The effect of melatonin to antifungal susceptibility in planktonic and biofilm forms of candida strains which isolated from clinical samples

YÖK Tez No: 460028Son yıllarda, biyofilm varlığında antifungallere dirençli Candida türlerinin izolasyonunda belirgin biçimde artış olması, bu enfeksiyonların tedavisi için alternatif ajanların geliştirilmesini zorunlu hale getirmiştir. Bu çalışmada, Düzce Üniversitesi Tıp Fakültesi Hastanesi Tıbbi Mikrobiyoloji Laboratuvarına gönderilen klinik örneklerden izole edilen Candida suşlarının planktonik ve biyofilm formlarında, melatoninin antifungal duyarlılığa etkisi araştırıldı. Suşların identifikasyonu germ tüp testi, Mısır unu-Tween 80 agarda morfolojik değerlendirme ve otomatize sistem ile yapıldı. Modifiye mikroplak yöntemi ile biyofilm formasyonu araştırıldı. Biyofilm oluşumu gözlenen suşlarda antifungal duyarlılığını belirlemek için planktonik formda sıvı mikrodilüsyon yöntemi ile MİK, biyofilm formunda Calgary biyofilm yöntemi ile MBEK değerleri saptandı. Duyarlılık testleri melatonin varlığında tekrarlandı. Çalışmaya dahil edilen 350 adet suşun % 64,8'i C. albicans, % 15,7'si C. glabrata, % 8,6'sı C. tropicalis, % 5,4'ü C. parapsilosis, % 5,5'i diğer türler (C. kefyr, C. guilliermondii, C. dubliniensis, C. krusei, C. lusitaniae) olarak saptandı. Suşların % 9,7'sinde biyofilm oluşumu gözlendi; tür düzeyinde incelendiğinde C. albicans'ta biyofilm oluşumu % 2,6, Non-albicans Candida türlerinde ise % 22,7 olarak belirlendi. Planktonik formda antifungal duyarlılığı araştırılan bütün suşlar, amfoterisin B MİK değeri ?0,25 ?g/ml olduğu için duyarlı olarak değerlendirilirken; C. tropicalis suşlarından biri flukonazole karşı doza bağımlı duyarlı, bir C. albicans suşu da vorikonazole karşı doza bağımlı duyarlı ve kaspofungine dirençli, birer adet C. tropicalis ve C. kefyr suşu ise kaspofungine karşı dirençli olarak tespit edildi. Biyofilm formunda antifungal duyarlılığı araştırılan bütün suşlar, amfoterisin B MBEK değeri ?16 ?g/ml olduğu için dirençli olarak değerlendirilirken; flukonazole suşların üçü doza bağımlı duyarlı (C. albicans, C. parapsilosis, C. guilliermondii), diğerleri dirençli; vorikonazole sadece C. guilliermondii duyarlı, diğerleri dirençli; kaspofungine ise tüm suşlar dirençli olarak saptanmıştır. Antifungallerle melatonin kombine edilerek tekrar edilen antifungal duyarlılık testleri sonucu hem MİK hem de MBEK değerlerinde düşüş gözlendi. Ancak planktonik formda dirençli veya doza bağımlı duyarlı olan suşlar duyarlı hale gelirken, biyofilm formunda MBEK değerinde düşüş olsa da suşların direnç profilinde değişiklik gözlenmedi. Sonuç olarak antifungal ajanlarla kombine edilmesi sonucu MİK ve MBEK değerlerinde görülen düşüş, melatoninin Candida enfeksiyonlarının tedavisinde yeni bir alternatif olabileceğini düşündürmektedir.In recent years, significant increase in the isolation of the antifungal resistant Candida species in the presence of biofilm has made it mandatory to develop alternative agent for the treatment of these infections. In this study the effect of melatonin to antifungal susceptibility in planktonic and biofilm forms of Candida strains which isolated from clinical samples that sent to Duzce University, Faculty of Medicine, Department of Medical Microbiology was investigated. The identification of the strains made with germ tube test, cornmeal-Tween 80 agar morphological assessment and automated system. Biofilm formation was investigated with modified microplate method. MIC and MBEC values were detected with broth microdilution method for planktonic form and Calgary biofilm method for biofilm form, respectively to determine antifungal susceptibility of strains which biofilm formation was observed. Susceptibility tests were repeated in the presence of melatonin. The species distribution of the 350 strains which included in the study 64,8% C. albicans, 15,7% C. glabrata, 8,6% C. tropicalis, 5,4% C. parapsilosis, 5,5% other species (C. kefyr, C. guilliermondii, C. dubliniensis, C. krusei, C. lusitaniae) were determined. Biofilm formation was observed in 9.7% of the strains. Considering the species level biofilm formation reported in C. albicans was 2,6% while Non-albicans Candida species was 22,7% . All strains which investigated antifungal susceptibility in planktonic form were susceptible to amphotericin B. One of the C. tropicalis strains was susceptible-dose dependent to fluconazole, one C. albicans strain was susceptible-dose dependent to voriconazole and resistance to caspofungin, one each C. tropicalis and C. kefyr strains were resistance to caspofungin. All strains which investigated antifungal susceptibility in biofilm form were resistance to amphotericin B. Three of the strains (C. albicans, C. parapsilosis, C. guilliermondii) were susceptible to fluconazole while other strains were resistance. Only C. guilliermondii was susceptible to voriconazole while others were resistance. All of the strains were resistance to caspofungin. According to the repeated antifungal susceptibility tests presence of melatonin, both MİC and MBEC values were decreased. In planktonic form, resistance or susceptible-dose dependent strains became susceptible while in biofilm form even if MBEC values were decreased, strains resistance profile was not changed. Consequently, the result of the combination of melatonin with antifungal agents decline in the value of MIC and MBEC suggests that melatonin is a new alternative in the treatment of Candida infections

