Risk factors and clinical characteristics of Stenotrophomonas maltophilia infections in neonates

BackgroundThe aim of this study was to review the risk factors and clinical, bacteriological, and epidemiological characteristics of Stenotrophomonas maltophilia infections in our neonatal intensive care unit.MethodsA retrospective matched case–control study was performed by comparing 23 cases of S maltophilia with 45 controls to identify the potential risk factors. To identify the case patients, the admission and medical records of patients in the neonatal intensive care unit and records from the Microbiology Department were reviewed between 2003 and 2008.ResultsSepsis in two neonates (9%), conjunctivitis in two neonates (9%), and ventilator-associated pneumonia in 19 (82%) neonates were determined. Invasive-procedures, exposure to aminoglycoside and carbapenem, total parenteral nutrition, histamine 2 blockers, exposure to steroids, cholestasis, and duration of hospitalization were significantly associated with S maltophilia infections (p<0.05). On multivariate analysis, invasive procedures (odds ratio, 18.81) and duration of hospitalization (odds ratio, 1.06) were determined to be the risk factors for S maltophilia infection. The most active antimicrobial agent was trimethoprim/sulfamethoxazole (87%) for S maltophilia infection, and the mortality rate was 17%.ConclusionsNeonatologists should avoid from unnecessary invasive procedures and broad-spectrum antibiotics to reduce S maltophilia infections. Invasive procedures should be finished in the shortest time possible. Agent/factor-specific antibacterial treatment should be administered. Patients being discharged as early as possible will also reduce infection frequency. Stenotrophomonas maltophilia should be considered in patients with high Stenotrophomonas infection risk factors

YÖNETİMDE KARAR VERME SÜREÇLERİNE İLİŞKİN BİR ÖNERİ: KURUMSAL KAYNAK PLANLAMASI (ERP)

Teknolojide yaşanan hızlı değişim ve bunun kamu yönetimlerine yansımasıyla “Dijital Kamu Yönetimi”lerinin hayata geçmesi, yönetim şeklinde ve yönteminde birtakım yenilikleri gündeme getirmiştir. Dijitalleşme süreciyle beraber, kaynakların etkin ve verimli kullanım çabaları, tasarrufların sağlanması, vatandaşların yönetimle diyalog kanallarının artması ve özellikle karar alma süreçlerine daha etkin katılması, şeffaflık gibi unsurlar, yönetişimci bir yönetim modelini hızlandırdığı gibi yeni yöntemlerin ortaya çıkmasına da katkı sağlamaktadır. Özellikle kamu hizmetlerinin hızla artması ve çeşitlenmesi, kamu kaynaklarının kullanım kapasitesinin artması, insan kaynaklarının etkinlik ve verimlilik sorunu, sistemin yükünü arttırmaktadır. Kamu yönetiminin artan yükü yönetim ve karar alma süreçlerinin yavaş ilerlemesine sebep olmaktadır. Bu açıdan yönetimde karar verme süreçlerinin optimize edilmesi ve kaynak kullanımında etkinlik ve verimliliğin sağlanması amacıyla kamu kurum/kuruluşları için süreç analizlerinin yapılmasının akabinde kurumsal kaynak planlama (ERP) sistemlerinin kurulması öne sürülmüştür. İşte bu çalışma, kamu yönetimindeki karar verme süreçlerine kurumsal kaynak planlamasının ne ölçüde katkı sağlayabileceği ve karar verme sürecinde bir öneri olarak uygulanabilirliğini irdelemektedir

Early left ventricular functional alterations in patients with obstructive sleep apnea syndrome

