Prospective Evaluation of Infections in Geriatric Patients in Intensive Care Units.

Objective: Nosocomial infections (NIs) are major health problems with morbidity and mortality. Geriatric patients require intensive care unit (ICU) admission more frequently, and serious challenges occur during treatment. We aimed to evaluate the risk factors of NI and mortality in geriatric patients admitted to the ICU. Materials and Methods: The study was conducted between April 2018 and April 2019 in two hospitals. We prospectively recorded the data on the forms prepared according to daily ICU visits. Results: During the study period, 600 patients were hospitalized in the ICUs. Geriatric patients constituted 446 (74.3%) of the total number. The NI rate was 59% in adult patients and 80% in geriatric patients. The most frequent NI in geriatric patients was pneumonia (42%). Furthermore, the need for mechanical ventilation support, prolongation of hospital stay, total parenteral nutrition, and tracheostomy were statistically higher in geriatric patients with NI. The mortality rate in geriatric patients was statistically higher than in non-geriatric. We found the rates of prolonged hospitalization, NI development, malignancy, and cerebrovascular disease diagnosis significantly higher in geriatric patients than in non-geriatric patients. Conclusion: NI and mortality rate are higher in geriatrics than in adult patients. Pneumonia is the most common type of NI in the ICU. Identification of risk factors regarding NI and mortality in geriatric patients in ICU will contribute to developing strategies for prevention.

[Case of pneumonia associated sepsis accompaning pulmonary myiasis]. / Pulmoner miyazisin eslik ettigi pnömoniye bagli sepsis olgusu.

Myiasis; is defined as the infestation of dead or living tissues of humans and animals by the diptera larvae. It is prevalent all over the world, especially in tropical and subtropical countries with low socioeconomic status. Myiasis of humans has been associated with low socioeconomic status, alcoholism, mental or neurological diseases, poor personal hygiene, patients with varicose veins, diabetes, malnutrition, advanced stage cancer, pediculosis, immunosuppression, sexually transmitted disease, gingivitis and other oral cavity lesions. Myiasis is most commonly seen as skin invasion in the human body, but can be observed in many areas such as eye, ear, nose, throat, urogenital, intestinal, cerebral and tracheopulmonary. Tracheo pulmonary myiasis is a very rare condition. This report presents a case of pneumonia-associated sepsis in a patient with a tracheostomy accompanied by third-stage larval Sarcophagidae. A 51-year-old male patient developed hypoxic brain injury after myocardial infarction 10 months ago before his admission to the hospital. Tracheostomy and percutaneous endoscopic gastrostomy were performed. Shortness of breath and fever were present for five days. The patient has been admitted to the emergency service with the reason for the deterioration of the general situation. The patient was unconscious. Purulent secretion in the tracheostomy area and bilateral crepitation rales in the lung bases were detected. Leukocyte level was normal with C reactive protein (CRP) 14 mg/dl. Nodular infiltration was detected bilaterally in the middle and lower zones, more prominently in the right thoracic computerized tomography. Seftriaxon, moxifloxacin and fluid therapy were initiated in the patient who was admitted with pneumonia-related sepsis diagnosis. The tracheostomy cannula has changed. On the fourth day of admission, Sarcophagidae third stage larvae were detected in deep tracheal aspiration. Treatment of piperacillin/tazobactam and teicoplanin was started by discontinuing the current antibiotherapy of the patient who had no clinical response and elevated CRP level, 18 mg/dl. The patient was discharged on the 25th day of hospitalization with improved clinical and laboratory responses. Complete healing was observed in the control performed by the home care unit. Bed-dependent, lack of self-care, and poor tracheostomy hygiene were risk factors for this patient. In this case, fluid therapy and antibiotic treatment for sepsis was given but no treatment for myiasis. Larva has been considered to have prepared a base for pneumonia due to the foreign body effect and secretion accumulation. Untreated injuries, especially those with impaired oxygenation, leave the eggs of adult flies and provide a suitable environment for larval development. Therefore, should be given importance to combat with flies and regular tracheostomy care in bedside and tracheostomized patients.

