Aims: Antimicrobial drugs are among the most commonly prescribed drugs in hospitals. Inappropriat... more Aims: Antimicrobial drugs are among the most commonly prescribed drugs in hospitals. Inappropriate use of antibiotics leads to development of antimicrobial resistance. The aims of this study were to determine the rate of antibiotic usage in hospitalized patients, the reasons for antibiotic therapy, irrational uses, and the rates of irrational use in patients hospitalized in Ankara Education and Research Hospital. Materials and Methods: A point prevalence surveillance study was performed on 27 April 2006 at Ankara Education and Research Hospital. Data of all hospitalized patients were collected. Results: On the day of the study, 153 patients (36.2%) out of 422 in-patients were being given one or more antibiotics. In 64 of the patients (41.8%), antibiotic therapy was for treatment, and in 89 (58.2%) it was given as prophylaxis. Usage of antibiotics for either treatment or prophylaxis was appropriate in 69 patients (45.7%), whereas it was inappropriate in the remaining 84 patients (54.3%). Inappropriate use of antibiotics was more common in surgical clinics (62.7%) when compared with medical clinics (24.1%) (P<0.001). Conclusions: Inappropriate usage of antibiotics was detected particularly in surgical clinics in our hospital. A strict surveillance of surgical patients and preparation of a local surgical prophylaxis guideline could help to improve the appropriate use of antibiotic treatment.
Brucellosis is a prevalent disease in Turkey. The object of this study was to assess the findings... more Brucellosis is a prevalent disease in Turkey. The object of this study was to assess the findings in brucellosis cases with and without complications. Materials and methods: A total of 324 patients diagnosed with brucellosis between 1999 and 2005 were reviewed retrospectively. The diagnosis of brucellosis was established serologically and/or by positivite blood culture. Epidemiologic features, clinical symptoms, and laboratory findings of the patients were assessed in both complicated and noncomplicated brucellosis cases by univariate and multivariate analysis. Results: The mean age of patients was 44.0 ± 18.3 years (range 15-83 years). In addition, 56% of the patients were male. Animal husbandry (62.7%) and consumption of raw milk and/or fresh cheese (27.7%) were identified as being the main risk factors for brucellosis. Fever, malaise, sweating, and arthralgia were the most frequent clinical symptoms. The most common physical findings were fever, hepatomegaly, and splenomegaly. Complications were detected in 142 of 324 cases (43.8%). Osteoarticular involvement (25.9%) was the most common complication. Dealing with animal husbandry, living in a rural area, being between 31 years and 50 years of age, and an elevated C-reactive protein (CRP) level were significantly associated with the existence of complications by univariate analysis (P < 0.05). Elevated CRP level remained independently associated with complications by multivariate analysis (P < 0.05). Conclusion: Elevated CRP levels, in accordance with clinical manifestations of the patient, may be a sign of complications, and needs further investigation.
To review the radiological fi ndings of the chests of swine fl u patients whose infections were c... more To review the radiological fi ndings of the chests of swine fl u patients whose infections were confi rmed clinically and/or by laboratory tests. Materials and methods: Th is study was conducted in the radiology and infectious diseases departments of a tertiary care hospital, Ankara Training and Research Hospital, Ankara, Turkey. Th e X-ray and thorax computed tomography (CT) fi ndings of swine fl u patients were evaluated. Results: Included were 53 cases of swine fl u. Th irty-eight of the patients (72%) underwent an initial chest X-ray and 17 (32%) underwent thorax CT examinations. Th e mean age of the patients was 41 years; 23 (43%) patients were male and 30 (57%) were female. In the chest X-rays, the most common pathology was patchy consolidations with a prevalence of 27%. Bilateral symmetrical involvement was observed in 42% of the cases. In the thorax CT, patchy consolidations (47%) and ground glass opacifi cation (24%) were the most commonly observed patterns. Bilateral symmetrical involvement was observed in 41% of the cases. Pleural eff usion was seen in 29% of the cases and mediastinal lymphadenopathy was observed in 41% of the cases. Conclusion: Th e most commonly observed radiological pattern of infl uenza A (H1N1) pulmonary infection is bilateral, symmetrical, patchy consolidations and/or ground glass opacities, predominantly located in middle-inferior zones with central peribronchovascular distribution. Associated mediastinal lymph nodes, pleural eff usion, and tree-in-bud patterns should raise the suspicion of superimposed infection.
Flora Infeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi, 2009
Introduction: Intensive care unit (ICU)-acquired infections increase morbidity, mortality and tre... more Introduction: Intensive care unit (ICU)-acquired infections increase morbidity, mortality and treatment cost. In this study, we aim to evaluate epidemiological features of ICU-acquired infections in patients followed in neurology-neurosurgery ICU. Patients and Methods: The study was conducted in Ankara Training and Research Hospital between 1 July 2005 and 31 December 2006. The patients hospitalized in neurology-neurosurgery ICU more than 48 hours were followed prospectively. The data were collected from patients' cards and forms used by infection control committee for surveillance purposes. Centers for Disease Control and Prevention (CDC) definitions were used for diagnosis of nosocomial infections. Results: In the 18 months period, 1066 patients followed in the neurology-neurosurgery ICU were included in the study. Three hundred and twenty five ICU-acquired infections were detected in 206 (19.3%) patients in 5564 patient days. Infection rate was 30.5 per 100 patients and 58.4 ...
There are many Institutions and Ministries working on social welfare directly or indirectly, aimi... more There are many Institutions and Ministries working on social welfare directly or indirectly, aiming to provide better life conditions for all citizens in Turkey. Although the center of the social policies is the newly founded Ministry of Family, Labor and Social Services, the Ministry needs to work in cooperation with other public institutions and voluntary organizations in order to fulfill the tasks given. An effective way of coordinating the services provided by diversity of institutions is using integration opportunities presented by information technologies. Aim of this paper is to expose the key points and the problems of interagency information sharing and integrations in social service welfare besides the benefits, from the perspective of MoFLSS members.
