The significance of cervical discopathy diagnosis in patients with mastalgia.

OBJECTIVE: The primary aim of this study was to explore the involvement of cervical discopathy in the development of non-cyclic mastalgia by employing cervical magnetic resonance imaging (MRI). PATIENTS AND METHODS: A total of 407 patients were included in the study. Individualized management plans were developed for each patient. Pathological findings in MRI results were assessed by specialists in physical therapy and neurosurgery, and appropriate treatment was administered. Visual assessments of patients were conducted. The Analog Scale (VAS) scoring system was used at the initial presentation, and patients were evaluated at 1 and 3 months following the treatment. RESULTS: In the MRI examinations of the patients included in the study, simultaneous cervical disc protrusion was observed in 29% (n: 124) of those with annular bulging. Comparing the VAS scores of patients before treatment, at the 1st and at the 3rd month showed a significant decrease in mastalgia pain (p < 0.001). CONCLUSIONS: The diagnosis of cervical discopathy holds significant importance in the treatment of mastalgia patients. Therefore, clinicians should keep the cervical spine in mind as a potential contributing factor to mastalgia.

Predictive value of immature granulocyte and delta neutrophil index in the diagnosis of complicated acute cholecystitis.

OBJECTIVE: The complicated gallbladder disorders are associated with increased mortality and morbidity. Thus, this study was aimed at evaluating the predictive value of immature granulocyte count and delta neutrophil index in the prediction of complicated cholecystitis. PATIENTS AND METHODS: We retrospectively reviewed patients who underwent surgery for acute cholecystitis between January 2018 and April 2022. Overall, 351 patients fulfilling the inclusion criteria were included in the study. In all patients, demographic data, immature granulocyte count (IGC), delta neutrophil index (DNI), white blood cell (WBC) count, C-reactive protein (CRP), and albumin levels were recorded. Based on operative findings and histopathological examination, the patients were classified into 2 groups uncomplicated (group I) and complicated (e.g., perforation, gangrenous and emphysematous cholecystitis; group II) groups. The IBM SPSS version 26.0 (SPSS Corp, Armonk, NY, USA) was used to assess differences in blood parameters between groups. The predictive values of the parameters evaluated were estimated using ROC analysis. A p-value<0.05 was considered statistically significant. RESULTS: Acute complicated cholecystitis was found in 138 of 351 patients. No significant difference was detected in age and gender distribution between groups (p=0.352 and p=0.214, respectively). When blood parameters were assessed, it was found that IGC, DNI, WBC, and CAR values were significantly higher in group II (p<0.001; p<0.001, p<0.001, and p=0.036, respectively), while there was no significant difference in CRP and albumin between groups (p=0.099 and p=0.53, respectively). In the ROC analysis, the highest AUC value was found for IG count and DNI (0.784 and 0.775, respectively). The sensitivity and specificity were found as 68.8% and 86.9% for IG count and 49.3% and 96.2% for DNI, respectively. CONCLUSIONS: The IG count and DNI are two novel parameters with strong predictive value in the early diagnosis of acute complicated cholecystitis, which may support clinical findings, imaging studies, and other laboratory parameters.

The relationship between papillary thyroid cancer and triglyceride/glucose index, which is an indicator of insulin resistance.

OBJECTIVE: The incidence of thyroid cancer and metabolic syndrome has been increasing at the same rate over the past few decades. We hypothesized that there would be a direct relationship between thyroid papillary cancer and triglyceride/glucose index (TyG). PATIENTS AND METHODS: A total of 382 operated patients were divided into two groups: patients operated on for papillary thyroid cancer and for non-malignant reasons. Each patient's age, gender, operation times, presence of neck dissection, serum thyroid-stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4), fasting blood glucose and triglyceride levels were scanned retrospectively from the archive system. RESULTS: TyG index was statistically higher in the malignant group. Receiver operating characteristic (ROC) curves obtained for TyG levels at the time of diagnosis of thyroid papillary cancer were AUC: 0.608. The threshold value for TyG was 6,252. The sensitivity of this value was 62.8% and the specificity was 49.2%. CONCLUSIONS: In this study, we investigated the predictive effect of the TyG index in differentiating thyroid papillary carcinoma from non-malignant thyroid lesions. We concluded that the TgY index can be used to identify people at high risk of thyroid papillary cancer and to plan treatment.

