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In pandemic conditions, patients with febrile neutropenia are also at risk of COVID-19. Aim of this systematic review is to evaluate COVID-19 cases presented with febrile neutropenia and provide information regarding incidence, clinical course and prognosis.We systematically searched on COVID-19 and febrile neutropenia cases in PubMed, SCOPUS and Web of Science.A total of 19 febrile neutropenic patients were analyzed. A male predominance was noted. Eleven cases had hematological malignancies. Fourteen of the cases were previously received chemotherapy. Five patients had severe neutropenia: 3 had hematologic cancer and none died. 17 (89.5%) cases have pulmonary involvement and seven of them had severe disease with acute respiratory distress syndrome (ARDS). Three cases with ARDS were died. 12 of them received G-CSF for treatment. Five cases were developed respiratory failure after G-CSF use. Overall mortality was 15.8%, while death was not observed in patients without malignancy and solid organ tumors, the mortality rate was 27% in cases with hematological malignancies.In ongoing pandemic, febrile neutropenic patients should be precisely evaluated for COVID-19 disease. It should be remembered that there may not be typical signs and symptoms and laboratory findings of COVID-19 disease because of the immunosuppression.

To the Editor—We read the paper of Mehmood et al1 with great interest. Their letter was based on a newspaper report of novel coronavirus (COVID-19) and Crimean–Congo hemorrhagic fever (CCHF) coinfection, and its scientific basis is questionable. 34462024

Vertical direct chill (VDC) casting is commonly used to produce slabs and billets from wrought aluminium alloys. The fact that the VDC is not a continuous process and moulds must be prepared for the next batch decreases the productivity of the process. Alternatively, horizontal direct chill (HDC) casting simplifies the process and allows a continuous production. The casting speed in the HDC casting is easier to control and can be optimized for different alloys by changing the speed. This study focuses on investigating the effects of casting speed on the macrostructure of 6082 aluminium billets with 60 mm diameter. A demo-scale casting unit was used and the casting speed was changed from 310 to 385 mm/min. Changes in surface condition, macrocracks, microporosity, and diameter of the billets were investigated. Surface quality of the billets became better with the increasing casting speed, while diameter of the billet expands. Furthermore, centreline cracks appear at the casting speed of 355 mm/min.

Background Increasing number of patients with COVID-19-associated mucormycosis have been reported, especially from India recently. We have described a patient with COVID-19-associated mucormycosis and, searched and analyzed current medical literature to delineate the characteristics of COVID-19-associated mucormycosis. Method We reported a patient developed mucormycosis during post-COVID period. We searched literature to describe the incidence, clinical features, and outcomes of COVID-19-associated mucormycosis. Demographic features, risk factors, clinical features, diagnostic methods, treatment and outcome were analyzed. Results We describe a 54-year-old male, hospitalized due to severe COVID-19 pneumonia. He was given long-term, high doses of systemic steroids. He developed maxillo-fascial mucormycosis and died of sepsis. Our literature search found 30 publications describing 100 patients including present case report. The majority (n = 68) were reported from India. 76% were male. The most commonly seen risk factors were corticosteroid use (90.5%), diabetes (79%), and hypertension (34%). Also, excessive use of broad-spectrum antibiotics were noted in cases. Most frequent involvements were rhino-orbital (50%), followed by rhino-sinusal (17%), and rhino-orbito-cerebral (15%). Death was reported as 33 out of 99 patients (33,3%). Conclusions Steroid use, diabetes, environmental conditions, excessive use of antibiotics, and hypoxia are main risk factors. Despite medical and surgical treatment, mortality rate is high. A multidisciplinary approach is essential to improve the conditions facilitating the emergence of COVID-19-associated mucormycosis.

Yard. Doc. Dr. Cengiz Kaya, Ondokuz Mayis Universitesi Anestezi ve Rean. AD. Kurupelit, Samsun Turkiye, Tel. 0505 679 33 59 Email. raufemre@yahoo.com Gelis Tarihi: 25.08.2014 • Kabul Tarihi: 08.02.2015 ABSTRACT AIM: To compare a lighted intubation stylet (LIS), Storz DCI videolaryngoscope, and Macintosh laryngoscope regarding endotracheal intubation (ETI) times, the number of intubation attempts required, hemodynamic findings, and complications related to intubation-extubation.

Objective: To detect the effects of care bundle that is prepared depending on guidelines for central line associated infections. Material and Method: Patients in a tertiary medical intensive care unit were followed up during one year period in terms of catheter infections. The care bundle that was prepared depending on guidelines was performed for all central catheter placements. Catheters were evaluated in terms of local or systemic bloodstream infections everyday. Data obtained were compared with the previous year’s data. Results: We concluded that age, gender or weight characteristics have no effect on central venous catheter related infections but we detected higher infection rates at patients who had higher APACHE 2 scores. Bloodstream infection rates related with central catheter were similar between catheters inserted at operation rooms or intensive care units but catheters inserted at out services had higher infections rates. It was shown that prolonged catheter duration is related with high infection levels but anatomic place of catheter has no relationship with infection rates. No relationship was found between clothing type and infection rate. Total parenteral nutrition, blood or blood product administration via central catheter has increased infection rates. Conclusion: Performing care bundles decreases central venous catheter utilization rates central line associated bloodstream infection rates.

