Incidentally discovered cold hemagglutinins within autologous blood bag and cardioplegia line in a patient with a recent history of COVID-19 undergoing coronary artery surgery

INTRODUCTION

Cold agglutinin disease (CAD) is a rare autoimmune disorder characterized by destruction (hemolysis) of erythrocytes. In CAD, autoantibodies that cause agglutination at temperature of optimum +3-+4 ℃ degree cause symptoms. It is known that CAD often occurs after viral infections. Also, it has been reported in case reports that COVID-19 disease can cause CAD.

CASE REPORT

46-year-old male patient with a history of diabetes mellitus and hypertension presented to outpatient clinic in our department to have CABG surgery. He recovered from COVID-19 disease 1.5 months ago. Cardiopulmonary bypass was initiated and the cross-clamp was placed and antegrade Delnido cardioplegia solution was started to be given at +4 ℃. It was observed that the cardioplegia line was agglutinated. On the other hand, it was seen that the autologous blood taken by the anesthesiologist was also agglutinated and formed air bubbles and became unusable. X-clamp was removed and the heart rhythm recovered. The patient was consulted to hematology during postoperative intensive care follow-ups. The cold agglutinin test performed at of +4 ℃ was reported as positive. In this case, we associated the CAD with covid-19 for three main reasons. First one, the patient's complaints about CAD started after COVID-19 disease. Secondly, in the national health archive, the patient's pre-COVID-19 blood tests were completely normal but it was seen that LDH increased and RBC-HCT incompatibility started after COVID-19. As the third, when we search the literature, we have seen the COVID-19 related CAD in many case reports published by hematologists.

CONCLUSION

With the rare cold agglutinin disease, it seems that we will encounter it more often after the COVID-19 pandemic. Except for deep hypothermia, the most important problem is seen during cardioplegia administration. Therefore, non-blood cardioplegia can be lifesaving.

Long-term Results of Imatinib Discontinuation in Patients with Chronic-phase Chronic Myeloid Leukemia: A National Multicenter Prospective Study

Objective

The discovery of imatinib was a milestone for chronic myeloid leukemia (CML). As the life expectancy of CML patients has approached that of the general population, research has shifted towards improving quality of life and economic considerations. After 2010, it was shown that some patients could maintain molecular response even after discontinuing imatinib. This national multicenter prospective cohort study aimed to observe the long-term consequences of discontinuing imatinib therapy in adult chronic-phase CML patients.

Materials and Methods

We enrolled 41 CML patients from 4 different centers in this non-randomized single-arm trial. Molecular responses of all patients were re-evaluated using real-time polymerase chain reaction at a single center. The median follow-up time after imatinib discontinuation was 48 months (minimum-maximum: 6-81 months).

Results

The rate of molecular relapse-free survival at 48 months was 33.2% (confidence interval: 48.2-18.2). Twenty-seven of 41 patients lost their major molecular response, treatment was started again, and deep molecular response was re-achieved with imatinib in all cases. There was no significant relationship between molecular relapse and clinical factors such as duration of treatment or molecular response status. Discontinuing imatinib resulted in savings of approximately 4,392,000 Turkish lira or 245,150 US dollars.

Conclusion

Tyrosine kinase inhibitor discontinuation with close molecular monitoring is a safe option and provides important national economic benefits for chronic phase CML patients. This approach should be considered for all eligible patients. This is the first tyrosine kinase inhibitor discontinuation study from Türkiye.

