Aim: Therapeutic plasma exchange (TPD) is the separation of the patient's plasma for treatment purposes and the replacement of another fluid. Therapeutic plasma exchange, the use of which has ...expanded in recent years, is a treatment method that cleans the blood extra-corporeally and is used in many immunological and toxicological diseases. The aim of this study is to prospectively examine critical patients who are followed up in the intensive care unit and undergo therapeutic plasma exchange.
Material and Method: Patients who were hospitalized in the Intensive Care Unit of Erciyes University, Faculty of Medicine, older than 18, and whose therapeutic plasma exchange (TPD) indication were included in the study. Demographic information of the patients, indication for admission to intensive care unit, and TPD indication were recorded before the procedure. Patients who were indicated for plasmapheresis were observed for side effects during the procedure.
Results: A total of 31 patients were included in the study. The mean age of the patients was 46 ± 18 years. 52% of the patients were female and 48% were male. The hospitalization medyan APACHE II score (min-max: 5-40) of the patients was 20. When the patients were evaluated in terms of TPD indications in intensive care, the most common causes were 56% microangiopathic hemolytic anemia (MAHA), 13% Crimean Congo Hemorrhagic Fever (KKKA) and 10% Guillen Barre Syndrome.
The patients were divided into two groups: living and dying. When these two groups were analyzed in terms of APACHE II Score, the mean APACHE II score of living patients was 17±7, and the mean APACHE II score of the patients who died was 25 ± 9. This difference was statistically significant (p = 0.02). The median day of the patients staying in intensive care unit was 12 (min-max: 1-86), and intensive care mortality was 48%.
Conclusion: The frequency of TPD indications of patients included in the study is compatible with the literature, and TPD was applied most frequently because of MAHA. The patients were younger than the normal intensive care population. This study provides clinicians with some helpful information about the intensive care clinical course before patients undergo TPD.
Road safety is the result of the interaction between human, vehicle, and environment-related factors. Road familiarity, as a human- and environment-related factor in road safety, was investigated in ...the present study. More specifically, the main aim of the current study is to investigate the subjective risk evaluations of drivers on familiar and unfamiliar roads. A total sample of 479 drivers, 278 males and 201 females, participated in the present study, and filled out the demographic information questionnaire and Risk Perception Inventory. The results showed that drivers evaluated risk as higher when driving on an unfamiliar road as compared to driving in a familiar road. Moreover, females reported a higher risk perception level than males on both familiar and unfamiliar roads. As a result, familiarity with the road was evaluated as an essential factor in the risk evaluation of drivers. The results were discussed with regard to their implications for road safety in light of the relevant literature.
These days, cloud computing is one of the most promising technologies to store information and provide services online efficiently. Using this rapidly developing technology to protect computer-based ...systems from cyber-related attacks can bring many advantages over traditional protection schemes. The protected assets can be any computer-based systems such as cyber-physical systems (CPS), critical systems, desktop and laptop computers, mobile devices, and Internet of Things (IoT). Malicious software (malware) is any software which targets the computer-based system to launch cyber-attacks to threaten the integrity, confidentiality and availability of the data. To detect the massively growing malware attacks surface, we propose an intelligent behavior-based detection system in the cloud environment. The proposed system first creates a malware dataset on different virtual machines which identify distinctive features efficiently. Then, selected features are given to the learning-based and rule-based detection agents to separate malware from benign samples. Totally, 10,000 program samples have been analyzed to evaluate the performance of the proposed system. The proposed system can detect both known and unknown malware efficiently with high detection and accuracy rate. Besides, the proposed method results have outperformed the leading methods' results in the literature. Our evaluation results show that the proposed algorithms along with machine learning (ML) classifiers achieve 99.8% detection rate, 0.4% false positive rate, and 99.7% accuracy. Our proposed system and algorithms may assist those who would like to develop a novel malware detection system in the cloud environment.
