Serological diagnosis of syphilis: Preliminary study searching for an algorithm in Turkey

Different algorithms have been proposed to increase the diagnostic capacity of syphilis. We analyzed three common algorithms for detecting suspected syphilis cases in low prevelance Turkish population. The study included a total of 340 clinical serum samples from adults throughout Turkey, who had syphilis as a clinical preliminary diagnosis and  were positive on at least one of the following tests: Rapid Plasma Reagin (RPR), Treponema pallidum Haemagglutination test (TPHA) and FTA-abs Ig. In adittion to percent agreement, kappa coefficients were calculated to compare the conformity between the three algorithms. Both the reverse and the ECDC algorithms had higher diagnostic efficacy than the conventional algorithm. The sensitivity/specificity/ accuracy of conventional, reverse and ECDC algorithms were 51.3%/86.1%/55%; 80.9%/86.1%/81.4% and 80.9%/100%/82.9% respectively. The interrater reliability was moderate for conventional-reverse algorithm (73.53%; к=0.484; 95%CI=0.41-0.56; p=0.001) and conventional-ECDC algorithm (72.06%; к=0.454; 95% CI= 0.37-0.54; p=0.001), and near perfect for reverse-ECDC algorithm (98.53%; к=0.963; 95% CI=0.93-0.99; p=0.0001). Our data support the use of ECDC algorithm in serological diagnosis of syphilis. It may increase the diagnostic capacity if treponemal tests are used for screening, and then positive results are confirmed with a different and second treponemal test. e idea that non-Dsg antigens may also be the target for pemphigus autoimmunity.  </p

Obstrüktif uyku apneli ve horlayan erişkin erkek hastaların dentofasiyal özelliklerinin değerlendirilmesi

Amaç: Bu çalışmanın amacı obstrüktif uyku apne sendromu (OUAS) olan erişkin erkek hastaların kraniofasiyal morfolojik özellikleri değerlendirmektir. Gereç ve Yöntem: Çalışmada 80 erkek hastanın (60 sefalogramları değerlendirildi. Bireyler Grup 1: horlama (AHİ5); Grup 2: hafif OUAS (5AHİ15); Grup 3: orta OUAS(15 AHİ30) ; Grup 4: şiddetli OUAS (AHİ30) olarak değerlendirildi. Sefalogramlar üzerinde hyoid, dil kökü ve yumuşak damak konumu, kranioservikal postür ve havayolu genişliğini belirleyen ölçümler yapıldı. Gruplar arasındaki farklar normal dağılım gösteren değişkenlerde tek yönlü varyans analizi ve Duncan testiyle, normal dağılım göstermeyen değişkenlerde Kruskal düzeltmesi uygulanarak Mann Whitney U testiyle yapıld

Clinical presentation of abdominal tuberculosis in HIV seronegative adults

BACKGROUND: The accurate diagnosis of abdominal tuberculosis usually takes a long time and requires a high index of suspicion in clinic practice. Eighty-eight immune-competent patients with abdominal tuberculosis were grouped according to symptoms at presentation and followed prospectively in order to investigate the effect of symptomatic presentation on clinical diagnosis and prognosis. METHODS: Based upon the clinical presentation, the patients were divided into groups such as non-specific abdominal pain & less prominent in bowel habit, ascites, alteration in bowel habit, acute abdomen and others. Demographic, clinical and laboratory features, coexistence of pulmonary tuberculosis, diagnostic procedures, definitive diagnostic tests, need for surgical therapy, and response to treatment were assessed in each group. RESULTS: According to clinical presentation, five groups were constituted as non-specific abdominal pain (n = 24), ascites (n = 24), bowel habit alteration (n = 22), acute abdomen (n = 9) and others (n = 9). Patients presenting with acute abdomen had significantly higher white blood cell counts (p = 0.002) and abnormalities in abdominal plain radiographs (p = 0.014). Patients presenting with alteration in bowel habit were younger (p = 0.048). The frequency of colonoscopic abnormalities (7.5%), and need for therapeutic surgery (12.5%) were lower in patients with ascites, (p = 0.04) and (p = 0.001), respectively. There was no difference in gender, disease duration, diagnostic modalities, response to treatment, period to initial response, and mortality between groups (p > 0.05). Gastrointestinal tract alone was the most frequently involved part (38.5%), and this was associated with acid-fast bacteria in the sputum (p = 0.003). CONCLUSION: Gastrointestinal tract involvement is frequent in patients with active pulmonary tuberculosis. Although different clinical presentations of patients with abdominal tuberculosis determine diagnostic work up and need for therapeutic surgery, evidence based diagnosis and consequences of the disease does not change

