Rapid emergence of colistin resistance and its impact on fatality among healthcare-associated infections

This article describes the emergence of resistance and predictors of fatality for 1556 cases of healthcare-associated Gram-negative bloodstream infection in 2014 and 2015. The colistin resistance rate in Klebsiella pneumoniae was 16.1%, compared with 6% in 2013. In total, 660 (42.4%) cases were fatal. The highest fatality rate was among patients with Acinetobacter baumannii bacteraemia (58%), followed by Pseudomonas aeruginosa (45%), Klebsiella pneumoniae (41%), Enterobacter cloacae (32%) and Escherichia coli (28%). On multi-variate analysis, the minimum inhibitory concentrations for carbapenems [odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01-1.04; P = 0.002] and colistin (OR 1.1, 95% CI 1.03-1.17; P = 0.001) were found to be significantly associated with fatality.

Cold pressed versus refined winterized corn oils: quality, composition and aroma

The aims of this study were to characterize and compare cold pressed and fully refined winterized corn oils. Free fatty acidity (FFA), peroxide (PV) and p-anisidin (p-AV) values, saponification number, total carotenoid and phenolic contents of cold pressed corn oils were higher than that of the refined winterized corn oils. Linoleic and oleic acids (approximately 53-54% and 30-31%, respectively) were detected as the major fatty acids in both oil samples. Fifteen different sterols with a majority of β-sitosterol, campesterol, and stigmasterol were quantified in both oil samples. Although phenolic compounds were not quantified in the refined winterized oil samples, some flavonoids (hesperidin, rutin) and phenolic acids (gallic, syringic, rosmaniric and trans-ferulic) were detected in the cold pressed oil samples. This study concludes that cold pressed corn oils could be superior in terms of bioactive compounds but still need some quality improvements for sensory attributes.

Test of Mindfulness-Based Psychosocial Skills Training to İmprove Insight and Functional Recovery in Schizophrenia

This study was conducted with two groups (training and control) using a pretest/posttest design to determine the effect of mindfulness-based psychosocial skills training for improving insight and functional recovery levels in patients with schizophrenia. The study sample included 45 patients with schizophrenia (21 were in the training group/mindfulness-based psychosocial skills training and 24 were in the control group/standard drug medication). The data were collected using a Personal Information Form, Functional Remission of General Schizophrenia (FROGS) scale, and Beck Cognitive Insight Scale (BCIS). The training group was divided into two groups of 10 to 12 persons on average. Training was given as a group training for a total of 16 sessions, two sessions a week for 8 weeks. The training group scored significantly higher in functional recovery and insight levels than the control group after training ( p < .05). The study determined training has an effect on increasing the levels of insight and functional recovery in schizophrenia.

The Effect of Internalized Stigma on the Self Esteem in Patients with Schizophrenia

AIM

This study has been conducted to determine the relationship between internalized stigma and self-esteem in patients with schizophrenia.

MATERIALS AND METHODS

This study was conducted using 60 patients with schizophrenia who were diagnosed as schizophrenic according to the DSM-IV diagnostic criteria in the psychiatric clinics of hospitals in Erzurum. The data were collected using the "Questionnaire on Internalized Stigma of Mental Illness Scale" (ISMI) that determines the socio-demographic characteristics of patients, and the "Short Form of Self-Esteem Scale" (SF-SES).

RESULTS

The mean Internalized Stigma of Mental Illness Scale score was high; the mean of the positive dimension of the self-esteem scale score was lower than negative dimension. A negative significant relationship was found (r=-.758, p<0.01) between the ISMI and SF-SES when we examined the relationship between the mean scores of self-esteem and internalized stigma levels of the patients. There is a significantly positive relationship between the mean scores of the stigma resistance and SERS-SF (r=.339, p<0.01).

CONCLUSION

The findings show that the patients' self-esteem decreases with the increasing levels of internalized stigma. In particular, the high level of accepting stereotyped judgments and the low stigma resistance can be associated with low self-esteem. Based on these results, increasing psychoeducation and counseling services for patients with schizophrenia, and increasing the public awareness of this issue are recommended. Advanced quantitative studies should be conducted to determine the factors related to fighting stigma.

Effects of Relaxation Exercises and Music Therapy on the Psychological Symptoms and Depression Levels of Patients with Schizophrenia

PURPOSE

This study aims to identify the effects of relaxation exercises and music therapy on the psychological symptoms and depression levels of patients with chronic schizophrenia.

