinamik bozukluk açısından kalp monitorizasyonu ve yakın takip yapılmalıdır.Bu çalışma Ç.Ü. Bilimsel Araştırma Projeleri Birimi Tarafından Desteklenmiştir. Proje No:TF2005LTP1

Çok fazlı akışlar için yüksek basarımlı yüksek seviyeli süreksiz galerkin metodları.

This thesis study focuses on the development of GPU accelerated, high-order discontinuous Galerkin methods for the solution of unsteady incompressible and immiscible multiphase flows with level set interface representation. Nodal discontinuous Galerkin framework is used for Navier-Stokes, level set evolution and reinitialization equations on unstructured elements. Computations are localized mostly near the interface location with an adaptive method to reduce computational cost without sacrificing the accuracy. An artificial diffusion approach with a modal decay rate based regularity estimator is used to damp out high frequency solution components near kinks. For the computation of interface equations, a multi-rate Adams-Bashforth time integrator is designed to avoid time step restrictions resulting from artificial diffusion stabilization and local mesh refinement. Implicit systems arising from the semi-explicit time discretization of the flow equations are solved with a matrix-free $p$-multigrid preconditioned conjugate gradient method to minimize memory requirements and to increase overall runtime performance. The developed numerical scheme is accelerated using modern GPUs and many-core CPUs. Platform independence of the solver is achieved with an extensible multi-threading programming API as common kernel language that allows runtime selection of different computing devices and threading interfaces. Efficiency, scalability, local high-order accuracy and mass conservation of the method are confirmed through distinct numerical test cases.Ph.D. - Doctoral Progra

On the Second-Degree Exterior Derivation of Kahler Modules on X ⊗ Y

This article presents a new approach to stress the properties of Kahler modules. In this paper, we construct the Kahler modules of second-degree exterior derivations and we constitute an exact sequence of X &otimes; Y -modules. Particularly, we examine Kahler modules on X &otimes; Y , and search for the homological size of &Lambda; 2 ( &Omega; 1 ( X &otimes; Y ) )

Incidence, etiology, and patterns of maxillofacial traumas in Syrian patients in Hatay, Turkey: A 3 year retrospective study

BACKGROUND: This study aimed to assess the demographics, clinical features, and treatment costs of maxillofacial trauma cases referred to our hospital during the Syrian civil war. METHODS: The study included 80 cases of maxillofacial trauma. Patients with additional pathologies were excluded from the study. The patients were examined with respect to their demographics and clinical characteristics, Injury Severity Score (ISS), Glasgow Coma Score (GCS), treatments applied, costs, and outcomes. RESULTS: A total of 80 patients included 76 (95%) males and 4 (5%) females, with the mean age of 29.05±9.97 years (range, 13–56 years), and 72 (90%) of them were Syrians injured in the war. The most common mechanism of trauma was the firearms injury in 72 (90%) cases, and the most frequently seen lesion was the mandible fracture (n=48, 60%). The ISS of all the patients was <16, as a severe trauma score. The GCS value was 8–12 in 4 (5%) patients, and 15 in 76 (95%). The most common treatment applied were the reduction and fixation, and graft-flap following fracture (n=12, 15%). The mean duration of hospitalization was 15.27±13.0 days (range, 2–60 days). All patients were discharged from hospital. The mean cost per case was calculated as 5,581.55±56.3 Turkish Lira (range, 772–18,697 TL) or 1,251.24±14.2 US Dollars (US$173–4,192). There was a significant correlation between the costs and the length of hospitalization (p<0.001, r=+0.729) and trauma scores (p=0.004, r=−0.616). CONCLUSION: Firearms-injured young males with mandible fractures were the most common group of maxillofacial trauma cases seen during the Syrian war. The intensity of patients and the cost of the hospital stay have significantly increased because of the ongoing conflict in the neighboring country of Syria