Volume 4, Issue 2

The development of antimicrobial resistance by bacteria is inevitable and is considered as a major problem in the treatment of bacterial infections in the hospital and in the community. Despite efforts to develop new therapeutics that interact with new targets, resistance has been reported even to these agents. In this review, an overview is given of the many therapeutic possibilities that exist for treatment of bacterial infections and how bacteria become resistant to these therapeutics.

The study looked at the antimicrobial resistance patterns, serotypes, molecular types, metallo beta-lactamase, and chromosomal betalactamase enzymes of P. aeruginosa strains isolated from the patients and the staffs of the intensive care unit. P. aeruginosa isolates from the patients as nosocomial pathogens and from the staffs were evaluated for their susceptibilities to the antimicrobials by the disk diffusion and E-test methods. Metallo beta-lactamase enzymes were investigated by E-test, the inducibility of β - lactamase enzymes were detected by the disk antagonism test. Serotyping was performed by slide agglutination method. The P. aeruginosa isolates were typed by pulsed field gel electrophoresis. Twenty-five P. aeruginosa strains from the patients and three from the staffs were isolated. Fifteen P. aeruginosa, eleven of which composed of MDR bacteria, were found in serogroup E, 7 strains in G, 4 strains in B, and 1 strain in serogroup A. In all 12 bacteria in the MDR and serogroup E, metallo beta-lactamase enzyme was found to be positive. And in other 15 strains, except the bacterium which could not be serotyped, chromosomal beta-lactamase was found to be positive. The result of the molecular typing showed PFGE A pattern. In conclusion, a pattern in PFGE which included bacteria from MDR and serogroup E, G which was observed in the P. aeruginosa strains which was isolated from the staff’s hands and from the 5 patients, and PFGE F pattern were found to be observed the most. Finally, the two different clonal strains were found to be established in the intensive care.

The aim of the study was to evaluate and collect current evidence on the effect of antibiotics in pretreatment of pouchitis after restorative ileal pouch anal anastomosis (IPAA). Pubmed, Embase, Web of Science, Scopus, and Cochrane Library databases were searched between 1966 and July 2008; and relevant clinical trials extracted, reviewed, and validated according to the study protocol. The outcome of interest was clinical improvement after treatment. Nine randomized, placebo-controlled clinical trials were found relevant and studied but 3 of them with 70 patients were entered into meta-analysis. Pooling of the results from these trials yielded an odds ratio of 15.96 with a 95% CI of 4.20–60.70, indicating a significant OR (p<0.0001) in treatment group in comparison to the placebo group. In conclusion, the meta-analysis confirms benefit of antibiotics in management of pouchitis after IPAA operation.

In geriatric practice, data regarding infections including the epidemiology, morbidity, and mortality are lacking. Our aim was to evaluate the frequency, location, microbiological and laboratory characteristics of infectious diseases in elderly population admitted to a training hospital. The patients were included total of 330 patients, aged over 65 with infection, seen between January 1, 2005 and January 1, 2006. In the result, of patients 136 (41%) had respiratory system infection, 90 (27%) urinary system infection, 39 (12%) gastrointestinal system infection, 34 (10%) bloodstream infections, 17 (5%) soft tissue infection, 8 (2%) central nervous system infections, and 6 (2%) others. Average length of hospitalization was 8.6±7.7 days. Mortality rate from all causes was 57 (17%). The most common infections in elderly patients were respiratory tract and urinary system infections, and there were no fever, leukocytes and high CRP levels in approximately 1/3 of cases. Infectious diseases may occur even in the absence of such infection indicators as fever, raised WBC count and high CRP level in the elderly population.

