Visceral Leishmaniasis Mimicking Autoimmune Hepatitis, Primary Biliary Cirrhosis, and Systemic Lupus Erythematosus Overlap

Visceral leishmaniasis (VL) is a life-threatening infection caused by Leishmania species. In addition to typical clinical findings as fever, hepatosplenomegaly, and cachexia, VL is associated with autoimmune phenomena. To date, VL mimicking or exacerbating various autoimmune diseases have been described, including systemic lupus erythematosus (SLE), rheumatoid arthritis, and autoimmune hepatitis (AIH). Herein, we presented a patient with VL who had overlapping clinical features with SLE, AIH, as well as antimitochondrial antibody (AMA-M2) positive primary biliary cirrhosis

Visual and software-based quantitative chest CT assessment of COVID-19: correlation with clinical findings

PurposeThe aim of this study was to evaluate visual and software-based quantitative assessment of parenchymal changes and normal lung parenchyma in patients with coronavirus disease 2019 (COVID-19) pneumonia. The secondary aim of the study was to compare the radiologic findings with clinical and laboratory data.MethodsPatients with COVID-19 who underwent chest computed tomography (CT) between March 11, 2020 and April 15, 2020 were retrospectively evaluated. Clinical and laboratory findings of patients with abnormal findings on chest CT and PCR-evidence of COVID-19 infection were recorded. Visual quantitative assessment score (VQAS) was performed according to the extent of lung opacities. Software-based quantitative assessment of the normal lung parenchyma percentage (SQNLP) was automatically quantified by a deep learning software. The presence of consolidation and crazy paving pattern (CPP) was also recorded. Statistical analyses were performed to evaluate the correlation between quantitative radiologic assessments, and clinical and laboratory findings, as well as to determine the predictive utility of radiologic findings for estimating severe pneumonia and admission to intensive care unit (ICU).ResultsA total of 90 patients were enrolled. Both VQAS and SQNLP were significantly correlated with multiple clinical parameters. While VQAS >8.5 (sensitivity, 84.2%; specificity, 80.3%) and SQNLP 9.5 (sensitivity, 93.3%; specificity, 86.5%) and SQNLP <81.1% (sensitivity, 86.5%; specificity, 86.7%) were predictive of ICU admission. Both consolidation and CPP were more commonly seen in patients with severe pneumonia than patients with nonsevere pneumonia (P = 0.197 for consolidation; P < 0.001 for CPP). Moreover, the presence of CPP showed high specificity (97.2%) for severe pneumonia.ConclusionBoth SQNLP and VQAS were significantly related to the clinical findings, highlighting their clinical utility in predicting severe pneumonia, ICU admission, length of hospital stay, and management of the disease. On the other hand, presence of CPP has high specificity for severe COVID-19 pneumonia

The incidence and risk factors of surgery site infection (ssi) developed in cardiovascular and thoracic surgery departments in gazi university faculty of medicine

