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Introduction: The superiority of favipiravir which is one of the agents used in the treatment of COVID-19, over other treatments is still controversial. With this study, we aimed to show whether there is a difference between the initial or subsequent addition of the drug to the treatment on the treatment success and 28-day mortality in hospitalized patients receiving favipiravir, and to contribute to the literature on this subject. Material and method: PCR-positive patients who were hospitalized in our hospital with the diagnosis of COVID-19 between June 1 and July 1, 2020 were included in the study. The data of the patients were analyzed retrospectively. The patients were divided into 3 groups: those who started treatment with favipiravir, those who added favipiravir to the treatment regimen because there was no response to the first-line treatment, and those who did not receive favipiravir. Results: A total of 662 patients, mean age of 58.38±18.86 years and 59.4% male were included in the study. Mortality developed in 74 people, and the mortality rate was 11.17%. More than 50% involvement was detected in thorax CT in 69% of hospitalized COVID-19 PCR positive patients. The mean age of those who added favipiravir to the treatment was 66.95±15.88 years, which was statistically significantly higher than the group that was not added. Those who received favipiravir from baseline had higher viral clearance rates. In our study, it was found that 17.9% of those who received it from the beginning and 34.0% of those who were added later developed mortality on the 28th day, and there was a statistically significant difference between these groups. Conclusion: Those who received favipiravir from baseline had higher viral clearance rates and lower mortality. It can be concluded that late initiation of favipiravir treatment increases mortality.

Objective: In this retrospective observational study, we aimed to investigate the COVID 19 treatment protocols applied in our hospital in terms of side effects and 28-day mortality. Methods: All 621 patients diagnosed as COVID-19 and treated with any drugs were included in the study. Inclusion criteria for patients were hospitalization with COVID-19 diagnosis and being over 18 years old. The patients were divided into 4 groups according to the treatments against COVID-19: Group 1 (only favipiravir), Group 2 (hydroxychloroquine (HQ)+ Azithromycin (AZ), Group 3 (only HQ), and Group 4 (HCQ+AZ +antibiotics). The gender, age, medications, underlying comorbidities, possible side effects due to the treatments (cardiotoxicity, hepatotoxicity, nephrotoxicity), and mortality rates were evaluated. Results: There was no difference in terms of side effects between treatment groups. Mortality rates were lowest in the HQ+AZ group. HCQ+AZ treatment was the most effective treatment protocol. Conclusion: It can be concluded from the study that the higher mortality rate due to favipiravir may be due to the administration of this drug only to critically ill patients during the initial period of the pandemic.

Aim: Healthcare workers are the most risky group in terms of Coronavirus disease 2019 (COVID-19) transmission. The aim of this study was to reveal the relationships related to the departments in which contact healthcare workers work, personal protective equipment (PPE) use status, risk category, clinical picture and prognosis in follow-up.Materials and Methods: Healthcare workers who had contact with COVID-19 cases in our hospital between March 23, 2020 and June 1, 2020 were included in the study. The healthcare workers included in the study were divided into 3 groups according to their main departments and evaluated. In addition, healthcare workers included in the study were divided into groups and evaluated according to PPE use and risk categories, regardless of the departments they work in.Results: A total of 42 healthcare workers were included in the study. The total number of probable cases was determined as 10 (23.8%). None of the 42 individuals were positive for SARS-CoV-2 PCR. It was found that there was no need for hospitalization in any probable case and all of them were removed from follow-up with recovery. Proportionally, the most probable cases were seen in the intensive care unit (42.8%). The highest rate of contact without PPE was seen in the emergency department (87.5%). There were 15 people (35.7%) who used all PPE completely and were not considered as risky contact according to PPE usage situation; However, despite the complete use of PPEs, probable cases were detected in 4 (26.6%) of these 15 people.Conclusion: In centers where COVID-19 patients are cared for, such as our hospital, education should be given to increase compliance with PPE use. In addition, the working conditions of healthcare workers should be regulated in a way to increase compliance with PPE use. Studies involving more healthcare workers are needed for a more detailed understanding of the relationships related to the issues mentioned., Amaç: COVID-19 bulaşı açısından en riskli grup sağlık çalışanlarıdır. Bu çalışma ile temaslı sağlık çalışanlarının çalıştığı birim, KKE kullanım durumu, risk kategorisi, klinik tablo ve takipteki prognoz ile alakalı ilişkilerin ortaya konması amaçlanmıştır.Gereç ve Yöntem: Çalışmaya hastanemizde 23 Mart 2020-1 Haziran 2020 tarihleri arasında COVID-19 vakası ile teması olan sağlık çalışanları dahil edildi. Çalışmaya dahil edilen sağlık çalışanları, çalıştığı ana birimlere göre 3 gruba ayrıldı ve değerlendirildi. Bunun yanında çalışmaya dahil edilen sağlık çalışanları, çalıştığı birimlerden bağımsız olarak KKE kullanım durumu ve risk kategorilerine göre de gruplara ayrıldı ve değerlendirildi.Bulgular: Çalışmaya toplam 42 sağlık çalışanı dahil edildi. Toplam olası vaka sayısı 10 (%23,8) olarak saptandı. 42 kişinin hiçbirinde SARS-CoV-2 PCR pozitifliği saptanmadı. Hiçbir olası vakada hastaneye yatış gereksinimi olmadığı ve hepsinin şifa ile takipten çıkarıldığı saptandı. Oransal olarak en fazla olası vaka yoğun bakım ünitesinde görüldü (%42,8). En yüksek oranda KKE olmadan temas ise acil serviste görüldü (%87,5). Tüm KKE’leri eksiksiz kullanan ve KKE kullanım durumuna göre riskli temaslı olarak değerlendirilmeyen 15 kişi (%35,7) mevcuttu; ancak KKE’lerin eksiksiz kullanılmasına rağmen bu 15 kişinin 4’ünde (%26,6) olası vaka saptandı.Sonuç: Hastanemiz gibi COVID-19 hastalarının bakımının yapıldığı merkezlerde KKE kullanımına yönelik uyumun artırılması için eğitimler verilmesi gerekmektedir. Bunun yanında sağlık çalışanlarının çalışma koşulları KKE kullanımına yönelik uyumu artıracak şekilde düzenlenmelidir. Bahsedilen konular ile alakalı ilişkilerin daha detaylı anlaşılması için daha çok sayıda sağlık çalışanının dahil edildiği çalışmalara ihtiyaç vardır.

