The usability of the ratio of bi-humerus breadth to maximum pelvic breadth in sex estimation.

BACKGROUND: Although sex can be determined with high accuracy in forensic anthropology, additional parameters are still required. AIM: To estimate with known simple statistical methods, the usability of the bi-humerus/maximum pelvic breadth ratio in sex estimation. SUBJECTS AND METHODS: Bi-humerus breadth and maximum pelvic breadth were measured using the topogram images (196 males, 171 females), the ratio between them was calculated. We examined the usability of the ratio of the distance between the lateral edges of the right and left humeral heads to the maximum distance between the two most lateral parts of the iliac crests in sex estimation. RESULTS: There was significant difference in the bi-humerus breadth and "bi-humerus breadth/maximum pelvic breadth" according to sex. The greatest breadth of the pelvis was higher in females, yet the difference was not statistically significant. The ratio yielded 80.6%-90.3% accuracy for females and 73.6%-74.7% for males, depending on arm position. CONCLUSIONS: The obtained data may contribute to the development of formulas created with metric measurements used in sex estimation. This can be used as a parameter to help in estimating the sex of skeletal remains found as a whole or excavated without losing their integrity, and also in the reconstruction of body structure.

Pharmacoeconomic evaluation of micafungin versus caspofungin as definitive therapy for candidaemia and invasive candidiasis (IC) in Turkey.

Micafungin was shown to be as efficacious as caspofungin in treating patients with candidaemia and invasive candidiasis (IC). However, it remains unknown if micafungin or caspofungin is a cost-effective definitive therapy for candidaemia and IC in Turkey. The present study aimed to determine the economic impact of using micafungin versus caspofungin for treatment of candidaemia and IC in the Turkish setting. A decision analytic model was constructed and was populated with data (i.e. transition probabilities, duration of initial antifungal treatment, reasons for treatment failure, percentage of patients who stepped down to oral fluconazole, and duration on oral fluconazole) obtained from a published randomised clinical trial. Cost inputs were derived from the latest Turkish resources while data that were not readily available in the literature were estimated by expert panels. One-way sensitivity analyses, threshold analyses, scenario analyses and probabilistic sensitivity analyses were conducted. Caspofungin (€2693) incurred a lower total cost than micafungin (€4422), with a net cost saving of €1729 per treated patient. Drug acquisition cost was the main cost driver for both study arms. The model outcome was robust over wide variations (of ±100.0% from the base case value) for all input parameters except for micafungin drug cost and the duration of initial treatment with micafungin. Caspofungin appears to be a cost-saving option in treating candidaemia and IC from the Turkish hospital perspective.

Cost effectiveness of caspofungin vs. voriconazole for empiric therapy in Turkey.

Invasive fungal infections from febrile neutropenia are associated with significant cost and mortality. The mainstay of treatment has been liposomal amphotericin B, however, echinocandins and azoles have shown promise as alternative treatments. Data on clinical efficacy exist, however, data incorporating pharmacoeconomic considerations are required in Turkey. The aim of this study was to investigate the cost effectiveness of caspofungin vs. voriconazole in empiric treatment of febrile neutropenia in Turkey. A decision analytic model was utilised, built upon two randomised-controlled trials and supplemented with expert panel input from clinicians in Turkey. A five-point composite outcome measure was utilised and sensitivity analyses were performed to demonstrate the robustness of the model. The base case scenario resulted in caspofungin being preferred by TL2,533, TL29,256 and TL2,536 per patient treated, successfully treated patient and patient survival, respectively (approx. USD1414, 16 328 and 1415); sensitivity analyses did not change the outcome. Monte Carlo simulation highlighted a 78.8% chance of favouring caspofungin. The result was moderately sensitive to treatment duration and acquisition cost of the antifungal agents compared. This is the first pharmacoeconomic study comparing caspofungin to voriconazole within Turkey, resulting in an advantage towards caspofungin. The study will aid in formulary decision-making based on the clinical and economic consequences of each agent in the Turkish health care setting.

A comparison of Ki 67 proliferative index in primary tumor and axillary metastatic lymph nodes with length of survival in patients with breast cancer.

OBJECTIVE: The aim of the present study was to investigate the possibility to predict the histopathological features of breast and metastatic lymph nodes and survey and prognosis of patients and likelihood of being a predictive factor for treatment by using Ki67 immunohistochemical stain. MATERIALS AND METHODS: 95 patients who were admitted to Uludag University Medical Faculty, Department of General Surgery with a diagnosis of stage II-III breast cancer between dates May 1997 and December 2002 were retrospectively evaluated with respect to breast cancer related prognostic factors treatments and last-control related data. Ki67 immunohistochemical staining was performed to appropriate specimens using Streptavidin-biotin technique. Ki67 was reported as the proliferation index, and the number of stained nuclei were stated to be / 1000. RESULTS: In the evaluation of the lymph node by univariate analysis, we ascertained that duration of survival is shorter above the 227 cut-off value for Ki67 proliferative index. Length of survival of patients with tumor Ki67 proliferative index below 141 and with no distant metastasis was established to be better. Ki67 proliferative index in the lymph node was detected to increase more with increasing histological and nuclear grade, estrogen and progesterone receptor negativity and at stage III. CONCLUSION: Since numerous factors are effective on breast cancer, each patient and tumor behaves differently. A lot of prognostic factors are taken into account while treatment choice is determined. We may have information on the biological behavior of the tumor in patients who underwent sentinel lymph node biopsy or axillary dissection in staining with Ki67 pattern (Tab. 5, Fig. 3, Ref. 13).

