Comparison of respiratory tract pathogens and antibiotic susceptibility profiles of patients diagnosed with COVID-19 with pre-COVID-19

Objective: It is aimed to compare the respiratory tract agents and antibiotic resistance rates in patients with a diagnosis of COVID-19 with the non-COVID-19 period. Material and Method: Patients diagnosed with bacterial respiratory tract infection between March 2019 and March 2021 were included in the study. Bacteria identification and antibiotic susceptibility were evaluated according to automated system and EUCAST standards. Results: Between March 2019-March 2020 (before the pandemic), the most common bacterium was Pseudomonas aeruginosa (P. aeruginosa) 280 (15.5%) second Acinetobacter baumannii (A. baumannii) in a total of 1797 patients hospitalized in the service and intensive care units, and the resistance rates were the same. Between March 2020 and 2021, a total of 1357 COVID -19 patients were found in clinical and intensive care units, and the most common reproducing agent was A. baumannii 168 (12.3%), the second P. aeruginosa 164, and resistance rates were found to invrease. Conclusion: The increase in the resistance rates of bacteria causing respiratory tract infection was remarkable. It was determined that P. aeruginosa and A. baumannii, which were the most common isolates before the pandemic and showed high resistance rates against all antibiotic groups, were the most common bacteria during the pandemic period

Antibiotics resistance rates of gram negative esbl positive bacteria isolated from various clinical specimens

Amaç: Genişlemiş Spektrumlu Beta Laktamaz (GSBL) pozitif mikroorganizmaların neden olduğu enfeksiyonların tedavisindeki zorluklar günümüzde en önemli sağlık sorunlarından biridir. çeşitli bakteriyolojik kültürlerinden izole edilen Gram negatif GSBL pozitif bakterilerin örnek türüne göre ampirik ve semptomatik tedaviye etkili antibiyotiklerin belirlenmesi amaçlanmıştır. Gereç ve Yöntem: Bu çalışma 1 Ağustos 2019-1 Şubat 2020 tarihleri arasında çeşitli servis ve polikliniklerden rutin mikrobiyoloji laboratuvarına yollanan idrar, kan, yara, balgam, eklem sıvısı, plevral sıvı örneklerinden izole edilen bakteriyel etkenler ve antimikrobiyal duyarlılıkların retrospektif araştırılması ile yapılmıştır. Gram negatif GSBL pozitif bakterilerin tanımlanmaları ve antibiyotik duyarlılık testleri konvansiyonel yöntem ve MicroScan (Beckman Coultre, USA ) otomatize sistem ile yapılmıştır. Bulgular: Laboratuvara gönderilen 13,968 klinik örnekten izole edilen 1735 Gram negatif bakterinin 1041 (%60)’i GSBL pozitif idi. 1041 örneğin; 901 (%86,55)’i idrar, 47 (%4,51)’si Trakeal aspirat, 35 (%3,36)’i yara idi. GSBL pozitif bakterilerin en sık izole edilenleri 732(%70,3) ile Escherichia coli, 249(%23,9)’u Klebsiella pneumonia, 22(%2,11)’si Proteus mirabilis oluşturmaktaydı. Bu bakterilerin tamamı ampisilin, ampisilin-sulbaktam ve sefalosporin grubu antibiyotiklere dirençli iken bakterilerin en duyarlı olduğu grup ise karbapenem grubu antibiyotikler idi. Sonuç: Gram negatif bakterilerde, antibiyotiklere dirençli izole edilen suşların oranlarındaki artış, kullanılabilecek tedavi seçeneklerini oldukça kısıtlamaktadır. Özellikle çoklu antibiyotik dirençli, sıklıkla toplum ve hastane kökenli enfeksiyonlara neden olan Gram negatif GSBL pozitif bakterilerin antibiyotik direnç durumlarının belirlenmesi güncel direnç oranını ortaya çıkaracağı gibi tedavi başarısının artırılmasında yardımcı olacaktır. Her kurum kendi antibiyotik direncini saptayarak ülke verilerine katkı sunmalıdırAim: The difficulties in the treatment of infections caused by Extended Spectrum Beta-Lactamase (ESBL) positive microorganisms are one of the most important health problems today. In this study, it was aimed to determine the antibiotics effective in empirical and symptomatic treatment according to the sample type of Gram negative ESBL positive bacteria isolated from various bacteriological cultures. Materials and Methods: This study was carried out by retrospective investigation of bacterial agents and antimicrobial susceptibility various samples sent to routine microbiology laboratory from various services and outpatient clinics between 1 August 2019 and 1 February 2020. Identification of Gram-negative ESBL-positive bacteria and antibiotic susceptibility tests were performed using the conventional method and MicroScan (Beckman Coultre, USA) automated system. Results: Of the 1735 Gram-negative bacteria isolated from 13,968 clinical samples sent to the laboratory, 1041 (60%) were ESBL positive. 1041 for example; 901 (86.55%) were urine, 47 (4.51%) were aspirate, 35 (3.36%) were wounds. Escherichia coli with 732 (70.3%) of ESBL positive bacteria, Klebsiella pneumonia with 249 (23.9%) and Proteus mirabilis with 22 (2.11%) were the most frequently isolated bacteria. While all of these bacteria were resistant to ampicillin-sulbactam, cephalosporin group antibiotics, the group to which the bacteria were most susceptible was carbapenem group antibiotics. Conclusion: Determining the antibiotic resistance status of Gram-negative ESBL-positive bacteria, which are resistant to multiple antibiotics and frequently cause infections, will reveal the current resistance rate and will help increase the success of treatment. Each institution should contribute to country data by detecting its own antibiotic resistance

