RÉSUMÉ
An influential observation is any point that has a huge effect on the coefficients of a regression line fitting the data. The presence of such observations in the data set reduces the sensitivity and validity of the statistical analysis. In the literature there are many methods used for identifying influential observations. However, many of those methods are highly influenced by masking and swamping effects and require distributional assumptions. Especially in the presence of influential subsets most of these methods are insufficient to detect these observations. This study aims to develop a new diagnostic tool for identifying influential observations using the meta-heuristic binary particle swarm optimization algorithm. This proposed approach does not require any distributional assumptions and also not affected by masking and swamping effects as the known methods. The performance of the proposed method is analyzed via simulations and real data set applications.
RÉSUMÉ
OBJECTIVE: The aim of this study was to analyze the temporal trends of HIV epidemiology in Turkey from 2011 to 2016. METHODS: Thirty-four teams from 28 centers at 17 different cities participated in this retrospective study. Participating centers were asked to complete a structured form containing questions about epidemiologic, demographic and clinical characteristics of patients presented with new HIV diagnosis between 2011 and 2016. Demographic data from all centers (complete or partial) were included in the analyses. For the cascade of care analysis, 15 centers that provided full data from 2011 to 2016 were included. Overall and annual distributions of the data were calculated as percentages and the Chi square test was used to determine temporal changes. RESULTS: A total of 2,953 patients between 2011 and 2016 were included. Overall male to female ratio was 5:1 with a significant increase in the number of male cases from 2011 to 2016 (p<0.001). The highest prevalence was among those aged 25-34 years followed by the 35-44 age bracket. The most common reason for HIV testing was illness (35%). While the frequency of sex among men who have sex with men increased from 16% to 30.6% (p<0.001) over the study period, heterosexual intercourse (53%) was found to be the most common transmission route. Overall, 29% of the cases presented with a CD4 count of >500 cells/mm3 while 46.7% presented with a CD4 T cell count of <350 cells/mm3. Among newly diagnosed cases, 79% were retained in care, and all such cases initiated ART with 73% achieving viral suppression after six months of antiretroviral therapy. CONCLUSION: The epidemiologic profile of HIV infected individuals is changing rapidly in Turkey with an increasing trend in the number of newly diagnosed people disclosing themselves as MSM. New diagnoses were mostly at a young age. The late diagnosis was found to be a challenging issue. Despite the unavailability of data for the first 90, Turkey is close to the last two steps of 90-90-90 targets.
Sujet(s)
Infections à VIH/épidémiologie , VIH (Virus de l'Immunodéficience Humaine)/pathogénicité , Hepacivirus/pathogénicité , Virus de l'hépatite B/pathogénicité , Hépatite B/épidémiologie , Hépatite C/épidémiologie , Adolescent , Adulte , Agents antiVIH/usage thérapeutique , Thérapie antirétrovirale hautement active , Numération des lymphocytes CD4 , Lymphocytes T CD4+/effets des médicaments et des substances chimiques , Lymphocytes T CD4+/virologie , Enfant , Enfant d'âge préscolaire , Co-infection , Retard de diagnostic , Femelle , VIH (Virus de l'Immunodéficience Humaine)/effets des médicaments et des substances chimiques , VIH (Virus de l'Immunodéficience Humaine)/physiologie , Infections à VIH/traitement médicamenteux , Infections à VIH/mortalité , Infections à VIH/virologie , Hepacivirus/effets des médicaments et des substances chimiques , Hepacivirus/physiologie , Hépatite B/traitement médicamenteux , Hépatite B/mortalité , Hépatite B/virologie , Virus de l'hépatite B/effets des médicaments et des substances chimiques , Virus de l'hépatite B/physiologie , Hépatite C/traitement médicamenteux , Hépatite C/mortalité , Hépatite C/virologie , Hétérosexualité/statistiques et données numériques , Homosexualité masculine/statistiques et données numériques , Humains , Incidence , Nourrisson , Mâle , Adulte d'âge moyen , Études rétrospectives , Analyse de survie , Turquie/épidémiologie , Charge virale/effets des médicaments et des substances chimiquesRÉSUMÉ
OBJECTIVES: Integrase strand transfer inhibitor (INSTI) is a new class of antiretroviral (ARV) drugs designed to block the action of the integrase viral enzyme, which is responsible for insertation of the HIV-1 genome into the host DNA. The aim of this study was to evaluate for the first time INSTI resistance mutations in Turkish patients. METHODS: This study was conducted in Turkey, between April 2013 and April 2015 using 169 HIV-1-infected patients (78 ARV naive patients and 91 ARV-experienced patients). Laboratory and clinical characteristics of ARV naive and ARV-experienced patients were as follows: gender (M/F): 71/7 and 80/11, median age: 38 and 38.4; median CD4(+) T-cell: 236 and 216 cells/mm(3), median HIV-1 RNA: 4.95+E5 and 1.08E+6 copies/ml. Population-based seqeunces of the reverse transcriptase, protease, and integrase domains of the HIV-1 pol gene were used to detect HIV-1 drug resistance mutations. RESULT: INSTI resistance mutations were not found in recently diagnosed HIV-1-infected patients. However, ARV-experienced patients had major resistance mutations associated with raltegravir and elvitegravir; the following results were generated:F121Y, Y143R, Q148R and E157Q (6/91 - 6.6%). CONCLUSIONS: The prevalence of INSTI resistant mutations in ART-experienced patients suggested that resistance testing must be incorporated as an integral part of HIV management with INSTI therapies.
