Mustafa Altındiş

Hormone replacement therapy, C-reactive protein, and fibrinogen in healthy postmenopausal women

OBJECTIVE To investigate short-term and long-term effects of combined hormone replacement therapy (HRT) on C-reactive protein (CRP) and fibrinogen plasma concentrations in healthy postmenopausal women. METHODS In this cross-sectional study 241 healthy postmenopausal women were enrolled. A total of 81 women were receiving the following treatments for 3 months; transdermal 17beta-estradiol (17beta-E2) + medroxyprogesterone acetate (MPA) (n = 21), oral 17beta-E2 + norethisterone acetate (NETA) (n = 27), and conjugated equine estrogens (CEE) + MPA (n = 33). The same combined therapies were implemented in another 58 women for 12 months; transdermal 17beta-E2 + MPA (n = 10), oral 17beta-E2 + NETA (n = 16), and CEE + MPA (n = 32). Control group included 102 healthy postmenopausal women not receiving HRT. The effect of the type and the duration of HRT regimens on plasma levels of CRP, fibrinogen and lipids were investigated. RESULTS Median CRP concentrations were significantly higher in women receiving oral 17beta-E2 + NETA (P = 0.037) and CEE + MPA (P = 0.0001) for 3 months than in women taking the same types of HRT for 12 months and of those were not on HRT. Median CRP levels were similar in women taking transdermal 17beta-E2 + MPA for 3 and 12 months, compared with controls. Fibrinogen levels were not different between nonusers and any group of HRT users. CONCLUSIONS These elevated levels of CRP, which appears very recently as a crucial marker for cardiovascular disease, may be responsible for the early increased cardiovascular risk after starting oral combined HRT. But this increased risk in the early period seems to decrease with long-term use. Transdermal 17beta-E2 + MPA had insignificant effect on CRP both in short-term or in long-term use.

Investigation of the incidence of hepatitis E virus among pregnant women in Turkey

Aim:  The aim of our study was to determine the prevalence of hepatitis E virus (HEV) among pregnant and non‐pregnant women in Middle Anatolia, identify the factors that affect being HEV positive and to study the effects of HEV positivity on mother and fetus.

Bacterial vaginosis: comparison of Pap smear and microbiological test results

Our purpose was to determine the reliability of the Pap smear in making the diagnosis of bacterial vaginosis and to examine the characteristics of Pap smear vs vaginal culture in diagnosis of bacterial vaginosis, with the vaginal Gram stain used as the diagnostic standard. We performed a prospective, blinded study involving 245 women who referred to the Department of Gynecology and Obstetrics in our hospital for routine genital examination between September 2001 and September 2002. Exclusion criteria included vaginal bleeding and pregnancy. Each patient had standard Pap smear, Gram-stained vaginal smear and culture of vaginal swab. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic value of Pap smear and vaginal culture results were determined with Gram stain used as the standard for diagnosis of bacterial vaginosis. Using Gram stain diagnosis of bacterial vaginosis as the standard, Pap smear and vaginal culture test results had sensitivity of 43.1 and 77.8%, specificity of 93.6 and 97.7%, positive predictive value of 73.8 and 93.3%, negative predictive value of 79.8 and 91.4%, diagnostic value of 78.8 and 91.8%, respectively, for the diagnosis of bacterial vaginosis. Compared to the microbiological test results, Pap smear is not sensitive enough for screening of bacterial vaginosis. However, because of its high specificity, it may be an adequate diagnostic criteria when it is positive.

In vitro anti-Helicobacter pylori activity of usnic acid.

Eradication of Helicobacter pylori is an important objective in overcoming gastric diseases. Many regimens are currently available but none of them could achieve 100% success in eradication. Medicinal lichen is used in the treatment of gastric ulcer in local folk medicine in Anatolia (Turkey). The present study was performed to assess the in vitro effects of usnic acid from Usnea dasypoga against clinical isolates and standard H. pylori strains and their minimum inhibitory concentrations (MICs). A total of 38 strains was assayed for anti‐H. pylori activity. The agar dilution method was used for the determination of usnic acid and clarithromycin resistance.

Frequency of norovirus in stool samples from hospitalized children due to acute gastroenteritis in Anatolia, Turkey, 2006-2007.

