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BACKGROUND: Recent advances in data-driven computational approaches have been helpful in devising tools to objectively diagnose psychiatric disorders. However, current machine learning studies limited to small homogeneous samples, different methodologies, and different imaging collection protocols, limit the ability to directly compare and generalize their results. Here we aimed to classify individuals with PTSD versus controls and assess the generalizability using a large heterogeneous brain datasets from the ENIGMA-PGC PTSD Working group. METHODS: We analyzed brain MRI data from 3,477 structural-MRI; 2,495 resting state-fMRI; and 1,952 diffusion-MRI. First, we identified the brain features that best distinguish individuals with PTSD from controls using traditional machine learning methods. Second, we assessed the utility of the denoising variational autoencoder (DVAE) and evaluated its classification performance. Third, we assessed the generalizability and reproducibility of both models using leave-one-site-out cross-validation procedure for each modality. RESULTS: We found lower performance in classifying PTSD vs. controls with data from over 20 sites (60 % test AUC for s-MRI, 59 % for rs-fMRI and 56 % for d-MRI), as compared to other studies run on single-site data. The performance increased when classifying PTSD from HC without trauma history in each modality (75 % AUC). The classification performance remained intact when applying the DVAE framework, which reduced the number of features. Finally, we found that the DVAE framework achieved better generalization to unseen datasets compared with the traditional machine learning frameworks, albeit performance was slightly above chance. CONCLUSION: These results have the potential to provide a baseline classification performance for PTSD when using large scale neuroimaging datasets. Our findings show that the control group used can heavily affect classification performance. The DVAE framework provided better generalizability for the multi-site data. This may be more significant in clinical practice since the neuroimaging-based diagnostic DVAE classification models are much less site-specific, rendering them more generalizable.

A growing number of studies have examined alterations in white matter organization in people with posttraumatic stress disorder (PTSD) using diffusion MRI (dMRI), but the results have been mixed which may be partially due to relatively small sample sizes among studies. Altered structural connectivity may be both a neurobiological vulnerability for, and a result of, PTSD. In an effort to find reliable effects, we present a multi-cohort analysis of dMRI metrics across 3047 individuals from 28 cohorts currently participating in the PGC-ENIGMA PTSD working group (a joint partnership between the Psychiatric Genomics Consortium and the Enhancing NeuroImaging Genetics through Meta-Analysis consortium). Comparing regional white matter metrics across the full brain in 1426 individuals with PTSD and 1621 controls (2174 males/873 females) between ages 18-83, 92% of whom were trauma-exposed, we report associations between PTSD and disrupted white matter organization measured by lower fractional anisotropy (FA) in the tapetum region of the corpus callosum (Cohen's d = -0.11, p = 0.0055). The tapetum connects the left and right hippocampus, for which structure and function have been consistently implicated in PTSD. Results were consistent even after accounting for the effects of multiple potentially confounding variables: childhood trauma exposure, comorbid depression, history of traumatic brain injury, current alcohol abuse or dependence, and current use of psychotropic medications. Our results show that PTSD may be associated with alterations in the broader hippocampal network.

Abstract The ten countries with the highest population during the pandemic were analyzed for clustering based on the quantitative numbers of COVID-19 and policy plans. The Fuzzy K-Means (FKM) and K-prototype algorithms were used for clustering, and various performance indices such as Partition Coefficient (PC), Partition Entropy (PE), Xie-Beni (XB), and Silhouette Fuzzy (SIL.F) were used for evaluating the clusters. The analysis included variables such as confirmed cases, tests, vaccines, school and workplace closures, event cancellations, gathering restrictions, transport closures, stay-at-home restrictions, international movement restrictions, testing policies, facial coverings, and vaccination policy statuses. PC, PE, XB, and SIL.F indices were used to analyze the performance indices of the clusters. The Elbow method was used to analyze the performance evaluations for the K-prototype. The K-prototype algorithm's performance evaluations were analyzed using the Elbow method, and the optimum number of clusters for both methods was found to be two. The first cluster included Brazil, Mexico, Nigeria, Bangladesh, US, Indonesia, Russia, and Pakistan, while the second cluster comprised India and China. The analysis also examined the relationship between population and confirmed tests and vaccines, and standardization was made for the country with the largest population for significant correlations. The results showed that the FKM method was superior to the K-prototype method in terms of clustering. In conclusion, it is crucial to accurately evaluate COVID-19 data for countries and develop appropriate policies. The clustering analysis using the FKM and K-prototype algorithms provides valuable insights into identifying groups of countries with similar COVID-19 data and policy plans.

