Predictors of surgical management in diabetic foot infections.

OBJECTIVE: Early recognition of the need for surgical intervention is crucial in terms of limiting amputation level and decreasing mortality. We aimed to determine the risk factors for limb loss in patients with diabetic foot infection (DFI). METHOD: Data of hospitalised patients with a DFI between 2010 and 2019 were collected retrospectively from their hospital records. Clinical and laboratory findings were analysed according to the type of treatment. RESULTS: Data were collected for 401 patients, 280 (69.8%) of whom were male. The mean age was 59.6±11.1 years. Treatment modalities included: medical treatment (36.4%); debridement/drainage (21.9%); minor amputation (17.7%); and major amputation (23.9%). Forefoot infection (odds ratio (OR): 3.347; 95% confidence interval (Cl): 1.408-7.956) and peripheral arterial disease (OR: 4.990; 95% Cl: 1.225-20.324) were found to be significant in predicting limb loss, while duration of diabetes (≥20 years) and absence of forefoot infection were significant predictors of debridement/drainage. Subgroup analysis showed that high leukocyte levels (>16.4K/µl) and forefoot infections were independent predictors for major and minor amputation, respectively. CONCLUSION: The clinical parameters used in this study are simple, broadly available, cost-effective and promising for predicting limb loss in patients with DFI.

Photoantimicrobial activity of Schiff-base morpholino phthalocyanines against drug resistant micro-organisms in their planktonic and biofilm forms.

Antimicrobial photodynamic inactivation (aPDI) is a treatment for the eradication of drug-resistant micro-organisms. One of the advantages of this technique, is that there is minimal possibility of microbial resistance. Hence, herein, the preparation and characterization of novel neutral and cationic morpholine containing Schiff base phthalocyanines are reported. The cationic complexes gave moderate singlet oxygen quantum yields (ΦΔ) of ∼0.2 in aqueous media. Conversely, the neutral complexes generated very low ΦΔ values making them very poor candidates for antimicrobial studies. The cationic phthalocyanines showed excellent photodynamic activity against planktonic cells of all micro-organisms (Candida albicans, Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Salmonella enterica subspecies enterica serovar Choleraesuis, vancomycin-resistant Enterococcus faecium, and methicillin-resistant Staphylococcus aureus). The efficiency of aPDI was shown to be both concentration and light-dose-dependent. Mono biofilms were susceptible when treated with 200 µM of cationic Pcs at 108 J/cm2. However, ∼10% of the mixed biofilm survived after treatment.

Diiodinated Mono- and Dipyridylvinyl BODIPY Dyes: Photophysicochemical Properties, in vitro Antibacterial Studies, Molecular Docking and Theoretical Calculations.

In this study, novel mono- and dipyridylvinyl boron dipyrromethene dyes are prepared to compare their photodynamic antimicrobial chemotherapy (PACT) activities against Staphylococcus aureus to the corresponding core dyes. Pyridylvinyl substitution at the 3- or 3,5-positions of a meso-4-bromophenylBODIPY core dye via a Knoevenagel reaction with an aromatic 2-bromopyridinecarboxaldehyde shifts the major BODIPY spectral band to longer wavelength. The extended π-conjugation red shifts the main spectral band into the 602-618 nm region in CHCl3 , THF, ethanol and DMSO after monopyridylvinyl substitution and to 685-704 nm after dipyridylvinyl substitution. An enhancement of the population of the T1 state through the incorporation of iodine atoms at the 2,6-positions results in moderately high singlet oxygen quantum yields in DMSO. The π-extended dyes were found to have significantly lower PACT activities than the diiodinated core dye.

Diagnostic and prognostic value of new bioscore in critically ill septic patients.

