Rapid culture and identification: a practical method for early preliminary laboratory diagnosis of sepsis

ABSTRACTThis study describes the development of a method for rapid preliminary species identification of bacteria from positive blood culture vials. The method yielded preliminary identification results for 496 (92%) of 541 positive blood cultures within 5 h. The method was capable of identifying the most frequently isolated bacteria (i.e., Staphylococcus aureus, coagulase-negative staphylococci, Escherichia coli, Streptococcus pneumoniae and Enterococcus spp.) to the species level. The method can be established easily, with a materials cost of 2–5 Euros per sample

The principal types of artificial prostesesand ventricular functions

Artifisyel protezlerin tiplerinin özellikleri ve ventrikül fonksionları. Artifisyel kalb kapaklarının tiplerinin özellikleri ve biolojik grefler disküze edilerek, kapak değişiminden sonra oskültasyon bulguları hakkında izahatta bulunulmuştur. İyi bir cerrahi uygulamayı takiben mitral valu değişiminden sonra sol ventrikül volümünde % 20 bir azalma ve aort valu değişiminden sonra sol ventrikül volümünde % 23 azalma vardır. Kapak değişiminden sonra hastanın aynı doktor tarafından tekrar dinlenilmesi komplikasyonların erken tanımına yardımcı olabilir.The principal types of artificial prostesesand ventricular functions. The principal types of artificial heart values and biologic grafts are discussed briefly and mentioned about the auscultatory signs after replacement. After satisfactory surgical applications the decrease in left ventricular volume is 20 % after mitral and 23 % after aorfic valve replacement. After replacement, repeated auscultation of the patient by the same physician may help in early recognition of complications

Early and late mortality rate and complications after cardiac valve replacement

Mitral'e uygulanmış yapay kapaklarda erken ve geç mortalite oranları genellikle %7-9 ile %21,3 arasındadır. Biolojik greflerde ise bu oranlar %14,6- 13,6' dır. Aortadaki oranlar yapay kapaklar için genellikle %3-5 (Sovyetler Birliğinde %12,7) ve operasyondan 5 yıl sonra her yıl için %5 civarındadır. Aortaya uygulanmış biyolojik greflerde ise erken ve geç mortalite oranları, %4 - %4 tür. Kapak değişimi (Replacement ) sonrası önemli komplikasyonlar ise: Şiddetli kalıcı veya tekrarlaycı kalp yetmezliği, tromboembolizm, hernaliz ve mekanik fonksiyon bozuklukları ile özellikle biyolojik greflerin dejenrasyon ve infeksiyonlarıdır.In the artificial valves on mitral position, the early mortality rate is generally between 7- 9 % and late mortality rate is 21, 3 %. Those rates in biologic graft are 14,6% and 13. 6 %. The sume rates in artifical valves on aortic position are generally between 3-5 % (in Soviet Union 12.7%) and 5% for every year after 5 year after operation. On biologic grafts of aorta, those rates are nearly 4% and 4%. The complications consist of Severe persistant or recurrent heart failure, tromboembolism, hemolysis and mechanical dysfunction for artifical valves and degeneration and infection for biologic grafts

Natural history of cardiac valve diseases and replacement indications

New York Heart Association sınıflandırımına göre grade III de bulunan MD vakalarının % 65'i semptomlardan sonraki ilk 3 yılda kaybedilirler. Her gruptan MD vakalarının tabi seyrinde ise yaşama oranları genellikle ilk 5 yıl için % 80, ikinci 5 yıl içinse % 60 tır. Bu oranlar MY içinde aynı kalırken, mikst mitral vakalarında %66 ve %33’e düşer. AD da ise bu oranlar birinci ve ikinci 5 yıl için %48 ve %10 dur. AY ve AD de genellikle anginadan sonra 5, senkoptan sonra 3 ve kalb yetmezliğinden sonra 2 yıllık yaşama şansı vardır. Mitral lezyonlarda kapak değişimi tavsiyesi grade III ve IV için yapılırken, aortik lezyonlarda erken grade'lar tercih edilmektedir.65% of patients with mitral stenosis who are grade III according to New York heart association died in first three year after symtoms. General survival of all grades of stenotic patients are 80% on first 5 year and 60 % on second 5 year. Those ratios are nearly same in mitral insufficiency but in mixt mitral lesions 66 % and 33 %. After apperiance of symptoms in aortic stenosis, survival is 48 % in the first five years and 10 % in the second 5 years. The survival either in aortic stenosis or sufficency are 5 year after angina, 3 year after syncope and 2 year after heart failure. While the replacement indication on mitral lesion is valuable in grade III and IV, on aortic lesion replacement is offered especially in early grades

