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The response surface method and process capability analysis were conducted in this study to improve evenness, hairiness, imperfections, and tensile strength of ring spun Supima cotton yarn by optimizing values of spinning parameters including traveler mass, yarn density, spindle speed, and yarn twist. The yarns were spun into three densities: 20 Ne, 30 Ne, and 38 Ne. An USTER Tester 5-S800 was used to evaluate the irregularity parameters of yarn. A Lloyd tester was also used to determine the yarn breaking load. The response surface method was applied to optimize the statistical values obtained from the tests of the yarns produced based on the combination values of system parameters. Each response was subjected to a response surface design study, and the optimal values were achieved by using a response optimizer to perform multiple response optimization. Interpreting the response surface design results yielded information such as the absolute values of effects, response degree of significance, data compatibility, and model suitability. Individual desirability, composite desirability, different estimates for each response, and the relationship between response and system variables were all revealed by interpreting the response optimization results. The capability indices of process capability analysis were used to compare process performance before and after response optimization. By interpreting the capability indices’ values of process capability analysis, the capability of the process to meet requirements and improvement potential were acquired. The data was analyzed by implementing Minitab software (Version 19).

Background Accidental exposure to percutaneous needle stick and sharp injuries (NSSIs) and blood and other body fluids is the unintended contact with risky medical instruments or patient secretions during a medical intervention. During the COVID-19 pandemic, the significance of occupational injuries in healthcare professionals was revealed once again. To assess the occupational injuries, we compared rates, distribution and type of exposure to blood and body fluids and NSSIs of health care workers for 2019 (pre-pandemic era) and 2020 (pandemic era) years, respectively. Material and methods Our study included data collected by the ‘Hospital Infection Control Committee’ for the years 2019–2020. Data collected using the active surveillance method were analyzed retrospectively. Results During 2019 (pre-pandemic period) and 2020 (pandemic period), 112 (27.65%0) and 82 (21.4%0) NSSIs reported, respectively. Of the exposed HCWs in 2019 (pre-pandemic period), 16.8%0 (14) were doctor, 53.6%0 (60) were nurse and 47.4%0 (14) were intern doctors. In the 2020 (pandemic period), NSSIs were observed most frequently in nurses and cleaning staff, 50.24%0 and 33.64%0, respectively. Concerning the total percentage of exposure to blood and other body fluids, a slight increase was revealed from 1.48%0 to 2.62%0 in 2019 and 2020, respectively. A significant decrease in exposure rate was reported among the doctors between the pre-pandemic and pandemic era; 3.6%0 and 1.19%0 at 2019 and 2020, respectively. A significant increase in exposure rate was reported among the nurses between pre-pandemic and pandemic era; 0.8%0 and 6.89%0, respectively. Conclusion In conclusion, the exposure to NSSIs during the pandemic period decreased; however, there was no severe difference at pre-pandemic and pandemic periods concerning exposure to blood and body fluids. Well-designed training and awareness programs can be effective in preventing exposure to NSSIs and blood and other body fluids and exposure to respiratory acquired viruses.

Objectives: The aim of this study was to investigate the effect of chalazion excision on corneal aberrations and corneal densitometry. Methods: Thirty-six patients with a chalazion in 1 eyelid and 40 healthy subjects were included in the study. Corneal aberration parameters of total root mean square (RMS), RMS high-order aberration (HOA), horizontal trefoil, oblique trefoil, horizontal coma, vertical coma, and spherical aberration values were measured using Scheimpflug corneal topography (Pentacam HR; Oculus Optikgeräte GmbH, Wetzler, Germany). Corneal densitometry values measured from 4 regions of the cornea (0–2, 2–6, 6–10, and 10–12 mm) and 4 corneal depths (anterior, central, posterior, and total) were recorded. Preoperative measurements of the patients (Group 1), postoperative first-month measurements (Group 2), and control group (Group 3) measurements were compared. Results: The total RMS measurement was 1.64±0.48 μm in Group 1, 1.35±0.32 μm in Group 2, and 1.17±0.38 μm in Group 3 (Group 1–2: p=0.007, Group 1–3: p