Combined metabolic activators improve metabolic functions in the animal models of neurodegenerative diseases

Background: Neurodegenerative diseases (NDDs), including Alzheimer's disease (AD) and Parkinson's disease (PD), are associated with metabolic abnormalities. Integrative analysis of human clinical data and animal studies have contributed to a better understanding of the molecular and cellular pathways involved in the progression of NDDs. Previously, we have reported that the combined metabolic activators (CMA), which include the precursors of nicotinamide adenine dinucleotide and glutathione can be utilized to alleviate metabolic disorders by activating mitochondrial metabolism. Methods: We first analysed the brain transcriptomics data from AD patients and controls using a brain-specific genome-scale metabolic model (GEM). Then, we investigated the effect of CMA administration in animal models of AD and PD. We evaluated pathological and immunohistochemical findings of brain and liver tissues. Moreover, PD rats were tested for locomotor activity and apomorphine-induced rotation. Findings: Analysis of transcriptomics data with GEM revealed that mitochondrial dysfunction is involved in the underlying molecular pathways of AD. In animal models of AD and PD, we showed significant damage in the high-fat diet groups' brain and liver tissues compared to the chow diet. The histological analyses revealed that hyperemia, degeneration and necrosis in neurons were improved by CMA administration in both AD and PD animal models. These findings were supported by immunohistochemical evidence of decreased immunoreactivity in neurons. In parallel to the improvement in the brain, we also observed dramatic metabolic improvement in the liver tissue. CMA administration also showed a beneficial effect on behavioural functions in PD rats. Interpretation: Overall, we showed that CMA administration significantly improved behavioural scores in parallel with the neurohistological outcomes in the AD and PD animal models and is a promising treatment for improving the metabolic parameters and brain functions in NDDs.PoLiMeR Innovative Training Network ; SNIC ; ScandiBio Therapeutics ; ScandiBio Therapeutics and Knut ; Knut och Alice Wallenbergs Stiftels

Combined metabolic activators improve cognitive functions in Alzheimer's disease patients: A randomised, double-blinded, placebo-controlled phase-II trial

