Assessment of the requisites of microbiology based infectious disease training under the pressure of consultation needs

<p>Abstract</p> <p>Background</p> <p>Training of infectious disease (ID) specialists is structured on classical clinical microbiology training in Turkey and ID specialists work as clinical microbiologists at the same time. Hence, this study aimed to determine the clinical skills and knowledge required by clinical microbiologists.</p> <p>Methods</p> <p>A cross-sectional study was carried out between June 1, 2010 and September 15, 2010 in 32 ID departments in Turkey. Only patients hospitalized and followed up in the ID departments between January-June 2010 who required consultation with other disciplines were included.</p> <p>Results</p> <p>A total of 605 patients undergoing 1343 consultations were included, with pulmonology, neurology, cardiology, gastroenterology, nephrology, dermatology, haematology, and endocrinology being the most frequent consultation specialties. The consultation patterns were quite similar and were not affected by either the nature of infections or the critical clinical status of ID patients.</p> <p>Conclusions</p> <p>The results of our study show that certain internal medicine subdisciplines such as pulmonology, neurology and dermatology appear to be the principal clinical requisites in the training of ID specialists, rather than internal medicine as a whole.</p

Discordant Hepatitis B Serology in Twins Despite Active and Passive Immunoprophylaxis: A Case Report

Hepatitis B virus (HBV) infection is still one of the most important causes of liver disease. In highly endemic areas, infection occurs mainly in infancy and early childhood with mother-to-child transmission, accounting for more than half of chronic infections. In this manuscript, discordant manifestations and evolution of HBV infection in a pair of monozygotic twins are reported. A 8-year-old child was admitted to our clinic with HbsAg positivity. She had a history of normal vaginal delivery without any complications. HBV vaccine and HBIG were administered to the newborn within the first hour of life. HBV vaccination series were completed with the administration of second and third doses during one month and 6 months of age. HBsAg positivity was determined in a different center and referred to our clinic. In laboratory analysis, HBsAg was (+), anti-HBs (-), HBeAg (-), anti-HBe: (+), AST was 39 IU/L, ALT: 20 IU/L and HBV-DNA: 203 IU/mL by real time polymerase chain reaction (RT-PCR). However, in the tests of the twin sister of the patient HBsAg was (-), anti-HBs > 1000 mIU/mL. In the mother’s laboratory analysis HBsAg was (+), anti-HBe (-), HBeAg (+), HBV-DNA > 108 IU/mL, AST: 34 IU/L, ALT: 34 IU/L. In order to decrease the rate of perinatal transmission, an oral antiviral agent may be administered during the third trimester of the pregnancy in order to reduce the level of maternal viremia. Although administration of HBIG with hepatitis B vaccine is the most effective way of preventing the perinatal transmission, HBV infection may occur in 5%-10% of cases

Şanlıurfa'da mevsimlik tarım işçilerinin yoğun olarak yaşadıkları bir aile sağlığı merkezi bölgesinde gebelerde HbsAg pozitifliği düzeyi ve etkileyen faktörler/HbsAg seropositivity and other related factors among pregnant women in crowded living condition

Özet Amaç: Bu araştırmada, mevsimlik tarım işçilerinin yoğun olarak yaşadıkları bir aile sağlığı merkezi bölgesinde gebelerde HbsAg pozitifliği düzeyini ve etkileyen faktörleri ortaya koymak amaçlanmıştır. Yöntem: Kesitsel tipteki bu çalışma, Şanlıurfa Zeliha Öncel Aile Sağlığı Merkezi (ASM) bölgesinde Ekim 2011-Ocak 2012 tarihleri arasında yapılmıştır. Çalışmaya kayıtlı ve takipli olan tüm gebeler(N=261) dahil edilmiştir. Gebelere yapılandırılmış soru formu uygulanmıştır. HBsAg ve anti-HBs sonuçları ASM kayıtlarından alınmıştır. Bulgular: Tüm gebelerde Hepatit B sıklığı %3.2’ dir.  HBsAg pozitifliği mevsimlik tarım işçilerinde 5.1 kat, ailesinde hepatit B hastalığı bulunan gebelerde 18.9 kat daha fazla görülmektedir (P&lt;0.05). Sonuç: Mevsimlik tarım işçileri hepatit B açısından önemli bir risk grubudur. Temel sağlık hizmetleri mevsimlik tarım işçileri için erişilebilir hale getirilmeli ve hizmet taleplerini arttırmak için sağlık eğitimleri yapılmalıdır. Tüm gebelere doğum öncesi bakım hizmeti sağlanmalı ve hepatit B'ye karşı duyarlı olanlara aşı önerilmelidir. Anahtar Kelimeler: Gebe, hepatit B sıklığı, mevsimlik tarım işçiliğiAbstract Objective: This study determined the HbsAg seropositivity and other related factors among women living in the Sanliurfa district among seasonal farm workers. Methods: This cross-sectional study was carried out within the service area of the Zeliha Öncel Family Health Center between October 2011-January 2012 in the Sanliurfa district. All pregnant women (N=261) enrolled by a family health center were included in the study. A structured questionnaire was applied. The levels of HBsAg and anti-HBs measures were taken from family health centers records. Results: HbsAg seropositivity was 3.2% in pregnant women. HBsAg seropositivity was 5.1 times in seasonal farmworker and 18.9 times greater in families with a history of hepatitis B (p&lt;0.05).Conclusions: Seasonal farworkers are an important risk group for hepatitis B. Primary health care should be made accessible to seasonal farmworkers and the demands for health care should be increased through health education. Antenatal care should be provided to all pregnant women and hepatitis B vaccine should be advised for those who are susceptible to HBV. Key Words: Seasonal farmworker, primary health care, Hepatitis B risk factors </p