Long-term Results of Imatinib Discontinuation in Patients with Chronic Phase Chronic Myeloid Leukemia: National Multicenter Prospective Study

The discovery of imatinib is a milestone for chronic myeloid leukemia (CML) (1). As life expectancy in CML patients has approached that of the general population (2), research has shifted towards improving quality of life and economic considerations. After 2010, it has been shown that some patients could maintain molecular response even after discontinuing imatinib (3). This national multicenter prospective cohort study aimed to observe the long-term consequences of discontinuing imatinib therapy in adult chronic phase CML patients. A total of 41 patients were included. The median follow-up time after imatinib discontinuation was 48 months (minimum-maximum 6-81 months). The rate of molecular relapse-free survival (MRFS) at 48 months was 33,2% (CI:48.2-18.2). Twenty-seven of 41 patients lost their major molecular response MMR, treatment was started again, and the molecular response was re-achieved with imatinib in all patients. There was no significant relationship between molecular relapse and clinical factors like duration of treatment or molecular response status. Discontinuing imatinib resulted in approximately 4,392,000 Turkish Liras (TRY) or 245,150 US dollars (USD) in savings. In conclusion, imatinib discontinuation with close molecular monitoring is a safe option and provides important national economic benefits and enhanced quality of life. This approach should be considered for all eligible patients. This is the first tyrosine kinase inhibitor discontinuation study from Turkey.

Comparison of different intravenous iron preparations in terms of total oxidant and total antioxidant status, single center data

Iron deficiency anemia is the most common and preventable cause of anemia. Oral and parenteral iron preparations can be used for treatment. There are some concerns about the effect on oxidative stress of parenteral preparations. In this study, we aimed to investigate the effect of ferric carboxymaltose and iron sucrose on short- and long-term oxidant-antioxidant status. The study was designed as a prospective, single-center, observational study. Patients diagnosed with iron deficiency anemia and receiving intravenous iron therapy were included. Patients were divided into 3 groups as those receiving 1000 mg iron sucrose, 1000 mg ferric carboxymaltose, and 1500 mg ferric carboxymaltose. Blood samples were collected for blood tests before treatment, at the 1st hour of the first infusion, and at the 1st month of follow-up. The total oxidant and total antioxidant status were analyzed to evaluate oxidative stress and antioxidant status. Fifty-eight patients are included. Nineteen patients received iron sucrose 1000 mg (G1), 21 patients received ferric carboxymaltose 1000 mg (G2), and 18 patients received ferric carboxymaltose 1500 mg (G3). First hour total antioxidant status was higher in the iron sucrose group than in the ferric carboxymaltose group [G1 and G2 (p = 0.027), G1 and G3 (p = 0.004)]. At the 1st hour, total oxidant status was higher in iron sucrose group than in ferric carboxymaltose group [G1 and G2 (p = 0.016), G1 and G3 (p = 0.011)]. There was no difference in total oxidant and antioxidant stress between the three treatment groups at the 1st month evaluation [p: 0.19 and p: 0.12]. Total oxidant and antioxidant status in iron sucrose and ferric carboxymaltose formulations were found to be higher in the iron sucrose group in the acute period at the 1st hour after infusion. There was no significant difference between antioxidant and oxidant total status in all three treatment groups at the 1st month of long-term control. The fact that total oxidant status was lower in the ferric carboxymaltose group containing high-dose treatment compared to iron sucrose according to the 1st hour change showed that high-dose iron did not significantly affect oxidant stress in the short term. In addition, long-term oxidant stress evaluation at the 1st month did not show any difference between iron preparations. In conclusion, it has been shown that high-dose intravenous iron therapy, which is easier to use in clinical practice, has no effect on the oxidant-antioxidant system.

A Giant Mass in the Eyelid: Peripheral T-Cell Lymphoma, Not Otherwise Specified

Purpose

To report a case with an unusual giant mass in the eyelid which was diagnosed as peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS).

Methods

A 40-year-old woman was referred with a 1-year history of rapidly and constantly growing eyelid mass.

Results

The patient underwent an incisional biopsy and histopathological examination revealed a PTCL-NOS. After achieving regression by the combination of cyclophosphamide, hydroxydoxorubicin, vincristine (oncovin), etoposide, and prednisolone therapy, the remaining crusts were debrided, the eyelids were separated, and the wound was left to heal by secondary intention. Cicatricial ectropion of the lower eyelid occurred during follow-up and it was corrected with a free skin graft successfully.

Conclusion

PTCL-NOS is uncommon but it may reach massive dimensions in the eyelid region.

