Erkan Yula

Investigation of demodex species frequency in patients with a persistent itchy ear canal treated with a local steroid

OBJECTIVEnTo investigate the frequency of demodex species in the external acoustic meatus in patients with an itchy ear canal.nnnMETHODSnPatients were assigned to one of three groups. Group one consisted of 54 patients with an itchy ear canal who were using a local agent, while group two was composed of 51 patients with an itchy ear canal who were not using a local agent. Group three consisted of 50 healthy individuals without an itchy ear canal.nnnRESULTSnDemodex species test results were positive in nine (5.8 per cent) of the cases. Six of these positive cases were in group one, two in group two and one in group three. The frequency of demodex species in the external acoustic meatus was similar between those patients with an itchy ear canal who did not use a local agent and the healthy individuals (pxa0=xa00.571), but it was significantly higher in those using a local steroid compared with those not using a local agent (pxa0=xa00.046).nnnCONCLUSIONnAlthough demodex species was not significantly higher in patients with an itchy ear canal compared with the control group, use of a local steroid increased the parasite frequency in the external ear canal of affected patients.

Mardin\'de doğurganlık çağındaki kadınlarda toksoplazma ve rubella antikor seroprevalansı

Objectives: In present study, we investigated the seroprevalence of the antibodies against Toxoplasma gondii and Rubella virus, which may cause congenital infections in risk groups including childbearing age women in a period of two years. Materials and Methods: The samples of sera, which were taken from risk groups including pregnant and childbearing age women admitted to our hospital during May 2008 and April 2010, were tested for antibodies against Toxoplasma gondii and Rubella virus. Anti-Toxoplasma IgM/IgG and anti-Rubella IgM/IgG antibodies were assayed with chemiluminescent method by autoimmunanalyzer (Advia Centaur, Siemens) according to the manufacturer’s instructions. Results: Seroprevalences of IgM and IgG for Toxoplasma gondii (n=3.474) were found as 4.6% and 17.5%, respectively. Seroprevalences of IgM and IgG for Rubella virus (n=3.460) were found as 0.95% and 76.5%, respectively. Conclusion: Widespread population screening may contribute to the prevention of congenital infections due to Toxoplasma gondii and Rubella virus. Because of the high seropositivity of Toxoplasma gondii and Rubella virus in childbearing age women, preventive measures should be implemented. J Clin Exp Invest 2010; 1(2): 81-85

Evlilik öncesi yapılan tarama testi sonuçlarının değerlendirilmesi

Objectives: Human immunodeficiency virus (HIV), Hepa titis B and Hepatitis C viruses and Treponema pallidum are parenterally and sexually transmitted infection agents. Screening test is made before marriage to pre-marital couples legally under the relevant legislation and legal procedures in our country; applicants are evaluated in terms of sexually transmitted diseases. The aim of this study is to evaluate pre-marital test results for HBsAg, anti-HCV, anti-HIV I/II and Treponema pallidum.

Prognostic significance of transforming growth factor- beta-1 in chronic hepatitis C virus infection

Interferon treatment in hepatitis C virus (HCV) infection is expensive and has various adverse effects. Some markers may help in making decision to stop or maintain the treatment. The aim of this study was to evaluate the effectiveness of serum transforming growth factor beta-1 (TGF-β1) in assessing outcome of interferon treatment in patients with HCV infection. Twelve patients with chronic HCV infections included in the study as treatment group [Treatment group: anti-HCV (+), HCV RNA (+)] and 12 patients with anti-HCV positive, HCV-RNA negative and normal liver function tests included as control group. All patients in the treatment group were administered with peginterferon and ribavirin for 24 weeks. HCV-RNA levels were determined by realtime-PCR and TGF-β1 levels were measured with ELISA methods, at the beginning and 24th week of the treatment. Mann-Whitney U Test and Wilcoxon Test were used to compare variables within and between groups. Median age and male/female ratios were 46 years and 5/7, and 45 years and 3/9 for treatment groups and control group, respectively. Although no difference was found in TGF-β1 levels at the beginning of the treatment between groups (p>0.05), significantly decreased TGF-β1 levels were observed following 24 weeks of interferon treatment in treatment group (p=0.015). Despite limited number of patients, our data suggested that, TGF-β1 levels may be used as a prognostic marker for effectiveness of interferon treatment in patients with hepatitis C virus infection. n n xa0 n n Key words:xa0Chronic hepatitis C infection, transforming growth factor β1, pegylated interferon, ribavirin, prognostic marker.

