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Abstract This multicentre (22 centres in Turkey) retrospective cohort study aimed to assess the clinical outcomes of patients with neutropenic fever and SARS-CoV-2 positivity. Study period was 15 March 2020–15 August 2021. A total of 170 cases (58 female, aged 59 ± 15.5 years) that fulfilled the inclusion criteria were included in the study. One-month mortality rate (OMM) was 44.8%. The logistic regression analysis showed the following significant variables for the mentioned dependent variables: (i) achieving PCR negativity: receiving a maximum of 5 days of favipiravir (p = 0.005, OR 5.166, 95% CI 1.639–16.280); (ii) need for ICU: receiving glycopeptide therapy at any time during the COVID-19/FEN episode (p = 0.001, OR 6.566, 95% CI 2.137–20.172), the need for mechanical ventilation (p

Background: In this study it was aimed to evaluate the efficacy and timing with technique of the source control for the subgroup of septic shock (SS) patients with intraabdominal infections (IAI) in a tertiary-care educational hospital. Methods: Patients who had SS with IAI and consulted by Infectious Diseases consultants between December 2013 and October 2022 in our centre were analyzed retrospectively. Results: A total number of 390 patients were included. Overall day-30 mortality (OMM) was 42.5% on day 3 while day 14 and 30 mortality rates were 63.3% and 71.3%, respectively. Source control by surgical or percutaneous operation was performed in 123 of 390 cases (31.5%) and mortality rate was significantly lower in cases that were performed source control at anytime during SS (65/123-52.8% vs 213/267-79.8%, p3 mg/dl (p

Neurobrucellosis is a rare and challenging complication of brucellosis. Its non-specific clinical presentation makes it challenging to diagnose. The coexistence of neurobrucellosis with subdural empyema is extremely rare, with only a few cases reported in the literature. Herein, we present the case of a 27-year-old male with a ventriculoperitoneal shunt in-situ and a history of exposure to Brucella via animal care and consumption of raw milk. The patient presented with a left frontal headache and vertigo following a head trauma. The initial cranial imaging demonstrated a left-sided subdural hematoma and slit ventricles. The patient underwent drainage by craniotomy. Brucella spp. was detected in the drained sample, and the patient was treated with a multi-modal approach, which included antibiotics and surgical drainage. The follow-up plan involved a repeat cranial computed tomography and shunt adjustment for recurrent subdural effusions. This case adds to the few reports of neurobrucellosis associated with subdural empyema. Furthermore, it highlights the importance of considering neurobrucellosis in patients with neurological symptoms and a subdural collection in brucellosis-endemic areas.

Abstract Background Herein, we analyzed the efficacy of main antibiotic therapy regimens in the treatment of healthcare-associated meningitis (HCAM). Materials/methods This retrospective cohort study was conducted in 18 tertiary-care academic hospitals Turkey, India, Egypt and Romania. We extracted data and outcomes of all patients with post-neurosurgical meningitis cases fulfilling the study inclusion criteria and treated with empirical therapy between December 2006-September 2018. Results Twenty patients in the cefepime + vancomycin-(CV) group, 31 patients in the ceftazidime + vancomycin-(CFV) group, and 119 patients in the meropenem + vancomycin-(MV) group met the inclusion criteria. The MV subgroup had a significantly higher mean Glasgow Coma Score, a higher rate of admission to the intensive care unit within the previous month, and a higher rate of antibiot herapy within the previous month before the meningitis episode (p 0.05) among the three cohorts. No regimen was effective against carbapenem-resistant bacteria, and vancomycin resulted in an EOT clinical success rate of 60.6% in the methicillin-resistant staphylococci or ampicillin-resistant enterococci subgroup (n = 34). Conclusions Our study showed no significant difference in terms of clinical success and mortality among the three treatment options. All regimens were ineffective against carbapenem-resistant bacteria. Vancomycin was unsuccessful in approximately 40% of cases involving methicillin-resistant staphylococci or ampicillin-resistant enterococci.

Isabel Morales-Muñoz,1,2 Buse Beril Durdurak,1 Ayten Bilgin,3 Steven Marwaha,1,4 Catherine Winsper5 1Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK; 2Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland; 3School of Psychology, University of Kent, Canterbury, UK; 4The Barberry National Centre for Mental Health, Birmingham and Solihull Mental Health Trust, Birmingham, UK; 5Coventry and Warwickshire Partnership NHS Trust, Research and Innovation, Coventry, UKCorrespondence: Isabel Morales-MuñozInstitute for Mental Health, School of Psychology, University of Birmingham, 52 Pritchatts Road, Birmingham, B15 2TT, UKEmail I.Morales-Munoz@bham.ac.ukObjective: Recent research indicates that sleep problems in childhood precede the development of borderline personality disorder (BPD) symptoms, but the mechanisms by which sleep problems associate with BPD are still unknown. This narrative review aims to provide some potential explanations for how early sleep problems might associate with BPD.Methods: We used the biosocial developmental model of BPD as a framework to discuss how sleep problems may associate with BPD. Articles were identified via PubMed and Embase, and papers published between January 1991 and April 2021 were extracted. Authors made a series of literature searches using the following keywords: Sleep problems, Insomnia, Nightmares, Hypothalamic–Pituitary–Adrenal Axis (HPA), Prefrontal Cortex, Family Psychopathology, Disrupted Attachment, Child Maltreatment, Impulsivity, Emotion Regulation, Internalizing, Externalizing, Rumination, Childhood, Adolescence, Young people. The inclusion criteria were published in peer-reviewed journals; human studies or reviews; published in English. The exclusion criteria were commentaries; abstracts from conferences; studies with animal samples. A total of 96 articles were included for the purpose of this review.Results: The evidence from this review suggests that some biological factors and core features of BPD act as potential mechanisms mediating the associations between early sleep and subsequent BPD, while some family-related factors might constitute common risk factors for sleep problems and BPD.Conclusion: The biosocial developmental model of BPD provides a plausible characterization of how sleep disruption might lead to subsequent BPD. Further research on new developmental and early intervention approaches to understand how sleep in early stages associates with BPD could have significant clinical impact on these patients and could inform targeted therapeutic interventions.Keywords: sleep, borderline personality disorder, biosocial developmental model, childhood, adolescence, mechanisms

Point of care (PoC) devices are highly demanding to control current pandemic, originated from severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2). Though nucleic acid-based methods such as RT-PCR are widely available, they require sample preparation and long processing time. PoC diagnostic devices provide relatively faster and stable results. However they require further investigation to provide high accuracy and be adaptable for the new variants. In this study, laser-scribed graphene (LSG) sensors are coupled with gold nanoparticles (AuNPs) as stable promising biosensing platforms. Angiotensin Converting Enzyme 2 (ACE2), an enzymatic receptor, is chosen to be the biorecognition unit due to its high binding affinity towards spike proteins as a key-lock model. The sensor was integrated to a homemade and portable potentistat device, wirelessly connected to a smartphone having a customized application for easy operation. LODs of 5.14 and 2.09 ng/mL was achieved for S1 and S2 protein in the linear range of 1.0–200 ng/mL, respectively. Clinical study has been conducted with nasopharyngeal swabs from 63 patients having alpha (B.1.1.7), beta (B.1.351), delta (B.1.617.2) variants, patients without mutation and negative patients. A machine learning model was developed with accuracy of 99.37% for the identification of the SARS-Cov-2 variants under 1 min. With the increasing need for rapid and improved disease diagnosis and monitoring, the PoC platform proved its potential for real time monitoring by providing accurate and fast variant identification without any expertise and pre sample preparation, which is exactly what societies need in this time of pandemic.

