Bulent M. Ertugrul

Evaluation of species distribution and risk factors of candidemia: A multicenter case-control study

This study was planned to determine the risk factors of candidemia, and the most common Candida species causing bloodstream infections. A case-control study which included adult patients was conducted over a 1-year period at tertiary-care educational hospitals in Turkey. A total of 83 candidemia episodes were identified during the study period. Candida albicans was the most common species recovered (45.8%) followed by Candida tropicalis (24.1%) Candida parapsilosis (14.5%) and Candida glabrata which was isolated from only four (4.8%) patients. Presence of a urethral catheter (odds ratio [OR] 2.38; 95% confidence interval [CI] 1.09-5.19; P = 0.02), previous use of antibiotics (OR 2.61; 95% CI 1.05-6.46; P = 0.03), RBC transfusions (OR 2.14; 95% CI 1.16-3.94; P = 0.01) and parenteral nutrition (OR 4.44; 95% CI 2.43-8.11; P < 0.01) were found as independent risk factors for candidemia. TPN (Total Parenteral Nutrition) was an independent risk factor for both C. albicans and non-Candida albicans Candida species (P < 0.001). Most of the risk factors were invasive procedures and former medications. We conclude that a great number of candidemia cases are preventable by means of reduction of unnecessary invasive procedures and the use of antimicrobials.

Osteomyelitis or Charcot neuro- osteoarthropathy? Differentiating these disorders in diabetic patients with a foot problem

Both osteomyelitis and Charcot neuro-osteoarthropathy (CN) are potentially limb-threatening complications of diabetic neuropathy, but they require quite different treatments. Almost all bone infections in the diabetic foot originate from an infected foot ulcer while diabetic osteoarthropathy is a non-infectious process in which peripheral neuropathy plays the critical role. Differentiating between diabetic foot osteomyelitis and CN requires careful evaluation of the patient, including the medical history, physical examination, selected laboratory findings, and imaging studies. Based on available studies, we review the approaches to the diagnostic differentiation of osteomyelitis from CN of the foot in diabetic patients.

Treatment of two postoperative endophthalmitis cases due to Aspergillus flavus and Scopulariopsis spp. with local and systemic antifungal therapy

AbstractBackgroundEndophthalmitis is the inflammatory response to invasion of the eye with bacteria or fungi. The incidence of endophthalmitis after cataract surgery varies between 0.072–0.13 percent. Treatment of endophthalmitis with fungal etiology is difficult.Case PresentationCase 1: A 71-year old male diabetic patient developed postoperative endophthalmitis due to Aspergillus flavus. The patient was treated with topical amphotericin B ophthalmic solution, intravenous (IV) liposomal amphotericin-B and caspofungin following vitrectomy. Case 2: A 72-year old male cachectic patient developed postoperative endophthalmitis due to Scopulariopsis spp. The patient was treated with topical and IV voriconazole and caspofungin.ConclusionAspergillus spp. are responsible of postoperative fungal endophthalmitis. Endophthalmitis caused by Scopulariopsis spp. is a very rare condition. The two cases were successfully treated with local and systemic antifungal therapy.

Mean platelet volume in patients with subclinical hypothyroidism.

Subclinical hypothyroidism (SCH) is frequently encountered in the general population. Since it is generally asymptomatic, these patients are mostly identified through routine screening or evaluation of non-specific symptoms. It has been suggested as a risk factor for cardiovascular disease. On the other hand, mean platelet volume (MPV), which is a determinant of platelet function, is an independent risk factor for cardiovascular disease. The aim of this study was to evaluate MPV values in subclinical hypothyroidic patients when they were subclinical hypothyroidic and became euthyroidic after 12 weeks of levothyroxine replacement therapy. Sixty patients with subclinical hypothyroidism and 78 euthyroid healthy subjects matched for age, gender and body mass index were enrolled in the study. None of the study subject had diabetes, hypertension or dyslipidemia. All the study subjects were evaluated by biochemical and platelet parameters. Subclinical hypothyroidic patients were then reevaluated with the same parameters when they became euthyroid after 12 weeks of levothyroxine treatment. Platelet counts and metabolic parameters, except serum triglyceride and high density lipoprotein cholesterol (HDLC) levels, were similar between the two groups. Serum triglyceride and MPV values were significantly higher (pTG = 0.007 and pMPV < 0.001) while HDLC levels were lower (pHDLC = 0.008) in the subclinical hypothyroidic group. MPV was found to be correlated with only antithyroid peroxidase (anti-TPO) antibody levels (P < 0.001). MPV values were decreased after subclinical hypothyroidic patients became eythyroid. However, post-treatment MPV values were still higher (p = 0.035) in the patient group than in control group. These results suggest that subjects with SCH are susceptible to increased platelet activation and increased MPV values which contribute to increased risk of cardiovascular complications.

Insulin Resistance in Nodular Thyroid Disease

Background. Insulin had been shown to have a mitogenic effect on thyroid cell cultures. The aim of this study was to investigate insulin resistance in patients with euthyroid nodular goiter. Methods. Sixty-three patients with nodular thyroid disease and 83 healthy controls were included in the study. Both the patient and the control group were euthyroid, euglycemic and normotensive. None of the study subjects had risk factors for insulin resistance. All the study subjects were evaluated by serum insulin levels and biochemical parameters and thyroid ultrasound. All subjects with thyroid nodules greater than 1cm (n = 36) were offered to undergo thyroid fine needle aspiration biopsy. Results. The two groups were similar with respect to age, gender, BMI, waist circumference, serum lipid levels, serum fT3, fT4 and TSH levels. But HOMA was found to be significantly higher in the patient group (p: 0.007) and thyroid volume was significantly greater in the patient group (p = 0.03). In the patient group there was a significant correlation between HOMA and nodule volume (p < 0.001) while there was not a significant correlation between HOMA and number of thyroid nodules. Thyroid cancer was diagnosed in 3 of the 36 patients (8.33 %). Conclusions. Insulin resistance may induce increased thyroid proliferation and nodule volume and nodule formation. Therefore, insulin resistance may be a risk factor for euthyoid nodular goiter.

