Salih Hosoglu

The complications of chronic otitis media: Report of 93 cases

The aim of this study was to investigate the incidence, mortality and morbidity of complications due to chronic otitis media (COM). During the nine-year period 1990-1999, 2890 cases of COM were reviewed, 93 (3.22 per cent) having 57 (1.97 per cent) intracranial complications (IC) and 39 (1.35 per cent) extracranial complications (EC). In three patients more than one complication was observed. Meningitis and brain abscess were common in the IC group. Subperiosteal abscess (mastoid and Bezolds abscess) was a common complication in the EC group. Cholesteatoma and granulation/polyp in the middle ear/mastoid were the major findings in both groups. Fifteen patients died from IC. Overall, the mortality rate was 16.1 per cent in all patients having complications, and in patients with IC it was 26.3 per cent. In all of the patients with complications, the morbidity rate was 11.8 per cent. Our study supports the finding that meningitis and brain abscess are the common complications of COM and the main reason for mortality.

Efficacy and tolerability of pegylated-interferon alpha-2a in hemodialysis patients with chronic hepatitis C.

Background and Aim:  Hepatitis C virus (HCV) is prevalent in hemodialysis (HD) patients. These patients experience more side‐effects with antiviral treatment. The aim of the present study was to evaluate the efficacy and tolerability of pegylated interferon (PEG‐IFN) α‐2a in chronic hemodialysis patients with chronic hepatitis C.

Epidemiology of burn unit infections in children

OBJECTIVE The aim of this study was to determine the epidemiology of burn unit infections, the effect of these infections on the mortality rate, and antibiotic resistance pattern of the predominant bacteria isolated from children. Patients and method Epidemiologic data for 610 children, aged 0 to 15 years, admitted to the burn unit at Dicle University Hospital during a 5-year period were collected and analyzed. RESULTS In 207 patients (33.9%), 279 nosocomial infections were identified. The most common types of infections were burn wound infections (72.4%), urinary tract infections (10.8%), pneumonia (9.3%), and septicemia (7.5%). Pseudomonas aeruginosa (181 isolates) was the most common microorganism. Thirty-six patients (5.9%) died at the hospital. Sepsis was associated with mortality in 18 (50%) cases, pneumonia in 6 (17%), and varied noninfectious reasons in 12 patients (33%). P aeruginosa isolates showed high resistance to commonly used antimicrobials. Antibiotic susceptibility test results suggested that imipenem was the most effective agent for P aeruginosa and Escherichia coli strains. CONCLUSION The major type of nosocomial infections in the burn unit was burn wound infections, and the majority of nosocomial infections resulted from multiple drug-resistant, gram-negative bacteria.

Clinical and laboratory features of brucellosis in two university hospitals in Southeast Turkey

This prospective study was carried out in two university hospitals between January 2000 and December 2002. The diagnosis of brucellosis was made with compatible clinical findings, positive Brucella agglutination 1/160 titres, and/or the isolation of Brucella species. The patients were followed up without intervention. One hundred and thirty-eight patients with active brucellosis were evaluated. Of the participants, 79 (57.2%) cases were acute, 23 (16.7%) sub-acute and 36 (26.1%) chronic. Brucella melitensis was isolated in the specimens of 24 (26.9%) out of 89 patients. The most frequent symptoms were fever (78.3%), arthralgia (77.5%) and sweating (72.5%). The most common physical findings were fever (40.6%), splenomegaly (36.2%), and hepatomegaly (26.8%). The osteoarticular involvement was found in 64 patients (46.4%). Ten (7.5%) patients had orchiepididymitis. Meningitis, pulmonary involvement, endocarditis, and hepatitis were found in five (3.6%), three (2.1%), two (1.5%) and one (0.7%) patient, respectively. Relative lymphomonocytosis was found in 80 cases (58.8%), anaemia in 46 (33.3%) and leucopoenia in 30 cases (21.7%). Clinical relapse was observed in 14 patients (10.1%).

Extended-spectrum beta-lactamases in ceftazidime-resistant Escherichia coli and Klebsiella pneumoniae isolates in Turkish hospitals.

