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Objectives: Currently, both entecavir (ETV) and tenofovir (TDF) are recommended first-line therapy for chronic hepatitis B treatment due to good tolerance, lower side-effect profile and high genetic barrier. However, mutations that may develop in the polymerase gene during treatment may result treatment failure. In this study, we aimed to evaluate the efficacy and virologic response of ETV plus TDF combination therapy in chronic hepatitis B patients with suboptimal response to nucleos(t)ide analogues (NAs) monotherapy. Methods: A total of 813 patients who were followed-up with the diagnosis of chronic hepatitis B and who were treated with TDF or ETV monotherapy were screened. Patients who had a partial or non response to monotherapy during at least 12 months and who was the presence of serum HBV-DNA levels ≥ 2000 IU/mL at the time of initiation of the ETV plus TDF combination therapy were included. Results: Ten (1.2%) patients (9 TDF, 1 ETV) were identified to have had partial response (50%) or breaktrough (40%) or virologic rebound (10%) to monotherapy. The median age was 36.8 years (range, 22-55 years), and 5/10 (50%) patients were male. Of 10 patients, nine of achieved undetectable HBV-DNA (< 15 IU/mL) levels (50% of in 6 months and 90% of in 18 months) with combination therapy. One patient showed no response. Conclusions: Our results suggest that combination therapy is superior to the antiviral change in treatment failure with NAs. In addition, it is important to conduct HBV drug resistance analyzes to prevent false drug change in treatment.

Aim of the study The quantitative hepatitis B surface antigen (qHBsAg) level indicates the amount of transcriptional activity of covalently closed circular DNA (cccDNA) and integrated DNA in hepatocytes which plays a role in development of chronic hepatitis B (CHB) and may help decide whether the treatment is necessary or not. The aim of this study is to evaluate the association between serum qHBsAg levels and viral replication and stage of liver fibrosis in treatment-naive CHB patients and to determine the role of qHBsAg levels in predicting when liver biopsy is necessary. Material and methods 967 patients were included in the study. Because of refusal of liver biopsy the study was conducted on 123 patients. The association between qHBsAg levels with HBV DNA, a-fetoprotein, fibrosis stage and histology activity index was evaluated. Results Of the patients, mean age was 48 ±11.2 years and 56.1% were male. We found that patients with HBV DNA ≥ 2000 IU/ml had a higher qHBsAg titer in comparison with HBV DNA < 2000 IU/ml. However, there was no relationship between qHBsAg titer and liver necroinflammation or fibrosis stage. Conclusions Monitoring of qHBsAg together with HBV DNA may be helpful in CHB management. However, qHBsAg level does not provide knowledge about the timing of biopsy or the decision of CHB treatment.

Background: Infective endocarditis (IE) is an infection of the heart’s endocardial surface. In recent years, nuclear imaging methods have gained importance in the diagnosis of IE. The present study aims to investigate the imaging potential of 99mTc-labeled vancomycin (99mTc-Vancomycin) as a new agent that would enable the diagnosis of IE in its early stages when it is difficult to diagnose or has small vegetation in the experimental rat model. Methods: 99mTc-Vancomycin scintigraphy was evaluated for its accumulation in IE with Staphylococcus aureus performed in an experimental rat model. Serial planar scintigraphic and biodistribution analysis of infected vegetations are compared to rats with sterile vegetations. The heart was identified as an infected organ, the liver was identified as a non-infected organ and the heart/liver uptake ratio (T / NT ratio) was compared between infective endocarditis and sterile endocarditis groups. Results: Planar scintigrams (in vivo measurements) showed more uptake in the heart of rats in the infective endocarditis group compared to the uptake in the heart of rats in the sterile endocarditis group, but this difference was not statistically significant (p>0.05). From the ex vivo measurements, the 99mTc-Vancomycin heart uptake increased significantly (p = 0.016), liver uptake was significantly decreased (p = 0.045) and the T/NT ratio was significantly higher (p = 0.014) in the infective endocarditis group compared to the sterile endocarditis group. Conclusions: In this experimental study, 99mTc-Vancomycin scintigraphy ensured the detection of ex vivo infected tissue in a rat model of IE. In addition, the absence of significant 99mTc-Vancomycin uptake in the sterile endocarditis group indicates that this agent targeted the infected tissue instead of the sterile inflammatory tissue. Finally, this agent should also be evaluated with animal- specific imaging devices.

