Gram-negative bacteremia, the risk factors, and outcome in children.

We aimed to determine the epidemiology and resistance patterns of Gram-negative bacteria, the risk factors and outcome of bloodstream infection (BSI). In all, 412 episodes in children who were hospitalized with the diagnosis of bacteremia were analyzed. The most common microorganisms were Klebsiella spp. (43.9%), Escherichia coli (13.5 %) and Acinetobacter spp. (10.6 %). Among isolates, 41.2 % were multidrug-resistant, 13.5 % were extensively drug-resistant and 0.4 % were pan-drug-resistant. Carbapenem resistance was revealed in 27.6 % of isolates. Carbapenem and colistin resistance increased over the years. The most common risk factors were the presence of a central-venous catheter and pediatric intensive care unit admission. Clinical response and infection-related mortality were significantly different in cases infected with carbapenem-resistant gram-negative (CRGN) vs carbapenem-susceptible gram-negative bacteria. The increase in multi-resistant Klebsiella spp. seems to be the biggest obstacles in fight against nosocomial infections. The increasing number of CRGN infections over the years affects both the clinical response and mortality rate of BSI.

The validity, reliability, and responsiveness of a new biopscyhosocial questionnaire for patients with systemic lupus erythematosus.

OBJECTIVE: In recent years, the importance of holistic care in individuals with systemic lupus erythematosus (SLE) has been emphasized, and therefore a measurement tool that evaluates biopsychosocial impact is needed. This study was conducted to determine the validity, reliability, and responsiveness of the Cognitive Exercise Therapy Approach-Biopsychosocial Questionnaire (BETY-BQ) in individuals with SLE. METHODS: Lupus Quality of Life (LupusQoL), Short Form-36 (SF-36), Health Assessment Questionnaire (HAQ), and Hospital Anxiety and Depression Scale (HADS) were used for the validity. For reliability, evaluations were repeated at 1 -week intervals and for responsiveness, the same scales were re-administered at 3-month intervals to 30 patients. RESULTS: BETY-BQ showed moderate to high correlations with LupusQoL subparameters (rho = -0.522 to -0.718, p < 0.001), moderate to very high correlations with SF-36 subparameters (r = -0.826 to rho = 0.594, p < 0.001), high correlations with HAQ and HADS-D (rho = 0.735, p < 0.001; rho = 0.622, p < 0.001, respectively) and a moderate correlation with HADS-A (rho = 0.571, p < 0.001). In the test-retest method the correlation between the responses was very high (r = 0.989, p < 0.001). The intraclass correlation coefficient (r = 0.944, p < 0.001) and Cronbach's alpha value were found to be excellent (0.952). BETY-BQ showed moderate correlations with LupusQoL subparameters (the body image r = -0.443, p = 0.014; planning rho = -0.529, p = 0.003; fatigue r = -0.484, p = 0.007; intimate relationships rho = -0.421, p = 0.02), SF-36 social function subparameter (rho = -0.427, p = 0.019) and anxiety and depression subparameter of HADS (rho = 0.418, p = 0.021; r = 0.507, p = 0.004, respectively). CONCLUSION: BETY-BQ which was found as a valid, reliable, and responsive scale in individuals with SLE, was presented to healthcare professionals for use in clinical and research studies as a scale that can be preferred in the evaluation of biopsychosocial status of individuals with SLE.

A systematic chart review of pharmacological interventions in patients with clozapine-induced hypersalivation.

