Evaluation of tularaemia courses: a multicentre study from Turkey

In this multicentre study, which is the largest case series ever reported, we aimed to describe the features of tularaemia to provide detailed information. We retrospectively included 1034 patients from 41 medical centres. Before the definite diagnosis of tularaemia, tonsillitis (n = 653, 63%) and/or pharyngitis (n = 146, 14%) were the most frequent preliminary diagnoses. The most frequent clinical presentations were oropharyngeal (n = 832, 85.3%), glandular (n = 136, 13.1%) and oculoglandular (n = 105, 10.1%) forms. In 987 patients (95.5%), the lymph nodes were reported to be enlarged, most frequently at the cervical chain jugular (n = 599, 58%), submandibular (n = 401, 39%), and periauricular (n = 55, 5%). Ultrasound imaging showed hyperechoic and hypoechoic patterns (59% and 25%, respectively). Granulomatous inflammation was the most frequent histological finding (56%). The patients were previously given antibiotics for 1176 episodes, mostly with β-lactam/β-lactamase inhibitors (n = 793, 76%). Antituberculosis medications were provided in seven (2%) cases. The patients were given rational antibiotics for tularaemia after the start of symptoms, with a mean of 26.8 ± 37.5 days. Treatment failure was considered to have occurred in 495 patients (48%). The most frequent reasons for failure were the production of suppuration in the lymph nodes after the start of treatment (n = 426, 86.1%), the formation of new lymphadenomegalies under treatment (n = 146, 29.5%), and persisting complaints despite 2 weeks of treatment (n = 77, 15.6%). Fine-needle aspiration was performed in 521 patients (50%) as the most frequent drainage method. In conclusion, tularaemia is a long-lasting but curable disease in this part of the world. However, the treatment strategy still needs optimization.

Paraoxonase, oxidized low density lipoprotein, monocyte chemoattractant protein-1 and adhesion molecules are associated with macrovascular complications in patients with type 2 diabetes mellitus

AIM

The aim of this paper was to evaluate the association between blood glucose, oxidative stress, inflammation, endothelial dysfunction and paraoxonase activity as contributors to the accelerated atherosclerosis seen in type 2 diabetic patients.

METHODS

Plasma malondialdehyde (MDA), oxidized LDL (oxLDL), monocyte chemoattractant protein-1 (MCP-1), intercellular adhesion molecule-1 (ICAM-1), and vascular cellular adhesion molecule-1 (VCAM-1) levels and paraoxonase-1 (PON1) activity were measured in sixty type 2 diabetic patients, 30 of whom had macrovascular complications, and 30 controls.

RESULTS

Diabetics with macrovascular complications had higher levels of MDA, oxLDL, MCP-1, ICAM-1, VCAM-1 than those without, and the difference was significant for all molecules except for ICAM-1. PON1 activity and ApoA1 levels of the controls were significantly higher than that of the patients, while PON1 activity and ApoA1 levels in the patients with macrovascular complications were significantly lower than that in patients without. Ambient plasma glucose concentration showed a significant positive association with plasma MDA, oxLDL, MCP-1, and VCAM, and a significant inverse association with PON1 and ApoA1 in diabetic patients. A significant positive correlation between oxLDL and MDA, a negative correlation between oxLDL and PON1; a significant inverse association between MDA and PON1; a positive correlation between MDA and MCP-1 and VCAM while a negative correlation between PON1 and MCP-1 and VCAM were detected in patients.

CONCLUSION

Hyperglycemia might play a significant role in generating increased oxidative stress, and decreased PON1 activity, resulting in elevated oxLDL, MCP-1 and VCAM levels. This might be one of the causal pathogenic factors initiating accelerated atherosclerosis in patients with type 2 diabetes mellitus. The implication of these findings are unclear and therefore further studies are required.

