Ultrasonic treatment of biologically treated baker’s yeast effluent

The aim of this study was to examine the removal of color and chemical oxygen demand COD of biologically treated baker’s yeast effluent with ultrasonic irradiation. An ultrasonic homogenizator with 20 kHz frequency was used for this purpose. TiO2/ZnO composite was used as a sonocatalyst. The effect of the amount of catalyst on color and COD removal was investigated. According to results, by using ultrasound and TiO2/ZnO composite, decolorization increases until the optimum of the catalyst amount. The highest decolorization was obtained at 0.15 g/L of catalyst concentration. COD removal was 17% with ultrasonic irradiation and increased to 33% when using ultrasound along with the catalyst at the optimum amount. The effect of the solution pH on ultrasonic decolorization was also investigated in this stud

Cognitive And Behavioral Impairment In Mild Hyperphenylalaninemia

As elevated phenylalanine (Phe) is detrimental to brain functions, determining a safe upper limit of blood Phe is important for initiation of treatment plans and setting Phe targets in hyperphenlalaninemic patients. It is accepted that Phe levels below 360 mu mol/L does not impair brain function and hence does not require treatment. Therefore, we aimed to compare cognitive functions and attention-related problems among healthy children and untreated patients with hyperphenylalaninemia (HPA). This study included 41 hyperphenylalaninemic patients ("all HPA group") aged 6-16 years with untreated blood Phe between 240 and 600 mu mol/L and 29 healthy controls. "All HPA group" was further divided into 2 subgroups according to their lifetime median blood Phe levels as "Phe 360-600 mu mol/L" and "Phe 240-360 mu mol/L" groups. Wechsler Intelligence Scale for Children-IV (WISC-IV), Conners' Continuous Performance Test (CPT), Strength and Difficulties Questionnaire (SDQ) and Schedule for Affective Disorders and Schizophrenia for School-Age Children: Present and Lifetime Version (K-SADS-PL) were performed as a comprehensive neurocognitive, attention and behavioral assessment. The study illustrated that "all HPA" patients had significantly lower scores on all WISC-IV indexes compared to controls, except for Working Memory. Both "Phe 360-600 mu mol/L" and "Phe 240-360 mu mol/L" subgroups had lower Full Scale intelligence quotient (IQ) and Verbal Comprehension scores compared to controls. "All HPA" patients also had longer reaction times and more peer problems than controls, indicating attention deficits and behavioral problems. Since the results demonstrated that children with untreated Phe levels between 240-360 mu mol/L are at higher risk for cognitive and attention-related problems, lowering the "safe" upper Phe level should be considered.WoSScopu

Hepatosplenic Fungal Infections in Children With Leukemia-Risk Factors and Outcome: A Multicentric Study

###EgeUn###Background: Invasive fungal infections, including hepatosplenic fungal infections (HSFI), cause significant morbidity and mortality in children with leukemia. There are not enough data to support for the best approach to diagnosis of HSFI in children, nor for the best treatment. Procedure: In this multicentric study, we assessed the demographic data, clinical and radiologic features, treatment, and outcome of 40 children with leukemia and HSFI from 12 centers. Results: All cases were radiologically diagnosed with abdominal ultrasound, which was performed at a median of 7 days, of the febrile neutropenic episode. Mucor was identified by histopathology in 1, and Candida was identified in blood cultures in 8 patients. Twenty-two had fungal infection in additional sites, mostly lungs. Nine patients died. Four received a single agent, and 36 a combination of antifungals. Conclusions: Early diagnosis of HSFI is challenging because signs and symptoms are usually nonspecific. In neutropenic children, persistent fever, back pain extending to the shoulder, widespread muscle pain, and increased serum galactomannan levels should alert clinicians. Abdominal imaging, particularly an abdominal ultrasound, which is easy to perform and available even in most resource-limited countries, should be recommended in children with prolonged neutropenic fever, even in the absence of localizing signs and symptoms

Consensus Report on Diagnosis, Treatment and Prevention of Infective Endocarditis by Turkish Society of Cardiovascular Surgery (TSCVS), Turkish Society of Clinical Microbiology and Infectious Diseases (KLIMIK), Turkish Society of Cardiology (TSC), Turkish Society of Nuclear Medicine (TSNM), Turkish Society of Radiology (TSR), Turkish Dental Association (TDA) and Federation of Turkish Pathology Societies (TURKPATH) Cardiovascular System Study Group

