Investigation of group A rotavirus G10, G12 genotypes emerging in patients with acute gastroenteritis in a tertiary care hospital

Rotaviruses are the most common cause of viral gastroenteritis with the highest mortality and morbidity rates in children aged 0-5 years. The aim of this study was to determine the frequency of rotavirus infection in patients whose stool samples were sent to microbiology laboratory to investigate the etiology of diarrhea, to investigate the rotavirus genotypes that are common in our region and G10, G12 genotypes that have recently become common in the world. Fecal samples of 476 patients aged between 0-92 years who applied between November 2016 and February 2018 were studied via immunochromatographic rapid test and enzyme-linked immunosorbent assay (ELISA) methods. ELISA positive samples were studied by nested reverse transcriptase chain reaction (RT-PCR) and genotyped by agarose gel electrophoresis. Rotavirus was found positive in 18.3% and 17% of stool samples by immunochromatographic test and ELISA, respectively. All ELISA positive samples were also detected as positive by RT-PCR. 18.5% of female patients and 15.7% of male patients were found to be positive and rotavirus positivity was not statistically significant between genders. The frequency of rotavirus in different age groups was 23.5% (6-12 years), 17.3% (13-24 months) and 16% (25-36 months). It was determined that rotavirus cases were most common in the spring. G1, G2, G3, G4, G9, G10, and G12 were detected in 37%, 7.4%, 16.1%, 6.2%, 9.9%, 2.5%, 26% of the samples, respectively. G12 was the most common genotype after G1. The most common G and P genotype combination was G1P[8] (17.2%). This was followed by G12P[8] (11.11%) and G3P[8] (11.11%). P[8] (53%) was found to be the dominant P genotype. In this study, it was observed that rotavirus, which is the cause of childhood diarrhea, can also be encountered in advanced ages and even new genotypes that infect humans worldwide may also be the causative agents. Therefore, we concluded that it is important to investigate new genotypes such as G10 and G12 in molecular epidemiological studies

Re-emergence of genotype G9 during a five-and-a-half-year period in Turkish children with rotavirus diarrhea.

This study was done to understand the dynamics of rotavirus genotype distribution in Turkish children. Samples were collected from January 2006 through August 2011 from children at a hospital in Ankara. Rotavirus was detected in 28 % (241/889) of the samples. Genotype G9P[8] was predominant (28 %), followed by G1P[8] (16.3 %) and G2P[8] (15.9 %). G9 was absent in the samples from 2006 and 2007 and then re-emerged in 2008 and increased gradually. Phylogenetic analysis showed that Turkish G9 rotaviruses of the present study formed a sublineage with strains from Italy and Ethiopia, possibly indicating spread of a clone in these countrie

Multi-assay investigation of viral etiology in pediatric central nervous system infections

Introduction: In an attempt to identify a wide spectrum of viral infections, cerebrospinal fluid (CSF) specimens were collected from pediatric cases with the preliminary diagnosis of viral encephalitis/meningoencephalitis in two reference hospitals, from October 2011 to December 2015. Methodology: A combination of nucleic acid-based assays, including in house generic polymerase chain reaction (PCR) assays for enteroviruses, flaviviruses and phleboviruses, a commercial real-time PCR assay for herpesviruses and a commercial real time multiplex PCR, enabling detection of frequently-observed viral, bacterial and fungal agents were employed for screening. Results: The microbial agent could be characterized in 10 (10%) of the 100 specimens. Viral etiology could be demonstrated in 7 (70%) specimens, which comprises Human Herpesvirus 6 (4/7), Herpes Simplex virus type1 (2/7) and Enteroviruses (1/7). In 3 specimens (30%), Streptococcus pneumoniae, Listeria monocytogenes and Staphylococcus aureus were detected via the multiplex PCR, which were also isolated in bacteriological media. All specimens with detectable viral nucleic acids, as well as unreactive specimens via nucleic acid testing remained negative in bacteriological cultures. Conclusions: Herpes and enteroviruses were identified as the primary causative agents of central nervous system infections in children. Enterovirus testing must be included in the diagnostic work-up of relevant cases