Comparison of daily oral iron replacement therapy with every other day treatment in female reproductive age patients with iron-deficiency anemia

Iron-deficiency anemia (IDA) is accepted as the most common cause of anemia in the world. The main goals of iron replacement therapy are to normalize the hemoglobin level and to replace iron stores. Current guidelines for treating iron deficiency recommend daily divided doses of iron to increase absorption. Hepcidin is a key regulator of systemic iron balance and acts in harmony with intracellular iron metabolism. Daily dosing and divided doses may increase serum hepcidin and decrease iron absorption. In this study, it was aimed to compare the effectiveness of daily and every other day oral iron replacement therapy in women of reproductive age with iron-deficiency anemia. We included premenopausal female patients aged between 18 and 50 years with iron-deficiency anemia. Forty patients were given oral iron therapy at a daily dose of 2*80 mg (iron sulfate). Forty-three patients were given iron treatment at a dose of 2*80 mg (iron sulfate) every other day. After 2 months of oral iron therapy, there was a significant improvement in hemoglobin, mean corpuscular volume, serum iron, total iron-binding capacity, and transferrin saturation in both groups. The values of hemoglobin, serum iron, transferrin saturation, and ferritin significantly increased at the end of the treatment for both groups. Although the median hepcidin level on the 15th-day measurement in the every other day treatment group was higher than that in the daily treatment group, there was no significant difference. As a result, the patients' compliance with the treatment can be increased by offering treatment every other day instead of daily, since it provides similar treatment effectiveness.

The effect of urgent blood pressure lowering on left atrial mechanics in patients with hypertensive episode in emergency setting

Funding Acknowledgements

Type of funding sources: None.

Background

Left atrial (LA) dilatation and dysfunction are early manifestation of hypertension and represent end-organ damage. Hypertension is a well-known risk factor for atrial fibrillation. Long term effect of hypertension on the left ventricle and left atrium was well-studied before. In this study, we aimed to investigate the acute effect of urgent blood pressure reduction on the left atrial strain.

Methods

We prospectively enrolled 52 consecutive patients (age: 67.5 ± 8.9 years, 48.1% male) (Fig1) admitted to our emergency department with a hypertensive attack. All patients underwent baseline standard echocardiographic evaluation. 2D images from apical 4-chamber view were recorded for offline analysis. Reservoir (PALS) and contractile (PACS) left atrial strain measurements were performed by automated software using the onset of QRS as a reference point. Patients with systolic dysfunction, acute coronary syndrome and any rhythym other than sinus or with poor echogeneicity were excluded. All measurements were repeated after achieving target blood pressure reduction and analyzed.

Results

Urgent blood pressure reduction result in improvement in LA contractile strain (PACS) and LVEF and increase in heart rate and RV systolic function while LV dimensions, LA volumes and LAVI were decreased. There is a statistically significant negative moderate relationship between absolute change of DBP and absolute change of PALS (r=-0.423; p = 0.002). There is a statistically significant negative and weak correlation between the absolute change in SBP and the absolute change in PACS (r=-0.280; p = 0.044).

Conclusion

Assessment of LA strain by 2D speckle tracking echocardiography is easy to apply and noninasive method to quantify LA function even in emergency setting. This study showed that LA contractile strain (PACS) rather than LA reservoir strain (PALS) was significantly affected from LV end diastolic pressure. Abstract Figure 1  Abstract Figure 2

The effects of plasma viscosity in thromboembolic events among patients with essential thrombocytosis: A case-control study

INTRODUCTION

Essential thrombocythemia (ET) is an entity of classic Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs), characterized by thrombocytosis with megakaryocytic hyperplasia where in the thrombocytes are increased with abnormal function.Thrombotic events are seen frequently and represent the main cause of morbidity and mortalityin patients with MPNs, mainly polycythemia vera and ET. This study has aimed to research the effects of clonally increased thrombocytes on plasma viscosity (PV) levels among patients with ET and the relationship between PV and thromboembolism history, according to the hypotheses about the effects of PV in thromboembolic events among patients with ET.

