Clinical features, laboratory data, management and the risk factors that affect the mortality in patients with postoperative meningitis

Background: Nosocomial meningitis is a rare complication following neurosurgical procedures and is associated with high morbidity and mortality. Aim: The aim of this study was to describe the clinical characteristics and the risk factors associated with mortality in patients who developed nosocomial meningitis following neurosurgical operations. Setting and design: Tertiary care hospital and an observational study. Materials and Methods: The study subjects included 2265 patients who underwent various neurosurgical operations during 2003-05. The diagnosis of nosocomial meningitis was based on the Center for Disease Control criteria. Statistical analysis: It was performed by using Statistical Package for Social Sciences for Windows 10.0 program. Results: The incidence of postoperative nosocomial meningitis was 2.7% (62 episodes in 49 patients among 2265 patients operated). Staphylococcus aureus and Acinetobacter spp. were the most frequently isolated pathogens. Of the 49 with meningitis 20 (40.8%) patients died. In the logistic regression analysis model, Glascow coma scale score less than 10 (Odds Ratio (OR): 19.419, 95% Confidence Interval (CI); 1.637-230.41, P = 0.001), and low cerebrospinal fluid glucose level (= 30 mg/dL) (OR: 10.272, 95% CI; 1.273-82.854, P= 0.002), and presence of concurrent nosocomial infection (OR: 28.744, 95% CI; 1.647-501.73, P= 0.001) were the independent risk factors associated with mortality. Conclusion: The mortality in patients who developed meningitis was high. The high percentage of concurrent nosocomial infections was associated with a high mortality rate which was a serious problem

Malaria: An evaluation of 40 cases

Bu çalışmada, Şubat 1996- Ekim 2009 yılları arasında kliniğimizde izlenen 40 erişkin malaryalı olgu, retrospektif olarak değerlendirilmiştir. Tanı, tüm olgularda Giemsa ile boyanan kalın ve ince yayma preparatlarda parazitin gösterilmesi ile konulmuştur. Otuz dört olgu erkek, 6 olgu kadın olup; ortalama yaş 31.1 olarak belirlenmiştir. Tüm olgularda endemik bölgelere (24 olguda Afrika, Afganistan, Azerbaycan ve Arap Yarımadası'na, 16 olguda Güneydoğu Anadolu Bölgesi'ne) seyahat öyküsü vardı ve hiçbirine kemoproflaksi uygulanmamıştı. Olguların 20'sinde Plasmodium vivax, 18'inde P. falciparum, ikisinde P. vivax ve P. falciparum saptanmıştır. Hastalarda ateş (%100), splenomegali (%72,5), hepatomegali (%45,0), anemi (%67,5), lökopeni (%32,5), trombositopeni (%75,0), sedimantasyon yüksekliği (%65,0), karaciğer fonksiyon testlerinde anormallikler (%62,5), serum kreatininde artış (%27,5) belirlendi. P. vivax sıtması olgularına klorokin ve primakin, P. falciparum olgularına meflokin veya kinin sülfat ile doksisiklin, mikst olgulara kinin sülfat ile doksisiklin, sonrasında primakin tedavisi uygulandı. İki olguda akut böbrek yetmezliği, iki olguda serebral tutulum; bir olguda akut böbrek yetmezliği, serebral tutulum, yaygın damar içi koagülasyon ve erişkin solunum yetmezliği sendromu gelişti. P. falciparum sıtmalı iki olgu kliniğimize yatırıldıkları gün kaybedildi, hastalık diğer olgularda şifa ile sonlandı. Sonuç olarak, endemik bölgelere seyahat öyküsü olan her ateşli olguda sıtma ayırıcı tanıda mutlaka yer almalıdır. Bu bölgelere seyahat edecek bireylere kemoproflaksi uygulanması ve kişisel korunma önlemlerinin sağlanması çok önemlidir.In this study, the epidemiological, clinical, laboratory and therapeutic features of forty adult malaria patients referred our clinic between February 1996-September 2009, were assessed retrospectively. Diagnosis was established by Giemsa-stained thick and/or thin blood smears in all cases. Thirty-four patients were male and 6 patients were female and mean age was 31.1 years. All patients had a history of travel to endemic areas (24 cases to Africa, Afghanistan, Azerbaijan, Arabian Peninsula, 16 cases to Southestern Anatolia Region), and none of them had chemoprophylaxis. Plasmodium vivax was detected in 20 patients, and P.falciparum in 18 and mixed (P. vivax and P. falciparum) in two. Parasitemia ranged from 0.5%- 25%. Fever (100%), periodic fever (62.5%), splenomegaly (72.5%), hepatomegaly (45.0%), anemia (67.5%), leukopenia (32.5%), thrombocytopenia (75.0%), a rise in erytrocyte sedimentation rate (65.0%), abnormalities in hepatic enzymes (62.5%), hyponatremia (32.5%), hypoglisemia (25%) and an elevated serum creatinine level (27.5%) were determined in the patients. Two patients with P. falciparum developed acute renal failure and cerebral involvement died soon after admission. Acute renal failure, acute respiratory distress syndrome, cerebral involvement and dissemine intravasculer coagulation were observed in one patient with falciparum malaria who recovered completely. In conclusion, every febril patients with a history of travel to the endemic regions should raise the suspicion of malaria. Effective pre-exposure chemoprophylaxis and personal protection measures should be provided to travellers visiting endemic regions

