The use of fosfomycin in infections caused by multidrug-resistant pathogens, especially pneumonia in children: a five-year retrospective single-centre experience.

BACKGROUND: Fosfomycin is gaining increasing attention for its activity against MDR or XDR pathogens. Currently, IV fosfomycin is a potential option for treating various infections, including urinary tract infections, pneumonia and skin infections when first-line treatments fail. OBJECTIVES: To evaluate the demographic, clinical, microbiological and treatment modality of children received IV fosfomycin to treat infections caused by MDR pathogens since there are few data on the use of fosfomycin in children. METHODS: This study was conducted retrospectively with patients under 18 years of age who were treated with IV fosfomycin for at least 72 h due to infections caused by MDR pathogens between January 2019 and October 2023 at Marmara University Pendik Training and Research Hospital, Istanbul, Türkiye. Data on demographic and clinical features, microbiological findings, treatment modalities and side effects were evaluated. RESULTS: Twenty-five children, for a total of 32 cases of infection episodes, with a mean age of 11.4 ±â€Š3.92 years who received IV fosfomycin were included. The most frequent comorbidity was chronic pulmonary diseases, and the most common infection needed for IV fosfomycin was MDR Pseudomonas aeruginosa pneumonia. In all cases, fosfomycin was administered in combination with other antibiotics, mainly meropenem-colistin (68.7%) or meropenem (15.6%). Twenty-two (71.9%) cases had favourable clinical responses at the end of therapy. CONCLUSIONS: Our results suggest that IV fosfomycin may be an effective treatment option for MDR pathogens in the paediatric population. Nevertheless, careful stewardship is necessary to maintain efficacy and reduce antimicrobial resistance selection risk.

Challenging Treatment of Disseminated Aspergillosis in a Child With Nephrotic Syndrome.

INTRODUCTION: Central nervous system (CNS) aspergillosis is an opportunistic infection with an increasing incidence and a high mortality rate. It is seen in immunocompromised patients as well as in immunocompetent patients. Here, we present disseminated aspergillosis in a child with nephrotic syndrome treated with long-term and aggressive systemic antifungal treatment and intraventricular (IVent) liposomal amphotericin B (L-AmB) as well as surgical excision and drainage due to difficulty in management. CASE REPORT: A 10-year-old boy with nephrotic syndrome on steroid therapy was admitted with limping and weakness. The cranial magnetic resonance imaging showed multiple intraparenchymal scattered abscesses. The largest one was excised and drained. Abscess culture revealed Aspergillus fumigatus and histopathological examination revealed septate hyphae compatible with Aspergillosis. Intravenous (IV) voriconazole was started, and IV L-AmB was added. The size of lesions and perilesional edema continued to increase, and then IVent L-AmB was added. With IVent and systemic antifungal treatment, regression of the lesions was observed. He was followed up with oral voriconazole and weekly IVent L-AmB. After 2 and a half months, he was re-operated because of increased lesion size, number and perilesional edema, and IV voriconazole and other salvage antifungal therapies were started. Since the lesions had decreased and remained stable, IV voriconazole was switched to oral therapy, and he was followed up as an outpatient. Immunodeficiency diseases were excluded by immunological and genetic tests. CONCLUSION: Management of central nervous system aspergillosis can be challenging despite long-term and aggressive systemic and IVent antifungal treatment as well as surgical excision and drainage.

Water/organic liquid interface properties with amine, carboxyl, thiol, and methyl terminal groups as seen from MD simulations.

Molecular dynamics simulations were performed to study structural and dynamic properties of polar butanamine/water/butanamine, pentanoic acid/water/pentanoic acid, butanethiol/water/butanethiol, and nonpolar pentane/water/pentane systems. The mass density profiles along the interface normal to the organic liquid/water system, the difference in the local structure of H 2 O molecules in bulk and in the vicinity of interface, as well as the diffusion behavior of water molecules at the interface with above-mentioned organic liquids have been investigated. Our MD simulation has shown that the diffusion of water molecules across the water/organic liquid interface is influenced by the hydrogen bonds n HB between water molecules and the terminal groups of organic liquids. It was found that the loss of the hydrogen bonds n HB in the nonpolar organic liquid leads to a decrease in the value of the normal component of the diffusion coefficient D z , while the tangential diffusion coefficients, both D x and D y , increase.

Are cytokine levels in serum, endometrial tissue, and peritoneal fluid a promising predictor to diagnosis of endometriosis-adenomyosis?

