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Yersinia pseudotuberculosis is an important animal pathogen, particularly for birds, rodents, and monkeys, which is also able to infect humans. Indeed, an increasing number of reports have been published on zoo animals that were killed by this species. One option to treat diseased animals is the application of strictly lytic (virulent) phages. However, thus far relatively few phages infecting Y. pseudotuberculosis have been isolated and characterized. To determine the prevalence of Y. pseudotuberculosis phages in zoo animals, fecal samples of birds and some primates, maras, and peccaries kept in the Tierpark Berlin were analyzed. Seventeen out of 74 samples taken in 2013 and 2017 contained virulent phages. The isolated phages were analyzed in detail and could be allocated to three groups. The first group is composed of 10 T4-like phages (PYps2T taxon group: Myoviridae; Tevenvirinae; Tequatrovirus), the second group (PYps23T taxon group: Chaseviridae; Carltongylesvirus; Escherichia virus ST32) consists of five phages encoding a podovirus-like RNA polymerase that is related to an uncommon genus of myoviruses (e.g., Escherichia coli phage phiEcoM-GJ1), while the third group is comprised of two podoviruses (PYps50T taxon group: Autographiviridae; Studiervirinae; Berlinvirus) which are closely related to T7. The host range of the isolated phages differed significantly. Between 5.5 and 86.7% of 128 Y. pseudotuberculosis strains belonging to 20 serotypes were lysed by each phage. All phages were additionally able to lyse Y. enterocolitica B4/O:3 strains, when incubated at 37°C. Some phages also infected Y. pestis strains and even strains belonging to other genera of Enterobacteriaceae. A cocktail containing two of these phages would be able to lyse almost 93% of the tested Y. pseudotuberculosis strains. The study indicates that Y. pseudotuberculosis phages exhibiting a broad-host range can be isolated quite easily from zoo animals, particularly birds.

Chronic diseases cannot be treated completely, and, therefore, often require repeated treatments. This issue leads to long-term drug utilization. However, medical foods can offer alternative natural drugs in the management and treatment of chronic diseases. Medical foods are specially formulated food to meet the particular nutritional requirements of patients affected by certain diseases. They play an important role in nutritional support for patients in clinical applications such as deglutition, dyspepsia or eating disorders. Moreover, they considerably enhance the quality of living of patients by reducing drug usage, preventing complications that may arise through the overreliance of drugs, and reducing the expenses of treatments. The nutritive value of medical foods can be regulated and personalized depending on the disease. Since they are not drugs, they exempt from regulations applying to drugs. Each medical food is formulated specifically for the relevant chronic disease. However, there are no studies in the literature that provide examples of medical foods for different diseases available in the market. The examination and compilation of medical foods, including examples from the market, is vital both in terms of creating new products and filling the gap in the relevant literature. Consequently, the aim of this review is to explain the use of medical foods for Alzheimer’s, Parkinson’s, anxiety and sleep disorder, pain syndrome, cancer, congenital metabolic disorders, diabetes mellitus, and indicate why should be used as a nutritional supplement for these chronic diseases.

A new coronavirus, emerging toward the end of 2019, rapidly disseminated around the world and resulted in a pandemic. The virus was named as severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) and the disease caused by the virus as coronavirus disease-2019 (COVID-19). The clinical spectrum of COVID-19 in adults varies from asymptomatic infection to acute respiratory distress syndrome and multi-organ dysfunction. Information on the disease and its management has been continuously updated, especially with the development of SARS-CoV-2 variants and vaccines against the virus. The disease is generally mild in most patients with COVID-19 and requires no medical intervention or hospitalization; follow-up and treatment in an outpatient setting are adequate. Patients with a risk of severe disease or unvaccinated patients, and elderly patients with comorbidities with dyspnea and deteriorated oxygenation should be admitted, treated and followed up at hospital. Current local sources and the individual evaluation of the patients is important in the management of the disease.

