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

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

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

Liver involvement in patients with brucellosis: results of the Marmara study

WOS: 000336986700024PubMed ID: 24557334Brucellosis is a zoonotic disease that primarily affects the reticuloendothelial system. But, the extent of liver damage in due course of the disease is unclear. This study included 325 brucellosis patients with significant hepatobiliary involvement identified with microbiological analyses from 30 centers between 2000 and 2013. The patients with a parts per thousand yen5 times of the upper limit of normal for aminotransferases, total bilirubin level a parts per thousand yen2 mg/dl or local liver lesions were enrolled. Clinical hepatitis was detected in 284 patients (87.3 %) and cholestasis was detected in 215 (66.1 %) patients. Fatigue (91 %), fever (86 %), sweating (83 %), arthralgia (79 %), and lack of appetite (79 %) were the major symptoms. Laboratory tests showed anemia in 169 (52 %), thrombocytopenia in 117 (36 %), leukopenia in 81 (25 %), pancytopenia in 42 (13 %), and leukocytosis in 20 (6 %) patients. The most commonly used antibiotic combinations were doxycycline plus an aminoglycoside (n = 73), doxycycline plus rifampicin (n = 71), doxycycline plus rifampicin and an aminoglycoside (n = 27). The duration of ALT normalization differed significantly in three treatment groups (p 0.05). During the follow-up, treatment failure occurred in four patients (1 %) and relapse was seen in three patients (0.9 %). Mortality was not observed. Hepatobiliary involvement in brucellosis has a benign course with suitable antibiotics and the use of doxycycline and an aminoglycoside regimen seems a better strategy in select patients