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Identification of oxa-gene in acinetobacter baumannii isolates obtained from clinical specimens and the clonality between these isolates [Klinik örneklerden elde edilen acinetobacter baumannii izolatlarinda oxa-geni araştirilmasi ve bu izolatlar arasindaki klonal ilişki]
No full textObjective: Our study aimed to reveal the OXA-like carbapenemase genes and molecular epidemiological relationship in A. baumannii isolates and compare antibiotic susceptibility status-resistance genes-Pulsed Field Gel Electrophoresis (PFGE) patterns. Material and Method: A total of 100 A. baumannii isolates obtained from several clinical specimens were examined by VITEK2 automated identification system (Biomerieux, France) for the antibiotic susceptibility profile, by multiplex polymerase chain reaction (PCR) method for OXA-type ?-lactamases and by PFGE method for the clonal relationship. Results: 57% of the isolates were obtained from respiratory system specimens. Among all the antibiotics, colistin was the most effective agent with 100% sensitivity, followed by tigecycline with 93%. All of the isolates were resistant to piperacillin, piperacillin/tazobactam and ciprofloxacin. Resistance against both imipenem and meropenem were detected as 95%. OXA-51 gene was found in all and OXA-23 gene was found in 92 (92%) of the isolates. None of the isolates had OXA-24 or OXA-58 genes. We identified 19 different clonal clusters among 100 isolates by PFGE method. We revealed that some of the clones were clustered in a certain period of time, and this was supported by the antibiogram results and OXA gene profiling. Conclusion: Our study identified high rates OXA-23 gene locus positivity, presented the current clonal similarity and time relationship among the clonal clusters. These results emphasize the importance of molecular epidemiological methods as well as standard infection control programs to prevent spreading of A. baumannii. © 2019, Nobelmedicus. All rights reserved
Kısa Bir Soru: Amantadin Sülfat İnfüzyonu Yoğun Bakım Ünitesinde Hayat Kurtarıcı Olur mu?
No full textObjective: Traumatic brain injury (TBI) is one of the leading causes that cognitive and behavioral problems. Many pharmacological therapies reveal early neurochemical changes. The CRS-R is a standardized neuro-behavioral evaluation tool comprising six organized subscales (auditory, visual, motor, oromotor–verbal, communication, and arousal). We hypothesized that, the effect of amantadine sulfate infusion treatment on conscious recovery and clinical improvement in patients with severe head injury in terms of CRS-R and clinical recovery. Material and Methods: Patients’ age, gender, days of hospitalization, pre-treatment and post-treatment GCS, education level, day of amantadine sulfate, intubated or non-intubated when he/she come to intensive care unit (ICU), recovery time of conscious, discharge time, CT or MR pathology will be retrospectively recorded. Patients were aged >18 years, had brain trauma, had amantadine sulfate therapy in ICU were included the study between June 2016-June 2017. Results: A total of 40 patients using amantadine sulfate infusion were included in the study. It was determined that 13 of patients had mortality. Improvement in CT and MRI findings were detected in 21 of the living patients (77.8%). There were no differences between the mean starting time according to the clinical recovery levels and recovery status on CT-MRI. There were statistically significant differences between starting time and time of extubation and starting time of consciousness recovery and discharge time. Conclusion: In conclusion, we believe that amantadine treatment accelerates neurological recovery in terms of CRS-R and clinical recovery in TBI patients.Amaç: Travmatik beyin hasarı (TBH), bilişsel ve davranışsal sorunların önde gelen nedenlerinden biridir. Birçok farmakolojik tedavi erken nörokimyasal değişiklikleri açıklamaktadır. CRS-R, altı organize alt ölçek (işitsel, görsel, motor, oromotor-sözel, iletişim ve uyarılma) içeren standartlaştırılmış bir nöro davranışsal değerlendirme aracıdır. Biz CRS-R ve klinik iyileşme açısından ağır kafa travmalı hastalarda amantadin sülfat infüzyon tedavisinin bilinç düzeyinde ve klinik iyileşme üzerindeki etkisini sunmayı amaçladık. Gereç ve Yöntemler: Hastaların yaşı, cinsiyeti, hastanede yatış günleri, tedavi öncesi ve tedavi sonrası GKS, eğitim düzeyi, amantadin sülfat günü, entübe gelip gelmediği, bilinçte düzelme zamanı, taburculuk süresi, BT veya MR patolojileri retrospektif olarak kaydedildi. Haziran-Haziran 2017 tarihleri arasında 18 yaş üstü, beyin travması geçiren, yoğun bakımda