OBJECTIVE: To evaluate the diagnostic and prognostic value of biomarkers and new bioscore in septic patients in intensive care unit (ICU). MATERIALS AND METHODS: A study was conducted on septic and non-septic patients in ICU. Diagnostic and prognostic values of C-reactive protein (CRP), procalcitonin (PCT), Sequential Organ Failure Assessments (SOFA) score and new bioscore were analysed statistically. RESULTS: A total of 226 patients were enrolled in the study. In septic patients, PCT, SOFA and bioscore were found significantly increased (p = .007, p = .001 and p = .001, respectively). The AUC value of bioscore was higher than PCT and SOFA in septic patients. SOFA was found to be more significant prognostic marker than bioscore in predicting 28-day mortality. The prognostic value of bioscore and SOFA was similar for predicting 90-day mortality. CONCLUSIONS: The new bioscore formed by combination of CRP, PCT and SOFA score may be useful in early diagnosis of sepsis.

The Epidemiology, Clinical Manifestations, Radiology, Microbiology, Treatment, and Prognosis of Echinococcosis: Results of NENEHATUN Study.

Aim: Echinococcosis, caused by Echinococcus species, is an important zoonotic disease causing major health problems in humans and animals. Herein, we aimed to evaluate the epidemiology, clinical and laboratory parameters, radiological, serological, pathological, and treatment protocols of followed-up cases of hydatidosis. Methods: A total of 550 patients diagnosed with hydatid cyst disease were included in this study. Patients who were positive for one or more of the enzyme-linked immunosorbent assay or indirect hemagglutination test, pathological results, or radiological findings were examined. The data analyzed were collected from nine centers between 2008 and 2020. Records were examined retrospectively. Results: Among the patients, 292 (53.1%) were women and 258 (46.9%) were men. The patients' mean age was 44.4 ± 17.4 years. A history of living in rural areas was recorded in 57.4% of the patients. A total of 435 (79.1%) patients were symptomatic. The most common symptoms were abdominal pain in 277 (50.4%), listlessness in 244 (44.4%), and cough in 140 (25.5%) patients. Hepatomegaly was found in 147 (26.7%), and decreased breath sounds were observed in 124 (22.5%) patients. Radiological examination was performed in all cases and serological methods were also applied to 428 (77.8%) patients. The most frequently applied serological test was IHA (37.8%). A single cyst has been found in 66% patients. Hepatic involvement occurred in 327 (59.4%), pulmonary involvement was found in 128 (23.3%), whereas both of them were recorded in 43 (7.8%) patients. Splenic involvement was only detected in nine (1.6%) patients. Echinococcus granulosus (72.5%) was most frequently detected. Cyst diameters of 56.9% of the patients were in the range of 5-10 cm. A total of 414 (75.2%) patients received albendazole as an antiparasitic. Mortality was noted in nine (1.6%) patients. Conclusion: Echinococcosis is an important public health problem in Turkey. It can affect the social, economic, and political structures of the community. Public education and awareness are extremely important.

The antibacterial and antifungal properties of neutral, octacationic and hexadecacationic Zn phthalocyanines when conjugated to silver nanoparticles.

The syntheses and characterization of novel octacationic and hexadecacationic Pcs is reported. With the aim of enhancing singlet oxygen generation efficiencies and hence antimicrobial activities, these Pcs (including their neutral counterpart) are conjugated to Ag nanoparticles (AgNPs). The obtained results show that the conjugate composed of the neutral Pc has a higher loading of Pcs as well as a greater singlet oxygen quantum yield enhancement (in the presence of AgNPs) in DMSO. The antimicrobial efficiencies of the Pcs and their conjugates were evaluated and compared on S. aureus, E. coli and C. albicans. The cationic Pcs possess better activity than the neutral Pc against all the microorganisms with the hexadecacationic Pc being the best. This work therefore demonstrates that increase in the number of cationic charges on the reported Pcs results in enhanced antimicrobial activities, which is maintained even when conjugated to Ag nanoparticles. The high activity and lack of selectivity of the cationic Pcs when conjugated to Ag NPs against different microorganisms make them good candidates for real life antimicrobial treatments.

Promising photodynamic antimicrobial activity of polyimine substituted zinc phthalocyanine and its polycationic derivative when conjugated to nitrogen, sulfur, co-doped graphene quantum dots against Staphylococcus aureus.

