Istanbul Medipol University

About: Istanbul Medipol University is a education organization based out in Istanbul, Turkey. It is known for research contribution in the topics: Medicine & Computer science. The organization has 1599 authors who have published 3332 publications receiving 24304 citations. The organization is also known as: İstanbul Medipol Üniversitesi.

Effect of Piperacillin-Tazobactam vs Meropenem on 30-Day Mortality for Patients With E coli or Klebsiella pneumoniae Bloodstream Infection and Ceftriaxone Resistance A Randomized Clinical Trial

Abstract: Importance Extended-spectrum β-lactamases mediate resistance to third-generation cephalosporins (eg, ceftriaxone) in Escherichia coli and Klebsiella pneumoniae. Significant infections caused by these strains are usually treated with carbapenems, potentially selecting for carbapenem resistance. Piperacillin-tazobactam may be an effective “carbapenem-sparing” option to treat extended-spectrum β-lactamase producers. Objectives To determine whether definitive therapy with piperacillin-tazobactam is noninferior to meropenem (a carbapenem) in patients with bloodstream infection caused by ceftriaxone-nonsusceptible E coli or K pneumoniae . Design, Setting, and Participants Noninferiority, parallel group, randomized clinical trial included hospitalized patients enrolled from 26 sites in 9 countries from February 2014 to July 2017. Adult patients were eligible if they had at least 1 positive blood culture with E coli or Klebsiella spp testing nonsusceptible to ceftriaxone but susceptible to piperacillin-tazobactam. Of 1646 patients screened, 391 were included in the study. Interventions Patients were randomly assigned 1:1 to intravenous piperacillin-tazobactam, 4.5 g, every 6 hours (n = 188 participants) or meropenem, 1 g, every 8 hours (n = 191 participants) for a minimum of 4 days, up to a maximum of 14 days, with the total duration determined by the treating clinician. Main Outcomes and Measures The primary outcome was all-cause mortality at 30 days after randomization. A noninferiority margin of 5% was used. Results Among 379 patients (mean age, 66.5 years; 47.8% women) who were randomized appropriately, received at least 1 dose of study drug, and were included in the primary analysis population, 378 (99.7%) completed the trial and were assessed for the primary outcome. A total of 23 of 187 patients (12.3%) randomized to piperacillin-tazobactam met the primary outcome of mortality at 30 days compared with 7 of 191 (3.7%) randomized to meropenem (risk difference, 8.6% [1-sided 97.5% CI, −∞ to 14.5%]; P = .90 for noninferiority). Effects were consistent in an analysis of the per-protocol population. Nonfatal serious adverse events occurred in 5 of 188 patients (2.7%) in the piperacillin-tazobactam group and 3 of 191 (1.6%) in the meropenem group. Conclusions and relevance Among patients with E coli or K pneumoniae bloodstream infection and ceftriaxone resistance, definitive treatment with piperacillin-tazobactam compared with meropenem did not result in a noninferior 30-day mortality. These findings do not support use of piperacillin-tazobactam in this setting. Trial Registration anzctr.org.au Identifiers:ACTRN12613000532707andACTRN12615000403538and ClinicalTrials.gov Identifier:NCT02176122

Classifications and Applications of Physical Layer Security Techniques for Confidentiality: A Comprehensive Survey

Abstract: Physical layer security (PLS) has emerged as a new concept and powerful alternative that can complement and may even replace encryption-based approaches, which entail many hurdles and practical problems for future wireless systems. The basic idea of PLS is to exploit the characteristics of the wireless channel and its impairments including noise, fading, interference, dispersion, diversity, etc. in order to ensure the ability of the intended user to successfully perform data decoding while preventing eavesdroppers from doing so. Thus, the main design goal of PLS is to increase the performance difference between the link of the legitimate receiver and that of the eavesdropper by using well-designed transmission schemes. In this survey, we propose a conceptual, generic, and expandable framework for classifying the existing PLS techniques against wireless passive eavesdropping. In this flexible framework, the security techniques that we comprehensively review in this treatise are divided into two primary approaches: signal-to-interference-plus-noise ratio-based approach and complexity-based approach. The first approach is classified into three major categories: first, secrecy channel codes-based schemes; second, security techniques based on channel adaptation; third, schemes based on injecting interfering artificial (noise/jamming) signals along with the transmitted information signals. The second approach (complexity-based), which is associated with the mechanisms of extracting secret sequences from the shared channel, is classified into two main categories based on which layer the secret sequence obtained by channel quantization is applied on. The techniques belonging to each one of these categories are divided and classified into three main signal domains: time, frequency and space. For each one of these domains, several examples are given and illustrated along with the review of the state-of-the-art security advances in each domain. Moreover, the advantages and disadvantages of each approach alongside the lessons learned from existing research works are stated and discussed. The recent applications of PLS techniques to different emerging communication systems such as visible light communication, body area network, power line communication, Internet of Things, smart grid, mm-Wave, cognitive radio, vehicular ad-hoc network, unmanned aerial vehicle, ultra-wideband, device-to-device, radio-frequency identification, index modulation, and 5G non-orthogonal multiple access based-systems, are also reviewed and discussed. The paper is concluded with recommendations and future research directions for designing robust, efficient and strong security methods for current and future wireless systems.

Comparison of digital and conventional impression techniques: evaluation of patients’ perception, treatment comfort, effectiveness and clinical outcomes

Abstract: Background The purpose of this study was to compare two impression techniques from the perspective of patient preferences and treatment comfort.

The mgrB gene as a key target for acquired resistance to colistin in Klebsiella pneumoniae

Abstract: Objectives Alterations in the PhoPQ two-component regulatory system may be associated with colistin resistance in Klebsiella pneumoniae. MgrB is a small transmembrane protein produced upon activation of the PhoPQ signalling system, and acts as a negative regulator on this system. We investigated the role of the MgrB protein as a source of colistin resistance in a series of K. pneumoniae. Methods Colistin-resistant K. pneumoniae isolates were recovered from hospitalized patients worldwide (France, Turkey, Colombia and South Africa). The mgrB gene was amplified and sequenced. A wild-type mgrB gene was cloned and the corresponding recombinant plasmid was used for complementation assays. Clonal diversity was evaluated by MLST and Diversilab analysis. Results Of 47 colistin-resistant isolates, 12 were identified as having a mutated mgrB gene. Five clonally unrelated isolates had an mgrB gene truncated by an IS5-like IS, while one clone also harboured an insertional inactivation at the exact same position of the mgrB gene, but with ISKpn13. Another clone harboured an insertional inactivation due to ISKpn14 at another location of the mgrB gene. Two clonally related isolates harboured an IS (IS10R) in the promoter region of mgrB. Finally, three clonally unrelated isolates harboured substitutions leading to anticipated stop codon in the MgrB protein. Complementation assays with a wild-type MgrB protein restored full susceptibility to colistin for all colistin-resistant isolates identified with qualitative or quantitative MgrB modifications. Conclusion The inactivation or down-regulation of the mgrB gene was shown to be a source of colistin resistance in K. pneumoniae. Interestingly, identical genetic events were identified among clonally unrelated isolates.