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Objective: Leptospirosis is one of the most common zoonotic diseases worldwide. Transmission to humans usually occurs by mucosal inoculation of the bacteria or exposure of non-intact skin via contact with water or soil contaminated with urine or feces of rodents. Occupational groups such as farmers, rice plant workers, sewer workers, miners, hunters, military personnel, mariners, shepherds, milkers, slaughterhouse workers, veterinarians and laboratory personnel are under risk for leptospirosis. In this study, we aimed to determine the seroprevalence of leptospirosis in coal miners in Zonguldak region. Methods: Blood samples were obtained from total 185 volunteer coal miners, who worked in 5 coal mines of Turkish Hard Coal Authority in Zonguldak and Bartın provinces, during June and July 2013. Serum samples were stored at-80°C. Additionally, we conducted an interview with each miner about demographical and epidemiological data such as age, location, duration of mining, other occupations, observing rodent or rodent excreta in the mine, noticing rodent contact with personal belongings or drinks or food in mine and hand hygiene compliance. Microscopic agglutination test (MAT), the reference diagnostic test for seroepidemiological studies of leptospirosis, was conducted in Spirochetal Diseases Diagnostic Laboratory, Veterinary Control Central Research Institute, Etlik, Ankara in June 2014. Anti-Leptospira antibody levels for 8 serotypes (Leptospira grippotyphosa Moskva V, L. australis Bratislava Jez Bratislava, L. canicola Hund Utrech IV, L. hardjo Hardjoprajitno, L. pomona Pomona, L. icterohaemorrhagiae Ictero 1, L. hebdomadis Hebdomadis ve L. patoc Patoc 1) was investigated with MAT. Results: All the miners were male and the mean age was 36±6. The mean duration of working in underground part of the mine was 11±6 years, the mean working hours was 44±6 hours a week on average. Distribution of the miners according to inhabiting location was 18.5% village, 50.3% county and 30.8% city. In addition to mining, some of the miners were also occupied with farming (7%), hunting (2.7%), seafaring (0.5%) and livestock raising (0.5%). 82.7% of the miners confirmed seeing rodents in the mine every day and 35.7% of the miners confirmed seeing rodent excreta in the mine. 68.1% reported observing sign of rodent bite on their clothes or food saving box. 91.9% of the miners reported that they saved their food in plastic or paper bags up to meal time. Hand washing rate in the mine was 76.2% among the miners and 94.3% of those were washing their hands without soap. Although, a risky environment for leptospirosis was defined, no seropositivity was detected in any of the serum samples of the miners. Conclusions: Miners reported risky environmental conditions and risky behavioral models for transmission of leptospirosis. However, no seropositivity was detected in any of the serum samples obtained from 185 miners in Zonguldak region. Klimik Dergisi 2019; 32(2): 174-7. © 2019, AVES. All rights reserved.

Objective: Health care workers are exposed to many infectious agents when compared with general population. Immunization to vaccine-preventable diseases is an important part of infection control among health care workers, both for their own health and against the spread of infections. The aim of this study is to detect the immune status of health care workers of our hospital to measles, mumps, rubella (MMR) and varicella and to define an appropriate vaccination program and also to analyze the cost efficiency of pre-vaccination screening. Methods: This study was conducted at Bülent Ecevit University Hospital between March 2014 and January 2015. The following data were recorded for each participant: age, gender, profession, department, duration of employment, childhood residence location, history of MMR and varicella, and status of vaccinations. The specific IgG antibodies were screened by im-munosorbent enzyme-linked assay. Results: 184 health care workers participated in the study. 61.2% were female, and 38.8% were male. The mean age was 32.43±6.4. The serologic test results revealed that 92.2% of the health care workers were immune to measles, 98.2% were immune to rubella, 94% were immune to mumps and 94.3% were immune to varicella. The validity of the medical history of participants were high for mumps and measles (81.6% and 80.5%, respectively) and low for rubella (43.4%). The positive predictive values for the history of rubella, mumps, varicella and measles were 98.9%, 97.5% and 96.9%, 95.6%, respectively. Cost efficiency analysis showed that the cost of vaccination without screening was more expensive for varicella and MMR (cost difference 18 253 Turkish Lira and 1432 Turkish Lira, respectively) Our findings support that a negative medi-cal history or serological screening before vaccination is cost effective especially for varicella. Conclusions: In conclusion, immune status of health care workers who worked in high-risk departments should be determined by serologic tests and susceptible health care workers must be vaccinated. © 2019, AVES İbrahim KARA. All rights reserved.

