Foot infections are a common and serious problem in persons with diabetes Diabetic foot infections (DFIs) typically begin in a wound, most often a neuropathic ulceration While all wounds are colonized with microorganisms, the presence of infection is defined by ≥2 classic findings of inflammation or purulence Infections are then classified into mild (superficial and limited in size and depth), moderate (deeper or more extensive), or severe (accompanied by systemic signs or metabolic perturbations) This classification system, along with a vascular assessment, helps determine which patients should be hospitalized, which may require special imaging procedures or surgical interventions, and which will require amputation Most DFIs are polymicrobial, with aerobic gram-positive cocci (GPC), and especially staphylococci, the most common causative organisms Aerobic gram-negative bacilli are frequently copathogens in infections that are chronic or follow antibiotic treatment, and obligate anaerobes may be copathogens in ischemic or necrotic wounds Wounds without evidence of soft tissue or bone infection do not require antibiotic therapy For infected wounds, obtain a post-debridement specimen (preferably of tissue) for aerobic and anaerobic culture Empiric antibiotic therapy can be narrowly targeted at GPC in many acutely infected patients, but those at risk for infection with antibiotic-resistant organisms or with chronic, previously treated, or severe infections usually require broader spectrum regimens Imaging is helpful in most DFIs; plain radiographs may be sufficient, but magnetic resonance imaging is far more sensitive and specific Osteomyelitis occurs in many diabetic patients with a foot wound and can be difficult to diagnose (optimally defined by bone culture and histology) and treat (often requiring surgical debridement or resection, and/or prolonged antibiotic therapy) Most DFIs require some surgical intervention, ranging from minor (debridement) to major (resection, amputation) Wounds must also be properly dressed and off-loaded of pressure, and patients need regular follow-up An ischemic foot may require revascularization, and some nonresponding patients may benefit from selected adjunctive measures Employing multidisciplinary foot teams improves outcomes Clinicians and healthcare organizations should attempt to monitor, and thereby improve, their outcomes and processes in caring for DFIs

2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infections

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Hyperbaric oxygen therapy

HMG-CoA reductase inhibitors (statins) are a widely used class of drug, and like all medications, have potential for adverse effects (AEs). Here we review the statin AE literature, first focusing on muscle AEs as the most reported problem both in the literature and by patients. Evidence regarding the statin muscle AE mechanism, dose effect, drug interactions, and genetic predisposition is examined. We hypothesize, and provide evidence, that the demonstrated mitochondrial mechanisms for muscle AEs have implications to other nonmuscle AEs in patients treated with statins. In meta-analyses of randomized controlled trials (RCTs), muscle AEs are more frequent with statins than with placebo. A number of manifestations of muscle AEs have been reported, with rhabdomyolysis the most feared. AEs are dose dependent, and risk is amplified by drug interactions that functionally increase statin potency, often through inhibition of the cytochrome P450 3A4 system. An array of additional risk factors for statin AEs are those that amplify (or reflect) mitochondrial or metabolic vulnerability, such as metabolic syndrome factors, thyroid disease, and genetic mutations linked to mitochondrial dysfunction. Converging evidence supports a mitochondrial foundation for muscle AEs associated with statins, and both theoretical and empirical considerations suggest that mitochondrial dysfunction may also underlie many nonmuscle statin AEs. Evidence from RCTs and studies of other designs indicates existence of additional statin-associated AEs, such as cognitive loss, neuropathy, pancreatic and hepatic dysfunction, and sexual dysfunction. Physician awareness of statin AEs is reportedly low even for the AEs most widely reported by patients. Awareness and vigilance for AEs should be maintained to enable informed treatment decisions, treatment modification if appropriate, improved quality of patient care, and reduced patient morbidity.

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Statin Adverse Effects: A Review of the Literature and Evidence for a Mitochondrial Mechanism

Colchicine—Update on mechanisms of action and therapeutic uses

Introduction. Colchicine is used mainly for the treatment and prevention of gout and for familial Mediterranean fever (FMF). It has a narrow therapeutic index, with no clear-cut distinction between nontoxic, toxic, and lethal doses, causing substantial confusion among clinicians. Although colchicine poisoning is sometimes intentional, unintentional toxicity is common and often associated with a poor outcome. Methods. We performed a systematic review by searching OVID MEDLINE between 1966 and January 2010. The search strategy included “colchicine” and “poisoning” or “overdose” or “toxicity” or “intoxication.” Toxicokinetics. Colchicine is readily absorbed after oral administration, but undergoes extensive first-pass metabolism. It is widely distributed and binds to intracellular elements. Colchicine is primarily metabolized by the liver, undergoes significant enterohepatic re-circulation, and is also excreted by the kidneys. Therapeutic and toxic doses. The usual adult oral doses for FMF is 1.2–2.4 mg/day;...

