An epidemiologic analysis of Candida spp. urinary infections in intensive care unit / Uma análise epidemiológica das infecções urinárias por Candida spp. em unidade de terapia intensiva / Un análisis epidemiológico de las infecciones urinarias por Candida spp. en la unidad de cuidados intensivos

Background and objectives: The finding of Candida species in urine is an usual finding and is called candiduria. There is an increase in the frequency of urinary tract infections (UTI) caused by Candida especially in critically ill patients. This study aimed to determine the epidemiological, clinical, and mycological characteristics of Candida urinary infections in intensive care unit (ICU) and antifungal susceptibilities. Methods: Urine cultures of 394 ICU patients with clinical suspicion of UTI were evaluated. After 24-48 hours of incubation, colonies appeared to grow as yeast, were morphologically examined by Gram staining. Candida strains that grew 104 ≥ CFU/mL in urine cultures were accepted as candiduria. The susceptibilities of the Candida strains to amphotericin B, itraconazole, fluconazole, voriconazole, flucytosine, and caspofungin were investigated with broth microdilution method. Results: The distribution of the isolated 100 urinary Candida strains were as, 54 Candida albicans, 34 C. glabrata, 7 C. tropicalis, 2 C. kefyr, 2 C. lusitaniae, and 1 as C. parapsilosis. Among 100 Candida species isolated in our study susceptibility rates of amphotericin B, flucytosine, caspofungin, fluconazole, itraconazole, and voriconazole were 100%, 100%, 91%, 23%, 13%, 25.8%, respectively. Conclusion: Accurate identification of Candida spp., as well as the investigating the antifungal susceptibility, will be beneficial in terms of the effectiveness of the treatment and the prevention of resistance development.(AU)

Justificativa e objetivos: O achado de espécies de Candida na urina é um achado comum e é chamado de candidúria. Há um aumento na frequência de infecções do trato urinário (ITU) causadas por Candida, principalmente em pacientes críticos. Este estudo teve como objetivo determinar as características epidemiológicas, clínicas e micológicas das infecções urinárias por Candida em unidade de terapia intensiva (UTI) e a susceptibilidade aos antifúngicos. Métodos: Foram avaliadas culturas de urina de 394 pacientes de UTI com suspeita clínica de ITU. Após 24-48 horas de incubação, as colônias pareceram crescer como leveduras, foram morfologicamente examinadas por coloração de Gram. As cepas de Candida que cresceram ≥104 UFC/mL em culturas de urina foram aceitas como candidúria. As suscetibilidades das cepas de Candida à anfotericina B, itraconazol, fluconazol, voriconazol, flucitosina e caspofungina foram investigadas com o método de microdiluição em caldo. Resultados: A distribuição das cepas 100 isoladas de Candida urinária foi de 54 Candida albicans, 34 C. glabrata, 7 C. tropicalis, 2 C. kefyr, 2 C. lusitaniae e 1 como C. parapsilosis. Entre 100 espécies de Candida isoladas em nosso estudo, as taxas de susceptibilidade de anfotericina B, flucitosina, caspofungina, fluconazol, itraconazol e voriconazol foram de 100%, 100%, 91%, 23%, 13%, 25,8%, respectivamente. Conclusão: A identificação precisa de Candida spp., bem como a investigação da susceptibilidade aos antifúngicos, será benéfica em termos de eficácia do tratamento e prevenção do desenvolvimento de resistência.(AU)

Justificación y objetivos: El hallazgo de especies de Candida en la orina es un hallazgo habitual y se denomina candiduria. Hay un aumento en la frecuencia de infecciones del tracto urinario (ITU) causadas por Candida, especialmente en pacientes críticamente enfermos. Este estudio tuvo como objetivo determinar las características epidemiológicas, clínicas y micológicas de las infecciones urinarias por Candida en la unidad de cuidados intensivos (UCI) y la susceptibilidad antifúngica. Métodos: Se evaluaron urocultivos de 394 pacientes de UCI con sospecha clínica de ITU. Después de 24-48 horas de incubación, las colonias parecían crecer como levadura, se examinaron morfológicamente mediante tinción de Gram. Las cepas de Candida que crecieron 104 ≥ UFC / ml en urocultivos se aceptaron como candiduria. Las susceptibilidades de las cepas de Candida a la anfotericina B, itraconazol, fluconazol, voriconazol, flucitosina y caspofungina se investigaron con el método de microdilución en caldo. Resultados: La distribución de las cepas 100 urinarias aisladas de Candida fue de, 54 C. albicans, 34 C. glabrata, 7 C. tropicalis, 2 C. kefyr, 2 C. lusitaniae y 1 como C. parapsilosis. Entre las 100 especies de Candida aisladas en nuestro estudio, las tasas de susceptibilidad de anfotericina B, flucitosina, caspofungina, fluconazol, itraconazol y voriconazol fueron 100%, 100%, 91%, 23%, 13%, 25,8%, respectivamente. Conclusión: La identificación precisa de Candida spp., así como la investigación de la susceptibilidad antifúngica, será beneficiosa en términos de la eficacia del tratamiento y la prevención del desarrollo de resistencias.(AU)

