Bir Eğitim ve Araştırma Hastanesi Çocuk Kliniklerinde Alınan Kültür Sonuçlarının Değerlendirilmesi

Amaç: Çoklu ilaç direnci olan mikroorganizmalar ile enfeksiyon sıklığı giderek artmakta olup; enfeksiyonların erken tanınması, etkili tedavisi ve prognoz açısından kültür örneklerinin değerlendirilmesi önemlidir. Bu çalışmanın amacı, yenidoğan yoğun bakım ünitesi dışındaki çocuk servislerinde yatan hastalardan alınan kan ve idrar kültürü sonuçlarının değerlendirilmesidir. Gereç ve Yöntem: Bu çalışmada 2007-2008 yılları arasında bakılan 2277 kan kültürü ve 857 idrar kültürü retrospektif olarak değerlendirilmiştir. Kan kültüründe %6,8 (n=156), idrar kültüründe ise %6 (n=52) üreme anlamlı görülerek çalışmaya dahil edilmiştir. Alınan kan kültürleri Bact-Alert 3D otomatize kan kültür sistemlerinde, idrar örnekleri MacConkey ve %5 koyun kanlı agar besiyerlerine ekimi yapılarak üreyen mikroorganizmalar tanımlanmış, antibiyotik duyarlılık testleri yapılmıştır. Bulgular: Çocuk kliniklerinde bakteriyemi saptanan hastalarda %79,4 gram pozitif (%69’u Koagülaz-negatif stafilokok, KNS), idrar kültüründe ise %86,5 gram negatif (%61,5 Escherichia coli, %11,5 Enterokoklar) mikroorganizma üremiştir. Kan kültürlerinde üreyen mikroorganizmalar: %48 (n=75) Metisilin-dirençli KNS, %21(n=33) Metisilin-hassas KNS, %7,5 (n=12) Klebsiella pneumoniae (%4,5 genişlemiş spektrumlu beta-laktamaz, GSBL pozitif), %4,5 (n=7) Pseudomonas suşları, %3,2 (n=5) Enterococcus spp., %2,6 (n=4) Streptococcus pneumoniae, %2,6 (n=4) Metisilin-hassas Staphylococcus aureus, %2 (n=3) Acinetobacter, %2,6 (n=4) Candida tropicalis, %2 (n=3) Escherichia coli, %2 (n=3) Enterobacter, %1,3 (n=2) Hemofilus influenza, %0,6 (n=1) Brucella spp. idi. İdrar kültürlerinde saptanan mikroorganizmalar; %61,5 (n=32) E. coli, (%40 genişlemiş spektrumlu beta-laktamaz, GSBL pozitif), %11,5 (n=6) Enterococcus spp., %5,8 (n=3) Proteus spp., %3,8 (n=2) Pseudomonas spp., %3,8 (n=2) Stenotrophomonas maltophilia, %2 (n=1) Metisilin-hassas Staphylococcus aureus, %2 (n=1) Acinetobacter baumannii, %2 (n=1) Klebsiella spp. idi. Sonuç: Enfeksiyon etkeni mikroorganizmaların ve antibiyotik duyarlılıkları ile direnç oranlarının belirlenmesi uygun ve etkili ampirik antimikrobiyal tedavi başlanmasında ve enfeksiyonların tedavisinde önemlidir

Urinary tuberculosis: A cohort of 79 adult cases

WOS: 000361339400015PubMed ID: 26123266We aimed to investigate the demographic, clinical, diagnostic, treatment and outcome features of patients with urinary tuberculosis (UTB). Patients with UTB admitted to seven separate centers across Turkey between 1995 and 2013 were retrospectively evaluated. The diagnosis of UTB was made by the presence of any clinical finding plus positivity of one of the following: (1) acid-fast bacilli (AFB) in urine, (2) isolation of Mycobacterium tuberculosis, (3) polymerase chain reaction (PCR) for M. tuberculosis, (4) histopathological evidence for TB. Seventy-nine patients (49.36% male, mean age 50.1 +/- 17.4 years) were included. Mean time between onset of symptoms and clinical diagnosis was 9.7 +/- 8.9 months. The most common signs and symptoms were hematuria (79.7%), sterile pyuria (67.1%), dysuria (51.9%), weakness (51.9%), fever (43%) and costovertebral tenderness (38%). Cystoscopy was performed in 59 (74.6%), bladder biopsy in 18 (22.8%), kidney biopsy in 1 (1.26%) and nephrectomy in 12 (15.2%) patients. Histopathological verification of UTB was achieved in 12 (63.1%) patients who undergone biopsy and in 100% of those undergone nephrectomy. Mycobacterium tuberculosis was isolated in the urine of 50 (63.3%) cases. Four-drug standard anti-TB treatment was the preferred regimen for 87.3% of the patients. Mean treatment duration was 10.5 +/- 2.7 months. Deterioration of renal function occurred in 15 (18.9%) patients two of whom progressed to end-stage renal disease and received hemodialysis. Only one patient died after 74-day medical treatment period. Cases with UTB may present with non-specific clinical features. All diagnostic studies including radiology, cyctoscopy and histopathology are of great importance to exclude UTB and prevent renal failure