Background: Alzheimer’s disease (AD) is associated with metabolic abnormalities linked to critical elements of neurodegeneration. We recently administered combined metabolic activators (CMA) to the AD rat model and observed that CMA improves the AD-associated histological parameters in the animals. CMA promotes mitochondrial fatty acid uptake from the cytosol, facilitates fatty acid oxidation in the mitochondria, and alleviates oxidative stress. Methods: Here, we designed a randomised, double-blinded, placebo-controlled phase-II clinical trial and studied the effect of CMA administration on the global metabolism of AD patients. One-dose CMA included 12.35 g L-serine (61.75%), 1 g nicotinamide riboside (5%), 2.55 g N-acetyl-L-cysteine (12.75%), and 3.73 g L-carnitine tartrate (18.65%). AD patients received one dose of CMA or placebo daily during the first 28 days and twice daily between day 28 and day 84. The primary endpoint was the difference in the cognitive function and daily living activity scores between the placebo and the treatment arms. The secondary aim of this study was to evaluate the safety and tolerability of CMA. A comprehensive plasma metabolome and proteome analysis was also performed to evaluate the efficacy of the CMA in AD patients. Results: We showed a significant decrease of AD Assessment Scale-cognitive subscale (ADAS-Cog) score on day 84 vs day 0 (P = 0.00001, 29% improvement) in the CMA group. Moreover, there was a significant decline (P = 0.0073) in ADAS-Cog scores (improvement of cognitive functions) in the CMA compared to the placebo group in patients with higher ADAS-Cog scores. Improved cognitive functions in AD patients were supported by the relevant alterations in the hippocampal volumes and cortical thickness based on imaging analysis. Moreover, the plasma levels of proteins and metabolites associated with NAD + and glutathione metabolism were significantly improved after CMA treatment. Conclusion: Our results indicate that treatment of AD patients with CMA can lead to enhanced cognitive functions and improved clinical parameters associated with phenomics, metabolomics, proteomics and imaging analysis. Trial registration ClinicalTrials.gov NCT04044131 Registered 17 July 2019, https://clinicaltrials.gov/ct2/show/NCT04044131

Validity and reliability of the assessment tool for Asthma (ATA) questionnaire: the ATA study

OBJECTIVES: A multicenter trial was designed to validate the “Assessment Tools for Asthma (ATA)” questionnaire, a newly developed questionnaire, which evaluates both asthma control and risk factors associated with asthma control with a single instrument. MATERIALS AND METHODS: This cross-sectional study involved 810 cases from 14 clinics in 9 Turkish cities. The ATA questionnaire and Asthma Control Test (ACT) were administered. The Visual Analog Scale (VAS) was used to evaluate the control status of 100 randomized cases. ATA is an eight-item physician-administered questionnaire. It comprises the following two sections-ATA1, assesses symptomatic control criteria, and the remaining section, queries the flre-up of asthma, control of comorbidities, treatment adherence, and inhaler technique. RESULTS: The mean scores for ATA1, ATA total, VAS, and ACT were 24.7±14.8, 53.8±19, 7.1±3, and 18.8±5.5, respectively. According to the ATA questionnaire, among all patients, 34.3% had controlled, 18.8% had partly controlled, and 46.9% had uncontrolled asthma. Furthermore, 16.6% patients had flre-ups between visits, 96.4% patients had uncontrolled comorbidity, 17% patients had irregular asthma treatment, and only 8.4% patients used the incorrect inhaler technique. The ATA questionnaire showed internal consistency (Cronbach’s alpha coeffiient=0.683). ACT, ATA1, and two specialists’ evaluations using VAS correlated strongly with the ATA total scores (Spearman correlation coeffiient (r) values: 0.776, 0.783, and 0.909, respectively; p-values: p<0.001, p<0.001, and p<0.001, respectively). According to Receiver Operating Characteristic analysis, the cut-off value of ATA was 50 (sensitivity=84.4%, specifiity=82.40%). CONCLUSION: The validated ATA questionnaire may be a practical tool for physicians in asthma management

Inappropriate antimicrobial use in Turkish pediatric hospitals: A multicenter point prevalence survey