Background The effect of preadmission metformin usage (PMU) on the mortality of coronavirus disease-2019 (COVID-19) patients with diabetes is conflicting. Most studies have focused on in-hospital mortality; however, mortality after discharge also increases in COVID-19 patients. Aims Examining the effect of PMU on all-cause mortality, including the post-discharge period. Methods Patients with diabetes who were hospitalised in 2020 due to COVID-19 were included in the study. They were divided into two groups: those with a history of metformin use (MF( +)) and those without such history (MF( −)). Propensity score matching (PSM) was performed at a ratio of 1:1 for age and sex. COX regression analyses were used to demonstrate risk factors for mortality. Results We investigated 4103 patients hospitalised for COVID-19. After excluding those without diabetes or with chronic liver/kidney disease, we included the remaining 586 patients, constituting 293 women (50%) with an overall mean age of 66 ± 11.9 years. After PSM analysis, the in-hospital and post-discharge mortality rates were higher in the MF( −) group though not significantly different. However, overall mortality was higher in the MF( −) group (51 (42.5%) vs. 35 (29.2%), p = 0.031). For overall mortality, the adjusted HR was 0.585 (95% CI: 0.371 − 0.920, p = 0.020) in the MF( +) group. Conclusion PMU is associated with reducing all-cause mortality. This effect starts from the in-hospital period and becomes more significant with the post-discharge period. The main limitations were the inability to evaluate the compliance with metformin and the effects of other medications due to retrospective nature.

It was aimed to make a retrospective analysis of the vaccines administered in the vaccine unit of our hospital since the beginning of the COVID-19 pandemic. The study was carried out retrospectively from the vaccination records our hospital, 14 January 2021 to 01 July 2022. In the 18-month period, a total of 75079 (100%) vaccines were administered, 59386 (79%) were Biontech and 15693 (21%) were Sinovac vaccines. Only Sinovac was available until June, therefore, 66% of the Sinovac vaccines were administered in the first five months period. After the Biontech vaccine started to be applied in our hospital, the rates of Sinovac vaccination have declined drastically. When the epidemic and vaccination graphs were examined separately, inverse correlation was found between the peak points of the epidemic and vaccine graphics. Biontech was found to be the most preferred vaccine by individuals against COVID-19 in this study.

Objective: Diabetes and vascular disorders raise the risk of diabetic foot infection and lower extremity amputation. Although DFI risk factors and microbiological analyses have been thoroughly researched, data for this specific group is limited. In this study, it was aimed to examine the underlying vascular risk factors of patients who were followed up and treated with the diagnosis of DFIs and clinical outcomes. Methods: Clinical, demographic, laboratory, microbiological, and foot examination data for 153 patients referred to our center for DFI between 2016 and 2021 were collected retrospectively from hospital information system. Results: The present center collected a total of 153 DFI patients during 5 year this period. There were 86 male and 67 women with a mean age of 67.71±15 years. There was 104 patients in non-vascular induced DFI group and 49 vascular induced DFI group. The top two comorbidities of DFI patients were cardiovascular disease and hypertension respectively. The rate of male patients was statistically higher in the vascular induced DFI group (p=0.003). Also hypertension and cardiovascular disease were more common in the vascular induced DFI group (p=0.0006, p=0.01). History of extremity amputation/debridement, having Wagner grade 5 DFI and Gram negative microorganism growth in tissue cultures were more common in the vascular induced DFI group (p=0.01, p=0.01 and p=0.0006). Extremity amputation/debridement rates were higher in the vascular induced DFI group (p=0.01) Conclusion: DFIs cause increased risk of amputation, prolonged antibiotic therapy, increased hospitalization, and increased healthcare costs as a result of investigations. Awareness of the vascular pathologies underlying DFIs can help clinicians manage the disease. The aim of this study is to emphasize the importance of vascular factors.

