24 research outputs found
The ongoing challenge of ventilator-associated pneumonia: epidemiology, prevention, and risk factors for mortality in a secondary care hospital intensive care unit
No full textSummary: Background: Ventilator-associated pneumonia (VAP) is a leading cause of morbidity and mortality among intensive care unit infections. Despite various preventive measures, the incidence of VAP remains high. Aims: This study aimed to explore the epidemiology and risk factors for VAP associated mortality in a secondary care hospital, comparing outcomes before and after implementing a VAP prevention bundle. Methods: This retrospective study was conducted from July 1, 2021, to June 30, 2023, at a secondary care hospital. Patients over 18 years old who underwent mechanical ventilation for more than 48 hours were included. The study compared the incidence, microbiological etiology, and outcomes of VAP before and after implementing the VAP prevention bundle and analyzed risk factors for mortality from VAP. Results: A total of 83 patients diagnosed with VAP were included. Despite concerted efforts to implement the VAP prevention bundle, there was no significant decrease in the VAP rate per 1000 ventilator days, early-onset VAP, secondary bloodstream infections, acute respiratory distress syndrome, and 30-day mortality. The microbiological etiology of VAP remained consistent between the two periods. A decrease in lymphocyte count and albumin level were identified as independent risk factors for 30-day mortality. Conclusions: Concerted efforts to implement a VAP prevention bundle did not significantly reduce the incidence or improve outcomes of VAP in this secondary care hospital setting. The microbiological etiology remained unchanged. Monitoring lymphocyte count and albumin level may help identify patients at high mortality risk. Further research is needed to develop more effective VAP prevention and management strategies
Clonal relationship in fluconasole resistant candida parapsilosis strains isolated from blood cultures
No full textNozokomiyal kan dolaşımı enfeksiyonlarında kandidemiler 4. sırada yer almakta ve bunların %50’den fazlasında etken olarak C. albicans saptanmıştır. Ancak son yıllarda albicans dışı Candida’lar da artmaktadır. Özellikle yenidoğan ve cerrahi yoğun bakım birimlerinde C. parapsilosis’in ve C.glabrata’nın artan sıklıkla izole edildiği bildirilmektedir. Bu durum ampirik vekanıtlanmış antifungal seçimini etkilemektedir. Son çalışmalar, C. parapsilosis kandidemi insidansının %7-24 oranında arttığını göstermiştir. Özellikle invazif girişimlerin artışı, port ve benzeri kalıcı kataterlerin kullanımının yaygınlaşması, uzun yatış süreleri, antibiyotik kullanımının artması, total parenteral nutrisyon (TPN) desteklerinin çoğalması bu insidans artışı nedenleri arasında sayılmaktadır. C. parapsilosis’e bağlı kandidemilerde mortalite diğer kandidemilere göre düşük olsa da etken hastanede salgın yapabilir, yatış süresinin uzamasına, katater değişimine neden olabilir, en kısa sürede uygun ve etkili antifungal tedavi başlanmasını gerektirir. Kandidemilerde uygun, ampirik tedavinin bir an önce başlanmasının mortalite ve yatış süresini etkilediği bilinmektedir. Bu nedenle hastalarda kandidemi riskini, mortaliteyi etkileyen faktörleri belirlemek, etkenlerin tür tayini, duyarlılık profillerinin bilinmesi yararlıdır. Hastalarda uygun ve etkili tedaviye hızla başlanması için hastane veya bölümde epidemiyolojinin bilinmesi önemlidir. Ayrıca antifungal tedavilerin giderek yaygın kullanılması, dirençli etkenlerin ortaya çıkabilmesi, hasta profillerindeki değişim bu konularda yeni çalışmalara ihtiyaç doğurmaktadır. Bu çalışmanın amacı laboratuvarımızda, kan kültürlerinden izole edilen flukonazol dirençli C. parapsilosis tür kompleksi suşları arasında genotipik ilişki ve belirlenmesi ve bu suşlarla enfekte hastaların özellikleri ve klinik seyrinin incelenmesidir. Çalışmada 1997-2019 yılları arasında, flukonazol dirençli 88 C. parapsilosis kandidemisi tanılı hasta değerlendirildi. 30. gün mortalitesi %21.5 (n=19) olarak bulundu. Risk faktörlerine bakıldığında kemoterapi almanın iii mortaliyeti arttığı görüldü. İstatistiksel olarak santral venöz kateterin (SVK) çekilmesinin ve antifungal tedavi seçiminin mortalite üzerinde etkisi anlamlı bulunmadı. 88 suştan, izole edilebilen 47 suş genotipik olarak mikrosatellit yöntemi ile analiz edildi. Bu suşlar içinde, altı farklı genotip tespit edilmiş olup, en küçük ağaç yolu çizimi ve dendogram değerlendirilmesi neticesinde esas olarak iki farklı grup halinde kümelendikleri gösterilmiştir. Aynı dönemde, aynı klinikte yatan hastalarda aynı genotipe sahip etkenler tespit edilmiş ve etkenin endojen kaynaklı olmasından ziyade, çevre kaynaklı yayıldığı düşünülmüştür. Bu sonuçlar ile C. parapsilosis’e bağlı kandidemi görülen, genel durumu kötü ve altta yatan hastalıkları fazla olan hasta grubunda kataterlerin çekilmesinin bir süre ertelenebileceği, in vitro dirençli olmasına karşın flukonazol veya ekinokandin seçeneklerinin tedavide tercih edilebileceği, C. parapsilosis salgınlarından