Hasan Salih Zeki Aksu

Osteoarthricular Involvement of Brucellosis in Turkey

Abstract: The aim of this study was to determine the rates, types, clinical features and treatment of osteoarthricular involvement of brucellosis in Turkey. In a restrospective study in adults, we investigated 238 patients diagnosed with brucellosis over a period of 6 years. A diagnosis of brucellosis was established by isolation of Brucella species in blood or by a compatible clinical picture together with a standard tube agglutination titre of ≥1/160 of antibodies for brucellosis and/or demonstration of an at least four-fold rise in antibody titre in serum specimens taken over 2 or 3 weeks. Osteoarthricular involvement was defined by inflammatory signs in peripheral joints or by unrelieved pain at rest together with radiological alterations and/or radionuclide uptake in any deep joint. Eighty-seven patients (36.5%) had osteoarthricular involvement (58.6% female, 41.4% male), 47 (54.1%) of whom were reported to consume unpasteurised dairy products. The mean age was 32.3 ± 16 years. Sacroiliitis was the most common involvement (n= 53, 60.9%) followed by peripheral arthritis (n= 17, 19.5%), spondylitis (n= 12, 13.8%) and bursitis (n= 5, 5.7%). During the observation period, 60 (69%) patients with osteoarthricular involvement and radiographic abnormalities. A bone scan was positive in 15 patients with no radiographic abnormalities. All patients received merely medical treatment and relapse occurred in five (5.7%) patients. Sacroiliitis has been determined as the most frequently observed type of osteoarthricular involvement in brucellosis in Turkey.

Risk factors of carbapenem-resistant Klebsiella pneumoniae infection: a serious threat in ICUs.

Background Nosocomial infections caused by Carbapenem-resistant Klebsiella pneumoniae (CRKP) are increasing. Our aim in this study was to investigate the risk factors of CRKP infections. Material/Methods A retrospective cohort study was performed between 1 January and 31 December 2012 in ICU patients. Data was taken from the hospital infection control database for CRKP. The clinical samples collected from the patients were tested by an automatized system and disk diffusion. SPSS software v11.5 was used for statistical analysis. Results Totally, 105 Klebsiella pneumoniae isolates were found in 2012 and the carbapenem resistance rate was 48%. The first episode of infection was taken into risk factor analysis. Of the 98 patients, 61 (62.2%) were male and the mean and median ages were 30.4±29.8 and 25 (0–93). The length of stay was longer in the resistant group (p=0.026). Mortality was 48% in the whole group and similar between groups (p=0.533). There was a relationship between meropenem and third-generation cephalosporin use and resistance (OR 3.244 (1.193–8.819) and OR: 3.590 (1.056–12.209). The other risk factors in univariate analysis were: Immunosuppression OR: 2.186 (1.754–2.724), nasogastric catheter OR: 3.562 (1.317–9.634), peripheral arterial catheter OR: 2.545 (1.027–6.307), and being admitted to the neurosurgical unit OR: 4.324 (1.110–16.842). The multivariate analysis showed use of third-generation cephalosporin OR: 4.699 (1.292–17.089), nasogastric catheter use OR: 3.983 (1.356–11.698), and being admitted to neurosurgical ICU OR: 4.603 (1.084–19.555) as independent risk factors. Conclusions Restriction of third-generation cephalosporin and carbapenem use and invasive procedures, along with infection control precautions and disinfection policies, may be effective in reducing the carbapenem resistance in ICUs.

Role of KIR genes and genotypes in susceptibility to or protection against hepatitis B virus infection in a Turkish cohort

Background Killer cell immunoglobulin-like receptors (KIRs) are a family of inhibitory and activating receptors expressed by natural killer (NK) cells and regulate NK cell activity in the innate response against viral infections. The aim of this study was to determine the possibility of KIR genes and genotypes as a candidate for susceptibility to or protection against chronic hepatitis B virus (HBV) infection or spontaneous remission of the infection in a Turkish cohort. Material/Methods The present study was carried out on 37 patients with chronic HBV infection, 36 patients in spontaneous remission of HBV infection, and 85 healthy subjects. Sequence-specific oligonucleotide probes analysis was used to investigate 16 KIR genes. All data were statistically analyzed by the Fisher exact test. Results The rate of inhibitory KIR2DL3 (p=0.0) and 3DS1 (p=0.0) were higher in the healthy group than the group composed of chronic HBV patients and patients with spontaneous remission. There were no statistically significant differences between the rate of AA and Bx genotypes of chronic HBV patients and patients with spontaneous remission and the control group (p>0.05). Conclusions Our results suggest that KIR2DL3 and KIR3DS1 genes could be protector genes for HBV infection and they could be important immuno-genetic markers in determining antiviral immunity in the Turkish population.

