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In the current study, the protective effect of a mistletoe extract (Helixor®, HLX) on Itraconazole (ITZ)-induced hepatocellular injury and acute oxidative stress in rats was aimed to be investigated by histological, biochemical and comet assay methods. Four groups a control group, an HLX group (5mg/kg/14days/intraperitoneally (ip)), an ITZ group (100mg/kg/14days/oral) and an HLX plus ITZ group (5mg/kg/14days/ip+100mg/kg/14days/oral) were all created from 32 female Wistar albino rats. At the end of the experiment, AST and ALT liver enzymes, total oxidant status (TOS) levels and total antioxidant status (TAS) levels, histopathological analysis and comet assay were carried out. Highest genotoxicity, higher levels of plasma AST and ALT, higher TOS, more degeneration of liver histopathology including hepatocyte degeneration, hepatocyte apoptosis and necrosis, portal/periportal inflammation, bile ductus hyperplasia and multinuclear giant cell formation were observed in ITZ group (p<0.05). As opposed to that, administration of HLX plus ITZ improved histopathological changes and DNA damage and showed a dramatic decrease in AST, ALT and TOS levels (p<0.05) and an increase in TAS level (p<0.001) when compared to ITZ group. This study showed that the antioxidant properties of HLX administration significantly decreased acute oxidative stress and hepatocellular damage in rats given ITZ.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Muérdago , Viscum album , Femenino , Animales , Ratas , Antioxidantes/farmacología , Antioxidantes/metabolismo , Itraconazol/farmacología , Viscum album/metabolismo , Carcinoma Hepatocelular/metabolismo , Ratas Wistar , Neoplasias Hepáticas/patología , Estrés Oxidativo , Hígado , Oxidantes/farmacología , Extractos Vegetales/farmacología , Extractos Vegetales/metabolismoRESUMEN
BACKGROUND: The aim of this study was to assess health-related quality of life (HRQOL) among chronic hepatitis B (CHB) patients in Turkey and to study related factors. METHODS: This multicenter study was carried out between January 01 and April 15, 2015 in Turkey in 57 centers. Adults were enrolled and studied in three groups. Group 1: Inactive HBsAg carriers, Group 2: CHB patients receiving antiviral therapy, Group 3: CHB patients who were neither receiving antiviral therapy nor were inactive HBsAg carriers. Study data was collected by face-to-face interviews using a standardized questionnaire, Short Form-36 (SF-36) and Hepatitis B Quality of Life (HBQOL). Values equivalent to p < 0.05 in analyses were accepted as statistically significant. RESULTS: Four thousand two hundred fifty-seven patients with CHB were included in the study. Two thousand five hundred fifty-nine (60.1 %) of the patients were males. Groups 1, 2 and 3, consisted of 1529 (35.9 %), 1721 (40.4 %) and 1007 (23.7 %) patients, respectively. The highest value of HRQOL was found in inactive HBsAg carriers. We found that total HBQOL score increased when antiviral treatment was used. However, HRQOL of CHB patients varied according to their socio-demographic properties. Regarding total HBQOL score, a higher significant level of HRQOL was determined in inactive HBV patients when matched controls with the associated factors were provided. CONCLUSIONS: The HRQOL score of CHB patients was higher than expected and it can be worsen when the disease becomes active. Use of an antiviral therapy can contribute to increasing HRQOL of patients.