Laboratuvardan Kliniğe Transplantasyon Pratiği

Transplantasyon; Temel Tıbbi Bilimler, Moleküler Tıp, Genetik ve İmmünolojiden klinik uygulamalardan destek alan multidisipliner bir tıp dalıdır. Temel bilimlerdeki başarılı çalışmaların kliniğe uygulanması, klinikte karşılaşılan sorunların da, oluşturulan deneysel hayvan modellerinde irdelenmesi, elde edilen bilgilerin klinik uygulamalara aktarılması; diğer deyişle tecrübelerin “Translational” özellikli olması günümüz transplantasyon çalışmalarında bir gerekliliktir. İmmün sistemin bileşenlerinin ve reaksiyonlarının iyi bilinmesi, hücreler arası ilişkilerde greftin reddi ya da kabul edilmesinin şartlarını doğru anlamak ve uygun laboratuvar yöntemleri ile klinik durumun aydınlatılması transplantasyonda stratejik önemdedir. Bu nedenle, klinik transplantasyon çalışmaları yapanlar temel bilimler bilgileri ile de donanımlı olmalıdırlar. Multidisipliner bir dal olma bilinci ile yapılan klinik transplantasyon çalışmalarında başarı yakalanmaktadır. Laboratuvardan Kliniğe Transplantasyon kitabımızda tüm yönleri ile transplantasyonun organizmaya etkileri ve bunların klinik sonuçlarını, çalışmalarımızın ışığında sunmayı ve tartışmayı hedefledik. Editör: Prof.Dr. Mesut İzzet TİTİZ Yardımcı Editör: Doç.Dr. Pınar AT

Fever of Unknown Origin: Analysis of 35 Cases

In this study, 35 cases of fever of unknown origin, hospitalized at our department between June 1993 and June 1999, were evaluated. Eighteen (51.4%) of the cases were female and 17 (48.6%) were male. Ages were between 14 and 71 with a mean of 38. The diagnosis was able to be reached in 24 days (range: 5-58 days). Fourteen (40%) of the patients were found to have an infectious disease while 8 (23%) had collagen-vascular diseases, 5 (14%) had neoplasms, 2 (5.7%) had hipersensitivity reactions and 1 (2.8%) had sarcoidosis. No diagnosis has been established in 3 (8.5%) out of 35 patients. Two patients died during evaluation period. Among infectious diseases, tuberculosis was the leading cause with six (42.8%) cases, followed by brucellosis with 4 (28.5%) cases, 2 (14.2%) cases of infective endocarditis and 2 (14.2%) cases of intraabdominal infections. Among collagen-vascular diseases, five were Still’s disease, two were sistemic lupus erythematosus and one was juvenile rheumatoid arthritis. Among 5 neoplastic diseases, 3 were (60%) lymphomas, 1 was colon carcinoma and the other was malign histiocytosis

Incidence, etiology, and antibiotic resistance patterns of Gram-negative microorganisms isolated from patients with ventilator-associated pneumonia in a medical-surgical hospital in Istanbul, intensive care unit of a teaching Turkey (2004-2006)

The identification of microorganisms causing ventilator-associated pneumonia (VAP) is important for formulating appropriate therapies. In this study, we report the incidence, etiology, and antibiotic resistance patterns of Gram-negative microorganisms isolated from patients diagnosed with VAP in our medical-surgical intensive care unit (ICU) during the years 2004-2006. VAP was diagnosed by using the clinical criteria of the Centers for Disease Control and Prevention. Antibiotic resistance patterns of isolated microorganisms were defined by standard methods. The VAP incidence rate was 22.6/1,000 ventilator days. The most frequently isolated pathogens were Acinetobacter spp., methicillin-resistant Staphylococcus aureus, and Pseudomonas aeruginosa. Ninety percent of Acinetobacter spp. isolates were resistant to ceftazidime, 64% to imipenem, and 80% to ciprofloxacin. Fifty-nine percent of P. aeruginosa isolates were resistant to ceftazidime, 32% to imipenem, and 62% to ciprofloxacin. Cefoperazone-sulbactam was the most active agent against Acinetobacter spp. In conclusion, the incidence of VAP and the prevalence of multidrug-resistant microorganisms are quite high in our ICU. Comparison of the resistance rates of isolates demonstrates that certain antibiotic agents are more effective than others

Incidence, etiology, and antibiotic resistance patterns of Gram-negative microorganisms isolated from patients with ventilator-associated pneumonia in a medical-surgical intensive care unit of a teaching hospital in Istanbul, Turkey (2004-2006)

The identification of microorganisms causing ventilator-associated pneumonia (VAP) is important for formulating appropriate therapies. In this study, we report the incidence, etiology, and antibiotic resistance patterns of Gram-negative microorganisms isolated from patients diagnosed with VAP in our medical-surgical intensive care unit (ICU) during the years 2004-2006. VAP was diagnosed by using the clinical criteria of the Centers for Disease Control and Prevention. Antibiotic resistance patterns of isolated microorganisms were defined by standard methods. The VAP incidence rate was 22.6/1,000 ventilator days. The most frequently isolated pathogens were Acinetobacter spp., methicillin-resistant Staphylococcus aureus, and Pseudomonas aeruginosa. Ninety percent of Acinetobacter spp. isolates were resistant to ceftazidime, 64% to imipenem, and 80% to ciprofloxacin. Fifty-nine percent of P. aeruginosa isolates were resistant to ceftazidime, 32% to imipenem, and 62% to ciprofloxacin. Cefoperazone-sulbactam was the most active agent against Acinetobacter spp. In conclusion, the incidence of VAP and the prevalence of multidrug-resistant microorganisms are quite high in our ICU. Comparison of the resistance rates of isolates demonstrates that certain antibiotic agents are more effective than others