Colchicine poisoning: the dark side of an ancient drug

e15107 Background: Epstein-Barr virus (EBV) causes gastric adenocarcinoma besides other etiologic factors EBV prevalence among gastric cancers has been reported in several countries EBV-positive gastric cancer frequency has not been known in Turkey We aimed to investigate EBV positivity and describe associated clinicopathologic parameters in north-west region of Turkey Methods: Eighty-five gastric cancer patients and 50 control patients with HP negative chronic gastritis were admitted to the study Epstein–Barr virus-encoded small RNAs (EBER) in situ hybridization was used for EBV positivity Results: ISH-EBER was positive in tumor tissues from 2 cancer patients First EBER positive patient was a 56 years old-woman (in diagnose) Tumor was intermediate-differentiated intestinal type adenocarcinoma in antrum (T3N1M0) After adjuvant chemoradiotherapy, she has been followed up without relapse for over 9 years Second patient was a 71 years-old man T3N0M0 tumor was diffuse type, intermediate-differentia

The Epstein-Barr virus-associated gastric carcinoma in Turkey.

Çorum İli ve Çevresinde Ailesel Akdeniz Ateşi Artriti Olarak Farklı Bir Fenotip mi Var

A 20-year-old otherwise healthy male patient with depression had ingested 1200 mg (60 tablets) of trimetazidine. He was taken to the emergency unit of our institution by his relatives four hours after the ingestion and gastric decontamination was done by gastric lavage and application of 50 g activated charcoal. Follow-up was unremarkable except sleepiness and a brief period of hypotension. No life-threatening risk was observed following oral ingestion of high-dose trimetazidine when the patient was treated after four hours. 	Turkish 	Baslik: 	Yuksek Doz Trimetazidin ile Intihar Girisimi: Olgu Sunumu 	Anahtar Kelimeler: 	Trimetazidin (TMZ); intoksikasyon; intihar; depresyon 	Daha once depresyon disinda bilinen bir hastaligi olmayan 20 yasinda erkek hasta, intihar amacli 1200 mg (60 tablet) trimetazidini oral olarak almis. Alimdan dort saat sonra hastanemiz acil servisine yakinlari tarafindan getirilen hastaya gastrik dekontaminasyon (gastrik lavaj ve 50 gr aktif komur) uygulandi. Hastanin izleminde uykululuk hali ve kisa sureli hipotansiyon disinda bulgu saptanmadi. Yuksek dozda trimetazidinin oral alimindan dort saat sonra mudahale edildiginde yasami tehdit eden risk olusturmadigi gozlenmistir.

Suicide Attempt With High-Dose Trimetazidine: Case Report

A twenty years old male patient was presented with purpuric rashes and wounds in bilateral ankles, and he was diagnosed with Henoch  Schonlein Purpura. He received ten sessions of hyperbaric oxygen therapy. Both rashes and wounds were improved after hyperbaric oxygen therapy. .©2008, Firat University, Medical Faculty.

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Henoch Schönlein Purpurası ve Hiperbarik Oksijen Tedavisi: Bir Olgu Sunumu

The present report describes a patient with common variable immunodeficiency who suffered severe pulmonary arterial hypertension and bilateral lung destruction due to bronchiectasis. Initially, the patient's treatment included antibiotics, diuretics, bronchodilators, mucolytics, oxygen and immunoglobulin replacement therapy. However, the patient's condition improved significantly only after low dose sildenafil treatment. To our best notice, our patient is the first report displaying a favorable outcome with sildenafil treatment in secondary pulmonary hypertension. (Anatol J Clin Investig 2009:3(1):97-99). Ozet

Secondary pulmonary arterial hypertension in a patient with common variable immunodeficiency: treatment with low dose sildenafil kombi̇ne i̇mmun yetmezli̇kli̇ bi̇r hastada sekonder pulmoner arteryel hi̇pertansi̇yon: düşük doz si̇ldenafi̇l i̇le tedavi̇

Emrullah Solmazgül

Papers

The Epstein-Barr virus-associated gastric carcinoma in Turkey.

Çorum İli ve Çevresinde Ailesel Akdeniz Ateşi Artriti Olarak Farklı Bir Fenotip mi Var

Suicide Attempt With High-Dose Trimetazidine: Case Report

Henoch Schönlein Purpurası ve Hiperbarik Oksijen Tedavisi: Bir Olgu Sunumu

Secondary pulmonary arterial hypertension in a patient with common variable immunodeficiency: treatment with low dose sildenafil kombi̇ne i̇mmun yetmezli̇kli̇ bi̇r hastada sekonder pulmoner arteryel hi̇pertansi̇yon: düşük doz si̇ldenafi̇l i̇le tedavi̇