Increased liver mast cells in patients with chronic hepatitis C

Background and Aim: The aim of the study was to investigate the mast cell (MC) concentration in the liver tissue of patients diagnosed with chronic hepatitis C and to determine whether there was a correlation with clinical and pathological characteristics of patients. Materials and Methods: The study was conducted on liver biopsy samples from 60 patients with chronic hepatitis C. Clinical and laboratory data were obtained from follow-up records. Stained liver biopsies were examined. Immunohistochemical staining was performed by using an anti-c-kit antibody. Patients were divided into four groups (minimal, mild, moderate, and severe) based on the intensity of inflammation and their hepatic activity index scores and into two groups (no-mild, moderate-severe) according to fibrosis grade. Results: Among patients enrolled, 60.0% (n=36) were men with a mean age of 48.3±12.7 (range 18-64) years. The mean number of mast cells per portal area in the liver was 0.87±0.86 (0-4.0). No correlation was found between alanine aminotransferase (ALT) and hepatitis C virus (HCV). Ribonucleic acid ( RNA ) levels and the degree of inflammation of cases with number of mast cells and liver steatosis (P>0.05). As the degree of fibrosis increased in the liver so did the number of mast cells in portal areas (P=0.001). On the other hand, no correlation was found between the degree of fibrosis and the number of MCs in the sinusoids and steatosis (P<0.05). The increase in the number of MCs in the portal areas correlated with an increase in liver steatosis (t: 0.02, P=0.04). Conclusion: In light of these findings, it appears possible that MC accumulation in chronic HCV patients may be used as an indicator of fibrosis and possibly be considered in the follow-up of these patients

Assessment of the requisites of microbiology based infectious disease training under the pressure of consultation needs

Methods: A cross-sectional study was carried out between June 1, 2010 and September 15, 2010 in 32 ID departments in Turkey. Only patients hospitalized and followed up in the ID departments between January-June 2010 who required consultation with other disciplines were included.Background: Training of infectious disease (ID) specialists is structured on classical clinical microbiology training in Turkey and ID specialists work as clinical microbiologists at the same time. Hence, this study aimed to determine the clinical skills and knowledge required by clinical microbiologists.Results: A total of 605 patients undergoing 1343 consultations were included, with pulmonology, neurology, cardiology, gastroenterology, nephrology, dermatology, haematology, and endocrinology being the most frequent consultation specialties. The consultation patterns were quite similar and were not affected by either the nature of infections or the critical clinical status of ID patients.Conclusions: The results of our study show that certain internal medicine subdisciplines such as pulmonology, neurology and dermatology appear to be the principal clinical requisites in the training of ID specialists, rather than internal medicine as a whole

Evaluation of the Continuous Ambulatory Peritoneal Dialysis Related Peritonitis Attacks

Peritonitis is a common clinical problem that occurs in patients with end stage renal disease treated by peritoneal dialysis. The aims of this study were to assess demographic aspects, rates of peritonitis, causative organisms, clinical outcomes and treatment approach for continuous ambulatory peritoneal dialysis (CAPD) -related peritonitis of patients undergoing CAPD. Seventy cases of peritonitis occurred in 55 patients treated in Infectious Diseases and Clinical Microbiology Department of Ankara Training and Research Hospital between May 2003 and April 2004 were enrolled into this study. Cloudiness of the peritoneal dialysis fluid and/or abdominal pain were considered suggestive of peritonitis and were confirmed by cell count and culture. The overall incidence of peritonitis was 2.46 ± 2.52 episodes/patient-year. Age, gender, education and profession of the patients have not been found as a risk factor in peritonitis attacks. The most common presentations of peritonitis included abdominal pain, cloudiness of the peritoneal dialysis fluid, nausea and vomiting. Peritoneal dialysate fluid white blood cell count was 1773 ± 1224/mm3 in 70 episodes. Cultures were positive in 51 (%72.9) peritonitis episodes; coagulase-negative staphylococci was the most common organism (%22.8), followed by Staphylococcus aureus (%21.4), 19 episodes (%27.2) had negative culture results. At the end of the study, 61 episodes of peritonitis in 55 patients were treated with intraperitoneal cefazolin and gentamicin protocol. Seven of the patients did not respond to initial therapy and the therapy was converted to intravenous protocol. Nine episodes were treated with IV antibiotics on admission for medical reasons (systemic infection and/or concurrent exit-side or tunnel infection). There were two deaths. Two catheters were removed and the patients were transferred to haemodialysis programme. Despite all technical improvements during recent decades, peritonitis and exit-side infections are still the major complication of CAPD. For the optimizing complication rates in individual centers, causative organisms and their antimicrobial susceptibilities must be known