Duran Tok

Prevalence and risk factors of onychomycosis in primary school children living in rural and urban areas in Central Anatolia of Turkey

BACKGROUND Onychomycosis is a world-wide public health concern in children, requiring epidemiological data for different regions for control and prevention. AIM The aim of this study was to evaluate the predominant pathogens and risk factors for onychomycosis in school children living in Kayseri, Turkey. METHODS This study included 8122 school children, aged 5-16 years, living in the rural and urban areas around Kayseri. Onychomycosis was clinically classified as distal and lateral subungual (DLSO), proximal subungual, superficial white, endonyx and totally dystrophic onychomycosis. Nail samples from children with clinically diagnosed onychomycosis were collected, examined by direct microscopy and inoculated for culture study. The demographic features and possible risk factors were recorded and assessed by logistic regression models. RESULTS We clinically diagnosed onychomycosis in 152 out of 8,122 (0.18%) school children. DLSO was the most frequent clinical diagnosis (120/152, 78.9%). Culture-positive onychomycosis was detected in 27/152 (17.7%) children. The prevalence of culture-positive onychomycosis was determined as 0.33%. All culture-positive samples were only from toenails. The onychomycosis causative agents were dermatophytes in 17/27 cases (62.9%), including Trichophyton rubrum 12 (44.4%), Trichophyton mentagrophytes 1 (3.7%), Trichophyton tonsurans 1 (3.7%) and Trichophyton spp. 3 (11.1%) and yeasts in 10/27 cases (37.1%), including Candida glabrata 4 (14.8%), Candida parapsilosis 1 (3.7%), Trichosporon 2 (7.4%) and Rhodotorula 3 (11.1%). Age, fathers occupation, number of siblings and rooms were statistically associated with the frequency of onychomycosis. CONCLUSIONS Although to be prevalence of onychomycosis in school children in central Anatolia of Turkey seems very low degree, pediatric onychomycosis is a growing public health concern all over the world. Children having more siblings or unemployed fathers and children living in small house as well as older children should be examined carefully for onychomycosis.

The Knowledge of the Physicians about Sepsis Bundles is Suboptimal: A Multicenter Survey.

OBJECTIVES Sepsis is a severe condition with possible high mortality outcomes. A multicentre-survey to detect the knowledge of the physicians who are involved in sepsis management in daily work was conducted. MATERIALS AND METHODS The study was held in October 2013. A questionnaire consisting of questions about sepsis bundles was prepared. Eight centers from different regions of the country were invited to join the survey. The questionnaires were introduced to physicians from infectious diseases, internal diseases, emergency (ER) and anaesthesiology departments. RESULTS Two-hundred-and-twenty-three physicians from eight different centers were included. Of total 112 (50%) were male, median age was 30 years (24-59 years). Median working duration of participants was 5 years; 153 (69%) were residents, 70 (31%) were consultants. Of total 131 (59%) declared that they have enough knowledge on sepsis management. About the most important approach in sepsis, 151 (68%) voted for fluid replacement while 59 (26%) and 13 (6%) said early antibiotic use and inotropic support are the most important approaches respectively. Physicians from ER (56.5%) and anaesthesiology departments (55.4%) were more aware of the fluid replacement element of the bundle (30ml/kg, 3-hours bundle) in severe sepsis. The ID physicians, who routinely follow sepsis patients, were not aware of the fluid resuscitation (only 20% replied the element correctly) but almost all of them answered the question on early antibiotic use and blood culture sampling correctly. The knowledge of target CVP and MAP in severe sepsis were also below expectant among ID physicians. The overall knowledge of sepsis bundles of internal medicine physicians was poor. Almost all of the ER physicians knew that they have to measure lactate level upon admission but they were not aware of the threshold of the lactate level. CONCLUSION The knowledge of the sepsis bundles of the physicians, who are in charge of sepsis patients in routine work, was suboptimal. Most of the participants were unaware of SSC and new bundles. Training of the physicians of all centers about sepsis bundles is suggested according to these results.