Introduction: Inflammation plays an important role in the basis of coronary artery diseases and their adverse outcomes. Neutrophil-lymphocyte ratio (NLR), Systemic Immune Inflammation Index (SII) and C-reactive protein (CRP) are simple and useful markers that reflect the inflammatory state. Our study evaluated the usability of these markers in predicting in-hospital mortality in patients with COVID-19 with the diagnosis of coronary artery disease. Material and Method: Our study population consisted of 111 (48 male, 63 female) newly diagnosed patients with COVID-19. Neutrophil-lymphocyte ratio (NLR) was estimated using neutrophil (N), and lymphocyte (L) counts and the systemic immune inflammation index SII (NxP / L) was calculated using N, L and platelet (P) values. The relationship of NLR, SII and CRP values with in-hospital mortality was investigated. Results: During the treatment process, 16 patients exited. Any statistically significant intergroup difference was not observed as for SII and NLR values obtained by their use in combination (p = 0.872, p = 0.979, respectively), CRP values were statistically significant in the group with in-hospital mortality (p

In the medical literature, the term of "new-onset refractory status epilepticus" (NORSE) is a novel term. Herpes Simplex Virus-1 and other viral infections can be cause to NORSE. Seizures are a rare sign of HSV encephalitis, but they can occur as the first symptom. Herein, we present a case of NORSE triggered by HSV-1 encephalitis, which had been diagnosed via cerebrospinal fluid polymerase chain reaction (PCR) method and magnetic resonance imaging findings.

OBJECTIVE: To evaluate the rate of pneumococcal pneumonia (PP) among patients with community-acquired pneumonia (CAP) in Turkey and to investigate and compare features of PP and non-PP CAP patients. MATERIAL AND METHODS: This multicenter, non-interventional, prospective, observational study included adult CAP patients (age = 18 years). Diagnosis of PP was based on the presence of at least 1 positive laboratory test result for Streptococcus pneumoniae (blood culture or sputum culture or urinary antigen test [UAT]) in patients with radiographic findings of pneumonia. RESULTS: Four hundred sixty-five patients were diagnosed with CAP, of whom 59 (12.7%) had PP. The most common comorbidity was chronic obstructive pulmonary disease (30.1%). The mean age, smoking history, presence of chronic neurological disease, and CURB-65 score were significantly higher in PP patients, when compared to non-PP patients. In PP patients, 84.8% were diagnosed based ony on the UAT. The overall rate of PP patients among CAP was calculated as 22.8% considering the UAT sensitivity ratio of 63% (95% confidence interval: 45-81). The rate of intensive care treatment was higher in PP patients (P =.007). While no PP patients were vaccinated for pneumococcus, 3.8% of the non-PP patients were vaccinated (P =.235). Antibiotic use in the preceding 48 hours was higher in the non-PP group than in the PP group (31.8% vs. 11.1%, P =.002). The CURB-65 score and the rate of patients requiring inpatient treatment according to this score were higher in the PP group. CONCLUSION: The facts that PP patients were older and required intensive care treatment more frequently as compared to non-PP patients underline the burden of PP., Pfizer Pharmaceuticals, Turkey, This work was supported by Pfizer Pharmaceuticals, Turkey.

Data about Turkish coronavirus disease 2019 patients are limited. We evaluated hospitalized coronavirus disease 2019 patients who were followed up in the first 3 months of the pandemic.This retrospective, single-center, observational study included 415 confirmed hospitalized coronavirus disease 2019 patients. The patients were divided into groups, namely, mild, moderate, and critically ill patients. Symptoms at the time of admission, clinical, laboratory, and imaging findings were examined.In our study, 6.74% of coronavirus disease 2019 patients had severe disease, 59.5% were male, and the mortality rate was 11.3%. Diabetes mellitus and chronic obstructive pulmonary disease were more frequently seen in critically ill patient groups and hypertension in moderate patient groups. Anemia and aspartate aminotransferase levels were higher in non-survivors among mild coronavirus disease 2019 patients. In the moderate patients' group, aspartate aminotransferase, lactate dehydrogenase, international normalized ratio, ferritin, and D-dimer levels were higher and lymphocyte, hemoglobin levels were lower; in the critically ill patients' group, platelets were lower and uric acid levels were higher in non-survivor patients.In mild patients, anemia, lymphopenia, and increased aspartate aminotransferase levels; in moderate patients, leukopenia, anemia, and increased aspartate aminotransferase, lactate dehydrogenase, international normalized ratio, ferritin, and D-dimer levels; in the critically ill patient group, lower platelet and increased uric acid levels should be followed closely as they are mortality predictors.