Effect of High-Risk Obstructive Sleep Apnea on Clinical Outcomes in Adults with Coronavirus Disease 2019

Rationale: Coronavirus disease (COVID-19) is an ongoing pandemic, in which obesity, hypertension, and diabetes have been linked to poor outcomes. Obstructive sleep apnea (OSA) is associated with these conditions and may influence the prognosis of adults with COVID-19. Objectives: To determine the effect of OSA on clinical outcomes in patients with COVID-19. Methods: The current prospective observational study was conducted in three hospitals in Istanbul, Turkey from March 10 to June 22, 2020. The participants were categorized as high-risk or low-risk OSA according to the Berlin questionnaire that was administered in the out-patient clinic, in hospital, or shortly after discharge from hospital blinded to the clinical outcomes. A modified high-risk (mHR)–OSA score based on the snoring patterns (intensity and/or frequency), breathing pauses, and morning/daytime sleepiness, without taking obesity and hypertension into account, were used in the regression models. Results: The primary outcome was the clinical improvement defined as a decline of two categories from admission on a 7-category ordinal scale that ranges from 1 (discharged with normal activity) to 7 (death) on Days 7, 14, 21, and 28, respectively. Secondary outcomes included clinical worsening (an increase of 1 category), need for hospitalization, supplemental oxygen, and intensive care. In total, 320 eligible patients (median [interquartile range] age, 53.2 [41.3–63.0] yr; 45.9% female) were enrolled. In all, 121 (37.8%) were categorized as known (n = 3) or high-risk OSA (n = 118). According to the modified scoring, 70 (21.9%) had mHR-OSA. Among 242 patients requiring hospitalization, clinical improvement within 2 weeks occurred in 75.4% of the mHR-OSA group compared with 88.4% of the modified low-risk–OSA group (P = 0.014). In multivariate regression analyses, mHR-OSA (adjusted odds ratio [OR], 0.42; 95% confidence interval [CI], 0.19–0.92) and male sex (OR, 0.39; 95% CI, 0.17–0.86) predicted the delayed clinical improvement. In the entire study population (n = 320), including the nonhospitalized patients, mHR-OSA was associated with clinical worsening (adjusted hazard ratio, 1.55; 95% CI, 1.00–2.39) and with the need for supplemental oxygen (OR, 1.95; 95% CI, 1.06–3.59). Snoring patterns, especially louder snoring, significantly predicted delayed clinical improvement, worsening, need for hospitalization, supplemental oxygen, and intensive care. Conclusions: Adults with mHR-OSA in our COVID-19 cohort had poorer clinical outcomes than those with modified low-risk OSA independent of age, sex, and comorbidities. Clinical trial registered with www.clinicaltrials.gov (NCT04363333)

Novel Triazolothiadiazines Act As Potent Anticancer Agents In Liver Cancer Cells Through Akt And Ask-1 Proteins

Newly designed triazolothiadiazines incorporating with structural motifs of nonsteroidal analgesic anti-inflammatory drugs were synthesized and screened for their bioactivity against epithelial cancer cells. Compounds with bioactivities less then similar to 5 mu M (IC50) were further analyzed and showed to induce apoptotic cell death and SubG(1) cell cycle arrest in liver cancer cells. Among this group, two compounds (1g and 1h) were then studied to identify the mechanism of action. These molecules triggered oxidative stress induced apoptosis through ASK-1 protein activation and Akt protein inhibition as demonstrated by downstream targets such as GSK3 beta, beta-catenin and cyclin D1. QSAR and molecular docking models provide insight into the mechanism of inhibition and indicate the optimal direction of future synthetic efforts. Furthermore, molecular docking results were confirmed with in vitro COX bioactivity studies. This study demonstrates that the novel triazolothiadiazine derivatives are promising drug candidates for epithelial cancers, especially liver cancer. (c) 2016 Published by Elsevier Ltd.Wo