Introduction: Ventilator-associated pneumonia (VAP) is one of the major hospital-acquired infections in the intensive care unit (ICU). The Centers for Disease Control and Prevention (CDC) made changes in the definitions of VAP. In this study, we aimed to prospectively evaluate patients in the tertiary-level chest diseases ICU between December 2016 and May 2017 in terms of ventilator-related events using the new surveillance criteria for patients requiring invasive mechanical ventilation. Materials and Methods: Patients in the chest diseases ICU were prospectively evaluated in terms of VAP development, and the incidence was calculated according to the old and new CDC criteria. Results: A total of 82 patients (31 women, 51 men) were followed up in the chest diseases ICU. Twenty-four patients who met the new surveillance criteria (survived >4 days) with 1632 patient-days and 601 ventilator days were included in the study. The incidences of VAP according to the old and new criteria were 31.6 and 1.6 per 1000 ventilator days, respectively. Conclusion: Our data suggest that new CDC definitions underdiagnose pneumonia in the daily practice. We may conclude that it does not seem rational to switch to the newer VAP definitions in the daily practice from the elder CDC definitions.

Objectives: The aim of this study was to compare the antibacterial activity of ceftaroline versus vancomycin in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) meningitis in an experimental rabbit meningitis model. Methods: The antibacterial activity of ceftaroline was compared with vancomycin in the treatment of meningitis induced by MRSA strain ATCC 43300 in an experimental rabbit meningitis model. Quantitative cerebrospinal fluid (CSF) cultures were performed at the beginning of antibiotic treatment and 24 h and 73 h after the first antibiotic dose. Furthermore, in vitro time–kill data were investigated at 0, 2, 4, 6, 8, 12 and 24 h in sterile human serum. Results: The difference between the control group versus both treatment groups was significant when comparing the decrease in colony counts in CSF both at 24 h and 73 h after the first antibiotic dose (P

Vegetable oils can be considered as an alternative or emergency fuel for diesel engine. However, vegetable oils result in operational and durability problems for the long-term operation because of being much more viscous than diesel fuel. To eliminate this drawback, blending of vegetable oils with diesel fuel or alcohol is one of the most widely used techniques. In the existing literature, many studies are available on the measurement and prediction of density and viscosity of binary blends (especially biodiesel (BD)-diesel fuel (DF) blends), although, there is still the lack of comprehensive studies in which reliable density and viscosity data are presented, new regression models are proposed and compared with other regression models for waste cooking oil (WCO)-DF binary blends. Therefore, in the present study, (1) WCO was blended with DF on the volume basis of 2, 4, 6, 8, 10, 15 and 20 %, (2) the measurements of viscosities and densities of the binary blends were performed at various temperatures (278.15–343.15 K) in accordance with DIN 53015 and ISO 4787 standards, respectively, (3) the variations of viscosity and density values of binary blends vs. temperature were evaluated, (4) the new rational and exponential models as a function of temperature were fitted to the experimental data measured by the authors and Baroutian et al. (regarded as typically different data), and finally (5) the models were also compared to Yoon et al. and linear models, previously proposed by other authors, in order to investigate their reliability. According to results, (i) the best correlation was obtained by the rational model with the lowest maximum relative errors of 2.9679 % and 3.2725 % for the viscosity data measured by the authors (WCO-DF blends) and Baroutian et al. (palm oil (PO)-DF blends), and (ii) for the density data of WCO-DF and PO-DF binary blends, the best correlation was obtained using the exponential model giving the lowest maximum relative errors of 0.0470 % and 0.0581 %, respectively.

Nowadays, biodiesel is drawing attention as a renewable and clean alternative to fossil diesel fuel because of numerous advantages such as higher flash point, cetane number and density. However, the high viscosity of biodiesel is one of the critical shortcomings and it causes poor atomization, decrease in engine performance and increase in exhaust emissions. To overcome this shortcoming, in this study, the effects of main transesterification reaction variables on the viscosities of produced safflower oil methyl and ethyl esters (biodiesel) were investigated as a full factorial experimental design, and optimum parametric values giving the lowest viscosity were determined. Density and viscosity were measured according to ISO 4787 and DIN 53015 standards. Sodium ethoxide (C2H5ONa) was utilized as a catalyst, and 90 and 120 minutes of reaction duration were kept constant for methanolysis and ethanolysis reactions. According to the results, the optimal reaction parameters were determined as: 0.75 % catalyst concentration, 8:1 alcohol to oil molar ratio and 56 °C reaction temperature for methanolysis; 1.00 % catalyst concentration, 12:1 alcohol to oil molar ratio and 70 °C reaction temperature for ethanolysis. Based on the reaction parameters, the methyl and ethyl esters were produced with the lowest viscosities of 3.989 mm2/s and 4.393 mm2/s, respectively. In the light of results obtained in this study, similar studies on production of biodiesels from different oils and alcohols can be performed.

Nowadays, biodiesel and vegetable oils have received increasing attention as renewable clean alternative fuels to fossil diesel fuel because of decreasing petroleum reserves and increasing environmental concerns. However, the straight use of biodiesel and vegetable oils in pure form results in several operational and durability problems in diesel engines because of their higher viscosity than fossil diesel fuel. One of the most used methods for solving the high viscosity problem is to blend them with fossil diesel fuel or alcohol. The reliable viscosity and density data of various biodiesel-diesel-alcohol ternary blends or biodiesel-diesel binary blends are plentifully available in existing literature, however, there is still the scarcity of dependable measurement values on different biodiesel-diesel-vegetable oil ternary blends at various temperatures. Therefore, in this study, waste cooking oil biodiesel (ethyl ester) was produced, and it was blended with fossil diesel fuel and waste cooking oil at different volume ratios to prepare ternary blends. Viscosities and densities of the ternary blends were determined at different temperatures according to DIN 53015 and ISO 4787 standards, respectively. The variation in viscosity with respect to temperature and oil fraction and the change of density vs. temperature were evaluated, rational and exponential models were proposed for these variations, and these models were tested against the density and viscosity data measured by the authors, Nogueira et al. and Baroutian et al. by comparing them to Gupta et al. model, linear model, Cragoe model and ANN (artificial neural networks) previously recommended in existing literature.

