Turan Aslan

A new model using platelet indices to predict liver fibrosis in patients with chronic hepatitis B infection

SummaryBackgroundWe aimed to investigate whether mean platelet volume (MPV) and platelet distribution width (PDW) are variables determining the severity of liver fibrosis in patients with chronic HBV infection.MethodsPatients were divided into two groups with fibrosis scores of 0–2 and 3–6 (according to Ishac scoring system). Whether MPV and PDW were independent variables determining the severity of liver fibrosis score or not was investigated by comparing these groups.ResultsOf the 111 cases, 74 (66.7 %) were male (mean age 37.7 ± 11.6 years). Twenty-two of the cases (19.8 %) were HBeAg-positive. Fibrosis scores of 42 cases (37.8 %) were ≥ 3 and the remaining 69 cases had fibrosis scores < 3 (62.2 %). Independent variables determining the severity of fibrosis score were low levels of albumin and mean platelet volume, and high levels of prothrombin time and PDW (Odds ratio (95 % confidence interval) and p values were 0.105 (0.018–0.605) and 0.012 for albumin, 0.402 (0.234–0.692) and 0.001 for mean platelet volume, 1.529 (1.183–1.975) and 0.001 for PDW, and 0.924 (0.875–0.976) and 0.005 for prothrombin time, respectively). The sensitivity, specificity, positive predictive value and negative predictive value of regression model that is established using above mentioned parameters were 88.1, 75.3, 68.5, and 91.7 %, respectively (AUC = 0.886, p = 0.0001).ConclusionsMPV and PDW are independent variables determining the severity of liver fibrosis, and the regression model that is established using these parameters along with other markers, may give more information about the severity of liver fibrosis.ZusammenfassungHintergrundWir untersuchten, ob das mittlere Thrombozytenvolumen und die Verteilung der Thrombozytenbreite Variable sind, die den Schweregrad der Leberfibrose bei Patienten mit chronischer Hepatitis B (HBV) Infektion bestimmen.MethodenDie Patienten (n = 111, davon waren 74 (66,7 %) männlich, mittleres Alter: 37,7 ± 11,6 Jahre) wurden in 2 Gruppen je nach Fibrose Score (0–2 und 3–6) eingeteilt. Verwendet wurde das Ishac Score System. Ob das mittlere Thrombozytenvolumen und die Breitenverteilung der Thrombozyten unabhängige, den Schweregrad der Leberfibrose bestimmende Variable sind, wurde durch Vergleich dieser Gruppen geprüft.ErgebnisseZweiundzwanzig (19,8 %) Patienten waren HbeAg positiv. Die Fibrose Scores waren bei 42 Patienten (37,8 %) ≥ 3 und bei den restlichen 69 (62,2 %) Patienten < 3. Folgende Parameter stellten sich als unabhängige, den Schweregrad der Leberfibrose bestimmende Variable heraus: niedrige Albumin- und niedrige mittlere Thrombozytenvolumen-Werte, sowie hohe Werte der Prothromin Zeit und der Breite der Thrombozyten (Odds ratio (95 % Konfidenz Intervalle) und p Werte waren respektive: 0,105 (0,018–0,605) und 0,012 für Albumin, 0,402 (0,234–0,692) sowie 0,001 für das mittlere Thrombozytenvolumen, 1,529 (1,183–1,975) and 0,001 für die Verteilung der Thromzytenbreite, und 0,924 (0,875–0,976) and 0,005 für die Prothrombin Zeit). Die Sensitivität, Spezifität, der positive und der negative Vorhersagewert des Regressionsmodells, das unter Verwendung der oben erwähnten Parameter etabliert wurde waren: 88,1, 75,3, 68,5, and 91.7 %, respektive (AUC = 0,886, p = 0,0001).SchlussfolgerungenDas mittlere Thrombozytenvolumen und die Verteilung der Thrombozytenbreite sind unabhängige Variable, die den Schweregrad der Leberfibrose bestimmen. Das auf Basis dieser und anderer Parameter etablierte Regressionsmodell könnte mehr Information über den Schweregrad der Leberfibrose geben.

A case of cerebral phaeohyphomycosis caused by Fonsecaea monophora, a neurotropic dematiaceous fungus, and a review of the literature.

The Fonsecaea species, which are the leading causes of chromoblastomycosis, are not considered neurotropic fungal agents. Fonsecaea pedrosoi is the primary species in the genus and is usually isolated from chromoblastomycosis cases. However, the recently distinguished species F. monophora has been reported in a few cerebral phaeohyphomycosis cases. Here, a case of cerebral phaeohyphomycosis caused by Fonsecaea monophora is presented in a 71‐year‐old female subject with chronic diabetes mellitus and hypertension. The identification of F. monophora was made through mycological and molecular analysis, and an isolate was differentiated from the closely related F. pedrosoi by sequence data on key bases on the ribosomal internal transcribed spacer region. The case was successfully treated with surgical and medical approaches, and the patient has remained healthy and stable after a ten‐month follow up. Given the increasing incidence of this type of infection of the central nervous system (CNS), this case provides further support for the consideration that F. monophora might represent a neurotropic agent.