Foramen Magnum Meningiomas: A Report of 10 Cases and Literature Review.

AIM: To present the findings and surgical results of foramen magnum meningioma surgeries performed by the authors. MATERIAL AND METHODS: Ten patients operated between 2014 and 2019 were retrospectively analyzed in terms of age, gender, neurological examination, and postoperative status. The female-to-male (F/M) ratio of the patients was 6/4, and the age range was 19?70 years (mean = 59). All patients presented with occipitocervical pain and were operated using the midline lateral suboccipital approach. RESULTS: One of the operated patients died in the intensive care unit due to upper gastrointestinal tract bleeding. Additionally, one patient had paresis in the early postoperative period, which resolved in the third follow-up month. CONCLUSION: Foramen magnum meningiomas are operated safely by microsurgical methods using the midline lateral suboccipital approach after suboccipital triangle and vertebral artery are exposed.

The diagnostic utility of the "Thwaites' system" and "lancet consensus scoring system" in tuberculous vs. non-tuberculous subacute and chronic meningitis: multicenter analysis of 395 adult patients.

BACKGROUND: Tuberculous meningitis (TBM) represents a diagnostic and management challenge to clinicians. The "Thwaites' system" and "Lancet consensus scoring system" are utilized to differentiate TBM from bacterial meningitis but their utility in subacute and chronic meningitis where TBM is an important consideration is unknown. METHODS: A multicenter retrospective study of adults with subacute and chronic meningitis, defined by symptoms greater than 5 days and less than 30 days for subacute meningitis (SAM) and greater than 30 days for chronic meningitis (CM). The "Thwaites' system" and "Lancet consensus scoring system" scores and the diagnostic accuracy by sensitivity, specificity, and area under the curve of receiver operating curve (AUC-ROC) were calculated. The "Thwaites' system" and "Lancet consensus scoring system" suggest a high probability of TBM with scores ≤4, and with scores of ≥12, respectively. RESULTS: A total of 395 patients were identified; 313 (79.2%) had subacute and 82 (20.8%) with chronic meningitis. Patients with chronic meningitis were more likely caused by tuberculosis and had higher rates of HIV infection (P < 0.001). A total of 162 patients with TBM and 233 patients with non-TBM had unknown (140, 60.1%), fungal (41, 17.6%), viral (29, 12.4%), miscellaneous (16, 6.7%), and bacterial (7, 3.0%) etiologies. TMB patients were older and presented with lower Glasgow coma scores, lower CSF glucose and higher CSF protein (P < 0.001). Both criteria were able to distinguish TBM from bacterial meningitis; only the Lancet score was able to differentiate TBM from fungal, viral, and unknown etiologies even though significant overlap occurred between the etiologies (P < .001). Both criteria showed poor diagnostic accuracy to distinguish TBM from non-TBM etiologies (AUC-ROC was <. 5), but Lancet consensus scoring system was fair in diagnosing TBM (AUC-ROC was .738), sensitivity of 50%, and specificity of 89.3%. CONCLUSION: Both criteria can be helpful in distinguishing TBM from bacterial meningitis, but only the Lancet consensus scoring system can help differentiate TBM from meningitis caused by fungal, viral and unknown etiologies even though significant overlap occurs and the overall diagnostic accuracy of both criteria were either poor or fair.

Evaluation of ventricular repolarization features with Tp-e, Tp-e/QTc, JTc and JTd during electroconvulsive therapy.

