Semra Kurutepe

Drug-resistant pulmonary tuberculosis in western Turkey: prevalence, clinical characteristics and treatment outcome.

BACKGROUND Although high antituberculosis (anti-TB) drug resistance rates have been reported in Turkey, the clinical characteristics and implications for the outcome of anti-TB treatment have not been fully investigated. We determined the prevalence of anti-TB drug resistance and examined demographic data, clinical characteristics and treatment outcome in relation to patterns of resistance. METHODS From the TB case registry of a university hospital and the two largest dispensaries in Manisa city, we identified all pulmonary TB cases with a culture-proven definitive diagnosis and antimicrobial susceptibility results for a 7-year period. We collected and analyzed demographic and clinical data and information on treatment outcome for those cases in relationship to anti-TB drug resistance. RESULTS Of 355 M. tuberculosis strains, 71.5% were susceptible to streptomycin, isoniazid, rifampicin and ethambutol. Any drug resistance and multi-drug resistance (MDR ) rates were 21.1% and 7.3% and were higher in males (53% and 9%, respectively) than in females (22% and 1%, respectively). Drug resistance was significantly higher in old cases (acquired drug resistance) vs new cases (primary drug resistance), and was associated with treatment failure (P<0.001). The prevalence of MDR was significantly higher in the old cases (22.4%) than in the new cases (4.4%) (P<0.001). Symptoms, radiographic findings, associated diseases, and sputum smear positivity were unrelated to the development of resistance. The prevalence of any drug resistance and MDR was significantly higher in those with treatment failure than in patients with treatment success. CONCLUSION High resistance rates, particularly for acquired MDR, indicate a need for improvement in the TB control programme in our region.

The Effect of Circumcision Status on Periurethral and Glanular Bacterial Flora

Introduction: Circumcision is a historical operation which is still performed for different purposes. The aim of this study is to investigate the changes in periurethral and glanular sulcus flora due to circumcision to determine the role of circumcision on urinary tract infections (UTIs). Patients and Methods: Fifty patients who were circumcised for social-religious reasons between January 2000 and January 2001 were evaluated in this prospective study. Two swabs were taken from the periurethral and glanular sulcus regions both just before circumcision and 4 weeks after, and the bacteria cultured were recorded. Results: We isolated pathogenic bacteria in the periurethral region of 32 (64%) patients (enterococci in 14 cases; Escherichia coli in 12 cases) before circumcision, and this number decreased to 5 (10%) after circumcision. Similarly, pathogenic bacteria were cultured from the glanular sulcus swabs of 33 (68%) patients (enterococci in 14 cases; E. coli in 10 cases), as well as coagulase-negative staphylococci in another 15 patients before circumcision. Following circumcision, we detected pathogenic bacteria in the glanular cultures of only 4 cases, whereas 40 children had non-pathogenic skin flora. Only 1 of 5 children with history of UTIs (n = 1) and retractable phimosis (n = 4) had periurethral pathogenic bacteria (Proteus spp.) in the post-circumcision period. The differences between pre- and post-circumcision values of the pathogenic bacterial colonizations were statistically significant in both groups sampled (p < 0.05). Conclusion: Non-circumcised patients have similar pathogenic bacterial colonizations in the periurethral and the inner preputial regions, although they have no phimosis. The origin of periurethral flora should be the deeper preputial regions. The flora greatly changed with skin commensals after circumcision. Circumcision might be beneficial from this point of view.

Use of DNA hybridization test for diagnosing bacterial vaginosis in women with symptoms suggestive of infection.

The purpose of this study was to evaluate a DNA hybridization test (Affirm VPIII) as an alternative to Gram stain for the rapid diagnosis of bacterial vaginosis in women with clinical signs of vaginal infection. Vaginal specimens were collected from 321 symptomatic women, and analyzed for bacterial vaginosis by both Gram stain using Nugent criteria and DNA hybridization test. Sensitivity, specificity, positive predictive value, and negative predictive value of the DNA hybridization test were determined using the Gram staining as the standard for diagnosis of bacterial vaginosis. Of the 321 patients, 115 (35.8%) were Gram positive for bacterial vaginosis and 126 (39.2%) were negative. 80 patients (25.0%) demonstrated intermediate Gram staining that was also considered negative. The Affirm system detected G. vaginalis in 107 (93.0%) of 115 vaginal specimens positive for bacterial vaginosis diagnosed by Gram stain. Compared to the Gram stain, DNA hybridization test had a sensitivity of 87.7% and a specificity of 96.0%. Positive and negative predictive values of the DNA hybridization test were 93.0% and 92.7%, respectively. In conclusion, Affirm VPIII hybridization test correlated well with Gram stain and may be used as a rapid diagnostic tool to exclude bacterial vaginosis in women with genital complaints.

Early renal parenchymal histological changes in an experimental model of vesico-ureteral reflux and the role of apoptosis.

