Empiric antibiotic therapy in acute uncomplicated urinary tract infections and fluoroquinolone resistance: a prospective observational study

<p>Abstract</p> <p>Background</p> <p>The aims of this study were to determine the antimicrobial susceptibility patterns of urinary isolates from community acquired acute uncomplicated urinary tract infections (uUTI) and to evaluate which antibiotics were empirically prescribed in the outpatient management of uUTI.</p> <p>Methods</p> <p>Among the patients which were admitted to outpatient clinics of Ankara University Medical Faculty, Ibni-Sina Hospital during 2005-2006, a total of 429 women between the age of 18 and 65 years old who were clinically diagnosed with uUTI and to whom prescribed empirical antibiotics were enrolled in this prospective observational study. Patients' demographical data, urine culture results, resistance rates to antimicrobial agents and prescribed empiric antimicrobial therapy were analyzed.</p> <p>Results</p> <p>Totally 390 (90.9%) patients among all study population were requested for urine culture by their physicians. 150 (38.5%) of these urine cultures were positive. The most common isolated uropathogen was <it>Escherichia coli (E. coli) </it>(71.3%). The variations of uropathogens according to age and menopause status were not significantly different.</p> <p>The resistance rates of <it>E. coli </it>isolates for ampicillin, ampicillin-sulbactam, amoxicillin-clavulonate, cefuroxime, ceftriaxone, fluoroquinolones (FQ), co-trimoxazole (TMP-SMX) and gentamicin were 55.1%, 32.7%, 32.7%, 23.4%, 15.9%, 25.2%, 41.1%, 6.1% respectively. FQ were the most common prescribed antibiotics (77.9%) (<it>P </it>< 0.001), followed by TMP-SMX (10.7%), fosfomycin (9.2%), nitrofurantoin (2.1%). Treatment durations were statistically longer than the recommended 3-day course (<it>P </it>< 0.001).</p> <p>Conclusion</p> <p>Empirical use of FQ in uUTI should be discouraged because of increased antimicrobial resistance rates.</p

Unilateral Absence of the Pulmonary Artery Incidentally Found in Adulthood

Unilateral absence of the pulmonary artery (UAPA) or pulmonary artery agenesis is a rare congenital disorder presenting with a wide spectrum of symptoms. UAPA is usually associated with cardiac anomalies and surgically treated in childhood. We report a rare case of a 50-year-old woman who was diagnosed with left pulmonary artery agenesis without any other cardiac anomalies. Clinicians should be aware of the possibility of undiagnosed cases of UAPA in patients through a chest radiograph that suggests the diagnosis. Confirmation of the diagnosis and anatomic details can be discerned by CT scanning

Impact of smoking and nicotine addiction on HbA1c levels and diabetic microvascular complications

Introduction. In this study we aimed to determine whether a difference in complications between smok­ers and non-smokers exists in type 2 diabetes mellitus (T2DM) and to evaluate if there is a correlation between microvascular complications and Fagerström test score. Material and methods. Patients with T2DM who at­tended the family medicine outpatient clinics were enrolled in the study. Smokers and non-smokers were compared according to their metabolic outcomes and presence of microvasculer complications. The level of smoking addiction was determined by Fagerström Test for Nicotine Dependence. Results. Fasting blood glucose (FBG), low-density lipoprotein, systolic and diastolic blood pressures were found to be higher in smokers. The presence of neuropathy was significantly higher in smokers. The presence of retinopathy rate increased with increasing level of smoking addiction. The nicotine dependence test score were found to be positively correlated with HbA1c and FBG levels whereas, negatively correlated with body mass index among smokers. Conclusions. Assessing the cigarette smoking status of diabetic patients at the initial clinic visit and indicating the importance of smoking cessation should be the essential part of diabetes follow up program

Van depreminin su-kaynaklı bazı bulaşıcı hastalıklar üzerine etkisi

Objective: In this study, it was aimed to compare the isolation frequency of some water-borne disease causing microorganisms in pediatric patients before and after Van earthquake in order to determine the potential impact of earthquake on those selected infectious diseases. Methods: The laboratory test results of Adenovirus, Rotavirus, Hepatitis A virus (HAV), Giardia intestinalis and E.histolytica/dispar which were requested from 0-14 years old children, during six months before and six months after Van earthquake which took place on 23 October 2011, were retrospectively reviewed. Results: Adenovirus, Rotavirus, Anti HAV IgM and E.histolytica/dispar showed reduction in the isolation frequency rate during the six months period after the earthquake compared with the same period of previous year. The reduction rates in the isolation frequencies of Rotavirus and E.histolytica/dispar were found to be statistically significant (p<0.001). In contrast, Giardia intestinalis isolation frequency was significantly higher in the six months period after the earthquake (<0.001). Conclusion: Disaster management programme which was conducted after Van earthquake have been shown to be effective in preventing water-borne infectious diseases. Taking special precautions against Giardia spp. after earthquakes should be kept in mind

The evaluation of vancomycin-resistant enterococci and carbapenamase producing Klebsiella colonization among ICU-Hospitalized Patients