In 2005, 440 patients infected with HIV were registered in the AIDS center in Lodz, Poland. The aim of our study was to analyze the causes of death in 70 fatal cases. We analyzed the data from 70 fatal cases from 1995 through 2005. Of the fatal cases we investigated, 10 were in women and 60 in men. The most common route of HIV transmission was intravenous drug use (50%). At the time of death, the mean age of patients was 36,48 years, and the mean CD4 count was 115,14 cells per microliter. The mean time from HIV diagnosis to death was 3,75 years. The leading cause of death in the group from 1995 through 2004 was AIDS. In 2002, liver diseases resulting from hepatitis C virus (HCV) infection were the cause of death in two patients. In 2005, two patients died as a result of myocardial infarction. The prevalence of fatal cases decreased from 9,09 % in 1995 to 1,59 % in 2005. Hepatitis B surface antigen (HBsAg) was found in 4 of 62 patients (6,45%), anti-HCV in 28 patients (45,16%), and both hepatitis B virus (HBV) and HCV infection in 5 patients (8,07%). Coinfections occurred most frequently in intravenous drug users (IDUs). In conclusions: (1) AIDS is still the leading cause of death in HIV-positive patients in the Lodz region; (2) the emerging cause of death in HIV-positive patients is liver disease as the sequel of HBV and HCV coinfections; (3) heart disease is becoming an important cause of death in HIV-positive patients.

The present study was designed to investigate the protective effects of L-carnitine (LC) on changes in the levels of lipid peroxidation and endogenous antioxidants induced by cisplatin (cis-diamminedichloroplatinum II, CDDP) in the liver and kidney tissues of rats. Twenty-four Sprague Dawley rats were equally divided into four groups of six rats each: control, cisplatin, L-carnitine, and L-carnitine plus cisplatin. The degree of protection produced by L-carnitine was evaluated by determining the level of malondialdehyde (MDA). The activity of glutathione (GSH), glutathione peroxidase (GSH-Px), glutathione S-transferase (GST), and superoxide dismutase (SOD) were estimated from liver and kidney homogenates, and the liver and kidney were histologically examined as well. L-carnitine elicited significant liver and kidney protective activity by decreasing the level of lipid peroxidation (MDA) and elevating the activity of GSH, GSHPx, GST, and SOD. Furthermore, these biochemical observations were supported by histological findings. In conclusion, the present study indicates a significant role for reactive oxygen species (ROS) and their relation to liver and kidney dysfunction, and points to the therapeutic potential of LC in CDDP-induced liver and kidney toxicity.

The aim of the study was to determine pathways involved in contraction and relaxation of the mouse urinary bladder. Mouse bladder strips were set up in gassed Krebs-bicarbonate solution and responses to various drugs and electrical field stimulation were obtained. Isoprenaline (b-receptor agonist) caused a 63% inhibition of carbachol precontracted detrusor (EC50=2nM). Carbachol caused contraction (EC50=0.3µM), responses were antagonised more potently by 4-DAMP (M3-antagonist) than methoctramine (M2-antagonist). Electrical field stimulation caused contraction, which was inhibited by atropine (60%) and less by guanethidine and α,β-methylene-ATP. The neurogenic responses were not potentiated by inhibition of nitric oxide synthase. Presence of an intact urothelium significantly depressed responses to carbachol (p=0.02) and addition of indomethacin and L-NNA to remove prostaglandin and nitric oxide production respectively did not prevent the inhibitory effect of the urothelium. In conclusion, b-receptor agonists cause relaxation and muscarinic agonists cause contraction via the M3-receptor. Acetylcholine is the main neurotransmitter causing contraction while nitric oxide has a minor role. The mouse and human urothelium are similar in releasing a factor that inhibits contraction of the detrusor muscle which is unidentified but is not nitric oxide or a prostaglandin. Therefore, the mouse may be used as a model to study the lower urinary tract.

Many experimental studies have been performed and the mechanism of hyperbaric oxygen therapy on the frostbitten tissue has not been elucidated. In this study, we evaluated the effect of hyperbaric oxygen therapy on the frostbitten ears of rabbits in an experimental animal model by examining the concentrations of thromboxane A2 (as thromboxane B2-Tx B2) and of prostaglandin I2 (PG I2) (as 6-keto-prostaglandin F1α-PG F1α) in tissues, and by counting the numbers of inflammatory cells (neutrophils and mast cells-MC) Hyperbaric oxygen therapy (HBO) at 2.5 ATA for 90 minutes twice daily for fourteen days to rabbits, the ears of which were subjected to frostbite, decreased presence of inflammatory cells (mast cells −75%; neutrophils −40%) and increased prostaglandin I2 (PG I2) (as 6-Keto-PGF1α) in the involved skin. Thromboxane A2 (TxA2) (as Tx B2) was unaffected. Our results revealed that an inflammatory process was the underlying cause of frostbite injury and that hyperbaric oxygen therapy was active in pathological situations involving an inflammatory process in frostbite.