AIM: The basic aim was to find a non-invasive procedure to diagnose and monitor endometriosis-adenomyosis. MATERIALS AND METHODS: A prospective study was carried out. The authors conducted a series of 60 consecutive patients who underwent diagnostic laparoscopy for benign gynecologic conditions. Endometrial, peripheral blood and peritoneal lavage samples were analyzed. IL-6, IL-16, TNF-alpha, and LIF levels were measured and compared. RESULTS: The authors analyzed clinical data of 52 patients (26 endometriosis, 13 adenomyosis, and 13 control group). Peritoneal fluid IL-6 is significantly higher in stage IV endometriosis group than the control group (p = 0.001). In the endometriosis group, the levels of TNF-alpha in the peritoneal fluid was higher than the control group (p = 0.008). In the endometriosis and adenomyosis groups, the levels of IL-16 in the peritoneal fluid were significantly higher than the control group (p = 0.000 and p = 0.002). CONCLUSIONS: Significant immune-inflammatory changes were observed. When the underlying molecular mechanisms will be investigated, this will elicit studies on the immunotherapeutic treatment of endometriosis. Further studies are needed to assess various potential therapeutic interests for biomarkers in a large, well-defined patient population.

Molecular structure and elastic properties of thermotropic liquid crystals: integrated molecular dynamics--statistical mechanical theory vs molecular field approach.

The connection between the molecular structure of liquid crystals and their elastic properties, which control the director deformations relevant for electro-optic applications, remains a challenging objective for theories and computations. Here, we compare two methods that have been proposed to this purpose, both characterized by a detailed molecular level description. One is an integrated molecular dynamics-statistical mechanical approach, where the bulk elastic constants of nematics are calculated from the direct correlation function (DCFs) and the single molecule orientational distribution function [D. A. McQuarrie, Statistical Mechanics (Harper & Row, New York, 1973)]. The latter is obtained from atomistic molecular dynamics trajectories, together with the radial distribution function, from which the DCF is then determined by solving the Ornstein-Zernike equation. The other approach is based on a molecular field theory, where the potential of mean torque experienced by a mesogen in the liquid crystal phase is parameterized according to its molecular surface. In this case, the calculation of elastic constants is combined with the Monte Carlo sampling of single molecule conformations. Using these different approaches, but the same description, at the level of molecular geometry and torsional potentials, we have investigated the elastic properties of the nematic phase of two typical mesogens, 4'-n-pentyloxy-4-cyanobiphenyl and 4'-n-heptyloxy-4-cyanobiphenyl. Both methods yield K3(bend) >K1 (splay) >K2 (twist), although there are some discrepancies in the average elastic constants and in their anisotropy. These are interpreted in terms of the different approximations and the different ways of accounting for the structural properties of molecules in the two approaches. In general, the results point to the role of the molecular shape, which is modulated by the conformational freedom and cannot be fully accounted for by a single descriptor such as the aspect ratio.

Removal of intra-abdominal mislocated intrauterine devices by laparoscopy.

This retrospective study was carried out on 15 patients who underwent laparoscopy for the removal of a mislocated IUD from 2003 to 2009. The mean duration of usage of an IUD was 16.1 months. The IUD was found in the Pouch of Douglas in six patients; in the posterior wall of the uterus in three patients; in the adnexa in three patients; in the omentum in two patients and it was embedded in the rectal serosa in one patient. The types of the IUDs were TCu-380A (n = 13) and Mirena(®) (n = 2). The mean laparoscopic operation time was 25 min. No major complications occurred. A second ancillary port was required in three patients. All patients were discharged within 24 h. Laparoscopic removal of the intra-abdominal IUD must be the first choice of therapy. If possible, a single ancillary port should be preferred for the removal of mislocated IUDs. We advise that surgical removal and surgical risk should be discussed with the patients, even if asymptomatic.

Transvaginal Burch operation for stress urinary incontinence: 5-year results.

Several techniques have been developed for the management of stress urinary incontinence (SUI). To establish 5-year outcomes for women who underwent our previously described new retropubic suspension operation (transvaginal Burch operation) for SUI at the Meram Medicine Faculty, a prospective study was performed on 231 women who had been operated on for stress incontinence and who had completed 5 years of follow up. We observed complete remission during the follow-up period in 215 women (93%). No major complication related to the procedure was reported, and results were found to be satisfactory and encouraging.

The treatment of 65 women with imperforate hymen by a central incision and application of Foley catheter.

