Different epidemiology of bloodstream infections in COVID-19 compared to non-COVID-19 critically ill patients: A descriptive analysis of the Eurobact II study

Background: The study aimed to describe the epidemiology and outcomes of hospital-acquired bloodstream infections (HABSIs) between COVID-19 and non-COVID-19 critically ill patients. Methods: We used data from the Eurobact II study, a prospective observational multicontinental cohort study on HABSI treated in ICU. For the current analysis, we selected centers that included both COVID-19 and non-COVID-19 critically ill patients. We performed descriptive statistics between COVID-19 and non-COVID-19 in terms of patients’ characteristics, source of infection and microorganism distribution. We studied the association between COVID-19 status and mortality using multivariable fragility Cox models. Results: A total of 53 centers from 19 countries over the 5 continents were eligible. Overall, 829 patients (median age 65 years [IQR 55; 74]; male, n = 538 [64.9%]) were treated for a HABSI. Included patients comprised 252 (30.4%) COVID-19 and 577 (69.6%) non-COVID-19 patients. The time interval between hospital admission and HABSI was similar between both groups. Respiratory sources (40.1 vs. 26.0%, p < 0.0001) and primary HABSI (25.4% vs. 17.2%, p = 0.006) were more frequent in COVID-19 patients. COVID-19 patients had more often enterococcal (20.5% vs. 9%) and Acinetobacter spp. (18.8% vs. 13.6%) HABSIs. Bacteremic COVID-19 patients had an increased mortality hazard ratio (HR) versus non-COVID-19 patients (HR 1.91, 95% CI 1.49–2.45). Conclusions: We showed that the epidemiology of HABSI differed between COVID-19 and non-COVID-19 patients. Enterococcal HABSI predominated in COVID-19 patients. COVID-19 patients with HABSI had elevated risk of mortality. Trial registration ClinicalTrials.org number NCT03937245. Registered 3 May 2019

Effects of modafinil therapy on clinical and neurophysiological tests of multiple sclerosis (MS) patients with fatigue

