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Author(s): Balaswamy Reddy [1]; Arun Kathuveetil [2]; Sapna Erat Sreedharan [1]; VT Jissa [3]; PN Sylaja (corresponding author) [1] Introduction In developing countries, the epidemiologic trends of young ischemic stroke [...], Background and Objectives: Ischemic stroke (IS) in young is increasingly recognized as an important health problem in low- and middle-income countries (LMICs). Limited data is available from LMICs about the predictors of outcome and recurrence of IS in young. The study aims to assess the predictors of short-term and long-term functional outcome and the recurrence of the first-ever IS and transient ischemic attack in young. Methods: The clinical, radiological data, functional outcome, and recurrence of 569 IS patients aged 18-50 years were recorded. The etiological classification was done. The functional outcome was assessed using the modified Rankin scale (mRS), with a good outcome being mRS 0-2. Logistic regression was used to analyze the predictors of recurrence and outcome. Results: The most common risk factors were hypertension (40.3%) and diabetes mellitus (34.3%). Stroke of undetermined etiology (33.6%) was the most common etiological subtype. Among the cardioembolic subtypes, rheumatic heart disease constituted 47.4%. A good functional outcome at 1 year was seen in 76.3%. While baseline stroke severity predicted both the 3-month and 1-year functional outcome, age ≥40 years and male gender predicted poor outcome at 1 year. The risk of recurrent strokes at 1 year was 2.5%. On multiple logistic regression analysis, diabetes mellitus independently predicted recurrent vascular events at 1 year (odds ratio = 2.43, 95% confidence interval 1.07-5.50). Conclusions: We found a good functional outcome with a relatively low recurrence at 1 year among young IS patients. Baseline stroke severity, age, and male gender predicted a poor 1-year functional outcome. Keywords: Young stroke, ischemic, recurrence, outcome

In recent years, an evident rise in the frequency of candidaemia caused by non-albicans Candida species has been reported. Candida utilis is a low-virulence fungus that is commonly used in the food processing industry. Only a few studies have reported invasive infection due to C. utilis. In this paper, we present two cases of clinically manifested candidaemia and sepsis caused by C. utilis. This was a retrospective study carried out at a tertiary intensive care center in Turkey. Two C. utilis were isolated from blood culture over a 6-month period. C. utilis fungemia has mainly been reported in immunocompromised patients, neonates, and following surgical intervention. The two cases discussed here did not have a defined immunodeficiency. Both patients had common risk factors such as prolonged stay in the pediatric intensive care unit and the presence of a central venous catheter. Our aim in reporting these cases is to highlight C. utilis as a probable cause of candidemia in hospitalized pediatric patients and can be mortal.

Feedback is crucial in every step of education, and we provide feedback to students in order to help them to either understand or improve their performance if they wish to improve their skills and abilities. However, how or whether they can benefit depends on their response to that feedback. Thus, when they receive feedback, they ought to be receptive because either too much or too little confidence influences their perceptions of their own performance. The study described in this article looks at overconfidence, and whether or not this evolves over time, that is, with more experience and also whether providing feedback to students can improve their own assessment of their own skills and abilities. A two-stage experiment was conducted, measuring the actual performance of students taking a course, at two points within it. After the examination that students took, we collected how students had assessed themselves and the degree of confidence that they had. Later, we provided feedback to students about their actual performance. In the second stage, we again measured their actual and self-estimated performance. The aim was to find out whether the feedback provided to students improved their assessment of their own performance and whether or not there had been a change in the level of their confidence. The results shed light on whether or not confidence, in particular, overconfidence, changes over time, in response to the feedback provided, and whether the provision of feedback is an effective policy when it comes to reducing overconfidence.

Infections caused by resistant Gram-negative bacteria are a serious public health problem, with Klebsiella spp. being the most common cause and increasing over the years. There is a striking increase in antibiotic resistance worldwide. The aim of this study was to retrospectively evaluate the characteristics and treatment of bloodstream infections (BSIs) caused by Klebsiella spp. and to identify possible risk factors for extended-spectrum β-lactamase (ESBL) resistance in our hospital between August 2019 and March 2023. Of 250 Klebsiella isolates, 112 (44.8%) were ESBL producers and 138 (55.2%) were ESBL nonproducers. Catheter-related BSIs (CRBSIs) accounted for 49.6% of infections and were more common in the ESBL nonproducer group. Most of the Klebsiella spp. were K. pneumoniae (233/250). Most of the infections were healthcare-associated infections (85.6%). Most patients had an underlying disease, the most common underlying disease in the ESBL-producing group was neurometabolic disease (26.8%), whereas in the ESBL-non-producing group it was malignancy (35.5%). The median age of the ESBL-producing group was 14 months and was younger (p=0.01). Previous antibiotic use in the last 30 days, especially aminoglycosides (p