Antimicrobial Activity of the Istranca Oak (Quercus hartwissiana Steven) against Nosocomial Pathogens

Amaç: Bu çalışmada, Istranca meşesi (Quercus hartwissiana Steven) kabuğu ekstraktlarının bakteriyelve fungal patojenlere karşı antimikrobiyal aktivitesini araştırmak amaçlanmıştır.Gereç ve Yöntemler: Istranca meşesinin, etanol, formaldehit, aseton, etil asetat ve metanol çözücüleriile ekstraksiyonu gerçekleştirilmiştir. Bu ekstraktlardan 50 µl alınarak steril disklere emdirildiktensonra ekstraktlarda bulunan çözücülerin sonucu etkilememesi amacıyla diskler 24 saat steril ortamdakurutulmuştur. Disk difüzyon yöntemiyle Pseudomonas aeruginosa, Acinetobacter baumannii, Escherichiacoli, Klebsiella pneumoniae, Salmonella spp., metisilin dirençli Staphylococcus aureus, metisilinduyarlı Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus spp., Candida albicans,Candida glabrata ve Candida tropicalis türlerine karşı antimikrobiyal aktivite araştırılmıştır.Bulgular: En geniş zon çapının etanolle hazırlanan ekstraktta Enterococcus spp. (8 mm) ve S. epidermidis(8 mm) suşlarına, formaldehit ve etil asetatla hazırlanan ekstraktlarda E. Coli suşuna (16 mm,28 mm), asetonla hazırlanan ekstraktta Enterococcus spp. suşuna (21 mm), metanolle hazırlananekstraktta ise metisilin duyarlı S. aureus suşuna (28 mm) karşı oluştuğu görülmüştür. Mayalarda iseen geniş zon çapının etanolle hazırlanan ekstraktta C. glabrata suşuna (12 mm), formaldehitle hazırlananekstraktta C. albicans (28 mm) ve C. tropicalis (28 mm) suşlarına, aseton, etil asetat ve metanollehazırlanan ekstraktlarda C. albicans suşuna (19 mm, 30 mm, 22 mm) karşı oluştuğu saptanmıştır.Tartışma ve Sonuç: Etil asetat ile hazırlanan ekstraktın diğer çözücülerle hazırlanan ekstraktlara kıyaslaçalışılan suşlara karşı daha geniş zon çapı oluşturduğu saptanmıştır. En geniş zon çapı E. coli, S. aureusve C. albicans türlerinde oluştuğundan, ülkemizde doğal olarak yetişen Istranca meşesinin inhibeedici etkilerine yönelik in vivo antimikrobiyal çalışmalar yapılmasının önemli olduğunu düşünmekteyiz.Aim: This study aimed to investigate the antimicrobial activity of extracts from the Istranca oak (Quercushartwissiana Steven) against bacterial and fungal pathogens.Materials and Methods: Extraction of the Istranca oak was carried out with ethanol, formaldehyde,acetone, ethyl acetate, and methanol solvents. After injecting 50 ?l of these extracts into sterile discs,the discs were dried in a sterile environment for 24 hours in order for the results not to be affected bythe solvents present in the extracts. Antimicrobial activity against the species Pseudomonas aeruginosa,Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Salmonella spp., methicillin-resistantStaphylococcus aureus, methicillin-susceptible Staphylococcus aureus, Staphylococcusepidermidis, Enterococcus spp., Candida albicans, Candida glabrata and Candida tropicalis was investigatedby disc diffusion method.Results: It was observed that the extract prepared with ethanol showed the widest zone diameteragainst Enterococcus spp. (8mm) and S. epidermidis (8mm), the extracts with formaldehyde and ethylacetate against E. coli (16mm, 28mm), the extract with acetone against Enterococcus spp. (21mm),and the extract with methanol against methicillin-susceptible S. aureus (28mm). For the yeasts, theextract prepared with ethanol showed the widest zone diameter against C. glabrata (12mm), the extractwith formaldehyde against C. albicans (28mm) and C. tropicalis (28mm), and the extracts preparedwith acetone, ethyl acetate, and methanol against C. albicans (19mm, 30mm, 22mm).Discussion and Conclusion: It was determined that the extract prepared with ethyl acetate showedwider zone diameter against the strains studied, compared to extracts prepared with the other solvents.Given that the widest zone diameters were observed against the strains E. coli, S. aureus and C.albicans, we think that it is important to conduct in vivo antimicrobial studies on the inhibitory effectsof the Istranca oak indigenous to our country