Introduction: This study investigated differences in clinical features, types, etiology, and risk factors for complications between young and older patients with skin and soft tissue infections. Futhermore, age-related differences in healthcare-associated and complicated infections were identified. Materials and Method: This retrospective study included 206 skin and soft tissue infection patients hospitalized during an 8-year period. Data were collected using a form: patients’ characteristics, clinical features, laboratory values, prior antibiotic use, causative microorganisms, and antibiotic treatment. For cases with clinically diagnosed, samples were taken from the suspected infection sites. Gram staining, deep swab, deep tissue and blood culture results were evaluated. Results: The incidence of diabetes mellitus was significantly higher among patients aged ?65 years. Among these old patients, Escherichia coli (11/31, 35.5%) and Pseudomonas aeruginosa (8/31, 25.8%) were the most frequently isolated pathogens. Approximately half of the Staphylococcus aureus and Staphylococcus epidermidis strains isolated from patients with health care-associated infection were resistant to methicillin (8/15, 53.3%), and these patients produced higher levels of extended-spectrum beta-lactamase. Venous insufficiency (p=0.008) and prior hospitalization (p=0.001) were identified as risk factors for complication in patients aged ?65. The median time- to -clinical response was 7 days in older patients with non-complicated infection (p=0.007). Conclusion: Diabetes mellitus was the most common co-morbid factor in older patients. Risk factors for complication may differ by age. Gram-negative pathogens were more commonly isolated in older patients. The time- to -clinical response was significantly longer in older patients with non-complicated infection than young patients. © 2018 Geriatrics Society. All rights reserved.

PMID = 26048857

Joint Congress of European Neurology -- MAY 31-JUN 03, 2014 -- Istanbul, TURKEY, WOS: 000347674000672, European Federat Neurol Soc

Introduction: The aim of this study was to investigate the various features of infectious disease consultations, antibiotic usage before and after consultations and adherence to the recommendations of the infectious disease physicians in hospitalized elderly patients. Materials and Method: This retrospective study was conducted in Zonguldak Karaelmas University Teaching and Research Hospital. Hospitalized patients aged 65 years and over for whom an infectious disease consultation was requested between January 2010 and January 2011 were included in the study. Results: The most common causes of consultation requests were the presence of high fever alone, leukocytosis alone, infiltration on chest X-ray, and skin and soft tissue infections. The most commonly diagnosed infections by the infectious disease physicians were community-acquired pneumonias, nosocomial pneumonias and urinary tract infections. In 99 patients, empirical antimicrobial therapy was initiated prior to the infectious disease consultation request, and the most commonly used antibiotics were third-generation cephalosporins and ciprofloxacin ± ampicillin-sulbactam. The most common antimicrobial regimens initiated after the consultation were carbapenems, piperacillin-tazobactam and cefoperazone-sulbactam. The mortality rate of the patients in whom the initiated antibiotic treatment regimens were broadened was significantly higher than the mortality rate of the patients in whom the treatment regimens were not changed and in patients whose treatment was initiated by the infectious disease physicians. Adherence to the recommendations was complete in 292 of 303 consultations. Conclusion: The empirical treatment of hospitalized elderly patients may include broader spectrum antibiotics. Adherence to the recommendations of the infectious disease team may help solve serious and complex infectious problems.

