Different Types of Resources Used by Master Students Considering Their Thinking Styles

The aim of this research is to determine the different types of resources, regarding the thinking styles, used by mathematics teachers to create an a-didactical situation using a video-game from an essential resource. In this research embedded mixed method was used. Participants were ten teacher-student-researchers, studying at the master degree program at a university in Turkey. The data obtained is analyzed regarding thematic analysis and descriptive statistic. The assignments were analysed in three categories; teacher resources, student resources, and researcher resources. It was found that assignments were used two types of resources, namely "teacher resources" and "student resources". There were no assignments that used "researcher resources. Also, it was also found that the legislative forms, hierarchic and monarchic forms, local levels, external scopes and liberal leanings were dominant among the students. It is suggested to increase the work to put forward the researcher identities in teacher-students’ education at the Universities

Impact of the ST101 clone on fatality among patients with colistin-resistant Klebsiella pneumoniae infection

Objectives: We describe the molecular characteristics of colistin resistance and its impact on patient mortality

Changes in antimicrobial resistance and outcomes of health care-associated infections

To describe the change in the epidemiology of health care-associated infections (HAI), resistance and predictors of fatality we conducted a nationwide study in 24 hospitals between 2015 and 2018. The 30-day fatality rate was 22% in 2015 and increased to 25% in 2018. In BSI, a significant increasing trend was observed for Candida and Enterococcus. The highest rate of 30-day fatality was detected among the patients with pneumonia (32%). In pneumonia, Pseudomonas infections increased in 2018. Colistin resistance increased and significantly associated with 30-day fatality in Pseudomonas infections. Among S. aureus methicillin, resistance increased from 31 to 41%

Characteristics and outcomes of carbapenemase harbouring carbapenem-resistant Klebsiella spp. bloodstream infections: a multicentre prospective cohort study in an OXA-48 endemic setting

A prospective, multicentre observational cohort study of carbapenem-resistant Klebsiella spp. (CRK) bloodstream infections was conducted in Turkey from June 2018 to June 2019. One hundred eighty-seven patients were recruited. Single OXA-48-like carbapenemases predominated (75%), followed by OXA-48-like/NDM coproducers (16%). OXA-232 constituted 31% of all OXA-48-like carbapenemases and was mainly carried on ST2096. Thirty-day mortality was 44% overall and 51% for ST2096. In the multivariate cox regression analysis, SOFA score and immunosuppression were significant predictors of 30-day mortality and ST2096 had a non-significant effect. All OXA-48-like producers remained susceptible to ceftazidime-avibactam

Diagnosis, Treatment And Prevention Of Infective Endocarditis: Turkish Consensus Report