Objectives. To observe early renal parenchymal cellular changes in an experimental model of vesico-ureteral reflux (VUR) and to show whether the apoptotic pathway plays a role in these cellular changes. Material and methods. Fourteen New Zealand breed rabbits were used and were divided into two equal groups (control and experimental groups). Urine samples were obtained in a sterile manner and cultured. In the study group, reflux was created in the right kidneys surgically. Renal scintigraphy and voiding cystourethrography (VCUG) were performed in both groups on Day 17. The kidneys were examined in terms of histology, apoptotic activity and caspase activity. Results. No growth was observed in urine cultures in either group. VUR was manifested in only two rabbits in the experimental group on VCUG. On renal scintigraphy, no renal scarring was observed in either of the groups and renal uptake values were in the normal range. There was a greater increase in collagen in the right kidneys in the experimental group than in the control group and apoptotic activity was significantly increased in the study group: 0% in the control group, 10.8%±0.7% in the experimental group (p<0.001). Caspase-6 activity was strongly positive and caspase-8 and -9 activities were moderately positive in the right kidneys of the experimental group. Caspase-6 activity was moderately positive, and caspase-8 and -9 activities were weakly positive in the contralateral kidneys of the experimental group. Caspase activities in the control group were negative (p<0.001). Conclusions. In this experimental model of VUR, apoptotic activity was initiated via the caspase-8 and -9 pathway and collagen tissue increased in the renal parenchyma where reflux occurred. The balance of apoptotic activity may play a key role in the occurrence of reflux nephropathy.

Manisa'da Retrospektif Onikomikoz Çalışması: 2003-2010

Objective: This study performed to detect agents of onychomycosis in Manisa and evaluate tests of mycologic diagnosis. Material and Methods: 3518 persons clinically prediagnosed with onychomycosis who presented to the mycology laboratory within the 7- year period were reviewed retrospectively for the outcomes of direct microscopic examination and culture, and analysed statistically. Results: Growth on cultures were detected in 940 patients. The sensitivity and specificity of direct microscopic examination using culture as a gold standard were found 87.7% and 52.2% respectively. The positive and negative predictive values were calculated 40.1% and 92% respectively and the concordance in both tests was 61.7%. Trichopyhton rubrum was the agent most frequently isolated on culture. Conclusion: It was concluded that only clinical pre-diagnosis and direct microscopic examination alone cannot be sufficient and culture is also required

Prevalence of Anti-HCV Positivity in Hemodialysis Patients

Accessible online at: www.karger.com/journals/nef Dear Sir, Hepatitis C viruses (HCV) play important roles in the genesis of both acute and chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma. The most frequent modes of transmission of this virus are via blood and blood products and via body secretions such as semen, saliva, and sweat. For this reason, hemodialysis (HD) patients undergoing repeated venipunctures and frequent blood transfusions constitute one of the most important risk groups [1]. In this study, 85 HD patients were screened for anti-HCV antibody positivity; the factors that were thought to cause this positivity were also investigated. Anti-HCV positivity was detected by using third-generation enzyme-linked immunosorbent assay kits (Sorin Biomedica). The data thus obtained were processed with the aid of the SPSS version 6 package program using chisquare and Student’s t tests where appropriate. Thirty-three out of total 85 HD patients were women, the remaining 52 were men. Their average age was 49 B 14.4 (range 20– 79) years. Thirty-three out of 85 patients were found to be anti-HCV positive (38.8%). HCV RNA could not be detected because of financial problems. While a statistically significant correlation was found between antiHCV positivity and HD duration (p = 0.001), anti-HCV positivity could not be found to be correlated with factors such as age, number of blood transfusions, number of HD sessions per week, and alanine aminotransferase level elevations (p 1 0.05). The prevalence of anti-HCV positivity when compared with the healthy population and blood donors living in the same geographic region is considerably higher. While the prevalence of anti-HCV positivity in the general population of Turkey is below 1%, this figure shows an enormous increase in the different HD populations, ranging from 14.4 to 79.1% [2]. The prevalence of antiHCV positivity in our HD patients is an intermediate one. A number of studies were conducted in order to elucidate the factors responsible for this high anti-HCV prevalence. While some studies underlined the importance of blood transfusions, others insisted that the number of blood transfusions is not important, the duration of dialysis being the vital determinant. In our study, too, an important correlation was observed with regard to the dialysis duration (p = 0.001) but not for the number of blood transfusions. The probable reason for this was thought to be the widespread use of recombinant human erythropoietin and the screening of blood and blood products for HCV. The correlation with the duration of dialysis tempted us to assume that the HD procedure itself could constitute a risk factor for the transmission of HCV. Sampietro et al. [3] insisted on the possibility of a nosocomial transmission as a result of the observation of a relative homogeneity and a rare variance of HCV strains in their HD facility. In concordance with this hypothesis is the fact that the prevalence of anti-HCV positivity is relatively lower in continuous ambulatory peritoneal dialysis and home HD patients. The most probable route of transmission in HD units is said to be the dialysis procedure itself not performed under strict infection control precautions and asepsis, via materials contaminated with infectious blood [4]. In conclusion, HD patients must be screened for hepatitis B surface antigen and anti-HCV positivity periodically and in the case of positivity, if possible, must be dialyzed in different rooms by different personnel. The patients must be kept informed about the modes of transmission and the outcome of these infections.