Türkiye Romatizma Araştırma ve Savaş Derneği ankilozan spondilit ulusal tedavi önerileri

Objectives: To develop Turkish League Against Rheumatism (TLAR) National Recommendations for the management of ankylosing spondylitis (AS). Materials and methods: A scientific committee of 25 experts consisting of six rheumatologists and 19 physical medicine and rehabilitation specialists was formed by TLAR. Recommendations were based on the 2006 ASsessment in Ankylosing Spondylitis International Working Group(ASAS)/European League Against Rheumatism (EULAR) recommendations and a systematic review of associated publications between January 2005 and September 2010. A Delphi process was used to develop the recommendations. Twelve major recommendations were constructed for the management of AS. Voting using a numerical rating scale assessed the strength of each recommendation. Results: The 12 recommendations include patient assessment, patient follow-up along with pharmacological and non-pharmacological methods. Some minor additions and changes have been made to the ASAS/EULAR recommendations. All of the recommendations had sufficient strength. Conclusion: National recommendations for the management of AS were developed based on scientific evidence and consensus expert opinion. These recommendations will be updated regularly in accordance with recent developments.Türkiye Romatizma Araştırma ve Savaş Derneği᾽nin (TRASD) Ankilozan Spondilit (AS) için ulusal tedavi önerilerinin oluşturulmasıdır. Gereç ve yöntemler: TRASD tarafından altı Romatoloji ve 19 Fiziksel Tıp ve Rehabilitasyon uzmanı olmak üzere toplam 25 kişiden oluşan bir bilimsel kurul oluşturuldu. Önerilerde 2006 yılında yayınlanan Ankilozan Spondilit Değerlendirme Uluslararası Çalışma Grubu (ASAS)/Romatizmaya karşı Avrupa Ligi (EULAR) önerileri ve Ocak 2005 - Eylül 2010 arasında yayınlanmış olan ilişkili yayınlar konusundaki sistematik bir inceleme temel alındı. Öneriler oluşturulurken Delphi süreci kullanıldı. Ankilozan spondilit tedavisi ile ilgili 12 ana öneri oluşturuldu. Oylama yapılarak önerilerin güçlülük düzeyi bir nümerik derecelendirme skalası ile belirlendi. Bulgular: On iki öneri hasta değerlendirilmesini, hasta takibini ve farmakolojik ve non-farmakolojik yöntemleri içermektedir. ASAS/EULAR önerilerine bazı ilaveler ve önerilerde bazı küçük değişiklikler yapılmıştır. Tüm öneriler yeterli kuvvete sahipti. Sonuç: Bilimsel kanıtlar ve uzmanların görüş birliği ile AS tedavisine yönelik ulusal öneriler oluşturulmuştur. Bu öneriler, yeni gelişmeler doğrultusunda düzenli olarak güncellenmelidi

The prevalence of norovirus infection in 0-5 years old children with acute gastroenteritis

