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Background Coronavirus disease 2019 (COVID-19) has quickly turned into a global pandemic with close to 5 million cases and more than 320,000 deaths. Cancer patients constitute a group that is expected to be at risk and poor prognosis in COVID pandemic. We aimed to investigate how cancer patients are affected by COVID-19 infection, its clinical course and the factors affecting mortality. Methods In our single-center retrospective study, we included cancer patients with laboratory confirmed COVID-19 in our hospital. Demographic, clinical, treatment, and laboratory data were obtained from electronic medical records. Logistic regression methods were used to investigate risk factors associated with in-hospital death. Results In the hospital, 4489 patients were hospitalized with COVID infection and 77 were cancer patients. The mean age of cancer patients was 61.9 ± 10.9 and 44 of them were male (62%). While the mortality rate in non-cancer patients was 1.51% (n = 68), this rate was significantly higher in cancer patients, 23.9% (n = 17). The stage of the disease, receiving chemotherapy in the last 30 days also lymphopenia, elevated troponin I, d-dimer, CRP, and CT findings were associated with severe disease and mortality. Severe lung involvement (OR = 22.9, p = 0.01) and lymphopenia (OR = 0.99, p = 0.04) are the most important factors influencing survival in logistic regression. Conclusions The disease is more severe in cancer patients and mortality is significantly higher than non-cancer patients. These data show that it may be beneficial to develop dynamic prevention, early diagnosis and treatment strategies for this vulnerable group of patients who are affected by the infection so much.

The aim of this study is to investigate the combination of cefepime and sulbactam. Sulbactam, when administered , will effectively inhibit all Extended-spectrum beta lactamases (ESBLs) of the microorganism, while cefepime will inhibit the growth of the resistant microorganisms since it will not be hydrolyzed by OXA-48. Forty OXA-48-producingK. pneumoniaestrains were investigated for their Minimum inhibitory concentrations (MICs) for carbapenems, cefepime, and cefepime + sulbactam by broth microdilution method. Also, the mutant prevention concentration (MPC)s of cefepime alone or in combination with sulbactam was determined. Additionally, the bactericidal activities of cefepime and cefepime + sulbactam were evaluated by the time-kill curve (TKC) assay against selected strains. Also, the in vitro synergistic activity of cefepime + sulbactam combination was determined by TKC. Based on MIC results, up to 35/40 and 34/40 of the strains were resistant to carbapenems and cefepime, respectively. Cefepime + sulbactam MIC range was lower than those for cefepime alone against all the studied isolates. Moreover, cefepime + sulbactam combination presented lower MPC values than cefepime alone. The synergistic interactions of cefepime + sulbactam were also achieved against studied strains at 24 h. No antagonism was observed against studiedK. pneumoniaestrains. The findings of this study displayed that cefepime + sulbactam combination had synergistic or additive effect against OXA-48-producingK. pneumoniaestrains. Additionally, it was first observed that this combination could display a lower MPC than cefepime alone. Further investigations may be helpful for understanding the effectiveness of cefepime + sulbactam combinations for OXA-48-positive carbapenem-resistantK. pneumoniaeisolates. Istanbul University

Background The aim of this study was to investigate the risk factors effective in perioperative morbidity and mortality in 161 living donor liver transplantations (LDLT). Results The most common indication for living donor transplantation was cryptogenic cirrhosis. The most common complication was biliary problems in 62.16% cases. Sepsis was the most common cause of in 52%. Patients in whom sepsis was observed, significantly prolonged stay under mechanical ventilation and prolonged ICU stay were detected. In patient group in whom mortality was observed, higher amounts of erythrocytes, fresh frozen plasma (FFP), and platelets were transfused, and patients remained longer under mechanical ventilation treatment, and in the ICU. Conclusion Perioperative morbidity and mortality was found to be significantly related with higher amounts of erythrocytes and FFP transfusions and longer operative and warm ischemia times. Sepsis was found to be the most common cause of mortality.

The conventional lithium-ion battery fabrication process involves mixing of the active cathode material with additives and tape casting on metallic current collectors. The thickness of this layer limits the performance of the cathode. In this work, a novel cathode platform is presented consisting of a micropatterned array of vertically aligned carbon nanotubes (CNTs) on aluminum (Al) foil that serves as host for active cathode powders. This highly conductive three-dimensional structure provides a high specific surface area to support greater mass loading capable of achieving high energy and power densities. The feasibility of this structure was demonstrated by using commercially available lithium iron phosphate (LFP) powder which was processed and dispersed using two different techniques—vibration-assisted drip-coating and electrophoretic deposition. A high specific capacity of 143 mAh/g at 3.4 V was achieved at C/20 rate for the novel cathode fabricated using electrophoretic deposition, which seemed superior to vibration-assisted drip coating with its easier application, more uniform particle coating, stronger particle attachment to the CNTs, and better electrochemical performance. In addition, CNT array on Al has been demonstrated to be a viable candidate for fabricating cathodes for energy storage applications without the need for any additives and/or binders.

