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In this study, it was aimed to reveal the in vitro interactions of combinations of colistin with meropenem, rifampicin and tigecycline in colistin-resistant, biofilm-forming Klebsiella pneumonia. A total of 30 isolates, 15 of which formed biofilms and 15 did not form biofilms, were randomly selected from K. pneumoniae isolates growing in blood samples. The synergy rates of colistin-meropenem, colistin-tigecycline, colistin-rifampicin combinations in planktonic/sessile bacteria are; It was determined as 83,3%/73,3%, 66,6%/33,3%, 100%/60% respectively. Biofilm inhibitory concentration (BIC) of colistin, meropenem, tigecycline, and rifampicin significantly increased after biofilm formation. The synergistic activity seen in the sessile form was independent of the planktonic form. Although a high synergistic effect was observed in the meropenem-colistin combination on sessile bacteria, colistin had very high BIC ââin all combinations. Large-scale studies are needed in which the number of isolates studied is large, bacterial resistance profiles are evaluated genomically, and various antimicrobial groups are included.
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BACKGROUND: Enterocytozoon bieneusi is the most common species found in humans. Although E. bieneusi has been investigated in humans, genotype profile of E. bieneusi is not known in Türkiye. METHODS: In this study, we screened E. bieneusi in patients (n = 94) with different types of malignant solid tumors by Real Time PCR and then sequenced E. bieneusi positive samples. All cancer patients were undergoing chemotherapy and had diarrhea. Moreover, as control groups, we also screened E. bieneusi in patients with diarrhea (n = 50) and without diarrhea (n = 50). RESULTS: Among all patients analyzed, 33 (17%) were found to be E. bieneusi-positive. As the patients were categorized, the molecular prevalence of E. bieneusi increased to 25.5% among cancer patients with diarrhea. However, the molecular prevalence of E. bieneusi was found to be lower in patients with presenting only diarrhea (8%) and patients without diarrhea (10%). The high molecular prevalence value detected among cancer patients with diarrhea was also statistically significant compared to other patient groups (P = 0.00112 and P = 0.0269). Among the 33 Real Time PCR positive samples, 10 of them were amplified by nested PCR and among these 10 samples, 6 of them were successfully genotyped. The phylogenetic tree showed the presence of D and Type IV which were also identified in stray cats living in Izmir in our previous study. CONCLUSIONS: High molecular prevalence value indicates the importance of screening stool samples of cancer patients with diarrhea for E. bieneusi and genotyping results indicate that D and Type IV are circulating between humans and cats.
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Diarreia , Enterocytozoon , Genótipo , Microsporidiose , Neoplasias , Humanos , Enterocytozoon/genética , Enterocytozoon/isolamento & purificação , Microsporidiose/microbiologia , Microsporidiose/epidemiologia , Microsporidiose/veterinária , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Masculino , Feminino , Diarreia/microbiologia , Diarreia/epidemiologia , Pessoa de Meia-Idade , Prevalência , Adulto , Idoso , Reação em Cadeia da Polimerase em Tempo Real , Adulto Jovem , Filogenia , Análise de Sequência de DNA , Antineoplásicos , DNA Fúngico/genética , Idoso de 80 Anos ou mais , Fezes/microbiologiaRESUMO
BACKGROUND: Carbapenem-resistant Acinetobacter baumannii (CRAB) infections are one of the most common causes of nosocomial infections and have high mortality rates due to difficulties in treatment. In this study, the in vitro synergistic interactions of the colistin (CT)-meropenem (MEM) combination and patient clinical outcomes were compared in CRAB-infected patients that receive CT-MEM antimicrobial combination therapy. In addition, in vitro synergistic interactions of MEM-ertapenem (ETP), MEM-fosfomycin (FF) and CT-FF antimicrobial combinations were investigated. Finally, the epsilometer (E) test and checkerboard test results were compared and the compatibility of these two tests was evaluated. METHODS: Twenty-one patients were included in the study. Bacterial identification was performed with MALDI-TOF, and antimicrobial susceptibility was assessed with an automated system. Synergy studies were performed using the E test and checkerboard method. RESULTS: For the checkerboard method, the synergy rates for CT-MEM, MEM-FF, MEM-ETP and CT-FF were 100%, 52.3%, 23.8% and 28.5%, respectively. In the E test synergy tests, synergistic effects were detected for two isolates each in the CT-MEM and CT-FF combinations. Microbial eradication was achieved in nine (52.9%) of the 17 patients that received CT-MEM combination therapy. The agreement between the E test and the checkerboard test was 6.5%. CONCLUSIONS: A synergistic effect was found with the checkerboard method for the CT-MEM combination in all isolates in our study, and approximately 70% of the patients benefited from treatment with this combination. In addition, more than half of the isolates showed a synergistic effect for the MEM-FF combination. Combinations of CT-MEM and MEM-FF may be options for the treatment of CRAB infections. However, a comprehensive understanding of the potential of the microorganism to develop resistant mutants under applied exposures, as well as factors that directly affect antimicrobial activity, such as pharmacokinetics/pharmacodynamics, is essential for providing treatment advice. We found a low rate of agreement between the E test method and the checkerboard test method in our study, in contrast to the literature. Comprehensive studies that compare clinical results with methods are needed to determine the ideal synergy test and interpretation method.