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Hepatitis B Crónica , Calidad de Vida , Adulto , Anciano , Antivirales/uso terapéutico , Estudios Transversales , Femenino , Indicadores de Salud , Hepatitis B Crónica/tratamiento farmacológico , Hepatitis B Crónica/psicología , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Estudios Prospectivos , TurquíaRESUMEN
BACKGROUND: The role of echocardiography in adult patients with community-acquired pneumonia (CAP) has not been tested in a clinical trial. The aim of the study was to assess the cardiac changes secondary to CAP by echocardiography and to find out the correlation between echocardiographic findings and the severity of CAP. METHODS: A total of 111 unselected consecutive adult patients hospitalized with CAP were enrolled. The control group consisted of 100 consecutive sex- and age-matched patients. The severity of CAP was evaluated with the pneumonia severity index and the CURB-65 (confusion, urea, respiratory rate, arterial blood pressure and age) score. Blood samples were taken and echocardiography was performed within the first 48 hours. RESULTS: White blood count, N-terminal pro-brain natriuretic peptide, and red blood cell distribution width were significantly higher in the CAP group compared with the control group. The 2 groups did not differ in terms of left and right ventricle ejection fraction, left atrial diameter, pulmonary artery systolic pressure, and left ventricular end-diastolic and end-systolic diameter. However, tricuspid annular plane systolic excursion (21.1 ± 4.3 vs 22.3 ± 4.1 mm; P = .04), aortic distensibility (2.5 ± 0.9 vs 3.5 ± 0.9 cm(2):dyne:10, P < .001), and aortic strain (5.8% ± 2% vs 6.5% ± 1.9%, P = .009) were significantly reduced in CAP group than in controls. The plasma concentration of N-terminal pro-brain natriuretic peptide correlated with aortic strain, aortic distensibility, tricuspid annular plane systolic excursion, pneumonia severity index score, and CURB-65 score. CONCLUSIONS: Tricuspid annular plane systolic excursion and elastic properties of aorta may play a role in the diagnosis and clinical assessment of CAP severity, which could potentially guide the development of new prognostic models.
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Aorta/fisiopatología , Ecocardiografía Doppler en Color , Neumonía/diagnóstico por imagen , Función Ventricular Derecha/fisiología , Adulto , Anciano , Biomarcadores/sangre , Estudios de Casos y Controles , Infecciones Comunitarias Adquiridas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Neumonía/sangre , Neumonía/fisiopatología , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Troponina I/sangreRESUMEN
BACKGROUND: The aim of this study is to evaluate in-house antibiotic use in a state hospital in Turkey with its cost, using the ATC/DDD index, which is an accepted standard method. METHODS: This study was performed as a point prevalence study in a state hospital with 372 beds. All in-house patients using antibiotics on July 19, 2011 were included in the study. Indications for antibiotic use and information about the patients were recorded on special forms. Antibiotic use and cost analysis were evaluated using the ATC/DDD index, which is also suggested by the WHO to be used in similar studies. FINDINGS: 147 patients out of 308 patients who were in-house were identified to use antibiotics with appropriate indications for prophylaxis or treatment in 61% of the patients. The rate of appropriate antibiotic use was identified to be in 78%, while this rate was 38.9% in surgical clinics. The daily cost of the antibiotics consumed on the date of the study was calculated as 4104.79 TL (=2476.80 USD). DISCUSSION: The rate of inappropriate use of antibiotics seems to be high in our hospital. This will result in both increased costs and also increased nosocomial infection rates with resistant species. Infectious disease specialists should take more active roles in the in-house antibiotic use, hospitals should prepare and implement their own principles of antibiotic use, and microbiology laboratories should be used more effectively. These measures would decrease the conspicuous shortcomings in the antibiotic use.
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Antibacterianos/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Revisión de la Utilización de Medicamentos/métodos , Antibacterianos/economía , Femenino , Hospitales Generales , Humanos , Prescripción Inadecuada/efectos adversos , Prescripción Inadecuada/economía , Masculino , Pautas de la Práctica en Medicina , Mal Uso de Medicamentos de Venta con Receta/efectos adversos , Mal Uso de Medicamentos de Venta con Receta/economía , Turquía , Organización Mundial de la SaludRESUMEN
This multi-centre study aimed to determine the antibiotic consumption in Turkish hospitals by point prevalence. Antibiotic consumption of 14 centres was determined using the DDD method. Among hospitalized patients, 44.8% were using antibiotics and the total antibiotic consumption was 674.5 DDD/1000 patient-days (DPD). 189.6 (28%) DPD of the antibiotic consumption was restricted while 484.9 (72%) DPD was unrestricted. Carbapenems (24%) and beta lactam/beta lactamase inhibitors (ampicillin-sulbactam or amoxicillin-clavulanate; 22%) were the most commonly used restricted and unrestricted antibiotics. Antibiotics were most commonly used in intensive care units (1307.7 DPD). Almost half of the hospitalized patients in our hospitals were using at least one antibiotic. Moreover, among these antibiotics, the most commonly used ones were carbapenems, quinolones and cephalosporins, which are known to cause collateral damage. We think that antibiotic resistance, which is seen at considerably high rates in our hospitals, is associated with this level of consumption.
