Assessment of the requisites of microbiology based infectious disease training under the pressure of consultation needs

<p>Abstract</p> <p>Background</p> <p>Training of infectious disease (ID) specialists is structured on classical clinical microbiology training in Turkey and ID specialists work as clinical microbiologists at the same time. Hence, this study aimed to determine the clinical skills and knowledge required by clinical microbiologists.</p> <p>Methods</p> <p>A cross-sectional study was carried out between June 1, 2010 and September 15, 2010 in 32 ID departments in Turkey. Only patients hospitalized and followed up in the ID departments between January-June 2010 who required consultation with other disciplines were included.</p> <p>Results</p> <p>A total of 605 patients undergoing 1343 consultations were included, with pulmonology, neurology, cardiology, gastroenterology, nephrology, dermatology, haematology, and endocrinology being the most frequent consultation specialties. The consultation patterns were quite similar and were not affected by either the nature of infections or the critical clinical status of ID patients.</p> <p>Conclusions</p> <p>The results of our study show that certain internal medicine subdisciplines such as pulmonology, neurology and dermatology appear to be the principal clinical requisites in the training of ID specialists, rather than internal medicine as a whole.</p

A case of brucellosis with acute abdomen and pancytopenia

Brucellosis is an endemic zoonotic infectious disease in Turkey, which can effect many systems. Gastrointestinal and osteoarticular complications are common manifestations of the disease. A young male patient with acute abdomen and pancytopenia as a rare complication of brucellosis is reported in this study

AVASCULER NECROSIS OF THE FEMUR HEAD IN A CASE USING STEROID AND WITH SALMONELLA ENTERITIDIS BACTEREMIA

Avascular necrosis of the femur head in adults has been associated with a variety of disease entities. It is usually recognized as a potential complication of trauma or systemic corticosteroid therapy and chronic alcoholism. We present an unusual case of avascular necrosis in a patient who had many risk factors. A 61-year-old woman with known chronic lymphocytic leukemia in remission for 6 years and who had used metilprednisolon for autoimmune hemolytic anemia for 5 months was admitted to the hospital for a severe right hip pain, difficulty in walking and high fever We have isolated Salmonella enteritidis from blood cultures. MR imaging and scintigraphy showed avascular necrosis of the femoral head. By conventional treatment of the decompression of femoral head and specific antimicrobial therapy, the patient survived. She has had common risk factors because of the underlying disease and medical approach to avascular necrosis of the femoral head and Salmonella enteritidis bacteremia. This case has been presented to emphasize the tare comorbity of these situations and differential diagnosis

Comparison of silver-coated dressing (Acticoat (R)), chlorhexidine acetate 0.5% (Bactigrass (R)) and nystatin for topical antifungal effect in Candida albicans-contaminated, full-skin-thickness rat burn wounds

Background: In this experimental animal study, the effects of three different topical antimicrobial dressings on Candida albicans contaminated full-thickness burn in rats were analyzed

A novel id-iri score: development and internal validation of the multivariable community acquired sepsis clinical risk prediction model

El-Sokkary, Rehab/0000-0002-8135-7671; Uysal, Serhat/0000-0002-4294-5999WOS: 000520706000011PubMed: 31823148We aimed to develop a scoring system for predicting in-hospital mortality of community-acquired (CA) sepsis patients. This was a prospective, observational multicenter study performed to analyze CA sepsis among adult patients through ID-IRI (Infectious Diseases International Research Initiative) at 32 centers in 10 countries between December 1, 2015, and May 15, 2016. After baseline evaluation, we used univariate analysis at the second and logistic regression analysis at the third phase. in this prospective observational study, data of 373 cases with CA sepsis or septic shock were submitted from 32 referral centers in 10 countries. the median age was 68 (51-77) years, and 174 (46,6%) of the patients were females. the median hospitalization time of the patients was 15 (10-21) days. Overall mortality rate due to CA sepsis was 17.7% (n = 66). the possible predictors which have strong correlation and the variables that cause collinearity are acute oliguria, altered consciousness, persistent hypotension, fever, serum creatinine, age, and serum total protein. CAS (%) is a new scoring system and works in accordance with the parameters in third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). the system has yielded successful results in terms of predicting mortality in CA sepsis patients