METHODS

A total of 55 patients were enrolled in the study group, 18 of who had been newly diagnosed with ET according to 2016 World Health Organization criteria and had not previously been treated. 37 of them had already been diagnosed with ET and had been treated. There were 47 healthy volunteers in the control group. 5 cc blood samples were taken from the patients into tubes including an anticoagulant to measure their PV levels.

RESULTS

PV of the control group was found to be lower than in the study group and both each patient groups (p <  0.05). No relationship was found between the patient groups in terms of PV (p = 0.404). The mean PV levels of the 16 patients with a history of thromboembolism and the 39 patients with no such history were 2.42±0.17 cP and 2.33±0.20 cP, respectively. The mean PV levels were found to be similar according to their history of thromboembolism in all patient groups and in treated patients (p = 0.572 vs p = 0.991).

CONCLUSION

We have found that PV levels were increased in clonally increased thrombocytes in patients with ET when compared with the control group. This is the first study in this field according to our knowledge.

Clinical Characteristics and Outcome of COVID-19 in Turkish Hematological Malignancy Patients

Objective:

Patients with solid malignancies are more vulnerable to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection than the healthy population. The outcome of SARS-CoV-2 infection in highly immunosuppressed populations, such as in patients with hematological malignancies, is a point of interest. We aimed to analyze the symptoms, complications, intensive care unit admissions, and mortality rates of patients with hematological malignancies infected with SARS-CoV-2 in Turkey.

Materials and Methods:

In this multicenter study, we included 340 adult and pediatric patients diagnosed with SARS-CoV-2 from March to November 2020. Diagnosis and status of primary disease, treatment schedules for hematological malignancies, time from last treatment, life expectancy related to the hematological disease, and comorbidities were recorded, together with data regarding symptoms, treatment, and outcome of SARS-CoV-2 infection.

Results:

Forty four patients were asymptomatic at diagnosis of SARS-CoV- 2 infection. Among symptomatic patients, fever, cough, and dyspnea were observed in 62.6%, 48.8%, and 41.8%, respectively. Sixty-nine (20%) patients had mild SARS-CoV-2 disease, whereas moderate, severe, and critical disease was reported in 101 (29%), 71 (20%), and 55 (16%) patients, respectively. Of the entire cohort, 251 (73.8%) patients were hospitalized for SARS-CoV-2. Mortality related to SARS-CoV-2 infection was 26.5% in the entire cohort; this comprised 4.4% of those patients with mild disease, 12.4% of those with moderate disease, and 83% of those with severe or critical disease. Active hematological disease, lower life expectancy related to primary hematological disease, neutropenia at diagnosis of SARS-CoV-2, ICU admission, and first-line therapy used for coronavirus disease-2019 treatment were found to be related to higher mortality rates. Treatments with hydroxychloroquine alone or in combination with azithromycin were associated with a higher rate of mortality in comparison to favipiravir use.

Conclusion:

Patients with hematological malignancy infected with SARS-CoV-2 have an increased risk of severe disease and mortality.

Infections in hematopoietic stem cell transplant patients admitted to Hematology intensive care unit: a single-center study

OBJECTIVE

The aim of this study was to investigate the data of HSCT patients who were admitted to our Hematology ICU due to infections or infectious complications.

MATERIALS AND METHODS

HSCT patients who were admitted to our Hematology ICU between 01 January 2014 and 01 September 2017 were analyzed retrospectively.

RESULTS

62 HSCT patients were included in this study. The median age was 55.5 years and 58% of the patients were allogeneic HSCT patients. Major underlying hematologic disorders were multiple myeloma (29%) and lymphoma (27.4%). The most common reasons for ICU admission were sepsis/septic shock (61.3%) and acute respiratory failure (54.8%). Overall ICU mortality rate was 45.2%. However, a lot of factors were related with ICU mortality of HSCT patients in univariate analysis, only APACHE II score was found to be an independent risk factor for ICU mortality. While there was infection in 58 patients at ICU admission, new infections developed in 38 patients during ICU stay. The most common new infection was pneumonia/VAP, while the most frequently isolated bacteria were Acinetobacter baumannii. Length of ICU stay, sepsis/septic shock as a reason for ICU admission and the presence of urinary catheter at ICU admission were determined factors for ICU-acquired infections. There was no difference between autologous and allogeneic stem cell transplant patients in terms of ICU morbidities and mortality. However, pneumonia/VAP developed in the ICU was higher in autologous HSCT patients, while bloodstream/catheter-related bloodstream infection was higher in allogeneic HSCT patients.