OBJECTIVE: To determine the surgical outcome of 65 women with imperforate hymen treated with a central surgical incision and insertion of a Foley catheter. DESIGN: A prospective study. SETTING: The study was carried out at Department of Obstetrics and Gynecology, Faculty of Meram Medicine, Selcuk University, between 1 January 1996 and 30 June 2006. POPULATION: A total of 65 women diagnosed as imperforate hymen. METHODS: A central oval incision was performed to imperforate hymenal membrane, then 16F Foley catheter was protruded and the balloon was insufflated. Catheter was removed after 2 weeks duration. Estrogen cream was prescribed to all women for application onto hymenal structure for 2 weeks. MAIN OUTCOME MEASURES: Efficacy of procedure in treatment of imperforate hymen, preserving hymenal structural integrity that is accepted as important for virginity in some societies. RESULTS: After the procedure, hymenal orifice created remained open and intact in all women except two women. Closure of artificially created hymenal orifice in these two women was believed to be related to inappropriate administration of estrogen cream. Subsequent treatment with local estrogen treatment results in the hymenal orifice remaining opened in these two women. CONCLUSIONS: We have previously reported the technique in 2002, but now we are able to demonstrate results of our technique in an expanded number of women. This technique is less invasive than other methods and prevents many social problems related to virginity by preventing destruction of the integrity of the hymenal structure and providing an annular-intact hymenal ring.

Adding ketoprofen to intravenous patient-controlled analgesia with tramadol after major gynecological cancer surgery: a double-blinded, randomized, placebo-controlled clinical trial.

Ketoprofen is a NSAIDs of the 2-aryl propionic acid class commonly used in the treatment of inflammatory rheumatic disease, acute pain and fever. Clinically, ketoprofen seems to reduce morphine requirements by 33 to 40% with ketoprofen's supposed central mechanism of analgesia. We evaluated the efficacy and safety of intravenous (IV) ketoprofen as an adjuvant to IV PCA (patient controlled analgesia) with tramadol after major gynecological cancer surgery for postoperative analgesia. Fifty patients were enrolled in this double-blinded, randomized, placebo-controlled study. Patients were allocated randomly to two groups: group I (25 patients) served as a control group, with patients receiving saline; group II (25 patients) received ketoprofen. Patients received an intravenous bolus of saline or 100 mg ketoprofen at the end of surgery. Then, PCA was given as a 20 mg tramadol bolus and 10 min lockout time. Pain relief was regularly assessed using a visual analog scale. Tramadol consumption, side-effects, and patient satisfaction were noted during the 24 hours after the surgery. No significant difference was observed in pain score, side-effects and patient satisfaction between the groups (p > 0.05). The cumulative PCA-tramadol consumption was lower in the ketoprofen-treated patients than placebo-treated patients (p < 0.05). Our results demonstrate that a single dose of 100 mg ketoprofen reduced tramadol consumption for treatment of postoperative pain after major gynecological cancer surgery.

[Eleven years of registration of congenital anomalies in Croatia associated with the EUROCAT international project]. / Jedanaestogodisnje registriranje kongenitalnih anomalija u Hrvatskoj u sklopu medunarodnog projekta EUROCAT.

Results of the eleven-year registration of congenital anomalies in Croatia are presented. Zagreb Registry as a part of international EUROCAT (European Registration of Congenital Anomalies) project covers four regional centers (Varazdin Rijeka, Pula and Koprivnica). The ascertainment, calculation of prevalence rates and statistical methods are based on EUROCAT method of investigation. Mean prevalence rate of 18.86/1000 births (1228 children with congenital anomalies per 65,100 births) was registered in the 1983-1993 period. The most frequently registered anomalies were congenital heart diseases, a heterogenous group of limb defects, oral clefts, central nervous system anomalies and chromosomal aberrations. The most frequent structural anomalies expressed as rates per 1000 births are ventricular septal defect (1.8), cleft lip +/- palate (1.1), atrial septal defect (0.8) polydactyly (0.8) and limb reduction defects (0.5). Statistical analysis shows a fluctuation of Down's syndrome prevalence rates during the monitored period. Statistically significant differences (p < 0.01) in prevalence rates among four regions of Croatia were established. The prevalence rates of marker anomalies (Down's syndrome, polydactyly, oral clefts) are tenfold higher compared to routine statistical data of Republic of Croatia. Acquired experience, collaboration and results obtained in this project represent a good basis for more rational planning of medical care and further investigation of this significant medical and public health problem.