Coexistence of pancreatic tuberculosis with systemic brucellosis: a case report

Isolated pancreatic tuberculosis is an extremely rare clinical entity and is difficult to diagnose particularly in immunocompetent individuals. Clinical findings and symptomatology of brucellosis are often similar to tuberculosis thus making the differentiation amongst the two entities difficult. We report a case of pancreatic tuberculosis with systemic brucellosis in a 29 year old veterinarian who presented with epigastric pain and loss of appetite. Initial investigations revealed leukocytosis with moderately elevated transaminase, gamma glutamyl transferase, amylase and lipase levels. Imaging studies revealed an anechoic multiloculated cyst in the body and tail of the pancreas. Given the patient's occupational risk coupled with the presence of a positive Brucella agglutination test (with a titer of 1:320); a diagnosis of pancreatitis secondary to brucellosis was given. In addition to standard pancreatitis therapy of bowel rest with intravenous fluid/electrolyte replacement, anti-brucellosis therapy was also administered. The patient's initial response to therapy was positive however, 6 weeks into therapy, his abdominal pain recurred and repeat CT scan revealed the development of a pseudocyst in the pancreas. After failing a second attempt at conservative supportive therapy, the patient underwent an explorative laparotomy. Histological examination of the resected pancreatic specimen showed necrosis and was positive for tuberculosis by polymerase chain reaction. Herein, we describe the first case reported in the medical literature of the coexistence of systemic brucellosis with pancreatic tuberculosis. We suggest that the possibility of the coexistence of brucellosis with tuberculosis be kept in mind when assessing pancreatitis patients in endemic regions and in individuals with occupational risk hazards

Evaluation of 1380 Percutaneous Blind Liver Needle Biopsies Performed in Patients With Chronic Viral Hepatitis

Grading and staging of chronic viral hepatitis B and C is essential in order to initiate treatment, choose interferon or antiviral treatment approach and assess the prognosis

Ixodes scapularis saliva components that elicit responses associated with acquired tick-resistance

Ticks and tick-borne diseases are on the rise world-wide and vaccines to prevent transmission of tick-borne diseases is an urgent public health need. Tick transmission of pathogens to the mammalian host occurs during tick feeding. Therefore, it is reasoned that vaccine targeting of tick proteins essential for feeding would thwart tick feeding and consequently prevent pathogen transmission. The phenomenon of acquired tick-immunity, wherein, repeated tick infestations of non-natural hosts results in the development of host immune responses detrimental to tick feeding has served as a robust paradigm in the pursuit of tick salivary antigens that may be vaccine targeted. While several salivary antigens have been identified, immunity elicited against these antigens have only provided modest tick rejection. This has raised the possibility that acquired tick-immunity is directed against tick components other than tick salivary antigens. Using Ixodes scapularis, the blacklegged tick, that vectors several human pathogens, we demonstrate that immunity directed against tick salivary glycoproteins is indeed sufficient to recapitulate the phenomenon of tick-resistance. These observations emphasize the utility of tick salivary glycoproteins as viable vaccine targets to thwart tick feeding and direct our search for anti-tick vaccine candidates

Development and validation of a modified quick SOFA scale for risk assessment in sepsis syndrome

Sepsis is a severe clinical syndrome owing to its high mortality. Quick Sequential Organ Failure Assessment (qSOFA) score has been proposed for the prediction of fatal outcomes in sepsis syndrome in emergency departments. Due to the low predictive performance of the qSOFA score, we propose a modification to the score by adding age. We conducted a multicenter, retrospective cohort study among regional referral centers from various regions of the country. Participants recruited data of patients admitted to emergency departments and obtained a diagnosis of sepsis syndrome. Crude in-hospital mortality was the primary endpoint. A generalized mixed-effects model with random intercepts produced estimates for adverse outcomes. Model-based recursive partitioning demonstrated the effects and thresholds of significant covariates. Scores were internally validated. The H measure compared performances of scores. A total of 580 patients from 22 centers were included for further analysis. Stages of sepsis, age, time to antibiotics, and administration of carbapenem for empirical treatment were entered the final model. Among these, severe sepsis (OR, 4.40; CIs, 2.35-8.21), septic shock (OR, 8.78; CIs, 4.37-17.66), age (OR, 1.03; CIs, 1.02-1.05) and time to antibiotics (OR, 1.05; CIs, 1.01-1.10) were significantly associated with fatal outcomes. A decision tree demonstrated the thresholds for age. We modified the quick Sequential Organ Failure Assessment (mod-qSOFA) score by adding age (> 50 years old = one point) and compared this to the conventional score. H-measures for qSOFA and mod-qSOFA were found to be 0.11 and 0.14, respectively, whereas AUCs of both scores were 0.64. We propose the use of the modified qSOFA score for early risk assessment among sepsis patients for improved triage and management of this fatal syndrome