Hastanede yatan yaşlı hastalarda enfeksiyon hastalıkları konsültasyonları

Giriş: Çalışmanın amacı hastanede yatan yaşlı hastaların enfeksiyon hastalıkları konsültasyonlarının, konsültasyon öncesinde ve sonrasında antibiyotik kullanımlarının ve enfeksiyon hastalıkları uzmanlarının önerilerine uyumun değerlendirilmesiydi. Gereç ve Yöntem: Bu retrospektif çalışma Zonguldak Karaelmas Üniversitesi Eğitim ve Araştırma Hastanesi'nde yapıldı. Atmış beş yaş ve üzerinde olan, Ocak 2010 ve Ocak 2011 yılları arasında hastanede yatıp enfeksiyon hastalıkları konsültasyonu istenen hastalar çalışmaya dahil edildi. Bulgular: En sık konsültasyon istenme nedenleri yalnızca ateş, yalnızca lökositoz, akciğer radyogramında infiltrasyon ve deri ve yumuşak doku enfeksiyonu varlığıydı. Enfeksiyon hastalıkları uzmanlarınca sık konulan tanılar toplum kökenli pnömoni, nozokomiyal pnömoni ve idrar yolu enfeksiyonuydu. Konsültasyon öncesinde 99 hastaya ampirik antimikrobiyal tedavi diğer klinisyenler tarafından başlandı ve en sık başlanan antibiyotikler üçüncü kuşak sefalosporinler, siprofloksasin veya ampisilin-sulbaktam ve siprofloksasin kombinasyonuydu. Konsültasyon sonrasında enfeksiyon hastalıkları uzmanları tarafından en sık başlanan antibiyotikleri ise karbapenemler, piperasilin- tazobaktam veya sefaperazon-sulbaktam oluşturdu. Başlangıç antibiyotik tedavileri genişletilen hastaların mortalitesi, başlangıç tedavileri değiştirilmeyen ve enfeksiyon hastalıkları uzmanlarınca başlanan hastaların mortalitesinden istatistiksel olarak anlamlı yüksekti. Enfeksiyon hastalıkları uzmanlarının önerilerine 303 konsültasyonun 292'sinde tam olarak uyuldu. Sonuç: Yaşlı hastaların ampirik tedavisi geniş spektrumlu antibiyotikleri içerebilmektedir. Enfeksiyon hastalıkları uzmanlarının önerilerine uyulmasıyla ciddi ve karmaşık enfeksiyöz problemler daha kolay çözülebilmektedir.Introduction: The aim of this study was to investigate the various features of infectious disease consultations, antibiotic usage before and after consultations and adherence to the recommendations of the infectious disease physicians in hospitalized elderly patients. Materials and Method: This retrospective study was conducted in Zonguldak Karaelmas University Teaching and Research Hospital. Hospitalized patients aged 65 years and over for whom an infectious disease consultation was requested between January 2010 and January 2011 were included in the study. Results: The most common causes of consultation requests were the presence of high fever alone, leukocytosis alone, infiltration on chest X-ray, and skin and soft tissue infections. The most commonly diagnosed infections by the infectious disease physicians were community-acquired pneumonias, nosocomial pneumonias and urinary tract infections. In 99 patients, empirical antimicrobial therapy was initiated prior to the infectious disease consultation request, and the most commonly used antibiotics were third-generation cephalosporins and ciprofloxacin ± ampicillin-sulbactam. The most common antimicrobial regimens initiated after the consultation were carbapenems, piperacillin-tazobactam and cefoperazone-sulbactam. The mortality rate of the patients in whom the initiated antibiotic treatment regimens were broadened was significantly higher than the mortality rate of the patients in whom the treatment regimens were not changed and in patients whose treatment was initiated by the infectious disease physicians. Adherence to the recommendations was complete in 292 of 303 consultations. Conclusion: The empirical treatment of hospitalized elderly patients may include broader spectrum antibiotics. Adherence to the recommendations of the infectious disease team may help solve serious and complex infectious problems