OBJECTIVE: The purpose of this study was to investigate the influence of electrical stimulation transmitted through the body during electroconvulsive therapy on traditional and relatively new ventricular repolarization parameters (Rate corrected QT interval (QTc), QT dispersion (QTd), rate corrected JT interval (JTc), JT dispersion (JTd), T-peak to T-end interval (Tp-e) and Tp-e/QTc ratio) under propofol anaesthesia. METHODS: Twenty-two patients (aged 18-50 years) who were each scheduled for ECT for major depression, bipolar disorder or schizophrenia enrolled to the study. Electrocardiography (ECG) recordings were obtained before anaesthesia and within 3-5 min after electrical stimulus of ECT for measurements. QTc, QTd, JTc, JTd, Tp-e and Tp-e/QTc were measured as repolarization indices. RESULTS: The study included twenty-two patients, 9(40.9%) females and 13(59.1%) males, and the mean age accounted for 33.57 ±â€¯9.95 years. The comparison of the measured parameters before and after ECT, which were not statistically different, were as follows: QTc (416.52 ±â€¯46.64 vs 430.00 ±â€¯34.00msn; p = 0.18), JTc (308.09 ± 25.09 vs 315.47 ±â€¯26.89msn; p = 0.30), QTd (22.27 ±â€¯11.51 vs 20.45 ±â€¯9.9msn; p = 0.52) and JTd (22.72 ±â€¯11.2 vs 17.72 ±â€¯10.20msn; p = 0.06). Also, no significant difference was detected at the following parameters Tp-e (80.0 ±â€¯13.45 vs 78.63 ±â€¯15.21msn; p = 0.65) and Tp-e/QTc ratio (0.19 ±â€¯0.03 vs 0.18 ±â€¯0.07; p = 0.08). On the other hand, HR showed a significant increase after ECT at 88.13 ±â€¯13.74 vs 93.0 ±â€¯15.2 bpm; p = 0.03. CONCLUSION: QTc, QTd, JTc, JTd, Tp-e interval and Tp-e/QTc ratio, which are thought to be potential repolarisation markers for ventricular arrhythmias, did not demonstrate significant change within 3-5 min of electrical stimulation during ECT.

Is ultrasound-guided suction curettage a reliable option for treatment of cesarean scar pregnancy? A cross-sectional retrospective study.

PURPOSE: The purpose of our study is to present clinical courses and outcomes of 50 first-trimester cesarean scar pregnancy (CSP) cases, which are managed either with transabdominal ultrasound (TAUS)-guided suction curettage alone or abdominal hysterotomy. METHODS: We retrospectively analyzed our records from 2011 to 2016 at a single-center. TAUS-guided suction curettage alone was preferred in hemodynamically stable patients when the myometrial thickness was ≥3 mm and there was no vascular invasion. If the myometrial thickness was <3 mm and/or vascular invasion was present, then hysterotomy was preferred. RESULTS: Statistical analysis of age, gravidity, parity, history of previous CS (≥3 or <3), presence of embryonic cardiac activity, complaints (vaginal bleeding, pelvic pain, or both), preoperative and postoperative hemoglobin levels (g/dl), blood transfusion, initial serum ß-hCG levels, and duration to resolution of ß-hCG demonstrated no significant difference between TAUS-guided suction curettage and abdominal hysterotomy groups. There was a significant difference between two groups in terms of postoperative length of stay in the hospital and gestational age. CONCLUSION: TAUS-guided suction curettage in selected cases may be considered as a reliable first-line treatment option due to its low cost, ease of application, lower side-effect profile, and potentially minimal influence on future fertility in CSP patients that are hemodynamically stable.

The effects of preemptive tramadol and dexmedetomidine on shivering during arthroscopy.

BACKGROUND: Shivering, the rate of which in regional anesthesia is 39% is an undesired complication seen postoperatively. AIMS: This study aims to compare the ability of preventing the shivering of preemptive tramadol and dexmedetomidine during the spinal anesthesia (SA). METHODS: A total of 90 patients with American Society of Anesthesiologists physical status I-II, aged 18-60 years and undergoing elective arthroscopic surgery with SA were divided into three groups randomly. After spinal block, 100 mg tramadol in 100 ml saline was applied in group T- (n = 30) and 0.5 µg/kg dexmedetomidine in 100 ml saline was applied in group D- (n = 30) and 100 ml saline was administered in group P- (n = 30) in 10 min. The hemodynamics, oxygen saturation, tympanic temperature, shivering and sedation scores were evaluated and recorded intraoperatively and 45 min after a postoperative period. RESULTS: In group T and D, shivering scores were significantly lower when compared with group P in the intraoperative 20(th) min (P = 0.01). Sedation scores in group D were significantly higher than the baseline values (P = 0.03) and values in group T and P (P = 0.04). CONCLUSIONS: Preemptive tramadol and dexmedetomidine are effective in preventing the shivering under SA. In addition, dexmedetomidine was superior in increasing the level of sedation which is sufficient to prevent the anxiety without any adverse effects.