Background: Multi-drug resistant organisms, especially Vancomycin-Resistant Enterococcus (VRE) and Carbapenam Resistant Klebsiella pneumoniae (KPC), are serious health threat. Early detection of resistant bacteria colonization amongpatients in intensive care units (ICUs) not only enables effective treatment but more importantly prevents disease and limits transmission. Therefore, we aimed to to assess the frequency of VRE and KPC colonization via rectal swab sampling. Methods: The study was carried out in ICUs of a tertiary hospital. Two rectal swab samples were collected within the first 24 hours of admission and another one was taken every subsequent 15 days to test for for VRE and KPC carriage. Results: A total 316 rectal swab samples taken from 230 patients. Forty-seven patients were screened at least 2 times. 183 patients were not further screened due to discharge, exitus or transfer to other wards. Thirty-six patients (16%) were determinedto be VRE (+). The most frequently isolated strain was E. faecium (80.5%) and its most common genotype was VanA (87.5%). Seven patients (3%) were identified as KPC (+). OXA-48 type crbapenamase was confirmed in all KPC isolates. Conclusion: This study shows that VRE and KPC colonization continues to be a serious threat in ICUs. Keywords: Carbapenam resistant klebsiella pneumoniae; vancomycin-resistant enterococci; intensive care units

The Relationship between Thyroid Hormones, Metabolic Syndrome and HOMA-IR in People with Obesity or Overweight

Objective: In the literature the data about the relationship between thyroid hormone (TH) levels and Metabolic Syndrome (MetS) components are conflicting. Our aim was to evaluate the associations between THs and MetS as well as individual components of MetS and homeostatic model assessment of insulin resistance (HOMA-IR) in euthyroid people with obesity and overweight. Materials and methods: Adult patients who presented to Family Medicine Outpatient Clinics of a tertiary hospital between May 2019 and December 2019 with the intention of weight loss were enrolled in this cross-sectional, descriptive study. The data including height, weight, waist circumference, hip circumference, blood pressure (BP), fasting blood glucose (FBG), total cholesterol, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglyceride, thyroid stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), insulin, HOMA-IR, and HbA1c were analyzed. Results: A total of 175 patients, 135 (77.1%) female, 40 (22.9%) male (mean age: 40.8 ± 13.1 years), without known thyroid dysfunction were included. A total of 86 were overweight and 89 were obese. Fifty-nine (33.7%) of the study participants were diagnosed with MetS. Subjects with MetS had significantly higher level of fT3 even within the normal range (p = 0.039). When TSH, fT4 and fT3 values were compared with other metabolic components in the group with MetS, a significant positive correlation was found only between fT4 level and HOMA-IR (Rho = 0.316, p = 0.026). Conclusions: MetS was associated with high normal fT3 suggesting differential thyroid hormone metabolism in people with MetS

The Effect of Training About Sleep Hygiene on HbA1c Levels of Type 2 Diabetes Mellitus Patients: A Randomized Controlled Trial

Objective: In this study, we aimed to reveal whether training on sleep hygiene have an effect on blood glucose regulation of type 2 diabetes patients. Materials and methods: Those with even protocol numbers were included in the case group and those with odd numbers were included in the control group. Pittsburgh sleep quality index was applied face-to-face to all patients included in the study and at the first admission sleep hygiene training was given to the case group. HbA1c values were noted separately as first and second visit for both groups. Those with known sleep disorders and language or psychiatric problems that would prevent them from answering the questionnaire were excluded from the study. Differences between demographic and clinical features of groups were evaluated using chi-square and Student’s t-tests. Comparisons of the case and control groups before and after sleep hygiene training were evaluated using ANCOVA test adjusted for BMI and DM duration. Results: A total of 347 Type 2 diabetes patients included in this randomized controlled trial (113 case 234 control). Significant difference was observed in the HbA1c values measured before and after the training of the case group. The second mean HbA1c (8.13 ± 2.03 mmol/L) of the control group was significantly higher than the second mean HbA1c (7.51 ± 1.42 mmol/L) values of the case group (p = 0.004). Conclusions: Our study revealed that in addition to classical diabetes treatment, sleep hygiene training also has a positive effect on blood glucose regulation of patients

Knowledge, Attitude and Behavior Levels about Osteoporosis among 18-35 Years Old Women

Objective: Osteoporosis (OP) which is a global health problem can be prevented or the development of the disease can be delayed. To educate individuals at risk and to intervene in a timely manner will provide significant reduction in morbidity and mortality caused by OP. Possible interventions in the age group of developed OP are important to determine. Therefore, in this study, it was aimed to determine information, attitudes and behaviors levels on osteoporosis at young women. Materials and Methods: This study was carried out among 18-35 years old females who attended to outpatient clinics of Dışkapı Yıldırım Beyazıt Training and Research Hospital Family Medicine Clinic. A questionnaire was used to assess knowledge, beliefs, and practices towards OP. The questionnaire to assess practices related to OP included questions on positive and negative behaviors towards OP. The positive behaviors assessed were dietary calcium intake, physical activity and exposure to sun. The negative behavior assessed was on smoking status. Results: A total of 218 women (mean age= 26.2±5.6 years) were enrolled in the study. The median score of knowledge about OP was 40, out of a total score of 100. Knowledge scores were lower than the median in 138 (63.3%) and were higher than the median in 80 (36.7%) of the participants. In the group who had high knowledge score than median (n=80); 24 (30%) were smokers, 8 (10%) were not exposed to the sun for at least 10 minutes a day and 45 (56.2%) of the participants did not achieve the recommended daily allowances for calcium and 64 (80%) were not engaged in the recommended exercises in type and duration. Conclusion: Awareness for OP is low in young women and practices towards preventing OP are inadequate. Thus, preventive measures are required in order to encourage OP-preventive life style especially before reaching peak bone mass