A new needle suspension procedure for genuine stress incontinence and anterior vaginal wall prolapse.

A new suspension method was developed for the correction of anterior vaginal wall relaxation and genuine stress incontinence. This procedure suspends the anterior vaginal wall to the anterior rectus fascia, and in doing so gives support to the bladder neck, anterior vaginal wall and vaginal apex. The procedure is performed at the time of vaginal hysterectomy or correction of anterior vaginal wall relaxation. The authors present their experience with this technique in 31 patients.

The need and value of routine screening of all pregnant women for hepatitis B surface antigen.

A prospective study was performed to determine whether the risk factor for hepatitis B, proposed by Centers for Disease Control (CDC), USA, are reliable predictors for the hepatitis B surface antigen (HBsAg) carrier state in an obstetric population. In the period between January 1, 1991 and December 31, 1992, all pregnant women from geographically defined areas of the Istrian and Rijeka districts were routinely screened for hepatitis B surface antigen (HBsAg). Among 10,627 pregnant women, 107 (1%) HBsAg positive cases were registered. History risk factors recommended by CDC were recorded in 46 (43%) out of 107 HBsAg positive women. The other 61 subjects had no recognizable risk factors. The screening of pregnant women for HBsAg only on the basis of the CDC recommended history guidelines, would have left 57% of our HBsAg positive mothers undetected and therefore their children unvaccinated against hepatitis B infection. Our results confirmed the need and value of the new CDC recommendations about routine prenatal screening of all pregnant women for HBsAg until hepatitis B vaccine is included in the scheme of compulsory vaccination of all newborns.

[Hospital treatment of child-tourists at the Pula Medical Center 1983-1988]. / Bolnicki lijecena djeca-turisti u Puli od 1983. do 1988. godine.

During the 6-year period, 687 children-tourists, aged up to 12 years, were treated at the departments of the Medical Center of Pula; on average 114.5 (standard deviation +/- 17.79) children per year. There were 449 (65.4%) patients from different parts of Yugoslavia and 238 (24.6%) from abroad. Two hundred and fifty-four (37.9%) patients were treated at the Department of Paediatrics 231 (33.7%) at the Department of Surgery, 168 (24.4%) at the Department of Infectious Diseases, then 30 (4.4%) at the Department of Ear, Nose and Throat, 3 female patients (0.4%) at the Department of Gynecology and only one boy was treated at the Department of Ophthalmology. There were 22 (3.2%) newborns, 48 (7%) infants, 143 (20.8%) were one to three years old, then 130 (18.9%) were 4 to six years old and 344 (50.1%) older than 7 years. During the 6-year period, children-tourists accounted for 5.1% of the hospitalized children. 81.3% of the patients were treated during June, July and August, the peak being in July (39%). The most frequent diseases were from the group "infectious and parasitic diseases" (188 patients = 27.4%) and among them "diarrheal syndrome" in 82% of patients, then the group "injuries and poisons" (140 patients 20.4%) among which there were 57 (40.4%) superficial injuries, contusions and open wounds, then in 33 (23.5%) patients different fractures; in this group 10% of children were poisoned mostly by drugs (sedatives and tranquilizers) used by their parents.(ABSTRACT TRUNCATED AT 250 WORDS)

[Changes in the incidence and clinical picture of rheumatic fever in 6 communities in the Istrian Subregion (1962-1986)]. / Promjena incidencije i klinicke slike reumatske vrucice u sest opcina Istarske subregije (1962-1986).

Two hundred patients up to 13 years of age who were admitted to the Department of Pediatrics, Pula, between 1962 and 1986 with acute rheumatic fever were studied. Of these patients, 21 (10.5%) were in relapse. During the first 12 years of follow-up, 177 patients were treated and during the last 13 years only 23 patients. The average hospital incidence declined from 2.7% in 1963 to 0.3% or less between 1975 and 1986. The average annual incidence of acute rheumatic fever in a group of patients aged 0 to 14 years decreased from 67/100,000 in 1963 to 5.4/100,000 children in 1986. Within the last 13 years of follow-up, no relapse was observed. From 1966, no patient with decompensation of the heart was treated; and from 1961, no mortality was observed as a consequence of acute rheumatic fever. There are a number of factors which influenced these good trends, such as advances in health protection of children, better primary and secondary antirheumatic prophylaxis and, of course, continued improving of the standards of living in this subregion. It is concluded that in spite of the declining incidence and milder course of acute rheumatic fever, the disease still remains a serious public health problem due to a possible cardiac damage.