[Immunotherapy and multidisciplinary approach to treatment in lung cancer]. / Akciger kanserinde immünoterapi ve tedavide multidisipliner yaklasim.

Lung cancer remains as the main cause of cancer-related deaths worldwide. Over the last two decades, information about biology and pathogenesis of cancer has increased, immune checkpoint inhibitors (ICIs) have been introduced, and thus a significant period has started in treatment of solid cancers. This review discussed lung cancer in the framework of innovations in treatment, immunotherapy, and multidisciplinary approach to treatment. Non-small cell lung cancer (NSCLC) was the focal point of this article as it is the most frequent lung cancer type and the type of lung cancer which can ideally benefit from ICI treatment due to its characteristics. This review is the first review in Turkish language, which aimed to raise the multidisciplinary awareness about immunotherapy approach in lung cancer treatment in all branches, primarily in chest diseases, and to provide information about its management. Moreover, this review has importance as it presents the remarkable results of recent clinical trials on the use of ICIs in NSCLC treatment. Immunotherapy has initiated a new era in cancer treatment; the specific mechanism of action of ICIs has resulted in a group of some new adverse events, among which pneumonitis is particularly important and when necessary, patients are needed to be consulted with relevant specialties about adverse events. Lung cancer treatment should be planned specific to each patient by considering patient characteristics, histological features, and genetic status and specialty areas of chest diseases, thoracic surgery, medical oncology, radiation oncology, pathology, and radiology should collaborate together for diagnostic evaluation and optimal treatment of a lung cancer patient. Moreover, family physicians may have an important role in early diagnosis of lung cancer and in preventing lung cancer by encouraging their patients regarding tobacco cessation. Moreover, screening studies for lung cancer should be targeted to create awareness in society and for early diagnosis.

Investigation of risk factors for community-acquired urinary tract infections caused by extended-spectrum beta-lactamase Escherichia coli and Klebsiella species.

PURPOSE: The aim of this study was to determine the prevalence and risk factors for community-acquired urinary tract infections (CA-UTIs) caused by extended-spectrum ß-lactamase (ESBL) producing Escherichia coli and Klebsiella species. MATERIALS AND METHODS: The patients diagnosed with CA-UTIs caused by E. coli or Klebsiella spp. were included in the study. All of the patients were compared to demographic characteristics, underlying diseases, urinary tract pathology, history of hospitalization, use of antibiotics according to ESBL positivity. RESULTS: A total of 322 urine isolates were studied. Sixty-six patients (37.1%) of a total of 178 patients were ESBL positive E. coli and Klebsiella spp. Being over the age of sixty (odds ratio [OR], 1.90; p=0.03), history of renal stone (OR, 3.00; p=0.03), urinary tract anatomical of physiological disorder (OR, 2.17; p=0.01), urologic intervention (OR, 3.43; p<0.001), history of urinary tract surgery (OR, 3.10; p=0.01), history of urinary catheterization (OR, 3.43; p<0.001), and hospitalization for last 1 year (OR, 3.70; p=0.01) and antibiotic usage in the last 3 months (OR, 1.90; p=0.04) were found as significant risk factors for the producing of ESBL. However, gender and underlying disease were not related for ESBL production. CONCLUSIONS: In present study, high rate of ESBL positivity was detected in CA-UTIs. The increasing of infections caused by ESBL positive E. coli and Klebsiella spp. are bringing together a lot of the problem, such as antibiotic resistance and reducing treatment options for outpatients. Identification of underlying risk factors would be important for the development of preventive strategies.

Risk factors for linezolid-associated thrombocytopenia and negative effect of carbapenem combination.