The role of immature granulocyte count and delta neutrophil index in the early prediction of mesenteric ischemia.

OBJECTIVE: Mesenteric ischemia is a fatal condition leading to ischemia and necrosis of the intestines following the interruption of blood flow in the vessels feeding the intestines. The present study investigated the significance of immature granulocyte count and delta neutrophil index in the early prediction of mesenteric ischemia. PATIENTS AND METHODS: The study included 248 patients who applied to the hospital between 01.01.2020 and 01.04.2022 and underwent emergency and elective bowel resection in the general surgery clinic. The study population was divided into two groups as patients who underwent surgery for causes non-related to mesenteric ischemia (Group 1) and patients with findings of mesenteric ischemia who underwent laparotomy (Group 2). Preoperative immature granulocyte counts, and delta neutrophil index levels were compared between the groups with and without perioperative mesenteric ischemia. RESULTS: No statistical difference was observed between the groups in terms of age or sex. Comparing the two groups regarding immature granulocyte count and delta neutrophil index revealed a statistically significant difference (p<0.001). The median immature granulocyte count was 0.04 (0.02-0.06) in Group 1 and 1.83 (0.18-2.5) in Group 2, with a statistically significant difference (p<0.001). Also, the comparison of delta neutrophil index levels revealed a median value of 0.4 (0.2-0.6) in Group 1 and 5.6 (0.7-8.1) in Group 2, with a statistically significant difference. CONCLUSIONS: The results of this study have demonstrated that immature granulocyte counts, and delta neutrophil index levels are reliable markers that do not require any additional time or expense, can be easily measured in a complete blood count, and can be used for evaluating intestinal necrosis in mesenteric ischemia.

Predictive value of triglyceride/glucose index (TyG) in predicting breast cancer in patients with breast mass.

OBJECTIVE: Since both breast carcinogenesis and the triglyceride glucose index (TyG) are associated with metabolic syndrome, this study aims at focussing on the TyG index in the breast control group to investigate risk factors causing breast cancer. The predictive value of triglyceride glucose score in predicting breast cancer was investigated. PATIENTS AND METHODS: Patients with a pathological diagnosis of cancer and patients with benign breast lesions who were operated on between May 2018 and December 2021 were included in the study. Patients were divided into two groups: those with Breast Cancer (BC) and those with benign breast lesions. The predictive value of the TyG in predicting breast cancer was investigated. The mean standard deviation (SD) or median values with a 25-75 percent interquartile range (IQR) were used to represent the distribution of continuous data. The Student's t-test was used to evaluate parametric values, and the Mann-Whitney U test was used to analyze non-parametric values. The Chi-square test was used to see if categorical variables could be compared. The optimal cut-off points for the TyG value had been determined using receiver operating curve (ROC) analysis. Cut-off points that are optimal for the TyG value were determined using receiver operating curve (ROC) analysis. RESULTS: The patients in the study had a median age of 51 [IQR (25-75) = 44-62]. Of the 510 patients who had been operated for a breast lesion, 13 were male and 499 were female. While the median glucose value of the patients was 97 [IQR (25-75) = 89-109-9], the median triglyceride value was 155 [IQR (25-75): 86-159]. When glucose and triglyceride values were examined, group I seemed to have significantly lower values (p<0.001, p=0.001, respectively). The mass size was larger in group 2 (p<0.001). In addition, ln TyG was statistically higher in the malignant group (p<0.001). Receiver operating characteristic curves were obtained for TyG levels in BC diagnosis. (AUC = 0.606, standard error 0.025, p<0.001; 95% CI = 0.556-0.655). The cut-off value for TyG was 8,628. The sensitivity of this value was 57.5% and the specificity was 42.6%. CONCLUSIONS: In this study, we investigated the predictive effect of the TyG index in distinguishing benign and malignant lesions of the breast and concluded that the TyG index can be used to differentiate BC in patients with BC.