Pharmacoeconomic evaluation of caspofungin versus liposomal amphotericin B in empirical treatment of invasive fungal infections in Turkey.

Invasive fungal infections (IFIs) are a major concern within healthcare systems. This pharmacoeconomic study evaluated the use of caspofungin (CAS) versus liposomal amphotericin B (L-AmB) in the empirical treatment of IFIs within the Turkish healthcare system. A decision-analytic model was adopted, utilising data from a randomised, non-inferiority clinical trial and a panel of clinical experts in Turkey. A five-point composite outcome measure was used to evaluate both agents. Sensitivity analyses were performed. In the base-case scenario, CAS was preferred over L-AmB by Turkish Lira (TL) 3961 per patient treated, TL 12 904 per successfully treated patient and TL 3972 per death averted. One-way sensitivity analysis did not change the study outcome. Monte Carlo simulation concluded a 71.0% chance of the outcome favouring CAS. The results were most sensitive to changes in length of stay. This is the first economic evaluation of the empirical treatment of IFIs in Turkey and suggests that CAS is more cost effective than L-AmB.

H1N1 infection in a cohort of hematopoietic stem cell transplant recipients: prompt antiviral therapy might be life saving.

Influenza A H1N1 virus, causing a pandemic since spring 2009, has been an important cause of morbidity and mortality worldwide. Patients with hematological malignancies and hematopoietic stem cell transplant (HCT) recipients are in a high-risk group and might require hospitalization more commonly because of H1N1 infection. Early demonstration of H1N1 influenza virus and commencing antiviral therapy promptly can be life saving particularly in immunosuppressed patients. We retrospectively reviewed the data of 10 HCT recipients who were diagnosed with influenza H1N1 infection at the Stem Cell Transplantation Unit of Gazi University Hospital in Turkey, from October through December 2009. All patients, except 1, were started empirically on oseltamivir on admission, after nasopharyngeal and oropharyngeal sampling for H1N1 virus. Four of the patients, 2 of whom developed pneumonia, required hospitalization. One of the patients with pneumonia died of respiratory failure caused by bacterial co-infection. The course of the remaining patients was uneventful. In conclusion, HCT recipients infected with H1N1 during the influenza H1N1 pandemic did not necessarily have an adverse prognosis, particularly with prompt administration of the appropriate antiviral therapy.

Hematopoietic stem cell transplantation in patients with active fungal infection: not a contraindication for transplantation.

Increasing use of more aggressive treatment approaches in patients with hematologic malignancies leads to an increased frequency of invasive fungal infections, which is a major cause of transplant-related mortality in hematopoietic stem cell recipients. In this respect, the presence of an active fungal infection prior to transplantation may hinder subsequent hematopoietic stem cell transplantation (HSCT); which sometimes is the only curative treatment. We report here the results of 13 consecutive patients transplanted with active fungal infection. Thirteen patients (7 males and 6 females) with a median age of 34 years (range, 16-53 years) underwent 15 HSCT between September 2003 and April 2007. In this group of 15 patients, consisting of hematologic malignancies with high risk of relapse or severe aplastic anemia, 11 (73%) transplants performed in subjects with active invasive fungal infection (IFI) patients survived 30 days after transplantation. Three patients (1 patient with primary disease relapse, 1 patient with graft versus host disease [GVHD] complicated with fungal pneumonia, and 1 patient with severe sinusoidal obstruction syndrome and GVHD complicated with aspiration pneumonia) died on days +66, +74, and +62 posttransplantation, respectively, within the first 100 days of HSCT. After a median follow-up time of 306 days (range, 145-680 days), four of 13 (31%) patients with active IFI were alive and disease free. Among a population of HSCT recipients with a dismal prognosis without transplantation, performing the procedure despite active IFI saved a considerable proportion of the patients. The presence of active IFI did not seem to be an absolute contraindication for HSCT, particularly among high-risk patients in whom a treatment delay could be fatal.

Age and duration of disease as factors affecting clinical findings and sacroiliitis in brucellosis.

