Mustafa Altindis

A national survey of surgical antibiotic prophylaxis in Turkey.

OBJECTIVE To assess the quality of antibiotic prophylaxis for clean and clean-contaminated elective surgical procedures. DESIGN A cross-sectional, country-wide survey. SETTING Thirty-six hospitals in 12 cities in Turkey. PARTICIPANTS Four hundred thirty-nine surgeons from 6 different specialties who performed selected procedures of interest. METHODS A random sample of surgeons from different hospitals was selected. A standardized data collection form was used to record the type of procedure, the names, doses, timing of the first doses, and duration of antibiotics, important decisive factors, and problems in the management of prophylactic antibiotic use for surgical procedures. RESULTS Fifty-five percent of surgeons addressed completed the survey. For clean-contaminated procedures, 6% of surgeons did not use antibiotic prophylaxis, whereas 88% used more than a single dose. Inappropriate antibiotics were chosen for 32% of procedures. In 39% of procedures, the first dose of antibiotics was not administered during induction of anesthesia. Duration of prophylaxis was longer than 24 hours in 80% and longer than 48 hours in 46% of all procedures. Only 112 surgeons (26%) were using definitely appropriate prophylaxis in all ways. Multivariate analysis revealed that surgeons in university hospitals (OR, 2.353; CI95, 1.426-3.884; P = .001) and general surgeons (OR, 4.986; CI95, 2.890-8.604; P < .001) used antibiotic prophylaxis more appropriately. Patients not covered by health insurance (OR, 0.417; CI95 0.225-0.772; P < .001) were associated with inappropriate prophylaxis. CONCLUSION Given the high frequency of antibiotics prescribed for surgical prophylaxis in Turkey, adherence to surgical prophylaxis guidelines is urgently needed.

Levels of serum pentraxin 3, IL-6, fetuin A and insulin in patients with rheumatoid arthritis

OBJECTIVE The aim of this study was to investigate the relationship between disease severity and biochemical parameters such as pentraxin-3, fetuin-A, IL-6, insulin and HOMA-IR levels in patients with rheumatoid arthritis. METHODS This study included 60 patients with RA and 20 healthy controls. Serum pentraxin-3, fetuin-A, IL-6 and insulin concentrations were measured. Also, HOMA-IR values were calculated. Disease activity was assessed with Disease Activity Score (DAS28). To evaluate quality of life, the Health Assessment Questionnaire disability index was applied. RESULTS The serum values for ESR, CRP, pentraxin-3 and fetuin-A in patients with RA were found to be higher than control subjects (p values=0.001, 0.001, 0.000, 0.000, 0.01, 0.02, respectively). A positive correlation was evident between the DAS 28 score and IL6 levels (r=0.263, p=0.045). We found no correlation between the DAS28 score and HOMA-IR, the levels of pentraxin 3, fetuin A, insulin (p<0.05). Fetuin A levels were positively correlated with cumulative steroid dose (r=0.382, p=0.035). A statistically significant correlation was evident between presence of cardiovascular disease and HOMA-IR values in RA patients (r=0.437, p=0.032). CONCLUSION Elevated levels of pentraxin-3, fetuin-A, CRP, ESR might play a role in the pathogenesis of RA. Levels of fetuin-A, insulin HOMA-IR, pentraxin-3, CRP and ESR were not associated with clinical severity of the RA.

Socioeconomic indicators are strong predictors of hepatitis A seroprevalence rates in the Middle East and North Africa

