Five-Years Tigecycline Experience an Analysis of Real-Life Data

Aim: Tigecycline has been approved by the Food and Drug Administration for the treatment of complicated intra-abdominal infections, skin and soft tissue infections and community-acquired pneumonia. In our study, we examined the efficacy of tigecycline in clinical practice and reported real life data from our hospital over a period of five years. Methods: The study was conducted between 2008 and 2013 on patients who received tigecycline for longer than 48 hours in Ankara Training and Research Hospital. Clinical success was defined as clinical recovery and microbiological cure in patients who used tigecycline. Any reason for discontinuation of tigecycline treatment was considered a clinical failure. Results: In our hospital, 320 patients were administered tigecycline between 2008 and 2013. Tigecycline was mainly used for pneumonia and skin and soft tissue infections. Tigecycline was used as monotherapy in 174 patients (54.1%). The most frequently isolated agent in tigecycline-treated patients was Acinetobacter baumannii (43.4%) followed by Enterococcus (6.9%). A change in treatment was not considered necessary in 243 (75.9%) patients who received tigecycline, while it was changed in 77 patients (24.1%). Conclusion: In conclusion, the use of tigecycline can be an effective treatment choice, either as monotherapy or as a combination antibiotic therapy

Some Properties of Over 40 Years Women with High School and Over Regarding Menopausal Period and Conception of Calcium Source Foods in Diyarbakır

The aim of this study was to determine the properties of women in pre or post menopausal period and their conception of calcium source foods. We interviewed randomly selected, aged over 40 years, 390 women with high school or higher education level in Diyarbakir. Body mass indexes (BMI) of the women were also calculated by measuring height and weight. 28,72% of the study population were postmenopausal. Of the postmenopausal women, 18,75 % had experienced a surgical or medical intervention causing menopause. Average menopausal age was 45,63±4,60 for natural menopause. According to BMI 37,44% of the women was with over weight and 8,21% of them was with obesity. Prevalence of overweight was higher in post menopausal women than others (16,10% - 5,00%) (p: 000). Only 24,62 % of the women attended to a physician for medical counseling. 14,61% of them were using calcium supplementary drugs and 6,41% of them were using estrogen regularly. Although most of the women (82,31%) had information bout increasing calcium requirement during postmenopausal period but 35,13% of them were consuming calcium source foods sufficiently. This result showed that knowledge on good nutrition was not reflected to their nutritional habits, and health education programmes should be conducted on this manner

In Vitro Activity of Fosfomycin Trometamol Against Extended-Spectrum Beta-Lactamase Producing Escherichia coli Strains Isolated from Community-Acquired Urinary Tract Infections

Introduction: Escherichia coli is the most common microorganism in community acquired UTIs. Treating infections caused by extended-spectrum beta-lactamase (ESBL) producing E. coli strains is problematic. In recent years, in our country and the world, susceptibility of E. coli strains to commonly used antibiotics in the treatment of UTIs has decreased. The aim of this study was to investigate the in vitro activity of fosfomycin in ESBL positive E. coli strainst isolated from community-acquired UTIs. Materials and Methods: The study included E. coli positive urine samples taken from outpatients in the Department of Infectious Disease and Clinical Microbiology at Ankara Training and Research Hospital between June 2012 and January 2013. Antibiotic susceptibilities of the isolates were determined by Kirby-Bauer disc diffusion method and ESBL production was confirmed by double-disc diffusion method according to the recommendations of CLSI (Clinical and Laboratory Standards Institute). Minimum inhibitor concentration (MIC) values for fosfomycin were detected by E-test method. Results: Thirty-five of the 80 E. coli strains (43.7%) producing ESBL was included into the study. However, ESBL-non producing isolates weren’t resistant to fosfomycin but ESBL-producing isolates were 8.6% resistant to fosfomycin (determined by Kirby-Bauer disc diffusion method according to CLSI recommendations). Regarding fosfomycin MIC breakpoints defined by CLSI, 100% of ESBL-producing and non-producing isolates were found susceptible to fosfomycin, indicating no significant difference between the two groups (p= 0.457). Conclusion: It isconcluded that fosfomycin isan appropriate alternative antibiotic in the treatment of community-acquired UTIs because of its high susceptibility rates

