Antakya örneğinde Türkiye’de bildirimi zorunlu bulaşıcı hastalıklar ve bildirim durumu

Introduction: The aim of this study was to determine the frequency and notification status of notifiable infectious diseases (NIDs) in primary, secondary and tertiary healthcare institutions in Antakya. Materials and Methods: This cross-sectional research was conducted in 2015, in Antakya. In 19 family medicine units, 1 state, 1 private and 1 university hospitals representing health care institutions, the electronic codes of NIDs (Groups A, B, C, D) for the year 2014 in accordance with the case identification in surveillance system were analyzed by being scanned based on ICD-10 diagnostic codes. Descriptive statistics and Chi-square test were used in the analyses, and p< 0.05 was considered significant. Results: Having made 30 different types of 3923 NID diagnoses, 75.2% of the NIDs were in Group A, 15.0% in Group D, and 9.8% in Group C; 16.4% of the diagnoses were gotten in Syrian refugees. The wrong ICD-10 diagnostic code was given to 59.8% of the NIDs. 41.9% of the NIDs were notified; 51.7% of Group A, 17.7% of Group D and 0.6% of Group C were notified. State hospital notified 54.5% of the NIDs, private hospital 30.9% of and university hospital 12.0% (p< 0.001). Most frequently diagnosed NIDs were rabies and rabies risky contact (32.4%), varicella (18.4%), rotavirus (11.0%), toxoplasmosis (7.5%), leishmaniasis (7.3%), acute hepatitis A (6.7%), brucella (4.7%) and tuberculosis (3.1%). In Syrian patients, the most frequently diagnosed NCD was leishmaniasis (27.0%). Among the cases with NIDs diagnosis, the most notified ones were salmonella (100.0%), malaria (100.0%), rabies and rabies risky contact (96.8%), measles (81.0%), tuberculosis (76.9%), acut hepatitis A (26.3%), brucellosis (26.1%) and rotavirus (%16.6). Conclusion: NIDs are frequently observed in Turkey in the Antakya sample, and more than half of them are not notifiedGiriş: Bu çalışmanın amacı, Antakya’da birinci, ikinci ve üçüncü basamak sağlık hizmeti kurumlarında bildirimi zorunlu bulaşıcı hastalıkların (BZBH) görülme sıklığını ve bildirim durumunu saptamaktır. Materyal ve Metod: Bu kesitsel çalışma 2015 yılında Antakya’da yapılmıştır. Sağlık kurumlarını temsil eden 19 aile hekimliği birimi, bir devlet, bir özel ve bir üniversite hastanesinde sürveyans sistemi olgu tanımlamasına uygun BZBH (A, B, C, D Grubu)’lerin 2014 yılı elektronik kayıtları, ICD-10 tanı kodlarına göre taranarak analiz edilmiştir. Analizlerde tanımlayıcı istatistikler ve ki-kare testi kullanılmış, p< 0.05 önemli kabul edilmiştir. Bulgular: Otuz farklı tipte 3923 BZBH tanısı konulmuş olup, %75.2’si A, %15.0’ı D ve %9.8’i C grubundadır; %16.4’ü Suriyeli sığınmacılara aittir. BZBH’lerin %59.8’ine yanlış ICD-10 kodu verilmiştir. BZBH’lerin %41.9’u bildirilmiştir; Grup A’nın %51.7’si, Grup D’nin %17.7’si ve Grup C’nin %0.6’sı bildirilmiştir. BZBH’lerin devlet hastaneleri %54.5’ini, özel hastaneler %30.9’unu, üniversite hastaneleri ise %12.0’ını bildirmiştir (p< 0.001). En sık tanısı konulan BZBH’ler; kuduz ve kuduz riskli temas (%32.4), suçiçeği (%18.4), rotavirüs infeksiyonu (%11.0), toksoplazmozis (%7.5), leyşmanyaz (%7.3), akut hepatit A (%6.7), brusellozis (%4.7) ve tüberküloz (%3.1)’dur. Suriyeli sığınmacılarda en çok tanısı konulan leyşmanyadır. BZBH tanısı konulanlar içinde en çok bildirimi yapılanlar; salmonella infeksiyonu (%100.0), sıtma (%100.0), kuduz ve kuduz riskli temas (%96.8), kızamık (%81.0), tüberküloz (%76.9), akut hepatit A (%26.3), brusella (%26.1) ve rotavirüs (%16.6)’tür. Sonuç: Bildirimi zorunlu bulaşıcı hastalıklar Türkiye’de Antakya örneğinde sık gözlenmekte olup, yarısından fazlası bildirilmemektedi