A case of acute hemorrhagic cystitis caused by Salmonella paratyphi A in a pediatric patient

It is a very rare medical condition that Urinary tract infection (UTI) caused by Salmonella species. Sevenyear-old boy admitted to our hospital with complaint of lower abdominal pain, burning and pain during urination (dysuria), nausea and increased fever. The patient had normal vital signs but abdominal examination revealed bilateral suprapubic tenderness. In the laboratory, it was found the amount of hemoglobin 12.9 g/dL, red blood cell count 4.8 million/mm3, white blood cell count 11.800/ mm3, platelet count 275.000/mm3, level of C-reactive protein 30.2 mg/L, serologically S. paratyphi A “O” antibody (1/160) and S. paratyphi A “H” antibody (1/320) positivity. Urine examination showed gross hematuria and leukocyte esterase was positive. Urine culture was performed and isolate obtained urine culture was identified with conventional methods. Result of urine culture was reported as Salmonella species and isolate was determined as Salmonella paratyphi A by using anti-sera during the advanced identification. Results of radiological imaging were found normal. The patient was diagnosed ÖZET Salmonella türlerinin neden olduğu üriner sistem enfeksiyonu (ÜSE) oldukça nadir görülen bir klinik durumdur. Yedi yaşında erkek bir hasta; alt karın ağrısı, idrar yaparken yanma ve ağrı, bulantı ve ateş yükselmesi şikayeti ile hastanemize başvurmuştur. Fizik muayenesinde hastanın vital bulgularının normal olduğu saptanmış ancak abdominal muayene ile bilateral suprapubik hassasiyet bulunduğu belirlenmiştir. Laboratuvar tetkiklerinde; hemoglobin miktarı 12,9 g/dL, eritrosit sayısı 4,8 milyon/ mm3, lökosit sayısı 11.800/mm3, trombosit sayısı 275.000/ mm3, C-reaktif protein düzeyi 30,2 mg/L, serolojik olarak paratyphi A “O” antikoru (1/160) ve paratyphi A “H” antikoru (1/320) pozitifliğinin bulunduğu belirlenmiştir. İdrar mikroskobisinde ise hematüri görülmüş ve lökosit esteraz pozitif bulunmuştur. İdrar kültürü çalışılmış ve kültürden elde edilen izolat konvansiyonel yöntemlerle tanımlanmıştır. İdrar kültürü sonucu Salmonella spp. olarak bildirilmiş ve antiserumlarla yapılan ileri tanımlamalarda izolatın Salmonella paratyphi A olduğu tespit edilmiştir. Radyolojik görüntüleme sonuçları normal bulunmuştur. Türk Hijyen ve Deneysel Biyoloji Dergisi 1 Mustafa Kemal Üniversitesi, Tıp Fakültesi, Tıbbi Mikrobiyoloji ABD, HATAY 2 Dicle Üniversitesi, Tıp Fakültesi, Enfeksiyon Hastalıkları ABD, DİYARBAKIR 3 Kızıltepe Devlet Hastanesi, Mikrobiyoloji Laboratuvarı, MARDİN 4 Dicle Üniversitesi, Tıp Fakültesi, Tıbbi Mikrobiyoloji ABD, DİYARBAKIR 5 Mustafa Kemal Üniversitesi, Tıp