Bulent Ahmet Besirbellioglu

Saccharomyces boulardii and infection due to Giardia lamblia

Therapy with metronidazole is the recommended option in giardiasis. However, some clinical trial reports suggest the appearance of drug resistance to explain therapeutic failure. Several investigations have been carried out on the effect of probiotic microorganisms for preventing or treating gastrointestinal diseases, but little is known about their efficacy against protozoal infections. The principal objective of our study was to evaluate the efficacy of Saccharomyces boulardii against Giardia lamblia infections. A double-blind, placebo-controlled study was carried out on adult patients with giardiasis. Group 1 (30 patients) included metronidazole 750 mg 3 times daily along with S. boulardii capsules (250 mg b.i.d. orally) for 10 d while group 2 (35 patients) was treated with metronidazole 750 mg 3 times daily and with empty capsules as placebo for 10 d. Patients were re-examined at 2 and 4 weeks after treatment, and stool examinations were performed. At week 2, G. lamblia cysts were detected in 6 cases (17.1%) of group 2 and none in group 1. At the end of the fourth week, presence of the cysts continued in the same 6 cases in group 2 (control group). These findings indicated that S. boulardii may be effective in treating giardiasis when combined with metronidazole therapy.

Human orf complicated with erythema multiforme

References 1 Hynes LR, Shenefelt PD. Unilateral nevoid telangiectasia: occurrence in two patients with hepatitis C. J Am Acad Dermatol 1997; 36: 819–822. 2 Karakas M, Durdu M, Sonmezoglu S, et al. Unilateral nevoid telangiectasia. J Dermatol 2004; 31: 109–112. 3 Wilkin JK. Unilateral nevoid telangiectasia: three new cases and the role of estrogen. Arch Dermatol 1977; 113: 486–488. 4 Uhlin SR, McCarty KS Jr. Unilateral nevoid telangiectatic syndrome. The role of estrogen and progesterone receptors. Arch Dermatol 1983; 119: 226–228. 5 Kreft B, Marsch WC, Wohlrab J. Unilateral nevoid telangiectasia syndrome. Dermatology 2004; 209: 215–217. 6 Sadick NS, Urmacher C. Estrogen and progesterone receptors: their role in postsclerotherapy angiogenesis telangiectatic matting. Dermatol Surg 1999; 25: 539–543. 7 Sharma VK, Khandpur S. Unilateral nevoid telangiectasia – response to pulsed dye laser. Int J Dermatol 2006; 45: 960–964.

War and infection in the pre-antibiotic era: The Third Ottoman Army in 1915

Abstract Background: The aim of this study, which evaluated historical data, was to delineate the probable impacts of infectious diseases on human populations under extraordinary circumstances. The second goal was to disclose the mortality rates for infectious diseases in the absence of antibiotics. Methods: The Third Ottoman Army records at the Turkish General Staff Military History and Strategic Study Directorate were studied retrospectively for the period between March 1915 and February 1916. Results: For the Third Ottoman Army, the number of infection-related deaths over the single-year period was 23,601. Malaria, relapsing fever and dysentery were the most common infections. In that pre-antibiotic era, the highest mortality rates were seen for cholera (80%), pulmonary tuberculosis (58%) and typhoid fever (51%). However, typhus had the maximum share in soldier deaths (6053 soldiers). The rate of vector-borne infections peaked in the summer of 1915, while the frequency of respiratory tract infections was highest in the colder months. In contrast, gastrointestinal tract infections appeared to maintain a steady state throughout the year. Conclusions: If the wartime data for 1915 are accepted to provide a model for extraordinary circumstances in the 21st century, vector-borne, respiratory tract and gastrointestinal infections can be accepted as the challenging issues with significant mortality.