Association of insulin resistance, viral load, and adipokine levels with liver histology in patients with chronic hepatitis C: an observational, multicenter study in Turkey.

Objective To evaluate the association of insulin resistance (IR), viral load, and adipokine levels with liver histology in patients with chronic hepatitis C (CHC). Patients and methods In this noninterventional, multicenter study carried out at 11 infectious diseases clinics in Turkey, 103 CHC patients [mean (SD) age: 50.2 (11.0) years, 60 (58.3%) women] planned to be treated by ribavirin and peginterferon-&agr;2a were included. Data on hepatic fibrosis and steatosis, IR, viral load, and hepatitis C virus-RNA genotyping, adipokine, and cytokine levels were collected. Results The mean (SD) Knodell score was 8.1 (3.6); grade I steatosis was evident in 46 (44.7%) patients and IR was identified in 56 (54.9%). There was a significant positive correlation of the homeostasis model assessment-IR index with Knodell fibrosis (r=0.235; P=0.027) and hepatic steatosis (r=0.435; P<0.001). There was a significant positive correlation of leptin levels with Knodell fibrosis (r=0.265; P=0.013) and hepatic activity index (r=0.218; P=0.041). Hepatic steatosis was correlated negatively with adiponectin (r=−0.320; P=0.001) and positively with leptin (r=−0.368; P<0.001) levels. Logistic regression analysis showed that increase in age [odds ratio (OR), 1.056; 95% confidence interval (CI), 1.005–1.110; P=0.030] was the only significant predictor of hepatic fibrosis (OR, 1.056; 95% CI, 1.005–1.110; P=0.030), whereas increase in age (OR, 1.066; 95% CI, 1.006–1.130; P=0.030), the presence of IR (OR, 5.621; 95% CI, 1.547–20.425; P=0.009), and decrease in adiponectin levels (OR, 0.808; 95% CI, 0.682–0.957; P=0.013) were the significant predictors of hepatic steatosis. Conclusion Our findings indicate a significant relationship of hepatic fibrosis and hepatic steatosis with IR and leptin levels, but not with the viral load in Turkish patients with CHC.

Plasma Levels of Tumor Necrosis Factor Alpha during Hemodialysis

Tumor necrosis factor alpha (TNF-alpha) levels were measured by immunoradiometric assay in chronically hemodialyzed patients consisting of 9 males and 3 females aged between 14 and 60 years. TNF-alpha levels were 5.47-15.1 pg/ml (mean 9.76 +/- 6.63) before hemodialysis (HD), and 5.75-58.55 pg/ml (mean 22.15 +/- 15.14) after HD. According to these results TNF-alpha levels in chronically hemodialyzed patients were within normal limits, but after 4 h of HD, higher levels of TNF-alpha were found.

The Place and the Efficacy of Infectious Disease Consultations in the Hospitals

Abstract Our study aims to determine the efficacy of infectious disease consultations and the interrelations between doctors in this social laboratory. This study was conducted at 34 centers located in 22 cities across Turkey and contributed by 210 infectious disease specialists (IDSs) and 970 non–infectious disease specialists (NIDSs), totaling 1180 medical doctors. Infectious disease specialists and NIDSs have separately contributed by responding to questionnaires designed specifically for the consultation process. It appears that a satisfactory collaboration has been established between IDSs and NIDSs during the consultation practices. There are some discrepancies in the perceptions of some of the NIDSs. These are the evaluation of patients holistically, the expectation of NIDSs in critical infection cases to start the therapy immediately, losing the support of drug companies by NIDSs, and the restriction of NIDSs in routine medical practice. On the other hand, NIDSs seem to have real problems in the diagnosis or treatment of infectious diseases. The consultation service provided by the IDSs in Turkey is widely accepted among other clinicians and appears to be of a crucial importance.

Rickettsia sibirica mongolitimonae Infection, Turkey, 2016

In 2016, Rickettsia sibirica mongolitimonae was diagnosed for a man in Turkey. He had been bitten by a Hyalomma marginatum tick, from which PCR detected rickettsial DNA. Sequence analysis of the DNA identified R. sibirica mongolitimonae. Immunofluorescence assay of patient serum indicated R. conorii, which cross-reacts. PCR is recommended for rickettsiosis diagnoses.