amantadin sülfat tedavisi alan hastalar çalışmaya dahil edildi. Bulgular: Çalışmaya amantadin sülfat infüzyonu kullanan toplam 40 hasta dahil edildi. Hastaların 13’ünde mortalite olduğu tespit edildi. Yaşayan hastaların 21’inde (%77,8) BT ve MR bulgularında iyileşme saptandı. Klinik iyileşme düzeylerine ve BT-MR'da iyileşme durumuna göre ortalama başlangıç zamanı arasında fark yoktu. Başlangıç zamanı ve ekstübasyon zamanı ile bilincin düzelme ve taburculuk süresinin zamanı arasında istatistik olarak anlamlı fark gözlendi. Tartışma: Sonuç olarak, amantadin sülfat tedavisinin, CRS-R açısından da değerlendirildiğinde TBH hastalarında klinik iyileşme ve nörolojik iyileşmeyi hızlandırdığını düşünüyoruz
Investigation of Brucella Seropositivity in Patients with Suspected Brucellosis: A 4-Year Retrospective Evaluation
No full textAmaç: Brucella cinsi bakterilerle oluşan bruselloz, sistemik bir enfeksiyon hastalığı olup dünyanın birçok ülkesinde yaygın olarak saptanmakta ve ülkemizde de oldukça sık görülmektedir. Çalışmamızın amacı, İstanbul ve çevre illerdeki yerleşim bölgelerinden dört yıllık dönemde bruselloz kuşkusu ile merkezimize başvuran 6.045 olgudan alınan serum örneklerinde bruselloz serolojik göstergelerini retrospektif olarak değerlendirmek ve sonuçları yine merkezimizde 2005-2011 yılları arasında gerçekleştirilmiş çalışmanın verileriyle karşılaştırarak değişkenlikleri irdelemektedir. Yöntem: Çalışmamıza Mart 2013- Mart 2017 tarihleri arasında İstanbul Üniversitesi-Cerrahpaşa, Cerrahpaşa Tıp Fakültesi Hastanesi Tıbbi Mikrobiyoloji Laboratuvarı Seroloji/ELISA birimine gönderilen bruselloz şüpheli olgulara ait serum örnekleri dahil edilmiştir. Örneklerden Brucella Serum Aglütinasyon (SAT), Coombs’lu Wright (CT) ve Rose-Bengal (RB) testleri yapılmıştır. Bulgular: Dört yıllık değerlendirme sonucunda, bruselloz şüpheli 6045 olgunun 107 (%1.8)’si seropozitif, 5938 (%98.2)’i seronegatif bulunmuştur. Brusella seropozitif 107 olgunun 73 (%68.2)’ü RB ve SAT ile eş zamanlı pozitif bulunmuş, 34 (%31.7) olgu ise RB ve SAT test sonuçları arasında uyumsuzluk görülmesi nedeniyle, CT sonucuna göre brusella seropozitif olarak belirlenmiştir. Brusella seropozitiflik oranı kadınlarda (%58) erkeklere (%42) göre daha yüksek olsa da istatistiksel olarak anlamlı bir fark bulunmamıştır. Olguların %28’inde aile içi aynı kaynaktan bulaş, %48’inde kırsal kesimde yaşama öyküsü saptanmıştır. Sonuç: Verilerimizin retrospektif değerlendirmesi sonucunda, bu çalışmada İstanbul ve çevre illerinde saptadığımız bruselloz seropozitiflik oranı (%1.8), aynı merkezde bir önceki dönem elde edilen orana göre (%3) düşük bulunmuştur. Bruselloz seropozitifliğinin oransal düşüklüğünde, son yıllarda görsel ve yazılı iletişim araçlarındaki artışla hayvansal kaynaklı beslenme konusunda daha bilinçli ve hijiyen kurallarına uyan insan kitlelerindeki artışın rolü olabileceğini düşünmekteyiz.Objective: Brucellosis is a systemic infectious disease that is commonly detected in many countries of the world and is very common in our country. The aim of this study was to evaluate the serological markers of brucellosis in 6045 patients from Istanbul and surrounding provinces, who were admitted to our center in a 4-year period and to compare the results with the study conducted between 2005-2011. Method: Serum samples of suspected brucellosis patients who were admitted to Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty Hospital, Serology / ELISA unit, between March 2013-2017 were included in the study. Brucella Serum Agglutination, Coombs Wright and Rose-Bengal tests were performed. Results: As a result of a 4 years evaluation, 107 (1.8%) of the 6045 suspected brucellosis cases were found seropositive and 5938 (98.2%) of them were seronegative. Of the seropositive 107 cases, 73 (68.2 %) were found to be concurrently positive with RB and SAT; 34 (31.7%) of the cases were seropositive according to CT. Although brucella seropositivity rate was higher in females (58%) than males (42%), no statistically significant difference was found. Of the cases 28% had transmission from the same source within the family and 48% had a history of living in rural areas. Conclusion: Consequently, the seropositivity rate of brucellosis (1.8%) that we found was found to be lower than the rate obtained in the same center (3%) previously. We believe that, by the increase in visual and written communication tools people comply and are more conscious about the hygienic rules on consuming animal based nutrition
Adult Tetanus With Fatal Course: A Case Report