Graphical abstract Associations between inherited Killer Immunoglobulin-like Receptor (KIR) genotypes and the severity of multiple RNA virus infections have been reported. This prospective study was initiated to investigate if such an association exists for COVID-19. In this cohort study performed at Ankara University, 132 COVID-19 patients (56 asymptomatic, 51 mild-intermediate, and 25 patients with severe disease) were genotyped for KIR and ligands. Ankara University Donor Registry (n:449) KIR data was used for comparison. Clinical parameters (age, gender, comorbidities, blood group antigens, inflammation biomarkers) and KIR genotypes across cohorts of asymptomatic, mild-intermediate, or severe disease were compared to construct a risk prediction model based on multivariate binary logistic regression analysis with backward elimination method. Age, blood group, number of comorbidities, CRP, D-dimer, and telomeric and centromeric KIR genotypes (tAA, tAB1, and cAB1) along with their cognate ligands were found to differ between cohorts. Two prediction models were constructed; both included age, number of comorbidities, and blood group. Inclusion of the KIR genotypes in the second prediction model exp (-3.52 + 1.56 age group - 2.74 blood group (type A vs others) + 1.26 number of comorbidities - 2.46 tAB1 with ligand + 3.17 tAA with ligand) increased the predictive performance with a 92.9% correct classification for asymptomatic and 76% for severe cases (AUC: 0.93; P

The most important need in the aviation industry is the realization of high-strength and lightweight designs. For this reason, topology optimization methods have become widespread recently. Besides, meeting the natural frequency requirements is one of the important design elements. However, topology optimization with stiffness maximization requires a static finite element analysis evaluation while the natural frequency calculation requires a modal analysis evaluation. Using these two different analysis procedures at the same time in the topology optimization process, on the other hand, is a challenging task. To address this challenge, a topology optimization methodology that accounts for the natural frequency constraint in a compliance minimization process is presented in this study. Since the commercial software can either minimize compliance or minimize the vibration frequency at one time, using these two different analysis procedures at the same time together stands out as an innovative aspect of this study. The applicability of the developed methodology is shown for two bracket designs; namely, the so-called GE bracket and a real-world satellite bracket with natural frequency and mass constraints. The prototypes of the designs are fabricated using the additive manufacturing technique.

Objective: Skull base osteomyelitis (SBO) is a rare, life-threatening infection and frequently followed and treated by otolaryngologists previously. In this study, we analyzed the diagnosis, treatment and long-term outcomes of SBO from the perspective of infectious diseases and clinical microbiology (IDCM). Methods: Hospitalized patients with SBO between 2012-2019 were evaluated retrospectively. Epidemiological, clinical, laboratory data of the patients were recorded. The patients who recovered with and without sequelae were compared. Results: The mean age of 16 SBO cases was 66 years, 75% of them were male and 87.5% had diabetes mellitus (DM). Cranial nerve and vascular/dural involvement were present in 75% and 56.3% of them, respectively. The most common isolated microorganism were P. aeruginosa, staphylococci and Candida spp. 81.2%, 43.7%, and 56% of the patients received anti-pseudomonal antibiotics, additional glycopeptide and additional antifungal drugs, respectively. The sequelae rate was 46.7% in a 24-month follow-up. Hypertension (p=0.041), duration of complaints (p=0.003), bilateral involvement of skull base (p=0.001), vascular thrombosis/inflammation or dural involvement (p=0.007), previous surgical intervention (p=0.041) and elevated ESR at the end of treatment (p=0.014) were defined as risk factors for permanent sequelae. There was no in-hospital mortality. Conclusions: SBO mainly affects older male patients with DM and causes significant sequelae in half of them. In the cases unresponsive to anti-pseudomonal agents, the addition of antifungal therapy empirically may provide a clinical response. Permanent sequelae are more common in cases with delayed diagnosis/treatment, bilateral, vascular or dural involvement, and elevated ESR at the end of treatment. ESR can be used to determine the treatment response and duration. The follow-up and treatment of SBO cases by IDCM with the support of experienced surgeons may contribute to the positive clinical results.

