Sağlık personelinde kızamık, kızamıkçık, kabakulak ve suçiçeği seroprevalansının değerlendirilmesi

Amaç: Sağlık personeli, infeksiyon hastalıkları açısından toplum geneline göre artmış bir risk altındadır. Sağlık personelinin bağışıklanması, hem personelin korunmasını sağlayacak hem de sağlık hizmeti verilen ortamlarda ve toplumda hastalıkların yayılımını önleyecektir. Bu çalışmada, hastanemizin sağlık personelinde aşıyla önlenebilir hastalıklardan olan kızamık, kızamıkçık, kabakulak (KKK) ve suçiçeği antikorlarının belirlenerek etkin bir bağışıklama programı oluşturulması ve serolojik taramanın maliyet etkinliğinin değerlendirilmesi amaçlandı. Yöntemler: Bu çalışma 10 Mart 2014-10 Ocak 2015 tarihleri arasında Bülent Ecevit Üniversitesi Sağlık Uygulama ve Araştırma Merkezi’nde yapıldı. Katılımcıların yaş, cinsiyet, meslek, bölüm, çalışma süreleri, çocukluklarının geçtiği yerleşim birimleri, hastalık geçirme öyküleri ve aşılanma durumları bir anket formuyla sorgulandı. Spesifik IgG antikorları “enzyme-linked immunosorbent assay” yöntemiyle araştırıldı. Bulgular: Çalışmaya toplam 384 gönüllü sağlık personeli dahil edilmiş olup katılanların %61.2’si kadın, %38.8’i erkek, yaş ortalaması 32.43±6.4 idi. Serolojik test sonuçları değerlendirildiğinde seropozitiflik düzeylerinin kızamık için %92.2, kızamıkçık için %98.2, kabakulak için %94 ve suçiçeği için %94.3 olduğu belirlendi. Sağlık personelinde hastalık geçirme öyküsünün duyarlılığı kabakulak ve kızamık için yüksek değerlerde bulunurken (sırasıyla %81.6 ve %80.5), kızamıkçık için %43.4 olduğu bulundu. Hastalığı geçirme öyküsü için pozitif prediktif değerler, kızamık, kızamıkçık, kabakulak ve suçiçeği için sırasıyla %95.6, %98.9, %97.5 ve %96.9 olarak saptandı. Maliyet etkinlik çalışması sonucunda, gerek KKK gerekse suçiçeği için serolojik tarama yapılarak aşılama uygulanması lehine sırasıyla 1432 TL ve 18 253 TL gibi bir maliyet farkı saptandı. Özellikle suçiçeği için aşılama öncesi öykü negatifliğinin veya seronegatifliğin gösterilmesinin maliyet etkin olduğu belirlendi. Sonuçlar: Özellikle riskli bölümlerde çalışan sağlık personelinin bağışıklık durumunun serolojik testlerle taranması ve duyarlı sağlık personelinin aşılanması gerektiği sonucuna varılmıştır

Detection of CTX-M Enzymes in ESBL (ExtendedSpectrum Beta-Lactamases) Producing Escherichia coli and Klebsiella spp Isolates

