Ahmet Şen

Molecular characterisation and control of Acinetobacter baumannii isolates resistant to multi-drugs emerging in inter-intensive care units

BackgroundA nosocomial outbreak of Acinetobacter baumannii (AB) infections occurred among intensive care units (ICU) (surgery, medical, cardiovascular surgery, coronary unit) of Recep Tayyip Erdogan University Medical School (Rize, Turkey) between January 2011 and May 2012. The identification of isolates and clonal relation among them were investigated by molecular techniques.MethodsA total of 109 AB isolates were obtained from 64 clinical materials from 54 ICU patients and 3 from the hands of healthcare workers (HCWs) of 42 environmental samples. The isolates were identified by 16S rDNA sequencing and OXA- specific PCR. The clonal relation between isolates was investigated by PFGE methods using ApaI restriction enzyme.ResultsAll isolates were determined as AB by 16S rDNA sequencing and OXA-spesific PCR. While the blaOXA-51-like gene was amplified in all isolates, the blaOXA-23-like gene was amplified from 103 isolates. The PFGE pattern generated 9 pulsotypes and showed that the isolates from patients, HCWs, and the environment were genetically related. In 7 of these pulsotypes, there were 107 strains (98%) showing similar PFGE profiles that cannot be distinguished from each other, ranging from 2 to 53. The remaining 2 pulsotypes were comprised of strains closely associated with the main cluster. Two major groups were discovered with similarity coefficient of 85% and above. The first group consisted of 97 strains that are similar to each other at 92.7% rate, and the second group consisted of 12 strains that are 100% identical.ConclusionsThe common utilization of the blood gas device among ICU was the reason for the contamination. AB strains can remain stable for a long period of time, although due to the disinfection procedures applied in hospitals, there is a small chance that the same clone might reappear and cause another epidemic. For that reason, the resistance profiles of the strains must be continuously followed with amplification-based methods, and these methods should be used to support the PFGE method in the short term.

Efficacy of Continuous Epidural Analgesia versus Total Intravenous Analgesia on Postoperative Pain Control in Endovascular Abdominal Aortic Aneurysm Repair: A Retrospective Case-Control Study

We reviewed our experience to compare the effectiveness of epidural analgesia and total intravenous analgesia on postoperative pain control in patients undergoing endovascular abdominal aortic aneurysm repair. Records of 32 patients during a 2-year period were retrospectively investigated. TIVA group (n = 18) received total intravenous anesthesia, and EA group (n = 14) received epidural anesthesia and sedation. Pain assessment was performed on all patients on a daily basis during rest and activity on postoperative days until discharge from ward using the numeric rating scale. Data for demographic variables, required anesthetic level, perioperative hemodynamic variables, postoperative pain, and morbidities were recorded. There were no relevant differences concerning hospital stay (TIVA group: 14.1 ± 7.0, EA group: 13.5 ± 7.1), perioperative blood pressure variability (TIVA group: 15.6 ± 18.1, EA group: 14.8 ± 11.5), and perioperative hemodynamic complication rate (TIVA group: 17%, EA group: 14%). Postoperative pain scores differed significantly (TIVA group: 5.4 ± 0.9, EA group: 1.8 ± 0.8, P < 0.001). Epidural anesthesia and postoperative epidural analgesia better reduce postoperative pain better compared with general anesthesia and systemic analgesia, with similar effects on hemodynamic status.

Spinal anestezi altında yapılan lomber disk cerrahilerinin retrospektif değerlendirmesi