Korona virüs aralık 2019’un sonu itibari ile tüm dünyada yaygınlaşmış ve Mart 2020’den sonra ülkemizde de yaygın görülmeye başlamıştır. Tedavide uygulanan antiviral ilaçlardan sitokin reseptör antagonistlerine kadar çok geniş bir yelpazededir. Burada ayaktan hasta bakımındaki tedavi önerileri ile birlikte yoğun bakımdaki kritik hasta bakımı önerileri de yer almaktadır.

Objectives: COVID-19 associated coagulopathy and prophylactic anticoagulant therapy (PAT) are ongoing topics globally. Using PAT for anti-inflammatory effect may prevent thromboembolic events (TEEs). The objective of this study was to determine the anti-inflammatory effects of PAT in hospitalized COVID-19 patients. Methods: We conducted a retrospective observational study in a tertiary pandemic hospital. Patients were divided into two categories according to their PAT therapy status (PAT (+) and PAT (-)) and into three categories according to clinical features (mild: group 1; moderate: group: 2; and severe: group 3). We then evaluated laboratory parameters and clinical courses. Results: We included 662 hospitalized COVID-19 patients in this study. Enoxaparin sodium was given to all patients as PAT therapy. TEE was developed in five patients in the PAT (+) group. Pulmonary embolism developed in 3/5 patients and deep venous thrombosis in 2/5 patients. Disseminated intravascular coagulation (DIC) was detected in 54 patients in group 3. No statistically significant difference was found in 28-day mortality, development of DIC rates, intubation rates, and TEEs. Conclusions: The use of PAT in critically ill patients was not effective in reducing C-reactive protein, which is one of the biomarkers of inflammation.

Gunal, Ozgur/0000-0002-7744-4123; KARABAY, OGUZ/0000-0003-1514-1685 WOS: 000490537600009 PubMed: 31580558 Objective: Treponema pallidum and HIV are transmitted frequently through sexual contact, these agents with epidemiological similarities co-infect the same host. The current number of HIV-infected cases in Turkey is increasing. For this reason, we aimed to reveal the characteristics of syphilis in HIV/AIDS cases. Methods: A retrospective longitudinal cohort study was performed, patients were followed up at 24 clinics in 16 cities from all seven regions of Turkey between January 2010 to April 2018. We examined the socio-demographic characteristics, laboratory parameters and neurosyphilis association in HIV/AIDS-syphilis co-infected cases. Results: Among 3,641 patients with HIV-1 infection, 291 (8%) patients were diagnosed with syphilis co-infection. Most patients were older than 25 years (92%), 96% were males, 74% were working, 23% unemployed, and 3% were students. The three highest prevalence of syphilis were in Black Sea (10.3%), Mediterranean (8.4%) and Marmara Regions (7.4%). As for sexual orientation, 46% were heterosexuals, 42% men who have sex with men (MSM), and no data available for 12%. Patients with the number of CD4+

WOS: 000471726700008, PubMed ID: 30989418, Brucellosis in pregnant women is reported to be associated with obstetric complications (OCs), and adequate data for human brucellosis during pregnancy are largely lacking. We performed this multicenter retrospective cross-sectional study to evaluate the epidemiology, clinical course, treatment responses, and outcomes of brucellosis among pregnant women. The study period comprised a 14-year period from January 2002 to December 2015. All consecutive pregnant women diagnosed with brucellosis in 23 participating hospitals were included. Epidemiological, clinical, laboratory, therapeutic, and outcome data along with the assessment data of the neonate were collected using a standardized questionnaire. Data of 242 patients were analyzed. The OC rate was 14.0% (34/242) in the cohort. Of the 242 women, 219 (90.5%) delivered at term, 3 (1.2%) had preterm delivery, 15 (6.2%) aborted, and 5 (2.1%) had intrauterine fetal demise. Seventeen (7.0%) of the newborns were considered as low birth weight. Spontaneous abortion (6.1%) was the commonest complication. There were no maternal or neonatal deaths and pertinent sequelae or complications were not detected in the newborns. Splenomegaly (p=0.019), nausea and/or vomiting (p41IU/L; p=0.025), oligohydramnios on ultrasonography (p=0.0002), history of taking medication other than Brucella treatment during pregnancy (p=0.027), and Brucella bacteremia (p=0.029) were the significant factors associated with OCs. We recommend that pregnant women with OC or with fever should be investigated for brucellosis if they live in or have traveled to an endemic area.