WOS: 000319788900007 PubMed: 23567483 Study Objective: To assess the effect of two different remifentanil infusion doses on hemodynamic stability and recovery characteristics in children undergoing tracheobronchial foreign body removal during rigid bronchoscopy. Design: Prospective, randomized, clinical comparison study. Setting: Operating room of a university hospital. Patients: 70 ASA physical status 1 and 2 children, aged 3-12 years, presenting for tracheobronchial foreign body removal during rigid bronchoscopy. Interventions: Children were divided equally into two groups to receive either a 0.1 mu g/kg/min (Group R1) or 0.2 mu g/kg/min (Group R2) remifentanil infusion. Ten minutes after the remifentanil infusion, 3 mg/kg of propofol and 0.02 mg/kg of atropine were given. Anesthesia was maintained with 0.1 mu g/kg/min of remifentanil and 100-250 mu g/kg/min of propofol in Group R1 and 02 mu g/kg/min of remifentanil and 100-250 mu g/kg/min of propofol in Group R2. After baseline measurements were recorded, 0.2 mg/kg of mivacurium was given intravenously. Ventilation was maintained with 100% O-2 via a "T" piece connected to the side arm of the bronchoscope. Measurements: Heart rate (HR), systolic (SBP), diastolic (DBP) and mean arterial pressures (MAP), and O-2 saturation (SpO(2)) were recorded before (baseline) and after induction, and 1, 3, 5, 10, 15, 20, 25, and 30 minutes after insertion of the rigid bronchoscope into the trachea. Emergence characteristics and complications were noted. Statistical analysis was performed using independent samples t-test, repeated measures, and chi-square test as appropriate. Main Results: Groups were similar in demographics and duration of bronchoscopy and anesthesia (P>0.05). In Group R1, HR, SBP, DBP, and MAP increased one minute after insertion of the bronchoscope in Group R1 (P

Introduction: The pandemic H1N1 virus has also affected our country between June 2009 and March 2010. This study aimed to evaluate the cases affected by the pandemic and hospitalized in one’s clinic. Materials and Methods: Demographic characteristics, risk factors, laboratory and radiological findings of the patients hospitalized with a provisional diagnosis of H1N1 influenza between October 2009 and March 2010 were retrospectively evaluated. Results: Seventy-five patients admitted to the study, 49 (65.3%) of them were female, and the mean age was 35.9 (18-80). Of the female patients, 13 (26%) were pregnant. The most obvious symptoms of referred patients were fever (98.6%), chills (89.3%), weakness (88%) and cough (85%). Bilateral involvement existed on direct chest X-ray examination during the first application of all patients who needed mechanical ventilation or died later. Forty three percent of the patients had at least one chronic disease. Five of the patients died. The presence of H1N1 was confirmed in 44 (58%) cases by polymerase change reaction (PCR). Exposure to a patient with influenza was positive in 45.5% of the cases (p= 0.019). Lymphopenia was the most common laboratory finding in all patients (64%). Monocyte values were significantly low in certain cases (p= 0.0016). Oseltamivir treatment was used in 72 (96%) patients. Antibiotics were added to treatment in 63 (84%) patients. The most common complication was pneumonia (82%). Conclusion: H1N1 pandemic showed a similar pattern of seasonal influenza but transmission from person to person had been more frequent. Mortality was more common in middle-aged population without underlying comorbid condition.

Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University Medical School, Samsun, Turkey Liverpool School of Tropical Medicine, Liverpool, United Kingdom, Department of Intensive Care, Ondokuz Mayis University Medical School, Samsun, Turkey Department of Haematology, Ondokuz Mayis University Medical School, Samsun, Turkey NIHR Helalth Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool L69 7BE, United Kingdom

Background Scant information exists about the epidemiological characteristics and outcome of patients in the intensive care unit (ICU) at risk of acute respiratory distress syndrome (ARDS) and how ventilation is managed in these individuals. We aimed to establish the epidemiological characteristics of patients at risk of ARDS, describe ventilation management in this population, and assess outcomes compared with people at no risk of ARDS. Methods PRoVENT (PRactice of VENTilation in critically ill patients without ARDS at onset of ventilation) is an international, multicentre, prospective study undertaken at 119 ICUs in 16 countries worldwide. All patients aged 18 years or older who were receiving mechanical ventilation in participating ICUs during a 1-week period between January, 2014, and January, 2015, were enrolled into the study. The Lung Injury Prediction Score (LIPS) was used to stratify risk of ARDS, with a score of 4 or higher defining those at risk of ARDS. The primary outcome was the proportion of patients at risk of ARDS. Secondary outcomes included ventilatory management (including tidal volume [VT] expressed as mL/kg predicted bodyweight [PBW], and positive end-expiratory pressure [PEEP] expressed as cm H2O), development of pulmonary complications, and clinical outcomes. The PRoVENT study is registered at ClinicalTrials.gov, NCT01868321. The study has been completed. Findings Of 3023 patients screened for the study, 935 individuals fulfilled the inclusion criteria. Of these critically ill patients, 282 were at risk of ARDS (30%, 95% CI 27–33), representing 0·14 cases per ICU bed over a 1-week period. VTwas similar for patients at risk and not at risk of ARDS (median 7·6 mL/kg PBW [IQR 6·7–9·1] vs 7·9 mL/kg PBW [6·8–9·1]; p=0·346). PEEP was higher in patients at risk of ARDS compared with those not at risk (median 6·0 cm H2O [IQR 5·0–8·0] vs 5·0 cm H2O [5·0–7·0]; p

Aims: To evaluate the effectiveness of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach in Turkey and analyse predictors of poor hand hygiene compliance. Design: An observational, prospective, interventional, before-and-after study was conducted from August 2003 to August 2011 in 12 intensive care units (ICU) of 12 hospitals in 11 cities. The study was divided into a baseline and a follow-up period and included random 30-minute observations for hand hygiene compliance in ICU. The hand hygiene approach included administrative support, supplies availability, education and training, reminders in the workplace, process surveillance, and performance feedback. Results: We observed 21,145 opportunities for hand hygiene. Overall hand hygiene compliance increased from 28.8% to 91% (95% CI 87.6–93.0, p 0.0001). Multivariate and univariate analyses showed that several variables were significantly associated with poor hand hygiene compliance: males vs. females (39% vs. 48%; 95% CI 0.79–0.84, p 0.0001), ancillary staff vs. physicians (35% vs. 46%, 95% CI 0.73–0.78, p 0.0001), and adult vs. pediatric ICUs (42% vs. 74%, 95% CI 0.54–0.60, p 0.0001). Conclusions: Adherence to hand hygiene was significantly increased with the INICC Hand Hygiene Approach. Specific programmes should be directed to improve hand hygiene in variables found to be predictors of poor hand hygiene compliance.

