Multi-criteria assessment framework for evaluation of Green Deal performance.

The European Green Deal (EGD) is a long-term and important policy to combat climate change. It contains comprehensive regulations that concern the European continent beyond individuals, companies, and cities. Moreover, achieving environmental sustainability depends on the whole world taking responsibility and concrete steps quickly. Although successful and rapid change requires collective effort and high performance across all topics, involving all countries, communities, and sectors, leaving no one behind, since the economic conditions and infrastructures of countries are different, the process of adaptation to green transformation varies. In this study, the multi-criteria decision-making approach has been used to evaluate the performance of the EU member states in terms of many different criteria under the protecting, reducing, and enabling dimensions in an integrated and comprehensive manner. In this context, the data of the EU member states obtained from Eurostat on 3 main and 15 sub-criteria were used, criterion weights were determined by the MEREC method, and then the EGD performances of the countries were revealed by the MAIRCA method. According to the results, "the primary energy consumption" and "freight transport by mode" were selected as the most significant criteria in terms of EGD compliance performance. As a result of the evaluation of the performances of the alternatives, the Netherlands had the best EGD performance which was followed by Sweden while Ireland had the worst ranking and Cyprus was the other underperforming member. Comparative analyses were conducted with the aim of testing the consistency of the proposed methodology.

A Retrospective Evaluation of Serological Results of Cystic Echinococcosis Suspected Cases Admitted to Adiyaman Training and Research Hospital Between 2013-2020

Objective: Cystic echinococcosis (CE) is prevalent, especially in animals in Turkey and stands as a significant zoonose. In this study, we aimed to retrospectively evaluate the indirect hemagglutination (IHA) tests results performed on samples of CE suspected patients in microbiology laboratory of our hospital. Methods: One thousand six hundred-seven files of patients admitted to hospital between January 2013 and December 2020 were examined for the presence of anti-E. granulosus immunoglobulin G antibodies. The patient's socio-demographic characteristics and radiological data were obtained from the hospital automatization system. Results: A total of 1.607 file records; 644 (40.1%) males and 963 (59.9%) females, aged between 1-96 years (average 45.26±19.91) were examined. It was found that 244 (15.18%) of the patients were positive, 78 (4.86%) were determined at an intermediary value and 1.285 (79.96%) were negative. According to the IHA method a titer of 1/320 and above were evaluated as positive. Compared to anti-E. granulosus IgG antibody titers 164 radiological data; while 28.6% of 21 patients who are evaluated as negative (1/80) and 46.2% of 78 patients who were evaluated as intermediary titer (1/160) had cystic lesion in the radiological findings. Conclusion: Based on the data, it is suggested that while interpreting the patient's serum antibody titers, patient's clinical and radiological findings should also be taken into account. If possible, it should be used along with another serological method like ELISA to assist CE patient's diagnosis and treatment.

In vitro scolicidal effects of Sideritis perfoliata extract against Echinococcus granulosus.

BACKGROUND: Cystic echinococcosis, caused by helminths within the genus Echinococcus, is mainly localised in the liver and lungs of affected hosts. Surgery has been the best choice for the treatment of hydatidosis and using effective scolicidal agents during hydatid surgery is required to prevent secondary infection. Several plant extracts have been shown to exert scolicidal efficacy. This study was designed to investigate the in vitro scolicidal activity of methanol extract of Sideritis perfoliata against the protoscolices of hydatid cysts. METHODS: The protoscolices were collected from a liver of a sheep slaughtered in Adiyaman city slaughter, Turkey. Three concentrations of the aerial part extract of S perfoliata (0.1, 0.2 and 0.4 mg/mL) were assessed at three different exposure periods. All tests were carried in duplicate. The viability of protoscolices was assessed by the eosin exclusion test (0.1% eosin staining). RESULTS: Scolicidal effect of S perfoliata extract at exposure periods of 10, 20 and 30 minutes was 29.6%, 32.5% and 43.6% at the concentration of 0.1%, 37.8%, 50% and 58.1% at concentration of 0.2 mg/mL, and 57.9%, 71.8% and 79.1% at the concentration of 0.4 mg/mL, respectively; indicating a longer time is required to display protoscolicidal effects. LC-MS/MS analysis showed that some phenolic acids, such as fumaric acid (260.13 mg/L), syringic acid (27.92 mg/L) and caffeic acid (26.84 mg/L), and a flavonoid, luteolin (11.23 mg/L) were detected in high concentrations in the extract. CONCLUSIONS: This study has demonstrated that the methanol extract of S perfoliata has high scolicidal activity in vitro. However, research on the in vivo efficacy of S perfoliata extract and its potential side effects is required.