We aimed to monitor the adverse effects (AE) and efficacy of post exposure prophylaxis (PEP) in health care workers (HCWs) exposed to a rabies patient. In this study 109 HCWs and eight household contacts were PEP candidates. Contact persons without infection control precautions were in Group I (high risk-82 cases). HCWs indirectly exposed to environmental surfaces were classified in Group II (low risk-35 cases). PEP schedule was rabies vaccine (RBV) + equine rabies immunoglobulin (eRIG) in Group I and only RBV in Group II. Local and systemic AE were observed in all cases. Efficacy of post exposure prophylaxis (PEP) was determined by rabies development in a six month follow-up. 585 doses of RBV have been used in 117 cases and eRIG has been used in 82 cases. 32 Nurses (39%); 22 emergency medicine technicians (26.8%); 12 doctors (14%); six laboratory technicians (0.07%); six radiology technicians (0.07%); four cleaners (0.05%) were in Group I (82 cases), respectively. One doctor, laboratory technician, nurse and radiology technician (0.02%); two emergency medicine technicians (0.04%) and nine cleaners (25.7%) were in Group II (35 cases), respectively. Routes of transmission were blood in five (0.06%); saliva in 14 (17%); sweat in 50 (61%); CSF/serum in five (0.06%); sexual intercourse in one (0.01%); personal equipment in seven (0.09%) in Group I, respectively. Indirect contact was the only route in Group II. The most common local and systemic AE were seen in Group I; pain at injection side (19 cases) and fever (13 cases). Both of them showed statistically significant difference (P

Introduction: In this study, we aimed to determine the risk factors associated with inadequate empirical antibiotherapy (IEAT) and hospital-related mortality in elderly patients being treated for upper urinary tract infections (UTI). Materials and Methods: This study included individuals aged 65 years and over who were hospitalized after being diagnosed of communityacquired UTI or community-onset healthcare-associated UTI and followed-up in clinics and/or intensive care units (ICU) of 33 hospitals between March and September 2017. Results: A total of 525 patients (48% males; mean age: 76.46±7.93 years) were included in the study. Overall, 68.2% of the patients were hospitalized through the emergency department and 73.9% of patients were followed-up for pyelonephritis. Gram-negative, Gram-positive, and Gram-negative and positive mix growths were determined in 88%, 9.3%, and 2.7% of urine cultures, respectively. Fifty-six (10.7%) of the patients died. In multivariate analysis, the presence of chronic obstructive pulmonary disease [Odds ratio (OR): 2.278], age 85 years and over (OR: 2.816), admission to the ICU (OR: 14.831), and IEAT (OR: 2.364) were independent factors that significantly affected mortality. The presence of a urinary catheter, being followed-up in the ICU, benign prostate hypertrophy, use of antibiotics other than piperacillin-tazobactam and carbapenem were determined as independent factors that significantly affected IEAT (p

Introduction: Although diabetic foot infections are polymicrobial, gram-positive microorganisms comprise the majority. Daptomycin is a novel agent in treating infections due to multidrug-resistant gram-positive pathogens. In this multicenter study, the outcomes of the daptomycin treatment were evaluated retrospectively in the treatment of diabetic foot infectious without osteomyelitis. Materials and Methods: Patients with diabetic foot infection without osteomyelitis and who received daptomycin treatment were included into the study. Sociodemographic characteristics of the patients, risk factors for methicillin resistant Staphylococcus aureus (MRSA), antimicrobial treatment, and the data of microbiological and clinical outcomes of the cases were registered in a standard form by eleven centers. Clinical success was defined as a combination of end-of-treatment laboratory parameters, clinical and microbiological responses. Results: A total of 46 patients (30 males, 16 females) were clinically evaluated for the outcome of daptomycin therapy. Mean age was 61.09 ± 11.82 years (31-81) and mean diabetes duration was 13 ± 8.2 years. The number of mild, moderate and severe infections identified according to the infection scoring system of the Infectious Diseases Society of America (IDSA) were 12 (26.1%), 25 (54.3%), and 9 (19.6%) respectively. Duration of daptomycin therapy was 17.5 ± 9.3 days and overall daptomycin success rate was 82.6% (n= 38). Two patients developed side effects. Conclusion: The clinical success rate of this study which assessed the efficacy of daptomycin in diabetic foot infections was 82.6%. Daptomycin can be safely used even in severe cases having had no success with previous antibiotic therapy.