Sujet(s)
Résistance virale aux médicaments , Infections à VIH/traitement médicamenteux , Infections à VIH/virologie , Inhibiteurs de l'intégrase du VIH/usage thérapeutique , VIH-1 (Virus de l'Immunodéficience Humaine de type 1)/effets des médicaments et des substances chimiques , VIH-1 (Virus de l'Immunodéficience Humaine de type 1)/génétique , Mutation , Adulte , Sujet âgé , Substitution d'acide aminé , Numération des lymphocytes CD4 , Codon , Co-infection , Femelle , Génotype , Infections à VIH/transmission , Inhibiteurs de l'intégrase du VIH/pharmacologie , Humains , Mâle , Tests de sensibilité microbienne , Adulte d'âge moyen , ARN viral , Facteurs de risque , Turquie , Charge virale , Jeune adulteRÉSUMÉ
We aimed to describe clinical, laboratory, diagnostic and therapeutic features of spinal tuberculosis (ST), also known as Pott disease. A total of 314 patients with ST from 35 centres in Turkey, Egypt, Albania and Greece were included. Median duration from initial symptoms to the time of diagnosis was 78 days. The most common complications presented before diagnosis were abscesses (69%), neurologic deficits (40%), spinal instability (21%) and spinal deformity (16%). Lumbar (56%), thoracic (49%) and thoracolumbar (13%) vertebrae were the most commonly involved sites of infection. Although 51% of the patients had multiple levels of vertebral involvement, 8% had noncontiguous involvement of multiple vertebral bodies. The causative agent was identified in 41% of cases. Histopathologic examination was performed in 200 patients (64%), and 74% were consistent with tuberculosis. Medical treatment alone was implemented in 103 patients (33%), while 211 patients (67%) underwent diagnostic and/or therapeutic surgical intervention. Ten percent of the patients required more than one surgical intervention. Mortality occurred in 7 patients (2%), and 77 (25%) developed sequelae. The distribution of the posttreatment sequelae were as follows: 11% kyphosis, 6% Gibbus deformity, 5% scoliosis, 5% paraparesis, 5% paraplegia and 4% loss of sensation. Older age, presence of neurologic deficit and spinal deformity were predictors of unfavourable outcome. ST results in significant morbidity as a result of its insidious course and delayed diagnosis because of diagnostic and therapeutic challenges. ST should be considered in the differential diagnosis of patients with vertebral osteomyelitis, especially in tuberculosis-endemic regions. Early establishment of definitive aetiologic diagnosis and appropriate treatment are of paramount importance to prevent development of sequelae.
