Secondary infections in COVID-19 patients: A two-centre retrospective observational study

INTRODUCTION

We sought to evaluate secondary infections (SIs) in patients admitted to the intensive care unit (ICU) for COVID-19 with respect to incidence, causative pathogens, and clinical outcomes.

METHODOLOGY

In this two-centre retrospective study, we analysed 146 patients (96 males, 50 females; median age, 64 years) admitted to the ICU with COVID-19 between March 26 and December 31, 2020. Inclusion criteria were an ICU admission for at least 48 hours and age beyond 18 years. Patients with and without SIs were compared and the impacts of SIs and carbapenem resistance on mortality were analysed.

RESULTS

During ICU admission, 84 episodes of SIs developed in 58 patients (39.7%). A total of 104 isolates were recovered, with Gram-negative bacteria most frequent accounting for 74%. At least one carbapenem-resistant pathogen (n = 61) was recovered in 41 patients (70.1%). In multivariate analysis, the use of ECMO and an elevated procalcitonin level were significantly associated with the development of SIs. The mortality rate and the incidence of carbapenem resistance did not differ significantly in COVID-19 patients with and without SIs (p = 0.059 and p = 0.083, respectively).

CONCLUSIONS

The incidences of SIs and carbapenem resistance among COVID-19 patients were alarming, emphasizing stricter infection control measures in the ICU setting.

Evaluation of extensively drug-resistant gram-negative bacteremia among solid-organ transplant recipients: a multicenter study

Background/aim

The aim of this study is to evaluate the distribution, sources, clinical features, and mortality rates of bacteremia due to evaluation of extensively drug-resistant (XDR) gram negative among solid-organ transplant (SOT) recipients.

Materials and methods

A retrospective study of SOT recipients with bacteremia due to XDR gram-negative pathogens in 11 centers between 2016 and 2018 was conducted. Patients’ records were evaluated.

Results

Of 171 bacteremia that occurred in 164 SOT recipients, 93 (56.7%) were liver, 46 (28%) kidney, 14 (8.5%) heart, and 11 (6.7%) lung recipients. Bacteremia episodes were recorded in the first year in 63.7% of the patients (n = 109), early-onset bacteremia was recorded in 45% (n = 77) of the episodes. In multivariate analysis, catheter-associated bacteremia was an independent risk factor for 7-day mortality (p = 0.037), and early-onset bacteremia was found as an independent risk factor for 30-day mortality (p = 0.017).

Conclusion

Difficult-to-treat infections due to XDR bacteria in SOT recipients shadow the success of transplantation. Central venous catheters seem to be the main risk factor. Judicious use of medical devices is of pivotal importance.

Examination of daily water consumption behaviors of individuals living in a semi-rural area

Background

The aim of this study is to investigate water consumption behaviors and related factors in the summer period of the population over the age of 15 who apply to family health centers in the semi-rural region.

Methods

The universe of this cross-sectional study consisted of adult patients who applied to community health centers of a region in Malatya. A questionnaire was applied to random 303 individuals about sociodemographic information and water and other fluid consumption and water use behavior.And also Chrobach alpha coefficient of 0.83, the validity adopted in Turkey Likert type consisting of 16 questions Water Consumption Behavior Scale-16 (WCBS) was used for data collection. Scale score height is considered good. In the analysis of the data; Mann Whitney-U and Kruskal-Wallis tests were used. P < 0.05 was chosen as the level of error.

Results

49.8% of the participants were male and 64.4% were married. The median daily drinking water consumption of the individuals was 2000 ml (320 ml-1000 ml) and the median daily liquid consumption was 3300 ml (718ml-17001ml). There was no significant difference between age groups, marital status and education level and daily water and other fluid consumptions (p > 0,05). 48.8% of individuals stated that they saved water and the most important reason for this was the high level of water consumption prices.In our study, there was no significant difference between gender, place of residence and number of households and total WCBS scale score.(p > 0,05). But the married individuals' scale score were significantly higher than the single individuals (p < 0,05)

Conclusions

Water and fluid consumption of individuals are at moderate levels in the region. Marital status was most important factor influencing the water consumption behaviors has been found in this study.When the most important factors in saving water are examined, the high price water bills were noteworthy.

