Tuncer Özekinci

Antibacterial Activity of 2% Chlorhexidine Gluconate and 5.25% Sodium Hypochlorite in Infected Root Canal: In Vivo Study

In this study, the antibacterial activity of the different antibacterial solutions using as root canal irrigant was compared in the teeth with pulpal necrosis and with periapical pathosis. Thirty root canals of incisors and premolars of 20 patients were used. Before and after the root canal preparation, two canal samples were obtained by a harvesting method using a sterile paper point in the first appointment. During the biomechanical preparation, both irrigant solutions were used for each tooth which were randomly divided into two groups. Last samples were also obtained before the root filling procedure. Samples obtained from the root canals were subjected to microbiologic processing, including anaerobic incubation on trypticase soy agar for 5 to 7 days. After counting of CFU on the plates, we concluded that both chlorhexidine gluconate and sodium hypochlorite were significantly effective to reduce the microorganisms in the teeth with necrotic pulp, periapical pathologies, or both, and could be used successfully as an irrigant solution.

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.

Lamivudine for the prevention of hepatitis B virus reactivation in hepatitis-B surface antigen (HBSAG) seropositive cancer patients undergoing cytotoxic chemotherapy

Hepatitis B virus (HBV) is one of the major causes of chronic liver disease worldwide. Cancer patients who are chronic carriers of HBV have a higher hepatic complication rate while receiving cytotoxic chemotherapy (CT) and this has mainly been attributed to HBV reactivation. In this study, cancer patients who have solid and hematological malignancies with chronic HBV infection received the antiviral agent lamivudine prior and during CT compared with historical control group who did not receive lamivudine. The objectives were to assess the efficacy of lamivudine in reducing the incidence of HBV reactivation, and diminishing morbidity and mortality during CT. Two groups were compared in this study. The prophylactic lamivudin group consisted of 37 patients who received prophylactic lamivudine treatment. The historical controls consisted of 50 consecutive patients who underwent CT without prophylactic lamivudine. They were followed up during and for 8 weeks after CT. The outcomes were compared for both groups. Of our control group (n= 50), 21 patients (42%) were established hepatitis. Twelve (24%) of them were evaluated as severe hepatitis. In the prophylactic lamivudine group severe hepatitis were observed only in 1 patient (2.7%) of 37 patients (p < 0.006). Comparison of the mean ALT values revealed significantly higher mean alanine aminotransferase (ALT) values in the control group than the prophylactic lamivudine group; 154:64 (p < 0.32). Our study suggests that prophylactic lamivudine significantly decreases the incidence of HBV reactivation and overall morbidity in cancer patients during and after immunosuppressive therapy. Further studies are needed to determine the most appropriate nucleoside or nucleotide analogue for antiviral prophylaxis during CT and the optimal duration of administration after completion of CT.

Comparison of Interferon-Gamma Release Assay Versus Tuberculin Skin Test for Latent Tuberculosis Screening in Hemodialysis Patients

ABSTRACT Early diagnosis and proper treatment of latent tuberculosis infection (LTBI) in patients with end stage renal diseases (ESRD) is critical to reduce increased reactivation risk of LTBI. However, this condition is known to decrease responsiveness to the tuberculin skin test (TST). A new diagnostic test [QuantiFERON-TB Gold in-tube (QFT-GIT)] has been developed using mycobacterium tuberculosis specific antigens for the identification of LTBI. We aimed to evaluate the two test methods among hemodialysis patients for their diagnostic usefulness. We performed a cross-sectional comparison study on 275 ESRD recruits tested for LTBI using the TST and QTF-GIT. Valid TST and QFT-GIT results were available for 259 and 246 patients, respectively. Overall, 46.7% of 246 patients were tested positive for the QTF-GIT and 35.5% of 259 were found to be TST positive. The QTF-GIT but not TST results were correlated with the history of tuberculosis; conversely, QTF-GIT and TST results were not associated with contact to tuberculosis. Moreover, QTF-GIT test generated indeterminate results in 10.4% of subjects. The concurrence between the two test methods was poor (67.8%, k = 0.34). Inconsistent results, most of which were tested as TST negative/QTF-GIT positive were observed in 32.2% patients. The present results suggest that the QTF-GIT is more sensitive than TST in the detection of LTBI among renal dialysis patients. Nevertheless, large longitudinal studies are required for more accurate results.

