RESUMO
OBJECTIVES: Integrase strand transfer inhibitor (INSTI) is a new class of antiretroviral (ARV) drugs designed to block the action of the integrase viral enzyme, which is responsible for insertation of the HIV-1 genome into the host DNA. The aim of this study was to evaluate for the first time INSTI resistance mutations in Turkish patients. METHODS: This study was conducted in Turkey, between April 2013 and April 2015 using 169 HIV-1-infected patients (78 ARV naive patients and 91 ARV-experienced patients). Laboratory and clinical characteristics of ARV naive and ARV-experienced patients were as follows: gender (M/F): 71/7 and 80/11, median age: 38 and 38.4; median CD4(+) T-cell: 236 and 216 cells/mm(3), median HIV-1 RNA: 4.95+E5 and 1.08E+6 copies/ml. Population-based seqeunces of the reverse transcriptase, protease, and integrase domains of the HIV-1 pol gene were used to detect HIV-1 drug resistance mutations. RESULT: INSTI resistance mutations were not found in recently diagnosed HIV-1-infected patients. However, ARV-experienced patients had major resistance mutations associated with raltegravir and elvitegravir; the following results were generated:F121Y, Y143R, Q148R and E157Q (6/91 - 6.6%). CONCLUSIONS: The prevalence of INSTI resistant mutations in ART-experienced patients suggested that resistance testing must be incorporated as an integral part of HIV management with INSTI therapies.
Assuntos
Farmacorresistência Viral , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Inibidores de Integrase de HIV/uso terapêutico , HIV-1/efeitos dos fármacos , HIV-1/genética , Mutação , Adulto , Idoso , Substituição de Aminoácidos , Contagem de Linfócito CD4 , Códon , Coinfecção , Feminino , Genótipo , Infecções por HIV/transmissão , Inibidores de Integrase de HIV/farmacologia , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , RNA Viral , Fatores de Risco , Turquia , Carga Viral , Adulto JovemRESUMO
We investigated the therapeutic effects of valproic acid (VPA) on erectile dysfunction and reducing penile fibrosis in streptozocin (STZ)-induced diabetic rats. Eighteen male rats were divided into three experimental groups (Control, STZ-DM, STZ-DM plus VPA) and diabetes was induced by transperitoneal single dose STZ. Eight weeks after, VPA and placebo treatments were given according to groups for 15 days. All rats were anesthetised for the measurement of in vivo erectile response to cavernous nerve stimulation. Afterward penes were evaluated histologically in terms of immune labelling scores of endothelial nitric oxide synthase (eNOS), vascular endothelial growth factor (VEGF) and transforming growth factor-ß1 (TGF-ß1). Slides were also evaluated in terms of collagen/smooth muscle ratio and penile apoptosis. After the treatment with VPA, erectile responses were found as improved when compared with STZ-DM rats but not statistically meaningful. eNOS and VEGF immune expressions diminished in penile corpora of STZ-DM rats and improved with VPA treatment. VPA led to decrease in TGF-ß1 expression and collagen content of diabetic rats' penes. Penile apoptosis was not diminished with VPA. In conclusion, VPA treatment seems to be effective for reducing penile fibrosis in diabetic rats and more prolonged treatment period may enhance erectile functions.