Mediterranean Journal of Infection Microbes and Antimicrobials, 2021
This study investigated the association and prognostic values of serum C-reactive protein (CRP), ... more This study investigated the association and prognostic values of serum C-reactive protein (CRP), procalcitonin (PCT), soluble urokinase plasminogen activator receptor (suPAR), and neopterin levels in patients with ventilator-associated pneumonia (VAP). Materials and Methods: This prospective observational age-and gender-matched study included 38 adult patients who were diagnosed with VAP and 40 adult patients without VAP. The Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and Clinical Pulmonary Infection Scores were calculated, and the daily positive end-expiratory pressure values of the patients were recorded. The serum levels of CRP, PCT, suPAR, and neopterin were measured once in controls (control group) and on days 0, 3, and 5 and at the end of treatment in the VAP group. Results: The CRP, PCT, neopterin, and suPAR levels were significantly higher in the VAP group than in the control group. APACHE II and SOFA values were higher in the VAP group than in the control group. C-reactive protein value on day 0 of >14.5 ng/ml and PCT level on day five of >1.23 ng/ml were 100% specific for the prediction of mortality in the VAP group. Conclusion: Measuring CRP, PCT, neopterin, and suPAR levels may aid in the early diagnosis of VAP in patients hospitalized in the ICU. High CRP and PCT levels, as well as high APACHE II and SOFA scores, may have prognostic value in the follow-up of patients with VAP.
The hematological findings of 233 patients with brucellosis are presented and the possible pathol... more The hematological findings of 233 patients with brucellosis are presented and the possible pathologies discussed. Anemia was present in 128 patients (55%), leukopenia in 49 (21%) and thrombocytopenia in 59 (26%). Bone marrow aspirates of 18 patients (8%) with pancytopenia were examined. The bone marrow was hypercellular in 15 and normocellular in 3 patients. Granulomatous lesions were detected in 12 cases (67%), and slight to moderate cytophagocytosis of erythrocytes, granulocytes and platelets existed in all patients. Blood cell counts reverted to normal within 2-3 weeks of initiating chemotherapy with recovery from the disease.
Renal tüberküloz akciğer tüberkülozunun lenfohematojen yayılımı sonucunda gelişir. Renal tüberkül... more Renal tüberküloz akciğer tüberkülozunun lenfohematojen yayılımı sonucunda gelişir. Renal tüberkülozun en önemli bulgusu steril pyüridir. Gelişmekte olan ülkelerde Addison hastalığının %10-15'inden tüberküloz hastalığı sorumludur. Tüberküloza bağlı adrenal tutulum bilateral adrenal genişleme, atrofi ve kalsifikasyon şeklinde görülebilir. Mycobacterium tuberculosis komplekse bağlı adrenal bezlerin infeksiyonu hematojen yaylılım sonucu gelişir. Klinik bulguları yıllar sonra belirgin olabilir, asemptomatik infeksiyon oldukça sıktır. Bu yazıda, önceden Addison hastalığı (adrenokortikal yetmezlik) tanısı alan 60 yaşında bir kadın hastada saptanan renal tüberküloz sunuldu .
Kırım Kongo kanamalı ateşi (KKKA) klinik olarak ateş, hemoraji, gastrointestinal semptomlar ve la... more Kırım Kongo kanamalı ateşi (KKKA) klinik olarak ateş, hemoraji, gastrointestinal semptomlar ve laboratuvar olarak da trombositopeni, karaciğer enzimlerinde yükselme, hemostaz bozukluğu ile karakterize bir hastalıktır. Bu semptom ve laboratuvar bulgularının ayırıcı tanısında KKKA ilk akla gelen hastalıklardan biri olmakta ve bazen hastalığın bulaşıcı özelliği ve mortalitesinin yüksek seyretmesinden dolayı diğer olası durumları geri planda bırakmaktadır. Diğer ön tanılar atlanılarak KKKA tanı ve ön tanısına gösterilen bu artmış hassasiyet gereksiz izolasyon önlemlerine sebep olabilir. Bu yazıda, KKKA ön tanısı ile takip edilen ancak siroz ve üriner sistem infeksiyonu kesin tanısı konulan bir olguyu sunduk.
Hantavirüs ülkemizde bazı bölgelerde görülebilen zoonotik bir enfeksiyondur. Hantavirüs, Bunyavir... more Hantavirüs ülkemizde bazı bölgelerde görülebilen zoonotik bir enfeksiyondur. Hantavirüs, Bunyaviridae ailesinde yer alan segmenter yapıda RNA virüsüdür ve Hantavirüsün coğrafi olarak farklı dağılım gösteren çok sayıda alt tipi bulunmaktadır.
Tularemi ülkemizde endemik olarak görülen zoonotik enfeksiyonlar içerisinde yer almaktadır. Tüm d... more Tularemi ülkemizde endemik olarak görülen zoonotik enfeksiyonlar içerisinde yer almaktadır. Tüm dünyada en sık görülen tularemi formu ülseroglandüler form olmasına rağmen Türkiye'de en sık görülen formu orofaringeal form tularemidir. Orofaringeal form tularemi kontamine su veya gıdaların ağız yoluyla alınmasıyla bulaşır, su kaynaklı salgınlara neden olabilir. Bu yazıda beş gün önce kırsal alana gitme öyküsü olan, ancak kaynak suyu içme, vahşi hayvan teması, kemirgen tarafından ısırılma öyküsü olmayan bir orofaringeal tularemi olgusu sunuldu. Hastanın tanısı mikroaglütinasyon testinde 1/320 titrede pozitiflik saptanması ile konuldu. Daha önceden beta-laktam antibiyotik tedavisi alan ancak servikal bölgedeki lenfadenopatisi gerilemeyen olgunun moksifloksasin tedavisi sırasında lenfadenopatisi fistülize olarak spontan drene oldu, ondört gün tedavi sonrası lezyonu geriledi.
