Canan Agalar

In vitro S. epidermidis and S. aureus adherence to composite and lightweight polypropylene grafts.

BACKGROUNDnDespite the significant risk of infection, prosthetic graft materials have become indispensable for incisional hernia repair. Composite and lightweight grafts have been developed to overcome adhesion and rigidity. The aim of this study was to evaluate in vitro S. epidermidis and S. aureus adherence to these new generation grafts, which have modified composition and textile properties.nnnMATERIALS AND METHODSnIn this experimental study, sterile samples of multifilament polypropylene, multifilament lightweight composite, monofilament composite, and monofilament polypropylene grafts were incubated with slime positive S. epidermidis and S. aureus strains for 24 h. The grafts were washed and vortexed in saline. The saline was passaged to blood agar and incubated for 24 h. The colonies were counted. Naïve and incubated graft materials were examined by scanning electron microscopy to reveal both textile properties and biofilm formation. Physicochemical properties were evaluated. Wilcoxon signed ranks test and Friedman test were used for statistical analysis.nnnRESULTSnS. epidermidis showed a significantly decreased adherence to monofilament polypropylene graft, and increased adherence to multifilament polypropylene graft (P<0.05). S. aureus showed a significant affinity for monofilament composite graft (P<0.05). SEM studies showed that biofilm formation was present on multifilament polypropylene graft.nnnCONCLUSIONSnBoth S. epidermidis and S. aureus had significantly less adherence to multifilament lightweight composite than multifilament polypropylene graft. S. epidermidis showed a greater affinity to monofilament composite graft compared with monofilament polypropylene graft. Overall S. epidermidis adherence for multifilament lightweight composite and monofilament composite was less than multifilament polypropylene and higher than monofilament polypropylene. S. epidermidis and S. aureus showed different adherence for each graft. Changes in material composition and textile properties may well influence bacterial adherence.

The microbiological diagnosis of tuberculous meningitis: results of Haydarpasa-1 study

We aimed to provide data on the diagnosis of tuberculous meningitis (TBM) in this largest case series ever reported. The Haydarpasa-1 study involved patients with microbiologically confirmed TBM in Albania, Croatia, Denmark, Egypt, France, Hungary, Iraq, Italy, Macedonia, Romania, Serbia, Slovenia, Syria and Turkey between 2000 and 2012. A positive culture, PCR or Ehrlich-Ziehl-Neelsen staining (EZNs) from the cerebrospinal fluid (CSF) was mandatory for inclusion of meningitis patients. A total of 506 TBM patients were included. The sensitivities of the tests were as follows: interferon-γ release assay (Quantiferon TB gold in tube) 90.2%, automated culture systems (ACS) 81.8%, Löwenstein Jensen medium (L-J) 72.7%, adenosine deaminase (ADA) 29.9% and EZNs 27.3%. CSF-ACS was superior to CSF L-J culture and CSF-PCR (p <0.05 for both). Accordingly, CSF L-J culture was superior to CSF-PCR (p <0.05). Combination of L-J and ACS was superior to using these tests alone (p <0.05). There were poor and inverse agreements between EZNs and L-J culture (κ = -0.189); ACS and L-J culture (κ = -0.172) (p <0.05 for both). Fair and inverse agreement was detected for CSF-ADA and CSF-PCR (κ = -0.299, p <0.05). Diagnostic accuracy of TBM was increased when both ACS and L-J cultures were used together. Non-culture tests contributed to TBM diagnosis to a degree. However, due to the delays in the diagnosis with any of the cultures, combined use of non-culture tests appears to contribute early diagnosis. Hence, the diagnostic approach to TBM should be individualized according to the technical capacities of medical institutions particularly in those with poor resources.