Assuntos
Diabetes Mellitus Experimental/metabolismo , Disfunção Erétil/tratamento farmacológico , Induração Peniana/tratamento farmacológico , Pênis/efeitos dos fármacos , Ácido Valproico/uso terapêutico , Animais , Apoptose/efeitos dos fármacos , Diabetes Mellitus Experimental/induzido quimicamente , Disfunção Erétil/metabolismo , Humanos , Injeções Intraperitoneais , Masculino , Óxido Nítrico Sintase Tipo III/metabolismo , Ereção Peniana/efeitos dos fármacos , Pênis/metabolismo , Pênis/patologia , Ratos , Ratos Sprague-Dawley , Estreptozocina/administração & dosagem , Estreptozocina/toxicidade , Fator de Crescimento Transformador beta1/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismoRESUMO
We aimed to investigate the effects of two different chronic immobilization stress protocols on depression-related behaviors and brain mineral levels. Adult female Wistar albino rats were divided into 3 groups as follows (n = 10/group): control, immobilization stress-1 (45 min daily for 7 days), and immobilization stress-2 (45 min twice a day for 7 day). Stress-related behavior was evaluated by means of the forced swimming test (FST) and open field test (OFT). Minerals were analyzed using an inductively coupled plasma mass spectrometer. In the FST, swimming and immobility were significantly lower in the immobilization stress-1 and immobilization stress-2 groups. The climbing duration of the immobilization stress-2 group was higher than the control group. In the OFT, percentage of time spent in the central area was significantly lower in the immobilization stress-1 and immobilization stress-2 groups. Values of latency to center area, rearing, and grooming did not significantly differ between groups. In the immobilization stress-1 group, zinc was lower, and iron, copper, and manganese were higher than the control group. In the immobilization stress-2 group, copper and manganese were higher, and phosphate was lower than the control group. Our results showed that depression-related behaviors were more dominant in the immobilization stress-1 group. A decrease in the brain zinc level was valid only for the immobilization stress-1 group. These results point to the role of low brain zinc levels in the pathophysiology of depression.
Assuntos
Depressão , Natação , Animais , Comportamento Animal , Encéfalo , Feminino , Minerais , Ratos , Ratos Wistar , Estresse PsicológicoRESUMO
We analysed nosocomial MRSA cases between January 2004 and December 2006 in a retrospective case-control study in a 250-bed tertiary-care teaching hospital. During the study period, 265 nosocomial Staphylococcus aureus infections were identified in 231 patients. There was a significant increase in methicillin resistance in isolates (MRSA) from these infections with frequencies for 2004 of 39/88 (44.3%), 2005 (62/80, 77.5%), and 2006 (75/97, 77.3%) (P<0.001). Multivariate analysis showed that associated factors for nosocomial MRSA infection were prolonged hospitalization (OR 3.982, 95% CI 2.235-7.094, P<0.001), mechanical ventilation (OR 3.052, 95% CI 1.666-5.590, P<0.001), surgical operation (OR 2.032, 95% CI 1.102-3.748, P=0.023), and male sex (OR 2.000, 95% CI 1.081-3.699, P=0.027). The determination of associated factors for methicillin resistance in nosocomial S. aureus infections in hospitals will play an important role in efforts to reduce MRSA infection rates.
Assuntos
Infecção Hospitalar/epidemiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Criança , Pré-Escolar , Infecção Hospitalar/microbiologia , Feminino , Hospitais , Humanos , Lactente , Recém-Nascido , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Respiração Artificial , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Infecções Estafilocócicas/microbiologia , Procedimentos Cirúrgicos Operatórios , Adulto JovemRESUMO
OBJECTIVE: The aim of this study was to analyze the temporal trends of HIV epidemiology in Turkey from 2011 to 2016. METHODS: Thirty-four teams from 28 centers at 17 different cities participated in this retrospective study. Participating centers were asked to complete a structured form containing questions about epidemiologic, demographic and clinical characteristics of patients presented with new HIV diagnosis between 2011 and 2016. Demographic data from all centers (complete or partial) were included in the analyses. For the cascade of care analysis, 15 centers that provided full data from 2011 to 2016 were included. Overall and annual distributions of the data were calculated as percentages and the Chi square test was used to determine temporal changes. RESULTS: A total of 2,953 patients between 2011 and 2016 were included. Overall male to female ratio was 5:1 with a significant increase in the number of male cases from 2011 to 2016 (p<0.001). The highest prevalence was among those aged 25-34 years followed by the 35-44 age bracket. The most common reason for HIV testing was illness (35%). While the frequency of sex among men who have sex with men increased from 16% to 30.6% (p<0.001) over the study period, heterosexual intercourse (53%) was found to be the most common transmission route. Overall, 29% of the cases presented with a CD4 count of >500 cells/mm3 while 46.7% presented with a CD4 T cell count of <350 cells/mm3. Among newly diagnosed cases, 79% were retained in care, and all such cases initiated ART with 73% achieving viral suppression after six months of antiretroviral therapy. CONCLUSION: The epidemiologic profile of HIV infected individuals is changing rapidly in Turkey with an increasing trend in the number of newly diagnosed people disclosing themselves as MSM. New diagnoses were mostly at a young age. The late diagnosis was found to be a challenging issue. Despite the unavailability of data for the first 90, Turkey is close to the last two steps of 90-90-90 targets.