Objective: We investigated feasibility, possible advantages and disadvantages of spinal anesthesia in lomber disc surgery. Methods: We retrospectively analyzed a total of 100 patients operated for elective lomber spinal surgery under spinal anesthesia. Results: Spinal anesthesia was sufficient for lumbar disc surgery in 97 of 100 patients. Three patients received general anesthesia due to insufficient spinal block. Aller gic reaction was observed in one patient receiving general anesthesia, and treated with intravenous steroid and antihistaminic drugs. We observed bradycardia and hypotension necessitating ephedrine administration in eight patients, post dural puncture headache in 10 patients (two patients were discharged at 4 and 7 days later therefore), who received spinal anesthesia. Following spinal anesthesia, patients required first analgesic at 10th hour. Patients receiving general anesthesia demanded first an algesic in the post operative care unit. Conclusion: We are of the opinion that spinal anesthesia may be safely used in lumbar disc surgeries, provided that patients are not positioned until sufficient anxiolytic and spinal block are established. J Clin Exp Invest 2014; 5 (1): 54-58 Key word: Spinal anesthesia, spinal surgery, intraoperative complications, postoperative pain OZET Amac: Lomber disk cerrahisinde spinal anestezinin uygu

The role of cultural interaction in Tianeptine Abuse and Different Tianeptine Application Methods.

Tianeptine is a selective serotonin reuptake enhancer, possessing strong antidepressant and anxiolytic properties. Its relative lack of sedative, anticholinergic and cardiovascular side effects makes it a highly tolerable substance of abuse. However, physical dependence quickly develops and withdrawal symptoms are common. Abusers in Georgia and Armenia use tianeptine by intravenous injection. Drug abusing behaviour usually starts during puberty, since it stems from psychological, social and cultural circumstances. Sociodemographic studies show that drug abusing behaviour in Turkey varies according to region and substance. This paper investigates differences between Georgian foreigners and the local population in the eastern Black Sea region in terms of tianeptine abuse and discusses complications resulting from intravenous injection of tiapentine.

Difficult Airway Management in Osmed Syndrome

Dear Editor; Otospondylomegaepiphyseal dysplasia (OSMED) is an autosomal recessive inherited disorder characterized by sensorineural hearing loss and short legs associated with enlarged epiphyses (1). It is a rare disease, and many mutations and polymorphisms, such as micrognathia, glossoptosis, nonsyndromic cleft palate, Kawasaki disease, coronary artery lesions and decreased hearing, are reported in the COL11A2 gene (2). Typical facial features include mid-facial hypoplasia with a small nose and a flattened bridge of the nose. We wanted to share difficult airway management for a patient who was scheduled for nasal reconstruction with rib grafting due to flattened bridge of the nose (saddle nose) and operated. A 21-year-old patient had sensorineural hearing loss, micrognathia, protruding upper incisors, proximal cortical thickening and anterior curvature of both tibia (Figure 1). Anaesthesia induction with fentanyl and propofol after midazolam premedication and routine monitoring and muscle relaxation were provided. The patient, who had not been intubated in three attempts in spite of cricoid compression with a stylet and positioning by elevation of the head (Mallampati score III, Cormack-Lehane score IV) was hardly intubated with a video laryngoscope. At the end of the operation, lasting for approximately 80 minutes, the patient was extubated with sugammadex and referred to the service after a while. Figure 1 Presence of micrognathia, flattened nose and protrusive eyes in accordance with OSMED syndrome In these patients, palate and mid-facial congenital anomalies show a high possibility of difficult intubation (3). In this condition, the preoperative evaluation and difficult airway preparation must be complete. Moreover, airway instruments, including a laryngeal mask, flexible fibreoptic bronchoscope and video laryngoscope, must be kept available. In our case, the characteristic findings and typical facial appearance, such as disproportionate short stature, short lower extremities and enlarged epiphyses, vertebral body abnormalities and sensorineural hearing loss, were remarkable. The medical history of the patient was questioned in detail, and no pathology was detected in the cardiological examination. Awakening and recovery can also be difficult in patients who had difficult intubation (4). Short-acting rocuronium was preferred for its rapid myorelaxant action, and the specific antagonist sugammadex, which is able to reverse the myorelaxant activity in a prompt fashion. Thus, delayed extubation and haemodynamic fluctuation were prevented. In OSMED syndrome, preoperative evaluation and preparations in the operating room are important with regard to mortality and morbidity because of a difficult airway. We thought that sharing the typical findings in our case and the benefits of alternative airway instruments in the management of difficult airways would be helpful to your readers.