Introduction: Hand hygiene is one of the most cost-effective infection control measures. In this multicenter study we analyzed the hand hygiene compliance observation results of 15 hospitals in Turkey. Materials and Methods: This study was performed in the intensive care units of 15 hospitals (eight tertiary-care educational hospitals, six state hospitals, and one private hospital) from 11 cities located in six regions of Turkey. The observations were made by infection control practitioners according to the World Health Organization (WHO) - Five Moments for Hand Hygiene (WHO-5) indications rule for hand hygiene and overall compliance rates were calculated. Observations were unblinded (healthcare professionals knew that they were observed). The study period included 2015 and 2016 calendar years. Results: There was a statistically significant increase in hand hygiene compliance rates in 2016 versus 2015. The overall number of hand hygiene opportunities and instances of compliance in 2015 and 2016 were 60071/78116 (76.9%) and 66551/83607 (79.6%) (p=0.0001), respectively. Nurses were the most compliant group in both years. The highest compliance was after body fluid exposure (88.2% in 2015 and 91.4% in 2016), while the lowest compliance was before patient contact (61.3% in 2015 and 65% in 2016). Conclusion: The presented data suggest that under unblinded observations, hand hygiene compliance seems to be in relatively acceptable rates in Turkey. Centers with compliance rates below the 50th percentile in any of the five moments should increase efforts to enhance compliance for that indication.

Introduction: Hand hygiene is one of the most effective infection control measures to prevent the spread of healthcare-associated infections (HCAI). Water, soap, paper towel and hand disinfectant must be available and adequate in terms of effective hand hygiene. The adequacy of hand hygiene products or keeping water-soap and paper towel is still a problem for many developing countries like Turkey. In this multicenter study, we analyzed the adequacy in number and availability of hand hygiene products. Materials and Methods: This study was performed in all intensive care units (ICUs) of 41 hospitals (27 tertiary-care educational, 10 state and four private hospitals) from 22 cities located in seven geographical regions of Turkey. We analyzed water, soap, paper towel and alcohol-based hand disinfectant adequacy on four different days, two of which were in summer during the vacation time (August, 27th and 31st 2016) and two in autumn (October, 12th and 15th 2016). Results: The total number of ICUs and intensive care beds in 41 participating centers were 214 and 2357, respectively. Overall, there was no soap in 3-11% of sinks and no paper towel in 10-18% of sinks while there was no alcohol-based hand disinfectant in 1-4.7% of hand disinfectant units on the observation days. When we compared the number of sinks with soap and/or paper towel on weekdays vs. weekends, there was no significant difference in summer. However, on autumn weekdays, the number of sinks with soap and paper towel was significantly lower on weekend days (p

Zero-valent iron (ZVI) represent a promising agent for environmental remediation. The research was aimed to determine the influence of copper in doses of 0, 80, 150, 300, and 600 mg Cu·kg−1 of soil as well as ZVI, and lignite additives on the content of macroelements in the Indian mustard (Brassica juncea (L.) Czern.). The average accumulation of analyzing elements in Indian mustard grown in copper contaminated soil were found to follow the decreasing order Mg > Na > P > Ca > K > N. Soil contamination at 600 mg Cu·kg−1 of soil led to the highest increase in P, Mg, N, and Ca content. The application of ZVI had a positive influence on the average phosphorus and potassium content of Indian mustard. Moreover, the application of ZVI and lignite had a positive influence on the average Mg and Ca content in the above-ground parts of Indian mustard. From the analyzed reactive materials, the application of lignite was shown to be the most effective resulting in the decrease in the average nitrogen and calcium content when compared to the control crop. Calcium content in plants from the control group, without the addition of zero-valent iron, and powered lignite (control), was positively correlated with increasing doses of copper.

Introduction: In this multicenter study, we analysed the magnitude of healthcare worker (HCW) [infection control practitioner (ICP), nurses and others] workforce in hospitals participated in the study. Materials and Methods: This study was performed in 41 hospitals (with intensive care units-ICU) located in 22 cities from seven regions of Turkey. We analysed the ICP workforce, nursing and auxiliary HCW (AHCW) workforce in ICUs, number of ICU beds and occupied beds in four different days [two of which were in summer during the vacation time (August 27 and 31, 2016) and two others in autumn (October 12 and 15, 2016)]. The Turkish Ministry of Health (TMOH) requires two patients per nurse in level 3 ICUs, three patients per nurse in level 2 ICUs and five patients per nurse in level 1 ICUs. There is no standardization for the number of AHCW in ICUs. Finally, one ICP per 150 hospital beds is required by TMOH. Results: The total number of ICUs, ICU beds and ICPs were 214, 2377 and 111, respectively in he 41 participated centers. The number ICPs was adequate only in 12 hospitals. The percentage of nurses whose working experience was 2. The number of patients per other HCW was minimum 3.75 and maximum 4.89 on weekdays and on day shift while it was minimum 5.02 and maximum 7.7 on weekends or on night shift. When we compared the number of level 1, 2 and 3 ICUs with adequate nursing workforce vs inadequate nursing workforce, the p value was

Background: Ozone is a three-oxygen molecule (O3). Ozone therapy (OT) is systematically effective when pathological inflammatory and immunologic processes are activated. Among of these conditions are wound healing, macular degeneration related to aging, and conditions that are ischemic or infectious. Aims: The aim of this study was to determine the effects of OT on wound healing of intestinal anastomosis in the presence of peritonitis in a rat model. Study Design: Animal experimentation. Methods: A total of 40 Wistar albino rats were randomized into four groups (n=10) including: sham (S), peritonitis (P), ozone 0 (O0), and ozone 24 (O24). In group S, only cecal dissection was carried out. The S group had only a cecal dissection and intestinal anastomosis performed, but no peritonitis. In all other groups, cecal ligation and puncture (CLP) followed the cecal dissection to induce bacterial peritonitis. 24 h after puncture, a cecal resection and ileocolic anastomosis were performed. In group P, 24 h after CLP, a cecal resection and ileocolic anastomosis were performed and no ozone was administered. In group O0, immediately after the anastomosis, and in group O24, starting 24 hours after the anastomosis, an intraperitoneal 1 mg/kg/day ozone administration was applied for seven days. On the seventh day the animals were sacrificed, the anastomotic bursting pressures (BP) and the hydroxyproline values of the anastomotic tissues were measured, and histopathologic examination of the anastomotic segment was carried out. Results: The highest BP was in group S, with 211±23.13 mmHg. The mean BP of group P was 141±56.25 mmHg, which was significantly lower than in the other two peritonitis groups that received ozone therapy, group O0 and O24, where it was 192±22 and 166±45 mmHg, respectively (p0.05). Histopathologic analyses of the anastomotic segments determined there was significantly more oedema and necrosis in the control group rats, and collagen deposition in the anastomotic tissue was significantly higher in the ozone-treated groups on postoperative day 7. Hydroxyproline levels were significantly higher in groups O0 and O24 compared to the peritonitis group (P). Conclusion: Ozone therapy has a beneficial effect on anastomotic healing of the colon in the presence of peritonitis. (Balkan Med J 2014;31:249-53).