This study was performed to compare the mortality associated with carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-sensitive A. baumannii (CSAB) infections, to identify potential risk factors for CRAB infections, and to investigate the effects of potential risk factors on mortality in CRAB and CSAB patients. This retrospective case-control study was conducted in a university hospital between January 1, 2005 and December 30, 2006. One hundred and ten patients with CRAB and 55 patients with CSAB infection were identified during the study period. The mortality rate was 61.8z and 52.7z in CRAB and CSAB cases, respectively (P = 0.341). In CRAB cases, the risk factors for mortality were identified as intubation (odds ratio [OR], 3.3; 95z confidence interval [CI], 1.0-10.1; P = 0.042) and high APACHE II score (OR, 1.2; 95zCI, 1.1-1.3; P = 0.000), by multivariate analysis. Previous use of carbapenem (OR, 6.1; 95z CI, 2.2-17.1; P = 0.001) or aminopenicillin (OR, 2.5; 95z CI, 1.2-5.1; P = 0.013) were independently associated with carbapenem resistance. Although the mortality rate was higher among patients with CRAB infections, this difference was not found to be statistically significant. Previous use of carbapenem and aminopenicillin were found to be independent risk factors for infections with CRAB.

Visceral leishmaniasis (VL) which is a chronic disease caused by the protozoon, Leishmania, occurs widely worldwide and it is widespread in most of the countries in the Mediterranean basin. The infection which is transmitted by a sandfly (Phlebotomus) vector, has a prolonged incubation period and insidious onset. VL generally affects children and may be fatal if not treated. In this report, a 31 years old male patient, who was the first adult VL case from Zonguldak (a province located at western Black-Sea region of Turkey) was presented. He was admitted to the hospital with two-months history of fever, chills, sweating and weight loss. There was no history of travel outside the city nor insect bites, however, he indicated that there would be unnoticed sandfly bites since sandflies were very common in the coal mines he worked. His physical examination revealed body temperatue of 39.2°C and hepatosplenomegaly, while laboratory findings yielded anemia, leucopenia, hypoalbuminemia and hypergamaglobulinemia. Erythrocyte sedimentation rate was 62 mm/h, C-reactive protein was 113 mg/L and liver transaminases were 2 to 5 folds higher than the reference values. The only pathological finding was hepatosplenomegaly in the abdominal ultrasound and computerized tomography. He was further examined to rule out infections with similar signs and symptoms, connective tissue diseases and malignancies and all were found negative. Hypercellular bone marrow were detected in the aspiration material. Bone marrow smears, bone marrow samples inoculated in NNN medium and serum samples of the patient were sent to the reference parasitology laboratory of Refik Saydam National Public Health Agency for evaluation in terms of VL. The diagnosis was confirmed by the detection of Leishmania IgG titer as 1/512 with in-house indirect immunofluorescence antibody test, by positivite rK39 Dipstick (InBios, USA) test and by the observation of Leishmania amastigote forms in the bone marrow smears. Bone marrow culture in NNN medium also revealed positive result by the determination of Leishmania promastigote forms on the 7 th day. The treatment was initiated by pentavalent antimony [glucantime 1 × 10 mg/kg/day intramuscular (IM)] however, due to severe adverse effects it has switched to liposomal amphotericin B (3 mg/kg/day). The patient completely recovered without complication. In conclusion VL should be considered in the differential diagnosis of patients, even adults, with persistent fever, hepatosplenomegaly and pancytopenia, in endemic countries such as Turkey.

Staphylococcus lugdunensis is an infrequent cause of infective endocarditis (IE) and usually involves native valves of the heart. It causes life-threatening events such as rupture of cardiac valve or cerebral or pulmonary embolism due to necrosis on the endocardial tissue involved by the bacteria. Antibiotic therapy without cardiac surgery or delayed cardiac surgery usually follows a fatal course in S.lugdunensis endocarditis. In this report the first case of S.lugdunensis endocarditis from Turkey was presented. A 37 years-old man was admitted to the emergency department with a 2-weeks history of fever chills and accompanying intermittent pain on the left side of the thorax. Other than recurrent folliculitis continuing for 20 years, his history was unremarkable. Echocardiography revealed vegetation on the mitral valve of the patient and vancomycin plus gentamicin were initiated with the diagnosis of IE. All blood cultures (5 sets) taken on admission and within the initial 48 hours of the antibiotic therapy yielded S.lugdunensis. According to the susceptibility test results, the antibiotic therapy was switched to ampicillin-sulbac-tam plus rifampin. Blood cultures became negative after the third day of therapy, however, cardiac failure was emerged due to rupture of mitral valve and chorda tendiniea on the 12 th day of the therapy. Cardiac surgery revealed that mitral valve and surrounding tissue of the valve were evidently necrotic and fragile, anterior leaflet of the mitral valve was covered with vegetation, posterior leaflet and chorda tendiniea were ruptured. Vegetation was removed and the destructed mitral valve was replaced with a mechanical valve. Vegetation culture remained sterile, however, antibiotics were switched to vancomycin plus rifampin due to persistent fever on the 21 st day of the therapy (9 th day of operation). Fever resolved four days after the antibiotic switch. Antibiotics were stopped on the 9 th weeks of admission and the patient was discharged. He had no problem in follow-up controls for one year. In conclusion, proper antibiotic therapy combined with early cardiac surgery seems to be the optimal therapeutic approach in IE caused by S.lugdunensis.