The features of infectious diseases departments and anti-infective practices in France and Turkey: a cross-sectional study

The aim of this study was to assess the infectious diseases (ID) wards of tertiary hospitals in France and Turkey for technical capacity, infection control, characteristics of patients, infections, infecting organisms, and therapeutic approaches. This cross-sectional study was carried out on a single day on one of the weekdays of June 17-21, 2013. Overall, 36 ID departments from Turkey (n = 21) and France (n = 15) were involved. On the study day, 273 patients were hospitalized in Turkish and 324 patients were followed in French ID departments. The numbers of patients and beds in the hospitals, and presence of an intensive care unit (ICU) room in the ID ward was not different in both France and Turkey. Bed occupancy in the ID ward, single rooms, and negative pressure rooms were significantly higher in France. The presence of a laboratory inside the ID ward was more common in Turkish ID wards. The configuration of infection control committees, and their qualifications and surveillance types were quite similar in both countries. Although differences existed based on epidemiology, the distribution of infections were uniform on both sides. In Turkey, anti-Gram-positive agents, carbapenems, and tigecycline, and in France, cephalosporins, penicillins, aminoglycosides, and metronidazole were more frequently preferred. Enteric Gram-negatives and hepatitis B and C were more frequent in Turkey, while human immunodeficiency virus (HIV) and streptococci were more common in France (p < 0.05 for all significances). Various differences and similarities existed in France and Turkey in the ID wards. However, the current scene is that ID are managed with high standards in both countries.

Atherosclerosis, some serum inflammatory markers in psoriasis

AIM

Psoriasis is an autoimmune inflammatory disease which is associated with increased inflammatory markers and atherosclerosis. We wanted to investigate whether there is a relationship between some inflammatory markers and subclinical atherosclerosis markers.

METHODS

We studied 60 psoriasis patients and 50 healthy controls. Demographic, biochemical parameters, C3, C4, d-dimer, CRP, fibrinogen and YKL-40 (human cartilage glycoprotein-39) levels were measured. After measuring carotid intima-media thickness (cIMT) and aortic elasticity parameters such as aortic strain, (beta) stiffness index and compliance, statistical comparisons were done.

RESULTS

Patients with psoriasis had significantly higher diastolic blood pressure, CRP, fibrinogen, C3, uric acid levels, β-stiffness index, and cIMT values than the control group. cIMT was correlated with CRP, YKL-40 and psoriasis area and severity index (PASI) score (r=0.219, P=0.038; r=0.225, P=0.033 and r=0.275, P=0.034). Aortic strain (%), aortic compliance and aortic stiffness index were correlated with C3 (r=-0.349, r=-0.526 and r=0.235) and fibrinogen (r=-0.354, r=-0.275 and r=0.289), all P values <0.05, but not with PASI score. The presence of psoriasis was related to aortic strain (β±SE: -2.055±0.861, P=0.019) and β-stiffness index (β±SE: 2.934±1.143, P=0.012).

CONCLUSION

Serum C3, CRP, fibrinogen and YKL-40 levels are elevated as well as increased cIMT and impaired aortic elasticity in psoriasis. CRP, YKL-40 and PASI score are correlated with cIMT. Increased serum C3 and fibrinogen levels correlate negatively with aortic strain and aortic compliance, and correlate positively with the β-stiffness index.

Liver involvement in patients with brucellosis: results of the Marmara study

Brucellosis is a zoonotic disease that primarily affects the reticuloendothelial system. But, the extent of liver damage in due course of the disease is unclear. This study included 325 brucellosis patients with significant hepatobiliary involvement identified with microbiological analyses from 30 centers between 2000 and 2013. The patients with ≥5 times of the upper limit of normal for aminotransferases, total bilirubin level ≥2 mg/dl or local liver lesions were enrolled. Clinical hepatitis was detected in 284 patients (87.3 %) and cholestasis was detected in 215 (66.1 %) patients. Fatigue (91 %), fever (86 %), sweating (83 %), arthralgia (79 %), and lack of appetite (79 %) were the major symptoms. Laboratory tests showed anemia in 169 (52 %), thrombocytopenia in 117 (36 %), leukopenia in 81 (25 %), pancytopenia in 42 (13 %), and leukocytosis in 20 (6 %) patients. The most commonly used antibiotic combinations were doxycycline plus an aminoglycoside (n = 73), doxycycline plus rifampicin (n = 71), doxycycline plus rifampicin and an aminoglycoside (n = 27). The duration of ALT normalization differed significantly in three treatment groups (p < 0.001). The use of doxycycline and an aminoglycoside in clinical hepatitis showed better results compared to doxycycline and rifampicin or rifampicin, aminoglycoside, doxycycline regimens (p < 0.05). However, the length of hospital stay did not differ significantly between these three combinations (p > 0.05). During the follow-up, treatment failure occurred in four patients (1 %) and relapse was seen in three patients (0.9 %). Mortality was not observed. Hepatobiliary involvement in brucellosis has a benign course with suitable antibiotics and the use of doxycycline and an aminoglycoside regimen seems a better strategy in select patients.

