Antibiotic management programme in a tertiary intensive care unit: effects of a carbapenem-restricted period on clinical and laboratory parameters and costs of infections.

BACKGROUND: Carbapenems are antibiotics used for serious infections. The consumption of carbapenems has increased worldwide due to increasing microbial resistance. AIM: To investigate the effects of a carbapenem-restricted antimicrobial stewardship programme (ASP) on changes in the resistance profiles of infectious agents, the amount of antibiotics used, length of stay in the intensive care unit (ICU), mortality, and costs. METHODS: Patients hospitalized in ICU between July 1st, 2020 and May 1st, 2021 were divided into two periods: the carbapenem-non-restricted period (CNRP); and the carbapenem-restricted period (CRP) in which alternative antibiotics to carbapenems were preferred during infection. The defined daily dose (DDD) per 100 patient-day methodology was used to calculate the antibiotic consumption. FINDINGS: Of the 572 patients included in the study, 62.2% were male, and mean age was 70.5 years. In the blood culture the most frequently Gram-negative agent was Acinetobacter baumannii (25%). A. baumannii bloodstream infections with multidrug-resistant and extensively drug resistant micro-organisms were significantly different between the two periods (CNRP: 95.6% (N = 22), CRP: 66.6% (N = 8); P = 0.04). There was a gradual decrease in the incidence density and rate of nosocomial infection (P = 0.06), and a significant decrease in meropenem consumption between the two periods (CNRP vs CRP: 21.19 vs 6.37 DDD per 100 patient-days respectively; P = 0.007). ASP yielded US$8,600 of antibiotic cost savings and a total of 14% patient cost savings (P < 0.05) per patient. CONCLUSION: Combining an effective ASP with a comprehensive infection control programme may mitigate the emergence of antimicrobial-resistant bacteria.

Economic burden of severe asthma in Turkey: a cost of illness study from payer perspective.

Summary: Objective. To estimate economic burden of severe asthma in Turkey from payer perspective based on expert panel opinion on practice patterns in clinical practice. Methods. This cost of illness study was based on identification of per patient annual direct medical costs for the management of sever easthma in Turkey from payer perspective. Average per patient direct medical cost was calculated based on cost items related to outpatient visits, laboratory and radiological tests, hospitalizations and interventions, drug treatment and equipment, and co-morbidities/complications. Results. Based on total annual per patient costs calculated for outpatient admission ($ 177.91), laboratory and radiological tests ($ 82.32), hospitalizations/interventions ($ 1,154.55), drug treatment/equipment ($ 2,289.63) and co-morbidities ($ 665.39) cost items, total per patient annual direct medical costrelated to management of severe asthma was calculated to be $ 4,369.76 from payer perspective. Drug treatment/equipment (52.4%) was the main cost driver in the management of severe asthma in Turkey, as followed by hospitalizations/interventions (26.4%) and co-morbidities (15.2%). Conclusions. In conclusion, our findings indicate that managing patients with severe asthma pose a considerable burden to health economics in Turkey, with medications as the main cost driver.

Characteristics of daily and occasional smoking among youths.

