労働界の再編と八六年体制の意味 : 労組・自民・政府三者関係 一九七五～八七年（特集 新保守主義の台頭）

社会党・総評ブロックの社会的適応への「失敗」と民間大企業労組の自民党との政策協調の「成功」という二重の帰結の中で、政府を入れた三者の新しい関係・構図の成立と国際的・国内的問題への対応を分析する

Covid-19: Pathogenesis, genetic polymorphism, clinical features and laboratory findings

COVID-19 caused by a novel agent SARS-CoV-2 progressed to a pandemic condition and resulted in a major public health concern worldwide, leading to social and economic issues at the same time. The pathogenesis of COVID-19 starts with the bonding of the virus to ACE2 receptors expressed in many tissues, and the triggered excessive immune response plays a critical role in the course of the disease. The cytokine storm that occurs upon excessive production of pro-inflammatory cytokines is considered responsible for the severe progression of the disease and the organ damage. However, the accurate pathophysiological mechanism of the disease, which progresses with various clinical presentations, is still substantially unknown. While various studies have been conducted on the effect of genetic polymorphism on the course and severity of the disease, the presence of a significant effect has not been proven yet. The clinical course of the disease is variable, with clinical representation ranging from 81% mild course to 14% severe course along with 5% critical course in patients. Asymptomatic course is considered to be higher than expected, although its frequency is not known exactly. Older adults and those with comorbidities are exposed to a more severe disease course. The disease progress with various symptoms, such as fever, cough, dyspnea, malaise, myalgia, taste and smell dysfunctions, diarrhea, and headache. A range of complications (acute respiratory distress syndrome, thromboembolic conditions, arrhythmia and cardiac events, secondary infections) could be seen during the course of the disease. Varied laboratory tests are vital to determine these verity and prognosis of the disease, along with the condition and exposure of the affected systems during thecourse of COVID-19

Multiple Drug Resistant Pneumococcal Meningitis: A Case Report

Streptococcus pneumoniae is the most common pathogen in adult bacterial meningitis. The resistance of S. pneumoniae to penicillin and other antimicrobial agents is increasing worldwide. This case report documents failure of a third generation cephalosporin in the treatment of meningitis caused by multiple drug resistant S. pneumoniae. The isolated S. pneumoniae had a minimal inhibitory concentration of >2 µg/mL for penicillin, ≥8 µg/mL for erythromycin, >8 µg/mL for imipenem and 0.5 µg/mL for ceftriaxone. Ceftriaxone (4g/day IV) was given for the treatment but, on the sixth hospital day the patient showed no clinical improvement and no improvement in laboratory parameters. Vancomycin was added to the therapy and the patient improved on the third day of combination therapy. The treatment options of resistant pneumococcal meningitis were discussed

Multiple drug resistant pneumococcal meningitis: A case report

Streptococcus pneumoniae erişkinlerde en sık akut bakteriyel menenjit etkenidir. Dünyanın pek çok yerinde penisilin ve diğer antibiyotiklere direnç artmaktadır. Bu yazıda, tek başına sefalosporin ile tedavide başarısız kalınan çok ilaca dirençli bir pnömokokal menenjit olgusu sunulmuştur. Olgudan izole edilen pnömokokun penisilin, eritromisin, imipenem ve seftriakson duyarlılıkları sırası ile; > 2 $\mu$g/mL, $\geq$ 8 $\mu$g/mL, > 8 $\mu$g/mL ve 0.5 $\mu$g/mL idi. ilk olarak 4 g/gün seftriakson olarak başlanan tedaviye, 6. günde beklenen klinik iyileşme ve laboratuvar bulgularında düzelme sağlanamaması nedeniyle vankomisin (2 g/gün) eklendi. Bu kombinasyon tedavisinin 3. gününde hastada belirgin klinik iyileşme görüldü ve hasta sekelsiz taburcu edildi. Bu olgu nedeniyle antibiyotiklere dirençli pnömokokal menenjit tedavisi literatür bilgileri ışığında değerlendirildi.Streptococcus pneumoniae is the most common pathogen in adult bacterial meningitis. The resistance of S. pneumoniae to penicillin and other antimicrobial agents is increasing worldwide. This case report documents failure of a third generation cephalosporin in the treatment of meningitis caused by multiple drug resistant S. pneumoniae. The isolated S. pneumoniae had a minimal inhibitory concentration of >2 $\mu$g/mL for penicillin, $\geq$8 $\mu$g/mL for erythromycin, >8 $\mu$g/ml for imipenem and 0.5 $\mu$g/mL for ceftriaxone. Ceftriaxone (4g/day IV) was given for the treatment but, on the sixth hospital day the patient showed no clinical improvement and no improvement in laboratory parameters. Vancomycin was added to the therapy and the patient improved on the third day of combination therapy. The treatment options of resistant pneumococcal meningitis were discussed