Assuntos
Infecções por HIV/epidemiologia , HIV/patogenicidade , Hepacivirus/patogenicidade , Vírus da Hepatite B/patogenicidade , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Adolescente , Adulto , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Contagem de Linfócito CD4 , Linfócitos T CD4-Positivos/efeitos dos fármacos , Linfócitos T CD4-Positivos/virologia , Criança , Pré-Escolar , Coinfecção , Diagnóstico Tardio , Feminino , HIV/efeitos dos fármacos , HIV/fisiologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/mortalidade , Infecções por HIV/virologia , Hepacivirus/efeitos dos fármacos , Hepacivirus/fisiologia , Hepatite B/tratamento farmacológico , Hepatite B/mortalidade , Hepatite B/virologia , Vírus da Hepatite B/efeitos dos fármacos , Vírus da Hepatite B/fisiologia , Hepatite C/tratamento farmacológico , Hepatite C/mortalidade , Hepatite C/virologia , Heterossexualidade/estatística & dados numéricos , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Turquia/epidemiologia , Carga Viral/efeitos dos fármacosRESUMO
We aimed to investigate the effects of the aromatase inhibitor letrozole on femur fracture and serum levels of alkaline phosphatase (ALP), calcium and phosphate in female rats. Intact 32 Sprague-Dawley female rats were divided into four groups (n=8): control, letrozole 0.2 , letrozole 1 (treatment of 0.2 and 1 mg/kg for six weeks) and recovery (letrozole-treated 1 mg/kg for six weeks then allowed to recover for two weeks). Besides, 24 ovariectomized rats were divided into three groups (n=8): ovariectomized+control, ovariectomized+letrozole and ovariectomized+letrozole+ estradiol (10 microg/rat). After experimental period, rats' femur bones were removed for biomechanical studies following decapitation. Serum ALP, calcium and phosphate were measured. Biomechanical values, ALP and phosphate significantly increased by letrozole in a dose-dependent manner (p<0.05) while calcium levels and net bone area decreased (p<0.05). Ultimate strength was positively correlated with ALP and phosphate and negatively correlated with calcium. The results indicate that letrozole may increase risk of bone fracture and affect bone biomarkers such as ALP, calcium and phosphate in both intact and ovariectomized rats.
Assuntos
Inibidores da Aromatase/farmacologia , Osso e Ossos/efeitos dos fármacos , Fraturas do Fêmur/induzido quimicamente , Nitrilas/farmacologia , Triazóis/farmacologia , Fosfatase Alcalina/sangue , Animais , Biomarcadores/sangue , Fenômenos Biomecânicos/efeitos dos fármacos , Cálcio/sangue , Estradiol/farmacologia , Feminino , Letrozol , Ovariectomia , Fosfatos/sangue , Ratos , Ratos Sprague-DawleyRESUMO
Agomelatine is a new antidepressant drug acting as an antagonist of 5-hydroxytryptamine receptor 2C (5-HTR2C) and agonist of melatonergic receptors 1 and 2 (MT1 and MT2). Because of this dual action, it is an atypical antidepressant. The aim of this study was to investigate chronic anticonvulsant effects of agomelatine on penicillin-induced epilepsy model. Adult male Sprague-Dawley rats divided into four groups and were administered with tap water (vehicle), and agomelatine doses of 10 mg/kg, 50 mg/kg and 100 mg/kg for 14 days via oral gavage. After the last doses were given, epileptic seizures were induced by intracortical penicillin (500 IU/2.5 µl) application in rats under urethane (1.25 g/kg intraperitoneal) anesthesia. Electrocorticogram (ECoG) recordings were obtained from the somatomotor cortex through 90 min, and spike frequencies and amplitudes were analyzed. The spike frequency analyses revealed that only 50 mg/kg agomelatine administration decreased the spike frequencies of hypersynchronous discharge of neurons caused by penicillin (p < 0.05). No significant differences in amplitudes between experimental groups were observed. In addition, mRNA expressions of vesicular glutamate transporter 1 (VGLUT1) and vesicular gamma-aminobutyric acid transporter (VGAT) in response to the agomelatine active dose, 50 mg/kg, showed no significant effect of agomelatine on the mRNA expression. Our results indicate that chronic treatment with agomelatine may have potential anticonvulsant effects. Agomelatine may be a promising drug for epilepsy patients having depression due to its antiepileptic and antidepressant effects.