Introduction: World population is ageing. Accordingly, the prevalence of health problems and diseases are also increasing. Aging is associated with a growing demand for acute and primary healthcare. Urinary tract infections (UTIs) are among the most common infectious diseases associated causes of hospitalization. When considering the fact that complicating factors are encountered more often in elderly patients, it is very important to find out these factors and start the appropriate treatment for the management of these patients in order to prevent untoward consequences. In this study, we aimed to evaluate the patients diagnosed with UTI in two different age groups and analyze the differences in advanced ages. Materials and Methods: We retrospectively evaluated demographic characteristics, complaints, underlying diseases and the results of physical examination and laboratory analyses in patients with diagnosis of UTI in our clinic. We divided the subjects into two groups: ≥65 years of age and

This study investigates the effects of various operating conditions in spark ignition engines via an exergy analysis. A thermodynamic cycle model including compression, combustion and expansion processes was used for investigation. Induction and exhaust processes were computed with a simple approximation method. The principles of the second law were applied to the cycle model to perform the exergy analysis. Exergetic variables, i.e., the exergy transfers with heat and work, irreversibilities, thermomechanical exergy, fuel chemical exergy and total exergy were calculated in the exergy analysis. Variation of the exergetic parameters and the distribution of them into the fuel exergy were determined for various operating conditions, i.e., engine speed and load. The first and second law efficiencies and specific fuel consumption were also computed to reveal the optimum operating conditions. The results show that the exergy transfer with heat decreases and the exergy transfer with exhaust gases increases with increasing engine speed. Engine speed of 3 000 rpm gives the maximum exergy transfer as work, the minimum irreversibility and the best efficiency and fuel consumption. Exergy transfers with heat, work and exhaust and irreversibilities increase with increasing engine load. Additionally, the first and second law efficiencies increase and fuel consumption decreases with increasing engine load, so a high engine load gives the best efficiency and fuel consumption. Cette étude examine les effets des différentes conditions de fonctionnement de moteurs à allumage commandé via une analyse exergétique. Un modèle de cycle thermodynamique comprenant les processus de compression, combustion et détente a été utilisé. Les processus d’admission et d’échappement sont modélisés à l’aide d’une méthode simple d’approximation. Les principes de la deuxième loi de la thermodynamique ont été appliqués au modèle de cycle pour effectuer l’analyse exergétique. Des variables exergétiques comme les transferts exergétiques de chaleur et de travail, les irréversibilités, l’exergie thermomécanique, l’exergie chimique du carburant et l’exergie totale ont été calculées dans l’analyse exergétique. La variation des paramètres exergétiques et leur distribution dans l’exergie du combustible ont été déterminées pour différentes conditions de fonctionnement, c’est à dire différentes vitesses du moteur et différentes charges. L’efficacité déduite, d’une part, de la première et la deuxième loi de la thermodynamique et, d’autre part, de la consommation spécifique de carburant ont également été calculées pour révéler les conditions optimales de fonctionnement. Les résultats montrent que le transfert exergétique de chaleur diminue et que le transfert exergétique par l’échappement augmente avec la vitesse du moteur. Le régime moteur de 3 000 tr/min donne le transfert d’exergie maximal de travail, les irréversibilités minimales, les meilleurs rendements et la moindre consommation de carburant. Les transferts exergétiques avec la chaleur, le travail et l’échappement et ainsi que les irréversibilités augmentent avec la charge du moteur. En outre, l’efficacité déduite de la première et la seconde loi de la thermodynamique augmente et la consommation de carburant diminue avec la charge du moteur, donc une charge du moteur élevée donne les meilleurs rendements et la moindre consommation de carburant.

Introduction: The prevalence of hospital-acquired or healthcare-associated infections (HAI) varies from country to country even between different units of the same hospital. By the help of prevalence studies, HAI rates can be demonstrated in a wider perspective and, based on these data; infection control measures may be reevaluated. In this study, we investigated the HAI prevalence in hospitalized patients on 23 December 2013 at our tertiary-care educational hospital. Materials and Methods: On 23 December 2013, patients diagnosed with HAI (by using Centers for Disease Control and Prevention criteria) by infectious diseases and clinical microbiology specialists in our 1850-bedded (including 1.516 adult, 334 pediatric and a total of 328 intensive care unit beds) tertiary-care hospital, were evaluated in terms of underlying disease, risk factors, implementation initiatives, focus of infection and causative microorganisms. Results: The number of patients hospitalized on 23 December 2014 was 1.470, the prevalence of HAI was found to be 7.21%. The most common type of HAI was pneumonia followed by urinary tract infection, bacteremia, surgical site infections and intra-abdominal infections. Conclusion: We conclude that repeated HAI prevalence studies at appropriate intervals are very useful for taking effective infection control measures and follow-up of HAI in large hospitals like our tertiary care hospital where active surveillance could not be done in all clinics.

In this case report we aimed to present a patient with granulocytic sarcomaa, neutropenic fever, ARDS and Pneumocystis jirovecii pneumoniae that was hospitalized in our intensive care unit. The patient recovered and then developed vancomycin resistant enterococci (VRE) bacteremia due to port catheter during follow up. The patient had risk factors for VRE bacteremia and he was administered linezolide without removing the catheter. He was discharged with recovery.

Streptococcus pneumoniae is the most frequently encountered microorganism in the etiology of community-acquired acute bacterial meningitis. In Turkey, third-generation cephalosporin resistance is extremely rare in S. pneumoniae. Third-generation cephalosporins are the most commonly used antimicrobial agents in the treatment of pneumococcal meningitis. In this paper, we report a meningitis case of S. pneumoniae with decreased susceptibility to third-generation cephalosporins. A 56-year-old man admitted to our clinic with headache, nausea-vomiting and fever in March 2012. In the physical examination, his Glasgow coma scale was 15 and his cooperation and orientation were normal. He did not have any meningeal irritation finding. His physical examination did not reveal any other pathology. Lumbar puncture revealed turbid cerebrospinal fluid (CSF) with a white cell count of > 1000 cells/mm3 with 80% polymorphonuclear leukocytes. CSF laboratory findings were as follows: glucose level < 2 g/dL and protein level 255 mg/dL. Gram staining of CSF revealed gram-positive diplococci. Ceftriaxone was started. Vancomycin was added after blood and CSF cultures yielded S. pneumoniae with intermediate susceptibility to cefotaxime. On the seventh day, rifampicin was added due to the persistence of fever. CSF findings were normal at the end of the treatment. The patient was discharged after 28 days of antibiotherapy. The patient did not develop any relapse after eight months of follow-up. To our knowledge, this is the first S. pneumoniae meningitis case from Turkey with intermediate susceptibility to cefotaxime who was treated successfully. The presented case emphasizes the importance of CSF sampling and penicillin and ceftriaxone minimum inhibitory concentration (MIC) evaluation in the management of meningitis.

