Effect of magnesium sulfate administration on blood–brain barrier in a rat model of intraperitoneal sepsis: a randomized controlled experimental study

INTRODUCTION: Permeability changes in the blood–brain barrier (BBB) and their possible contribution to brain edema formation have a crucial role in the pathophysiology of septic encephalopathy. Magnesium sulfate has been shown to have a protective effect on BBB integrity in multiple experimental models. In this study we determine whether magnesium sulfate administration could have any protective effects on BBB derangement in a rat model of sepsis. METHODS: This randomized controlled experimental study was performed on adult male Sprague–Dawley rats. Intraperitoneal sepsis was induced by using the infected fibrin–thrombin clot model. To examine the effect of magnesium in septic and sham-operated rats, a dose of 750 μmol/kg magnesium sulfate was given intramuscularly immediately after surgery. Control groups for both infected and sham-operated rats were injected with equal volume of saline. Those rats surviving for 24 hours were anesthetized and decapitated for the investigation of brain tissue specific gravity and BBB integrity by the spectrophotometric assay of Evans blue dye extravasations. Another set of experiments was performed for hemodynamic measurements and plasma magnesium level analysis. Rats were allocated into four parallel groups undergoing identical procedures. RESULTS: Sepsis significantly increased BBB permeability to Evans blue. The dye content of each hemisphere was significantly lower in the magnesium-treated septic rats (left hemisphere, 0.00218 ± 0.0005; right hemisphere, 0.00199 ± 0.0007 [all results are means ± standard deviation]) than in control septic animals (left hemisphere, 0.00466 ± 0.0002; right hemisphere, 0.00641 ± 0.0003). In septic animals treated with magnesium sulfate, specific gravity was higher (left hemisphere, 1.0438 ± 0.0007; right hemisphere, 1.0439 ± 0.0004) than in the untreated septic animals (left hemisphere, 1.0429 ± 0.0009; right hemisphere, 1.0424 ± 0.0012), indicating less edema formation with the administration of magnesium. A significant decrease in plasma magnesium levels was observed 24 hours after the induction of sepsis. The dose of magnesium that we used maintained the baseline plasma magnesium levels in magnesium-treated septic rats. CONCLUSIONS: Magnesium administration attenuated the increased BBB permeability defect and caused a reduction in brain edema formation in our rat model of intraperitoneal sepsis

Hematologic Adverse Effects of Prolonged Piperacillin- Tazobactam Use in Adults

Objective: We aimed to find the incidence and risk factors of hematologic adverse effects of piperacillin-tazobactam (TZP). Materials and Methods: Adult patients who used TZP for more than 10 days were included in the study. Results: The incidence of leukopenia, neutropenia, and eosinophilia in 110 TZP therapy episodes was found to be 16.3%, 10%, and 10%, respectively. Lower Charlson Comorbidity Index score, lower initial leukocyte count, combination of TZP with another antibiotic, and total duration of TZP therapy were found to be independent risk factors for leukopenia, while initial higher eosinophil count (IHEC) and usage of TZP for >20 days were independent risk factors for neutropenia and IHEC and total duration of TZP therapy were independent risk factors for eosinophilia. Conclusion: Longer duration of therapy, combination with other antibiotics, younger age with fewer comorbidities, and IHEC could result in hematologic adverse effects in patients treated with TZP. Patients with IHEC may be more prone to allergic reactions, so immunological mechanisms may facilitate the development of hematological adverse effects of TZP

Management of Chronic Hepatitis C Virus Infection: A Consensus Report of the Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases-2017 Update

Türk Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Derneği Viral Hepatit Çalışma Grubu tarafından, ilk olarak 2014 yılında tüm dünyada önemli bir sağlık sorunu olan hepatit C virusu (HCV) infeksiyonunun yönetimine ilişkin bir uzlaşı raporu hazırlanmış ve Klimik Dergisi'nde yayımlanmıştır. Kronik hepatit Recently, we needed to update this report considering the new developments in treatment of chronic hepatitis C (CHC). This new consensus report is based on review of current literature and international guidelines. Agreed recommendations are presented at the end of each section such as epidemiology and natural history of HCV infection, diagnosis of acute hepatitis C (AHC) and CHC, treatment of AHC, goals of CHC therapy and pre-therapeutic assessment of CHC therapy, indications for treatment, contraindications to therapy, direct-acting antivirals (DAA) in the treatment of CHC and drug-drug interactions in the treatment of DAA, resistance problem in DAA treatment and clinical assesment of resistance, monitoring and managing treatment safety and side effects, post-treatment follow-up of patients who achieve a sustained virological response (SVR), follow-up of patients who didn't achieve an SVR and prevention of HCV infection. Klimik Dergisi 2017; 30(Suppl. 1): 2-3