Assuntos
Acetamidas/farmacologia , Eletrocorticografia/efeitos dos fármacos , Penicilinas/farmacologia , Convulsões/prevenção & controle , Animais , Relação Dose-Resposta a Droga , Expressão Gênica/efeitos dos fármacos , Masculino , Microinjeções , Córtex Motor/metabolismo , Córtex Motor/fisiopatologia , Ratos , Convulsões/induzido quimicamente , Convulsões/fisiopatologia , Proteína Vesicular 1 de Transporte de Glutamato/biossíntese , Proteínas Vesiculares de Transporte de Aminoácidos Inibidores/biossínteseRESUMO
BACKGROUND AND OBJECTIVE: Despite important advances in available knowledge, management of neuropathic pain remains incomplete, and results from experimental and clinical studies indicate that some anticonvulsants show promise for treating neuropathic pain. The aim of this study was to assess the antinociceptive efficacy of levetiracetam (LEV, ucb L059) in a mice model for painful diabetic neuropathy using the in vivo nociceptive behavioral 'hot-plate test.' METHODS: The hot-plate test consisted of placing individual mice (adult male Balb/C) on the hot plate at 50+/-0.1 degrees C and timing the delay for the first hind paw lift (nociceptive threshold). After obtaining control values, diabetes was induced by injection of streptozotocin [200 mg/kg intraperitoneally (i.p.)] and 2 weeks after induction of diabetes (serum glucose > or =400 mg/dL) LEV was administered i.p. and hot-plate tests were repeated. Pain threshold values were determined and analyzed by Kruskal-Wallis one-way analysis of variance (ANOVA) followed by a pairwise comparison using a Dunnett's t-test on the ranked data. RESULTS: LEV (60, 300 and 900 mg/kg) had no significant effect on the nociceptive threshold in normal mice (n=8 for each dose, P>0.05). There were significant decreases in pain threshold latency in diabetic mice compared with the normal healthy group and these were significantly and dose-dependently restored by much lower doses of LEV (20, 100 and 200 mg/kg) in a reversible manner. CONCLUSION: Results obtained from the in vivo behavioral test lend support to the validation of the promising therapeutic potential of the novel antiepileptic agent LEV in the treatment of neuropathic pain.
Assuntos
Analgésicos/uso terapêutico , Anticonvulsivantes/uso terapêutico , Neuropatias Diabéticas/tratamento farmacológico , Dor/tratamento farmacológico , Piracetam/análogos & derivados , Animais , Comportamento Animal/efeitos dos fármacos , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Temperatura Alta , Levetiracetam , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Medição da Dor/métodos , Medição da Dor/estatística & dados numéricos , Piracetam/uso terapêutico , Fatores de Tempo , Resultado do TratamentoRESUMO
Statins have cholesterol-independent effects including an increased vascular nitric oxide activity and are commonly used by patients with cardiovascular disease. Such patients frequently have cardiovascular diseases, which may be treated with cilostazol, a platelet aggregation inhibitor. This study was designed to investigate whether combined use of cilostazol would increase the inhibitory effect of statin on vascular smooth muscle and how maturation would affect these responses. Female Wistar rats, aged 3-4 months (young) and 14-15 months (adult), were sacrificed by cervical dislocation and the thoracic aorta was dissected and cut into 3- to 4-mm-long rings. The rings were mounted under a resting tension of 1 g in a 20-ml organ bath filled with Krebs-Henseleit solution. Rings were precontracted with phenylephrine (10-6 M), and the presence of endothelium was confirmed with acetylcholine (10-6 M). Then, the concentration-response curves were obtained for atorvastatin alone (10-10 to 3 × 10-4 M; control) and in the presence of cilostazol (10-6 M) in young and adult rat aortas. This experimental protocol was also carried out in aorta rings, which had been pretreated with NG-nitro-l-arginine methyl ester (l-NAME, 10-4 M). Atorvastatin induced concentration-dependent relaxations in young and adult rat thoracic aorta rings precontracted with phenylephrine. The pIC50 value of atorvastatin was significantly decreased in adult rat aortas. In addition, pretreatment of aortas with cilostazol enhanced the potency of atorvastatin in both young and adult aortas. Incubation with l-NAME did not completely eliminate the relaxations to atorvastatin in the presence of cilostazol. These results suggest that combined application of cilostazol with atorvastatin was significantly more potent than atorvastatin alone. Combined drug therapy may be efficacious in delaying the occurrence of cardiovascular events.