Yalcin, Ata Nevzat/0000-0002-7243-7354; dursun, oguz/0000-0001-5482-3780; Oncul, Oral/0000-0002-1681-1866; Leblebicioglu, Hakan/0000-0002-6033-8543; demirdal, tuna/0000-0002-9046-5666; Ciftci, Ergin/0000-0002-4955-160X; Erben, Nurettin/0000-0003-0373-0132; Kendirli, Tanil/0000-0001-9458-2803; Acar, Ali/0000-0003-2008-5112; Geyik, Mehmet Faruk/0000-0002-0906-0902; Dursun, Oguz/0000-0001-5482-3780; KAYA, ZEYNEP/0000-0002-8468-2103; KARABAY, OGUZ/0000-0003-1514-1685; Karabay, Oguz/0000-0003-0502-432X; Kaya, Sehnaz/0000-0003-0002-1517 WOS: 000347654600011 PubMed: 25564124 Background: Surgical site infections (SSIs) are a threat to patient safety; however, there were no available data on SSI rates stratified by surgical procedure (SP) in Turkey. Methods: Between January 2005 and December 2011, a cohort prospective surveillance study on SSIs was conducted by the International Nosocomial Infection Control Consortium (INICC) in 20 hospitals in 16 Turkish cities. Data from hospitalized patients were registered using the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) methods and definitions for SSIs. Surgical procedures (SPs) were classified into 22 types according to International Classification of Diseases, Ninth Revision criteria. Results: We recorded 1879 SSIs, associated with 41,563 SPs (4.3%; 95% confidence interval, 4.3-4.7). Among the results, the SSI rate per type of SP compared with rates reported by the INICC and CDC NHSN were 11.9% for ventricular shunt (vs 12.9% vs 5.6%); 5.3% for craniotomy (vs 4.4% vs 2.6%); 4.9% for coronary bypass with chest and donor incision (vs 4.5 vs 2.9); 3.5% for hip prosthesis (vs 2.6% vs 1.3%), and 3.0% for cesarean section (vs 0.7% vs 1.8%). Conclusions: In most of the 22 types of SP analyzed, our SSI rates were higher than the CDC NHSN rates and similar to the INICC rates. This study advances the knowledge of SSI epidemiology in Turkey, allowing the implementation of targeted interventions. Copyright (C) 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

AVCI, Bahattin/0000-0001-6471-6495; KOZAN, AHMET/0000-0002-7442-694X WOS: 000350093600010 PubMed: 23299191 This study is intended to examine the effects of administration of asymmetric dimethylarginine (ADMA) on the levels of tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and IL-10. A total of 30 Wistar adult albino rats were used. Group I was administrated (n = 10) with I mg/kg/day of ADMA, group 11 (n = 10) was administrated with 2 mg/kg/day of ADMA and the control group was administrated (n = I 0) with 0.9% sodium chloride. ADMA was intraperitoneally administrated for 7 days. The serum levels of IL-6, TNF-alpha and IL-10 were measured. There was a significant decrease in the levels of TNF-alpha, IL-6 and IL-10 in group 1 compared with that of the control group (p < 0.001). There was also a significant decrease in the levels of IL-10 in group II compared with that of the control group (p < 0.05) but the increase was much more distinct in the levels of IL-6 and TNF-alpha (p < 0.001). When comparing the groups by the doses given, no difference between the levels of IL-6 and IL-10 in groups 1 and II (p > 0.05) was observed; the levels of TNF-alpha in group II were significantly lower than those of group 1 (p < 0.05). A significant decrease in the serum levels of inflammatory cytokines IL-6, TNF-alpha and IL-10, after administration of 1 mg/kg/day and 2 mg/kg/day of ADMA, indicates that ADMA has an effect on inflammation. Increase in ADMA levels in the rats shows that the effects of inflammatory cytokines were suppressed.

Mobile communication devices help accelerate in-hospital flow of medical information, information sharing and querying, and contribute to communications in the event of emergencies through their application and access to wireless media technology. Healthcare-associated infections remain a leading and high-cost problem of global health systems despite improvements in modern therapies. The objective of this article was to review different studies on the relationship between mobile phones (MPs) and bacterial cross-contamination and report common findings. Thirty-nine studies published between 2005 and 2013 were reviewed. Of these, 19 (48.7%) identified coagulase-negative staphylococci (CoNS), and 26 (66.7%) identified Staphylococcus aureus; frequency of growth varied. The use of MPs by healthcare workers increases the risk of repetitive cyclic contamination between the hands and face (e.g., nose, ears, and lips), and differences in personal hygiene and behaviors can further contribute to the risks. MPs are rarely cleaned after handling. They may transmit microorganisms, including multiple resistant strains, after contact with patients, and can be a source of bacterial cross-contamination. To prevent bacterial contamination of MPs, hand-washing guidelines must be followed and technical standards for prevention strategies should be developed.

Objective: In this study, our objective was to compare the Cormack and Lehane (C-L) sight scores of direct laryngoscopy in endotracheal intubation with the endoscopic sight scores of the LMA CTrach and video laryngoscope. We also compared the success of endoscopy with the LMA CTrach and video laryngoscopy, intubation time, and its effects on haemodynamic and stress responses.Methods: The study included 100 patients, with American Society of Anesthesiologists (ASA) scores I-III and aged 18-65, who will undergo elective surgery. Patients were randomly divided into two groups: Group C and Group V. The patients in both groups underwent direct laryngoscopy with a Macintosh laryngoscope, and their C-L scores were recorded. In Group C, the patients were intubated with the LMA CTrach, and in Group V, the patients were intubated with a video laryngoscope. Patients’ haemodynamic parameters, oxygen saturation, end-tidal carbondioxide, and endoscopic sight scores were recorded.Results: The demographic characteristics and the ASA classifications of the groups were similar. When endoscopic sight scores were compared with C-L, better sight was obtained in the LMA CTrach group; no significant difference was detected in Group V. Regarding the success of the intubation, no significant difference was detected between groups. However, when intubation times were compared, there was a significant difference between groups. The intubation time was longer in Group C. There was no difference between groups in terms of the percentage changes of haemodynamic parameters, oxygen saturation, and end-tidal carbondioxide values of the patients.Conclusion: In this study, when endoscopic sight scores were compared, better visualization was obtained in the LMA CTrach group. Therefore, in cases where intubation is difficult to apply in patients, the LMA CTrach can be an alternative application. © 2014 by Turkish Anaesthesiology and Intensive Care Society.

