Muhammet Hamidullah Uyanik

Is HMGB1 a new indirect marker for revealing fibrosis in chronic hepatitis and a new therapeutic target in treatment

In chronic hepatitis B virus (HBV) infection, inflammation-associated cytokines including proinflammatory cytokines are involved in the development and progression of liver fibrosis. The liver is a source of many cytokines that may influence liver function. High-mobility group box 1 (HMGB1) was identified as an inflammatory cytokine. HMGB1 is present in nuclei of all mammalian cells and is released both through active secretion from various cells and by passive release from necrotic cells. Here we explore the relationship between HMGB1 plasma levels and liver fibrosis. HMGB1 serum levels, HBV-DNA, and ALT values were significantly higher in patients with chronic HBV than in controls. In addition, HMGB1 serum levels were significantly higher in patients with low fibrosis (fibrosis score 1-2) compared to those with high fibrosis (fibrosis score 3-4). In the present study, we have shown that HMGB1 is a noninvasive, repeatable, and convenient marker for distinguishing advanced fibrosis from low fibrosis in chronic HBV patients. We believe that the inhibition of HMGB1 may reduce inflammation, apoptosis, and fibrosis, and may stop the progression of chronic liver disease. Furthermore, we are of the opinion that fibrotic progression in chronic liver patients may be prevented by the inhibition of HMGB1, and that this substance can be a new means of following chronic HBV treatment.

An evaluation of the hand and nasal flora of Turkish nursing students after clinical practice

AIM The purpose of this study was to evaluate and compare the hand and nasal flora of nursing students before and after the clinical practice. BACKGROUND Hospitals are places where infective agents abound. Healthcare workers, relatives of patients and students practising in the hospital medium are often exposed to these infective agents. Although the role of the hand and nasal flora of healthcare workers in the development of nosocomial infections has been emphasised by earlier studies, there are a limited number of studies which investigate the hand and nasal flora of nursing students. DESIGN Descriptive. METHODS This descriptive study involved 66 volunteer nursing students. Two samples of flora from both hands and nose of each student were obtained. The inoculated samples were then evaluated through routine bacteriological study methods. Chi-square and percentage calculations were used in comparisons. RESULTS None of the students had methicillin-resistant Staphylococcus aureus or methicillin-resistant coagulase-negative Staphylococcus colonisation in the hand samples before clinical practice, 6.1% of the students had methicillin-resistant Staphylococcus aureus and 4.5% had methicillin-resistant coagulase-negative Staphylococcus colonisation after the practice. Although the differences between the rates of contamination with pathogen micro-organisms in the hand and nasal flora of the student nurses before and after clinical practice were not significant, the rate of colonisation after clinical practice was higher. CONCLUSIONS In this study, the rate of colonisation after clinical practice was higher. These findings indicate that students might have been contaminated with bacteria during clinical practice. RELEVANCE TO CLINICAL PRACTICE The results of this study have practical importance in clinical practice. The role of the hand and nasal flora of nursing students in the development of nosocomial infections is significant. For this reason, some precautions, such as using gloves and handwashing with special solutions when needed, should be taken to prevent nosocomial infections and protect students against associated risks.

Mycological examination of the barbers’ tools about sources of fungal infections

The purpose of this study was to determine the colonisation of causative agents for fungal skin infections on the tools and surfaces of barbershops. A total of 357 samples from tools and surfaces of 32 barbershops in Erzurum, Turkey were collected and examined for fungal pathogens. From the combs, Trichophyton rubrum (1), non‐dermatophytic moulds (35) and Candida albicans (1); from the hairbrushes, T. rubrum (3), T. mentagrophytes (1), non‐dermatophytic moulds (21) and yeast (1); from the shaving brushes, non‐dermatophytic moulds (2) and C. albicans (2); from the headrest of barber chairs, T. rubrum (1), non‐dermatophytic moulds (19) were isolated. No fungi were isolated from towels. In conclusion, this study showed that shared tools and contacted surfaces in barbershops are important sources for fungal colonization and may play an important role in spreading mycotic infections among people.

Comparison of coagulase-negative staphylococci isolated from blood cultures as a true bacteremia agent and contaminant in terms of slime production and methicillin resistance.