The predictive value of platelet/mean platelet volume ratio in predicting colon diverticulitis relapse.

OBJECTIVE: Diverticulitis is a health problem that has increased in frequency recently. It has a wide spectrum from simple inflammation to fecal peritonitis, sepsis and even mortality. Thus, it is important to predict diverticulitis, especially recurrent diverticulitis, and take measures to prevent it. In this study, we investigated the predictive value of the PLT/MPV ratio, which is an inflammation marker in predicting the recurrence of diverticulitis disease. PATIENTS AND METHODS: In this study, 132 patients diagnosed with diverticulitis were analyzed retrospectively. Patients' gender, age, localization of diverticulitis, number of diverticula in computed tomography (CT), hospitalization status, length of hospitalization, control colonoscopies, polyps' number and localizations in colonoscopies, presence of malignancy, need for surgery, and recurrences were not reported. White blood cell (WBC), Neutrophil (NE), Lymphocyte (LY), Hemoglobin (Hb), PLT, MPV, Albumin, Creatine Kinase (CK) and C-reactive protein (CRP) levels were examined. The patients were divided into two groups as those who did not relapse concerning diverticulitis and those who did, and statistical analysis was performed between the two groups about related parameters. RESULTS: Among all patients, recurrence was seen in 11 (10.1%) patients. The patients were divided into two groups according to their recurrence status and statistical significance was sought between the data. The calculated PLT/MPV ratio of patients who did not relapse was 25.61±8.05 and 34.98±11.37 for those who had a relapse (p=0.006). The sensitivity for MPV was 81.8%, a specificity of 57.1% and a cut-off of 9.85. The cut-off value for PLT was 207.5 with 100% sensitivity and 33.7% specificity. A cut-off value of 25.11 was found for PLT/MPV with 100% sensitivity and 49% specificity. CONCLUSIONS: PLT/MPV ratio was significantly higher in relapsed cases. Since it is easily accessible and inexpensive, it will guide physicians for diagnosis concerning early detection of relapse cases and initiation of appropriate treatment.

The determination of carbapenem resistance in Escherichia coli and Pneumoniae isolates related to nosocomial infections and the evaluation of risk factors.

We aimed to investigate carbapenem resistance, resistance mechanisms, risk factors and epidemiological features of Escherichia coli and Klebsiella pneumoniae strains isolated from related infections in intensive care unit (ICU) patients. Carbapenemase activity was determined by MHT, MBL Etest and enzyme extraction methods. Presence of extended-spectrum beta-lactamase (ESBL) and carbapenemase-encoding genes were investigated by PCR and sequencing. Clonal relationship of the strains was investigated by pulse field gel-electrophoresis. Acquired AmpC and Qnr were investigated by PCR. Throughout this study, 1,657 patients, and 11,483 hospitalization days were followed by active surveillance in the ICU of our 1,000-bed training hospital. Out of 108 of 196 patients, 130 E. coli- and K. pneumoniae-related nosocomial infections were determined. Minimum inhibitory concentration (MIC) levels of ertapenem were > or = 1 mg/1 in 14 K. pneumoniae and 2 E. coli strains. The highest MIC level of carbapenem was found in K. pneumoniae and E. coli strains of > or = 128 mg/l and 8 mg/l, respectively. In the carbapenem resistant strains, KPC and MBL activity were not found. On the other hand, 14 strains of K. pneumoniae and one strain of E. coli exhibited OXA-48 beta-lactamase activity. Fifty-seven percent of K. pneumoniae isolates produced OXA-48 orginating from two clones and remaining isolates originated from different clones. Thus carbapenem resistance was determined as 22% and 3% in K. pneumoniae and E. coli strains, respectively. Invasive devices, duration of total parenteral nutrition, duration of hospitalization, presence of transfusions, ESBL and multiple drug resistance were found to be risk factors for carbapenem resistance.

Comparison of colistin-carbapenem, colistin-sulbactam, and colistin plus other antibacterial agents for the treatment of extremely drug-resistant Acinetobacter baumannii bloodstream infections.