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Infecções por Acinetobacter , Acinetobacter baumannii , Antibacterianos , Carbapenêmicos , Colistina , Testes de Sensibilidade Microbiana , Acinetobacter baumannii/efeitos dos fármacos , Humanos , Colistina/farmacologia , Carbapenêmicos/farmacologia , Masculino , Feminino , Pessoa de Meia-Idade , Testes de Sensibilidade Microbiana/métodos , Antibacterianos/farmacologia , Antibacterianos/administração & dosagem , Idoso , Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/microbiologia , Adulto , Sinergismo Farmacológico , Idoso de 80 Anos ou mais , Quimioterapia Combinada/métodos , Meropeném/farmacologia , Meropeném/administração & dosagemRESUMO
This multicentre (22 centres in Turkey) retrospective cohort study aimed to assess the clinical outcomes of patients with neutropenic fever and SARS-CoV-2 positivity. Study period was 15 March 2020-15 August 2021. A total of 170 cases (58 female, aged 59 ± 15.5 years) that fulfilled the inclusion criteria were included in the study. One-month mortality rate (OMM) was 44.8%. The logistic regression analysis showed the following significant variables for the mentioned dependent variables: (i) achieving PCR negativity: receiving a maximum of 5 days of favipiravir (p = 0.005, OR 5.166, 95% CI 1.639-16.280); (ii) need for ICU: receiving glycopeptide therapy at any time during the COVID-19/FEN episode (p = 0.001, OR 6.566, 95% CI 2.137-20.172), the need for mechanical ventilation (p < 0.001, OR 62.042, 95% CI 9.528-404.011); (iii) need for mechanical ventilation: failure to recover from neutropenia (p < 0.001, OR 17.869, 95% CI 3.592-88.907), receiving tocilizumab therapy (p = 0.028, OR 32.227, 95% CI 1.469-707.053), septic shock (p = 0.001, OR 15.4 96% CI 3.164-75.897), and the need for ICU (p < 0.001, OR 91.818, 95% CI 15.360-548.873), (iv) OMM: [mechanical ventilation (p = 0.001, OR 19.041, 95% CI 3.229-112.286) and septic shock (p = 0.010, OR 5.589,95% CI 1.509-20.700)]. Although it includes a relatively limited number of patients, our findings suggest that COVID-19 and FEN are associated with significant mortality and morbidity.
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COVID-19 , Neutropenia , Choque Séptico , Humanos , Feminino , Estudos Retrospectivos , SARS-CoV-2 , PrognósticoRESUMO
Human immunodeficiency virus (HIV)/acquired immundeficiency syndrome (AIDS) is a critical global public health problem that significantly affects both life expectancy and the overall quality of life of individuals in all age groups. The landscape of HIV infection has changed significantly in recent years due to the introduction of effective combination antiretroviral therapies (ART). A key component of first-line ART regimens for HIV treatment is abacavir, a nucleoside HIV reverse transcriptase inhibitor. Although abacavir is effective in suppressing viral replication and managing disease, its clinical utility is overshadowed by the potential for life-threatening hypersensitivity reactions in HLA-B*57:01-positive patients. In our country, local data obtained from various centers regarding the prevalence of HLA-B*57:01 in HIV-1-infected patients are available. In this study, it was aimed to determine the prevalence of the HLA-B*57:01 genotype in HIV-infected patients who were followed up and treated in many regions of our country. This retrospective study consists of the data of the patients aged 18 years and over diagnosed with HIV-1 infection between 01.01.2019 and 31.07.2022. Age, gender, place of birth, mode of transmission of the disease, death status, CD4+ T cell count and HIV RNA levels at the first clinical presentation, HLA-B*57:01 positivity, and the method used, clinical stage of the disease, virological response time with the treatment they received were recorded from the patient files. Data were collected from 16 centers and each center used different methods to detect HLA-B*57:01. These methods were sequence-specific oligonucleotide probe hybridization (SSOP), DNA sequence-based typing (SBT), single-specific primer-polymerase chain reaction (SSP-PCR), allele-specific PCR (AS-PCR) and quantitative PCR (Q-PCR). A total of 608 HIV-infected individuals, 523 males (86%) and 85 females (14%), were included in the study. The mean age of the patients was 36.9 ± 11.9 (18-73) years. The prevalence of HLA-B*57:01 allele was found to be 3.6% (22 patients). The number of CD4+ T lymphocytes in HLA-B*57:01 allele-positive patients was > 500/ mm3 in 10 patients (45.5%), while the number of CD4+ T lymphocytes in HLA-B*57:01 negative patients was > 500/mm3 in 216 patients (36.9%) (p> 0.05). Viral load at the time of diagnosis was found to be lower in patients with positive HLA-B*57:01 allele but it was not statistically significant (p> 0.05). Although different treatment algorithms were used in the centers following the patients, it was observed that the duration of virological response was shorter in HLA-B*57:01 positive patients (p= 0.006). Although the presence of the HLA-B*57:01 allele has a negative impact due to its association with hypersensitivity, it is likely to continue to attract interest due to its association with slower progression of HIV infection and reduced risk of developing AIDS. In addition, although the answer to the question of whether it is cost-effective to screen patients for HLA-B*57:01 before starting an abacavir-containing ART regimen for the treatment of HIV infection is being sought, it seems that HIV treatment guidelines will continue to recommend screening to identify patients at risk in this regard.