INTRODUCTION: Linezolid is a synthetic antimicrobial agent with a broad spectrum of activity against virtually all Gram-positive bacteria. Although linezolid is generally well tolerated, the prolonged use of linezolid can lead to myelosuppression, including neutropenia, thrombocytopenia, and anemia. The aim of this study was investigating the risk factors for thrombocytopenia in patients who received linezolid therapy. METHODOLOGY: This retrospective study was performed on patients who received linezolid therapy between July 2007 and December 2017. Thrombocytopenia was defined as either a platelets count of < 100×109/L or a 25% reduction from the baseline platelet count. RESULTS: A total of 371 patients, (198 (53%) male and 173(47%) female were included into the study. Mean duration of therapy was 12.81 ± 5.19 days. Linezolid-induced thrombocytopenia was detected in a total of 111 patients. Using the univariate analysis advanced sex, serum urea concentration, baseline platelet level and low eGFR value were found to be risk factors for linezolid associated thrombocytopenia (p < 0.05). According to a multivariate analysis, patients undergoing carbapenem treatment combination therapy (p = 0.003) and with a baseline platelet level of < 200×109/L (p = 0.00) were found to have a high risk of developing thrombocytopenia. CONCLUSIONS: Several factors may influence of linezolid associated thrombocytopenia. Platelet count should be monitored during therapy and thrombocytopenia should be kept in mind in patients with baseline platelet level of < 200×109/L, low eGFR, linezolid-carbapenem combination therapy.

[Cutaneous larva migrans in Turkey: an imported case report]. / Türkiye'de kütanöz larva migrans: bir importe olgu sunumu.

Cutaneous larva migrans (CLM) is a parasitic infection most commonly found in tropical and subtropical areas. However, with the ease and increase of foreign travel to many countries around the world, the infection is not limited to these areas. CLM is an erythematous, serpiginous infection with skin eruption caused by percutaneous penetration of the larvae to the skin. In this report, a case diagnosed as imported CLM after an Amazon trip and treated with albendazole was presented. A 36 year-old male patient admitted to infectious diseases clinic with intense itching, erythematous, raised, streaklike serpiginious eruptionand some redness at bilateral foot especially at the right foot for about one week. The patient was living in Turkey, and travelled to Brazil for an Amazon trip three months ago and the lesions began immediately after this occasion. CLM was diagnosed with the typical lesions in the patient and oral albendazole treatment 2 x 400 mg/day for 3 consecutive days was carried out with oral amoxicillin/clavulanat 3 x 1 g/day for the secondary bacterial infection. The patient responded very well to oral albendazole treatment with a result of a rapid improvementof pruritus in days and no side effect was observed during the treatment period.After discharge, during his controlit was seenthat the lesions were regressed with leaving hyperpigmentation. In cases with cutaneous larva migrans, diagnosis is often made by the presence of pruritic typical lesions and tunnels, travel story to endemic regions, the story of barefoot contact with sand and soil in these regions, and the sun tanning story on the beach. The lesions are often seen in the lower extremities, especially in the dorsal and plantar surface of the foot. Laboratory findings are not specific. Temporary peripheral eosinophilia can be seen and biopsy can be done to confirm the diagnosis but usually no parasite is seen in the histopathological examination. Contact dermatitis, bacterial and fungal skin infections and other parasitic diseases should be considered in differential diagnosis. For the treatment ivermectin 1 x 200 mg/kg single dose or albendazole 400 mg/day for three days is recommended. As a result, cutaneous larva migrans should be kept in mind especially in patients with a history of travel to endemic areas and a history of bare feet contact with sandy beaches and soil in this region and with itchy, red and serpiginous skin lesions.