Maghsoudi, Behzad/0000-0002-1279-8799; Kritsotakis, Evangelos/0000-0002-9526-3852; Yalcin, Ata Nevzat/0000-0002-7243-7354; Mikaszewska-Sokolewicz, Malgorzata A/0000-0002-1148-7817; ALDEMIR KOCABAS, Bilge/0000-0002-6396-5243; Masjedi, Mohammad Reza/0000-0002-6871-382X; Masjedi, Mansoor/0000-0001-6175-9289; Gan, Chin Seng/0000-0002-6758-4798; Oncul, Oral/0000-0002-1681-1866; Sabetian, Golnar/0000-0001-8764-2150; YAMAN, Ayhan/0000-0002-5651-1286; Ozdemir, Halil/0000-0002-7318-1688; Leon, Hector Armando Rincon/0000-0003-0715-200X; Delia, Muntean/0000-0001-9100-4530; Atasay, Fatma Begum/0000-0002-9114-5293; Zand, Farid/0000-0003-3489-3372; Kuchenbecker, Ricardo/0000-0002-4707-3683; Medeiros, Eduardo A/0000-0002-6205-259X; ROMERO LOPEZ-ALBERCA, CRISTINA/0000-0001-5856-8668; Salomao, Reinaldo/0000-0003-1149-4598; ozdemir, sonay incesoy/0000-0003-2863-901X; Meco, Basak Ceyda/0000-0003-2951-9634; Horoz, Ozden Ozgur/0000-0001-7590-650X; Horhat, Florin George/0000-0001-6133-0204; Kazi, Mohammad Mukhit/0000-0003-3824-5540; Ciftci, Ergin/0000-0002-4955-160X; Abouqal, Redouane/0000-0002-6117-4341; Leblebicioglu, Hakan/0000-0002-6033-8543; Garcell, Humberto Guanche/0000-0001-7279-0062; Kendirli, Tanil/0000-0001-9458-2803; de Souza, Maria Cecilia B V/0000-0003-0318-3087; Sanaei Dashti, Anahita/0000-0002-2827-3575; UNAL, SERHAT/0000-0003-1184-4711; alvarez Moreno, carlos Arturo/0000-0001-5419-4494; Barahona G., Nayide/0000-0003-3559-6900; Rodriguez Ferrer, Marena Luz/0000-0002-8053-8454; Karabay, Oguz/0000-0003-0502-432X; Kaya, Sehnaz/0000-0003-0002-1517; ERDEVE, OMER/0000-0002-3193-0812; Gonzalez Martinez, Marisela del Rocio/0000-0003-1474-736X; Gikas, Achilleas/0000-0002-8455-9631; Baylan, Orhan/0000-0002-6529-7824; Mitrev, Zan/0000-0001-7859-8821; yildizdas, dincer/0000-0003-0739-5108; Ngo, Quy Chau/0000-0002-6787-2757; Duszynska, Wieslawa/0000-0002-5880-4904; KAYA, ZEYNEP/0000-0002-8468-2103; Dragan, Barbara/0000-0003-3108-4211; Gupta, Umesh/0000-0001-7717-1404; Navarro Fuentes, Karla Reyna/0000-0002-6894-8872; zali, Mohammadreza/0000-0002-9027-4560; Morocho Tutillo, Diego Rolando/0000-0002-4974-7856; El Kholy, Amani/0000-0002-0645-7664; Kanj, Souha/0000-0001-6413-3396; Assiri, Abdullah/0000-0002-5605-2876; Unal, Necmettin/0000-0002-9440-7893; Jayatilleke, Kushlani/0000-0002-3931-6630; KARABAY, OGUZ/0000-0003-1514-1685 WOS: 000341307100001 PubMed: 25179325 We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line-associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U. S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN. Copyright (C) 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

WOS: 000324374700060 PubMed: 23683570 Purpose: To investigate predictive powers of S100B and cell-free DNA (cfDNA) levels in patients in the intensive care unit (ICU) who have with intracranial hemorrhage (ICH) for prognosis. Methods: Ninety-nine patients diagnosed with ICH were included in the study. The blood samples were drawn on the day of admittance to ICU and again on the third day. Duration of stay in the ICU and mortality were recorded. Results: A positive correlation was determined between the values of S100B and cfDNA from both the analysis and the Acute Physiology and Chronic Health Evaluation II scores. For all patients, there was a positive correlation between the duration of stay in the ICU and the values of S100B and cfDNA on the third day. The levels of both S100B and cfDNA in patients who died in the ICU were significantly higher than of those who survived on the day of admittance. Conclusions: Both S100B and cfDNA values can be used as markers to predict the prognosis of ICU patients with ICH. However, S100B is more powerful for predicting the prognosis. (C) 2013 Elsevier Inc. All rights reserved. Ondokuz Mayis University Scientific Research FoundationOndokuz Mayis University This study was supported by the Ondokuz Mayis University Scientific Research Foundation.

Caprinuloidea rudists are locally abundant and widespread in Lower Cretaceous (Albian Stage) Edwards Formation in Texas. Landward of the shelf margin on the shallow marine Comanche Shelf rudists built circular and elongate bioherms with coarse-grained flank deposits. Two caprinid morphotypes suggest that some lived as elevators above the substrate and others were recumbent upon mobile grain flats. Elevators have elongated attached valves and weakly coiled free valves and recumbents have arcuate attached valves and strongly coiled free valves. Detailed morphologic studies are not possible on the many molds and casts, but a few specimens are silicified. Their internal structures can be seen by X-ray computed tomographic scanning (CT), which provides three-dimensional representations of internal features. This technique enables the specific identification of caprinid rudists that otherwise could only be identified by sectioning the specimen. The abundant Edwards species is identified as Caprinuloidea perfecta because it has only two rows of polygonal canals on its ventral and anterior margins. X-ray CT images reveal ontogenetic stages of these unusual gregarious bivalves. Allometric to isometric growth characterizes the left-free valve (LV). Although the prodissoconch is unknown, the plots suggest that the initial length was greater than the width, which is like the D-shaped prodissoconch of Cardiacea. The LV has the morphology of loosely coiled gastropods and the right-attached valves are elongated and are unlike most Bivalvia.