A Stability Indicating HPLC Assay Method for Analysis of Rivastigmine Hydrogen Tartrate in Dual-Ligand Nanoparticle Formulation Matrices and Cell Transport Medium.

The objective of this study was to develop and validate a method for quantitative analysis of rivastigmine hydrogen tartrate (RHT) in dual-ligand polymeric nanoparticle formulation matrices, drug release medium, and cellular transport medium. An isocratic HPLC analysis method using a reverse phase C18 column and a simple mobile phase without buffer was developed, optimised, and fully validated. Analyses were carried out at a flow rate of 1.5 mL/min at 50°C and monitored at 214 nm. This HPLC method exhibited good linearity, accuracy, and selectivity. The recovery (accuracy) of RHT from all matrices was greater than 99.2%. The RHT peak detected in the samples of a forced degradation study, drug loading study, release study, and cellular transport study was pure and free of matrix interference. The limit of detection (LOD) and limit of quantification (LOQ) of the assay were 60 ng/mL and 201 ng/mL, respectively. The method was rugged with good intra- and interday precision. This stability indicating HPLC method was selective, accurate, and precise for analysing RHT loading and its stability in nanoparticle formulation, RHT release, and cell transport medium.

The clinical and laboratory characteristics, treatments, and outcomes of patients with Brucella epididymo-orchitis (BEO) compared to those without BEO.

BACKGROUND/AIM: We aim to describe the clinical and laboratory characteristics, treatment, and outcomes of 21 patients with Brucella epididymo-orchitis (BEO) from Eskisehir Yunus Emre State Hospital, Turkey. MATERIALS AND METHODS: A total of 21 patients with BEO who were diagnosed and followed in the Infectious Diseases Clinic between June 2001 and June 2013 were evaluated retrospectively. RESULTS: One hundred and twenty-eight of 192 patients evaluated throughout the study were male and BEO was determined in 21 (16.4%) patients. A total of 18 (85.7%) patients had a titer of b1:160 in standard agglutination test (STA). Three patients with STA `160 were diagnosed by blood culture. When all the male patients were evaluated in terms of demographic, clinical, and laboratory findings, animal contact, rural living, and subacute clinical type were statistically significantly higher in the group that developed epididymo-orchitis. None of the patients underwent surgery after medical treatment, but due to a delay in diagnosis of brucellosis, orchiectomy was performed in 1 patient with the suspicion of tumor. CONCLUSION: In endemic countries like Turkey, BEO should be considered in the differential diagnosis of epididymo-orchitis. In uncomplicated patients, medical treatment is adequate for BEO.

Awareness regarding the importance of calcium and vitamin D among the undergraduate pharmacy students in Bangladesh.

BACKGROUND: Calcium and vitamin D are two important micronutrients required for maintaining proper bone health. Previous works intended to determine the status of these micronutrients in local population have reported that the people in Bangladesh are at high risk of calcium insufficiency and hypovitaminosis D related health complications. Lack of awareness and insufficient knowledge of the essentiality of these two nutrients are assumed to cause this problem in Bangladesh. The present study was designed and conducted to establish a basic understanding on the level of gap of knowledge and awareness among pharmacy students at undergraduate level in Bangladesh. FINDINGS: A total of 713 students of Bachelor of Pharmacy course participated in the study. The students were asked about basic idea related to calcium and vitamin D and the disorders due to their deficiency, name of common foods containing calcium and vitamin D, their perception regarding the essentiality of the said nutrients etc. It was found that most of the students were familiar with the importance of calcium (98.9%) and vitamin D (99.3%) in bone health. 82.2% students know about the term osteoporosis. Unfortunately, 10.7% and 18.8% students failed to mention at least one food that is rich in calcium and vitamin D, respectively. Most of the students got familiar about the nutrients from their teachers (48.9%) and textbooks (32.8%). CONCLUSION: Being a student of pharmacy, the students should have more comprehensive knowledge about calcium and vitamin D. The present study indicates that the pharmacy students have lack of knowledge about calcium and vitamin D and thus it can be clearly predicted that the condition of general people may be worse.

