Systemic and local antibiotic prophylaxis in the prevention of Staphylococcus epidermidis graft infection

BACKGROUND: The aim of the study was to investigate the in vivo efficacy of local and systemic antibiotic prophylaxis in the prevention of Staphylococcus (S.) epidermidis graft infection in a rat model and to evaluate the bacterial adherence to frequently used prosthetic graft materials. METHODS: Graft infections were established in the subcutaneous tissue of 120 male Wistar rats by implantation of Dacron/ePTFE grafts followed by topical inoculation with 2 × 10(7 )CFUs of clinical isolate of methicillin-resistant S. epidermidis. Each of the graft series included a control group, one contaminated group that did not receive any antibiotic prophylaxis, two contaminated groups that received systemic prophylaxis with teicoplanin or levofloxacin and two contaminated groups that received teicoplanin-soaked or levofloxacin-soaked grafts. The grafts were removed 7 days after implantation and evaluated by quantitative culture. RESULTS: There was significant bacterial growth inhibition in the groups given systemic or local prophylaxis (P < 0.05). Methicillin-resistant S. epidermidis had greater affinity to Dacron graft when compared with ePTFE graft in the untreated contaminated groups (P < 0.05). CONCLUSION: The study demonstrated that the usage of systemic or local prophylaxis and preference of ePTFE graft can be useful in reducing the risk of vascular graft infections caused by staphylococcal strains with high levels of resistance

Epigenetic perturbations in the pathogenesis of mustard toxicity; hypothesis and preliminary results

Among the most readily available chemical warfare agents, sulfur mustard (SM), also known as mustard gas, has been the most widely used chemical weapon. SM causes debilitating effects that can leave an exposed individual incapacitated for days to months; therefore delayed SM toxicity is of much greater importance than its ability to cause lethality. Although not fully understood, acute toxicity of SM is related to reactive oxygen and nitrogen species, oxidative stress, DNA damage, poly(ADP-ribose) polymerase (PARP) activation and energy depletion within the affected cell. Therefore several antioxidants and PARP inhibitors show beneficial effects against acute SM toxicity. The delayed toxicity of SM however, currently has no clear mechanistic explanation. One third of the 100,000 Iranian casualties are still suffering from the detrimental effects of SM in spite of the extensive treatment. We, therefore, made an attempt whether epigenetic aberrations may contribute to pathogenesis of mustard poisoning. Preliminary evidence reveals that mechlorethamine (a nitrogen mustard derivative) exposure may not only cause oxidative stress, DNA damage, but epigenetic perturbations as well. Epigenetic refers to the study of changes that influence the phenotype without causing alteration of the genotype. It involves changes in the properties of a cell that are inherited but do not involve a change in DNA sequence. It is now known that in addition to mutations, epimutations contribute to a variety of human diseases. Under light of preliminary results, the current hypothesis will focus on epigenetic regulations to clarify mustard toxicity and the use of drugs to correct possible epigenetic defects

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Molecular, genetic and epigenetic pathways of peroxynitrite-induced cellular toxicity

Oxidative stress plays a key role in the pathogenesis of cancer and many metabolic diseases; therefore, an effective antioxidant therapy would be of great importance in these circumstances. Nevertheless, convincing randomized clinical trials revealed that antioxidant supplementations were not associated with significant reduction in incidence of cancer, chronic diseases and all-cause mortality. As oxidation of essential molecules continues, it turns to nitro-oxidative stress because of the involvement of nitric oxide in pathogenesis processes. Peroxynitrite damages via several distinctive mechanisms; first, it has direct toxic effects on all biomolecules and causes lipid peroxidation, protein oxidation and DNA damage. The second mechanism involves the induction of several transcription factors leading to cytokine-induced chronic inflammation. Finally, it causes epigenetic perturbations that exaggerate nuclear factor kappa-B mediated inflammatory gene expression. Lessons-learned from the treatment of several chronic disorders including pulmonary diseases suggest that, chronic inflammation and glucocorticoid resistance are regulated by prolonged peroxynitrite production

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Penil septal hematom: Nadir bir olgu sunumu