Background: The knowledge regarding myocardial alterations in patients with obstructive sleep apnea syndrome (OSAS) in the absence of any known cardiovascular disorders including hypertension is limited. The aim of this study was to assess the early alterations of left ventricular (LV) functions caused by OSAS before the development of hypertension and other cardiovascular manifestations of OSAS.Methods: Eighty consecutive patients who underwent polysomnography (PSG) were enrolled in the study. Patients with hypertension, diabetes mellitus or any other known cardiac diseases were excluded from the study. Subjects were separated into two groups by their apnea/hypopnea index (AHI) (group 1: AHI &lt; 15, and group 2: AHI ≥ 15). Fourty-three patients with normal polysomnographic examination or mild OSAS (group 1) and 37 patients with moderate to severe OSAS (group 2) were compared. After PSG examination, LV functions were assessed by using the conventional and tissue Doppler echocardiographic methods.Results: The mean age was similar between the groups. The ratio of male patients was higher in group 2 (male/female: 31/12 in group 1 vs. 34/3 in group 2, p = 0.04). Body mass index was higher in group 2 (p = 0.05). Conventional echocardiography showed that interventricular septum thickness was 9.5 ± 1.1 mm in group 1, and 10.5 ± 1.4 mm in group 2 (p = 0.02). Mean left atrial diameter was 35.6 ± 4.1 mm in group 2, and 33.8 ± 3.1 mm in group 1 (p = 0.04). Ratio of early to late transmitral diastolic velocities was lower in group 2 (p = 0.01), indicating that impairment of diastolic function was more frequent in moderate to severe OSAS patients. Tissue Doppler echocardiography showed that early diastolic myocardial velocity was lower ingroup 2 (21.1 ± 5.6 cm/s in group 1 vs. 18.3 ± 5.3 cm/s in group 2, p = 0.01).Conclusions: Left ventricular diastolic dysfunction, LV hypertrophy and left atrial dilatationoccur in patients with OSAS even before the development of hypertension and other cardiovascular diseases

DETERMINATION OF OPTIMUM SELECTIVE FLOTATION CONDITIONS OF KOYULHISAR Pb-Cu-Zn ORE BY GUM ARABIC

Bu çalıĞ¢mada, Sivas-Koyulhisar yöresinden temin edilen Pb-Cu-Zn kompleks cevherinin gang bastırıcı olarak Gum Arabic kullanılarak selektif flotasyonla zenginleĞ¢tirilmesinde optimum flotasyon koĞ¢ulları belirlenmeye çalıĞ¢ılmıĞ¢tır. Deneylerde kullanılan Koyulhisar Pb-Cu-Zn kompleks cevherinin %6.54 Pb, %1.45 Cu ve %7.47 Zn tenörlü olduğu kimyasal analiz ile tespit edilmiĞ¢tir. Selektif flotasyonun ilk kademesinde Pb, ikinci kademesinde Cu ve üçüncü kademesinde ise Zn kaba konsantresi eldesinde en uygun flotasyon koĞ¢ulları belirlenmiĞ¢tir. Elde edilen kaba konsantreler daha sonra temizleme flotasyonlarına tabi tutulmuĞ¢tur. Selektif flotasyonla kazanılan Pb, Cu ve Zn kaba konsantrelerinin tenör değerleri sırasıyla; %24.33 Pb, %15.10 Cu ve %41.43 Zn, konsantre verim değerleri ise sırasıyla %93.45, %78.52 ve %89.57'dir. Deneyler sonucunda bu cevherin selektif flotasyonu için belirlenen optimum koĞ¢ullar: Pb kaba flotasyonu için; pH=8, 600 gr/ton Gum Arabic, 40 gr/ton NaCN, 600 gr/ton ZnSO4, 120 gr/ton KAX, 90 gr/ton 2 Etil Hekzanol, köpük alma süresi 5 dakika, Cu kaba flotasyonu için; pH=8, 400 gr/ton Gum Arabic, 20 gr/ton NaCN, 800 gr/ton ZnSO4, 100 gr/ton Na2Cr2O7, 60 gr/ton KAX, 40 gr/ton 2 Etil Hekzanol, köpük alma süresi 5 dakika, Zn kaba flotasyonu için; pH=11, 400 gr/ton Gum Arabic, 60 gr/ton NaCN, 80 gr/ton Na2Cr2O7, 250 gr/ton CuSO4, 100 gr/ton KAX, 90 gr/ton 2 Etil Hekzanol, köpük alma süresi 5 dakika, olarak bulunmuĞ¢tur. Kaba konsantrelerin temizleme flotasyonuna tabi tutulmasıyla elde edilen Pb, Cu ve Zn nihai konsantrelerinin tenörleri sırasıyla; %69.26 Pb, %29.52 Cu ve %58.14 Zn, konsantre verim değerleri ise %72.33, %66.16 ve %75.65'dir. In this study, optimum flotation conditions for Koyulhisar Pb-Cu-Zn ore was determined using by Gum Arabic as depressant. Ore sample's grade is 6.54% Pb, 1.45% Cu and 7.47% Zn from chemical analysis. The most suitable conditions were fixed for Pb, Cu, and Zn rough flotation in first, second and third stage respectively and cleaning experiments were carried out for each of these concentrates. The grade of Pb, Cu and Zn rough concentrates are 24.33% Pb, 15.10% Cu and 41.43% Zn were obtained with recoveries 93.45%, 78.52% and 89.57% respectively. The optimum conditions for selective flotation are below: Pb rough flotation: pH=8, 600 gr/ton Gum Arabic, 40 gr/ton NaCN, 600 gr/ton ZnSO4, 120 gr/ton KAX, 90 gr/ton 2 Etil Hekzanol, flotation time 5 min. Cu rough flotation: pH=8, 400 gr/ton Gum Arabic, 20 gr/ton NaCN, 800 gr/ton ZnSO4, 100 gr/ton Na2Cr2O7, 60 gr/ton KAX, 40 gr/ton 2 Etil Hekzanol, flotation time 5 min. Zn rough flotation: pH=11, 400 gr/ton Gum Arabic, 60 gr/ton NaCN, 80 gr/ton Na2Cr2O7, 250 gr/ton CuSO4, 100 gr/ton KAX, 90 gr/ton 2 Etil Hekzanol, flotation time 5 min. The grades of concentrates after cleaning flotation 69.26% Pb, 29.52% Cu and 58.14% Zn were obtained with recoveries 72.33%, 66.16% and 75.65% respectively