Complications and efficiency of liver biopsies using the Tru-Cut biopsy Gun.

OBJECTIVES: The study aimed to evaluate the complications and quality of the specimens of percutaneous liver biopsy in patients with chronic viral hepatitis who were scheduled for treatment and also to evaluate the contribution of the knowledge of ultrasound guided (USG) biopsy localization to the existing data. METHODOLOGY: Liver biopsies conducted at our clinic between 2003 and 2008 were retrospectively evaluated. In 53.8% of the cases, hepatobiliary USG was performed to mark the localization of the biopsy site. An automatically triggered Tru-Cut biopsy gun was used. RESULTS: Biopsies were taken from the livers of 236 patients (46.6% male, 53.4% female) with a mean age of 47.1 +/- 12.5 years. The majority of patients had hepatitis C (61.9%); 1.6% experienced major complications (3 patient biliary peritonitis, 1 patient liver bleeding); 52.1% of the samples were > or = 1 cm in length; And 69.7% of the biopsy samples with specified portal area had > or = 4 portal areas. There was no statistically significant difference between the patients with localized and non-localized biopsy site in terms of major complications and length of biopsy samples ( respectively p = 1.000, p = 0.209 ). CONCLUSION: We believe that percutaneous liver biopsy using Tru-Cut biopsy gun can be performed safely, with complications in 1.6% of the procedures. The length of the biopsy specimen is shorter than ideal values. Evaluation of the patients with and without USG-guided biopsy revealed no significant difference in terms of major complications and specimen size.

Treatment of autoimmune thrombocytopenia in a case of chronic hepatitis C with ursodeoxycholic acid.

Pegylated interferon (PEG-IFN) alpha and ribavirin therapy has become the standard treatment in chronic hepatitis C virus (HCH)-infected patients. While thrombocytopenia associated with IFN use is frequently observed among these patients, autoimmune thrombocytopenia is one of the rarely observed adverse effects. In the present report, we present a case with chronic HCV infection in which autoimmune thrombocytopenia developed at week 7 of PEG-IFN alpha 2b plus ribavirin therapy. The patient subsequently received ursodeoxycholic acid (UDCA) treatment. Although there is not an adequate number of studies on this subject, it was concluded that the use of UDCA in cases of autoimmune thrombocytopenia that have developed due to PEG-IFN treatment in chronic HCV infection is a favorable option.

Influenza vaccination in healthcare workers.

BACKGROUND: This study aims to determine side effects in healthcare workers receiving influenza vaccination, and to scrutinize the opinion of and attitude toward vaccination of healthcare workers. METHODS: Five hundred forty-seven hospital personnel employed by the Eskisehir Yunus Emre State Hospital were included in the study which was conducted in November 2006,. Hospital personnel were administered 0.5 ml inactivated influenza vaccine consisting of 2006/2007 strains. Inoculations were given intramuscularly into the deltoid muscle. A specially designated area in the emergency unit was used for the procedure. RESULTS: An evaluation on Day 10 following influenza vaccination demonstrated at least one adverse effect in 197 (36%) hospital personnel. There was no statistical relationship between side effects and age or gender (p=0.860, p=0.929), while side effects were significantly more frequent among subjects receiving their first vaccination (p=0.008) and nurses (p=0.021). The reasons for the lack of prior immunization in 420 (76.8%) HCWs included not considering influenza a serious disease in 124 (29.5%), disbelief in the efficacy of vaccination in 109 (26%), the lack of reimbursement of vaccination in 105 (25%), fear of the side effects of vaccination in 45 (10.7%), preference for other methods of protection in 75 (17.9%), and fear of injection in 29 (6.9%). CONCLUSIONS: The increase in the rate of influenza immunization among healthcare personnel is possible through education, contestation of fear, amelioration of misconceptions, solution of financial issues, constitution of a registry system, and tracking of vaccination.