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Antibacterianos/uso terapéutico , Utilización de Medicamentos/estadística & datos numéricos , Estudios Transversales , Hospitales/estadística & datos numéricos , Humanos , Prevalencia , TurquíaRESUMEN
INTRODUCTION: Obstructive Sleep Apnea syndrome (OSA) is the most serious consequence of adenoid hypertrophy (AH) and it is one of the most common reasons of nocturnal hypoxia in children. There is some information about the relationship between childhood OSA and atherosclerosis or cardiac diseases. In this study, we evaluated the relationship between, neutrophil-lymphocyte ratio (NLR) and AH which is the most frequent cause leading OSA in children. AIM: Thus we aimed to contribute about subject of preoperative and postoperative NLR values in patients undergoing adenoidectomy that there is limited information. MATERIALS AND METHODS: The study group comprised 76 children undergoing adenoidectomy. A preoperative and 3(rd)-month postoperative complete blood cell count was performed to calculate the NLR values in all patients. The NLR values were calculated as the ratio of neutrophils to lymphocytes in peripheral blood. Data analysis was performed using SPSS 15. RESULTS: The mean NLR (min - max) was 1.0 (0.16-3.57) preoperatively and 1.06 (0.35-4.95) 3 months postoperatively (p = 0.052> 0.05). Haemoglobin 12.9 ± 0.95 (preop) 12.94 ± 0.91 (postop) (p= 0.522), WBC (min-max) 7.75 (3.90-14.99) 7.8 (4-15.64) (p= 0.297 <0.005), platelet 344.5 ± 98.7 328.4 ± 68.9 (p<0,005). CONCLUSION: There is limited information in the English literature. This study has investigated the association between the NLR and adenoidectomy. The results of the present study demonstrate that the NLR is not a statistically significant inflammatory factor. So, NLR values do not appear related to stage of upper airway obstruction.
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In this article, we report a case with febrile neutropenia occurring after implementation of intraocular bevacizumab. A 60-year-old female patient who had received intravitreal bevacizumab applied to hospital for oral lesions accompanying fever and neutropenia. In spite of empiric antibiotherapy, patient's clinical condition did not improve. Her sputum culture yielded Stenotrophomonas maltophilia. Trimethoprim/ sulfamethoxazole and levofloxacin were commenced according to antibiogram. In immunologic evaluation, antinuclear antibodies and anti-double stranded deoxyribonucleic acid were positive as compatible with systemic lupus erythematosus. After proper antibiotic treatment, patient's clinical symptoms resolved. Development of severe neutropenia after procedures which are not expected to create systemic adverse effects should bring to mind underlying immunosuppressive diseases such as systemic lupus erythematosus.