Kronik hepatit C virusu infeksiyonunun yönetimi: Türk klinik mikrobiyoloji ve infeksiyon hastaliklari derneği viral hepatit çalişma grubu uzlaşi raporu-2017 güncellemesi

Previously a consensus report about management of hepatitis C virus (HCV) infection, a major health problem all over the world had been prepared by Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases. It was first published in the Klimik Journal in 2014. Recently, we needed to update this report considering the new developments in treatment of chronic hepatitis C (CHC). This new consensus report is based on review of current literature and international guidelines. Agreed recommendations are presented at the end of each section such as epidemiology and natural history of HCV infection, diagnosis of acute hepatitis C (AHC) and CHC, treatment of AHC, goals of CHC therapy and pre-therapeutic assessment of CHC therapy, indications for treatment, contraindications to therapy, direct-acting antivirals (DAA) in the treatment of CHC and drug-drug interactions in the treatment of DAA, resistance problem in DAA treatment and clinical assesment of resistance, monitoring and managing treatment safety and side effects, post-treatment follow-up of patients who achieve a sustained virological response (SVR), follow-up of patients who didn’t achieve an SVR and prevention of HCV infection. © 2017, AVES Ibrahim Kara. All rights reserved

(Trans)cribing History: The Oral Histories of Transgender Clergy in America

Popular American rhetoric around religion and LGBTQ issues puts the two at odds. The Bible has been the center of many debates over sexuality, gender identity, and faith. However, very few conversations have included or revolved around the authentic experiences of LGBTQ people of faith. Nine participants from various Protestant backgrounds shared their narratives with me and spoke on issues of gender and faith. This report is an in-depth summary of a short oral history project of transgender clergy (as well as candidates for ordination or exemplary church members)

Dio-sensimedia: a novel culture medium for rapid detection of extended spectrum β-lactamases

BACKGROUND: Resistance to contemporary broad-spectrum β-lactams, mediated by extended-spectrum β-lactamases (ESBL), is an increasing problem worldwide. Many of the emerging antimicrobial resistance problems of this decade have been characterized by difficulty in the recognition of resistance in the laboratory, particularly by rapid susceptibility test methods. The plasmid-encoded ESBL represent such a resistance phenomenon that is difficult to recognize. We compared Dio-Sensimedia-ES (DSM-ES; Diomed, Istanbul, Turkey) and Mueller-Hinton (MH) agar in the double-disk synergy test (DDST) as a novel rapid system for detecting ESBL directly from bacterial culture. METHODS: Sixty ESBL-producing Klebsiella pneumoniae isolates cultured from blood (30), endotracheal aspirates (20), urine (5) and pus (5), as well as 40 Escherichia coli isolates cultured from endotracheal aspirates (15), urine (10), blood (8) and pus (7) were studied. Isolates positive for ESBL by the combined disk tests were tested with the DDST using MH and DSM-ES agar to detect ESBL-mediated resistance in K. pneumoniae and E. coli. DSM-ES agar was also used to determine the susceptibility of Enterobacteriaceae and staphylococci. RESULTS: Among 60 ESBL-producing K. pneumoniae isolates, 59 (98.3%) were identified as ESBL-positive by the DDST using MH, and 58 (96.6%), using DSM-ES agar. Of 40 ESBL-producing E. coli isolates, 38 (95%) were ESBL-positive by the DDST on MH agar, and 37 (92.5%), on DSM-ES agar. The average incubation period required for ESBL detection by the DDST on DSM-ES agar was 4 hours. CONCLUSIONS: Since the DDST results were available within 4 hours when DSM-ES agar was used, the use of this media may significantly lower the length of hospital stay, the total cost for patient care and even the mortality rate by fascilitating early treatment against ESBL-producing organisms