A case of generalized tetanus discharged with recovery

Tetanoz, akut başlangıçlı, Clostridium tetani'nin ekzotoksiniyle meydana gelen bir hastalıktır. Tonik kas kasılmalarıyla karakterize olup, yüksek morbidite ve mortaliteye sahiptir. Jeneralize tetanozda mortaliteye sebep olan en ciddi sorun solunumsal tutulumdur. Solunum yetmezliği ve hava yolu obstrüksiyonu olan hastalarda sıklıkla ventilatör desteği gerekmektedir. Burada jeneralize tetanoz tanısı alan 60 yaşında bir erkek hasta sunulmuştur. Hasta acil servise çenesini açamama, yutma güçlüğü, nefes almada zorluk ve yüksek ateş yakınmalarıyla başvurdu. Öyküsünde yedi gün önce sol ayak parmağından paslı çiviyle yaralandığı öğrenildi. Tek doz tetanoz aşısı yapılmıştı ancak tetanoz immünglobulini verilmemişti. Önceki aşı durumunu bilmiyordu. Tetanoz tanısı koyulan hasta, yoğun bakımda takip edildi. İntravenöz metronidazol ve 60.000 IU at kaynaklı tetanoz immünglobulini uygulandı. Jeneralize kas spazmları için midazolam verildi. Mekanik ventilatörde 11 gün süreyle kaldı. Hastaneye yattıktan 28 gün sonra şifa ile taburcu edildi. Sonuç olarak günümüzde tetanoz ülkemiz için nadir görülse de unutulmamalıdır. Hastaneye yaralanmayla başvuran hastalarda önceki aşılama sorulmalı, aşılama ve immünglobulin açısından doğru değerlendirilme yapılmalıdır.Tetanus is an acute-onset disease that results from exposure to the exotoxins produced by Clostridium tetani. It is characterized by tonic muscle spasms and has high morbidity and mortality. Respiratory failure is the most severe problem causing mortality in generalized tetanus. Mechanical ventilation is almost always mandatory for tetanus patients with respiratory failure and airway obstruction. Here, we report a 60-year-old man with generalized tetanus. He was admitted to the emergency department with jaw stiffness, dysphagia, breathlessness, and fever. His history revealed that he had suffered an injury to his left toe by a rusted nail seven days ago. He had received one dose of tetanus vaccine but no anti-tetanus immunoglobulin was given. He also did not know his prior vaccination history. He was diagnosed as tetanus and was followed up in the intensive care unit. He was treated with intravenous metronidazole and 60.000 IU equine tetanus antiserum. Midazolam was given for generalized muscle spasms. He was put on mechanical ventilation for 11 days and was discharged from the hospital 28 days after admission with recovery. In conclusion, although tetanus is now rare for our country, it should not be forgotten. Prior vaccination should be queried in patients who are admitted to hospitals with injury, and they should be accurately evaluated for vaccination and immunoglobulin

Coinfection of malaria and Brucellosis in a patient with persistent fever

Sıtma ve bruselloz Türkiye'nin Güneydoğu Anadolu Bölgesi'nde endemik olup bu bölgeden gelen uygun tedaviye rağmen klinik düzelme görülmeyen olgularda ko-infeksiyon olasılığı akılda tutulmalıdır. Burada Diyarbakır'dan gelen sıtma ve bruselloz ko-infeksiyonlu, uygun sıtma tedavisine yanıt vermeyen 14 yaşında bir erkek hasta sunulmuştur.Malaria and brucellosis are endemic in Southeastern Anatolia. The possibility of coinfection should be kept in mind in patients from this region, who do not respond to appropriate treatment. This paper reports a 14-year-old male with malaria and brucellosis from Diyarbakır, who did not respond to appropriate malaria treatment

Nadir BT bulgusunun eşlik ettiği beyinde hidatik kist olgusu

Hidatik kist hastalığında beyin tutulumu yaygın değildir ve sıklıkla çocuklarda gözlenir. Bilgisayarlı tomografi (BT) incelemede perifokal ödemin eşlik etmesi beklenen bir bulgu değildir ve mevcut olması kistin infekte olduğunu gösterir. Biz bu yazımızda, beyin BT incelemede çevresel ödem gösteren ancak infekte olmayan hidatik kist olgumuzu sunduk.Brain involvement in hydatid disease is uncommon and usually seen in children. On computed tomography (CT) scans perifocal edema is not usually present and, when noted, usually reflects an infected cyst. We report an unusual case of an uninfected hydatid cystic lesion with surrounding edema on brain CT