Evaluation Of Use Of Blood And Blood Components By Clinics At Düzce University Health Application And Research Center

Objective: Blood transfusion is equivalent to tissue transplantation, and is a life-saving treatment with many risks associated with it. The inability to reach blood and blood components at all times and the inadequate number of volunteer blood donors are important problems of our country's health. It is also very important to use it only when necessary, such as the origin of blood and blood components. This study was conducted to evaluate the use of blood and blood components according to clinics at Düzce University Health Application and Research Center.Methods: The data of patients who underwent blood transfusion in our hospital clinics between January and December 2016 were reviewed retrospectively.Results: Patients (n=2745) were included in the study. The number of blood components unit were 8749 and requested from the clinics for these patients; it was determined that 7341 (84%) units were used. Blood and blood components were found to be the most used in patients older than 65 years (4095/55.8%). It was seen that the most preferred blood component by clinics was erythrocyte suspension (4327/59%). Erythrocyte suspension, platelet suspension and cryoprecipitate were mostly used by internal clinics while whole blood and fresh frozen plasma were found to be the most used by surgical clinics. There was a difference between the number of blood component requests and usage of the clinics. It has been determined that the incidence of the number of erythrocyte suspension and fresh frozen plasma requests and usage numbers is higher in the surgeon clinics than in other clinics. Whole blood use was found to be extremely low in our hospital (41/0.55%).Conclusion: In some clinics, more blood components than used were requested. It is thought that detailed evaluation should be done at transfusion committee meetings because this situation causes unnecessary extermination in blood products

Kan Transfüzyonu ve Reaksiyonları İle İlgili Sağlık Çalışanlarının Bilgi Düzeylerinin Araştırılması