The goal of this analysis was to examine the association between age-specific hepatitis A virus (HAV) seroprevalence rates and various socioeconomic indicators within the Middle East and North Africa (MENA) region. We conducted a systematic review of all recently published studies on HAV conducted in the MENA region and identified the highest quality studies for inclusion in our analysis. We calculated the age at midpoint of population immunity (AMPI) for each study and estimated seroprevalence rates at the ages of 5, 10, and 15 years. Next, we identified the correlations between these metrics and several socioeconomic variables. HAV data collected in or after 2000 were available for 14 of the 19 countries in the MENA region. Four of the 14 included countries had intermediate HAV endemicity (Algeria, Saudi Arabia, Turkey, and UAE), five had high endemicity (Iran, Jordan, Lebanon, Morocco, and Tunisia), and five had very high endemicity (Egypt, Iraq, Palestine, Syria, and Yemen). Water and sanitation were not significant predictors of AMPI or seroprevalence, most likely because most countries in this region have high rates of access to these utilities. However, gross domestic product (GDP), gross national income (GNI), and the human development index (HDI) were all highly associated with AMPI and prevalence. The observed correlations suggest that of the MENA countries without recent HAV data, Bahrain, Kuwait, and Qatar most likely have low endemicity, Oman likely has intermediate endemicity, and Libya likely has high endemicity. While it is unlikely that a single correlation model would be suitable for use in all world regions, the approach utilized in this analysis might provide a simple but accurate method for using economic data to impute the endemicity profiles of countries without recent data in regions where at least several neighboring countries have conducted recent serostudies.

Usefulness of soluble urokinase plasminogen activator receptor (suPAR) as an inflammatory biomarker in obese children

OBJECTIVE Soluble urokinase plasminogen activator receptor (suPAR) has emerged as a relatively new biomarker that reflects increased inflammatory status and been associated with cardiovascular risk. We wanted to investigate the predictive value and usefulness of suPAR as an inflammatory biomarker in obese children. METHODS AND RESULTS Of the total 136 participants, 76 (36 male, 40 female) were in obese group and 60 (24 male, 36 female) were in control group. The median age was 12.05 (6.16-17.30) years old for obese group, and 12.83 (8.00-16.75) years old for control group. Obese children had statistically significantly higher heart rate, systolic and diastolic blood pressure, EAT and LV mass than control group (p<0.01). The median suPAR level in obese group was not statistically different than in control group (0.54 vs. 0.59, p=0.26). The median hsCRP level in obese group was found statistically significantly higher than in control group (1.97 vs. 0.41, p<0.01). A significant positive correlation between hsCRP and BMI in the obese participants was found (r=0.45, p<0.01), but not a relationship between suPAR and BMI (r=-0.21, p>0.05). CONCLUSION Our research did not demonstrate the usefulness of suPAR as an inflammatory biomarker and a predictive value for future atherosclerosis in obese children. Further studies with larger sample size are required to determine whether suPAR is useful as an inflammatory biomarker in childhood obesity.

Six-year distribution pattern of hepatitis C virus in Turkey: a multicentre study

ABSTRACT Hepatitis C infection is a public health problem. The aim of this retrospective study was to determine the distribution of hepatitis C virus (HCV) genotypes in seven regions of Turkey, by evaluating 7002 patients with chronic HCV in a six-year period. During the 2009–2014 period, serum/plasma samples from 7002 new consecutive HCV RNA positive patients were collected. The female patients were 3867 (55.2%). The genotype distribution of HCV patiens was evaluated by ages and years. Statistical analysis was performed by using the Mann–Whitney test and the χ2 analysis. During the six-year period, genotype 1b was the most common genotype (67.7%) followed by untypeable genotype 1 (7.7%), genotype 4 (7.3%) and genotype 3 (6.7%). In 2014, genotype 3 was the second most common one (11.3%) and genotype 4 was the third most common one (9.8%). In the group with <25 years old patients, genotype 1b was most common (78.48%, 62/79) between the years of 2009 and 2011, whereas genotype 3 (34.8%, 86/247), between the years of 2012 and 2014. Genotype 1b was the most common in the groups between 26 and 35 years, 36 and 45 years, 46 and 55 years, 56 and 65 years. The rate of genotype 3 was increased from 4.78% to 10.06% and the rate of genotype 4 was increased from 1.3% to 3.84%, from 2009–2011 to 2012–2014. In recent years, genotypes 3 and 4 have gained importance. New therapeutic strategies and survey studies may be required for the modified HCV genotype pattern.