Scedosporium apiospermum complex members are opportunistic fungi that can be found in environments such as soil and polluted water. In this report, we aimed to present a case of mycetoma caused by Scedosporium apiospermum complex that developed in a 40-year-old female patient with immunocompetent system and diagnosed by fungal culture. In the anamnesis of the patient who admitted in 2015 with the complaint of more than one fistulized discharge wound, pain and swelling in the dorsal of the right hand and wrist; it was learned that her complaints started about 20 years ago with a slight swelling on the back of the wrist, and when it worsened, the abscess was drained and antibiotic treatment was initiated in a private surgical center. However, it was learned that she did not benefit from the treatments, and over time, fistulized, yellow-discharged wounds appeared on the back of her hand and wrist, and she had undergone various surgical interventions and used antibiotics. Routine laboratory tests of the patient, who did not have an underlying chronic disease, were normal. Magnetic resonance imaging (MRI) and X-ray findings were compatible with osteomyelitis and 'dot in circle' sign seen on MRI was characteristic for mycetoma. Pathological examination was interpreted as active chronic inflammatory reaction in the soft tissue and chronic osteomyelitis. Mycobacteria, bacteriological and fungal cultures of the two biopsy samples taken during surgical debridement and one month later were performed. Bacteriological and mycobacterial cultures were negative, while Scedosporium genus grew in the fungal cultures of the both samples. Isolates were identified as Scedosporium apiospermum/Pseudallescheria boydii with MALDI Biotyper (Bruker Daltonics, Bremen, Germany) system and Scedosporium boydi by sequence analysis of the ITS region. The antifungal susceptibility tests were performed according to CLSI M38-A2 criteria, and were evaluated at the 72nd hour. The minimum inhibitory concentration (MIC) values of fluconazole, caspofungin, amphotericin B, itraconazole, vorikonazole, posaconazole and isavuconazole were > 64 µg/ml, 16 µg/ml, 4 µg/ml, 16 µg/ml, 0.25 µg/ml, 2 µg/ml and 0.25 µg/ml, respectively. Voriconazole and terbinafine treatment was initiated. In the control performed in the 9th month of the treatment, it was observed that the complaints of discharge, pain and swelling were resolved, pain and swelling complaints were recovered, fistula tracts were closed and joint movements were painless. In the control MRI performed at 15th and 18th months, it was observed that there was no soft tissue involvement and the findings were compatible with osteoarthritis after infective osteomyelitis. This case whose longterm complaints improved with mycological diagnosis and appropriate treatment; reveals the importance of keeping mycological diagnosis in mind in chronic bone and soft tissue infections. Identifying the fungus to the genus and species level and arranging the treatment according to the antifungal susceptibility test results are very important in patient management.

ObjectivesThe WHO Access, Watch and Reserve (AWaRe) classification has been developed to support countries and hospitals in promoting rational use of antibiotics while improving access to these essential medicines. We aimed to describe patterns of worldwide antibiotic use according to the AWaRe classification in the adult inpatient population.MethodsThe Global Point Prevalence Survey on Antimicrobial Consumption and Resistance (Global-PPS) collects hospital antibiotic use data using a standardized PPS methodology. Global-PPS 2015, 2017 and 2018 data, collected by 664 hospitals in 69 countries, were categorized into AWaRe groups to calculate proportional AWaRe use, Access-to-Watch ratios and the most common indications for treatment with selected Watch antibiotics. Only prescriptions for systemic antibiotics on adult inpatient wards were analysed.ResultsRegional Access use ranged from 28.4% in West and Central Asia to 57.7% in Oceania, whereas Watch use was lowest in Oceania (41.3%) and highest in West and Central Asia (66.1%). Reserve use ranged from 0.03% in sub-Saharan Africa to 4.7% in Latin America. There were large differences in AWaRe prescribing at country level. Watch antibiotics were prescribed for a range of very different indications worldwide, both for therapeutic and prophylactic use.ConclusionsWe observed considerable variations in AWaRe prescribing and high use of Watch antibiotics, particularly in lower- and upper-middle-income countries, followed by high-income countries. The WHO AWaRe classification has an instrumental role to play in local and national stewardship activities to assess prescribing patterns and to inform and evaluate stewardship activities.

