Evaluation of English 'Pediatric Basic Life Support' and 'Pediatric Cardiopulmonary Resuscitation' Videos in YouTube

Pediatric Basic Life Support is the initiation of cardiopulmonary resuscitation (CPR) until advanced life support is available. The American Heart Association (AHA) 2015 guideline recommend the people to perform CPR. YouTube is a video sharing site where internet users can learn about many topics, including health. Everyone can upload videos easily. Therefore, there is no control mechanism for the accuracy and up-to-dateness of the videos. Thus, there is a risk of spreading incorrect or inaccurate information. After the pediatric CPR and BLS guidelines were updated in 2015, we aimed to evaluate the quality and content of the videos published in English on YouTube. The YouTube website was searched in 15th June, 2020, using the terms “pediatric cardiac massage” and “pediatric BLS”. A total of 200 videos were evaluated.by two anesthetists in terms of instructional, content, up-to dateness and resource. 33 videos included in the study were evaluated according to Azer SA criteria. 14 videos were found to be useful and 19 of them as misleading. The average total viewing times and daily viewing numbers of useful videos were found to be higher. When evaluated in terms of content, similar results were obtained in both groups. This shows that viewers value videos more being educational than content. For this reason, we think that while editing videos, Azer criteria should be taken into account as an objective criterion and their content should be prepared according to current guidelines

Characteristics of food allergy in children: National multicenter study

Conference: Congress of the European-Academy-of-Allergy-and-Clinical-Immunology (EAACI) Location: Lisbon, PORTUGAL Date: JUN 01-05, 2019Background : Food allergies impose a significant burden on the life of the child and the family. In this study, to determine the demographic characteristics of food allergies, we investigated the characteristics of patients with food allergies in different regions of Pediatric Allergy- Immunology departments in Turkey. Method : Turkey ' s National Study of Allergy and Clinical Immunology Society has conducted a Study Group on Food Allergies. 25 centers participated in this multicenter, cross- sectional and descriptive study.European Academy of Allergy and Clinical Immunolog

t030 is the most common spa type among methicillin-resistant staphylococcus aureus strains isolated from Turkish hospitals