D-dimer level predicts in-hospital mortality in patients with infective endocarditis: A prospective single-centre study

BACKGROUND Increased circulating D-dimer levels have been correlated with adverse outcomes in various clinical conditions. To our knowledge, the association of on-admission D-dimer and in-hospital mortality in infective endocarditis (IE) has not been investigated. We hypothesized that increased on-admission D-dimer levels would correlate with adverse outcomes when prospectively studied in patients with IE. METHODS In this prospective study, a total of 157 consecutive patients with the definite IE diagnosis met the inclusion criteria and underwent testing for on-admission D-dimer and CRP assays. The outcome measure was in-hospital death from any cause. RESULTS In-hospital mortality occurred in 40 (26%) patients. Increased levels of plasma D-dimer (5.1 ± 1.7 vs 1.9 ± 0.8, p<0.001), CRP [45(13-98) vs 12(5-28), p<0.001] were found in dead patients compared with those survived. In addition to S. aureus infection, increased leukocyte count, end-stage renal disease, LVEF<50%, vegetation size of >10mm, perivalvular abscess, on-admission D-dimer (HR: 1.32; 95% CI: 1.24-1.40; p<0.001) and CRP (HR: 1.18; 95% CI: 1.09-1.36; p=0.001) levels were significantly associated with in-hospital mortality. Furthermore, the sensitivity and specificity of D-dimer ≥ 4.2mg/L in predicting in-hospital death in IE were 86% and 85%, respectively. Moreover, the sensitivity and specificity of CRP levels ≥ 13.6 mg/L were 72% and 69%, respectively. CONCLUSION Our findings suggest that on-admission D-dimer level may be a simple, available and valuable biomarker that allows us to identify high-risk IE patients for in-hospital mortality. D-dimer ≥ 4.2mg/L, CRP ≥ 13.6 mg/L were independently associated with IE related in-hospital death.

Monocyte to HDL ratio in prediction of BMS restenosis in subjects with stable and unstable angina pectoris

AIM This study aims to assess the predictive role of the preprocedural circulating monocyte to high-density lipoprotein (HDL) cholesterol ratio (MHR) on the occurrence of stent restenosis (SR) in patients with stable and unstable angina pectoris undergoing successful bare-metal stenting (BMS). PATIENTS & METHODS Between February 2008 and June 2014, a total of 831 patients with stable and unstable angina pectoris who underwent successful BMS were retrospectively analyzed. Demographic and clinical characteristics of the patients were recorded. Left ventricular ejection fraction and laboratory data were also noted. RESULTS In the receiver operating characteristics curve analysis, MHR >14 had 71% sensitivity and 69% specificity in predicting SR. CONCLUSION Our study results show that preprocedural MHR is an independent predictor of SR in this patient population.

Neutrophil-lymphocyte ratio is associated with low high-density lipoprotein cholesterol in healthy young men.

Objective: It has been reported that the neutrophil–lymphocyte ratio is significantly elevated in patients with low high-density lipoprotein cholesterol (<35 mg/dL). But in this study, some patients had hypertension that may have affected the neutrophil–lymphocyte ratio. This study consisted of 1274 asymptomatic healthy young men. In contrast with the previous study, we investigated the neutrophil–lymphocyte ratio in healthy young men with low high-density lipoprotein cholesterol compared with controls. Methods: We studied 1274 asymptomatic young males (military personnel screening) who underwent routine health check-up. Of them, 102 subjects had low high-density lipoprotein cholesterol. Results: The neutrophil–lymphocyte ratio was significantly higher among the men with low high-density lipoprotein cholesterol than that of the control group (P < 0.001). Conclusion: We conclude that the neutrophil–lymphocyte ratio is significantly elevated in asymptomatic healthy young men with low high-density lipoprotein cholesterol compared with control participants.