CONCLUSION

It was concluded that early or late post-HSCT infections and related complications (sepsis, organ failure, etc.) constituted a major part of the reasons for ICU admission, ICU mortality and ICU morbidities.

Comparison of post-remission strategies in acute myeloid leukemia: Autologous hematopoietic stem cell transplantation versus consolidation chemotherapy

Autologous Hematopoietic Stem Cell Transplantation (auto-HSCT) has become a therapeutic option for first-line consolidation in Acute Myeloid Leukemia (AML) patients with favorable and intermediate risk features. A total of 101 AML patients in first complete remission, who were not eligible for allogeneic HSCT, were randomized to receive intensive cytarabine-based chemotherapy or to undergo auto-HSCT. The probability of LFS was significantly better in auto-HSCT recipients compared to chemotherapy arm (43% vs 4.8%, p=0.008). At the end of 915 (30-4470) days of followup, the probability of overall survival was better in auto-HSCT group compared to chemotherapy, without statistical significance (79.2% vs 38.8%, p=0.054). Multivariate analysis revealed a significant predictive impact of cytogenetic risk status on OS (p=0.002, HR: 2.824, 95% CI: 1.445-5.521). Auto-HSCT is considered as an effective consolidation approach in favorable and intermadiate risk AML patients.

The Impact of Pre-transplant Cell-free DNA Levels on Leukemia Relapse and Transplant-related Complications in Allogeneic Hematopoietic Stem Cell Transplant Recipients

Background:

Cell-free DNA, which may be considered as “liquid” biopsy, may serve as a diagnostic and prognostic marker not only in hematological malignancies but in solid tumors as well.

Aims:

To investigate the prognostic role of pre-transplant cell-free DNA levels in allogeneic hematopoietic stem cell transplant recipients.

Study Design:

Retrospective cohort study.

Methods:

A total of 177 allogeneic hematopoietic stem cell transplant recipients [median age: 36 (16-66) years; male/female: 111/66] with an initial diagnosis of acute leukemia were included in the study. Cell-free DNA was extracted from pre-transplant serum samples by using the MagNA Pure Compact Nucleic Acid Isolation Kit I with the MagNA Pure Compact instrument (Roche Diagnostics, Penzberg, Germany).

Results:

A positive correlation was demonstrated between cell-free DNA and age (p=0.018; r=0.177). Pre-transplant cell-free DNA levels were lower in bcr-abl (+) patients (p=0.001), while an adverse correlation was indicated between cell-free DNA and bcr-abl levels (p=0.001; r=−0.531). Acute lymphoblastic leukemia patients with bcr-abl positivity (p=0.001) or abnormal cytogenetics (p=0.038) represented significantly lower pre-transplant cell-free DNA levels. Cell-free DNA levels were lower in patients who developed sinusoidal obstruction syndrome (p=0.035). In terms of long-term complications, acute myeloid leukemia patients who experienced post-transplant relapse had significantly lower pre-transplant cell-free DNA levels (p=0.024). Overall survival was not statistically different between high- and low- cell-free DNA groups (45.2% vs 22.5; p=0.821).

Conclusion:

In general, low serum levels of pre-transplant cell-free DNA seem to be associated with transplant-related morbidities and may be considered an adverse prognostic factor for allogeneic hematopoietic stem cell transplant recipients.

