Nazim Dogan

Effectiveness of Antiviral Treatment in Human Influenza A(H5N1) Infections: Analysis of a Global Patient Registry

BACKGROUND Influenza A(H5N1) continues to cause infections and possesses pandemic potential. METHODS Data sources were primarily clinical records, published case series, and governmental agency reports. Cox proportional hazards regression was used to estimate the effect of treatment on survival, with adjustment using propensity scores (a composite measure of baseline variables predicting use of treatment). RESULTS In total, 308 cases were identified from 12 countries: 41 from Azerbaijan, Hong Kong SAR, Nigeria, Pakistan, and Turkey (from clinical records); 175 from Egypt and Indonesia (from various sources); and 92 from Bangladesh, Cambodia, China, Thailand, and Vietnam (from various publications). Overall crude survival was 43.5%; 60% of patients who received ≥1 dose of oseltamivir alone (OS(+)) survived versus 24% of patients who had no evidence of anti-influenza antiviral treatment (OS(-)) (P <.001). Survival rates of OS(+) groups were significantly higher than those of OS(-) groups; benefit persisted with oseltamivir treatment initiation <or=6-8 days after symptom onset. Multivariate modeling showed 49% mortality reduction from oseltamivir treatment. CONCLUSIONS H5N1 causes high mortality, especially when untreated. Oseltamivir significantly reduces mortality when started up to 6-8 days after symptom onset and appears to benefit all age groups. Prompt diagnosis and early therapeutic intervention should be considered for H5N1 disease.

The Effects of Bupivacaine and Neostigmine on Articular Cartilage and Synovium in the Rabbit Knee Joint

We investigated the effects of intraarticular injections of bupivacaine and neostigmine on articular cartilage and the synovial membrane of rabbit knee joints. Saline, bupivacaine or neostigmine were each administered intra-articularly into 15 knee joints. Five joints per drug treatment were prepared for histopathological examination 24 h, 48 h and 10 days after injection. A pathologist examined the histological samples for inflammation of the articular cartilage, inflammatory cell infiltration, hypertrophy and hyperplasia of the synovial membrane, in a blinded manner. There were no histopathological changes in the saline-treated control joints. Joints treated with bupivacaine and neostigmine showed significantly more histopathological changes than control joints. Joints treated with neostigmine showed significantly more histopathological changes than those treated with bupivacaine, except for articular cartilage inflammation on day 10. We conclude that intra-articular bupivacaine and neostigmine cause histopathological changes in rabbit knee joints, with neostigmine having a greater effect than bupivacaine.

H5N1 Avian Influenza in Children

BACKGROUND Avian influenza continues to pose a threat to humans and maintains the potential for greater transmissibility. Understanding the clinical presentation and prognosis in children will help guide effective diagnosis and treatment. METHODS A global patient registry was created to enable systematic collection of clinical, exposure, treatment, and outcomes data on confirmed cases of H5N1. Bivariate and multivariate statistical tools were used to describe clinical presentation and evaluate factors prognostic of survival. RESULTS Data were available from 13 countries on 193 children <18 years who were confirmed as having been infected with H5N1; 35.2% of cases were from Egypt. The case fatality rate (CFR) for children was 48.7%, with Egypt having a very low pediatric CFR. Overall, children aged ≤5 years had the lowest CFR and were brought to hospitals more quickly and treated sooner than older children. Children who presented for medical care with a complaint of rhinorrhea had a 76% reduction in the likelihood of death compared with those who presented without rhinorrhea, even after statistical adjustment for age, having been infected in Egypt, and oseltamivir treatment (P = .02). Delayed initiation of treatment with oseltamivir increases the likelihood of death, with an overall 75% increase in the adjusted odds ratio for death for each day of delay. CONCLUSIONS The presence of rhinorrhea appears to indicate a better prognosis for children with H5N1, with most patients surviving regardless of age, country, or treatment. For individuals treated with oseltamivir, early initiation of treatment substantially enhances the chance of survival.