Altered Mental Status in Emergency Department Patients with Cancer

Introduction

Although cancer patients with acute altered mental status (AMS) often present to the emergency department (ED), there is lack of documentation for survival in ED cancer patients with related causes of AMS (structural or metabolic causes). The aim of this study was to evaluate reasons for acute AMS of cancer patients in the ED and their prognostic value for survival.

Methods

Medical records of cancer patients presenting to ED with acute AMS were reviewed. Patients were divided into 3 groups with respect to AMS etiologies: metabolic causes (Group 1), structural causes (Group 2) and both (Group 3). Median survival time was calculated from the ED presentation and Kaplan-Meier survival curve was generated to demonstrate survival in the three groups.

Results

Forty-nine patients had only metabolic causes of AMS (Group 1), 21 of whom had more than one metabolic abnormality. Forty-six patients had only structural causes (Group 2) and 7 had both metabolic and structural causes (Group 3). Survival probability at one month was 33% for all patients, 25% for Group 1, 48% for Group 2 and 0% for Group 3 (p=0.11). In Group 1, 32% of patients with only one metabolic disorder and 14% of those with more than one metabolic disorder were alive at one month (p=0.197).

Conclusions

Regardless of aetiology, cancer patients presented with AMS to the ED usually have poor outcomes. Survival in our ED cancer patients with AMS is not related to the either structural or metabolic causes of AMS. (Hong Kong j.emerg.med. 2014;21:10-15)

Nanosecond thermo-optical dynamics of polymer loaded plasmonic waveguides

The thermo-optical dynamics of polymer loaded surface plasmon waveguide (PLSPPW) based devices photo-thermally excited in the nanosecond regime is investigated. We demonstrate thermo-absorption of PLSPPW modes mediated by the temperature-dependent ohmic losses of the metal and the thermally controlled field distribution of the plasmon mode within the metal. For a PLSPPW excited by sub-nanosecond long pulses, we find that the thermo-absorption process leads to modulation depths up to 50% and features an activation time around 2 ns whereas the relaxation time is around 800 ns, four-fold smaller than the cooling time of the metal film itself. Next, we observe the photo-thermal activation of PLSPPW racetrack shaped resonators at a time scale of 300 ns followed however by a long cooling time (18 μs) attributed to the poor heat diffusivity of the polymer. We conclude that nanosecond excitation combined to high thermal diffusivity materials opens the way to high speed thermo-optical plasmonic devices.

Photo-thermal modulation of surface plasmon polariton propagation at telecommunication wavelengths

We report on photo-thermal modulation of thin film surface plasmon polaritons (SPP) excited at telecom wavelengths and traveling at a gold/air interface. By operating a modulated continuous-wave or a Q-switched nanosecond pump laser, we investigate the photo-thermally induced modulation of SPP propagation mediated by the temperature-dependent ohmic losses in the gold film. We use a fiber-to-fiber characterization set-up to measure accurately the modulation depth of the SPP signal under photo-thermal excitation. On the basis of these measurements, we extract the thermo-plasmonic coefficient of the SPP mode defined as the temperature derivative of the SPP damping constant. Next, we introduce a figure of merit which is relevant to characterize the impact of temperature onto the properties of bounded or weakly leaky SPP modes supported by a given metal at a given wavelength. By combining our measurements with tabulated values of the temperature-dependent imaginary part of gold dielectric function, we compute the thermo-optical coefficients (TOC) of gold at telecom wavelengths. Finally, we investigate a pulsed photo-thermal excitation of the SPP in the nanosecond regime. The experimental SPP depth of modulation obtained in this situation are found to be in fair agreement with the modulation depths computed by using our values of gold TOC.