Chronic Intermittent Hypoxemia in Patients with Obstuctive Sleep Apnea Syndrome Causes Reduction of Peripheral Nerve Motor Fibers (Unit Number)

Objective:Obstructive Sleep Apnea syndrome (OSAS) is a chronic intermittent hypoxic process. In this study, we aimed to investigate electrophysiologically the changes in number of skeletal muscle motor unit due to chronic intermittent hypoxemia in cases followed up with the diagnosis of OSAS.Materials and Methods:According to the apnea-hypopnea index (AHI), patients divided into two groups (group 1: AHI 0.5). Maximum M mean area of nerve medianus was 50.8±20.4 (16.1-121.7) in group 1 and 48.6±20.05 (10.5-111.4) in group 2 (p=0.55). The mean MUNE values were 155.3±41.17 (46.6- 251.7) in group 1 and 127.7±40.2 (22.8-235) in group 2 (p<0.00).Conclusion:The MUNE method demonstrates that chronic intermittent hypoxemia during sleep causes reduction of the motor unit number in OSAS patients and is an independent risk factor for subclinical polyneuropathy

A newborn with moderate hemophilia A with severe intracranial and extracranial hemorrhage: A case report

Intracranial hemorrhage among term newborns is a rare clinical condition with high morbidity and mortality. Although major bleeding is relatively uncommon, the incidence of intracranial hemorrhage in hemophilic children is higher during the first few days of life than at any other stage in childhood, which relates to the trauma of delive ry. Here, we reported a newborn case diagnosed with moderate hemophilia A, without the presence of a positive family history of hemophilia and presenting with intracranial and extracranial hemorrhage and we aimed to emphasize that the early diagnosis and replacement therapy carries an essential importance

Surgical Treatment of Osteopetrosis-Related Femoral Fractures: Two Case Reports and Literature Review

Osteopetrosis is a rare hereditary disease which is characterized by increased bone density. Bone resorption is insufficient or fails due to the osteoclast defect in osteopetrosis. Half of the patients are asymptomatic and diagnosed incidentally or based on the presence of fracture. Adult onset osteopetrosis usually presents with hip and proximal femoral fractures. Internal fixation can be performed; however, technical challenges may be experienced due to increased bone density. As in other fractures, nonunion or varus malunion of these fractures may occur. Although rare, osteopetrosis may complicate treatment of fractures in such patients. In this study, we aimed to present two new cases of ADO type II with an osteopetrotic femoral fracture along with the clinical and radiological findings in the light of a comprehensive literature review. Orthopaedics surgeons should be aware of intraoperative technical difficulties and possible postoperative complications during the follow-up period. Investigation would be beneficial for the diagnosis of osteopetrosis such the patient with fractures who has minor trauma history and increased bone density in radiography

Türkiye’de inme hastalarında atrial fibrilasyonun yönetimi: NöroTek çalışması gerçek hayat verileri