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Síndrome da Imunodeficiência Adquirida , Ciclopropanos , Didesoxiadenosina/análogos & derivados , Infecções por HIV , HIV-1 , Feminino , Masculino , Humanos , Adolescente , Adulto , Pessoa de Meia-Idade , Prevalência , Qualidade de Vida , Estudos Retrospectivos , Turquia , Antígenos HLARESUMO
This study aimed to evaluate the antibody and T cell responses of homologous and heterologous booster doses for SARS-CoV-2 vaccines. Our study was performed on those with two doses of mRNA vaccine BNT162b2 (2B, n:44), those with heterologous booster dose BNT162b2 vaccine after two doses of inactivated vaccine CoronaVac (2S+1B, n:44), those with homologous booster dose vaccine CoronaVac after two doses of vaccine CoronaVac (3S, n:44) SARS-CoV-2 IgG antibody levels were significantly higher in individuals who received heterologous boosters(p<0.001). IFN-Æ, IL-2 and IL-13 median values were detected higher in 2S+1B group than in 3S group, respectively (p=0.112, p=0.057, p=0.341). Although the antibody levels in 2S+1B group were similar (p=0.153) to the 2B group; IFN-Æ, IL-2 and IL-13 levels were higher (p<0.001). In conclusion, supplementing an improved strategy based on inactivated vaccines with an mRNA vaccine as a heterologous booster is likely to be more beneficial in the course of the pandemic.
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Vacina BNT162 , COVID-19 , Humanos , Vacinas contra COVID-19 , Vacinas de mRNA , Interleucina-13/genética , Interleucina-2 , COVID-19/prevenção & controle , SARS-CoV-2 , Imunização , RNA Mensageiro , Anticorpos AntiviraisRESUMO
BACKGROUND: Herein, we analyzed the efficacy of main antibiotic therapy regimens in the treatment of healthcare-associated meningitis (HCAM). MATERIALS/METHODS: This retrospective cohort study was conducted in 18 tertiary-care academic hospitals Turkey, India, Egypt and Romania. We extracted data and outcomes of all patients with post-neurosurgical meningitis cases fulfilling the study inclusion criteria and treated with empirical therapy between December 2006-September 2018. RESULTS: Twenty patients in the cefepime + vancomycin-(CV) group, 31 patients in the ceftazidime + vancomycin-(CFV) group, and 119 patients in the meropenem + vancomycin-(MV) group met the inclusion criteria. The MV subgroup had a significantly higher mean Glasgow Coma Score, a higher rate of admission to the intensive care unit within the previous month, and a higher rate of antibiot herapy within the previous month before the meningitis episode (p < 0.05). Microbiological success on Day 3-5, end of treatment (EOT) clinical success (80% vs. 54.8%% vs 57.9%), and overall success (EOT success followed by one-month survival without relapse or reinfection 65% vs. 51.6% vs. 45.3%), EOT all cause mortality (ACM) and day 30 ACM (15% vs. 22.6% vs. 26%) did not differ significantly (p > 0.05) among the three cohorts. No regimen was effective against carbapenem-resistant bacteria, and vancomycin resulted in an EOT clinical success rate of 60.6% in the methicillin-resistant staphylococci or ampicillin-resistant enterococci subgroup (n = 34). CONCLUSIONS: Our study showed no significant difference in terms of clinical success and mortality among the three treatment options. All regimens were ineffective against carbapenem-resistant bacteria. Vancomycin was unsuccessful in approximately 40% of cases involving methicillin-resistant staphylococci or ampicillin-resistant enterococci.
