Ekrem Kireçci

Status of pandemic influenza vaccination and factors affecting it in pregnant women in Kahramanmaras, an eastern Mediterranean city of Turkey.

Background Pregnant women are a target group for receipt of influenza vaccine because there appears to be an elevated mortality and morbidity rate associated with influenza virus infection in pregnant women. The goal of this study is to determine the factors affecting the decisions of pregnant women in Turkey to be vaccinated or not for 2009 H1N1 influenza. Methodology We enrolled 314 of 522 (60.2%) pregnant women who attended to the antenatal clinics of the Medical Faculty of Kahramanmaras Sutcuimam Universitys Department of Gynecology and Obstetrics between December 23, 2009, and February 1, 2010. We developed a 48-question survey which was completed in a face-to-face interview at the clinic with each pregnant woman. Principal Findings Of the 314 pregnant women, 27.4% were in the first trimester, 33.8% were in the second trimester, and 38.8% were in the third trimester. Twenty-eight pregnant women (8.9%) got vaccinated. Of all the women interviewed, 68.5% stated that they were comfortable with their decisions about the vaccine, 7.3% stated they were not comfortable, and 24.2% stated that they were hesitant about their decisions. The probability of receiving the 2009 H1N1 vaccine was 3.46 times higher among working women than housewives, 1.85 times higher among women who have a child than those who do not, and 1.29 times higher among women with a high-school education or higher than those with only a secondary-school education and below. Correct knowledge about the minimal risks associated with receipt of influenza vaccine were associated with a significant increase in the probability of receiving the 2009 H1N1 vaccine. Conclusions/Significance The number of pregnant women in the study group who received the 2009 H1N1 vaccine was very low (8.9%) and two-thirds of them stated that they were comfortable with their decisions concerning the vaccine. Our results may have implications for public health measures to increase the currently low vaccination rate among pregnant women. Further studies are required to confirm whether our findings generalize to other influenza seasons and other settings.

The use of 808-nm light therapy to treat experimental chronic osteomyelitis induced in rats by methicillin-resistant Staphylococcus aureus.

BACKGROUND DATA In vivo and in vitro studies have reported that laser energy in differing wavelengths and irradiation regimes has a potential bactericidal effect on Staphylococcus aureus. OBJECTIVE The purpose of this study was to investigate whether a light wavelength of 808  nm in varying doses has an effect on chronic osteomyelitis induced experimentally in the rat tibia. METHODS Intramedullary cavities were surgically created in the left tibias of 39 adult Wistar albino rats. Five randomly selected subjects were injected with a sterile saline solution, and methicillin-resistant S. aureus (MRSA) was used to induce osteomyelitis in the remaining rats. After 3 weeks, rats with evidence of osteomyelitis were treated with debridement alone (n = 7), with debridement plus laser irradiation to induce photoeradication (n = 21), or were not treated at all [negative control, (n = 6)]. Active irradiation was performed using an 808  nm, 100  mW continuous-wave diode laser with a beam spot size of 0.7854  cm(2) (irradiance = 127.3  mW/cm(2)). Laser treatment commenced immediately after debridement surgery and was applied daily for 5 consecutive days. Irradiation lasted 60  secs (6  J at 7.64  J/cm(2): n = 7), 120  secs (12  J at 15.29  J/cm(2): n = 7), or 180  secs (18  J at 22.93  J/cm(2): n = 7). Rats in the sham and negative control groups were killed 21 days post-induction surgery, and those in the treatment groups were killed after 42 days. Following killing, tibias were removed and analyzed histopathologically, radiographically, and microbiologically. RESULTS Histopathological analysis showed that infection levels had decreased by 37%, 67%, 81%, and 93% in the groups treated by debridement or by debridement plus 7.64, 15.29, and 22.93  J/cm(2) light therapy, respectively, compared to the negative control group. Osteomyelitis-induced rats had the highest bacteria count (5 × 10(5)). Bacterial counts fell to 1.6 × 10(4), 4.3 × 10(2), 5.5 × 10(1), and 3.3 × 10(0) in groups treated by debridement or by debridement plus 7.64, 15.29, and 22.93  J/cm(2) light therapy, respectively, compared to the negative control group. CONCLUSIONS Within the limitations of this study, laser phototherapy with the appropriate irradiation parameters appears to be a promising adjunct and/or alternative technique to pharmacological agents in the treatment of osteomyelitis. The 808  nm 100  mW (127.3  mW/cm(2)) laser device used in this study achieved a maximum effect with an irradiation time of 180  secs, delivering 18  J at an energy density of 22.93  J/cm(2).