Predictors for limb loss among patient with diabetic foot infections: an observational retrospective multicentric study in Turkey

We aimed to investigate the predictors for limb loss among patients with diabetes who have complicated skin/soft-tissue infections. In this observational study, consecutive patients with diabetic foot infection (DFI) from 17 centres in Turkey, between May 2011 and May 2013 were included. The Turkish DFI Working Group performed the study. Predictors of limb loss were investigated by multivariate analysis. In total, 455 patients with DFI were included. Median age was 61 years, 68% were male, 65% of the patients were hospitalized, 52% of the patients had used antibiotics within the last month, and 121 (27%) had osteomyelitis. Of the 208 microorganisms isolated, 92 (44.2%) were Gram-positive cocci and 114 (54.8%) were Gram-negative rods (GNR). The most common GNR was Pseudomonas; the second was Escherichia coli, with extended spectrum β-lactamase positivity of 33%. Methicillin-resistant Staphylococcus species were found in 14% (29/208). Amputations were performed in 126/455 (28%) patients, 44/126 (34%) of these were major amputations. In multivariate analysis, significant predictors for limb loss were, male gender (OR 1.75, 95% CI 1.04-2.96, p 0.034), duration of diabetes >20 years (OR 1.9, 95% CI 1.18-3.11, p 0.008), infected ulcer versus cellulitis (OR 1.9, 95% CI 1.11-3.18, p 0.019), history of peripheral vascular disease (OR 2, 95% CI 1.26-3.27, p 0.004), retinopathy (OR 2.25, 95% CI 1.19-4.25, p 0.012), erythrocyte sedimentation rate >70 mm/hr (OR 1.6, 95% CI 1.01-2.68, p 0.05), and infection with GNR (OR 1.8, 95% CI 1.08-3.02, p 0.02). Multivariate analysis revealed that, besides the known risk factors such as male gender, duration of diabetes >20 years, infected ulcers, history of peripheral vascular disease and retinopathy, detection of GNR was a significant predictor of limb loss.

Can platelet indices be used as predictors of complication in subjects with appendicitis

SummaryBackgroundWe examined the changes of mean platelet volume (MPV) and platelet distribution width (PDW) in subjects with appendicitis and whether MPV and PDW could be used to predict the development of complication due to appendicitis.MethodsThe healthy control group, the cases of appendicitis with perforation, and the cases of appendicitis without perforation were compared with regard to MPV and PDW. We determined whether MPV and PDW were independent variables predictive of the development of complication in subjects with appendicitis.ResultsThis retrospective case-control study included a total of 362 patients (249 of which were male (68.8 %) and 113 were female (31.2 %); median age, 30 [range, 18–84 years]). One hundred and ninety-two subjects (53 %) presented with appendicitis and 170 (47 %) comprised the healthy control group. Sixty-six (18.2 %) of the subjects with appendicitis developed complication. MPVs were lower in subjects of appendicitis without complication compared to the subjects of appendicitis with complication and the control group (MPV, 9.78 ± 0.99 vs. 10.20 ± 1.21 and 10.14 ± 1.03, respectively [p = 0.005]). The PDW levels were not different between the three groups. Independent variables predictive of the presence of complication included increased MPV and time from onset of symptoms to hospital presentation (odds ratio[confidence interval], p-value: 1.507[1.064–2.133], 0.021 and 18.887[5.139-69.410], 0.0001, respectively).ConclusionsOur findings suggested these, MPV values in cases of appendicitis without complication were lower than the cases with complication and healthy control and MPV is a predictor of the development of complication in subjects with appendicitis.

Comparison of colistin monotherapy and non-colistin combinations in the treatment of multi-drug resistant Acinetobacter spp. bloodstream infections: a multicenter retrospective analysis.