Yalcin, Ata Nevzat/0000-0002-7243-7354; dursun, oguz/0000-0001-5482-3780; Geyik, Mehmet Faruk/0000-0002-0906-0902; Dursun, Oguz/0000-0001-5482-3780; Leblebicioglu, Hakan/0000-0002-6033-8543; Unal, Necmettin/0000-0002-9440-7893 WOS: 000325254600011 PubMed: 23623158 Background: We evaluate the effectiveness of a multidimensional infection control approach for the reduction of catheter-associated urinary tract infections (CAUTIs) in 13 intensive care units (ICUs) in 10 hospital members of the International Nosocomial Infection Control Consortium (INICC) from 10 cities of Turkey. Methods: A before-after prospective active surveillance study was used to determine rates of CAUTI. The study was divided into baseline (phase 1) and intervention (phase 2). In phase 1, surveillance was performed applying the definitions of the Centers for Disease Control and Prevention/National Healthcare Safety Network. In phase 2, we implemented a multidimensional approach that included bundle of infection control interventions, education, surveillance and feedback on CAUTI rates, process surveillance, and performance feedback. We used random effects Poisson regression to account for clustering of CAUTI rates across time periods. Results: The study included 4,231 patients, hospitalized in 13 ICUs, in 10 hospitals, in 10 cities, during 49,644 patient-days. We recorded a total of 41,871 urinary catheter (UC)-days: 5,080 in phase 1 and 36,791 in phase 2. During phase 1, the rate of CAUTI was 10.63 per 1,000 UC-days and was significantly decreased by 47% in phase 2 to 5.65 per 1,000 UC-days (relative risk, 0.53; 95% confidence interval: 0.4-0.7; P value = .0001). Conclusion: Our multidimensional approach was associated with a significant reduction in the rates of CAUTI in Turkey. Copyright (C) 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. Foundation to Fight against Nosocomial Infections Funding for the activities carried out at INICC headquarters were provided by the corresponding author, Victor D. Rosenthal, and the Foundation to Fight against Nosocomial Infections.

UNAL, SERHAT/0000-0003-1184-4711; Yalcin, Ata Nevzat/0000-0002-7243-7354; Dursun, Oguz/0000-0001-5482-3780; Geyik, Mehmet Faruk/0000-0002-0906-0902; Leblebicioglu, Hakan/0000-0002-6033-8543; dursun, oguz/0000-0001-5482-3780; Topeli, Arzu/0000-0002-5874-9087 WOS: 000316641000020 PubMed: 23355330 Purpose To evaluate the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach on the reduction of ventilator-associated pneumonia (VAP) in adult patients hospitalized in 11 intensive care units (ICUs), from 10 hospitals, members of the INICC, in 10 cities of Turkey. Methods A prospective active before-after surveillance study was conducted to determine the effect of the INICC multidimensional approach in the VAP rate. The study was divided into two phases. In phase 1, active prospective surveillance of VAP was conducted using the definitions of the Centers for Disease Control and Prevention National Health Safety Network, and the INICC methods. In phase 2, we implemented the multidimensional approach for VAP. The INICC multidimensional approach included the following measures: (1) bundle of infection control interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of VAP rates, and (6) performance feedback of infection control practices. We compared the rates of VAP obtained in each phase. A time series analysis was performed to assess the impact of our approach. Results In phase 1, we recorded 2,376 mechanical ventilator (MV)-days, and in phase 2, after implementing the multidimensional approach, we recorded 28,181 MV-days. The rate of VAP was 31.14 per 1,000 MV-days during phase 1, and 16.82 per 1,000 MV-days during phase 2, amounting to a 46 % VAP rate reduction (RR, 0.54; 95 % CI, 0.42-0.7; P value, 0.0001.) Conclusions The INICC multidimensional approach was associated with a significant reduction in the VAP rate in these adult ICUs of Turkey. Foundation to Fight against Nosocomial Infections The authors thank the many health care professionals at each member hospital who assisted with the conduct of surveillance in their hospital, including the surveillance nurses, clinical microbiology laboratory personnel, and the physicians and nurses providing care for the patients during the study; without their cooperation and generous assistance this INICC would not be possible; Mariano Vilar, Debora Lopez Burgardt, Santiago Suarez, Cecilia Cappelini, Denise Brito, Eugenia Manfredi, Luciana Soken, Dario Pizzuto, Yuan Ding, Katie Saunders, and Isaac Kelmeszes who work at INICC headquarters in Buenos Aires, for their hard work and commitment to achieve INICC goals; the INICC country coordinators (Altaf Ahmed, Carlos A. Alvarez Moreno, Anucha Apisarnthanarak, Luis E. Cuellar, Bijie Hu, Hakan Leblebicioglu, Eduardo A. Medeiros, Yatin Mehta, Lul Raka, Namita Jaggi, and Toshihiro Mitsuda); the INICC Advisory Board (Carla J. Alvarado, Gary L. French, Nicholas Graves, William R. Jarvis, Patricia Lynch, Dennis Maki, Russell N. Olmsted, Didier Pittet, Wing Hong Seto, Syed Sattar, and William Rutala), who have so generously supported this unique international infection control network; and specially to Patricia Lynch, who inspired and supported us to follow our dreams despite obstacles. The funding for the activities carried out at INICC head quarters were provided by the corresponding author, Victor D. Rosenthal, and Foundation to Fight against Nosocomial Infections.