Doğankent Sağlık Eğitim Araştırma Bölgesindeki 15-49 yaş kadınların ruh sağlığı ve aile içi şiddete maruz kalma açısından değerlendirilmesi üzerine bir çalışma

TEZ4708Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2003.Kaynakça (s. 70-77) var.xi, 93 s. ; 30 cm.

Ergenlerde İnternet kullanımı ile uyku problemleri arasındaki ilişki

Giriş: Uyku sorunları ergenlerde sık olarak görülmektedir. Elektronik medyanın ergenlerin uyku kalitelerini ve günlük işlevselliklerini olumsuz etkilediği gösterilmiştir. Bu çalışma ergenlerde internet kullanımı ile uyku problemleri arasındaki ilişkiyi incelemeyi amaçlamaktadır. Yön­tem­: Toplam 1212 ergen çalışmaya dahil edildi. Kendi bildirim çalışma anketi iki ana bölüm içeriyordu: Young’ın İnternet Bağımlılık Ölçeği (İBÖ) ve uyku alışkanlıkları/uyku problemleri üzerine yarı yapılandırılmış bir ölçek. Bul­gu­lar: Çalışma örnekleminin %16’sı uyku kalitelerini kötü ya da çok kötü değerlendirdi. Örneklemin dörtte biri interneti hergün kullandığını bildirirken, %27’si online olduğunda bir saatten fazla zaman geçirdiğini bildirdi. Ortalama İBÖ total skoru 35,56±13,87 idi. Yüksek İBÖ skoru olan ergenlerin düşük İBÖ skoru olanlara göre gece yatağa daha geç gittiği, uykuya dalmak için daha uzun süreye ihtiyaç duyduğu ve gece daha sık uyandığı bildirildi (p=0,001). Yüksek İBÖ skoru olan ergenlerde içlerinde uykuya dalma ve sürdürme güçlükleri, uyanma güçlüğü ve gün içinde uykulu hissetmeyi içeren çok sayıda uyku probleminin daha sık olduğu bulundu. Ayrıca, uyku kaliteleri düşük İBÖ skoru olan ergenlere göre daha kötü idi (p=0,001). So­nuç: Problemli uyku alışkanlıkları ve uyku sorunlarının yüksek İBÖ skoru olan ergenlerde daha sık olduğu bulundu. Sağlık çalışanları, aşırı ve kontrolsüz internet kullanımının ergenlerin uyku alışkanlıkları üzerine yaptığı muhtemel olumsuz etkiler konusunda farkında olmalıdırlar.Introduction: Sleep problems are commonly encountered in adolescents. It has been shown that electronic media have a negative influence on the sleep quality and daytime functioning in adolescents. This study aims to investigate the association between internet use and sleep problems in adolescents. Met&shy;hod: A total of 1212 adolescents were recruited to the study. Self-report study questionnaire included two main parts: Young’s Internet Addiction Scale (IAS) and a semi-structured inquiry on sleep habits/problems. Re&shy;sults: Of the study sample, 16% (n=198) reported their sleep quality as bad or very bad. One-fourth of the sample reported using internet everyday and 27% of them reported spending more than one hour when online. The mean IAS total score was 35.56&plusmn;13.87. Adolescents with a higher IAS score reported getting to bed later in the night, needing more time to fall asleep and having an increased number of awakenings in the night than the adolescents with lower IAS score (p=0.001). They were also found to have higher frequencies of several sleep problems including difficulty in initiating and sustaining sleep, difficulty in waking up and feelings of sleepiness in day. In addition, sleep quality of them was worse when compared to the adolescents with a lower IAS score (p=0.001). Conc&shy;lu&shy;si&shy;on: Problematic sleep habits and sleep problems were found to be more frequent in adolescents with a higher IAS total score. Health care providers must be aware of the possible negative impact of excessive and uncontrolled internet use on adolescents’ sleep habits