Community-acquired pneumonia (CAP) is a common infectious disease with high morbidity and mortality. In this study, demographic features, underlying conditions, causative pathogens and factors affecting length of hospital stay and mortality were retrospectively investigated in patients who were diagnosed as CAP and followed-up in our unit between January 2005-December 2007. Among 97 patients 65 (67%) were male, 32 (33%) were female and the mean age was 62.7 (age range: 18-94) years. Patients were grouped according to criteria of Turkish Thoracic Society into four groups; 22 were group 2 (patients with risk factors, without aggrevating factors), 59 were group 3 (patients with aggravating factors), and 16 were group 4 (patients who have necessity for intensive care) CAP. The patients have also been grouped according to criteria of American Thoracic Society (CURB-65 score = Confusion, Urea > 7 mmol/L, Respiratory rate ? 30/min, low Blood pressure and being ? 65 years old), as group I (n= 65), group II (n= 20), and group III (n= 12). During follow-up 11 (11.3%) patients required mechanical ventilation support and 6 (6.2%) patients have died. Causative pathogens were isolated from 14 (23.3%) out of 27 well-qualified sputum samples obtained from 60 patients who could produce sputum (8 Streptococcus pneumoniae, 2 methicillin-sensitive Staphylococcus aureus, 2 Klebsiella pneumoniae, 1 Haemophilus influenzae, 1 Moraxella catarrhalis). Thirty-seven of cases were treated with levofloxacin, 10 with moxifloxacin, 24 with ceftriaxone ± clarithromycin, 16 with sulbactam-ampicillin ± ciprofloxacin, 10 with beta-lactam/beta-lactamase inhibitor combinations, and fever declined within 2.5 days in 83 (85.6%) of them. The mean duration of hospital stay was estimated as 11.1 days. In the evaluation of the factors that affect the length of hospital stay, being ? 65 years old, gender, underlying conditions, central venous catheterisation, presence of nasogastric tube, positive culture result, previous antibiotic treatment, fever continuing for > 3 days despite antibiotic therapy and scoring groups were not determined as risk factors (p> 0.05 for all of these parameters). However, mechanical ventilation was found as a significant risk factor (p< 0.05). In the evaluation of the factors that affect mortality, mechanical ventilation (p< 0.001), staying in intensive care unit (p< 0.001), being group 4 CAP (p< 0.001) and fever continuing for > 3 days despite antibiotic therapy (p= 0.05) were found to be significant risk factors. In conclusion, length of hospital stay, mortality and treatment costs in CAP patients could be reduced by defining the risk factors and starting empirical antibiotic therapy according to the national and international guidelines.