Background/aim: The increasing prevalence and global spread of difficult-to-treat carbapenem-resi... more Background/aim: The increasing prevalence and global spread of difficult-to-treat carbapenem-resistant Acinetobacter baumannii has become a serious problem. The aim of this study is to investigate the resistance patterns and tigecycline sensitivity of carbapenemresistant A. baumannii strains. Materials and methods: Acinetobacter strains that were carbapenem-resistant and collected mainly from intensive care units were included into this study. The antibiotic sensitivity/resistance of the strains to other antibiotics and tigecycline were noted. Presence of blaOXA-23, blaOXA-48, blaOXA-58, and NDM-1 was investigated by PCR. Results: In total, 44 carbapenem-resistant A. baumannii strains were detected. In addition, 57% (25/44) showed resistance to netilmicin and 2% (1/43) to tigecycline. All of the strains were susceptible to colistin. blaOXA-58 was found only in one (2%) strain while blaOXA-23 was found in 14 (32%) strains. All strains were negative for blaOXA-48 and NDM-1. Conclusion: blaOXA-23 was the main resistance pattern in carbapenem-resistant A. baumannii strains. blaOXA-58 was present only in one strain and no blaOXA-48 was found. Tigecycline susceptibility is high and it can be a treatment option for a possible combination therapy of carbapenem-resistant A. baumannii, especially for those for whom colistin is contraindicated because of its toxicity.
The immunopathogenesis of chronic hepatitis B (CHB) has not been clarified yet. Toll-like recepto... more The immunopathogenesis of chronic hepatitis B (CHB) has not been clarified yet. Toll-like receptors (TLR) are a receptor family that initiates immunity with exogenous–endogenous ligands and plays a role in the pathogenesis of infections. In this study, we aimed to investigate the frequency of TLR 3 1377C/T (rs3775290) polymorphism and its role in patients with CHB. We included 50 healthy individuals as control group and 73 active and 43 inactive hepatitis B patients. All DNA samples were isolated from blood samples. For the detection of TLR 3 1377C/T single-nucleotide polymorphism, restriction fragment length polymorphism was used. A statistically significant difference was determined in Hepatitis B virus (HBV) DNA levels of CHB patients with the CC, CT, and TT genotypes (p = 0.013). The highest levels of HBV DNA were detected in individuals with TT genotypes. Additionally, the frequency of CC genotype was higher in the active CHB patients compared with that of the inactive CHB pati...
Objectives. Rabies is a fatal acute viral zoonotic disease causing encephalomyelitis in humans an... more Objectives. Rabies is a fatal acute viral zoonotic disease causing encephalomyelitis in humans and many other mammalian animals. Prophylaxis is vital since there is no treatment for rabies. This study was a comparison of antibody levels in patients who were vaccinated following different vaccinationprotocols. Methods. Eightyfive patients who were included in the rabies vaccination program who presented to the vaccination center of our clinic with the complaint of suspicious contact with rabies were included the study. In 61 (71.8%) patients a 2-1-1 vaccine program (Zagreb regimen) was implemented, and in 24 (28.2%) patients, a 5-dose rabies vaccine and rabies immune globulin (RIG) in a dose of 40 IU/kg (Essen regimen) was applied. Results. In patients on the 2-1-1 vaccine program, antibody levels on the 21 st day were greater than 0.5 IU/ml in 49 (80.3%) patients. Antibody levels on the 28 th day in the group that received the 5-dose rabies vaccine and rabies immune globulin administration was greater than 0.5 IU/ml in 17 (70.8%) patients. The difference between the two groups of vaccination programs was not statistically significant (p=0.344). Seroconversion rates for approximately one month after the last dose of vaccination in the serum samples were 90% and 75% in the groups with 2-1-1 vaccination, and RIG and 5-dose vaccinations, respectively. The differences were not statistically significant (p=0.071). Conclusions. Identification of similar seroconversion rates suggests that the 2-1-1 vaccination program may be a good alternative option to the standard vaccination program when RIG is unavailable.
Turkiye Klinikleri Journal of Medical Sciences, 2010
Pe ri to ni tis is a com mon cli ni cal prob lem that oc curs in pa ti ents with end stage re nal... more Pe ri to ni tis is a com mon cli ni cal prob lem that oc curs in pa ti ents with end stage re nal di se a se and is tre a ted by pe ri to ne al di aly sis. We eva lu a ted the po ten ti al risk fac tors in con tinu o us am bu la tory pe ri to ne al di aly sis (CAPD) re la ted pe ri to ni tis in our hos pi tal. M Ma at te er ri ia al l a an nd d M Me et t h ho od ds s: : The study was a ca se-con trol study. CAPD re la ted pe ri to ni tis pa ti ents tre a ted in In fec ti o us Di se a ses and Cli ni cal Mic ro bi o logy De part ment bet we en Ja nu ary 2005 and July 2006 for med the study gro up. The con trol gro up com pri sed CADP pa ti ents wit ho ut pe ri to ni tis. De mog rap hic cha rac te ris tics of the study and the con trol gro up we re re cor ded. Po ten ti al risk fac tors for pe ri to ni tis we re al so re cor ded. Comp le te blo od co unt and al bu min le vels we re tes ted in both gro ups. Age, gen der, hand was hing habits, edu ca ti o nal back gro und, re a son of re nal di se a se, re a son of CAPD who per son