BackgroundBacterial resistance to antibiotics is increasing worldwide. Antibiotic-resistant strains can lead to serious problems regarding treatment of infection. Carbapenem antibiotics are the final treatment option for infections caused by serious and life-threatening multidrug-resistant gram-negative bacteria. Therefore, an understanding of carbapenem resistance is important for infection control. In the study described herein, the phenotypic and genotypic features of carbapenem-resistant Enterobacteriaceae strains isolated in our hospital were evaluated.MethodsIn total, 43 carbapenem-resistant strains were included in this study. Sensitivity to antibiotics was determined using the VITEK®2 system. The modified Hodge test (MHT) and metallo-β-lactamase (MBL) antimicrobial gradient test were performed for phenotypic identification. Resistance genes IMP, VIM, KPC, NDM-1, and OXA-48 were amplified by multiplex PCR.ResultsThe OXA-48 gene was detected in seven strains, and the NDM-1 gene in one strain. No resistance genes were detected in the remainder of strains. A significant correlation was observed between the MHT test and OXA-48 positivity, and between the MBL antimicrobial gradient test and positivity for resistance genes (p < 0.05).ConclusionThe finding of one NDM-1-positive isolate in this study indicates that carbapenem resistance is spreading in Turkey. Carbapenem resistance spreads rapidly and causes challenges in treatment, and results in high mortality/morbidity rates. Therefore, is necessary to determine carbapenem resistance in Enterobacteriaceae isolates and to take essential infection control precautions to avoid spread of this resistance.

IntroductionHistological changes of psoriasis include invasion of neutrophils into the epidermis and formation of Munro abscesses in the epidermis. Neutrophils are the predominant white blood cells in circulation when stimulated; they discharge the abundant myeloperoxidase (MPO) enzyme that uses hydrogen peroxide to oxidize chloride for killing ingested bacteria.AimTo investigate the contribution of neutrophils to the pathogenesis of psoriasis at the blood and tissue levels through inducible nitric oxide synthase (iNOS) and MPO.Material and methodsA total of 50 adult patients with a chronic plaque form of psoriasis and 25 healthy controls were enrolled to this study. Serum MPO and iNOS levels were measured using ELISA method. Two biopsy specimens were taken in each patient from the center of the lesion and uninvolved skin. Immunohistochemistry was performed for MPO and iNOS on both normal and psoriasis vulgaris biopsies.ResultsWhile a significant difference between serum myeloperoxidase levels were detected, a similar statistical difference between participants in the serum iNOS levels was not found. In immunohistochemistry, intensely stained leukocytes with MPO and intensely staining with iNOS in psoriatic skin was observed.ConclusionsNeutrophils in psoriasis lesions are actively producing MPO and this indirectly triggers the synthesis of iNOS. Targeting of MPO or synthesis of MPO in the lesion area may contribute to development of a new treatment option.

IntroductionAccording to studies conducted in outpatients, it is estimated that 2.5% of children who are treated with a drug will experience a cutaneous adverse drug reaction (CADR).AimTo analyze the CADR reports involving pediatric patients recorded by three different university hospitals for describing common, serious, and interesting cutaneous drug eruption patterns.Material and methodsFor this purpose, the patients’ data from three different universities were reviewed retrospectively. Diagnosis was based on history, clinical findings and laboratory test results. The CADRs were classified into seven categories; urticaria, angioedema, maculopapular eruption, fixed drug eruption, erythema multiforme, acute generalized exanthematous pustulosis, drug rash with eosinophilia and systemic symptoms syndrome.ResultsA total of 122 patients who had CADRs were enrolled in the study. The most frequently detected cutaneous drug reactions were urticaria + angioedema. Most of patients had no previous experience with the same drug and the most common causative agent of CADRs was antimicrobials.ConclusionsSince CADRs are relatively rare, the current multicentric study can provide meaningful information about the cutaneous eruption patterns of commonly used drugs.

rable from the pericardium and spreading along right lateral section of the ascending aorta ( Fig. 2a and b). Following these findings, a positron-emission tomography and a computed tomography scan were taken, which showed an increased metabolism in the lesion with standardized uptake values of 2.5 and suggested an active disease (Fig. 2c). After thorough consultation with a patient, a left side thoracotomy and resection of lesion was performed along with a resection of pericardium and diaphragm. Histopathologic finding showed that the lesion was a metastasis from a primary ILC (Fig. 3). She is currently undergoing her 18 month of treatment with capecitabine therapy and tolerating it well.Although metastatic breast cancer is considered as an incurable disease, a small number of patients remain disease-free for a long time. This is the first imaging report of breast cancer metastasis in the retrosternal fat tissue. The management of patients who have metastatic cancer is a systemic treatment, and the role of breast cancer metastasectomy is still unclear. The evidence of improved survival outcomes when systemic therapy is combined with local therapy (surgery or radiation), should raise up a possibility of incorporating other imaging modalities in standard for breast cancer follow-up, emphasizing the importance to recognize breast cancer metastasis at the time of suggestive symptoms.A 27-year-old woman presented to our department with a small, painful, white, soft tissue growth on the nipple of her right breast. Physical examination revealed an immobile, firm, centrally located smoothsurfaced, well-defined,~4 mm in diameter oval mass on the right nipple (Fig. 1). The patient had nipple discharge. There was no associated history of trauma.The mass had been there for 2 years, and it was asymptomatic and very slowly growing. The surrounding areola and underlying mammary ducts and breast tissue were unremarkable. Left breast of the patient was normal. After the regional cleaning, discharge culture samples were taken from the patient. Staphylococcus aureus (MSSA) has been isolated from discharge, and the patient was treated with antibiotics, in accordance with the culture and antibiotic susceptibility results. Sonography showed a well-defined, central hyperechoic mass. Three weeks later, an excisional biopsy was performed. The histology of the specimens showed a cyst lined by mature stratified Figure 3. Photomicrograph of retrosternal mass biopsy showing metastatic lobular carcinoma (hematoxylin and eosin staining, original magnification 920).

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