Antimicrobial resistance is a most important problem facing the treatment of infectious diseases. Antimicrobial photodynamic therapy is an alternative treatment strategy, considered to be cost-effective and feasible. For this purpose, octa-imine substituted ZnPc (3) have been prepared and conjugated to nitrogen, sulfur co-doped graphene quantum dots (N,S-GQDs) through π-π stacking. The photophysical and photochemical properties of Pc alone and and Pc-conjugated to the GQD nanomaterial such as absorption, fluorescence, fluorescence life time, singlet oxygen quantum yields, triplet state quantum yields and exited state lifetimes were investigated in solutions before in vitro cell studies. The PACT activity of prepared structures was investigated against Gram-positive (Staphylococcus aureus). Our results suggest that the in the case of conjugation of zinc Pc to N,S-GQDs, photodynamic inactivation increased with the 100 % reduction percentage.

Predictive ability of LRINEC score in the prediction of limb loss and mortality in diabetic foot infection.

It was aimed to analyze the effectiveness of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score in predicting amputation and mortality in diabetic foot infection (DFI). Data of 416 patients who were hospitalized for DFI were recorded retrospectively. LRINEC scores were calculated for each patient from laboratory data. The diagnostic performance of LRINEC score was investigated in amputated/nonamputated and survived/deceased patient groups. Median LRINEC score of patients who underwent amputation was higher than those without amputation (P < 0.001). The area under the curve (AUC) value for LRINEC score was 0.638 with the cut-off point of ≥5 in predicting amputation. Median LRINEC score of deceased patients was higher than those who survived (P= 0.022). AUC value for LRINEC score was 0.663 with the cut-off point of ≥7 in predicting mortality. LRINEC score may be a promising scoring system in predicting both amputation and mortality in DFI.

Predictors of mortality in invasive pneumococcal disease: a meta-analysis.

OBJECTIVES: To assess risk factors for mortality in invasive pneumococcal disease (IPD). METHODS: We conducted a systemic literature search in January 2019. The main outcome measure included death within 30 days after diagnosis of IPD. The study protocol was registered in PROSPERO (CRD42019120189). RESULTS: After reviewing 2514 potentially relevant records, remaining 190 articles were included in the analysis. A total of 228,782 IPD patients were identified and the mortality rate was 17.2% in the included articles. No significant evidence of publication bias was found according to the funnel plot and Egger's test (t = 1.464, p = 0.145). Male sex, older age, alcohol abuse, previous tuberculosis, meningitis, hospital acquired infections, multilobar infiltrate or effusion, Pitt bacteremia score≥4, Pneumonia Severity Index≥4, clinical conditions requiring intensive care, underlying clinical conditions, disease caused by serotypes 3, 6B, 9 N, 10A, 11A, 16 F, 17 F, 19, 19 F, 22 F, 23A, 23 F, 31 and 35 F, previous antibiotic use, inappropriate initial antibiotic therapy, penicillin resistance, and vancomycin use during the course of treatment were predicators of 30-day mortality. CONCLUSIONS: This meta-analysis highlights important risk factors for IPD-related mortality, many of which may be targeted through preventive measures.

Evaluation of mortality risk factors in diabetic foot infections.