OBJECTIVE The aim of this study is to determine the species distribution, slime activity, and methicillin resistance of coagulase-negative staphylococci (CoNS) isolated from blood cultures as either contaminants or true bacteremia agents. MATERIALS AND METHODS In this study, 13.268 blood culture samples sent to our laboratory from various clinics during a two-year period were examined in terms of the presence of CoNS to clarify whether the isolates are true bacteremia agents, as defined by Centers for Disease Control and Prevention (CDC) criteria. The slime activities of true bacteremia agents (58 CoNS strains) and contaminants (50 randomly selected CoNS strains) were investigated by the Christensen method. The methicillin susceptibilities of the strains were determined by the disk diffusion method. RESULTS Although the frequency of slime production was 39.7% among the true bacteremia CoNS agents, it was 18% in CoNS that were judged to be contaminants (p<0.05). S. epidermidis was the most frequently isolated species for both the true bacteremia agent group (56.9%) and contaminant group (74%). Additionally, S. epidermidis was the bacterium most frequently characterized as slime producing in both groups. The methicillin resistance of slime-producing CoNS was determined to be 82.6% for the true bacteremia agent group and 77.8% for the contaminant group. CONCLUSION The presence of slime activity in CoNS isolated from blood culture samples is supportive evidence that they are most likely the agents of true bacteremia cases.

Should increased levels of urinary 8-hydroxydeoxyguanosine in chronic gastritis imply intestinal metaplasia or gastric atrophy?

Objectives: Helicobacter pylori (H pylori) infection induces chronic inflammation that can progress to gastric atrophy, intestinal metaplasia, and gastric adenocarcinoma. We have examined oxidative damage caused by Helicobacter pylori, metaplasia, and atrophy of gastric mucosal cells in patients with chronic gastritis by measuring their urinary 8-hydroxydeoxyguanosine (8-OHdG) levels. Methods: We recruited 77 outpatients with chronic gastritis, confirmed by endoscopic examination. H pylori status was evaluated by histology (modified Giemsa staining), the H pylori stool antigen test (n=20), and the 13C urea breath test (n=27), as described in the Maastricht consensus report. Results: The mean amount of 8-OHdG (&mgr;g/g creatinine) in 77 subjects was 18.07 ± 13.49 x 10-3 &mgr;g/g creatinine. The levels of urinary 8-OHdG in the H pylori-positive gastritis patients were also significantly higher than those in the H pylori-negative gastritis patients (P=0.003, respectively, 20.42 ± 13.33 x 10-3 &mgr;g/g creatinine, 13.16 ± 12.71 x 10-3 &mgr;g/g creatinine). The level of urinary 8-OHdG was markedly higher in patients with gastric atrophy and intestinal metaplasia than in those without (P=0.000, P=0.002, respectively). There were significant correlations between levels of urinary 8-OHdG and both the atrophy score (r=0.441, P=0.000) and the intestinal metaplasia score (r=0.436, P=0.000). Conclusions: Urinary 8-OHdG levels could be investigated in every patient with chronic gastritis, since it is a simple and completely noninvasive procedure. In patients with high levels of urinary 8-OHdG, endoscopic procedures or even pathological investigation may then be carried out, with the consideration that there is a high risk of intestinal metaplasia or atrophy.

Comparison of Slime-producing Coagulase-negative Staphylococcus Colonization Rates on Vinyl and Ceramic Tile Flooring Materials

This study investigated the colonization of slime-producing coagulase-negative Staphylococcus (CoNS) in 80 patient wards in Turkey (40 vinyl and 40 ceramic tile floors). A total of 480 samples that included 557 CoNS isolates were obtained. Slime production was investigated with the Christensen method and methicillin-susceptibility was tested by the diskdiffusion method. There was a significant difference in the percentage of slime-producing CoNS isolates on vinyl (12.4%) versus ceramic tile flooring (4.4%). From vinyl flooring, the percentage of slime producing methicillin-resistant CoNS (MRCoNS) (8.9%) was significantly higher than for methicillin-sensitive CoNS (MSCoNS) (3.6%), whereas there was no difference from ceramic tile flooring (2.5% MRCoNS versus 1.8% MSCoNS). The most commonly isolated slime-producing CoNS species was S. epidermidis on both types of flooring. It is concluded that vinyl flooring seems to be a more suitable colonization surface for slime-producing CoNS than ceramic tile floors. Further studies are needed to investigate bacterial strains colonized on flooring materials, which are potential pathogens for nosocomial infections.

Comparison of Various Methods in the Diagnosis of Entamoeba histolytica in Stool and Serum Specimens.