Ventilator-associated pneumonia (VAP) due to Acinetobacter spp. is one of the most common infections in the intensive care unit. Hence, we performed this prospective-observational multicenter study, and described the course and outcome of the disease. This study was performed in 24 centers between January 06, 2014, and December 02, 2016. The patients were evaluated at time of pneumonia diagnosis, when culture results were available, and at 72 h, at the 7th day, and finally at the 28th day of follow-up. Patients with coexistent infections were excluded and only those with a first VAP episode were enrolled. Logistic regression analysis was performed. A total of 177 patients were included; empiric antimicrobial therapy was appropriate (when the patient received at least one antibiotic that the infecting strain was ultimately shown to be susceptible) in only 69 (39%) patients. During the 28-day period, antibiotics were modified for side effects in 27 (15.2%) patients and renal dose adjustment was made in 38 (21.5%). Ultimately, 89 (50.3%) patients died. Predictors of mortality were creatinine level (OR, 1.84 (95% CI 1.279–2.657); p = 0.001), fever (OR, 0.663 (95% CI 0.454–0.967); p = 0.033), malignancy (OR, 7.095 (95% CI 2.142–23.500); p = 0.001), congestive heart failure (OR, 2.341 (95% CI 1.046–5.239); p = 0.038), appropriate empiric antimicrobial treatment (OR, 0.445 (95% CI 0.216–0.914); p = 0.027), and surgery in the last month (OR, 0.137 (95% CI 0.037–0.499); p = 0.003). Appropriate empiric antimicrobial treatment in VAP due to Acinetobacter spp. was associated with survival while renal injury and comorbid conditions increased mortality. Hence, early diagnosis and appropriate antibiotic therapy remain crucial to improve outcomes. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.

ResumoJustificativa e objetivosOs filtros antibacterianos para cateter epidural são barreiras da analgesia/anestesia controlada pelo paciente para evitar a contaminação do local de inserção epidural. A eficácia desses filtros varia de acordo com o material e o tamanho dos poros.MétodoA capacidade de aderência bacteriana dos dois filtros foi medida em experimento in vitro. Avaliamos a capacidade de aderência das cepas padrão de Staphylococcus aureus (ATCC 25923) e Pseudomonas aeruginosa (ATCC 27853) de dois filtros diferentes (Portex e Rusch), mas com poros do mesmo tamanho. Uma suspensão bacteriana grau 0,5 de McFarland foi colocada na bomba de analgesia controlada pelo paciente e filtrada a uma velocidade de 5mL/h em infusão contínua por 48horas e acumulada em frasco. Os dois filtros foram comparados com contagens de colônias de bactérias nos filtros e frascos. Ao mesmo tempo, os filtros e as bactérias aderidas foram monitorados com microscópio eletrônico de varredura.ResultadosO exame dos filtros por microscópico eletrônico mostrou que a estrutura do filtro Portex era granulada e a do filtro Rusch fibrilar. A contagem de colônias do cateter e do frasco mostrou que ambos os filtros tinham uma capacidade de adesão bacteriana significativa (p

WOS: 000315000900024, PubMed ID: 25207054, Adenoid basal carcinoma (ABC) is a rare epithelial tumor of the cervix. It makes up approximately 1% of all cervical adenocarcinomas. Rare cases have been associated with common cervical epithelial tumors. We present a case of ABC associated with typical squamous cell carcinoma. A 54-year-old postmenopausal woman underwent D&C for vaginal bleeding. Histologically, the tumor was characterized by small cells with a narrow cytoplasm, making up islands and cords. Peripheral palissading in the cells surrounding the cystic areas that contained central cellular debris and keratin was noted. The patient underwent total hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy and omentectomy. Large cell keratinized type squamous cell carcinoma areas in the cervix were noted besides the limited ABC areas. After surgery, the patient was treated with radiation therapy. A retroperitoneal metastasis was found on the first year and chemotherapy was administered. The patient has no evidence of disease 27 months after the first diagnosis. ABC makes up quite a rare group of cervical cancers and should be kept in mind during the evaluation so that a differentiation can be made with tumors with similar morphology as it can show various histological patterns, and can be seen together with more aggressive cancers.

