Impact of antimicrobial drug restrictions on doctors' behaviors

Background/aim: Broad-spectrum antibiotics have become available for use only with the approval of infectious disease specialists (IDSs) since 2003 in Turkey. This study aimed to analyze the tendencies of doctors who are not disease specialists (non-IDSs) towards the restriction of antibiotics.Materials and methods: A questionnaire form was prepared, which included a total of 22 questions about the impact of antibiotic restriction (AR) policy, the role of IDSs in the restriction, and the perception of this change in antibiotic consumption. The questionnaire was completed by each participating physician.Results: A total of 1906 specialists from 20 cities in Turkey participated in the study. Of those who participated, 1271 (67.5%) had 5 years of occupational experience in their branch expressed that they followed the antibiotic guidelines more strictly than the JSs (P < 0.05) and 755 of physicians (88%) and 720 of surgeons (84.6%) thought that the AR policy was necessary and useful (P < 0.05).Conclusion: This study indicated that the AR policy was supported by most of the specialists. Physicians supported this restriction policy more so than surgeons did

Effect of cis-(Z)-flupentixol on DPPC membranes in the presence and absence of cholesterol

Cis-(Z)-flupentixol dihydrochloride (FLU), a thioxanthene drug, is used in therapy of schizophrenia as well as in anxiolytic and depressive disorders. Since the action mechanism of FLU is not completely understood, the main objective of present study is to provide a detailed evaluation of flupentixol-phospholipid membrane interactions at molecular level. FLU-dipalmitoylphosphatidylcholine (DPPC) interactions in presence and absence of cholesterol (CHO) were investigated as a function of temperature. The changes in upper part of membrane were more pronounced than those in central part of membrane, as indicated by EPR and FTIR. FLU was proposed to incorporate into phospholipid membranes with its triple ring parallel to head group and its chain toward alkyl chain of phospholipids. According to DSC results, the incorporation of 10 mol% FLU into DPPC caused a shoulder in transition peak, suggesting the occurence of a phase separation, and formation of this new phase is still observable in presence of CHO. It is well known that, structure and dynamics of lipids have significant influence on the function of membrane bound proteins, and consecutively their actions. Based upon these, it was proposed that FLU may modify membrane associated receptors and transport proteins, which would form the basis of its clinical efficiency. (C) 2016 Elsevier Ireland Ltd. All rights reserved

Evaluation of oxidative status in patients with Fasciola hepatica infection

Background: F. hepatica infection is rare and mostly subclinical. Migration of juvenile forms of F. hepatica into the host&rsquo;s liver is accompanied by an inflammatory reaction followed by fibrosis and cirrhosis. Objective: The aim of this study was to evaluate oxidative status by using a novel automated method in patients with Fasciola hepatica. Methods: Twenty two patients with a diagnosis of F. hepatica and 26 healthy volunteers were enrolled in the study. Their Total antioxidant capacity status (TAC), total oxidant status (TOS) and catalase were measured in them and oxidative stress index (OSI) was calculated. These measurements were also taken for the control group and the values were compared. Results: Plasma levels of total TOS and OSI were significantly increased in patients as compared with healthy controls (P&lt;0.001, P&lt;0.001, P=0.001, P=0.008) respectively. In contrast, TAC level was significantly lower in patients as compared with controls (p&lt;0.05). There was no significant difference between the catalase results of the two groups (p&gt;0.05). Conclusion: Total oxidative status and OSI were increased and total antioxidative status capacity was decreased in patients with F. hepatica infeciton. A high oxidative stress occurs during F. hepatica infection, which may cause severe damage in both the liver.Keywords: Fasciola hepatica, total antioxidant capacity, total oxidative status, oxidative stress inde

Evaluation of oxidative status in patients with Fasciola hepatica infection

Background: F. hepatica infection is rare and mostly subclinical. Migration of juvenile forms of F. hepatica into the host’s liver is accompanied by an inflammatory reaction followed by fibrosis and cirrhosis. Objective: The aim of this study was to evaluate oxidative status by using a novel automated method in patients with Fasciola hepatica. Methods: Twenty two patients with a diagnosis of F. hepatica and 26 healthy volunteers were enrolled in the study. Their Total antioxidant capacity status (TAC), total oxidant status (TOS) and catalase were measured in them and oxidative stress index (OSI) was calculated. These measurements were also taken for the control group and the values were compared. Results: Plasma levels of total TOS and OSI were significantly increased in patients as compared with healthy controls (P<0.001, P<0.001, P=0.001, P=0.008) respectively. In contrast, TAC level was significantly lower in patients as compared with controls (p<0.05). There was no significant difference between the catalase results of the two groups (p>0.05). Conclusion: Total oxidative status and OSI were increased and total antioxidative status capacity was decreased in patients with F. hepatica infeciton. A high oxidative stress occurs during F. hepatica infection, which may cause severe damage in both the liver

Association of paraoxonase activity and atherosclerosis in patients with chronic hepatitis B

