The Isolates of Bacteriuria and Fungiuria: Single Center Laboratory-Based 14-Year Analysis

Introduction: Developing and changing medical practices may cause a change in the frequency, variety and susceptibility of infection agents over years. Therefore, the analysis reports of the isolates in urinary tract infections (UTIs) will provide significant contributions to the correct management of these infections. We aimed to analyze the trends of frequency, distribution and antimicrobial susceptibility of agents isolated from urine cultures of both ambulatory patients and inpatients in this study. Materials and Methods: We evaluated the results of urine cultures for a 14-year period, retrospectively. Results: A total of 49.034 isolates from 46.626 culture positive nonrepetitive specimens were included. The most common isolate was E. coli (46.2%), followed by Enterococcus species (12.2%). Significant differences in species distribution were observed based on gender and the units where patients were treated, including ambulatory care, inpatient units, and intensive care units. The highest susceptibility rates for E. coli were observed with imipenem (≥99%) and amikacin (≥86%). The susceptibility of E. coli to cefazolin decreased over the years (from 70% to 32%). Enterococcus spp. were susceptible to vancomycin and linezolid with high rates (≥92% and ≥95%, respectively). A prominent decrease was observed in the susceptibility rate for Enterococcus spp. against ampicillin in years; from 94% to 68%. A continuous decreasing trend was detected in the susceptibility of Klebsiella spp. Conclusion: E. coli continues to be the most common urinary isolate. The distribution and frequency of isolates may show difference among centers and units. Continuous monitoring of antimicrobial susceptibility is important for accurate management of UTIs

Knowledge, beliefs, and practices regarding tick bites in the Turkish population in a rural area of the Middle Anatolian Region

The aim of this study is to determine the knowledge, beliefs, and practices of a population living in a rural area in regards to tick bites and Crimean-Congo hemorrhagic fever (CCHF). The study was conducted in a rural area located in Central Anatolia in the region of EskiAYehir. A total of 1,500 individuals aged 20 years and older chosen by a stratified random sample were enrolled. A questionnaire was administered in person. In 264 (17.4%) participants, there was a history of being bitten by a tick. This rate was higher in older persons, males, married persons, and farmers. The most commonly reported protective behavior was wearing long sleeves and long pants when wandering in rural areas (65.1% of participants). The least commonly reported behavior was using insect repellent on skin or clothes (3.3% of participants). Only 799 participants (54%) had heard about CCHF as a disease associated with ticks. Females, those with primary school education, housewives, and male farmers had a high frequency of having heard about CCHF. Tick bites and CCHF are important public health problems, yet the current knowledge of these problems is not sufficient in populations living in rural areas of the Middle Anatolian Region of Turkey

Investigation of Human Papillomavirus Prevalence in Women in Eskişehir, Turkey by Pap Smear, Hybrid Capture 2 Test and Consensus Real-Time Polymerase Chain Reaction and Typing with Pyrosequencing Method

