GEÇMİŞTEN BİR ANALİZ; GAZİANTEP ÜNİVERSİTESİ TIP FAKÜLTESİ HASTANESİ YOĞUN BAKIM ÜNİTELERİNDE NOZOKOMİYAL ENFEKSİYONLARIN İRDELENMESİ VE ENFEKSİYON RİSK FAKTÖRLERİNİN BELİRLENMESİ

Giriş: Bu calışmada, Gaziantep Üniversitesi Tıp Fakültesi Hastanesi yoğun bakım ünitelerinde enfeksiyon gelişmesi için risk faktörleri ve enfeksiyon etkenlerinin belirlenmesi amaçlanmıştır.  Gereç ve Yöntem: 15 Kasım 2004-15 Mayıs 2005 tarihleri arasında yoğun bakım ünitelerinde 48 saatten sure kalan hastalar prospektif olarak izlendi. Etken mikroorganizma izole edilerek nozokomiyal enfeksiyon tanısı konulmuş 63 hasta calışmaya alındı. Kontrol grubu olarak hastane enfeksiyonu gelişmeyen 56 olgu rastgele alındı. Olgu grubu ve kontrol grubunun, ortalama yaşları, yoğun bakımda kalış sureleri, Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi II skorları, mortalite oranları, entubasyon, trakeostomi, ventilasyon desteği, santral venöz kateter, periferik venöz kateter, üriner kateter, nazogastrik sonda, enteral ve parenteral beslenme günleri ve tanı konmadan önceki antibiyotik kullanma süresi saptandı. Bulgular: Yaş, yatış süresi ve Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi II skorunun enfeksiyon gelişimi açısından anlamlı ve bağımsız risk faktorleri olduğu saptandı. Diğer risk faktorleri olarak mekanik ventilasyon, trakeostomi, santral venöz kateter ve total parenteral nutrisyon varlığı belirlendi (p<0.05). Yoğun bakım ünitesinde yatan hastane enfeksiyonu gelişen hastalarda mortalite %46 iken, kontrol grubunda bu oran %19.6 olarak belirlendi. Sonuç: Enfeksiyon gelişiminde risk faktörleri uzerine çalışmaların her hastanede enfeksiyon etkenleri ve antibiyotik duyarlılık paternlerini araştıran çalışmalarla birlikte yapılması uygun, hastaneye özgü enfeksiyon kontrol önlemlerinin alınmasını sağlayacaktır

An unusual case of childhood sarcoidosis

Sarcoidosis is a systemic granulomatous disease of unknown etiology that may affect many systems, mainly lungs. Most of the patients present at stages I and II lung involvement. Pulmonary infiltrates without hilar lymphadenopathy (state III) rarely occurs. Extrapulmonary organ involvement is common in pediatric sarcoidosis

Diagnostic value of combined serum biomarkers for the evaluation of liver fibrosis in chronic hepatitis C infection: A multicenter, noninterventional, observational study

Background/Aims: The hepatitis C virus (HCV) infection is important cause of chronic hepatitis. Liver biopsy is considered the gold standard for assessment of fibrosis but this procedure is an invasive procedure. We aimed to evaluate the diagnostic efficiency of non-invasive serum biomarkers, separately and in combinations, on liver fibrosis in treatment-naive chronic hepatitis C (CHC) patients. Materials and Methods: Two hundred and sixteen treatment-naive CHC patients were enrolled from 32 locations across Turkey in this open-labelled, non-interventional prospective observational study. FibroTest®, aspartate aminotransferase-to-platelet ratio index(APRI), aspartate aminotransferase and alanine aminotransferase ratio (AAR), fibrosis index based on four factors (FIB-4), Age-platelet(AP) index and Forns index were measured and compared with Metavir scores got from liver biopsies. Results: Data from 182 patients with baseline liver biopsy were suitable for analysis. One hundred and twenty patients (65.9%) had F0-F1 fibrosis and 62 patients (34.1%) had F2-F4 fibrosis. APRI 0.732 area under the curve(AUC) indicated advanced fibrosis with 69% sensitivity and 77% specificity. FIB-4 0.732 AUC and FibroTest 0.715 AUC indicated advanced fibrosis with 69% and 78.4% sensitivity, and 75% and 71.4% specificity, respectively. The combined use of tests also led to an increase in AUC and specificity. Combinations of FibroTest with APRI and/or FIB-4, and FIB-4 with APRI were optimal for the evaluation of liver fibrosis. Conclusion: Fibrotest, FIB-4, APRI, AP index and Forns index exhibit good diagnostic performance for determining liver fibrosis in CHC patients, and the use of at least two tests together will increase their diagnostic value still further. © Copyright 2018 by The Turkish Society of Gastroenterology

Effects of Speech Output on Maintenance of Requesting and Frequency of Vocalizations in Three Children with Developmental Disabilities

Item does not contain fulltextWe evaluated the role of digitized speech output on the maintenance of requesting and frequency of vocalizations in three children with developmental disabilities. The children were taught to request access to preferred objects using an augmentative communication speech-generating device (SGD). Following acquisition, rates of requesting and vocalizations were compared across two conditions (speech output on versus speech output off) that were alternated on a session-by-session basis. There were no major or consistent differences across the two conditions for the three children, suggesting that access to preferred objects was the critical variable maintaining use of the SGDs. The results also suggest that feedback in the form of digitized speech from the SGD did not inhibit vocalizations. One child began to speak single words during the latter part of the study, suggesting that in some cases AAC intervention involving SGDs may facilitate speech

Treatment of ventilator-associated pneumonia (VAP) caused by Acinetobacter: results of prospective and multicenter ID-IRI study

