Pleurisy due to brucellosis.

Any system or organ involvement can be seen in brucellosis, which is still a significant public health problem in developing countries. The rate of respiratory system involvement is lower than that of other systems and which is also difficult to document. Brucellosis-associated pleurisy is a rare complication even in endemic regions. In this case report, a 78-year-old male patient who was assessed for pleural effusion etiology is presented. Brucella spp. were isolated on the 14th day of the pleural fluid incubation in the blood culture set and the patienthas been treated successfully for brucellosis. Based on our experience we think that it is important to use blood culture media for sterile body fluids, particularly for microorganisms that are difficult to isolate such as Brucella spp.

The occurrence and consequences of violence against healthcare workers in Turkey: before and during the COVID-19 pandemic.

BACKGROUND: Before and throughout the COVID-19 pandemic, healthcare workers (HCWs) were victims of workplace violence (WPV). There are no reliable statistics on the occurrence and consequences of WPV against HCWs in Turkey throughout the pandemic period. OBJECTIVE: We investigated the rates of WPV against HCWs in Turkey in the pre-pandemic and pandemic periods, variables associated with WPV, and the relationship between these variables and job satisfaction and burnout. METHODS: A structured online questionnaire was disseminated through social media channels to HCWs in various healthcare settings. All the respondents also completed the Maslach Burnout Inventory (MBI) and Job Satisfaction Scale. Based on the data obtained, we determined the frequency, causes, and consequences of WPV against HCWs before and during the pandemic. RESULTS: There were 701 completed questionnaires. 68.2% of participants were female, and 65.6% of them were doctors. The rate of WPV was 54.1% and 24.3% before and during the pandemic, respectively. Verbal abuse was the most common kind of WPV. Female HCWs were more likely to be physically assaulted than their male counterparts, especially those working in COVID-19 units. The majority of HCWs who were exposed to the violence at least once did not report WPV. HCWs exposed to WPV during the pandemic reported more emotional exhaustion and depersonalization and a lower perceived level of personal achievement. CONCLUSION: HCWs were exposed to significant levels of violence both before and during the pandemic. Preventing WPV against HCWs and removing barriers to reporting abuse is crucial.

An investigation of the effectiveness against bacteriuria of silver-coated catheters in short-term urinary catheter applications: A randomized controlled study.

AIM: The aim of this study was to investigate the effectiveness of antimicrobial-coated catheters against bacteriuria and urinary tract infection in patients who have urinary catheterization. METHODS: Twenty eight and twenty six people similar in terms of demographic characteristics and primary and underlying diseases were randomly selected from patients undergoing short-time urinary catheterization in the intensive care unit. Silver-coated slicone foley catheters and normal slicone foley catheters were used for uninary catheterization in the first and second group of the patients respectively. Urine specimens were collected from patients at 2-day intervals and assessed in terms of bacteriuria. RESULTS: Bacteriuria was found in 12 (46.2%) of the patients using normal catheters and 13 (46.4%) of those using silver-coated catheters throughout the monitoring period. No significant relationship was determined between use of different catheter types and bacteriuria (p = 0.98). The most common microorganism was identified as E. coli in the normal catheter group while microorganism other than E. coli was identified in the silver-coated catheter group. The prevalence of bacteriuria was statistically significantly higher in patients with a history of hospitalization in the previous 3 months (p = 0.028). CONCLUSION: The use of silver-coated silicone catheters was not shown to have a protective effect against bacteriuria in this study. Further well-designed studies with larger case numbers are now needed to confirm whether history of hospitalization, which emerged as a statistically significant factor in this study, increases the prevalence of catheter-related bacteriuria.

A Case Report of Black Hairy Tongue (Melanotrichia Linguae or Lingua Pilosa Nigra).

Black hairy tongue is a benign condition that can be associated with several varying causes. Its etiology is often linked with fungal infection and adverse reactions to various drugs. We present a case of an adult patient who developed a black hairy tongue while on ceftriaxone and pantoprazole for 10 days. The fungus on his tongue was not identified as the causative agent, and recovery was achieved by changing his medications. Ceftriaxone was replaced with trimethoprim/sulfamethoxazole 5 mg/kg intravenous, and pantoprazole was fully stopped. The black lesion on the tongue was observed to regress over several days. Clinicians should be aware of this particular side effect of certain antibiotics.

Nebivolol protects the liver against lipopolysaccharide-induced oxidative stress, inflammation, and endoplasmic reticulum-related apoptosis through Chop and Bip/GRP78 signaling.