Assuntos
Envelhecimento/fisiologia , Aorta/efeitos dos fármacos , Aorta/fisiologia , Atorvastatina/administração & dosagem , Tetrazóis/administração & dosagem , Animais , Cilostazol , Relação Dose-Resposta a Droga , Combinação de Medicamentos , Sinergismo Farmacológico , Feminino , Técnicas In Vitro , Ratos , Ratos Wistar , Resultado do Tratamento , Vasodilatadores/administração & dosagemRESUMO
Although Brucella species are susceptible to many antimicrobial agents in vitro, the susceptibility tests for these bacteria are not well standardized and the break point values are not described yet clearly. The aim of this study was to investigate the minimum inhibitory concentration (MIC) values of 43 Brucella strains isolated from blood cultures by E-test. Streptomycin and rifampicin E-tests were performed for all of the strains, however, tetracycline and ciprofloxacin were tested for only 27 and 17 strains, respectively. The MIC interval for streptomycin was 0.025-1 mg/L, for rifampicin 0.19-1.5 mg/L, for tetracycline <0.016-0.032 mg/L, and for ciprofloxacin 0.094-0.64 mg/L. One strain was found intermediately susceptible to rifampicin. In may be concluded that development of resistance is not eligible against antibiotics which are currently used for brucellosis therapy.
Assuntos
Antibacterianos/farmacologia , Brucella/efeitos dos fármacos , Ciprofloxacina/farmacologia , Rifampina/farmacologia , Estreptomicina/farmacologia , Tetraciclina/farmacologia , Humanos , Testes de Sensibilidade MicrobianaRESUMO
The effects of pinealectomy and exogenous melatonin (N-acetyl-5-methoxytryptamine) on serum leptin levels were investigated in rats. Exogenous administration of melatonin to intact rats resulted in significant decreases in serum leptin levels (P < 0.05) compared to those of the intact control group. Serum leptin levels were significantly elevated in the pinealectomised rats in comparison to the sham-pinealectomised animals (P < 0.001) and were significantly suppressed by exogenous administration of melatonin compared to those of non-treated pinealectomised rats (P < 0.001). Hormone concentrations in the melatonin-treated pinealectomised group were found to be similar to those seen in the sham-pinealectomised group. These results suggest that pineal gland has an effect on leptin release.
Assuntos
Leptina/sangue , Melatonina/farmacologia , Glândula Pineal/fisiologia , Animais , Masculino , Ratos , Ratos WistarRESUMO
We have investigated the role of mu- and kappa-opioid receptors in the central control of preovulatory LH and FSH release in the proestrous rat. Animals were anesthetized with chloral hydrate at 14:00 h on proestrus day. Following femoral artery cannulation, they were mounted in a stereotaxic apparatus. Morphine and U-50488H (benzene-acetamide methane sulphonate) were infused intracerebroventricularly either alone or in combination with naloxone and MR1452, respectively. Controls received sterile saline alone. Blood samples were obtained at hourly intervals between 15:00 h and 17:00 h. Plasma LH and FSH levels were measured by radioimmunoassay. Morphine did not significantly change plasma LH levels at 15:00 h and 16:00 h sampling intervals. A significant increase was observed at 17:00 h compared to the controls (p<0.05). U-50488H significantly increased LH levels at 16:00 h and 17:00 h (p<0.05). The co-administration of naloxone and MR1452 with mu- and kappa-agonist had no significant effect on LH levels at any sampling interval. In all groups, LH levels showed a linear rise over the sampling period between 15:00 h and 17:00 h. None of the treatments significantly altered plasma FSH levels which however, declined towards the end of the afternoon surge. In conclusion, we suggest that the secretion of LH and FSH is differentially regulated by mu- and kappa-opioid receptors. It is thought that in all groups chloral hydrate interfered with the LH surge secretory systems.
