İbrahim Koruk

Prevalence of Staphylococcus aureus and intestinal parasites among food handlers in Sanliurfa, Southeastern Anatolia.

OBJECTIVES Food-borne diseases represent a persistent global health burden, and food handlers play a major role in their transmission. Staphylococcus aureus carriage and intestinal parasitism are important risk factors for the contamination of food and water. This study was undertaken to determine the prevalence of Staphylococcus aureus and intestinal parasites among food handlers working in Sanliurfa, Southeastern Anatolia. METHODS In this cross-sectional study, 299 food handlers selected randomly were enrolled. Nasal swabs, throat cultures, and stool samples were examined. RESULTS The mean age of participants was 26.7 (+/-9.6) years. Only 33.6 percent of food handlers had education beyond the elementary school level. Within this group, 50.8 percent had never previously received a carrier examination and only 31.4 percent received regular examinations. We found that 52.2 percent of food handlers carried intestinal parasites including Giardia intestinalis (26.8%), Ascaris lumbricoides (10.7%), Tenya saginata (10.0%), and Staphylococcus aureus (23.1%). None of the food handlers was positive for Salmonella sp and Shigella sp. CONCLUSIONS These findings necessitate improvements in regional carrier detection, infection control, and food hygiene. Subsequent to this study, researchers from the Department of Public Health, Harran University, instituted a series of interventions aimed at improving infection control. These included establishment of an evidence-based carrier control system, training of municipal food controllers and health professionals, creation of electronic outbreak records and follow-up procedures, and development of a source eradication system for Sanliurfas primary healthcare center staff.

Management of Brucella endocarditis: results of the Gulhane study

Brucella endocarditis (BE) is a rare but life-threatening complication of human brucellosis. The aim of this study was to investigate the course of BE along with the therapeutic interrelations. A total of 53 patients with BE hospitalised in 19 health institutions between 2006 and 2011 were included in the Gulhane study. Diagnosis of brucellosis was established by either isolation of Brucella sp. or the presence of antibodies, and the definition of endocarditis was made according to Dukes criteria. There were four treatment groups: ceftriaxone combined with oral antibiotics (Group 1); aminoglycosides combined with oral antibiotics (Group 2); oral antibiotic combinations (Group 3); and aminoglycoside plus ceftriaxone combined with an oral antibiotic (Group 4). Involvement rates of the aortic, mitral and tricuspid valves were 49.1%, 43.4% and 5.7%, respectively. Thirty-two patients (60.4%) had an underlying cardiac valvular problem, including previous prosthetic valve replacement (n=18). Medical treatment was provided to 32 patients (60.4%), whilst concordant medical and surgical approaches were provided to 21 patients (39.6%). Mortality in Group 1 was 15% (3/20), whilst in Group 2 it was 5.3% (1/19). In Group 3, 25.0% (3/12) of the cases died, whereas none of the cases in Group 4 died. In conclusion, mortality increased 47-fold with pericardial effusion and 25-fold due to congestive heart failure that developed after BE. Although mortality was lower in the aminoglycoside-containing arm (Groups 2 and 4), statistical analysis could not be performed owing to the small number of patients.

Decreasing oxidative stress in response to treatment in patients with brucellosis: could it be used to monitor treatment?

OBJECTIVES The aims of this study were to evaluate oxidant and antioxidant status in patients with acute brucellosis before and after therapy, and to determine whether this index could be used to monitor the treatment of brucellosis. METHODS Thirty patients with a diagnosis of acute brucellosis and 37 healthy volunteers were enrolled in the study. Total antioxidant status (TAS) and total oxidant status (TOS) were measured in patients before and after therapy, and an oxidative stress index (OSI) was calculated. These measurements were also taken for the healthy control group and the values were compared. RESULTS Plasma levels of TOS and OSI were significantly higher in patients with brucellosis before therapy as compared to the treated group (t: 11.19, p<0.000 and t: 9.91, p<0.000, respectively). After treatment, TOS and OSI levels were lower, whereas in contrast, TAS levels were significantly higher (t: -4.17, p<0.000). TOS and OSI levels were found to be significantly higher in the patients before treatment than in the control group (t: 15.01, p<0.000 and t: 15.00, p<0.000, respectively). TAS levels in patients before treatment were lower than in the controls and the difference was significant (t: -8.03, p<0.000). TOS and OSI levels were significantly higher in the treated group than in the control group (t: 4.58, p<0.000 and t: 9.91, p<0.000, respectively). TAS levels in the treated group were lower than in the control group and the difference was significant (t: -3.02, p<0.004). CONCLUSION Reduced TAS capacity and elevated TOS levels may lead to considerable oxidative stress in brucellosis. Increased oxidative stress may cause severe oxidative damage in the body, and even though this damage ameliorates considerably with 6weeks of treatment, normal healthy levels are not attained. In addition, it appears possible that these oxidant and antioxidant parameters could be used to monitor treatment.