Infective endocarditis has variable clinical presentations and may present with rheumatologic manifestations. Infective endocarditis due to high level aminoglycoside resistant enterococci represents a severe therapeutic challenge as none of the currently recommended treatment regimens are bactericidal against these isolates. In this report, a case of infective endocarditis with double aetiology, high level aminoglycoside resistant Enterococcus faecalis together with methicillin-resistant coagulase-negative staphylococci (MR-CNS), presenting with leukocytoclastic vasculitis and rapidly progressive glomerulonephritis, has been presented. A 48-years-old woman was admitted to our hospital with malaise and non-pruritic purpural rush on her lower extremities. On admission she had no fever or leukocytosis. Skin biopsy showed leukocytoclastic vasculitis and steroid therapy was started. On 12th day of admission rapidly progressive glomerulonephritis was diagnosed and she received plasmapheresis and haemodialysis support. Transthoracic echocardiography (TTE) demonstrated 1 × 1.5 cm vegetation on the mitral valve. An initial diagnosis of infective endocarditis was made and empirical treatment with vancomycin and gentamicin was started. All blood cultures yielded high level aminoglycoside resistant E. faecalis and additionally two of them yielded MR-CNS. Vancomycin was administered in combination with high dose ampicillin and repeated blood cultures taken after administration of ampicillin, revealed no growth. The patient remained afebrile, renal functions improved and a repeat TTE done on 20th day of ampicillin therapy showed waning of the vegetation. On 42nd day of treatment repeat TTE showed new vegetation on the mitral valve and severe valve insufficiency, so the patient was scheduled for mitral valve replacement. She was treated for 12 weeks with vancomycin and ampicillin and recovered successfully. In conclusion; infective endocarditis should be considered in the differential diagnosis of leukocytoclastic vasculitis and rapidly progressive glomerulonephritis. Physicians should document their treatment outcomes and experience with high level aminoglycoside resistant enterococcal infective endocarditis, which is a therapeutic challenge, so that the best therapeutic options can be identified.

Mediterranean spotted fever (MSF) is one of the tick-borne rickettsial infections caused by Rickettsia conorii. It is transmitted to humans by brown dog ticks (Rhipicepholus songuineus). In this case report, a 16-years-old male patient who was diagnosed as MSF after an exposure to dog-tick in Bartin province (located at middle Black Sea region of Turkey) has been presented. His history revealed that, five days before admission to the hospital (on June, 2007) he had cleaned dog-ticks from his dog, and after 12 hours he found a stucked tick on his leg and he took it out right away with a tweezer. High fever, headache and generalized maculopapular rash including soles and palms and a black-colored lesion at the tick bite site developed three days later. In clinical examination, there was a black escar circled with a red-purple colored halo in front of the right tibia at the site of the tick bite showing high similarity to "tache noire" which was specific to MSF. Indirect immunofluorescence assay (IFA) for Rickettsia yielded negative result in the serum sample collected on admission day, however, it was found positive at 1/512 titer in the serum sample collected 10 days after admission. The patient has recovered completely without any complication after 10 days of doxycycline therapy. The aim of this presentation is to point out that MSF should be considered for the differential diagnosis of a patient with a history of tick bite, fever, maculopapular rash, headache, myalgia, arthralgia and especially with black escar during summer months in our country where the incidence of tick-borne infections has been increasing since recent years.

Cryptococcosis caused by Cryptococcus neoformans has a wide range of clinical presentations, varying from asymptomatic colonization of the respiratory airways to the dissemination of infection into different parts of body. It is more common among immunosupressed patients such as human immunodeficiency virus (HIV) positive ones. in this report we present a case with C. neoformans meningitis and miliary pulmonary infiltrates suggesting pulmonary tuberculosis without HIV infection. A-70-years-old male was admitted to the hospital with mental confusion, 3-weeks history of headache, weight loss, dry cough and fatigue. Physical examination was normal except neck stiffness. Cerebrospinal fluid (CSF) white cell count was 120/mm3 (80% polimorphonuclear cells). Gram staining of CSF revealed poorly stained gram-positive yeast cells. Empirical therapy with lipozomal amphotericin B, ceftriaxone and ampicillin combination was started. When C. neoformans growth was detected on CSF culture, ceftriaxone and ampicillin were discontinued. Patient became conscious at 24th hour of the treatment. Peripheric blood flow-cytometric analysis revealed a significant decrease in absolute CD4+ T lymphocytes, and in CD8+28+ T lymphocytes in addition a significant increase in natural killer cell ratio. Blood immunoglobulin and complement levels were found normal. Cranial magnetic resonance imaging and computerized tomography (CT) of the abdomen were normal, however, chest CT revealed multiple parenchymal millimetric nodular infiltrations on both sides and minimal fibrotic alterations. Acid-fast staining of CSF, tuberculosis culture, tuberculosis PCR results and repeated HIV serology were found negative, Despite the lack of microbiological confirmation, empirical antituberculosis treatment was also started with the suspicion of miliary tuberculosis as the patient had a symptom of long-term dry cough, miliary infiltrations on chest CT anergic tuberculin skin test and a history of pulmonary tuberculosis in childhood. After two weeks, amphotericin B was changed to oral fluconazole which was continued for an additional eight weeks. Antituberculosis therapy was given for nine months. Control chest CT taken after four months of antituberculosis therapy revealed improvement of the lesions. This presentation emphasizes the fact that cryptococcal infections may develop in HIV negative patients, even together with tuberculosis in certain case and radiological findings of the two infections may be confusing when both of them invade the lungs.