Background and study aims Rapid virologic response (RVR) is defined as undetectable hepatitis C virus (HCV) RNA in serum after 4 weeks of treatment for chronic hepatitis C (CHC). Paritaprevir/ritonavir/ombitasvir (PRO) and/or dasabuvir (D), with or without ribavirin [PRO (D) ± ribavirin], which are direct-acting antivirals (DAAs), is the currently approved treatment regimen for CHC genotype 1; this regimen can also be used in patients with end-stage renal failure (ESRF). In this study, we aimed to evaluate the effect of pretreatment factors on RVR in patients treated with PRO (D) ± ribavirin. Patients and methods This study included 60 patients with CHC genotype 1 who were treated with PRO (D) ± ribavirin and achieved RVR. Patients’ demographic data; baseline HCV RNA levels; HCV genotype information; biochemical, histologic, and radiologic results; and previous treatment history were recorded. Patients were categorized into two groups: virologic responses achieved in the first week (group 1) and in the first to the fourth week (group 2). Pretreatment factors were compared between the groups. Results Patients in group 1 who achieved ultraRVR (undetectable HCV RNA after 1 week of treatment) had significantly lower mean pretreatment HCV RNA levels and lower prevalence of ESRF than patients in group 2. Conclusions RVR has been indicated to be a robust positive predictor of sustained virologic response. We concluded that some pretreatment factors such as low HCV RNA level and absence of ESRF might lead to faster RVR and shorter treatment duration with DAAs for CHC.

Infective endocarditis (IE) is an infection of the heart's endocardial surface. In recent years, nuclear imaging methods have gained importance in the diagnosis of IE. The present study aims to investigate the imaging potential ofPlanar scintigrams (in vivo measurements) showed more uptake in the heart of rats in the infective endocarditis group compared to the uptake in the heart of rats in the sterile endocarditis group, but this difference was not statistically significant (p0.05). From the ex vivo measurements, theIn this experimental study

Background and Aim: Hepatitis C virus transmission continues to be a significant public health concern in patients undergoing hemodialysis and occasionally causes outbreaks despite risk reduction after the anti-HCV screening. This study aimed to investigate an outbreak of hepatitis C virus in the hemodialysis unit to identify the infection source and underline lapses in the infection control practices. Material and Methods: Patients and staff were assessed for hepatitis C virus infection after the outbreak. All anti‐HCV-positive patients were tested for genotype or subtypes by performing a phylogenetic analysis of NS3 sequences. The current infection control applications and possible risk factors in the unit were examined to determine the source of infection. Results: Overall, 115 patients, including three patients who were followed up for chronic hepatitis C infection, were evaluated. Anti‐HCV seroconversion was detected in 10 new patients. All patients were in the same room and during the same shift. Several lapses in infection control practices were observed. Phylogenetic analysis showed that the outbreak was caused by the same viral strain. Notably, all patients were infected with genotype 1a, and mutations in the NS3 region, subgenotype, and drug resistance were identical to one of the three patients with chronic hepatitis C. Conclusion: Direct observation and molecular test results indicated a transmission from patient to patient, thereby highlighting the importance of infection control.

Background: This study aimed at creating a new predictive model of significant fibrosis in chronic hepatitis B using direct and indirect parameters and comparing this model with other noninvasive models for its validation in clinical settings. Methods: Patients (n = 81), according to the ISHAK score, were classified as mild and significant fibrosis. Serum matrix metalloproteinase-2, tissue inhibitor of metalloproteinase-2, beta-nerve growth factor levels, and indirect parameters were analyzed. To evaluate the presence of significant hepatic fibrosis, well-known conventional models were also evaluated. The cut-off values of each model were determined using receiver operating characteristic curves to distinguish patients with mild and significant fibrosis. Results: Significant hepatic fibrosis index-1 was constructed using the following equation: (matrix metalloproteinase-2 × age × prothrombin time × direct bilirubin) / (albumin × platelet). The sensitivity and specificity for significant hepatic fibrosis index-1 were 73.3% and 95.6%, respectively. Area under the curve of significant hepatic fibrosis index-1 was 0.895 (P < 0.001), which was higher than the other models. Due to limitations of matrix metalloproteinase-2, significant hepatic fibrosis index-2 was constructed using a formula without matrix metalloproteinase-2. However, there were no significant differences between significant hepatic fibrosis index-1 and significant hepatic fibrosis index-2 or other models, except for 3 models. Conclusions: Significant hepatic fibrosis index-1 employs a new marker; matrix metalloproteinase-2 along with routine parameters had the best diagnostic performance for significant fibrosis in patients with chronic hepatitis B. Using significant hepatic fibrosis index-1 or even significant hepatic fibrosis index-2 might be an alternative approach in place of liver biopsy to predict significant fibrosis in chronic hepatitis B cohort.

