Evaluation of the relationship between inflammation and bone turnover by sclerostin and Dickkopf-1 (DKK-1) levels in patients with SIRS

Introduction: In intensive care units (ICU), patients remain bedridden for a long time. In addition, severe infections are frequently seen in ICUs. Both prolonged immobilization and serious infections are associated with bone tissue loss. The Wnt pathway has recently been focused on evaluating bone tissue loss. The Wnt pathway participates in both infections and the formation of bone tissue. Wnt pathway inhibitors sclerostin and Dickkopf-1 (DKK-1) inhibit bone formation and increase osteoclastic activity. In this study, we aimed to examine bone turnover by the Wnt inhibitors sclerostin and DKK-1 and their possible associations with inflammation in SIRS patients.Methods: We included 30 patients diagnosed with systemic inflammatory response syndrome (SIRS) in the study group and 16 in the control group. Serum sclerostin, DKK-1, white blood cell (WBC), and C-Reactive Protein (CRP) levels on the day of SIRS diagnosis (basal), the 7th, 14th, and 21stdays were evaluated in the study group, and the results were compared with the control group.Results: When the control group was compared with the basal SIRS, there was a significant elevation in both sclerostin (p=0.003) and DKK-1 (p=0.001). Statistical analysis showed significant decreases in sclerostin levels between basal and the 7th, 14th, and 21st days (p=0.033, p=0.003, p=0.002, respectively). Similarly, significant decreases in DKK-1 levels between basal and the 7th and 21st days (p=0.015, p=0.001, respectively) and an insignificant decrease on the 14th day (p=0.191) was observed. Sclerostin was positively and significantly correlated with WBC and CRP in basal and 7th-day measurements and WBC in 7th and 14th days. DKK-1 is positively and significantly correlated with WBC in basal and 7th-daymeasurements, while DKK-1 negatively correlates with CRP in basal-7th-day measurements.Conclusion: In this study, it was shown for the first time that the Wnt antagonists sclerostin and DKK-1 values are high in SIRS patients in ICU. Both biomarker levels decreased in parallel with the treatment. However, it could not be associated with disease severity and inflammatory marker levels. We believe that monitoring the change of Wnt antagonists will be useful in demonstrating bone turnover in patients with SIRS.Keywords: Dickkopf-1, Intensive care unit, Sclerostin, Systemic inflammatory response syndrome, Wnt signaling pathway, Bone turnove

The Evaluation of Studies On Decreasing Intensive Care Infections with the Data of 8 Years Surveillance

AimIn this article, we aimed to discuss studies on decreasing intensive care infection rates in two different ICU of Burdur State Hospital under the light of 8 years of surveillance data.Materials and MethodsEducation, correction of physical conditions, number of beds and category changes were examined for the corrective actions in order to reduce the infection rate. For the determination of infection rate; held surveillance data was considered between 01/01/2008 and 30/11/2015.ResultsIn two different ICU, total 5354 patient, 28164 patients day was evaluated. In 8 years, surgical intensive care unit’s (SICU) bed count elevated 5, internal intensive care unit’s (IICU) 9 and degree from 1 to2. Training was organized for all ICU staff. The average annual was 45.8. In the use of invasive instruments; there was no significant difference observed in urinary catheterization, however there was a reduction in the use of central venous catheters and ventilator in this period. Hospital infection rates decresed from 46.67% to 3.76% in SICU and from 39.68% to 4.87% in IICU. Catheter-associated urinary tract infections was decresed 21.35% in SICU and 22.8% in IICU. Decrease in ventilator-associated pneumonia was observed as 19% in SICU and 17.37% in IICU. Also decrease in catheter related infections was observed as 3.87% in SICU and 9.22% in IICU.ConclusionA multidisciplinary approach is needed for the control of infections in intensive care unit. As the reducing the use of invasive instruments, critical importance of hygiene rules should be noted during the use of these tools. For this purpose, performing a qualified and targeted education with the participation of all staff in intensive care unit would be beneficial

The Evaluation of Studies On Decreasing Intensive Care Infections with the Data of 8 Years Surveillance

