Relationship between Prognostic Nutritional Index and Amputation in Patients with Diabetic Foot Ulcer

The prognostic nutritional index (PNI) is a new marker used to assess a patient's nutritional and immune status. It is calculated using serum albumin levels and total lymphocyte count. The aim of this study was to investigate the relationship between PNI and amputation in patients with diabetic foot ulcer (DFU). Patients with DFU were enrolled in this retrospective study. In our study, a total of 386 patient data, of 110 (28.5%) amputated and 276 (71.5%) non-amputated patients, were statistically analyzed. PNI values were significantly lower in the amputated patient group than in the non-amputee patient group (p < 0.001). According to the ROC analysis results, PNI was significant in the prediction of amputation at an excellent level (AUC = 0.937 (0.911-0.963), p < 0.001). The optimal cut-off point for PNI was found to be 39,005. There was classification success for this cut-off point: sensitivity was calculated as 82.7% (74.1-89) and specificity as 93.1% (89.3-95.7). In the multivariate model, the odds ratio (OR) (95% CI) was calculated as 81.8 (38.5-173.7) for PNI. The PNI was associated with an increase in amputation rate in patients with DFU. By using PNI, patients can be directed to advanced centers and have access to early and appropriate interventions.

Point prevalence of antibiotic usage in major referral hospital in Turkey

INTRODUCTION

The most important and undesirable consequence of inappropriate antibiotic use is the spread of antibiotic resistance, increased adverse effects, increased mortality and healthcare costs. We aimed to assess antibiotic usage characteristics in inpatient setting in our center.

MATERIALS AND METHODS

A one-day, single center point-prevalence study was carried out on June 9th 2021, in Ankara City Hospital in Turkey. Data of antibiotic consumption, appropriateness of usage and predictors of inappropriate use in adult patients were evaluated.

RESULTS

Out of 2640 adult patients, 893 (33.8%) were receiving at least one antibiotic. A total of 1212 antibiotic prescriptions with an average of 1.44±0.64 were found. Antibiotics were most commonly used for therapeutic purpose (84.7%), followed by surgical prophylaxis (11.6%). Majority of therapeutically used antibiotics were empirical (67.9%). Infectious diseases consultation was present in 68.3% with a compliance rate of 95.7%. Rate of inappropriate use was 20%. The most frequent cause of inappropriateness was unnecessary use (52.5%). Most commonly and most inappropriately used antibiotics were carbapenems (17.5%) and first generation cephalosporins (38.7%), respectively. Most of the inappropriateness observed in first-generation cephalosporins was due to inappropriate longer surgical prophylaxis. While age is an independent risk factor for inappropriate antibiotic use (p = 0.042), COVID-19 unit admission, use for therapeutic purpose and infectious diseases consultation were protective factors (p<0.001, p<0.001, p<0.001).

CONCLUSION

Rate of inappropriate use was low, but inappropriate surgical prophylaxis remains an important problem in surgical units. There is a considerable need to implement an antimicrobial stewardship program that focuses on surgical prophylaxis practices.

D-index: A New Scoring System in Febrile Neutropenic Patients for Predicting Invasive Fungal Infections

OBJECTIVE

Neutropenia is a critical risk factor for invasive fungal infections (IFIs). We retrospectively performed this study to assess the performance of the D-index, a new test that combines both the duration and the severity of neutropenia, in predicting IFIs among patients with acute myelogenous leukemia. 


MATERIALS AND METHODS

Fifteen patients with IFIs and 28 patients who did not develop IFIs were enrolled in the study. The D-index was defined as the area over the neutrophil curve, whereas the cumulative-D-index (c-D-index) was the area over the neutrophil curve from the start of neutropenia until the first clinical manifestation of IFI.


RESULTS

The D-index and the c-D-index tended to be significantly higher in patients with IFIs, with medians of 10,150 (range: 4000-22,000) and 5300 (range: 2300-22,200), respectively (p=0.037 and p=0.003, respectively). The receiver operating characteristic analyses showed that there was a cutoff point of 3875 for the D-index in predicting IFI; the sensitivity, specificity, and positive and negative predictive values were 100%, 67.9%, 35.4%, and 100%, respectively. There was also a cutoff point of 4225 for the c-D-index in predicting IFI; the sensitivity, specificity, and positive and negative predictive values for the c-D-index were 93.3%, 71.4%, 36.6%, and 98.4%. 