Liver biopsy is still the gold standard for the determination of liver fibrosis and necroinflammatory activity. It is an invasive method and may lead to severe complications. The aim of this study was to determine the evaluation of percutaneous liver biopsy complications in patients with chronic viral hepatitis.1165 patients, who were followed with the diagnosis of chronic viral hepatitis and who were applied percutaneous liver biopsy between January 2000 and February 2013 at the out-patient clinic of Infectious Diseases and Clinical Microbiology, were included in the study.Of 1165 patients who underwent liver biopsy, 196 (86 male, 110 female) were diagnosed with chronic hepatitis C, 969 (559 male, 410 female) were diagnosed with chronic hepatitis B. The mean age was 43.3 and 55.4% were male. 11% of the patients were diagnosed with chronic renal failure and underwent haemodialysis. Minor complication rate was about 20% (severe pain required usage of analgesic drugs in 19.8%, abdominal pain in 22.6%) whereas major complication rate was 1.15% (pneumothorax in 0.17%, heamobilia in 0.08%, hematoma in 0.9%). We did not observe severe complications such as fever, abscess, anaphylaxis, bacteraemia, organ perforations, sepsis or death.Despite being an invasive procedure, percutaneous liver biopsy can be considered a safe method because of the low rates of severe complications observed in our patients.Karaciğer biyopsisi karaciğer fibrozisi ve nekroinflamatuvar aktivitesini belirlemede günümüzde halen altın standart olarak kabul edilmektedir. Ancak invaziv olması nedeniyle ciddi komplikasyonları olabilen bir işlemdir. Bu çalışma ile perkütan karaciğer biyopsisi yapılan kronik viral hepatitli hastalarda biyopsiye bağlı komplikasyonların değerlendirilmesi amaçlanmıştır.Ocak 2000–Şubat 2013 tarihleri arasında İzmir Tepecik Eğitim ve Araştırma Hastanesi Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Kliniğinde kronik viral hepatit tanısı ile izlediğimiz ve karaciğer biyopsisi yapılan 1165 hasta retrospektif olarak incelendi.Karaciğer biyopsisi yapılan 1165 hastanın 196’sı (86 erkek, 110 kadın) kronik hepatit C, 969’sı (559 erkek, 410 kadın) kronik hepatit B tanılı idi. Hastaların yaş ortalaması: 43,3, %55,4’ü erkek, %11’i kronik böbrek yetmezliği tanısı ile hemodiyalize giriyordu. Hastaların yaklaşık beşte birinde minör komplikasyonlar gözlenirken (%19,8’inde analjezik gereksinimi olan ağrı, %22,6’sında sağ üst kadran ve sağ kola vuran ağrı), majör komplikasyon oranı %1,15 idi (%0,17’sinde pnömotoraks, %0,08’inde hemobiliya, %0,9’unda hematom). Ateş, abse, anaflaksi, bakteriyemi, organ perforasyonu, sepsis, ölüm gibi komplikasyonlar görülmedi.Perkütan karaciğer biyopsisi invaziv bir işlem olmasına rağmen hastalarımızda görülen ciddi komplikasyon oranı düşüktür, bu nedenle güvenli bir işlem olarak kabul edilebilir.

WOS: 000347140200009, PubMed ID: 25622485, The purpose of this study was to determine prevalence of natural rubber latex (NRL) allergy among healthcare employees and identify sensitive individuals. A total of 1,115 healthcare workers (HCWs) employed in Izmir Tepecik Education and Research Hospital participated in the study. Information on age, gender, occupation, history of allergy, and complaints were collected through a questionnaire. Serum latex-specific IgE level was determined. Among HCWs enrolled in the study, prevalence of latex sensitization was determined as 4.2%. More frequent occurrence of latex allergy was detected among nurses. Family history of allergy and history of personal food allergy were significantly more often noted among individuals with latex allergy. Latex is considered to be the leading source of occupational health problems.