Local treatment of chronic osteomyelitis with surgical debridement and tigecycline-impregnated calcium hydroxyapatite: an experimental study

OBJECTIVE The aim of this study was to determine the efficacy of tigecycline-impregnated hydroxyapatite in the local treatment of chronic osteomyelitis experimentally induced in rat tibias with methicillin-resistant Staphylococcus aureus. STUDY DESIGN Monocortical defects were established in the left tibias of 32 adult Wistar albino rats. Five rats were randomly selected and injected intramedullarly with saline solution (group 1), whereas chronic osteomyelitis was induced in other rats by intramedullary injection of S. aureus. Infected rats were then randomized and divided into 4 groups: group 2, no further treatment; group 3, debridement only; group 4, debridement followed by implantation of calcium hydroxyapatite; and group 5, debridement followed by implantation of tigecycline-impregnated calcium hydroxyapatite. On day 21 after induction, all rats in groups 2-5 showed signs of osteomyelitis. Rats in groups 1 and 2 were killed on day 21 after induction, whereas rats in groups 3, 4, and 5 underwent debridement surgery on day 21 after induction and were killed 21 days after debridement surgery. Tibias were analyzed histopathologically and cultured for S. aureus. RESULTS Compared with group 2, histopathologic disease severity scores in groups 3, 4, and 5 were 37%, 44%, and 83% lower, respectively. Nontreated infected rats had the highest bacteria count (mean 5 × 10(5) colony-forming units/g bone), and bacterial count was 26%, 29%, and 79% lower in groups 3, 4, and 5, respectively, compared with group 2. CONCLUSIONS Tigecycline-impregnated hydroxyapatite can have a potential in the treatment of chronic osteomyelitis of methicillin-resistant S. aureus origin, which may be considered as a therapeutic alternative by surgeons dealing with osteomyelitis.

Serratia ficaria isolated from sputum specimen.

Serratia ficaria was first described in 1979 as a Gram-negative facultative anaerobic rod. S. ficaria was found in figs, but also isolated from human specimens in a few cases. We now report an isolate of S. ficaria from sputum specimen.A 46-year-old man was suffering from a chronic renal failure of five years, four months of peritoneal dialysis and one week of fever due to respiratory tract infection, accompanied by cough. Sputum culture yielded a Gram-negative rod. It was identified as S. ficaria and the antibiotic susceptibility test was performed by automated Vitek II (bioMerieux). The tested S. ficaria strain was susceptible to amikacin, gentamicin, cefepime, trimethoprim-sulfamethoxazole, imipenem, meropenem, tigecycline and ciprofloxacin. This strain was resistant to ampicillin, amoxicillin-clavulanic acid, cephalothin, cefoxitine, cefuroxime and ceftriaxone. The patient was treated successfully (80 mg trimethoprim/400 mg sulfamethoxazole twice daily for 7 days)S. ficaria is an opportunistic pathogen responsible for intestinal colonization or serious infections such as septicaemia, gall bladder empyema in immunocompromised patients. The fig tree and fig play an important role in human colonization. It should be remembered that S. ficaria infections may be encountered frequently especially in fig tree culture zones.

Urogenital Myiasis Caused by Psychoda albipennis

Myiasis is one of the reasons for urogenital parasitosis in our country. Psychoda albipennis is a fly that leads to urogenital myiasis. In this case, a 28-year-old female with complaints of dysuria, nausea, vomiting, abdominal pain, and dropping larvae with urine was referred to our hospital. Larvae in the urine sample were macroscopically and microscopically examined. Subsequently, the patient was diagnosed with urogenital myiasis due to P. albipennis fourth phase larvae. The symptoms were relieved with antibiotic and urinal antiseptic treatments. A diagnosis of urogenital myiasis should be considered in patients with urogenital complaints.

