Cemal Üstün

The accuracy and validity of a weekly point-prevalence survey for evaluating the trend of hospital-acquired infections in a university hospital in Turkey

OBJECTIVE To evaluate the validity of a weekly point-prevalence survey (WPS) by comparing it with a prospective-active incidence survey (PIS). METHODS WPS and PIS were conducted at a tertiary referral hospital between January and December 2006. Each Wednesday, an infection control team reviewed all clinical records of patients with hospital-acquired infections (HAIs) by WPS. Routine PIS was conducted with daily visits by the same team. The Rhame and Sudderth formula was used for converting the data between WPS and PIS. RESULTS During the study period, 1287 HAIs were detected in 37 466 patients by WPS. The mean observed prevalence and calculated prevalence were 5.42% and 5.45%, respectively. The reanimation intensive care unit (ICU) (49.4%) and burns unit (27.6%) had the highest prevalence rates. Pneumonia (0.94%) and urinary tract infections (0.37%) were the most frequent infections. Overall 602 HAIs were detected in 545 patients by PIS. The mean observed incidence and calculated incidence were 2.42/1000-admissions and 2.41/1000-admissions, respectively. The Critical care ICU (37.0/1000-admissions) and burns unit (24.8/1000-admissions) had the highest incidences of HAI. Pneumonia (0.64/1000-admissions) and urinary tract infections (0.37/1000-admissions) were the most frequent infections. CONCLUSIONS This study confirms a close relationship between prevalence and incidence data. WPS may be a useful method for following HAIs when PIS cannot be performed.

Two cases of bacterial meningitis accompanied by thalidomide therapy in patients with multiple myeloma: is thalidomide associated with bacterial meningitis?

Morbidity and mortality in multiple myeloma is often attributed to life-threatening infections. A defect in humoral immunity has been proposed for the predisposition to bacterial infections. Most of the infections are of bacterial origin, and the most serious are septicemia, meningitis, and pneumonia. Thalidomide is a drug with pleiotropic effects. The immunomodulatory effects of thalidomide are at least partially mediated through its ability to down-regulate the pathogenic over-production of tumor necrosis factor-alpha (TNF-alpha). TNF-alpha is a cytokine that plays a central role in the regulation of the host immune and inflammatory response to infection. In the central nervous system, TNF-alpha is involved in induction of a fever response and triggers the release of other cytokines, and may also influence transport of compounds into the brain, leading to cerebrospinal fluid leukocytosis, increased protein influx, and lactate accumulation. Thalidomide has been shown to down-regulate the production of TNF-alpha. On the other hand, knowledge of the effects of thalidomide on granulocyte functions is limited. Thalidomide has been shown to attenuate neutrophil adhesion and chemotaxis. We present herein two cases of Streptococcus pneumoniae bacterial meningitis that developed soon after the initiation of thalidomide treatment, and discuss the effect of thalidomide on the immune system. Although, it is not clear whether thalidomide caused the development of the bacterial infections and meningitis, or what its pathogenetic mechanisms are, physicians should be alert for signs and symptoms of meningitis in patients with multiple myeloma who are treated with thalidomide, especially those in neutropenic states.

Beyin cerrahisi yogun bakım ünitesi enfeksiyon etkenleri ve antibiyotik duyarlılıkları

Osteoporoz ve romatizmal hastaliklar gozun tum tabakalarini etkileyen bulgular ile karsimiza cikmaktadir. Eriskin ve Juvenil Romatoid Artrit, Sjogren Sendromu, Ankilozan Spondilit siklikla goz bulgulari ile beraberlik gosteren romatizmal hastaliklardir. Goz bulgulari siklikla sistemik hastaligin semptomlarina onculuk etmektedirler. Bu hastaliklarda en sik olarak uveit, iridosiklit, vitritis, keratit, sklerit, anterior iskemik optik noropati ve retinal vaskulit gibi okuler inflamasyon bulgulari gorulmektedir. Okuler inflamasyon hastaligin kendisinden kaynaklanabilecegi gibi bu hastaliklarin tedavisinde kullanilan ilaclara bagli olarak da karsimiza cikabilmektedir. Bu calismada osteoporoz ve en sik goz bulgusu izlenen romatizmal hastaliklarin okuler bulgulari literatur esliginde arastirildi.Mirizzi syndrome is an unusual complication of gallstone disease and occurs in approximately 1% of these patients. Some cases can not be identified preoperatively, despite modern imaging techniques. Today, treatment of Mirizzi syndrome is surgical. If Mirizzi syndrome is present, the risk of bile duct injury increases, particularly during laparoscopic surgery. Therefore, preoperative or intraoperative diagnosis is important. Here, we presented a 29 year-old woman with obstructive jaundice who diagnosed as cholelithiasis and choledocholithiasis. Preoperative endoscopic retrograde cholangiography relieved the common bile duct stone but cound not diagnosed the Mirizzi syndrome preoperatively. During laparoscopy, the diagnosis of Mirizzi syndrome was suspected early and the procedure was converted to open cholecystectomy and T-tube to common bile duct. There was no bile duct injury and postoperative course was uneventful.Lenfomalarda akciger tutulumu primer ve sekonder olmak uzere iki sekilde gorulmektedir. Lenfoma hucreleri, akcigerin degisik bolgelerini, yogun bicimde infiltre edebilmektedir. 57 yasinda erkek hastanin 6 aydir devam eden gogus agrisi, boyunda sislik, halsizlik, oksuruk ve balgam yakinmalari mevcuttu. Hasta, hepatosplenomegali, son bir ayda kilo kaybi, ates ve boynunun sol yaninda buyuyen agrili sislik nedeniyle klinigimize yatirildi. Fizik muayenede, boyunda agrili lenfadenopati saptandi. Solunum sistemi muayenesinde sagda solunum seslerinin siddetinde azalma, yer yer krepitan raller mevcuttu. PA akciger grafisinde sag parahiler bolgede non homojen yaygin infiltrasyon saptandi. Toraks tomografisinde ise sag akcigerde santralde hava bronkogrami izlenen konsolide alan, periferde noduler ve retikulonoduler, sol akciger alt lop posterobazal segmentte ve sol akciger ust lop apikoposterior segmentte birkac adet noduler lezyon, paratrakeal lenf bezi ve lokalize alveoler diffuz infiltrasyonlar saptandi. Servikal lenf nodunu histolojik incelenmesinde yuksek grade buyuk hucreli Non-Hodgkin lenfoma tanisi kondu. Hasta 6 siklus CEOP kuru aldi. Kemoterapi tamamlandiktan sonra yapilan incelemelerde daha once varolan akciger lezyonlarinin tumunun kayboldugu goruldu. Bu vaka sistemik non-Hodgkin lenfoma seyri sirasinda akcigeri tutulumu gelisen ve tek basina kemoterapi ile uzun sureli remisyona giren bir nadir olgudur.In this study, we are presenting the results of cytogenetic analysis and molecular cytogenetic analysis (FISH) of the couple and their family, who were referred to our genetic diagnostic laboratory and had bad obstetrics history. We found a normal karyotype (46,XY) in male, and A de novo complex chromosome rearrangement found in a phenotypically normal female was characterized by G-bands, FISH with probes. Her chromosome structure was 46,XX,der(18;22)(18pterrp11.1::22p11.1rqter) del(18)(:p11.1rqter). To determine the parental origin of translocation, we examined the individuals of the family, and we found that the translocation was de novo. We concluded that this carrier family might be due to the unbalanced distribution of translocation, during gamete formation and prenatal diagnosis recommended for their future pregnancies.