Infective endocarditis (IE) is rare, but associated with significant morbidity and mortality rates. Estimates of the incidence of IE in Turkey are compromised by the absence of population-based prospective studies. Due to the frequent presence of predisposing cardiac conditions and higher rates of nosocomial bacteremia in high-risk groups, the incidence of IE is expected to be higher in Turkey. Additionally, while IE generally affects older people in developed countries, it still affects young people in Turkey. In order to reduce the mortality and morbidity, it is critical to diagnose the IE to determine the causative agent and to start treatment rapidly. However, most of the patients cannot be diagnosed in their first visits, about half of them can be diagnosed after three months, and the disease often goes unnoticed. In patients diagnosed with IE, the rate of identification of causative organisms is significantly lower in Turkey than in developed countries. Furthermore, most of the centers do not perform some essential microbiological diagnostic tests as a routine practice. Some antimicrobials that are recommended as the first-line of treatment for IE, particularly antistaphylococcal penicillins, are not available in Turkey. These problems necessitate reviewing the epidemiological, laboratory, and clinical characteristics of IE in our country, as well as the current information about its diagnosis, treatment, and prevention together with local data. Physicians can follow patients with IE in many specialties. Diagnosis and treatment processes of IE should be standardized at every stage so that management of IE, a setting in which many physicians are involved, can always be in line with current recommendations. Study Group for Infective Endocarditis and Other Cardiovascular Infections of the Turkish Society of Clinical Microbiology and Infectious Diseases has called for collaboration of the relevant specialist organizations to establish a consensus report on the diagnosis, treatment, and prevention of IE in the light of current information and local data in Turkey

Diagnosis, Treatment And Prevention Of Infective Endocarditis: Turkish Consensus Report

