Daptomycin versus teicoplanin in the treatment of osteomyelitis: Results of the Göztepe retrospective cohort study.

OBJECTIVES: Daptomycin is highly effective against Gram-positive multidrug-resistant bacteria. Publications on daptomycin in osteomyelitis treatment are limited. PATIENTS AND METHODS: In this multicenter retrospective cohort study, the aim was to evaluate the outcomes of osteomyelitis cases having received daptomycin or teicoplanin. This multicenter retrospective cohort study gathered data from seven centers located in five cities of Turkey. Study inclusion criteria were as follows: (a) magnetic resonance imaging and/or direct X-ray revealed osteomyelitis or biopsy pathologic examination results concomitant with osteomyelitis. Chi-squareand Student t-tests were used for statistical comparison. RESULTS: A total of 72 patients, 38 cases in the daptomycin group and 34 cases in the teicoplanin group diagnosed with osteomyelitis fulfilling the study inclusion criteria, were included in the study. Clinical success at the end of induction therapy was achieved in 32/38 cases in the daptomycin cohort vs. 30/34 cases in the teicoplanin cohort (p: 0.73). CONCLUSION: Although this is a limited experience in a small but well-defined cohort, our data suggest that daptomycin may be a safe alternative to glycopeptides in osteomyelitis treatment. A randomized controlled clinical study involving larger cohorts may increase the available evidence.

Modulation of cigarette smoke extract-induced human bronchial epithelial damage by eucalyptol and curcumin.

Smoking is one of the most important leading death cause worldwide. From a toxicological perspective, cigarette smoke serves hazards especially for the human being exposed to passive smoke. Over the last decades, the effects of natural compounds on smoking-mediated respiratory diseases such as COPD, asthma, and lung cancer have been under investigation, as well as the mechanistic aspects of disease progression. In the present study, the protective mechanism of eucalyptol (EUC), curcumin (CUR), and their combination on BEAS-2B cells were investigated in vitro to understand their impact on cell death, oxidative cell injury, and inflammatory response induced by 3R4F reference cigarette extract (CSE). According to the present findings, EUC, CUR, and their combination improved cell viability, attenuated CSE-induced apoptosis, and LC3B expression. Further, CSE-induced oxidative damage and inflammatory response in human bronchial epithelial cells were remarkably reduced by the combination treatment through modification of enzymatic antioxidant activity, GSH, MDA, and intracellular ROS levels as well as nitrite and IL-6 levels. In addition, nuclear translocation of Nrf2, a regulatory protein involved in the indirect antioxidant response, was remarkably up-regulated with the combination pre-treatment. In conclusion, EUC and CUR in combination might be a potential therapeutic against smoking-induced lung diseases through antioxidant and inflammatory pathways and results represent valuable background for future in vivo pulmonary toxicity studies.

Toxicity, mutagenicity and stability assessment of simply produced electrolyzed water as a wound healing agent in vitro.

Over the last decade, electrolyzed water (EW) produced by salt and tap water has gained importance due to its antimicrobial effects. Regarding to chlorine-based compounds, EW also used in post-harvest safety of food processing and sterilization of surfaces. The latest studies suggested that EW might act as wound healing agent due to anti-infective and cell proliferative properties. In this study, we evaluated acute contact cytotoxicity in L929 mice fibroblast cells and wound healing activity of EWs in vitro. In addition, mutagenic activity was evaluated by Ames test with and without metabolic activation by S9 fraction and the stability profile of freshly prepared EWs has been followed up. According to the results, strong acid (StAEW) and mixed EW (MEW) showed dose-dependent cytotoxicity due to possible high HOCl concentration, while slightly acidic and catholyte EW (CEW) were not cytotoxic even applied directly for 30 sec. Further, StAEW and CEW showed a significant increase in L929 cell migration in scratch assay. Likewise, with/ without metabolic activation, neither of EWs had shown mutagenic profile in TA 98 and TA100 strains of Salmonella typhimurium. Follow-up of ORP (oxidation-reduction potential), pH and FCC (free chlorine concentration) showed that temperature and light were important storage conditions to maintain a stable profile particularly for ORP and FCC, which are the most important indicators for biological activity of EW. According to the present findings, it can be suggested that particularly StAEW, may represent a valuable wound healing agent with an achievable, economical and easy production system when stored under proper conditions.

In vitro biocompatibility study approaches to evaluate the safety profile of electrolyzed water for skin and eye.

Electrolyzed water (EW) is a widely used disinfectant agent with high oxidation-reduction potential (ORP). Although EW has been used in many areas, such as food hygiene, agriculture, and animal husbandry, the studies presented in the literature are not enough to clarify the toxic effects of EW. The aim of this study is, therefore, to produce EWs at different pH, ORP, and chlorine concentrations and to assess their safety in terms of toxicology. At the beginning of the study, the antimicrobial activity of the EW types with respect to bacteria and fungus was investigated. EWs below pH 7 were all effective in inactivating Enterococcus hirae, Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans completely. In vitro studies of cell cultures revealed that different concentrations of EWs were not cytotoxic for the L929 cells under 10- to 80-fold dilutions. In addition, it has been determined that produced EWs did not have irritation potential, according to the in vitro EpiDerm™, reconstituted skin irritation test in the frames of biocompatibility tests. For the mucous membrane irritation test, the hen's egg test-chorioallantoic membrane experiment was performed, and EWs were found to have no eye irritation. In conclusion, it has been shown that produced EWs with antimicrobial efficacy were found to be safe for skin and eye according to in vitro biocompatibility study studies. Thus, the establishment of a technological infrastructure for the EW production and the use of produced EW as an effective disinfectant in the food, medical, and agricultural areas should be encouraged.