Amaç: Bu çalışmada, hastanemize başvuran hastalardan etken olarak izole edilen Escherichia coli ve Klebsiella spp. izolatlarının, GSBL üretiminin ve CTX-M enzim tiplerinin araştırılması amaçlandı. Gereç ve Yöntem: Haziran-Aralık 2009 tarihleri arasında çeşitli klinik örneklerden toplam 593 izolat çalışmaya dâhil edildi. Antibiyotik duyarlılık testi disk difüzyon yöntemi ile yapıldı. GSBL üretimi çift disk sinerji ve E test ile doğrulandı. GSBL üreten izolatlar için sefotaksim minimal inhibitör konsantrasyonları agar dilüsyon ile belirlendi. İzolatlarda polimeraz zincir reaksiyonu yöntemiyle CTX-M enzim grupları (CTX-M grup, CTX-M-1 grubu, CTX-M-2 grubu, CTX-M-8 grubu, CTX-M-9 grubu, CTX-M-25 grubu) araştırıldı. Bulgular: İzolatların %33.7'sinin (200/593) GSBL ürettiği (E. coli %34.3, K. pneumoniae %31.3) belirlendi. Yatan hastalardan izole edilen izolatlarda GSBL üretimi anlamlı olarak yüksek bulundu. GSBL üreten izolatlar diğer izolatlara göre, siprofloksasin, levofloksasin, amoksisilin/klavulanik asit, piperasilin/tazobaktam, gentamisin, amikasin, tobramisin, trimetoprim-sülfometoksazol ve nitrofurantoine anlamlı olarak dirençli bulundu. GSBL üreten izolatların 192'sinde (%96) CTX-M enzimi belirlendi. CTX-M ürettiği saptanan izolatların %96.8'inde (186/192) CTXM-1 grubu %5.2'sinde (10/192) CTX-M-2 grubu, %1'inde (2/192) CTX-M-8 grubu ve %1.5'unda (3/192) CTX-M-9 grubu saptandı. CTX-M-1 grubu GSBL ürettiği belirlenen 186 izolatın 165'inde (%88.7) CTX-M-15 enzim tipi saptandı. Sonuç: Hastanemizden elde edilen izolatlarda GSBL oranları oldukça yüksek bulunmuş olup, en sık enzim grubu CTX-M-1 grubu ve en sık enzim tipi CTX-M-15 enzimi olarak saptanmıştır.Objective: The aim of this study is to evaluate ESBL production and CTX-M enzyme types in Escherichia coli and Klebsiella spp isolates obtained from patients admitted to our hospital. Material and Method: A total of 593 isolates from various clinical specimens of patients between June 2009 and December 2009 were included in the study. Antibiotic susceptibility test was performed by Kirby-Bauer disk diffusion method. ESBL production was confirmed by double-disc synergy and E tests.The minimal inhibitory concentrations of cefotaxim for the isolates with ESBL were detected by agar dilution method. Polymerase chain reaction was used to determine the CTX-M enzyme types including CTX-M group, CTX-M-1 group, CTX-M-2 group, CTX-M-8 group, CTX-M-9 group, CTX-M-25 group, CTXM-15, CTX-M-3, and CTX-M-10 types. Results: ESBL production was found in 33.7% (200/593) of the isolates (34.3% for E. coli and 31.3% for Klebsiella isolates). ESBL production was significantly high in isolates from inpatients. Resistance to ciprofloxacin, levofloxacin, amoxicillin/clavulanic acid, piperacillin/tazobactam, gentamicin, amikacin, tobramycin, trimetoprimsulphametoxazol and nitrofurantoin was significantly higher in ESBL producing isolates. CTX-M enzymes were found in 192 (96%) of the 200 ESBL producing isolates. Of the CTX-M producing isolates, CTX-M-1, CTX-M-2, CTXM-8 and CTX-M-9 groups were found in 96.8% (186/192), 5.2% (10/192), 1% (2/192) and 1.5% (3/192), respectively. CTX-M-15 was found in 165 of the 186 (88.7%) CTX-M-1 group ESBL producing isolates. Conclusions: High rates of ESBL production was found among the isolates in our hospital. The most common enzyme type was CTX-M-1 group, CTX-M-15 being the most common enzyme type

The Evaluation of Resistance Genes and Gene Mutations in Quinolone Resistant Escherichia coli and Klebsiella spp. Isolates

