Yusuf Onlen

High prevalence of Staphylococcus aureus cultivation and superantigen production in patients with psoriasis

The aim of this study was to evaluate the association of Staphylococcal enterotoxins (se) a through e, exfoliative toxin (et) a and b, toxin and toxic shock syndrome toxin (tst) and mecA with psoriasis. We also investigated the distribution of Staphylococcus aureus (S. aureus) in the skin and nares. Fifty consecutive patients with chronic plaque-type psoriasis and 50 sex- and age-matched healthy controls were included in this study. There was a statistical difference in cultivation of S. aureus between lesional (64%) and non-lesional skin (14%) in patients with psoriasis (p = 0.037). S. aureus was cultivated from the nares in 25 (50%) of 50 patients with psoriasis and in 17 (34%) of 50 healthy controls (p > 0.05). In psoriasis patients, 31 (96.8%) out of the 32 strains isolated from the lesional skin and 3 (42.3%) out of the 7 strains isolated from the non-lesional skin were toxigenic (p = 0.01). Isolated strains from the nares were toxigenic in 96% (24/25) for patients with psoriasis and in 41.2% (7/17) for healthy controls, respectively (p = 0.006). Patients with cultivation-positive in lesional skin had a significantly higher PASI score than patients who were cultivation-negative in lesional skin (8.28 +/- 3.97 vs. 5.89 +/- 2.98, p = 0.031). Our results confirm that S. aureus colonization and its toxigenic-strains are associated with psoriasis. According to our findings, non-classical superantigens such as methicillin resistance gene (mecA), see and etb may also be associated with psoriasis.

Prospective Evaluation of 140 Patients With Brucellosis in the Southern Region of Turkey

The aim of this study was to asses the epidemiological, clinical, and laboratory characteristics of brucellosis in Adana region, Turkey. In this prospective study, a total of 140 patients with brucellosis were investigated in terms of spread of infection; seasonal, age, and sex distribution; clinical and laboratory characteristics; depression and anxiety rates; relapse rates; and response to different treatment combinations. One hundred two patients (72.9%) were female, and 38 patients (27.1%) were male; mean age was 45.81 ± 15.62 years, ranging from 2 to 77 years. Twenty-five patients (17.8%) had history of contact with animals, and 31 patients (22.1%) had history of consumption of raw milk and/or its products. The highest seasonal distribution was observed during summer. Malaise (95.0%), sweating (85.7%), and arthralgia (85.0%) were the major presenting symptoms. The most common physical examination findings were fever (52.9%), hepatomegaly (20.7%), and splenomegaly (12.1%). Osteoarticular involvement, orchitis, and iridocyclitis were observed in 64.9%, 38.0% (of male patients), and 0.7% of the patients, respectively. Scintigraphy was performed for 114 patients who have focal joint and bone complaints and findings. Beck Depression Inventory and State-Trait Anxiety Inventory testing were applied to 98 patients with brucellosis, and depression was observed in 37.8% of these patients. The total point of State Anxiety Inventory testing was 46.21 ± 12.87, and the total point of Trait Anxiety Inventory testing was 46.98 ± 10.11. Either the depression rates or points of State Anxiety Inventory testing and Trait Anxiety Inventory testing in patients with brucellosis were statistically higher than in the control group. In 134 patients, initial standard tube agglutination testing titer was 1/160 or more. Brucella melitensis was found positive in 22 patients. Relapse rate was 3.5%. Brucellosis continues to be a health problem in countries where consumption of unpasteurized dairy products and stockbreeding are common.

Efflux pump genes and antimicrobial resistance of Pseudomonas aeruginosa strains isolated from lower respiratory tract infections acquired in an intensive care unit

The aim of this study was to determine the antimicrobial resistance rates and the resistance genes associated with efflux pumps of Pseudomonas aeruginosa strains isolated from the patients who acquired lower respiratory tract infection (LRTI) in intensive care unit (ICU). Fifty P. aeruginosa strains isolated from the lower respiratory tract specimens of the patients who acquired LRTIs in ICU were included in this study. P. aeruginosa strains were isolated from tracheal aspirate (27), bronchoalveolar lavage (14) and sputum (9). The susceptibilities of the isolates were investigated by the disk diffusion method. Multiplex PCR assay was carried out for the detection of 13 antibiotic-resistance genes. Antimicrobial resistance rates of the isolates were found high and the highest resistance rate of the isolates studied was determined against to mezlocillin (50%) followed by norfloxacin (48%), ciprofloxacin (46%), meropenem (40%). Fourty-three isolates (86%) were determined to carry one and more resistance genes. NfxB gene was most often determined in the genes that were investigated. The significant relation between the resistance to cefepime, piperacilline/tazobactam and the mexC gene, that between the resistance to mezlocillin, piperacilline/tazobactam, ceftazidime, cefepime and ampC genes, and that between the resistance to ciprofloxacin, norfloxacin and oprJ, oprN and nfxB genes was identified. Resistance caused by genes for carbapenemases, aminoglycoside-modifying enzymes and other mechanisms were not identified in this study. Understanding the prevalence and mechanism of antimicrobial resistance in P. aeruginosa may help to select empirical therapy for nosocomial LRTIs due to P. aeruginosa in our ICU.