Background: Recent advances in data-driven computational approaches have been helpful in devising tools to objectively diagnose psychiatric disorders. However, current machine learning studies limited to small homogeneous samples, different methodologies, and different imaging collection protocols, limit the ability to directly compare and generalize their results. Here we aimed to classify individuals with PTSD versus controls and assess the generalizability using a large heterogeneous brain datasets from the ENIGMA-PGC PTSD Working group. Methods: We analyzed brain MRI data from 3,477 structural-MRI; 2,495 resting state-fMRI; and 1,952 diffusion-MRI. First, we identified the brain features that best distinguish individuals with PTSD from controls using traditional machine learning methods. Second, we assessed the utility of the denoising variational autoencoder (DVAE) and evaluated its classification performance. Third, we assessed the generalizability and reproducibility of both models using leave-one-site-out cross-validation procedure for each modality. Results: We found lower performance in classifying PTSD vs. controls with data from over 20 sites (60 % test AUC for s-MRI, 59 % for rs-fMRI and 56 % for d-MRI), as compared to other studies run on single-site data. The performance increased when classifying PTSD from HC without trauma history in each modality (75 % AUC). The classification performance remained intact when applying the DVAE framework, which reduced the number of features. Finally, we found that the DVAE framework achieved better generalization to unseen datasets compared with the traditional machine learning frameworks, albeit performance was slightly above chance. Conclusion: These results have the potential to provide a baseline classification performance for PTSD when using large scale neuroimaging datasets. Our findings show that the control group used can heavily affect classification performance. The DVAE framework provided better generalizability for the multi-site data. This may be more significant in clinical practice since the neuroimaging-based diagnostic DVAE classification models are much less site-specific, rendering them more generalizable.

Background: Although chemotherapy-induced cardiotoxicity is an emerging problem, limited information is available on the effects of chemotherapy on left ventricular (LV) mechanical functions in patients with non-small cell lung cancer (NSCLC). Objective: We aimed to explore chemotherapy-induced alterations in cardiac mechanical functions in patients with NSCLC using speckle tracking echocardiography (STE). Methods: Seventy-one patients with NSCLC and 34 age and sex matched control subjects were consecutively included. Based on their good performance status (Eastern Cooperative Oncology Group performance status), 39 patients were treated with paclitaxel plus carboplatin (PC) regimen and 32 patients were treated with vinorelbine plus cisplatin (VC) regimen. All patients and controls underwent conventional two-dimensional echocardiography and STE at baseline to assess their LV functions. The echocardiographic examinations of NSCLC patients were repeated after the chemotherapy regimens. Results: None of the NSCLC patients developed any signs or symptoms of clinical heart failure during or after the chemotherapy. There were not any significant differences in LV ejection fraction between NSCLC patients and controls before and after chemotherapy. There were not any significant differences in baseline LV global longitudinal strain (GLS), radial strain (RS), and circumferential strain (CS) between NSCLC patients and controls. However, all LV GLS, RS and CS significantly decreased in patients treated with the PC regimen resulting in a significant difference compared to both VC group and controls while no significant decreases were observed in strain measures in VC group. Conclusion: Paclitaxel plus carboplatin, but not VC, may induce subclinical cardiotoxicity in patients with NSCLC, which may be detected by STE. Resumo: Introdução: Embora a cardiotoxicidade induzida pela quimioterapia seja um problema emergente, existe informação limitada sobre os efeitos da quimioterapia na função do ventrículo esquerdo (VE) em doentes com cancro do pulmão não de pequenas células (CPNPC). Objetivo: Avaliar alterações induzidas pela quimioterapia na função cardíaca em doentes com CPNPC utilizando a ecocardiografia de speckle tracking (EST). Métodos: Foram incluídos consecutivamente 71 doentes com CPNPC e 34 indivíduos caso controlo emparelhados por idade e género. Com base no seu desempenho (Eastern Cooperative Oncology Group performance status), 39 doentes foram tratados com regime de paclitaxel e carboplatina (PC) e 32 doentes foram tratados com regime de vinorelbina e cisplatina (VC). Todos os doentes e casos controlo foram submetidos a ecocardiografia bidimensional convencional (2DE) e a EST na fase basal para avaliar a função VE. As avaliações ecocardiográficas dos doentes com CPNPC foram repetidas após quimioterapia. Resultados: Nenhum dos doentes com CPNPC desenvolveu qualquer sinal ou sintoma clínico de insuficiência cardíaca durante ou após a quimioterapia. Não houve diferenças significativas na fração de ejeção do VE entre os doentes com CPNPC e os casos controlo antes e depois da quimioterapia. Não houve diferenças significativas nos valores basais da deformação longitudinal global do VE (GLS), deformação radial (RS) e deformação circunferencial (CS) do VE entre os doentes com CPNPC e os casos controlo. No entanto, todos os valores de deformação miocárdica VE diminuíram significativamente nos doentes tratados com o regime CP, resultando numa diferença significativa em comparação tanto com o grupo CV como com os casos controlo, embora não se tenham observado diminuições significativas nas medidas de strain no grupo VC. Conclusão: Apenas a PC, mas não a VC, pode induzir cardiotoxicidade subclínica em doentes com CPNPC, o que pode ser detetado por ecocardiografia de speckle tracking.