Assessment of the requisites of microbiology based infectious disease training under the pressure of consultation needs

BackgroundTraining of infectious disease (ID) specialists is structured on classical clinical microbiology training in Turkey and ID specialists work as clinical microbiologists at the same time. Hence, this study aimed to determine the clinical skills and knowledge required by clinical microbiologists.MethodsA cross-sectional study was carried out between June 1, 2010 and September 15, 2010 in 32 ID departments in Turkey. Only patients hospitalized and followed up in the ID departments between January-June 2010 who required consultation with other disciplines were included.ResultsA total of 605 patients undergoing 1343 consultations were included, with pulmonology, neurology, cardiology, gastroenterology, nephrology, dermatology, haematology, and endocrinology being the most frequent consultation specialties. The consultation patterns were quite similar and were not affected by either the nature of infections or the critical clinical status of ID patients.ConclusionsThe results of our study show that certain internal medicine subdisciplines such as pulmonology, neurology and dermatology appear to be the principal clinical requisites in the training of ID specialists, rather than internal medicine as a whole.

A case of mucosal leishmaniasis: Mimicking intranasal tumor with perforation of septum

A 79-year-old male suffering from nasal congestion was referred to our hospital. Endoscopic examination revealed a hyperemic mass obstructing the left nasal passage. The lesions surface was smooth. The findings of imaging studies were consistent with a benign tumor despite the erosion and perforation of the septum. The lesion originated from the middle concha and was attached to it with a thin stalk. It was removed easily by endoscopic resection. Histopathology revealed significant infiltration of mononuclear inflammatory cells, mostly lymphocytes and histiocytes, into the edematous subepithelial connective tissue. High-power magnification showed numerous Leishmania amastigotes in the cytoplasm of the histiocytes. A polymerase chain reaction experiment for Leishmania also confirmed the morphological diagnosis. No relapse was observed in the 12 months after surgery and the patient was doing well.

Oropharyngeal tularemia cases admitted to a military hospital in Ankara, Turkey.

INTRODUCTION This study aimed to review the possible sources of infection of 16 oropharyngeal tularemia hospital cases, and to document their epidemiological and demographical characteristics, laboratory findings, treatment methods, and treatment results. METHODOLOGY Sixteen cases from a Turkish military hospital between January 2011 and December 2012 were retrospectively evaluated. The age, sex, occupation, place of residence, symptoms, duration of symptoms, laboratory results, treatment and duration, and treatment results were recorded. Tularemia was diagnosed through tularemia-specific tests once the other conditions that may have caused lymphadenopathy were excluded. RESULTS Twelve of the patients included in this study were males. The average age of the patients was 32.1 ± 17.2 years. Sore throat, fatigue, and fever were the most frequent symptoms. The mean duration of symptoms was 21.6 ± 6.9 days. All the patients had been treated for tonsillopharyngitis in primary healthcare institutions previously. However, despite the treatment, cervical lymphadenopathy had developed in these cases. Patients were given streptomycin, doxycycline, and ciprofloxacin monotherapy or in combination. Ten of the cases fully recovered, while five required surgical lymph node drainage. Spontaneous drainage occurred in the single remaining case. CONCLUSIONS Turkey is considered to be an endemic country with regards to tularemia. Prompt diagnosis and proper treatment of the disease is imperative in providing cure. Since it can be potentially confused with tuberculous lymphadenitis, differential diagnosis is vital. Patients presenting with a condition of tonsillopharyngitis in endemic areas must be carefully monitored.

Profiles of biochemical parameters in central nervous system fluid during the therapeutic courses of adult Mycobacterium tuberculosis meningitis