Background: The aim of this study is to investigate the association between hepatic activity index (HAI) and fibrosis score (FS) with inflammation biomarkers in non-uremic and uremic hepatitis C positive patients. Methods: Fifty chronic hepatitis C (cHepC) positive patients, having a liver biopsy were included in this study. Liver biopsies were scored according to modified ISHAC scoring system. 25 healthy controls of similar age and gender were also enrolled as control group. Serum YKL-40, neutrophil/lymphocyte ratio (NLR), thrombocyte/lymphocyte ratio (PLR), CRP and Immunoglobulin (IgG, A and M) levels were used to determine inflammation. AST to Platelet Ratio Index (APRI) score was also evaluated. According to biopsy findings patients were divided into 2 groups: low (0–2) and severe (3–6) FS. Results: Patients with cHepC had increased inflammation compared to the healthy controls. End-stage renal disease (ESRD) patients had higher levels of inflammation markers (NLR, IgG, CRP and YKL-40) and lower HCV RNA levels, HAI and FS compared to non-uremic patients. When patients were grouped into 2 according to FS as mild and severe, IgG (p < 0.001), YKL-40 (p = 0.02) levels and APRI score (p = 0.002) were significantly higher compared to mild FS (p = 0.002). YKL-40 levels (t value: 3.48; p = 0.001) and APRI score (t value: 4.57, p < 0.001) were found as independent associated with FS in non-uremic patients. However, in adjusted models, only APRI score (t value: 3.98, p = 0.002) was an independent associated with FS in ESRD patients. Conclusion: In non-uremic cHepC patients, YKL-40 levels and APRI score may be valuable markers of FS. In ESRD patients, there is not sufficient data for prediction of HAI and FS. In these patients, APRI score may provide better information.

Plasmodium falciparum may cause serious and sometimes even fatal cerebral malaria. Cerebral malaria is a disease characterized by alterations in consciousness and epileptic attacks; therefore, it requires a rapid evaluation and quick intervention. It may progress to a fatal outcome despite administering targeted therapeutic interventions. There are studies indicating that erythrocyte exchange (erythrocytapheresis) can be a treatment modality for managing severe malaria patients. In this case report, the successful management of a cerebral malaria patient by the combination of antimalarial drug therapy and erythrocyte exchange is presented.

Background: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are widespread health problems all over the world and have high morbidity and mortality. Hemodialysis patients are more frequently exposed to these viruses as they have poor immune system and frequently undergo parenteral interventions. The vaccination against HBV prevents infection and it has been recommended for the prevention of HBV infection in all susceptible dialysis patients. This study aimed to determine the seroprevalence of HBV and HCV infections and analyzed the factors affecting inadequate response to HBV vaccine in dialysis patients. Methods: The data for 584 dialysis patients that were followed up at seven dialysis centers were analyzed. The patients received four doses of 40 μg recombinant hepatitis B vaccine at 0, 1, 2, and 6 months and were tested for anti-HBs titer after one month of completion of vaccination. If patients showed a titer of anti-HBs 30 (p = 0.019), over the age of 65 years (p = 0.009), and duration of dialysis treatment >5 years (p = 0.001). There was no statistically significant difference between gender, causes of renal disease, erythropoietin treatment, and the type of dialysis. Conclusion: Hepatitis C infection, obesity, being elderly, and having long hemodialysis period reduced the hepatitis B vaccination response in hemodialysis patients. © 2017, Springer Science+Business Media Dordrecht.

Objective: In recent years, there is an increase in infections caused by non-fermentative Gram-negative bacteria especially in intensive care units. The aim of this study is to determine the antibiotic sensitivity of Pseudomonas aeruginosa strains isolated from the clinical samples of the patients in intensive care unit.