Noroviruses are among the most common causes of sporadic enteritis in childhood. In this pilot study, the frequency of norovirus infection in children in mid-western Turkey was investigated from November 2006 to June 2007. Noroviruses were detected in 17% of samples (15/88) by a combination of 2 different RT-PCR assays, both targeting an overlapping region of the RNA-dependent RNA polymerase gene. By sequence analysis, most strains were characterized as GIIb/Hilversum. One strain was characterized as GII.4/2006a, a variant that appeared worldwide in 2006, while another strain was characterized as a rare genotype, GII.6. This study demonstrates the importance of norovirus in paediatric diarrhoea and suggests the heterogeneity of circulating strains in Turkey.

Octenidine hydrochloride in hydatid disease.

Hydatid disease is still endemic in many devoloping countries and continues to be an important cause of morbidity. The objective of this study was to determine the in vitro scolicidal effects of octenidine hydrochloride in different concentrations using different exposure times. After hydatid cyst liquid was left to precipitate for 1 h to obtain cystic sand, various concentrations of octenidine (undiluted, 1% and 0.1% diluted) were added to concentrated hydatid cyst sediments for 5, 10, 15, 20, 25, 30, 45, and 60 min, and scolicidal effects of octenidine were compared with 20% saline and control group for the same times. It was found that undiluted octenidine had a strong scolicidal effect at 15 min compared to saline at 20%. One percent octenidine had a scolicidal effect at 30 min. However, 0.1% octenidine did not have enough scolicidal effect in 1 h. It was concluded that undiluted and 1% diluted octenidine might be used for scolicidal purpose in the treatment of hydatid disease.

Molecular characterization of rotaviruses in mid-western Turkey, 2006–2007

Vaccines against rotaviruses are now available in numerous countries, including Turkey. As the vaccines may show various efficiencies against different type specificities and routine vaccination in infants might result in selection and immune escape of wild-type rotavirus strains, strain surveillance has been initiated before and during the vaccine introduction. We aimed to provide corresponding information on local strain prevalence in Anatolia, mid-western Turkey during the introduction of rotavirus vaccines. Stool samples positive for group A rotavirus by commercial enzyme immunoassay were subjected to reverse transcription-polymerase chain reaction based genotyping of the outer capsid antigens, VP7 and VP4, determining G and P type specificities respectively. Among 36 fully and 5 partially typeable strains we detected genotype G1, G2, and G9 VP7 specificities and genotype P[4], P[6] and P[8] VP4 specificities in 5 individual and 4 mixed combinations. The most common strain was G2P[4] (n=17), followed by G9P[8] (n=9). Other strains were G1P[8] (n=2), G2P[8] (n=2), G1+2P[8] (n=2), G9P[4] (n=1), G2+9P[8] (n=1), G4+9P[6] (n=1), and G2P[4+8] (n=1). Partially typed strains included 2 G1P[NT] and 3 G2P[NT] strains. Our data may help determine a baseline of the rotavirus genotype prevalence in Turkey and see if changes in the incidence of individual strains will be observed after routine use of vaccine.

Molecular characterization of nosocomial CTX-M type ß-Lactamase producing Enterobacteriaceae from University Hospital in Turkey

Extended-spectrum ß–Lactamase (ESBL) producing members of the Enterobacteriaceae family are important nosocomial pathogens. CTX-M type extended-spectrum ß–Lactamases (ESBLs) are now the most important cause of resistance to beta-lactam antibiotics in Escherichia coli and are reported worldwide with increasing frequency. Dominant CTX-M genotype varies geographically. CTX-M 15 dominates in many countries including the UK and India whereas CTX-M 2 is the most common genotype in Latin America while CTX-M 9 and CTX-M 14 is common in Spain and Far East. In this study, a total of 100 consecutive ESBL positive nosocomial isolates of Enterobacteriaceae collected from Afyon Kocatepe University Hospital were screened for production of ESBLs by double disk synergy test and the susceptibility to antibiotics was determined. Then this results was confirmed by Phoenix ®

A Multicenter Evaluation of Blood Culture Practices, Contamination Rates, and the Distribution of Causative Bacteria

