efficacy of dexamethasone treatment in adult patients with acute bacterial meningitis

To evaluate the efficacy of dexamethasone added to the treatment of adult patients with bacterial meningitis in our region. One hundred and forty-four patients were randomized prospectively and evaluated to determine the efficacy of dexamethasone treatment in adult patients with acute bacterial meningitis at Dicle University Hospital, Diyarbakir, Turkey between January 2000 and December 2004. While the first group received ceftriaxone 4 gr/day plus dexamethasone, the second group received ceftriaxone 4 gr/day only Dexamethasone was given I 10-15 minutes before the first 8 mg dose of antibiotic treatment. It was continued at 16 mg/day for 3 days. The study included 144 patients with the diagnosis of acute bacterial meningitis. Cerebrospinal fluid [CSF] was analyzed at the time of admission, after 24-48 hours [Table 1], and at the end of treatment. Accordingly, CSF leukocyte level was found to be 1710 +/- 2140/mm3 in group 1 receiving dexamethasone treatment compared to 1950 +/- 2244/mm[3] in group 2 [p=0.001]. The consciousness in the group receiving dexamethasone improved significantly more rapidly than the control group [p=0.001]. While mortality was 9.7% in the patient group receiving dexamethasone it was 16.7% in the control group, however, it was not significant [p=0.093]. The use of dexamethasone in adult patients is still under debate, and the administration of dexamethasone 10-15 minutes before antibiotherapy to unconscious patients in a poor state of health, is effective in the clinical improvement of the patient

6-year prospective surveillance study for healthcare associated infections in a neurology unit

To assess the epidemiology of healthcare-associated infections [HAIs] in a neurology unit in a university hospital. The study was carried out prospectively at Dicle University Hospital, Diyarbakir, Turkey [1050-bed] between 1st January 1999 and 31st December 2004. Active surveillance for HAIs was performed by the infection control team, using the criteria proposed by the Centers for Diseases Control and Prevention [CDC] and National Nosocomial Infections Surveillance System [NNIS] methodology. During the 6-year follow up period, 219 HAIs episodes were detected in 203 patients out of 3323 in patients. The mean length of stay of patients with HAI was 28 +/- 5 days, while that of patients without infections was 11 +/- 1 days. Eighty-two patients died with HAIs, while 1330 died in the patients without infections. The overall incidence rates [HAI/100] and incidence densities [HAI/1000 days of stay] of HAIs were 6.6% and 4.4/1,000 patients-days. The most common HAIs by primary site were urinary tract infection [44.2%] and decubitus infection [30.4%]. The most prevalent microorganisms were Escherichia coli [27%], Klebsiella species [14%], Pseudomonas aeruginosa [13%], Enterobacter species [12%], coagulase-negative Staphylococci [10%] and Staphylococcus aureus [7%]. The results may contribute to observe the magnitude and characteristics of HAIs and to plan and evaluate policies and guidelines of infection control in neurology units

Multiresistant bacterial colonization due to increased nurse workload in a neurology intensive care unit

To determine the prevalence, clinical manifestations, and laboratory features of Neuro-Behcet's disease. This prospective study was carried out in the Behcet's Research Clinic in Shiraz [south-west Iran] and included the patients referred from 1990-1999. The patients' clinical records, images, CSF analyses, and electrodiagnostic studies were reviewed. Eighteen [15 males and 3 females] out of 690 Behcet's patients [2.6%, 95% CI = 1.4-3.8%] were found to have neurological involvement. The mean +/- standard deviation age of these patients was 34.7 +/- 8.6 years. All fulfilled the criteria of the International Study Group of Behcet's Disease. Central nervous system involvement was more common than peripheral nervous system manifestations. Headache, weakness, tingling, and numbness were the most common symptoms. Hyperreflexia, upward plantar reflex, and somatosensory findings were the most frequent signs. Hemispheral and brainstem stroke-like syndromes and cerebral venous thrombosis were the major neurologic presentations. There were also cases of myelitic, pure meningoencephalitic, amyotrophic lateral sclerosis-like, multiple sclerosis-like, and Guillain Barre syndromes. Neuro-Behcet's disease must be considered in the differential diagnosis of stroke in young adults, chronic meningitis, intracranial hypertension, multiple sclerosis, myelopathies, and peripheral neuropathies