A case report of brain abscess caused by carbapenem- resistant Klebsiella pneumoniae

The treatment of infections caused by carbapenem-resistant Klebsiella pneumoniae (CR-Kp) strains is difficult due to the limited antimicrobial options and high mortality. There are many reports on intracranial infections caused by CR-Kp, but only a few on brain abscesses caused by CR-Kp. Here, we present a case of brain abscess caused by CR-Kp successfully treated with combined antibiotics. A 26-year-old male patient was admitted to our hospital due to high fever and headache. His past medical history includes a surgical intervention due to an acute subdural hematoma, performed at an external healthcare center. After the current diagnosis of cerebral abscess, he underwent two surgeries. During the procedure, multiple cerebral abscesses were drained and capsulotomies were performed under ultrasound guidance. The combination of meropenem and vancomycin was started. The contents of the abscesses were sent to the microbiology and pathology laboratory. On the 3rd day of treatment, the medical team was informed that CR-Kp grew in an abscess culture. The patient's treatment was changed to meropenem + colistin + tigecycline. The patient developed electrolyte disturbances during the follow-up and this was considered an adverse effect of colistin. On the 41st day of treatment, colistin was discontinued, fosfomycin was added, and meropenem and tigecycline were maintained. Treatment was discontinued on the 68th day, when the patient was discharged. The general condition of the patient, who has been followed up for two years, is satisfactory. The treatment of CR-Kp infections should be individualized, and the pharmacokinetics and pharmacodynamics of antibiotics should be considered in each case

A case report of brain abscess caused by carbapenem-resistant Klebsiella pneumoniae

The treatment of infections caused by carbapenem-resistant Klebsiella pneumoniae (CR-Kp) strains is difficult due to the limited antimicrobial options and high mortality. There are many reports on intracranial infections caused by CR-Kp, but only a few on brain abscesses caused by CR-Kp. Here, we present a case of brain abscess caused by CR-Kp successfully treated with combined antibiotics. A 26-year-old male patient was admitted to our hospital due to high fever and headache. His past medical history includes a surgical intervention due to an acute subdural hematoma, performed at an external healthcare center. After the current diagnosis of cerebral abscess, he underwent two surgeries. During the procedure, multiple cerebral abscesses were drained and capsulotomies were performed under ultrasound guidance. The combination of meropenem and vancomycin was started. The contents of the abscesses were sent to the microbiology and pathology laboratory. On the 3 rd day of treatment, the medical team was informed that CR-Kp grew in an abscess culture. The patient’s treatment was changed to meropenem + colistin + tigecycline. The patient developed electrolyte disturbances during the follow-up and this was considered an adverse effect of colistin. On the 41 st day of treatment, colistin was discontinued, fosfomycin was added, and meropenem and tigecycline were maintained. Treatment was discontinued on the 68 th day, when the patient was discharged. The general condition of the patient, who has been followed up for two years, is satisfactory. The treatment of CR-Kp infections should be individualized, and the pharmacokinetics and pharmacodynamics of antibiotics should be considered in each case

Investigation of survivin gene polymorphism in patients with gastric carcinoma

Objectives: Despite decreasing incidence of gastric cancerin worldwide, it is still a major health problem. Everyyear, 30.000 new gastric cancer cases emerging, and itis the second most common cancer in Turkey. Gastriccancer is a complex multifactorial disease, emerging byinteraction between genetic and environmental factors.Survivin, apoptosis inhibitory protein is over-expressed incancer tissue. In this study, association between Survivin-31G/C polymorphism and gastric carcinoma was investigated.Materials and Methods: 46 gastric carcinoma patientswho had been admitted at Düzce University Researchand Practice Hospital, Laboratory of Pathology and 42healthy individuals have been included in the study. Sampleshave been subjected to genetic analysis by PCRRFLPmethod in Medical Genetics Department laboratoryat Düzce University.Results: GG genotype was found in 16 (34.8%), GCgenotype in 21 (45.7%), CC genotype in 9 (19.6%) in patientgroup. In control group, genotype distribution werefound 13 (31%), 26 (61.9%) and 3 (7.1%) respectively.The statistically significant difference was not found whencompared between patient and control groups. However,we observed the increased occurrence of gastric cancerassociated with CC genotype (OR=1.52).Conclusions: In our knowledge, this study is the first toevaluate the relationship between gastric carcinoma andSurvivin -31G/C polymorphism in Turkish population. Ourresults show that there is no any association betweengastric carcinoma and Survivin -31G/C polymorphismin the community which is represented by our study andcontrol groups. However, it was concluded that CC genotypemay create the susceptibility to gastric cancer.Key words: Polymorphism, gastric carcinoma, survivinggene, apoptosi

Effect of financial constraints on invsetment: The case of Turkish manufacturing industry firms

Asimetrik bilgiden kaynaklanan finansal piyasa aksaklıkları, firmaların yatırımlarını finanse etmekte kullandıkları dışsal fonların maliyetini artırmakta, içsel fonların maliyeti ile dışsal fonların maliyeti arasında bir fark ortaya çıkmaktadır. Bu şartlar altında, firmalar ya hiç dışsal fon temin edememekte ya da dışsal fonlara yüksek maliyetlerle erişebildiklerinden yatırımlarının maliyetleri artmaktadır. Finansal kısıtlılık olarak adlandırılan bu durum, firmaların yatırımlarını ve nihai olarak ekonomideki toplam yatırımları ve refah düzeyini olumsuz etkilemektedir. Bu çalışmada, Türkiye’de finansal kısıtların firma yatırımları üzerindeki etkilerinin analiz edilmesi amaçlanmaktadır. Bu çerçevede, Türkiye imalat sanayiinde faaliyet gösteren ve hisseleri Borsa İstanbul’da (BİST) işlem gören 125 imalat sanayii firması üzerine odaklanılmakta, 1998-2010 dönemini kapsayan ve finansal kısıtlı olduğu öngörülen 76 firmaya ait dengeli bir panel veri seti kullanılmaktadır. Bulgular, Türkiye imalat sanayiinde faaliyet gösteren firmaların finansal kısıtlarla karşı karşıya bulunduğunu ve yatırımlarının finansal kısıtlardan olumsuz etkilendiğini ortaya koymaktadır. Buna göre, söz konusu firmalar yatırımlarını finanse ederken önemli ölçüde içsel fonlara (nakit akışları) bağımlı olmaktadır.Financial market failure, originated from asymmetric information, increase the cost of external funds that firms use to invest, and there will be a gap between the costs of internal and external finance. In this case,investment cost for firm increases because of either firms’can not obtain external funds or they can obtainexternal funds with high cost. This situation defined as financial constraint affects firms’ investment, aggregate investment and welfare in economy ultimately.In this study, it is aimed to analyze the effect of financial constraints on firm investment and to evaluate policy recommendations developed for eliminate these possible unfavorable effects. In this framework, this study concentrates on firms that operate in Turkish manufacturing industry and that are quoted in Borsa İstanbul (BİST). A balanced panel data set that contains 125 firms and ranges from 1998 to 2010 is used. Findings reveal that, firms operating in Turkish manufacturing industry are faced with financial constraint and their investments are adversely affected by financial constraints. Accordingly, these firms are severely dependent on internal funds (cash flows) when financing their investment