Although infective endocarditis (IE) is rare, it is still important as an infectious disease because of the resulting morbidity and substantial mortality rates. Epidemiological studies in developed countries have shown that the incidence of IE has been approximately 6/100 000 in recent years and it is on the fourth rank among the most life-threatening infectious diseases after sepsis, pneumonia and intraabdominal infections. Although IE is not a reportable disease in Turkey, and an incidence study was not performed, its incidence may be expected to be higher due to both more frequent presence of predisposing cardiac conditions and higher rates of nosocomial bacteremia which may lead to IE in risk groups. Additionally, while IE generally affects elderly people in developed countries it still affects young people in Turkey. In order to reduce the mortality and morbidity, it is critical to diagnose the 1E, to determine the causative agent and to start treatment rapidly. However, most of the patients cannot be diagnosed in their first visits, about half of them can be diagnosed after 3 months, and the disease often goes unnoticed. In patients diagnosed as IE, the rate of identification of causative organisms is more than 90% in developed countries, while it is around 60% in Turkey. Furthermore, some important microbiological diagnostic tests are not performed in most of the centers. Some antimicrobials that are recommended as the first option for treatment of IE, particularly antistaphylococcal penicillins, are unavailable in Turkey. These problems necessitate to review the epidemiological, laboratory and clinical characteristics of IE in the country, as well as the current information about its diagnosis, treatment and prevention together with local data. Patients with IE can be followed by physicians in many specialties. Diagnosis and treatment processes of IE should be standardized at every stage so that management of IE, a setting in which many physicians are involved, can always be in line with current recommendations. From this point of view, Study Group for Infective Endocarditis and Other Cardiovascular Infections of the Turkish Society of Clinical Microbiology and Infectious Diseases has called for collaboration of the relevant specialist organizations to establish a consensus report on the diagnosis, treatment and prevention of IE in the light of current information and local data in Turkey. In the periodical meetings of the assigned representatives from all the parties, various questions were identified. Upon reviewing related literature and international guidelines, these questions were provided with consensus answers. Several of the answers provided in the report are listed below: [1] IE is more frequent in patients with a previous episode of IE, a valvular heart disease, a congenital heart disease, any intracardiac prosthetic material, an intravenous drug addiction, chronic hemodialysis treatment, solid organ and hematopoietic stem cell transplantation as compared with normal population. [2] The most frequent causative organisms are Staphylococcus aureus, streptococci, coagulase-negative staphylococci, and enterococci, respectively, both in Turkey and globally. Brucella spp. is the fifth common causative agent of IE in Turkey. [3] The echocardiography is the imaging modality of choice to define cardiac lesions in patients with suspected IE. Both transthoracic and transesophageal echocardiography are generally necessary in almost all patients. Both are inconclusive approximately in 15% of total IE cases whereas the percentage is up to 30% in patients with intracardiac prosthetic devices. In these instances, multi-slice (MS) computed tomography (CT) should be the imaging modality in patients with native valve IE, whereas MS-CT or radiolabelled leukocyte scintigraphy with single-photon emission tomography/CT should be choosen for patients who have prosthetic valve IE within the first 3 months of surgery, and MS-CT or positron-emission tomography/CT should be chosen for patients with prosthetic valve IE after 3 months of surgery. [4] Blood cultures should be taken without any delay to catch-up the febrile period as 3 sets with 30-minute intervals (3 aerobic and 3 anaerobic bottles, totally 6 bottles) in patients with suspected IE. Each set, comprised of 1 aerobic and 1 anaerobic bottle, should be inoculated with 18-20 ml of blood (9 -10 ml blood per bottle). Totally 60 ml of blood should be taken from one patient with suspected IE. Two sets of control blood cultures should be repeated in every 48 hours after initiation of therapy in order to show blood sterility. If causative organism do not grow in the usual blood culture bottles, additional three mycobacterial blood culture bottles should be inoculated in patients with suspected prosthetic valve IE and who had a cardiac surgery in the last decade. [5] The excised valvular tissue from patients with suspected IE should be evaluated both microbiologically and histopathologically.[6] First of all, Wright agglutination test (if negative, by adding Coombs' serum) and indirect fluorescent antibody (IFA) test to investigate Coxiella burnetii phase I IgG antibodies should be done in culture-negative patients. If these two tests are negative, IgG antibodies for Bartonella spp., Legionella spp., Chlamydia spp., and Mycoplasma spp. should be tested respectively and preferably by IFA test. [7] Multiplex polymerase chain reaction (PCR) tests should be used to identify the pathogen in whole blood in a culturenegative patient who has received previous antibiotic therapy. If the blood cultures are negative in a patient who has not received previous antibiotic therapy, PCR tests for 16S rRNA gene analysis and Tropheryma whipplei should be performed on the resected valve obtained during surgery. [8] Histopathological examination of resected valvular tissue in patients with suspected IE give valuable information about the activation and degree of the inflammation. Moreover, histopathological examination with appropriate routine and immunohistochemical staining, aid to identify especially intracellular pathogens like C. burnetii, Bartonella spp. and T. whipplei in blood culture-negative patients. [9] Bactericidal agents given parenterally for long duration is the general principle of antimicrobial treatment of IE. The pathogenic organism, presence of prosthetic material and duration of symptoms specifies the duration of treatment. The therapy duration is generally 4-6 weeks for native valve IE and >6 weeks for prosthetic valve IE. [10] As the efficacy and feasibility of oral antimicrobial choices of left-sided IE are not well defined in Turkey and it is related with substantial mortality, parenteral route should be preferred for the complete duration of antimicrobial treatment of left-sided IE in Turkey. In case of unavailability of intravenous access or outpatient parenteral antibiotic therapy, oral agents may be feasible to complete the therapy duration in stable patients with uncomplicated native valve IE due to drug-susceptible viridans streptococci, provided that initial two weeks should be completed parenterally, and the patient should give an informed consent after notifying all possible risks, and regular post-discharge follow-up should be possible. The decision for oral maintenance therapy has to be given by the IE team. [11] The appropriate antimicrobials should be initiated without any delay as it reduces not only the risk of an embolic event in patients with either acute or subacute IE, but also decreases the mortality associated with sepsis in acute IE. Therefore, the empirical antimicrobials should be promptly initiated after blood cultures are taken. [12] Ampicillin-sulbactam +/- gentamicin can be initiated empirically in the treatment of community-acquired, both acute and subacute types of native and late prosthetic valve IE in adults whereas either vancomycin + ampicillin-sulbactam or ceftriaxone +/- gentamicin can be the choice for acute types. Vancomycin + cefepime +/- gentamicin combination can be initiated empirically in the treatment of nosocomial native, early and late prosthetic valve IE in adults. Gentamicin should be avoided initially in patients with impaired renal function. Rifampin can be added to initial empirical treatment of early prosthetic valve IE. Daptomycin alone is not a drug of choice for initial empirical treatment of IE because of its suboptimal efficacy for streptococci and enterococci in which resistance can easily develop during therapy.WoSScopu