The aim of this study was to evaluate the clinical, epidemiological and demographical features of adult measles cases admitted to our hospital, during the measles epidemic which emerged in Europe and in our country in the year 2001. A total of 35 adult measles cases (10 male, 25 female) ages between 16-36 (mean age: 23.1 ±4.6) years were detected between January and June 2001. The diagnosis was based on the clinical findings, however only 11 of the cases could be serologically confirmed with the presence of measles IgM antibody positivities. Fever (91.4%), cough (94.3%) and conjunctivitis (77.1%) were the most common symptoms. All of the patients had maculopapular rash, and the presence of Koplik spots, lymphadenopathy and hepatomegaly were observed in 77.1%, 57.1%, and 5.7% of patients, respectively. Leukopenia and elevated liver enzymes were detected in 28.5% and 37.2% of the patients, respectively. Pneumonia was the most common complication which was seen in 20% of the patients. Of the cases 2.9% exhibited otitis media and 17.1% diarrhea. Spontaneous abortus occurred in one of the three pregnant women. In conclusion, measles is still an important public health problem in our country, and since it may lead to severe complications and economic and labor loss, an effective elimination programme should be obtained by the use of vaccine in two doses and effective strategies for the immunization of the target populations.

Leptospirosis which is caused by Leptospira species, may present with clinical features that vary from a mild flu-like illness to an acute life-threatening condition. Weil's disease, the most severe form of leptospirosis is characterized by multiorgan involvement including liver, kidney and lungs. In this report a severe Weil's disease was presented. A 43 years old male patient who had a history of swallowing water while swimming in the creek, was admitted to the hospital with the complaints of weakness, cough, bloody sputum, generalized jaundice and dark urine. Acute renal failure, bilateral lung infiltration, hyperbilirubinemia, leukocytosis and thrombocytopenia were detected, and the patient has undergone to hemodialysis. Ceftriaxone and ciprofloxacin treatment was applied to the patient after collection of blood, urine and sputum cultures and serum samples for serological tests. None of the cultures yielded pathogenic microorganisms. Microscopic agglutination test (MAT) was applied to two serum samples which were collected with 10 days interval. The first serum sample revealed antibody positivity at 1/200 titer against L.semeranga Patoc I, while the second serum revealed antibody positivity at 1/400 titer against both L.semeranga Patoc I and L.icterohaemorrhagiae Wijnberg. By the administration of antibiotic therapy and early supportive care the patient was cured completely. In conclusion Weil's disease should be taken into consideration in the patients with multiple organ involvements.

Objectives: To investigate the correlation between the characteristics of urethral stricture and incision scars in patients with urethral stricture and median sternotomy incision. Methods: We identified 368 patients who had undergone internal urethrotomy between January 2014 and December 2017. A total of 49 male patients with a median sternotomy scar and diagnosed with urethral stricture were retrospectively evaluated. The median sternotomy incision scars were assessed using the Vancouver Scar Scale (VSS) and the patients were divided into 2 groups. Group I consisted of patients with a VSS score of less than 4 points, and those with ≥4 points constituted group II. The groups were compared in terms of age, smoking habit, body mass index, diabetes mellitus, hypertension, urethral stricture etiology, length and localization, and stricture relapse after intervention. Results: The mean total VSS score was 2.0 points in group I and 7.46 points in group II. There was a significant correlation between the VSS total score and the urethral stricture length among the whole study population (correlation coefficient value=0.481; p less than 0.001). The urethral stricture was longer as the VSS score increased. Conclusion: A poorly healed median sternotomy incision scar can predict a poor wound healing in the urethra tissue. Further large scale, multi-center and prospective studies are needed to clarify this relationship. Saudi Med J 2019; Vol. 40 (7): 701-706 doi:10.15537/smj.2019.7.24285 How to cite this article: Aydemir H, Saglam H, Budak S, Kose O, Gokce A . Can proliferative hypertrophic scars of the median sternotomy incision predict the occurance and characteristics of urethral stricture? Saudi Med J 2019; 40 (7): 701-706. doi:10.15537/smj.2019.7.24285