Fakültesi, Acil Tıp ABD, HATAY Geliş Tarihi / Received : Kabul Tarihi / Accepted : İletişim / Corresponding Author : Erkan YULA Mustafa Kemal Üniversitesi, Tıp Fakültesi, Tıbbi Mikrobiyoloji ABD, HATAY Tel : +90 326 229 10 00-3428 E-posta / E-mail : erkanyula@gmail.com 16.01.2012 24.08.2012 DOI ID : 10.5505/TurkHijyen.2012.17894 Yula E, Deveci Ö, Toka-Özer T, Tekin A, İnci M, Karakuş A. Pediatrik bir hastada Salmonella paratyphi A’nın neden olduğu bir akut hemorajik sistit olgusu. Turk Hij Den Biyol Derg, 2012; 69(3): 163-8. * Bu olgu sunumu; “4th Eurasia Congress of Infectious Diseases, June 01-05 2011, Sarajevo-Bosnia&Herzegovina” kongresinde poster bildiri olarak sunulmuştur. Cilt 69 uf03c Sayı 3 uf03c 2012 Turk Hij Den Biyol Derg 164 Salmonella türleri çoğunlukla kendi kendini sınırlayan ve klinik olarak sıklıkla gastroenterit tablosu ile seyreden enfeksiyonlara yol açan Enterobacteriaceae ailesi üyesi Gram negatif basillerdir. Bu mikroorganizmalar, bağışıklık sistemi tam olarak olgunlaşmamış süt çocuklarında veya baskılanmış kişilerde bakteriyemi ve çeşitli ekstraintestinal organ tutulumları gibi daha ağır klinik tablolarla karşımıza çıkabilmektedir. Ülkemizde yapılan çok merkezli bir çalışmada; en sık izole edilen suşlar Salmonella serovar enteritidis ve Salmonella paratyphi B olarak bildirilmiştir (1). Tüm dünyada enfeksiyonlara neden olan Salmonella türlerinin idrar yolu enfeksiyonlarına yol açması oldukça nadir görülen bir klinik tablodur. Salmonella türlerine bağlı üriner sistem enfeksiyonlarının çoğu üst üriner sistem (üreter ve böbrek) kökenli olduğu belirtilmektedir. Hastaların çoğunun malignensi veya solid organ transplantasyonu gibi altta yatan bir bağışıklık yetmezliği veya önceden var olan böbrek taşı, hidronefroz, anatomik anomali gibi patolojilere sahip oldukları da söylenmiştir (2-5). S. typhimurium’un renal transplantlı hastalarda en çok izole edilen Salmonella türü olduğu da tespit edilmiştir (2). Salmonella türlerinin neden olduğu akut hemorajik sistit ise oldukça nadir görülen ve genellikle dizüri, hematüri ve suprapubik bölgede hassasiyet ile kendini gösteren, prognozu iyi olan bir hastalıktır. Sistit olgularında daha çok idrarda Salmonella’ların M form izolatlarının bulunduğu ve bu izolatların çoğunlukla S. paratyphi B olduğu bildirilmiştir (6). Akut hemorajik sistit, pediatrik yaş grubunda nadir görülen bir hastalıktır ve daha çok adenovirüs, Escherichia coli ve kemoterapötik ilaçlarla ortaya çıkan ve daha çok kız çocuklarını etkileyen bir tablodur. Bu çalışmamızda, Güneydoğu Anadolu Bölgesinde S. paratyphi A’nın akut hemorajik sistit tablosunda etken olarak bildirildiği ilk vakayı ortaya koymak amaçlanmıştır.