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Meningite , Vancomicina , Humanos , Vancomicina/uso terapêutico , Meropeném/uso terapêutico , Cefepima/uso terapêutico , Ceftazidima/uso terapêutico , Estudos Retrospectivos , Antibacterianos/uso terapêutico , Meningite/tratamento farmacológico , Bactérias , Staphylococcus , Atenção à Saúde , AmpicilinaRESUMO
AIM: This study aimed to compare the outcomes of transanal and transvaginal NOSES in patients undergoing laparoscopic colorectal surgery. MATERIAL AND METHODS: This study included 45 patients who were scheduled for NOSES after undergoing laparoscopic colorectal resection in our clinic between January 2019 and March 2020. To ensure homogeneity between the groups, the data of 22 female patients were analyzed in this study. Patients were divided into two groups according to the specimen extraction technique used. Demographic data, preoperative and postoperative findings, as well as the pathology and sizes of the specimens were examined in both the groups. RESULTS: The demographic characteristics and preoperative and early postoperative outcomes were similar in both the groups. The size of the lesion was larger in the transvaginal group than that in the transanal group [4.58 ± 1.28 and 2.71 ± 1.55, respectively (P = 0.039)]. Two complications associated with extraction were observed (%9.09). A patient who underwent transanal extraction developed transient anal incontinence, which spontaneously resolved, and a patient who underwent transvaginal extraction developed anastomotic leakage and rectovaginal fistula associated with anastomotic leakage; a colonic stent was inserted for the management of this condition following which the patient recovered. CONCLUSION: Only the lesion size was statistically significantly different between the transanal and transvaginal routes. Further, avoiding secondary organ injury is essential; therefore, the transanal route is primarily preferred. However, if the diameter of the lesion is large and the patient is female, the transvaginal route can be a useful alternative. KEY WORDS: Natural orifice specimen extraction surgery, Laparoscopic colorectal surgery, Minimally invasive surgery.
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Neoplasias Colorretais , Cirurgia Colorretal , Laparoscopia , Cirurgia Endoscópica por Orifício Natural , Humanos , Feminino , Fístula Anastomótica/cirurgia , Cirurgia Endoscópica por Orifício Natural/métodos , Laparoscopia/métodos , Colectomia/métodos , Neoplasias Colorretais/cirurgia , Resultado do Tratamento , Estudos RetrospectivosRESUMO
Background: Rapid initiation of antiretroviral therapy (ART) reduces the transmission of HIV infection in the community. This study aimed to determine whether rapid ART initiation is effective compared to standard ART treatment in our country. Methods: Patients were grouped based on time to treatment initiation. HIV RNA levels, CD+4 T cell count, CD4/CD8 ratio, and ART regimens were recorded at baseline and follow-up visits for 12 months. Results: There were 368-ART naive adults (treatment initiated at the time of HIV diagnosis; 143 on the first day, 48 on the second-seventh day, and 177 after the seventh day). Although virological suppression rates at 12th months were higher in all groups, over 90% on average, there were no statistically significant differences in HIV-1 RNA suppression rates, CD+4 T cell count, and CD4/CD8 ratio normalization in the studied months but in multivariate logistic regression analysis; showed a significant correlation between both virological and immunological response and those with CD4+ T <350 cells/mL at 12th month in total patients. Conclusion: Our findings support the broader application of recommendations for rapid ART initiation in HIV patients.
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OBJECTIVE: Some studies have reported that the systemic immune inflammatory index (SII) and neutrophil/lymphocyte ratio (NLR) provide predictive data on prognosis in gastric cancer patients. In the present study, it was aimed to examine the diagnostic and prognostic values of SII and NLR in gastric cancer. METHODS: A total of 152 patients, operated with the diagnosis of gastric cancer and followed up in the General Surgery Department of our hospital between January 2012 and April 2018, and 152 healthy controls were included in the study. RESULTS: The mean SII (989±685) and the mean NLR (3.9±5.2) were significantly higher in gastric cancer patients than the healthy control group (433±203 and 1.9±0.8, respectively) (p<0.001 for both). In the receiver operating characteristic analyzes, a threshold value of 892 for SII had a sensitivity of 66.7% and a specificity of 62.7% in terms of predicting 5-year survival (AUC: 0.637; p=0.076; LB: 0.475; UB: 0.799; CI 95%). The 5-year survival rate was found to be significantly higher in those with a SII of above 892 than those with a SII of 892 and below (p=0.026). The 5-year mortality risk was 0.67-fold lower in those with SII above 892 (p=0.111; 95% CI 0.4-1.1). CONCLUSION: The present study findings show that SII and NLR are far from providing reliable data on gastric cancer prognosis.