PURPOSE To study the prevalence of TEM-, SHV- and GES-type beta -lactamases among Escherichia coli and Klebsiella pneumoniae strains having ceftazidime MICs higher than 2 mg/L. METHODS A total of 63 E. coli and 41 K. pneumoniae isolated from five different university hospitals were studied for the existence of TEM-, SHV- and GES-type beta -lactamases. Susceptibility tests were carried out according to the criteria of National Committee for Clinical Laboratory Standards. MICs were obtained by agar dilution method. Existence of extended-spectrum beta -lactamases (ESBLs) were assessed by double-disc synergy test (DDST). Existence of the above-mentioned beta -lactamase genes were studied both by PCR with specific oligonucleotide primers and isoelectric focusing methods. RESULTS None of the isolates were carbapenem-resistant. DDSTs were positive in 50 (79.3%) and 33 (80.5%) of E. coli and K. pneumoniae , respectively. TEM gene was detected in 41 (65.1%) and 19 (46.3%), whereas SHV gene in 18 (28.6%) and 20 (48.8%) of E. coli and K. pneumoniae strains, respectively. GES genes were not detected. CONCLUSIONS TEM and SHV genes are highly prevalent among ESBL-producing E. coli and K. pneumoniae , whereas GES-type ESBLs are absent and found not to be responsible of ceftazidime resistance in Turkish hospitals.

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.

Genetic and Enzymatic Properties of Metallo-β-Lactamase VIM-5 from a Clinical Isolate of Enterobacter cloacae

ABSTRACT A VIM-5-producing Enterobacter cloacae isolate (EDV/1) was identified in a collection of clinical strains stored before 2002. The gene, blaVIM-5, was located on a 2,712-bp BamHI-HindIII fragment of a 23-kbp (approximately) nonconjugative plasmid (pEDV5) in a class 1 integron as a single gene cassette.

Risk factors for drug resistant tuberculosis in southeast Turkey

SUMMARY We undertook a cross-sectional survey of 116 patients at Dicle Hospital, Turkey, who had with bacteriologically confirmed tuberculosis (TB). Demographic and clinical features, including age, gender, pulmonary TB history, associated diabetes mellitus, previous TB treatment, residential area and education, were collected from charts. Eighty-four of the strains were found to be susceptible to all drugs. The resistance to one or more drug(s) was found in 32 strains. Multi-drug resistant (MDR) TB was found in 13 strains (11.3% of the total and 40.7% of the drug resistant strains). The resistance to isoniazid was the most frequently seen (25 strains, 21.5%). In the multivariable analysis, only previous TB treatment (P = 0.000) remained a significant predictor for drug resistance; in MDR, previous TB treatments (P = 0.002) remained significant in the final model. The patients educational status was found to be negatively correlated with the risk of MRD-TB (P = 0.035). Previous TB treatment and low educational status were found to important risk factors for the development of MDR-TB.

Increased antimicrobial consumption following reimbursement reform in Turkey

OBJECTIVES This study examined antibiotic utilization patterns in Turkey between 2001 and 2006. METHODS A comprehensive collection and analysis of Turkish antibiotic data from 2001 to 2006 was conducted. The anatomical therapeutic chemical (ATC) classification and the defined daily dose (DDD) methodology were used to calculate antibiotic consumption. Data were presented as DDD/1000 inhabitant-days, and the relation between antimicrobial consumption and governmental reimbursement policy was evaluated. RESULTS Total utilization of antibiotics increased from 14.62 to 31.36 DDD/1000 inhabitant-days between 2001 and 2006. The largest increase took place after the implementation of social insurance reform (SIR) in 2005, as evidenced by the DDD ratio increasing 1.87-fold after SIR went into effect. The largest increase occurred in the prescription of penicillins, from 7.13 in 2001 to 14.09 in 2006. CONCLUSIONS In Turkey, antibiotic consumption increased markedly in recent years, in a close relationship, to a new reimbursement policy following the implementation of the SIR, which facilitated the prescription and consumption of drugs compared with the earlier SIR conditions.

Effects of ursodeoxycholic acid, glutamine and polyclonal immunoglobulins on bacterial translocation in common bile duct ligated rats

Background:  The present study was conducted to investigate the effects of ursodeoxycholic acid (UDCA), glutamine and i.v. polyclonal immunoglobulins (IVIG) on the bacterial translocation (BT) and intestinal integrity of obstructive jaundice (OJ) in an animal model.