Synergistic effects of sulbactam in multi-drug-resistant Acinetobacter baumannii

Abstract Acinetobacter baumannii is a frequently isolated etiologic agent of nosocomial infections, especially in intensive care units. With the increase in multi-drug resistance of A. baumannii isolates, finding appropriate treatment alternatives for infections caused by these bacteria has become more difficult, and available alternate treatments include the use of older antibiotics such as colistin or a combination of antibiotics. The current study aimed to evaluate the in vitro efficacy of various antibiotic combinations against multi-drug resistant A. baumannii strains. Thirty multi-drug and carbapenem resistant A. baumannii strains isolated at the Ankara Training and Research Hospital between June 2011 and June 2012 were used in the study. Antibiotic susceptibility tests and species-level identification were performed using conventional methods and the VITEK 2 system. The effects of meropenem, ciprofloxacin, amikacin, tigecycline, and colistin alone and in combination with sulbactam against the isolates were studied using Etest (bioMérieux) in Mueller-Hinton agar medium. Fractional inhibitory concentration index (FIC) was used to determine the efficacy of the various combinations. While all combinations showed a predominant indifferent effect, a synergistic effect was also observed in 4 of the 5 combinations. Synergy was demonstrated in 43% of the isolates with the meropenem-sulbactam combination, in 27% of the isolates with tigecycline-sulbactam, and in 17% of the isolates with colistin-sulbactam and amikacin-sulbactam. No synergy was detected with the sulbactam-ciprofloxacin combination and antagonism was detected only in the sulbactam-colistin combination (6.66% of the isolates). Antibiotic combinations can be used as an alternative treatment approach in multi-drug resistant A. baumannii infections.

Incidence of acute prostatitis caused by extended-spectrum beta-lactamase-producing Escherichia coli after transrectal prostate biopsy.

OBJECTIVES: To study the clinical and bacteriologic picture of acute prostatitis caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli after transrectal ultrasound-guided prostate biopsy. METHODS: The retrospective data from 1339 patients who had undergone transrectal ultrasound-guided biopsy from November 2003 to June 2008 were reviewed. An automatic biopsy gun with an 18-gauge needle was used to obtain 10-core biopsies for first biopsies and > or =12-core for repeat biopsies. These patients had received 500 mg ciprofloxacin orally twice daily for 5 days, beginning 24 hours before biopsy. All biopsies were performed as outpatient procedures. RESULTS: Of the 1339 patients, 28 (2.1%) had acute bacterial prostatitis detected after transrectal ultrasound-guided prostate biopsy. Acute prostatitis occurred after the first biopsy in 15 patients (1.3%) and after repeat biopsy in 13 (6.8%). The patients had developed infective symptoms a mean of 3 days after transrectal ultrasound-guided prostate biopsy. Of the 28 patients, 17 (61%) had positive urine and/or blood cultures, including E. coli in 14. Of the 14 patients, 6 had acute prostatitis caused by ESBL-producing E. coli. Bacteria isolated from urine were tested for drug susceptibility to a wide range of antibiotics. All patients with ESBL-producing E. coli were treated with imipenem. The bacteria detected in these urine cultures were resistant to ciprofloxacin, ceftriaxone, sulbactam/ampicillin, and cefazolin. Imipenem and piperacillin-tazobactam were the most active agents against ESBL-producing E. coli. ESBL-producing isolates had a significant reduction in activity for most antimicrobial agents, including fluoroquinolones and amikacin. CONCLUSIONS: The prompt initiation of effective antimicrobial treatment is essential in patients with ESBL-producing E. coli, and empirical decisions must be determined by knowledge of the local distribution of pathogens and their susceptibility.

Panniculitis as the initial manifestation of brucellosis: a case report.

Here, we describe a 38-year-old male with an abrupt manifestation acute panniculitis as unusual presentation of brucellosis. Brucellosis is a reemerging disease in Turkey, and the disease is primarily transmitted from farm animals to humans. Farmers and shepherds are the major risk groups for brucellosis in Anatolia. Brucellosis may involve almost all systems and organs, including the skin, and may mimic a wide range of illness and syndromes. Although the cutaneous manifestation of brucellosis is not disease specific, but it occurs in about 6%-13% of patients with brucellosis. Some of these lesions including rashes, papules, ulcers, abscess, erythema nodosum, ecchymosed skin rash, purpura, and vasculitis may be seen frequently in brucellosis, but panniculitis is rarely described. The case confirmed by positive blood culture had manifest skin lesion as an initial finding represented by lobular panniculitis with vasculitis.