A Case of Generalized Tetanus Discharged with Recovery

Tetanus is an acute-onset disease that results from exposure to the exotoxins produced by Clostridium tetani. It is characterized by tonic muscle spasms and has high morbidity and mortality. Respiratory failure is the most severe problem causing mortality in generalized tetanus. Mechanical ventilation is almost always mandatory for tetanus patients with respiratory failure and airway obstruction. Here, we report a 60-year-old man with generalized tetanus. He was admitted to the emergency department with jaw stiffness, dysphagia, breathlessness, and fever. His history revealed that he had suffered an injury to his left toe by a rusted nail seven days ago. He had received one dose of tetanus vaccine but no anti-tetanus immunoglobulin was given. He also did not know his prior vaccination history. He was diagnosed as tetanus and was followed up in the intensive care unit. He was treated with intravenous metronidazole and 60.000 IU equine tetanus antiserum. Midazolam was given for generalized muscle spasms. He was put on mechanical ventilation for 11 days and was discharged from the hospital 28 days after admission with recovery. In conclusion, although tetanus is now rare for our country, it should not be forgotten. Prior vaccination should be queried in patients who are admitted to hospitals with injury, and they should be accurately evaluated for vaccination and immunoglobulin

Immobilization of alcohol dehydrogenase onto metal-chelated cryogels

WOS: 000351749000004PubMed ID: 25715869In this presented work, poly(HEMA-GMA) cryogel was synthesized and used for the immobilization of alcohol dehydrogenase. For this, synthesized cryogels were functionalized with iminodiacetic acid and chelated with Zn2+. This metal-chelated cryogels were used for the alcohol dehydrogenase immobilization and their kinetic parameters were compared with free enzyme. Optimum pH was found to be 7.0 for both immobilized and free enzyme preparations, while temperature optima for free and immobilized alcohol dehydrogenase was 25 degrees C. Kinetic constants such as K-m, V-max, and k(cat) for free and immobilized form of alcohol dehydrogenase were also investigated. k(cat) value of free enzyme was found to be 3743.9min(-1), while k(cat) for immobilized enzyme was 3165.7min(-1). Thermal stability of the free and immobilized alcohol dehydrogenase was studied and stability of the immobilized enzyme was found to be higher than free form. Also, operational stability and reusability profile of the immobilized alcohol dehydrogenase were investigated. Finally, storage stability of the free and immobilized alcohol dehydrogenase was studied, and at the end of the 60days storage, it was demonstrated that, immobilized alcohol dehydrogenase was exhibited high stability than that of free enzyme

Dye functionalized cryogel columns for reversible lysozyme adsorption

WOS: 000349444000001PubMed ID: 25555198In this study, poly (methyl methacrylate-glycidyl methacrylate) [poly(MMA-GMA)] cryogels were prepared by radical cryocopolymerization of MMA with GMA as a functional comonomer. Reactive Green 19 dye was then attached to the cryogel by nucleophilic substitution reaction, and this dye-attached cryogel column was used for lysozyme adsorption. Characterization of the cryogel was performed by Fourier transform infrared spectroscopy, environmental scanning electron microscopy, Brunauer-Emmett-Teller, and energy dispersive X-ray analysis. Pore size of the cryogels was 15-30 mu m and pores were interconnected structure. Attached amount of Reactive Green 19 to cryogel support was calculated as 106.25 mu mol/g cryogel. Lysozyme adsorption studies were carried out by using a continuous system. It was found that the maximum amount of lysozyme adsorption (32 mg/g cryogel) obtained from experimental results was found to be approximately same with the calculated Langmuir adsorption capacity (33 mg/g cryogel). Desorption of adsorbed lysozyme was carried out by using 1.5 M NaCl in pH 4.5 acetate buffer, and desorption yield was found to be 97.4%. Cryogels were very stable, and it was found that there was no remarkable reduction in the adsorption capacity at the end of ten adsorption-desorption cycles. As a result, Reactive Green 19-attached cryogels have great advantages such as easy preparation, rapid adsorption, and desorption, being economic and allowing the direct separation of proteins