şüphelenildiği durumlarda salgın analizinde mikrosatellit analiz yönteminin uygun bir seçenek olarak düşünülebileceği gösterilmiştir.Candidemias take the 4th place in nosocomial bloodstream infections and C. albicans has been detected as the agent in more than 50% of them. However, in recent years, non-albicans Candida are also on the increase. It has been reported that C. parapsilosis and C. glabrata are isolated with increasing frequency, especially in neonatal and surgical intensive care units. This affects empirical and proven antifungal selection. Recent studies have shown that the incidence of C. parapsilosis candidemia increases by 7-24%. Especially the increase in invasive interventions, widespread use of ports and similar permanent catheters, long hospitalization periods, increased use of antibiotics, and the increase in total parenteral nutrition (TPN) support are among the reasons for this increase in incidence. Although mortality in candidemia due to C. parapsilosis is lower than other candidemias, the agent may cause an epidemic in the hospital, prolong the hospitalization period, cause catheter change, and require appropriate and effective antifungal treatment as soon as possible. It is known that initiating appropriate empirical treatment as soon as possible affects mortality and length of stay in candidemias. For this reason, it is useful to determine the risk of candidemia, the factors affecting mortality, the determination of the factors and their susceptibility profiles. It is important to know the epidemiology in the hospital or department for the rapid initiation of appropriate and effective treatment in patients. In addition, the widespread use of antifungal treatments, the emergence of resistant agents, and the change in patient profiles call for new studies on these issues. The aim of this study is to determine and determine the genotypic relationship between fluconazole-resistant C. parapsilosis strains isolated from v blood cultures in our laboratory, and to examine the characteristics and clinical course of patients infected with these strains. Eighty-eight fluconazole-resistant patients diagnosed with C. parapsilosis candidemia between 1997 and 2019 were evaluated in the study. 30th day mortality was found as 21.5% (n = 19). Considering the risk factors, it was seen that the mortality of receiving chemotherapy increased. Statistically, the effect of withdrawal of central venous catheter (CVC) and choice of antifungal therapy on mortality was not significant. 47 strains that can be isolated from 88 strains were genotypically analyzed by microsatellite method. Six different genotypes were identified among these strains, and it was shown that they were clustered in two different groups as a result of the smallest tree path drawing and dendogram evaluation. In the same period, factors with the same genotype were identified in patients hospitalized in the same clinic and it was thought that the agent was spread by environmental rather than endogenous origin. With these results, the withdrawal of catheters may be delayed for a while in the patient group with candidemia due to C. parapsilosis, whose general condition is poor and with high underlying diseases, fluconazole or echinocandin treatment may be preferred for treatment despite in vitro resistance, and in epidemic analysis in cases where C. parapsilosis outbreaks are suspected. It has been shown that microsatellite analysis method can be considered as a suitable option
Evaluation of YouTube Videos on HIV/AIDS: A Critical Analysis of Content Quality and Reliability
No full textHIV and AIDS remain as significant global health issues, with misinformation and stigma surrounding the diseases still being prevalent. Accurate and reliable information is crucial for promoting prevention, early detection, and effective management of the disease. YouTube has emerged as a popular platform for sharing and consuming health-related content, but the quality and reliability of its videos on various health topics have been questioned. Objective: This study aims to systematically review and evaluate the quality and reliability of YouTube videos on HIV/AIDS. Methods: We searched for videos on YouTube using two search terms, "HIV" and "AIDS," and evaluated the top 100 videos for each search term. We recorded video features such as length, likes, comments, views, and upload date. Two independent evaluators assessed the videos' quality and reliability using the Global Quality Scale and the modified DISCERN tool. We classified the videos into two groups based on the source that uploaded the video, professional and non-professional, and analyzed the data using statistical methods. Results: Of the 159 videos evaluated, the most common content categories were HIV transmission routes, basic information and definition of HIV, and HIV/AIDS activism and awareness. Non-professional videos tended to be shorter, but there were no significant differences in views, likes, and likes per day counts. Comments were significantly higher in non-professional videos. Professional videos had higher quality and reliability scores than non-professional videos. Conclusion: Accurate and reliable information on HIV/AIDS is critical for promoting prevention, early detection, and effective management of the disease. YouTube has the potential to disseminate this information, but the quality and reliability of its videos must be improved. Our study highlights the need to prioritize professional, high-quality, and reliable video content on HIV/AIDS on YouTube to improve the public health outcome