Amaç: Bu çalışmada, bölgemizdeki Escherichia coli ve Klebsiella spp. izolatlarında kinolon direnç sıklığının belirlenmesi, bu izolatlarda sık görülen kinolon direnç mekanizmalarının varlığının araştırılması amaçlanmıştır.Gereç ve Yöntem: Şubat-Ağustos 2009 tarihleri arasında izole edilen nalidiksik asite dirençli/orta duyarlı bulunan 265 Escherichia coli, 33 Klebsiella pneumoniae ve 2 Klebsiella oxytoca izolatında qnrA, qnrB, qnrS, aac(6')-Ib, gyrA ve parC gen bölgelerinin araştırılması polimeraz zincir reaksiyonu yöntemiyle yapılmıştır. gyrA ve parC gen bölgelerindeki mutasyonların saptanması için dizi analizi yapılmıştır.Bulgular: Nalidiksik asit direnci E. coli için % 52, Klebsiella spp. için % 27.5 olarak belirlenmiştir. Nalidiksik aside dirençli izolatlarda beta-laktam, aminoglikozit, trimetoprim-sülfometoksazole direncinin ve GSBL üretiminin anlamlı olarak daha yüksek olduğu belirlenmiştir. gyrA için kinolon direncini tanımlayan bölgede (Ala67-Gln106) çift mutasyon olduğu, bunların Ser83Leu ve bir izolat dışında Asp87Asn, tek izolatta ise Asp87Tyr şeklinde olduğu belirlenmiştir. parC için dizileme yapılan izolatların hepsinde Ser80Ile değişimi olduğu gözlenmiş, izolatların 32'sinde (% 40,3) ilave bir mutasyon bulunduğu ve bunların 26 izolatta Glu84Val, 4 izolatta Glu84Gly, 2 izolatta ise Glu84Ala olduğu belirlenmiştir. E. coli izolatlarının 99'unda (% 37,4), K. pneumoniae izolatlarının dördünde (% 12,1) aac(6')-Ib geni belirlenmiştir. İncelenen izolatlarda qnr geni bulunmamıştır.Sonuç: İzolatlarımızda kinolon direnci ve GSBL üretimi yüksek bulunmuştur. Kinolon dirençli izolatlarımızda gyrA ve parC bölgelerinde üç ve daha fazla mutasyonun bulunduğu ilave olarak aac(6')-Ib'nin belirgin olarak direnç mekanizmasına eşlik ettiği belirlenmiştir. İzolatlarımızda qnr belirlenmemiştirObjective: The aims of this study are to detect the quinolone resistance rates among Escherichia coli and Klebsiella pneumoniae spp. isolates in our region and to investigate the most common quinolone resistance mechanisms. Material and Methods: The presence of qnrA, qnrB, qnrS, aac(6’)-Ib, gyrA and parC genes were investigated by polymerase chain reaction method in 265 Escherichia coli, 33 Klebsiella pneumoniae and two Klebsiella oxytoca strains which were isolated between February–August 2009, and found to be non/intermediate susceptible to nalidixic acid . Sequence analysis was used for detection of gyrA and parC mutations. Results: Resistance to nalidixic acid was determined as 52% for E. coli and 27.5% for Klebsiella spp. Beta-lactam, aminoglycoside, trimethoprim-sulfamethoxazole resistance and ESBL-production rates were significantly higher among nalidixic acid resistant isolates. Double mutations were detected in gyrA quinolone resistance defining region (Ala67-Gln106); the first one being Ser83Leu in all isolates and the other being Asp87Tyr in one isolate and Asp87Asn in other isolates. Ser80Ile alteration was observed among all isolates sequenced for parC mutations; while 32 (40.3%) of the isolates had an additional mutation, as Glu84Val, Glu84Gly and Glu84Ala in 26, four and two, respectively. The aac(6’)-Ib gene was detected in 99 (37.4%) of E. coli and four (12.1%) of K. pneumoniae isolates. The qnr gene was not detected in any of the tested isolates. Conclusion: The quinolone resistance rates and accompanying ESBL-production was high among the isolates in our region. We have detected three or more mutations in gyrA and parC regions in quinolone resistant isolates, and additional aac(6’)- Ib gene in a significant number of isolates. The qnr gene was not detected in any of the tested isolates

Effects of Ozonated Olive Oil on Acute Radiation Proctitis in Rats

Background: Acute radiation proctitis is a common complication of pelvic radiation and management of acute radiation proctitis is under evaluation. The beneficial effects of ozonated olive oil (OzOO) have already been shown in the treatment of chronic wounds. Thus, this study was designed to evaluate the therapeutic effects of topical OzOO on acute radiation proctitis. Aims: To evaluate the therapeutic effects of topical OzOO on acute radiation proctitis. Study Design: Animal experimentation. Methods: Rats were divided into three groups: control; irradiation+saline (1 mL); and irradiation +OzOO (1 mL). A single fraction of 17.5 Gy was delivered to each rat. The OzOO was administered rectally each day after irradiation. Each rat was observed daily for signs of proctitis. Irradiated rats were euthanised on days 5 and 10. The mucosal changes were evaluated macroscopically and pathologically. Results: According to the clinical findings, five rats in the irradiation+saline group showed Grade 4 symptoms on the 10th day. Macroscopic finding scores on the 10th day in the irradiation+saline and irradiation+OzOO groups were statistically significantly different. On pathological examination, radiationinduced mucosal damage was the most prominent 10 days after irradiation in saline-treated rats. On the 10th day, the irradiation+OzOO group showed mild inflammation and slight crypt change, which corresponded to Grade 1 pathological findings. Conclusion: OzOO attenuates macroscopic and pathological findings of acute radiation proctitis in rats.Background: Acute radiation proctitis is a common complication of pelvic radiation and management of acute radiation proctitis is under evaluation. The beneficial effects of ozonated olive oil (OzOO) have already been shown in the treatment of chronic wounds. Thus, this study was designed to evaluate the therapeutic effects of topical OzOO on acute radiation proctitis. Aims: To evaluate the therapeutic effects of topical OzOO on acute radiation proctitis. Study Design: Animal experimentation. Methods: Rats were divided into three groups: control; irradiation+saline (1 mL); and irradiation +OzOO (1 mL). A single fraction of 17.5 Gy was delivered to each rat. The OzOO was administered rectally each day after irradiation. Each rat was observed daily for signs of proctitis. Irradiated rats were euthanised on days 5 and 10. The mucosal changes were evaluated macroscopically and pathologically. Results: According to the clinical findings, five rats in the irradiation+saline group showed Grade 4 symptoms on the 10th day. Macroscopic finding scores on the 10th day in the irradiation+saline and irradiation+OzOO groups were statistically significantly different. On pathological examination, radiationinduced mucosal damage was the most prominent 10 days after irradiation in saline-treated rats. On the 10th day, the irradiation+OzOO group showed mild inflammation and slight crypt change, which corresponded to Grade 1 pathological findings. Conclusion: OzOO attenuates macroscopic and pathological findings of acute radiation proctitis in rats

