Mustafa Ertek

Prevalence of rotavirus genotypes in children younger than 5 years of age before the introduction of a universal rotavirus vaccination program: report of rotavirus surveillance in Turkey.

Background Group A rotaviruses are the most common causative agent of acute gastroenteritis among children less than 5 years of age throughout the world. This sentinel surveillance study was aimed to obtain baseline data on the rotavirus G and P genotypes across Turkey before the introduction of a universal rotavirus vaccination program. Methods Rotavirus antigen-positive samples were collected from 2102 children less than 5 years of age who attended hospitals participating in the Turkish Rotavirus Surveillance Network. Rotavirus antigen was detected in the laboratories of participating hospitals by commercial serological tests such as latex agglutination, immunochromatographic test or enzyme immunoassay. Rotavirus G and P genotypes were determined by reverse transcription polymerase chain reaction (RT-PCR) using consensus primers detecting the VP7 and VP4 genes, followed by semi-nested type-specific multiplex PCR. Results RT-PCR found rotavirus RNA in 1644 (78.2%) of the samples tested. The highest rate of rotavirus positivity (38.7%) was observed among children in the 13 to 24 month age group, followed by children in the age group of 25 to 36 months (28.3%). A total of eight different G types, six different P types, and 42 different G–P combinations were obtained. Four common G types (G1, G2, G3, and G9) and two common P types (P[8] and P[4]) accounted for 95.1% and 98.8% of the strains, respectively. G9P[8] was the most common G/P combination found in 40.5% of the strains followed by G1P[8] (21.6%), G2P[8] (9.3%), G2P[4] (6.5%), G3P[8] (3.5%), and finally, G4P[8] (3.4%). These six common genotypes included 83.7% of the strains tested in this study. The rate of uncommon genotypes was 14%. Conclusion The majority of the strains analyzed belonged to the G1–G4 and G9 genotypes, suggesting high coverage of current rotavirus vaccines. This study also demonstrates a dramatic increase in G9 genotype across the country.

Role of HLA Allele Polymorphism in Chronic Hepatitis B Virus Infection and HBV Vaccine Sensitivity in Patients from Eastern Turkey

Human leukocyte antigen (HLA) alleles have been associated with the clinical outcomes of hepatitis B virus (HBV) infection, which range from spontaneous recovery to hepatocellular carcinoma. In this study involving subjects from eastern Turkey, the frequencies of HLA-B35, HLA-CW4, HLA-DQ2, and HLA-DQ8 were markedly higher in the chronic HBV group than those in the spontaneously recovered group; the frequencies of HLA-A11 and HLA-A24 in the nonresponsive HBV vaccine group were markedly higher than those in the responsive HBV vaccine group; and the frequency of HLA-CW6 in the nonresponsive HBV vaccine group was significantly lower than in the responsive group. A complete understanding of HLA types associated with the progression to chronic HBV infection and their effects within the cell at the molecular level will be an important contribution in the development of new HBV vaccines and new treatment strategies for chronic HBV infection.

A Comparison of High-Level Aminoglycoside Resistance in Vancomycin-Sensitive and Vancomycin-Resistant Enterococcus Species

The aim of this study was to investigate whether there was a significant difference in high-level aminoglycoside resistance (HLAR) between vancomycin-sensitive enterococci (VSE) and vancomycin-resistant enterococci (VRE). Vancomycin resistance was determined in 116 Enterococcus isolates using brain-heart infusion agar containing 6 μg/ml vancomycin. HLAR was determined by both standard agar screening and disk diffusion methods. Streptomycin and gentamicin were used as predictors of HLAR. Vancomycin resistance and HLAR were found in 17 (14.7%) and 41 (35.3%) of the Enterococcus strains, respectively. HLAR was found in 11 of 17 VRE and 30 of 98 VSE strains. HLAR in VRE strains was significantly higher than in VSE. More enterococcal strains were found to be resistant to both gentamicin and streptomycin (29) than to gentamicin (one) or streptomycin (11) alone. The HLAR rate in VRE was two-fold higher than in VSE. The synergistic bactericidal effect of aminoglycosides and β-lactam or glycopeptide antibiotics is lost if there is high-level resistance to aminoglycosides.

Effects of interferon-alpha therapy on cardiac function in patients with chronic hepatitis B infection.