In this study, it was aimed to optimize the ultrasonic rehydration conditions of dried tomatoes. Rehydration conditions were optimized by Response Surface Method (RSM). The optimization of ultrasonic (37 kHz) rehydration conditions were performed with independent variables at different temperatures (20-80°C), time (2-60 min) and water ratios (1/50-1/100 g/g water), and rehydration ability, color a* (redness) and texture values were selected as responses (dependent variable). The estimated and experimental analysis results were compared in the selection of the optimum rehydration condition. As a result, it was determined that ultrasonic rehydration at 58°C/54 min/72 ml water conditions could be used as the optimum point. At the selected optimum point, the rehydration ability, color a* value and texture values were determined as 2.82±0.16, 13.09 ±1.63 and 0.46±0.13 N, respectively. These results are seen as proof that ultrasound application can be used in the rehydration of dried tomatoes.

Background and objectivesAlthough several repurposed antiviral drugs have been used for the treatment of COVID-19, only a few such as remdesivir and molnupiravir have shown promising effects. The objectives of our study were to investigate the association of repurposed antiviral drugs with COVID-19 morbidity.MethodsPatients admitted to 26 different hospitals located in 16 different provinces between March 11–July 18, 2020, were enrolled. Case definition was based on WHO criteria. Patients were managed according to the guidelines by Scientific Board of Ministry of Health of Turkey. Primary outcomes were length of hospitalization, intensive care unit (ICU) requirement, and intubation.ResultsWe retrospectively evaluated 1,472 COVID-19 adult patients; 57.1% were men (mean age = 51.9 ± 17.7years). A total of 210 (14.3%) had severe pneumonia, 115 (7.8%) were admitted to ICUs, and 69 (4.7%) were intubated during hospitalization. The median (interquartile range) of duration of hospitalization, including ICU admission, was 7 (5–12) days. Favipiravir (n = 328), lopinavir/ritonavir (n = 55), and oseltamivir (n = 761) were administered as antiviral agents, and hydroxychloroquine (HCQ, n = 1,382) and azithromycin (n = 738) were used for their immunomodulatory activity. Lopinavir/ritonavir (β [95% CI]: 4.71 [2.31–7.11]; p = 0.001), favipiravir (β [95% CI]: 3.55 [2.56–4.55]; p = 0.001) and HCQ (β [95% CI]: 0.84 [0.02–1.67]; p = 0.046) were associated with increased risk of lengthy hospital stays. Furthermore, favipiravir was associated with increased risks of ICU admission (OR [95% CI]: 3.02 [1.70–5.35]; p = 0.001) and invasive mechanical ventilation requirement (OR [95% CI]: 2.94 [1.28–6.75]; p = 0.011).ConclusionOur findings demonstrated that antiviral drugs including lopinavir, ritonavir, and favipiravir were associated with negative clinical outcomes such as increased risks for lengthy hospital stay, ICU admission, and invasive mechanical ventilation requirement. Therefore, repurposing such agents without proven clinical evidence might not be the best approach for COVID-19 treatment.

Introduction: The human population is aging at an astonishing rate. The aim of this study is to capture a situation snapshot revealing the proportion of individuals aged 65 years and over among inpatients in healthcare institutions in Turkey and the prevalence and type of infections in this patient group in order to draw a road map. Materials and Methods: Hospitalized patients over 65 years at any of the 62 hospitals in 29 cities across Turkey on February 9, 2017 were included in the study. Web-based SurveyMonkey was used for data recording and evaluation system. Results: Of 17,351 patients 5871 (33.8%) were ≥65 years old. The mean age was 75.1 ± 7.2 years; 3075 (52.4%) patients were male. Infection was reason for admission for 1556 (26.5%) patients. Pneumonia was the most common infection. The median length of hospital stay was 5 days (IQR: 2–11 days). The Antibiotic therapy was initiated for 2917 (49.7%) patients at the time of admission, and 23% of the antibiotics prescribed were inappropriate. Healthcare-associated infections developed in 1059 (18%) patients. Urinary catheters were placed in 2388 (40.7%) patients with 7.5% invalid indication. Conclusion: This study used real data to reveal the proportion of elderly patients in hospital admissions. The interventions done, infections developed during hospitalization, length of hospital stay, and excessive drug load emphasize the significant impact on health costs and illustrate the importance of preventive medicine in this group of patients.