Introduction: The objective of this study was to investigate the disease course after direct vision internal urethrotomy (DVIU) for short anterior urethral strictures. Methods: We retrospectively analyzed 94 patients who underwent DVIU of the anterior urethra. Patients' age, etiology, length and localization of the strictures, total number of DVIU procedures, comorbidities, and other data were evaluated. Results: The mean age of the patients was 67.2 years. The mean followup duration was 27.1 months. Recurrence was observed in 27.6% of the patients. Recurrence had occurred in these patients at a mean of 12 months. Both the comorbidity score (rs=0.395; p

WOS: 000401046000017, Two mitogenomes of remarkable size of the stem-boring sawflies, Trachelus tabidus (18539 bp) and T. iudaicus (20730 bp), were characterized and compared with previously known mitogenomes of Cephini. A rearrangement in the IQM gene cluster, an unusual elongation in rrnS gene and supposedly functional tandem repeat sequences in the A+T- rich region are synapomorphies of Cephini. Mitogenome evolution of the Cephini was investigated in a dataset of seven species representing all genera. The noticeably divergent mitogenomes of the Cephini both at nucleotide and amino acid level, and the variable rates of omega values, indicate the effects of different selective forces, rather than neutral evolution. The effect of positive selection is revealed by radical amino acid changes with ten physicochemical properties (P-alpha, B-r, pK', h, E-l, H-nc, alpha(c), alpha(n), R-alpha and H-p) throughout each branch of the tree. The radical changes in the ND and ATP complexes are mostly related to chemical and energetic properties due to different energy requirements among species. The phenology of Cephini species and their host plants, together with habitat structure, rather than host plant preferences or phylogenetic constraint, are suggested to explain the role of adaptive evolution in shaping Cephini mitogenomes. (C) 2017 Elsevier Ltd. All rights reserved., Scientific and Technological Research Council of Turkey (TUBITAK) [112T418], This study was supported by The Scientific and Technological Research Council of Turkey (TUBITAK) via a research project with grant number 112T418. We are grateful to Dr. Gavin Broad (The Natural History Museum, London, UK) for his critical reading and his valuable comments on the manuscript. We thank the two anonymous reviewers for their constructive comments and suggestions. The member of Cumhuriyet University Molecular Systematics Research Group helped in every stage of laboratory work.

This prospective analysis assessed the effect of histological prostatitis on lower urinary tract functions and sexual function. The patients were separated into two groups as histologically observed prostatitis (Group A) and no prostatitis (Group B) according to the biopsy outcomes. International prostate symptom score, international index of erectile function-5 scores, maximal and average flow rate, and residual urine volumes were compared statistically between groups. There was no significant difference (P>0.05) in baseline age (t=0.64), body mass index value (t=0.51), prostate volume (t=0.87), prostate-specific antigen levels (t=0.43), maximal (t=0.84) and average flow rate (t=0.59), and post-void residual urine volume (t=0.71). Mean international prostate symptom score in patients with prostatitis was numerically but not significantly higher than that in those without prostatitis (t=0.794, P=0.066). Mean international index of erectile function-5 score in the prostatitis group was significantly lower than that in those without prostatitis (t=1.854, P=0.013). Histological prostatitis notably affected sexual function of patients and may serve as a major risk factor for sexual dysfunction while having little effect on lower urinary tract symptoms.

Conclusion: We found high numbers of fluoroquinolone-resistant E. coli in faeces collected prior to prostate biopsy. Thus, fluoroquinolones should not be used for prostate biopsy prophylaxis. We found no difference in the extent of quinolone-resistance in patients graded by age, prostate specific antigen level, or antibiotic use in the prior 6 months. In risky cases, faecal culture results may be used to choose appropriate prophylaxis.