Evaluation of the mutagenic and genotoxic effects of the ALC67 thiazolidine compound in Salmonella strains and human lymphocytes in vitro.

ALC67 is an N-acylated thiazolidine compound with promising anticancer activity that led to the recent discovery of a series of 3-propionyl thiazolidine-4-carboxylic acid ethyl esters as a family of novel antiproliferative agents. Since the mutagenic and genotoxic properties of marketed anticancer molecules constitute a main issue to be addressed, this study focused on the analysis of the mutagenicity, antimutagenecity, and genotoxicity of this molecule. The mutagenicity and antimutagenicity of ALC67 were evaluated by Ames test performed on Salmonella TA98 and TA100 strains. The genotoxicity of this molecule was investigated in the chromosomal aberration assay on human lymphocytes. All results revealed that the analyzed structure is not mutagenic in the two Salmonella strains tested and was not genotoxic in human lymphocytes in vitro On the other hand, it showed a weak antimutagenic effect in these two bacterial strains. The above results indicate that after performing some more mutagenicity assays using the other recommended strains, this compound can be safely used for the development of new structures exhibiting anticancer activities.

Piperacillin/tazobactam vs. cefoperazone/sulbactam in adult low-risk febrile neutropenia cases.

AIM: The aim of this study was to compare the efficacy of piperacillin/tazobactam (P/T) and cefoperazone/sulbactam (C/S) in the empirical treatment of adult neutropenic fever. METHODS: Data and outcomes of low-risk adult cases with neutropenic fever and treated with P/T (4.5 g q6h) or C/S (2 g q8h) between 2005 and 2011 June were extracted from our database. Risk evaluation was made according to criteria of Multinational Association for Supportive Care in Cancer (MASCC) and a score of ≥ 21 was considered as low risk. Data were collected prospectively by daily visits and evaluated retrospectively. Primary outcome was - fever defervescence at 72 h in combination with success without modification (referring to episodes where the patient recovered from fever with disappearance of signs of infection without modification to initial empirical treatment). All-cause mortality referred to death resulting from a documented or presumed infection or unidentified reason during the treatment and 30-day follow-up period. RESULTS: A total of 172 patients (113 cases P/T and 59 cases C/S) fulfilled the study inclusion criteria. Persistent response in P/T arm was 73.5%, whereas it was 64.5% in C/S arm (p > 0.05). Rates of any modification were also similar in both treatment arms. All-cause mortality during the treatment and 30-day follow-up period was not significantly different (P/T: 4/113 vs. C/S: 2/59, p > 0.05). There was no severe adverse effect requiring antibiotic cessation in both cohorts. CONCLUSION: In conclusion, our data suggest that C/S may be a safe alternative to P/T in the empirical treatment of adult low-risk febrile neutropenia cases.

Publication rates of public health theses in international and national peer-review journals in Turkey.

BACKGROUND: Thesis is an important part of specialisation and doctorate education and requires intense work. The aim of this study was to investigate the publication rates of Turkish Public Health Doctorate Theses (PHDT) and Public Health Specialization (PHST) theses in international and Turkish national peer-review journals and to analyze the distribution of research areas. METHODS: List of all theses upto 30 September 2009 were retrieved from theses database of the Council of Higher Education of the Republic of Turkey. The publication rates of these theses were found by searching PubMed, Science Citation Index-Expanded, Turkish Academic Network and Information Center (ULAKBIM) Turkish Medical Database, and Turkish Medline databases for the names of thesis author and mentor. The theses which were published in journals indexed either in PubMed or SCI-E were considered as international publications. RESULTS: Our search yielded a total of 538 theses (243 PHDT, 295 PHST). It was found that the overall publication rate in Turkish national journals was 18%. The overall publication rate in international journals was 11.9%. Overall the most common research area was occupational health. CONCLUSION: Publication rates of Turkish PHDT and PHST are low. A better understanding of factors affecting this publication rate is important for public health issues where national data is vital for better intervention programs and develop better public health policies.

Carbapenem versus fosfomycin tromethanol in the treatment of extended-spectrum beta-lactamase-producing Escherichia coli-related complicated lower urinary tract infection.