İnsan papillomavirus (HPV) enfeksiyonları, subklinik veya asemptomatik enfeksiyonlardan anogenital kanserlere kadar değişen geniş bir klinik spektruma sahiptir. Önlenebilir bir hastalık olarak düşünülen servikal kanser (SK), dünyada, kadınlarda üçüncü en sık görülen kanser türü olduğundan, SK taramalarında HPV-DNA'sının saptanması ve risk grubunun belirlenmesi büyük önem taşımaktadır. Bu çalışmada, Eskişehir'de, kadınlarda HPV-DNA varlığının iki farklı moleküler yöntemle araştırılarak, moleküler yöntem sonuçlarının hem birbirleriyle hem de sitoloji sonuçlarıyla karşılaştırılması amaçlanmıştır. Araştırmaya, Eskişehir Kanser Erken Teşhis, Tarama ve Eğitim Merkezi'ne (KETEM) tarama amaçlı başvuran, 30-65 yaş arası 1081 kadın dahil edilmiştir. Katılımcılardan Pap yayması ve moleküler yöntemler için, eş zamanlı üç ayrı servikal sürüntü örneği alınmıştır. Araştırmanın ilk aşamasında, tüm servikal örneklerde HPV-DNA varlığı Hybrid Capture 2 (HC2; Qiagen, Almanya) yöntemiyle araştırılmış; ikinci aşamada ise HPVDNA'sı pozitif bulunan kadınların dahil edildiği, geri kalanının ise rastgele seçildiği toplam 152 kadının örnekleri konsensus gerçek zamanlı polimeraz zincir reaksiyonu (RT-PCR) ile tekrar çalışılmış (Takara Bio Inc., Japonya) ve HPV-DNA varlığı saptanan örneklerde pirodizilemeye dayalı ticari sistem (Diatech Pharmacogenetics S.R.L, İtalya) ile genotip tayini yapılmıştır. Çalışmanın ilk basamağında; kadınların %3 (32/1081)'ünde HC2 testi, 47 (%4.4)'sinde ise sitoloji sonucu tek başına ve/veya birlikte pozitif olarak raporlanmıştır. Beş (%0.5) örnekte her iki test ile de pozitif sonuç alınmış, bunların dördünde yüksek riskli HPV-DNA saptanmıştır. HC2 testi ile yüksek riskli HPV varlığı saptanan 23 (23/1081, %2.1) kadının 19'unda sitoloji sonuçları negatif olarak raporlanmıştır. Sitoloji sonucu pozitif olarak saptanan 42 (42/1081, %3.9) örnekte ise HC2 testi ile HPV-DNA varlığı saptanmamıştır. Çalışmanın ikinci aşamasına dahil edilen 152 örnekten 32 (%21.1)'si HC2 testi ile, 40 (%26.3)'ı Pap yayması ile, 53 (%34.9)'ü de konsensus RT-PCR ile tek başına ve/veya birlikte pozitif bulunmuştur. HC2 testi ile pozitif saptanan 32 örneğin tamamı konsensus RT-PCR ile de pozitif olarak saptanmış; ancak RT-PCR ile pozitif saptanan 21 örnek HC2 testi ile negatif sonuç vermiştir. Sitolojisinde anomali saptanan 40 örneğin ise dokuzunda (%22.5) RT-PCR ile ve beşinde (%12.5) HC2 ile HPV-DNA varlığı gösterilirken 31 (%77.5) örnekte her iki yöntemle de HPV-DNA saptanmamıştır. Genotip tayini yapılabilen 44 örnekte en sık saptanan tip, HPV tip 16 (n=15, %34.1) olmuş, bunu tip 90 (n=11, %25) ve tip 18 (n=4, %9.1) izlemiştir. Çalışmamızda, FDA (U.S. Food and Drug Administration) onaylı HC2 testi esas alındığında, Pap yaymasının duyarlılık, özgüllük, pozitif ve negatif prediktif değerleri, sırasıyla %16.1, %96, %10.6 ve %97.5 olarak saptanmıştır. HC2 ve konsensus RT-PCR yöntemleri arasında ise önemli derecede uyumluluk (Cohen's kappa: 0.665) bulunmuştur. Sonuç olarak, ülkemizdeki sitopatolog sayısının yetersizliği ile birlikte, ASCCP (American Society for Colposcopy and Cervical Pathology) ve FDA'nın da önerileri göz önüne alındığında; SK taramasının tam ve etkin şekilde yapılabilmesi için, Pap testine ilave olarak moleküler tanı yöntemlerinin uygulanmasına ihtiyaç olduğu bir kez daha ortaya konmuşturHuman papillomavirus (HPV) infections have a broad range of clinical spectrum from subclinical or asymptomatic infection to anogenital carcinoma. The detection of HPV-DNA and determination of the risk groups in cervical cancer (CC) screening is very important because CC is considered to be a preventable illness which is the third most common cancer type of women in the world. The aims of this study were to investigate the presence of HPV-DNA in women by two different molecular methods and to compare their results together with the results of cytology, in Eskişehir, Central Anatolia, Turkey. A total of 1081 women aged between 30-65 years, who applied to Eskişehir Early Diagnosis, Screening and Training of Cancer Center (KETEM) for screening were included in the study. Three separate cervical samples were collected simultaneously from the participants for cytologic examination and molecular studies. In the fi rst step of the study, all cervical samples were investigated for the presence of HPV-DNA by Hybrid Capture 2 (HC2; Qiagen, Germany) method. In the second part of the study, consensus real-time polymerase chain reaction (RT-PCR) (Takara Bio Inc., Japan) was performed in 152 samples which included HC2 positive and randomly selected negative samples, and then the HPV genotypes were detected by using a commercial kit based on pyrosequencing method (Diatech Pharmacogenetics S.R.L, Italy). In the fi rst part of the study, HC2 test was found positive in 3% (32/1081) of the women, while in 4.4% (47/1081) Pap smear was positive alone or with HC2 test. Five (0.5%) samples yielded positive results with both of the methods, and four of them were positive for high risk HPV types. Cytology results were negative in 19 out of 23 (23/1081, 2.1%) samples that were reported as high risk HPV by HC2 test. On the other hand, 42 (42/1081, 3.9%) samples that were positive by cytology yielded negative results by HC2 test. In the second part of the study, 32 (21.1%) of 152 selected samples were positive by HC2 test, 40 (26.3%) were positive by Pap smear, and 53 (34.9%) were positive by consensus RT-PCR. All of the 32 samples that were positive by HC2 were also positive by RT-PCR, however 21 samples that were positive by RT-PCR were negative by HC2 test. Among 40 samples that were positive (abnormal) by Pap smear, HPV-DNA was positive in nine (22.5%) by RT-PCR and in fi ve (12.5%) by HC2 test, but HPV-DNA was not detected in 31 (77.5%) samples by both of the tests. Genotyping of the strains could be performed in 44 samples, and the most common type detected was HPV type 16 (n=15, 34.1%), followed by type 90 (n=11, 25%) and type 18 (n= 4, 9.1%). In our study, the sensitivity, specifi city, positive and negative predictive values of Pap smear method were estimated as 16.1%, 96%, 10.6% and 97.5%, respectively, based on the HC2 results which was approved by U.S. Food and Drug Administration (FDA). In addition, a signifi cant degree of concordance was detected between HC2 and concensus RT-PCR methods (Cohen's kappa: 0.665). In conclusion, regarding the insuffi cient number of cytopathologists in our country and according to the recommendations of American Society for Colposcopy and Cervical Pathology (ASCCP) and FDA, it was once again demonstrated that, the implementation of molecular diagnostic methods in addition to the Pap smear for effective screening of CC are neede