Bu çalışmada, Gazi Üniversitesi Tıp Fakültesi Hastanesi Kardiyovasküler Cerrahi ve Göğüs Cerrahisi bölümlerinde gelişen Cerrahi alan enfeksiyonu (CAE) insidansı ve risk faktörleri araştırılmıştır. Hastaların taburculuk sonrası 30 gün, implantı olanlarda bir yıl aktif izlemi yapılmıştır. İki yüz otuz sekiz hastada toplam 22 CAE saptanmıştır. Cerrahi alan enfeksiyonu insidans dansitesi 7.04/1000 yatış günü olarak hesaplanmıştır. CAE'nin 6'sı (%27) yüzeyel primer insizyonel, 11 'i (%50) derin primer insizyonel, 5'i (%23) organ boşluk enfeksiyonu olarak bulunmuştur. Sekonder insizyonel CAE saptanmamıştır. CAE tespit edilen hastalardan en sık izole edilen etken literatürdekine benzer şekilde Staphylococcus aureus olup, bunu koagülaz negatif stafilokok, Proteus spp ve Acinetobacter spp izlemektedir. Çalışmamızda tüm CAE incelendiğinde preoperatif risk faktörlerinden ASA skorunun yüksek olması anlamlı bulunmuştur. Diğer preoperatif, intraoperatif ve postoperatif risk faktörleri ile CAE gelişimi arasında anlamlı ilişki bulunmamıştır. Ancak 65 yaş üstü hastalar için hastane yatış süresinin uzaması CAE gelişimini artırmaktadır. National Nosocomial Infection Surveillance (NNIS) sistemi risk indeksi ile CAE gelişimi arasında ise pozitif yönde zayıf korelasyon bulunmuştur. Diabetes mellitus varlığı yüzeyel CAE, malignite varlığı ise organ boşluk enfeksiyonları açısından anlamlı risk faktörleri olarak bulunmuştur. Çalışmaya alınan 238 hastanın 23'ünde (%9.7) mortalite saptanmıştır. CAE olan hastaların 19'u (%86.4) taburcu olmuş, 3'ü (% 13.6) hayatını kaybetmiştir. CAE gelişimi ile mortalite arasında anlamlı ilişki saptanmamıştır. Mortalite ile risk faktörleri arasındaki ilişki incelendiğinde; preoperatif risk faktörlerinden böbrek yetmezliği, sigara kullanımı, operatif risk faktörlerinden operasyonun acil yapılması, post operatif risk faktörlerinden akut böbrek yetmezliği (ABY) gelişimi ile mortalitenin arttığı görülmüş ve istatiksel olarak anlamlı bulunmuştur. Yaşla mortalite arasında anlamlı ilişki saptanmış, 65 yaş üstü hastalarda mortalitenin istatiksel olarak anlamlı oranda fazla olduğu görülmüştür (p=0.05). Ayrıca ASA skoru ve NNIS risk indeksi arttıkça da mortalitenin arttığı bulunmuştur. Sonuç olarak; Kalp-damar ve Göğüs Cerrahisi servislerinde, hastanemiz cerrahi servislerinde düzenli olarak uygulanmayan CAE sürveyansının yapıldığı bu çalışmanın, diğer cerrahi branşlar için de CAE sürveyans çalışmalarına örnek olabileceği düşünülmektedir. Taburculuk sonrası CAE sürveyansının zorlukları görülmüş ve bu zorlukların aşılması için yapılabilecekler hakkında öneriler geliştirilmiştir. Enfeksiyon kontrolünün bir parçası olarak CAE sürveyansının yapılması öncelik taşımaktadır. Risk faktörlerinin de belirlenerek bunların sonucunda geliştirilen enfeksiyon kontrol politikalarının etkinliğinin izlenmesi CAE lerin yönetimi için gereklidir.The incidence and risk factors of surgery site infection (SSI) developed in Cardiovascular and Thoracic Surgery Departments in Gazi University Faculty of Medicine has been investigated in this study. The 30 days follow-up after discharge and one year follow-up of patients with active implants were conducted. Totally 22 SSI were identified in 238 patients. Surgical site infection incidence density was calculated as 7.04 / 1000 days of hospitalization. Six (27%) primary superficial incisional, 11 (50%) primary deep incisional and 5 (23%) organ space infection were found. Any secondary incisional SSI was not found. In accordance with the literature, the most frequently isolated pathogens from patients defined as SSI was Staphylococcus aureus, coagulase negative staphylococcus, Proteus spp and Acinetobacter spp. respectively. When all SSI was considered (analyzed), higher ASA score, as one of preoperative risk factors, was thought to be significant. There was not any significant correlation between SSI development and other preoperative, intraoperative and postoperative risk factors. But increased length of stay at hospital was found to increase development of SSI in patients older than 65 years old. A positive weak correlation was found between National Nosocomial Infection Surveillance (NNIS) system risk index and SSI development. In terms of superficial SSI, Diabetes mellitus and for organ space infections, malignancy was found as significant risk factors. Mortality was defined in 23 (%9.7) of 238 patients included in the study. Nineteen (%86.4) of patients with SSI were externed and 3(% 13.6) of them died. There was not any significant relation between SSI development and mortality. When the relationship between mortality and risk factors was analyzed; it was found that the mortality increased with acute kidney insufficiency (AKI) and smoking as preoperative risk factors, emergency surgery as operative risk factor and development of AKI as postoperative risk factor; which were statistically significant. There was a significant relationship between mortality and age, it was found that mortality was significantly higher in patients older than 65 years of age (p=0.05). It was also found that the mortality increased as ASA score and NNIS risk index increased. As a result; this study which we worked SSI surveillance at Cardio-Vascular and Thoracic surgery services of our hospital where the SSI does not regularly applied, thought to be a model for the work of surveillance at other branches of surgery. The challenges of post-discharge SSI surveillance were found and recommendations in order to overcome these challenges were defined. The work of SSI surveillance as a part of infection control has a priority. Risk factors should also be identificated and monitoring the effectiveness of infection control politics developed as a result of this, is essential for the management of SSI

Leptinotarsa decemlineata (Say) (Coleoptera: Chrysomelidae)'nın farklı yaşlardaki patates yapraklarını tercihi üzerine araştırmalar