Background: The hepatitis B virus is a significant pathogen that causes cirrhosis, and hepatocellular cancer as a result of the damage it causes to liver cells. Its infection affects more than 400 million people globally. Although there is an effective vaccine and treatment methods, almost 1, 000, 000 people die every year. Objective: To investigate paraoxonase and arylesterase activities along with oxidative status parameters and serum lipid levels, and to find out if there is any increased susceptibility to atherogenesis. Methods: Thirty-four subjects with chronic hepatitis B and 39 healthy subjects as control were enrolled in the study. Age, body mass index and gender, Serum Triglycerides (TG), High-density Lipoprotein (HDL) and Low-Density lipoprotein (LDL) levels, serum paraoxonase-1 and arylesterase activities were determined. Oxidative and antioxidative statuses were evaluated by measuring serum-free sulfhydryl groups, lipid hydroperoxide levels, total antioxidant capacity, total oxidant status, and oxidative stress index. Results: Serum TG and LDL levels were higher while serum HDL levels were lower in patients with chronic hepatitis B than in controls but the differences did not reach statistical significance. Serum paraoxonase-1 and arylesterase activities, plasma free sulfhydryl groups, and total antioxidant capacity were significantly lower in patients than in controls (p=0.018, p=0.005, p<0.001, p=0.037 respectively), while lipid hydroperoxide, total oxidant status, and oxidative stress index were significantly higher (for all p<0.001). Conclusion: The diminution in the paraoxonase-1 and arylesterase activities could contribute to the accelerated development of atherosclerosis in patients with chronic hepatitis B

Clinical and prognostic features of patients with pandemic 2009 influenza A (H1N1) virus in the intensive care unit

Objective: To investigate the clinical and prognostic features of patients admitted to intensive care unit (ICU) with pandemic 2009 influenza A (H1N1) virus.Methods: Patients admitted to the intensive care unit for severe pneumonia associated with pandemic 2009 influenza A (H1N1) virus were evaluated.Results: The study included 20 patients with the mean age of 36±13. Of the 20 subjects, 17 (85%) had underlying conditions. Of the 20 patients, 11(55%) were discharged and 9 (45%) died. Cardinal symptoms were fever, myalgia, and hemoptysis with the rates of 85 %, 75 % and 45 %, respectively. All patients had pneumonic infiltrations in their chestroentgenograms. Main laboratory findings were lymphopenia, high creatin phosphokinase (CPK) and Lactate dehydrogenase (LDH) levels. All patients had positivity on real time reverse transcription–polymerase chain reaction (RT-PCR). None of the patients had pandemic 2009 influenza A (H1N1) virus vaccination. None of them had taken oseltamivir within 48hours. Main reasons for mortality were cardiovascular complications and ventilatory associated pneumonia due to Acynetobacter baumannii.Conclusion: Early diagnosis and antiviral treatment in these cases seem to be the best approach to avoid serious illness. Special attention should be given to patients having underlying conditions such as cardiovascular and pulmonary diseases and pregnancy

Clinical and prognostic features of patients with pandemic 2009 influenza A (H1N1) virus in the intensive care unit

Objective: To investigate the clinical and prognostic features of patients admitted to intensive care unit (ICU) with pandemic 2009 influenza A (H1N1) virus. Methods: Patients admitted to the intensive care unit for severe pneumonia associated with pandemic 2009 influenza A (H1N1) virus were evaluated. Results: The study included 20 patients with the mean age of 36±13. Of the 20 subjects, 17 (85%) had underlying conditions. Of the 20 patients, 11(55%) were discharged and 9 (45%) died. Cardinal symptoms were fever, myalgia, and hemoptysis with the rates of 85 %, 75 % and 45 %, respectively. All patients had pneumonic infiltrations in their chest roentgenograms. Main laboratory findings were lymphopenia, high creatin phosphokinase (CPK) and Lactate dehydrogenase (LDH) levels. All patients had positivity on real time reverse transcriptionpolymerase chain reaction (RT-PCR). None of the patients had pandemic 2009 influenza A (H1N1) virus vaccination. None of them had taken oseltamivir within 48 hours. Main reasons for mortality were cardiovascular complications and ventilatory associated pneumonia due to Acynetobacter baumannii. Conclusion: Early diagnosis and antiviral treatment in these cases seem to be the best approach to avoid serious illness. Special attention should be given to patients having underlying conditions such as cardiovascular and pulmonary diseases and pregnancy

Tuberculous and brucellosis meningitis differential diagnosis.

BACKGROUND: The Thwaites and Lancet scoring systems have been used in the rapid diagnosis of tuberculous meningitis (TBM). However, brucellar meningoencephalitis (BME) has similar characteristics with TBM. The ultimate aim of this study is to infer data to see if BME should be included in the differential diagnosis of TBM when these two systems suggest the presence of TBM. METHOD: BME and TBM patients from 35 tertiary hospitals were included in this study. Overall 294 adult patients with BME and 190 patients with TBM were enrolled. All patients involved in the study had microbiological confirmation for either TBM or BME. Finally, the Thwaites and Lancet scoring systems were assessed in both groups. RESULTS: The Thwaites scoring system more frequently predicted BME cases (n = 292, 99.3%) compared to the TBM group (n = 182, 95.8%) (P = 0.017). According to the Lancet scoring system, the mean scores for BME and TBM were 9.43 ± 1.71 and 11.45 ± 3.01, respectively (P < 0.001). In addition, TBM cases were classified into "probable" category more significantly compared to BME cases, and BME cases were categorized into the "possible" category more frequently. CONCLUSIONS: When the Thwaites or Lancet scoring systems indicate TBM, brucellar etiology should also be taken into consideration particularly in endemic countries