No full textWOS: 000481718600018Despite improvements in medicine, tetanus is still a fatal infectious disease which can be prevented by immunoprophylaxis and it should always be kept in mind after injuries. in this case report, we present a patient who had no previous immunization history and did not have tetanus prophylaxis completed at the first visit of the emergency department after injury. the patient was followed with a clinical picture of generalized tetanus in intensive care unit, but autonomic dysfunction could not be taken under control despite treatment and resulted in mortality. Tetanus prophylaxis should be questioned in patients applying with injury or trauma. Strategies should be developed in order to achieve regular vaccination, with respect to adult immunization in particular
The efficacy of the electric patient hoist systems in mobilization
No full textOBJECTIVE: Long-term immobilization brings about physiological and biomechanical adverse effects on organs and systems. For enabling patients to stand on their feet and to be mobilized in the early period, electric patient hoist system (EPHS) accelerates the recovery of systemic functions and allows the patient with neurological diseases to become independent. This study aimed to investigate whether EPHS differs from conventional systems in the duration of hospitalization, mobility level and return to activities of daily living by analyzing patients mobilized with EPHS in the early period. METHODS: We analyzed 30 patients with neurological diseases, who were aged 50-75 years and immobile for more than one week. The patients were divided into two groups as EPHS patients and controls. Before and after the treatment, we recorded age, height, weight, hospitalization duration and time of mobilization. Mobility was assessed using the clinical and Rivermead mobility indexes while daily activities were evaluated with the Barthel index. RESULTS: Our results indicated that the hospitalization duration decreased significantly in the patients practicing with EPHS in comparison with the controls (p=0.014). When the groups were compared regarding the pre- and post-treatment outcomes of the clinical and Rivermead mobility indexes, the mobility levels of the EPHS group showed more considerable improvement (p<0.001). The Barthel index demonstrated that the EPHS patients showed significantly higher participation in daily life within a significantly shorter time (p=0.002). CONCLUSION: Applying EPHS in the early period of hospitalization extends the time patients stand on their feet, enabling them to spend this time effectively. In conclusion, intervening immobile patients with EPHS in addition to their early rehabilitation program achieved earlier mobilization, shorter hospitalization and easier return to daily life activities
Fingolimod Tedavisinin Yineleyici MS Hastalarındaki Etkilerini Değerlendiren Açık Etiketli, 12 Ay Süreli Pilot Çalışma - Fine Çalışma Grubu
No full textIntroduction: To assess satisfaction and quality of life in patients with relapsing–remitting multiple sclerosis (RRMS) who were receiving fingolimod (0.5 mg/day) for 12 months as a second-line treatment after switching from injectable agents.Methods: Patients aged 18–65 years with RRMS who fulfilled the eligibility criteria were enrolled from 16 centers throughout Turkey. Treatment Satisfaction Questionnaire for Medication and 36-item Short-Form Health Survey were completed at baseline and four visits to assess patient satisfaction and quality of life.Results: Forty-two patients (62% male; mean age: 35.7±9.4 years) were eligible for inclusion. Patient satisfaction scores at the end of the study (44.7±9.9) were significantly higher than those at baseline [32.0±9.9; (p<0.001)]. The only significant increase in the quality of life survey was in the emotional aspect (p=0.019). There were 124 adverse events and none of the five serious adverse events noted was considered drug-related.Conclusion: Large-scale comparative studies performed with disease specific quality of life instruments will allow more information on this issueAmaç: Prospektif, çok merkezli bu çalışmanın amacı, enjekte edilebilir ajanlardan sonra ikinci basamak ilaç olarak 12 ay süreyle 0,5 mg/gün dozunda fingolimod kullanan yineleyici multipl skleroz hastalarının memnuniyetlerinin ve yaşam kalitelerinin değerlendirilmesidir.Yöntem: Çalışmaya Türkiye genelinde 16 merkezden, 18-65 yaş arasında, dahil etme kriterlerini karşılayan yineleyici multipl skleroz hastaları katılmışlardır. Hastalara; memnuniyetlerinin ve yaşam kalitelerinin değerlendirmesi amacı ile başlangıç ve takip eden diğer dört vizitte İlaç Memnuniyet Anketi ve Kısa Form-36 Sağlık Durumu Anketi uygulanmıştır.Bulgular: Yaş ortalamaları 35,7±9,4 olan ve %62’sini erkek hastaların oluşturduğu toplamda 42 hasta çalışmaya dahil edilmiştir. Çalışmanın sonunda hasta memnuniyeti skorları (44,7±9,9) çalışma başlangıcına (32,0±9,9) kıyasla anlamlı olarak yüksek bulunmuştur (p<0,001). Yaşam kalitesi anketi sonuçlarında ise yalnızca emosyenel fonksiyon skorunda bir artış görülmüştür (p=0,019). Çalışma süresince 124 advers olay kaydedilirken, rapor edilen 5 ciddi advers olaydan hiçbiri ilaçla ilişkili olarak değerlendirilmemiştir.Sonuç: Hastalığa özgü yaşam kalitesi değerlendirme yöntemleri ile gerçekleştirilecek olan geniş ölçekli karşılaştırma çalışmaları, bu konuda daha çok bilgi alınmasına olanak sağlayacaktır