Tıp, hemşirelik ve sağlık meslek yüksekokulu öğrencileri Hepatit B’den korunuyor mu: Hatay’dan kesitsel bir çalışma, Türkiye

Aim: Hepatitis B is an important public health problem and many groups, including health workers, are at risk for hepatitis B. We aimed to determine the hepatitis B surface antibody levels and frequency of needlestick injury among health occupations students. Method: The study population and sample were 973 students in Mustafa Kemal University, Medical, Nursing and Health Vocational High School in 2015. Of the students, %63 were reached, and 67.7% of them gave blood samples. Anti-HBS values were calculated by enzyme-linked immunosorbent assay and an antibody titer over 10 mIU/mL was accepted as positive. Results: The mean age was 20.9 ± 2.7 and 68.5% were female. Anti-HBs positivity was 54.5%, and 37.3% of the vaccinated group was still anti-HBS negative. The difference in anti-hepatitis B positivity was not significant in terms of sex, age group and school, but it was higher in vaccinated students than in others (p <0.05). 29.0% of participants had a history of needle-stick injury. The highest percentage was in health emergency and anaesthesia departments (p <0.001). Needle-stick injury was observed more often in senior students.Amaç: Hepatit B önemli bir halk sağlığı sorunudur ve sağlık çalışanları dahil pek çok grup hepatit B açısından risk altındadır. Bu çalışmada tıp, hemşirelik ve sağlık meslek yüksekokulu öğrencilerinin anti-hepatit B antikor düzeylerini ve iğne batması sıklığını belirlemek amaçlanmıştır. Yöntem: Çalışmanın evreni ve örneklemi 2015 yılında Mustafa Kemal Üniversitesi Tıp, Hemşirelik ve Sağlık Meslek Yüksek Okulu ilk ve son sınıfında okuyan 973 öğrencidir. Öğrencilerden % 63’üne ulaşılabildi ve bunların % 67.7’sinden kan örneği alındı. Serum örneklerindeki hepatit B yüzey antikoru değerleri “enzyme-linked immunosorbent assay” yöntemiyle çalışıldı, antikor titresi 10 mIU/mL üzeri pozitif kabul edildi. Bulgular: Öğrencilerin yaş ortalaması ve standart sapması 20.9±2.7 olup % 68.5’i kadın idi. Anti-HBs pozitifliği % 54.5 olarak elde edildi. Anti-HBs pozitifliğindeki farklılık cinsiyet, yaş grubu ve okul açısından farksız iken, aşılı olanlarda diğerlerine göre daha yüksek idi (p<0.05). Katılımcıların % 29.0’unda iğne batması öyküsü vardı. En yüksek sıklık sağlık acil ve anestezi bölümü öğrencilerinde idi (p<0.001). Son sınıf öğrencilerinde iğne batması daha sık gözlendi. Sonuç: Öğrencilerin yaklaşık yarısında anti-HBs negatiftir ve çalışma ortamında yaralanma riskleri yüksektir. Buna karşın hepatit B’den korunmak amacı ile staj yapmakta olan öğrenciler için açık bir politika yoktur. Sağlık kuruluşlarında staj yapan öğrencileri işyeri risklerinden koruyacak bir politika gereklidir

