Sabahattin Ocak

Seroprevalence of Toxoplasma gondii, rubella and cytomegalovirus among pregnant women in southern Turkey.

Primary infections caused by Toxoplasma gondii, rubella and cytomegalovirus (CMV) can lead to serious complications in pregnant women. The aim of this study was to determine the seroprevalence of Toxoplasma, rubella and CMV infections through antenatal screening. In this study, the consecutive records of 1652 pregnant women examined between the period March 2004 to January 2006 were included. The results of the antenatal screening for Toxoplasma, rubella and CMV during the first trimester of pregnancy were evaluated. Anti-Toxoplasma, anti-rubella and anti-CMV IgG and IgM antibodies were assayed using an enzyme linked immunosorbent assay method. Of the 1652 pregnant women tested, anti-Toxoplasma IgG antibody was found in 860 (52.1%) of the cases, while 9 (0.54%) of the subjects tested positive for anti-Toxoplasma IgM. Anti-rubella IgG and IgM antibodies were reactive in 1570 (95.0%), and in 9 (0.54%) of the tested women, respectively. Moreover, 1568 (94.9%) of them were found to be positive for anti-CMV IgG, while 7 (0.4%) tested positive for anti-CMV IgM. Consequently, because of the high seropositivity of T. gondii, rubella and CMV in the pregnant women, the countrys health authorities should be alerted, and preventive measures should be taken.

Distribution of Candida species in women with vulvovaginal symptoms and their association with different ages and contraceptive methods

The aim of this study was to determine the frequency and distribution of Candida spp. within different age groups and different contraceptive methods users in women with vulvovaginal symptoms. The study included 569 female outpatients who had visited the Education and Research Hospital of Mustafa Kemal University, Turkey, between Jaunary 2004 and June 2005. Among 569 women with symptoms of vulvovaginitis, 240 (42.2%) were positive for Candida spp., of which 106 (44.2%) were C. albicans and 134 (55.8%) were non-albicans spp. The age group 26–30 y had the highest frequency of Candida spp. (23.7%). Candida spp. were isolated from 44.2% of contraceptive method users, and 37.9% of non-contraceptive users (p>0.05). The isolation rate of C. albicans was higher among oral-contraceptive users (57.5%) than IUCD users (38.5%), coitus interruptus (48.5%) and condom users (42.8%). These results indicate that factors associated with age and contraceptive method used may influence the occurrence and distribution of Candida spp. in women with vulvovaginal symptoms.

Staphylococcus aureus nasal carriage among the diabetic and non-diabetic haemodialysis patients

Staphylococcus aureus is the most common cause of serious infections in patients undergoing long‐term haemodialysis (HD). S. aureus infections in HD patients are associated with considerable morbidity and mortality. Especially, methicillin‐resistant S. aureus (MRSA) strains are becoming increasingly multidrug‐resistant and have recently developed resistance to vancomycin, used successfully to treat MRSA for more than 30 years. In vitro determination of resistance patterns of S. aureus is critical in terms of administering suitable antimicrobial treatment. The objective of this study was to identify the frequency of S. aureus among diabetic and non‐diabetic HD patients and to investigate resistance patterns against various antibiotics used broadly for treatment. This study was carried out between January 2004 and December 2004. In the present survey, 261 patients undergoing HD treatment from three HD units in Hatay were examined. A total of 148 Staphy‐lococcus aureus strains were processed to assess their occurrence rates and antimicrobial susceptibility profiles. S. aureus positivity was determined in 148 (56.7%) of the 261 HD patients and 26 (16.2%) of the 160 individuals in the control group. The difference was significant (p < 0.001). HD length was found to be 38.4 ± 24.3 months in the patients of S. aureus carrier and 27.3 ± 18.5 months in non‐carrier patients. Significant correlation was also identified between durations those on HD and the isolation of S. aureus (p < 0.001). However, the carrier state was unrelated to the presence of diabetes mellitus (DM), age or sex. In conclusion, nasal carriage of S. aureus was found to be more prevalent in HD patients than that in those in the control group. Also, it is concluded that DM was not a risk factor for the nasal carriage of S. aureus. In addition, the rates of antibiotic resistance of S. aureus strains were found to be quite higher in HD patients than in the control group (p < 0.05).

Seroprevalence of hepatitis C in patients with type 2 diabetes mellitus and non‐diabetic on haemodialysis

Type 2 diabetes mellitus (DM) has emerged as the commonest cause of end‐stage renal disease. Haemodialysis (HD) treatment constitutes a high‐risk environment for the transmission of hepatitis C virus (HCV). The aim of this study was to establish a potential relationship between type 2 DM and HCV infection in HD patients. Of the 267 HD patients, 67 (25.1%) had type 2 DM and 200 (74.9%) were with diverse aetiology for end‐stage renal disease. The serum markers of HCV infection were tested by a second‐generation enzyme‐linked immunosorbent assay test for antibodies and by qualitative reverse‐transcription polymerase chain reaction technique for viral RNA. The overall prevalence of anti‐HCV antibodies and HCV RNA was found to be 12.7% (34/267) and 10.1% (27/267), respectively. Patients with type 2 DM were found to have a higher HCV prevalence compared with non‐diabetic patients [20.8% (14/67) vs. 10% (20/200)] (p < 0.05). The mean period on dialysis of anti‐HCV‐positive patients with type 2 DM was shorter than that observed for anti‐HCV‐positive non‐diabetic patients (43.9 ± 9.8 months vs. 59.7 ± 28.4 months) (p < 0.05). This study has shown that although the period on dialysis of diabetic patients are shorter than non‐diabetic patients, the prevalence of HCV in HD patients with type 2 DM is higher than that detected in non‐diabetic HD patients.

