Gestational diabetes mellitus (GDM) complications increase with late diagnosis and late treatment, so early diagnosis and treatment is one of the most important factors in preventing complications. ...We tried to find an answer to the question of whether the detection of large for gestational age (LGA) fetus in fetal anomaly scan (FAS) requires earlier oral glucose screening test (OGTT) and predicts LGA fetus at birth.
Pregnant women who underwent fetal anomaly scan and gestational diabetes screening at the Department of Obstetrics and Gynecology, University of Health Sciences, Tepecik Training and Research Hospital between 2018 and 2020 were included in this large retrospective cohort study. FAS was routinely performed between 18-22 weeks in our hospital. 75 grams of OGTT was used for gestational diabetes screening and it was performed between 24-28 weeks.
This large retrospective cohort study was performed on 3,180 fetuses, 2,904 appropriate for gestational age (AGA) and 276 LGA, in the second trimester. The prevalence of GDM was significantly higher in the LGA group (OR 2.44, 95% CI 1.66-3.58; p < 0.001). Insulin requirement for blood glucose regulation was significantly higher in the LGA group (OR 3.6, 95% CI 1.68-7.7; p = 0.001). Fasting and 1st hour OGTT values were similar between the groups, but 2nd hour OGTT values were significantly higher in the second trimester LGA group (p = 0.041). The prevalence of LGA newborns at birth was higher in second trimester LGA fetuses than in fetuses with AGA (21.1% vs. 7.1%, p < 0.001).
The fact that the estimated fetal weight (EFW) measured in the second trimester FAS is LGA may be related to GDM in the future and LGA fetus at birth. A more detailed GDM risk questioning should be performed to these mothers and OGTT should be considered when additional risk factors are detected. In addition to all these, glucose regulation may not be possible with diet alone in mothers who have LGA in the second trimester ultrasound and who may have GDM in the future. These mothers should be monitored more closely and more carefully.
The environmental effects of air pollutants released to the atmosphere from coal-based residential heating should be regarded as one of the primary environmental concerns in cities. Unfortunately, in ...Turkey, hundreds of medical cases still occur due to gas poisoning from coal-based conventional stoves used for heating purposes. This study attempts to investigate the effects of coal-based residential heating on CO and SO
2
air quality in a city of the south Marmara Region located between Europe and Asia. A total of 138 chimneys were sampled in the heating season that falls from October 1st through March 31st in the city. Ambient air pollutants released from those chimneys were analyzed to evaluate the background air quality variations in the city. The mean of CO concentrations was approximately 11,000 mg/m
3
, with variations from nearly 9500 to 12,500 mg/m
3
, while the mean of SO
2
concentrations was roughly 173 mg/Nm
3
ranging from 108 to 240 mg/Nm
3
in the sampled chimneys. The AERMOD predicted the maximum daily mean CO concentration for the model was 41.5 μg/m
3
on February 29th at midnight for the downtown area and exceeded the official limits. The predicted highest periodic SO
2
concentration was 45.1 μg/m
3
on February 29th at midnight in the heating season. The highest periodic SO
2
concentration was observed in the old settlements of the downtown, where the most coals were utilized for residential heating with antiquated systems. It is confirmed that the AERMOD results are valid by using meteorological and air pollution data for the modeling study.
To investigate the prognostic value of the Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) in patients who received transplantation admitted to the intensive care unit (ICU).
...We investigated the association of HCT-CI with inpatient mortality and overall survival (OS) among 377 patients who were admitted to the ICU within 100 days of allogeneic stem-cell transplantation (ASCT) at our institution. HCT-CI scores were collapsed into four groups and were evaluated in univariate and multivariate analyses using logistic regression and Cox proportional hazards models.
The most common pretransplantation comorbidities were pulmonary and cardiac diseases, and respiratory failure was the primary reason for ICU admission. We observed a strong trend for higher inpatient mortality and shorter OS among patients with HCT-CI values ≥ 2 compared with patients with values of 0 to 1 in all patient subsets studied. Multivariate analysis showed that patients with HCT-CI values ≥ 2 had significantly higher inpatient mortality than patients with values of 0 to 1 and that HCT-CI values ≥ 4 were significantly associated with shorter OS compared with values of 0 to 1 (hazard ratio, 1.74; 95% CI, 1.23 to 2.47). The factors associated with lower inpatient mortality were ICU admission during the ASCT conditioning phase or the use of reduced-intensity conditioning regimens. The overall inpatient mortality rate was 64%, and the 1-year OS rate was 15%. Among patients with HCT-CI scores of 0 to 1, 2, 3, and ≥ 4, the 1-year OS rates were 22%, 17%, 18%, and 9%, respectively.