Staphylococcus aureus en sık görülen hastane enfeksiyon etkenleri arasındadır. Farklı koşullara adapte olabilme yeteneği sayesinde S.aureus, başarılı klonları ile epidemilere, hatta bir kıtadan diğerine yayılarak pandemilere yol açabilmektedir. Bu çalışmanın amacı, Türkiye’de farklı coğrafi bölgelerdeki 12 merkezden 2006-2008 yılları arasında izole edilen 397 metisiline dirençli S.aureus (MRSA) suşunun spa tiplendirmesinin yapılması ve PFGE ve MLST yöntemleri ile klonalitelerinin araştırılmasıdır. Ayrıca 12 merkezin dördünden 2011 yılında izole edilmiş olan 91 MRSA izolatının da spa tipleri belirlenmiştir. PFGE analizleri izolatlar arasında yaygın bir pulsotipin olduğunu göstermiştir. İzolatlardan 363 (%91.4)’ü pulsotip A, 18 (%4.5)’i pulsotip B ve 11 (%2.8)’i pulsotip C olarak bulunmuştur. SCCmec tipleme sonuçlarına göre 363 (%91.4) suş SCCmec tip III, 30 (%7.6) suş SCCmec tip IV olarak tanımlanmıştır. Pulsotipleri temsil eden suşların dizi analizi sonuçlarına göre en yaygın MLST tipinin ST239 (%85.1) olduğu, bunu her ikisi de SCCmec tip IV olarak bulunan ST737 (%4) ve ST97 (%2.8)’nin takip ettiği görülmüştür. İki SCCmec tip IV suşunun MLST tipi ise ST80 olarak bulunmuştur. Test edilen 397 suştan 338 (%85.1)’inin spa tipi t030 olarak saptanmış; bunu t005 (%2.5) ve t632 (%2) takip etmiştir. 2011 yılında izole edilen 91 suşun ise 64 (%70.3)’ü t030, 4 (%4.4)’ü t005, 2 (%2.2)’si t015 ve 2 (%2.2)’si t1094 olarak bulunmuştur. Spa tipi t030’un merkezlerde 2006-2008 suşları arasındaki prevalansı %59-100 arasındadır. İzole edilen suşlar arasında t030’un en yüksek düzeyi Ankara’da (%100) en düşük düzeyi ise Trabzon’da (%59) görülmüştür. İstanbul’da 2006-2008 örnekleri arasında %94.5 olan t030 oranının, 2011 suşları arasında %55’e düştüğü izlenmiştir. Benzer şekilde Konya ve Trabzon örneklerinde de t030 görülme oranının azaldığı belirlenirken, Aydın ilinde yıllar içinde t030 oranında artış olduğu saptanmıştır. Çalışmamızda, altı yıllık süreçte Türkiye’de en sık görülen MRSA klonunun t030 spa tipine sahip olduğu belirlenmiştir. PCR ile test edilen PVL toksin geni ise 5 (%3) suşta pozitif bulunmuş; bunlardan üçünün SCCmecIII-ST239 ve ikisinin SCCmec tip IV-ST80 olduğu görülmüştür. Bu çalışma şimdiye kadar Türkiye’de yapılmış olan en geniş epidemiyolojik çalışma olup, hastane kökenli Türkiye klonu olan TR09 (ST239-SCCmecIII-t030) ve toplum kökenli Türkiye klonu olan TR10’nun (ST737-SCCmecIV-t005) Türkiye’de yaygın olarak bulunduğunu göstermiştir.Staphylococcus aureus is one of the most frequent agents causing hospital infections. S.aureus has a great ability to adapt itself to variety of conditions and successful clones can be epidemic and even pandemic by its ability spread from one continent to another. The aims of this study were to detect spa types of 397 methicillin-resistant S.aureus (MRSA) strains isolated from 12 centers in different geographical regions of Turkey from 2006 to 2008, and to investigate their clonality by PFGE and MLST typing. Additionally, 91 MRSA from four of those 12 centers isolated during 2011 were also studied for their spa types. PFGE profiles indicated the presence of a major pulsotype, namely pulsotype A with a rate of 91.4% (363/397), followed by pulsotype B (n= 18, 4.5%) and pulsotype C (n= 11, 2.8%). Among isolates tested 363 (91.4%) were SCCmec type III, 30 (7.6%) were SCCmec type IV. Sequence analysis of represen tative isolates revealed that ST239 (85.1%) was the most common MLST type followed by two MLST types ST737 (4%), and ST97 (2.8%), both SCCmec type IV. Two isolates were ST80 with SCCmec type IV. Of 397 isolates, 338 (85.1%) were t030, followed by t005 (2.5%) and t632 (2%). Among MRSA isolated during 2011, 64 (70.3%) of 91 were t030, 4 (4.4%) were t005, 2 (2.2%) were t015, and 2 (2.2%) were t1094. Among centers the t030 prevalence of 2006-2008 isolates ranged from 59-100%. The highest t030 prevalence was found in Ankara (100%) and lowest in Trabzon (59%) provinces which are located at central and northestern Anatolia, respectively. In Istanbul province, the prevalence of t030 was 94.5% among 2006-2008 isolates which decreased to 55.5% among 2011 isolates. Also a decrease in t030 rates was observed among samples from Konya and Trabzon but not from Aydin. Our results showed that the most common MRSA clone in Turkey is ST 239-SCCmec type III, t030 which persisted during the six years of the study period. Presence of PVL toxin gene was tested by PCR and 5 (3%) isolates found to be positive, of them two were SCCmec Type IV-ST80 and three were SCCmec Type III- ST239. This study is the largest epidemiological survey ever done in Turkey which showed presence of a hospital Turkish clone TR09 (ST239-SCCmecIII-t030) and a community clone TR10 (ST737-SCCmecIV- t005) largely disseminated in Turkey

Eksfoliatif toksin genlerinin klonlanması ve toksin ekstraktının psoriasis oluşturulmuş farelerdeki etkisinin araştırılması