Amaç: Çalışmamızda, yorgunluğu olan Multiple skleroz'lu (MS) hastalara uygulanan modafinil tedavisinin klinik ve nörofizyolojik testler üzerine etkisini incelemeyi amaçladık. Gereç ve Yöntem: Çalışmaya Uludağ Üniversitesi Tıp Fakültesi Nöroloji Polikliniğinde Mc Donald's kriterlerine göre MS tanısıyla takip edilen hastalardan yorgunluk şikayeti olan ve Yorgunluk Değerlendirme Skalasından (YDS) 36 ve üstünde puan alan, Beck Depresyon Envanterine göre 16 ve altında puan alan, tiroid fonksiyon testleri, karaciğer fonksiyon testleri ve böbrek fonksiyon testlerinde patoloji saptanmayan ve sistemik hastalığı olmayan 16'sı kadın 2'si erkek toplam 18 hasta alındı. Çalışmaya alınan hastaların nörolojik muayeneleri yapılarak, genişletilmiş yetersizlik durum skalası (EDSS), Yorgunluk Şiddet Ölçeği (YŞÖ) ve MS Yaşam Kalitesi Ölçeği-54 (MSQoL-54) değerlendirildi. Nörofizyoloji laboratuarında Somatosensoriyel Uyarılmış Potansiyel (SEP), Görsel Uyarılmış Potansiyel (VEP), Beyin Sapı Uyarılmış Potansiyel (BAEP) ve Görsel Olaya İlişkin Endojen Potansiyel (Görsel P300) uygulanan hastalara hemen sonrasında Modafinil 100 mg ilk 1 hafta 1x1 tablet (sabah), sonraki haftalar 2x1 tablet (sabah ve öğlen dozunda) şeklinde tedavi başlandı. Tedavilerinin 6. haftası sonunda hastalar polikliniğimize davet edilerek nörolojik muayeneleri, EDSS, YDS, YŞÖ, MSQoL-54, SEP, VEP, BAEP ve Görsel P300 tekrarlandı. Bulgular: Hastaların tedavi öncesi YDS ve YŞÖ toplam skorları, tedavi sonrasındaki değerlerle karşılaştırıldığında fark istatistiksel olarak anlamlı bulundu. YŞÖ'nün her 3 alt boyutu (bilişsel, fiziksel ve sosyal) ayrı ayrı değerlendirildiğinde modafinil tedavisi sonrasında skorlarda başlangıca göre istatistiksel olarak anlamlı azalma saptandı. Modafinil tedavisinin MSQoL-54 ile değerlendirilen yaşam kalitesini düzelttiği saptandı. MS hastalık atak sayısı ile YŞÖ'nin her 3 alt boyutu arasında istatistiksel olarak anlamlı bir ilişki saptanmadı. Hastaların modafinil tedavisi öncesi YDS skorları ile EDSS ve Beck depresyon envanteri skorları arasında istatistiksel olarak anlamlı ilişki saptanmadı. Beck Depresyon Envanteri Skoru ile YŞÖ'nün sosyal boyut alt grubu arasında istatistiksel olarak orta derecede anlamlı korelasyon mevcuttu. iii Hastaların nörofizyoloji laboratuarında yapılan SEP, VEP, BAEP Görsel P300 testlerinden elde edilen ortalama değerler modafinil tedavisi öncesi ve sonrası karşılaştırıldığında, değerler arasında anlamlı fark izlenmedi. Sonuç: Çalışmamızda MS'in en sık semptomlarından biri olan yorgunluk semptomunun tedavisinde kullanılan modafinilin, hastaların klinik olarak yorgunluk semptomuna ve MS yaşam kalitesine olumlu etkisi olduğunu, ancak tedavinin hastaların nörofizyoloji laboratuarında değerlendirilen uyarılmış potansiyel yöntemleri (BAEP, SEP, VEP, P300) üzerine etkisi olmadığını saptadık.Aim: In our study, we investigated the effects of modafinil therapy on clinical and neurophysiological tests of Multiple Sclerosis (MS) patients with fatigue. Methods and materials: The study was performed on 18 MS patients16 (female, 2 male) at Uludağ University Medical Faculty Neurology department , who are followed up according to Mc Donald's criteria, who had 36 points or above based on the fatigue severity scala (FSS), whose Beck depression inventory points were 16 and below, whose thyroid, liver and renal functions were evaluated as normal, and who had no systemic disorder. All patients went under neurological examination and their expanded disability status scale (EDSS), Modified Fatigue Impact Scala (MFIS) and multiple sclerosis quality of life (MSQoL-54) were evaluated. Somatosensory evoked potential (SEP), visual evoked potential (VEP), brainstem auditory evoked potential (BAEP), visual event related evoked potential ( visual P300) were performed in our neurophysiology laboratory. After that the patients were given modafinil 100 mgr 1x1 (morning) for 1 week, the following weeks 2x1 (morning and noon). At the end of the 6 weeks of therapy the patients were called to the neurology polyclinic, and their neurological examinations, EDSS, FSS, MFIS, MSQoL-54, SEP, VEP, BAEP and visual P300 were repeated. Results: When the patients' previous and subsequent FSS and MFIS total scores were compared, a significant statistical difference was found. When all 3 subgroups of MFIS (consciousness, physical and social) were evaluated after the modafinil therapy, a significant statistical decrease in previous and successive scores were found. It is found out that modafinil therapy improves life quality which is evaluated due to MSQoL-54. A significant statistical relation between the number of MS disease attacks and the three subgroups of MFIS was not figured out. There were no v statistically significant relation between the FSS, EDSS and Beck depression inventory scores before the modafinil therapy had been applied. There was a statistically correlation between Beck depression inventory score and MFIS's social subgroup. When the patient's SEP, VEP, BAEP, visual P300 average test values before and after the modafinil therapy were compared, a statistically significant difference was not observed. Conclusion: In our study, it is found that modafinil therapy, which is used against fatigue, one of the MS disase's most common symptom, has a positive impact on MS life quality and patients' clinical symptoms of fatigue, although it has no effect on patients' evoked potential methods (BAEP, SEP, VEP, visual P300) performed in neurophysiology laboratory