Memory storage in the brain is one of the most extensively studied subjects in neuroscience. However, due to the highly complex structure of the memory-related systems in the brain, the mystery remains unsolved. Consolidation is one of the most important parts of the memory process, and one that can be affected by numerous neurodegenerative diseases. Hypothalamic melanin-concentrating hormone (MCH) neuronal activity has been of particular interest to researchers in terms of the association between sleep, neurodegenerative diseases, and memory consolidation. We used Pmch-Cre animals to investigate the role of MCH neuronal activity in memory consolidation. In order to observe the differences in memory consolidation, we chemogenetically inhibited MCH neurons using the DREADD method and measured hippocampus-dependent memory performance with a novel object recognition test applicable to early memory impairment in Alzheimer's disease. Our results revealed no significant improvement or worsening with MCH inhibition, suggesting that the role of MCH should now be evaluated in a wider setting.

Background: The authors aimed to determine the efficacy of frequently used antibiotics, alone or in combination, against biofilms of ventilator-associated pneumonia isolates. Materials & methods: The authors determined the MICs, minimum biofilm inhibitory concentrations and minimum biofilm eradication concentrations of meropenem, ciprofloxacin and colistin as well as their combinations against planktonic forms and biofilms of Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter baumannii clinical isolates. Results: Generally, the minimum biofilm inhibitory concentrations and minimum biofilm eradication concentrations of the antibiotics were 1000-fold higher than their MICs, and synergy was provided by different concentrations of meropenem-colistin and meropenem-ciprofloxacin combinations with checkerboard and time–kill curve methods. Conclusion: The combination of meropenem and ciprofloxacin seems to be a good candidate for the treatment of biofilm-associated infections; none of the concentrations obtained as a result of the synergy test were clinically significant.

Introduction: Infection and sepsis continue to be the leading cause of morbidity and death in burn injuries. Diagnosing sepsis in burns is challenging as signs and symptoms of sepsis are not specific and overlap with those related to the burn injury. While use of procalcitonin (PCT) as a biomarker is recommended for diagnosing sepsis in burns, evidence for children with burns is scarce. In this study, we aimed to investigate the role of PCT for distinguishing sepsis in pediatric burns.Methods: A prospective observational study was conducted in a single pediatric burn unit. Children hospitalized with burns ≤30% of total body surface area were included while patients with chemical burn, inhalation injury or concomitant chronic disease were excluded. Patients were classified into three groups for sepsis, systemic inflammatory response syndrome (SIRS) or controls using the American Burn Association (ABA) criteria. Predictive role of C-reactive protein (CRP) and PCT was investigated for distinguishing sepsis.Results: Seventy-two patients were included in the study. Median total body surface area (TBSA) size was 12% (2.0-28.5%) and median abbreviated burn severity index (ABSI) score was 3 (2-7). Median length of burn unit stay was 9.5 days (1-59 days). Sepsis was diagnosed in 11 patients (15.2%) and SIRS was present in 23 patients (40.0%), whereas 38 patients (52.8%) had neither SIRS nor sepsis (control group). Receiver operating characteristic analysis revealed that CRP and PCT levels distinguished sepsis patients from non-sepsis patients while PCT had a higher positive predictive value (64.3% vs 47.6%). Optimal cut-off values of CRP and PCT for distinguishing sepsis were 66.75 mg/L and 2.54 ng/mL. Conclusions: PCT levels could distinguish sepsis in children with burn injuries, performing better than CRP levels. Confirmatory studies are needed to evaluate the development of sepsis and role of PCT for diagnosing sepsis in pediatric burn patients.