per for med CAPD, he mog lo bin and al bu min le vels we re in ves ti ga ted as po ten ti al risk fac tors by uni va ri a te and mul ti vari a te analy ses. R Re e s su ul lt ts s: : The re we re 47 pa ti ents in the study gro up and 50 pa ti ents in the con trol group. The me an age of the pa ti ents was 49.6 ± 16.41 ye ars and 44.82 ± 14.41 ye ars in the study and con trol gro ups, res pec ti vely (p> 0.05). Ane mi a and low al bu min le vel we re fo und as risk fac tors in univa ri a te analy sis. Low al bu min le vel (p< 0.001) was a sta tis ti cally sig ni fi cant and in de pen dent risk factor for CAPD-re la ted pe ri to ni tis in the mul ti va ri a te analy sis. It was fo und to in cre a se the re la ti ve risk of pe ri to ni tis 11 fold. C Co on nc c l lu u s si i o on n: : In se ve ral pre vi o us stu di es, low al bu min le vel was re por ted as a risk fac tor in CAPD pa ti ents with pe ri to ni tis. Hi po al bu mi ne mi a can be con si de red an iden tif ying pa rame ter and the CAPD pa ti ents with hi po al bu mi ne mi a can be fol lo wed up clo sely for pe ri to ni tis. K Ke ey y W Wo or rd ds s: : Pe ri to ne al di aly sis, con ti nu o us am bu la tory; pe ri to ni tis; risk Ö ÖZ ZE ET T A Am ma aç ç: : Pe ri to nit son dö nem böb rek yet mez li ği ta nı sı alan ve pe ri to ne al di ya liz te da vi si uygu la nan has ta lar da sık gö rü len bir kli nik prob lem dir. Biz bu ça lış ma da has ta ne miz de sü rek li ayaktan pe ri ton di ya li zi (SAPD) ile iliş ki li pe ri to nit için risk fak tör le ri ni araş tır dık. G Ge er re eç ç v ve e Y Yö ön n t te em ml le er r: : Ça lış ma va ka kon trol ça lış ma sı ola rak ger çek leş ti ril di. Ocak 2005-Tem muz 2006 ta rih le ri ara sın da İnfek si yon Has ta lık la rı ve Kli nik Mik ro bi yo lo ji Kli ni ğin de SAPD ile iliş ki li pe ri to nit ta nı sı ile iz lenen has ta lar ça lış ma gru bu ola rak alın dı. Ay nı dö nem de SAPD uy gu la nan an cak pe ri to ni ti ol ma yan has ta lar kon trol gru bu ola rak alın dı. Ça lış ma ve kon trol gru bu nun de mog ra fik özel lik le ri kay de dildi (p> 0.05). Pe ri to nit için po tan si yel risk fak tör le ri ka yıt al tı na alın dı. Her iki grup ta tam kan sayı mı ve al bu min dü ze yi için tet kik ya pıl dı. Yaş, cin si yet, el yı ka ma alış kan lı ğı, eği tim du ru mu, re nal yet mez lik se be bi, SAPD ya pıl ma se be bi, SAPD ya pan ki şi, he mog lo bin ve al bu min dü ze yi tek değiş ken li ve çok de ğiş ken li ana liz yön tem le ri kul la nı la rak po tan si yel risk fak tör le ri ola rak in ce lendi. B Bu ul l g gu u l la ar r: : Ça lış ma gru bu na 47, kon trol gru bu na 50 has ta alın dı. Ça lış ma ve kon trol gru bun da ki has ta la rın yaş or ta la ma la rı sı ra sı ile 49.6 ± 16.41 ve 44.82 ± 14.41 ola rak bu lun du (p> 0.05). Tek değiş ken li ana liz de ane mi ve al bü min dü ze yi nin dü şük ol ma sı pe ri to nit ris ki ni ar tı ran fak tör ler olarak sap tan dı. Al bü min dü ze yi nin dü şük ol ma sı çok de ğiş ken li ana liz de de an lam lı bu lun du (p< 0.001) ve al bü min dü ze yi dü şük olan has ta lar da SAPD iliş ki li pe ri to nit ris ki nin 11 kat da ha faz la ol du ğu be lir len di. S So o n nu uç ç: : Da ha ön ce ya pıl mış bir kaç ça lış ma da dü şük al bü min dü ze yi SAPD has tala rın da pe ri to nit için risk fak tö rü ola rak bil di ril miş tir. SAPD has ta la rın da hi po al bü mi ne mi pe ri tonit oluş ma sı açı sın dan be lir le yi ci bir pa ra met re ola rak de ğer len di ri le bi lir ve al bü min dü ze yi dü şük olan SAPD has ta la rı pe ri to nit yö nün den ya kın dan iz le ne bi lir. A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Pe ri ton di ya li zi, sü rek li ayak tan pe ri ton di ya li zi; pe ri to nit; risk T Tu ur rk ki iy ye e K Kl li in ni ik kl le er ri i J J M Me ed d S Sc ci i 2 20 01 10 0; ;3 30 0((1 1)): :1 14 44 4-9 9
Sıtma başta Sahra altı Afrika olmak üzere dünyada önemli bir sağlık problemidir. Türkiye'de en ço... more Sıtma başta Sahra altı Afrika olmak üzere dünyada önemli bir sağlık problemidir. Türkiye'de en çok görülen sıtma türü Plasmodium vivax olup başlıca Güneydoğu Anadolu ve Çukurova bölgesinde endemiktir. Globalleşme ve turizme bağlı olarak seyahat ilişkili Plasmodium falciparum olgularında artış gözlenmektedir. Optimal antimalaryal tedaviye rağmen P. falciparum yüksek mortalite ile seyredebilmektedir. Burada mesleki nedenle Afrika'ya giden ve üveit, hiperglisemi ve purpurik döküntünün eşlik ettiği sıtma ile dönen bir Türk radyolog sunuldu.
Sıtma dünyada en sık ölüme yol açan enfeksiyonlar arasında beşinci sırada yer almaktadır. Plasmod... more Sıtma dünyada en sık ölüme yol açan enfeksiyonlar arasında beşinci sırada yer almaktadır. Plasmodium türlerinin insan hücrelerini infekte ederek sıtmaya neden olan P. falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi olmak üzere beş türü bulunmaktadır. Dünya Sağlık Örgütü verilerine göre Uganda, malarya açısından en yüksek insidansa sahip ve her yıl 1000 insandan 478'inin sıtmaya yakalandığı bir ülkedir. Bu makalede Uganda'ya yaptığı iş seyahati sonrası P. falciparum'un etken olduğu bir malarya olgusu değerlendirildi. Hastanın başlıca klinik bulguları üşüme-titreme ve yüksek ateşti. Periferik kandan hazırlanan ince yayma ve kalın damla kan preparatlarının incelenmesi sonucunda P. falciparum parazitemisi saptandı. Bilinci, oryantasyon ve kooperasyonu bozulan hastada serebral sıtma düşünüldü. Tedavi sonrası belirgin bir şekilde klinik iyileşme gözlenen hastanın yapılan kontrol kan yaymasında parazite rastlanmadı.