Amaç Burdur Devlet Hastanesinin iki farklı yoğun bakım ünitesinde, enfeksiyon hızlarının azaltılmasına yönelik yaptığımız çalışmaları, 8 yıllık sürveyans verileri ışığında tartışmayı amaçladık. Materyal ve Metot Enfeksiyon hızının azaltılması için düzeltici faaliyetlerde; eğitimler, fiziki şartlardaki düzeltmeler, yatak sayısı ve basamak değişiklikleri irdelendi. Enfeksiyon hızının tespitinde; 01 Ocak 2008 – 30 Kasım 2015 tarihleri arasında yapılan sürveyans verileri dikkate alındı. Bulgular İki farklı yoğun bakımda toplam 5354 hasta ve 28164 hasta günü değerlendirildi. Sekiz yıllık süreçte; cerrahi yoğun bakım (CYB) yatak sayısı 5, dahili yoğun bakım (DYB) yatak sayısı 9 artarken ve basamak 1’den 2’ye yükseldi. Başta temizlik personelleri olmak üzere, tüm yoğun bakım çalışanlarına eğitimler düzenlendi. Yılda ortalama 45,8 eğitim yaplmıştı. İnvaziv araç kullanımında; üriner kateterde belirgin bir fark gözlenmezken, santral venöz kateter ve ventilatör kullanımında azalma olduğu görüldü. Hastane enfeksiyonu hızında CYB’da %46,67’den %3,76’ya, DYB’da %39,68’den %4,87’ye gerileme oldu. Kateter ilişkili üriner sistem enfeksiyonunda CYB’da %21,35, DYB’da %22,8 gerileme tespit edildi. Ventilatör ilişkili pnömonide CYB’da %19, DYB’da %17,37 azalma görüldü. Kateter ilişkili enfeksiyonda CYB’da %3,87, DYB’da %9,22 azalma görüldü. Sonuç Yoğun bakımlarda enfeksiyonların kontrol altına alınması için; multidisipliner bir yaklaşım gereklidir. İnvaziv araç kullanımının azaltılması kadar, bu araçların kullanılması esnasında hijyen kurallarının da kritik öneme sahip olduğu unutulmamalıdır. Bu amaçla nitelikli ve hedefe yönelik eğitimlerin yapılması, tüm yoğun bakım çalışanlarının bu eğitimlere dahil edilmesi faydalı olacaktır.Aim In this article, we aimed to discuss studies on decreasing intensive care infection rates in two different ICU of Burdur State Hospital under the light of 8 years of surveillance data. Materials and Methods Education, correction of physical conditions, number of beds and category changes were examined for the corrective actions in order to reduce the infection rate. For the determination of infection rate; held surveillance data was considered between 01/01/2008 and 30/11/2015. Results In two different ICU, total 5354 patient, 28164 patients day was evaluated. In 8 years, surgical intensive care unit’s (SICU) bed count elevated 5, internal intensive care unit’s (IICU) 9 and degree from 1 to2. Training was organized for all ICU staff. The average annual was 45.8. In the use of invasive instruments; there was no significant difference observed in urinary catheterization, however there was a reduction in the use of central venous catheters and ventilator in this period. Hospital infection rates decresed from 46.67% to 3.76% in SICU and from 39.68% to 4.87% in IICU. Catheter-associated urinary tract infections was decresed 21.35% in SICU and 22.8% in IICU. Decrease in ventilator-associated pneumonia was observed as 19% in SICU and 17.37% in IICU. Also decrease in catheter related infections was observed as 3.87% in SICU and 9.22% in IICU. Conclusion A multidisciplinary approach is needed for the control of infections in intensive care unit. As the reducing the use of invasive instruments, critical importance of hygiene rules should be noted during the use of these tools. For this purpose, performing a qualified and targeted education with the participation of all staff in intensive care unit would be beneficial

Are Fetuin-A levels beneficial for estimating timing of sepsis occurrence?

WOS: 000452509700005PubMed ID: 29968890Objectives: To evaluated Fetuin-A levels of patients admitted in the intensive care unit with a diagnosis of sepsis. Methods: This study was conducted at the Faculty of Medicine, Canakkale Onsekiz Mart University Hospital, Canakkal, Turkey, between February 2015 and October 2015. Forty septic patients were included in the study. Subsequent to clinical suspicion of sepsis, serum levels of C-reactive protein (CRP) and procalcitonin; and white blood cell (WBC) counts were evaluated at 3 time-points: 0 (basal), 24, and 72 hours. Results: The mean Fetuin-A levels at the 3 time-points were 58.5 +/- 29.2 ng/mL, 40.9 +/- 23.6 ng/mL, and 47.8 +/- 25.7 ng/mL, respectively. Fetuin-A levels at 24 hours were significantly lower than the basal level (p0.05). Correlation between the temporal changes in Fetuin-A levels and the changes in other inflammatory markers (CRP, procalcitonin and WBC) was examined. Fetuin A was found to have only a negative correlation with serum procalcitonin level (p<0.05). Conclusion: In this study, serum Fetuin-A levels in septic patients decreased significantly in the first 24 hours, followed by an insignificant increase at 72 hours. These findings suggest that monitoring of Fetuin-A levels may help predict the time of occurrence of sepsis and prognosis of sepsis.Scientific Research Projects Coordination Unit, Canakkale Onsekiz Mart University, Canakkale, TurkeyThis study was supported by the Scientific Research Projects Coordination Unit, Canakkale Onsekiz Mart University, Canakkale, Turkey. We would like to thank Enago for English language editing

The acute effects of preoperative ozone theraphy on surgical wound healing

WOS: 000380801700007PubMed: 27487282PURPOSE: To investigate the effects of preoperative rectal ozone insufflation on surgical wound healing over the proinflammatory cytokines and histopathological changes. METHODS: Twenty one rabbits were divided into 3 groups Sham, surgical wound, and ozone applied (6 sessions, every other day 70 mu g/mL in 12 mL O2-O3 mixture rectally) surgical wound groups were created. TNF-alpha and IL-6 levels from all rabbits were studied at the basal, 24th hour, and 72nd hour. the histopathological examination was done by removing the surgical scar tissue at the end of 72nd hour. RESULTS: TNF-alfa and IL-6 levels were significantly lower compared to the control group, in the rabbits treated with ozone. the increase in angiogenesis, the decrease in the number of inflammatory cells, epidermal and dermal regeneration, better collagen deposition, and increased keratinisation in stratum corneum were observed in the histopathological examination It was determined that the wound healing noticeably accelerated in the ozone group. CONCLUSION: Preoperative rectal ozone insufflation had a positive effect on surgical wound healing in acute period