OBJECTIVES: Coronavirus 2019 disease (COVID-19) lead to one of the pandemics of the last century. We aimed to predict poor prognosis among severe patients to lead early intervention. METHODS: The data of 534 hospitalized patients were assessed retrospectively. Risk factors and laboratory tests that might enable the prediction of prognosis defined as being transferred to the intensive care unit and/or exitus have been investigated. RESULTS: At the admission, 398 of 534 patients (74.5%) were mild-moderate ill. It was determined that the male gender, advanced age, and comorbidity were risk factors for severity. To estimate the severity of the disease, receiver operating characteristic analysis revealed that the areas under the curve which were determined based on the optimal cut off values that were calculated for the variables of values of neutrophil to lymphocyte ratio (NLR > 3.69), C-reactive protein (CRP > 46 mg/L), troponin I ( > 5.3 ng/L), lactate dehydrogenase (LDH > 325 U/L), ferritin ( > 303 ug/L), d-dimer ( > 574 µg/L), neutrophil NE ( > 4.99 × 109 /L), lymphocyte (LE 7.4 ng/L), age ( > 62), SO2 ( 40 mg/dL), procalcitonin ( > 0.21 ug/L), CKMB ( > 2.6 ng/L) were 0.715, 0.685, 0.644, 0.632, 0.627, and 0.617, respectively. CONCLUSIONS: The clinical progress could be severe if the baseline values of NLR, CRP, troponin I, LDH, are above, and LE is below the specified cut-off point. We found that the troponin I, elder age, and SO2 values could predict mortality.

Amaç: Preeklampsi, gebeliğin 20. haftasından sonra ortaya çıkan patogenezi hala tam anlaşılamamış hipertansiyon, proteinüri ile karakterize multisistemik bir sendromdur. Bu çalışmada, preeklampsi patogenezinde önemli rollere sahip olduğu düşünülen oksidatif stres mekanizmasının aydınlatılmasına yardımcı olabilmek için angiyogenezde majör rolü olan, endotel fonksiyon bozukluğu ve endotel fonksiyonunu koruyucu olduğu düşünülen VEGF-A (Vasküler endotelyal büyüme faktörü-A) ve oksidatif stresin birçok aşamasında farklı işlevleri olan HSP90 (ısı şoku proteini90) ile preeklamptik plasentalardaki değişiklikleri immünohistokimyasal olarak incelemeyi amaçladık. Gereç ve Yöntemler: Doku örnekleri vaka grubunda 10 preeklampsili gebeden ve kontrol grubunda ise 10 sağlıklı gebeden alındı. Gebelerin yaş, gravida ve parite gibi bilgileri veri olarak alındı. Kontrol grubu ve preeklampsili gebelerden alınan örnekler histokimyasal, immunohistokimyasal ve elektron mikroskobik yöntemlerle değerlendirildi. Bulgular: Değerlendirmeler sonucu, preeklampsili gebelerin plasenta dokularında serbest villus sayısında azalma, villuslardaki fetal kapiller sayısında azalma, fetomaternal bariyerlerin morfolojik yetersizliği, villus stromasında kolajen artması, sinsisyotrofoblast bazal membranında kalınlaşma gibi histolojik farklılıklar gözlenmiştir. Bununla birlikte preeklamptik gebelerde plasental VEGF-A immünreaktivitesinin kontrole göre azaldığı, HSP90’ın ise arttığı saptanmıştır. Sonuç: Bu sonuçlar, her iki endojen molekülün de preeklampsi patogenezinde oldukça önemli rollere sahip olduğunu göstermektedir.