Assuntos
Analgésicos Opioides/farmacologia , Hormônio Foliculoestimulante/sangue , Fase Folicular/fisiologia , Hormônio Luteinizante/sangue , Morfina/farmacologia , Proestro/fisiologia , (trans)-Isômero de 3,4-dicloro-N-metil-N-(2-(1-pirrolidinil)-ciclo-hexil)-benzenoacetamida/farmacologia , Analgésicos não Narcóticos/farmacologia , Animais , Benzomorfanos/farmacologia , Feminino , Naloxona/farmacologia , Antagonistas de Entorpecentes/farmacologia , Sistemas Neurossecretores/efeitos dos fármacos , Sistemas Neurossecretores/metabolismo , Ratos , Receptores Opioides kappa/fisiologia , Receptores Opioides mu/fisiologiaAssuntos
Acrodermatite/tratamento farmacológico , Imunoglobulina G/uso terapêutico , Receptores do Fator de Necrose Tumoral/uso terapêutico , Ciclosporina/uso terapêutico , Resistência a Medicamentos , Etanercepte , Humanos , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
OBJECTIVE: The aim of this study was to investigate the effects of melatonin on spontaneous and oxytocin-induced contractility of pregnant and non-pregnant rat myometrium in vitro. DESIGN: Myometrial strips were removed from virgin or late pregnant (21 days gestation) Wistar rats following decapitation and placed in an organ bath containing Krebs' solution at 37 degrees C and pH 7.4, constantly bubbled with 95% oxygen-5% carbon dioxide and isometric contractions were recorded. Effects of cumulative concentrations of melatonin (0.1 to 10 microM) on spontaneous and oxytocin-induced contractions were studied. Possible involvement of Ca(2+)-activated K (+) channels in inhibitory actions of melatonin was investigated by using apamin (100 nM). RESULTS: Melatonin inhibited spontaneous and oxytocin-induced contractions of myometrium from both virgin and late pregnant rats in a dose-dependent manner. After inhibition of oxytocin-induced contractions by melatonin, application of prostaglandin F (2alpha) (1 microM) but not high KCl (30 mM) containing solution initiated contractile activity. Inhibitory response induced by melatonin (13 microM) was not affected by apamin (100 nM). CONCLUSIONS: Data from this study demonstrates that melatonin inhibits spontaneous and oxytocin-induced contractions of myometrium from pregnant and non-pregnant rats. Although the exact mechanism is not clear, melatonin-induced inhibition of myometrial contractions may results from its interactions with Ca(2+) channels.
Assuntos
Melatonina/farmacologia , Ocitocina/farmacologia , Contração Uterina/efeitos dos fármacos , Animais , Apamina/farmacologia , Cálcio/farmacologia , Inibidores de Ciclo-Oxigenase/farmacologia , Dinoprosta/farmacologia , Feminino , Técnicas In Vitro , Indometacina/farmacologia , Canais de Potássio/efeitos dos fármacos , Canais de Potássio/fisiologia , Cloreto de Potássio/farmacologia , Gravidez , Ratos , Ratos Wistar , SoluçõesRESUMO
We aimed to establish that a bronchoscopic view can be as reliable as microbiology, and support an empirical tracheobronchial fungal infection (TBFI) treatment decision. We retrospectively studied 95 respiratory failure patients with suspected TBFI admitted to the intensive-care unit (ICU) in 2008 with sticky secretions, hyperaemic mucosa, and whitish plaques on bronchoscopic view. Patients not suspected of having TBFI were chosen as a control group (n = 151). Broncheoalveolar lavage (BAL) fluid was cultured, and biopsy samples were taken from the lesions. Biopsy samples positive for fungi were defined as 'proven', only BAL-positive (+ fungi) cases were 'probable TBFI', and BAL-negative (- fungi) cases were 'possible TBFI'. BAL (+ fungi) and BAL (- fungi) in the control group were defined as 'colonization' and 'no TBFI', respectively. The sensitivity, specificity and positive and negative predictive values of BAL (+ fungi) were 85.1% (63/74), 81.4% (140/172), 66.3% (63/95), and 92.7% (140/151), respectively. Biopsies were performed in 78 of 95 patients, and 28 were proven TBFI with fungal elements, and 100% were BAL (+ fungi). Probable TBFI was seen in 30 of 95 patients with BAL (+ fungi), and possible TBFI (BAL(- fungi)) in 25 of 95. Among the 95 patients, microbiology revealed fungi (90.5% Candida species; 9.5% Aspergillus) in 63 (66.3%). In the controls, the colonization and no TBFI rates were 11 of 151 and 140 of 151, respectively. Observing sticky secretions, hyperaemic mucosa and whitish plaques by bronchoscopy is faster than and may be as reliable as microbiology for diagnosing TBFI. These findings are relevant for empirical antifungal therapy in suspected TBFI patients in the ICU.