Identifying risk factors for mortality is crucial in the management of diabetic foot syndrome. We aimed to evaluate risk factors for mortality in patients with diabetic foot infection (DFI). A retrospective chart review was conducted on 401 patients from 2010 through 2019. Our primary endpoint was in-hospital mortality. Patients were divided into two groups according to the outcome (survival or death). Clinical data were compared between the two groups statistically. A total of 401 patients were enrolled in the study, 280 (69.8%) of them were male and the mean age was 59.6 ± 11.1 years. The mean follow-up period was 23.7 ± 22.9 months. In-hospital mortality rate was 3%. Univariate analysis indicated that ischaemic wound (P = .023), hindfoot infection (P = .038), whole foot infection (P = .010), peripheral arterial disease (P = .024), high leucocyte levels (>12 040 K/µL) (P = .001), high thrombocyte levels (>378 000 K/µL) (P < 0.001), high C-reactive protein levels (>8.81 mg/dL) (P = .022), and polymicrobial growth in deep tissue culture (P = .041) were significant parameters in predicting mortality. In multivariate analysis, peripheral arterial disease (odds ratio [OR]: 13.430, 95% confidence interval [Cl]: 1.129-59.692; P = .040), high thrombocyte levels (OR: 1.000, 95% Cl: 1.000-1.000; P = .022), and polymicrobial growth in deep tissue culture (OR: 7.790, 95% Cl: 1.592-38.118; P = .011) were independent risk factors for mortality. In conclusion, peripheral arterial disease, high thrombocyte levels, and polymicrobial growth in deep tissue culture were independent risk factors for mortality in DFI.

Risk factors for focal involvement in brucellosis.

PURPOSE: We aimed to evaluate the risk factors of focal involvement in brucellosis. METHODS: The data of brucellosis patients were analyzed retrospectively from 2010 through 2019. Patients were divided into two groups: focal involvement (-) and focal involvement (+). The clinical findings, complications and laboratory findings of patients were compared between the two groups. RESULTS: Two hundred thirty patients were included in the study. One hundred twenty-seven of the patients (55.2%) were male and mean age was 45.8 ±â€¯17.1 (16-86) years. Focal involvement was observed in 98 (42.6%) patients. The variables that differed significantly between groups were age (P < 0.001), fever (P = 0.016), back pain (P < 0.001), leukocyte (P = 0.012), neutrophil (P = 0.004), platelet (P = 0.002), mean platelet volume (MPV) (P = 0.043) and erythrocyte sedimentation rate (ESR) (P = 0.001). Older age (>45 years) and back pain were found to be independent risk factors for predicting focal involvement (P = 0.036 and P < 0.001). CONCLUSIONS: The clinical findings and markers that are significant in determining focal involvement may be useful in identifying complicated brucellosis.

Acetophenone substituted phthalocyanines and their graphene quantum dots conjugates as photosensitizers for photodynamic antimicrobial chemotherapy against Staphylococcus aureus.

This work reports on the synthesis and characterization of novel acetophenone substituted phthalocyanines along with the self-assembled nanoconjugates formed via π-π stacking interaction between the synthesized unmetalated (2), zinc (3) and indium (4) phthalocyanines and graphene quantum dots (GQDs) to form 2@GQDs, 3@GQDs and 4@GQDs. The complexes and conjugates exhibited high singlet oxygen ranging from 0.20 to 0.79 in DMSO for Pcs and nanoconjugates where in all cases, the indium complexes showed the highest singlet oxygen quantum yields. The photodynamic antimicrobial chemotherapy activity of both phthalocyanines and nanoconjugates were tested against Staphylococcus aureus. 4@GQDs was found to be highly effective causing a 9.68 log reduction of the bacteria at 10 µM (based on Pc) when compared to 3.77 log reduction of 3@GQDs.

Predictive Value of Inflammation Markers in Brucellosis.

BACKGROUND: It is important to identify new biomarkers for early detection of complications and treatment success in patients with brucellosis. METHODS: A total of 187 brucellosis patients in the Department of Infectious Diseases of Izmir Katip Celebi University Ataturk Training and Research Hospital were evaluated retrospectively from January 2010 to January 2016.Complications of brucellosis were hematologic, osteoarticular, genitourinary, neurologic, cardiovascular, gastrointestinal and ocular involvement. Specific organ involvement was defined as the presence of infection signs in any specific anatomic site except hematologic involvement. Neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR) and platelet-to-lymphocyte-ratio (PLR) were evaluated statistically to predict complications and specific organ involvement of brucellosis. RESULTS: Complications occurred in 125 patients. We found that PLR and erythrocyte sedimentation rate (ESR) were higher in complicated patients (P = 0.007, P < 0.001). The area under curve (AUC) for PLR was 0.622 (95% confidence interval [CI], 0.538- 0.707) with a cutoff value of >119.6 in predicting complications in brucellosis. LMR and NLR were not significant in terms of predicting complications in brucellosis. We also evaluated only specific organ involvement as a complication due to frequent occurrence of hematologic abnormalities in brucellosis. ESR, mean platelet volume (MPV), NLR, PLR and LMR were significantly different in patients with specific organ involvement (P = 0.001, P = 0.011, P = 0.001, P = 0.013 and P = 0.040). The AUC values for NLR and LMR were 0.649 (95% CI 0.570-0.728) and 0.589 (95% Cl 0.507-0.671), respectively. CONCLUSION: These biomarkers are cost-effective, simple and broadly available parameters for predicting complications and specific organ involvement of brucellosis.