CONCLUSION

The D-index and especially the c-D-index could be useful tools with high negative predictive value to exclude as well as to predict IFIs in the management of neutropenic patients.

An Unusual Manifestation of Q Fever: Peritonitis

Q fever has rarely been reported and can be difficult to diagnose, especially in immunocompromised patients. In the present report, we describe an unusual case of Q fever that presented as peritonitis and was treated with long-term combination therapy with doxycycline, ciprofloxacin and rifampicin for five weeks in a patient who had been on peritoneal dialysis for six years due to hypertensive nephropathy.

A Quasi-Experimental Study Analyzing the Effectiveness of Portable High-Efficiency Particulate Absorption Filters in Preventing Infections in Hematology Patients during Construction

Objective:

The increased risk of infection for patients caused by construction and renovation near hematology inpatient clinics is a major concern. The use of high-efficiency particulate absorption (HEPA) filters can reduce the risk of infection. However, there is no standard protocol indicating the use of HEPA filters for patients with hematological malignancies, except for those who have undergone allogeneic hematopoietic stem cell transplantation. This quasi-experimental study was designed to measure the efficacy of HEPA filters in preventing infections during construction.

Materials and Methods:

Portable HEPA filters were placed in the rooms of patients undergoing treatment for hematological malignancies because of large-scale construction taking place near the hematology clinic. The rates of infection during the 6 months before and after the installation of the portable HEPA filters were compared. A total of 413 patients were treated during this 1-year period.

Results:

There were no significant differences in the antifungal prophylaxis and treatment regimens between the groups. The rates of infections, clinically documented infections, and invasive fungal infections decreased in all of the patients following the installation of the HEPA filters. When analyzed separately, the rates of invasive fungal infections were similar before and after the installation of HEPA filters in patients who had no neutropenia or long neutropenia duration. HEPA filters were significantly protective against infection when installed in the rooms of patients with acute lymphocytic leukemia, patients who were undergoing consolidation treatment, and patients who were neutropenic for 1-14 days.

Conclusion:

Despite the advent of construction and the summer season, during which environmental Aspergillus contamination is more prevalent, no patient or patient subgroup experienced an increase in fungal infections following the installation of HEPA filters. The protective effect of HEPA filters against infection was more pronounced in patients with acute lymphocytic leukemia, patients undergoing consolidation therapy, and patients with moderate neutropenia.

Alcohol-induced lung damage and increased oxidative stress

BACKGROUND

Alcohol-induced lung damage may be associated with increased oxidative stress.

OBJECTIVE

Our aim was to investigate alcohol-induced changes in the biochemistry and histopathology of the lung.

METHODS

Rats were divided into two groups, a control group and an ethanol group. The ethanol group received 2 g/kg ethanol (total: 3 ml) intraperitoneally. The controls were given the same amount of saline via the same route. Three hours later, the rats were sacrificed, and blood and lung tissue samples were obtained. Oxidative stress was assessed by measuring the levels of erythrocyte reduced glutathione (GSH), tissue malondialdehyde (MDA), myeloperoxidase (MPO) and Na(+)-K(+) ATPase. Histopathologic evaluation of the lung tissues was also performed.

RESULTS

In the ethanol group, serum and tissue MDA levels and MPO activities were increased (p = 0.007, p = 0.001 and p = 0.000), and lung tissue Na(+)-K(+) ATPase activities and erythrocyte GSH were decreased (p = 0.001 and p = 0.000) compared to the controls. Histopathologic examination demonstrated alveolocapillary thickening, alveolar degeneration, leukocyte infiltration and erythrocyte extravasation in the lungs of the ethanol group (p < 0.05).