Assuntos
Broncoscopia/métodos , Micoses/diagnóstico , Infecções Respiratórias/diagnóstico , Idoso , Biópsia , Líquido da Lavagem Broncoalveolar/microbiologia , Estudos de Casos e Controles , Feminino , Fungos/classificação , Fungos/isolamento & purificação , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Micoses/patologia , Valor Preditivo dos Testes , Infecções Respiratórias/patologia , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
Bartonella henselae infections are usually detected among people who have close contact with animals. Veterinarians and cattle breeders, in particular, are considered as the risk groups for B. henselae infections. In this study, the seroprevalence of antibodies to B. henselae was investigated in these two groups of subjects in the two cities of Aydin and Denizli, which are located in the same region in the southwest of Turkey. Total antibodies to B. henselae were evaluated by indirect immunofluorescence assay in serum samples taken from 63 cattle breeders and 27 veterinarians. Twenty samples (22.2%) were found to react on 1/64 titre with B. henselae antigens. Bartonella henselae seroprevalence was found to be significantly related to age (P = 0.033) and higher in those living in Aydin (P = 0.047). Age was the only independent factor in multivariate analysis (P = 0.008). Seroprevalence was found to be 2-fold higher in those people who had had tick contact (P = 0.093). In conclusion, the physicians in the region should consider B. henselae infection among veterinarians and breeders in their differential diagnosis list of fever of unknown origin.
Assuntos
Anticorpos Antibacterianos/sangue , Infecções por Bartonella/epidemiologia , Bartonella henselae/imunologia , Doenças Profissionais/epidemiologia , Exposição Ocupacional , Adulto , Criação de Animais Domésticos , Animais , Antígenos de Bactérias/imunologia , Infecções por Bartonella/microbiologia , Bartonella henselae/isolamento & purificação , Bovinos , Demografia , Feminino , Humanos , Masculino , Doenças Profissionais/microbiologia , Fatores de Risco , Estudos Soroepidemiológicos , Inquéritos e Questionários , Turquia/epidemiologia , Médicos Veterinários/estatística & dados numéricosRESUMO
BACKGROUND: Laboratory healthcare workers (HCWs) are at risk of laboratory-acquired brucellosis (LAB). AIM: To describe the risk factors of LAB among HCWs. METHODS: A multicentre survey study was conducted by face-to-face interview in 38 hospitals from 17 provinces of Turkey. A structured survey was administered to the HCWs, working in infectious diseases clinics and microbiology departments, who were at risk of brucella infection. FINDINGS: The survey response rate was 100%. Of the 667 laboratory workers, 38 (5.8%) had a history of LAB. In multivariate analysis, factors independently associated with an increased risk of LAB included working with the brucella bacteria (odds ratio: 5.12; 95% confidence interval: 2.28-11.52; P < 0.001) and male gender (2.14; 1.02-4.45; P = 0.042). Using a biosafety cabinet level 2 (0.13; 0.03-0.60; P = 0.009), full adherence to glove use (0.27; 0.11-0.65; P = 0.004) and longer duration of professional life (0.86; 0.80-0.92; P < 0.001) were found to be protective. CONCLUSIONS: Working with the brucella bacteria, being male, a lack of compliance with personal protective equipment and biosafety cabinets were the independent risk factors for the development of LAB in our series. Increased adherence to personal protective equipment and use of biosafety cabinets should be priority targets to prevent LAB.