Alpay, Yeşim (Balikesir Author), "Background: Manynoninvasive methods, including aspartateaminotransaminase (AST)/alanineaminotransaminase (ALT) ratio (AAR), AST-to-platelet ratio index (APRI), Bonacini cirrhosis discriminant score (CDS), fibrosis-4 (FIB4) index, and age-platelet index (API), have been described to determine the stage of hepatic fibrosis. However, thesemethodsare developed for patients with chronic hepatitisC(CHC) andproduce conflicting results in the prediction of liver fibrosis in patients with chronic hepatitis B (CHB). Objectives: The aim of this study was to evaluate the relationship between 7 noninvasive models, including AAR, APRI, CDS, API, FIB-4, neutrophil-to-lymphocyte ratio (NLR), and red cell distribution width (RDW)-to-platelet ratio (RPR) in patients with CHB. Methods: The study population included all patients with CHB, undergoing liver biopsy to determine HBsAg and HBV DNA positivity in more than 6 months. Results: A total of 2520 treatment-naive CHB patients from 40 different centers were included in the study. In total, 62.6% of the patients were male, and the mean age was 40.60 +/- 12.34 years (minimum, 18 years; maximum, 77 years). The Ishak fibrosis score was >= 3 in 29.8% of the patients, indicating significant fibrosis. The mean API, APRI, CDS, NLR, FIB4, and RPR scores in the noninvasive models were significantly different between the groups with significant and low fibrosis (P < 0.05). All the noninvave models (API, APRI, AAR, CDS, NLR, RPR, and FIB4) were found to be significant in the discrimination of cirrhosis (P < 0.05). In the multiple logistic regression analysis, CDS, albumin, alkaline phosphatase (ALP), total bilirubin, neutrophil count, NLR, mean platelet volume (MPV), and FIB4 were independent indices for cirrhosis. Conclusions: In the present study, the role of noninvasive tests in the prediction of liver fibrosis stage and cirrhosis was evaluated in a large cohort of CHB patients. Overall, noninvasive models are gradually becoming more promising. Accordingly, the need for liver biopsy can be reduced with a combination of noninvasive methods in the future."

Background: Oxybutynin is a tertiary amine and has chemical similarities like protamine sulfate. Protamine sulfate's effect on bacterial viability has been shown in some studies; however, there is scanty data regarding the effect of oxybutynin on bacterial viability. Accordingly, the aim of the present study was to investigate the effect of oxybutynin on bacterial viability. Methods: Twenty of Staphylococcus epidermidis (S. epidermidis) strains were isolated from patients who had catheter-associated urinary tract infection. These strains were exposed to 5 different concentrations of oxybutynin in tryptic soy broth (TSB) media (max: 5 mg/mL, min: 0.05 mg/mL). Quantitative growth patterns were measured by spectrophotometer. Under the same media conditions, biofilm production of individual strains was measured by Deighton's micromethod at the end of the 6-hour incubation period. Results: After the incubation period, weak and strong slime-producing bacteria groups were obtained and both groups' slime productions were extensively low at 5 mg/mL concentration of oxybutynin. Slime production of S. epidermidis was inversely correlated with oxybutynin concentrations. Conclusion: Although there was a dose-dependent reduction of biofilm production, there seemed to be no bactericidal effect of oxybutynin on S. epidermidis.

WOS: 000348654600010, PubMed ID: 25667788, Background: Intraoperative frozen section procedure may be required in some operations performed for breast masses. Aims: We investigated the effect of frozen section procedure on the immunoprofile of breast carcinoma cells. Study Design: Cross-sectional study. Methods: A total of 53 breast carcinoma cases evaluated with intraoperative frozen sections were included in this study. Immunohistochemically, oestrogen (ER), progesterone (PR) and HER2 primary antibodies were evaluated in both frozen and non-frozen sections of each tumour sample. Results: No difference was found between the frozen and non-frozen sections in 33 cases in terms of staining rate and intensity of ER, PR and HER2. A decrease was found in the ER, PR and HER2 staining rate (in 10 cases, 9 cases and 6 cases, respectively). Likewise, a decrease was detected in ER, PR and HER2 staining intensity in 6 patients for each. Although there was no staining in frozen sections, immunopositivity was observed in 3 non-frozen sections for ER, in 2 for PR and in 5 for HER2. Statistically, a significant difference was found between the frozen and non-frozen sections in terms of staining rate and intensity for each of the three markers. Conclusion: In this study, the frozen section procedure in breast carcinoma had a negative effect on the immunoprofile. However, considering the importance of hormone receptor status in the treatment, these results should be supported with larger series.

WOS: 000345825900004, PubMed ID: 24849547, We aimed to provide data on the diagnosis of tuberculous meningitis (TBM) in this largest case series ever reported. The Haydarpasa-1 study involved patients with microbiologically confirmed TBM in Albania, Croatia, Denmark, Egypt, France, Hungary, Iraq, Italy, Macedonia, Romania, Serbia, Slovenia, Syria and Turkey between 2000 and 2012. A positive culture, PCR or Ehrlich-Ziehl-Neelsen staining (EZNs) from the cerebrospinal fluid (CSF) was mandatory for inclusion of meningitis patients. A total of 506 TBM patients were included. The sensitivities of the tests were as follows: interferon- release assay (Quantiferon TB gold in tube) 90.2%, automated culture systems (ACS) 81.8%, Lowenstein Jensen medium (L-J) 72.7%, adenosine deaminase (ADA) 29.9% and EZNs 27.3%. CSF-ACS was superior to CSF L-J culture and CSF-PCR (p