ChatGPT (GPT-3.5) as an assistant tool in microbial pathogenesis studies in Sweden: a cross-sectional comparative study

ChatGPT (GPT-3.5) has entered higher education and there is a need to determine how to use it effectively. This descriptive study compared the ability of GPT-3.5 and teachers to answer questions from dental students and construct detailed intended learning outcomes. When analyzed according to a Likert scale, we found that GPT-3.5 answered the questions from dental students in a similar or even more elaborate way compared to the answers that had previously been provided by a teacher. GPT-3.5 was also asked to construct detailed intended learning outcomes for a course in microbial pathogenesis, and when these were analyzed according to a Likert scale they were, to a large degree, found irrelevant. Since students are using GPT-3.5, it is important that instructors learn how to make the best use of it both to be able to advise students and to benefit from its potential

Association study of Interleukin 10 gene polymorphisms in Iraqi patients with multiple sclerosis

Multiple sclerosis (MS) is a type of autoimmune disease where immune cell attacks our cells mistakenly; its severity is measured by expanded disease status scale (EDSS). The study aims the investigation of −1082 polymorphism in interleukin 10 (IL-10) as one of the etiologies that develops the disease. This is a case-control study that allele-specific polymerase chain reaction (AS-PCR) were provided to compare 100 relapsing-remitting MS (RRMS) patients, which fulfills McDonald criteria with 100 healthy controls depending on the −1082 (G/A) polymorphism of the gene encoding IL-10. The A allele frequency of IL-10 gene has been considerably less in MS patients compare to healthy control (60.50 Vs. 81%). Genotype distributions of the single nucleotide polymorphism (SNP) -1082 fulfills Hardy-Weinberg equilibrium in cases (P = 0.155) but it doesn't in controls (P < 0.0001). In MS patients, Heterozygous (GA) genotypes were non-significantly associated with MS (OR = 0.834,95% CI = 0.6890 to 1.29, P 0.706) but homozygous (AA) were significantly associated with this condition (OR = 3.420, 95% CI = 1.450 to 8.065, P = 0.0037). To conclude, the genotype distribution of −1082 (G/A) polymorphism has been showed a significant difference in the case/control study recruited in Erbil province-Iraq, and EDSS is significantly higher in A allele's carrier genotypes. There was non-significance association AA genotypes and duration of the disease

European candidaemia is characterised by notable differential epidemiology and susceptibility pattern: Results from the ECMM Candida III study.

The objectives of this study were to assess Candida spp. distribution and antifungal resistance of candidaemia across Europe. Isolates were collected as part of the third ECMM Candida European multicentre observational study, conducted from 01 to 07-07-2018 to 31-03-2022. Each centre (maximum number/country determined by population size) included ∼10 consecutive cases. Isolates were referred to central laboratories and identified by morphology and MALDI-TOF, supplemented by ITS-sequencing when needed. EUCAST MICs were determined for five antifungals. fks sequencing was performed for echinocandin resistant isolates. The 399 isolates from 41 centres in 17 countries included C. albicans (47.1%), C. glabrata (22.3%), C. parapsilosis (15.0%), C. tropicalis (6.3%), C. dubliniensis and C. krusei (2.3% each) and other species (4.8%). Austria had the highest C. albicans proportion (77%), Czech Republic, France and UK the highest C. glabrata proportions (25-33%) while Italy and Turkey had the highest C. parapsilosis proportions (24-26%). All isolates were amphotericin B susceptible. Fluconazole resistance was found in 4% C. tropicalis, 12% C. glabrata (from six countries across Europe), 17% C. parapsilosis (from Greece, Italy, and Turkey) and 20% other Candida spp. Four isolates were anidulafungin and micafungin resistant/non-wild-type and five resistant to micafungin only. Three/3 and 2/5 of these were sequenced and harboured fks-alterations including a novel L657W in C. parapsilosis. The epidemiology varied among centres and countries. Acquired echinocandin resistance was rare but included differential susceptibility to anidulafungin and micafungin, and resistant C. parapsilosis. Fluconazole and voriconazole cross-resistance was common in C. glabrata and C. parapsilosis but with different geographical prevalence

CD20 therapies in multiple sclerosis and experimental autoimmune encephalomyelitis - Targeting T or B cells?