MATERIALS AND METHODS

This semi-experimental study was conducted using pre- and post-tests with a control group. The study population consists of patients with schizophrenia who regularly attended community mental health centers in the Malatya and Elazığ provinces of Turkey between May 2015 and September 2015. The study's sample consists of 70 patients with schizophrenia (n=35 in the control group; n=35 in the experimental group) who were selected randomly based on power analysis. The "Patient Information Form," the "Brief Psychiatric Rating Scale (BPRS)" and the "Calgary Depression Scale for Schizophrenia (CDSS)" were used for data collection. Patients in the experimental group participated in relaxation exercises and music therapy 5 times a week for 4 weeks. The experimental group of 35 persons was divided into three groups of approximately 10-12 individuals in order to enable all participants to attend the program. No intervention was applied to the patients in the control group. The data were evaluated using percentage distribution, arithmetic means, standard deviations, Chi-square and independent samples t-tests.

RESULTS

The study found that patients in the experimental group showed a decrease in total mean scores on the BPRS and CDSS; the difference between the post-test scores of the experimental group and the post-test scores of the control group was statistically significant (p<0.05). The practice of relaxation exercises and music therapy was proven to be effective in reducing schizophrenic patients' psychological symptoms and levels of depression.

CONCLUSION

Relaxation exercises and music therapy can be used as a complementary therapy in the medical treatment of patients with chronic schizophrenia.

Healthcare-associated Gram-negative bloodstream infections: antibiotic resistance and predictors of mortality

This article describes the prevalence of antibiotic resistance and predictors of mortality for healthcare-associated (HA) Gram-negative bloodstream infections (GN-BSI). In total, 831 cases of HA GN-BSI from 17 intensive care units in different centres in Turkey were included; the all-cause mortality rate was 44%. Carbapenem resistance in Klebsiella pneumoniae was 38%, and the colistin resistance rate was 6%. Multi-variate analysis showed that age >70 years [odds ratio (OR) 2, 95% confidence interval (CI) 1.22-3.51], central venous catheter use (OR 2.1, 95% CI 1.09-4.07), ventilator-associated pneumonia (OR 1.9, 95% CI 1.1-3.16), carbapenem resistance (OR 1.8, 95% CI 1.11-2.95) and APACHE II score (OR 1.1, 95% CI 1.07-1.13) were significantly associated with mortality.

Relationship of hemoxygenase-1 and prolidase enzyme activity with oxidative stress in papillary thyroid cancer

AIM

Recent studies associate thyroid cancer with oxidative stress. We aim to clarify the relation between papillary thyroid cancer, oxidative stress, hemoxygenase-1, prolidase enzymes and investigate the availability of these enzymes as markers for diagnosis, success of treatment, and follow-up.

METHODS

Thirty-one patients with papillary thyroid carcinoma and 25 healthy control subjects were included in this study. Hemoxygenase-1, prolidase (oxidant stress indicator), malondialdehyde, protein carbonyl, and superoxide dismutase (an indicator of antioxidant defense system) were measured pre-operatively and 30 days after thyroidectomy.

RESULTS

There was a significant decrease in serum levels of malondialdehyde and superoxide dismutase (p <0.001 for both) after thyroidectomy in papillary thyroid carcinoma group. In addition, there was a significant difference in the postoperative serum levels of prolidase, malondialdehyde, protein carbonyl, and superoxide dismutase between papillary thyroid carcinoma and control groups (p =0.024, p <0.001, p =0.002, and p =0.016, respectively) beside significant difference of malondialdehyde, protein carbonyl, hemoxygenase-1, and superoxide dismutase pre-operative serum levels (p <0.001, p =0.003, p =0.006, and p =0.025, respectively).

CONCLUSION

When the unquestionable role of oxidative stress in the pathogenesis of cancer is considered, in the future it is expected to associate parametric changes in the serum of patients caused by oxidative stress to papillary thyroid cancer. Hippokratia 2016, 20(1): 55-59.

The Effect of Internalized Stigma on the Adherence to Treatment in Patients With Schizophrenia

This study was conducted to determine the effect of internalized stigma on the adherence to the treatment of patients with schizophrenia. The population of the study consisted of patients who were diagnosed with schizophrenia according to the DSM IV diagnostic criteria and compatible with the study criteria. The study was completed with 63 patients overall. The researcher used Demographics Questionnaire, Morisky Medication Adherence Scale, Drug Attitude Inventory and Internalized Stigma of Mental Illness Scale to gather data. Among the patients, 11.1% adhered to the treatment, and 54.0% did not. The mean score for the internalized stigma level of patients was 76.39±14.30. A positive significant relationship was found among the scales (p<0.05). The level of internalized stigma of patients with schizophrenia was determined to be high, and the internalized stigma had a negative impact on the adherence and attitude toward the treatment.