Objectives: To compare the efficacy of colistin (COL) monotherapy versus non-COL based combinations in the treatment of bloodstream infections (BSIs) due to multidrug resistant Acinetobacter spp.(MDR-A). Materials and Methods: Retrospective data of 107 MDR-A BSI cases from 27 tertiary centers in Turkey were included. Primary End-Point: 14-day mortality. Secondary End-Points: Microbial eradication and clinical improvement. Results: Thirty-six patients in the COL monotherapy (CM) group and 71 in the non-COL based combinations (NCC) group were included in the study. Mean age was 59.98 ± 20 years (range: 18–89) and 50.5% were male. Median duration of follow-up was 40 days (range: 9–297). The 14-day survival rates were 52.8% in CM and 47.23% in NCC group (P = 0.36). Microbiological eradication was achieved in 69% of CM and 83% of NCC group (P = 0.13). Treatment failure was detected in 22.9% of cases in both CM and NCC groups. Univariate analysis revealed that mean age (P = 0.001), Charlson comorbidity index (P = 0.03), duration of hospital stay before MDR-A BSI (P = 0.04), Pitt bacteremia score (P = 0.043) and Acute Physiology and Chronic Health Evaluation II score (P = 0.05) were significant in terms of 14-day mortality. Advanced age (P = 0.01) and duration of hospital stay before MDR-A BSI (P = 0.04) were independently associated with 14-day mortality in multivariate analysis. Conclusion: No significant difference was detected between CM and non-COL based combinations in the treatment of MDR-A BSIs in terms of efficacy and 14-day mortality.

Seroprevalence of Rubella in northeastern Turkey

SummaryAimThe aim of this study was to search rubella prevalence and compare the results with national and international data.Materials and methodsThe presence of anti-rubella immunoglobulin G (IgG) and anti-rubella immunoglobulin M (IgM) antibodies were studied in the sera obtained from cases with fever in last week and applied to the Microbiology Laboratory in the period between February 2010 and December 2010. No clinical sign or symptom regarding rubella infection has been evaluated for cases to obtain blood samples. IgM and IgG antibodies were tested with ELISA (Vitros ECI Q (J&J) Company Ortho Clinical Diagnostic Macro) method. The data obtained were assessed with SPSS statistical package using chi-square trend analysis method.ResultsAnti-rubella IgM positivity was found 8/68 (8.8 %) of males and 3/138 (2.2 %) of females who are under 18 years-old (p = 0.028). Meanwhile 47/65 (72.3 %) of males and 99/122 (81.8 %) of females under 18 years-old were presented with anti-rubella IgG positivity (p = 0.164). In all, 2/8 (25 %) males and 28/1,181 (2.4 %) females older than 18 years-old were anti-rubella IgM positive (p = 0.013). Anti-rubella IgG antibodies were found positive in 862/1,181 (73 %) of females and all males (8/8) older than 18-years-old (p = 0.086).ConclusionIn spite of the active immunization programme commenced after 2006, rubella infection is still a risk in Turkey without discriminating the gender.ZusammenfassungZiel der StudieErhebung der regionalen Seroprävalenz und Vergleich mit nationalen und internationalen Daten.Material und MethodenIn der Zeit zwischen Februar und Dezember 2010 wurden in an das mikrobiologische Labor eingesandten Sera von Patienten mit Fieber in der Woche vor der Abnahme auf das Vorliegen von Anti-Röteln IgG – und Anti-Röteln IgM Antikörper geprüft. Klinische Zeichen oder Symptome einer Röteln-Infektion wurden nicht erhoben. Die IgM und IgG Antikörper wurden mittels der ELISA Methode (Vitros ECI Q (J&J) Company Ortho Clinical Diagnostic Macro) getestet. Die Daten wurden mit Hilfe des SPSS statistical Package unter Verwendung der Chi-Quadrat Trend Analyse getestet.ErgebnisseIn 8/68 (8,8 %) Sera der Männer und in 3/138 (2,2 %) Sera der Frauen, die jünger als 18 Jahren waren konnten Anti Röteln-IgM-Antikörper nachgewiesen werden (p = 0,028). Anti-Röteln IgG Antikörper lagen dahingegen bei 47/65 (72,3 %) der Männer unter 18 und bei 99/122 (81,8 %) der Frauen unter 18 Jahren vor (p = 0,164). Bei den über 18 Jahre alten hatten zwei von acht (25 %) Männern und 28 von 1181 (2,4 %) Frauen nachweisbare Anti-Röteln IgM Antikörper (p = 0,013). Die IgG Anti-Röteln Antikörper waren bei 862 (73 %) der 1181 Frauen beziehungsweise bei allen Männern (8/8) positiv.SchlussfolgerungTrotz des seit 2006 existierenden aktiven Immunisierungsprogramms ist die Rötelninfektion in der Türkei noch immer ein Risiko, wobei dieses für Frauen und Männer gleich hoch ist.