Serum levels of nitric oxide and malondialdehyde in patients with brucellosis

Amaç: Bu çalışmanın amacı bruselloz hastalarında serum nitrik oksit (NO) ve malondialdehit (MDA) düzeylerini saptamak; bulunan NO ile MDA değerlerini, eritrosit sedimentasyon hızı (ESR), aspartat aminotransferaz (AST), alanin aminotransferaz (ALT) gibi laboratuvar testleri ve ateş, terleme, eklem ağrısı gibi klinik bulgularla karşılaştırmaktı. Gereç ve Yöntemler: Bu çalışmada 39 brusellozlu hastada tedaviden önce ve kontrol grubu olarak 20 sağlıklı kişide NO ve MDA düzeyleri araştırıldı. NO düzeylerini saptamak için Green yöntemi ile nitrat düzeyleri ölçüldü. MDA düzeylerini saptamak için Yagi metodu kullanıldı. Bulgular: Brusellozlu hastalarda serum NO ve MDA düzeyleri kontrol grubuna göre istatistiksel olarak anlamlı derecede yüksek bulundu (p 0.05), AST 40 IU/L’nin üzerinde olanlarda MDA değerleri düşük bulundu (p< 0.05). Ayrıca terleme öyküsü olanlarda MDA değerleri yüksekti (p< 0.05). Sonuç: Bu yüksek NO ve MDA değerlerinin klinik olarak anlamlı olup olmadığını göstermek için bu konuda daha fazla klinik çalışmaya ihtiyaç vardır.Objective: The aim of this study was to determine serum levels of nitric oxide (NO) and malondialdehyde (MDA) in patients with brucellosis and to compare these levels with laboratory tests such as erythrocyte sedimentation rate (ESR), aspartate aminotransferase (AST), alanine aminotransterase (ALT), brucella serum agglutination test (SAT), as well as clinical findings such as fever, sweating, and arthricular pain for the diagnosis of brucellosis. Material and Methods: In this study, serum NO and MDA levels were determined in 39 patients with brucellosis before treatment, and in 20 healthy individuals as a control group. Nitrate levels were measured by Green&amp;#8217;s method, and Yagi&amp;#8217;s method was used to determine MDA levels. Results: Serum NO and MDA levels were significantly raised in patients with brucellosis when compared to those of the control group (p&lt; 0.05). There was no relation between serum levels of NO, SAT, AST, ALT, or fever, sweat, and arthricular pain. Contrarily, the ESR was also high in patients with high levels of NO (p&lt; 0.05). In addition, there was no relation between MDA and ESR, ALT, SAT, fever, and arthricular pain (p&gt; 0.05); however, in patients with AST levels higher than 40 IU/L, levels of MDA were low (p&lt; 0.05). Furthermore, MDA levels were high in patients with a history of sweating (p&lt; 0.05). Conclusion: Further studies are needed in order to determine whether high levels of NO and MDA in patients with brucellosis are clinically significant

Prospective analysis of antibiotic susceptibility patterns of MRSA in a Turkish university hospital

Methicillin-resistant Staphylococcus aureus (MRSA) is an important nosocomial pathogen. The prevalence of MRSA in many countries is increasing and, in some hospitals, more than half of all S. aureus disease isolates are MRSA. MRSA strains are becoming increasingly multiresistant, and have recently developed resistance to vancomycin, which has been used successfully to treat MRSA for more than 30 years. In-vitro determination of resistance patterns of S. aureus is critical in terms of administering suitable antimicrobial treatments. The objective of this study was to identify the frequency of MRSA from various clinical samples and resistance patterns against various antibiotics used broadly for treatments. All isolated S. aureus strains were identified using standard procedures and tested for oxacillin resistance according to methods of the National Committee for Clinical Laboratory Standards. A total of 345 coagulase-positive Staphylococci and 187 MRSA were isolated. We found that the incidence of MRSA in intensive care units (ICUs) and burn center was 23.4% (145/620) and 29.6% (32/108), respectively. This rate was 7% (10/143) in the other units. Resistance rates of MRSA were 29.9% for trimethoprim-sulfamethoxazole, 60.8% for clindamycin, 71.8% for erythromycin, 7.7% for teikoplanin, 90.1% for gentamycin, 88.8% for ofloxacin, 88.1% for norfloxacin and 100% for penicillin. All isolates were found to be sensitive against vancomycin. In our region, although methicillin resistance increased in S. aureus strains, teicoplanin resistance remained low in MRSA, suggesting an effective alternative treatment for Staphylococcus aureus infections. These results indicated that vancomycin seemed to be the only antimicrobial agent effective against MRSA and it could be the choice of medicine in treating multidrug resistant MRSA infection.Methicillin-resistant Staphylococcus aureus (MRSA) is an important nosocomial pathogen. The prevalence of MRSA in many countries is increasing and, in some hospitals, more than half of all S. aureus disease isolates are MRSA. MRSA strains are becoming increasingly multiresistant, and have recently developed resistance to vancomycin, which has been used successfully to treat MRSA for more than 30 years. In-vitro determination of resistance patterns of S. aureus is critical in terms of administering suitable antimicrobial treatments. The objective of this study was to identify the frequency of MRSA from various clinical samples and resistance patterns against various antibiotics used broadly for treatments. All isolated S. aureus strains were identified using standard procedures and tested for oxacillin resistance according to methods of the National Committee for Clinical Laboratory Standards. A total of 345 coagulase-positive Staphylococci and 187 MRSA were isolated. We found that the incidence of MRSA in intensive care units (ICUs) and burn center was 23.4% (145/620) and 29.6% (32/108), respectively. This rate was 7% (10/143) in the other units. Resistance rates of MRSA were 29.9% for trimethoprim-sulfamethoxazole, 60.8% for clindamycin, 71.8% for erythromycin, 7.7% for teikoplanin, 90.1% for gentamycin, 88.8% for ofloxacin, 88.1% for norfloxacin and 100% for penicillin. All isolates were found to be sensitive against vancomycin. In our region, although methicillin resistance increased in S. aureus strains, teicoplanin resistance remained low in MRSA, suggesting an effective alternative treatment for Staphylococcus aureus infections. These results indicated that vancomycin seemed to be the only antimicrobial agent effective against MRSA and it could be the choice of medicine in treating multidrug resistant MRSA infection