Determination of Susceptibility Rates of Nosocomial Acinetobacter baumannii Isolates to Sulbactam by E-test Method

Hastane infeksiyonlarına yol açan etkenler arasında Acinetobacter cinsi bakteriler önemli bir yer tutmaktadır. Çoklu ilaç dirençli Acinetobacter infeksiyonları dünyada artan oranlarda görülmektedir. Bu nedenle, terapötik seçenekler sınırlı hale gelmektedir. Duyarlılık oranları net olarak bilinmese de, tek başına sulbaktam veya sulbaktam-ampisilin, Acinetobacter infeksiyonlarının tedavisinde kombinasyonlarda yer almaktadır. Bu çalışmada, çoğul dirençli Acinetobacter baumannii kökenlerinde, sulbaktamın minimum inhibitör konsantrasyonu (MİK) değerleri E-test yöntemi ile incelenmiştir. Materyal ve Metod: Çalışmaya, 15 Haziran 2011-15 Haziran 2013 tarihleri arasında, Sağlık Bakanlığı Ankara Eğitim ve Araştırma Hastanesinde yatan hastalardan alınan klinik örneklerden izole edilen, karbapenem direncini de barındıran çoklu ilaca dirençli 100 A. baumannii kökeni alındı. Antibiyotik duyarlılıkları ve tür düzeyinde tanımlaması konvansiyonel yöntemler ve VITEK 2 (bioMérieux SA, Fransa) sistemi ile yapılmıştır. Üç veya daha fazla ilaç grubuna karşı direnç saptanması çoğul ilaç direnci olarak kabul edildi. Yüz izolat çalışma gününe kadar -80ºC'de gliserollü "brain heart" besiyerinde (Oxoid, UK) saklandı. Kontrol kökeni olarak Escherichia coli ATCC (American Type Culture Collection) 25922 kullanıldı. Sulbaktamın 100 izolata karşı E-test yöntemi ile saptanan MİK değerleri (µg/mL), MİK50 ve MİK90 değerleri (µg/mL) kaydedildi. Tek başına sulbaktamın Acinetobacter'e karşı belirlenmiş bir duyarlılık sınırı olmadığı için, duyarlılık oranları, literatürde rapor edilen MİK sınır değerleri dikkate alınarak hesaplanmıştır (<= 4 µg/mL ve <= 8 µg/mL). Bulgular: Acinetobacter izolatlarına karşı sulbaktam MİK değerleri geniş bir aralıkta dağılmıştı (1 µg/mL ile 256 µg/mL arasında); MİK50 ve MİK90 değerleri ise sırasıyla 12 µg/mL ve 96 µg/mL saptandı. Duyarlılık sınırı 8 µg/mL kabul edildiğinde, izolatların %44'ü duyarlı saptanmışken, sınır 4 µg/mL kabul edildiğinde bu oran %21 ile sınırlı kaldı. Sonuç: Çalışmamızdaki sulbaktam MİK değerleri göz önüne alındığında, çoklu ilaca dirençli A. baumannii tedavisinde sulbaktam umut verici bir ajan olarak görülmektedir. Ancak, özellikle klinik etkinlik konusunda farklı çalışmalara ihtiyaç vardır.Bacteria of the genus Acinetobacter play an important role as causative agents of hospital-acquired infections. Especially in recent years, multidrug-resistant Acinetobacter infections have increasingly been observed worldwide. In parallel with the increasing rate of infections, therapeutic options are becoming limited. Although the susceptibility rates are not exactly known, sulbactam alone or sulbactam with ampicillin play a part in combination therapies against Acinetobacter infections. This study aimed to determine the minimum inhibitory concentrations (MICs) of sulbactam against multidrug-resistant Acinetobacter baumannii strains using the E-test method and to deduce the susceptibility rates based on literature data.Materials and Methods: The study included 100 multidrug-resistant A. baumannii strains isolated from clinical samples obtained from patients hospitalized in intensive care units of the Ministry of Health Ankara Training and Research Hospital between June 15, 2011 and June 15, 2013. Antibiotic susceptibility testing and strain identification were performed using conventional methods and the VITEK 2 (bioM&eacute;rieux SA, France) system. Resistance to three or more drugs was considered as multidrug resistance. MIC, MICMIC values (&micro;g/mL) of sulbactam against the 100 isolates were determined using the E test method. Since the breakpoint MIC of sulbactam against Acinetobacter had not been established, the susceptibility rates were estimated based on the MIC values reported in the literature (&lt;= 4 or 8 &micro;g/mL).Results: The MIC values of sulbactam against the Acinetobacter isolates ranged widely (between 1 and 256 &micro;g/mL), and the MICand MIC values were determined to be 12 and 96 &micro;g/mL, respectively. When 8 &micro;g/mL was considered as the susceptibility breakpoint, 44% of the isolates were found to be susceptible; however, the rate was only 21% when 4 &micro;g/mL was considered as the breakpoint.Conclusion: Based on its MIC values determined in our study, sulbactam appeared to be a promising agent for the treatment of infections caused by multidrug-resistant A. baumannii isolates. Nonetheless, more studies are needed, especially on its clinical effectiveness