The purpose of this investigation was to compare the efficacy of colistin-based therapies in extremely drug-resistant Acinetobacter spp. bloodstream infections (XDR-ABSI). A retrospective study was conducted in 27 tertiary-care centers from January 2009 to August 2012. The primary end-point was 14-day survival, and the secondary end-points were clinical and microbiological outcomes. Thirty-six and 214 patients [102 (47.7%): colistin-carbapenem (CC), 69 (32.2%): colistin-sulbactam (CS), and 43 (20.1%: tigecycline): colistin with other agent (CO)] received colistin monotherapy and colistin-based combinations, respectively. Rates of complete response/cure and 14-day survival were relatively higher, and microbiological eradication was significantly higher in the combination group. Also, the in-hospital mortality rate was significantly lower in the combination group. No significant difference was found in the clinical (p = 0.97) and microbiological (p = 0.92) outcomes and 14-day survival rates (p = 0.79) between the three combination groups. Neither the timing of initial effective treatment nor the presence of any concomitant infection was significant between the three groups (p > 0.05) and also for 14-day survival (p > 0.05). Higher Pitt bacteremia score (PBS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Charlson comorbidity index (CCI), and prolonged hospital and intensive care unit (ICU) stay before XDR-ABSI were significant risk factors for 14-day mortality (p = 0.02, p = 0.0001, p = 0.0001, p = 0.02, and p = 0.01, respectively). In the multivariable analysis, PBS, age, and duration of ICU stay were independent risk factors for 14-day mortality (p < 0.0001, p < 0.0001, and p = 0.001, respectively). Colistin-based combination therapy resulted in significantly higher microbiological eradication rates, relatively higher cure and 14-day survival rates, and lower in-hospital mortality compared to colistin monotherapy. CC, CS, and CO combinations for XDR-ABSI did not reveal significant differences with respect to 14-day survival and clinical or microbiological outcome before and after propensity score matching (PSM). PBS, age, and length of ICU stay were independent risk factors for 14-day mortality.

The microbiologic profile of diabetic foot infections in Turkey: a 20-year systematic review: diabetic foot infections in Turkey.

The causative pathogens in diabetic foot infections differ in studies of European compared with Asian populations. The purpose of this study was to determine the causative microorganisms and their antibiotic sensitivity patterns in diabetic patients with a foot infection in Turkey, a country at the crossroads of these two continents. We performed a comprehensive literature search to identify all published studies pertaining to DFIs in patients cared for in Turkey. To assess changes in causative organisms and their antibiotic sensitivity patterns over time, we compared the results of just the most recent 5 years (2007-2011) with those of the past 20-years (1989-2011). We identified 31 studies meeting our inclusion criteria. Overall, these studies reported 2,097 patients, from whom 1,974 microorganisms were isolated. The total percentage of gram-negative and gram-positive aerobic bacteria were similar in each of the assessed periods. The rate of isolation of Staphylococcus aureus during the entire period, compared with just the past 5 years, was 23.8% and 19.1%, respectively, while the rate of methicillin-resistant S. aureus was 7.8% and 5.7%, respectively. The isolation rate of Pseudomonas aeruginosa was 13.7% for the entire period and 14.9% for the past 5 years. While linezolid, vancomycin and teicoplanin were the most active agents against gram-positive microorganisms, imipenem and cefoperazone-sulbactam were the most active against gram-negative microorganisms. This systematic review demonstrated few substantial changes in diabetic foot microbiology over the past 20 years. The data may help develop and update local clinical guidelines regarding antibiotic therapy for diabetic foot infections in Turkey. Further studies, especially with optimal culture methods, would be useful to validate these findings.

Update on treatment options for spinal brucellosis.