Background: The prognostic value of blood culture testing in the diagnosis of bacteremia is limited by contamination. Objectives: In this multicenter study, the aim was to evaluate the contamination rates of blood cultures as well as the parameters that affect the culture results. Materials and Methods: Sample collection practices and culture data obtained from 16 university/research hospitals were retrospectively evaluated. A total of 214,340 blood samples from 43,254 patients admitted to the centers in 2013 were included in this study. The blood culture results were evaluated based on the three phases of laboratory testing: the pre-analytic, the analytic, and the post-analytic phase. Results: Blood samples were obtained from the patients through either the peripheral venous route (64%) or an intravascular catheter (36%). Povidone-iodine (60%) or alcohol (40%) was applied to disinfect the skin. Of the 16 centers, 62.5% have no dedicated phlebotomy team, 68.7% employed a blood culture system, 86.7% conducted additional studies with pediatric bottles, and 43.7% with anaerobic bottles. One center maintained a blood culture quality control study. The average growth rate in the bottles of blood cultures during the defined period (1259 - 26,400/year) was 32.3%. Of the growing microorganisms, 67% were causative agents, while 33% were contaminants. The contamination rates of the centers ranged from 1% to 17%. The average growth time for the causative bacteria was 21.4 hours, while it was 36.3 hours for the contaminant bacteria. The most commonly isolated pathogens were Escherichia coli (22.45%) and coagulase-negative staphylococci (CoNS) (20.11%). Further, the most frequently identified contaminant bacteria were CoNS (44.04%). Conclusions: The high contamination rates were remarkable in this study. We suggest that the hospitals’ staff should be better trained in blood sample collection and processing. Sterile glove usage, alcohol usage for disinfection, the presence of a phlebotomy team, and quality control studies may all contribute to decreasing the contamination rates. Health policy makers should therefore provide the necessary financial support to obtain the required materials and equipment.

A Diagnostic Algorithm for the Detection of Clostridium difficile-Associated Diarrhea

BACKGROUND Clostridium difficile is a common cause of hospital-acquired diarrhea, which is usually associated with previous antibiotic use. The clinical manifestations of C. difficile infection (CDI) may range from mild diarrhea to fulminant colitis. Clostridium difficile should be considered in diarrhea cases with a history of antibiotic use within the last 8 weeks (community-associated CDI) or with a hospital stay of at least 3 days, regardless of the duration of antibiotic use (hospital-acquired CDI). AIMS This study investigated the frequency of CDI in diarrheic patients and evaluated the efficacy of the triple diagnostic algorithm that is proposed here for C. difficile detection. STUDY DESIGN Cross-sectional study. METHODS In this study, we compared three methods currently employed for C. difficile detection using 95 patient stool samples: an enzyme immunoassay (EIA) for toxin A/B (C. diff Toxin A+B; Diagnostic Automation Inc.; Calabasas, CA, USA), an EIA for glutamate dehydrogenase (GDH) (C. DIFF CHEK-60TM, TechLab Inc.; Blacksburg, VA, USA), and a polymerase chain reaction (PCR)-based assay (GeneXpert(®) C. difficile; Cepheid, Sunnyvale, CA, USA) that detects C. difficile toxin genes and conventional methods as well. In this study, 50.5% of the patients were male, 50 patients were outpatients, 32 were from inpatient clinics and 13 patients were from the intensive care unit. RESULTS Of the 95 stool samples tested for GDH, 28 were positive. Six samples were positive by PCR, while nine samples were positive for toxin A/B. The hypervirulent strain NAP-1 and binary toxin was not detected. The rate of occurrence of toxigenic C. difficile was 5.1% in the samples. Cefaclor, ampicillin-sulbactam, ertapenem, and piperacillin-tazobactam were the most commonly used antibiotics by patients preceding the onset of diarrhea. Among the patients who were hospitalized in an intensive care unit for more than 7 days, 83.3% were positive for CDI by PCR screening. If the PCR test is accepted as the reference: C. difficile Toxin A/B ELISA sensitivity and specificity were 67% and 94%, respectively, and GDH sensitivity and specificity were 100% and 75%, respectively. CONCLUSION Tests targeting C. difficile toxins are frequently applied for the purpose of diagnosing CDI in a clinical setting. However, changes in the temperature and reductant composition of the feces may affect toxin stability, potentially yielding false-negative test results. Therefore, employment of a GDH EIA, which has high sensitivity, as a screening test for the detection of toxigenic strains, may prevent false-negative results, and its adoption as part of a multistep diagnostic algorithm may increase accuracy in the diagnosis of CDIs.