Pre-transplant sTIM-3 levels may have a predictive impact on transplant outcome in acute leukemia patients

Objectives: T-cell immunoglobulin and mucin domain-containing protein-3 (TIM-3) is considered as a negative regulator of T-cell driven immune response. This study is planned to investigate the prognostic role of pre-transplant soluble TIM-3 (sTIM-3) levels in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. Methods: Pre-transplant serum sTIM-3 levels were measured in 177 allo-HSCT recipients [median age: 36(16-66) years; male/female: 111/66]. Results: Pre-transplant sTIM-3 levels were significantly higher in acute myeloid leukemia (AML) patients compared to acute lymphoblastic leukemia (ALL) patients (p = 0.01). Pre-transplant sTIM-3 levels were significantly lower in patients with abnormal cytogenetics (p = 0.017). Pre-transplant sTIM-3 levels were significantly higher in patients who developed viral hemorrhagic cystitis (p = 0.034). A positive correlation was demonstrated between sTIM-3 levels and acute graft versus host disease (GvHD) grade (p = 0.013; r = 0.299). Overall survival (OS) was not statistically different between low- and high-TIM-3 groups (%35.2 vs %20.4; p > 0.05). Primary diagnosis (p = 0.042), sinusoidal obstruction syndrome (p < 0.001), acute GvHD (p = 0.001), chronic GvHD (p = 0.009) and post-transplant relapse (p = 0.003) represented significant impact on OS. Discussion: Increased sTIM-3 levels in AML patients seem to be compatible with the previous reports. The inhibitor role of TIM-3 in cellular immune response may be a possible explanation for the association of sTIM-3 with viral infections and GvHD. However, the main challenge remains to be the ambiguous association of pre-transplant sTIM-3 levels and post-transplant complications, as allo-HSCT recipients are expected to represent donor genetic features in the post-transplant setting. Conclusion: Further studies are warranted to clarify the particular role of sTIM-3 in the allo-HSCT setting.

Broad spectrum antibacterial photodynamic and photothermal therapy achieved with indocyanine green loaded SPIONs under near infrared irradiation

Antimicrobial photodynamic therapy (aPDT) and antimicrobial photothermal therapy (aPTT) are promising local and effective alternative therapies for antibiotic resistant bacterial infections and biofilms.

Different patterns of hepatocellular carcinoma-related malign thrombosis in 18F-FDG PET/CT

Tumor thrombus is an intravascular malign tumor extension that may occur in various types of cancer. Hepatocellular carcinomas (HCC) are common causes of malign thrombus. The presence of a malign thrombus due to HCC has a dismal prognosis, which affects treatment choices. We present three cases of tumor thrombi due to advanced HCC detected by ¹⁸F-FDG PET/CT.

The Role of AcrAB-TolC Efflux Pumps on Quinolone Resistance of E. coli ST131

Escherichia coli ST131 is a cause for global concern because of its high multidrug resistance and several virulence factors. In this study, the contribution of acrAB-TolC efflux system of E. coli ST131 to fluoroquinolone resistance was evaluated. A total of nonrepetitive 111 ciprofloxacin-resistant E. coli isolates were included in the study. Multilocus sequence typing was used for genotyping. Expressions of acrA, acrB, and TolC efflux pump genes were measured by RT-PCR. Mutations in marA, gyrA, parC, and aac(6')-lb-cr positivity were studied by Sanger sequencing. Sixty-four (57.7%) of the isolates were classified as ST131, and 52 (81.3%) of the ST131 isolates belonged to H30-Rx subclone. In ST131, CTX-M 15 positivity (73%) and aac(6')-lb-cr carriage (75%) were significantly higher than those in non-ST131 (12.8% and 51%, respectively) (P < 0.05). The ampicillin-sulbactam (83%) resistance was higher, and gentamicin resistance (20%) was lower in ST131 than that in non-ST131 (64% and 55%, respectively) (P = 0.001 and P = 0.0002). Numbers of the isolates with MDR or XDR profiles did not differ in both groups. Multiple in-dels (up to 16) were recorded in all quinolone-resistant isolates. However, marA gene was more overexpressed in ST131 compared to that in non-ST131 (median 5.98 vs. 3.99; P = 0.0007). Belonging to H30-Rx subclone, isolation site, ciprofloxacin MIC values did not correlate with efflux pump expressions. In conclusion, the marA regulatory gene of AcrAB-TolC efflux pump system has a significant impact on quinolone resistance and progression to MDR profile in ST131 clone. Efflux pump inhibitors might be alternative drugs for the treatment of infections caused by E. coli ST131 if used synergistically in combination with antibiotics.

