Huseyin Bilgin

Betulinic Acid Protects against Ischemia/ Reperfusion-induced Renal Damage and Inhibits Leukocyte Apoptosis

The possible protective effect of betulinic acid on renal ischemia/reperfusion (I/R) injury was studied. Wistar Albino rats were unilaterally nephrectomized and subjected to 45 min of renal pedicle occlusion followed by 6 h of reperfusion. Betulinic acid (250 mg/kg, i.p.) or saline was administered at 30 min prior to ischemia and immediately before the reperfusion. Creatinine, blood urea nitrogen (BUN), lactate dehydrogenase (LDH) and TNF‐α as well as the oxidative burst of neutrophil and leukocyte apoptosis were assayed in blood samples. Malondialdehyde (MDA), glutathione (GSH) levels, Na+, K+‐ATPase and myeloperoxidase (MPO) activities were determined in kidney tissue which was also analysed microscopically. I/R caused significant increases in blood creatinine, BUN, LDH and TNF‐α. In the kidney samples of the I/R group, MDA levels and MPO activity were increased significantly, however, GSH levels and Na+, K+‐ATPase activity were decreased. Betulinic acid ameliorated the oxidative burst response to both formyl‐methionyl‐leucyl‐phenylalanine (fMLP) and phorbol 12‐myristate 13‐acetate (PMA) stimuli, normalized the apoptotic response and most of the biochemical indices as well as histopathological alterations induced by I/R. In conclusion, these data suggest that betulinic acid attenuates I/R‐induced oxidant responses, improved microscopic damage and renal function by regulating the apoptotic function of leukocytes and inhibiting neutrophil infiltration. Copyright

Delftia Acidovorans: A Rare Pathogen in Immunocompetent and Immunocompromised Patients

Delftia acidovorans is usually a nonpathogenic environmental organism, which is rarely clinically significant. This article documents a case of D acidovorans-associated pneumonia in a B cell lymphoblastic leukemia patient. The authors also provide a review of the literature regarding D acidovorans infection and discuss how unusual pathogens may be clinically significant in both immunocompromised and immunocompetent patients.

Healthcare-associated Gram-negative bloodstream infections: antibiotic resistance and predictors of mortality.

This article describes the prevalence of antibiotic resistance and predictors of mortality for healthcare-associated (HA) Gram-negative bloodstream infections (GN-BSI). In total, 831 cases of HA GN-BSI from 17 intensive care units in different centres in Turkey were included; the all-cause mortality rate was 44%. Carbapenem resistance in Klebsiella pneumoniae was 38%, and the colistin resistance rate was 6%. Multi-variate analysis showed that age >70 years [odds ratio (OR) 2, 95% confidence interval (CI) 1.22-3.51], central venous catheter use (OR 2.1, 95% CI 1.09-4.07), ventilator-associated pneumonia (OR 1.9, 95% CI 1.1-3.16), carbapenem resistance (OR 1.8, 95% CI 1.11-2.95) and APACHE II score (OR 1.1, 95% CI 1.07-1.13) were significantly associated with mortality.

Miliary Tuberculosis Induced Acute Liver Failure

Hepatobiliary tuberculosis is uncommon even in endemic countries. It is associated with a high mortality and is even diagnosed early in the disease course. Acute liver failure (ALF) caused by tuberculosis bacilli has been reported in only a few reports. All previous cases have been diagnosed by postmortem examination. Time to antituberculosis treatment is very critical. In case of suggestive findings on clinical and radiologic examination, antituberculosis treatment should be initiated immediately. Drug use can be a challenge in patients with ALF. However, as long as the other possible causes of ALF can be excluded and hepatotoxic drugs were avoided during the early course of treatment, such a highly fatal presentation of tuberculosis can be treated safely. Here, we report a case of acute liver failure as a presentation of miliary tuberculosis. He was treated successfully with antituberculosis treatment.

Risk factors, characteristics, and outcomes of candidemia in an adult intensive care unit in Turkey

HighlightsThis brief report shows risk factors of candidemia in the intensive care unit in our country.Determining the risk factors associated with candidemia may lead to the quick diagnosis, identification of prevention measures and early antifungal therapy that may reduce mortality rates.All countries should know their risk factors for candidemia especially in the intensive care unit and they should apply many prevention measure to reduce this infection. &NA; Thirty‐six patients with candidemia and 37 control patients were included consecutively to determine the characteristics of candidemia episodes. The patients with candidemia had higher mortality with higher Sequential Organ Failure Assessment scores and frequency of use of a central venous catheter, total parenteral nutrition, and broad‐spectrum antibiotics; chronic renal failure with replacement therapy; and longer stay in an intensive care unit. Candida albicans was the predominant species followed by Candida glabrata, Candida tropicalis, and Candida parapsilosis. All isolates of C glabrata were itraconazole‐resistant.

Successful treatment of an invasive fungal infection caused by Talaromyces sp. with voriconazole.

Invasive fungal infections (IFI) are on the rise due to increasing numbers of immunosuppressed and critically ill patients. A malignant-looking pulmonary nodule in an immunosuppressed patient may indeed be caused by a fungal organism. We report a patient, who was eventually diagnosed with an IFI caused by an agent of hyalohyphomycosis, Talaromyces sp. determined via molecular methods and succesfully treated with voriconazole.

Sequential Measurements of Pentraxin 3 Serum Levels in Patients with Ventilator-Associated Pneumonia: A Nested Case-Control Study

Purpose The main purpose of this study was to investigate the dynamics of pentraxin 3 (PTX3) compared with procalcitonin (PCT) and C-reactive protein (CRP) in patients with suspicion of ventilator-associated pneumonia (VAP). Materials and Methods We designed a nested case-control study. This study was performed in the Surgical Intensive Care Unit of a tertiary care academic university and teaching hospital. Ninety-one adults who were mechanically ventilated for >48 hours were enrolled in the study. VAP diagnosis was established among 28 patients following the 2005 ATS/IDSA guidelines. Results The median PTX3 plasma level was 2.66 ng/mL in VAP adults compared to 0.25 ng/mL in non-VAP adults (p < 0.05). Procalcitonin and CRP levels did not significantly differ. Pentraxin 3, with a 2.56 ng/mL breakpoint, had 85% sensitivity, 86% specificity, 75% positive predictive value, and 92.9% negative predictive value for VAP diagnosis (AUC = 0.78). Conclusions With the suspicion of VAP, a pentraxin 3 plasma breakpoint of 2.56 ng/mL could contribute to the decision of whether to start antibiotics.

Dev mitral kapak vejetasyonu

Biz burada klinik durumu cerrahi mudahaleye firsat vermeden kotulesen ve septik emboli ve coklu organ yetmezligine bagli olen 66 yasinda mitral kapakta dev vejetasyonu olan bayan hastayi sunuyoruz. Amacimiz buyuk vejetasyonlari olan vakalarda embolik komplikasyon riskinin ve mortalite oranlarinin yuksek oldugunu, cok hizli mudahale edilmesi gerektigini vurgulamaktir.

Reports of four cyst hydatid cases in different size and location

Hydatid disease/echinococcus is caused by Echinococcus granulosus and it is endemic in many countries. Echinococcus commonly affect the liver but it has propensity to involve any organ or unusal location of the body. Treatment is surgical and medical but in many cases desicion of teatment is hard because of the location and size of cyst hydatid. In the present report, authors presented four patients with echinococcus with different anatomical site, size and desicion of treatment.