BİR HUZUREVİ YAŞLI BAKIM VE REHABİLİTASYON MERKEZİNDEKİ YAŞLILARDA

Amac: Bu calisma 2012 Şubat ayinda bir huzurevi yasli bakim ve rehabilitasyon merkezinde yasayan yaslilarda Pediculus humanus capitis (P.h.capitis) gorulme sikligini ve hijyenik kosullar ile iliskisini belirlemek amaciyla yapilmistir. Gerec ve Yontem: Calismaya, yaslari 61-100 arasinda degisen 106 (%62.7) erkek ve 63 (%37.3) kadin olmak uzere toplam 169 kisi dahil edildi. Yaslilarin saclari, ozellikle ense ve baslarinin arkasi olmak uzere bitin eriskin, nimf ve yumurtalari yonunden incelendi. Bulgular: Arastirmada erkek ve kadinlardan birer kiside olmak uzere (%0.9 ve %1.6, sirasiyla), toplam iki (%1.18) yaslida P.h.capitis infestasyonu bulundu. Sonuc: Yasli kisilere saglik personeli ve bakicilar tarafindan etkin bir sekilde bakilmasi nedeniyle enfestasyon oraninin dusuk oldugu dusunulmustur. Anahtar kelimeler; Pediculus humanus capitis, yasli bakim merkezi, yasli kisiler, Hatay SUMMARY Objectives: The aim of the study is to determine frequency of Pediculus humanus capitis (P.h.capitis) in elderly people living in an aged care facility and rehabilitation center and association with hygiene conditions. Matherial and Methods: The study was performed on 169 individuals aged between 61 and 100 years, 106 (62.7%) was male and 63 (37.3%) was female. Elderly persons’ hairs especially on the neck and the back of the head were investigated to detect the egg, nymph and adult stages of the parasites. Results: P.h.capitis infestation detected in two (1.18%) individuals and the frequency was found one (0.9%) in males and one (1.6%) in females. Conclusions: It is thought that infestation rate is low due to effective caring of elderly people by health personnel and caretakers. Key words: Pediculus humanus capitis, aged care facility, elderly people, Hatay.

GENOTYPING OF MYCOBACTERIUM TUBERCULOSIS STRAINS ISOLATED IN HATAY CITY BY SPOLIGOTYPING METHOD

Mycobacterium tuberculosis bacilli infect a significant proportion of the world population and constitute a major public health problem, particularly in developing regions. The aim of the study is to determine genotypes of M. tuberculosis strains isolated from Hatay city by spoligotyping method. Nineteen M. tuberculosis strains isolated from various clinical samples between 2010-2011 years were included the study. The samples send to Mustafa Kemal University, Faculty of Medicine, Department of Microbiology laboratory were cultivated to BacT/ALERT MP bottles and BacT/ALERT 3D system were used. Culture positive samples were identified by biochemical properties. The DNA of bacteria was extracted using Mickle cell disruptor. Genotypes of the M. tuberculosis isolates were determined by spoligotyping method. The most prevalent M. tuberculosis lineages were: T1 family (7, 36.8%), LAM7 TUR family (5, 26.3%), T3 family (3, 15.8%), X3 family (2, 10.5%) and H3 family (2, 10.5%) by spoligotyping method. In conclusion, it is observed that the dominant strains were belong to T1 family and followed by LAM7 TUR family in our region.

Assessment of the levels of nitric oxide (NO) in chronic diarrhea patients infected with Giardia intestinalis

Department of Parasitology, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey. Department of Parasitology, Faculty of Medicine, Inonu University, Malatya, Turkey. Department of Microbiology, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey. Department of Biochemistry, Faculty of Medicine, Inonu University, Malatya, Turkey. Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey. Department of Biochemistry, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey. Department of Internal Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey.

Intestinal parasites and report of etiological analysis in a state hospital

Objectives: Intestinal parasitosis is a major public health problem particularly in the developing countries and af� fects approximately 4 billion people globally. The pre� sented study aimed to determine the prevalence of mul� tiple (mixt) intestinal parasites and potential source of in� fection in our region.