Where Do We Stand in the Control of Rabies? Knowledge and Practices Among Physicians in a Health District in Turkey

OBJECTIVE The aim of this study was to determine the level of knowledge of rabies transmission and control among physicians practicing in healthcare centers in Sanliurfa, Turkey where 2 cases of human rabies were reported in the past 12 months. Implementation issues regarding the current guidelines will also be discussed. METHODS A cross-sectional study was conducted among 84 physicians practicing in healthcare centers in Sanliurfa, located in the Southeastern Anatolian region of Turkey. RESULTS Among physicians, average duration of medical practice was 8.5 ± 6.7 years. The correct incubation period of rabies cases was known by 57.1% of the physicians. While 88.1% of physicians were aware of possible exposure routes, only 44.0% of them had the information that mucosal contact may also lead to transmission. While 96.4% of the physicians correctly indicated that cats and dogs can transmit the disease, the fact that foxes also have a role in transmission was known by only 48.8%. Post-exposure prophylaxis was correctly indicated by 65.5% of participants, but only 17.9% had correct information about pre-exposure prophylaxis. CONCLUSION An important approach in rabies control is to increase community awareness, particularly among healthcare providers. It was found that basic management issues and insufficient awareness still exist despite the presence of legal regulations. To control rabies, the issue must be dealt with locally, through both economic and social means, by supporting rabies control efforts of local health and agricultural directorate managers and by encouraging collaboration with academics.

Hemostatic Efficacy of Folkloric Medicinal Plant Extract in a Rat Skin Bleeding Model

Objective To assess the in vivo hemostatic effect of a folkloric medicinal plant extract. Subjects and Methods Wistar rats were randomized into four groups of seven. Group 1, a control group, received no pretreatment and was irrigated with saline. Group 2 received no pretreatment and was irrigated with the plant extract. Group 3, a control group, received pretreatment with heparin and was irrigated with saline. Group 4 received pretreatment with heparin and was irrigated with the plant extract. A standardized skin‐bleeding model was created using full‐thickness skin defects on the Wistar rats’ dorsal skin. To control bleeding, compressive dressings were placed after inserting 1 mL of the plant extract or saline into the bleeding area. Hemostasis time and amount of nasal bleeding were measured in all groups to compare the treatments without and with the plant extract. Results Without heparin pretreatment, the folkloric medicinal plant extract shortened the hemostasis time by 1.29 minute and reduced the amount of bleeding by 0.63 g. With heparin pretreatment, the plant extract shortened the hemostasis time by 2.29 minutes and reduced the amount of bleeding by 0.70 g. Conclusion The medicinal plant extract irrigation was more effective than saline irrigation for treating hemorrhagic skin defects in animals using a compressive dressing with or without heparin pretreatment.

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.

The Frequency of Antibiotics Sold without A Prescription and the Appropriateness of Antibiotic Use in Sanliurfa

AIM: The aim of this study was to determine the frequency with which antibiotics were sold without a prescription, to examine factors related to such practices and to determine the appropriateness of antibiotics sold with a prescription in Sanliurfa city center in Turkey. METHOD: This cross-sectional study was carried out between September and December 2010, on patients who visited the pharmacies to ask for antibiotics with or without prescription. To determine the research sample the cluster sampling method was used and from 186 pharmacies, 25 pharmacies were selected at random. The pharmacies were visited and asked to complete a structured questionnaire. RESULTS: 373 patients obtained antibiotics from pharmacies. The patients who received antibiotics by prescription comprised 98.6% (n=359) of all patients. A total 36 different antibiotics had been prescribed to the patients. Inappropriate prescription of antibiotics was documented in 63.7%. The most-prescribed antibiotic was co-amoxiclav (28.8%). The rate of inappropriate antibiotic prescriptions with the diagnosis of upper respiratory tract infection (77.8%) was highest, while the rate was lowest with the diagnosis of urinary tract infection (23.3%) (χ2: 68.8, P