Staged Abdominal Repair for Treatment of Moderate to Severe Secondary Peritonitis

The aim of this study was to evaluate the effects of planned relaparotomy and to assess factors that may contribute to mortality in patients with moderate to severe secondary peritonitis. A total of 36 consecutive patients with an Acute Physiologic and Clinical Health Evaluation (APACHE) II score of >10 were enrolled the study for a 2-year period. The mean age of the patients was 56 years (17-92 years), and 23% of them were male. One-third of them had postoperative peritonitis; 152 scheduled operations were done, and the overall mortality rate was 36%. For patients whose septic source was in the upper gastrointestinal system, control of the source was more difficult (p = 0.004). Overall, 28 complications developed in 61% of the patients. Initial and second-day APACHE II scores were 14.5 (11-27) and 12.0 (9-25), respectively. The initial APACHE II score of survivors was lower than that of nonsurvivors [p = 0.0001, 95% confidence interval (CI) -9.5, -3.6]. Second-day APACHE II scores were not different (p = 0.19; 95% CI -3.79, 0.80). Striking end or lateral duodenal leaks were clearly associated with high mortality. It is found that the initial APACHE II score, the success of controlling the source, the occurrence of complications, and the type of illness are independent factors that may affect mortality. We concluded that staged abdominal repair should be used with caution in the treatment of lateral or end duodenal leaks. It is a good alternative to conventional laparotomy for moderate to severe forms of secondary peritonitis from other sources.

Hamsi scoring in the prediction of unfavorable outcomes from tuberculous meningitis: results of Haydarpasa-II study

Predicting unfavorable outcome is of paramount importance in clinical decision making. Accordingly, we designed this multinational study, which provided the largest case series of tuberculous meningitis (TBM). 43 centers from 14 countries (Albania, Croatia, Denmark, Egypt, France, Hungary, Iraq, Italy, Macedonia, Romania, Serbia, Slovenia, Syria, Turkey) submitted data of microbiologically confirmed TBM patients hospitalized between 2000 and 2012. Unfavorable outcome was defined as survival with significant sequela or death. In developing our index, binary logistic regression models were constructed via 200 replicates of database by bootstrap resampling methodology. The final model was built according to the selection frequencies of variables. The severity scale included variables with arbitrary scores proportional to predictive powers of terms in the final model. The final model was internally validated by bootstrap resampling. A total of 507 patients’ data were submitted among which 165 had unfavorable outcome. Eighty-six patients died while 119 had different neurological sequelae in 79 (16xa0%) patients. The full model included 13 variables. Age, nausea, vomiting, altered consciousness, hydrocephalus, vasculitis, immunosuppression, diabetes mellitus and neurological deficit remained in the final model. Scores 1–3 were assigned to the variables in the severity scale, which included scores of 1–6. The distribution of mortality for the scores 1–6 was 3.4, 8.2, 20.6, 31, 30 and 40.1xa0%, respectively. Altered consciousness, diabetes mellitus, immunosuppression, neurological deficits, hydrocephalus, and vasculitis predicted the unfavorable outcome in the scoring and the cumulative score provided a linear estimation of prognosis.

Genitourinary brucellosis: results of a multicentric study

This study reviewed the clinical, laboratory, therapeutic and prognostic data on genitourinary involvement of brucellosis in this largest case series reported. This multicentre study pooled adult patients with genitourinary brucellar involvement from 34 centres treated between 2000 and 2013. Diagnosis of the disease was established by conventional methods. Overall 390 patients with genitourinary brucellosis (352 male, 90.2%) were pooled. In male patients, the most frequent involved site was the scrotal area (n=327, 83.8%), as epididymo-orchitis (n=204, 58%), orchitis (n=112, 31.8%) and epididymitis (n=11, 3.1%). In female patients, pyelonephritis (n=33/38, 86.8%) was significantly higher than in male patients (n=11/352, 3.1%; p<0.0001). The mean blood leukocyte count was 7530±3115/mm3. Routine laboratory analysis revealed mild to moderate increases for erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The mean treatment duration and length of hospital stay were significantly higher when there were additional brucellar foci (p<0.05). Surgical operations including orchiectomy and abscess drainage were performed in nine (2.3%) patients. Therapeutic failure was detected in six (1.5%), relapse occurred in four (1%), and persistent infertility related to brucellosis occurred in one patient. A localized scrotal infection in men or pyelonephritis in women in the absence of leucocytosis and with mild to moderate increases in inflammatory markers should signal the possibility of brucellar genitourinary disease.