Electroweak Baryogenesis in Two Higgs Doublet Models and B meson anomalies

Motivated by 3.9 sigma evidence of a CP-violating phase beyond the standard model in the like-sign dimuon asymmetry reported by DO, we examine the potential for two Higgs doublet models (2HDMs) to achieve successful electroweak baryogenesis (EWBG) while explaining the dimuon anomaly. Our emphasis is on the minimal flavour violating 2HDM, but our numerical scans of model parameter space include type I and type II models as special cases. We incorporate relevant particle physics constraints, including electroweak precision data, b to s gamma, the neutron electric dipole moment, R_b, and perturbative coupling bounds to constrain the model. Surprisingly, we find that a large enough baryon asymmetry is only consistently achieved in a small subset of parameter space in 2HDMs, regardless of trying to simultaneously account for any B physics anomaly. There is some tension between simultaneous explanation of the dimuon anomaly and baryogenesis, but using a Markov chain Monte Carlo we find several models within 1 sigma of the central values. We point out shortcomings with previous studies that reached different conclusions. The restricted parameter space that allows for EWBG makes this scenario highly predictive for collider searches. We discuss the most promising signatures to pursue at the LHC for EWBG-compatible models.Comment: 58 pages, 16 figures, 6 tables; v2 added references; v3 minor corrections and improvements, published versio

Fosfomycin: In vitro efficacy against multidrug-resistant isolates beyond urinary isolates

WOS: 000398570500036PubMed ID: 28167307Objectives: Fosfomycin (FOF) is a bactericidal antimicrobial agent active against a range of Gram-negative bacteria, including multidrug-resistant (MDR) and metallo-beta-lactamase (MBL)-producing Enterobacteriaceae. However, data are scarce regarding use of the drug beyond urinary tract infections (UTIs). Methods: In this study, susceptibility rates to FOF among 290 MDR Enterobacteriaceae isolates were analysed by gradient and disk diffusion tests and the results were compared with agar dilution according to the Clinical and Laboratory Standards Institute (CLSI). Minimum inhibitory concentrations (MICs) of imipenem (IPM) for isolates IPM-resistant/intermediate-susceptible isolates were determined by gradient test. In addition, the gradient test was used to determine MBL production. Results: Of the 290 extended-spectrum beta-lactamase (ESBL)-positive isolates, 60 (20.7%) were resistant to FOF, with rates of 9.5% for Escherichia coli, 28.0% for Enterobacter spp., 35.7% for Klebsiella spp. and 50.0% for Morganella spp. Among the 290 ESBL-positive isolates, 19 (6.6%) were resistant/intermediate-susceptible to IPM. In addition, 72.2% of extensively drug-resistant (XDR) and 61.1% of carbapenem-resistant isolates were resistant to FOF. In vitro FOF activity was higher among blood (86.9%) and genitourinary (91.7%) isolates. FOF showed excellent activity for a wide range of infections; however, further trials are necessary to evaluate its clinical efficacy. Conclusions: FOF presented good activity even against carbapenem-resistant isolates and may be a treatment alternative for non-UTI isolates, but should be used with caution for infections related to ESBL-producing Klebsiella spp. (C) 2017 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved

Bloodstream infection with Oligella ureolytica in a newborn infant: a case report and review of the literature

WOS: 000343790600018PubMed ID: 24916881Oligella species are small, Gram-negative, nonsaccharolytic aerobic rods or coccobacilli that are catalase and oxidase-positive, mostly isolated from the urinary tract and rarely from wounds, bloodstream infections, septic arthritis, or peritonitis. In this article, we report a case of O. ureolytica-related bloodstream infection in a newborn infant and we review the literature for previously reported cases of Oligella infections

Seroprevalence Rates of Hepatitis A Virus in Different Age Groups in the Province of Kirsehir and a Review of the Literature

WOS: 000217248600003Objective: Hepatitis A is one of the most common infectious diseases in the world. The prevalence of hepatitis A virus (HAV) infection correlates with the economic development of a region due to the transmission by fecal-oral route. In this study, we aimed to determine the seroprevalence of hepatitis A among patients of different age groups admitted to a training and research hospital. Materials and Methods: During the study period, January 2009-June 2013, serum samples of patients admitted to Ahi Evran University Research and Training Hospital were tested for anti-HAV IgM and IgG antibodies by the chemiluminescent microparticle immunoassay using Cobas 6000 (Roche, Germany) analyzer. The patients were divided into the age groups: 0-5, 6-10, 11-20, 21-30, 31-40, 41-50, 51-60, 61-70, and 71 years and over. The statistical analysis was performed using SPSS 15.0 software and a p value of less than 0.05 was considered statistically significant. Results: Anti-HAV IgM and anti-HAV IgG positivity rates were 0.5% and 87.3%, respectively. The highest anti-HAV IgM positivity was detected in the 41-50 age group and the lowest in the 0-5 and 11-20 age groups. The highest anti-HAV IgG positivity rate was observed in patients 0-5 years of age (99.7%) and lowest in those 11-30 years of age (61%). Anti-HAV IgM positivity rate was highest in August, September and December. Conclusion: In this study, the prevalence of HAV infection was found to be similar to that in previous studies performed in our country. It is clear that implementation of vaccination programs as well as improving sanitation practices are essential for decreasing the prevalence of the infection