Evaluation of Giardia intestinalis, Entamoeba histolytica and Cryptosporidium hominis/Cryptosporidium parvum in human stool samples by the BD MAXTM Enteric Parasite Panel.

Although the microscopic examination of stool samples remains the reference method of choice for the diagnosis of intestinal protistan infections, this method is time-consuming and requires experienced and well-trained operators. The purpose of this study was to evaluate the level of agreement between the BD MAX TM Enteric Parasite Panel (EPP) and microscopy for the detection of Giardia intestinalis (Lambl, 1859), Cryptosporidium spp. and Entamoeba histolytica Schaudinn, 1903 in stool samples. The study included faecal samples of 362 patients who were admitted to our hospital due to gastrointestinal complaints. In the microscopic examination, which was made with the native-lugol method on the stool samples that were taken from the patients, cysts, trophozoites and eggs of the parasite were examined. The diagnosis of G. intestinalis, Cryptosporidium parvum Tyzzer, 1912 and Cryptosporidium hominis Morgan-Ryan, Fall, Ward, Hijjawi, Sulaiman, Fayer, Thompson, Olson, Lal et Xiao, 2002, and E. histolytica was made in the faecal samples using the EPP assay. In the microscopic examination, Cryptosporidium spp. positive stool samples were stained with kinyoun's acid-fast. In the microscopic examination, parasites were detected in 41 (11%) of the 362 stool samples. In contrast, EPP assay identified parasites in 23 (6.3%) of the samples. In the microscopic examination, E. histolytica and Entamoeba dispar Brumpt, 1925 were detected in 22 (6.1%) of the samples, G. intestinalis was seen in 15 (4.1%), and C. parvum or C. hominis were detected in three (0.8%); these values were five (1.4%), 16 (4.4%) and two (0.5%) positive with the EPP assay. Although C. parvum or C. hominis were detected as positive in the microscopic examination of three samples, only two of the samples were positive in both EPP assay and kinyoun's acid-fast method. The EPP assay is a relatively simple test that can distinguish E. histolytica and E. dispar, but it cannot replace microscopy in the diagnosis of amoebiasis. Diagnosis for G. intestinalis and C. parvum/C. hominis with the BD MAXTM enteric parasite panel was equivalent to that with microscopy. We believe that E. histolytica must be diagnosed with nucleic acid amplification tests that have a high sensitivity and specificity like EPP assay in certain patient groups.

Pre-operative stool analysis for intestinal parasites and fecal occult blood in patients with acute appendicitis.

BACKGROUND: Etiology of acute appendicitis (AA) rarely involves parasitic infections of gastrointestinal (GI) tract. Preoperative diagnosis of parasitic infections in appendix remains difficult, although parasites can sometimes be observed inside the lumen during histopathological examination. The aim of the present study was to prospectively screen prevalence and species of intestinal parasites and adherence of fecal occult blood (FOB) in patients admitted to emergency department (ED) with clinical symptoms of AA who underwent appendectomy. METHODS: Demographic and stool analysis data of a total of 136 patients (≥13 years old) who underwent appendectomy between July 2009 and December 2014 were prospectively assessed, and histopathological data of all patients were retrospectively assessed. RESULTS: In histopathological examination after appendectomy, of 136 patients, 75.5% (n=103) had AA, 11.1% (n=15) had perforated appendicitis (PA), and 13.2% (n=18) had a negative appendicitis (normal appendix, NA). Pre-operative stool analysis revealed that 25% (n=34) had intestinal parasites and 14.7% (n=20) of patients had positive fecal occult blood test (FOBT). Those with positive FOBT represented 9.7% (n=10) of 103 AA patients, 53.3% (n=8) of 15 PA patients, and 11.1% (n=2) of 18 NA patients; this was statistically more significant for PA than other groups (p<0.001). CONCLUSION: Presence of intestinal parasites in stool might not be associated with appendicitis, but it can occasionally lead to pathological findings of appendicitis. A positive FOBT may be a predictor for PA.

Association between latent toxoplasmosis and clinical course of schizophrenia - continuous course of the disease is characteristic for Toxoplasma gondii-infected patients.