Investigation of Microorganisms in Infected Dental Root Canals

ABSTRACT Objective: The purpose of this study is to investigate the type of microorganisms isolated from necrotic pulp tissues and from failed endodontic treatments in infected root canals. Methods: This study is based on an experiment conducted on 90 patients between November, 2002 and November, 2003 using a sampling. One hundred single root canals were microbiologically sampled from these patients by using sterile paper points. Among 100 canals sampled, 61 had primary infection and 39 had a history of secondary infection. Microorganisms were isolated and identified by using established advanced microbiologic techniques for anaerobic species. Results: A total of 197 cultivable isolates were recovered, the microbial findings in both types of canals, such as the number of species isolated, the 68.0% of Gram-positives and 27.9% gram-negatives, the 52.8% of facultative and 43.1 % strict anaerobic microorganisms 4.1% fungi and so on. Ten canals presented no microbial growth. Conclusions: The prevalence of bacteria and fungi found in 100 root canals is the prevalence of the microbial genera in primary and secondary endodontic infection. Peptostreptococcus spp was the most predominantly isolated microbial genera, followed by Streptococcus spp (14.2%), Porphyromonas spp (12.2%), E. faecalis (9.6%), Staphylococcus salivarius (8.6%), Prevotella spp (8.1%), Lactobacillus spp (7.1%), Actinomyces spp (7.1%), Candida albicans (4.1%), Fusobacterium spp (3.6%) Veillonella spp (2.5%), Eubacterium spp (2.5%), Bacillus spp (2.0%), and Escherichial coli (1.6%) were other types of bacteria recovered.

THE VALUE OF CMV AND RUBELLA IGG AVIDITY TESTS IN THE DIAGNOSIS OF CYTOMEGALOVIRUS (CMV) AND RUBELLA INFECTIONS IN PREGNANT WOMEN

ABSTRACT IgG avidity tests, which came on the scene recently with regard to most efficient use of time and early onset to the therapy, are considered in this study, and compared with Enzyme immunoassay(EIA). Serums of a total of 879 women in the first trimester of their gestations who referred to Dicle University, Faculty Hospital, Department of Gynaecology and Obstetrics in between the dates of 09 April 2002–09 May 2003 were evaluated with the classical method ELISA (Cobas Core II, Roche, USA), in terms of Rubella and HCMV IgG and IgM. Avidity tests were performed with (IgG avidity EIA. Well; Radim, Italy) commercial kits. 4 samples among the 8 that were positive for HCMV IgM and IgG were found to have low AIs (AI<35%), 2 samples to have intermediate AIs (AI 35–45%), and the other 2 to have high AIs (AI >45%). One of the 156 IgG positive serum samples had an intermediate AI (AI 35–45%), and 155 had high AIs. In the Rubella IgG avidity tests, 9 of the 13 IgM and IgG positive samples had low AIs (AI <50%), 1 had an intermediate AI (AI 50–60%), and 3 had high AIs (AI >60%). Only one of the 151 IgG positive samples had a low AI, whereas the remaining 150 had high AIs. If only avidity test is taken into consideration, gray region or low avidity test results especially negative for IgM with ELISA and showing a clear chronical pattern will be falsely interpreted in accord with an infection, if the results for these serums are new. IgG avidity test is useful in serums revealing suspected results in IgM ELISA test. Follow-up of patients with intermediate and low AIs and repeating tests in certain intervals, and examination of the amniotic fluid by PCR will be appropriate. As only IgG avidity test taken into consideration will cause unnecessary abortus and anxiety, use of single confirmation tests in such cases is not right. IgG avidity tests should only be used as confirmation tests in pregnant women.

Beyin cerrahisi yogun bakım ünitesi enfeksiyon etkenleri ve antibiyotik duyarlılıkları