Varicocele has been regarded a curable cause of infertility for dozens of years. The impact of varicocele treatment in terms of increase in pregnancy rates is a debated issue. We evaluate data from a 10-year cohort of results from laparoscopic operative treatment of varicocele patients according to pregnancy rate, complication rate, and satisfaction with varicocele repair. Ninety seven patients were treated by means of laparoscopy between 1993 and 1996. Ten years after operation questionnaires were sent to all patients. Answers were obtained from 49/97 pts. (50,5%). Details connected with marital status, pregnancy rate, addictions and scrotal pain discomfort were collected. Statistical analysis was performed using chi-square independence test and Spearman’s rank correlation coefficient. After 10 years, 75.5% who answered the questionnaire were fully satisfied with the results of treatment, 12.3% pts of patients were partially satisfied; 63.3% of patients fathered 1 to 3 children. Married patients and those who fathered children were found to be the most satisfied with the operation. We also found the statistically significant negative dependency between smoking addiction and number of children. There were no major complications intra- or postoperatively. No harmful consequences of testicular artery ligation were found. In conclusion, long-time 10 years follow-up enables better estimation of the results of laparoscopic treatment in patients with varicocele. Pregnancy rate may depend not only on varicocele repair but on smoking addiction as well. There is still no evidence of harmful consequences due to testicular artery ligation after varicocele repair

This study included patients with upper gastrointestinal hemorrhage who were treated in intensive care unit of GATA Haydarpasa Training Hospital, Division of Internal Medicine during 1 year. Medical and demographic data of the patients were recorded. These patients were followed for 3 months after being discharged from the intensive care unit. Of the 50 patients in the study, 18 were female (36%), 32 were male (64%). The mean age was 47±2 years, and the ages ranged between 17 and 89 years. We did not find any statistically significant results in our evaluation of the relationship between the mean platelet volume and the number of transfusions, endoscopic findings, and prognosis after 3 months of follow-up.

Current European and American guidelines recommend early discharge for patients with uncomplicated acute myocardial infarction (AMI). However, this concept has not been widely accepted, and experience with direct discharge from the coronary care unit is limited. We aimed to investigate safety and cost effectiveness of early discharge directly from coronary care unit following successful percutaneous coronary angioplasty (PTCA) in patients with uncomplicated AMI. We included consecutive thirty-one patients with uncomplicated AMI and successful PTCA admitted to coronary care unit of a university hospital. Uncomplicated course was defined as absence of reinfarction, ischemia, VF/VT, repeated PTCA, and heart failure within first 72 hours. Incidence of death, reinfarction, VF/VT, need for revascularisation, and hospitalisation due to heart failure at 1, 6, and 12 months was compared with 56 randomly selected AMI patients with successful PTCA but longer hospitalisation. Average hospital stay was 4 days in early and 6.7 days in control group (p<0.05). Control group had more extensive coronary disease (54% two or more vessels vs. 28% in early discharge, p<0,05). During follow up, none of the early discharged patients died, the only observed event was repeat PTCA due to angina pectoris. In the control group, mortality at 12 months was 3.5% (p<0.05). Cumulative 12 month event free survival was 96% in early discharge group and 87% in control group, but difference was not significant (p=0.15, Cox-Mantel test). Cost reduction of early discharge amounted to 1100 Euro per patient. In conclusions, our study confirmed that for a selected population of patients with AMI, successful PTCA, and uncomplicated clinical course during first 72 hours, discharge as early as three days following the admission is safe.