Hydatid disease with atypical localization: 4 cases report.

Hydatid disease caused by Echinococcus often manifests as slowly growing cystic mass and mainly affects the liver or lung and rarely other parts of the body such as brain, heart, bone and muscle. Cyst may be single or multiple, uni-or multiloculated. In this paper 4 hydatic cases, multiple and atypically localized are presented. Of the 4 cases, 2 were known to suffer from hydatid disease, having had a hepatic cyst removal previously. Thus, when faced with a hydatid cyst in any part of the body, it is preferable to examine other parts of the body by radiological imaging methods.

Evaluation of nosocomial infections and risk factors in critically ill patients

Summary Background Nosocomial infections are one of the most serious complications in intensive care unit patients because they lead to high morbidity, mortality, length of stay and cost. The aim of this study was to determine the nosocomial infections, risk factors, pathogens and the antimicrobial susceptibilities of them in intensive care unit of a university hospital. Material/Methods The patients were observed prospectively by the unit-directed active surveillance method based on patient and the laboratory. Results 20.1% of the patients developed a total of 40 intensive care unit-acquired infections for a total of 988 patient-days. The infection sites were the lower respiratory tract, urinary tract, bloodstream, wound, and the central nervous system. The respiratory deficiency, diabetes mellitus, usage of steroid and antibiotics were found as the risk factors. The most common pathogens were Enterobacteriaceae, Staphylococcus aureus, Candida species. No vancomycin resistance was determined in Gram positive bacteria. Imipenem and meropenem were found to be the most effective antibiotics to Enterobacteriaceae. Conclusions Hospital infection rate in intensive care unit is not very high. The diabetes mellitus, length of stay, usage of steroids, urinary catheter and central venous catheter were determined as the risk factors by the final logistic regression analysis. These data, which were collected from a newly established intensive care unit of a university hospital, are important in order to predict the infections and the antimicrobial resistance profile that will develop in the future.

Effect of Thymoquinone on Oxidative Stress in Escherichia coli–Induced Pyelonephritis in Rats

BACKGROUND Recurrent urinary tract infections are important in children and adults with diabetes mellitus and/or incontinence due to risk of pyelonephritis (PYN) and renal damage. There is a positive correlation released free radicals during PYN and renal damage. Experimental studies showed that antioxidant agents improve renal damage when used immediately after bacterial inoculation. OBJECTIVE The aim of the present study was to evaluate whether treatment by thymoquinone (TQ) before or during Escherichia coli inoculation prevents oxidative damage in acute pyelonephritis (PYN) in an ascending obstructive rat model. METHODS In this study, 42 Wistar rats were grouped as follows: control, PYN (24, 48, and 72 hours), and TQ-PYN (24, 48, and 72 hours). E. coli (1 ×10(9) colony forming units) was inoculated into the bladder via urethral catheterization in both the PYN and TQ groups. TQ injections were performed 24 hours before bacteria inoculation and repeated at 24-hour intervals during the indicated time at a dose of 10 mg/kg body weight intraperitoneally in TQ groups. RESULTS Superoxide dismutase activity was statistically lower in the TQ-PYN-48 and -72 groups than the PYN-48 and -72 groups (P < 0.001, P = 0.004, respectively). Catalase activity was significantly higher in PYN-24, -48, and -72 groups than the control group (P < 0.001). In addition, there was a significant difference between the TQ-PYN-24, -48, and -72 groups and PYN groups in terms of glutathione peroxidase activity (P < 0.001, P = 0.026, P = 0.046, respectively). When the TQ-PYN-72 group was compared with the PYN-72 group, malondialdehyde levels were significantly lower in the TQ-PYN-72 group than in the PYN-72 group (P = 0.033). A histologic examination also confirmed the protective effect of TQ. In statistical analysis of histopathologic findings, there were significant differences between the PYN-24 and TQ-PYN-24, PYN-48 and TQ-PYN-48, and PYN-72 and TQ-PYN-72 groups (P = 0.008, P < 0.001, P < 0.001, respectively). CONCLUSIONS The results indicate that TQ administration attenuated the oxidative damage that occurred in PYN and, therefore, could be used as a supportive agent to protect the kidneys from oxidative damage caused by PYN.