Clinical features, cerebrospinal fluid (CSF) examination, and neuroimaging findings can yield a presumptive diagnosis of tuberculosis meningitis (TM). However, confirmed diagnosis depends on the culture of Mycobacterium tuberculosis from the CSF [1]. Generally, the decision to begin with tuberculostatic treatment cannot await the proof of the causative agent and the prognosis of the disease may be devastating even if treatment is started promptly [2]. Sometimes the clinicians are confused from the diagnostic burden whether to start therapy for TM or not. In some TM cases without microbiological confirmation, the clinical and laboratory parameters resolve very quickly after the initiation of antibiotics. There remains another controversy in this situation, i.e. whether the clinician will stop therapy or continue for 12 months. There is little knowledge on the changes of CSF biochemical parameters during antituberculosis therapy in TM patients. What happens to the biochemical profile in CSF in due course? To the authors’ knowledge there are no data in the literature on this issue. Our study, which was performed between 1 January 2000 and 31 December 2004, focuses on these CNF changes in biochemical profiles for TM patients receiving therapy. There is a chain of military hospitals over the country in Turkey. If a soldier is diagnosed as TM in 1 of the military hospitals, the patient is given antibiotics and sent home for 2 /3 months of rest following the hospitalization necessary for patient stabilization. The patient returns to hospital either in an emergency situation or following the end of the official rest period. Thus, all TM patients return to military hospitals every 2 to 3 months, but the patient does not necessarily apply to the hospital where the disease is diagnosed. Generally the patient applies to the military hospital nearest to where he lives, i.e. another institution may follow a TM case diagnosed in our hospital in the follow-up periods or we may follow a previously diagnosed case in another military hospital during the therapeutic course. In every periodical visit the patient was punctured once again either to delineate the status of infection or to present an official clue to provide the patient with an additional rest time. After the end of 12-month therapy, the surveillance of the patient is stopped. Therefore we have sparse data on TM patients which we may have encountered at any period during anti-tuberculosis therapy. All the cases were young males ranging from 20 to 28 y of age without immunosuppression. Dexamethasone was given to all patients in standard dosages

Urinary tract infections caused by Shigella species.

tp://dx.doi.org/10.1016/j.tmaid.20 77-8939/a 2015 Elsevier Ltd. All rig Dear sir, it is well known that Shigella spp. primarily cause gastrointestinal infections. Extra-intestinal manifestations are uncommon and mainly include neurological manifestations and arthritis [1]. Urinary tract infections (UTIs) due to Shigella spp. are rare, and Shigella sonnei UTIs are particularly unusual [2]. S. sonnei can be responsible for UTI during pregnancy even when no predisposing factors or an apparent source of infection can be identified [3]. In a study from USA, laboratory confirmed 208,368 Shigella isolates were examined and of these 71.7% were S. sonnei, 18.4% S. flexneri, 1.6% S. boydii, and 0.7% S. dysenteriae. Nearly all of these strains (99%) were recovered from stool and only 0.63% from urine [4]. This study also stressed that urine is the second most common source of positive isolates after feces. The contribution of fecal contamination should be noted for this rate. Unlike other studies, S. boydii was the most common isolated pathogen

Determination the knowledge, attitude and motivation of voluntary blood donors about being hematopoietic stem cell donor

Aim: The aim of this study is to explore the knowledge and motivations of voluntary blood donors toward allojeneic hematopoietic stem cell donation also, and to determine predictors of hematopoietic stem cell donation motivation among them. Material and methods: The knowledge and motivations of voluntary blood donors toward hematopoietic stem cell donation were evaluated using a questionnaire with 42 items. The sample consisted of 100 voluntary blood donors that admitted to Gulhane Military Medical Faculty Blood Training Center and Blood Bank Department, between May 1st and September 1st, 2015. Results: The mean age of participant was 33.5±6.8 and 83% of them was male. 91% of participant have never get information about hematopoietic stem cell donation and transplantation and 80% of them would like to get information. although 47% of participants keen on for donate ; they haven’t considered such concerns as the deterioration of bodily integrity (75.5%), a negative impact on their health (64.1%) and discomfort (37.7%) before. It was found to be willing for HSC donor both in routine blood donors and in higher education group (respectively values of p,

Assessment of risk factors in the development of MRSA infection at Gülhane Military Medical Faculty Education Hospital and the role of antibiotic use on the development of MRSA infection

This research was carried out to determine most important risk factors in the development of MRSA by comparing infections due to methicillin resistant and susceptible strains to make suggestions to decrease MRSA ratios by pointing out the importance of pre-infection antibiotic usage in the development of MRSA infection and its place among the other risk factors.