Crystal structure and Hirshfeld surface analysis of 4-[4-(1H-benzo[d]imidazol-2-yl)phen-oxy]phthalo-nitrile dimethyl sulfoxide monosolvate.

This work presents the synthesis and structural characterization of [4-(1H-benzo[d]imidazol-2-yl)phen-oxy]phthalo-nitrile, a phthalo-nitrile derivative carrying a benzimidazole moiety. The compound crystallizes as its dimethyl sulfoxide monosolvate, C21H12N4O·(CH3)2SO. The dihedral angle between the two fused rings in the heterocyclic ring system is 2.11 (1)°, while the phenyl ring attached to the imidazole moiety is inclined by 20.7 (1)° to the latter. In the crystal structure, adjacent mol-ecules are connected by pairs of weak inter-molecular C-H⋯N hydrogen bonds into inversion dimers. N-H⋯O and C-H⋯O hydrogen bonds with R 2 1(7) graph-set motifs are also formed between the organic mol-ecule and the disordered dimethyl sulfoxide solvent [occupancy ratio of 0.623 (5):0.377 (5) for the two sites of the sulfur atom]. Hirshfeld surface analysis and fingerprint plots were used to investigate the inter-molecular inter-actions in the crystalline state.

Meta-analysis of risk factors for amputation in diabetic foot infections.

BACKGROUND: Knowledge of risk factors is crucial to develop management and treatment protocols for the prevention of lower extremity amputation for patients with diabetic foot infections (DFIs). METHODS: We searched the research literature for studies reporting risk factors for lower extremity amputation in patients with DFI. The main outcome variables included both minor and major amputations. This study was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, and the protocol was registered in PROSPERO (CRD42018118543). RESULTS: A total of 2471 potential articles from the database search met the inclusion criteria. After reviewing the titles, abstracts, and full texts, remaining 25 articles were included in the final analysis. We identified 6132 patients with DFI in the 25 included articles. Of these, 1873 patients who underwent amputation were investigated. Male gender (odds ratio [OR]: 1.31), smoking (OR: 1.38), history of amputation (OR: 1.47), history of osteomyelitis (OR: 1.94), peripheral arterial disease (OR: 2.35), retinopathy (OR: 1.32), International Working Group on the Diabetic Foot (IWGDF) grades 3 and 4 (OR: 1.7 and 2.5), Wagner grades 4 and 5 (OR: 4.3 and 6.4), gangrene/necrosis (OR: 9.9), osteomyelitis (OR: 4.5), neuroischaemic DFI (OR: 3.06), severe infection (OR: 3.12), length of hospitalization (standardized mean difference [SMD]: 0.7), leukocytosis (OR: 1.76), mean erythrocyte sedimentation rate (ESR) (SMD: 0.5), mean C-reactive protein (CRP) (SMD: 0.8), tissue culture positivity (OR: 1.61), and isolation of Gram-negative bacteria from tissue culture (OR: 1.5) were found as predictors of amputation in DFI. CONCLUSIONS: The present study highlighted some differences in diabetic foot ulcers and DFIs in terms of risk factors for lower extremity amputation. These data provide detailed information about risk factors for amputations among patients with DFI, thus contributing to the creation of new classification systems for assessment of high-risk patients.