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OBJECTIVE: This study aimed to determine the incidence of Strongyloides stercoralis in individuals who live in rural areas in the towns near Mugla and have contact with humid soil and gather saffron milk cap mushroom in autumn, and to obtain epidemiological data in our region. METHODS: A total of 281 volunteers were included; 192 of them were the individuals who only gather mushroom, only work in the garden, or gather mushroom as well as work in the garden, while 89 had no contact with the soil. Totally, 281 sera were tested for the presence of S. stercoralis-IgG antibodies by ELISA technique, using a commercial kit (DRG® Diagnostics Strongyloides IgG ELISA EIA-4208; Germany). RESULTS: One of 281 volunteers (0.3 %) was found positive for S. stercoralis-IgG antibodies, while the other 280 volunteers (99.7 %) were found negative. Thirty-seven, 33, and 43 of 192 volunteers reported wearing only boots, only gloves, and both boots and gloves, respectively. Seventy-nine of 192 volunteers reported wearing neither boots nor gloves. CONCLUSION: This preliminary study is the first study that involves the individuals with soil contact in our country, and it was concluded that this study will offer an insight into the other studies on S. stercoralis.
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Enfermedades de los Trabajadores Agrícolas/epidemiología , Strongyloides stercoralis/aislamiento & purificación , Estrongiloidiasis/epidemiología , Adolescente , Adulto , Agaricales , Enfermedades de los Trabajadores Agrícolas/sangre , Animales , Ensayo de Inmunoadsorción Enzimática/métodos , Femenino , Humanos , Incidencia , Masculino , Estudios Seroepidemiológicos , Estrongiloidiasis/sangre , Turquía/epidemiología , Verduras , Adulto JovenRESUMEN
AIM: Clinical practice guidelines for the management of diabetic foot infections developed by the Infectious Diseases Society of America (IDSA) are commonly used worldwide. The issue of whether or not these guidelines need to be adjusted for local circumstances, however, has seldom been assessed in large prospective trials. METHODS: The Turk-DAY trial was a prospective, multi-center study in which infectious disease specialists from centers across Turkey were invited to participate (NCT02026830). RESULTS: A total of 35 centers throughout Turkey enrolled patients in the trial. Overall, investigators collected a total of 522 specimens from infected diabetic foot wounds for culture from 447 individual patients. Among all isolates, 36.4% were gram-positive organisms, with Staphylococcus aureus the most common among these (11.4%). Gram-negative organisms constituted 60.2% of all the isolates, and the most commonly isolated gram-negative was Escherichia coli (15%). The sensitivity rates of the isolated species were remarkably low for several antimicrobials used in the mild infection group. CONCLUSIONS: Based on our findings, several of the antimicrobials frequently used for empirical treatment, including some also recommended in the IDSA guidelines, would not be optimal for treating diabetic foot infections in Turkey. Although the IDSA guideline recommendations may be helpful to guide empiric antimicrobial therapy of DFIs, they should be adjusted to local conditions.
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Antibacterianos/uso terapéutico , Pie Diabético/microbiología , Farmacorresistencia Bacteriana Múltiple , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Grampositivas/efectos de los fármacos , Infección de Heridas/tratamiento farmacológico , Infección de Heridas/microbiología , Anciano , Pie Diabético/fisiopatología , Escherichia coli/efectos de los fármacos , Escherichia coli/aislamiento & purificación , Infecciones por Escherichia coli/tratamiento farmacológico , Infecciones por Escherichia coli/microbiología , Infecciones por Escherichia coli/fisiopatología , Femenino , Estudios de Seguimiento , Bacterias Gramnegativas/aislamiento & purificación , Bacterias Grampositivas/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/fisiopatología , Staphylococcus aureus/efectos de los fármacos , Staphylococcus aureus/aislamiento & purificación , Turquía , Infección de Heridas/fisiopatologíaRESUMEN
Background. Spontaneous orbital haemorrhage is a very rare condition and vision-threatening event. It may occur due to trauma, orbital surgery/injections, orbital vascular anomalies, and a variety of systemic predisposing factors. Signs of retrobulbar hemorrhage include proptosis, ophthalmoplegia, increased intraocular pressure, loss of pupillary reflexes, and optic disc or retinal pallor. Both Computed Tomography scan and Magnetic Resonance Imaging may be performed in the diagnosis. Case Report. A 31-year-old woman was referred to our hospital with a complaint of headache and blurred vision following a strong sneeze. Ophthalmological examination revealed mild Relative Afferent Pupillary Defect in left eye. Computed Tomography revealed left hyperdense retrobulbar mass and displaced optic nerve. T1 weighted hypointense, T2 weighted hyperintense and non-enhanced round shape, sharply demarcated lesion measuring 18 × 15 × 14 × mm in diameter compatible with haematoma was detected by MRI. Surgically Caldwell-Luc procedure was performed. Histological examination confirmed haematoma. Follow-up Magnetic Resonance Imaging revealed a small reduction in the size of lesion but not complete resolution. The patient's complaint was regressed. She is now free of symptoms and is still under surveillance. To our knowledge, this is the first reported case of retrobulbar haematoma caused by sneeze.