Crimean-Congo hemorrhagic fever: five patients with hemophagocytic syndrome.

Three pediatric and two adult Turkish patients with Crimean Congo Hemorrhagic Fever (CCHF) induced hemophagocytic syndrome (HPS) were admitted to Ondokuz Mayis University Hospital, which is in the Middle Black Sea Region of Turkey. All of them had remarkable hemophagocytosis in the bone marrow with severe bleeding symptoms along with the other known clinical and laboratory findings of CCHF. We would like to present these patients and to discuss the pathophysiology and the effect of acquired HPS on the severity of the disease.

[Comparison of the diagnostic value of blood and bone marrow cultures in brucellosis]. / Brusellozda kan ve kemik iligi kültürlerinin tani degerinin karsilastirilmasi.

The aim of this study was to compare the rates of brucellosis revealed by blood and bone marrow (BM) cultures obtained from patients followed up in our hospital, between 2002-2004 period. A total of 102 patients (62 male, 40 female; mean age: 39 +/- 5 years) were included to the study and 61 of them were in acute, 29 were in subacute, and 12 were in chronic stages of brucellosis. Blood and BM samples collected from all of the hospitalized patients were cultured by using the BACTEC 9050 system. The mean isolation period for BM cultures was 4.2 days, whereas it was 5.8 days for blood cultures. Overall the rate of positive blood cultures in brucellosis cases was found as 48% (n: 49), while the rate was was 34% (n: 35) for BM cultures, and the difference was statistically significant (p<0.05). Blood and BM culture positive results were detected in 40 (66%) and 28 (46%) of acute brucellosis cases, respectively. BM culture positive 23 samples yielded positive blood culture, while five were negative. These rates were found as 31% (n: 9), and 21% (n: 6) for subacute acute brucellosis cases, respectively. On the other hand Brucella spp. could not be isolated from blood cultures of 12 chronic cases, however, one (8%) was positive for BM culture. The patients were grouped according to their standard tube agglutination (STA) test results (group 1: 1/160-1/640, group 2: 1/1280-1/2560 STA titers), and when comparing these groups for their positive blood and BM culture results, the high rate in group 2 was found statistically significant (p<0.05). Nineteen (70%) of 27 patients who had previously received specific brucellosis therapy were positive for blood and/or BM cultures, indicating insufficient use of antibiotics, or the use of inappropriate antibiotic combinations. It was concluded that, since the rate of positive blood cultures were low in especially chronic brucellosis cases, bone marrow cultures should be obtained for the definite evaluation of these patients.

Bacteriuria, pyuria and bacteremia frequency following outpatient cystoscopy.

AIM: The assumed necessity of antimicrobial prophylaxis prior to cystoscopy is controversial. In this study, the rate of bacteriuria, pyuria and bacteremia in outpatients who underwent cystoscopy without antimicrobial prophylaxis is investigated prospectively. METHODS: The study included 75 patients who underwent cystoscopy for various indications and had sterile urine prior to intervention. A clean midstream urine sample was obtained 24 h before and 48 h after the procedure. Blood cultures were taken 1 h after cystoscopy. Patients were questioned for newly developed symptoms 48 h after cystoscopy. Blood cultures were taken again from patients who presented with fever. RESULTS: Six patients (8%) developed significant bacteriuria, and six patients (8%) developed pyuria without significant bacteriuria. Bacteremia was not determined in any of the patients. The association between presence of pyuria prior to the procedure and development of bacteriuria after the procedure was significant (P < 0.05). Four patients out of six who had bacteriuria were asymptomatic. In our study we found significant bacteriuria after cystoscopy in 8% of patients, and no bacteremia. CONCLUSIONS: Thus we conclude that cystoscopy is a safe and well-tolerated procedure. Antimicrobial prophylaxis should not be administrated unless specific indications are present.