MS is widely considered to be a T cell-mediated disease although T cell immunotherapy has consistently failed, demonstrating distinct differences with experimental autoimmune encephalomyelitis (EAE), an animal model of MS in which T cell therapies are effective. Accumulating evidence has highlighted that B cells also play key role in MS pathogenesis. The high frequency of oligoclonal antibodies in the CSF, the localization of immunoglobulin in brain lesions and pathogenicity of antibodies originally pointed to the pathogenic role of B cells as autoantibody producing plasma cells. However, emerging evidence reveal that B cells also act as antigen presenting cells, T cell activators and cytokine producers suggesting that the strong efficacy of anti-CD20 antibody therapy observed in people with MS may reduce disease progression by several different mechanisms. Here we review the evidence and mechanisms by which B cells contribute to disease in MS compared to findings in the EAE model

Predictors for prolonged hospital stay solely to complete intravenous antifungal treatment in patients with candidemia: Results from the ECMM candida III multinational European observational cohort study

Background To date, azoles represent the only viable option for oral treatment of invasive Candida infections, while rates of azole resistance among non-albicans Candida spp. continue to increase. The objective of this sub-analysis of the European multicenter observational cohort study Candida III was to describe demographical and clinical characteristics of the cohort requiring prolonged hospitalization solely to complete intravenous (iv) antifungal treatment (AF Tx). Methods Each participating hospital (number of eligible hospitals per country determined by population size) included the first ~ 10 blood culture proven adult candidemia cases occurring consecutively after July 1st, 2018, and treating physicians answered the question on whether hospital stay was prolonged only for completion of intravenous antifungal therapy. Descriptive analyses as well as binary logistic regression was used to assess for predictors of prolonged hospitalization solely to complete iv AF Tx. Findings Hospital stay was prolonged solely for the completion of iv AF Tx in 16% (100/621) of candidemia cases by a median of 16 days (IQR 8 – 28). In the multivariable model, initial echinocandin treatment was a positive predictor for prolonged hospitalization to complete iv AF Tx (aOR 2.87, 95% CI 1.55 – 5.32, p < 0.001), while (i) neutropenia, (ii) intensive care unit admission, (iii) catheter related candidemia, (iv) total parenteral nutrition, and (v) C. parapsilosis as causative pathogen were found to be negative predictors (aOR 0.22 – 0.45; p < 0.03). Interpretation Hospital stays were prolonged due to need of iv AF Tx in 16% of patients with candidemia. Those patients were more likely to receive echinocandins as initial treatment and were less severely ill and less likely infected with C. parapsilosis

Guideline adherence and survival of patients with candidaemia in Europe: results from the ECMM Candida III multinational European observational cohort study

© 2022 Elsevier Ltd. All rights reserved.[Background] The European Confederation of Medical Mycology (ECMM) collected data on epidemiology, risk factors, treatment, and outcomes of patients with culture-proven candidaemia across Europe to assess how adherence to guideline recommendations is associated with outcomes.[Methods] In this observational cohort study, 64 participating hospitals located in 20 European countries, with the number of eligible hospitals per country determined by population size, included the first ten consecutive adults with culture-proven candidaemia after July 1, 2018, and entered data into the ECMM Candida Registry (FungiScope CandiReg). We assessed ECMM Quality of Clinical Candidaemia Management (EQUAL Candida) scores reflecting adherence to recommendations of the European Society of Clinical Microbiology and Infectious Diseases and the Infectious Diseases Society of America guidelines.[Findings] 632 patients with candidaemia were included from 64 institutions. Overall 90-day mortality was 43% (265/617), and increasing age, intensive care unit admission, point increases in the Charlson comorbidity index score, and Candida tropicalis as causative pathogen were independent baseline predictors of mortality in Cox regression analysis. EQUAL Candida score remained an independent predictor of mortality in the multivariable Cox regression analyses after adjusting for the baseline predictors, even after restricting the analysis to patients who survived for more than 7 days after diagnosis (adjusted hazard ratio 1·08 [95% CI 1·04–1·11; p<0·0001] in patients with a central venous catheter and 1·09 [1·05–1·13; p<0·0001] in those without one, per one score point decrease). Median duration of hospital stay was 15 days (IQR 4–30) after diagnosis of candidaemia and was extended specifically for completion of parenteral therapy in 100 (16%) of 621 patients. Initial echinocandin treatment was associated with lower overall mortality and longer duration of hospital stay among survivors than treatment with other antifungals.[Interpretation] Although overall mortality in patients with candidaemia was high, our study indicates that adherence to clinical guideline recommendations, reflected by higher EQUAL Candida scores, might increase survival. New antifungals, with similar activity as current echinocandins but with longer half-lives or oral bioavailability, are needed to reduce duration of hospital stay.Scynexis.Peer reviewe