Nanotıp, mikrodizilimler ve klinik mikrobiyolojide kullanımları

Regional anaesthesia has advantages such as, control of postoperative pain, early mobilization, and does not affect respiratory function. In recent years, regional anaesthesia had improved by the application of the peripheral nerve stimulator and ultrasound guided blocks, new local anaesthetic drugs with the use of additional adjunctive agents. Especially in emergency conditions, combination of regional anaesthesia may avoid the complications of general anesthesia in patients with chronic disease who suffer from upper and lower extremity injuries. In this paper, we present two cases who underwent combined regional anaesthesia techniques for the lower and upper extremity surgery.Objectives: In order to maximize the benefits from stesroids, patients should understand treatment with this drug. The aim of this study was to investigate inpatients compliance to steroid treatment. Materials and methods: This study was carried out from April to June 2005 on a total voluntary 118 inpatients in internal medicine clinics of a university hospital. The data were collected using by a questionnaire form and data analysis was performed using frequency tables and chimsquare tests. Results: The mean age of the subjects was 48.94p14.72 years and 70.3% of them was female. With regard of educational status, 44.9% of patients were elementary school graduates. A total of 45.8% reported that they had received information about steroids from a health professsional. Although 99.2% - 94.6% of subjects knew the corsrect drug scheduling, only 52.5% knew how to calculate steroid dose. Additionally majority of them (83.1%) did not know side effects of drug and prevention from their side effects. Conclusion: According to our results, patients using stesroid did not have sufficient information for adherence to this drug therapy and the patients experienced various problems. In order to relieve these problems, the patients should be better trained about steroid therapy by health professionals.Piyoderma gangrenozum seyrek gorulen ve enfeksiyoz olmayan bir notrofilik cilt hastaligidir. Etyolopatogenezi bixadlinmemektedir. Olgularin yarisinda altta yatan bir hastalik mevcuttur. En sik inflamatuvar bagirsak hastaligina eslik eder. Tedavisinde immun baskilayici veya immunmodulaxadtor ilaclarla bazi topikal ajanlar kullanilmaktadir. Sistemik kortikosteroidler, tedavide ilk secenek ilaclardir. Crohn hastaligi zemininde gelismis ve basarili bir sekilde tedavi edilmis olan bir piyoderma gangrenozum vakasi sunuldu. Crohn hastaligi, diyabetes mellitus ve hipertansiyonu olan 54 yasinda bir kadin, her iki bacagin on ic tarafinda kirmixadzimsi ve agrili lezyonlari nedeniyle hastanemize basvurxaddu. Anormal laboratuar bulgusu olarak lokositoz (13500/μL) ve artmis sedimantasyon hizi (120 mm/saat) tespit edildi. Genis spektrumlu antibiyotik tedavisi baslanildi, ancak beklenen cevap alinamadi. Lezyon biyopsisinden histopatolojik degerlendirme yapildi. Ust dermiste nekroz, siddetli odem, eritrosit ekstravazasyonuyla cevre dokuda rejeneratif degisiklikler, dermisin ic bolumunde nekrozu kusatan mikst inflamatuvar reaksiyon goruldu. Klinigi, laboratuvar bulgulari ve altta yatan hastaligi piyoderma gangrenozumu dusundurdu. Oral metil prednizolon basxadlanildi, lezyonlarinda duzelme gorulmesi uzerine taburcu edildi. Ayaktan takiplerinde kortikosteroid dozu tedricen azaltilarak kesildi. Vakamiz, sistemik kortikosteroidlerin piyoderma gangrenozum tedavisinde hâlâ favori ilaclar oldugunu gostermistir.Epidural blok uygulamasi esnasinda yanlislikla dural yirtik olusturup subaraknoid alana girilmesi ender rastlanan bir komplikasyondur. Bu komplikasyonun tedavi yonetiminxadde pratikte uygulanan birtakim yontemler yer almaktadir. Epidural ignenin cekilip baska bir intervertebral disk araxadligindan girilmesi, subaraknoid alana kateter birakilmasi, epidural kateterden spinal anestezik