Evaluation of rabies suspected bites in an immunization center

Aim: Rabies is a fatal viral disease. Timely and appropriate vaccination is of vital importance in preventing this disease. The present study explored characteristics of patients that presented to our vaccination center for rabies prophylaxis, reasons for prophylaxis, prophylaxis approach employed, and the rate of compliance to prophylaxis. Materials and Methods: The study included patients who presented to our vaccination center between 2010 and 2012 due to contact with mammals suspected of rabies. Age, gender, site of the bite, previous vaccination status, adherence to vaccination schedule, vaccination schedule employed, type and vaccination status of the attacking animal were recorded on the forms. Results: A total of 591 patients (444 males, 75.1%), who were admitted for vaccination between 2010 and 2012, and who had accessible data, were included in the study. The mean age was 23.82±14.86 years (minimum-maximum: 1-83 years). Of these patients, 97.5% presented after exposure, while 2.5% presented for prophylaxis before exposure. The animals involved in these injuries were dogs in 50.9% and cats in 42.1%. Three cases were medical personnel at the department of forensic medicine that presented for prophylaxis after performing an autopsy to a patient who died from rabies. When the patients were evaluated according to age groups, 48.2% were in the 16-30 years age group. The affected body site was upper extremity in 63.8% of the injuries, lower extremity in 26.1%, head-neck region in 3.2%, and trunk in 1.9%. When the time between the injury and presentation to the hospital was evaluated, 73.6% of the cases presented in the same day, 25% presented between days 1 and 6, and 1.3% presented between days 7 and 15. After exposure, 54% of the patients received 5 doses, 46% received 3 doses, and 4.2% of the patients additionally received rabies hyperimmunoglobulin. Conclusion: The patients presented to our center due to suspected exposure to rabies mostly consisted of young individuals. Dogs were the most frequent animals involved in these injuries. Vaccination of the petted cats and dogs using a particular vaccination schedule, and breeding of stray animals are particularly important in combat with rabies. One fourth of the cases presented to our center days after the exposure. Public awareness campaigns must be conducted by the health authorities due to the fact that administration of prophylaxis as soon as possible after exposure.

Hepatitis B Prevalance in Young Adult Men Commando Candidates Applying for a Public Hospital

Our country is in the median endemicity belt in terms of hepatitis B virus infection. This study was performed in the commando candidates who came from all over Turkey to a military division/brigade, between January 2007 and December 2009, 20.681 commando candidates were checked for HBsAg positivity and these data were investigated retrospectively. In our study, hepatitis B virus carriage among young men as the Turkey\s average was 3.3%. This data was lower than those reported previously. We attribute this positive trend to the dissemination of immunization programs, the increase of births in the hospitals rather than home delivery, and the widespread use of HBsAg screening tests before marriage

Anti-HAV IgG seropositivity in young adults aged 16-24 years admitted to a public hospital -

Introduction: In this study, we aimed to determine the seropositivity of antiHAV IgG in young adults aged 16-24 years admitted to department of pediatrics and department of infectious diseases of a hospital in Kayseri. Material and Methods: This retrospective study was performed in a public hospital in Kayseri. In this study, the anti-HAV IgG results of 1032 patients aged 16-24 years admitted to hospital between 1st January, 2006 and 1st April, 2010 were investigated and the association between the anti-HAV IgG results and demographic features such as age and gender was analysed. Patients having immunisation history with HAV vaccine were not included in the study. The SPSS 15.0 was used for statistical analysis of data. Results: The study population were included a total of 1032 patients, 769 (74.6%) male and 263 (25.4%) female, mean age of 22.3± 2 years in male and 20.6±4 years in female. Total Anti-HAV IgG seropositivity was %61.8 (638/1032). Anti-HAV IgG results were seropositive 150 out of 263 (57.0%) in female group and 488 out of 769 (63.4%) in male group. There was no statistically significant association between seropositivity and age or gender (p>0,05). Conclusion: In this study, it was shown a lower seropositivity of anti-HAV IgG in young adults. It seems that effective precautions such as vaccination should be carried out for prevention of HAV infection and its complications which are more severe in adults.