The aim of the present study was to investigate the association between various clinical aspects of schizophrenia and seropositivity against Toxoplasma gondii (Nicolle et Manceaux, 1908). We selected 94 patients with schizophrenia and investigated the seropositivity rate for anti-T. gondii IgG antibodies by ELISA. Clinical parameters of schizophrenic patients such as illness type and status, clinical course, awareness of the illness and need for electroconvulsive therapy (ECT) were compared with their serological status. Anti-T. gondii IgG antibodies were detected in 43 (46%) of schizophrenic patients. Chronic patients had a rate of 34 (72%) seropositivity, whereas 9 (22%) of the patients with partial remission showed evidence of latent toxoplasmosis. Of continuous patients, 35 (81%) were found to be seropositive and this rate was significantly more than in the other groups. The rate of latent toxoplasmosis was detected significantly higher in patients who lack awareness of schizophrenia (36, i.e. 72%) than the patients who were aware of their illnesses (7, i.e. 16%). Anti-T. gondii IgG antibodies were detected in 38 (70%) of ECT performed patients while this percentage was 13% in the ones who had never been treated with ECT. This difference was also statistically significant. We showed that Toxoplasma-infected subjects had 15× higher probability of having continuous course of disease than Toxoplasma-free subjects. Our results put forth the possibility of latent toxoplasmosis to have a negative impact on the course of schizophrenia and treatment response of schizophrenic patients.

Hydatid cyst of paravertebral muscle mimicking disc herniation.

STUDY DESIGN: Case report. OBJECTIVE: To present a case of primary hydatid cyst in the lumbar subcutaneous tissue affecting posterior paravertebral muscle and mimicking disc herniation. SUMMARY OF BACKGROUND DATA: Cystic hydatid disease is a rare but significant parasitic disease in endemic areas. Musculoskeletal or soft tissue hydatidosis accounts for about 0.5% to 5% of all echinococcal infections in endemic areas and is almost secondary to the hepatic or pulmonary disease. Primary lumbar subcutaneous hydatid cyst affecting paravertebral muscle and extending to neural foramina is a very rare condition even in endemic areas. METHODS: A 25-year-old-female patient was admitted with swelling and pain in the right lumbar region for 3 months. The pain was reflecting in the right gluteal region and the right leg. Lumbar extension and right lateral flexion was painful and straight leg raising test was positive at right side. There was a mild hypoesthesia at L5 dermatome. According to the magnetic resonance image that the clinician obtained for initial diagnosis of lumbar disc herniation, we found multi-cystic masses located at the right paravertebral muscle at the level of L3-L5 which extended to L4-L5 neural foramina and at subcutaneous tissue at the right gluteal region. RESULTS: The patient was operated for the purpose of removal of cysts. Postoperatively, diagnosis of hydatid cyst was confirmed by histopathology. CONCLUSION: By this case, we emphasize that cystic hydatid disease should be taken into consideration in the differential diagnosis of low back pain and could mimic disc herniation. LEVEL OF EVIDENCE: N/A.

Toxocara seroprevalence in patients with idiopathic Parkinson's disease: chance association or coincidence?

Most cases of idiopathic Parkinson disease (IPD) are believed to be due to a combination of genetic and environmental factors. The purpose of this study is to investigate the relationship between toxocariasis and Parkinson disease (PD). Patients were selected from people who were admitted to the Movement Disorders Branch, Neurology Department of Elazig University Faculty of Medicine Elazig, Turkey. We studied specific IgG antibodies against Toxocara canis (T. canis) in 50 patients with idiopathic Parkinson and 50 healthy volunteers. We investigated the clinical history of three patients infected with T. canis. We also studied specific IgG antibodies against Toxoplasma gondii in these groups. Antibodies anti-Toxocara canis were found in 3 idiopathic PD (6%) (P = 0.121) and antibody titer was not found in control. A patient had history of the presence of dog in current dog ownership. We did not detect any statistically significant association between T. canis and IPD. But, we believe that further comprehensive studies are required for understanding whether there is a causal relation between toxocariasis and PD. We didn't find possible association between Toxoplasma gondii and IPD (P = 0.617).

[Malaria cases detected by active and passive surveillance in Adiyaman between 2000-2008]. / Adiyaman'da 2000-2011 Yillari Arasinda Aktif ve Pasif Sürveyans ile Saptanan Sitma Olgulari