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OBJECTIVES: The aim of this study was to determine bacterial contamination of needleless connectors before and after disinfection to assess the risk for the point of catheter-related bloodstream infections. RESEARCH METHODOLOGY/DESIGN: Experimental study design. SETTING: The research was carried out on patients with a central venous catheter hospitalized in the intensive care unit. MAIN OUTCOMES MEASURES: Bacterial contamination of needleless connectors integrated into central venous catheters was assessed before and after disinfection. Antimicrobial susceptibilities of colonized isolates were investigated. In addition, the compatibility of the isolates with the bacteriological cultures of the patients was determined over a one-month period. RESULTS: Bacterial contamination varied between 5×103 and 1×105 colony forming unit was detected before disinfection in 91.7% of needleless connectors. Most common bacteria were coagulase-negative staphylococci; others were Staphylococcus aureus, Enterococcus faecalis, and Corynebacterium species. While most isolates were resistant to penicillin, trimethoprim-sulfamethoxazole, cefoxitin, and linezolid, each was susceptible to vancomycin or teicoplanin. Bacterial survival was not detected on needleless connectors after disinfection. There was no compatibility between the one-month bacteriological culture results of the patients and the bacteria isolated from the needleless connectors. CONCLUSION: Bacterial contamination was detected on the needleless connectors before disinfection, although they were not rich in bacterial diversity. There was no bacterial growth after disinfection with an alcohol-impregnated swab. IMPLICATIONS FOR CLINICAL PRACTICE: The majority of needleless connectors had bacterial contamination before disinfection. Needleless connectors should be disinfected for 30 seconds before use, particularly in immunocompromised patients. However, the use of needleless connectors with antiseptic barrier caps may be a more practical and effective solution instead.
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Cateteres Venosos Centrais , Desinfecção , Humanos , Desinfecção/métodos , Contaminação de Equipamentos , Cateteres Venosos Centrais/microbiologiaRESUMO
Coronavirus disease-2019 (COVID-19) is the most challenging health problem of our century, but our knowledge about the disease is limited. Most individuals infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which causes COVID-19, have mild symptoms such as headache, sore throat, joint pain, loss of sense of taste and smell. However, infection also causes significant morbidity and mortality, especially in individuals over 65 years of age with comorbidities. However, it is not known exactly which patients will have a poor prognosis. In this study, it was aimed to determine serum Pentraxin-3 (PTX3) and soluble urokinase plasminogen activator receptor (suPAR) levels in COVID-19 patients, and to evaluate the relationship between PTX3 and suPAR levels and the clinical status of the disease. This study was conducted with 150 patients who were confirmed to have COVID-19 by microbiological or clinical/radiological methods between April 1 and December 31, 2020. Thirty people with no known history or symptoms of COVID-19 and negative reverse transcription-polymerase chain reaction (RT-PCR) results also constituted the control group. Patients admitted to inpatient services due to COVID-19 constituted the service group (n= 75) and patients admitted to the intensive care unit (ICU) constituted the ICU group (n= 75). Serum PTX3 and suPAR levels were analyzed by enzyme-linked immunoassay (ELISA) and the results were compared between the three groups. The patients' leukocyte, neutrophil, neutrophil/lymphocyte ratio (NLR), troponin, procalcitonin (PCT), D-dimer, C-reactive protein (CRP), lymphocyte and ferritin results were included in the analysis. The mean age of the patients was 67.2 ± 11.8, and 62.0 ± 8.4 in the control group. There was no significant difference between the groups in terms of female/male ratio (p= 0.582). The PTX3 and suPAR levels of the patients were higher than the controls (p= 0.001, p= 0.023, respectively). PTX3 and suPAR levels were higher in the service group than the ICU group (p<0.001, p= 0.004, respectively) and the control group (p<0.001, p= 0.001, respectively). However, PTX3 (p= 0.291) and suPAR (p= 0.411) concentrations did not differ between ICU and control groups. The most determining parameters in ICU admission were found to be leukocytes (AUC= 0.840), neutrophils (AUC= 0.840), and NLR (AUC= 0.835), respectively. The most predictive parameters for mortality were PCT (AUC= 0.712), NLR (AUC= 0.708) and D-dimer (AUC= 0.695), respectively. In our study, serum PTX3 and suPAR concentrations were found to be high in COVID-19 patients. In patients admitted to the ICU, PTX3 and suPAR levels were observed at low levels. Low levels of PTX3 and suPAR in COVID-19 patients were thought to be clinically important.