Salomao, Reinaldo/0000-0003-1149-4598; alvarez Moreno, carlos Arturo/0000-0001-5419-4494; Medeiros, Eduardo A/0000-0002-6205-259X; Leblebicioglu, Hakan/0000-0002-6033-8543; Yalcin, Ata Nevzat/0000-0002-7243-7354; Barahona G., Nayide/0000-0003-3559-6900; Mitrev, Zan/0000-0001-7859-8821; Kanj, Souha/0000-0001-6413-3396; Unal, Necmettin/0000-0002-9440-7893; Matta, Lorena/0000-0002-5215-3215 WOS: 000309340400006 PubMed: 22711598 We aimed to evaluate the impact of a multidimensional infection control strategy for the reduction of the incidence of catheter-associated urinary tract infection (CAUTI) in patients hospitalized in adult intensive care units (AICUs) of hospitals which are members of the International Nosocomial Infection Control Consortium (INICC), from 40 cities of 15 developing countries: Argentina, Brazil, China, Colombia, Costa Rica, Cuba, India, Lebanon, Macedonia, Mexico, Morocco, Panama, Peru, Philippines, and Turkey. We conducted a prospective before-after surveillance study of CAUTI rates on 56,429 patients hospitalized in 57 AICUs, during 360,667 bed-days. The study was divided into the baseline period (Phase 1) and the intervention period (Phase 2). In Phase 1, active surveillance was performed. In Phase 2, we implemented a multidimensional infection control approach that included: (1) a bundle of preventive measures, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of CAUTI rates, and (6) feedback of performance. The rates of CAUTI obtained in Phase 1 were compared with the rates obtained in Phase 2, after interventions were implemented. We recorded 253,122 urinary catheter (UC)-days: 30,390 in Phase 1 and 222,732 in Phase 2. In Phase 1, before the intervention, the CAUTI rate was 7.86 per 1,000 UC-days, and in Phase 2, after intervention, the rate of CAUTI decreased to 4.95 per 1,000 UC-days [relative risk (RR) 0.63 (95 % confidence interval [CI] 0.55-0.72)], showing a 37 % rate reduction. Our study showed that the implementation of a multidimensional infection control strategy is associated with a significant reduction in the CAUTI rate in AICUs from developing countries. Foundation to Fight against Nosocomial Infections The authors declare that they did not receive any personal funding, and the funding for the activities carried out at the INICC headquarters were provided by the corresponding author, Victor D. Rosenthal, and Foundation to Fight against Nosocomial Infections. The authors state that they do not have any conflicts of interest to declare. Every hospital's Institutional Review Board agreed to the study protocol, and patient confidentiality was protected by codifying the recorded information, making it only identifiable to the infection control team (ICT).

Yalcin, Ata Nevzat/0000-0002-7243-7354; alvarez Moreno, carlos Arturo/0000-0001-5419-4494; Abouqal, Redouane/0000-0002-6117-4341; Salomao, Reinaldo/0000-0003-1149-4598; Leblebicioglu, Hakan/0000-0002-6033-8543; Medeiros, Eduardo A/0000-0002-6205-259X; Barahona G., Nayide/0000-0003-3559-6900; Consunji, Rafael/0000-0002-9854-3585; Rodriguez Ferrer, Marena Luz/0000-0002-8053-8454; Chatterjee, Sharmila/0000-0001-5905-1089; Kanj, Souha/0000-0001-6413-3396; Chatterjee, Sharmila/0000-0002-3890-8386; Mitrev, Zan/0000-0001-7859-8821; Unal, Necmettin/0000-0002-9440-7893 WOS: 000283842300009 PubMed: 21029008 BACKGROUND. The International Nosocomial Infection Control Consortium (INICC) was established in 15 developing countries to reduce infection rates in resource-limited hospitals by focusing on education and feedback of outcome surveillance (infection rates) and process surveillance (adherence to infection control measures). We report a time-sequence analysis of the effectiveness of this approach in reducing rates of central line-associated bloodstream infection (CLABSI) and associated deaths in 86 intensive care units with a minimum of 6-month INICC membership. METHODS. Pooled CLABSI rates during the first 3 months (baseline) were compared with rates at 6-month intervals during the first 24 months in 53,719 patients (190,905 central line-days). Process surveillance results at baseline were compared with intervention period data. RESULTS. During the first 6 months, CLABSI incidence decreased by 33% (from 14.5 to 9.7 CLABSIs per 1,000 central line-days). Over the first 24 months there was a cumulative reduction from baseline of 54% (from 16.0 to 7.4 CLABSIs per 1,000 central line-days; relative risk, 0.46 [95% confidence interval, 0.33-0.63]; P < .001). The number of deaths in patients with CLABSI decreased by 58%. During the intervention period, hand hygiene adherence improved from 50% to 60% (P < .001); the percentage of intensive care units that used maximal sterile barriers at insertion increased from 45% to 85% (P < .001), that adopted chlorhexidine for antisepsis increased from 7% to 27% (P = .018), and that sought to remove unneeded catheters increased from 37% to 83% (P = .004); and the duration of central line placement decreased from 4.1 to 3.5 days (P < .001). CONCLUSIONS. Education, performance feedback, and outcome and process surveillance of CLABSI rates significantly improved infection control adherence, reducing the CLABSI incidence by 54% and the number of CLABSI-associated deaths by 58% in INICC hospitals during the first 2 years.

Objective: Our purpose was to study whether or not intravenous (IV) administration of lidocaine reduces propofol dose requirement as intramuscular (IM) lidocaine in a placebo-controlled manner. Subjects and Methods: Seventy-five adult patients with American Society of Anesthesiologists physical status I and II, aged 20–60 years who were scheduled for surgery under general anaesthesia were included in the study. The patients were randomly allocated to 3 groups: IM: intramuscular administration; IV: intravenous administration and C: control. There were 25 patients in each group. The patients in group IM received lidocaine 1.5 mg · kg–1 administered into the deltoid muscle 10 min before anaesthesia induction. In group IV, the patients received IV lidocaine 1.5 mg · kg–1, 2 min before anaesthesia induction. Group C patients served as control group who received only propofol injection. Hypnosis after propofol administration was measured with response to verbal commands. Results: There were no statistical differences between group IM (100.8 ± 26.1 mg) and group IV (110.8 ± 30.1 mg) regarding the induction dose of propofol (p > 0.05). In group C, the required propofol dose (151.2 ± 27.4 mg) for anaesthesia induction was significantly higher than in the other groups (p < 0.001). No side effect was observed in any patients. Conclusion: In this study, both IV and IM lidocaine administration were effective in reducing the hypnotic dose of propofol without any side effects. In addition, IV lidocaine may be more comfortable for awake patients.