Rationale Rapid and timely treatment with intravenous thrombolysis and endovascular treatment (EVT) in patients with acute ischaemic stroke (AIS) and large vessel occlusion (LVO) significantly improves patient outcomes. Bridging therapy is the current standard of care in these patients. However, an incompletely answered question is whether one thrombolytic agent is better than another during bridging therapy.Aim The current study aims to understand if one thrombolytic agent is superior to the other during bridging therapy in the treatment of AIS and LVO.Sample size estimates Using 80% power and an alpha error of 5 %, presuming a 10% drop out rate, a total of 372 patients will be recruited for the study.Methods and design This study is a prospective, randomised, multicentre, open-label trial with blinded outcome analysis design.Study outcomes The primary outcomes include proportion of patients who will be independent at 3 months (modified Rankin score (mRS) ≤2 as good outcome) and proportion of patients who achieve recanalisation modified thrombolysis in cerebral infarction grade 2b/3 at first angiography run at the end of EVT. Secondary outcomes include proportion of patients with early neurological improvement, rate of symptomatic intracerebral haemorrhage (ICH), rate of any ICH, rate of any systemic major or minor bleeding and duration of hospital stay. Safety outcomes include any intracranial bleeding or symptomatic ICH.Discussion This trial is envisioned to confirm the theoretical advantages and increase the strength and quality of evidence for use of tenecteplase (TNK) in practice. Also, it will help to generate data on the efficacy and safety of biosimilar TNK.Trial registration number CTRI/2022/01/039473.

Çevre kirliliği ve ekonomik büyüme arasındaki ilişkinin yanı sıra literatürde ekolojik ayak izi ile ekonomik büyüme arasındaki ilişki de son zamanlarda yoğun ilgi gören bir konu haline gelmiştir. Bu çalışmanın amacı Türkiye’de 1961-2018 yılları arasında ekonomik büyüme ile ekolojik ayak izi arasındaki ilişkiyi, Granger nedensellik analizi kullanarak incelemektir. Bu analiz için, ekonomik büyüme ve ekolojik ayak izinin orijinal verilerinin yanı sıra, Azami Çakışan Kesikli Dalgacık Dönüşümü (MODWT) yöntemi ile frekanslara ayrıştırılan verilerin kısa, orta ve uzun dönem bileşenleri yeniden yapılandırılmıştır. Analiz sonuçları, orijinal verilere dayanarak iki serinin arasında nedensellik olmadığını göstermektedir. Ancak, kısa dönem Granger nedensellik sonuçları, orijinal serilerden elde edilen sonuçlarla çelişmekte ve karşılıklı nedensellik ilişkisi olduğunu göstermektedir. Nedensellik ilişkisi; orta dönemde kaybolurken, uzun dönemde ekonomik büyümeden ekolojik ayak izine doğru tek yönlüdür.

Introduction: There are very limited data on the role of biomarkers correlating with the outcome in acute ischemic stroke (AIS). We evaluated the predictive values of the plasma concentrations of soluble serum stimulation-2 (sST2), matrix metalloproteinase-9 (MMP-9), and claudin-5 in AIS. Methods: The biomarker levels in the plasma samples of consecutive AIS patients collected at baseline, 12 h, and 24 h from stroke onset were quantified using immunoassays. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) and functional outcome at 90 days using the modified Rankin Scale (mRS), with scores above 3 defined as poor outcome. Receiver operating characteristic curve analysis and multiple logistic regression were performed for evaluating the discriminative power of each marker. Results: We included 108 patients in the study (mean age 62.3 ± 11.7 years). Median NIHSS score was 12 (interquartile range 8–18). High baseline glucose levels, systolic blood pressure, baseline NIHSS, low Alberta Stroke Program Early CT Score, and hemorrhagic transformation were associated with poor outcomes. Elevated sST2 at 12 h (50.4 ± 51.0 ng/mL; p = 0.047) and 24 h (81.8 ± 101.3 ng/mL; p = 0.001) positively correlated with poor outcomes. MMP-9 (p = 0.086) and claudin-5 (p = 0.2) were not significantly associated with the outcome, although increased expressions of both markers were observed at 12 h. Multiple logistic regression showed that sST2 levels ≥71.8 ng/mL at 24 h, with a specificity of 96.9%, emerged as an independent predictor of poor functional outcome (OR: 6.44; 95% CI: 1.40–46.3; p = 0.029). Conclusion: Evaluation of sST2 may act as a reliable biomarker of functional outcome in AIS.