Fitness and competitive growth comparison of methicillin resistant and methicillin susceptible Staphylococcus aureus colonies

Exponential developments of both Methicillin resistant Staphylococcus aureus (MRSA) 3R ve 36R and methicillin susceptible Staphylococcus aureus (MSSA) 27S were evaluated in the presence and absence of oxacillin. The strains were isolated from the specimens collected in microbiology department. It was also determined the transfer of mecA gene from 3R to 27S strain by using the replica plate technique. It was observed that the presence of antibiotics in the preliminary culture had a positive impact on the growth of the secondary culture of MRSA isolates. Comparison results of Rt bacteria in three different mixed cultures, assessed with Tukeys HSD test, showed a significant statistical difference among the groups. The values were as following; on the first day; Df: 2, F: 60.90, P: 0.0001, second day; Df:2, F:90.56, P: 0.0000, and third day; Df:2, F:4.86, P:0.0557. As a result of the study, we can suggest that the gene expression levels of the transferred antibiotic resistance genes could help us in both controlling hospital originated sickness and developing new strategies to prevent the spread of resistant bacteria.

Hepatitis a virus epidemiology in turkey as universal childhood vaccination begins: seroprevalence and endemicity by region

This paper presents the results of a comprehensive examination of current distribution of Hepatitis A virus (HAV) seroprevalence and endemicity in Turkey and the possible links between HAV endemicity and socioeconomic development. We performed a systematic search in online resources published between January 2000 and August 2015. The 22 provinces were able to be assigned a hepatitis A endemicity level based on this systematic review. The incidence rates for symptomatic hepatitis A infection are higher in the eastern part of Turkey than in the western and central region. These differences in socioeconomic indicators by region suggest the likelihood of lower seroprevalence rates in the western parts of the country and higher rates in the eastern region. Turkeys current policy of recommending hepatitis A immunization for all children without contraindications is an appropriate one and is likely to remain the best option for at least the next decade or two.

Nail scissors and fingernails as reservoirs of hepatitis B virus DNA: Role of nail scissors in household transmission of hepatitis B virus

Background: No study in the current literature has scientifically clarified the transmission of hepatitis B virus (HBV) via personal hygiene tools. We determined risk of household transmission of HBV via nail scissors. Moreover, we assessed whether nails from HBV‐infected people contained HBV, and evaluated correlations of HBV DNA levels of serum, nail specimens, and nail scissors. Methods: Seventy patients testing positive for the surface antigen of the hepatitis B virus (63 positive for HBV DNA) treated for HBV infection and 27 healthy individuals were included. Real‐time polymerase chain reaction method was used to detect HBV DNA levels in sera, nail, and nail scissors. Results: HBV DNA was detected on 27% of nail scissors and in 50% of nail specimens from 63 serum HBV DNA‐positive patients. Serum HBV DNA level >105 IU/mL was associated with 71.8% probability of nail scissors being HBV DNA‐positive (P < .05). Serum HBV DNA level >107 IU/mL was associated with 71.5% probability of fingernails being HBV DNA‐positive (P > .05). Shared‐use of nail scissors was correlated with surface antigen of the hepatitis B virus positivity and total hepatitis B core antibody/immunoglobulin G positivity. A high HBV DNA level was detected in nail scissors and low level HBV DNA in the nails of persons with high serum HBV DNA levels. Conclusions: Nail scissors, shared‐use of nail scissors, and duration of shared use play important roles in household transmission of HBV. Level of education within society in this regard should be increased via mass media.