WOS: 000268290100015 PubMed: 19810636 Background/Objective: Patients with traumatic upper thoracic and cervical spinal cord injuries are at increased risk for the development of autonomic dysfunction, including thermodysregulation. Thermoregulation is identified as an autonomic function, although the exact mechanisms of thermodysregulation have not been completely recognized. Quad fever is a hyperthermic thermoregulatory disorder that occurs in people with acute cervical and upper thoracic spinal cord injuries. First described in 1982, it has not been widely discussed in the literature. Methods: Case reports of 5 patients with cervical spinal cord injury (SCI). Results: Five of 18 patients (28%) with acute cervical SCI who were admitted during a 1-year period had fatal complications caused by persistent hyperthermia of unknown origin. Conclusions: Patients with acute traumatic cervical and upper thoracic SCI are at risk for thermoregulatory dysfunction. Changes in the hypothalamic axis may be implicated, especially in the light of modification in hypothalamic afferent nerves, but this hypothesis has not yet been explored. Thermodysregulation may be an early sign of autonomic dysfunction. A comprehensive guideline is needed for the management of elevated body temperature in critically ill patients with cervical SCI, because this condition may be fatal.

Bilge, S.Sirri/0000-0003-2878-6968; Ciftcioglu, Engin/0000-0003-4402-3004; Bozkurt, Ayhan/0000-0002-5794-709X; BOSTANCI, Mehmet Omer/0000-0002-2887-1073 WOS: 000268298600049 PubMed: 19608839 BACKGROUND: In comparison with cutaneous pain, the role of alpha(2)-adrenoceptor (alpha(2)-AR) agonists in visceral pain has not been extensively examined. We aimed to characterize the antinociceptive effect of IV dexmedetomidine on visceral pain in rats and to determine whether antinociception thus produced is mediated by opioid receptors. METHODS: Male Sprague Dawley rats (250-300 g) were instrumented with a venous catheter for drug administration and with enameled nichrome electrodes for electromyography of the external oblique muscles. Colorectal distension (CRD) was used as the noxious visceral stimulus, and the visceromotor response to CRD was quantified electromyographically before and 5,15, 30, 60, 90, and 120 min after dexmedetomidine or clonidine administration. Antagonists were administered 10 min before dexmedetomidine. After confirmation of normal distribution of data, one-way analysis of variance with the Tukey-Kramer post hoc test was used for multiple comparison. RESULTS: IV administration of dexmedetomidine (2.5-20 mu g/kg) and clonidine (10-80 mu g/kg) produced a dose-dependent reduction in visceromotor response with 50% effective dose values of 10.5 and 37.6 mu g/kg, respectively. Administration of the nonspecific alpha(2)-AR antagonist yohimbine (1 mg/kg), but not the peripherally restricted alpha(2)-AR antagonist MK-467 (1 mg/kg), abolished the antinociceptive effect of dexmedetomidine (10 mu g/kg). In addition, inhibition of opioid receptors by naloxone (1 mg/kg) attenuated the antinociceptive effect of dexmedetomidine. CONCLUSION: Our data indicate that IV dexmedetomidine exerts pronounced antinociception against CRD-induced visceral pain and suggest that the antinociceptive effect of dexmedotimidine is mediated in part by opioid receptors, but peripheral alpha(2)-ARs are not involved. (Anesth Analg 2009;109:616-22) Ondokuz Mayis University Scientific Research Foundation; Mar Medical Instruments Ltd., Co Supported by the Ondokuz Mayis University Scientific Research Foundation and Mar Medical Instruments Ltd., Co.

PubMed: 27594753 We consider that general anesthesia will be an appropriate and safe method as regional methods could lead to significant time loss in the prevention or minimization of complications. High blockage required for regional anesthetic methods in pregnant women with TGA and the maintenance of hemodynamic stability may become difficult due to neuroaxial sympathectomy even if a successful neuroaxial block has been provided. Agents with minimal effect on cardiovascular functions should be preferred for anesthesia induction and maintenance and close hemodynamic monitoring should be done during intraoperative and postoperative periods.

Objectives: The purpose of this study was to investigate the effects of PEEP on oxygenation and airway pressures during PCV-OLV. Design: Randomized, crossover, clinical study. Setting: University hospital. Participants: Twenty-five patients undergoing thoracotomy. Interventions: During the first 5 minutes of OLV, all patients were ventilated with VCV (PEEP: 0) (VCV-ZEEP). Afterward, ventilation was changed to PCV with PEEP: 0 (PCV-ZEEP) or PEEP: 4 cmH 2 O (PCV-PEEP) for 20 minutes. In the following 20 minutes, PCV-PEEP and PCV-ZEEP were applied in reverse sequence. Measurements and Main Results: At the end of VCV-ZEEP airway pressures (peak airway pressure, plateau airway pressure, mean airway pressure, and pause airway pressure) were recorded. At the end of PCV-PEEP and PCV-ZEEP airway pressures, PaO 2 and Qs/Qt were recorded. Ppeak and Pplat were significantly lower with PCV-PEEP compared with VCV-ZEEP (eg, Ppeak: 33.4 ± 4.2, 28.3 ± 4.1, and 28.9 ± 3.7 cmH 2 O in VCV-ZEEP, PCV-ZEEP, and PCV-PEEP, respectively; p v VCV-ZEEP and PCV-PEEP v VCV-ZEEP). PCV-PEEP was associated with an increased PaO 2 (230.3 ± 69.8 v 189.0 ± 54.8 mmHg, p v 38.4% ± 5.7%, p Conclusion: During OLV, PCV with a low level of PEEP leads to improved oxygenation with lower airway pressures.