The prevalence of tinea pedis and tinea manuum in adults in rural areas in Turkey

The aim of this study was to determine the frequency of tinea pedis and manuum (dermatophyte infections of the hands and feet) in adults in rural areas of Turkey, the risk factors and self-administered treatment options. A total of 2,574 people living in a rural area were enrolled in the study. Participants were asked demographic data, hygienic habits in a questionnaire. KOH preparations and culture were performed from suspicious lesions. Medical and alternative therapy methods and former dermatophytosis diagnosis history were taken from the respondents with suspicious lesions. Microbiological samples were taken from 285 (11.1%) participants. Culture was positive in 109 (4.2%) of those. The most common agent was Trichophyton rubrum. The predisposing factors were found as age older than 40, male gender and obesity. Forty-nine (44.9%) of patients had taken a medical therapy, 56 (51.4%) had performed non-medical methods (cologne, Lawsonia inermis-Henna and softener creams). Patient's education about the treatment compliance is important

Retrospective evaluation of “Rods and Rings” pattern detected in the anti-nuclear antibody (ANA) indirect immunofluorescence (IIF) test

Introduction: Anti-rods and rings (anti-RR) antibodies have recently been described as a cytoplasmic pattern in IIF-based screening of autoantibodies on HEp-2 cells and ICAP has named it as AC-23. It is most frequently related to drug-induced antibody generation. This study aimed to investigate the clinical significance of AC-23 positivity and its relevance to the diagnosis and/or follow-up of the associated diseases and/or drug use. Methods: A multicenter retrospective study was conducted among 10 hospitals from six different provinces in Türkiye from January 2017 to December 2021. The laboratory data and clinical information of 600 patients with positive anti-RR antibodies out of 547.558 HEp-2 IIF ANA samples were analyzed. Results: The distribution of AC-23 positive patients by year indicated a steady increase between 2017-2021. Anti-RR prevalence in post-COVID-19 period was significantly higher than that of pre-COVID-19 period (p=0.00). Concomitant ANA positivity was detected in 56.5% of patients, the most common patterns being AC-4 and AC-5 (41.1%). The most frequent pathology among the anti-RR positive patients was an autoimmune disease (19.83%); 28.57% of which had rheumatoid arthritis and 17.65% autoimmune liver disease. Among the 600 patients, 65 (10.83%) were diagnosed as hepatitis C virus (HCV) infection. Available data for 38 of the HCV patients revealed that 71.05% of them had a history of interferon alfa+ribavirin and 28.95% of them had a history of NS3/4/5A/5B polymerase inhibitor or protease inhibitor drug use. Significant increase in the rate of anti-RR positivity was observed in the post-COVID-19 period when compared to pre-COVID-19 period (p:0.00). Discussion: This is the first multicenter study in Türkiye about the clinical association of anti-RR antibodies which may be ignored during routine HEp-2 IIF testing. Pathologies other than HCV should be taken into consideration in terms of the possible role of anti-RR in autoimmune diseases and other pathologies. The preliminary data obtained in this study suggest that anti-RR antibody development might also be associated to COVID-19, supporting the several previous data related to the potential of viruses triggering the formation of autoantibodies. Large-scale prospective studies should elucidate the clinical significance of RR pattern and determine its role in patient diagnosis and follow-up