Brucellosis in central Anatolia: evaluation of complications and relapse.

Brucellosis is an infectious disease involving many organs and tissues. We investigated retrospectively the brucellosis cases at our hospital, in order to study the relationship between clinical, laboratory and therapy findings, and relapse rates. We found that relapse was related to a positive family history, living in a rural area and the presence of complications.

[Peritonitis related to peritoneal dialysis: evaluation of 179 attacks]. / Periton diyalizi ile iliskili peritonit: 179 atagin degerlendirilmesi.

One of the leading problems encountered in patients undergoing peritoneal dialysis is infectious complications including peritonitis. We aimed to investigate the etiology, clinical presentation and therapy of peritonitis attacks in patients undergoing peritoneal dialysis (PD) in two ultimate hospitals in Eskisehir (located at middle Anatolia region of Turkey) over seven years. We determined 179 peritonitis attacks in 74 (62.2%) of 119 patients undergoing PD. The average annual peritonitis incidence in PD patients was found as 0.4. Of 42 patients with multiple peritonitis attacks, seven (16.7%) had relapsing and eight (19%) had recurrent peritonitis. Four (2.2%) of the 179 peritonitis attacks were evaluated as nosocomial peritonitis. The most common findings were abdominal pain (80.4%), cloudy peritoneal fluid (70.9%), increased erythrocyte sedimentation rates (69.3%) and elevated CRP levels (57.5%). Co-morbidities, initial serum albumin reduction, obesity or overweight status and duration of PD catheterization were found as risk factors related to the development of peritonitis in PD patients. The most common causative microorganisms were coagulase-negative staphylococci (21.8%), Staphylococcus aureus (8.9%), Enterococcus spp. (5.6%) and Escherichia coli (3.3%). Eighty two (45.8%) of 179 peritonitis attacks were culture-negative. The antimicrobial agents which have been used for the therapy of peritonitis attacts were cefazolin+ceftazidim (27.9%), cefazolin+amikacin (24%), ceftazidim+vancomycin (9.5%), vancomycin+amikacin (7.3%), vancomycin+amikacin+cefazolin (5.6%), vancomycin alone (5%) and the others (20.7%). Ten (5.6%) patients were placed under hemodialysis due to peritonitis, and seven of 179 attacks in 74 patients who developed peritonitis were fatal (fatality rate: 3.9%). It could be concluded that the patients to undergo PD should be given education about the process, as well the microbiological evaluation of these patients should be looked over. Since gram-positive bacteria were commonly responsible for peritonitis following PD, empirical treatment with vancomycin would lead to more successful results.

Anti-HCV positivity in sexual partners and offspring of patient with chronic hepatitis C.

We investigated the seroprevalence of HCV in stable sexual partners and offspring of chronic hepatitis C patients, and aimed to determine the risk factors involved. 191 anti-HCV and HCV RNA positive subjects who coinhabited with their spouse and/or offspring were included. Risk factors of index cases for disease transmission, liver biopsy results, anti-HCV and HCV-RNA in spouses and/or offspring were evaluated. Together with index cases, a total of 404 family members including 174 stable sexual partners and 230 offspring were included. The most common risk factors among index cases were dental procedures (73.8%), history of surgery (64.9%), and blood transfusions (24.1%). Anti-HCV positivity was established in 11 (2.7%) of the total 404 family contacts--6 sexual partners and 5 offspring. HCV seropositivity was significantly higher in the spouses of index cases with severe hepatitis C compared to those with mild to moderate hepatitis C (p=0.008), but there was no statistically significant correlation between the severity of liver disease in index cases and anti-HCV positivity in their offspring. In conclusion, anti-HCV seropositivity in the spouses and children of patients who are HCV-RNA positive HCV carriers does not appear to be higher than the HCV seroprevalence in our country.