Psoriasis ülkeden ülkeye oranlar değişmekle birlikte görülme sıklığı %1-11 arasında değişen kronik bir hastalıktır. Dünyada yaklaşık 125 milyon insanın bu hastalıktan etkilendiği düşünülmektedir. Deri bulguları özellikle epidermis kalınlaşması ve keratinizasyon yalnızca fiziki değil psişik ve sosyal sorunlar da oluşturabilmektedir. Eksfoliatif toksin özellikle Staphylococcus bakterileri tarafından sentezlenen ve desmoglein üzerine etkili bir proteazdır. Desmoglein epidermal hücreleri birbirlerine bağlar ve yıkımlarıyla epidermal tabakada kopukluklar oluşur. Bu çalışmanın amacı Staphylococcus suşları tarafından sentezlenen eksfoliatif toksin A ve eksfoliatif toksin D’nin rekombinant olarak sentezlenmesi ve psoriasis oluşturulmuş farelerdeki etkisinin gözlenmesiydi. Materyal ve Metod. Kolleksiyonumuzdaki 415 MRSA suşunda eta, etb ve etd genlerinin varlığı PCR ile araştırılmış ve eta ve etd pozitif suşlar gen klonlanması için kullanılmıştır. PCR ile histidin kuyruğu ve restriksiyon enzim yeri eklenen primerler kullanılarak çoğaltılan genler pUC19 plazmidine klonlanmış ve E. coli DH10B suşuna aktarılmıştır. Rekombinant toksin proteinleri NiNTA kolonlarıyla saflaştırılmış ve %2 ve %5’lik dozlarda aldara uygulanarak psoriasis geliştirilmiş farelere uygulanmıştır. Bulgular. Aldara (imikimod) uygulanarak psoriasis geliştirilen farelerde keratinizasyon ve epiderm kalınlaşması görülmüş, eksfoliatif toksin uygulamasıyla keratinizasyon ve kalınlaşmada patolojik analizlerde azalma gözlenmiştir. Lezyonlardaki iyileşmenin %5 toksin dozu uygulanan farelerde daha belirgin olduğu saptanmıştır. Sonuç. Proje hipotezinde öngörülen psoriatik lezyonlarda epidermal tabaka ayrılması uygulanan doz ve yöntemle elde edilememiş ancak keratinizasyon ve epidermal tabaka kalınlaşmasında azalma gözlenmiştir. Eksfoliatif toksinin psoriasis olgularında kullanılabilirliğinin ileri saflaştırma, yüksek doz uygulamaları ve uzun süreli tedavi ile derinlemesine araştırılması uygulama potansiyelinin değerlendirilebilmesi için fayda sağlayabilir.Psoriasis is a chronic disease with a frequency ranging from 1 to 14% in the world. Approximately 125 million people worldwide are thought to be affected by this disease. Skin findings, especially epidermal thickening and keratinization in addition to physical problems, cause psychicologic and social problems. Exfoliative toxin is a protease that is synthesized especially by Staphylococcus bacteria and selectively targets desmoglein protein. Desmoglein binds the epidermal cells together and their destruction cause loss of keratinocytes, the cell‐cell adhesion, induces peeling of the skin. The aim of this study was to recombinantly synthesize exfoliative toxin A and exfoliative toxin D and to observe their effect on psoriasis-generated mice. Material and Method. The presence of the eta, etb, and etd genes in 415 MRSA strains from our collection was investigated by PCR and eta and etd positive strains were used for gene cloning. Theese genes were amplified using primers with histidine tail and restriction enzyme site by PCR and amplicons were cloned in pUC19 plasmid and transferred to E. coli strain DH10B by transformation. Recombinant toxin proteins were purified with NiNTA columns and applied to psoriasis-developed mice at 2% and 5% doses. Results. Keratinization and epidermis thickening were observed in mice treated with Aldara (imiquimod). The mice with psoriasis application of recombinant exfoliative toxin decreased keratinization and epidermal thickening. It was determined that the healing of lesions was more prominent in 5% toxin applied mice. Conclusion. Separation epidermal layer in the psoriatic lesions by application of recombinant exfoliative toxin was the main hypothesis of this project. However, our hypothesis was not confirmed with the doses and methods applied. But a decrease in keratinization and epidermal layer thickening was observed among toxin treated mice compared to non-treated ones. In-depth investigation of the efficacy of exfoliative toxin in psoriasis cases with advanced purification, high-dose treatments and long-term therapy may be helpful in assessing the potential for application of exfoliative toxin