CONCLUSION

These results suggest that high-dose acute alcohol administration aggravates systemic and local oxidative stress leading to acute lung injury, ranging from mild pulmonary dysfunction to severe lung injury. It should be borne in mind that rapid onset of the acute respiratory distress syndrome (ARDS) may also be due to increased oxidative stress following alcohol abuse, especially when ischemic disturbances, e.g. coronary heart disease, acute ischemia of the extremities and traumatic accidents, are concomitantly present. Therefore, precautions against ARDS may prevent morbidity and mortality in alcohol-induced lung damage in at-risk patients.

In situ rumen degradation and in vitro gas production of some selected grains from Turkey

An investigation of the dry matter degradability (DMD) and effective dry matter degradability (EDDM) was performed for barley, wheat, rye, corn, triticale and oat samples, using the Nylon-bag technique. Gas production (GP), metabolizable energy (ME) and in vitro organic matter digestibility (IVOMD) were also studied by using Hohenheim gas test. The DM from barley, wheat, rye and triticale was digested rapidly in the rumen, and, at the 48 h of incubation, degradability was found to be approximately about 80%. The higher degradability observed for these grains than for oats and corn was attributable to the structure of these grains. In contrast, DM of corn and oats was degraded very slowly and reached 66.7 and 66.5 at 48 h, respectively. Effective degradability values of barley, wheat, rye, corn, triticale and oats were determined to be 61.4, 69.0, 64.0, 41.7, 66.7 and 58.6% in 5% rumen outflow rate, respectively. At the end of the 48 h incubation, total gas productions in barley, wheat, rye, corn, triticale and oats were estimated to be 83.6, 87.2, 87.5, 83.5, 85.8 and 63.9 ml/200 mg DM, respectively. The mean ME values of these grains calculated from cumulative gas amount at 24 h incubation were 11.8, 12.1, 12.3, 10.9, 12.4 and 10.2 MJ/kg DM, respectively. In vitro digestible organic matter of barley, wheat, rye, corn, triticale and oats were estimated to be 85.0, 87.3, 88.2, 79.5, 89.0 and 72.6%. Percentage overall EDDM (k=5%) of barley, wheat, rye, triticale and oats was positively correlated with in vitro GP at 6 h, cumulative GP at 24 h and total GP at 48 h (p<0.05). As a result, in situ dry matter degradation of grains showed great differences depending on the chemical compositions. In situ EDDM of grains may be predicted from in vitro gas production parameters.

Effect of lactose and dried whey supplementation on growth performance and histology of the immune system in broilers

The objective of this study was to evaluate the effect of lactose and dried whey supplementation as dietary component on growth performance and histology of lymphoid organs and ileum in broilers. A total of 480 day-old chicks were utilised for 42 days. Animals were assigned randomly to one of three treatments: control, lactose (2.5%), and dried whey (3.85%). Body weight was greater for animals supplemented with lactose or dried whey than for those not supplemented. There were no effects of treatments on feed intake and feed efficiency. In general, the effects of lactose or dried whey supplementation on histology of lymphoid organs and ileum were variable. Plasma cell counts were lower for animals supplemented with lactose than for those supplemented with dried whey. However, the length of intestinal villi during the starter period was greater for experimental groups than for control group.

Effects of boron supplementation of adequate and inadequate vitamin D3-containing diet on performance and serum biochemical characters of broiler chickens

In this study, supplementation of two levels (5 and 25 parts per million; ppm) of boron into broiler diets including 125 IU kg(-1) (inadequate) and 2000 IU kg(-1) (adequate) vitamin D3 was investigated. The effects of supplementation on performance and biochemical characters (Ca, P, Mg, glucose and AP) of broilers from 1 to 45 days of age were evaluated. Boron provided significant increases in performances of chicks fed both adequate and inadequate vitamin D3-containing diets. The improvements in the inadequate vitamin D3-containing group were higher than that of adequate vitamin D3-containing group. The boron addition had a positive effect on Ca, P and alkaline phosphatase levels of chicks. Boron might be regarded as beneficial in inadequate vitamin D3-containing broiler feed.