Aims: Antimicrobial drugs are among the most commonly prescribed drugs in hospitals. Inappropriat... more Aims: Antimicrobial drugs are among the most commonly prescribed drugs in hospitals. Inappropriate use of antibiotics leads to development of antimicrobial resistance. The aims of this study were to determine the rate of antibiotic usage in hospitalized patients, the reasons for antibiotic therapy, irrational uses, and the rates of irrational use in patients hospitalized in Ankara Education and Research Hospital. Materials and Methods: A point prevalence surveillance study was performed on 27 April 2006 at Ankara Education and Research Hospital. Data of all hospitalized patients were collected. Results: On the day of the study, 153 patients (36.2%) out of 422 in-patients were being given one or more antibiotics. In 64 of the patients (41.8%), antibiotic therapy was for treatment, and in 89 (58.2%) it was given as prophylaxis. Usage of antibiotics for either treatment or prophylaxis was appropriate in 69 patients (45.7%), whereas it was inappropriate in the remaining 84 patients (54.3%). Inappropriate use of antibiotics was more common in surgical clinics (62.7%) when compared with medical clinics (24.1%) (P<0.001). Conclusions: Inappropriate usage of antibiotics was detected particularly in surgical clinics in our hospital. A strict surveillance of surgical patients and preparation of a local surgical prophylaxis guideline could help to improve the appropriate use of antibiotic treatment.
Brucellosis is a prevalent disease in Turkey. The object of this study was to assess the findings... more Brucellosis is a prevalent disease in Turkey. The object of this study was to assess the findings in brucellosis cases with and without complications. Materials and methods: A total of 324 patients diagnosed with brucellosis between 1999 and 2005 were reviewed retrospectively. The diagnosis of brucellosis was established serologically and/or by positivite blood culture. Epidemiologic features, clinical symptoms, and laboratory findings of the patients were assessed in both complicated and noncomplicated brucellosis cases by univariate and multivariate analysis. Results: The mean age of patients was 44.0 ± 18.3 years (range 15-83 years). In addition, 56% of the patients were male. Animal husbandry (62.7%) and consumption of raw milk and/or fresh cheese (27.7%) were identified as being the main risk factors for brucellosis. Fever, malaise, sweating, and arthralgia were the most frequent clinical symptoms. The most common physical findings were fever, hepatomegaly, and splenomegaly. Complications were detected in 142 of 324 cases (43.8%). Osteoarticular involvement (25.9%) was the most common complication. Dealing with animal husbandry, living in a rural area, being between 31 years and 50 years of age, and an elevated C-reactive protein (CRP) level were significantly associated with the existence of complications by univariate analysis (P < 0.05). Elevated CRP level remained independently associated with complications by multivariate analysis (P < 0.05). Conclusion: Elevated CRP levels, in accordance with clinical manifestations of the patient, may be a sign of complications, and needs further investigation.
To review the radiological fi ndings of the chests of swine fl u patients whose infections were c... more To review the radiological fi ndings of the chests of swine fl u patients whose infections were confi rmed clinically and/or by laboratory tests. Materials and methods: Th is study was conducted in the radiology and infectious diseases departments of a tertiary care hospital, Ankara Training and Research Hospital, Ankara, Turkey. Th e X-ray and thorax computed tomography (CT) fi ndings of swine fl u patients were evaluated. Results: Included were 53 cases of swine fl u. Th irty-eight of the patients (72%) underwent an initial chest X-ray and 17 (32%) underwent thorax CT examinations. Th e mean age of the patients was 41 years; 23 (43%) patients were male and 30 (57%) were female. In the chest X-rays, the most common pathology was patchy consolidations with a prevalence of 27%. Bilateral symmetrical involvement was observed in 42% of the cases. In the thorax CT, patchy consolidations (47%) and ground glass opacifi cation (24%) were the most commonly observed patterns. Bilateral symmetrical involvement was observed in 41% of the cases. Pleural eff usion was seen in 29% of the cases and mediastinal lymphadenopathy was observed in 41% of the cases. Conclusion: Th e most commonly observed radiological pattern of infl uenza A (H1N1) pulmonary infection is bilateral, symmetrical, patchy consolidations and/or ground glass opacities, predominantly located in middle-inferior zones with central peribronchovascular distribution. Associated mediastinal lymph nodes, pleural eff usion, and tree-in-bud patterns should raise the suspicion of superimposed infection.
Flora Infeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi, 2009
Introduction: Intensive care unit (ICU)-acquired infections increase morbidity, mortality and tre... more Introduction: Intensive care unit (ICU)-acquired infections increase morbidity, mortality and treatment cost. In this study, we aim to evaluate epidemiological features of ICU-acquired infections in patients followed in neurology-neurosurgery ICU. Patients and Methods: The study was conducted in Ankara Training and Research Hospital between 1 July 2005 and 31 December 2006. The patients hospitalized in neurology-neurosurgery ICU more than 48 hours were followed prospectively. The data were collected from patients' cards and forms used by infection control committee for surveillance purposes. Centers for Disease Control and Prevention (CDC) definitions were used for diagnosis of nosocomial infections. Results: In the 18 months period, 1066 patients followed in the neurology-neurosurgery ICU were included in the study. Three hundred and twenty five ICU-acquired infections were detected in 206 (19.3%) patients in 5564 patient days. Infection rate was 30.5 per 100 patients and 58.4 ...
There are many Institutions and Ministries working on social welfare directly or indirectly, aimi... more There are many Institutions and Ministries working on social welfare directly or indirectly, aiming to provide better life conditions for all citizens in Turkey. Although the center of the social policies is the newly founded Ministry of Family, Labor and Social Services, the Ministry needs to work in cooperation with other public institutions and voluntary organizations in order to fulfill the tasks given. An effective way of coordinating the services provided by diversity of institutions is using integration opportunities presented by information technologies. Aim of this paper is to expose the key points and the problems of interagency information sharing and integrations in social service welfare besides the benefits, from the perspective of MoFLSS members.