The evaluation of immune responses to hepatitis B vaccination in diabetic and non‐diabetic haemodialysis patients and the use of tetanus toxoid

Aim:  The aim of this study was to investigate whether haemodialysis (HD) patients suffering from diabetes mellitus could be considered at risk for the development of the protective antibodies to hepatitis B (HB) vaccination and, to evaluate the effectiveness of tetanus toxoid (TT) administrated 2 days before HB vaccination.

Morganella morganii-associated arthritis in a diabetic patient

This case report involves a 60-year-old diabetic man who developed septic arthritis as a result of the pathogen Morganella morganii. The patient had complaints of elevated body temperature, malaise, rigors and pain in the left knee, despite no history of trauma. On examination of the knee, erythema, warmth, tenderness and swelling was observed. Arthrocentesis performed on his left knee indicated the presence of straw-coloured, cloudy fluid without crystals. Bacterial identification based on biochemical and automated methods indicated the growth of M morganii. M morganii was also isolated sedimentafrom the exudate of a diabetic ulcer in the left foot, with antibiotic susceptibilities identical to those from the knee effusion. This case indicates that M morganii may be considered as a possible cause of septic arthritis in diabetic patients, especially those with diabetic foot infections.

Preventive effect of rolipram, a phosphodiesterase 4 enzyme inhibitor, on oxidative renal injury in acute ascending pyelonephritis model in rats.

OBJECTIVES To evaluate the effects of rolipram, a phosphodiesterase 4 enzyme inhibitor, on Escherichia coli-induced renal oxidative damage in an acute pyelonephritis (PYN) rat model. METHODS A total of 35 male Wistar albino rats were randomly divided into 7 groups (n = 5) as follows: control (uninfected), PYN 24 hours, PYN 48 hours, PYN 72 hours, PYN + rolipram 24 hours, PYN + rolipram 48 hours, and PYN + rolipram 72 hours. Ascending PYN was induced in the study groups by E. coli inoculation into the bladder, and the urethras were then occluded by collodium for 4 hours. Rolipram injections (1 mg/kg) were started before bacterial inoculation and repeated at 24-hour intervals in the PYN + rolipram groups until death. The rats were killed at the indicated times. Malondialdehyde and nitric oxide levels and superoxide dismutase and catalase activities were determined in kidney homogenates. Histopathologic examinations were also performed. RESULTS Tissue malondialdehyde and nitric oxide levels and superoxide dismutase and catalase activities were significantly increased in the kidneys from the PYN groups. However, rolipram administration reduced renal malondialdehyde and nitric oxide levels and enhanced superoxide dismutase and catalase activities. The histopathologic examinations demonstrated that rolipram treatment reduced the inflammation grade in the kidney specimens. CONCLUSIONS The results of our study have shown that rolipram has a protective effect on renal tissue from E. coli-induced oxidative injury. Therefore, phosphodiesterase 4 inhibitors might be a novel therapeutic option for the prevention and/or management of acute PYN.

Comparison of Bacterial Isolates Cultured from Hemodialysis Patients and Other Patients with Diabetic Foot and Their Antimicrobial Resistance

The aim of this study was to compare microbial findings and their resistance to antibiotics between hemodialysis patients and patients without end-stage renal failure with diabetic foot infections. An 18-month-long descriptive study analyzed bacterial isolates obtained from 32 hemodialysis (HD) patients with diabetic foot infection in an Antakya hemodialysis center and 65 patients with diabetic foot infection admitted to the Education and Research Hospital of Mustafa Kemal University, Turkey. No significant difference in the mean number of pathogens per patient was found between the dialysis patients and other patients (2.3 vs. 2.1, respectively) (p > 0.05). While the occurrence of gram-positive bacteria in the HD patients was found to be 59.0%, this rate in the other patients was 53.1% (p > 0.05). While most frequent bacterial species isolated in the HD patients were S. aureus (22.9%), followed by coagulase-negative Staphylococcus spp. (CNS) (19.7%), the microorganisms in the other patients were found as CNS (20.7%), followed S. aureus (18.0%). The data recommend that antibiotic therapy in HD patients with diabetic foot infection should be more closely guided by culture findings and antimicrobial susceptibility results.

Lamivudine Experience in Acute Hepatitis B Developing in a Patient Under Chemotherapy

Acute hepatitis B (AHB) results 90% in spontaneous healing and often does not require antiviral therapy. It may rarely result in severe liver damage as fulminant hepatitis. The possibility of fulminant hepatitis is high in immunosuppressed patients than in immunocompetent patients. Although the exact cause is unexplained, immunosuppression associated with chemotherapy may increase the possibility of fulminant hepatitis by increasing hepatitis B virus replication in immunosuppressed patients. According to this hypothesis, in immunosuppressed patients with AHB, maintaining viral load suppression with lamivudine therapy may cause less host response and may be effective in preventing risk of fulminant hepatitis. A case in which AHB developed while receiving maintenance chemotherapy for haematological malignancy is presented. Based on similar cases in the literature, the patient was treated with lamivudine and maintenance chemotherapy was continued. In the fourth week of treatment, transaminase levels were normal and anti-HBs was positive. In immunocompromised patients in whom AHB develops, many questions such as the effectiveness of lamivudine treatment, duration of treatment, whether or not to suspend the chemotherapy and when to continue the chemotherapy are still unanswered. Lamivudine experience in this case is reported because there is no guide for this subject in the literature except few case reports. Klimik Dergisi 2014; 27(3): 118-20.