Objectives: The aim of this study was to evaluate histopathological improvement and virological, biological and serological response rates in patients receiving long-term entecavir therapy who were followed with the diagnosis of chronic hepatitis B (CHB).Materials and Methods: Ninety-eight nucleoside(t)e-naive CHB patients who were receiving 0.5mg/day entecavir (ETV) were included in the study. Virological, serological and biochemical test results were assessed baseline and every 12-week intervals. Liver biopsy specimens were assessed according to the modified Ishak scoring.Results: Forty-six CHB patients receiving ETV treatment underwent liver biopsy. The mean age of the patients was 4412.9, 26.1% of them were female. The mean duration of follow-up was 44.9 +/- 10.8months. All patients had hepatitis B virus (HBV) genotype D infection. Of 21 patients who were HBeAg positive at baseline, HBeAg loss occurred in 9 and seroconversion occurred in 5. HBsAg loss occurred in none of the patients. Serum HBV DNA levels became undetectable in 93.5% patients. Of the patients, 50% achieved2 point improvement in HAI scores and 30.4% achieved1 point improvement in fibrosis scores with treatment. The mean improvement in HAI and fibrosis score were 1.94 +/- 1.93 and 0.11 +/- 0.9 points, respectively.Conclusion: ETV is an effective treatment in histological improvement and virological response in CHB patients. Large-scale, long-term studies are still warranted to evaluate the long-term outcomes of entecavir therapy.

Background: Leptospirosis is a zoonotic disease caused by spirochetes of the genus Leptospira. While the majority of leptospirosis cases occur in the tropics, some cases are also observed in temperate regions of developing countries. The disease has various clinical presentations ranging from a mild influenza-like form to a severe potentially fatal illness accompanied by multi-organ failure. However, atypical presentations of leptospirosis have occasion­ally been described. Here, a case of leptospirosis presenting as thrombotic thrombocytopenic purpura (TTP) is reported. Case Report: A 58-years-old male presented with fever, oliguria, darkening of urine, and visual hallucinations. Laboratory investigations revealed anaemia, severe thrombocytopaenia, elevated total bilirubin with indirect predominance, high lactate dehydrogenase, and increased urea (293 mg/dL) and creatinine (7.6 mg/dL) levels. He was diagnosed with TTP. Patient was thought leptospirosis due to atypical clinical manifestations. Leptospirosis was confirmed by strongly positive Microscopic Agglutination Test. Patient recovered completely with antibiotics and plasmapheresis. Conclusion: Leptospirosis may be accompanied by thrombotic thrombocytopenic purpura in particular subtropic regions. Turkish Başlık:Trombotik Trombositopenik Purpurayla Seyreden Bir Leptospiroz Olgusu Anahtar Kelimeler:Leptospiroz, Weil hastalığı, trombotik trombositopenik purpura Arkaplan: Leptospiroz, leptospira cinsi spiral mikroorganizmalar tarafından oluşturulan bir zoonozdur. Leptospiroz sıklıkla tropikal bölgelerde görülmesine rağmen, gelişmekte olan ülkelerde ılıman bölgelerde de rastlanabilmektedir. Hastalık asemptomatik enfeksiyondan ciddi, ölümcül seyredebilen çoklu organ yetmezliğine kadar geniş klinik yelpaze görülür. Bununla birlikte atipik başvuru nadiren görülmektedir Olgu Sunumu: Elli sekiz yaşında erkek olgu ateş yüksekliği, idrar renginde koyulaşma ve görsel halüsinasyonla başvurdu. Laboratuvar incelemesinde anemi, ciddi trombositopeni,indirek hakimiyeti olan bilirubin yüksekliği, yüksek laktat dehidrogenaz, yüksek üre (293 mg/dL) ve kreatinin (7.6 mg/dL) düzeyleri mevcuttu. TTP tanısı aldı. Atipik klinik şekilli leptospiroz düşünüldü. Leptospirozis tanısı yüksek pozitif mikroskopik aglütinasyon testi ile doğrulandı. Hasta antibiyotik tedavisi ve plazmaferezle tamamen iyileşti. Sonuç: Özellikle subtropik bölgelerde, leptospiroz trombotik trombositopenik purpurayla birliktelik gösterebilir.