Objective:To assess the clarity and efficacy of the World Health Organization (WHO) hand-rub diagram, develop a modified version, and compare the 2 diagrams.Design:Randomized group design preceded by controlled observation and iterative product redesigns.Setting:The Cognitive Ergonomics Lab in the School of Psychology at the Georgia Institute of Technology.Participants:We included participants who were unfamiliar with the WHO hand-rub diagram (convenience sampling) to ensure that performance was based on the diagram and not, for example, on prior experience.Methods:We iterated through the steps of a human factors design procedure: (1) Participants simulated hand hygiene using ultraviolet (UV) absorbent lotion and a hand-rub technique diagram (ie, WHO or a redesign). (2) Coverage, confusion judgments, and behavioral videos informed potentially improved diagrams. And (3) the redesigned diagrams were compared with the WHO version in a randomized group design. Coverage was assessed across 72 hand areas from multiple UV photographs.Results:The WHO diagram led to multiple omissions in hand-surface coverage, including inadequate coverage by up to 75% of participants for the ulnar edge. The redesigns improved coverage significantly overall and often substantially.Conclusions:Human factors modification to the WHO diagram reduced inadequate coverage for naïve users. Implementation of an improved diagram should help in the prevention of healthcare-associated infections.

IntroductionVitamin D (VD) deficiency is a common disease that occurs in all stages of life. A growing number of studies call attention to the relationship between VD deficiency and cardiovascular disease. The aim of this study was to investigate the effect of VD on subclinical left ventricular (LV) function in diabetic and non-diabetic patients with no significant coronary artery disease.Material and methodsWe recruited 140 patients (80 diabetics and 60 non-diabetics) with symptoms of stable ischemic heart disease who underwent coronary angiography and who had no significant coronary artery disease in our clinic. The 25(OH)D3 levels were measured and patients who had 25-(OH)D3 levels below 20 ng/dl were defined as the VD deficient group. In addition to conventional echocardiographic parameters, tissue Doppler echocardiography was used for LV diastolic functions and 2D speckle tracking strain echocardiography (2D STE) for evaluating the longitudinal deformation indices of the LV myocardium.ResultsIn all groups, LV global longitudinal strain (GLS) was significantly impaired in patients with VD deficiency (p < 0.001) compared to patients without VD deficiency. LV global longitudinal strain rate (GLSR) was significantly impaired in patients with VD deficiency (p = 0.003). The GLS was negatively associated with 25-(OH)D3 in the VD deficiency group (r = –0.52623, p < 0.001). Conversely, GLS was positively associated with 25-(OH)D3 levels in the normal VD group (r = 0.28, p = 0.048).ConclusionsVD deficiency is associated with impaired myocardial GLS. The present study demonstrated that VD deficiency may be the cause of subclinical myocardial dysfunction in patients with or without diabetes mellitus and no history of significant coronary artery disease.

Evaluating trends in antibiotic resistance is a requisite. The study aimed to analyze the profile of multidrug-resistant organisms (MDROs) among hospitalized patients with bacteremia in intensive care units (ICUs) in a large geographical area. This is a 1-month cross-sectional survey for blood-borne pathogens in 57 ICUs from 24 countries with different income levels: lower-middle-income (LMI), upper-middle-income (UMI), and high-income (HI) countries. Multidrug-resistant (MDR), extensively drug-resistant (XDR), or pan-drug-resistant isolates were searched. Logistic regression analysis determined resistance predictors among MDROs. Community-acquired infections were comparable to hospital-acquired infections particularly in LMI (94/202; 46.5% vs 108/202; 53.5%). Although MDR (65.1%; 502/771) and XDR (4.9%; 38/771) were common, no pan-drug-resistant isolate was recovered. In total, 32.1% of MDR were Klebsiella pneumoniae, and 55.3% of XDR were Acinetobacter baumannii. The highest MDR and XDR rates were in UMI and LMI, respectively, with no XDR revealed from HI. Predictors of MDR acquisition were male gender (OR, 12.11; 95% CI, 3.025-15.585) and the hospital-acquired origin of bacteremia (OR, 2.643; 95%CI, 1.462-3.894), and XDR acquisition was due to bacteremia in UMI (OR, 3.344; 95%CI, 1.189-5.626) and admission to medical-surgical ICUs (OR, 1.481; 95% CI, 1.076-2.037). We confirm the urgent need to expand stewardship activities to community settings especially in LMI, with more paid attention to the drugs with a higher potential for resistance. Empowering microbiology laboratories and reports to direct prescribing decisions should be prioritized. Supporting stewardship in ICUs, the mixed medical-surgical ones in particular, is warranted.