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Proteína C-Reativa , COVID-19 , Receptores de Ativador de Plasminogênio Tipo Uroquinase , Feminino , Humanos , Masculino , Proteínas de Fase Aguda , Proteína C-Reativa/análise , COVID-19/sangue , COVID-19/diagnóstico , Receptores de Ativador de Plasminogênio Tipo Uroquinase/sangue , SARS-CoV-2 , Pessoa de Meia-Idade , IdosoRESUMO
Objective: In this study, it was aimed to retrospectively evaluate the anti-Toxoplasma IgG, IgM and avidity index results of patients who were requested for Toxoplasma serology in our hospital between 01.01.2017 and 31.12.2021. Methods: Anti-Toxoplasma antibodies are studied with Abbott Architect I2000 SR device that using the chemiluminescent microparticle immunoassay method (CMIA), according to the company's recommendations. The age, gender, nationality, sending clinic/polyclinic, and pregnancy status information of patients were scanned from the hospital system. Results: In the five-year period between 2017 and 2021, 29.58% of anti-Toxoplasma IgG tests requested from 12694 patients and 0.94% of anti-Toxoplasma IgM tests sent from 12546 patients were found positive. It is striking that the number of test requests is higher in women. IgG positivity is highest in women in the age group of 30-39 (9.97%), and in men in the age group of 60-69 (6.97%). IgM positivity is higher in both women and men in the 20-29 age group (0.48% and 0.38%, respectively). Anti-Toxoplasma IgG was positive in 27.78% and IgM in 0.64% of the pregnant women. IgG positivity in Turkish and Syrian pregnant women were determined as 25.88%; 47.10% and IgM positivity as 0.49% and 1.83%, respectively, and the difference was statistically significant (p<0.001). Conclusion: Our anti-Toxoplasma antibody positivity was found to be compatible with studies conducted in different centers in our country. The fact that IgM positivity in women is high in the 20-29 age group, which is the childbearing age, emphasizes the importance of screening before and during pregnancy. Consistent with other studies in the literature, the rate of seropositivity in Syrian pregnant women was found to be higher than Turkish. This is important in terms of showing the effect of socio-cultural behaviors on prevalence.
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Complicações Parasitárias na Gravidez , Toxoplasma , Toxoplasmose , Adulto , Idoso , Anticorpos Antiprotozoários , Feminino , Hospitais , Humanos , Imunoglobulina G , Imunoglobulina M , Masculino , Pessoa de Meia-Idade , Gravidez , Complicações Parasitárias na Gravidez/diagnóstico , Estudos Retrospectivos , Toxoplasmose/diagnóstico , Toxoplasmose/epidemiologiaRESUMO
Antimicrobial photodynamic inactivation (aPDI) of multidrug-resistant (MDR) wound pathogens was evaluated with cationic porphyrin derivatives (CPDs). MDR bacterial strains including Pseudomonas aeruginosa, Escherichia coli, Acinetobacter baumannii, and Klebsiella pneumoniae were used. The CPDs named PM, PE, PN, and PL were synthesized as a photosensitizer (PS). A diode laser with a wavelength of 655 nm was used as a light source. aPDI of the combinations formed with different energy densities (50, 100, and 150 J/cm²) and PS concentrations (ranging from 3.125 to 600 µM) were evaluated on each bacterial strain. Dark toxicity, cytotoxicity, and phototoxicity were determined on fibroblast cells. In the aPDI groups, survival reductions of up to 5.80 log10 for E. coli, 5.90 log10 for P. aeruginosa, 6.11 log10 for K. pneumoniae, and 6.78 log10 for A. baumannii were obtained. The cytotoxic effect of PL and PM on fibroblast cells was very limited. PN was the type of CPD with the highest dark toxicity on fibroblast cells. In terms of providing broad-spectrum aPDI without or with very limited cytotoxic effect, the best result was observed in aPDI application with PL. The other CPDs need some modifications to show bacterial selectivity for use at 50 µM and above.
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Acinetobacter baumannii , Anti-Infecciosos , Fotoquimioterapia , Porfirinas , Infecção dos Ferimentos , Humanos , Testes de Sensibilidade Microbiana , Escherichia coli , Fotoquimioterapia/métodos , Antibacterianos/farmacologia , Fármacos Fotossensibilizantes/farmacologia , Porfirinas/farmacologia , Klebsiella pneumoniae , Anti-Infecciosos/farmacologia , Pseudomonas aeruginosa , Bactérias , Infecção dos Ferimentos/tratamento farmacológicoRESUMO
Blastocystis sp. is a common enteric protist found in humans and many other animals. Although the clinical relevance of Blastocystis sp. is currently fully unknown for humans, the prevalence of Blastocystis and subtypes are investigated in immunocompetent individuals presenting with symptoms like diarrhea or immunocompromised individuals including cancer patients. In this comprehensive study, the prevalence of Blastocystis sp. and subtypes were investigated in patients (n=94) with different types of malignant solid tumors using PCR targeting SSU rDNA gene and sequencing. All patients were undergoing chemotherapy and had diarrhea. According to obtained results, 46 patients were found to be Blastocystis positive and the molecular prevalence was detected as 48.9%. Among the positive specimens, 43 (43/46; 93.5%) of them were successfully subtyped. ST4 was the most predominant subtype and detected in 24 (55.8%) patients, followed by ST1 (11 patients, 25.6%) and ST3 (8 patients, 18.6%). In the colon cancer group, which had the highest number of patients, Blastocystis sp. was detected with a higher prevalence rate of 61.5% compared with the prevalence rate (48.9%) of all patients. Interestingly, ST3 was not detected in any of this patient group in contrast to ST4 and ST1. In conclusion, high prevalence of the Blastocystis in the immunocompromised patient groups shows the susceptibility of this patient group against any other infectious agents.