Association of insulin resistance, viral load, and adipokine levels with liver histology in patients with chronic hepatitis C: an observational, multicenter study in Turkey.

Objective To evaluate the association of insulin resistance (IR), viral load, and adipokine levels with liver histology in patients with chronic hepatitis C (CHC). Patients and methods In this noninterventional, multicenter study carried out at 11 infectious diseases clinics in Turkey, 103 CHC patients [mean (SD) age: 50.2 (11.0) years, 60 (58.3%) women] planned to be treated by ribavirin and peginterferon-&agr;2a were included. Data on hepatic fibrosis and steatosis, IR, viral load, and hepatitis C virus-RNA genotyping, adipokine, and cytokine levels were collected. Results The mean (SD) Knodell score was 8.1 (3.6); grade I steatosis was evident in 46 (44.7%) patients and IR was identified in 56 (54.9%). There was a significant positive correlation of the homeostasis model assessment-IR index with Knodell fibrosis (r=0.235; P=0.027) and hepatic steatosis (r=0.435; P<0.001). There was a significant positive correlation of leptin levels with Knodell fibrosis (r=0.265; P=0.013) and hepatic activity index (r=0.218; P=0.041). Hepatic steatosis was correlated negatively with adiponectin (r=−0.320; P=0.001) and positively with leptin (r=−0.368; P<0.001) levels. Logistic regression analysis showed that increase in age [odds ratio (OR), 1.056; 95% confidence interval (CI), 1.005–1.110; P=0.030] was the only significant predictor of hepatic fibrosis (OR, 1.056; 95% CI, 1.005–1.110; P=0.030), whereas increase in age (OR, 1.066; 95% CI, 1.006–1.130; P=0.030), the presence of IR (OR, 5.621; 95% CI, 1.547–20.425; P=0.009), and decrease in adiponectin levels (OR, 0.808; 95% CI, 0.682–0.957; P=0.013) were the significant predictors of hepatic steatosis. Conclusion Our findings indicate a significant relationship of hepatic fibrosis and hepatic steatosis with IR and leptin levels, but not with the viral load in Turkish patients with CHC.

Ceftriaxone-Associated Biliary Sludge and Pseudolithiasis in Children

Detection of incidence and the risk factors of ceftriaxone (CTX)-associated pseudolithiasis (PL) in children. One hundred fourteen patients (75 boys and 39 girls) who used CTX for the treatment of various infections were admitted to the study. Pseudolithiasis was diagnosed by ultrasonography (USG). Ultrasonography was performed at the beginning, on the 5th and 10th days, and at the end of the treatment. Weekly USG was performed to patients who had PL until the findings improved. It was investigated whether the age, sex, weight, treatment duration, dosage, and the way of administration have effects on PL development. Ceftriaxone was administered intravenously. Fifty-seven patients received once-daily and 57 patients received twice-daily dosage. Pseudolithiasis was observed in 37 (32.5%) of 114 patients. Age, sex, weight, treatment duration, and dosage had no role in PL development, whereas once- or twice-daily administration was found effective. Once-daily dosage of CTX treatment is recommended because of its lower incidence of PL development. Besides that USG should be performed regarding the risk of PL in children who are treated with CTX, further studies are necessary to determine the risk factors.

Full recovered meningoencephalomyelitis caused by mumps virus

Meningitis is the most common central nervous system complication of mumps virus, whereas encephalitis, cranial nerve palsies, poliradiculoneuritis are less common and myelitis caused by mumps virus is very rare [Nussinovitch et al., Acta Pediatrica (1992) 81, 183]. Lesions in young age as a result of severe acute transverse myelitis [shown on a magnetic resonance imaging (MRI) procedure] often has a viral cause. The case of a young male afflicted by meningoencephalomyelitis because of mumps virus is discussed.

An evaluation of knowledge, attitudes, and behaviors of employees of a university hospital in an H1N1 influenza pandemic.

INTRODUCTION In this study, we aimed to evaluate the knowledge, attitudes, and behaviors concerning the transmission routes of an H1N1 pandemic and the protective measures of health professionals at a university hospital in Turkey. METHODOLOGY A stratified systematic sampling method was used to select the sample size of the study group. A total of 22 professors, 29 researchers, and 26 nurses were included in the study. RESULTS The mean scores of the individuals were 8.4±2.5 (over 20) for knowledge about H1N1 transmission, 27.6±4.0 (over 60) for knowledge about protection against H1N1, 25.8±4.2 (over 45) for correct or appropriate attitudes, and 33.6±8.9 (over 60) for correct behaviors. A negative correlation between total knowledge and behavior was found (p < 0.001, r = -0.543). CONCLUSIONS In epidemics, standard protection measures should be known and applied. Regarding this topic, the web page of the Ministry of Health comes to the forefront as a reliable source of information in addition to scientific explanations.