Combining Intrathecal Bupivacaine and Meperidine during Caesarean Section to Prevent Spinal Anaesthesia-Induced Hypotension and other Side-Effects

This study compared intrathecal hyperbaric bupivacaine with low-dose intrathecal plain bupivacaine plus different doses of meperidine (pethidine), administered sequentially, with regard to blood pressure stability, post-operative analgesia and incidence of side-effects in 80 parturients undergoing caesarean section. Patients were randomly assigned to one of four groups (n = 20 each group): the HB group received 10 mg hyperbaric bupivacaine intrathecally; the BM35, BM30 and BM25 groups received 5 mg plain bupivacaine plus 35, 30 or 25 mg of meperidine intrathecally, respectively. The incidence of hypotension in the BM25 group was significantly lower than in the HB group. Nausea and vomiting were less prevalent in the BM25 group than in the HB and BM35 groups. In conclusion, sequential administration of 5 mg plain bupivacaine and 25 mg meperidine intrathecally provided better blood pressure stability and a lower incidence of side-effects than bupivacaine alone, without affecting quality of anaesthesia or surgical and patient satisfaction.

Strengthening Observational Evidence for Antiviral Effectiveness in Influenza A (H5N1)

To the Editor—We recently reported findings from the largest ever patient registry of confirmed influenza A (H5N1) cases [1]. Using data collected from medical records, data made available by ministries of health and other clinical data sources, and data from published case reports, the registry deployed a structured data collection system to assemble data from 308 cases in 12 countries. The source documents for the registry contained varying types of information. The amount of missing data depends on both the record source, because not all data elements of interest were available from every source, and the reporter, because published case studies were selective in their reporting, and individual physicians had different styles and completeness of medical record annotations. The study showed a strong reduction in the risk of mortality for treatment with oseltamivir. In the editorial that accompanied this first report of findings from the global registry of human H5N1 cases, Couch and Davis [2] commented on the challenges of controlling for uneven data and bias-free comparisons when using observational data. While affirming the overall conclusion that treatment with oseltamivir significantly reduces mortality when commenced even as late as 6–8 days after symptom onset, they questioned the methods used for handling missing data. For one key analysis, we used Cox proportional hazards regression to estimate the hazard ratio for survival associated with oseltamivir treatment, and used a propensity score predicting probability of oseltamivir treatment for statistical adjustment in the Cox model. In the Cox model, we used mean imputation to estimate time from first presentation for medical care to death for 54 cases that were missing this information. For the propensity score, if time from symptom onset to first presentation for medical care was missing, it was dropped from the modeling step, but propensity scores were still generated for the 18 cases missing this date. A second key analysis examined survival by timing of oselta-mivir initiation and used a complete case method, which resulted in exclusion of 61 cases missing dates of symptom onset, oseltamivir treatment start, presentation for medical care, and/or death. To evaluate the sensitivity of our overall study conclusions to the data imputation method, we used multiple imputation of missing data and replicated the Cox proportional hazards model on 20 im-puted data sets. The overall estimate of benefit was essentially unchanged, showing roughly a 50% decrease in the risk of death from treatment with oseltamivir. The confidence …

A Succesful Treatment of Avian Influenza İnfection in Turkey

Abstract Avian influenza is a disease characterized with severe pneumonia caused by virus influenza A. Birds and poultry are vectors for spread of this disease. It is diagnosed by clinical evidence and reverse transcription-polymerase chain reaction. Here, we discuss the treatment procedures of a child diagnosed as avian influenza.