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Infecções por Blastocystis , Blastocystis , Neoplasias , Animais , Blastocystis/genética , Infecções por Blastocystis/tratamento farmacológico , Infecções por Blastocystis/epidemiologia , DNA de Protozoário/genética , Diarreia/epidemiologia , Fezes , Variação Genética , Humanos , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Filogenia , Prevalência , Turquia/epidemiologiaRESUMO
BACKGROUND: Discovery of new Toxoplasma gondii serotyping epitopes is important due to reports showing the influence of genotype on the severity of toxoplasmosis. In Turkey, genotypes belonging to type II, type III and Africa 1 lineages were mainly detected. The present study focused on to find out epitopes with high discriminative capacity to serotype these genotypes using well characterized strains isolated from Turkey. METHODS: To meet this objective, GRA6 and GRA7 genes were sequenced from strains belonging to the type II, III and Africa 1 lineages, and B cell epitopes inside these sequences were predicted by Bcepred and additional docking analysis was performed with B cell receptor. Based on these analyses, 22 peptides harboring lineage specific epitopes were synthesized. Then, the serotyping potency of these peptides was tested using peptide ELISA and well categorized serum samples collected from stray cats infected with genotypes of the different lineages type II (n:9), III (n:1) and Africa 1 (n:1). As a result of peptide-ELISA, a serotyping schema was constructed with peptides that show high discriminative capacity and this assay was validated by sera collected from humans after an outbreak (n:30) and mother/newborn pair sera (n:3). Later, the validated serotyping schema was used to serotype a larger group of human (n:38) and cat (n:24) sera. RESULTS: Among 22 peptides, GRA6II/c, GRA7III/d, and GRA6 Africa 1/b epitopes have shown discriminative capacity. During the validation of peptide-ELISA, the serotype of toxoplasmosis outbreak and mother/newborn cases were detected to be serotype II. Moreover, the analyses in a larger group showed that serotype II was prevalent in humans and stray cats. CONCLUSIONS: Overall, the results showed that the serotyping schema could be successfully used to serotype T. gondii infections caused by type II, III and Africa 1 genotype.
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Toxoplasma , Animais , Antígenos de Protozoários/genética , Gatos , Surtos de Doenças , Ensaio de Imunoadsorção Enzimática , Humanos , Peptídeos , Sorotipagem , Toxoplasma/genéticaRESUMO
BACKGROUND: Cryptosporidium spp. is a protozoan parasite that infects many vertebrate animals, including humans. Since Cryptosporidium spp. can cause chronic life-threatening diarrhea and severe malabsorption in immunocompromised patients, we investigated the prevalence of this parasite among patients undergoing chemotherapy for malignant solid tumors. OBJECTIVE: Investigate the prevalence of Cryptosporidium spp. in stool samples. DESIGN: Cross-sectional. SETTING: Tertiary care. PATIENTS AND METHODS: Stool samples were collected from adult patients with malignant solid tumors receiving chemotherapy and diarrhea. Cryptosporidium spp. prevalence was determined using Ziehl-Neelsen staining, ELISA, and real-time PCR targeting of the COWP gene. MAIN OUTCOME MEASURE: The prevalence of Cryptosporidium spp. in patients undergoing chemotherapy for malignant solid tumors. SAMPLE SIZE: 94 RESULTS: The prevalence was 2.1% (2/94), 5.3% (5/94), and 5.3% (5/94) as detected by Ziehl-Neelsen staining, real-time PCR and ELISA, respectively. The prevalence reached 8.5% (8/94) using all results obtained from the three methods. Among eight positive stool samples, four were positive by at least two different methods (Ziehl-Neelsen staining-ELISA or ELISA-real-time PCR) whereas the remaining four were positive by either ELISA or real-time PCR. CONCLUSION: These findings show the risk of cryptosporidiosis in cancer patients and the necessity to use at least two diagnostic methods during the diagnosis of cryptosporidiosis to reach more accurate and trustworthy results. LIMITATIONS: Further studies with a larger sample size are recommended. CONFLICT OF INTEREST: None.
Assuntos
Criptosporidiose , Cryptosporidium , Neoplasias , Animais , Estudos Transversais , Criptosporidiose/epidemiologia , Cryptosporidium/genética , Diarreia/epidemiologia , Humanos , Neoplasias/tratamento farmacológico , Neoplasias/epidemiologiaRESUMO
The passive nature of the half-time period with soccer/football can result in second-half performance decrements. As foam rolling (FR) can increase range of motion, neuromuscular efficiency, and enhance arterial function, the inclusion of FR during half-time may attenuate performance decrements. The objective of this acute study was to compare FR versus passive recovery during a simulated half-time period on simulated second-half soccer pass, sprint performance as well as quality of recovery. Thirteen male soccer players simulated a soccer match by performing two bouts of 15 × 20 m sprints with 30-s rest intervals. The bouts were separated by 10-min with either a passive recovery or they performed five FR exercises on both legs for 45-s each with 15-s rest. Tests were conducted before and following the simulated half-time period and consisted of Total Quality of Recovery (TQR), Loughborough Soccer Pass Test (LSPT), blood lactate (LAC), and sprint velocity of the simulated soccer match. Heart rates (HR) were recorded at the end of each test session and each sprint. Results showed no significant changes between conditions for TQR, LSPT, LAC and HR. However, while all sprint speed measures (mean, best of 15 sprints and mean of the first 5 sprints) significantly decreased with the passive condition, no decrement was noted with all sprint measures with the FR condition; there was only a significant (p = 0.001; d = 0.63) 2.1% decrease with the mean of the first 5 sprints. In conclusion, there is some evidence that FR may be beneficial to attenuate sprint speed impairments.