We evaluated the efficacy and tolerability of antibiotic regimens and optimal duration of therapy in complicated and uncomplicated forms of spinal brucellosis. This is a multicentre, retrospective and comparative study involving a total of 293 patients with spinal brucellosis from 19 health institutions. Comparison of complicated and uncomplicated spinal brucellosis was statistically analysed. Complicated spinal brucellosis was diagnosed in 78 (26.6%) of our patients. Clinical presentation was found to be significantly more acute, with fever and weight loss, in patients in the complicated group. They had significantly higher leukocyte and platelet counts, erythrocyte sedimentation rates and C-reactive protein levels, and lower haemoglobulin levels. The involvement of the thoracic spine was significantly more frequent in complicated cases. Spondylodiscitis was complicated, with paravertebral abscess in 38 (13.0%), prevertebral abscess in 13 (4.4%), epidural abscess in 30 (10.2%), psoas abscess in 10 (3.4%) and radiculitis in 8 (2.7%) patients. The five major combination regimens were: doxycycline 200 mg/day, rifampicin 600 mg/day and streptomycin 1 g/day; doxycycline 200 mg/day, rifampicin 600 mg/day and gentamicin 5 mg/kg; doxycycline 200 mg/day and rifampicin 600 mg/day; doxycycline 200 mg/day and streptomycin 1 g/day; and doxycycline 200 mg/day, rifampicin 600 mg/day and ciprofloxacin 1 g/day. There were no significant therapeutic differences between these antibiotic groups; the results were similar regarding the complicated and uncomplicated groups. Patients were mostly treated with doxycycline and rifampicin with or without an aminoglycoside. In the former subgroup, complicated cases received antibiotics for a longer duration than uncomplicated cases. Early recognition of complicated cases is critical in preventing devastating complications. Antimicrobial treatment should be prolonged in complicated spinal brucellosis in particular.

Emergence and co-infections of West Nile virus and Toscana virus in Eastern Thrace, Turkey.

The objective of this study was to identify the impact of West Nile virus (WNV) and Toscana virus (TOSV) in febrile diseases of unknown aetiology in Eastern Thrace, Turkey; this study was conducted during August-October 2012, and included 18 clinical cases and 296 blood donors for local serosurveillance. Antibodies were determined via commercial assays and further tested for specificity via neutralization assays (NA). Viral RNAs were sought via specific and/or generic primers. WNV infections were diagnosed in seven patients (38.8%), detected via RNA+IgM in four, RNA in one and IgM and low avidity IgG in two cases. The most common symptom was fever (>38°C), followed by headache, malaise/fatigue, myalgia/arthralgia, muscle stiffness/lower back pain, anorexia, nausea/vomiting, diarrhoea, supraorbital/retrobulbar pain and abdominal pain. Neurological symptoms were noted in one individual. WNV strains in RNA-detectable patients were characterized as lineage 1. TOSV RNA or IgM were identified in two individuals with confirmed WNV infections and in one patient without evidence of WNV exposure. The clinical and laboratory findings in individuals with WNV/TOSV co-infection were comparable to those in WNV-induced disease. The TOSV strain in the patient with detectable viral RNA was characterized as genotype A. In local blood donors, seroreactivity for specific WNV and TOSV immunoglobulins was observed in 1.7% (5/296) and 14.4% (26/180), respectively. These findings indicate the emergence of WNV and TOSV-associated diseases in Eastern Thrace. WNV/TOSV co-infections were documented for the first time.

Orchiectomy performed in two patients with brucella orchitis mimicking testicular tumour / Orquiectomía realizada en dos pacientes con orquitis brucelosa semejante a un tumor testicular

Brucellosis is a zoonosis caused by gram negative coccobacilli and it is an endemic infectious disease in Turkey. Infection is usually acquired as a result of direct contact with infected animals or by consuming milk or cheese freshly made from them. There exists a wide spectrum of clinical signs and symptoms in brucellosis. Many systems including musculoskeletal, gastrointestinal, cardiovascular and genitourinary may be involved in brucellosis. The genitourinary system is affected in 2% to 20% of the cases with brucellosis. The most common forms of brucellosis are epididymo-orchitis, testicular abscess and atrophy. The serum agglutination test to detect the presence of antibodies is a reliable test in patients with urogenital symptoms. Long-term and combined antibacterial therapy have been found to be effective in brucellosis. We present two cases undergoing orchiectomy because of testicular mass before the diagnosis ofbrucellosis was made.