Systemic infections by avian pathogenic Escherichia coli (APEC) are economically damaging to poultry industries Worldwide. E. coli strains of serotypes O1, O2, O18 and O78 are preferentially associated with avian colibacillosis. The rfb gene cluster that controls O antigen synthesis generally varies among different E. coli serotypes. In this study, the rfb gene clusters of E. coli serotypes O1, O2, O18 and O78 were characterized and compared, and it was also aimed to search for Colistin resistance on a molecular basis. For the research, 200 swab samples were taken from 200 chickens suspected of colibacillosis in broiler poultry farms located in the vicinity of Aydın, İzmir, and Manisa Provinces in Turkey 2022. Bacterial growth was obtained from 92% of the samples, and microbiological analysis identified 108 (54%) Escherichia coli isolates. In addition, Klebsiella spp. was identified in 35 (17.5%) samples, Proteus spp. in 23 (11.5%), Pseudomonas spp. in 18 (9%), and no bacterial growth was observed in 16 (8%) samples. mcr-1 (309 bp) and mcr–2 (567 bp) genes responsible for Colistin resistance was investigated in plasmid DNA extracted from 108 E. coli isolates obtained in the study, using the PCR method. However, neither mcr-1 nor mcr–2 genes were detected in any of the samples. In conclusion, the allele-specific PCR method was found sensitive and applicable for APEC identification and multiple drug resistance emerged in E. coli strains isolated according to the antibiogram results.

Objective This study aimed to define the association between altitude and ticagrelor-associated dyspnea in patients with acute coronary syndrome (ACS). Methods We studied consecutive patients with de novo ACS who were admitted to two centers at a low altitude (18 and 25 m, n = 65) and two centers at a high altitude (1313 and 1041 m, n = 136). We managed them with ticagrelor between May 2017 and September 2017. Patients with ACS underwent an interventional procedure within

Background Mechanical bowel obstruction (MBO) is one of the principal pathologies requiring emergency surgery and a significant worldwide cause of morbidity. The identification of patients in whom bowel obstruction resolves spontaneously is important in terms of preventing unnecessary surgical interventions and future potential adhesions. The decision-making process is difficult in patients presenting without classic examination findings. Methods 36 female Sprague-Dawley rats randomly divided into six experimental groups. In Group 1, 3 and 5, laparotomy was performed, with blood and tissue specimens being collected after 1, 2 and 6 h, respectively. In Group 2, 4 and 6, the ileum segment was ligated following laparotomy, and blood and tissue specimens were collected after 1, 2 and 6 h, respectively. The ileum specimens were examined macroscopically, after which 1-cm sections were taken and examined in terms of histopathological changes. IMA and SCUBE-1 levels were determined for each group, and macro- and microscopic tissue examination findings were compared between the groups. Results Comparison within the groups exposed to waiting times of 1 h (groups 1 and 2), 2 h (groups 3 and 4) and 6 h (groups 5 and 6) revealed higher mean IMA and SCUBE-1 levels in rats undergoing ligation together with incision (groups 2, 4, and 6) compared to those undergoing laparotomy only (groups 1, 3, and 5). Correlation analysis was applied to determine the relationship between total scores obtained from histopathological examination and IMA and SCUBE-1 values. The analysis revealed strong, significant and positive correlation between histopathological examination scores and IMA (r=0.643, p=0.000) and SCUBE-1 (r=0.509, p=0.002) values. Conclusion The study findings showed that both IMA and SCUBE-1 values increased in a strangulated MBO model in rats. We think that IMA and SCUBE-1 values can be used as a markers of damage in the early period in strangulated MBO, and that the patient's surgery requirement can thus be determined in the early period.