Fever of Unknown Origin: Evaluation of 54 Cases

In this study, 54 cases with fever of unknown origin (FUO) were analysed prospectively in Infectious Disease Department at Çukurova Medical Faculty between the years 1994-1997. Among the 54 cases included in this study 49 of them(90.7%) were determined as classic FUO whereas 5 of them (9.2%) were determined as neutropenic FUO. Infections (51.8%) were the most common causes of FUO in this series. Tuberculosis constituted the most common infectious reason (32.1%). Other FUO reasons were abdominal abcess, brucellosis, infective endocarditis, cytomegalovirus infection, rhinocerebral mucormycosis and cerebral toxoplasmosis. Non infectious reasons of FUO were neoplastic diseases found in 9 cases (16.6%), collagen vascular diseases found in 16 cases (16.6%) and other diseases diagnosed in 2 cases (3.7%). On the other hand, in 6 (11.6%) of the FUO cases no diagnosis could be reached. While the reasons of cases of neutropenic FUO were lymphoma, splenic abcess, brucellosis, sytemic lupus erytematosus only in one case no diagnosis could be reached. In undiagnosed cases of FUO, 5 of them (83.3%) completely recovered and only one of them (16.6%) died. Among these cases two of them (lymphoma and the undiagnosed) were neutropeni

Comparison of nested polymerase chain reaction ( PCR ) with commercial HCV PCR kit ( Amplicor HCV ) in the diagnosis of hepatitis C Virus infection

Bu çalışmada kronik hepatit tanısı ile izlenen 72 hastanın serumlarında nested polimeraz zincir reaksiyonu (PCR) ile ticari bir HCV PCR kiti (Amplicor-Roche Diagnostic) kullanılarak HCV RNA saptaması karşılaştırılmak istenmiştir. Anti-HCV'nin belirlenmesinde EIA yöntemi (Axsym-Abbott) kullanılarak 42 örnek pozitif, 30 örnek negatif bulunmuştur. HCV RNA saptanmasında nested PCR ile ticari HCV PCR kiti (Amplicor-Roche-Diagnostic) karşılaştırıldığında nested PCR ile 22 örnek pozitif, 50 örnek negatif iken amplicor ticari HCV PCR kiti ile 17 örnek pozitif, 55 örnek negatif sonuç vermiştir. Beş serum örneği sadece nested PCR ile pozitif sonuç vermiştir. Sonuçlar, nested PCR'm HCV RNA saptaması için daha duyarlı olduğunu düşündürmektedir.This study aimed at determining the sensitivities of two methods, nested polymerase chain reaction (nested PCR) and amplicor hepatitis C virus kit (amplicor HCV) in the detection of HCV RNA. The sera of 72 patients with chronic hepatitis were investigated using both methods. Forty-two anti-HCV positive and 30 anti-HCV negative sera were examined with EIA (Axsym Abbott) method. The nested RT-PCR assay was compared with -Amplicor- HCV PCR kit; 22 sera were positive and 50 sera negative with nested PCR and 17 sera were positive and 55 sera negative with -Amplicor- commercial HCV PCR assay. Five sera were positive only with nested PCR. The results indicate that nested PCR is more sensitive than amplicor HCV

Brucellosis: An evaluation of clinical, laboratory and treatment features of 238 adult cases