La brucelosis es una zoonosis causada por cocobacilos gram negativos, y es una enfermedad infecciosa endémica en Turquía. La infección generalmente se adquiere como resultado del contacto directo con animales infectados o por consumo de leche o queso recién producidos a partir de ellos. Existe un amplio espectro de signos y síntomas clínicos de la brucelosis. Muchos sistemas, incluyendo los sistemas musculoesquelético, cardiovascular, gastrointestinal y génitourinario, pueden estar implicados en la brucelosis. El sistema génitourinario se ve afectado en 2% a 20% de los casos con brucelosis. Las formas más comunes de brucelosis son la epidídimo-orquitis, el absceso testicular, y la atrofia. La prueba de aglutinación de suero para detectar la presencia de anticuerpos es una prueba confiable en pacientes con síntomas urogenitales. Se ha hallado que la terapia antibacteriana combinada y a largo plazo son eficaces en la brucelosis. Presentamos dos casos sometidos a orquiectomía debido a una masa testicular antes de que se realizara el diagnóstico de brucelosis.

Intraabdominal abscess related fungaemia caused by Rhodotorula glutinis in a non-neutropenic cancer patient.

Rhodotorula glutinis is a rare fungal infection that is especially observed in immune-compromised patients. It is common in the skin, faeces, nails, sputum, gastrointestinal system and adenoid tissue. However, the incidence of Rhodotorula glutinis is increased in both local and systemic infections in recent years. Presented here is a case of Rhodotorula glutinis fungaemia that isolated from subhepatic abscess formation and blood in a patient who was operated with Roux-en-Y technique due to gastric adenocarcinoma. Fungal sepsis is an important cause of fever resistant to antibiotic therapy that is often taken into marginal account. It should instead be particularly considered in patients with a history of intraabdominal surgery and non-neutropenic cancer patients. The case described illustrates an episode of systemic infection by Rhodotorula glutinis, correlated with the presence of intraabdominal abscess and without central venous catheters. This is the first case of fungaemia by Rhodotorula glutinis with an intraabdominal abscess source reported from Turkey.

Orchiectomy performed in two patients with Brucella orchitis mimicking testicular tumour.

Brucellosis is a zoonosis caused by gram negative coccobacilli and it is an endemic infectious disease in Turkey. Infection is usually acquired as a result of direct contact with infected animals or by consuming milk or cheese freshly made from them. There exists a wide spectrum of clinical signs and symptoms in brucellosis. Many systems including musculoskeletal, gastrointestinal, cardiovascular and genitourinary may be involved in brucellosis. The genitourinary system is affected in 2% to 20% of the cases with brucellosis. The most common forms of brucellosis are epididymo-orchitis, testicular abscess and atrophy. The serum agglutination test to detect the presence of antibodies is a reliable test in patients with urogenital symptoms. Long-term and combined antibacterial therapy have been found to be effective in brucellosis. We present two cases undergoing orchiectomy because of testicular mass before the diagnosis of brucellosis was made.

Diagnosis of chronic brucellar meningitis and meningoencephalitis: the results of the Istanbul-2 study.

No detailed data exist in the literature on the accurate diagnosis of chronic brucellar meningitis or meningoencephalitis. A multicentre retrospective chart review was performed at 19 health centres to determine sensitivities of the diagnostic tests. This study included 177 patients. The mean values of CSF biochemical test results were as follows: CSF protein, 330.64 ± 493.28 mg/dL; CSF/ blood-glucose ratio, 0.35 ± 0.16; CSF sodium, 140.61 ± 8.14 mMt; CSF leucocyte count, 215.99 ± 306.87. The sensitivities of the tests were as follows: serum standard tube agglutination (STA), 94%; cerebrospinal fluid (CSF) STA, 78%; serum Rose Bengal test (RBT), 96%; CSF RBT, 71%; automated blood culture, 37%; automated CSF culture, 25%; conventional CSF culture, 9%. The clinician should use every possible means to diagnose chronic neurobrucellosis. The high seropositivitiy in brucellar blood tests must facilitate the use of blood serology. Although STA should be preferred over RBT in CSF in probable neurobrucellosis other than the acute form of the disease, RBT is not as weak as expected. Moreover, automated culture systems should be applied when CSF culture is needed.