Amaç: Kan transfüzyonu, organ nakli gibi önemli bir girişim olarak düşünülmektedir. Kan ve kan ürünleri transfüzyonuhayat kurtarıcı olduğu gibi hata ve ihmal yapılması durumunda ciddi sorunlara, hatta hayatı tehdit edebilecek kayıplaraneden olmaktadır. Günümüz modern kan bankacılığında temel kurallardan biri hastaya gereken kan bileşenleriningüvenli bir şekilde transfüze edilmesinin sağlanmasıdır. Bu çalışma, kan ve kan ürünleri transfüzyonu konusundahemşirelerin bilgi düzeylerinin belirlenmesi amacıyla yapılmıştır.Gereç ve Yöntemler: Çalışmamızda, Düzce Üniversitesi Araştırma ve Uygulama Merkezi’nde kan transfüzyonuyapılan kliniklerinde çalışan 100 sağlık personeline 30 sorudan hazırlanmış olan anket uygulaması yapılmıştır. Anketformunda yaş, eğitim durumu, cinsiyet, çalışma süresi, kan transfüzyonuna yönelik hizmet içi eğitim programlarınakatılıp katılmadığı gibi kişisel bilgileri içeren altı soru bulunmaktadır. Diğer sorular kan ve kan ürünleri transfüzyonusonrası bakıma ve komplikasyonlara yönelik bilgileri saptamak amacıyla oluşturulmuştur. Verilerin istatistikseldeğerlendirmesinde Ki-kare testi kullanılmıştır.Bulgular: Çalışmaya katılanların tümü transfüzyon öncesi hasta kan grubu ile ürün kan grubunu ve hasta ismi iletransfüzyon takip formundaki ismin aynı olup olmadığını kontrol ettiğini belirtmiştir. Ayrıca cross-match yapıldığına veuygunluğuna dikkat ettiğini; transfüzyon öncesi ve sonrasında hastanın vital bulgularına baktığını bildirmiştir. Anketekatılanların %46’sı kanın koltuk altında ısıtılarak uygulanması gerektiği bilgisine sahiptir. Meslekte 11 yıldan uzunsüredir çalışanların transfüzyonla bulaşan enfeksiyonlar konusundaki bilgi düzeyinin, daha kısa süredir çalışanlardandaha yüksek olduğu görülmüştür.Sonuç: Meslekte daha uzun süredir çalışanların anket sorularına doğru cevap verme oranlarının yüksek olduğugörüldüğü için eğitimlerin sık aralıklarla tekrarlanması gerektiği düşünülmüştür.Aim: Blood transfusion is considered to be an important intervention such as organ transplantation. Blood and blood components transfusion is lifesaving; but if mistakes and negligence are made, it causes serious problems and even loss of life threatening. One of the main principles in modern day blood banking is ensuring that blood components that are needed for the patient are safely transfused. This study was conducted to determine the knowledge levels of nurses about blood and blood products transfusion. Material and Methods: In our study, a questionnaire of 30 questions was made on 100 health personnel working in blood transfusion-applied clinics of Duzce University Research and Application Center. There were six questions including personal information such as age, education level, gender, duration of work, participation in in-service training programs for blood transfusion, in the questionnaire. Other questions were established to determine the information related to care and complications after transfusion of blood and blood components. Chi-square test was used for statistical evaluation of the data. Results: All of the participants stated that they checked the patient blood group and component blood group and the name of the patient and the name in the transfusion follow-up form before transfusion. Participants also noted that cross-match was made and paid attention to its suitability; reported that looked at the vital signs of the patients before and after transfusion. Forty-six percent of participants stated that the blood had to be heated underarm. Employees who have been in employment for more than 11 years have been found to be aware of transfusion-transmitted infections at a higher rate than those who work shorter periods. Conclusion: Since it is seen that those who work longer in the profession have a higher rate of responding correctly to the questionnaire questions; it is thought that the training should be repeated at frequent intervals