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.

Study of the remarkable reactivity of HNCO/urea with NO2 in the NOx SCR by urea process over an oxide-based catalyst

An exceptional reactivity between NO₂ and the reductant species was demonstrated during NO₂-SCR experiments with urea, when only NO₂ was used as NO_x.

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.

Primary extranodal non-Hodgkin's lymphoma presenting as painful gingival swelling

Primary extra-nodal non-Hodgkin's lymphomas (NHL) constitute 25-40% of NHL but less than 1% arises in oral cavity. Here in 53-year-old man with stage IE gingival diffuse large B cell lymphoma who was treated successfully with chemotherapy and radiotherapy was presented.

Glucose oxidase-polypyrrole electrodes synthesized in p-toluenesulfonic acid and sodium p-toluenesulfonate

Amperometric glucose biosensors have been developed based on entrapment on platinum (Pt) electrode using cyclic voltammetry technique in glucose oxidase (GOD) and pyrrole containing p-toluenesulfonic acid (pTSA) or sodium p-toluenesulfonate (NapTS) as supporting electrolyte solutions. Both of electrolyte solutions were suitable media for the formation and deposition of polypyrrole-GOD (PPy-GOD) layers on Pt substrate. Pt/PPy-GOD electrodes brought about in different morphological properties as well as different electrochemical and biochemical response. The highest responses obtained in pTSA and NapTS electrolytes were observed at pH of 4.5 and 7.0 for Pt/PPy-GOD electrodes, respectively. While linearity was observed between 0.0-1.0 mM glucose substrate for both electrodes, I(max) value of Pt/PPy-GOD(NapTS) electrode was approximately twice as high as that of Pt/PPy-GOD(pTSA) electrode as 25.4 and 14.2 microA, respectively. Five commercial drinks were tested with enzyme electrodes and compared with results obtained spectrophotometrically using glucose kit. Results revealed that Pt/PPy-GOD(NapTS) electrode exhibited better biosensor response.

Determining in vitro synergistic activities of tigecycline with several other antibiotics against Brucella melitensis using checkerboard and time-kill assays

Antimicrobial therapy of Brucella spp. infection is difficult because there are relatively few effective treatment regimens, and single-agent therapy has generally been considered inadequate due to unacceptably high relapse rates. tigecycline, the first in a new class of antimicrobials, the glycylcyclines, is a 9-t-butylglycylamido derivate of minocycline. in this study, the in vitro activity of tigecycline in combination with gentamicin, streptomycin, rifampin, co-trimoxazole, levofloxacin, and minocycline was investigated using the checkerboard method to evaluate 16 Brucella melitensis isolates. The time-kill method was used to determine the bactericidal activities of combinations of tigecycline with rifampin, gentamicin, and levofloxacin, which were found (via the checkerboard method) to have a synergistic effect in combinations with tigecycline. Using the checkerboard method, combinations of rifampin, gentamicin, and levofloxacin with tigecycline showed synergistic effects against 5 (31.2%), 3 (18.9%), and 8 (50%) of the isolates. No synergy was observed with tigecycline in combination with minocycline, streptomycin, or co-trimoxazole. tigecycline with gentamicin achieved the earliest complete killing at 4x miC (in 6 h), while complete killing with the other combinations was delayed up to 24 h. the time-kill method showed that the combination of tigecycline and levofloxacin had an antagonistic effect, while the checkerboard method detected synergy and no interaction effects. these data suggest that a combination regimen of tigecycline with gentamicin and rifampin may be a good choice for treating brucellosis.