Sujet(s)
Tuberculose vertébrale/épidémiologie , Tuberculose vertébrale/anatomopathologie , Adolescent , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Antituberculeux/administration et posologie , Maladies endémiques , Femelle , Humains , Coopération internationale , Mâle , Région méditerranéenne/épidémiologie , Adulte d'âge moyen , Études rétrospectives , Procédures de chirurgie opératoire , Analyse de survie , Résultat thérapeutique , Tuberculose vertébrale/traitement médicamenteux , Tuberculose vertébrale/chirurgie , Jeune adulteSujet(s)
Techniques bactériologiques/méthodes , État de porteur sain/diagnostic , Milieux de culture/composition chimique , Infections bactériennes à Gram positif/diagnostic , Rectum/microbiologie , Entérocoques résistants à la vancomycine/isolement et purification , État de porteur sain/microbiologie , Infections bactériennes à Gram positif/microbiologie , Humains , Sensibilité et spécificitéRÉSUMÉ
PURPOSE: There has been a long-standing interest in the identification of medicinal plants and derived natural products for developing anticancer agents. This work aimed at investigating the antiprolipherative properties of Origanum acutidens (OA) on breast cancer. METHODS: OA water extracts were studied for cytotoxicity against the breast cancer cell lines MCF-7, MDA-MB-468 and MDA-MB-231. In vitro apoptosis studies of these cancer cell lines were performed by annexin V staining in flow cytometry analyses. Immunohistochemistry studies for Ki-67 and caspase-7 of tumor tissue sections of dimethylbenzanthracene (DMBA) -induced mammary cancer in rats were also performed. TUNEL assay was used to detect apoptotic cells of tumor tissue. In vivo anticancer activity testing was carried out by inhibiting the growth of DMBA-induced mammary cancer in rats. RESULTS: OA showed cytotoxicity on all 3 cancer cell lines. Annexin-positive cells level in OA-treated cell lines were significantly higher compared with untreated control cells (p=0.002). The expressions of caspase-7 protein and TUNEL-positive cells were much higher for the rats treated by OA, compared with the untreated control group (p<0.05). The expressions of the Ki-67 decreased in the treated groups compared with the control group (p<0.05). In vivo studies showed that the mean tumor volume inhibition ratio in OA-treated group was 41 % compared with the untreated rats (p<0.05). CONCLUSION: These results indicate that OA has antitumor activity against breast cancer cell lines.
Sujet(s)
Antinéoplasiques d'origine végétale/pharmacologie , Apoptose/effets des médicaments et des substances chimiques , Tumeurs du sein/traitement médicamenteux , Origanum/composition chimique , Extraits de plantes/pharmacologie , 7,12-Diméthyl-benzo[a]anthracène , Animaux , Annexine A5/métabolisme , Antinéoplasiques d'origine végétale/isolement et purification , Marqueurs biologiques tumoraux/métabolisme , Tumeurs du sein/métabolisme , Tumeurs du sein/anatomopathologie , Caspase-7/métabolisme , Relation dose-effet des médicaments , Femelle , Cytométrie en flux , Humains , Immunohistochimie , Méthode TUNEL , Antigène KI-67/métabolisme , Cellules MCF-7 , Extraits de plantes/isolement et purification , Plantes médicinales , Rats , Rat Wistar , Solvants/composition chimique , Facteurs temps , Charge tumorale/effets des médicaments et des substances chimiques , Eau/composition chimiqueRÉSUMÉ
OBJECTIVES: Although well-defined principles of rational antimicrobial use are available, inappropriate prescribing patterns are reported worldwide. Accurate information on the usage of antimicrobials, including factors associated with and influencing their use, is valuable for improving the quality of prescription practices. METHODS: In this cross-sectional point prevalence survey, data on patients hospitalized in 12 different children's hospitals were collected on a single day. Appropriateness of prescription was compared between the types of antimicrobials prescribed, indications, wards, and presence of/consultation with an infectious disease physician (IDP). RESULTS: A total 711 of 1302 (54.6%) patients evaluated were receiving one or more antimicrobial drugs. The antimicrobial prescription rate was highest in pediatric intensive care (75.7%) and lowest in the surgery wards (37.0%). Of the 711 patients receiving antimicrobials, 332 patients (46.7%) were found to be receiving at least one inappropriately prescribed drug. Inappropriate use was most frequent in surgery wards (80.2%), while it was less common in oncology wards (31.8%; p<0.001). Respiratory tract infection was the most common indication for antimicrobial use (29.4%). Inappropriate use was more common in deep-seated infections (54.7%) and respiratory infections (56.5%). Fluoroquinolones were used inappropriately more than any other drugs (81.8%, p=0.021). Consultation with an IDP appears to increase appropriate antimicrobial use (p=0.008). CONCLUSIONS: Inappropriate antimicrobial use remains a common problem in Turkish pediatric hospitals. Consultation with an IDP and prescribing antimicrobial drugs according to microbiological test results could decrease the inappropriate use of antimicrobials.
