Rapid Tetra-Primer Amplification Refractory Mutation System-Polymerase Chain Reaction Protocol for Detection of Y132F Mutation in Fluconazole Resistant Candida parapsilosis.

There is an emerging fluconazole resistance in Candida parapsilosis in recent years. The leading mechanism causing azole resistance in C. parapsilosis is the Y132F codon alteration in the ERG11 gene which encodes the target enzyme of azole drugs. In this study, we evaluated the sensitivity, compatibility, and specificity of a novel tetra-primer amplification refractory mutation system-polymerase chain reaction (T-ARMS-PCR) method for rapid detection of the Y132F mutation in fluconazole nonsusceptible C. parapsilosis. Antifungal susceptibility tests for detection of fluconazole resistance were performed by broth microdilution according to the CLSI guidelines. All susceptible and nonsusceptible C. parapsilosis isolates were analyzed for ERG11 mutations with Sanger sequencing. T-ARMS-PCR was fully concordant with the Sanger sequencing (100% of sensitivity and specificity) for detection of Y132F mutations. T-ARMS-PCR method could be a rapid, simple, accurate, and economical assay in the early detection of the most common cause of fluconazole resistance in C. parapsilosis isolates. In routine laboratories with high C. parapsilosis isolation rates, performing the T-ARMS-PCR for early detection of the most common reason of fluconazole resistance in C. parapsilosis, could be a life-saving approach for directing antifungal therapy before obtaining the definitive antifungal susceptibility tests results.

Long-Term Omalizumab Therapy in Patients with Chronic Spontaneous Urticaria: Does it Increase the Risk of COVID-19?

INTRODUCTION: Based on the existing literature, omalizumab (OMZ) is considered a safe treatment modality in chronic spontaneous urticaria (CSU) during the coronavirus disease 19 (COVID-19) era. OBJECTIVES: The aim of this study is to evaluate the effects of OMZ on CSU patients regarding COVID-19 infection. METHODS: In this retrospective study, files of CSU patients using OMZ during the COVID-19 pandemic were reviewed in terms of demographic features, medical history including COVID-19 vaccination status, clinical characteristics, pretreatment laboratory parameters, duration, and dosing regimen of OMZ treatment. Patients with a history of COVID-19 infection while on OMZ therapy and patients without COVID-19 history were compared with respect to these parameters. The urticaria activations following COVID-19 infection or vaccination were also recorded. RESULTS: Sixty-eight patients with CSU (female:male ratio = 1.8:1; mean age = 47.2 ± 15.1 years) continued to receive OMZ treatment. The median duration of OMZ treatment was 12 months (range: 6-60). Twelve patients (17.6%) were diagnosed with COVID-19 showing no exacerbation in urticaria. The duration of OMZ treatment was significantly higher in the group with COVID-19 infection history compared to patients with no history of COVID-19 (P = 0.01). Among 51 patients (75%) vaccinated against COVID-19, urticaria activation occurred in 4 patients without any recurrence following booster vaccinations. CONCLUSIONS: Considering the likelihood of increased COVID-19 infection risk in the setting of long-term OMZ in CSU patients, the duration of OMZ therapy might be kept at a minimum, or a temporary interruption of the treatment period might be preferred, particularly in high-risk patients regarding COVID-19.

Hypokalemic periodic paralysis as the first sign of thyrotoxicosis- a rare case report from Somalia.

BACKGROUND: Thyrotoxic hypokalemic periodic paralysis (THPP) is a rare complication of hyperthyroidism characterized by thyrotoxicosis, hypokalemia, and paralysis. It is the most common form of acquired periodic paralysis. THPP is precipitated by strenuous exercise, a high carbohydrate diet, stress, infection, alcohol, albuterol, and corticosteroid therapy. It is most common in Asian men with hyperthyroidism and exceptionally rare in black people. CASE PRESENTATION: A 29-year-old man was admitted to the emergency department in Somalia with a sudden onset of paralysis after a high carbohydrate meal. Laboratory investigations showed low serum potassium 1.8 mEq/l (3.5-4.5), and biochemical thyrotoxicosis with TSH 0.006 miu/l (0.35-5.1), total T3 3.2 ng/ml (0.9-2.8) and total T4 13.5 ng/ml (0.6-1.2). He was successfully treated with potassium chloride infusion and an antithyroid drug, methimazole. CONCLUSION: To prevent life-threatening cardiac and respiratory complications, it is critical to consider and diagnose THPP early, even in populations where the condition is rare.