India in a Warming World: Integrating Climate Change and Development Navroz K. Dubash (ed.) New Delhi, Oxford University Press, 2019, 576 pages, ISBN-13 (eBook): 978-0-19-909839-2 In India climate change claims [...]

Aim:Multidrug-resistant (MDR) tuberculosis (TB) and drug-sensitive-TB have long treatment periods which affect patient compliance and treatment outcomes. We planned to determine the factors that will affect the management of this disease in the elderly population.Methods:In a period of two years, a total of 82 elderly patients with bacteriologically proven TB enrolled into our retrospective study between 2011-2018. The patients’ demographic features, laboratory findings, and hospital records were analyzed.Results:We enrolled 67 (87.7%) patients with drug-sensitive TB and 15 (18.2%) MDR-TB in our study. In the study population, 73.2% (n=60) were male and the mean age was 75±9 years. When we compare treatment complications of MDR-TB and drug-sensitive-TB, we found out the rate of electrolyte imbalance, nephrotoxicity, and ocular toxicity more common among the MDR-TB group (p=0.008, p=0.008, and p=0.032, respectively). When we compare the mortality rate, cure, and treatment success between MDR-TB and drugsensitive TB, there were no statistically significant results (p=0.898, p=0.549, p=0.488; respectively).Conclusion:However, we think that this was due to the low sample size. Nevertheless, we should be careful in terms of complications management of the geriatric population.

Purpose: This study aimed to evaluate the effect of pain intensity levels and clinical symptoms on the treatment preferences of patients with endodontically involved teeth in a local Turkish population. Subjects and Methods: A total of 30 patients with symptomatic teeth requiring non-surgical root canal treatment were included in the study. The patients’ demographic (age, gender, and education level) and diagnostic data (tooth type, pain intensity, response to percussion and palpation, presence of referred pain, and diagnosis) were analyzed. Data on the patients’ explicit preferences (requested treatment, whether they are willing to accept a proposed extraction, choice of treatment if an anterior tooth was involved, and choice of treatment if the pain was not severe) as well as previous root canal treatment experiences were also analyzed. Pain intensity levels were evaluated using the Visual Analog Scale. Results: Pain intensity levels had a significant effect on the treatment requested by the patient (p=0.001). Among the patients who requested extraction upon referral to the clinic, the rate of those who reported that they would not accept extraction if the pain was located in an anterior tooth was significantly lower than that of patients stating that they would refuse (p=0.039). The presence of referred pain also had a significant effect on the requested treatment (p=0.001). Conclusion: The intensity of pain and the presence of referred pain influence patients’ treatment preferences.

OBJECTIVES: This study aimed to evaluate pain management practices in the emergency departments (EDs) in Turkey and to evaluate the prevalence and etiologies of oligoanalgesia to identify possible improvement strategies.METHODS: This multicenter cross-sectional observational study was conducted in 10 tertiary care hospitals in Turkey. Patients who were admitted to the ED with pain chief complaints were included in the study. Both patients and physicians were surveyed with two separate forms by the research associates, respectively. The patient survey collected data about the pain and the interventions from the patients' perspective. The pain was evaluated using the Numerical Rating Scale. The physician survey collected data to assess the differences between study centers on pain management strategies and physician attitudes in pain management.RESULTS: Ten emergency physicians and 740 patients (male/female: 365/375) enrolled in the study. The median pain score at admission at both triage and ED was 7 (interquartile range: 5–8). The most frequent type of pain at admission was headache (n = 184, 24.7%). The most common analgesics ordered by physicians were nonsteroidal anti-inflammatory drugs (n = 505, 67.9%), and the most frequent route of administration was intramuscular injection (n = 396, 53.2%). About half of the patients (n = 366, 49.2%) received analgesics 10–30 min from ED admission. The posttreatment median pain score decreased to 3 (P < 0.001). About 79.2% of patients did not need a second analgesic administration (n = 589), and opioid analgesics were the most frequently administered analgesic if the second application was required. Physicians prescribed an analgesic at discharge from the ED in 55.6% of the patients (n = 414) and acute pain was present in 7.5% (n = 56) of the patients.CONCLUSION: Our study on the pain management practices in the EDs in Turkey suggested that high rate of intramuscular analgesic use and long emergency room stay durations are issues that should constitute the focus of our quality improvement efforts in pain management.