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Itraconazole (ITZ) belongs to the triazole group of antifungals with potent keratinophilic and lipophilic features. Hepatotoxicity is one of its most remarkable features. Silibinin (SIL) is a plant used worldwide which is used in the treatment of many liver diseases and it is especially very well known for its hepatoprotective-cytoprotective effect. The aim of our study was to research the protective effect of SIL in ITZ-induced hepatotoxicity using biochemical and pathological tests. Liver enzymes and antioxidant enzyme activities were measured spectrophotometrically by using commercial kits. ALT and AST levels in ITZ group were significantly increased compared to the group, while the activities of GSH-Px and SOD had decreased (p < 0.05). When ITZ group was compared to ITZ + SIL group, AST, ALT, and levels of NO and MPO were significantly decreased, while the activities of GSH-Px and SOD were increased (p < 0.05). Histopathological evaluation showed that SIL significantly decreased periportal inflammation and parenchymal hepatocyte apoptosis in ITZ and ITZ + SIL groups (p < 0.05). Eventhough not statistically significant, partial improvement with the use of SIL has been detected (p > 0.05) in hepatocyte degeneration and multinuclear giant cell formation. According to the evaluation performed with comet assay method, ITZ leads to DNA damage, and the use of SIL significantly decreases DNA damage (p < 0.05). We have detected that the use of ITZ increases oxidative stress (MPO, NO), decreases antioxidant activity (SOD and GSH-Px), and leads to DNA damage and histopathological liver damage, whereas the use of SIL has a cytoprotective effect on the liver by increasing the antioxidant effect (SOD, GSH-Px) and by decreasing the oxidative stress (NO, MPO). ITZ causes the generation of ROS and leads to DNA damage and liver damage. SIL has a cytoprotective effect on the liver by increasing antioxidant enzyme activities, preventing the formation of ROS.
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Enfermedad Hepática Inducida por Sustancias y Drogas/metabolismo , Enfermedad Hepática Inducida por Sustancias y Drogas/prevención & control , Itraconazol/envenenamiento , Hígado/metabolismo , Especies Reactivas de Oxígeno/metabolismo , Silimarina/administración & dosificación , Animales , Antioxidantes/administración & dosificación , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Citoprotección/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Interacciones Farmacológicas , Femenino , Hígado/efectos de los fármacos , Estrés Oxidativo/efectos de los fármacos , Ratas , Ratas Wistar , Silibina , Resultado del TratamientoRESUMEN
BACKGROUND: Diazinon (0,0-Diethyl 0-(1-6-methyl-2-isoprophyl 4 pyrimidinyl) phosphorothioate) (DI) is a very effective organophosphate pesticide, used widely in agriculture. Consequently, data on poisoning cases secondary to DI exposure are important. The DI may affect a variety of tissues, including liver. Silibinin is a pharmacologically active constitute of Silybum marianum, with documented antioxidant activity. OBJECTIVES: The aim of our study was to evaluate both histopathologically and biochemically whether silibinin is protective in DI induced liver damage. MATERIALS AND METHODS: Thirty two Wistar albino rats were divided into four groups, as follows: 1) control group - oral corn oil was given; 2) DI group - rats were administered orally 335 mg/kg in the corn oil solution; 3) Silibinin group - 100 mg/kg/day silibinin was given alone orally, every 24 hours for 7 days; 4) Silibinin + DI group - DI plus silibinin was given. All rats were sacrificed at the end of experiment. Superoxide dismutases (SOD), glutathione peroxidase (GPX), nitric oxide (NO) and myeloperoxidase (MPO) were investigated in serum and liver tissue. In addition, serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) enzyme activities were evaluated. The