İnfertilite kadın yaşamında karmaşık bir kriz dönemidir. İnfertilite tedavisinin her aşamasında bireyler farklı fiziksel ve ruhsal zorluklar yaşamaktadır. Tedavi sürecinde bireyler bilişsel, ...emosyonel ve davranışsal tepkiler gösterebilirler. İnfertilite tedavi sürecinde yaşanan sorunlarla baş etmede psikososyal bakım ile infertilite sürecini optimize etmeleri ve infertilite tedavisinin psikolojik ve sosyal etkilerini yönetmeleri sağlanır. İnfertilite tedavi sürecinde kadınların stres, depresyon, kaygı düzeylerini azaltma, gebelik oranlarını ve yaşam kalitelerini artırmanın bir yolu da tedaviye alternatif psikososyal müdahalelerden yararlanmaktır. Duygusal Özgürleşme Tekniği ağrı, bağımlılık, uyku sorunları, stres, kaygı, depresyon, travma vb. fizyolojik ve psikolojik sorunların çözümünde olumlu psikososyal etkiler açısından önem taşımaktadır. Bu amaçla derlemede kadınlarda infertilite tedavi sürecinde duygusal özgürleşme tekniği ve psikososyal bakım ele alınmıştır.
The diagnosis and surgical treatment delays that occurred during the coronavirus disease-2019- (COVID-19) pandemic may have affected breast cancer presentation. This study aimed to determine whether ...there was a difference in the clinicopathological characteristics of breast cancers during the pandemic by comparing them with similar cases from the previous year. The study also aimed to determine the radiological findings of breast cancers during the pandemic.
A retrospective review was made of patients who underwent surgery for breast cancer between March 11, 2020, and December 11, 2020 (the pandemic group). These patients were compared with similar patients from the previous year (the pre-pandemic group). The postoperative histopathology results of both groups were compared, and the preoperative radiological findings of the pandemic group were defined.
There were 71 patients in the pandemic group and 219 patients in the pre-pandemic group. The tumor size was significantly greater, lymph node involvement was more frequent, and waiting time for surgery was longer in the pandemic group (
< 0.001,
= 0.044,
= 0.001, respectively). There was no significant difference between the groups in respect of
/invasive tumor distribution, histological type and histological grade of tumor, the presence of lymphovascular/perineural invasion, multifocal/multicentric focus, and Breast Imaging Reporting and Data System Classification (
> 0.15). The radiologic findings of breast cancer during the pandemic typically showed characteristics of malignancy.
Patients diagnosed with breast cancer during the COVID-19 pandemic had larger tumor sizes, more frequent lymph node involvement and longer waiting time for surgical treatment. Screening programs should be continued as soon as possible by taking necessary precautions.
Effectively detecting intrusions in the computer networks still remains problematic. This is because cyber attackers are changing packet contents to disguise the intrusion detection system (IDS) ...recently. Besides, everyday a lot of new devices are added to the computer networks. These new devices are also raising security issues in the computer networks. To effectively manage the computer network flows and provide the security in advance; the components of the IDSs, the approaches and technologies that are used, the nature of the attacks, and the tools that are used needs to be examined deeply. This paper discusses intrusion detection technologies, methodologies, and approaches and also investigates new attack types, protection mechanisms, and recent scientific studies that have been made in this area. In addition, available datasets, well-known IDS tools, and advantages and disadvantages of particular IDSs are explained deeply. We believe that this scientific review study presents a road map for researchers and industry employees who focus on IDSs.
Psychiatric comorbidity in autism spectrum disorder (ASD) is a subject of critical scientific importance, affecting the quality of life, prognosis, and functional outcomes. The prevalence of ...psychiatric disorders vary considerably according to variables such as index subject characteristics, study setting, sampling frame, diagnostic methods used, as well as country of geographic origin. To date, most studies comprise clinical or treatment referral samples in tertiary care or subjects enrolled in clinical trials and genetic cohort collections. Such samples carry the potential for overestimation of both the frequency and severity of psychiatric comorbidity. A systematic literature search was performed using PubMed and Web of Science databases restricted to population-based study publications in the English between May 1, 2015, and May 31, 2020. A comprehensive keyword list was generated to investigate co-occurrence of psychiatric disorders in children and adolescents with ASD. A wide range of DSM-5 based disorders such as anxiety, mood, ADHD, intellectual disability/intellectual developmental disorder, eating/feeding, gender dysphoria and sleep-wake disorders were assessed. Initial search revealed a total of 1674 articles after removal of duplicates. Two independent researchers conducted a parallel-blinded screening process to identify the eligible studies based on titles and abstracts; 39 studies were analyzed in the current review. The main findings show prevalence estimates of 22.9% (95% CI: 17.7- 29.2) for intellectual disability; 26.2% (22-31) for attention-deficit hyperactivity disorder; 11.1% (8.6-14.1) for anxiety disorders; 19.7% (11.9-30.7) for sleep disorders; 7% (5.2- 9.3) for disruptive disorders; 2% (1.3- 3.1) for bipolar disorders; 2.7% (1.8- 4.2) for depression; 1.8% (0.4-8.7) for obsessive-compulsive disorder; and 0.6% (0.3-1.1) for psychosis. Psychiatric comorbidity in population-based studies is lower than in clinical and referred samples. However, our results also indicate that the frequency of psychiatric comorbidity in children and adolescents with ASD in the population context is considerable, without the influence of referral bias implicit in clinical and treatment samples. There is a need for better targeted diagnostic tools to detect psychiatric comorbidity in children and youth in future population-based studies, as an essential component in providing care as well as new insights into the nature and mechanisms of its underlying associations.