Transrectal prostate biopsy (TPB) is a commonly used invasive technique for the diagnosis of prostate cancer. Escherichia coli is a rare cause of adult meningitis. It can cause nosocomial meningitis after invasive procedures. In this paper, we present two cases of E. coli meningitis developing after TPB. The first case was a 65-year-old man who was admitted to the emergency service with fever and unconsciousness two days after TPB. He had neck stiffness, leukocytosis, and high C-reactive protein (CRP) levels. His cerebrospinal fluid (CSF) had turbid appearance, low glucose and high protein levels. More than 1000/mm3 leukocytes were seen on direct microscopy, and gram-negative bacilli were observed. Ceftriaxone 2 g q12h was started. CSF culture yielded E. coli susceptible to ceftriaxone. Concomitant urine and blood cultures were sterile. The second case was a 69-year-old man admitted with fever and unconsciousness six days after TPB. He had neck stiffness, leukocytosis and high CRP levels. His CSF had purulent appearance, low glucose and high protein levels. On microscopy, there were 800 leukocytes/mm3. Ceftriaxone 2 g q12h was started. CSF culture yielded extended spectrum beta-lactamase producer E. coli. Treatment was changed to meropenem 6 mg daily. Both patients were cured with the three-week antibiotic treatment. After TPB, resistant microorganisms can be involved in the etiology of severe bacterial infections; carbapenems can be used until culture results are available.

Abstract The studies evaluating the impact of Her2 levels in neoadjuvant setting have conflicting data. The aim of the study was to evaluate the prognostic impact of Her2 status in early triple negative breast cancer(TNBC). In the study TNBC patients who were treated with neoadjuvant chemotherapy (NAC) and surgery were analyzed retrospectively. The primary aim of the study was to analyze the impact of Her2 status(Her2-0 and Her2-low) on pathological complete response (pCR). The secondary objectives were disease free survival (DFS) and overall survival (OS). 620 female triple negative breast cancer patients were evaluated. 427 patients (68.9%) had Her2-0 and 193(31.1%) had her2-low pathology. The pCR rates were similar between Her2-0 and Her2-low patients (33.0% vs. 27.5%, p = 0.098). Although Her2-0 group has better DFS (106 vs. 50 months, p = 0.002), in multivariate analysis it had a HR of 0.74 (p = 0.06). In addition, OS was similar (131 vs. 105 months, p = 0.13) with a HR of 0.88 (p = 0.61). In multivariate analysis; presence of LVI (HR:2.2 (95% CI 1.1–3.5) p = 0.001), Clinical stage T1/T2 (HR:0.39 (95% CI 0.2–0.6) p

Objective: The purpose of this study is to investigate the prevalence of restless legs syndrome (RLS) in pregnancy and its relationship with vitamin and mineral use. Materials and Methods: The study used a cross-sectional design. The target population of the study was 612 pregnant women. Data were collected between September and December 2020 using the “pregnant woman information form”, the “RLS diagnostic criteria questionnaire” and the “RLS severity assessment scale”. Results: Around one in eight participating pregnant women were found to have RLS symptoms. We found that more than half of the pregnant women with RLS experience severe symptoms of RLS. Pregnant women’s RLS symptoms were found to as the income level decreased, gestational week increased, coffee consumption increased, weight gained during pregnancy increased, and the number of weekly exercises decreased; RLS symptoms were less common in pregnant women who used magnesium, multivitamin, folic acid and vitamin D (p

Abstract Background Lower extremity amputations (LEAs) significantly contribute to mortality and morbidity, often resulting from peripheral artery disease and diabetes mellitus (DM). Traumatic injuries also account for many LEAs. Despite the global burden, the epidemiology of LEAs, particularly in the Middle East and North Africa (MENA) region, remains underexplored. This study utilizes the Global Burden of Disease (GBD) dataset to analyze temporal trends in LEAs in the MENA region from 1990 to 2019. Methods The study utilized the 2019 GBD dataset, which includes estimates for incidence, prevalence, and disability-adjusted life-years (DALYs) across 369 diseases. Age-standardized incidence rates (ASIRs) for LEAs were extracted for 21 MENA countries. Trends were analyzed using percentage change calculations and Joinpoint regression to identify significant shifts in LEA rates over time. Results From 1990 to 2019, male LEA rates generally decreased, while female rates increased. Significant increases in LEA rates were observed in Syria, Yemen, and Afghanistan, correlating with periods of conflict and instability. Conversely, countries like Iraq, Palestine, Sudan, Lebanon, Iran, and Kuwait saw marked decreases. The study highlighted a complex interplay of socio-political factors, natural disasters, and chronic diseases like DM in shaping LEA trends across the region. Conclusion The study reveals variable LEA trends in the MENA region, influenced by conflicts, natural disasters, and chronic diseases. These findings underscore the need for targeted public health interventions, improved healthcare access, and robust data collection systems to reduce the burden of LEAs and improve patient outcomes in the MENA region.

Objective: This study aimed to examine the association between hypo/hypercapnia and fluctuations in carbon dioxide (CO2) levels and severe intraventricular hemorrhage (IVH) during the initial 72 hours of life among preterm infants. Material and Methods: A retrospective study of premature infants with birth weights between 750 and 1.250 g and gestational ages of 30 weeks who required respiratory support. Blood gas measurements were collected during the first 3 days of life. Multivariate analyses were performed to assess the association between hypercapnia and carbon dioxide pressure (pCO2) fluctuations and IVH. Results: Our cohort included 376 patients with a median gestational age of 28 weeks and a median birth weight of 920 g. After controlling for gestational age and birth weight, histologic chorioamnionitis and pCO2 fluctuations remained significantly associated with severe IVH. Conclusion: Fluctuations in pCO2 over a short period may have a stronger association with severe IVH than the mere occurrence of hypo- or hypercapnia.

With the advent of quantum computing, traditional cryptography algorithms are at risk of being broken. Post-quantum encryption algorithms, developed to include mathematical challenges to make it impossible for quantum computers to solve problems, are constantly being updated to ensure that sensitive information is protected from potential threats. In this study, a hybrid examination of a (p,q)-Bernstein-type polynomial, which is an argument that can be used for encryption algorithms with a post-quantum approach, was made from a mathematical and cryptography perspective. In addition, we have aimed to present a new useful operator that approximates functions and can be used in cases where it is not possible to work with functions in the fields of technology, medicine, and engineering. Based on this idea, a new version of the (p,q)-Bernstein-Schurer operator was introduced in our study on a variable interval and the convergence rate was calculated with two different methods. At the same time, the applications of the theoretical situation in the study were presented with the help of visual illustrations and tables related to the approach. Additionally, our operator satisfied the statistical-type Korovkin theorem and is suitable for variable interval approximation. This is the first paper to study the statistical convergence properties of (p,q)-Bernstein-Schurer operators defined on a variable bounded interval, to obtain special matrices with the help of (p,q)-basis functions, and to give an application of (p,q)-type operators for encrypted image transmission.

Abstract It is important to understand the mathematical foundations of neural networks and to include robustness in model evaluation. Here, we introduce algorithms based on manifold curvature estimation to assess neural network robustness. These algorithms rely solely on training data and do not require regular or adversarial test data. Initially, a metric is proposed to measure the curvature of discrete data manifolds by introducing weighted angles concept between subspaces. Following this, a robustness measure is introduced that is independent of network architecture or model parameters. Lastly, two additional methods are introduced, utilizing curvature estimation of special manifolds formed by using gradient vectors between output and input network layers, alongside manifold curvature estimation. A comprehensive evaluation is provided on multiple network models using the CIFAR-10 dataset. Manifold geometry-based robustness analysis may lead to the development of not only accurate but also robust neural network models.