Kahramanmaraş İlindeki İçme, Kullanma ve Çevresel Suların Mikrobiyolojik Niteliğinin Membran Filtrasyon Sistemi İle Belirlenmesi

Bu calismada, Kahramanmaras ve cevresindeki icme/kullanma sulari ile cevresel (nehir, gol) gibi sularin mikrobiyolojik kalitesi arastirildi. Bu arastirmada, cesitli su orneklerinden membran filtrasyon yontemi ile bakteriler izole edildi. Bu amacla, su kaynaklarindan 6 ay suresince toplanan 67 adet su numunesi calismaya alindi. Numuneler, 0.45μm porlu seluloz membran filtrelerden suzuldukten sonra filtreler Endo-NKS ve Standart TTC-NKS besiyerlerine yerlestirildi. Daha sonra her besiyeri 37 oC’de 24 saat inkube edildi. Besiyerlerinde ureyen bakteri kolonileri biyokimyasal yontemlerle identifiye edildi. Sonucta, 67 adet su numunesinin 53’unde (%79) Escherichia coli ve diger bakteriler izole edildi. Icme ve kullanma sularindaki Escherichia coli varligi fekal bir kontaminasyonu gosterdiginden, bu durumun su kaynakli infeksiyonlara yol acabilecegi dusunulmektedir. Anahtar sozcukler: Membran filtrasyon yontemi, icme ve kullanma suyu, cevresel sular, bakteriler Detection of Microbial Quality of Drinking, Using and Environmental Waters in Kahramanmaras City by Membrane Filtration System ABSTRACT: In this study, the microbiological quality of drinking/using water and environmental (river, lake) waters was investigated in Kahramanmaras area. In this investigation, bacteria were isolated by using membrane filtration methods from some water samples. For this purpose, 67 water samples TTC were collected and analyzed over course of 6 months. The samples were filtered through 0.45μm pore size cellulose membrane filter. After filtration, filters was placed on the Endo-NKS and Standart TTC-NKS medium and incubated for 24h at 37 oC. Bacteria colonies on the medium were identified by biochemical methods. In conclusion, Escherichia coli and different bacteria were isolated in 53 (79 %) of 67 water samples . The presence of Escherichia coli in the water samples exhibited existence of fecal contamination in the drinking/using water, which is thought to cause water origin infections. Key words: Membrane filtration method, drinking and using water, environmental waters, bacteria

Huzurevi Sakinlerinde Nazal MRSA Taşıyıcılığı

Amac: Nazal MRSA tasiyiciligi, bircok malzemenin ortak kullanildigi hastane, huzurevi, yurt gibi kapali ve kalabalik topluluklarda siklikla gorulebilmektedir. Bu calismada, Kahramanmaras huzurevi personeli ve huzurevi sakinlerinde nazal MRSA tasiyiciliginin arastirilmasi amaclandi. Gerec ve Yontem: 01 Haziran–10 Temmuz 2010 tarihleri arasinda, Kahramanmaras huzurevinde bulunan ve bu calismayi kabul eden 146 kisi (98 yasli ve 48 personel) olusturdu. Calismaya katilanlarin tamamindan burun suruntu ornekleri alinarak mikrobiyolojik olarak incelendi. Bulgular: Arastirma sonuclarina gore, yasli ve personelin yas ortalamasi 62.5±20.7 (min-max:22–97) olup, % 62.3’u erkek, % 37.7’si kadindi. Huzurevinde calisan personellerin % 33.3’unde, huzurevi sakinlerinin ise % 40.8’inde nazal MRSA tasiyiciligi saptandi. Huzurevi sakinlerinde siklikla gorulen kronik hastaliklar, diyabetes mellitus, ortopedik hastaliklar, dekubitis, kalp hastaliklari, hepatit B, astim, KOAH, hipertansiyon, psikolojik ve norolojik hastaliklar seklinde idi. Sonuc: Huzurevi sakinlerinde nazal MRSA kolonizasyonu sikliginin ortaya konularak, huzurevinde standart hijyen uygulamalarinin artirilmasi ile bu patojenin yayilmasi engellenebilir. Boylece huzurevi sakinlerinde ve personelde MRSA enfeksiyonlari ve olasi komplikasyonlari onlenebilecektir