Single Enteral Loading Dose of Phenobarbital for Achieving Its Therapeutic Serum Levels in Neonates

Aim To investigate whether therapeutic serum drug levels may be achieved with a single enteral loading dose of phenobarbital. Methods The study was performed at the Mersin University Hospital in Turkey between April 2004 and August 2006, and included 29 newborn babies with seizure. After the acute treatment of the seizure with midazolam at a dose of 0.1 mg/kg, phenobarbital was administered by orogastric route at a loading dose of 20 mg/kg. Serum phenobarbital concentrations were measured at 0.5, 3, 6, and 12 hours after the loading. Serum phenobarbital levels between 10- 30 μg/mL were considered as the therapeutic range. Results The serum phenobarbital levels reached therapeutic values in 9 (31%), 19 (66%), 21 (72%), and 23 (79%) patients at 0.5, 3, 6, and 12 hours after loading, respectively, while they did not reach therapeutic values in 6 patients (21%) after 12 hours. Four of the patients in whom there was no increase in serum phenobarbital levels had hypoxic- ischemic encephalopathy. Conclusion Enteral loading of phenobarbital can achieve therapeutic serum levels in the large majority of newborn babies with seizure and may be safely used in babies with the intact gastrointestinal tract

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

Investigating the influence of farm layout on the energy production of simple wind park configurations

The interaction between wind turbines in simple wind farm layouts is investigated with the purpose of observing the influence of wake loss phenomenon on the energy production of downwind turbines. Following an intensive exploration stage about wind farm aerodynamics and wake modeling subjects, several tests cases are designed to represent various wind farm configurations, consisting of different number of wind turbines. These cases are simulated by using DNV GL WindFarmer software which provides the opportunity of performing simulations with two different wake modeling techniques, namely Modified PARK and Eddy Viscosity. Various terrain and ambient turbulence intensity conditions are considered during the test cases. Also three different turbine types having different hub heights, rotor diameters and power-thrust coefficients are used in order to observe the effect of turbine characteristics on wake formation. Besides WindFarmer, WAsP and MATLAB tools are used in some simulation stages in order to generate input data such as wind and terrain conditions or farm layout configurations; and to process the data obtained in the end of these test cases. Simulations which are executed in the presence of a predominant wind direction from a narrow direction bin indicate that, even though there exists no significant interaction between the turbines placed in abreast configurations, successive turbine rows affect each other strongly due to the existence of the wake region of upwind turbines. It is observed that downwind spacing between turbine rows required to recover wake deficit up to a certain level changes depending on terrain and ambient turbulence intensity conditions together with turbine characteristics. For instance increasing surface roughness length (or ambient turbulence intensity) of a given site by keeping all the other parameters constant can provide up to 20% (or 30%) decrease in the required downstream distance to reduce wake loss to 5% level in a simple tandem layout consisting of two wind turbines. Further test cases are executed with various numbers of wind turbines in different configurations to observe the effect of partial, full and multiple wake regions on total farm efficiency. The results obtained from these cases are used in order to have a comparison between several farm layouts and evaluate their advantages and drawbacks

Single Enteral Loading Dose of Phenobarbital for Achieving Its Therapeutic Serum Levels in Neonates

Aim To investigate whether therapeutic serum drug levels may be achieved with a single enteral loading dose of phenobarbital. Methods The study was performed at the Mersin University Hospital in Turkey between April 2004 and August 2006, and included 29 newborn babies with seizure. After the acute treatment of the seizure with midazolam at a dose of 0.1 mg/kg, phenobarbital was administered by orogastric route at a loading dose of 20 mg/kg. Serum phenobarbital concentrations were measured at 0.5, 3, 6, and 12 hours after the loading. Serum phenobarbital levels between 10- 30 μg/mL were considered as the therapeutic range. Results The serum phenobarbital levels reached therapeutic values in 9 (31%), 19 (66%), 21 (72%), and 23 (79%) patients at 0.5, 3, 6, and 12 hours after loading, respectively, while they did not reach therapeutic values in 6 patients (21%) after 12 hours. Four of the patients in whom there was no increase in serum phenobarbital levels had hypoxic- ischemic encephalopathy. Conclusion Enteral loading of phenobarbital can achieve therapeutic serum levels in the large majority of newborn babies with seizure and may be safely used in babies with the intact gastrointestinal tract

Bir diş hastalıkları araştırma hastanesinde görevli hekimlerin antibiyotik bilgisi ve antibiyotik kullanımlarına etki eden durumlar