A RAT MODEL OF POLYPROPYLENE GRAFT INFECTION CAUSED BY STAPHYLOCOCCUS EPIDERMIDIS

Background:u2003 The aim of this study was to constitute a valid graft infection model with Staphylococcus epidermidis in rats.

Evaluation of tularaemia courses: a multicentre study from Turkey

In this multicentre study, which is the largest case series ever reported, we aimed to describe the features of tularaemia to provide detailed information. We retrospectively included 1034 patients from 41 medical centres. Before the definite diagnosis of tularaemia, tonsillitis (nxa0=xa0653, 63%) and/or pharyngitis (nxa0=xa0146, 14%) were the most frequent preliminary diagnoses. The most frequent clinical presentations were oropharyngeal (nxa0=xa0832, 85.3%), glandular (nxa0=xa0136, 13.1%) and oculoglandular (nxa0=xa0105, 10.1%) forms. In 987 patients (95.5%), the lymph nodes were reported to be enlarged, most frequently at the cervical chain jugular (nxa0=xa0599, 58%), submandibular (nxa0=xa0401, 39%), and periauricular (nxa0=xa055, 5%). Ultrasound imaging showed hyperechoic and hypoechoic patterns (59% and 25%, respectively). Granulomatous inflammation was the most frequent histological finding (56%). The patients were previously given antibiotics for 1176 episodes, mostly with β-lactam/β-lactamase inhibitors (nxa0=xa0793, 76%). Antituberculosis medications were provided in seven (2%) cases. The patients were given rational antibiotics for tularaemia after the start of symptoms, with a mean of 26.8xa0±xa037.5xa0days. Treatment failure was considered to have occurred in 495 patients (48%). The most frequent reasons for failure were the production of suppuration in the lymph nodes after the start of treatment (nxa0=xa0426, 86.1%), the formation of new lymphadenomegalies under treatment (nxa0=xa0146, 29.5%), and persisting complaints despite 2xa0weeks of treatment (nxa0=xa077, 15.6%). Fine-needle aspiration was performed in 521 patients (50%) as the most frequent drainage method. In conclusion, tularaemia is a long-lasting but curable disease in this part of the world. However, the treatment strategy still needs optimization.

The effect of hypothermia on splanchnic flows and lung in a two-hit hemorrhagic shock model.

BACKGROUNDnTo evaluate the effect of hypothermia on bacterial translocation, splanchnic vascular flow, lung tissue weight, and levels of malondialdehyde (MDA) and nitric oxide (NO) in a two-hit model of hemorrhagic shock.nnnMETHODSnThirty rats were randomly allocated into three groups of 10 rats each. In the control group (group C), rats were treated without hemorrhage, and normothermia (37 degrees C) was maintained. In the mild hypothermia group (group MH), rats were subjected to volume-controlled hemorrhage (2 mL/100g) and a rectal temperature of 34 degrees C was maintained. In the normothermic group (group NT), rats were treated as in group MH, except for hypothermia. Seventy-two hours after hemorrhagic shock (first insult), Pseudomonas aeuruginosa was administered intratracheally as a second insult. Finally, mesenteric vascular flow patterns were recorded. Bacterial translocation was studied from tissue samples of spleen, liver, and mesenteric lymph nodes. Blood samples were obtained to evaluate the possible presence of bacteria in the bloodstream. Lung tissue weight ratio, MDA, and NO levels in lung tissue were assessed.nnnRESULTSnRenal, mesenteric, and portal venous flow rates were found to be lower in groups MH and NT in comparison with group C. Blood flow profiles were lower in group NT than in group MH (P<0.05). Bacterial translocation was not observed in group C, and it was detected more often in group NT than in group MH. Lung weight ratio was found to be higher in group NT compared with groups MH and C. Although it did not reach the level of statistical significance, MDA level in the control group was lower than that in the NT group (P=0.085).nnnCONCLUSIONnHypothermia corrected mesenteric blood flow and decreased the occurrence of bacterial translocation in the two-hit model of hemorrhagic shock and tracheal inoculaton of P. aeruginosa.