In vitro activity of linezolid and dalbavancin against vancomycin-resistant enterococci

Günümüzde, tüm dünyada çoğul ilaç direncine sahip gram-pozitif bakterilerin etken olduğu enfeksiyonların oranı giderek artmaktadır. Ayrıca, enterokok suşları arasında glikopeptid antibiyotiklere direncin ortaya çıkması ve giderek yayılması, bu bakterilerin etken olduğu enfeksiyonların tedavisinde kullanılabilecek yeni antimikrobiyallerin geliştirilmesini zorunlu hale getirmiştir. Oksazolidinon grubu antibiyotik olan linezolid ve bir ikinci kuşak yarı sentetik lipoglikopeptid antibiyotik olan dalbavansin, sıklıkla rastlanan antimikrobiyal maddelere dirençli gram-pozitif patojenlerle gelişen enfeksiyonların tedavisi için başlıca seçenekleri oluşturmaktadır. Bu çalışmanın amacı, linezolid ve dalbavansinin vankomisine dirençli enterokok (VRE) suşlarına karşı in vitro antimikrobiyal aktivitesini belirlemektir. 2006-2007 yılları arasında İstanbul Üniversitesi İstanbul Tıp Fakültesi kliniklerinde yatan hastaların rektal sürüntü örneklerinden izole edilmiş toplam 100 VRE suşu, çalışma kapsamına alınmıştır. Tüm suşlar, geleneksel yöntemlerle cins düzeyinde tanımlanmıştır. Mikrodilüsyon yöntemiyle yapılan duyarlılık deneylerinde vankomisinin minimum inhibitör konsantrasyonu (MİK) ? 32 ?g/ml olarak saptanmıştır. Linezolid ve dalbavansin duyarlılığının belirlenmesinde de mikrodilüsyon yöntemi uygulanmıştır. Kalite kontrolü için her bir deney serisinde, Staphylococcus aureus ATCC 29213 ve Enterococcus faecalis ATCC 29212 referans suşları kullanılmıştır. Linezolide dirençli suşlarda tür düzeyinde tanımlama, 16S rRNA’nın dizilenmesiyle yapılmış; direnç mekanizmaları ise 23S rRNA’nın dizilenmesiyle araştırılmıştır. İncelenen suşlar için, linezolid ve dalbavansin MİK50, MİK90 ve MİK aralıkları sırasıyla 4, 4, 1-6 ?g/ml ve 32, 64, 0.25-128 ?g/ml olarak bulunmuştur. Linezolide duyarlılık, orta duyarlılık ve direnç oranları ise, aynı sırayla %32, %66 ve %2 olarak saptanmıştır. Linezolide dirençli iki suş Enterococcus faecium olarak tanımlanmış ve sonuçlar Pasteur Enstitüsünde doğrulanmıştır. Bu, Türkiye’de ilk linezolide ve vankomisine dirençli E.faecium suşu bildirimidir. Her iki suşun 23S rRNA geninde G2576T mutasyonu saptanmıştır. Dalbavansin için henüz “Clinical and Laboratory Standards Institute (CLSI)” tarafından bir duyarlılık sınır değeri belirtilmediği için, duyarlılık ve direnç oranları saptanamamıştır. Belirlenen MİK değerlerine göre, linezolid VRE suşlarına karşı en etkili antibiyotik olarak belirlenmiş, dalbavansin ise vankomisinden daha etkili bulunmuştur. Ayrıca, çalışmamızın sonuçları yatan hasta örneklerinden izole edilen VRE suşlarında, linezolid direncinin rutin olarak izlenmesinin gerekliliğini de göstermiştir.The incidence of infections caused by multidrug resistant gram-positive bacteria is increasing worlwide. In addition, emergence and dissemination of glycopeptide resistance in enterococci has accelerated the need for the development of new antimicrobial agents for treatment. Linezolid which is an oxazolidinone and dalbavancin which is a second-generation, semi-synthetic lipoglycopeptid are important therapeutic options for infections caused by antimicrobial-resistant gram-positive pathogens. The aim of this study was to investigate the in-vitro antimicrobial activity of linezolid and dalbavancin against vancomycin- resistant enterococci (VRE). A total of 100 VRE strains, isolated from rectal swabs of patients hospitalized in Istanbul University Faculty of Istanbul Medicine between 2006-2007 were included in the study. All strains were identified as Enterococcus spp. by conventional methods and had minimum inhibitory concentrations (MICs) of ≥ 32 μg/ml for vancomycin. Vancomycin, linezolid and dalbavancin susceptibility testing was performed by broth microdilution method. For the quality control of the tests, S.aureus ATCC 29213 and E.faecalis ATCC 29212 were included in each run. Molecular identification of linezolid-resistant strains (n= 2) were done by 16S rRNA sequencing and resistance mechanisms were tested by 23S rRNA sequencing. Against VRE strains, MIC50, MIC90 and MIC ranges of linezolid and dalbavancin were found as 4, 4, 1-16 μg/ml and 32, 64, 0.25-128 μg/ml, respectively. Linezolid susceptibility, intermediate susceptibility and resistance rates were found as 32%, 66% and 2% in the same order. Linezolid-resistant two strains were identified as E.faecium, and this data was confirmed by Pasteur Institute. Both of those isolates had G2576T mutations in 23S rRNA genes. Because susceptibility breakpoint for dalbavancin has not been established by Clinical and Laboratory Standards Institute (CLSI) yet, susceptibility and resistance rates for dalbavancin were not indicated. According to the MIC results, linezolid was found to be the most effective antibiotic against VRE strains, and dalbavancin was found more effective than vancomycin. Additionally, our results showed that routine susceptibility testing of VRE strains isolated from hospitalized patients to linezolid was required