This study aimed to examine the protective role of nebivolol (NEB) on liver tissue against the lipopolysaccharide (LPS)-induced sepsis model in rats by targeting endoplasmic reticulum (ER) stress-related binding immunoglobulin protein (Bip), CCAAT-enhancer-binding protein homologous protein (Chop) signaling pathways. Four groups, each comprising eight rats, were established: control, LPS, LPS + NEB, and NEB. Biochemical analyses included total oxidant status (TOS), serum aspartate transaminase (AST), and alanine aminotransferase (ALT) levels. Additionally, genetic assessments involved Chop and Bip/GRP78 mRNA expression levels, while histopathological examinations were conducted. Immunohistochemistry was used to determine interleukin-1 beta (IL-1 ß) and caspase-3 levels. The LPS group exhibited significantly higher AST, ALT, oxidative stress index, and TOS levels compared to the control group. Moreover, the LPS group demonstrated markedly increased Chop and Bip/GRP78 mRNA expression compared to the control group. Immunohistochemical analysis of the LPS group revealed significant upregulation in IL-1ß and caspase-3 expressions compared to the control group. Additionally, the LPS group showed significant hyperemia, mild hemorrhage, and inflammatory cell infiltrations. Comparatively, the LPS+NEB group exhibited a reversal of these alterations when compared to the LPS group. Collectively, our findings, suggest that NEB holds promise as a treatment in conditions where oxidative damage, inflammation, and ER stress-related apoptosis play significant roles in the pathogenesis.

Evaluation of combination therapies with colistin in an experimental mouse pneumonia model induced by carbapenem-resistant Acinetobacter baumannii strain.

The treatment options are limited in Acinetobacter baumannii infections. In this study, the effectiveness of colistin monotherapy and combinations of colistin with different antibiotics were investigated in an experimental pneumonia model induced by carbapenem-resistant A. baumannii strain. Mice in the study were divided into five groups as control (no treatment), colistin monotherapy, colistin + sulbactam, colistin + imipenem, and colistin + tigecycline combinations. The modified experimental surgical pneumonia model of Esposito and Pennington was applied to all groups. The presence of bacteria in blood and lung samples was investigated. Results were compared. In blood cultures, while there was no difference between the control and colistin groups, there was a statistical difference between the control and the combination groups (P = 0.029). When the groups were compared in terms of lung tissue culture positivity, there was a statistical difference between the control group and all treatment groups (colistin, colistin + sulbactam, colistin + imipenem, and colistin + tigecycline) (P = 0.026, P < 0.001, P < 0.001, and P = 0.002, respectively). The number of microorganisms that grew in the lung tissue was found to be statistically significantly lower in all treatment groups in comparison with the control group (P = 0.001). Both monotherapy and combination therapies of colistin were found to be effective in the treatment of carbapenem-resistant A. baumannii pneumonia, but the superiority of combination therapies over colistin monotherapy has not been demonstrated.

Assessment and feedback of the COVID-19 pandemic's effects on physicians' day-to-day practices: good knowledge may not predict good behavior.

The importance of doctors' knowledge and awareness of infectious diseases was felt worldwide during the COVID-19 pandemic. With this study, we aimed to evaluate the effect of the long and dynamic pandemic process on resident physicians' knowledge and protective behaviors for infection control in a tertiary hospital setting and protective behaviors for infection control in a tertiary hospital setting. The population of this cross-sectional study consisted of assistant physicians working at Suleyman Demirel University Faculty of Medicine Training and Research Hospital. A questionnaire evaluating information and protective practices for COVID-19 was applied to the participants through face-to-face interviews using the convenience sampling method, with an interval of one year. In the second year of the pandemic, resident physicians' awareness of the correct use of personal protective equipment decreased (p = 0.001). Despite the continuous training, it was determined that the residents preferred masks with high protection at a lower rate when they encountered patients who received oxygen support of 5 lt/min and above (p < 0.001). To prevent the spread of COVID-19 infection in the hospital as the pandemic progresses, it has been determined that resident physicians are less prone to evaluate possible infection symptoms in patients hospitalized for non-COVID-19 reasons (p = 0.013). As a result, the data we obtained showed that despite the regular training during the pandemic and the death of many health workers, the residents' adherence to infection control and prevention practices, which also protect them, decreased significantly in the second year of the pandemic. These valuable data showed us that good knowledge does not predict good infection control and prevention practices. Our findings show that physicians need a new education system that motivates them. In addition, psychosocial determinants, physical and mental fatigue, and institutional control factors contributing to these results and affecting individual risk perception should be recognized and prevented.

Effect of Metatarsal Head Shape on the Development of Hallux Valgus Deformity: 10 Years of Natural Follow-up.