Mild Hypothermia Improves Survival During Hemorrhagic Shock Without Affecting Bacterial Translocation

Background: Accidental hypothermia in patients with hemorrhagic shock (HS) is associated with increased mortality. However, experimental mild and moderate hypothermia has beneficial effects. The mechanisms for beneficial effects of hypothermia have not been completely understood. Therefore, the aim of this study was to investigate the effect of hypothermia on survival, bacterial translocation (BT), and remote pulmonary injury in a controlled HS model in rats. Methods: HS was achieved by blood withdrawal through femoral vein. Rats in the normothermia group (group I) were maintained at 37°C. Mild hypothermia group (group II) was observed at 32°C that was spontaneously induced by exposure to ambient temperature. Moderate hypothermia of 28°C was actively induced by external cooling in group III for 90 min. Survival and neurological deficit scores (NDS) were recorded at 24th hr. Mesenteric lymph nodes, liver and spleen samples were collected. Myeloperoxidase (MPO) and malondialdehyde (MDA) levels were measured in lung tissue. Results: Blood pressure significantly increased in hypothermia groups. Mild hypothermia significantly increased survival. No difference was found in BT rates in groups. Hypothermia was found to significantly decrease the NDS points in group III, compared to group I. There was no difference in lung tissue MPO levels among groups. Lung tissue MDA levels increased significantly in groups II and III. Conclusions: Mild hypothermia improved blood pressure, survival, and neurological outcome with a possible detrimental effect on pulmonary ROS production during HS in rats. These effects of hypothermia are not associated with BT.

Liver involvement in patients with brucellosis: results of the Marmara study

Brucellosis is a zoonotic disease that primarily affects the reticuloendothelial system. But, the extent of liver damage in due course of the disease is unclear. This study included 325 brucellosis patients with significant hepatobiliary involvement identified with microbiological analyses from 30 centers between 2000 and 2013. The patients with ≥5 times of the upper limit of normal for aminotransferases, total bilirubin level ≥2xa0mg/dl or local liver lesions were enrolled. Clinical hepatitis was detected in 284 patients (87.3xa0%) and cholestasis was detected in 215 (66.1xa0%) patients. Fatigue (91xa0%), fever (86xa0%), sweating (83xa0%), arthralgia (79xa0%), and lack of appetite (79xa0%) were the major symptoms. Laboratory tests showed anemia in 169 (52xa0%), thrombocytopenia in 117 (36xa0%), leukopenia in 81 (25xa0%), pancytopenia in 42 (13xa0%), and leukocytosis in 20 (6xa0%) patients. The most commonly used antibiotic combinations were doxycycline plus an aminoglycoside (nu2009=u200973), doxycycline plus rifampicin (nu2009=u200971), doxycycline plus rifampicin and an aminoglycoside (nu2009=u200927). The duration of ALT normalization differed significantly in three treatment groups (pu2009<u20090.001). The use of doxycycline and an aminoglycoside in clinical hepatitis showed better results compared to doxycycline and rifampicin or rifampicin, aminoglycoside, doxycycline regimens (pu2009<u20090.05). However, the length of hospital stay did not differ significantly between these three combinations (pu2009>u20090.05). During the follow-up, treatment failure occurred in four patients (1xa0%) and relapse was seen in three patients (0.9xa0%). Mortality was not observed. Hepatobiliary involvement in brucellosis has a benign course with suitable antibiotics and the use of doxycycline and an aminoglycoside regimen seems a better strategy in select patients.