Development of advanced supercapacitors which provide greater energy density while retaining high power density can revolutionize energy storage solutions for both civilian and military applications. Herein, we present fabrication and characterization of nanostructured supercapacitor electrodes using manganese dioxide and carbon nanotubes (MnO2/CNTs) on flexible graphite foil substrate for integration into a supercapacitor prototype cell, without any additives or binders. Low-cost, thermal chemical vapor deposition process in a tube furnace was used to synthesize CNTs, acting as the current conductors, directly on both sides of the flexible, conducting graphite foil current collector. Thin-film MnO2 deposition on the CNTs was achieved by electrochemical technique using in situ reduction of potassium permanganate (KMnO4), without any supporting electrolyte, which provides excellent bonding between the two for enhanced stability. Eight electrodes were assembled in a stack with polypropylene separators and packaged in a pouch cell with organic electrolyte (1 M tetraethylammonium tetrafluoroborate in acetonitrile) yielding a total capacitance of nearly 2.8 F at 2.5 V and a corresponding specific capacitance of 388 F g−1 was calculated for MnO2. High cell capacitance and a low DC resistance yield a maximum specific power value of 36.1 kW kg−1 and a maximum specific energy of 48.5 Wh kg−1 at 2.5 V when considering the total mass including that of CNTs and MnO2. Cycling data showed nearly 100% capacitance retention over 3000 charge discharge cycles. To the best of our knowledge, a supercapacitor prototype cell in this configuration has not been fabricated and/or reported previously. Schematic representation of the prototype supercapacitor cell consisting of a stack of eight electrodes with polypropylene separators. On the right is a blow-up representation of a double side electrode with MnO2/CNT on both sides of the graphite foil substrate. The equivalent circuit diagram can be seen on the left, consisting of seven capacitors in parallel

We present a 35-year-old female patient who was started on rifampicin (900 mg orally once daily) and trimethoprim/sulfamethoxazole (TMP/SMX) (160/800 mg orally twice daily) after being diagnosed with brucellosis. Following defervescence and improvement in her general condition, fever recurred on the 12th day of treatment. A re-challenge drug test lead to causality assessment and treatment was switched to a combination of streptomycin (1 g intramuscularly) for 10 days and TMP/SMX (160/800 mg orally twice daily) for 4 weeks. Our patient is doing well after 12 months of follow-up.

Background: Group A streptococci (GAS) are the most common bacterial cause of acute pharyngitis and account for 15-30 % of cases of acute pharyngitis in children and 5-10 % of cases in adults. In this study, a real-time quantitative PCR (qPCR) based GAS detection assay in pharyngeal swab specimens was developed. Methods: The qPCR assay was compared with the gold standard bacterial culture and a rapid antigen detection test (RADT) to evaluate its clinical performance in 687 patients. The analytical sensitivity of the assay was 240 cfu/swab. Forty-five different potential cross-reacting organisms did not react with the test. Four different laboratories for the reproducibility studies were in 100 % (60/60) agreement for the contrived GAS positive and negative swab samples. Results: The relative sensitivities of the RADT and the qPCR test were 55.9 and 100 %; and the relative specificities were 100 and 96.3 %, respectively. Duration of the total assay for 24 samples including pre-analytical processing and analysis changed between 42 and 55 min depending on the type of qPCR instrument used. A simple DNA extraction method and a low qPCR volume made the developed assay an economical alternative for the GAS detection. Conclusion: We showed that the developed qPCR test is rapid, cheap, sensitive and specific and therefore can be used to replace both antigen detection and culture for diagnosis of acute GAS pharyngitis.

WOS: 000369571000002, PubMed ID: 26860463, Background: Staphylococcus aureus is one of the causes of both community and healthcare-associated bacteremia. The attributable mortality of S. aureus bacteremia (SAB) is still higher and predictors for mortality and clinical outcomes of this condition are need to be clarified. In this prospective observational study, we aimed to examine the predictive factors for mortality in patients with SAB in eight Turkish tertiary care hospitals. Methods: Adult patients with signs and symptoms of bacteremia with positive blood cultures for S. aureus were included. All data for episodes of SAB including demographics, clinical and laboratory findings, antibiotics, and outcome were recorded for a 3-year (2010-2012) period. Cox proportional hazard model with forward selection was used to assess the independent effect of risk factors on mortality. A 28-day mortality was the dependent variable in the Cox regression analysis. Results: A total of 255 episodes of SAB were enrolled. The median age of the patients was 59 years. Fifty-five percent of the episodes were considered as primary SAB and vascular catheter was the source of 42.1 %. Healthcare associated SAB was defined in 55.7 %. Blood cultures yielded methicillin-resistant S. aureus (MRSA) as a cause of SAB in 39.2 %. Initial empirical therapy was inappropriate in 28.2 %. Although overall mortality was observed in 52 (20.4 %), 28-day mortality rate was 15.3 %. Both the numbers of initial inappropriate empirical antibiotic treatment and the median hours to start an appropriate antibiotic between the cases of fatal outcome and survivors after fever onset were found to be similar (12/39 vs 60/216 and 6 vs 12 h, respectively; p > 0.05). High Charlson comorbidity index (CCI) score (p = 0.002), MRSA (p = 0.017), intensive care unit (ICU) admission (p < 0.001) and prior exposure to antibiotics (p = 0.002) all were significantly associated with mortality. The Cox analysis defined age [Hazard Ratio (HR) 1.03; p = 0.023], ICU admission (HR 6.9; p = 0.002), and high CCI score (HR 1.32; p = 0.002) as the independent predictive factors mortality. Conclusions: The results of this prospective study showed that age, ICU stay and high CCI score of a patient were the independent predictors of mortality and MRSA was also significantly associated with mortality in SAB.