Leptospirosis: A six-case report from west black sea, Turkey

PubMed ID: 32172267Leptospirosis is a ubiquitous acute bacterial zoonosis. This report describes six cases presenting to our hospital with symptoms such as fever and muscle pain and diagnosed as leptospirosis. All cases presented with fever, muscle pain, and lethargy and were engaged in activities such as farming, hunting, and fishing. Thrombocytopenia and impaired liver function tests were found in all patients, increased cre-atine-kinase in five, and increased creatinine in four. Leptospirosis was diagnosed using polymerase chain reaction (PCR). The course of the disease resulted in cure in three cases, chronic kidney disease sequelae in one, and death in two. In conclusion, the possibility of leptospirosis should be considered in patients presenting with non-specific symptoms such as fever and muscle pain and developing thrombocytopenia, and liver and kidney function disorder. Risk factors should also be investigated when taking histories. Early diagnosis and antibiotic therapy being started as quickly as possible are important in terms of the course of the disease. © 2020, EDIMES Edizioni Medico Scientifiche. All rights reserved

Investigation of the Effect of Stethoscope Usage on External Ear Canal and Resistant Bacterial Colonization Among Healthcare Workers

Kilincel, Ozge/0000-0003-1872-6670WOS: 000512305000011Introduction: The aim of this study was to determine whether the use of stethoscope affects the flora of external ear canal of healthcare workers and to investigate the colonization of bacteria that are the causative agents of hospital infections in the external ear canal. Materials and Methods: The study was conducted in our hospital between September-December 2017 with 156 healthcare workers who agreed to participate in the study. Participants were asked questions such as demographic data, habit of using common stethoscope, and frequency of stethoscope cleaning. The cultivation and incubation of the swab specimens taken from the right-left external ear canal were performed in appropriate conditions in the microbiology laboratory. The growth of coagulase-negative staphylococcus, bacillus and diphteroids alone or in combination was evaluated as normal flora. Results: Of the 156 healthcare workers with a mean age of 30.5 +/- 6.2 years, 46 (29.5%) reported not using stethoscope. When the right and left ear were evaluated together, normal flora was observed in 128 (82.1%) of the participants, 25 (16.0%) had no bacterial growth, 2 (1.3%) Pseudomonas aeruginosa, and 1 (0.6%) Acinetobacter baumannii growths were observed. It was determined that using or not using stethoscope did not affect bacterial growth in the right-left ear. In stethoscope users, it was observed that the frequency of cleaning of stethoscope was significantly higher in nurses than in doctors. Conclusion: In the study, the presence of P. aeruginosa in two healthcare workers, the lack of frequent cleaning practices and the use of common stethoscope in both workers suggested that stethoscopes could be the source of the transmission of infectious agents when the rules of sanitation were not applied. The fact that the person who was colonized with A. baumannii was a personnel working in the intensive care unit showed that the measures against this infectious agent should be increased in intensive care units

Screening Children for Infection with Hymenolepis diminuta due to a Previous Case Reported from the Same Village

Amaç: Bu çalışmada, daha önce Düzce'deki Kemerkasım köyünde yaşayan 21 aylık bir erkek çocukta Hymenolepis diminuta enfeksiyonu saptanması nedeniyle, aynı bölgede yaşayan tüm çocuklarda bu parazitin varlığının araştırılması amaçlanmıştır.Gereç ve Yöntemler: Köyde yaşayan ve yaşları 3 ay ila 11 yıl arasında değişen 83 çocuğun hepsi çalışmaya dahil edilmiştir. Çocukların ailelerine ulaşılmış ve çalışmanın amacı anlatılmıştır. Çalışmaya katılmayı kabul eden ailelere sözlü anket uygulanmış, çocuklardan alınan gaita örnekleri aynı gün laboratuvarda makroskobik ve mikroskobik olarak incelenmiştir. Mikroskobik incelemede direkt taze preparat ve konsantrasyon yöntemi kullanılmıştır.Bulgular: Hiçbir çocukta Hymenolepis diminuta saptanmamış, ancak dört çocukta Giardia intestinalis enfeksiyonu tespit edilmiştir.Tartışma ve Sonuç: Sonuç olarak bir çocukta daha önce Hymenolepis diminuta saptanmış olması nedeniyle aynı çevrede yapılan taramada bu türden yeni bir vakaya rastlanmamıştır. Enfeksiyonun bu bölgede sporadik olduğu düşünülmüştürAim: We previously reported that we detected Hymenolepis diminuta infection in a 21-monthold boy in the the Kemerkasım village in the Düzce province of Turkey. In this study, we aimed to screen all of the children in the same region for infection with Hymenolepis diminuta.Material and Methods: All of the eighty-three children who lived in this village and were aged between 3 months and 11 years were included in the study. The children's families were reached and informed about the aim of the study. The families who agreed to participate in the study were surveyed verbally, and the stool samples obtained from the children were examined macroscopically and microscopically within the same day. Fresh preparation and concentration methods were used for the microscopic examination. Results: Hymenolepis diminuta was not found in any of the children, but four children were found to have been infected with Giardia intestinalis. Discussion and Conclusion: No new cases were detected during the screening for infection with Hymenolepis diminuta, performed due to a previous case reported in the same region; and we have concluded that Hymenolepis diminuta infection is sporadic in this regio