Objective: Atrial fibrillation (AF) is the most common directly preventable cause of ischemic stroke. There is no dependable neurology-based data on the spectrum of stroke caused by AF in Turkiye. Within the scope of NoroTek-Turkiye (TR), hospital-based data on acute stroke patients with AF were collected to contribute to the creation of acute-stroke algorithms.Materials and Methods: On May 10, 2018 (World Stroke Awareness Day), 1,790 patients hospitalized at 87 neurology units in 30 health regions were prospectively evaluated. A total of 929 patients [859 acute ischemic stroke, 70 transient ischemic attack (TIA)] from this study were included in this analysis.Results: The rate of AF in patients hospitalized for ischemic stroke/TIA was 29.8%, of which 65% were known before stroke, 5% were paroxysmal, and 30% were diagnosed after hospital admission. The proportion of patients with AF who received "effective" treatment [international normalization ratio >= 2.0 warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) at a guideline dose] was 25.3%, and, either no medication or only antiplatelet was used in 42.5% of the cases. The low dose rate was 50% in 42 patients who had a stroke while taking NOACs. Anticoagulant was prescribed to the patient at discharge at a rate of 94.6%; low molecular weight or unfractionated heparin was prescribed in 28.1%, warfarin in 32.5%, and NOACs in 31%. The dose was in the low category in 22% of the cases discharged with NOACs, and half of the cases, who received NOACs at admission, were discharged with the same drug.Conclusion: NoroTekTR revealed the high but expected frequency of AF in acute stroke in Turkiye, as well as the aspects that could be improved in the management of secondary prophylaxis. AF is found in approximately one-third of hospitalized acute stroke cases in Turkiye. Effective anticoagulant therapy was not used in three-quarters of acute stroke cases with known AF. In AF, heparin, warfarin, and NOACs are planned at a similar frequency (one-third) within the scope of stroke secondary prophylaxis, and the prescribed NOAC dose is subtherapeutic in a quarter of the cases. Non-medical and medical education appears necessary to prevent stroke caused by AF.Amaç: Atrial fibrilasyon (AF) iskemik inmenin doğrudan önlenebilir en sık nedendir. Ülkemizde AF nedenli inme spektrumuna dair nöroloji kaynaklı geniş ölçekte bir veri bulunmamaktadır. NöroTek-Türkiye (TR) kapsamında akut inme algoritmalarının oluşturulmasına katkı yapması beklenen AF tespit edilen akut inme hastalarına dair hastane verisi toplanmıştır. Gereç ve Yöntem: 10 Mayıs 2018 Dünya İnme Farkındalık Günü’nde 30 sağlık bölgesine yer alan 87 nöroloji biriminde yatmakta olan 1.790 hasta prospektif olarak değerlendirilmiştir. Çalışmada yer alan toplam 929 hasta [859 akut iskemik inme, 70 geçici iskemik atak (GİA)] bu analize dahil edilmiştir. Bulgular: İskemik inme/GİA sebebiyle ile interne edilmiş hastalarda AF oranı %29,8 olup bunların %65’i bilinmekte olan, %5’i paroksismal ve %30’u yeni tanıdır. AF tanısı ile gelen hastalarda “etkin” tedavi [internasyonel normalizasyon oranı ≥2,0 varfarin veya rehber dozunda non-vitamin K antagonist oral antikoagülan (NOAK)] alanların oranı %25,3 olup, %42,5 olguda ya hiç ilaç kullanılmamakta ya da sadece antiplatelet kullanılmaktaydı. Düşük doz kullanım oranı 42 NOAK alırken inme geçirmiş olguda %50 idi. Taburcu edilirken antikoagülan %94,6 (düşük molekül ağırlıklı veya non-fraksiyone heparin %28,1; varfarin %32,5 ve NOAK %31) hastaya reçete edilmişti. NOAK ile taburcu edilen olguların %22’sinde doz düşük kategoride olup gelişte NOAK almakta olan olguların yarısı aynı ilaçla taburcu edilmiştir. Sonuç: NöroTekTR ülkemizde AF’nin akut inmedeki sıklığı yanı sıra sekonder proflaksi perspektifinde yönetiminin geliştirilebilecek yönlerini ortaya koydu. Türkiye’de hastanede yatan akut inme olgularının yaklaşık üçte birinde AF saptanmıştır. AF’si bilinen akut inme olgularının dörtte üçünde etkin antikoagülan tedavi kullanılmamaktaydı. AF’de inme sekonder proflaksisi kapsamında heparin, varfarin ve NOAK planlaması benzer sıklıkta (üçte bir) olup reçete edilen NOAK dozu dörtte bir olguda subterapötiktir. AF’ye bağlı inmenin önlenebilmesi non-medikal ve medikal eğitim gerekli görünmektedir

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030