Background A 26-year-old man with known but untreated ventricular septal defect was admitted to the emergency ward with abdominal pain, fever and weight loss. Transthoracic echocardiography showed multiple vegetations on the anterior mitral leaflet, a mobile vegetation on the surface of the aortic noncoronary cusp and another on the tricuspid valve. His blood cultures grew Streptococcus sanguis with a penicillin minimum inhibitory concentration of 3 µg/ml. Investigations Physical examination, echocardiography, blood cultures, minimal inhibitory concentration detection. Diagnosis Multivalvular infective endocarditis caused by S. sanguis with a high penicillin resistance. Management A combination of intravenous vancomycin and gentamicin, followed by early surgery.

Dear Sir, Hepatitis C virus (HCV) infection is common in hemodialysis patients and the relatively lower alanine aminotransferase (ALT) values in acute [1] and chronic hepatitis C infections [2, 3] of these patients make the diagnosis more difficult. Acute hepatitis C in hemodialysis patients can be treated by interferon (IFN) therapy [4], although the response rates are lower than in patients with normal renal function [5]. Lampe et al. [6] emphasized the role of recognizing acute HCV infection in hemodialysis patients by comparing the ALT level to the patient’s ALT baseline values. A 53-year-old male was under hemodialysis for 10 years due to hypertensive nephropathy. Hemodialysis was applied 3 times weekly and the serology of HCV and hepatitis B virus (HBV) and biochemistry were checked monthly. When his ALT level was measured as 29 U/l, which seemed significantly higher than his previous measurements (4, 5, 7, 4, and 6 IU/l, respectively), HCV and HBV serology was repeated. Although antiHCV remained negative and anti-HBs was positive, his ALT level was serially checked. Within 1 month, his ALT level increased to 114 U/l and anti-HCV was detected as positive. He remained symptomless. HCV ribonucleic acid (RNA) by polymerase chain reaction (PCR) was measured as 7,130 IU/l and the genotype study remained an indeterminate result. HCV RNA studies obtained 2 weeks apart gave comparable results of 5,150 and 6,120 IU/l. His ALT level increased to a maximum level of 155 U/l and then tended to decrease (Fig. 1). He was initiated with pegylated IFN alpha-2a 135 lg weekly. The study of Lemos et al. [7] emphasized the role of monitoring ALT for recognizing acute HCV infection, since the patients are almost always asymptomatic, as in our case. They observed ALT elevation in all patients and the median peak ALT was 4.79 the upper limit of normal (range: 1.1–47.4). The median interval between ALT elevation and anti-HCV seroconversion was 1 month. What is the upper limit of normal of ALT in hemodialysis patients? Espinosa et al. [1] reported the upper limit for ALT in hepatitis-free hemodialysis patients as 27 IU/l. The sensitivity of a mean ALT value C27 IU/l in the diagnosis of HCV viremia was 50% and the specificity was 100%. They reported the positive predictive value of this test in the diagnosis of hepatitis C viremia as 100% and concluded that a high ALT level can constitute an excellent tool in predicting viremia in hemodialysis patients, once other causes of liver disease have been excluded. In two studies including 19 and 32 patients with acute hepatitis C under hemodialysis, the peak median ALT levels of the patients were 345 IU/l (range: 24–1,473) [8] and 169 IU/l (range: 22–325), respectively. Another study used the definition of acute HCV infection as ‘‘a rise of twice the normal or more of serum ALT level compared to baseline in addition to a positive serum anti-HCV antibody’’ [4]. To conclude, recognizing acute HCV infection is critical, since treatment can prevent progressive liver damage by a considerable part. The ALT levels are not expected to increase by several times, so any increase compared to his/ her ‘‘normal’’ values should be considered as a warning. R. Ozaras (&) M. Yilmaz B. Mete A. Demirel Department of Infectious Diseases, Cerrahpasa Medical Faculty, University of Istanbul, Aksaray, Istanbul 34303, Turkey e-mail: rozaras@yahoo.com