Sujet(s)
Anti-infectieux/administration et posologie , Ordonnances médicamenteuses/normes , Hôpitaux pédiatriques , Enfant d'âge préscolaire , Études transversales , Ordonnances médicamenteuses/statistiques et données numériques , Revue des pratiques de prescription des médicaments , Humains , Prévalence , Turquie/épidémiologieRÉSUMÉ
Systemic lupus erythematosus (SLE) is a disease with wide range of signs and symptoms. SLE patients have increased infective diathesis, and infections are a very important cause of death in these patients. Infections can sometimes mimic the signs and symptoms of SLE. Thus, it is important to recognize that infection can induce a lupus flare-up or can be difficult to distinguish from a lupus flare-up. We describe a 36-year-old female patient with SLE, who presented with skin lesions and pancytopenia, and clinical manifestations similar to a flare-up of SLE. Bone marrow examination revealed infection with Mycobacterium avium complex (MAC). The patient had no history or clinical evidence of pulmonary involvement. This patient is the first case of invasive bone marrow MAC infection in SLE. With this unique case, we would like to emphasize that SLE patients can also be infected by non-tuberculous mycobacteria, and that bone marrow examination for tuberculosis as well as for non-tuberculosis mycobacteria should be considered in SLE patients with refractory pancytopenia.
Sujet(s)
Maladies de la moelle osseuse/microbiologie , Lupus érythémateux disséminé/complications , Infection due à Mycobacterium avium-intracellulare/complications , Adulte , Maladies de la moelle osseuse/physiopathologie , Femelle , Humains , Lupus érythémateux disséminé/physiopathologie , Complexe Mycobacterium avium/isolement et purification , Infection due à Mycobacterium avium-intracellulare/physiopathologie , Pancytopénie/étiologie , Pancytopénie/microbiologieRÉSUMÉ
Herpes simplex viruses (HSV), and especially HSV-1, are the most common cause of acute, sporadic viral encephalitis. HSV-2 is an uncommon cause of encephalitis. We report a rare case of HSV-2 encephalitis that was free of genital lesions. In terms of the patient's case history, she had a Cesarean section four months before, herpes labialis 30 days before, varicella zoster 20 days before. We discuss the possibility that postpartum stress may be one of the factors in this case.
Sujet(s)
Aciclovir/usage thérapeutique , Antiviraux/usage thérapeutique , Encéphalite à herpès simplex/traitement médicamenteux , Encéphalite à herpès simplex/virologie , Herpèsvirus humain de type 2/isolement et purification , Adulte , Encéphalite à herpès simplex/diagnostic , Femelle , Humains , Résultat thérapeutiqueSujet(s)
Amphotéricine B/usage thérapeutique , Antifongiques/usage thérapeutique , Arthrite infectieuse/diagnostic , Aspergillose/diagnostic , Coude , Leucémie myéloïde , Amphotéricine B/administration et posologie , Antifongiques/administration et posologie , Arthrite infectieuse/imagerie diagnostique , Arthrite infectieuse/traitement médicamenteux , Arthrite infectieuse/microbiologie , Arthrite infectieuse/chirurgie , Aspergillose/traitement médicamenteux , Aspergillose/chirurgie , Aspergillus fumigatus/isolement et purification , Débridement , Diagnostic différentiel , Humains , Mâle , Adulte d'âge moyen , RadiographieRÉSUMÉ
Fasciola hepatica, a zoonotic liver fluke, can also cause disease in humans. Common symptoms are epigastric pain, upper abdominal pain and malaise. Fever and arthralgia are common in acute fascioliasis. Eosinophilia is the predominant laboratory finding, especially in patients with the acute form of the disease. Diagnosis and treatment is not easy, as physicians rarely encounter this disease, and effective drugs are not available in many countries. Human fascioliasis may be underestimated. Patients with eosinophilia and abdominal pain should be evaluated for F. hepatica infestation by parasitological, radiological and serological tests.
Sujet(s)
Fasciolase/diagnostic , Fasciolase/traitement médicamenteux , Praziquantel/analogues et dérivés , Adulte , Sujet âgé , Albendazole/usage thérapeutique , Animaux , Anticorps antihelminthe/analyse , Antihelminthiques antiplathelminthes/usage thérapeutique , Benzimidazoles/usage thérapeutique , Fasciola hepatica/effets des médicaments et des substances chimiques , Fasciola hepatica/immunologie , Fasciolase/parasitologie , Femelle , Humains , Mâle , Adulte d'âge moyen , Praziquantel/usage thérapeutique , TriclabendazoleRÉSUMÉ
Vancomycin-resistant enterococci are unusual etiologic agents of bacterial meningitis and pose significant therapeutic difficulties. We report the first confirmed case of nosocomial vancomycin-resistant Enterococcus faecium meningitis in Turkey. The patient was treated with chloramphenicol and cerebrospinal fluid cultures became negative, but clinical success was not achieved. We also review the previously reported cases of vancomycin-resistant Enterococcus faecium meningitis.