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

Fluoroquinolones are the most commonly used antibiotics for the treatment and prophylaxis of patients with malignancies. But resistance development is a big problem.With the aim of identifying the epidemiological data about the local fluoroquinolone resistance of the patients with malignancies followed up in the hospital or on outpatient basis, fluoroquinolone resistance of gram negative bacteria isolated from different materials of these patients was investigated. In our hospital, from January 2013 to August 2014, gram negative isolates that were isolated from the samples of patients with malignancies followed-up by Hematology and Oncology Departments were retrospectively analyzed. Within a period of one and a half years, 227 Gram negative bacteria were isolated from the materials of the patients hospitalized in our hospital. Quinolone resistance rates were 63% for E.coli, 49% for Klebsiella pneumoniae, 34% for Pseudomonas aeruginosa, 72% for Acinetobacter baumannii , with a mean of 52% for all Gram negatives. When patients who received and who did not receive quinolone prophylaxis were compared, resistance rate was 57% (26/61) for those receiving prophylaxis and 50 %( 83/166) for those who did not. In conclusion, fluoroquinolone resistance rates were considerably high and it was higher in the patients who received quinolone prophylaxis, but it wasn't statistically significant. In the oral treatment of febrile neutropenic patients, empirical treatment aims at Gram negative pathogens and considers quinolones as the first choice; however this data raises a suspicion about the efficacy and adequacy of quinolones. [Med-Science 2016; 5(3.000): 805-8]

Introduction: Hand hygiene is one of the most effective infection control measures to prevent the spread of healthcare-associated infections (HCAI). Water, soap, paper towel and hand disinfectant must be available and adequate in terms of effective hand hygiene. The adequacy of hand hygiene products or keeping water-soap and paper towel is still a problem for many developing countries like Turkey. In this multicenter study, we analyzed the adequacy in number and availability of hand hygiene products. Materials and Methods: This study was performed in all intensive care units (ICUs) of 41 hospitals (27 tertiary-care educational, 10 state and four private hospitals) from 22 cities located in seven geographical regions of Turkey. We analyzed water, soap, paper towel and alcohol-based hand disinfectant adequacy on four different days, two of which were in summer during the vacation time (August, 27th and 31st 2016) and two in autumn (October, 12th and 15th 2016). Results: The total number of ICUs and intensive care beds in 41 participating centers were 214 and 2357, respectively. Overall, there was no soap in 3-11% of sinks and no paper towel in 10-18% of sinks while there was no alcohol-based hand disinfectant in 1-4.7% of hand disinfectant units on the observation days. When we compared the number of sinks with soap and/or paper towel on weekdays vs. weekends, there was no significant difference in summer. However, on autumn weekdays, the number of sinks with soap and paper towel was significantly lower on weekend days (p

Sepsis is a severe clinical syndrome owing to its high mortality. Quick Sequential Organ Failure Assessment (qSOFA) score has been proposed for the prediction of fatal outcomes in sepsis syndrome in emergency departments. Due to the low predictive performance of the qSOFA score, we propose a modification to the score by adding age. We conducted a multicenter, retrospective cohort study among regional referral centers from various regions of the country. Participants recruited data of patients admitted to emergency departments and obtained a diagnosis of sepsis syndrome. Crude in-hospital mortality was the primary endpoint. A generalized mixed-effects model with random intercepts produced estimates for adverse outcomes. Model-based recursive partitioning demonstrated the effects and thresholds of significant covariates. Scores were internally validated. The H measure compared performances of scores. A total of 580 patients from 22 centers were included for further analysis. Stages of sepsis, age, time to antibiotics, and administration of carbapenem for empirical treatment were entered the final model. Among these, severe sepsis (OR, 4.40; CIs, 2.35-8.21), septic shock (OR, 8.78; CIs, 4.37-17.66), age (OR, 1.03; CIs, 1.02-1.05) and time to antibiotics (OR, 1.05; CIs, 1.01-1.10) were significantly associated with fatal outcomes. A decision tree demonstrated the thresholds for age. We modified the quick Sequential Organ Failure Assessment (mod-qSOFA) score by adding age (> 50 years old = one point) and compared this to the conventional score. H-measures for qSOFA and mod-qSOFA were found to be 0.11 and 0.14, respectively, whereas AUCs of both scores were 0.64. We propose the use of the modified qSOFA score for early risk assessment among sepsis patients for improved triage and management of this fatal syndrome.