OBJECTIVES: To investigate the efficacy and tolerability of medications, such as mouthwash use of 1 % atropine sulfate and tropicamide drops, oral amitriptyline and amisulpride used for clozapine-induced hypersalivation (CIH). METHODS: The medical charts of inpatients with psychotic disorders between 2010 and 2022 were reviewed retrospectively. We detected 161 patients with eligible data who received or commenced clozapine. Primary outcome was defined as the percentage change in the diameter of a wet patch on the pillow (DWP) for improvements in CIH. RESULTS: The frequency of CIH was 42 % (n = 68). The first step medications for CIH were tropicamide drops (49 %), atropine drops (43 %) and amitriptyline (3 %). After the first step, the median DWP significantly decreased by -33 %. During the index hospitalization, in 18 patients with persistent CIH, the median DWP significantly decreased by -42 % with the second step medications which also included amisulpride. There were no reported serious adverse events. The change in DWP was significantly correlated with the duration of clozapine treatment (r = 306) and clozapine serum level at discharge (r = 0.294). A linear regression model showed a link between the change in DWP and reduced Positive and Negative Syndrome Scale scores. CONCLUSIONS: Our findings emphasize that mouthwash use of atropine or tropicamide drops has a satisfying and tolerable effect in treating CIH. Switching medications for CIH seems to be effective when CIH persists despite a first step agent. Controlled follow-up studies are needed to understand the relationship between CIH, clozapine serum levels, illness severity, and functioning.

A Novel Medical Image Enhancement Algorithm for Breast Cancer Detection on Mammography Images Using Machine Learning.

Mammography is the most preferred method for breast cancer screening. In this study, computer-aided diagnosis (CAD) systems were used to improve the image quality of mammography images and to detect suspicious areas. The main contribution of this study is to reveal the optimal combination of various pre-processing algorithms to enable better interpretation and classification of mammography images because pre-processing algorithms significantly affect the accuracy of segmentation and classification methods. In this study, the effect of combinations of different preprocessing methods in differentiating benign and malignant breast lesions was investigated. All image processing algorithms used for lesion detection were used in the mini-MIAS database. In the first step, label information and pectoral muscle resulting from the acquisition of mammography images were removed. In the second step, median filter (MF), contrast limited adaptive histogram equalization (CLAHE), and unsharp masking (USM) algorithms with different combinations of the resolution and visibility of images are increased. In the third step, suspicious regions are extracted from the mammograms using the k-means clustering technique. Then, features were extracted from the obtained ROIs. Finally, feature datasets were classified as normal/abnormal, and benign/malign (two class classification) using Machine Learning algorithms. Test performance measures of the classification methods were examined. In both classifications made in the study, lower classification performance values were obtained when the CLAHE algorithm was used alone as a pre-processing method compared to other pre-processing combinations. When the median filter and unsharp masking algorithms are added to the CLAHE algorithm, the performance of the classification methods has increased. In terms of classification success, Support Vector Machines, Random Forest, and Neural Networks showed the best performance. It was found by comparing the performances of the classification methods that different preprocessing algorithms were effective in detecting the presence of breast lesions and distinguishing benign and malignant.

A new tool to measure occupational balance: Adolescent Occupational Balance Scale (A-OBS).

BACKGROUND: The concept of occupational balance in adolescents is not clear enough. AIM: The current study aims at developing a valid and reliable scale to measure occupational balance in adolescents. METHOD: We conducted online interviews with the participant adolescents via semi-structured interview forms. We applied the Davis technique twice to 10 expert panellists and the test form to 600 individuals. Two weeks later, we re-tested 153 of the participants. We then carried out item analysis to evaluate the internal consistency of the scale. We also conducted explanatory factor analysis (EFA) and confirmatory factor analysis (CFA) to examine the construct validity of the scale. FINDINGS: The content validity index of the scale was found to be 0.986. EFA showed that the scale consisting of 27 items had a six-factor structure explaining 56.7% of the total variance. Model fit indices about the structure created by factor combination technique in CFA were CMIN/df = 2.135; RMSEA = 0.06; GFI = 0.866; NFI = 0.81, CFI = 0.887, TLI = 0.868; IFI = 0.89. The analysis to test the reliability of the scale resulted in ICC: 0.993 and Cronbach's alpha: 0.997. Pre-test and post-test analyses showed very strong correlational coefficients (p < 0.005). CONCLUSION: A-OBS is a valid and reliable scale consisting of 27 items and 4 sub-dimensions. It can be used in studies that will focus on occupational balance in healthy adolescents. It is the first occupational balance scale developed for adolescents in the occupational therapy literature. We recommend further studies to validate the scale and adapt it to different languages and cultures.