Ventilator-associated pneumonia (VAP) due to Acinetobacter spp. is one of the most common infections in the intensive care unit. Hence, we performed this prospective-observational multicenter study, and described the course and outcome of the disease. This study was performed in 24 centers between January 06, 2014, and December 02, 2016. The patients were evaluated at time of pneumonia diagnosis, when culture results were available, and at 72 h, at the 7th day, and finally at the 28th day of follow-up. Patients with coexistent infections were excluded and only those with a first VAP episode were enrolled. Logistic regression analysis was performed. A total of 177 patients were included; empiric antimicrobial therapy was appropriate (when the patient received at least one antibiotic that the infecting strain was ultimately shown to be susceptible) in only 69 (39%) patients. During the 28-day period, antibiotics were modified for side effects in 27 (15.2%) patients and renal dose adjustment was made in 38 (21.5%). Ultimately, 89 (50.3%) patients died. Predictors of mortality were creatinine level (OR, 1.84 (95% CI 1.279-2.657); p = 0.001), fever (OR, 0.663 (95% CI 0.454-0.967); p = 0.033), malignancy (OR, 7.095 (95% CI 2.142-23.500); p = 0.001), congestive heart failure (OR, 2.341 (95% CI 1.046-5.239); p = 0.038), appropriate empiric antimicrobial treatment (OR, 0.445 (95% CI 0.216-0.914); p = 0.027), and surgery in the last month (OR, 0.137 (95% CI 0.037-0.499); p = 0.003). Appropriate empiric antimicrobial treatment in VAP due to Acinetobacter spp. was associated with survival while renal injury and comorbid conditions increased mortality. Hence, early diagnosis and appropriate antibiotic therapy remain crucial to improve outcomes

Respiratory System Involvement in Brucellosis

Background Pulmonary involvement is a rare complication of brucellosis. We describe the largest series to date, to our knowledge, of patients with pulmonary brucellosis. Methods This 10-year, retrospective, descriptive study involved 27 centers in Turkey, including all patients with brucellosis with confirmed respiratory system involvement. Results Of 133 patients (67 men), 123 (92.5%) had acute infection (defined as < 2 months), with an overall mean ± SD duration of symptoms of 33.9 ± 8.5 days. The radiologic pattern of pulmonary disease was consolidation/lobar pneumonia in 91 patients (68.4%) and pleural effusion in 41 patients (30.8%), including 30 (22.5%) with both. Moreover, 23 patients (17.3%) had bronchitis (one with coexistent pneumonia), and 10 (7.5%) had nodular lung lesions (one with coexistent pneumonia and effusion). Blood culture results were positive in 56 of 119 patients, and all other cases were serologically confirmed. None of 60 sputum specimens and two of 19 pleural fluid samples (10.5%) yielded positive culture results for brucellosis. Other features of brucellosis, such as osteoarticular complications, were detected in 61 patients (45.9%); 59 (44.4%) had raised liver transaminase levels, and 59 (44.4%) had thrombocytopenia. Fifteen patients (11.3%) required management in an ICU for an average of 3.8 ± 2.2 days. All patients responded to standard combination antimicrobial therapy for brucellosis with no deaths, although treatment regimens required modification in seven patients. Conclusions Brucellosis with pulmonary involvement is rare but has a good prognosis following treatment with appropriate antibiotics. Many clues in the exposure history, presenting clinical features, and baseline blood tests should alert the clinician to consider brucellosis

Factors Affecting Inadequate Empirical Antimicrobial Therapy and the Clinical Course of Upper Urinary Tract Infections in Elderly Patients: A Multicenter Study

Introduction: In this study, we aimed to determine the risk factors associated with inadequate empirical antibiotherapy (IEAT) and hospital-related mortality in elderly patients being treated for upper urinary tract infections (UTI)

Can we predict patients that will not benefit from invasive mechanical ventilation? A novel scoring system in intensive care: the IMV mortality prediction score (IMPRES)

KUCUK, Ahmet Oguzhan/0000-0002-6993-0519; Kirakli, Cenk/0000-0001-6013-7330; KUCUK, Mehtap PEHLIVANLAR/0000-0003-2247-4074; Aksoy, Iskender/0000-0002-4426-3342WOS: 000504051300010PubMed: 31655511Background/aim: The present study aimed to define the clinical and laboratory criteria for predicting patients that will not benefit from invasive mechanical ventilation (IMV) treatment and determine the prediction of mortality and prognosis of these critical ill patients. Materials and methods: The study was designed as an observational, multicenter, prospective, and cross-sectional clinical study. It was conducted by 75 researchers at 41 centers in intensive care units (ICUs) located in various geographical areas of Turkey. It included a total of 1463 ICU patients who were receiving invasive mechanical ventilation (IMV) treatment. A total of 158 parameters were examined via logistic regression analysis to identify independent risk factors for mortality; using these data, the IMV Mortality Prediction Score (IMPRES) scoring system was developed. Results: The following cut-off scores were used to indicate mortality risk: 8, very high risk. There was a 26.8% mortality rate among the 254 patients who had a total IMPRES score of lower than 2. The mortality rate was 93.3% for patients with total 1M PRES scores of greater than 8 (P < 0.001). Conclusion: The present study included a large number of patients from various geographical areas of the country who were admitted to various types of ICUs, had diverse diagnoses and comorbidities, were intubated with various indications in either urgent or elective settings, and were followed by physicians from various specialties. Therefore, our data are more general and can be applied to a broader population. This study devised a new scoring system for decision-making for critically ill patients as to whether they need to be intubated or not and presents a rapid and accurate prediction of mortality and prognosis prior to ICU admission using simple clinical data