The prevalence and resistance patterns of Pseudomonas aeruginosa in intensive care units in a university hospital

The intensive care units (ICUs) are burdened with a high frequency of nosocomial infections often caused by multiresistant nosocomial pathogens. Pseudomonas aeruginosa has emerged as one of the most problematic Gram-negative pathogens. The objective of this study was to identify frequency of Pseudomonas aeruginosa from the various clinical samples in ICUs, and to investigate resistance patterns against various antibiotics widely used for treatment. This study was carried out between September 2000-September 2002. Antimicrobial susceptibility testing was performed by the disc diffusion method according to NCCLS (National Commitee for Clinical and Laboratory Standards) guidelines. The following antibiotics were tested: imipenem, meropenem, aztreonam, ciprofloxacin, ceftazidime, cefepime, piperacillin, norfloxacin and the aminoglycosides (gentamicin, netilmicin, tobramycin, and amikacin). Pseudomonas aeruginosa were isolated from 16.4 % (152/928) of the patients in ICUs. The highest Pseudomonas aeruginosa isolation was obtained in the burns unit (26.9%, 78/290) followed by, cardiovascular surgical ICU (17.6%, 13/74) general surgical ICU (24/164, 14.6 %), internal ICU (17/180, 9.4%) and coronary ICU (20/220, 9.1%). There is a statististically significant difference between surgical ICU and medical internal ICU (P &lt; 0.05). The most effective antibiotics were carbapenems (imipenem and meropenem) and the resistance rates were detected as 15% and 20.4%, respectively among 152 Pseudomonas aeruginosa strains. In conclusion, the frequency of Pseudomonas aeruginosa was found to be high in patients treated at ICUs. The results demonstrate that the resistance rates are alarmingly high. To reduce the emergence and spread of antimicrobial-resistant pathogens in ICUs, monitoring and optimization of antimicrobial use should be considered carefully. These findings suggest that the resistance rates of aminoglycosides, 3th generation antibiotics and quinolone are increasing progressively in Turkey.The intensive care units (ICUs) are burdened with a high frequency of nosocomial infections often caused by multiresistant nosocomial pathogens. Pseudomonas aeruginosa has emerged as one of the most problematic Gram-negative pathogens. The objective of this study was to identify frequency of Pseudomonas aeruginosa from the various clinical samples in ICUs, and to investigate resistance patterns against various antibiotics widely used for treatment. This study was carried out between September 2000-September 2002. Antimicrobial susceptibility testing was performed by the disc diffusion method according to NCCLS (National Commitee for Clinical and Laboratory Standards) guidelines. The following antibiotics were tested: imipenem, meropenem, aztreonam, ciprofloxacin, ceftazidime, cefepime, piperacillin, norfloxacin and the aminoglycosides (gentamicin, netilmicin, tobramycin, and amikacin). Pseudomonas aeruginosa were isolated from 16.4 % (152/928) of the patients in ICUs. The highest Pseudomonas aeruginosa isolation was obtained in the burns unit (26.9%, 78/290) followed by, cardiovascular surgical ICU (17.6%, 13/74) general surgical ICU (24/164, 14.6 %), internal ICU (17/180, 9.4%) and coronary ICU (20/220, 9.1%). There is a statististically significant difference between surgical ICU and medical internal ICU (P &lt; 0.05). The most effective antibiotics were carbapenems (imipenem and meropenem) and the resistance rates were detected as 15% and 20.4%, respectively among 152 Pseudomonas aeruginosa strains. In conclusion, the frequency of Pseudomonas aeruginosa was found to be high in patients treated at ICUs. The results demonstrate that the resistance rates are alarmingly high. To reduce the emergence and spread of antimicrobial-resistant pathogens in ICUs, monitoring and optimization of antimicrobial use should be considered carefully. These findings suggest that the resistance rates of aminoglycosides, 3th generation antibiotics and quinolone are increasing progressively in Turkey