Risk factors and outcome for bloodstream infections due to fluconazole-resistant <i>candida parapsilosis</i>: A 22-year single-center retrospective study
No full textCandidemia ranks among the top causes of nosocomial bloodstream infections, significantly increasing hospital stays and costs. Rapid and effective empirical antifungal therapy is crucial. The Candida parapsilosis species complex, the second most common cause of candidemia, has shown rising fluconazole resistance globally and in our country. Additionally, echinocandins exhibit higher minimum inhibitory concentrations (MICs) for C. parapsilosis, complicating empirical treatment decisions. This retrospective study analyzed 173 C. parapsilosis candidemia cases over 22 years in a tertiary care hospital. We compared 88 fluconazole non-susceptible (minimum inhibitory concentration [MIC] = 4 mu g/mL: susceptible dose dependent; MIC >= 8 mu g/ml resistant) and 85 fluconazole susceptible cases, examining demographics, clinical characteristics, risk factors, and 28-day mortality. Independent risk factors for fluconazole non-susceptibilty included age >= 66 years (p = 0.016), central venous catheter use (p < 0.001), total parenteral nutrition (p = 0.003), and colostomy (p = 0.049). Fluconazole non-susceptible cases had lower microbiological cure rates and higher mortality. Mortality in this group was independently associated with microbiological cure failure (p < 0.001). This study highlights the importance of identifying risk factors to estimate the likelihood of resistant pathogens, initiating targeted antifungal therapy, and providing individualized management. Monitoring local resistance patterns is essential to guide empirical therapy. Further multicenter research is needed to validate findings and optimize treatment for fluconazole resistant candidemia
Selenomethionine reduces visual deficits due to developmental methylmercury exposures
No full textPublished in final edited form as:
Physiol Behav. 2008 Jan 28; 93(1-2): 250–260.Developmental exposures to methylmercury (MeHg) have life-long behavioral effects. Many micronutrients, including selenium, are involved in cellular defenses against oxidative stress and may reduce the severity of MeHg-induced deficits. Zebrafish embryos (<4 hours post fertilization, hpf) were exposed to combinations of 0.0-0.30 μM MeHg and/or selenomethionine (SeMet) until 24 hpf then placed in clean medium. Fish were tested as adults under low light conditions (~60 μW/m2) for visual responses to a rotating black bar. Dose-dependent responses to MeHg exposure were evident (ANOVA, P<0.001) as evidenced by reduced responsiveness, whereas SeMet did not induce deficits except at 0.3 μM,. Ratios of SeMet:MeHg of 1:1 or 1:3 resulted in responses that were indistinguishable from controls (ANOVA, P<0.001). No gross histopathologies were observed (H&E stain) in the retina or optic tectum at any MeHg concentration. Whole-cell, voltage-gated, depolarization-elicited outward K+ currents of bipolar cells in intact retina of slices adult zebrafish were recorded and outward K+ current amplitude was larger in bipolar cells of MeHg-treated fish. This was due to the intense response of cells expressing the delayed rectifying IK current; cells expressing the transient IA current displayed a slight trend for smaller amplitude among MeHg-treated fish. Developmental co-exposure to SeMet reduced but did not eliminate the increase in the MeHg-induced IK response, however, IA responses increased significantly over MeHg-treated fish to match control levels. Electrophysiological deficits parallel behavioral patterns in MeHg-treated fish, i.e., initial reactions to the rotating bar were followed by periods of inactivity and then a resumption of responses
Outcome of carbapenem or colistin resistant Klebsiella pneumoniae bacteremia in the intensive care unit