HCT-CI is a valuable predictor of mortality and survival in critically ill patients after ASCT.
The use of drugs via feeding tube is problematic. Appropriate techniques must be used during the administration to prevent obstruction of a feeding tube, to avoid inadequate drug effects and to ...minimize the risk of toxicity of the given pharmaceuticals.
In this study, medications of all the patients in a University Hospital with 1100 beds were monitored to identify the appropriateness of administration. The study was performed on 5 days each in 5 consecutive weeks to observe the current practice. After evaluation of practice, a questionnaire was given to doctors, nurses and pharmacists to determine the health-care professionals' attitudes on drug administration through a feeding tube.
A total of 225 drugs (out of 13 935) were administered via feeding tube during the study period and 40.5% (n=91) were not administered in appropriate dosage forms. Only 86% of the doctors and 98% of the nurses stated that they pay attention to the suitability of drugs when they prescribe or administer drugs via feeding tube. Only 58% of pharmacists, 17% of nurses and 24% of doctors were aware of the fact that enteric-coated tablets should not be crushed owing to the risk of tube occlusion and lack of efficacy when they are administered via feeding tube.
This study demonstrated the discordance between the theoretical knowledge and the practical performance of the health-care professionals in drug administration. In patients with feeding tubes, assessment of drug dosage forms by a pharmacist would be beneficial for appropriate administration and to prevent drug interactions.
Our aim was to investigate platelets (PLT) and their indices - mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PCT) - in the differential diagnosis of benign and ...malignant thyroid disorders.
Platelet and platelet indices recently started to be defined as an useful clinical marker in cancer patients. Their higher reproducibility rates and low cost provide them a wide range of usage.
One-hundred and sixty patients were divided into three groups retrospectively. Group 1: papillary thyroid carcinoma patients (n = 65). Group 2: multi-nodular goiter patients (n = 65). Group 3: normal healthy subjects (n = 30). PLT, MPV, PDW and PCT measurements were compared between groups, and p < 0.05 was accepted as significant.
PDW was found to be significantly decreased in Group 1 (p < 0.01), and PCT was observed to be significantly increased in Group 1 (p < 0.01). There were no significant differences in PLT and MPV results.
Statistically significant increases in PCT and decreases in PDW were observed in papillary thyroid cancer patients when compared with other groups. Platelet indices may be used as useful clinical markers in the differential diagnosis of benign and malignant thyroid disorders (Tab. 1, Fig. 2, Ref. 21).
The emission spectra from an industrial, droplet-based, laser-produced plasma, extreme ultraviolet light source for nanolithography are here presented and analyzed. The dependence of spectral ...features on the CO2-drive-laser intensity is studied by changing the beam spot size at constant pulse energy and duration. We characterize the spectrum by fitting the results of atomic structure calculations to the short-wavelength region (7-11 nm), where the contributions from various charge states can be resolved, and obtain the relative contributions of charge states Sn9+ -Sn15+ . These relative contributions are compared to charge state populations as calculated with the non-equilibrium plasma kinetics code flychk. The calculations are shown to be in good qualitative agreement with the results, showing that the effective plasma temperature, and with it, the shape of the unresolved, main emission feature at 13.5 nm, is a remarkably weak function of laser intensity under this source normal operating conditions.
•Planning delivery of relief aid to en route refugees through mobile facilities.•Multi-period problem with mobile demand and service continuity consideration.•Objective is to minimize the total setup ...and travel costs of the mobile facilities.•A mathematical model and an adaptive large neighborhood search algorithm.•Case analysis on 2018 Honduras Migration Crisis.
Many humanitarian organizations aid en route refugee groups who are on their journey to cross borders using mobile facilities and need to decide the number and routes of the facilities. We define a multi-period facility location problem in which both the facilities and demand are mobile on a network. Refugee groups may enter and exit the network in different periods and follow various paths. In each period, a refugee group moves from one node to an adjacent one in their predetermined path. Each facility should be located at a node in each period and provides service to the refugees at that node. Each refugee should be served at least once in a predetermined number of consecutive periods. The problem is to locate the facilities in each period to minimize the total setup and travel costs of the mobile facilities, while ensuring the service requirement. We call this problem the multi-period mobile facility location problem with mobile demand (MM-FLP-MD) and prove its NP-hardness. We formulate a mixed integer linear programming (MILP) model and develop an adaptive large neighborhood search algorithm (ALNS) to solve large-size instances. We tested the computational performance of the MILP and the metaheuristic algorithm by extracting data from the 2018 Honduras Migration Crisis. For instances solved to optimality by the MILP model, the proposed ALNS determines the optimal solutions faster and provides better solutions for the remaining instances. By analyzing the sensitivity to different parameters, we provide insights to decision-makers.
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