Effect of dietary probiotic on performance and humoral immune response in layer hens

1. The effects of dietary supplementation of a commercial probiotic (Protexin) on daily feed consumption, egg yield, egg weight, food conversion ratio and humoral immune response in layer hens were investigated. In 7 replicates, a total of 280 40-week-old layers were given diets containing either 0, 250, 500 or 750 parts per million (ppm) for 90 d. 2. When compared with the controls, the food consumption, food conversion ratio and the proportions of damaged eggs were lower in the group consuming 500 ppm probiotic (P<0.05). 3. There was no significant difference between the controls and the groups receiving 250 and 750 ppm probiotic in food consumption, food conversion ratio and proportion of damaged eggs. Similarly, the egg yield, egg weight, specific gravity, and peripheral immune response showed no statistically significant differences between the groups.

The effects of withdrawal of vitamin and trace mineral supplements from layer diets on egg yield and trace mineral composition

1. This study was conducted as three trials. 2. In the first trial, zinc, manganese, copper and iron concentrations were determined in dietary raw materials collected from various regions of Turkey. 3. In the second trial, 200 Hisex Brown laying hens, 30 weeks of age, were divided into two groups. The first group served as controls and were fed on a standard commercial layer diet. The second group were fed on a commercial layer diet that was not supplemented with trace minerals and vitamins. Egg production, egg weight, specific gravity, food consumption and food efficiency of the birds in each group were determined. In the unsupplemented group, egg production (0.75 vs 0.83) and food intake (114 vs 122 g) were lower than the those of the control group (P < 0.05). Food efficiency was 2.42 (kg food/kg gain) in the group consuming the unsupplemented diet and 2.36 in the controls. 4. In the third trial, as in Trial 2, Hisex Brown laying hens, 62 weeks of age were used. In the unsupplemented group, the mean egg weight was significantly lower than that of controls (68.0 vs 69.6 g) (P < 0.01). 5. At the end of the second and third trials, egg samples collected from experimental groups were hard boiled in water. The levels of zinc, manganese, copper and iron in the egg yolk were determined. The zinc level of the egg yolk from the control group of second trial was higher (23.5 mg/kg) than those of the unsupplemented group (13.6 mg/kg).

Preventive efficacy of clinoptilolite in broilers during chronic aflatoxin (50 and 100 ppb) exposure

This study was conducted to evaluate the protective efficacy of clinoptilolite (CLI, a natural zeolite) in the prevention of toxic effects of aflatoxin (AF). A total of 576 1-day-old Ross broiler chicks were housed in six treatment groups [six replicates of 16 each; control, CLI (15 g kg(-1)diet), 50 parts per billion (ppb) AF, 50 ppb AF plus CLI, 100 ppb AF, 100 ppb AF plus CLI ] for 42 days. Compared to controls, 100 ppb AF treatment significantly decreased body weight gains of chicks. The addition of CLI to the 100 ppb AF - containing diet moderately reduced the adverse effects of AF on performances of chicks. The chicks consuming 50 ppb AF -containing diet showed no significant differences on investigated parameters compared to controls. Also, the single addition of CLI to the AF -free diet had no adverse effects in birds. These results suggest that CLI can be beneficial in broilers for protection of AF toxicity at the level above.

Effects of dietary levels of vitamin A on the egg yield and immune responses of laying hens

This research, which was designed and carried out as two consecutive experiments, investigated the effects of four different levels (0, 4,000, 12,000, and 24,000 IU/kg) of vitamin A supplementation on egg yield, plasma vitamin A levels, and immune responses of laying hens. Transmission of maternal immunity to their descendants was also studied. In the first experiment, egg yield, blood vitamin A levels, and various parameters of the immune system such as T lymphocyte levels in the peripheral blood, plasma cell counts in the spleen, and antibody titers against Newcastle Disease Virus (NDV) in the sera were investigated for a 1-yr period. A total of 864 Hisex-brown laying hens were used in this experiment. The chicks were reared as commercial flocks until the 18th wk of age. No significant differences occurred among the parameters of the different diet groups. In the second experiment, maternal immunity was assessed in the chickens, supplied by hatching the eggs from hens in the first experiment. Maternal immunity was assayed by using the parameters as in Experiment 1. For this purpose, both blood and tissue samples were taken on the 2nd, 7th, and 10th d posthatch. Vitamin A supplementation had no significant effects on maternally, derived antibody titers or histologic structure of the lymphoid organs.