No full textAbstract Carbapenem-resistant Klebsiella pneumoniae (CRKp) infections continue to be an important cause of mortality. In this retrospective study, the effect of carbapenem or colistin resistance on mortality in Klebsiella pneumoniae bacteremia and combined meropenem + colistin administration in CRKp bacteremia was evaluated. In addition to that, a mathematical model is applied to explore the relationships between the resistance and mortality. A total of 139 adult patients diagnosed with K. pneumoniae bacteremia(73 carbapenem sensitive and 66 carbapenem resistant) between 01/01/2000 and 31/07/2019 were included in the study. The 30-day mortality in entire cohort were 19.4%. 30-day mortality was significantly higher in the carbapenem resistant-colistin sensitive group and in the carbapenem resistant-colistin resistant group compared to the carbapenem susceptible group. Meropenem + colistin combination was administered to 37 (95%) of carbapenem resistant–colistin sensitive (n = 39) and 25 (93%) of carbapenem resistant–colistin resistant patients(n = 27). Notably, mortality was not significantly affected regardless of whether CRKp was colistin sensitive and whether a high dose and prolonged infusion of meropenem was administered. Mortality is higher in carbapenem resistant Klebsiella pneumoniae bacteremia compared to carbapenem susceptible group. In cases of combined meropenem and colistin administration, high dose and prolonged infusion of meropenem is not superior to standard dose and infusion in both carbapenem resistant–colistin sensitive and carbapenem resistant–colistin resistant K. pneumoniae bacteremia
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Effect of dietary methionine on selenomethionine metabolism and utilization for selenoproteins
No full textThe effects of dietary methionine (Met) on the utilization of selenium (Se) from stored tissue Se and dietary selenomethionine (SeMet) for glutathione peroxidase (GSH-Px) synthesis were studied in male rats. Plasma, liver and muscle Se significantly increased when rats were fed 0.5 mg Se/kg diet as SeMet in a Met-deficient diet for 21 d, whereas tissue GSH-Px activities decreased 43-50% during the SeMet supplementation period, suggesting that Se is deposited as SeMet in general body proteins. By calculation, a significant lower percentage of Se was associated with GSH-Px in Met-deficient as compared to Met-supplemented rats. Dietary Met supplementation increased the incorporation of 75Se from 75SeMet into specific rat selenoproteins in addition to liver GSH-Px. Overall, these results suggest that intact SeMet is preferentially incorporated non-specifically into general body proteins in Met-deficient rats, whereas with supplemental Met, more SeMet is degraded and the released Se used for specific selenoprotein synthesis. (Abstract shortened with permission of author.
Selenium uptake, translocation, subcellular distribution and speciation in winter wheat in response to phosphorus application combined with three types of selenium fertilizer
No full text© 2023, The Author(s). cc-byBackground: Selenium (Se) deficiency causes a series of health disorders in humans, and Se concentrations in the edible parts of crops can be improved by altering exogenous Se species. However, the uptake, transport, subcellular distribution and metabolism of selenite, selenate and SeMet (selenomethionine) under the influence of phosphorus (P) has not been well characterized. Results: The results showed that increasing the P application rate enhanced photosynthesis and then increased the dry matter weight of shoots with selenite and SeMet treatment, and an appropriate amount of P combined with selenite treatment increased the dry matter weight of roots by enhancing root growth. With selenite treatment, increasing the P application rate significantly decreased the concentration and accumulation of Se in roots and shoots. P1 decreased the Se migration coefficient, which could be attributed to the inhibited distribution of Se in the root cell wall, but increased distribution of Se in the root soluble fraction, as well as the promoted proportion of SeMet and MeSeCys (Se-methyl-selenocysteine) in roots. With selenate treatment, P0.1 and P1 significantly increased the Se concentration and distribution in shoots and the Se migration coefficient, which could be attributed to the enhanced proportion of Se (IV) in roots but decreased proportion of SeMet in roots. With SeMet treatment, increasing the P application rate significantly decreased the Se concentration in shoots and roots but increased the proportion of SeCys2 (selenocystine) in roots. Conclusion: Compared with selenate or SeMet treatment, treatment with an appropriate amount of P combined with selenite could promote plant growth, reduce Se uptake, alter Se subcellular distribution and speciation, and affect Se bioavailability in wheat
Preliminary X-ray crystallographic analysis of SMU.573, a putative sugar kinase from Streptococcus mutans
No full textSMU.573 from Streptococcus mutans is a structurally and functionally uncharacterized protein that was selected for structural biology studies. Native and SeMet-labelled proteins were expressed with an N-His tag in Escherichia coli BL21 (DE3) and purified by Ni2+-chelating and size-exclusion chromatography. Crystals of the SeMet-labelled protein were obtained by the hanging-drop vapour-diffusion method and a 2.5 angstrom resolution diffraction data set was collected using an in-house chromium radiation source. The crystals belong to space group I4, with unit-cell parameters a = b = 96.53, c = 56.26 angstrom, alpha = beta = gamma = 90 degrees.Biochemical Research MethodsBiochemistry & Molecular BiologyBiophysicsCrystallographySCI(E)PubMed0ARTICLEPt 147-496