Mediterranean Journal of Infection Microbes and Antimicrobials, 2021
This study investigated the association and prognostic values of serum C-reactive protein (CRP), ... more This study investigated the association and prognostic values of serum C-reactive protein (CRP), procalcitonin (PCT), soluble urokinase plasminogen activator receptor (suPAR), and neopterin levels in patients with ventilator-associated pneumonia (VAP). Materials and Methods: This prospective observational age-and gender-matched study included 38 adult patients who were diagnosed with VAP and 40 adult patients without VAP. The Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and Clinical Pulmonary Infection Scores were calculated, and the daily positive end-expiratory pressure values of the patients were recorded. The serum levels of CRP, PCT, suPAR, and neopterin were measured once in controls (control group) and on days 0, 3, and 5 and at the end of treatment in the VAP group. Results: The CRP, PCT, neopterin, and suPAR levels were significantly higher in the VAP group than in the control group. APACHE II and SOFA values were higher in the VAP group than in the control group. C-reactive protein value on day 0 of >14.5 ng/ml and PCT level on day five of >1.23 ng/ml were 100% specific for the prediction of mortality in the VAP group. Conclusion: Measuring CRP, PCT, neopterin, and suPAR levels may aid in the early diagnosis of VAP in patients hospitalized in the ICU. High CRP and PCT levels, as well as high APACHE II and SOFA scores, may have prognostic value in the follow-up of patients with VAP.
The hematological findings of 233 patients with brucellosis are presented and the possible pathol... more The hematological findings of 233 patients with brucellosis are presented and the possible pathologies discussed. Anemia was present in 128 patients (55%), leukopenia in 49 (21%) and thrombocytopenia in 59 (26%). Bone marrow aspirates of 18 patients (8%) with pancytopenia were examined. The bone marrow was hypercellular in 15 and normocellular in 3 patients. Granulomatous lesions were detected in 12 cases (67%), and slight to moderate cytophagocytosis of erythrocytes, granulocytes and platelets existed in all patients. Blood cell counts reverted to normal within 2-3 weeks of initiating chemotherapy with recovery from the disease.
Renal tüberküloz akciğer tüberkülozunun lenfohematojen yayılımı sonucunda gelişir. Renal tüberkül... more Renal tüberküloz akciğer tüberkülozunun lenfohematojen yayılımı sonucunda gelişir. Renal tüberkülozun en önemli bulgusu steril pyüridir. Gelişmekte olan ülkelerde Addison hastalığının %10-15'inden tüberküloz hastalığı sorumludur. Tüberküloza bağlı adrenal tutulum bilateral adrenal genişleme, atrofi ve kalsifikasyon şeklinde görülebilir. Mycobacterium tuberculosis komplekse bağlı adrenal bezlerin infeksiyonu hematojen yaylılım sonucu gelişir. Klinik bulguları yıllar sonra belirgin olabilir, asemptomatik infeksiyon oldukça sıktır. Bu yazıda, önceden Addison hastalığı (adrenokortikal yetmezlik) tanısı alan 60 yaşında bir kadın hastada saptanan renal tüberküloz sunuldu .
Kırım Kongo kanamalı ateşi (KKKA) klinik olarak ateş, hemoraji, gastrointestinal semptomlar ve la... more Kırım Kongo kanamalı ateşi (KKKA) klinik olarak ateş, hemoraji, gastrointestinal semptomlar ve laboratuvar olarak da trombositopeni, karaciğer enzimlerinde yükselme, hemostaz bozukluğu ile karakterize bir hastalıktır. Bu semptom ve laboratuvar bulgularının ayırıcı tanısında KKKA ilk akla gelen hastalıklardan biri olmakta ve bazen hastalığın bulaşıcı özelliği ve mortalitesinin yüksek seyretmesinden dolayı diğer olası durumları geri planda bırakmaktadır. Diğer ön tanılar atlanılarak KKKA tanı ve ön tanısına gösterilen bu artmış hassasiyet gereksiz izolasyon önlemlerine sebep olabilir. Bu yazıda, KKKA ön tanısı ile takip edilen ancak siroz ve üriner sistem infeksiyonu kesin tanısı konulan bir olguyu sunduk.
Hantavirüs ülkemizde bazı bölgelerde görülebilen zoonotik bir enfeksiyondur. Hantavirüs, Bunyavir... more Hantavirüs ülkemizde bazı bölgelerde görülebilen zoonotik bir enfeksiyondur. Hantavirüs, Bunyaviridae ailesinde yer alan segmenter yapıda RNA virüsüdür ve Hantavirüsün coğrafi olarak farklı dağılım gösteren çok sayıda alt tipi bulunmaktadır.
Tularemi ülkemizde endemik olarak görülen zoonotik enfeksiyonlar içerisinde yer almaktadır. Tüm d... more Tularemi ülkemizde endemik olarak görülen zoonotik enfeksiyonlar içerisinde yer almaktadır. Tüm dünyada en sık görülen tularemi formu ülseroglandüler form olmasına rağmen Türkiye'de en sık görülen formu orofaringeal form tularemidir. Orofaringeal form tularemi kontamine su veya gıdaların ağız yoluyla alınmasıyla bulaşır, su kaynaklı salgınlara neden olabilir. Bu yazıda beş gün önce kırsal alana gitme öyküsü olan, ancak kaynak suyu içme, vahşi hayvan teması, kemirgen tarafından ısırılma öyküsü olmayan bir orofaringeal tularemi olgusu sunuldu. Hastanın tanısı mikroaglütinasyon testinde 1/320 titrede pozitiflik saptanması ile konuldu. Daha önceden beta-laktam antibiyotik tedavisi alan ancak servikal bölgedeki lenfadenopatisi gerilemeyen olgunun moksifloksasin tedavisi sırasında lenfadenopatisi fistülize olarak spontan drene oldu, ondört gün tedavi sonrası lezyonu geriledi.