Various types of cardiovascular complications, such as myocardial infarction, cardiac arrhythmias, cardiomyopathy, and myocarditis attributed to interferon therapy have been reported. The aim of this study was to evaluate the cardiac effects of interferon-α (IFN-α) in patients with chronic hepatitis B infection. Forty-five patients with chronic hepatitis B infection (41 men and 3 women; mean age 34.2 ± 11.5 years) were included in the study, and 10 MU IFN-α 2b was administered three times a week for 6 months to the patients. Cardiac evaluation (detailed medical history, physical examination, electrocardiography, systolic and diastolic function parameters by echocardiography) was performed at the beginning, and at the 1st, 3rd, and 6th months of therapy. No patients had any cardiac symptoms during interferon therapy, and systolic and diastolic blood pressure and heart rate were not significantly affected (P > 0.05). None of the patients revealed cardiac rhythm disturbance on electrocardiography before or during the therapy period. No significant changes were detected in systolic (ejection fraction, fractional shortening, pre-ejection period, left ventricular ejection time, the ratio of pre-ejection period/ejection time, Q-V peak) and diastolic (E peak, A peak of transmitral flow velocity, E/A ratio, deceleration time, isovolumic relaxation time by conventional echocardiography, and E peak, A peak, deceleration time of E wave at the medial and lateral corners of the mitral annulus by tissue Doppler echocardiography) left ventricular function parameters between the beginning and the 1st, 3rd, and 6th months of therapy. The results of this study suggest that IFN-α therapy does not cause a significant deterioration in cardiac function in patients with chronic hepatitis B infection, and it may be used safely in patients without cardiac disease.

Demonstration of In Vitro Antagonism between Fusidic Acid and Quinolones

Fusidic acid is an antibiotic active against staphylococci and other bacterial pathogens. It is used in the treatment of staphylococcal infections usually in combination with other antibacterial agents. Reports of the clinical effects of antimicrobial combinations containing fusidic acid have been somewhat inconsistent. The aim of this study was to investigate the in vitro antagonism of fusidic acid and quinolones. Twenty-six staphylococci strains isolated from various clinical samples were tested. After detecting the diameter of the zone of inhibition around fusidic acid, levofloxacin, ciprofloxacin, ofloxacin and moxifloxacin for each strain, in vitro antagonism between fusidic acid and each quinolone was investigated using disk approximation. In all 26 strains, quinolones and fusidic acid were antagonist in vitro. The reason for this antagonistic effect and its clinical implications are not known. However, care should be exercised in prescribing quinolones and fusidic acid in combination.

Human Puumala and Dobrava Hantavirus Infections in the Black Sea Region of Turkey: A Cross-Sectional Study

This study was carried out to better understand the epidemiology of hantaviruses in a province of Turkey (Giresun) where human hantavirus disease has recently been detected. In this cross-sectional study, a total of 626 blood samples from healthy people aged 15 and 84 years old were collected both in urban and rural areas in 2009. The sera were tested by enzyme-linked immunosorbent assay (ELISA), immunoblotting assay, and the focus reduction neutralization test (FRNT). We screened the samples by an ELISA and found that 65/626 samples reacted positively for the presence of hantavirus-reactive immunoglobulin G (IgG). Twenty of the 65 ELISA-positive samples could be confirmed by an immunobloting assay, and the overall seroprevalence was thereby calculated to 3.2% (20/626). The seroprevalence of the people living in wood areas or adobe houses 9/17 (52.9%) was significantly higher than among people living in concrete houses 10/47 (21.3%) (p=0.014). Finally, 3 of the 20 immunoblot-positive sera were confirmed as specific for the Puumala hantavirus serotype by FRNT, 1 serum was confirmed as Dobrava virus-specific, whereas 1 serum was found to be equally reactive to Dobrava and Saaremaa viruses. We will now focus on further investigations of the ecology and epidemiology of hantaviruses in humans and their carrier animals in Turkey, studies that have already been started and will be further intensified.

Türkiye\'nin Karadeniz Bölgesinden seçilmiş merkezlerde Riketsiya seropozitivitesi ve risk faktörleri