Lung Abscess in Crimean-Congo Hemorrhagic Fever: A Case Report

Crimean-Congo hemorrhagic fever is a viral zoonotic infection that affects multiple organs and systems, and causes various complications and death. Here, we present a case of a Crimean-Congo hemmorrhagic fever with pulmonary abscess complication, which has not been previously reported

Evaluation of the Surgeons’ Approach to HIV Infection

Introduction: The number of persons diagnosed as HIV positive is increasing rapidly in Turkey. Although the overall prevalence of the disease is still low, the increase of newly diagnosed persons emerges an important concern dealing with the awareness of the clinicians, and especially the surgeons. The aim of the study is to evaluate the approach of surgeons to HIV infection in the hospital. Materials and Methods: A 12-item self-administered anonymous questionnaire about the HIV infection with true and false options was developed. The questionnaire also included the specialty, age, duration of occupation and position of the surgeons. The questions were targeted to learn the knowledge and attitude about transmission route, occupational risk of acquiring HIV infection, prophylaxis for prevention, reluctance for operation and current drug therapy. The questionnaires were voluntarily filled by surgeons in November 2017. The descriptive statistics of the study were calculated as numbers and percentages. Yates’ corrected chi-square and Fisher’s exact tests were used in comparative analysis. Mann-Whitney U test and Spearman correlation test was used for comparison of continuous variables and correlation, respectively. Results: The total number of filled questionnaires was 90. In 90 of them, the demographic fields were filled. Among 90 surgeons, 37% (33/90) were assistant doctors between the ages of 25-31 years, and the duration of occupation was between 1-6 years. The remaining was older than 31 years of age and the duration of occupation as surgeon was 5-40 years. Specialties were urology, orthopedics, plastic surgery, obstetrics and gynecology, ophthalmic surgery, ear-nose-throat surgery, cardiovascular, general surgery, and neurosurgery. The results generally denote that the surgeons are aware of the occupational risk of HIV infection. Current knowledge about transmission risk evaluation, existence of prevention prophylaxis, advance in HIV treatment and prolonged life expectancy were less than expected. Correspondingly, half of the surgeons were reluctant to touch the patients. For each question, there was no statistically important difference between the answers of the surgeons according to position (residency doctor or specialist) (p> 0.05). There was also no statistically important difference between the answers of the surgeons according to age and duration of occupation (p> 0.05). Any significant correlation was not detected when age and duration of occupation were evaluated according to the total number of true answers (p= 0.802, r= -0.028 and p= 0.831, r= 0.023 respectively) Conclusion: The survey revealed the need for a meeting to be held with the surgeons of our hospital regarding the current status of the disease in the near future

Interleukin-6 and Interleukin-10 Levels in Patients with Chronic Hepatitis B Virus Infection