Assuntos
Brucelose/epidemiologia , Pessoal de Saúde , Laboratórios Hospitalares , Doenças Profissionais/epidemiologia , Exposição Ocupacional , Adulto , Atitude do Pessoal de Saúde , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , TurquiaRESUMO
Intensive care units (ICUs) are unfortunately the epicenters of nosocomial infections. The aim of the study was to investigate device associated infection rates in a small Turkish hospital. Device utilization ratios and device associated infection rates were calculated according to definitions of the Centers for Disease Control (CDC). During a period of 24 months 1,387 patients were surveyed in our ICUs. A total of 287 device associated infections were detected. In our study ventilator associated pneumonia was the most frequent nosocomial infection with a rate of 59.7 per 1,000 ventilator days. The most frequent pathogen of device associated infection was Candida spp. High rates of device associated infections in a small Turkish hospital clearly indicate the urgent need of the implementation of infection control guidelines.
Assuntos
Cateterismo Venoso Central/efeitos adversos , Infecção Hospitalar/epidemiologia , Hospitais Universitários , Unidades de Terapia Intensiva , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Cateterismo Urinário/efeitos adversos , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Candida/classificação , Candida/isolamento & purificação , Candidíase/epidemiologia , Candidíase/microbiologia , Infecção Hospitalar/microbiologia , Bactérias Gram-Negativas/classificação , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Pneumonia Associada à Ventilação Mecânica/microbiologia , Turquia/epidemiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologiaRESUMO
To cut costs, many centres around the world utilise previously used, re-sterilized balloon catheters to perform coronary angioplasty. The fracture and lodging of an angioplasty device within the coronary arteries is a rare but increasingly noted complication. In this article, we report on the inadvertent retrieval of a coronary angioplasty catheter during off-pump coronary bypass. The accidental removal of the catheter, which extended to the descending aorta, has obviously been life saving. This experience has shown that a high degree of caution is required when planning an operation for the retrieval of PTCA hardware.
Assuntos
Angioplastia Coronária com Balão/instrumentação , Aorta Torácica/cirurgia , Ponte de Artéria Coronária sem Circulação Extracorpórea , Remoção de Dispositivo/instrumentação , Estenose Coronária/terapia , Migração de Corpo Estranho/etiologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: In this study the results of off-pump bypass in patients with advanced left ventricular dysfunction (LVD) and without bypassable circumflex disease were analysed retrospectively. METHODS: Fifty-five patients with advanced LVD underwent off-pump coronary bypass. Their ages ranged from 39 to 82 years (mean 62.3 +/- 8.4). Forty-two of the patients (76.3%) were in NYHA class III or IV. Mean left ventricular ejection fraction (LVEF) was 23.8 +/- 5.1%. Pre- and intra-operative variables, and postoperative complications and mortality of the patients were analysed. Mid-term follow-up was done by telephone either with the referring cardiologist or the patients. RESULTS: The mean number of coronary artery bypass grafts (CABG) per patient was 2.22 +/- 0.63. Eight coronary endarterectomies were achieved; early mortality was 3.6%. Pre-operative myocardial infarction (MI) occurred in one patient (1.8%). Two patients (3.6%) were supported with an intra-aortic balloon pump (IABP) and 10 (18.1%) needed inotropic support. Mean postoperative blood loss was 425 +/- 50 cm3. A significant improvement in ejection fraction was observed in the postoperative course. Mean intensive care unit stay was 2.1 +/- 1.1 days and mean hospital stay was 7.2 +/- 1.3 days. The mean follow-up period was 21.8 +/- 6.2 months and mid-term survival was 2.4%. Freedom from cardiac events requiring hospital admission was 89.7%. Most of the patients enjoyed symptomatic relief, however 16 patients (32.6% of survivors) remained in NYHA class III. CONCLUSION: These results support the effectiveness of off-pump coronary bypass with good early and mid-term results in patients with ischaemic cardiomyopathy and without bypassable circumflex lesion.