In vitro antifungal susceptibility patterns of dermatophyte strains causing tinea unguium

BACKGROUND

Dermatophytes are the major responsible organisms in onychomycosis. Although recent antifungal agents have high success rates in treating this condition, lack of clinical response may occur in 20%. Antifungal drug resistance may be one of the causes of treatment failure. The need for in vitro antifungal drug resistance in daily practice is still under discussion.

OBJECTIVE

We aimed to determine the in vitro susceptibility patterns of dermatophytes causing onychomycosis, against the traditionally available systemic antifungal agents terbinafine, itraconazole and fluconazole.

METHODS

In total, 100 otherwise healthy patients with suspected onychomycosis were included. Nail clippings were cultured on Sabouraud dexrose agar, mycobiotic agar and dermatophyte test medium. Antifungal susceptibility tests were carried out, mainly following The National Committee for Clinical and Laboratory Standards (M38-P) protocol standard for filamentous fungi. Different concentrations of terbinafine (0.008-8 microg/mL), itraconazole (0.015-16 microg/mL) and fluconazole (0.06-64 microg/mL) were tested. Minimum inhibitory concentration end-point determination was chosen as 100% growth inhibition for terbinafine and 80% for azoles.

RESULTS

Of the 100 nail samples, 43% grew dermatophytes. The main causative organism was Trichophyton rubrum (91%) followed by Trichophyton mentagrophytes (9%). Terbinafine had the lowest minimum inhibitory concentration (0.008 microg/mL) followed by itraconazole. Fluconazole showed the greatest variation in minimum inhibitory concentration (0.03-2 microg/mL) and had different susceptibility patterns for the two species.

CONCLUSIONS

Of the three antifungals tested, terbinafine had the most potent in vitro antifungal activity against dermatophytes. Antifungal susceptibility tests would be useful to screen antifungal-resistant dermatophyte strains.

Apoptosis and proliferation in gastric epithelium due to Helicobacter pylori: an immunohistochemical and ultrastructural study

The effect of H. pylori infection on gastric epithelial cell apoptosis and proliferation is contradictory. Using immunohistochemistry and electron microscopy, this study sought to demonstrate gastric epithelial changes (ie, apoptosis and proliferation) due to chronic H. pylori infection.

METHODS

Eighteen female 6- to 8-week old Swiss Albino mice were inoculated intragastrically with 3 doses of 10(9) CFU/mL H. pylori prepared in a Brucella Broth in 5 days. Nine others served as a control group. At the end of 28 weeks, tissue specimens from the gastric antrum were excised and examined immunohistochemically (epithelial growth factor for regeneration and Caspase-3 for apoptosis) and electron microscopically. Immunohistochemical assessment was performed using the indirect peroxidase-antiperoxidase method.

RESULTS

In the H. pylori-infected group, EGF staining in gastric epithelium was found to be decreased significantly compared to that in control group (P < 0.001). Caspase-3 reactivity was commonly observed in surface epithelial cells and glandular epithelial cells in H. pylori-infected group and totally it was statistically significant compared to Caspase-3 staining in control group (P < 0.001). Electron micrograph images demonstrated numerous apoptotic cells with condensed chromatin.

CONCLUSION

Chronic H. pylori infection of 28 weeks' duration increases apoptosis in gastric epithelium; however, increased apoptosis does not induce proliferation.

Control of Yellowmargined Leaf Beetle on Turnip, 1995

Insecticide treatments were applied at labeled rates on 11 May and 18 May at the Burden Research Plantation, Baton Rouge, LA, 1995 on turnip. A CO2 powered backpack sprayer calibrated to deliver 40 gallons per acre at 30 psi through a spray boom with three nozzles was used. Experimental plots consisted of single rows (30 ft long, 4 ft wide) arranged in a RCB design with 4 replications. Insect counts were made with beat sheets (3 X 2) on 10 and 17 May (pre-treatment counts) and 12 and 19 May (post-treatment counts). Three samples were taken from each plot and the number of insects present of each species was recorded.