The purpose of this retrospective study was to determine the results of coronary artery surgery in the elderly patients and to compare the outcome with a younger group. Two hundred thirteen patients aged 70 years and older who underwent on-pump coronary artery surgery were retrospectively studied and data were compared with those of 524 patients aged 50–69. The groups were similar with respect to preoperative characteristics except for sex distribution and the incidences of peripheral vascular disease and prior cerebrovascular accident. The use of internal mammarian artery grafts was significantly lower in the elderly patients (80.3% versus 91.6%, p<0.001). The 30-day mortality for the elderly group was 4.7% while that of younger group was 2.3%. The elderly patients had a significantly higher incidence of postoperative low cardiac output, pulmonary complications and acute renal failure. The elderly group also had also significantly longer intensive care unit length of stay (1.9 versus 1.7 days, p=0.006) and postoperative length of stay (10.1 versus 7.4 days, p<0.001). Although mortality and complication rates are higher, coronary artery surgery can be performed with acceptable risk in the elderly patients. Old age alone should not be a deterrent factor for surgical revascularization in coronary artery disease.

Ambulatory blood pressure monitoring and parallel polysomnographic study were performed in 116 adult males divided into 6 groups. Thirty blood-pressure (BP) and polysomnographic variables were measured to test their usefulness for screening for both arterial hypertension and sleep apnea-hypopnea syndrome (SAHS). The development of severe breathing disorders and hypoxemia during sleep was attributed to SAHS, when compared with measurements in healthy controls and in patients with arterial hypertension. Such disorders manifested as an increased apnea-hypopnea index, apnea index, duration of arterial oxygen saturation of less than 85%, and decrease of average arterial oxygen saturation that correlated with nocturnal average diastolic BP (p=0.0049, p=0.0027, p=0.049 and p=0.0457, respectively). These respiratory disorders resulted in various nocturnal, rather than diurnal, and diastolic and systolic BP variables. The acute antihypertensive effect of continuous positive airway pressure therapy for SAHS significantly reduced the episodes of apnea and hypopnea and the secondary component of hypertension caused by excessive sympathetic stimulation. For the SAHS-induced, dose-dependent component of hypertension that responded to continuous positive airway pressure, the following variables, in decreasing significance, were useful: nocturnal average systolic and diastolic BP and 24-hour average systolic and diastolic BP, as well as percent time elevation and mean blood pressure load. The monitoring of these variables could contribute to early diagnostic and prognostic stratification of complications and adequate therapy of the secondary component of hypertension caused by SAHS.

The cause of hypertension in young adults (age:18–29 years) is mostly a primary condition although secondary causes are frequent in this population. Clinical files of 100 patients were reviewed to evaluate the use of diagnostic tests after completion of diagnostic work-up for hypertension. Seventy-nine patients had primary hypertension while 21 patients had secondary hypertension. Renal imaging studies, serum levels of aldosterone and plasma renin activity, and screening tests for pheochromocytoma were more likely to be performed in patients younger than 24 years, in female patients and in patients without familial history of hypertension in primary hypertensive patients (p<0.05). Renal imaging studies and screening tests for pheochromocytoma were done more frequently in patients with Stage 2 hypertension (p<0,05). Among secondary hypertensives, renal imaging studies and renal biopsy were more ordered in patients younger than 24 years, in female patients, in patients with Stage 2 hypertension and in patients without family history for hypertension (p<0.05). Mean body mass index was higher in patients with primary hypertension than patients with secondary hypertension (p<0.05). Seventy patients (70%) had undergone several screening interventions with negative results. In conclusion, a simple, stepwise diagnostic evaluation would greatly benefit the management of young hypertensives.