BACKGROUND: We investigated the role of first metatarsal head shape in the etiology of hallux valgus. By pedobarographic analysis, we evaluated whether first metatarsal head shape causes an alteration in plantar pressure values that would result in metatarsalgia. METHODS: Referrals to our clinic for metatarsalgia, plantar fasciitis, and calcaneal spur were scanned retrospectively. Patients with severe hallux valgus, pes planus, gastrocnemius stiffness, generalized joint laxity, neuromuscular disease, or a history of lower-extremity orthopedic surgery were excluded. Sixty-two patients with plantar pressure assessment and radiographic evaluation were included. These patients were invited for reassessment after 10 years. Feet were divided into three groups by metatarsal head shape: round, square, and chevron. On anteroposterior radiographs, the hallux valgus and intermetatarsal angles, relative first metatarsal length, lateral sesamoid subluxation, and presence of bipartite sesamoid were noted. Plantar pressure was assessed with pedobarography. RESULTS: Feet with round-shaped first metatarsal heads had a statistically significantly greater progression in hallux valgus angle than the other shapes. Plantar pressures under the first, second and third, and fourth and fifth metatarsals increased with time. This can explain the mechanism of transfer metatarsalgia and painful callosities under the first metatarsal in hallux valgus. There was no correlation between hallux valgus angle, relative metatarsal length, and lateral sesamoid subluxation. CONCLUSIONS: We found a strong relation between round-shaped first metatarsal head and hallux valgus angle progression. No patients had a risk factor responsible for hallux valgus. In other words, this study gives approximately 10-year natural history results in nearly normal feet.

Early Treatment Was Life Saving in Varicella Pneumonia of an Immunocompetent Adult.

Chickenpox, an infection of childhood with vesicular skin rash, is caused by varicella-zoster virus (VZV). Although the infection is rare in adults, it can cause serious complications Varicella pneumonia is the most encountered complication. In this report, a VZV pneumonia case in a previously healthy adult is presented. The patient was treated with early intravenous acyclovir and both clinical and radiographic recovery has been observed.

A rare cause of healthcare-associated infective endocarditis: Enterobacter cloacae.

We report a case of infective endocarditis secondary to healthcare-associated bloodstream infection caused by an uncommon etiologic agent, multidrug-resistant Enterobacter cloacae. The patient was treated with a combination of antimicrobial therapy and surgery, but could not be saved. With this case, we discuss the prevalence, risk factors, treatment options, and outcomes of the rarely encountered Enterobacter cloacae-associated infective endocarditis.

Risk factors for bacteremia due to extended-spectrum beta-lactamase-producing Escherichia coli in a Turkish hospital.

INTRODUCTION: Bloodstream infection caused by extended-spectrum beta-lactamase (ESBL)-producing pathogens has become a serious concern worldwide. The purpose of this study was to identify risk factors for bacteremia due to ESBL-producing Escherichia coli in a Turkish hospital. METHODOLOGY: We retrospectively reviewed the medical records of patients with E. coli bacteremia in a tertiary care centre from January 2007 to October 2011. Data from patients such as demographic features, underlying conditions, and antibiotic exposure were analysed. RESULTS: A total of 113 patients with bacteremia due to E. coli were included and data from patients with ESBL-producing E. coli (case patients) were compared to those with non-ESBL-producing E. coli (control patients). The frequency of ESBL producers was 38.9% (44/113). Exposure to fluoroquinolones and cephalosporins, history of intra-abdominal surgery intervention, and presence of central venous catheteter and urinary catheteter were more frequently detected among case patients (P < 0.05). Independent risk factors for bacteremia due to ESBL-producing E. coli were exposure to fluoroquinolones (OR 13.39, 95% CI 1.28-140.03) and cephalosporins (OR 3.48, 95% CI 1.03-11.74). CONCLUSIONS: Previous use of fluoroquinolone and cephalosporin in patients with bacteremia caused by E. coli increased the risk for ESBL-producing strains.

Ceramide recruits and activates protein kinase C zeta (PKC zeta) within structured membrane microdomains.

We have previously demonstrated that hexanoyl-D-erythro-sphingosine (C(6)-ceramide), an anti-mitogenic cell-permeable lipid metabolite, limited vascular smooth muscle growth by abrogating trauma-induced Akt activity in a stretch injury model of neointimal hyperplasia. Furthermore, ceramide selectively and directly activated protein kinase C zeta (PKC zeta) to suppress Akt-dependent mitogenesis. To further analyze the interaction between ceramide and PKC zeta, the ability of ceramide to localize within highly structured lipid microdomains (rafts) and activate PKC zeta was investigated. Using rat aorta vascular smooth muscle cells (A7r5), we now demonstrate that C(6)-ceramide treatment results in an increased localization and phosphorylation of PKC zeta within caveolin-enriched lipid microdomians to inactivate Akt. In addition, ceramide specifically reduced the association of PKC zeta with 14-3-3, a scaffold protein localized to less structured regions within membranes. Pharmacological disruption of highly structured lipid microdomains resulted in abrogation of ceramide-activated, PKC zeta-dependent Akt inactivation, whereas molecular strategies suggest that ceramide-dependent PKC zeta phosphorylation of Akt3 at Ser(34) was necessary for ceramide-induced vascular smooth muscle cell growth arrest. Taken together, these data demonstrate that structured membrane microdomains are necessary for ceramide-induced activation of PKC zeta and resultant diminished Akt activity, leading to vascular smooth muscle cell growth arrest.