liver tissue was evaluated histopathologically with Hematoxilin & Eosin dye. RESULTS: Biochemically, ALT, AST, NO, MPO in serum and NO, MPO in liver tissue were found to be significantly higher in DI group, compared to control group (P < 0.001). In Group Silibinin + DI, serum AST, ALT, NO, MPO levels were significantly lower (P < 0.01), and both serum and tissue SOD activities were significantly higher, compared to DI group (P < 0.001). Diazinon induced histopathological changes in liver tissue were: severe sinusoidal dilatation, moderate disruption of the radial alignment of hepatocytes around the central vein, severe vacuolization in the hepatocyte cytoplasm, inflammation around central vein and portal region. In rats receiving both DI and silibinin, the DI induced changes accounted for less sinusoidal dilatation, vacuolization in the hepatocyte cytoplasm and the inflammation around central vein and portal region (P < 0.05). CONCLUSIONS: The DI was found to induce liver damage by oxidative stress mechanisms. Silibinin reduced the oxidative stress by inducing antioxidant mechanisms, thereby showing protective effect against DI induced liver damage. Further studies with silibinin should be performed regarding DI toxicity.
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BACKGROUND: Human toxocariasis is a parasitic infection caused by the larvae of Toxocara canis. We examine the Toxocara seroprevalance in veterinarians and animal husbandry workers living in the Mugla Province, Turkey to evaluate better the risk factors for Toxocara exposure. METHODS: In 2014, 376 volunteers participated in the study in 2014. All blood specimens were tested using a commercial enzyme immunoassay kit and ELISA positive samples were confirmed by Western Blot (WB) method. RESULTS: The seroprevalence of Toxocara, as determined by WB, was 8%. A statistically significant correlation was evident between patient age and Toxocara positivity among animal husbandry workers (P = 0.029). A strong association was also evident between sex and seropositivity in the animal husbandry group (P=0.024). Veterinarians working in pet clinics did in fact exhibit higher Toxocara seropositivities relative to those of other groups (P = 0.029). A statistically significant difference was detected between the rural geographic areas surveyed (P = 0.04). CONCLUSION: In Mugla Province, seroprevalence of Toxocara is lower than other regions. Despite the low seroprevalence observed, especially in high risk professions toxocariasis remains an important medical concern within the region.
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Pseudothrombocytopenia is the detection of low platelet counts by an autoanalyser despite lack of shortage in platelets. EDTA-induced pseudothrombocytopenia, the most frequently seen form in clinical practice, occurs mainly due to reaction of antiplatelet antibodies. Pseudothrombocytopenia is not only seen in healthy individuals but it is also reported in association with autoimmune, cardiovascular and liver parenchyma diseases and malignancy. We aimed to review approaches to pseudothrombocytopenia by presenting a case in which EDTA-dependent thrombocytopenia in association with bladder tumour was detected during examination for haematuria.
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Anticoagulantes/efectos adversos , Ácido Edético/efectos adversos , Hematuria/etiología , Trombocitopenia/inducido químicamente , Neoplasias de la Vejiga Urinaria/complicaciones , Anciano de 80 o más Años , Humanos , MasculinoRESUMEN
Splenic abscess due to acute brucellosis is a rare event. We report a case of splenic abscess caused by Brucella spp. in a 21-year-old man. The MRI revealed sharply demarcated lesions measuring 20 and 30 mm in diameter at the superior pole of spleen. Positive Wright agglutination test and positive blood culture confirmed the diagnosis. Antibiotic therapy, without surgical intervention, was successful.