Brusellozun klinik, laboratuvar ve tedavi özelliklerini saptamak amacıyla Ocak 1990 - Ekim 1997 tarihleri arasında bruselloz tanısı ile izlenip tedavi edilen 238 hasta retrospektif olarak değerlendirilmiştir. Yaş ortalaması 32.3 ± 14 olan olguların 126'sı(% 52.9) kadın, 112'si (% 47) erkek idi. Olguların 200'ünde (% 84) olası kaynak saptandı. Bunların 126'sında (% 63) taze peynir öyküsü vardı. En sık saptanan yakınmalar 193'ünde (% 83) ateş, 190'ında (% 80) halsizlik, 186'smda (% 78) artralji ve 150'sinde (% 63) terleme idi. Olguların 194'ünde (% 81.5) ateş > 37.5 C iken, 87'sinde (% 36.5) osteo-artikuler tutulum, 55'inde (% 23) hepatomegali, 52'sinde (% 21) splenomegali vardı. Sadece üç olguda meninjit, ikisinde orşit ve birinde de endokardit vardı. Eritrosit sedimentasyon hızı 81 (% 34) olguda > 40 mm/saat iken 50'sinde (% 21) lökopeni, 134'ünde (% 56.3) lenfositoz, 129'unda (% 54.2) anemi saptandı. Kan kültürü alınan 124 olgunun 15'inde (% 12) Brucella melitensis izole edildi. Olguların 207'sinde (% 87) STA testi $\leq$1/160 olarak bulundu. Değişik tedaviler verildi. Relapslar doksisiklin + r ifampisin alan 122 (% 54.2) olgunun dördünde (% 3.3), kinolon + rifampisin alan 70 (% 31) olgunun üçünde (% 4.3) ve tetrasiklin/doksisiklin + streptomisin alan 33 (% 14.7) olgunun birinde (% 3) görüldü. Diğer 13 olguya bu tedavi rejimlerinden biri en az üç ay uygulandıIn order to attain on overview of the clinical and laboratory findings in brucellosis, 238 patients (pts) with brucellosis followed up in the January 1990 - October 1997 period were retrospectively studied. Mean age was 32.4 + 14. Of patients 126 (52.9 %) were female and 112 (47 %) were male. Possible source for brucellosis was identified in 200 (84 %) pts. Consuming fresh cheese were reported in 126 (63 %) pts. The most frequent complaints were fever in 193 (83 %), malaise in 190 (80 %), arthalgia in 186 (78 %) and sweating in 150 (63 %). Of 238 pts 194 (81.5 %) had fever > 37.5 C, 87 (36.5 %) had osteoarticular involvements, 55 (23 %) had hepatomegaly and 52 (21 %) splenomegaly. There were meningitis in three, orchitis in two and endocarditis in one. Erytrocyte sedimention rate was > 40 mm/hour in 81 (34 %) pts. Blood cultures were drawn from 124 pts and only 15 (2 %) of them yielded Brucella melitensis. In the first examination SAT test was $\leq$1/160 in 207 (87 %) pts and in the remaining 38 (16 %) pts seroconversion was detected within two weeks. Relapse was seen in four (3.3 %) out of 122 doxycycline + rifampicin treated, three (4.3 %) out of 70 quinolon + rifampicin treated and one (3 %) out of 33 tetracycline/doxycycline + streptomycin treated pts. In the remanining 13 pts one of these regimens was taken for at least three months

Evaluation of 17 Cases of Adult Tuberculous Meningitis

Adult tuberculous meningitis is an extra-pulmonary form of tuberculosis which, because of a rapid course and neurological sequela, leads to high morbidity and mortality. For this reason, an early diagnosis is important but is not always possible. The aim of this study, which was carried out between 1991-1995, was to evaluate the factors affecting the prognosis of diseases in patients which had been diagnosied as tuberculous meningitis using the patients history, clinical picture, and laboratory and radiological findings. Fifty nine percent of the patients were between 25-45 years of age. The rate of mortality in these patients 47% and when they were admitted to the hospital, 62.5% were in the second stage of the disease. In 15 (88.2%) of all patients, the symptoms had occurred 2 weeks or more before hospitalization. In the microscobic examination of CSF of 5 (29.4%) of the patients, acid fast bacilli were seen. However, M. tuberculosis grew in the cultures of CSF of only 2 of these. Evidence of active or previous pulmonary tuberculosis was found in 4 (23.5%) of our patients. Ventriculoperitoneal shuts were placed in 3 out of 8 patients who developed hydrocephalus. Multipl tüberculomas which decreased with antituberculous treatment were detected in 2 patients during treatment. In conclusion, in patients with tuberculous meningitis, the most important factors affecting the prognosis is the time between the development of symptoms and treatment as well as the neurologic phase