Aim: Antibiotics should be used with caution because of the increase in bacterial resistance, high treatment costs and decrease of the new antibiotic discovery. Rational use of antibiotics is referred as appropriate antibiotic choice, appropriate d;ouml;şe and duration and the lowest cost. Dentists are frequently confronted with situations like endocarditis prophylaxis, tooth and gum infections, and therefore they often use antibiotics. In this study; the factors affecting rational antibiotic use of dentists working in educational dental hospital w ere investigated. Materials and Methods: The questionnaire consists of multiple choice questions was performed by answering under surveillance method. Results were analyzed with calculating of frequencies and percentages. Results: Out of 114 dentists included in the study, 73 (64% )were women. In terms of taking anamnesis for appropriate antibiotic prescription, dentists considered himself/herself as very good, good and moderate were 54.1 % , 22.3% and 11.5%, respectively. It was found that the dentists working more than fifteen years attended less post-graduation educations and courses about rational antibiotic use, and they often took information about antibiotics from their colleagues. Conclusion: It was observed that scientific resources such as diagnosis and treatment manuals or books, and post- graduation educations in rational antibiotic use are necessary instead of pharmaceutical industry informations.Amaç: Antibiyotikler, artan bakteriyel direnç, yüksek maliyetler ve yeni antibiyotik keşiflerinin azalması gibi nedenlerden dolayı dikkatli kullanılması gereken ilaçların başında gelmektedir. Akılcı antibiyotik kullanımı (AAK), uygun antibiyotik, uygun süre ve dozda, en düşük maliyet ile bilinir. Diş hekimleri, diş ve dişeti enfeksiyonları, endokardit profilaksisi gibi durumlarla sık karşılaşmakta ve bu nedenle antibiyotikleri sıkça kullanmaktadırlar. Bu çalışmada bir eğitim diş hastanesinde görev yapan hekimlerin AKK’ye etki eden durumlar irdelendi. Gereç ve Yöntem: Çoktan seçmeli sorulardan oluşan anket gözetim altında cevaplama yöntemi ile uygulandı. Sonuçlar sıklık ve yüzdeler hesaplanarak analiz edildi. Bulgular: Çalışmaya dahil olan 114 diş hekiminin 73’ü (%64) kadındı. Reçete yazarken verilecek antibiyotiğe uygun anamnez alma noktasında kendisini “çok iyi” , “iyi” ve “orta” şeklinde tanımlayanların oranı sırasıyla, % 54.1, % 22.3 ve % 11.5 olarak bulundu. Meslekte 15 yılı aşkın süredir çalışan diş hekimleri diğerlerine oranla daha az mezuniyet sonrası eğitim aldıkları, daha az AAK konusunda eğitim aldıkları fark edildi ve 15 yılı aşkı n süredir çalışan diş hekimleri, antibiyotik bilgi kaynağı olarak meslektaşlarını daha yüksek oranda kullandıkları görüldü. Sonuç: İlaç sanayinin bilgilendirmeleri yerine; tanı ve tedavi kılavuzları ve kitapları gibi bilimsel kaynaklar ile mezuniyet sonrası AAK eğitimlerine yönelmenin gerektiği görülmüştür

Use of Tigecycline for Diabetic Foot Infections

WOS: 000424372500007Objective. The aim of this study is to evaluate tigecycline for diabetic foot infections (DFIs). Materials and Methods. In this prospective observational study, the investigators included patients who had consultation with the Diabetic Foot Council of Ege University Faculty of Medicine (Izmir, Turkey) between March 2013 and July 2015 and who used tigecycline during their treatment. Treatment success was assessed by design-specific criteria for each evaluation. Results. The study included 105 cases. Of those, 37 (35.2%) were women (mean [+/- standard deviation] age, 61.9 +/- 11.9 years). The success rate of tigecycline treatment was 93.3% in mild infections, 56.2% in moderate, 57.7% in severe, and 61.9% in all cases. The authors found a 9-fold decrease (P = .046) in the success of tigecycline treatment among those who developed moderate or severe DFIs and a 6.4-fold decrease (P < .0001) among those who had arterial stenosis. For 33 (71.7%) of 46 (43.8%) patients who experienced a side effect, tigecycline treatment was continued as it could be tolerated. Conclusions. If tigecycline is to be the treatment choice, extra attention must be paid to patients with arterial stenosis, severe DFIs, and side effects. The common disadvantage is the high side effect rate, especially nausea. However, it is generally not necessary to discontinue the medication incases with nausea. Therefore, tigecycline may be used as a choice of therapy in mild DFIs

MLL-AF4 gene rearrangement in a child with Epstein-Baff virus-related posttransplant B-cell lymphoma

Recipients of solid organ allografts are known to be at increased risk of developing Epstein-Barr virus-related posttransplant lymphoproliferative diseases. A 28-month-old boy who had received a heterotopic liver transplant presented with lymphadenopathy in the abdomen, multiple nodules in the liver, and bilateral renal infiltration 19 months after transplantation. He was diagnosed with a Burkitt-like lymphoma based on bone marrow examination and the finding that the blastic cells in bone marrow were EBER-1 positive. Cytogenetic analysis of the bone marrow cells showed an MLL-AF4 rearrangement. He was treated with a combined chemotherapy regimen. He has been in continuous complete remission for 15 months now