INTRODUCTION: Febrile neutropenic episodes (FNEs) are among major causes of mortality in patients with hematological malignancies. Secondary infections develop either during the empirical antibiotic therapy or one week after cessation of therapy for a FNE. The aim of the study was to investigate the risk factors associated with secondary infections in febrile neutropenic patients. METHODS: We retrospectively analyzed 750 FNEs in 473 patients between January 2000 and December 2006. RESULTS: Secondary infections were diagnosed in 152 (20%) of 750 FNEs. The median time to develop secondary infection was 10 days (range 2-34 days). The duration of neutropenia over 10 days significantly increased the risk of secondary infections (p0.05) While fever of unknown origin (FUO) (p=0.005) and catheter-related bacteremia (p

Introduction: In this multicenter study, we analysed the magnitude of healthcare worker (HCW) [infection control practitioner (ICP), nurses and others] workforce in hospitals participated in the study. Materials and Methods: This study was performed in 41 hospitals (with intensive care units-ICU) located in 22 cities from seven regions of Turkey. We analysed the ICP workforce, nursing and auxiliary HCW (AHCW) workforce in ICUs, number of ICU beds and occupied beds in four different days [two of which were in summer during the vacation time (August 27 and 31, 2016) and two others in autumn (October 12 and 15, 2016)]. The Turkish Ministry of Health (TMOH) requires two patients per nurse in level 3 ICUs, three patients per nurse in level 2 ICUs and five patients per nurse in level 1 ICUs. There is no standardization for the number of AHCW in ICUs. Finally, one ICP per 150 hospital beds is required by TMOH. Results: The total number of ICUs, ICU beds and ICPs were 214, 2377 and 111, respectively in he 41 participated centers. The number ICPs was adequate only in 12 hospitals. The percentage of nurses whose working experience was 2. The number of patients per other HCW was minimum 3.75 and maximum 4.89 on weekdays and on day shift while it was minimum 5.02 and maximum 7.7 on weekends or on night shift. When we compared the number of level 1, 2 and 3 ICUs with adequate nursing workforce vs inadequate nursing workforce, the p value was

Achromobacter xylosoxidans is a microorganism found in the nature, soil and water. It may cause opportunistic infections in immunosuppressed patients. It may lead rarely to urinary system infections in patients with underlying urinary abnormalities. We report a case of urosepsis due to A. xylosoxidans in a 59-year-old female patient having had total bilateral salpingo-oophorectomy seven years ago due to the diagnosis of endometrial clear cell carcinoma.

Introduction: Clostridium difficile (C. difficile) is the most commonly identified causative agent of antibiotic-associated diarrhea. Since immunosuppression is a significant risk factor in febrile neutropenic patients who complain of diarrhea, investigation of toxin A/B is recommended. In this study we aimed at investigating the frequency of C. difficile toxin A or B in stools of patients with malignancies who developed diarrhea during the febrile neutropenic period and to analyze the epidemiological characteristics of toxin-positive patients. Materials and Methods: We analyzed stool samples of patients who were admitted to our hospital. These patients either had hematological malignancies or solid organ tumors and they had developed diarrhea during the febrile neutropenic period. The frequency of C. difficile toxin A and B was identified with chromatographic immunoassay method by using a commercial kit (MonlabTest, Spain) that allowed for qualitative identification of C. difficile toxins A and B at the same time. Results: From January 1, 2012 to August 15, 2015, 197 stool samples were analyzed. C. difficile toxin A+B positivity was identified in 9 samples (4.6%), Ascaris eggs were detected in 14 samples (7%) and Salmonella spp. were found in one sample. The mean age of the toxin-positive patients (6 female, 3 male) was 63.5 years; seven had hematological malignancies (78%) and two had solid organ tumors (22%). All the cases had a history of multiple antibiotic treatments. Seven patients had a history of quinolone prophylaxis, two patients had a history of intensive care admission and all the patients had long-term hospitalization with a mean length of 46 days hospitalization. Conclusion: In febrile neutropenic patients with diarrhea, the rate of C. difficile toxin A+B positivity was 4.6%. Having a history of chemotherapy, quinolone prophylaxis, carbapenem use, long-term hospitalization, and use of multiple antimicrobials were found to be common epidemiological characteristics.