Diagnosis, Treatment and Prevention of Infective Endocarditis: Turkish Consensus Report

Although infective endocarditis (IE) is rare, it is still important as an infectious disease because of the resulting morbidity and substantial mortality rates. Epidemiological studies in developed countries have shown that the incidence of IE has been approximately 6/100 000 in recent years and it is on the fourth rank among the most life-threatening infectious diseases after sepsis, pneumonia and intraabdominal infections. Although IE is not a reportable disease in Turkey, and an incidence study was not performed, its incidence may be expected to be higher due to both more frequent presence of predisposing cardiac conditions and higher rates of nosocomial bacteremia which may lead to IE in risk groups. Additionally, while IE generally affects elderly people in developed countries it still affects young people in Turkey. In order to reduce the mortality and morbidity, it is critical to diagnose the 1E, to determine the causative agent and to start treatment rapidly. However, most of the patients cannot be diagnosed in their first visits, about half of them can be diagnosed after 3 months, and the disease often goes unnoticed. In patients diagnosed as IE, the rate of identification of causative organisms is more than 90% in developed countries, while it is around 60% in Turkey. Furthermore, some important microbiological diagnostic tests are not performed in most of the centers. Some antimicrobials that are recommended as the first option for treatment of IE, particularly antistaphylococcal penicillins, are unavailable in Turkey. These problems necessitate to review the epidemiological, laboratory and clinical characteristics of IE in the country, as well as the current information about its diagnosis, treatment and prevention together with local data. Patients with IE can be followed by physicians in many specialties. Diagnosis and treatment processes of IE should be standardized at every stage so that management of IE, a setting in which many physicians are involved, can always be in line with current recommendations. From this point of view, Study Group for Infective Endocarditis and Other Cardiovascular Infections of the Turkish Society of Clinical Microbiology and Infectious Diseases has called for collaboration of the relevant specialist organizations to establish a consensus report on the diagnosis, treatment and prevention of IE in the light of current information and local data in Turkey. In the periodical meetings of the assigned representatives from all the parties, various questions were identified. Upon reviewing related literature and international guidelines, these questions were provided with consensus answers. Several of the answers provided in the report are listed below: [1] IE is more frequent in patients with a previous episode of IE, a valvular heart disease, a congenital heart disease, any intracardiac prosthetic material, an intravenous drug addiction, chronic hemodialysis treatment, solid organ and hematopoietic stem cell transplantation as compared with normal population. [2] The most frequent causative organisms are Staphylococcus aureus, streptococci, coagulase-negative staphylococci, and enterococci, respectively, both in Turkey and globally. Brucella spp. is the fifth common causative agent of IE in Turkey. [3] The echocardiography is the imaging modality of choice to define cardiac lesions in patients with suspected IE. Both transthoracic and transesophageal echocardiography are generally necessary in almost all patients