Osteoporoz ve romatizmal hastaliklar gozun tum tabakalarini etkileyen bulgular ile karsimiza cikmaktadir. Eriskin ve Juvenil Romatoid Artrit, Sjogren Sendromu, Ankilozan Spondilit siklikla goz bulgulari ile beraberlik gosteren romatizmal hastaliklardir. Goz bulgulari siklikla sistemik hastaligin semptomlarina onculuk etmektedirler. Bu hastaliklarda en sik olarak uveit, iridosiklit, vitritis, keratit, sklerit, anterior iskemik optik noropati ve retinal vaskulit gibi okuler inflamasyon bulgulari gorulmektedir. Okuler inflamasyon hastaligin kendisinden kaynaklanabilecegi gibi bu hastaliklarin tedavisinde kullanilan ilaclara bagli olarak da karsimiza cikabilmektedir. Bu calismada osteoporoz ve en sik goz bulgusu izlenen romatizmal hastaliklarin okuler bulgulari literatur esliginde arastirildi.Mirizzi syndrome is an unusual complication of gallstone disease and occurs in approximately 1% of these patients. Some cases can not be identified preoperatively, despite modern imaging techniques. Today, treatment of Mirizzi syndrome is surgical. If Mirizzi syndrome is present, the risk of bile duct injury increases, particularly during laparoscopic surgery. Therefore, preoperative or intraoperative diagnosis is important. Here, we presented a 29 year-old woman with obstructive jaundice who diagnosed as cholelithiasis and choledocholithiasis. Preoperative endoscopic retrograde cholangiography relieved the common bile duct stone but cound not diagnosed the Mirizzi syndrome preoperatively. During laparoscopy, the diagnosis of Mirizzi syndrome was suspected early and the procedure was converted to open cholecystectomy and T-tube to common bile duct. There was no bile duct injury and postoperative course was uneventful.Lenfomalarda akciger tutulumu primer ve sekonder olmak uzere iki sekilde gorulmektedir. Lenfoma hucreleri, akcigerin degisik bolgelerini, yogun bicimde infiltre edebilmektedir. 57 yasinda erkek hastanin 6 aydir devam eden gogus agrisi, boyunda sislik, halsizlik, oksuruk ve balgam yakinmalari mevcuttu. Hasta, hepatosplenomegali, son bir ayda kilo kaybi, ates ve boynunun sol yaninda buyuyen agrili sislik nedeniyle klinigimize yatirildi. Fizik muayenede, boyunda agrili lenfadenopati saptandi. Solunum sistemi muayenesinde sagda solunum seslerinin siddetinde azalma, yer yer krepitan raller mevcuttu. PA akciger grafisinde sag parahiler bolgede non homojen yaygin infiltrasyon saptandi. Toraks tomografisinde ise sag akcigerde santralde hava bronkogrami izlenen konsolide alan, periferde noduler ve retikulonoduler, sol akciger alt lop posterobazal segmentte ve sol akciger ust lop apikoposterior segmentte birkac adet noduler lezyon, paratrakeal lenf bezi ve lokalize alveoler diffuz infiltrasyonlar saptandi. Servikal lenf nodunu histolojik incelenmesinde yuksek grade buyuk hucreli Non-Hodgkin lenfoma tanisi kondu. Hasta 6 siklus CEOP kuru aldi. Kemoterapi tamamlandiktan sonra yapilan incelemelerde daha once varolan akciger lezyonlarinin tumunun kayboldugu goruldu. Bu vaka sistemik non-Hodgkin lenfoma seyri sirasinda akcigeri tutulumu gelisen ve tek basina kemoterapi ile uzun sureli remisyona giren bir nadir olgudur.In this study, we are presenting the results of cytogenetic analysis and molecular cytogenetic analysis (FISH) of the couple and their family, who were referred to our genetic diagnostic laboratory and had bad obstetrics history. We found a normal karyotype (46,XY) in male, and A de novo complex chromosome rearrangement found in a phenotypically normal female was characterized by G-bands, FISH with probes. Her chromosome structure was 46,XX,der(18;22)(18pterrp11.1::22p11.1rqter) del(18)(:p11.1rqter). To determine the parental origin of translocation, we examined the individuals of the family, and we found that the translocation was de novo. We concluded that this carrier family might be due to the unbalanced distribution of translocation, during gamete formation and prenatal diagnosis recommended for their future pregnancies.

Microbiological Evaluation of Dental Air-Turbine Handpieces after Different Disinfection Procedures