Objective: To investigate the clinical and epidemiological features and outcome of Chryseobacterium and Elizabethkingia spp. infections in children, together with antimicrobial susceptibilities. Methods: This retrospective study was conducted at a tertiary pediatric hospital in Turkey. All patients infected with Chryseobacterium/Elizabethkingia spp. among those presenting to Ankara City Hospital between March 2014 and March 2022 were included. Results: A total of 49 cases were included and 29 cases were identified as Elizabethkingia. The median age was 14 (0.2-185.0) months. The majority (89.8%) of these patients had an underlying disease, including malignancy (42.9%). Bacteremia (46.9%) and central line-associated bloodstream infection (28.6%) were the most common infections. The thirty-day all-cause mortality rate was 12.2%. The most commonly used antibiotics were ciprofloxacin and trimethoprim-sulfamethoxazole (TMP-SMX). Forty-five (91.8%) isolates were susceptible to ciprofloxacin, 44 (91.6%) to TMP-SMX, and 21 (87.5%) to levofloxacin. Conclusions: Chryseobacterium and Elizabethkingia spp. are emergent, nosocomial pathogens and the majority of cases were older than the neonatal period. They were mainly seen in patients with long hospital stays, indwelling devices, and those who have received antibiotics within the last month, especially carbapenems. In addition, they were associated with bloodstream infection and malignancy. The most commonly useful antibiotics according to the resistance patterns were ciprofloxacin and TMP-SMX.

Nationale Forschung genießt aktuell viel zu wenig Beachtung, obwohl Österreich sich im europäischen Umfeld als forschungsintensiver Standort mit exzellenten Forschenden positionieren möchte. Das Projekt RIS Synergy befasst sich mit Möglichkeiten, nationale Forschung und Forschungskompetenz mit effizienten und international anerkannten Maßnahmen einer breiten Öffentlichkeit zugänglich zu machen und Forschende untereinander zu vernetzen. Dabei stehen internationale Erfahrungen erfolgreicher Umsetzungen und Anforderungen verschiedenster Zielgruppen im Vordergrund.

Das Projekt RIS Synergy (2020–2024) verfolgt institutionsübergreifend wesentliche Aspekte digitaler Transformation: Im Teilprojekt Schnittstellen und Standards werden standardisierte Austauschmöglichkeiten für Systeme von Förderorganisationen, Forschungsstätten und der öffentlichen Verwaltung geschaffen. Das Teilprojekt Konzeptstudie Forschungsportal befasst sich mit Rahmenbedingungen und Anforderungen eines nationalen Forschungsportals. RIS Synergy schafft Entlastung und Sichtbarkeit für den Wissenschaftsbetrieb durch die Umsetzung von Standards, die Digitalisierung von Services sowie die Vernetzung von Expertise. Der vorliegende Artikel gibt Einblick in Herangehensweise und Best Practices aus dem Projekt.

Dihalna pot pri otrocih se pomembno razlikuje od dihalne poti pri odraslih. Obstajajo anatomske in fiziološke posebnosti, na katere moramo biti posebej pozorni. Na prvem mestu sta dobra anamneza in klinični pregled, s katerima lahko predvidimo možno težko predihavanje z masko ali težave pri intubiranju. Obstajajo številni dejavniki, s pomočjo katerih lahko napovemo možnost težke intubacije, žal pa niso vsi vedno zanesljivi. Za vzpostavitev dihalne poti uporabljamo različne pripomočke, med katerimi ima vsak svoje mesto, svoje pozitivne in svoje negativne lastnosti. Endotrahelni tubus pa je edini pripomoček, ki varuje pred aspiriranjem. Ob težki intubaciji so nam v pomoč algoritmi za hitro in učinkovito reševanje težav. Pri otrocih lahko zaradi večje odzivnosti zgornjih dihal pride do laringospazma, kar je urgentno stanje in lahko hitro vodi v dihalni in celo srčni zastoj.