Diagnostic value of repeated Dix-Hallpike and roll maneuvers in benign paroxysmal positional vertigo

Abstract Introduction: Benign Paroxysmal Positional Vertigo (BPPV) is the most common peripheral vestibular disorder. The Dix-Hallpike and Roll maneuvers are used to diagnose BPPV. Objective: This study aims to investigate the diagnostic value of repeated Dix-Hallpike and Roll maneuvers in BPPV. Methods: We performed Dix-Hallpike and roll maneuvers in patients who admitted with peripheral vertigo anamnesis and met our criteria. The present study consists of 207 patients ranging in age from 16 to 70 (52.67 ± 10.67). We conducted the same maneuvers sequentially one more time in patients with negative results. We detected patients who had negative results in first maneuver and later developed symptom and nystagmus. We evaluated post-treatment success and patient satisfaction by performing Dizziness Handicap Inventory (DHI) at first admittance and two weeks after treatment in all patients with BPPV. Results: Of a total of 207 patients, we diagnosed 139 in first maneuver. We diagnosed 28 more patients in sequentially performed maneuvers. The remaining 40 patients were referred to imaging. There was a significant difference between pre- and post-treatment DHI scores in patients with BPPV (p < 0.001). Conclusion: Performing the diagnostic maneuvers only one more time in vertigo patients in the first clinical evaluation increases the diagnosis success in BPPV. Canalith repositioning maneuvers are effective and satisfactory treatment methods in BPPV

Preterm Doğuma Neden Olan Risk Faktörleri

AMAÇ: Bu çalışmanın amacı gebede pretem doğuma neden olabilecek risk faktörlerinin belirlenmesidir. GEREÇ VE YÖNTEM: Çalışma Bülent Ecevit Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum servisinde yatan gebe hastalarda 1 Eylül 2008 - 1 Mayıs 2009 tarihleri arasında yapılmıştır. Çalışmada olası risk faktörlerini içeren bir form kullanıldı. BULGULAR: Preterm doğum için yaş, sistolik kan basıncı, ço- ğul gebelik, kronik hastalıklar, kansızlık, cinsel ilişki, 1 ay içinde yaşanan üzücü olay, travma, düşük gelir düzeyi ve lökositoz Lojistik Regresyon Analizine göre anlamlı bulunan faktörlerdi. SONUÇ: Düşük sosyoekonomik düzey, yüksek kan basıncı, stres, çoğul gebelik, tedavi gebelikleri, vajinal enfeksiyonlar, kronik hastalıklar ya da ağır anemi gibi durumlarda preterm doğum olabileceği düşünülmeli ve bu gebeler çok yakın takip edilerek tedavi edilmelidirler.AMAÇ: Bu çalışmanın amacı gebede pretem doğuma neden olabilecek risk faktörlerinin belirlenmesidir. GEREÇ VE YÖNTEM: Çalışma Bülent Ecevit Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum servisinde yatan gebe hastalarda 1 Eylül 2008 - 1 Mayıs 2009 tarihleri arasında yapılmıştır. Çalışmada olası risk faktörlerini içeren bir form kullanıldı. BULGULAR: Preterm doğum için yaş, sistolik kan basıncı, ço- ğul gebelik, kronik hastalıklar, kansızlık, cinsel ilişki, 1 ay içinde yaşanan üzücü olay, travma, düşük gelir düzeyi ve lökositoz Lojistik Regresyon Analizine göre anlamlı bulunan faktörlerdi. SONUÇ: Düşük sosyoekonomik düzey, yüksek kan basıncı, stres, çoğul gebelik, tedavi gebelikleri, vajinal enfeksiyonlar, kronik hastalıklar ya da ağır anemi gibi durumlarda preterm doğum olabileceği düşünülmeli ve bu gebeler çok yakın takip edilerek tedavi edilmelidirler