Objective: The current study investigated the applicability of the VAP prevention bundle and its effect on rates of VAP. Methods: This study was performed in the intensive care units (ICU) of anesthesia (AICU) and the neurology (NICU) in the Medical Faculty of Ondokuz Mayis University from October 2011 to September 2012 (for one year). Mechanically ventilated patients in the ICU for 48 hours were included. The bundle components were patient’s head elevated to 30–45°, assessment of daily extubation status (weaning), peptic ulcer prophylaxis, deep vein thrombosis (DVT) prophylaxis, and oral care with chlorhexidine. The VAP rate and ventilator usage rates were calculated and compared in quarterly periods for one year. Results: In the study, 35 patients developed VAP. There was full compliance with the prevention bundle in 30.5% of cases. No VAP developed in 51 patients whose compliance with the prevention bundle was 100%. In patients (n=35) whose compliance with prevention bundle was more than 50%, VAP (n=6) developed in 19% of the patients. But, in patients (n=35) whose compliance with prevention bundle was less than 50%, VAP (n=29) developed in 82.8% of the patients. There was a significant relationship between compliance with the prevention bundle and development of VAP (P

Calcium channel blocker poisoning is a common and sometimes life-threatening toxicity. Tarka is a combination antihypertensive medication composed of verapamil hydrochloride and trandolapril. Sinus bradycardia, severe hypotension, 2nd and 3rd degree atrioventricular (AV) blocks, cardiogenic shock and cardiac arrest can be seen due to excessive use of these drugs. In this study, we aim at discussing the case of a13-year-old female patient in the light literature, who took 4 tablets of Tarka ® forte tablets in order to commit suicide and reached our emergency department with sudden cardiac arrest and development of syncope. She was successfully resuscitated and given intravenous fluid and hyperinsulinemic/euglycemia therapy, epinephrine, vasopressor support, glucagon infusion and 6% hydroxyethyl starch support. © 2017, Kuwait Medical Association. All rights reserved.

Background Central line-associated bloodstream infections (CLABs) have long been associated with excess lengths of stay, increased hospital costs and mortality attributable to them. Different studies from developed countries have shown that practice bundles reduce the incidence of CLAB in intensive care units. However, the impact of the bundle strategy has not been systematically analyzed in the adult intensive care unit (ICU) setting in developing countries, such as Turkey. The aim of this study is to analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach to reduce the rates of CLAB in 13 ICUs of 13 INICC member hospitals from 8 cities of Turkey. Methods We conducted active, prospective surveillance before-after study to determine CLAB rates in a cohort of 4,017 adults hospitalized in ICUs. We applied the definitions of the CDC/NHSN and INICC surveillance methods. The study was divided into baseline and intervention periods. During baseline, active outcome surveillance of CLAB rates was performed. During intervention, the INICC multidimensional approach for CLAB reduction was implemented and included the following measures: 1- bundle of infection control interventions, 2- education, 3- outcome surveillance, 4- process surveillance, 5- feedback of CLAB rates, and 6- performance feedback on infection control practices. CLAB rates obtained in baseline were compared with CLAB rates obtained during intervention. Results During baseline, 3,129 central line (CL) days were recorded, and during intervention, we recorded 23,463 CL-days. We used random effects Poisson regression to account for clustering of CLAB rates within hospital across time periods. The baseline CLAB rate was 22.7 per 1000 CL days, which was decreased during the intervention period to 12.0 CLABs per 1000 CL days (IRR 0.613; 95% CI 0.43 – 0.87; P 0.007). This amounted to a 39% reduction in the incidence rate of CLAB. Conclusions The implementation of multidimensional infection control approach was associated with a significant reduction in the CLAB rates in adult ICUs of Turkey, and thus should be widely implemented.

Leblebicioglu, Hakan/0000-0002-6033-8543 WOS: 000411217800007 PubMed: 19267892 Background: The objective of this study was to determine the contamination rate of the healthcare workers' (HCWs') mobile phones and hands in operating room and ICU. Microorganisms from HCWs' hands could be transferred to the surfaces of the mobile phones during their use. Methods: 200 HCWs were screened; samples from the hands of 200 participants and 200 mobile phones were cultured. Results: In total, 94.5% of phones demonstrated evidence of bacterial contamination with different types of bacteria. The gram negative strains were isolated from mobile phones of 31.3% and the ceftazidime resistant strains from the hands were 39.5%. S. aureus strains isolated from mobile phones of 52% and those strains isolated from hands of 37.7% were methicillin resistant. Distributions of the isolated microorganisms from mobile phones were similar to hands isolates. Some mobile phones were contaminated with nosocomial important pathogens. Conclusion: These results showed that HCWs' hands and their mobile phones were contaminated with various types of microorganisms. Mobile phones used by HCWs in daily practice may be a source of nosocomial infections in hospitals.

Objectives: In pandemic conditions, patients with febrile neutropenia are also at risk of COVID-19. Aim of this systematic review is to evaluate COVID-19 cases presented with febrile neutropenia and provide information regarding incidence, clinical course and prognosis. Methods: We systematically searched on COVID-19 and febrile neutropenia cases in PubMed, SCOPUS and Web of Science. Results: A total of 19 febrile neutropenic patients were analyzed. A male predominance was noted. Eleven cases had hematological malignancies. Fourteen of the cases were previously received chemotherapy. Five patients had severe neutropenia: 3 had hematologic cancer and none died. 17 (89.5%) cases have pulmonary involvement and seven of them had severe disease with acute respiratory distress syndrome (ARDS). Three cases with ARDS were died. 12 of them received G-CSF for treatment. Five cases were developed respiratory failure after G-CSF use. Overall mortality was 15.8%, while death was not observed in patients without malignancy and solid organ tumors, the mortality rate was 27% in cases with hematological malignancies. Conclusion: In ongoing pandemic, febrile neutropenic patients should be precisely evaluated for COVID-19 disease. It should be remembered that there may not be typical signs and symptoms and laboratory findings of COVID-19 disease because of the immunosuppression. © 2022 Elsevier Ltd