Noroviruslar, özellikle beş yaş altı çocuklarda hastane yatışı gerektiren ağır gastroenterit olgularına neden olmaktadır. Çalışmamızda Ankara daki iki hastaneye akut gastroenterit tanısı ile başvuran 0-5 yaş arası çocuklarda norovirus sıklığının araştırılması amaçlanmıştır. Dışkı örnekleri, Eylül 2004-Haziran 2011 tarihleri arasında S.B. Ankara Eğitim Araştırma Hastanesi ve Gazi Üniversitesi Tıp Fakültesi Hastanesi ne başvuran akut gastroenteritli 0-5 yaş arasındaki 1000 çocuktan alınmıştır. Dışkı örneklerinde norovirus GI ve GII antijen pozitifliği ELISA yöntemi ile (RIDASCREEN® Norovirus (C1401) 3rd Generation, r-biopharm, Darmstadt, Almanya) araştırılmıştır. Norovirus GI ve GII antijeni toplam 141 (%14.1) örnekte pozitif saptanmıştır. ELISA pozitifliği ile yaş arasında istatistiksel olarak anlamlı fark bulunmamıştır (p>0.05). Norovirus prevalansı ilkbahar, yaz, sonbahar ve kış mevsimlerinde sırasıyla %13.8, %17.7, %14.7 ve %11.2 olarak saptanmış ve virus ile mevsimsel dağılımı arasında istatistiki fark bulunmamıştır (p>0.05). Ancak aylara göre NoV prevalansı incelendiğinde, istatistiksel olarak anlamlı bir fark bulunmuştur (p0.05). Norovirus pozitif hastaların %3.3 ünde parazit tespit edilmiştir. Norovirus ile enfekte dışkı örneklerinin hiçbirinde diyareye neden olan bakteriyel enfeksiyon ajanı bulunamamıştır. Diyareli örneklerde norovirus, %14 gibi yüksek bir oranda tespit edilmiştir. Ülkemizde rotavirus aşısının kullanılmaya başlanmasının bir sonucu olarak norovirus prevalansının artacağını ve 0-5 yaş ishalleri arasında daha sık rastlayacağımız bir etken olacağını düşünmekteyiz. Bu nedenle, norovirus testlerinin rutin laboratuvarlardaki gerekliliğinin artacağını öngörmekteyiz. Sonuç olarak, norovirusun rutin tanısının, norovirus ile enfekte olmuş akut gastroenteritli hastaların gereksiz antibiyotik kullanmasını da önleyerek ülke ekonomisine bir katkı sağlayacağını düşünmekteyiz.Norovirus causes severe gastroenteritis especially in children under five years old requiring hospitalization. We aimed to investigate the prevalence of norovirus in 0-5 years old children with acute gastroenteritis in two large hospitals in Ankara. Stool samples were obtained from 1,000 children of 0-5 years old with acute gastroenteritis attended between October 2004-June 2011 to the Department of Paediatrics, Ministry of Health Ankara Training and Education Hospital and Hospital of Gazi University Faculty of Medicine. Antigens of norovirus GI and GII in stool specimens were detected by ELISA (RIDASCREEN® Norovirus (C1401) 3rd Generation, r-biopharm, Darmstadt, Germany). Norovirus GI and GII antigens were determined in 141 (14.1 %) samples. Statistically significant difference was not found between the diversity of ELISA positivity and age (p>0.05). In spring, summer, autumn and winter the prevalence of norovirus infection was 13.8%, 17.7%, 14.7 % and 11.2%, respectively; seasonal variation was not found in the prevalence of norovirus infection. However analysis of the monthly prevalence, statistically significant difference was found (p0.05) when compared with patients without norovirus infection. Parasites were detected in 3.3% of patients with norovirus infection. No diarrhoeagenic bacteria were found in norovirus infected samples. Norovirus was detected in 14% of samples with diarrhea, which is significantly high in Turkey. We consider that the prevalence of norovirus will increase in 0-5 years old children as a result of increasing use of rotavirus vaccine in Turkey. We consider that the need for norovirus diagnosis in routine laboratory will be increasing. Consequently, routine diagnosis of norovirus might be cost-effective by preventing redundant antibiotic consumption in patients with acute gastroenteritis related to norovirus infection