Ege Üniversitesi Ziraat Fakültesi Bitki Koruma Bölümü'ne ait iklim odasında yürütülen bu çalışmada ana materyalini, Leptinotarsa decemlineata bireylerinin bırakmış olduğu yumurtalardan elde edilen tüm larva dönemleri, ergin erkek, preovipozisyon ve ovipozisyon dönemlerindeki dişi bireyleri ve Marabel çeşidi patates (Solanum tuberosum) bitkisi oluşturmuştur. Araştırma 25±1°C sıcaklık, %55±5 orantılı nem ve günlük 16 saat aydınlık, 8 saat karanlık koşullarının sahip tutulduğu iklim odasında yapılmıştır. Patates bitkisi ile beslenen L. decemlineata'nın patates yapraklarını tercihinde yaprak yaşının etkisi araştırılmıştır. Bu amaçla, zararlının bitkinin hangi kısmından besin olarak daha fazla yararlandığı ve sonrasında meydana getirilecek zararın hangi yaştaki bitkide daha fazla olacağı ortaya konulmaya çalışılmıştır. L. decemlineata bireylerinin farklı yaşlardaki patates yapraklarını tercihinde zamanın etkisi araştırılmış ve 1. larva dönemindeki bireylerin dışında tüm dönemlerin tercihleri 1. saatten itibaren gerçekleşmiştir, fakat 1. larva dönemindeki bireylerin tercihlerinin 1. saatte gerçekleşmediği, bununla birlikte 4. saatten itibaren gerçekleştiği ortaya konmuştur. Buna göre 1. larva dönemi de dahil olmak üzere, tüm dönemler ele alındığında, bireylerin 4., 8. ve 24. saatlerdeki tercihleri arasında istatiksel olarak anlamlı bir fark bulunmamıştır. Bu nedenle 3 farklı saatteki birey sayılarının ortalaması alınarak tercihler belirlenmiştir. Sonuç olarak yapılan değerlendirmelerde, ele alınan biyolojik dönemler arasından 4. larva dönemindeki bireyler hariç, tüm dönemlerin beslenmek için genç yaprağı tercih ettikleri ortaya konmuştur. Ayrıca denemeler, genç yaprak tercihi ve yaşlı yaprak tercihi arasında istatiksel olarak anlamlı bir fark olduğunu göstermiştir. Dördüncü larva dönemindeki bireylerin ise genç ve yaşlı yaprak tercihleri arasında istatiksel olarak anlamlı bir farkın olmadığı sonucuna varılmıştır

Risk of infection in patients with hematological malignancies receiving CAR T-cell therapy: systematic review and meta-analysis

Chimeric antigen receptor (CAR) T-cell therapy has emerged as a promising treatment option for relapsed or refractory B-cell malignancies and multiple myeloma. Underlying and treatment-related may contribute to the development of infectious complications. We conducted a systematic review and meta-analysis on the incidence of overall and severe (grade ≥3) infection in patients with hematological malignancies receiving CAR T-cells. Secondary outcomes included the specific rates of bacterial, viral and invasive fungal infection (IFI), and infection-related mortality. PubMed, Embase and Web of Science databases were searched from inception to 27 May 2022. Sensitivity analysis were performed according to the type of malignancy and study design (randomized clinical trials [RCTs] or observational studies). Forty-five studies (34 RCTs) comprising 3,591 patients were included. The pooled incidence rates of overall and severe infection were 33.8% (I2 = 96.31%) and 16.2% (I2 = 74.41%). The respiratory tract was the most common site of infection. Most events were bacterial or viral, whereas the occurrence of IFI was rare. The pooled attributable mortality was 1.8% (I2 = 43.44%). Infection is a frequent adverse event in patients receiving CAR T-cell therapy. Further research should address specific risk factors in this population.</p

Evaluation of Cleaning and Disinfection with Fluorescent Marking in Intensive Care Units and Importance of Cross-Monitoring

Introduction: The aim of this study is to emphasize the importance of monitoring the cleaning and disinfection process and, cross-audits in intensive care units (ICU). Materials and Methods: Cleaning and disinfection monitorization results were evaluated between January and June 2021. The reported rates of cleaning of the surfaces which was monitored by head nurses of the wards and housekeeping supervisors by using fluorescent marker were compared. Results: The results were evaluated in two quarters as; January-March 2021 and April-June 2021. In the first quarter, there was a significant difference between the housekeeping supervisors and the head nurses in the ratio of the area determined as completely clean. The attention of the housekeeping supervisors was drawn to the problems reported through the head nurses. Assessment rates of the two groups became closer in the second quarter compared to the previous quarter. Also, the rate of the area evaluated as completely clean by both groups increased significantly in the second period (p< 0.001). Conclusion: As a result of our study, cross-monitoring increased the awareness of housekeeping supervisors resulting with more appropriate assessments. It is believed that the these results will provide reducing the infection rates caused by multi-drug resistant microorganisms in risky units like ICUs