OBJECTIVE: Brucellosis may be seen in any age group, but it still involves young and middle aged adults more frequently. Our aim was to investigate the relationship between age and the duration of disease on clinical findings of brucellosis in adults in this study. PATIENTS AND METHOD: One hundred and sixty-three patients with brucellosis, treated in our hospital, between 1997 and 2003, were evaluated retrospectively. RESULTS: Fever was found in 60.7% of the patients, and it was significantly higher when the duration of disease was less than one month (p = 0.03). Fever was significantly lower in the > or = 65 age group (p = 0.01). Sacroiliitis was detected in 44.1% of patients. Sacroiliitis was significantly higher in the 15-35 age group (p = 0.03). There were no differences between age groups and other clinical and laboratory findings. CONCLUSIONS: Sacroiliac involvement was noted particularly in young adults who manifested lumbar pain and fever, but this might not be a major symptom of brucellosis in the elderly, or in patients showing symptoms for more than a month.

Stenotrophomonas maltophilia: the significance and role as a nosocomial pathogen.

Stenotrophomonas maltophilia is a significant pathogen that primarily affects patients with co-morbid illnesses, usually malignancies, who have been hospitalized for prolonged periods and received broad-spectrum antibiotic therapy. The organism has been associated with an expanding spectrum of clinical manifestations associated with high case to fatality ratios. Therapy of these infections presents a significant challenge both for the clinician and the microbiologists because of its high-level antibiotic resistance to most of the currently used agents and methodological difficulties in susceptibility testing with this organism.

A case report of multicentric Castleman's disease with simultaneous Epstein-Barr virus infection.

Castleman's disease is a rare B-cell lymphoproliferative disorder of unknown etiology. In this report we describe a 54-year-old woman with a 10-year history of asymptomatic bilateral, multiple cervical lymph node enlargements. She was not evaluated by lymph node biopsy during this period. She had been well until four months previously. The patient presented with multiple enlarged lymph nodes and systemic symptoms including fever, sweats, weight loss, and anorexia. Two lymph nodes were biopsied, yielding a diagnosis of multicentric Castleman's disease (MCCD) of mixed hyaline-vascular and plasma cell type histology. Serologic studies revealed the simultaneous presence of an acute Epstein-Barr virus (EBV) infection. She experienced an aggressive clinical course with a fatal outcome.

Effect of exposure variation on the clinical utility of chest radiographs.

PURPOSE: To study the effects of exposure error on the clinical utility of chest radiographs. MATERIALS AND METHODS: Under- and overexposed screen-film images were simulated by adding exposure offsets to the normalized CR log(10) exposure data from a computed radiography (CR) system and printed by using the sensitometric response of a medium-latitude system. The clinical utility of the overall image, lung, and soft tissue in 48 images were independently graded by eight radiologists. RESULTS: Most variability in image scores was due to differences in exposure. About 95% of the lung regions and 75% of the soft-tissue regions were rated as having good or ideal clinical utility at the nominal exposure. About 80% of the overall images were rated as good or better for exposures within 40% [0.15 log(10) exposure] of the nominal. The overall image scores were heavily influenced by the lung region, and reader tolerance for exposure error was greater for soft tissue than for lung. The optimal exposure for soft tissue was about 60% [0.25 log(10) exposure] greater than for lung; therefore, no single exposure was optimal for the entire image. CONCLUSION: Conventional medium-latitude screen-film systems have intrinsic limitations for capturing and displaying the wide transmittance differences in the thorax. The clinical utility of chest radiographs may be improved by developing better image capture and display techniques.

Prophylactic use of fluconazole in neutropenic cancer patients.

This study was carried out on 70 patients with haematological or solid malignancies who were receiving chemotherapy and/or radiotherapy. Forty-one patients were randomly assigned to receive fluconazole, 400 mg/day, while they were neutropenic. Systemic fungal infection developed in four of the 41 patients (9%) receiving prophylaxis in comparison to nine of 29 patients (31%) not receiving prophylaxis. The incidence of systemic fungal infection was significantly different between the groups receiving prophylaxis and those not receiving it (p < 0.05). Fluconazole was found to be effective for preventing systemic fungal infections in neutropenic patients with cancer.

[A food-borne outbreak of group A streptococcal pharyngitis]. / Bir kamu kurulusunda görülen besin kaynakli A grubu streptokok farenjiti epidemisi.

In August 1988, following a luncheon, an explosive epidemic of pharyngitis due to group A streptococci (M type 11, T type 3/13/B3264 and opacity factor positive) occurred among the staff of an institution in Ankara. Epidemiological investigation indicated that the outbreak was food-borne. A salad prepared by bean with boiled egg was incriminated as the vehicle of transmission. Group A streptococci were isolated from the throats of 37 (63.8 percent) of 58 persons with pharyngitis. High levels of antistreptolysin O titers were observed in serum samples from 39 (81.2 percent) of 48 persons with pharyngitis. Secondary transmission had accounted for only 3.8% of cases.