Evaluation of clinical, diagnostic and treatment aspects in hydatid disease: analysis of an 8-year experience.

BACKGROUND & OBJECTIVE: Echinococcosis is still a common health problem. The aim of this study was to discuss our 8-year data in terms of diagnosis, treatment and follow-up of cystic Echinococcosis. METHODS: A total of 178 patients who had hydatid cyst were analyzed retrospectively from the hospital records. The diagnosis of hydatid cyst was based on clinical-serological and radiological findings. Treatment response was evaluated with clinical, radiological and serological findings. RESULTS: A total of 178 medical records were evaluated; the male:female ratio was 0.73 and mean age 44.6±16.9 years. The most common symptom was abdominal pain (94, 52.8%). The mean cyst size was 9.5±3.9 cm. Eosinophilia was significantly higher in patients with complicated cyst (35.3%) (p=0.002). The average duration of hospitalization in surgical patients was shorter than non-surgical patients (p=0.026). There was no significant correlation between the preference of scolicidal agent (hypertonic saline, H2O2, povidone iodine) and recurrence in patients who underwent surgery (p>0.05). There was no significant difference between the patients who underwent radical and conservative surgery in terms of complication and recurrence (p=0.077, p=0.557). No significant difference was found between percutaneous and surgical treatment in terms of complication and recurrence (p=0.264, p=0.276). CONCLUSION: Even though considerable progress has been made, uncertainties remain in the diagnosis and treatment of Echinococcosis. Hence, standardized diagnostic and treatment procedures should be established with well-designed studies.

Erratum: Crystal structure and Hirshfeld surface analysis and of 2-ammoniumylmeth-yl-1H-benzimidazol-3-ium chloride monohydrate. Corrigendum.

[This corrects the article DOI: 10.1107/S205698901801335X.].

Infection markers as predictors of Bacteremia in an Intensive Care Unit: A prospective study.

OBJECTIVE: Although several biomarkers have been evaluated for the diagnosis and prognosis of sepsis, the gold standard biomarker has not yet been found. We aimed to evaluate the diagnostic value of neutrophil-to-lymphocyte count ratio (NLCR), neopterin, pro-adrenomedullin (pro-ADM) and the other infection markers to predict bacteremia in patients with SIRS, sepsis and severe sepsis/septic shock. METHODS: A prospective cohort study was conducted on septic patients in a tertiary referral hospital between December 2014- July 2015. A total of 156 patients diagnosed with SIRS, sepsis and severe sepsis/septic shock in Anesthesia intensive care unit (ICU) were included in the study. RESULTS: A total of 156 patients who had been diagnosed as SIRS(10.9%), sepsis (44.2%) and severe sepsis/septic shock (44.9%) were included. Positive blood cultures were obtained in 64 patients. NLCR, neopterin and pro-ADM levels were insignificant in predicting bacteremia (p>0.05). The mortality rate was significantly higher in bacteremic sepsis (43.9%) compared to non-bacteremic patients (20.8%) (p=0.001). Only procalcitonin levels were significant predictor of mortality (p<0.001). CONCLUSION: NLCR, CRP, procalcitonin, neopterin and pro-ADM levels were insignificant in diagnosis of bacteremia in critically ill patients. The gold standard method in predicting bacteremia is still blood culture positivity.

Crystal structure and Hirshfeld surface analysis and of 2-ammoniumylmeth-yl-1H-benzimidazol-3-ium chloride monohydrate.

The asymmetric unit of the title compound, C8H11N3 2+·2Cl-·H2O, contains three organic cations, six chloride anions and three water mol-ecules of crystallization, which are connected by extensive hydrogen-bonding inter-actions into a three-dimensional supra-molecular architecture. Hirshfeld surface analysis and two-dimensional fingerprint plots indicate that the most important contributions to the crystal packing are from H⋯H (37.4%), Cl⋯H/H⋯Cl (35.5%), C⋯H/H⋯C (9.5%) and C⋯C (6.9%) inter-actions.