OBJECTIVES: The purpose of this study was to develop a more detailed understanding of the characteristics of occasional smokers, and how the characteristics of occasional smokers differ from those of daily smokers. This information can then be used in youth smoking programmes to better address these differences in a manner that would target appropriate youth with appropriate cessation methods. METHODS: A questionnaire was administered to 976 university students, aged between 18 and 25 years, in Ankara, Turkey. The topics covered included age, sex and tobacco use characteristics. Daily and occasional smokers were defined according to traditional definitions of smoking. RESULTS: Among the 976 students surveyed, 482 (49.4%) reported being active smokers. Among these smokers, 199 (41.3%) were classified as occasional smokers and 283 (58.7%) were daily smokers using the traditional definitions of smoking. Many of the active smokers had relatives or friends who also smoked, specifically, 46.5% had a father who smokes, 13.3% had a mother who smokes, 26.8% had an older brother or sister who smokes, and 69.7% had two or more close friends who smoke. Although more than 51.3% of smokers planned on quitting smoking, only 26.1% had previously tried to quit smoking but 64.7% believed they could successfully quit. Daily smokers reported that they made fewer attempts to quit smoking than occasional smokers. More often than occasional smokers, daily smokers reported that they smoke because they like the image, they are addicted, smoking relieves stress and/or their friends smoke. Occasional smokers reported that they smoke less at home or at the university than in other places, and smoke more often with friends than when alone or with family members. This pattern is encouraged by the family structure in Turkish society, where smoking by adolescents at home in the presence of family members is frowned upon. CONCLUSIONS: This study demonstrates substantial differences between occasional and daily smokers. If effective future smoking prevention and cessation programmes that target youth are going to be developed, data like those gathered in this study are critical. Basic information regarding cigarette consumption patterns, while important, is insufficient to understand behaviour and key factors that trigger smoking among the youth population.

The prevalence of male sexual dysfunction and potential risk factors in Turkish men: a Web-based survey.

The purpose of this study is to detect the prevalence of sexual dysfunction and also to investigate possible risk factors that may cause sexual dysfunction in Turkish men. We developed a Web-based survey. In total, 3185 invitations to complete the survey were e-mailed and 2288 individuals submitted responses (72%). The men were interviewed in person, using the Florida Sexual History Questionnaire (FSHQ) Turkish version, and sexual dysfunction was assessed by this questionnaire. male sexual dysfunction (MSD) was evaluated with FSHQ. According to the FSHQ Turkish version, sexual function domains included sexual desire, sexual development, intercourse, erection, ejaculation, and satisfaction. According to the FSHQ score, 43.3% reported on MSD (FSHQ score

Diagnostic strategies for pulmonary arteriovenous fistula in pregnancy.

Pulmonary arteriovenous malformations (PAVMs) are a documented cause of hemoptysis, and usually necessitate pulmonary angiography for a definitive diagnosis. However, the diagnosis can become more problematic in pregnancy. We recently saw a young woman in her fifth month of pregnancy with hemoptysis, who was found to have multiple PAVMs. We report this case to highlight the various non-invasive methods of making this diagnosis.

Picosecond laser in situ keratomileusis with a 1053-nm Nd:YLF laser.

BACKGROUND: Excimer laser in situ keratomileusis requires a microkeratome to generate an anterior corneal flap, plus an excimer laser to ablate the underlying stromal tissue. In this paper we introduce the concepts of laser flap formation and in situ keratomileusis using a picosecond laser. METHODS: A neodymium-doped yttrium-lithium-fluoride (Nd:YLF) laser with a plano-plano quartz applanation lens was used to generate various patterns of intrastromal photodisruption in human donor eyes to fashion anterior corneal flaps and generate intrastromal lenticules. RESULTS: Smooth intrastromal dissections, 6 mm in diameter, were generated 160 microns below the corneal surface when the laser delivered pulses at 1 kHz with energies of either 40 microJ/pulse or 60 microJ/pulse, placed 20 microns apart in an expanding spiral. This enabled us to fashion anterior corneal flaps. The ease of the surgery and quality of the dissection corresponded well, and it was evident that both deteriorated noticeably when the laser pulses were separated by 25 microns or 30 microns, regardless of pulse energy. Using 40 microJ laser pulses placed 20 microns apart we also created a 5-mm diameter, 320 microns thick (130 microns-450 microns deep) stromal lenticule below a corneal flap that was easily extracted when the flap was raised. CONCLUSIONS: Anterior corneal flaps were easily fashioned using a Nd:YLF laser. Picosecond laser in situ keratomileusis with a Nd:YLF laser could offer a favorable alternative to combined microkeratome/excimer laser in situ keratomileusis.