BACKGROUND AND OBJECTIVES: Epidural catheter bacteria filters are barriers in the patient-controlled analgesia/anaesthesia for preventing contamination at the epidural insertion site. The efficiency of these filters varies according to pore sizes and materials. METHOD: The bacterial adhesion capability of the two filters was measured in vitro experiment. Adhesion capacities for standard Staphylococcus aureus (ATCC 25923) and Pseudomonas aeruginosa (ATCC 27853) strains of the two different filters (Portex and Rusch) which have the same pore size were examined. Bacterial suspension of 0.5 Mc Farland was placed in the patient-controlled analgesia pump, was filtered at a speed of 5 mL/h. in continuous infusion for 48 h and accumulated in bottle. The two filters were compared with colony counts of bacteria in the filters and bottles. At the same time, the filters and adhered bacteria were monitored by scanning electron microscope. RESULTS: Electron microscopic examination of filters showed that the Portex filter had a granular and the Rusch filter fibrillary structure. Colony counting from the catheter and bottle showed that both of the filters have significant bacterial adhesion capability (p < 0.001). After the bacteria suspension infusion, colony countings showed that the Portex filter was more efficient (p < 0.001). There was not any difference between S. aureus and P. aeruginosa bacteria adhesion. In the SEM monitoring after the infusion, it was physically shown that the bacteria were adhered efficiently by both of the filters. CONCLUSION: The granular structured filter was found statistically and significantly more successful than the fibrial. Although the pore sizes of the filters were same - of which structural differences shown by SEM were the same - it would not be right to attribute the changes in the efficiencies to only structural differences. Using microbiological and physical proofs with regard to efficiency at the same time has been another important aspect of this experiment. JUSTIFICATIVA E OBJETIVOS: Os filtros antibacterianos para cateter epidural são barreiras da analgesia/anestesia controlada pelo paciente para evitar a contaminação do local de inserção epidural. A eficácia desses filtros varia de acordo com o material e o tamanho dos poros. MÉTODO: A capacidade de aderência bacteriana dos dois filtros foi medida em experimento in vitro. Avaliamos a capacidade de aderência das cepas padrão de Staphylococcus aureus (ATCC 25923) e Pseudomonas aeruginosa (ATCC 27853) de dois filtros diferentes (Portex e Rusch), mas com poros do mesmo tamanho. Uma suspensão bacteriana grau 0,5 de McFarland foi colocada na bomba de analgesia controlada pelo paciente e filtrada a uma velocidade de 5 mL/h em infusão contínua por 48 horas e acumulada em frasco. Os dois filtros foram comparados com contagens de colônias de bactérias nos filtros e frascos. Ao mesmo tempo, os filtros e as bactérias aderidas foram monitorados com microscópio eletrônico de varredura. RESULTADOS: O exame dos filtros por microscópico eletrônico mostrou que a estrutura do filtro Portex era granulada e a do filtro Rusch fibrilar. A contagem de colônias do cateter e do frasco mostrou que ambos os filtros tinham uma capacidade de adesão bacteriana significativa (p < 0,001). Após a infusão da suspensão bacteriana, as contagens de colônias mostraram que o filtro Portex foi mais eficiente (p < 0,001). Não houve qualquer diferença entre as adesões de bactérias S. aureus e P. aeruginosa. Na monitoração por MEV após a infusão, ficou fisicamente evidente que as bactérias foram aderidas de modo eficaz por ambos os filtros. CONCLUSÃO: O filtro com estrutura granular foi estatística e significativamente mais bem- sucedido do que o filtro com estrutura fibrilar. Embora o tamanho dos poros dos filtros fosse igual - as diferenças estruturais mostradas pelo MEV eram semelhantes -, não seria justo atribuir as alterações de eficiência apenas às diferenças estruturais. O uso ao mesmo tempo de provas microbiológicas e físicas para avaliar a eficácia foi outro aspecto importante deste experimento.

Introduction: Invasive aspergillosis mostly involves lungs. Patients may present with fever, cough, hemoptysis and many other sign and symptoms. Underlying conditions that compromises pulmonary and immune responses to inhaled Aspergillus species serve as risk factors for pulmonary invasive aspergillosis. We are presenting a case of simple aspergilloma, successfully treated by caspofungin and surgery. Case Report: A 64­ year­old male patient has rheumatoid arthritis for ten years. Since three months he had interstitial pulmonary disease secondary to rheumatoid arthritis and hemoptysis. We performed microbiologic and pathologic investigations of the brochoalveolar lavage after computerized tomography for diagnosis of aspergillosis. Caspofungin was used for initial treatment of simple aspergilloma and also for follow­up treatment after apical wedge resection. The patient was discharged from the hospital at eighth week on itraconazol antifungal therapy. Conclusion: Three classes of drugs are available for the treatment of aspergillosis: polyens, azoles and echinocandins. Echinocandins have activity against Aspergillus spp. But have a limited role because they have not been studied for initial treatment of invasive aspergillosis.