Evaluation of the in vitro activity of fosfomycin tromethamine against Gram-negative bacterial strains recovered from community- and hospital-acquired urinary tract infections in Turkey

WOS: 000325986700007PubMed ID: 23742831Objectives: The aim of this study was to evaluate the in vitro activities of antimicrobial agents including fosfomycin tromethamine against Gram-negative isolates recovered from urine samples. Methods: A total of 2334 strains (1562 Escherichia coli, 509 Klebsiella spp, 85 Proteus spp, 75 Pseudomonas spp, 45 Enterobacter spp, 37 Acinetobacter baumannii, 8 Citrobacter spp, 7 Morganella morganii, and 6 Serratia spp) were identified by VITEK 2 during the study period, November 2008 to June 2012. Antimicrobial susceptibilities of the strains were also evaluated using the Kirby-Bauer disk diffusion method, in accordance with the Clinical and Laboratory Standards Institute guidelines. Results: Overall, 2160 (92.5%) of the isolates tested were susceptible to fosfomycin tromethamine. Higher resistance rates were observed among inpatients compared to outpatients. Resistance rates by strain were: 2.0% for E. coli, 4.4% for Enterobacter spp, 6.9% for Klebsiella spp, 9.4% for Proteus spp, 48.6% for A. baumannii, 56.0% for Pseudomonas spp, and 100% for Morganella morganii. All Serratia spp and Citrobacter spp strains were susceptible. Extended-spectrum beta-lactamase (ESBL)-producing isolates displayed higher fosfomycin resistance rates than negative strains (19.2% vs. 2.9%). The highest in vitro activity was detected for amikacin, piperacillin-tazobactam, and imipenem for all strains including ESBL-producers. Conclusions: Regardless of ESBL production, the excellent activity of fosfomycin against E. coli, Enterobacter spp, Serratia spp, and Citrobacter spp, indicates that the drug is a valuable therapeutic option for urinary tract infections, even those with co-trimoxazole- and ciprofloxacin-resistant isolates, but not in ESBL-producing Klebsiella spp, Pseudomonas spp, A. baumannii, and Proteus spp. Further studies should be carried out to determine the in vivo drug activity among Enterobacteriaceae other than E. coli. (C) 2013 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved

Comparison of cervico-vaginal colonization among sexually active women by intrauterine device use

WOS: 000366286500003PubMed ID: 26409733Introduction: In this study we aimed to evaluate the effect of intrauterine devices (IUDs) on cervico-vaginal colonization. Methodology: Cervico-vaginal samples of 96 patients with vaginal discharge were included in the study. Microscopic evaluation, bacteriological and fungal culture, and antigen testing for Chlamydia trachomatis using an immunochromatographic test method were performed. Results: Trichomonas vaginalis was not detected by wet mount examination. Gram smear revealed that seven patients (7.3%) had Candida spp. and five (5.2%) had clue cell. Of the 96 swabs tested for conventional culture, pathogenic microorganisms were isolated from 24 patients. While Neisseria gonorrhoeae was not found in any of the sample, five (5.2%) were positive for Gardnerella vaginalis. Five (5.2%) were positive for C. trachomatis antigen, while three positivity only for C. trachomatis antigen, one had G. vaginalis additionally, and the other had a mixed infection. Chlamydial antigen positivity was higher among women over 30 years of age (p = 0.157). Increase in polymorphonuclear leukocytes (PNL) was detected 40% and 35.2% of samples, positive and negative, for chlamydial antigen, respectively (p = 1.000). Among IUD+ cases, increase in PNL, fungal elements, E. coli and Gram-positive bacteria and decrease in Lactobacillus spp. were observed, compared to IUD-cases. No statistically significant relationship was detected between IUD and chlamydial antigen with the reported rates of 4.8% and 5.6% for IUD+ or IUD-, respectively (p > 0.05). Conclusion: Statistically significant relationship was not detected between IUD and cervico-vaginal colonization. More comprehensive studies using specific test methods should be conducted to better understand the relationship