Key messages

In order to ensure correct water consumption the society should be informed, the necessary sensitivity should be performed to behavioral change and measures should be taken. Adequate daily water consumption is required to protect the health of individuals.

Diffusion-weighted magnetic resonance imaging in a case of methanol intoxication

BACKGROUND

Methanol intoxication is an uncommon clinical problem leading to profound metabolic acidosis with serious neurological deterioration. We describe methanol induced brain lesions on diffusion-weighted MR images and discuss the pathophysiology of these lesions in light of diffusion changes.

CASE REPORT

Brain imaging was performed in a 32 year-old man in a coma with focal neurological signs. Bilateral putaminal [hyperintensity] was seen on fast spin echo T2-weighted sequences, on Fluid Attenuated Inversion Recovery (FLAIR) and on diffusion weighted images. Decreased ADC values were observed bilaterally in the putamina. In addition, FLAIR images showed diffuse hypersignal in the subarachnoidal space. The patient showed rapid neurological deterioration while blood chemical tests revealed a severe metabolic acidosis and plasma methanol levels of 21 mmol/L. The patient died from hepatic failure thirty six hours after admission.

CONCLUSION

Although decreased ADC values on diffusion-weighted imaging are commonly associated with arterial ischemic stroke, this pattern can also be observed in the case of putaminal necrosis following methanol ingestion.

[Cryptococcal lymphadenitis in a dog.]

We describe a case of canine crytococcosis, the clinical symptoms were: feverish syndrome, vomiting and diarrhoeas and bilateral lymphadenitis in superficial lymph nodes. Microbiology and histopathology study of popliteal lymph node biopsy demonstrated the presence of round yeasts of some 3 microm of diameter, which we identified as Cryptococcus neoformans. Thirty months after suspending the medication the dog returned to the surgery; the dog was very thin and it had nervous symptoms; the owners decided it upon euthanasia. After carrying out the necropsy we take samples for their microbiology and histopathology study, both techniques detect to C. neoformans in marrow, CNS tissue and lymph nodes.

Posterior wall perforation of duodenal ulcers. Report of two cases and survey of the literature

Retroperitoneal perforation of duodenal ulcer is a rare condition. Diagnostic difficulties lead to high mortality. Two cases are presented in this report.

Sebum production is increased in Behçet's syndrome and even more so in rheumatoid arthritis

Sebum production is under hormonal control. We had shown that male sex is associated with more severe disease in Behçet's syndrome and the acneiform skin lesion of this disorder is not different from ordinary acne, an androgen-dependent lesion. Sebum excretion rate was higher in patients with Behçet's syndrome than in healthy controls, children and patients with ankylosing spondylitis. On the other hand, patients with rheumatoid arthritis had high levels of sebum excretion rate comparable to those found in patients with acne vulgaris. These suggest the presence of a sebotrophic hormone and/or other hormonal effects in Behçet's syndrome and rheumatoid arthritis.

Behçet's disease. Relation of serum C-reactive protein and erythrocyte sedimentation rates to disease activity

In a prospective study of 150 patients with Behçet's disease, significant associations were shown between CRP positivity and the presence of erythema nodosum (p less than 0.02) and acute thrombophlebitis (p less than 0.05) and between ESR and erythema nodosum (p less than 0.01), acute thrombophlebitis (p less than 0.001), and acute arthritis (p less than 0.01). Mucocutaneous, ocular, or central nervous system activities did not show significant associations with these indices of inflammation. In 50 patients in whom quantitative CRP determinations were performed, clinical disease activity was accompanied by slight to moderate increases in CRP and ESR.