Western Asia represents a mixing pot of diverse bat species with distributions spanning across other geographic regions. Yet, relative to other regions, there is a significant gap in coordinated bat research in Western Asia, thereby resulting in a relatively limited number of curated occurrence records.The Western Asia Bat Research Network (WAB-Net) project was created to strengthen research capacity and knowledge of the diversity and distribution of bat species in a little-studied region, as well as to collect data to characterise the diversity and prevalence of coronaviruses in diverse bat species. Over a four-year period (2018–2022), we documented 4,278 individual records for 41 bat species using a cross-sectional survey approach at 50 sites in seven Western Asian countries, specifically Armenia, Azerbaijan, Georgia, Jordan, Oman, Pakistan and Turkiye. At each site, we captured, on average, 90 individual bats (range: 9-131) over multiple consecutive nights and used standardised methods to collect demographic and morphological data from captured individuals. We additionally completed a systematic evaluation of environmental characterisation and human-bat interactions at all 50 sites. Here, we report individual occurrence records and site conditions from this multi-country, multi-year sampling effort.

Objective: Eye injuries have a significant effect, causing vision loss and an increase in the prevalence of visual impairment on a global scale. Traffic accidents are increasingly responsible for eye injuries, especially in developing countries. Traffic accidents cause people to suffer physical and/or psychological damage every year in our country and around the world. Through the analysis of impairment rates, this research aims to identify the strengths and weaknesses of the impairment assessment criteria. Methods: Patients who applied to Mersin University Faculty of Medicine Forensic Medicine Department Impariment Polyclinic between January 1, 2015, and January 1, 2022 with eye injuries connected to traffic accidents had their sociodemographic and accident-related data scanned. Impairment rates were calculated individually for each case in accordance with the American Medical Association Guides to the Evaluation of Permanent Impairment (AMA guideline), the Regulation on Disability Assessment for Adults (Disability regulation), and The Regulation on Determination of Working Power and Loss of Profitability in Occupations [Social Security Institution (SSI) regulation]. Results: In our study, 67.1% of the 82 cases were male, with a mean age of 36.01. The cases exhibited the most common occurrences of corneal and nerve injuries. We observed a statistically significant difference in the medians of impairment rates calculated according to the AMA guidelines and the Disability and SSI regulations. Conclusion: The calculation of impairment rates based on the SSI regulation for eye injuries revealed a constrained methodology, resulting in higher impairment rates compared to those determined by the AMA guideline and the Disability regulation. The Disability regulation and AMA guidelines were found to follow similar and detailed calculation methodologies. Within our country, we advocate for the adoption of a comprehensive guideline devoid of subjective interpretation for the determination of impairment rates in eye injuries resulting from traffic accidents, encompassing all conceivable eye-related diagnoses.

This study aimed to provide a comprehensive understanding of how aging treatments (namely, HT1 and HT2) affect the microstructure, cracking behavior, and crystallographic texture of IN939 fabricated by powder bed fusion-laser beam (PBF-LB) method. Although both aged samples demonstrated similar grain structure and recrystallization behavior according to the electron backscatter diffraction (EBSD) analysis, as well as the precipitation of bimodal γ′ phase and MC- and M23C6-type carbides, notable differences were observed in the size and morphology, particularly the γ′ phase. The HT1 sample displayed coarsened primary γ′ phase, with sizes reaching up to 2 μm and exhibiting varied morphologies, including irregular and cuboidal shapes. Additionally, this treatment led to the formation of some γ′-γ eutectic regions and plate-like η phase, along with the decomposition of MC-type carbides into M23C6-type carbides. In contrast, the HT2 sample displayed uniformly distributed spherical primary γ′ phase with sizes ranging from 70 to 120 nm, accompanied by very fine secondary γ′ phase. Furthermore, it was found that changes in both aged sample microstructures could result in the formation of strain-age cracks due to the γ′ phase formation and liquation cracks due to the partial remelting of lower melting point phases. The findings also revealed that with the application of aging treatments, the hardness of the as-fabricated sample (339.8 ± 3.4 HV) increased to 440.2 ± 5.6 HV and 508.1 ± 4.8 HV for the heat treatment of HT1 and HT2, respectively.

Huge losses of life and property occurred as a result of two independent catastrophic earthquakes on 6 February 2023 in the Eastern Anatolian Fault Zone, where no significant earthquake has occurred in approximately 500 years. The earthquakes, whose epicenters were in the Pazarcık and Elbistan districts of Kahramanmaraş province at 9 h intervals, had magnitudes of Mw = 7.7 and Mw = 7.6 and caused different levels of structural damage, especially in masonry-style structures in rural areas. In this study, the damage that occurred in masonry village schools, especially in rural areas, during these two earthquakes was evaluated in terms of the characteristics of the earthquake and within the scope of civil engineering, and the causes of the damage were discussed. The damage levels of the masonry schools examined were classified using the European Macroseismic Scale (EMS-98). Information about the Kahramanmaraş earthquakes was given and structural analyses were carried out for a widely used reference school building. The school building block was analytically modeled, and its seismic load-bearing capacities were predicted through pushover analysis in TREMURI software. The study also includes repair and strengthening recommendations for such structures.

In order to prevent environmental pollution and to utilize natural resources more efficiently, environmentally friendly policies have been developed in our country in accordance with international developments. The Environmental Impact Assessment (EIA) Regulation, which came into effect for the first time in 1993, was introduced in Turkey in accordance with Law No. 2872 published in 1983. Within the scope of this study, the statistical analysis of EIA applications in Amasya province has been conducted since 2000 in accordance with the EIA Regulations in force, and an evaluation of the current situation has been presented. Additionally, investments decided within the scope of the EIA Regulation were evaluated in relation to gross domestic product (GDP) national calculations [GDP (in thousand TL), GDP per capita ($), and GDP per capita (TL)] using data from the Turkish Statistical Institute (TurkStat) for the years 2004-2022. Investments planned within the borders of Amasya province resulted in a total of 396 (100%), of which 37 (9%) listed as EIA Positive belonged to EIA Regulation Appendix-1 investments, and 359 (91%) listed as EIA Not Required belonged to EIA Regulation Appendix-2 investments between 2000-2023. According to the analysis based on decision numbers, it was evaluated that investments defined within the scope of Appendix-2 of the EIA Regulation were significantly high within the borders of Amasya province.