Tuberculous meningitis in adults – experience from Turkey

Background:  The annual incidence of tuberculous meningitis (TM) is unknown. TM is a disease that still often results in residual sequelae, and has a mortality rate ranging between 15 and 51%. Experience of countries such as Turkey where drug‐resistant tuberculosis and TM are prevalent is important.

The seroprevalence of Crimean-Congo haemorrhagic fever among inhabitants living in the endemic regions of Western Anatolia

Abstract Background: In Turkey, Crimean-Congo haemorrhagic fever (CCHF) is seen particularly in the north-eastern part of Anatolia. Aydin was thought to be a non-endemic area, however the first case was reported from Aydin in 2006 and a total of 39 cases were reported between 2006 and 2010. Methods: Four hundred and twenty-nine volunteers from 3 endemic regions of Aydin were enrolled in this study. We determined the IgG seropositivity against the virus by enzyme-linked immunosorbent assay (ELISA) method. Results: IgG seropositivity in the study group was found to be 19.6% (n = 84). Chi-squared automatic interaction detector (CHAID) analysis was performed and a significant relationship between IgG seropositivity and tick-bite was found. The IgG seropositivity rate was 13% in cases without a history of tick-bite, while it was 41.1% in those with a tick-bite history (p < 0.001). In cases without a history of tick-bite (n = 339), the most important factor related to seropositivity was cattle-dealing. The seropositivity rate was higher in women than in men in the group dealing with cattle without a history of tick-bite (p = 0.013). In cases with a tick-bite history, the most important factor related to IgG seropositivity was age; the rate was 81% in cases younger than 34 y old, while it was 29% in cases older than 34 y. Conclusions: This study indicates that people suffering from the disease did not ask for any professional healthcare or that the healthcare providers could not diagnose these cases.

Cyanoacrylate for wound closure in prosthetic vascular graft surgery to prevent infections through contamination

PurposeProsthetic vascular graft infection (PVGI) still occurs at an unacceptably high rate, despite the many measures that have proven effective against infection. The major cause of PVGI is perioperative contamination, which usually occurs before a histological barrier is completed and may threaten graft viability. We assessed the efficacy of cyanoacrylate as a tissue adhesive and barrier against early contamination through the skin.MethodA 1 × 0.5-cm Dacron graft was placed subcutaneously under sterile conditions in 16 Sprague-Dawley rats. The skin was closed with polypropylene sutures in eight rats (group A) and with N-butyl 2-cyanoacrylate in eight rats (group B). The closed incisions were then contaminated with 75 × 106 cfu/ml methicillin-sensitive Staphylococcus aureus. Microbiological and histopathological assessments were done 7 days later, after the rats were killed.ResultsAll of the graft cultures from group A (8/8) were positive for S. aureus whereas all of those from group B (0/8) were negative. This difference was significant (p < 0.001). Histological examination revealed denser inflammatory cell infiltration in group A than in group B.ConclusionsMaintaining skin integrity after closure is of the utmost importance because contamination during the first hours of the procedure may cause PVGI. Cyanoacrylate seems to be a promising molecule not only because of its bacteriostatic effects, but also because it seals the barrier effectively and immediately.

Does physical therapy and rehabilitation improve outcomes for diabetic foot ulcers

One of the most common and serious complications of diabetes mellitus is ulceration of the foot. Among persons with diabetes, 12%-25% will present to a healthcare institution for a foot disorder during their lifespan. Despite currently available medical and surgical treatments, these are still the most common diabetes-related cause of hospitalization and of lower extremity amputations. Thus, many adjunctive and complementary treatments have been developed in an attempt to improve outcomes. We herein review the available literature on the effectiveness of several treatments, including superficial and deep heaters, electro-therapy procedures, prophylactic methods, exercise and shoe modifications, on diabetic foot wounds. Overall, although physical therapy modalities seem to be useful in the treatment of diabetic foot wounds, further randomized clinical studies are required.

An Assessment of Intralesional Epidermal Growth Factor for Treating Diabetic Foot Wounds

BACKGROUND Intralesional epidermal growth factor (EGF) has been available as a medication in Turkey since 2012. We present the results of our experience using intralesional EGF in Turkey for patients with diabetic foot wounds. METHODS A total of 174 patients from 25 Turkish medical centers were evaluated for this retrospective study. We recorded the data on enrolled individuals on custom-designed patient follow-up forms. Patients received intralesional injections of 75 μg of EGF three times per week and were monitored daily for adverse reactions to treatment. Patients were followed up for varying periods after termination of EGF treatments. RESULTS Median treatment duration was 4 weeks, and median frequency of EGF administration was 12 doses. Complete response (granulation tissue >75% or wound closure) was observed in 116 patients (66.7%). Wounds closed with only EGF administration in 81 patients (46.6%) and in conjunction with various surgical interventions after EGF administration in 65 patients (37.3%). Overall, 146 of the wounds (83.9%) were closed at the end of therapy. Five patients (2.9%) required major amputation. Adverse effects were reported in 97 patients (55.7%). CONCLUSIONS In patients with diabetic foot ulcer who received standard care, additional intralesional EGF application after infection control provided high healing rates with low amputation rates.