Although infective endocarditis (IE) is rare, it is still important as an infectious disease because of the resulting morbidity and substantial mortality rates. Epidemiological studies in developed countries have shown that the incidence of IE has been approximately 6/100 000 in recent years and it is on the fourth rank among the most life-threatening infectious diseases after sepsis, pneumonia and intraabdominal infections. Although IE is not a reportable disease in Turkey, and an incidence study was not performed, its incidence may be expected to be higher due to both more frequent presence of predisposing cardiac conditions and higher rates of nosocomial bacteremia which may lead to IE in risk groups. Additionally, while IE generally affects elderly people in developed countries it still affects young people in Turkey. In order to reduce the mortality and morbidity, it is critical to diagnose the 1E, to determine the causative agent and to start treatment rapidly. However, most of the patients cannot be diagnosed in their first visits, about half of them can be diagnosed after 3 months, and the disease often goes unnoticed. In patients diagnosed as IE, the rate of identification of causative organisms is more than 90% in developed countries, while it is around 60% in Turkey. Furthermore, some important microbiological diagnostic tests are not performed in most of the centers. Some antimicrobials that are recommended as the first option for treatment of IE, particularly antistaphylococcal penicillins, are unavailable in Turkey. These problems necessitate to review the epidemiological, laboratory and clinical characteristics of IE in the country, as well as the current information about its diagnosis, treatment and prevention together with local data. Patients with IE can be followed by physicians in many specialties. Diagnosis and treatment processes of IE should be standardized at every stage so that management of IE, a setting in which many physicians are involved, can always be in line with current recommendations. From this point of view, Study Group for Infective Endocarditis and Other Cardiovascular Infections of the Turkish Society of Clinical Microbiology and Infectious Diseases has called for collaboration of the relevant specialist organizations to establish a consensus report on the diagnosis, treatment and prevention of IE in the light of current information and local data in Turkey. In the periodical meetings of the assigned representatives from all the parties, various questions were identified. Upon reviewing related literature and international guidelines, these questions were provided with consensus answers. Several of the answers provided in the report are listed below: [1] IE is more frequent in patients with a previous episode of IE, a valvular heart disease, a congenital heart disease, any intracardiac prosthetic material, an intravenous drug addiction, chronic hemodialysis treatment, solid organ and hematopoietic stem cell transplantation as compared with normal population. [2] The most frequent causative organisms are Staphylococcus aureus, streptococci, coagulase-negative staphylococci, and enterococci, respectively, both in Turkey and globally. Brucella spp. is the fifth common causative agent of IE in Turkey. [3] The echocardiography is the imaging modality of choice to define cardiac lesions in patients with suspected IE. Both transthoracic and transesophageal echocardiography are generally necessary in almost all patients. Both are inconclusive approximately in 15% of total IE cases whereas the percentage is up to 30% in patients with intracardiac prosthetic devices. In these instances, multi-slice (MS) computed tomography (CT) should be the imaging modality in patients with native valve IE, whereas MS-CT or radiolabelled leukocyte scintigraphy with single-photon emission tomography/CT should be choosen for patients who have prosthetic valve IE within the first 3 months of surgery, and MS-CT or positron-emission tomography/CT should be chosen for patients with prosthetic valve IE after 3 months of surgery. [4] Blood cultures should be taken without any delay to catch-up the febrile period as 3 sets with 30-minute intervals (3 aerobic and 3 anaerobic bottles, totally 6 bottles) in patients with suspected IE. Each set, comprised of 1 aerobic and 1 anaerobic bottle, should be inoculated with 18-20 ml of blood (9 -10 ml blood per bottle). Totally 60 ml of blood should be taken from one patient with suspected IE. Two sets of control blood cultures should be repeated in every 48 hours after initiation of therapy in order to show blood sterility. If causative organism do not grow in the usual blood culture bottles, additional three mycobacterial blood culture bottles should be inoculated in patients with suspected prosthetic valve IE and who had a cardiac surgery in the last decade. [5] The excised valvular tissue from patients with suspected IE should be evaluated both microbiologically and histopathologically.[6] First of all, Wright agglutination test (if negative, by adding Coombs' serum) and indirect fluorescent antibody (IFA) test to investigate Coxiella burnetii phase I IgG antibodies should be done in culture-negative patients. If these two tests are negative, IgG antibodies for Bartonella spp., Legionella spp., Chlamydia spp., and Mycoplasma spp. should be tested respectively and preferably by IFA test. [7] Multiplex polymerase chain reaction (PCR) tests should be used to identify the pathogen in whole blood in a culturenegative patient who has received previous antibiotic therapy. If the blood cultures are negative in a patient who has not received previous antibiotic therapy, PCR tests for 16S rRNA gene analysis and Tropheryma whipplei should be performed on the resected valve obtained during surgery. [8] Histopathological examination of resected valvular tissue in patients with suspected IE give valuable information about the activation and degree of the inflammation. Moreover, histopathological examination with appropriate routine and immunohistochemical staining, aid to identify especially intracellular pathogens like C. burnetii, Bartonella spp. and T. whipplei in blood culture-negative patients. [9] Bactericidal agents given parenterally for long duration is the general principle of antimicrobial treatment of IE. The pathogenic organism, presence of prosthetic material and duration of symptoms specifies the duration of treatment. The therapy duration is generally 4-6 weeks for native valve IE and >6 weeks for prosthetic valve IE. [10] As the efficacy and feasibility of oral antimicrobial choices of left-sided IE are not well defined in Turkey and it is related with substantial mortality, parenteral route should be preferred for the complete duration of antimicrobial treatment of left-sided IE in Turkey. In case of unavailability of intravenous access or outpatient parenteral antibiotic therapy, oral agents may be feasible to complete the therapy duration in stable patients with uncomplicated native valve IE due to drug-susceptible viridans streptococci, provided that initial two weeks should be completed parenterally, and the patient should give an informed consent after notifying all possible risks, and regular post-discharge follow-up should be possible. The decision for oral maintenance therapy has to be given by the IE team. [11] The appropriate antimicrobials should be initiated without any delay as it reduces not only the risk of an embolic event in patients with either acute or subacute IE, but also decreases the mortality associated with sepsis in acute IE. Therefore, the empirical antimicrobials should be promptly initiated after blood cultures are taken. [12] Ampicillin-sulbactam +/- gentamicin can be initiated empirically in the treatment of community-acquired, both acute and subacute types of native and late prosthetic valve IE in adults whereas either vancomycin + ampicillin-sulbactam or ceftriaxone +/- gentamicin can be the choice for acute types. Vancomycin + cefepime +/- gentamicin combination can be initiated empirically in the treatment of nosocomial native, early and late prosthetic valve IE in adults. Gentamicin should be avoided initially in patients with impaired renal function. Rifampin can be added to initial empirical treatment of early prosthetic valve IE. Daptomycin alone is not a drug of choice for initial empirical treatment of IE because of its suboptimal efficacy for streptococci and enterococci in which resistance can easily develop during therapy.WoSScopu