Evaluation of potential salivary acetaldehyde production from ethanol in oral cancer patients and healthy subjects

BACKGROUND

Acetaldehyde has been implicated as a major factor in oral carcinogenesis associated with alcohol consumption. In this study, saliva samples from oral cancer patients and healthy individuals were incubated in vitro with ethanol in order to investigate factors which can influence salivary acetaldehyde production.

MATERIALS AND METHODS

A total of 66 individuals (40 males and 26 females, mean age 52 years) participated in the study. Participants were classified into three groups: Group 1 (oral cancer patients [n = 20]); Group 2 (poor dental health status [n = 25]) and Group 3 (good dental health status [n=21]). Every patient chewed a 1g piece of paraffin chewing gum for 1 minute then saliva samples were collected from all individuals. After in vitro incubation of the samples with ethanol, the levels of salivary acetaldehyde production was measured by head space gas chromatography. Kruskal-Wallis and Mann-Whitney tests and Spearman's Correlations analysis were performed for statistical analyses.

RESULTS

The salivary acetaldehyde production was significantly higher (p <0.0001) in both group 1 and group 2 when compared to group 3. However, there was no significant difference between group 1 and group 2. Poor dental health status, infrequent oral hygiene habits and dental visits, smoking and presence of a dental prosthesis were significant parameters for increased levels of salivary acetaldehyde production from alcohol. The evaluation of salivary acetaldehyde production after in vitro incubation with ethanol may be useful for early detection of oral cancer.

CONCLUSION

According to the results of this study, the significantly higher levels of salivary acetaldehyde production in oral cancer patients and individuals with poor dental health status may suggest a possible link between increased salivary acetaldehyde production and oral cancer. Improved oral hygiene can effectively decrease the level of salivary acetaldehyde production in oral cavity. Hippokratia 2014; 18 (3): 269-274.

A mucormycosis case treated with a combination of caspofungin and amphotericin B

Mucormycosis is a rare, invasive and fatal disease that occurs mainly in diabetes mellitus patients with uncontrolled blood glucose levels or in immunocompromised patients. The mortality rate of this disease is as high as 25 to 80%, despite aggressive surgical treatment and antifungal therapy. This high mortality requires alternative treatment approaches. The accepted treatment modality of invasive mucormycosis are amphotericin B lipid formulations. Although echinocandins generally show no activity against Mucorales, it was shown that Rhizopus oryzae expressed the target enzyme for echinocandins, 1,3-beta-glucan synthase. Additionally, there are some experimental studies in a diabetic mouse model and case reports regarding the effects of caspofungin. In this report, we present a rhinocerebral mucormycosis case treated with liposomal amphotericin B and caspofungin. There was regression of the patient's clinical and radiological condition with the addition of caspofungin, but she died due to discontinuation of her treatment and reasons other than mucormycosis.

Skin tag and acanthosis nigricans: do they have a predictive value for gestational diabetes mellitus?

BACKGROUND

Gestational diabetes mellitus (GDM) is a metabolic condition that can cause severe fetal and maternal morbidity. Early diagnosis and treatment of GDM can significantly prevent maternal and perinatal morbidity.

OBJECTIVE

To investigate and compare the prevalence of gestational diabetes mellitus in pregnant women with skin tag (ST) and/or acanthosis nigricans (AN) and a control group.

METHODS

This cross-sectional study was conducted at Adana Numune Educational and Research Hospital, Seyhan Practice Center, Dermatology and Obstetrics Clinics between March, 2006 and July, 2008. All 249 pregnant women without risk factors for GDM examined dermatologically in terms of AN and ST in the first antenatal visit. A 50 g glucose screening test and, if test positive, 100 g oral glucose tolerance test was performed between theirs 24 and 28 weeks of pregnancy. GDM was diagnosed according to American Diabetes Association (ADA) criteria. AN and ST prevalence were compared in women with GDM and without GDM.

RESULTS

35.8% of the pregnant women with AN had GDM, while the same ratio was 9.2% for the women without AN. The probability of pregnant women with AN having GDM is 5.5 (95%CI: 2.6-11.6) times more than the pregnant women without AN. Among the pregnant women with both ST and AN, 40.0% of them had GDM, while the same ratio was 12.3% for the women free of both ST and AN. In this instance, the difference between the ratios was found statistically significant (p=0.001). Based on the results, the probability of pregnant women with both ST and AN having GDM is 4.8 (95%CI: 1.9-11.7) times more than the pregnant women without ST and AN.

CONCLUSIONS

AN or AN with ST may be a risk factor for GDM. If this supported with large case-control study, early screening for GDM to prevent serious complications of disease should be done in pregnant women with AN.