Selective ultrafast probing of transient hot chemisorbed and precursor states of CO on Ru(0001)

We have studied the femtosecond dynamics following optical laser excitation of CO adsorbed on a Ru surface by monitoring changes in the occupied and unoccupied electronic structure using ultrafast soft x-ray absorption and emission. We recently reported [M. Dell'Angela et al. Science 339, 1302 (2013)] a phonon-mediated transition into a weakly adsorbed precursor state occurring on a time scale of >2 ps prior to desorption. Here we focus on processes within the first picosecond after laser excitation and show that the metal-adsorbate coordination is initially increased due to hot-electron-driven vibrational excitations. This process is faster than, but occurs in parallel with, the transition into the precursor state. With resonant x-ray emission spectroscopy, we probe each of these states selectively and determine the respective transient populations depending on optical laser fluence. Ab initio molecular dynamics simulations of CO adsorbed on Ru(0001) were performed at 1500 and 3000 K providing insight into the desorption process.

Reduced total antioxidant status in postterm pregnancies

BACKGROUND

The placenta is the major source of oxidative stress in normal human pregnancy. The placental tissue is typically functional in postterm pregnancies. We hypothesized that such pregnancies experience deteriorating oxidative balance and increasing oxidative stress. In this case-control study, our aim was to investigate the oxidative status in postterm pregnancies comparing with term by using total antioxidant status (TAS) measurement.

METHODS

Fifty pregnant women who were in their 41st gestational week (GW) and whose labor had not yet started were selected for the study group. Fifty subjects whose spontaneous labor onset and who delivered before their 41st GW were included for control group. Venous blood samples were obtained from each participant before the onset of labor. A premixed reagent was used to obtain serum TAS measurements from the blood samples. The Mann-Whitney test was used to compare the groups.

RESULTS

Age, gravity, and parity of the subjects were similar between the groups (p> 0.05). Body mass index (BMI) were statistically higher in postterm group (p =0.011). The median (interquartile range) TAS level was lower in the pregnancies beyond 41 weeks than term pregnancies [1.69 (0.12) mM vs 1.75 (0.20) mM, (p< 0.05)].

CONCLUSIONS

A lower total antioxidant status in past days pregnancy suggests an association with decreased oxidative status compared to term. It can be speculated that pregnancies beyond 41 weeks are associated with decreased oxidative stress and this may be play a role in the etiology of the prolonged pregnancy.

Incisor trauma in a Turkish preschool population: prevalence and socio-economic risk factors

OBJECTIVE

This study aimed to assess the prevalence of traumatic injuries of the primary incisors in preschool children from 2 to 5 years old in South-Eastern Anatolia, Turkey. Additionally, the relationship between traumatic dental injuries, parents' education level, family income, size of incisal overjet and the presence of anterior open bite were examined.

BASIC RESEARCH DESIGN

A cross-sectional survey

CLINICAL SETTINGS

Data were collected through oral examinations and structured interviews, and included socio-economic indicators.

PARTICIPANTS

A total of 727 children of both genders were included in the study. 122 of these children were aged 2; 183 aged 3; 178 aged 4 and 186 aged 5.

RESULTS

The prevalence of dental injuries was 8.0% (n = 58). The highest frequency of trauma in the primary teeth was observed at the age of 4. Boys experienced more dental injuries than girls, 12.2% and 4.0%, respectively. The most common crown fracture was in enamel only (57%) followed by crown fracture of enamel and dentin (19%).