OBJECTIVE: In this study, malaria cases were determined in Adiyaman with active and passive surveillance studies by Local Health Authority, Centre for Struggle against malaria between the years 2000-2011. METHODS: In 312.125 blood samples, obtained with the method of active and passive surveillance from the region where malaria is common, malarial parasite was investigated by the method of thin and thick blood smears. RESULTS: In the observed samples, 184 malaria cases were determined; 38 (21.1%) with active, 145 (78.8%) of them with passive surveillance method. The rate of positive cases among all the observations was 0.05%. 108 (58.6%) of the cases were male, 76 (41.3%) of the cases were female. It was stated that 3 of the cases were provincial cases and 181 of them originated from extra-provincial sources. It was observed that, apart from one Plasmodium falciparum case which was from a foreign-source; all of the cases were plasmodium vivax positive. there were no cases of malaria between 2008 and 2011 years. CONCLUSION: The fact that there are many farming workers in Adiyaman and that these workers work in regions where malaria is endemic, threatens the population in the region with malarial infection . It was considered important for the Centre for the Struggle against Malaria and Adiyaman University, Medical Faculty to cooperate in the struggle against malaria by offering planned training programs in public health.

A heart transplant recipient lost due to Pneumocystis jiroveci pneumonia under trimethoprim-sulfamethoxazole prophylaxis: case report.

Infections in solid-organ transplant recipients are the most important causes of morbidity and mortality. A primary goal in organ transplant is the prevention or effective treatment of infection, which is the most common life-threatening complication of long-term immunosuppressive therapy. A 21-year-old woman who underwent heart transplant 3 years previous owing to dilated cardiomyopathy was referred to our hospital with symptoms of high fever and cough. The patient's history revealed that she had received a trimethoprim-sulfamethoxazole double-strength tablet each day for prophylactic purposes. On chest radiograph, pneumonia was detected, and in broncho-alveolar lavage sample, Pneumocystis jiroveci cysts were found. After diagnosing P. jiroveci pneumonia, trimethoprim-sulfamethoxazole was initiated at 20 mg/kg/d including intravenous trimethoprim in divided dosages every 6 hours. On the sixth day of therapy, she died in intensive care unit. In solid-organ transplant recipients, although antipneumocystis prophylaxis is recommended within the first 6 to 12 months after transplant, lifelong prophylaxis is also used in several settings. In addition, the physician should keep in mind that P. jiroveci pneumonia may develop in solid organ recipients, despite trimethoprim-sulfamethoxazole prophylaxis.

Is there a relationship between Toxoplasma gondii infection and idiopathic Parkinson's disease?

Idiopathic Parkinson's disease defines a group of Parkinson's disease (PD) of which the aetiology is unknown but an underlying brain disease is suspected. We selected patients of this subgroup of PD and investigated the seropositivity rate for anti-Toxoplasma IgG antibody by Sabin-Feldman dye test (SFDT). By measuring seropositivity in PD patients, we searched for a probable relationship between Toxoplasma gondii infection and idiopathic PD incidence. Fifty patients diagnosed with idiopathic PD and 50 healthy volunteers were included in the study. Blood samples were taken from all 100 participants and anti-T. gondii antibody titres were investigated using SFDT. Anti-T. gondii antibodies were detected at a titre of >or=1/16 in 25 of the 50 patients (50%) and in 20 of the control group (40%). No higher antibody titre was found in the control group. In conclusion, despite the emerging literature on a possible relationship between T. gondii infection and neurological disease, and the high anti-T. gondii seropositivity found in our PD patients, we did not detect any statistically significant association between T. gondii and idiopathic PD.

Evaluation of antibodies against hydatid cyst fluid antigens in the post-treatment follow-up of cystic echinococcosis patients.

BACKGROUND: Cystic echinococcosis (CE), caused by the metacestode stage of Echinococcus granulosus, is one of the most important zoonoses worldwide. Long post-treatment follow-up is required because of possible relapse. The objective of this study was to determine the values of different antigenic fractions of sheep hydatid cyst fluid in the follow-up of CE patients after treatment. MATERIAL/METHODS: After gradient gel electrophoresis of sheep hydatid cyst fluid, 45 post-treatment (1 month -16 years) serum samples of CE patients treated with PAIR (puncture, aspiration, injection, and reaspiration) and five post-treatment (1 month) sera of operated CE patients were studied using Western blot. Twenty healthy individuals and five patients infected with other helminths served as controls. RESULTS: Antigens with molecular weights of 6.5-8, 14, 20, 29, 45, 50, 66, 116-120, 205, and 215 kDa were identified. The bands detected at the highest frequency were 29 kDa (10.4%), 45 kDa (17.2%), and 66 kDa (12.8%). Sera of the 20 healthy controls recognized no specific bands. All of the sera of the five patients with other parasitic diseases recognized one or more hydatid cyst fluid antigen. There was a statistically significant difference between the time after treatment and band weights (p<0.001). CONCLUSIONS: The protein bands of 29 and 205-215 kDa may be valuable in the follow-up of cystic echinococcosis patients as they disappear one year and six months, respectively, after therapy.