II. Constitutional History National History Textbooks of Mehmet Fuat Köprülü

Fuat Köprülü'nün eseri olan Milli Tarih ders kitapları 1337 yılında II. Meşrutiyet dönemi müfredat programına uygun olarak, ilkokullarda okutulmak üzere Türkçülük bakış açısıyla, modern tarihçilik metotlarına uygun olarak dört cilt halinde yazılmıştır. Biz öncelikle elimizdeki Milli Tarih ders kitaplarını latinize ettik ve 1329 Maarif Nezareti Mekatib-i İbtidaiye Ders Müfredatı ile ona bağlı olarak hazırlanmış olan 1337 tarihli devre-i mutavassıta ve devre-i aliyye ders kitaplarını konu ve dikkat edilmesi gereken hususlara uygunluğu konusunda karşılaştırıp değerlendirmelerde bulunduk. Bilindiği üzere Fuat Köprülü, yaptığı çalışmalar ve tarihçiliğe getirdiği yeniliklerle çok mahir ve öncü bir ilim insanıdır. Türk tarihçiliğine kazandırdığı kendi usulünü eserlerinde ustaca uygulamıştır. Milli Tarih ders kitapları da buna verilecek en iyi örneklerdendir. Fuat Köprülü, Türk milliyetçiliğine büyük hizmetlerde bulunmuştur. Milli Tarih ders kitapları isminden de anlaşılacağı üzere Türk milliyetçiliği bakış açısı ile yazılmış ve milli kimliğini tanıyan, milli değerlerini bilen Türk milliyetçisi vatandaşlar yetiştirmeye hizmet etmiştir. Biz çalışmamız sayesinde bir dönemin ders kitaplarına ışık tuttuğumuza inanıyoruz ve geçmişimizde okutulmuş olan Tarih ders kitaplarını günümüze taşımanın sevincini yaşıyoruz.The National History textbooks, the work of Fuat Köprülü, In accordance with the curriculum of the constitutional period, it was written in four volumes in accordance with modern historiography methods, from a Turkism point of view, to be read in primary schools. We firstly lectured the National History textbooks of ours and compared them with the subjects of the 1329 Maarif Nezareti Mekatib-i İbtidaiye Course Curriculum and its related 1337 curriculum books and their relevance to the matters to be considered. As is known, Fuat Köprülü is a very sophisticated and pioneering scholar with innovations in his work and history. He practiced masterfully in his own method of work which he gained to Turkish historiography. National History textbooks are the best examples. Fuat Köprülü has been in great service to Turkish nationalism. The National History textbooks, as the name implies, were written with a perspective of Turkish nationalism and served to raise Turkish nationalist citizens who recognize national identity and who know their national values. We believe that we are shedding light on the textbooks of a period of time thanks to our work, and we are experiencing the joy of the day-to-day history textbooks that have been taught in our lives

Investigation of enteroviruses, herpesviruses (1, 2, 6, 7), flaviruses and phleboviruses in patients with atypical meningitides/encephalitis by polymerase chain reaction