CONCLUSION

The prevalence of dental injuries in Turkish preschool children was very low. The children with incisal overjet greater than 5mm and anterior open bite experienced more dental injuries in primary teeth than their counterparts with normal occlusion. Socio-economic indicators were not statistically significantly associated with the occurrence of traumatic dental injuries.

Oxidation of Pt(111) under near-ambient conditions

The oxidation of Pt(111) at near-ambient O2 pressures has been followed in situ using x-ray photoelectron spectroscopy (XPS) and ex situ using x-ray absorption spectroscopy (XAS). Polarization-dependent XAS signatures at the O K edge reveal significant temperature- and pressure-dependent changes of the Pt-O interaction. Oxide growth commences via a PtO-like surface oxide that coexists with chemisorbed oxygen, while an ultrathin α-PtO2 trilayer is identified as the precursor to bulk oxidation. These results have important implications for understanding the chemical state of Pt in catalysis.

Molecular epidemiology and the clinical significance of Acinetobacter baumannii complex isolated from cerebrospinal fluid in neurosurgical intensive care unit patients

OBJECTIVE

This study was intended to investigate the clinical significance and molecular epidemiology of Acinetobacter baumannii complex (ABC) isolated from cerebrospinal fluid (CSF) in neurosurgical intensive care unit (NSICU) patients, particularly comparing isolates from healthcare workers' (HCW) hands.

METHODS

We retrospectively reviewed the medical records of 30 patients with CSF cultures positive for ABC seen at our NSICU from the date it first opened, January 2007, to September 2010. Pulsed-field gel electrophoresis (PFGE) typing was performed on 68 strains isolated from 32 patients' CSF and 36 HCWs' hands.

RESULTS

ABC isolates were considered to be clinically significant in 21 (70.0%) patients but insignificant in the other nine (30.0%) patients. The prolonged (>7 days) use of cephalosporins was more common in patients with clinically significant ABC isolates (p = 0.049). Multiple drug resistance (MDR) was observed in 12 (57.1%) clinically significant isolates. Empirical antimicrobial therapies were not appropriate for nine of these 21 patients (42.8%). Mortality was significantly higher in the clinically significant group than in the clinically insignificant group (18/21 vs. 3/9; p = 0.008). Fifty-three isolates (77.9%) were grouped into 15 clusters, three of which contained possibly related isolates from patients' CSF and staff members' hands.

CONCLUSIONS

The fact that ABC isolates grown from CSF cultures do not always exhibit infection and have high multiple antibiotic resistance, including to carbapenems, should be borne in mind when planning treatment for these patients. In addition, HCWs' hands may play a significant role in transmission to patients, and compliance with infection control procedures, especially hand washing, must be enhanced in order to avoid ABC infections.

Successful management of a high-risk pregnancy with polyhydramnios, IUGR and recurrent pregnancy loss in a chronic renal failure patient: a case report

Pregnancy in patients with chronic renal failure occurs rarely but the incidence is increasing. The successful management of a 38-year-old woman suffering from chronic renal failure is discussed.

Emergency contraception: knowledge, attitudes and practice of the pharmacy staff in Aydin, Turkey

OBJECTIVES

This study aimed to explore the knowledge, attitudes, and practices related to emergency contraception (EC) among pharmacy staff.

METHODS

This descriptive and cross-sectional survey was conducted among 143 pharmacy staff in Aydin city centre who agreed to participate. Data was collected thorough questionnaires that were filled in by face to face interviews between April and June 2007.

RESULTS

Remarkably most of the participants (n = 110) did not know the action mechanism of these pills. Forty-four participants reported that these drugs caused mostly hormonal side-effects. Only four participants knew all indications of EC pills. According to 72 participants, contraceptive pills should not be available without a prescription. The number of pharmacy staff who reported giving counseling to clients about family planning methods was low (n = 12).

CONCLUSIONS

The current study revealed that pharmacy staff in the region had inadequate knowledge on EC. Pharmacy staff may play a crucial role in women's access to EC, and there is a need for new interventions to improve and update their knowledge on, and to improve their attitudes toward EC methods.