Hematoma associated with penile trauma, usually associated with a penile fracture involving a disruption in the integrity of tunica albuginea, is among the frequent causes of a penile mass. In this report, the authors present a 70-year-old patient with intercorporeal penile septal hematoma without a rupture of tunica albuginea following a traumatic event. Relevant imaging features are conclusive for an accurate diagnosis, particularly in cases with atypical clinical presentation, as was in the presented case.Penil travmaya bağlı olarak gelişen ve çoğu kez tunika albuginea’nın bütünlüğünde bir bozulmanın ve hematom oluşumunun eşlik ettiği klinik tablo en sık görülen penil kitle nedenidir. Bu yazıda, travma sonucu gelişen ve tunika albuginea’da bir rüptürün sözkonusu olmadığı 70 yaşındaki bir interkorporeal penil septal hematom olgusu sunulmaktadır. Sunulan olguda olduğu gibi, özellikle atipik bir kliniğin sözkonusu olduğu olgularda doğru tanı konulabilmesi için görüntüleme bulguları önem taşımaktadır

Imaging findings in pulmonary aspergilloma

Pulmoner aspergillom özellikle tüberküloza sekonder olmak üzere akciğerde daha önceden var olan kronik kavitelerde kolonize olmuş mantar kütlesi olarak tanımlanabilir. Lezyon daha çok üst loblarda yerleşim gösterir ve kavite içerisinde yuvarlak veya katlanmış solid kitle görünümü şeklindedir. Mantar topu ve kavite duvarı arasında görülen “hilal işareti” tipiktir. Öksürük ve hemoptizi yakınmalarıyla başvuran ve geçirilmiş tüberkü- loz öyküsü olan 3 olguya ait PA akciğer grafisi ve toraks BT incelemeleri sunulmuştur. Olgulardan birinde lezyonun alt lobda yerleşim göstermiş olması, bir başka olguda kavite içerisinde atipik irregüler duvar kalınlaşması izlenmesi ve aynı olguda eş zamanlı olarak adenokarsinom saptanmış olması pulmoner aspergillom için atipik bulgular olarak değerlendirilmiştir.Pulmonary aspergilloma can be defined as a fungal mass colonising in the pre-existing cavities in the lung, which are mostly secondary to tuberculosis. The lesion is usually located in the upper lobes and seen as round or folded solid mass within a cavity. “Crescent sign” between the fungus ball and cavity wall is typical. Chest radiogrographies and thorax CT scans of 3 patients presenting with the complaints of cough and hemoptysis and with a history of tuberculosis are presented. The lower lobe location for one of the cases and the detection of iregular wall thickening as well as the detction of a coexisting adenocarcinoma in another case have been regarded as atypical findings for pulmonary aspergilloma. Key Words: pulmonary aspergilloma, lung, radiography, computed tomograph

Evaluation of microplastics removal efficiency at a wastewater treatment plant discharging to the Sea of Marmara

Levels, composition and fate of microplastics (MPs) were investigated along different compartments of a secondary wastewater treatment plant (WWTP) with nutrient removal on the northern Sea of Marmara coast (Istanbul, Turkey). When all samples were combined, fibers were found to be the most dominant particles, followed by hard fragments. 500–1000 μm and 1000–2000 μm were the most common size ranges for wastewater and sludge, respectively. Rate of removal differed for sizes and shapes of the particles combined. Hard fragments of <500 μm and fibers of size ranges 250–500 μm and 1000–2000 μm were more successfully removed within the WWTP. Size averages increased throughout the WWTP units. 84.6–93.0% removal was achieved for grab and 3-hr composite samples. Despite the high removal rates of the WWTP, 2,934 × 106 microplastic particles/d were released in the effluent to the Sea of Marmara. Our results show that the Ambarlı WWTP considerably contributes to microplastics contamination in the Sea of Marmara since the plant has a high operating capacity

Penil septal hematom: Nadir bir olgu sunumu

Hematoma associated with penile trauma, usually associated with a penile fracture involving a disruption in the integrity of tunica albuginea, is among the frequent causes of a penile mass. In this report, the authors present a 70-year-old patient with intercorporeal penile septal hematoma without a rupture of tunica albuginea following a traumatic event. Relevant imaging features are conclusive for an accurate diagnosis, particularly in cases with atypical clinical presentation, as was in the presented case.Penil travmaya bağlı olarak gelişen ve çoğu kez tunika albuginea’nın bütünlüğünde bir bozulmanın ve hematom oluşumunun eşlik ettiği klinik tablo en sık görülen penil kitle nedenidir. Bu yazıda, travma sonucu gelişen ve tunika albuginea’da bir rüptürün sözkonusu olmadığı 70 yaşındaki bir interkorporeal penil septal hematom olgusu sunulmaktadır. Sunulan olguda olduğu gibi, özellikle atipik bir kliniğin sözkonusu olduğu olgularda doğru tanı konulabilmesi için görüntüleme bulguları önem taşımaktadır