ilac enjeksiyonu ile spinal anestezi saglanmasi yada genel anesteziye gecilxadmesi klinisyenler tarafindan uygulanan metodlar arasinxaddadir. Sezeryan icin epidural blok uygularken dural yirtik komplikasyonu gelisen olgumuzu sunduk. Olgumuzda beyin omurilik sivisi (BOS) serbest akisinin gozlemlenxadmesinden sonra girisim yapilan epidural ignenin BOS akxadmayacak seviyeye kadar geri cekilmesini ve bu seviyenin serum fizyolojik (SF) enjeksiyon aspirasyon teknigi ile epixaddural alan oldugu teyid edildikten sonra epidural kateterin yerlestirilmesini belirttik. Bu vaka sunumunda dural yirtik komplikasyonunda anestezistin yapabilecegi manevralar, basagrisi icin koruyucu ve tedavi edici yontemler gozden gecirilmistir.Amac: Sendrom X veya mikrovaskuler anjina pektoris, koroner anjiyografide, nonstenotik epikardiyal arterlexadri olan hastalarda, koroner mikrovaskuler disfonksiyona bagli gelisen anjina pektoris olarak tanimlanir. Bu caxadlismada sendrom X ile obstuktif uyku apnesi sendromu (OSAS) arasindaki iliski arastirilmistir. Gerec ve yontem: Bu calismaya Dicle Universitesi Tip Fakultesi Kardiyoloji poliklinigine gogus agrisi nedeniyle basvuran ve efor testi pozitif olup koroner anjiyografisinde epikardiyal koroner arterleri normal veya yavas koroner akim saptanan 20 hasta (11 erkek, 9 kadin) ile (Grup I) yapilan tetkiklerinde herhangi bir hastalik tespit edilmexadmis 30 kisi (Grup II) dahil edildi. Hastalara polisomnografi (PSG) ve ekokardiyografi (EKO) uygulandi. Bulgular: Calismaya alinan hastalar iki ayri gruba alindi. Grup 1; Kardiyak sendrom X tanili 20 hasta, Grup 2; 30 saglikli birey. Her iki grubun kardiyak yapi ve fonksiyonlaxadri ekokardiyografik olarak degerlendirildi. Grup I hastalaxadrin 11inde (%55) OSAS saptandi. Grup II hastalarda ise 3 olguda (%10) OSAS tespit edildi. Her iki grup arasinxadda OSAS sikligi bakimindan anlamli fark bulunmakta idi (pIki tarafli ses teli felci (ISTF) siklikla tiroid ve paratiroid cerrahisi gibi iyatrojenik bir hasar sonucu olusur. Fakat serebral infarkt sonrasi hava yolu tikanikligina neden olan BVKP nadir olarak bildirilmistir. Bu yazida tekrarlayan serebral infarktin, gec ortaya cikan ve hayati tehdit eden bir komplikasyonu olarak solunum durmasi ile sonuclanan bir ISTF olgusu sunduk. Atmis yedi yasinda erkek hasta, son 3-4 aydir giderek artan solunum yetmezligi sikayetiyle acil servisimize basvurdu. Ozgecmisinde kalp yetmezligi ve kronik obstruktif akciger hastaligi oykusu olmayan hasta, yaklasik bir yil once bir ayda iki kez serebral infarkt gecirmisti. Yapilan solunum sistemi muayenesinde bilateral wheezing ve stridor; norolojik muayenesinde ise sag tarafta kuvvet kaybi mevcuttu. Ust solunum yolu obstruksiyonunu degerlendirilmek uzere endoskopik laringoskopi yapildi. Laringoskopide iki tarafli ses tellerinin orta hatta sabit ve hareketsiz oldugu goruldu. Solunum yetmezliginde artma ve tekrarlayan solunum durmasi nedeniyle hastaya trakeostomi acildi. Operasyon sonrasi hastanin solunum yetmezligi geriledi. Solunum fonksiyonlari normale donen hasta taburcu edildi.Dysphagia aortica is a rare etiological factor of dysphagia resulting from extrinsic compression of the esophagus by thoracic aorta. There is no gold standard diagnostic proscedure for dysphagia aortica. Dysphagia aortica is usually escaped to attention in the differential diagnosis of dyssphagia. Here, we reported compression of the esophagus by thoracic aorta in a 54 years-old male patient who comsplained from dysphagia.Wegener granulomatozu cocukluk caginda nadir gorulen, tedavi edilmediginde morbidite ve mortalite ile seyredebixadlen bir vaskulittir. Basvurusunda pulmoner renal sendrom tablosunda olan 10 yasindaki bir kiz hasta sunuldu. Yapixadlan tetkikler sonucunda Wegener Granulomatozu tanisi konup immunosupresif tedavi baslandi. Bobrek biyopsisi kresentik glomerulonefrit ile uyumluydu. Hasta su anda evre 4 kronik bobrek yetmezligi tanisi ile takip edilmekxadtedir.