Evaluation of Agar-Based Medium with Sheep Sera for Testing of Drug Susceptibility of Mycobacterium tuberculosis to Isoniazid, Rifampin, Ethambutol, and Streptomycin

The performance of sheep sera instead of sheep blood in agar-based media was investigated for susceptibility testing of Mycobacterium tuberculosis against primary drugs. The levels of agreement between agar-based medium supplemented with sheep sera and the proportion method on Middlebrook 7H11 agar as the reference method for determining susceptibility to isoniazid (INH), rifampin (RIF), ethambutol (EMB), and streptomycin (STR) were 98.4, 98.4, 95.3, and 100%, respectively

Molecular Epidemiology and Antibacterial Susceptibility of Streptococci Isolated from Healthy Children Attending Day Care Units

Objective: The aims of the study were to investigate antibacterial susceptibility and resistance mechanisms of streptococci isolated from healthy children attending day care units and to evaluate clonal relatedness of the strains. Material and Methods: Antimicrobial susceptibilities of streptococci isolated from 212 children attending 3 different day care units were evaluated using the agar dilution method. Polymerase chain reaction and sequencing were used to investigate resistance mechanisms. Clonal relatedness was evaluated using pulsed field gel electrophoresis. Results: Of 212 children, 11 (5.2%) carried Streptococcus pneumoniae, 17 (8.0%) S. pyogenes, and 42 (19.8%) erythromycin resistant viridans group streptococci. All S. pyogenes were susceptible to penicillin G and macrolides. Ten of 11 clonally unique S. pneumoniae were resistant to penicillin G. Three of 11 S. pneumoniae were macrolide resistant and carried erm(B). Among clonally unique 42 erythromycin resistant viridans group streptococci, 2 (4.8%) had erm(B), 33 (78.6%) had mef(A) and 7 (16.6%) had both erm(B) and mef(A) genes. All S. pyogenes from the first centre and three strains from the second centre were pulse-type A. Conclusion: Among healthy children, colonization with penicillin resistant pneumococci and erythromycin resistant viridans group streptococci is quite high. Clonal spread of S. pyogenes is important for day care units

Environmental DNA extracted from the hospital wastewater.

Left: Lambda-PstI marker, right: total phagome DNA (30 ng/μl concentration).</p

Phage plaque formation after transformation of environmental DNA extracted from wastewater into chemical competent and electrocompetent cells.

A) Phage plaques obtained from transformation of chemical competent cells. Left; Agar spot method, right; Double-layer agar method. The titer of phage after transformation is approximately 1012 pfu/ml. B) Phage plaques obtained from transformation of electrocompetent cells. Left; Agar spot method, right; Double-agar plating method. The titer of phage after transformation is approximately 108 pfu/ml.</p