https://www.crd.york.ac.uk/prospero/, identifier CRD42021234464.
Purpose
To assess the diagnostic performance of biparametric magnetic resonance imaging (bp-MRI) in predicting detrusor muscle invasion for bladder cancer (BC) located at the ureteral orifice by ...comparing it with the Vesical Imaging Reporting and Data System (VI-RADS) system based on multiparametric MRI (mp-MRI).
Methods
Patients with histopathologically proven BC located at the ureteral orifice from December 2019 to November 2022 were analyzed retrospectively. Two sets, bp-MRI (set 1) and mp-MRI (set 2), were formed from the images. Both sets were evaluated independent of histopathology by three radiologists with different levels of experience in abdominal radiology. Receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic performance of VI-RADS in the prediction of muscle invasion. The intraclass correlation coefficient (ICC) was used to evaluate inter-reader agreement.
Results
Of 68 patients with BCs located at the ureteral orifice, 50 (48 males, median age: 72 years) met the study criteria. Out of the 50 patients, 36 had non-muscle invasive BC (pTa–T1) and 14 had muscle invasive BC (MIBC) (pT2–T4). In the comparison of VI-RADS categories with histopathologic data for MIBC detection, the area under the curve of the ROC analysis for the bp- and mp-MRI protocol was 1.000–0.986 for reader 1, 0.893–0.901 for reader 2, and 0.808–0.865 for reader 3. There was no statistically significant difference in predicting detrusor muscle invasion with the bp- and mp-MRI-based on VI-RADS categories for all readers (
p
= 0.126, 0.203, and 0.322, respectively). The ICCs between all the readers showed excellent agreement and were similar for both protocols.
Conclusion
The bp-MRI consisting of DWI and T2-WI can be used as an alternative to the mp-MRI in predicting detrusor muscle invasion for BCs located at the ureteral orifice; however, less experienced readers should exercise caution.
Graphical abstract
Objectives: Status epilepticus (SE) is one of the most common neurologic emergencies in children. The aim of this study was to investigate the clinical and demographic characteristics, treatment ...protocols, and outcomes of patients in our pediatric intensive care unit (PICU). Materials and Methods: Patients aged 1 month to 18 years, who were treated in the PICU with a diagnosis of SE between January 2020 and September 2021, were retrospectively evaluated. Demographics, indications for hospitalization, etiology, and types of SE, treatment modalities, mortality, and morbidity were recorded. Results: Seventy two patients 29 (40.3%) female, 43 (59.7%) male were enrolled in the study. The mean age of the patients was 11.78±12.87 months. Thirty-three (45.8%) patients were followed up with SE, 32 (44.4%) patients with refractory SE (RSE), and 7 (9.7%) patients with super RSE (SRSE). Most of the patients were in the age group of 1-5 years, and the most common etiology was remote symptomatic SE. Midazolam infusion was given to 40 (55.56%) patients, ketamine infusion to eight (11.11%) patients, thiopental infusion to seven (9.7%) patients, ketamine and propofol infusion to four (5%) patients, and valproic acid infusion to two (2.7%) patients. Seven patients (9.7%) died during the study, and the cause of death was due to their underlying diseases, independent of SE. Conclusion: Timely recognition of SE and timely administration of appropriate medications are important in the follow-up of critically ill children. Chronic underlying diseases of patients followed up with RSE and SRSE affect prognosis and mortality.
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