OBJECTIVE Entamoeba histolytica is indistinguishable from Entamoeba dispar in direct microscopic examination. A definitive diagnosis of E. histolytica is important in terms of the treatment of the patient and to avoid unnecessary costs. This studys aim is to determine the prevalence of E. histolytica and to make a comparison of the different diagnostic tests in the patients specimens defined as E. histolytica/E. dispar infection. MATERIALS AND METHODS Faecal and serum specimens of 90 patients defined as E. histolytica/E. dispar with microscopy (wet mount examination with 0.85% saline and Lugols iodine) were examined. Stool samples were examined by trichrome staining for trophozoites and cysts and by immunoassay methods for specific adhesin antigens (Wampole (®) E. histolytica II antigen testing) and for specific serine-rich 30 kD membrane protein (Serazym(®) E. histolytica antigen testing). Anti-E. histolytica antibodies were investigated using a latex slide test and indirect hemagglutination methods in serum specimens. RESULTS Presence of E. histolytica was not confirmed in 31.1% cases with trichrome staining, 62.2% of the Wampole antigen test, 64.4%, of the Serazym antigen test, 73.3% of the indirect hemagglutination test and 75.6%. of the latex agglutination. Considering the common results from Wampole and Serazym antigen testing as a reference standard, the specificity/sensitivity is 100/53.85% for trichrome staining, 75.00/98.11% for the latex agglutination test and 78.57/96.77% for the indirect hemagglutination test. CONCLUSION It has been shown that investigation of E. histolytica in stools by direct wet-smear microscopy alone can cause significant false positive results. To obtain a reliable diagnosis for E. histolytica and to avoid unnecessary treatment for this parasite, at least one more specific assay, particularly an antigen testing and microscopy, is required.

Anti-cyclic citrullinated Peptide frequency in patients with chronic hepatitis C virus infection and effect of presence of systemic disease.

OBJECTIVE Patients with chronic hepatitis C virus (HCV) infection may show a variety of rheumatic symptoms and signs. Anti-cyclic citrullinated peptide (anti-CCP) is widely used as as a marker, particularly for rheumatoid arthritis (RA), and may be positive in some diseases that also cause arthritis, such as systemic lupus erythematosus, familial Mediterranean fever, Behçets disease, and psoriatic arthritis. MATERIALS AND METHODS Blood samples were obtained (in routine protocols) from 57 patients with chronic HCV infection from the Gastroenterology Clinic of Ataturk University and Infectious Disease Clinic of Erzurum Region Research and Education Hospital. Normal sera were obtained from volunteer blood donors at Ataturk University. RESULTS Anti-CCP antibodies were found in 5 chronic HCV patients with RA. The patient with the highest anti-CCP antibody level had RA. No patient in the control group was positive for anti-CCP antibodies. CONCLUSION Anti-cyclic citrullinated peptide (anti-CCP) antibodies should be measured frequently in patients with HCV and an additional systemic disease, such as end-stage chronic renal failure, chronic obstructive airway disease, and decompensated liver cirrhosis, to differentiate RA from non-RA arthropathy.

A case of bacillary angiomatosis developed at a burn site.

Bacillary Angiomatosis (BA) is frequently seen in patients with human immunodeficiency virus (HIV)-induced immunodeficiency. Our patient was a case that developed granuloma-like lesions in the area of a burn, 8 days after being burnt on the upper right arm by scalding water. No indication of immune deficiency was observed and no history of direct contact with cats was evident. By the sixth day of the patients admission to our clinic, some of the lesions had reached a diameter of 2.5 cm. An excision biopsy was carried out from the lesions present on the patient. Electron microscopy revealed solitary bacilli located close to the capillary wall. Oral erythromycin treatment was implemented at 250 mg, 4 times a day for 2.5 months. Within this period of treatment, the lesions regressed completely, and a complete cure was achieved. This case demonstrates that BA must be considered in the differential diagnosis of both HIV-infected and immunocompetent patients.

Detection of Methicillin Resistance in Staphylococcus aureus Isolates by Classical and Molecular Methods

Objective: This study was planned to detect methicillin resistance in Staphylococcus aureus strains by conventional phenotypic methods and polymerase chain reaction for mecA gene and to compare the results of these tests for their sensitivity and specificity. Methods: Eighty six methicillin-resistant S. aureus (MRSA) and 30 methicillin-sensitive S. aureus (MSSA) strains from various clinical samples were included in this study. Methicillin resistance was detected by oxacillin and cefoxitin disk diffusion method. Presence of colonies on MRSA chromogenic agar was looked for methicillin resistance. The presence of the mecA gene investigated by polymerase chain reaction is considered to be the gold standard test, and sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated accordingly. Results: The percentage of sensitivity, specificity, PPV and NPV were 98.7%, 81.6%, 91.7%, 96.9% for the cefoxitin disk diffusion test, respectively; 100%, 78.9%, 90.7%, 100% for the oxacillin disk diffusion test, respectively; 45.8%, 63.2%, 70.2%, 38.0% for the 24-hour evaluation MRSA chromogenic agar, respectively; 51.4%, 63.2%, 72.5%, 40.7% for the 48-hour evaluation, respectively. Conclusions: Investigation of mecA is crucial for taking the necessary precautions in hospitals where the MRSA is a common problem. The results for cefoxitin and oxacillin disk diffusion method were found close to each other; hence, we think that oxacillin disk can be an alternative instead of cefoxitin disk. Results based on chromogenic agar should be interpreted with caution. Klimik Dergisi 2018; 31(1): 30-3.