The effect of melatonin on antifungal susceptibility in planktonic and biofilm forms of Candida strains isolated from clinical samples

Kilincel, Ozge/0000-0003-1872-6670WOS: 000460630700006PubMed: 29390164In recent years, the significant increase in the isolation ofantifungal resistantCandidaspecies in presence of biofilm, have made it necessary to develop alternative agents for the treatment of these infections. In this study, the effect of antifungal susceptibility of melatonin were investigated in planktonic and biofilm forms of Candida strains isolated from theclinical samplessent to our laboratory. Biofilm formation was determined by modified microplate method. In order to determine antifungal susceptibility in biofilm-forming strains, MIC was determined by broth microdilution method in planktonic form, and MBEC values by Calgary biofilm method in biofilm form. Susceptibility tests were repeated in the presence of melatonin. Antifungal susceptibility tests repeated with antifungals combined with melatonin showed a decrease in both MIC and MBEC values;melatonin was found to be more effective especially in planktonic forms. While the most effective combination was achieved with fluconazole in the planktonic form, no statistically significant difference was found between the combinations in biofilm form. As a result, melatonin was thought to be a new alternative in the treatment of Candida infections.Duzce University Scientific Research Projects CommissionDuzce University [2015.04.01.352]This work was supported by Duzce University Scientific Research Projects Commission [grant number 2015.04.01.352]

Urinary system infection at diabetes mellitus and obesity patients: A retrospective evaluation [Diabetes mellitus ve obezite hastalarında üriner sistem enfeksiyonu: Geriye dönük değerlendirme]

Aim: In this study, it was aimed to investigate the distribution of isolated pathogens, the resistance rates of these pathogens to antimicrobials, presence of glycosuria and pyuria in patients with diabetes mellitus (DM) and obesity in adult and pediatric endocrine outpatient clinics with urinary system infections. Material and Methods: Between January 2012 and February 2014, records of 107 patients with DM and obesity in Duzce University Medical Faculty Hospital Adult and Pediatric Endocrine outpatient clinics were retrospectively reviewed. Biochemical/microbiological laboratory results of urine specimens taken from these patients were evaluated. Fisher Exact and Pearson Chi-Square tests were used with statistical evaluation of SPSS 22.0 program. Results: Thirty-two (70%) of the patients were children, 75 (30%) are adults; 84 (78.5%) were female, 23 (21.5%) were male, mean of ages 25.1±23. Number of patients with diabetes and obesity were 76 (71.0%) and 31 (29.0%), respectively. Bacterial growth occurred 28 (26%) of urine cultures (23 (30.2%) of patients with DM, 5 (16.1%) of patients with obesity). E. coli was detected most frequently as causative agent. In patients with pyuria and glycosuria, more bacterial growth were detected and statistically significant correlation was found between pyuria and bacterial growth, but no significant relationship was found with glycosuria. Conclusion: Although glycosuria may increase the risk of infection, it may not be a determining parameter alone, but patients should be assessed considering the current risk; it has also been found that there is a strong relationship between the presence of the pyuria and urinary tract infection. However, it is considered appropriate to start antibiotic treatment according to the causative agent and sensitivity profile isolated in urine culture rather than to start empirical treatment according to the complete urine analysis result. © 2018, Duzce University Medical School. All rights reserved