Objective: Sarcoidosis is a chronic inflammatory disease that affects many organs and systems, especially the lungs, lymph nodes and musculoskeletal system. Musculoskeletal system involvement patterns in sarcoidosis are not well defined and literature data are limited in terms of clinical features. This study aimed to investigate the clinical and demographic characteristics of sarcoidosis patients with musculoskeletal system involvement. Methods: One hundred and four patients with sarcoidosis who were followed up in our clinic between June 2020 and January 2024 were evaluated retrospectively. Forty-four sarcoidosis patients aged >18 years with objectively detected musculoskeletal system involvement were included in the study. The musculoskeletal system involvement patterns, clinical and laboratory findings, and demographic characteristics of the patients were analyzed. Results: Musculoskeletal involvement was found in 44 of the 104 sarcoidosis patients (42%). Of the 44 patients with musculoskeletal involvement, 37 (77.3%) were female, the mean age was 46.9±12.2 years, and the mean follow-up time was 14±11.8 months. The most common objective musculoskeletal pathology was chronic arthritis (17%), mostly in the form of chronic oligoarthritis. Wrist (50% vs. 3.8%, p=0.001) and metacarpophalangeal joint involvement (38.9% vs. 0, p=0.001) were significantly higher in patients with chronic arthritis than in patients with acute arthritis. While joint involvement starting as monoarthritis was an independent negative predictor for the development of chronic arthritis [odds ratio (OR): 0.046, 95% confidence interval (CI): 0.003-0.815, p=0.036], the presence of obesity at baseline was a positive predictor for the development of chronic arthritis (OR: 11.968, 95% CI: 1.069-133.960, p=0.044). Conclusion: Sarcoidosis can present with a wide range of musculoskeletal manifestations. The most common musculoskeletal pathologies in sarcoidosis are acute and chronic arthritis. Sarcoidosis patients presenting with monoarthritis do not usually develop chronic arthritis. Patients with chronic sarcoid arthritis initially present more hand-joint involvement. Obesity is a risk factor for the development of chronic arthritis.

Zorunlu hücre içi bakteri olan Coxiella burnetii, insanlar da dahil olmak üzere omurgalıların zoonotik bir hastalığı olan Q ateşinin etkenidir. Yaygın enfeksiyon yolları kontamine ahır tozunu solumak ve enfekte hayvanların atıklarıyla temastır. Bu çalışmanın materyalini Haziran-Eylül 2019 tarihleri arasında Türkiye’nin doğusundaki Van ilinde bulunan 70 sokak köpeğinden toplanan 200 adet kene oluşturmuştur. Toplanan keneler %70’lik alkol içeren tüplere alınarak parazitoloji laboratuvarına nakledilmiştir. hangi etiketlerin yapıştırıldığı. Keneler tüplere yerleştirildi ve sıvı nitrojen ile dondurularak ezildi. DNA, kit üreticisinin protokolüne göre izole edildi. Coxiella burnetii’nin DNA’sını tespit etmek için IS1111 tekrarlayan transpozaz gen bölgesine özel bir Trans 1, Trans 2 primer çifti kullanıldı. Saflaştırılmış amplikonların çift yönlü dizi analizi, DNA dizileyici ile gerçekleştirildi. IS1111 transpozaz genini hedef alan PCR sonucunda 200 kenenin 2’sinde (%1) Coxiella burnetii pozitif sonuç elde edildi. Van ilinde serbest dolaşan köpeklerde Q ateşi epidemiyolojisinde potansiyel risk faktörleri ve kenelerin önemi, parazit kene türleri ve köpeklerde C. burnetii pozitif kenelerin prevalansı belirlenerek vurgulanmıştır.

Encapsulation is a pivotal technique for protecting and enhancing the efficiency of sensitive natural bioactive substances, notably essential oils, vitamins, and phenolic compounds, widely used in foods and nutraceuticals. Critical considerations in selecting encapsulation agents encompass safety, release kinetics, stability, and cost-effectiveness. Yeast cells emerge as versatile carriers distinguished by their low cost, compatibility with biological systems, and eco-friendly degradation properties, accommodating both hydrophilic and hydrophobic bioactive agents. Various yeast strains, including Saccharomyces cerevisiae, Torulopsis lipofera, Cutaneotrichosporon curvatus, Yarrowia lipolytica, and Candida utilis, find utility in microencapsulation. Yeast cell encapsulation relies on the permeation of bioactive agents through yeast cell walls, predominantly composed of mannoproteins and polysaccharides. The encapsulation process includes passive or vacuum-infused diffusion of bioactive compounds inside yeast cells, precise droplet size control, and attractive forces to trap bioactive components within cellular structures. Yeast cells display versatility in various states, whether alive or dead, intact or plasmolyzed. In addition, the loading capacity of hydrophobic bioactives can be increased through chemical pretreatment techniques such as plasmolysis, autolysis, and enzyme hydrolysis, freeing up space within yeast cells by eliminating water-soluble components. In summary, yeast cell encapsulation presents a promising and sustainable technology with diverse applications within the food industry. Yeast cells enhance the stability and controlled release of bioactive compounds, magnifying the efficacy of natural hydrophobic bioactives like curcumin, essential oils, β-carotene, and vitamin D across various food products. This comprehensive review focuses on the encapsulation procedures, influential factors, characterization techniques, and applications, with a pronounced emphasis on hydrophobic materials.

Introduction: High mobility group box (HMGB)-1 protein is a promising prognostic marker for predicting the course of retinopathy and the prognosis in patients with diabetic retinopathy (DR). The aim of this study is to investigate whether serum HMGB-1 protein levels can be used as a biomarker about the severity of the disease in patients with diabetic retinopathy. Material and methods: This study was carried out in the internal medicine and ophthalmology departments of the Gaziantep Medicalpark Hospital. The records of 50 patients diagnosed with type 2 diabetes mellitus with diabetic retinopathy and 47 healthy subjects who applied to our clinic between January 2016 and December 2018 were retrospectively scanned. Five cc of venous blood was taken from the patients, and control groups were included in the study for routine laboratory tests and serum HMGB-1 levels to be studied under appropriate conditions. Human HMGB-1 levels were measured using the ELISA method. Results: There was a significant difference among the groups in terms of HMGB-1 levels (p

Abstract While some clinics have adopted abbreviated neoadjuvant treatment for HER2-positive breast cancer, there remains a shortage of comprehensive clinical data to support this practice. This is a retrospective, multicenter study. A total of 142 patients were included in the study who are HER2-positive breast cancer, aged ≤ 65 years, with left ventricular ejection fraction ≥ 50%, received neoadjuvant chemotherapy and underwent surgery at 10 different oncology centers in Türkiye between October 2016 and December 2022. The treatment arms were divided into 4–6 cycles of docetaxel/trastuzumab/pertuzumab for arm A, 4 cycles of adriamycin/cyclophosphamide followed by 4 cycles of taxane/TP for arm B. There were 50 patients (35.2%) in arm A and 92 patients (64.8%) in arm B. The median follow-up of all of the patients was 19.9 months (95% CI 17.5–22.3). The 3-year DFS rates for treatment arms A and B were 90.0% and 83.8%, respectively, and the survival outcomes between the groups were similar (p = 0.34). Furthermore, the pathologic complete response rates were similar in both treatment arms, at 50.0% and 51.1%, respectively (p = 0.90). This study supports shortened neoadjuvant treatment of HER2-positive breast cancer, a common practice in some clinics.