Problem definition: Prototyping and testing are an integral part of almost any new product development process, helping firms navigate the inherent uncertainties of creating new products. Recent developments in rapid prototyping, including technologies that enable cheaper low-fidelity tests, have opened up the possibilities for firms in reconfiguring their product development processes. Firms can, by choosing the level of evaluation fidelity, alter the traditional cost-quality trade-offs inherent in sequential prototyping. Methodology/results: The current article formulates a general model of sequential search where firms can proceed by obtaining noisy low-fidelity evaluations of their prototypes. Our results demonstrate that the imperfect fidelity of evaluations alters the firm's optimal experimentation, with the starkest difference being that it may make it optimal for the firm to select and launch a prototype that did not yield the best evaluation. In addition, our analysis of optimal measurement technology reveals that the focal firm should demand the most precise measurements when their ex-ante uncertainty is moderate (not too high or low). We also consider extensions analyzing how the optimal choice of evaluation fidelity is affected by the number of available prototypes, by operational flexibility (to dynamically change measurement technology), and by the ability to outsource evaluations to an experimentation platform. Managerial implications: We develop managerial insights for how the optimal choice of fidelity and the optimal length of the evaluation cycle should be planned depending on the evaluation costs and the firm's ex-ante uncertainty. The resulting framework offers guidance to product and software development firms to successfully leverage imperfect fidelity experiments. Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2024.1133. [ABSTRACT FROM AUTHOR]

Background: Timely and effective recanalization to salvage the penumbra is the main determinant of outcome in acute ischemic strokes. Randomized controlled trials on late window mechanical thrombectomy (MT) have proved its safety and efficacy upto 24 h after stroke onset. We looked at the impact of time to reperfusion on vessel recanalization rates and short-term outcome in patients undergoing MT for large vessel occlusion. Methods: The clinical, imaging, and outcome of all patients undergoing MT upto 24 h from last seen normal was extracted from a prospectively maintained ischemic stroke database from January 2012 till September 2019. Results: There were 145 patients with a mean (SD) age of 58.2 (±14) years. Of them, 28 had wake up/unknown time of onset stroke and 9 presented beyond >360 min. There were 23 vertebrobasilar strokes. Median National Institute of Health Stroke scale score (NIHSS) at admission was 16.4 (Inter quartile range (IQR) 12–21). CT-Alberta Stroke program early CT score (CT-ASPECTS) was excellent (8–10) in 39 (31.6%) and fair (5–7) in 77 (63.6%) patients in anterior circulation strokes. About 25% underwent bridging therapy. Recanalization rates did not differ between those presenting early (

Background: Understanding SARS-CoV-2 seroprevalence among health care personnel is important to explore risk factors for transmission, develop elimination strategies and form a view on the necessity and frequency of surveillance in the future. Methods: We enrolled 4927 health care personnel working in pediatric units at 32 hospitals from 7 different regions of Turkey in a study to determine SARS Co-V-2 seroprevalence after the first peak of the COVID-19 pandemic. A point of care serologic lateral flow rapid test kit for immunoglobulin (Ig)M/IgG was used. Seroprevalence and its association with demographic characteristics and possible risk factors were analyzed. Results: SARS-CoV-2 seropositivity prevalence in health care personnel tested was 6.1%. Seropositivity was more common among those who did not universally wear protective masks (10.6% vs 6.1%). Having a COVID-19-positive co-worker increased the likelihood of infection. The least and the most experienced personnel were more likely to be infected. Most of the seropositive health care personnel (68.0%) did not suspect that they had previously had COVID-19. Conclusions: Health surveillance for health care personnel involving routine point-of-care nucleic acid testing and monitoring personal protective equipment adherence are suggested as important strategies to protect health care personnel from COVID-19 and reduce nosocomial SARS-CoV-2 transmission.

Introduction: Carotid Endarterectomy (CEA) is the standard treatment for patients with symptomatic carotid stenosis. Data from Low- and Middle-Income Countries (LMIC) is sparse on CEA and its outcomes. We aimed to describe the profile of our patients, and factors associated with periprocedural cerebral ischemic events in patients with symptomatic carotid stenosis who underwent CEA in our institute. Methods: Retrospective review of patients with symptomatic carotid stenosis(50-99%) who underwent CEA between January 2011 and December 2021 was done. Clinical and imaging parameters and their influence on periprocedural cerebral ischemic events were analysed. Results: Of the 319 patients (77% males) with a mean age of 64 years (SD ±8.6), 207 (65%) presented only after a stroke. Majority (85%) had high grade stenosis (70%) of the symptomatic carotid. The mean time to CEA was 50 days (SD ±36), however only 26 patients (8.2%) underwent surgery within 2 weeks. Minor strokes and TIA occurred in 2.2%, while major strokes and death occurred in 4.1% patients. None of the clinical or imaging parameters predicted the periprocedural cerebral ischemic events. The presence of co-existing significant (50%) tandem intracranial atherosclerosis (n=77, 24%) or contralateral occlusion (n=24, 7.5%) did not influence the periprocedural stroke risk. Conclusion: There is a delay in patients undergoing CEA for symptomatic carotid stenosis. Majority have high grade stenosis and present late only after a stroke reflecting a lack of awareness. CEA can be performed safely even in patients with significant intracranial tandem stenosis and contralateral carotid occlusion.