Objectives: Hepatitis C and interferon may trigger autoimmunity. We aimed to investigate the effects of combination treatment of peginterferon alpha (peg-IFN) + ribavirin in patients with chronic hepatitis C (CHC) on thyroid function tests and thyroid auto antibodies. Materials and Methods: The study included 45 outpatients with proven CHC having normal thyroid functions and previously not treated. The patients received combination of Peg-IFN+ribavirin. Values of fT3, fT4, TSH, antitiroglobulin (Anti-Tg) and thyroid peroxidase antibody (Anti-TPO) were measured at initial, fi rst, third and sixth months of treatment. Frequency of thyroid dysfunction was evaluated according to age and gender of patients. Results: Thyroid dysfunction emerged in 15 (%33.3) of 45 patients at the end of the six month of antiviral treatment. Symptomatic thyroid disease was confi rmed in 2 patients.Subclinical hyperthyroidism was determined in four patients (%8.9), and subclinical hypothyroidism in 3 patients (%6.7) at the end of third month.At the end of sixth month; symptomatic hyperthyroidism was observed in one patient (%2.2), subclinical hyperthyroidism in six (%13.3) and subclinical hypothyroidism in 7 patients (%15.6), and symptomatic hypothyroidism was determined in one patient (%2.2).At the end of the sixth month of antiviral treatment; Anti-Tg antibodies were positive in 12 patients (%26.7) and antiTPO in 11 patients (4 male and 7 female) (%24.5). No sig- nifi cant relationship was found between thyroid dysfunction and age, gender and ALT levels of patients (p>0.05). Conclusion: Periodic follow-up examinations should be done for thyroid autoimmunity and thyroid functions in CHC patients receiving combination treatment of PegINF+ribavirin.In adults, urethral foreign body is commonly observed with mental disorder, psychiatric or sexual behavior distursbance. In this paper, we reported a case which electrical cable wire was inserted into the urethra by the husband.Objectives: Dietary high fructose consumption which is closely associated with endothelial dysfunction via insulin resistance has recently increased in developed countries.Insulin resistance has a promoter effect on many meta-bolic disorders such as syndrome X, polycystic ovary syn-drome, Type 2 diabetes mellitus etc. Our aim in this study is to understand the impact of increased fructose intake on metabolisms of glucose, insulin and endothelial dys-function by measuring nitric oxide (NO) and endothelin-1(ET-1) levels in hepatic tissue which is crucial in fructose metabolism. Materials and Methods: We designed an animal study to understand increased fructose intake on hepatic en-dothelium. Twenty adult male albino rats were divided into two groups; the study group (group 1, n=10) received isocaloric fructose enriched diet (fructose-fed rats, con-taining 18.3% protein, 60.3% fructose and 5.2% fat) while the control group received purifi ed regular chow (group 2,n=10) for 2 weeks. After feeding period, blood and hepatictissue samples were collected and glucose, insulin, NO and ET-1 levels were analysed. Results: We found increased fasting glucose and insulin levels and impaired glucose tolerance in fructose fed rats. Higher NO and lower ETn1 levels were also detected in hepatic tissue samples of the group 1. Conclusion: Increased fructose consumption has delete- rious effects on glucose tolerance, insulin resistance and may cause to endothelial dysfunction. Key words: Fructose consumption, endothelial dysfunc-tion, nitric oxide, endothelin-1, liver.Oral squamous cell papilloma is a cutaneus lesions occurring due to human papilloma virus infections. These lesions spread locally and tend to have a high recurrence rate. Cases usually have a slow progression rather than acute symptoms. The course of disease is mostly subclinical. Although there are various treatment modalities which are recommended for the treatment of the disease, there is no particular and effective treatment modality that was proven. Limited surgical excisions result in frequent recurrences due to the presence of HPV in latent form around the lesions. Therefore, surgical excisions are combined with the other treatments such as systemically used interferons. We aimed to present a case of squmous cell papilloma with locally extensive lesions in the oral mucosa. Our patient was managed by the surgical excision and systemically given interferon treatment.

Serologic Investigation of Hantavirus Infection in Patients with Previous Thrombocytopenia, and Elevated Urea and Creatinine Levels in an Epidemic Region of Turkey

The first cases of Hantavirus infection in Turkey were reported in early 2009 in the Zonguldak and Bartin provinces. The aim of this study was to investigate the presence of Hantavirus antibodies in patients who had clinical and laboratory findings that were potentially associated with Hantavirus infection prior to the epidemic in Bartin in 2009. After screening 314,577 medical records from between 2007 and 2009, the clinical and laboratory data for 442 patients meeting the criteria of coexistent thrombocytopenia, and elevated urea and creatinine levels were transferred to a statistical program. Home visits were made to 170 patients, 84 of whom consented to participate in the study. The participants completed a questionnaire and provided a blood sample. Commercial anti-Hantavirus IgG and IgM ELISA and immunoblotting assays were used, with seropositive samples being confirmed by focus reduction neutralization tests (FRNT). ELISA and/or immunoblotting assays detected 10 positive samples; however, only 7 of these were recorded as positive by FRNT. FRNT positivity was significantly associated with female sex, the presence of a barn near to the house, and working in a forest (P < 0.05). In a Hantavirus endemic region, physicians must keep in mind that thrombocytopenia, and elevated urea and creatinine levels may indicate Hantavirus infection.