The evaluation of treat and release attitudes of pre-hospital emergency healthcare professionals in case of hypoglycemia.

AIM: It is aimed to evaluate the knowledge of Pre-Hospital Emergency Health Services (PHEMS) staff about the treat and release criteria in hypoglycemia cases and their attitudes in the decision-making processes related to hospitalization. MATERIALS AND METHODS: The sample of this descriptive cross-sectional study consisted of 714 paramedics working in PHEMS in Turkey. A survey developed in Microsoft Forms, which includes various features such as age, gender, years of professional experience, developed in line with the literature, and questions covering treat and release in hypoglycemia cases and absolute hospital transport criteria, was used in the collection of data. Participants who agreed to participate in the study answered the online survey. FINDINGS: Of the 714 participants, 402 (56.30%) were female and 312 (43.70%) were male. 598 (83.75%) of the participants, who had a dilemma regarding the transfer of hypoglycemia cases that became stable after treatment to the hospital, decide to transfer the patient to the emergency room. 706 (98.88%) reported that the presence of another emergency that needs intervention in addition to hypoglycemia was decisive in the decision to transfer to the absolute hospital, and 586 (82.07%) reported that the patient's who did not return to his normal mental state after emergency medical intervention was decisive in the treatment and release decision. CONCLUSION: PHEMS employees have high knowledge and awareness related to treat and release criteria in hypoglycemia cases with which they have high experience. PHEMS employee, who has a dilemma related to making a treat and release decision, decides to transfer to the hospital with a high rate. PHEMS systems should define the treat and release protocols for hypoglycemia cases more clearly in order to use emergency services and health resources effectively.

Bayesian prediction of psychophysical detection responses from spike activity in the rat sensorimotor cortex.

Decoding of sensorimotor information is essential for brain-computer interfaces (BCIs) as well as in normal functioning organisms. In this study, Bayesian models were developed for the prediction of binary decisions of 10 awake freely-moving male/female rats based on neural activity in a vibrotactile yes/no detection task. The vibrotactile stimuli were 40-Hz sinusoidal displacements (amplitude: 200 µm, duration: 0.5 s) applied on the glabrous skin. The task was to depress the right lever for stimulus detection and left lever for stimulus-off condition. Spike activity was recorded from 16-channel microwire arrays implanted in the hindlimb representation of primary somatosensory cortex (S1), overlapping also with the associated representation in the primary motor cortex (M1). Single-/multi-unit average spike rate (Rd) within the stimulus analysis window was used as the predictor of the stimulus state and the behavioral response at each trial based on a Bayesian network model. Due to high neural and psychophysical response variability for each rat and also across subjects, mean Rd was not correlated with hit and false alarm rates. Despite the fluctuations in the neural data, the Bayesian model for each rat generated moderately good accuracy (0.60-0.90) and good class prediction scores (recall, precision, F1) and was also tested with subsets of data (e.g. regular vs. fast spike groups). It was generally observed that the models were better for rats with lower psychophysical performance (lower sensitivity index A'). This suggests that Bayesian inference and similar machine learning techniques may be especially helpful during the training phase of BCIs or for rehabilitation with neuroprostheses.

Acute Renal Injury Due to Rhabdomyolysis Induced by Severe Hypothyroidism: First Case Report from Somalia.

Rhabdomyolysis is a life-threatening condition which is characterized by muscle injury and leakage of muscle contents into the systemic circulation. It has been known that hypothyroidism is associated with some degree of myalgia and muscle stiffness, but it can also be a cause of life-threatening rhabdomyolysis with end-organ damage. A combination of acute renal impairment due to rhabdomyolysis in patients with hypothyroidism, especially those who have no precipitating factors, is extremely rare. Here, we report a case of a 27-year-old male patient with severe hypothyroidism who presented to the emergency department with acute renal impairment due to rhabdomyolysis induced by severe hypothyroidism. The patient was admitted for 5 days and after levothyroxine 100 µg, intravenous fluid rehydration, input and output follow-up and close monitoring, the patient improved and was discharged in good condition.