The aim of this study was to investigate the plasma apelin levels in diabetic patients with and without neuropathy. All consecutive diabetic patients who presented for routine follow-up at our outpatient clinic were invited to participate in this clinical study. Forty diabetic patients (20 female and 20 male) and twenty-two non-diabetic control subjects (9 female and 13 male) were included in the study. Neurological evaluations in diabetic subjects were done by nerve conduction studies and evaluated with the Neuropathy Symptom Score. Fasting plasma glucose, HbA1c, lipid and apelin levels were measured in each subject. The mean plasma apelin level was significantly higher in the diabetic patients than in the control subjects (p = 0.026). Apelin levels were statistically similar between diabetic patients with and without neuropathy (p = 0.43). Further, plasma apelin levels were found to be higher in diabetic patients with neuropathy when compared with those of healthy control subjects (p = 0.02). In diabetic patients with neuropathy, plasma apelin levels correlated significantly with diabetes duration (r = 0.5, p = 0.02). We propose that apelin levels in diabetic patients are higher in the presence of neuropathy and longer disease duration, although this might not solely suffice as an indicator for the presence of neuropathy in diabetic patients. Drawing attention to the possible association between the apelinergic system and diabetes mellitus, we believe that further studies with larger samples should be carried out also to investigate the presence of retinopathy and nephropathy.

Neutrophils are a major source of reactive oxygen species (ROS). The role of airway mucous on ROS production is unknown. The aim of our study was to investigate the direct influence of bronchoalveolar lavage fluid (BALF) and induced sputum (IS) alone or in combination with chemical/biological stimulus on ROS production in peripheral blood neutrophils during chronic obstructive pulmonary disease (COPD). Neutrophils were isolated from peripheral blood of 47 patients with moderate COPD and 14 healthy individuals (HI). BALF/RPMI (1:1) or IS/RPMI (1:1) from COPD patients were used to stimulate neutrophils alone or in combination with phorbolmyristate- acetate (PMA) (0.1–30 nM) or Staphylococcus aureus bacteria (0.7–500 bact/neutrophil). Relative generation of ROS was measured flow cytometrically. BALF/RPMI and in combination with relatively low PMA or all bacteria concentrations stimulated ROS; while, combination with relatively high PMA concentrations suppressed ROS in of COPD patients and HI. IS/RPMI and its combination with PMA inhibited ROS generation in both groups; whereas, IS stimulated or had a tendency to stimulate ROS production with relatively high bacteria concentrations. In conclusion, BALF and IS directly or in combination with chemical/biological factors modulated ROS production. This effect was stronger in neutrophils from COPD patients and depended on chemical/biological stimulus intensity.

In the indexed medical literature, there have been a very limited number of studies to investigate the epidemiologic and clinical features of enteroviral meningitis in Turkey. The aim of the present retrospective study is to update the actual situation to recognize the spectrum and magnitude of this important clinical entity. Between June 1999 and December 2004, 612 cases of aseptic meningitis were followed up at our hospital. Enteroviral meningitis was defined by isolation of enteroviruses from cerebrospinal fluid (CSF) and/or stool samples. Mumps virus was detected in 310 cases (50.7%) and enteroviruses were the etiologic agents in 104 (17%) of the patients with aseptic meningitis. Most of the enteroviral meningitis cases (36 cases, 34.6%) were diagnosed in August and 70 (67.3%) of them were male. The mean age was 5.6 ± 3.4 years. The most common initial symptoms were fever (81.7%), vomiting (77.9%) and headache (57.7%). In the physical examination, 46.2% of the cases had neck stiffness and 38.5% had pharyngitis. Echovirus 30 was the most frequently (38 cases, 36.5%) isolated enterovirus with peaks in 1999, 2002 and 2004. The other frequently isolated enteroviruses were Coxsackie virus type B (17 cases, 16.3%), echovirus 6 (11 cases, 10.6%), echovirus 11 (6 cases, 5.8%), and echovirus 13 (4 cases, 3.8 %). Mean hospitalization time was 6.2 ± 2.4 days. All patients recovered without any sequelae. Enteroviruses have an important role in childhood aseptic meningitis cases in Turkey too, and the predominant serotypes vary according to years.

Wound infection and colonization following cardiac surgery is well known but rarely caused by vancomycin-resistant enterococci (VRE). A case of femoral wound colonization by vanA carrying Enterococcus faecalis in a patient following mitral prolapse surgery is described in this report.

A 3-year-old boy with a Nicolau Syndrome (NS) on the left side of the body and the limbs after benzathine penicilline injection is reported. To the authors’ best knowledge, this is the first report of hyperbaric oxygen used in the late treatment of NS preventing the progress of the necrosis and therefore limiting the amputation level.