Pegylated interferon in HBeAg-positive and -negative chronic hepatitis B patients: post-treatment 1-year results of three Turkish centres

Abstract In this study, we aimed to evaluate the 1-year post-treatment follow-up results of 112 patients who received pegylated interferon (PEG-IFN) for 52 weeks. HBeAg negativity/seroconversion and/or negative HBV-DNA at the end of the treatment were considered as response. Patients who had response at the end of treatment but had HBV-DNA breakthrough during 1-year follow-up were considered as relapse. The study group comprised 112 cases (34 HBeAg-positive, 78 HBeAg-negative). In HBeAg-positive and -negative cases, end-of-treatment response rates were 2·9% and 60·2%, whereas 1-year sustained virological response rates were 0 and 33·3%, respectively. When we compared relapse cases versus cases with response at the end of 1-year follow-up, being female and having low viral load were the two parameters associated with higher response rates (Chi-square, P  =  0·028; Mann–Whitney U test, P  =  0·023). Overall non-response rates to PEG-IFN were high (57·1%). Results in HBeAg-positive cases were disappointing.

The causes of post-operative meningitis: the comparison of gram-negative and gram-positive pathogens

AIM In this study, we aim to determine the microbiological etiology in critically ill neurosurgical patients with nosocomial meningitis (NM) and show the impact of Gram-negative rods and differences of patients characteristics, clinical and prognostic measures between Gram-negative and Gram-positive meningitis. MATERIAL AND METHODS In this prospective, one center study we reviewed all adult patients hospitalized during a 12-year period and identified pathogens isolated from post-neurosurgical cases of NM. Demographic, clinical, and treatment characteristics were noted from the medical records. RESULTS Of the 134 bacterial NM patients, 78 were male and 56 were female, with a mean age of 46±15.9 and median age of 50 (18-80) years. 141 strains isolated; 82 (58.2%) were Gram negative, 59 (41.8%) were Gram positive. Most common isolated microorganism was Acinetobacter baumannii (%34.8). In comparison of mortality data shows that the patients who have meningitis with Gram-negative pathogens have higher mortality than with Gram positives (p=0.034). The duration between surgery and meningitis was shorter in Gram negative meningitis cases compared to others (p=0.045) but the duration between the diagnosis and death was shorter in Gram-positive meningitis cases compared to Gram negatives (p= 0.017). CSF protein and lactate level were higher and glucose level was lower in cases of NM with Gram negatives (p value were respectively, 0.022, 0.039 and 0.049). CONCLUSION As conclusions; in NM, Gram-negative pathogens were seen more frequently; A.baumanni was the predominant pathogen; and NM caused by Gram negatives had worse clinical and laboratory characteristic and prognostic outcome than Gram positives.AIM To determine the microbiological etiology in critically ill neurosurgical patients with nosocomial meningitis (NM) and to show the impact of Gram-negative rods and the differences between patient characteristics and the clinical and prognostic measures in Gram-negative and Gram-positive meningitis. MATERIAL AND METHODS In this prospective, single-center study, we reviewed all adult patients hospitalized during a 12-year period and identified pathogens isolated from post-neurosurgical cases of NM. Demographic, clinical, and treatment characteristics were noted from the medical records. RESULTS Of the 134 bacterial NM patients, 78 were male and 56 were female, with a mean age of 46±15.9 and a median age of 50 (18-80) years. One hundred and forty-one strains were isolated; 82 (58.2%) were Gram-negative, 59 (41.8%) were Grampositive. The most commonly isolated microorganism was Acinetobacter baumannii (34.8%). Comparison of mortality data shows that the patients who have meningitis with Gram-negative pathogens have higher mortality than with Gram-positives (p=0.034). The duration between surgery and meningitis was shorter in Gram-negative meningitis cases compared to others (p=0.045) but the duration between the diagnosis and death was shorter in Gram-positive meningitis cases compared to Gram-negatives (p=0.017). Cerebrospinal fluid protein and lactate levels were higher and glucose level was lower in cases of NM with Gram-negatives (p values were respectively, 0.022, 0.039 and 0.049). CONCLUSION In NM, Gram-negative pathogens were seen more frequently; A. baumanni was the predominant pathogen; and NM caused by Gram-negatives had worse clinical and laboratory characteristic and prognostic outcome than Gram-positives.

Serodiagnostic Value of ELISA in Pulmonary Tuberculosis in Turkey Where Tuberculosis Is Highly Prevalent

We studied the diagnostic utility of ELISA in pulmonary tuberculosis (TBC) using serologically active glycolipid antigens. Twenty-seven patients who were smear positive, and 30 patients who were smear negative, but with evidence of active TBC (sputum culture positive in 10, response to anti-TBC chemotherapy in 20) were included in the study group. Twenty cured patients who had been free of TBC for at least 1 year, 50 TBC-free persons with PPD results of 0-10 mm and more than 10 mm, and 21 patients with active inflammatory diseases other than TBC formed the control groups. Sensitivity and specificity were 96 and 91%, respectively. We think that serologically active glycolipid antigens are as sensitive and specific as other purified antigens, and even superior to them from the point of view of their production: their extraction is quicker and easier.