Assuntos
Desempenho Atlético , Futebol , Exercício Físico , Teste de Esforço , Humanos , Masculino , DescansoRESUMO
OBJECTIVE: We aimed to define indication of Hartmann procedure (HP) under emergency conditions, analyze, and present in which cases this procedure should be used. METHODS: The patients who underwent emergency surgery for colorectal cancer were analyzed. Rates of mortality, overall, and disease-free survival of the patients were evaluated. The colostomy closure rate, operative mortality, and surgical complications of the secondary operation performed after the HP were also assessed. RESULTS: Fifty-seven patients who underwent HP were included in the study. The indications were obstruction (n = 37) or perforation (n = 20). The post-operative mortality and morbidity rates were 21.1% and 63.2%, respectively. The 1-, 3-, and 5-year survival rates for all patients were 54%, 49%, and 45%. CONCLUSION: HP can be a life-saving procedure in cases of high risk, emergency colorectal disease. Surgeons create a temporary stoma as a part of this procedure that is generally closed with a second operation. However, it is not possible to close the stoma in some cases, and the potential physical and emotional issues related to the stoma should be a part of the surgeon's considerations.
OBJETIVO: Definir la indicación del procedimiento de Hartmann en condiciones de emergencia y en qué casos debe utilizarse. MÉTODO: Se analizaron los pacientes sometidos a cirugía colorrectal de emergencia. Se evaluaron las tasas de mortalidad y de supervivencia global y libre de enfermedad. También se evaluaron la tasa de cierre de la colostomía, la mortalidad operatoria y las complicaciones quirúrgicas de la operación secundaria. RESULTADOS: Fueron incluidos en el estudio 57 pacientes sometidos a un procedimiento de Hartmann. Las indicaciones fueron obstrucción (n = 37) o perforación (n = 20). Las tasas de mortalidad y de morbilidad posoperatorias fueron del 21,1% y el 63,2%, respectivamente. Las tasas de supervivencia a 1, 3 y 5 años para todos los pacientes fueron del 54%, el 49% y el 45%. CONCLUSIÓN: El procedimiento de Hartmann puede salvar vidas en casos de enfermedad colorrectal de emergencia de alto riesgo. Los cirujanos crean un estoma temporal como parte de este procedimiento, que generalmente se cierra con una segunda operación. Sin embargo, en algunos casos no es posible cerrar la estoma, y los posibles problemas físicos y emocionales relacionados con este deberían ser parte de las consideraciones del cirujano.
Assuntos
Doenças do Colo , Neoplasias Colorretais , Anastomose Cirúrgica , Neoplasias Colorretais/cirurgia , Colostomia , Emergências , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologiaRESUMO
OBJECTIVE: To investigate the prognostic value of tumor diameter in the short term of 3 and 5 years in patients operated for gastric cancer. STUDY DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: Kartal Dr Lütfi Kirdar City Hospital, Istanbul, Turkey, from January 2014 to December 2018 Methodology: A total of 125 patients with stage 2 or 3 gastric cancer, followed up in the Department of General Surgery, were included. Demographic information, clinical, laboratory, and pathology reports were analysed in terms of postoperative 30-day mortality. RESULTS: The mean age of the patients was 63.9±11.9 (31-88) years. Forty-four (35.2%) were in stage 2, and 81 (64.8%) were in stage 3 cancers. The mean tumor diameter was 6.5±3.1 cm, and the mean metastatic lymph node rate was 35.6±29.8%. The mean follow-up period was 31.8±21 months. The 3-year and 5-year survival rates were 39.8% and 17.6%, respectively. Tumor diameter was not directly related to survival, differentiation, number of resected lymph nodes, number of metastatic lymph nodes, and metastatic lymph node rate in stage 2 and 3 cases (p>0.05 for each). The 5-year mortality risk was 1.2-fold higher in those with tumor diameter over 6.5 cm (95% CI 0.7-2.0; p=536). CONCLUSION: The tumor size did not have a direct effect on prognosis. It did not provide reliable data about short-term prognosis such as 3 and 5 years in stage 2 and 3 gastric cancer cases. Key Words: Gastric cancer, Stage 2, Stage 3, Tumor size, Prognosis.