The Effects of Elimination of Gate-Keeping on Tertiary Care and the Social Insurance System

The aim was to investigate the effects of elimination of gatekeeping on a university hospital and Social Insurance Institute (SII). Electronic records of 2006-2007 were analyzed. The mean outpatient visits was 273.8±69.9 before the gate-keeping elimination, it was 471.8±114.7 after the gate-keeping elimination (p<0.001). The increased rate of visits were in the department of cardiology (95.4%) followed by respiratory medicine (33.3%), orthopedics (22.6%), neurology (16.1%) and gynecology (11.4%). Also the most frequent diagnoses changed in these departments. The most frequent diagnoses before and after elimination were as follows; hypertension in comparison to anxiety disorders after elimination in cardiology, chronic obstructive lung disease compared to myalgia in respiratory medicine, fracture follow up compared to joint pain in orthopaedics, epilepsy compared to dizziness in neurology and infertility compared to vaginitis in gynecology. SII has paid 10.67 fold higher dues after elimination for these 7 departments and diagnoses. Consequently; elimination of the gate-keeping can easily be applied to tertiary care and can increase health expenditures

The comparison of the serological methods in diagnosis of brucellosis

Bu çalışmada Başkent Üniversitesi Adana Uygulama ve Araştırma Hastanesi polikliniklerine bruselloz kliniğini düşündüren bulgularla başvurmuş olan hastalara ait 4707 serum örneği seroepidemiyolojik açıdan değerlendirildi. Mevsimsel dağılım açısından Serum Aglutinasyon Testi (SAT) pozitifliğinin en sık ya: aylarında olduğu görüldü. 4707 serumun 166 (%3.5)'sının SAT'ı 1/160 ve üzerindeki dilüsyonlarda pozitif. 4541 (%96.5)'nin SAT'ı negatif bulundu. Tüm serumların 3436 (%73.0)'sı kadın, 1271 (%2 7.0) 'i erkek hastalardan alınmıştı. Benzer şekilde SAT'ı 1/160 ve üzerindeki dilüsyonlarda pozitif olan serumların 109 (%65.7)'u kadın. 57 (%34.3)'si erkek hastalara ait idi. Bütün serumlarda brusellozım serolojik tanısında kullanılan Rose Bengal ile SAT karşılaştırmalı olarak çalışıldı. SAT negatif 4541 (%96.5) serumun 123 (%2.6)'ünde Rose Bengal pozitif. Rose Bengal negatif olan 44S4 (%95.3) serumun 66 <%1.4) 'sında da SAT I 160 ve üzerindeki dilüsyonlarda pozitif bulundu (p<0.001).In this study 4707: sera which are belong to patients presenting to Başkent University of Adana Hospital with clinical findings of brucellosis were evaluated seroepidemiologically. According to seasonal distribution the highest rate of the positive SAT was seen in summer. Of the 4707 sera, 166 (3.5%) were SAT positive between 1/160 and 1/1280 dilutions and 4541 (96.5%) were negative. Of whole these sera, 3436 (73.0%) were belong to female and 1271 (2 7.0%) were belong to male patients. Of the 166 sera, 109 (65.7%) were belong to female and 57(34.3%) were belong to male patients. In all sera Rose Bengal test and SAT were compared. Rose Bengal test was found positive in 123 (2.6%) of 4541 SAT negative sera and SAT was found positive in 1/160 dilutions and more in 66 (1.4%) of 4484 (95.3%) sera (p&lt; 0.001)