Bu çalışmada, atipik menenjit/ensefalitli hastalarda, PZR yöntemi ile herpesvirüsler (tip 1,2,6,7), enterovirüsler (EV), flavivirüsler ve flebovirüslerin araştırılması ve epidemiyolojik veri elde edilmesi amaçlanmıştır. Ankara'da iki farklı hastanenin Çocuk Enfeksiyon Bölümü'ne Ekim 2011-Aralık 2015 tarihleri arasında nörolojik şikayetlerle başvuran, 0-18 yaş arasındaki 100 hastadan beyin omurilik sıvısı (BOS) örnekleri toplanmıştır. Nükleik asit ekstraksiyonu ve cDNA sentezi için ticari kitler kullanılmıştır. HSV1/2 gerçek zamanlı PZR (LightCycler® HSV1/2 QualKit, Roche, Almanya); enterovirüsler, flavi- ve flebovirüsler geleneksel PZR yöntemi ile araştırılmış ve ayrıca çeşitli menenjit etkenlerini saptayabilen gerçek zamanlı multipleks PZR yöntemi (MeningoFinder® 2SMART, Hollanda) kullanılmıştır. Çalışılan 100 örneğin 7'si (%7) viral etkenler (2 HSV1, 4 HHV6, 1 EV) açısından pozitif; diğer etkenler negatif bulunmuştur. HHV6 pozitif saptanan 4 hastanın 2'si 1-6 aylık, 1'i 13-36 aylık ve diğeri ise 4-6 yaş grubundadır. HHV6 pozitif hastaların 3'ü menenjit, 1'i viral ensefalit; HSV1 pozitif hastalar viral ensefalit; EV pozitif hasta ise menenjit ön tanısı almıştır. Merkezi sinir sistemi enfeksiyonlarında çok sayıda virüs etken olabilmektedir ve etkeni saptanabilen olgu sayısı düşüktür. HSV1 viral ensefalit etkenleri arasında başlarda yer alsa da, HHV6 ile nadir karşılaşılmaktadır. Ayrıca HHV6'nın etken olma durumu, latent bir virüs olması nedeniyle her olguda kesin değildir. Yine de bu etkenlerin, MSS enfeksiyonlarında rolü olabileceği için, tanı algoritmalarında değerlendirilmesi gerekmektedir.The aim of this study was to investigate the impact of enteroviruses (EV), herpesviruses (types 1,2,6,7), flaviviruses and phleboviruses in patients with atypical meningitis/encephalitis and to obtain epidemiological data. One hundred cerebrospinal fluid (CSF) specimens were collected from 100 patients (age:0-18) that presented with neurological complaints at Paediatric Infections Clinics of two hospitals in Ankara from October 2011 to December 2015. Commercial kits were used for nucleic acid extraction and cDNA synthesis. A commercial real time PCR assay (LightCycler® HSV1/2 QualKit, Roche, Germany) was employed for HSV1/2 detection; enteroviruses, flaviviruses, phleboviruses were investigated by in house PCR methods. Also a commercial real time multiplex PCR method (MeningoFinder® 2SMART, The Netherlands), which can detect various meningitis agents, was used. A total of 7 specimens (7%) were positive for viral agents (2 HSV1, 4 HHV6, 1 EV) and other agents tested were negative. Two of HHV6 positive patients were 1-6 months old, 1 was 13-36 months old and the other was 4-6 years old. HHV6 was detected in 3 patients with meningitis, in 1 patient with viral encephalitis, HSV1 was detected in 2 patients with viral encephalitis and EV positive patient had meningitis. Many viral agents can cause central nervous infections and detectable number of cases is low. Although HSV1 is the most common agent in viral encephalitis cases, HHV6 is a rare agent. Thus, these viral agents that might have a role in CNS infections, should be considered in diagnostic algorithms

Genomic Structure, Replication and Epidemiology of Norovirus

Norovirus is an RNA virus that causes commonly sporadic gastroenteritis or foodborne and waterborne outbreaks in children and adults. Its genomic organization includes three open reading frames (ORF) ORF1, ORF2 and ORF3 which encode the structural and the nonstructural proteins. ORF1 encodes the non-structural polyprotein, ORF2 encodes VP1 which is the structural major capsid protein and ORF3 encodes structural protein VP2. Noroviruses are subdivided into five genogroups according to the nucleotide sequence similarity. Genogroups infecting humans are GI, GII and GIV. Genogroup GIII infects bovine species, genogroup GV infects murine species. Due to the lack of an in vitro culture system, noroviruses replication is not elucidated, however several studies are carried out using the culture of other genogroups infecting animals. Around the world and in Turkey as well as norovirüs can infect every age groups of people, outbreaks commonly occur in communities containing rather children and elderly population. Genogroup II and especially genotype GII.4 strains are responsible from the bulk of these outbreaks. Genogroup II is followed by GI and GIV is seen less common. GI and GII genogroups were detected in an outbreak that occurred in Turkey in 2008. In a few studies had been carried out about norovirus in our country genogroup GII is detected more often. Especially, studies involved children with acute gastroenteritis are prominent and approximately 10-17% norovirüs positivity is detected. In the laboratory diagnosis of noroviruses reverse transcriptase-polymerase chain reaction is the gold standard to determine the genogroups, however ELISA and immunochromatographic rapid diagnostic tests are in common use for quick results