Nostalgic (Re)Visions of Englishness in Merchant Ivory’s Adaptation of Kazuo Ishiguro’s The Remains of the Day

*Göçmen, Gülşah ( Aksaray, Yazar )This article argues that the adaptation of Kazuo Ishiguro’s novel The Remains of the Day (1989) by Merchant Ivory evokes nostalgia as a trope that glorifies the imperial past of the British through portraying extravagantly both the butler protagonist’s professionalism and his attachment to the country house (Darlington Hall), one of the symbolic places used in heritage cinema. In the novel, Stevens’ sense of nostalgia is presented as a sensual impetus or a blueprint to revisit the past to construct a more insightful understanding of the self. Analysing both uses of nostalgia in the source text and its adaptation, this article reveals that the Merchant Ivory adaptation (1993) limits its nostalgic perspective to depicting the idealised imperial past, and it does not evoke any dissident conception of nostalgia for the audience as the novel provides through its protagonist’s retrospection for the reader. Discussing the politics and contextual background of the adaptation, it concludes that Merchant Ivory’s film version of Ishiguro’s novel exemplifies characteristics of heritage cinema to convey dominantly conservative ideologies such as elitism and nationalism as common norms upheld in Thatcher’s Britain

Prevalence of Periodic Leg Movements in Patients at a Sleep Center

Objective: This study aimed to determine the prevalence of periodic leg movements (PLMs) in patients who underwent polysomnographic examinations and to compare the demographic and polysomnographic characteristics of patients with and without PLM

Review of 15 Cases of Neurobrucellosis

Introduction: Brucellosis is a zoonotic disease remaining endemic worldwide and in Turkey. Central nervous system involvement is a rare complication in brucellosis. This study is an overview of 15 neurobrucellosis cases who were followed in our department as inpatients. Patients and Methods: This study is a retrospective analysis of fi fteen cases of neurobrucellosis in the Infectious Diseases and Clinical Microbiology Department of Inonu University Medical Faculty Hospital between the years 2005-2010. Clinical features, laboratory findings, diagnosis, and treatment strategies were recorded retrospectively. Results: Of the fi fteen patients, 6 were females and 9 were males. Mean age of the patientswas 36.2 years (range, 18-68 years). Mean disease duration before diagnosis was 2 months. The most common symptoms were headache and fever, 66 % and 60 %, respectively. Eight patients (53 %) had visual symptoms, 3 patients (20%) had senso-rineural hearing loss, and 2 patients (13%) had ataxia. Two patients had pancytopenia and four patients had abnormal liver function tests. Two patients did not give informed consent for lumbar puncture (LP). The diagnostic LP performed in all thirteen patients revealed high protein levels and pleocytosis in cerebrospinal fl uid (CSF). Seven patients (53.8 %) had low glucose levels in CSF. Twelve patients (80%) had a serum tube agglutination test value 1/160 or higher. Brucella spp. were isolated from the blood culture of six patients and from the CSF culture of three patients. All patients received antibiotic therapy initially with doxycycline, rifampin, ceftriaxone, and trimethoprim-sulfamethoxazole. None of the patients died, but sequelae resulted in two patients. Conclusion: Patients with unexplained fever, headache, and neurological symptoms should be considered for neurobrucellosis in endemic regions

Evaluation of Plasma Urokinase-Type Plasminogen Activator Receptor (UPAR) in Patients With Chronic Hepatitis B, C and Non-Alcoholic Fatty Liver Disease (NAFLD) as Serological Fibrosis Marker.

Progressive hepatic fibrosis is the main predictor of outcome and prognosis in chronic liver diseases. The importance of the coagulation cascade has been defined in liver fibrosis; however, the role of the fibrinolytic pathway has not been clear yet. We aimed to evaluate the association between the plasma levels of soluble urokinase Plasminogen Activator Receptor (uPAR) and the severity of liver fibrosis in chronic hepatitis B, C and Non-Alcoholic Fatty Liver Disease (NAFLD)