Hepatitis B virus (HBV) infection may progress to liver failure and liver cancer, for this reason it is a serious health problem. The mechanisms of chronicity are poorly understood. The balances in cytokine production profiles may play a crucial role in determining the resolution or persistence of infection. In this study, we aimed to determine various cytokine levels in patients with chronic HBV infection and to reveal the relationship between levels of cytokines and different clinical phases. HBsAg positive patients with a duration of positivity longer than six months who applied to outpatient clinic of Infectious Diseases and Clinical Microbiology Department of Ankara Training and Research Hospital between October 2005 and June 2006 were included to the study. There were 57 patients in chronic hepatitis B group. There were 24 healthy individuals in the control group. Serum interleukin (IL)-6 and IL-10 levels were detected and compared between patients and controls. There were 25 chronic hepatitis and 32 inactive carrier patients in the patient group. Serum IL-6 levels in patients with chronic HBV infection (8.496 pg/mL) were higher than those of the control group (6.850 pg/mL) and the difference was statistically significant (p= 0.022). Serum IL-10 levels were 0.784 pg/mL and 0.052 pg/mL in patient and control groups, respectively. There was a statistically significant difference between these groups (p= 0.019). Correlation between serum alanin aminotransferase (ALT) levels and cytokine levels were also examined. There wasn’t any correlation between the levels of IL-6 and IL-10, and ALT in patients. As a conclusion, increased IL-10 levels may be associated with persistence of hepatitis B infection. Testing the level of serum IL-6 may be helpful to determine the liver inflammation in patients with chronic hepatitis B infection

Serum Cytokine Levels in Acute Brucellosis and Their Relation with C-Reactive Protein and Erythrocyte Sedimentation Rate

Brucellosis is a common disease, seen worldwide and in our country as well. Effective immune response is mediated by Th1 cells in brucellosis. Cytokines are thought to have an important role in the pathogenesis of brucellosis and the Th1/Th2 balance may be involved in the susceptibility or resistance to the disease. The aim of this study was to detect the difference of serum interferon-gamma (IFN-γ), interleukin-6 (IL-6) and IL-12 levels between patients with acute brucellosis and the control group and to investigate the correlation between those cytokines, C-reactive-protein (CRP) and erythrocyte sedimentation rate (ESR) in acute brucellosis patients. Fifty patients with acute brucellosis followed between August 2002 and August 2006 in Ankara Research and Training Hospital Infectious Diseases and Clinical Microbiology Department were included to our study. The control group included 31 healthy persons. The mean serum IFN-γ, IL-6, and IL-12 levels in patients with acute brucellosis were higher than the control group and the difference between the two groups was statistically significant (p 0.05). In conclusion, significantly high levels of IFN-γ, IL-6 and IL-12 in acute brucellosis implies the role of those cytokines in the pathogenesis of that infection. Further studies including more patients at different stages of the disease would be helpful to understand the precise role of cytokines in brucellosis pathogenesis

The Impact of Whole Body Vibration Therapy on Spasticity and Disability of the Patients with Poststroke Hemiplegia

Objective. To determine if whole body vibration therapy (WBV) effectively improves functional outcome in patients with poststroke hemiplegia. Materials and Methods. In this single-blind RCT, WBV group (n=10) had 40 hz frequency/4 mm amplitude vibration during 5 minutes/session, 3 days a week, for a duration of 4 weeks. The control group (n=11) had no vibration therapy for the same duration while standing on the same platform. Patients in both of the groups did 15 minutes of stretching and active range of motion exercises before the intervention. Outcome measures were Modified Ashworth Scale (MAS), Functional Independence Measurement (FIM), and Timed 10-Meter Walk Test (10 mWT). Results. Only 10 mWT improved at the 1st week (p=0.002), 1st month (p<0.001), and 3rd month (p<0.001) in favor of the intervention group. There was positive correlation also between 10 mWT and ankle spasticity (p<0.001, r=0.931). Conclusion. This study suggests that WBV therapy may be a complementary therapy in gait rehabilitation and functional outcome of the patients with calf muscle spasticity