Radioligand therapies such as [177Lu] Lu-PSMA-617 have gained significant momentum in cancer treatment after clinical trials and multicenter studies demonstrated their safety and efficacy. As these innovative treatments become more widespread, rare and unique clinical manifestations are expected to be observed. In this report, we describe a case with metastatic castration-resistant prostate cancer (mCRPC) and peripancreatic lymph node metastases who developed acute pancreatitis following [177Lu] Lu-PSMA-617 therapy.

Introduction As healthcare is shifting from a paternalistic to a patient-centred approach, medical decision making becomes more collaborative involving patients, their support persons (SPs) and physicians. Implementing shared decision-making (SDM) into clinical practice can be challenging and becomes even more complex with the introduction of artificial intelligence (AI) as a potential actant in the communicative network. Although there is more empirical research on patients’ and physicians’ perceptions of AI, little is known about the impact of AI on SDM. This study will help to fill this gap. To the best of our knowledge, this is the first systematic empirical investigation to prospectively assess the views of patients, their SPs and physicians on how AI affects SDM in physician–patient communication after kidney transplantation. Using a transdisciplinary approach, this study will explore the role and impact of an AI-decision support system (DSS) designed to assist with medical decision making in the clinical encounter.Methods and analysis This is a plan to roll out a 2 year, longitudinal qualitative interview study in a German kidney transplant centre. Semi-structured interviews with patients, SPs and physicians will be conducted at baseline and in 3-, 6-, 12- and 24-month follow-up. A total of 50 patient–SP dyads and their treating physicians will be recruited at baseline. Assuming a dropout rate of 20% per year, it is anticipated that 30 patient–SP dyads will be included in the last follow-up with the aim of achieving data saturation. Interviews will be audio-recorded and transcribed verbatim. Transcripts will be analysed using framework analysis. Participants will be asked to report on their (a) communication experiences and preferences, (b) views on the influence of the AI-based DSS on the normative foundations of the use of AI in medical decision-making, focusing on agency along with trustworthiness, transparency and responsibility and (c) perceptions of the use of the AI-based DSS, as well as barriers and facilitators to its implementation into routine care.Ethics and dissemination Approval has been granted by the local ethics committee of Charité—Universitätsmedizin Berlin (EA1/177/23 on 08 August 2023). This research will be conducted in accordance with the principles of the Declaration of Helsinki (1996). The study findings will be used to develop communication guidance for physicians on how to introduce and sustainably implement AI-assisted SDM. The study results will also be used to develop lay language patient information on AI-assisted SDM. A broad dissemination strategy will help communicate the results of this research to a variety of target groups, including scientific and non-scientific audiences, to allow for a more informed discourse among different actors from policy, science and society on the role and impact of AI in physician–patient communication.

Abstract Background and aims The C‐reactive protein to albumin ratio (CAR) is a novel parameter that has been reported as a significant prognostic marker in some diseases. The purpose of the present research was to investigate the predictive value of this ratio with regard to nutritional status in geriatric patients. Methods and results A total of 154 geriatric patients (age ≥65 years) who consecutively presented to the internal medicine outpatient clinic were included in this cross‐sectional study. The Mini Nutritional Assessment (MNA) was used as a reference to determine the nutritional status of the patients. Based on the MNA results, the patients were divided into two groups: normal nutrition and malnourished or at risk of malnutrition. The median CAR of malnourished patients or those at risk of malnutrition was significantly higher than that of patients with normal nutritional status (p = .012). A significant negative correlation was also observed between the MNA score and the CAR (r = −0.196, p = .015). The receiver operating characteristic curve analysis indicated that the CAR was a significant predictor of malnourishment or the risk of malnutrition (p = .012). Conclusion The CAR could predict which geriatric patients were malnourished or at risk of malnutrition. CAR may be used as a new tool in the nutritional screening of geriatric patients.

The most important step in plant breeding is the correct selection of parents, and it would be wise to use heterotic groups for this. The purpose of this study is to analyse yield and its components as well as genetic diversity in line × tester wheat populations. It also seeks to present a coherent framework for the isolation of early superior families and the development of heterotic groups in bread wheat. F1 and F2 generations of 51 genotypes, including 36 combinations between 12 lines and three testers and 15 parents, were evaluated for yield and its components in a three-replication experiment according to the randomized block design. Line × tester analysis of variance, general and specific combining abilities, heterosis, heterobeltiosis and inbreeding depression were calculated. Heterotic groups created based on general and specific combining abilities were compared with each other. The results showed that there was sufficient genetic variation in the population and that further genetic calculations could be made. The selections made based on general and specific combining abilities, heterosis values and average performance of genotypes without heterotic grouping indicated different genotypes for each feature. The creation of heterotic groups made it possible to select genotypes that were superior in terms of all the criteria listed. It was concluded that heterotic groups created based on specific combining abilities may be more useful for breeding studies.

Antibody-mediated rejection (AMR) is a major cause of graft failure limiting long-term graft survival after kidney transplantation. Current diagnostic strategy to detect AMR is suboptimal and requires further improvement. Previously suggested treatment regimens for AMR could not demonstrate efficacy, however novel therapeutic agents are currently under investigation. Donor-derived cell-free DNA (dd-cfDNA) is a novel non-invasive biomarker for allograft injury, that has been mainly studied in the context of rejection. Its short-half-life in circulation and injury-dependent release are its key advantages that contribute to its superior diagnostic accuracy, compared to traditional biomarkers. Moreover, previous studies showed that dd-cfDNA-release is well-linked to histological and molecular features of AMR, and thus able to reflect real-time injury. Further observations suggest that dd-cfDNA can be used as a suitable screening tool for early detection of AMR in patients with donor-specific-anti-HLA-antibodies (DSA), as well as for monitoring AMR activity after anti-rejection treatment. The weight of evidence suggests that the integration of dd-cfDNA in the graft surveillance of patients with AMR, or those suspicious of AMR (e.g., due to the presence of donor-specific anti-HLA-antibodies) has an added value and might have a positive impact on outcomes in this specific cohort.

Antibody-mediated rejection (AMR) is among the most frequent causes for graft loss after kidney transplantation. While there are no approved therapies, several case reports with daratumumab and the very recent phase 2 trial of felzartamab in AMR have indicated the potential efficacy of therapeutic interventions targeting CD38. Donor-derived cell-free DNA (dd-cfDNA) is an emerging biomarker with injury-specific release and a short half-life, which could facilitate early diagnosis of AMR and monitoring of treatment response. We describe two cases of patients with chronic active AMR, who were treated with monthly daratumumab infusions, and in whom donor-derived cell-free DNA (dd-cfDNA) was measured longitudinally to monitor treatment response. In both patients, daratumumab treatment led to stabilization of kidney function parameters, a strong decline of dd-cfDNA below the previously established threshold for rejection, and partial or complete histologic resolution of AMR activity. Our case series suggests that dd-cfDNA may be a useful companion biomarker for longitudinal monitoring of anti-CD38 treatment in patients with AMR.