Background and Objectives: There is a lack of information regarding the effective duration of treatment necessary to prevent the development of acquired resistance when fluoroquinolones (FQ), and/or pyrazinamide (Z) resistance has occurred in patients with polydrug-resistant tuberculosis and isoniazid resistance. The management of these kinds of patients should be carried out in experienced centers according to drug susceptibility test results, clinical status of the patient and the extensity of the disease. Materials and Methods: We evaluated treatment regimens, treatment outcomes, and drug adverse effects in seven patients with polydrug-resistant tuberculosis, including those with Z and/or FQ resistance in a retrospective analysis Results: Regarding the patients with polydrug-resistant tuberculosis in addition to isoniazid (H) resistance, three had Z, two had FQ, and the remaining two had both Z and FQ resistance. In the intensive phase of the treatment, the patients were given at least four drugs according to drug susceptibility tests, and at least three drugs in the continuation phase. The duration of treatment was 9–12 months. Two of the patients were foreign nationals, and could not be followed up with due to returning to their home countries. Regarding the remaining five patients, three of them were terminated as they completed treatment, and two as cured. No recurrence was observed in the first year of the treatment. The most common, and serious drug side effect was seen for amikacin. Conclusions: In patients with polydrug-resistant TB, if Z and/or FQ resistance is detected in addition to H resistance, the treatment of these patients should be conducted on a case-by-case basis, taking into account the patient’s resistance pattern, clinical condition, and disease prognosis. Close monitoring of the side effects will increase the success rate of the treatment.

Purpose Detection of end-organ damage (EOD) in systemic hypertension is essential for the management of systemic hypertension. We aimed to evaluate subfoveal choroidal thickness (SFCT) and retinal layers’ thicknesses by using spectral domain optical coherence tomography (SD‑OCT) in patients with systemic hypertension and to assess the relationship between EOD and SD-OCT parameters. Methods A total of 189 consecutive patients with systemic hypertension and 100 controls were included. Patients were examined to detect EOD including hypertensive retinopathy (HTRP), left ventricular hypertrophy assessed by transthoracic echocardiography and microalbuminuria assessed by 24-h urine analysis. SFCT, inner plexiform-ganglion cell complex (IP-GCC), peripapillary retinal nerve fiber layer (pRNFL) and central macular thickness (CMT) were measured with SD-OCT. Results Patients with systemic hypertension had significantly lower SFCT and retinal layer thicknesses than controls (P˂0.001). In the dilated fundus photographic evaluation, 94 patients with systemic hypertension had HTRP and these patients had lower SFCT, CMT, IP-GCC and pRNFL thicknesses compared to hypertensive patients without HTRP and healthy controls. Patients with EOD had significantly lower SFCT, CMT, IP-GCC and pRNFL thicknesses and as the number of EOD increased, the SFCT decreased significantly. In the multivariate analysis, SFCT was found as an independent predictor of EOD (P˂0.001, odds ratio: 0.0605). Conclusion Hypertensive patients, especially with EOD had significantly lower SD-OCT parameters compared to controls. It would be rational to add SD-OCT assessment to conventional hypertensive retinopathy evaluation in patients with systemic hypertension for early diagnosis of end-organ damage, burden of target organ involvement and monitoring anti-hypertensive treatment.

The aim of present study is to evaluate left ventricular (LV) functions using speckle tracking echocardiography (STE) after iron therapy in patients with iron deficiency anemia (IDA). We consecutively enrolled 92 patients with IDA who needed iron therapy and 82 age- and gender-matched healthy volunteers in our study. Their clinical, laboratory, conventional two-dimensional echocardiography (2DE), and STE examinations were performed to all patients before and after iron therapy. Echocardiographic measurements were compared with healthy controls. The hemoglobin level increased after iron therapy (7.2±2.9 vs. 12.1±2.0, p [Med-Science 2019; 8(4.000): 947-52]