Objectives: Although well-defined principles of rational antimicrobial use are available, inappropriate prescribing patterns are reported worldwide. Accurate information on the usage of antimicrobials, including factors associated with and influencing their use, is valuable for improving the quality of prescription practices. Methods: In this cross-sectional point prevalence survey, data on patients hospitalized in 12 different children's hospitals were collected on a single day. Appropriateness of prescription was compared between the types of antimicrobials prescribed, indications, wards, and presence of/consultation with an infectious disease physician (IDP). Results: A total 711 of 1302 (54.6%) patients evaluated were receiving one or more antimicrobial drugs. The antimicrobial prescription rate was highest in pediatric intensive care (75.7%) and lowest in the surgery wards (37.0%). Of the 711 patients receiving antimicrobials, 332 patients (46.7%) were found to be receiving at least one inappropriately prescribed drug. Inappropriate use was most frequent in surgery wards (80.2%), while it was less common in oncology wards (31.8%; p < 0.001). Respiratory tract infection was the most common indication for antimicrobial use (29.4%). Inappropriate use was more common in deep-seated infections (54.7%) and respiratory infections (56.5%). Fluoroquinolones were used inappropriately more than any other drugs (81.8%, p = 0.021). Consultation with an IDP appears to increase appropriate antimicrobial use (p = 0.008). Conclusions: Inappropriate antimicrobial use remains a common problem in Turkish pediatric hospitals. Consultation with an IDP and prescribing antimicrobial drugs according to microbiological test results could decrease the inappropriate use of antimicrobials

Comparasion of remifentanil, fentanil, esmolol, lidokain and amiodaron in prevention of hemodynamic response in laryngotracheal intubation

VII- ÖZET Çalışmamızda genel cerrahi kliniğin de elektif girişim planlanan, 18- 60 yaş fentanil 1 μg/ kg olarak, arası, 90 hasta rastgele 6 gruba ayrılarak plasebo ve remifentanil 0.5 μg / kg , esmolol 0.5 μg / kg, amiodaron 0.5 mg / kg ise lidokain % 2 lik solüsyonundan 1 mg / kg olarak uygulanarak laringotrakeal entübasyona bağlı sempatoadrenerjik yanıt sonucu oluşan hemodinamik yanıtı önlemesin de ki; etkinliğine bakılmıştır. Vakaların bazal, indüksiyondan 1 dakika sonra, üçüncü dakika, entübasyondan sonra bir, üç, beş, onuncu dakikalardaki noninvazif tansiyon arteriyel, kalp hızı, oksijen saturasyonu ve maskeyle ventilasyondan itibaren ve entübasyondan sonra inspirasyon ve ekspirasyon havasında oksijen , desflurane ve endtidal karbondioksit değerleri kaydedildi. Gruplar arası karşılaştırmalarda: endotrakeal entübasyon sonrası meydana gelen hipertansiyonu önleme de, fentanil, remifentanil, esmolol daha etkin bulunmuştur. Kalp hızın da ki; artışı önlemek için de fentanil,remifentanil, esmolol, amiodaron ve lidokain etkili bulunmuştur.VIII- SUMMARY In our study , we grouped 90 patients aged between 18-60 in to six groups randomly , planned to be elective surgery in our General Surgery Clinic. In this six groups we applied fentanyl 1µg/kg , remifentanyl 0.5 µg/kg , esmolol 0.5 µg/kg , amiodarone 0.5 mg/kg, lidocaine with %2 solution 1 mg/kg and placebo than compared efficiency in the prevention of the hemodynamic response to sympathoadrenergic activation after laryngotracheal intubation. We measured and recorded the non-invasive arterial tension ,heart rate ,oxygen saturation at 1st and 3rd minute after basal induction, at 1st ,3rd , 5th ,10th minute after intubation, from ventilation and after intubation we measured oxygen, lidocaine, desflurane and endtidal carbon dioxide level in inspiration and expiration air with mask. Comparision between the groups , prevention of the hypertension after laryngotracheal intubation fentanyl, remifentanyl , esmolol found to be more effective. Prevention of heart rate increase fentanyl, remifentanyl, esmolol, amiodarone and lidocaine found to be more effective