Nosocomial infections in neurology intensive care unit

Hastanemiz Nöroloji Yoğun Bakım Ünitesi'nde (NYBÜ) izlenen hastalarda görülen hastane infeksiyon tiplerini ve izole edilen etkenlerin sıklığı ile antibiyotik duyarlılıklarını belirlemek amaçlanmıştır. Mart 2002 - Nisan 2004 arasında NYBÜ'nde 331 'i (% 56) erkek 593 hasta izlenmiş, 40'ı (% 60) erkek toplam 71 hastada hastane infeksiyonu saptanmıştır. Bu hastalarda 100 infeksiyon atağı tanımlanmıştır. Buna göre hastane kaynaklı infeksiyon insidansı hasta sayısına göre %12ve atak sayısına göre % 17 olarak bulunmuştur. Hastane infeksiyonu belirlenen hastalarda yaş ortalaması 59 yıl (medyan değer 45, alt değer 16 - üst değer 90) idi. Yüz infeksiyon atağının 52 'sinde üriner sistem infeksiyonu, 28'inde primer kan dolaşımı infeksiyonu (7'si kandidemi), 6'sında sekonder kan dolaşımı infeksiyonu, 11 'inde pnömoni, 2 'sinde bası yarası infeksiyonu, 1 'inde menenjit belirlenmiştir. Seksendokuz infeksiyon atağında patojen izole edilmiştir. Atakların beşinde polimikrobiyal üreme saptanmıştır. Üreyen 94 izolatın 57'si Gram negatif, 24'ü Gram pozitif bakteri ve 13'ü Candida türleri olarak belirlenmiştir. Gram negatif bakteriler Escherichia coli (n=23), Pseudomonas aeruginosa (n=16), Acinetobacter baumannii (n=10), Klebsiellapneumoniae (n-6), Stenotrophomonas maltophilia (n=l) ve Burkholderia cepacia (n-1) olarak, Gram pozitif bakteriler Staphylococcus aureus (n=8), koagulaz negatif stafibkok (n=8) ve enterokok (n=8) olarak idantifiye edilmiştir. İzole edilen bakterilerin antibiyotik dirençleri verilmiştir.The purpose of this study was to determine the types of nosocomial infections, frequency and resistance rates of pathogens isolated in our Neurology Intensive Care Unit (NICU). In the NICU, 593 patients (331 males, 56 %) were hospitalized between March 2002 and April 2004, and nosocomial infections were encountered in 71 patients (40 males, 60 %). The total number of infectious episodes was 100. The incidence of hospital infection was 12 %for patients' number and 17 %for episodes number. The average age of these patients was 59 (16-90, median 45). Of the 100 infectious episodes, 52 were urinary tract infections, 28 were primary blood stream infections (7 candidemia), 6 were secondery blood stream infections, 11 were pneumonia, 2 were decubitus infections and 1 was meningitis. Etiological agents were isolated in 89 episodes with polimicrobial growth in 5. Of the 94 isolates, 57 were Gram negative, 24 were Gram positive bacteria, and 13 were Candida spp. Gram negative bacteria were identified as Escherichia coli (n=23), Pseudomonas aeruginosa (n=16), Acinetobacter baumannii (n=10), Klebsiella pneumoniae (n=6), Stenotrophomonas maltophilia (n=l) and Burkholderia cepacia (n=l). The Gram positive bacteria were identified as Staphylococcus aureus, coagulase negative staphylococci and enterococci (8 from each). The antibiotic resistance of bacterial isolates were given