How cosmetic surgeons portray cosmetic procedures through Instagram? A content analysis on cosmetic surgeons' posts on Instagram.

The present study intends to explore the visual and textual content of posts cosmetic surgeons shared on Instagram pages in order to present their cosmetic surgical or non-surgical procedures. To do so, this study employed a qualitative approach using textual and visual content analysis on 200 Instagram posts shared by cosmetic surgeons. The results demonstrated that the content of analyzed posts can be categorized as 12 sub-themes which are clustered around four main themes; "You have got some body imperfections," "Body imperfections are worrisome," "Cosmetic procedure is the solution; we provide it for you" and "It's not a real surgery!."

Exceptional Variant with Distant Cutaneous Metastasis as the First Clinical Sign in Gastric Signet-Ring Carcinoma.

OBJECTIVE: Skin metastases from gastric cancer are rare and usually occur very late in the course of the disease. The most common metastatic sites liver, the peritoneal surfaces, and the non regional or distant lymph nodes. CASE REPORT: In this case we report the short-term survival of a 67-year-old man complined of multiple nodular lesions in various part of his skin. Histology showed a metastatic signet ring cell adenocarsinoma. Esophagogastroduodenoscopy was performed and a crater- like ulcer, about 3 cm in diameter, was observed on the anterior part of the stomach corpus distal. A biopsy specimen was obtained, and histopathological findings were consistent with gastric signet-ring cell carcinoma. XELOX chemotherapy regimen was initiated for the patient. CONCLUSION: Skin metastasis of gastric adenocarcinoma is a rare condition with a poor prognosis. It may be the first manifestation of a clinically silent visceral cancer or may represent a recurrence of an internal malignancy.

Real-Time Performance of a Tactile Neuroprosthesis on Awake Behaving Rats.

With the advancement of electrode and equipment technology, neuroprosthetics have become a promising alternative to partially compensate for the loss of sensorimotor function in amputees and patients with neurological diseases. Cortical neural interfaces are suitable especially for spinal cord injuries and amyotrophic lateral sclerosis. Although considerable success has been achieved in the literature by spike decoding of motor signals from the human brain, somatosensory feedback is essential for better motor control, interaction with objects, and the embodiment of prosthetic devices. In this paper, we present a tactile neuroprosthesis for rats based on intracortical microstimulation (ICMS). The rats wore mechanically-isolated boots covered with tactile sensors while performing a psychophysical detection task. The vibrotactile stimuli were measured by the artificial sensors and by using a real-time processor, this information was converted to electrical current pulses for ICMS. Some parameters of the real-time processor algorithm were specific to individual rats and were based on psychometric equivalence functions established earlier. Rats could detect the effects of the vibrotactile stimuli better (i.e., higher sensitivity indices) when the tactile neuroprosthesis was switched on compared to the boot only condition during active movement. In other words, the rats could decode the tactile information embedded in ICMS and use that in a behaviorally relevant manner. The presented animal model without peripheral nerve injury or amputation is also a promising tool to test various hardware and software components of neuroprosthetic systems in general.

Determining management strategies for the Sarikum Nature Protection Area.

In recent years, many environmental problems have become important factors in promoting the economic need to develop tourist activity: climate change such as energy wars, increasing hunger and aridity, population increases in urban areas, excessive and unthinking use of natural resources, difficult international relations, economic competition, and increasing environmental stress. Trends in global tourism have changed with changes in culture and our attitude to nature. Changes in both the profile and consumption patterns of tourists have called for the need to balance the use of natural and cultural assets with the need to adequately protect them. In this study, the Sarikum Nature Protection Area (SNPA) was selected as a case study because of its significance as a Turkish wetland area and the variety of different ecosystems coexisting within it. The study focussed on management strategies, but also provides a broader strategy for an area that currently has no management plan. Strengths and weaknesses, opportunities and threats (SWOT) analyses of the area were gathered and analyzed using R'WOT analysis (ranking + SWOT), a multi-criteria assessment method, in order to determine strategies, obtain the participation of interest groups, and assess their opinions and attitudes. The analysis showed the following: the rich biological diversity and the existence of endemic species were the reserve's most significant strength; the presence of natural areas in surrounding regions was the most significant opportunity; the shortage of infrastructure and lack of legal regulation of ecotourism was the most significant weakness; and the lack of a management plan was the most immediate threat.