Background/aim: The increasing prevalence and global spread of difficult-to-treat carbapenem-resi... more Background/aim: The increasing prevalence and global spread of difficult-to-treat carbapenem-resistant Acinetobacter baumannii has become a serious problem. The aim of this study is to investigate the resistance patterns and tigecycline sensitivity of carbapenemresistant A. baumannii strains. Materials and methods: Acinetobacter strains that were carbapenem-resistant and collected mainly from intensive care units were included into this study. The antibiotic sensitivity/resistance of the strains to other antibiotics and tigecycline were noted. Presence of blaOXA-23, blaOXA-48, blaOXA-58, and NDM-1 was investigated by PCR. Results: In total, 44 carbapenem-resistant A. baumannii strains were detected. In addition, 57% (25/44) showed resistance to netilmicin and 2% (1/43) to tigecycline. All of the strains were susceptible to colistin. blaOXA-58 was found only in one (2%) strain while blaOXA-23 was found in 14 (32%) strains. All strains were negative for blaOXA-48 and NDM-1. Conclusion: blaOXA-23 was the main resistance pattern in carbapenem-resistant A. baumannii strains. blaOXA-58 was present only in one strain and no blaOXA-48 was found. Tigecycline susceptibility is high and it can be a treatment option for a possible combination therapy of carbapenem-resistant A. baumannii, especially for those for whom colistin is contraindicated because of its toxicity.
The immunopathogenesis of chronic hepatitis B (CHB) has not been clarified yet. Toll-like recepto... more The immunopathogenesis of chronic hepatitis B (CHB) has not been clarified yet. Toll-like receptors (TLR) are a receptor family that initiates immunity with exogenous–endogenous ligands and plays a role in the pathogenesis of infections. In this study, we aimed to investigate the frequency of TLR 3 1377C/T (rs3775290) polymorphism and its role in patients with CHB. We included 50 healthy individuals as control group and 73 active and 43 inactive hepatitis B patients. All DNA samples were isolated from blood samples. For the detection of TLR 3 1377C/T single-nucleotide polymorphism, restriction fragment length polymorphism was used. A statistically significant difference was determined in Hepatitis B virus (HBV) DNA levels of CHB patients with the CC, CT, and TT genotypes (p = 0.013). The highest levels of HBV DNA were detected in individuals with TT genotypes. Additionally, the frequency of CC genotype was higher in the active CHB patients compared with that of the inactive CHB pati...
Objectives. Rabies is a fatal acute viral zoonotic disease causing encephalomyelitis in humans an... more Objectives. Rabies is a fatal acute viral zoonotic disease causing encephalomyelitis in humans and many other mammalian animals. Prophylaxis is vital since there is no treatment for rabies. This study was a comparison of antibody levels in patients who were vaccinated following different vaccinationprotocols. Methods. Eightyfive patients who were included in the rabies vaccination program who presented to the vaccination center of our clinic with the complaint of suspicious contact with rabies were included the study. In 61 (71.8%) patients a 2-1-1 vaccine program (Zagreb regimen) was implemented, and in 24 (28.2%) patients, a 5-dose rabies vaccine and rabies immune globulin (RIG) in a dose of 40 IU/kg (Essen regimen) was applied. Results. In patients on the 2-1-1 vaccine program, antibody levels on the 21 st day were greater than 0.5 IU/ml in 49 (80.3%) patients. Antibody levels on the 28 th day in the group that received the 5-dose rabies vaccine and rabies immune globulin administration was greater than 0.5 IU/ml in 17 (70.8%) patients. The difference between the two groups of vaccination programs was not statistically significant (p=0.344). Seroconversion rates for approximately one month after the last dose of vaccination in the serum samples were 90% and 75% in the groups with 2-1-1 vaccination, and RIG and 5-dose vaccinations, respectively. The differences were not statistically significant (p=0.071). Conclusions. Identification of similar seroconversion rates suggests that the 2-1-1 vaccination program may be a good alternative option to the standard vaccination program when RIG is unavailable.
Turkiye Klinikleri Journal of Medical Sciences, 2010
Pe ri to ni tis is a com mon cli ni cal prob lem that oc curs in pa ti ents with end stage re nal... more Pe ri to ni tis is a com mon cli ni cal prob lem that oc curs in pa ti ents with end stage re nal di se a se and is tre a ted by pe ri to ne al di aly sis. We eva lu a ted the po ten ti al risk fac tors in con tinu o us am bu la tory pe ri to ne al di aly sis (CAPD) re la ted pe ri to ni tis in our hos pi tal. M Ma at te er ri ia al l a an nd d M Me et t h ho od ds s: : The study was a ca se-con trol study. CAPD re la ted pe ri to ni tis pa ti ents tre a ted in In fec ti o us Di se a ses and Cli ni cal Mic ro bi o logy De part ment bet we en Ja nu ary 2005 and July 2006 for med the study gro up. The con trol gro up com pri sed CADP pa ti ents wit ho ut pe ri to ni tis. De mog rap hic cha rac te ris tics of the study and the con trol gro up we re re cor ded. Po ten ti al risk fac tors for pe ri to ni tis we re al so re cor ded. Comp le te blo od co unt and al bu min le vels we re tes ted in both gro ups. Age, gen der, hand was hing habits, edu ca ti o nal back gro und, re a son of re nal di se a se, re a son of CAPD who per son per for med