Diagnosis, Treatment and Prevention of Infective Endocarditis: Turkish Consensus Report

Although infective endocarditis (IE) is rare, it is still important as an infectious disease because of the resulting morbidity and substantial mortality rates. Epidemiological studies in developed countries have shown that the incidence of IE has been approximately 6/100 000 in recent years and it is on the fourth rank among the most life-threatening infectious diseases after sepsis, pneumonia and intraabdominal infections. Although IE is not a reportable disease in Turkey, and an incidence study was not performed, its incidence may be expected to be higher due to both more frequent presence of predisposing cardiac conditions and higher rates of nosocomial bacteremia which may lead to IE in risk groups. Additionally, while IE generally affects elderly people in developed countries it still affects young people in Turkey. In order to reduce the mortality and morbidity, it is critical to diagnose the 1E, to determine the causative agent and to start treatment rapidly. However, most of the patients cannot be diagnosed in their first visits, about half of them can be diagnosed after 3 months, and the disease often goes unnoticed. In patients diagnosed as IE, the rate of identification of causative organisms is more than 90% in developed countries, while it is around 60% in Turkey. Furthermore, some important microbiological diagnostic tests are not performed in most of the centers. Some antimicrobials that are recommended as the first option for treatment of IE, particularly antistaphylococcal penicillins, are unavailable in Turkey. These problems necessitate to review the epidemiological, laboratory and clinical characteristics of IE in the country, as well as the current information about its diagnosis, treatment and prevention together with local data. Patients with IE can be followed by physicians in many specialties. Diagnosis and treatment processes of IE should be standardized at every stage so that management of IE, a setting in which many physicians are involved, can always be in line with current recommendations. From this point of view, Study Group for Infective Endocarditis and Other Cardiovascular Infections of the Turkish Society of Clinical Microbiology and Infectious Diseases has called for collaboration of the relevant specialist organizations to establish a consensus report on the diagnosis, treatment and prevention of IE in the light of current information and local data in Turkey. In the periodical meetings of the assigned representatives from all the parties, various questions were identified. Upon reviewing related literature and international guidelines, these questions were provided with consensus answers. Several of the answers provided in the report are listed below: [1] IE is more frequent in patients with a previous episode of IE, a valvular heart disease, a congenital heart disease, any intracardiac prosthetic material, an intravenous drug addiction, chronic hemodialysis treatment, solid organ and hematopoietic stem cell transplantation as compared with normal population. [2] The most frequent causative organisms are Staphylococcus aureus, streptococci, coagulase-negative staphylococci, and enterococci, respectively, both in Turkey and globally. Brucella spp. is the fifth common causative agent of IE in Turkey. [3] The echocardiography is the imaging modality of choice to define cardiac lesions in patients with suspected IE. Both transthoracic and transesophageal echocardiography are generally necessary in almost all patients

Clinical characteristics and outcomes of nosocomial COVID-19 in Turkey: A retrospective multicenter study

Objective: To identify the clinical characteristics and outcomes of hospital-acquired SARS-CoV-2 infection during the vaccination period nationwide in Turkey. Methods: COVID-19 patients followed in the pandemic services across Turkey between January 1, 2021, and March 31, 2022 were investigated retrospectively. Nosocomial COVID-19 was defined as a patient neither diagnosed with COVID-19 nor suspected COVID-19 at the hospital admission and was confirmed COVID-19 ≥5 days after hospital admission. The primary outcome of this study was in-hospital mortality; demographic features and vaccination status was compared between survivors and non-survivors. Results: During the study period, 15 573 COVID-19 patients were followed in 18 centers and 543 (3.5%) patients were nosocomial COVID-19. Most patients with nosocomial COVID-19 (80.4%) were transferred from medical wards. 162 (29.8%) of the patients with nosocomial COVID-19 admitted to the intensive care unit due to disease severity and 138 (25.4%) of the patients died during hospital stay. Advanced age (≥65 years) and number of comorbid diseases (≥2) was found to be associated with mortality in nosocomial COVID-19 (OR 1.74, 95% Cl 1.11-2.74 and OR 1.60, 95% Cl 1.02-2.56, respectively). Vaccination was associated with survival in nosocomial COVID-19 (OR 0.25, 95% Cl 0.16-0.38). Conclusions: Patients with nosocomial COVID-19 had increased admission to intensive care units and higher mortality rate. Vaccination can decrease the in-hospital mortality rate