The protective effects of IgM-enriched immunoglobulin and erythropoietin on the lung and small intestine tissues of rats with induced sepsis: Biochemical and histopathological evaluation

Abstract Context: Sepsis continues to be a significant problem for critical care patients. Objective: To evaluate the protective effects of IgM-enriched immunoglobulin and erythropoietin on pulmonary and small intestine tissues in a rat model of intra-abdominal sepsis induced via the cecal ligation and puncture (CLP) method. Materials and methods: Male Sprague–Dawley rats were used. Control group (n = 6): surgical procedure was not performed. Laparotomy was only performed in the sham group (n = 6) and CLP was only performed in the sepsis (CLP) group (n = 30). After erythropoietin (2000 U/kg, intraperitoneal) was given in the sepsis + erythropoietin (CLP + EPO) group (n = 30), IgM-enriched immunoglobulin (600 mg/kg, intraperitoneal) was given in the sepsis + pentaglobin (CLP + PEN) group (n = 30), CLP was created. Intracardiac blood samples were collected for biochemical analysis; lung and small intestine tissue samples were removed for histopathological evaluation. Results: Plasma TNF-α levels (pg/ml) were similar among CLP, CLP + EPO, and CLP + PEN groups (204.0 ± 52.4, 198.5 ± 17.3, and 214.6 ± 93.6, respectively). The CLP group had higher plasma IL-1β levels (pg/ml) compared with CLP + EPO and CLP + PEN groups (325.1 ± 134.1, 164.3 ± 25.6, and 186.3 ± 26.0, respectively) (p < 0.05). Rats in CLP + EPO and CLP + PEN groups had abolished histopathologic appearance of lung and small intestine tissues compared with rats in the CLP group. Discussion and conclusion: Our findings support the use of EPO and IgM-enriched immunoglobulin in the prevention of lung and small intestine injuries associated with sepsis.

Meningitis following spinal anaesthesia in an obstetric patient.

Meningitis following lumbar puncture and spinal anaesthesia is a rare but serious complication. A 19-year-old woman was administered spinal anaesthesia at another centre prior to a Caesarean section. The following day she experienced headaches. On the fourth day, she started vomiting and having convulsions, and became agitated. Meningitis was diagnosed based on a clinical examination and analysis of a lumbar puncture sample. After 21 days of treatment, she was discharged. Meningitis should be considered in the differential diagnosis of a patient presenting with headaches following spinal anaesthesia. The causes of meningitis following spinal anaesthesia are debated, and it is difficult to distinguish between aseptic and bacterial meningitis. It should be compulsory to wear a face mask while performing a dural puncture.

A Suicide Attempt Using Zinc Phosphide (A Case Study)

DOI: 10.4328/JCAM.744 Received: 08.07.2011 Accepted: 09.08.2011 Printed: 01.01.2014 J Clin Anal Med 2014;5(1): 65-6 Corresponding Author: Ayşenur Sümer Coşkun, Department of Anesthesia and Reanimation, Medical Faculty, Atatürk University Erzurum, Turkey. T.: +90 4422341213 Fax: + 90 4422361301 GSM: +905356224482 E-Mail:anur.sumer@mynet.com Özet Çinko Fosfür, fare mücadelesinde zehirli buğday üretimi için kullanılır ve rodentisitin aktif maddesidir. İntihar amacıyla tarım ilacı [Zinc Phosphide (Zn3P2)] içen 17 yaşındaki erkek olgu acil serviste görüldüğünde: Genel durumu kötü, bilinci kapalı, kusmuğu ve cildinde sarımsak kokusu ve ileri derecece asidozu mevcuttu. Semptomatik tedavi uygulanan ve mekanik ventilatorde takip edilen olgu yatışının 5. günü psikiyatri kliniğine devir edildi.

Clinical Outcomes and Mortality Analysis of Patients with COPD Admitted to an Intensive Care Unit: Retrospective Analyses of Five-Year Data

Received: 16.06.2016 Accepted: 26.07.2016 1Sabuncuoğlu Şerafeddin Training Hospital, Department of Anesthesia 2Ataturk University, School of Medicine, Department of Anesthesiology and Reanimation 3Palandöken State Hospital, Department of Anesthesia 4Harakani State Hospital, Department of Anesthesia Yazışma adresi: Ali Ahıskalıoğlu, Ataturk University, School of Medicine, Department of Anesthesiology and Reanimation, Erzurum e-mail: aliahiskalioglu@hotmail.com GİRİŞ