How to safely implant a dual-chamber pacemaker for right ventricular outflow tract pacing in a patient with persistent left superior vena cava: A step by step guide
No full text[No abstract available
Second recurrence of familial atrial myxomas: mother and daughter simultaneously
No full textEZELSOY, MEHMET/0000-0002-8423-5071WOS: 000482773800002PubMed: 30729976Sporadic cardiac myxomas rarely recur, however recurrence rates are higher in patients with a familial aggregation or Carney complex. Carney complex is characterised by multiple mucocutaneous lesions and accounts for up to two-thirds of familial cardiac myxomas. A second recurrence is very rare, even in the case of Carney complex. We report on two cases of recurrent cardiac myxoma, a mother and daughter, who concurrently presented with a second recurrence of atrial myxomas. the time interval between the first and second recurrence following surgery was four years in both. the possibility of repeat recurrence of cardiac myxomas demonstrates the importance of regular echocardiography to detect recurrence and to prevent the potential complications associated with cardiac myxomas. Family screening should be recommended for familial myxomas
The reducing effect of agomelatine on pentylenetetrazol-induced convulsions
No full textErdogan, Mumin/0000-0003-0048-444XWOS: 000509672600010Introduction: Agomelatine is a potent MT1 and MT2 melatonin receptor agonist and a 5-HT2C serotonin receptor antagonist. the purpose of this study was to show the convulsion-reducing effect of agomelatine, in both clinical and electrophysiological terms, in a pentylenetetrazole (PTZ)-induced experimental epilepsy model in rats. Methods: the anti-convulsant activity of agomelatine (25 and 50 mg/kg) was evaluated in rat models of PTZ (35 and 70 mg/kg) and compared with the control groups. Results: Agomelatine administration at doses of 25 and 50 mg/kg resulted in a statistically significant decrease in convulsion scores and time to onset of myoclonic jerks compared to the control groups. in addition, comparison of the two doses employed showed that high-dose agomelatine (50 mg/kg) was significantly more effective than the lower dose. in addition to previous studies, we investigated the anticonvulsant effect of agomelatine using electroencephalogram (EEG). Administration of agomelatine at doses of 25 and 50 mg/kg in PTZ-induced seizures caused a significant decrease in the percentage of peak at EEG. Discussion: Our results suggest that agomelatine has anticonvulsant activity shown in PTZ-induced seizure model. the results also give some evidences that agomelatine can use on epileptic seizures, but more studies are needed
An antiquated contraindication for minimally invasive lung surgery: No place to staple the bronchus
No full textkaba, erkan/0000-0002-0793-8152WOS: 000492824600017PubMed: 32082920Background: This study aims to evaluate the feasibility and outcomes of lobectomy operations without using a stapler for bronchial closure. Methods: Between December 2014 and August 2018, a total of 108 patients (72 males, 36 females; mean age 62.1 +/- 9.8 years; range, 19 to 83 years) with primary lung cancer who underwent lobar resection with robot-assisted thoracoscopic surgery were included in this study. Primary bronchial closure (n=7) and sleeve anastomosis (n=9) were performed in some cases. These 16 patients were compared with other lobectomy cases (n=92) who had bronchial stapling for bronchial closure. Results: There was no statistically significant difference in the mean duration of operation, amount of intraoperative bleeding, length of postoperative stay in the hospital, and morbidity and readmission rates between the two groups (p=0.3, p=0.5, p=0.06, p=0.4, and p=0.63, respectively). No bronchial fistula developed in any of the patients. Conclusion: Primary bronchial closure and sleeve anastomosis can be safely performed with robot-assisted thoracoscopic surgery without conversion to thoracotomy, or a larger assistance incision with a similar success rate of the stapled bronchus