Influence of multidrug resistant organisms on the outcome of diabetic foot infection

OBJECTIVES We described the clinical outcomes of the diabetic patients who had foot infections with multidrug resistant organisms. METHODS We included the patients with diabetic foot infections (DFI) from 19 centers, between May 2011 and December 2015. Infection was defined according to IDSA DFI guidelines. Patients with severe infection, complicated moderate infection were hospitalized. The patients were followed-up for 6 months after discharge. RESULTS In total, 791 patients with DFI were included, 531(67%) were male, median age was 62 (19-90). Severe infection was diagnosed in 85 (11%) patients. Osteomyelitis was diagnosed in 291(36.8%) patients. 536 microorganisms were isolated, the most common microorganisms were S. aureus (20%), P. aeruginosa (19%) and E. coli (12%). Methicillin resistance (MR) rate among Staphylococcus aureus isolates was 31%. Multidrug resistant bacteria were detected in 21% of P. aeruginosa isolates. ESBL (+) Gram negative bacteria (GNB) was detected in 38% of E. coli and Klebsiella isolates. Sixty three patients (8%) were re-hospitalized. Of the 791 patiens, 127 (16%) had major amputation, and 24 (3%) patients died. In multivariate analysis, significant predictors for fatality were; dialysis (OR: 8.3, CI: 1.82-38.15, p=0.006), isolation of Klebsiella spp. (OR:7.7, CI: 1.24-47.96, p=0.028), and chronic heart failure (OR: 3, CI: 1.01-9.04, p=0.05). MR Staphylococcus was detected in 21% of the rehospitalized patients, as the most common microorganism (p<0.001). CONCLUSION Among rehospitalized patients, methicillin resistant Staphylococcus infections was detected as the most common agent, and Klebsiella spp. infections were found to be significantly associated with fatality.

Hand, foot, and mouth disease in an adult

A 43-year-old male patient was admitted to our clinic with fever and rash lasting for five days. His initial symptoms were sore throat, fever and rash on both hands and feet. He had been given ceftriaxone 2 g/day. Three days later no clinical improvement was observed and clindamycin 1200 mg/day was added to therapy. On admission, the patient had a body temperature of 37 ◦C, pulse 92 beats per minute, and blood pressure of 116/78 mmHg. On physical examination bilateral cryptic tonsillitis, rusty tongue and macular rashes on hands and feet were observed (Figs. 1–3). C reactive protein was 11.9 mg/dL, and erythrocyte sedimentation rate was 60 mm/h. The patient was on colchicine due to Behcet’s disease for 12 years. He had no fever on follow-up. Crypts on tonsils disappeared on the second day and vesicular rashes ensued on both tongue and labial mucosa. The patients’ IgM and IgG turned out positive for Coxsackie B virus by ELISA. Hand, foot, and mouth disease is known to be a childhood illness with fever and viral exanthema caused by species-A human enteroviruses (HEVA), genus Enterovirus, family Picornaviridae. Although it is rarely seen in adults, it must be considered in patients with fever of unknown origin.

Muscle Abscess due to Salmonella Enterica.

Non typhoidal Salmonellae spp. causes clinical symptoms especially in neonates, infants, aged and immunocompromised patients. Hematogenous dissemination may occur in complicated cases whereas the formation of abscess is rare. A 61-year old woman presented to our hospital with pain and a mass in her left arm, without fever and leukocytosis. She was using methotrexate, corticosteroids and quinine for rheumatoid arthritis. She had a history of cervix cancer and was given radiotherapy and chemotherapy 3 years ago. Upon physical examination and magnetic resonance imaging, the mass was considered as an abscess and was surgically drained. Salmonella enterica spp. enterica was yielded in the culture of the drainage material. Ceftriaxon 2g/day was started intramuscularly and continued for 4 weeks. Salmonellosis is usually a self-limited disease, generally restricted to gastrointestinal tract and acquired following food poisoning. Management of Salmonella abscess requires a combination of antibiotherapy, surgical drainage and eradication of primary foci.

Aortic stent infection in etiology of fever of unknown origin in a geriatric patient

Abstract Objective Aortic stent greft infections (ASGI) are associated with significant morbidity and mortality. ASGI may exist as a seldom cause of fever. Case report A 67 year-old male patient presented with fever, fatigue, chest pain and night sweats for a week. He had no infection sign except 3/6 systolic murmur. He admitted to the clinic with a prediagnosis of infective endocarditis. Combination therapy with ceftriaxon (2 g/day) + vancomycine (2 g/day) was administered. No vegetation was seen on neither transthoracic nor transesophageal ecocardiography. Methicillin-sensitive Staphylococcus aureus (MSSA) yielded in blood cultures. Antibiotherapy was changed to sulbactam-ampicilline (8 g/day). Then, we learned that the patient has an aortic stent placed due to aortic dissection. Contrast enhancement was detected in magnetic resonance imaging. Cardiovascular surgeons decided not to remove the stent because of increased mortality; therefore antimicrobial therapy was extended to 4 weeks. But soon after discharge from the hospital, the patient re-admitted with fever. Sulbactam-ampicilline was begun, and MSSA yielded in blood cultures again. Antibiotherapy was continued for an additional 6 weeks. No recurrent infection occurred during 6 months of follow-up. Conclusion ASGI could be one of the causes of fever of unknown origin (FUO). Despite the recommended treatment of ASGI being surgery, long-term conservative antimicrobial treatment may be performed successfully in patients with high surgical risk.