Comparative evaluation of the Brucella Coombs gel test in laboratory diagnosis of human brucellosis

ABSTRACT Brucellosis is widespread among humans and animals. Diagnosis of brucellosis mostly depends on serological methods. Serological tests are preferred over time-consuming and hazardous bacterial cultures in routine laboratory practice. However, these tests are somehow challenging due to ‘incomplete/blocking antibodies’ that prevent agglutination. Brucella Coombs gel test (BCGT) is newly developed test that contains Coombs antibodies (anti-human IgG) in gel microtubes and depends on gel centrifugation methods for the serological diagnosis of brucellosis. Here, performance of the BCGT is compared with standard serum tube agglutination (STA), standard serum tube agglutination with Coombs (C-STA) and immune capture agglutination (Brucellacapt). In total, 78 positive samples for study group and 16 samples for the control group were enrolled in the study. The samples were tested at dilutions of 1:40–1:5120. Titres at 1:160 and above were considered positive for brucellosis, whereas those lower than 1:160 were considered negative. Excellent agreement levels were determined between BCGT test and C-STA (κ, 0.894; p < 0.001), and BCGT and Brucellacapt (κ, 0.802; p < 0.001), when the diagnostic titre was accepted as 1:160. BCGT is easy to apply and interpret and provides reliable titre results in less than 2 h. It is also advantageous for screening.

THU0051 The Levels of Serum Pentraxin 3, IL 6, Fetuin A and Insulin in Patients with Rheumatoid Arthritis

Background The pathogenesis of RA is not well understood, but genetic, environmental and immunologic factors are known to be involved in the development of the disease. The long pentraxin, pentraxin-3 (PTX-3), is an inflammatory marker and a member of pentraxin superfamily which contains CRP and serum amyloid P. There are some published studies showing the relationship between RA and PTX-3. (1–3). We investigated that PTX3, IL 6, fetuin- A, insulin and HOMA-IR might also have a role in the pathogenesis of RA. Objectives The aim of this study was to evaluate the relationship between disease severity and biochemical parameters such as pentraxin-3, fetuin-A, IL-6,insulin and HOMA-IR levels in patients with rheumatoid arthritis. Methods This study included 60 patients with RA and 20 healthy controls. Serum pentraxin-3, fetuin-A, IL-6 and insulin concentrations were determined. Also, HOMA-IR values were calculated. Disease activity was assessed with Disease Activity Score (DAS28). Quality of life was evaluated by the use of the Health Assessment Questionnaire disability index. Results The serum values for ESR, CRP, pentraxin-3 and fetuin-A in patients with RA were elevated than control subjects (p values=0.001, 0.001, 0.000, 0.000, 0.01, 0.02, respectively) A positive correlation was evident between the DAS 28 score and IL6 levels (r =0.263, p=0.045). We found no correlation between the DAS28 score and HOMA-IR, the levels of pentraxin 3, fetuin A, insulin (p<0.05). Fetuin A levels was positively correlated with cumulative steroid dose (r=0.382, p=0.035). A statistically significant correlation was evident between presence of cardiovascular disease and HOMA-IR values in RA patients (r=0.437, p=0.032). In addition, DAS-28 score values were not in correlation with insulin, fetuin-A, HOMA-IR, IL-6 and pentraxin-3 levels (p>0.05). Conclusions Elevated levels of pentraxin-3, fetuin-A, CRP, ESR might play a role in the pathogenesis of RA. Levels of IL-6, fetuin-A, insulin HOMA-IR, pentraxin -3, CRP, ESR concentrations were not associated with clinical severity of the RA. References Dessein PH, Norton GR, Woodiwiss AJ, Joffe BI, Solomon A. Independent role of conventional cardiovascular risk factors as predictors of C-reactive protein concentrations in rheumatoid arthritis. J Rheumatol 2007;34:681–8. Hollan I, Nebuloni M, Bottazzi B, Mikkelsen K, Førre OT, Almdahl SM, Mantovani A, Fagerland MW, Aukrust P, Meroni PL; Feiring Heart Biopsy Study Group.Group. Pentraxin 3, a novel cardiovascular biomarker, is expressed in aortic specimens of patients with coronary artery disease with and without rheumatoid arthritis. Cardiovasc Pathol 2013 Sep-Oct;22(5):324–31. Klimek E, Skalska A, Kwaśny-Krochin B, Surdacki A, Sulicka J, Korkosz M, et al. Differential associations of inflammatory and endothelial biomarkers with disease activity in rheumatoid arthritis of short duration. Mediators Inflamm 2014;2014:681635. Disclosure of Interest None declared