CAPD, he mog lo bin and al bu min le vels we re in ves ti ga ted as po ten ti al risk fac tors by uni va ri a te and mul ti vari a te analy ses. R Re e s su ul lt ts s: : The re we re 47 pa ti ents in the study gro up and 50 pa ti ents in the con trol group. The me an age of the pa ti ents was 49.6 ± 16.41 ye ars and 44.82 ± 14.41 ye ars in the study and con trol gro ups, res pec ti vely (p> 0.05). Ane mi a and low al bu min le vel we re fo und as risk fac tors in univa ri a te analy sis. Low al bu min le vel (p< 0.001) was a sta tis ti cally sig ni fi cant and in de pen dent risk factor for CAPD-re la ted pe ri to ni tis in the mul ti va ri a te analy sis. It was fo und to in cre a se the re la ti ve risk of pe ri to ni tis 11 fold. C Co on nc c l lu u s si i o on n: : In se ve ral pre vi o us stu di es, low al bu min le vel was re por ted as a risk fac tor in CAPD pa ti ents with pe ri to ni tis. Hi po al bu mi ne mi a can be con si de red an iden tif ying pa rame ter and the CAPD pa ti ents with hi po al bu mi ne mi a can be fol lo wed up clo sely for pe ri to ni tis. K Ke ey y W Wo or rd ds s: : Pe ri to ne al di aly sis, con ti nu o us am bu la tory; pe ri to ni tis; risk Ö ÖZ ZE ET T A Am ma aç ç: : Pe ri to nit son dö nem böb rek yet mez li ği ta nı sı alan ve pe ri to ne al di ya liz te da vi si uygu la nan has ta lar da sık gö rü len bir kli nik prob lem dir. Biz bu ça lış ma da has ta ne miz de sü rek li ayaktan pe ri ton di ya li zi (SAPD) ile iliş ki li pe ri to nit için risk fak tör le ri ni araş tır dık. G Ge er re eç ç v ve e Y Yö ön n t te em ml le er r: : Ça lış ma va ka kon trol ça lış ma sı ola rak ger çek leş ti ril di. Ocak 2005-Tem muz 2006 ta rih le ri ara sın da İnfek si yon Has ta lık la rı ve Kli nik Mik ro bi yo lo ji Kli ni ğin de SAPD ile iliş ki li pe ri to nit ta nı sı ile iz lenen has ta lar ça lış ma gru bu ola rak alın dı. Ay nı dö nem de SAPD uy gu la nan an cak pe ri to ni ti ol ma yan has ta lar kon trol gru bu ola rak alın dı. Ça lış ma ve kon trol gru bu nun de mog ra fik özel lik le ri kay de dildi (p> 0.05). Pe ri to nit için po tan si yel risk fak tör le ri ka yıt al tı na alın dı. Her iki grup ta tam kan sayı mı ve al bu min dü ze yi için tet kik ya pıl dı. Yaş, cin si yet, el yı ka ma alış kan lı ğı, eği tim du ru mu, re nal yet mez lik se be bi, SAPD ya pıl ma se be bi, SAPD ya pan ki şi, he mog lo bin ve al bu min dü ze yi tek değiş ken li ve çok de ğiş ken li ana liz yön tem le ri kul la nı la rak po tan si yel risk fak tör le ri ola rak in ce lendi. B Bu ul l g gu u l la ar r: : Ça lış ma gru bu na 47, kon trol gru bu na 50 has ta alın dı. Ça lış ma ve kon trol gru bun da ki has ta la rın yaş or ta la ma la rı sı ra sı ile 49.6 ± 16.41 ve 44.82 ± 14.41 ola rak bu lun du (p> 0.05). Tek değiş ken li ana liz de ane mi ve al bü min dü ze yi nin dü şük ol ma sı pe ri to nit ris ki ni ar tı ran fak tör ler olarak sap tan dı. Al bü min dü ze yi nin dü şük ol ma sı çok de ğiş ken li ana liz de de an lam lı bu lun du (p< 0.001) ve al bü min dü ze yi dü şük olan has ta lar da SAPD iliş ki li pe ri to nit ris ki nin 11 kat da ha faz la ol du ğu be lir len di. S So o n nu uç ç: : Da ha ön ce ya pıl mış bir kaç ça lış ma da dü şük al bü min dü ze yi SAPD has tala rın da pe ri to nit için risk fak tö rü ola rak bil di ril miş tir. SAPD has ta la rın da hi po al bü mi ne mi pe ri tonit oluş ma sı açı sın dan be lir le yi ci bir pa ra met re ola rak de ğer len di ri le bi lir ve al bü min dü ze yi dü şük olan SAPD has ta la rı pe ri to nit yö nün den ya kın dan iz le ne bi lir. A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Pe ri ton di ya li zi, sü rek li ayak tan pe ri ton di ya li zi; pe ri to nit; risk T Tu ur rk ki iy ye e K Kl li in ni ik kl le er ri i J J M Me ed d S Sc ci i 2 20 01 10 0; ;3 30 0((1 1)): :1 14 44 4-9 9
Sıtma başta Sahra altı Afrika olmak üzere dünyada önemli bir sağlık problemidir. Türkiye'de en ço... more Sıtma başta Sahra altı Afrika olmak üzere dünyada önemli bir sağlık problemidir. Türkiye'de en çok görülen sıtma türü Plasmodium vivax olup başlıca Güneydoğu Anadolu ve Çukurova bölgesinde endemiktir. Globalleşme ve turizme bağlı olarak seyahat ilişkili Plasmodium falciparum olgularında artış gözlenmektedir. Optimal antimalaryal tedaviye rağmen P. falciparum yüksek mortalite ile seyredebilmektedir. Burada mesleki nedenle Afrika'ya giden ve üveit, hiperglisemi ve purpurik döküntünün eşlik ettiği sıtma ile dönen bir Türk radyolog sunuldu.
Sıtma dünyada en sık ölüme yol açan enfeksiyonlar arasında beşinci sırada yer almaktadır. Plasmod... more Sıtma dünyada en sık ölüme yol açan enfeksiyonlar arasında beşinci sırada yer almaktadır. Plasmodium türlerinin insan hücrelerini infekte ederek sıtmaya neden olan P. falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi olmak üzere beş türü bulunmaktadır. Dünya Sağlık Örgütü verilerine göre Uganda, malarya açısından en yüksek insidansa sahip ve her yıl 1000 insandan 478'inin sıtmaya yakalandığı bir ülkedir. Bu makalede Uganda'ya yaptığı iş seyahati sonrası P. falciparum'un etken olduğu bir malarya olgusu değerlendirildi. Hastanın başlıca klinik bulguları üşüme-titreme ve yüksek ateşti. Periferik kandan hazırlanan ince yayma ve kalın damla kan preparatlarının incelenmesi sonucunda P. falciparum parazitemisi saptandı. Bilinci, oryantasyon ve kooperasyonu bozulan hastada serebral sıtma düşünüldü. Tedavi sonrası belirgin bir şekilde klinik iyileşme gözlenen hastanın yapılan kontrol kan yaymasında parazite rastlanmadı.
Uploads
Papers by Ali DEMİRÖZ