The aim of this observational prospective study was to compare the effect of fosfomycin tromethanol (FT) and carbapenems (meropenem or imipenem cilastatin) in the treatment of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli-related complicated lower urinary tract infection (CLUTI). Inclusion criteria were: patients who were aged >18 yr with dysuria or problems with frequency or urgency in passing urine; those with >20 leukocytes/mm³ in urine microscopy and culture-proven ESBL-producing carbapenem or FT-sensitive E. coli in the urine (>105 cfu/mm³); no leukocytosis or fever; and who were treated with ft (oral 3 g sachet x 1 every other night, three times) or carbapenems between march 2005 and January 2006 in our outpatient clinic and hospital. A total of 47 CLUTI attacks in 47 patients (27 FT group, 20 carbapenem group) were observed prospectively. Clinical and microbiological success in the carbapenem and ft groups was similar (19/20 vs 21/27 and 16/20 vs 16/27 p>0.05). Drug acquisition costs were significantly lower in the FT group (p<0.001). Although it is not a randomized controlled study, these data show that ft may be a suitable, effective and cheap alternative in the treatment of ESBL-producing E. coli-related CLUTI.

Complementary-alternative medicine among cancer patients in the western region of Turkey.

PURPOSE: To investigate the complementary/alternative medicine (CAM) applications and factors affecting its use among cancer patients in the western region of Turkey. PATIENTS AND METHODS: Face-to-face interview technique was used. Patients were asked to answer a questionnaire about their socio-demographic features, their level of knowledge about the disease and CAM application features. RESULTS: 220 adult cancer patients (79 male) were evaluated. Ninety-three (42.3%) were using at least one CAM method, the most common being herbal products which were preferred by 81 (36.3%) patients. Stinging nettle (Urtica dioica) was the most commonly used herbal product. Next was nutritional support, preferred by 45 (20.3%) patients. Eighty- nine (44.5%) of 200 patients who knew the diagnosis and 4 of 20 (20%) who did not were using CAM. In the patient group with awareness of the diagnosis, CAM application was significantly higher (p=0.034). CAM applications were detected in 34 of 70 (48.5%) patients with recurrent disease while 54 of 150 (36%) patients without recurrent disease were using CAM. The CAM applications were significantly higher in the group with recurrent disease (p=0.006). Fifty-three of 103 (51.4%) patients who had advanced disease were using CAM, while only 40 of 117 (34.1%) patients with local or locally advanced disease were using it. CAM applications were significantly higher in the group with advanced disease (p=0.030). Besides, knowing the diagnosis and disease recurrence were also independent risk factors for CAM usage [odds ratio (OR(: 3.1; 95% confidence interval (CI): 1.0-9.8 and OR: 2.2; 95% CI: 1.2-4.0 respectively]. As a result, nearly half of the patients (42.3%) in this region were using at least one of the CAM methods. CONCLUSION: The severity of the disease (recurrence and dissemination) and patients' awareness of the diagnosis were the most important factors affecting the CAM applications.

Is neopterin level a predictive and differential biomarker in patients with thyroid disorders?

Neopterin production provides information about the extent of cellular immune activation. Measurement of neopterin levels may also provide predictive and prognostic information in patients with malignant thyroid diseases. In the present study, neopterin levels were investigated in patients with thyroid disorders (no.=68). Twenty-four patients had papillary thyroid cancers and the rest of them benign thyroid disorders. Results were compared with a healthy control group (no.=30). It was observed that there was a significant difference in neopterin levels between the control group and the thyroid disorders group (p<0.05). The mean neopterin levels in malignant and benign patients were also significantly different (p<0.05). Monitoring of urinary neopterin profile may be used in early diagnosis of papillary thyroid cancer. Neopterin seems to be a differential biomarker for malignant and benign thyroid disorders.

Pancreatitis in the elderly.

Inflammatory diseases of the pancreas are not uncommon in the elderly; although acute and chronic pancreatitis in this age group are essentially the same diseases as in younger patients, some features are unique to the old patient. Acute pancreatitis in the elderly is more commonly of gallstone etiology; it is also more likely to have an atypical clinical presentation, making recognition more difficult. In acute necrotizing pancreatitis, the elderly patient has an increased risk of complications including multisystem failure; for this reason, such patients should be more carefully monitored and aggressively treated. Chronic pancreatitis with initial onset older than 60 years is rare in the elderly, and generally without apparent cause; much more commonly, it is seen as the advanced stage of a disease started in youth. Diffuse glandular destruction and resulting severe insufficiency are usually present; thus, rather than pain, the most frequent clinical manifestations are steatorrhea and diabetes. These complications should be adequately treated to avoid malnutrition, which may seriously affect the well-being and quality of life in the elderly.

Acute pancreatitis associated with eclampsia: a case report.

This case report describes a 24-yr-old pregnant woman who developed acute pancreatitis while suffering from a severe eclamptic syndrome. Since she had no gallstones or other known aetiological factors of acute pancreatitis, the possibility of an aetiologic role of pancreatic ischaemic changes associated with eclampsia is discussed. From a clinical point of view, acute pancreatitis persisted longer than usual and rendered its management complex.

Ma absorcao e ma digestao: fisiopatologia, diagnostico, tratamento. / Malabsorption and maldigestion: physiopathology, diagnosis and treatment

Sao revistos o conceito, fisiopatologia, classificacao, diagnostico e tratamento da sindrome de ma absorcao, apresentados de forma a interessar o clinico geral e procurando, em diversos aspectos, traduzir a experiencia dos autores