Intramedullary hydatid cyst of the cervical spine.

Hydatid disease (Echinococcosis) is a common parasitic infection caused by Echinococcus granulosus mainly in sheep-raising areas of the world. Liver, lungs and brain are the predominantly involved organs. However, 0.5-1% of the hydatid disease involves the spine and in 90% of the cases it is confined to the bone and the epidural space. Although intramedullary involvement is extremely rare, in this report, we present a 55-year-old female patient who was diagnosed with a cervical intramedullary hydatid cyst during magnetic resonance imaging of the cervical vertebrae. Accordingly, we imply that particularly in endemic areas, hydatid cyst disease should be kept in mind for the differential diagnosis of spinal mass lesions.

Prospective analysis of nosocomial infections in a burn care unit, Turkey.

BACKGROUND & OBJECTIVE: Prevention of infection in burned patients poses a great challenge as infection is the most common cause of mortality after burn injury. An analysis of burned patients, admitted and treated between January 2004 and December 2005 in a nine-bed burn unit in Turkey, was performed prospectively to identify the common pathogens and incidence of nosocomial infection in these patients. METHODS: Of the 182 burn cases admitted to Burn Care Unit during the study period, 169 met the inclusion criteria. Information related to nosocomial infection (NI) was collected. Samples were collected for culture and microorganisms isolated were tested for antimicrobial sensitivity. RESULTS: Of the 169 burn patients, 127 acquired 166 nosocomial infection (NI) (15.7% pneumonia, 56.0% burn wound infection, 8.4% urinary tract infection and 19.9% blood stream infection) with an overall NI rate of 18.2 per 1000 patient-days. The mean age (38 +/- 21 yr), the mean length of hospitalization (45.06 +/- 11.67 days) and the total burned surface area (TBSA) (34.58 +/- 18.46%) of the patients with NI were higher than those of the patients with non NI (23 +/- 17 yr), (16.38 +/- 11.14 days) and (12.44 +/- 8.69%) (P=0.03, P=0.001, P=0.01) respectively. By multiple logistic regression analysis, TBSA co-morbidities, broad spectrum antibiotic usage and invasive devices usage were significantly related to acquisition of NI. Pseudomonas aeruginosa (57%), Acinetobacter baumannii (21%) and Staphylococcus aureus (14%) were the most common resistant organisms isolated. INTERPRETATION & CONCLUSION: Our findings emphasize the need for careful disinfection and more strict infection control procedures in areas that serve immunosupressed individuals, such as burn patients.

The preventive effect of diphenhydramine on bacterial growth in propofol: a laboratory study.

BACKGROUND AND OBJECTIVE: Diphenhydramine has local anaesthetic and antimicrobial activity and may be used to prevent intravenous propofol injection pain. We studied the effect of adding diphenhydramine to propofol emulsions for preventing bacterial growth. METHODS: Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli and Candida albicans cultures were inoculated into the following solutions: 1% propofol, 0.05% diphenhydramine + 1% propofol, 0.1% diphenhydramine + 1% propofol, 0.2% diphenhydramine + 1% propofol, 0.3% diphenhydramine + 1% propofol, 1% diphenhydramine and 0.1% lidocaine + 1% propofol. A 100-microL of inoculum suspension adjusted for each of the micro-organisms was added separately to each tube and left at 20 degrees C. A 10-microL aliquot of each mixture was inoculated onto blood agar medium at 5 and 24 h. These plates were incubated at 35 degrees C for 24 h. Each plated medium was read, and the number of colony-forming units were counted and recorded (n = 2). Analysis of variance (ANOVA) with a post hoc Tukey HSD test and paired t-tests were used for data analysis. P < 0.05 was considered as significant. RESULTS: Diphenhydramine inhibited bacterial growth in propofol solutions in a dose-dependent manner. It was more effective than 0.1% lidocaine at similar concentrations in preventing bacterial growth for all organisms. CONCLUSION: Diphenhydramine had a significant inhibitory effect on bacterial growth in propofol.