ABSTRACT The mouth is permanent source of microorganisms that can potentially transfer and cause infection in other people. The dental profession has traditional standards for cross-infection control, but the recent expression of real concerns by both the public and the profession over the transmissibility of infectious diseases in the dental office has demanded formalized teaching of cross-infection control in the dental curriculum. Disinfection is defined as the removal or killing of all pathogens, but not spores. Ideally, all vegetative microbes should be killed, but a reduction in the number of pathogens to a level that is unlikely to cause infection is acceptable. Methods of disinfection include heating (Pasteurization or boiling in water), ultrasonics, or chemical solutions. This study evaluated the microbiological effectiveness of different disinfectants used for dental aerator disinfection after clinical use. To evaluate the microbiological effectiveness of four different disinfectant sprays (Virkon®, Mikrozid® AF Liquid, Lysetol® AF, Maxispray®), 25 non-used aerators were selected. The in vitro antimicrobial activity against bacteria indicated that Virkon® and Lysetol AF® were more effective than the others. In addition, there was no bacterial growth after autoclave sterilization. Mikrozid AF® was not active against S. hominis; Maxispray® did not inactivate S. aureus and S. intermedius. S. aureus is probably a more frequent isolate from the oral cavity. A small proportion (5%) of the S. aureus isolates were methicillin-resistant Staphylococcus aureus (MRSA). There were insufficient data to determine whether the S. aureus isolates were colonizing or infecting the oral cavity. However, the role of S. aureus in several diseases of the oral mucosa merits further investigation.

Panton-Valentine leukocidin in community and hospital-acquired Staphylococcus aureus strains

Staphylococcus aureus causes serious hospital-acquired (HA) and community-acquired (CA) infections. Skin and soft-tissue infections especially are sometimes caused by strains harbouring Panton-Valentine leukocidin (PVL). PVL belongs to a family of bi-component leukocidal toxins produced by staphylococci. It is a pore-forming toxin encoded by lukF-PV and lukS-PV. A total of 70 S. aureus strains: 38 (54%) methicillin-resistant (MRSA) and 32 (46%) methicillin-susceptible (MSSA), were isolated from patients admitted to Dicle University Hospital (Turkey). Identification of S. aureus and antibiotics-susceptibility testing were performed with PHOENIX 100. PVL genes and mecA genes were detected by polymerase chain reaction. Of the 70 studied strains, 36 ones (51%) were community acquired and 34 ones (49%) were hospital acquired . A total of 38 (54%) strains were positive for mecA (mecA+), of which 32 ones (84%) were HA. Of the mecA− strains, 30 (94%) were CA. Of the 70 studied strains, 12 (17%) strains were PVL+: 8 (22%) of the 36 CA strains and 4 (12%) of the 34 HA strains. Of the 12 PVL+ strains, 4 strains were mecA+. The PVL positivity rate was 25% in MSSA, whereas 10.5% in MRSA. Of the overall PVL+ strains, seven strains were obtained from wounds; four ones from skin abscess; and one from blood culture. Taken together, the obtained results showed a substantial level of PVL genes in the studied region. Although PVL is known as a common virulence factor of CA MRSA, HA MRSA isolates in our study showed a considerable rate of PVL positivity.

Investigation of correlation between Toxoplasma gondii IgG positivity and Hs-CRP

Toxoplasmosis is a disease caused by the intracellular protozoan parasite, Toxoplasma gondii (T. gondii). Toxoplasmosis is 1 of the more common parasitic zoonoses worldwide and it has been estimated that up to one-third of the world human population has been exposed to the parasite [1]. Birgisdottir et al. [2] have investigated Hs-CRP positivity in IgG positive sera. The investigators have reported a weak yet statistically significant correlation between Toxoplasma gondii IgG positivity and Hs-CRP positivity. The aim of this study was to determine whether Hs-CRP positivity was significant in individuals infected with T.gondii, as has been reported by Birgisdottir et al. For this purpose, sera with suspected T.gondii positivity sent to Dicle University Faculty of Medicine Central Laboratory were studied in COBAS CORE II, Roche equipment by the Macroelisa method; and those sera found positive for Toxoplasma IgG (0 6 IU/ml) were investigated for Hs-CRP (0.00 0.744 mg/dl) in Beckman Coulter equipment by the nephelometric method. In a 2-month period, 56 serum samples were detected as Toxoplasma gondii IgG positive and Hs-CRP levels in only 15 of these (%26,78) were found to be above the normal level. No significant correlation was detected (p 0.05) between the Toxoplasma IgG values and Hs-CRP levels in the statistical evaluation performed by the paired samples correlation test. Furthermore, sera were grouped according to the cut-off levels detected in Toxoplasma gondii IgG positivity, Group I defining B50 IU/ml, Group II defining 51 200 IU/ml, and Group III defining 201 IU/ml. When 31 serum samples in Group I, 17 serum samples in Group II, and 8 serum samples in Group III were compared by the ANOVA statistical method for Hs-CRP levels in mg/dl, no statistical significance was observed (p 0.05). In conclusion, we did not detect the weak yet statistically significant correlation previously detected by Birgisdottir et al. between T.gondii IgG positivity and Hs-CRP.