Coagulopathy Induced by Cefoperazone/Sulbactam in a Geriatric Patient

Cefoperazone, which is a third generation cephalosporin, has a broad spectrum activity. In clinical studies, only a few adverse effects of this agent have been reported, and these effects are similar to those seen with other cephalosporins. An 86 year-old man was admitted to emergency department with complaints of high fever, cough and weakness. On his physical examination; the patient was alert and had a limited orientation, as well as a reduced general condition. After our investigations, the coagulation disorder was bonded with C/S treatment and we stopped administration of Cefoperazone/Sulbactam(C/S). The bleeding was controlled with intravenous vitamin K and fresh frozen plasma and coagulation tests were recovered to normal values. His antibiotherapy was changed with meropenem. Unfortunately, the patient died due to the progression of respiratory and renal failure. In conclusion, the clinician should keep in mind this complication while administrating this agent. Therefore, close follow-up of coagulation parameters is crucial. [Med-Science 2015; 4(4.000): 2978-81

FIRST REPORT OF THREE CULTURE CONFIRMED HUMAN LYME CASES IN TURKEY

Lyme disease which is caused by the spirochete Borrelia burgdorferi, is a multisysternic disease that involves skin, joints, cardiovascular and central nervous system, leading to chronic inflammatory response and late complications. First lyme cases have been reported after 1 990's in Turkey and the spirochete was isolated from the tick vectors. In this case series three human Lyme cases confirmed with not only serological tests but also growth in Barbour-Stoenner-Kelly medium were presented for the first time in Turkey. Two of these three cases were residents in Istanbul while the third one has acquired the infection in USA (imported case). First case was a previously healthy 46 years old male, admitted to the state hospital with the complaints of diarrheae, chills, nausea, vomiting, cough, sputum production and widespread myalgias. The patient was a chronic alcohol consumer with a history of frequent visits to the forest areas. The laboratory test results revealed hepatonephritis-like clinical picture and pulmonary involvement. Leptospiro IgM and Borrelio IgM antibodies were detected in the serum by ELISA and both of the agents were isolated in the blood cultures of the patient. This case was then diagnosed as Lyme disease with leptospirosis co-infection. The second case was a 32 years old female who suffered from Bell's palsy for the last 15 days. Cranial magnetic resonance imaging showed a nodular lesion at globus pallidus. Since the patient had a history of tick-bite, further testing was done for Lyme disease. Borrelio IgM and IgG antibodies were found negative, however, Borrelio was isolated from the cerebrospinal fluid sample. The third patient was a 68 years old female who had recently travelled to USA and exposed to a tick-bite in a recreational area. She suffered from nausea, vomiting, myalgia and cutaneous lesions compatible with erythema chronicum migrans. Samples taken from the skin lesions revealed growth of Borrelio. As far as the current literature is concerned, these were the first three culture proven cases of Borrelio in Turkey. These three cases supported the presence of Lyme disease in Turkey and indicated that the disease could present itself in various clinical pictures

Identification and quantification of some phytohormones in seaweeds using UPLC-MS/MS

The aim of this work was to identify main plant growth regulators (PGRs), such as, indole-3-acetic acid (IAA), abscisic acid (ABA), gibberellic acid (GA), zeatin, kinetin and 6-benzyl amino purine (BAP) and to determine corresponding quantity in nine seaweed varieties. The samples were extracted by methanol-water (75%) solvent from lyophilized seaweeds for 16 h at -20 degrees C. A rapid and sensitive UPLC-MS/MS method was developed and validated. Both individual and mixed standards were used to study the peak separation and identification of hormones. The precision of the method was tested with good RSD values of 0.67-2.01 for intra-day and 1.21-3.50 for inter-day in six and four replicates, respectively. Accuracy was in the range of 82.75-98.94% by spiking phytohormone standards to eliminate plant matrix. Excellent linearities were found within the ranges of 0.5-50 ng mL(-1) for zeatin and 0.5-10 ng mL(-1) for BAP, 5-500 ng mL(-1) for GA and kinetin, and 2.5-500 ng mL(-1) for IAA and ABA. The results showed that the applied SPE-UPLC-MS/MS method was very sensitive and can be used extensively for the routine analysis of trace amounts of multi-class phytohormones in seaweeds. The method developed greatly reduced both sample preparation and total analysis time

Increasing incidence of Gram-negative organisms in bacterial agents isolated from diabetic foot ulcers

Introduction: In the present study, we sought to identify the bacterial organisms associated with diabetic foot infections (DFIs) and their antibiotic sensitivity profiles

Development and validation of a modified quick SOFA scale for risk assessment in sepsis syndrome

Sepsis is a severe clinical syndrome owing to its high mortality. Quick Sequential Organ Failure Assessment (qSOFA) score has been proposed for the prediction of fatal outcomes in sepsis syndrome in emergency departments. Due to the low predictive performance of the qSOFA score, we propose a modification to the score by adding age. We conducted a multicenter, retrospective cohort study among regional referral centers from various regions of the country. Participants recruited data of patients admitted to emergency departments and obtained a diagnosis of sepsis syndrome. Crude in-hospital mortality was the primary endpoint. A generalized mixed-effects model with random intercepts produced estimates for adverse outcomes. Model-based recursive partitioning demonstrated the effects and thresholds of significant covariates. Scores were internally validated. The H measure compared performances of scores. A total of 580 patients from 22 centers were included for further analysis. Stages of sepsis, age, time to antibiotics, and administration of carbapenem for empirical treatment were entered the final model. Among these, severe sepsis (OR, 4.40; CIs, 2.35-8.21), septic shock (OR, 8.78; CIs, 4.37-17.66), age (OR, 1.03; CIs, 1.02-1.05) and time to antibiotics (OR, 1.05; CIs, 1.01-1.10) were significantly associated with fatal outcomes. A decision tree demonstrated the thresholds for age. We modified the quick Sequential Organ Failure Assessment (mod-qSOFA) score by adding age (> 50 years old = one point) and compared this to the conventional score. H-measures for qSOFA and mod-qSOFA were found to be 0.11 and 0.14, respectively, whereas AUCs of both scores were 0.64. We propose the use of the modified qSOFA score for early risk assessment among sepsis patients for improved triage and management of this fatal syndrome

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