Glutathione and malondialdehyde levels in patients with hydatid cyst.

OBJECTIVE: To investigate the levels of glutathione (GSH), and malondialdehide (MDA) in the sera of patients diagnosed with cyst hydatid. METHODS: Forty-six hydatid cyst patients who were indirect hemaglutination (IHA) and indirect fluorescence antibody (IFA) test positive constituted our study group in 2007. Patients diagnosed with hydatid cyst in the Inonu University School of Medicine, Department of Parasitology were re-called for the study. Forty healthy subjects who were negative for hydatid cyst by IHA and IFA methods, and who did not have any parasites on stool inspection formed the control group. The MDA level was analyzed in the sera by Uchiyama and Mihara method. The GSH activity was measured by the Ellman method. RESULTS: The GSH level was 11.31 -/+ 3.80 micromol/L and the MDA level was 67.94 -/+ 106.70 micromol/L in the study group, while they were 24.95 -/+ 6.55 micromol/L and 26.52 -/+ 19.42 micromol/L in the control group. CONCLUSION: An increase in MDA levels and a decrease in GSH activity in patients with hydatid cyst was observed.

Malondialdehyde, glutathione, and nitric oxide levels in Toxoplasma gondii seropositive patients.

The aim of this study was to investigate the difference in the serum malondialdehyde (MDA), glutathione (GSH), and nitric oxide (NO) levels between normal and T. gondii-infected patients. To this end, MDA, GSH, and NO levels in the sera of 37 seropositive patients and 40 participants in the control group were evaluated. In Toxoplasma ELISA, IgG results of the patient group were 1,013.0 +/- 543.8 in optical density (mean +/- SD). A statistically significant difference was found between patients and the control group in terms of MDA, GSH, and NO levels. A decrease in GSH activity was detected, while MDA and NO levels increased significantly. Consequently, it is suggested that the use of antioxidant vitamins in addition to a parasite treatment shall prove useful. The high infection vs control ratio of MDA and NO levels probably suggests the occurrence as a mechanism of tissue damage in cases of chronic toxoplasmosis. Moreover, it is recommended that the patient levels of MDA, GSH, and NO should be evaluated in toxoplasmosis.

[Demodex spp. in hairy skin biopsy specimens]. / Saçli Deri Biyopsi Orneklerinde Demodex spp.

It has been reported that Demodex mites play a role in the pathogenesis of rosacea, acne vulgaris, perioral dermatitis, seborrhoeic dermatitis, micropapular-pruritic dermatitis, and blepharitis. Methods used for diagnostic purposes included cyanoacrylic adhesives, comedone extractor, cellophane tape preparations, skin scraping, punch biopsy and standardized surface skin biopsy. This study is a retrospective work. The aim of the present retrospective study was the investigation of the incidence of Demodex mites using histopathological examination of skin biopsy specimens of keratinized cysts, fungal spores, tricholemmal cysts, nevi, dermatitis, fibrosis, carcinoma and inflammation of the scalp. Fifty-nine biopsy specimens were examined histologically after staining with hematoxylen-eosin. Demodex mites (i.e., tricholemmal cyst, dermatitis, sebaceous cyst, carcinoma, keratose cysts, nevi, fungal spores) were found in 9 (15.3%) of them. It was concluded that since this parasite is found in pathological cases of the scalp, the possible role of Demodex in the pathogenesis of such diseases should also be evaluated.

[Incidence of intestinal parasites among primary school children in Malatya]. / Malatya ili merkezinde üç ilkögretim okulu çocuklarinda bagirsak parazitlerinin dagilimi.

The aim of this study was to determine the incidence of intestinal parasites among primary school children in the central region of Malatya and to educate the children about parasitic diseases. During the study, cellophane tape preparations and stool samples that had been prepared using direct mounting methods were examined. In addition the students were informed about intestinal parasites. Parasitic infection was observed in 415 (22.5%) out of 1838 students and the highest rate of 10.6% was that of Enterobius vermicularis. The rates of Giardia intestinalis, Entamoeba coli, Blastocystis hominis, Taenia sp., Hymenolepis nana, Trichomonas hominis, Ascaris lumbricoides and Iodamoeba butschlii were found to be 8.5%, 1.9%, 1.4%, 0.3%, 0.1%, 0.1%, 0.05%, and 0.05%, respectively. Thus, intestinal parasites are important among primary school children in Malatya and it seems that there is a relationship between socioeconomic conditions and the rate of intestinal parasites.