Risk Factors Causing Preterm Labor

OBJECTIVE: The aim of this study was to determine the risk factors, that may cause preterm labor among the pregnant women. STUDY DESIGN: Our study was performed between the dates 1st September 2008 - 1st May 2009, among pregnant women, who are hospitalized in Obstetrics and Gynecology Department of Bülent Ecevit University Faculty of Medicine. A survey sheet was constituted to determine possible risk factors of preterm labor. RESULTS: Variables, which were evaluated as significant according to Logistic Regression Analysis, were found as age, systolic blood pressure, multiple pregnancies, presence of chronic disease, anemia, intercourse, experiencing a bitter event within the last month, trauma, low income and leukocytosis. CONCLUSIONS: Conditions related to low socio-cultural level, high blood pressure, stress, multiple pregnancies, therapeutic pregnancies, vaginal infections, presence of a chronic disease, or severe anemia led us to suspect about preterm labor; risk factors should be eliminated by intensive monitoring of these pregnant women

Beneficial effects of garlic (Allium sativum) oil in experimental corrosive esophageal burns effects of garlic oil in esophageal burns

BACKGROUND: Corrosive esophageal burns, particularly common in developing countries, lead to different problems in different age groups. The ingestion of corrosive substances can cause such problems as stricture of the esophagus, to acute perforation, and even death. Because stricture formation is related to the severity of the initial injury, the prevention of stricture constitutes a main goal of treatment. The aim of this study was to investigate the protective and anti-inflammatory effects of garlic (Allium sativum) oil in corrosive esophageal burn.METHODS: Twenty-eight rats were randomly divided into 4 equal groups: group 1 (sham), group 2 (control), group 3 (topical treatment), and group 4 (topical and systemic treatment). In groups 2, 3, and 4, corrosive esophageal burns were generated by applying sodium hydroxide to a 1.5-cm segment of the abdominal esophagus. Normal saline was applied to group 2, topical garlic oil to group 3, and topical and systemic garlic oil were used in group 4.RESULTS: The level of hydroxyproline was lower in the topical treatment groups than in the control group (p=0.023). There was difference in tumor necrosis factor alpha level between the systemic treatment groups and the control group (p=0.044). Treatment with garlic oil decreased stenosis index (SI) and histopathological damage score (HDS) in corrosive esophageal burn rats. The SI in the topical treatment group was significantly lower than that of the control group (p=0.016). The HDS was significantly lower in group 4 when compared with the control group (p=0.019).CONCLUSION: Garlic oil is an effective agent in promoting the regression of esophageal stenosis and tissue damage caused by corrosive burns. While the protective effect of garlic oil on tissue damage is more significant when applied topically, the anti-inflammatory effect is more pronounced when applied systemically. Therefore, we believe that the application of garlic oil in patients with corrosive esophageal burns can reduce complication ratesBACKGROUND: Corrosive esophageal burns, particularly common in developing countries, lead to different problems in different age groups. The ingestion of corrosive substances can cause such problems as stricture of the esophagus, to acute perforation, and even death. Because stricture formation is related to the severity of the initial injury, the prevention of stricture constitutes a main goal of treatment. The aim of this study was to investigate the protective and anti-inflammatory effects of garlic (Allium sativum) oil in corrosive esophageal burn.METHODS: Twenty-eight rats were randomly divided into 4 equal groups: group 1 (sham), group 2 (control), group 3 (topical treatment), and group 4 (topical and systemic treatment). In groups 2, 3, and 4, corrosive esophageal burns were generated by applying sodium hydroxide to a 1.5-cm segment of the abdominal esophagus. Normal saline was applied to group 2, topical garlic oil to group 3, and topical and systemic garlic oil were used in group 4.RESULTS: The level of hydroxyproline was lower in the topical treatment groups than in the control group (p=0.023). There was difference in tumor necrosis factor alpha level between the systemic treatment groups and the control group (p=0.044). Treatment with garlic oil decreased stenosis index (SI) and histopathological damage score (HDS) in corrosive esophageal burn rats. The SI in the topical treatment group was significantly lower than that of the control group (p=0.016). The HDS was significantly lower in group 4 when compared with the control group (p=0.019).CONCLUSION: Garlic oil is an effective agent in promoting the regression of esophageal stenosis and tissue damage caused by corrosive burns. While the protective effect of garlic oil on tissue damage is more significant when applied topically, the anti-inflammatory effect is more pronounced when applied systemically. Therefore, we believe that the application of garlic oil in patients with corrosive esophageal burns can reduce complication rate