Consensus Report on Diagnosis, Treatment and Prevention of Infective Endocarditis by Turkish Society of Cardiovascular Surgery (TSCVS), Turkish Society of Clinical Microbiology and Infectious Diseases (KLIMIK), Turkish Society of Cardiology (TSC), Turkish Society of Nuclear Medicine (TSNM), Turkish Society of Radiology (TSR), Turkish Dental Association (TDA) and Federation of Turkish Pathology Societies (TURKPATH) Cardiovascular System Study Group

Infective endocarditis (IE) is rare, but associated with significant morbidity and mortality rates. Estimates of the incidence of IE in Turkey are compromised by the absence of population-based prospective studies. Due to the frequent presence of predisposing cardiac conditions and higher rates of nosocomial bacteremia in high-risk groups, the incidence of IE is expected to be higher in Turkey. Additionally, while IE generally affects older people in developed countries, it still affects young people in Turkey. In order to reduce the mortality and morbidity, it is critical to diagnose the IE to determine the causative agent and to start treatment rapidly. However, most of the patients cannot be diagnosed in their first visits, about half of them can be diagnosed after three months, and the disease often goes unnoticed. In patients diagnosed with IE, the rate of identification of causative organisms is significantly lower in Turkey than in developed countries. Furthermore, most of the centers do not perform some essential microbiological diagnostic tests as a routine practice. Some antimicrobials that are recommended as the first-line of treatment for IE, particularly antistaphylococcal penicillins, are not available in Turkey. These problems necessitate reviewing the epidemiological, laboratory, and clinical characteristics of IE in our country, as well as the current information about its diagnosis, treatment, and prevention together with local data. Physicians can follow patients with IE in many specialties. Diagnosis and treatment processes of IE should be standardized at every stage so that management of IE, a setting in which many physicians are involved, can always be in line with current recommendations. Study Group for Infective Endocarditis and Other Cardiovascular Infections of the Turkish Society of Clinical Microbiology and Infectious Diseases has called for collaboration of the relevant specialist organizations to establish a consensus report on the diagnosis, treatment, and prevention of IE in the light of current information and local data in Turkey

Survival in rhino-orbito-cerebral mucormycosis: An international, multicenter ID-IRI study

Background: Mucormycosis is an emerging aggressive mold infection. This study aimed to assess the outcome of hospitalized adults with rhino-orbito-cerebral mucormycosis (ROCM). The secondary objective was to identify prognostic factors in this setting. Methods: This study was an international, retrospective, multicenter study. Patients’ data were collected from 29 referral centers in 6 countries. All qualified as “proven cases” according to the EORTC/MSGERC criteria. Results: We included 74 consecutive adult patients hospitalized with ROCM. Rhino-orbito-cerebral type infection was the most common presentation (n = 43; 58.1%) followed by rhino-orbital type (n = 31; 41.9%). Twenty (27%) had acquired nosocomial bacterial infections. A total of 59 (79.7%) patients (16 in combination) received appropriate antifungal treatment with high-doses of liposomal amphotericin B. Fifty-six patients (75.7%) underwent curative surgery. Thirty-five (47.3%) required intensive care unit admission (27; 36.5% under mechanical ventilation). Hospital survival was 56.8%, being reduced to 7.4% in patients with invasive mechanical ventilation. A multivariate binary backward logistic regression model identified confusion at admission (OR 11.48), overlapping hospital-acquired infection (OR 10.27), use of antifungal treatment before diagnosis (OR 10.20), no surgical debridement (OR 5.92), and the absence of prior sinusitis (OR 6.32) were independently associated with increased risk for death. Conclusion: Today, ROCM still has high mortality rate. Improving source control, rational therpy, and preventing nosocomial infections may improve survival in this severe infection