Objective: This study was designed to determine the efficacy and safety of Entecavir (ETV) after 96 weeks treatment in patients with chronic viral hepatitis B (CHB). Methods: Thirty-eight patients were included into the study. The criteria for starting ETV treatment were as follows: elevated ALT levels >upper limit of normal (ULN) two times, with HBV-DNA levels ≥5 log10 copies/ml (≥20000 IU/mL), in HBe Ag positive patients, ≥4log10 copies/ml (≥2000IU/mL) in HBe Ag negative patients and liver damage was confirmed by histopathology (Knodell HAI ≥4 or fibrosis ≥1). Patients were followed up every 12 weeks by virological and biochemical tests. Results: Twenty-four of 38 patients (63.2%) were male. Mean age of patients were 38.6 years, 14 of them were HBeAg positive (36.8%). At baseline, median ALT level was detected as 106.7 IU/ml, median HBV DNA levels were 4.8 x 107 copy/ml, and mean Knodell HAI score was nine. Eleven of 14 HBe Ag positive patients (78.6%) were treatment-naïve. No resistance mutation was determined during treatment. Biochemical responses (BR) at 48th and 96th week were 100% and virologic response (VR) were 57.1%, and 50%, respectively. Serological response (SR) at 48th and 96th weeks were 35.7% and 42.8% respectively. Fifteen (62.5%) of 24 HBe Ag negative patients were treatment-naïve; two patients were detected to have lamivudine resistance mutation. At 48th and 96th week, BR was 95.8%, and 100%, respectively; and VR were 83.3% both. Conclusion: In our study, virologic response was significantly high after two years of therapy with Entecavir in HBe Ag negative patients., Amaç: Bu çalışmada kronik hepatit B hastalarında 96 haftalık Entekavir (ETV) tedavi etkinliğinin ve güvenliğinin değerlendirilmesi amaçlandı.Yöntemler: Kronik Hepatit B tanısıyla 38 hasta çalışmaya alındı. Entekavir tedavisine başlama kriterleri: yükselmiş ALT düzeyleri, (>normalin iki katında fazla), HBe Ag pozitif hastalarda HBV DNA ≥5 log10 kopya/ml (≥20000 IU/ml), HBe Ag negatif hastalarda ≥4 log10 kopya/ml (≥ 2000 IU/ml) karaciğer hasarının histopatolojik olarak gösterilmesi (Knodell HAİ ≥4, fibrozis ≥1). Hastalar 12 haftada bir biyokimyasal ve virolojik testlerle takip edildi. Bulgular: Hastaların 24’ü (%63,2) erkekti. Yaş ortalaması 38,6 yıldı. Tüm hastaların 14’ünde (%36,8) HBe Ag pozitifti. Başlangıç ortalama ALT düzeyleri 106,7 IU/ml, HBV DNA düzeyleri 4,8 x 107 kopya/ml ve Knodell HAI skoru dokuz idi. HBe Ag pozitif hastaların 11’i (%78,6) naivdi. Hiçbirinde direnç mutasyonu yoktu. Biyokimyasal yanıt (BY) 48. ve 96. haftalarda %100, virolojik yanıt (VY) sırasıyla %57,1 ve %50 idi. Serolojik yanıt (SY) sırasıyla %35,7 ve %42,8 olarak saptandı. HBeAg negatif hastaların 15’i (%62,5) naivdi; iki hastada lamuvidin direnç mutasyonu saptandı. Kırksekizinci ve 96. haftalarda sırasıyla BY %95,8 ve %100, VY %83,3 saptandı.Sonuç: Çalışmamızda iki yıllık entakavir tedavisi sonucunda, özellikle HBe Ag negatif hastalarda tedaviye yüksek oranda yanıt sağlanmıştır

Objective: Recently, the prevalence of infections by multi-drug resistant Gram-positive cocci has increased. This leads to therapeutic problems in conditions caused by these organisms. Quinupristin/dalfopristin, which is not in clinical use in Turkey, is the first parenteral streptogramin antibiotic. We aimed to investigate the susceptibility of quinopristin/dalfopristin to Gram-positive cocci isolated from clinical samples and compare it with susceptibility to other antibiotics that are used to treat Gram-positives cocci, aiming to determine the efficacy of this antibiotic. Materials and Methods: Between June 2008 and June 2009, 279 Gram-positive cocci isolated from clinical samples were included in the study. Bacteria were identified by conventional methods and automatized Vitek 2 (Biomerieux, France) system. Antimicrobial susceptibility was measured by Kirby-Bauer disk diffusion test. Methicillin resistance was detected by measuring sefoxitin susceptibility according to Clinical and Laboratory Standards Institute (CLSI) criteriae. The minimum inhibitory concentration (MIC) of penicillin, vancomycin, teikoplanin, linezolide and quinupristin-dalfopristin was detected by the E-test (AB Biodisk, Solna, Sweden). Results: Coagulase negative staphylococcus (CoNS) (103), Staphylococcus aureus (94), enterococci (50), Streptococcus pneumoniae (21) and other streptococcal strains (11) were included in the study. The susceptibility rates were 100% for methicillin sensitive staphylococci, 93% for methicillin resistant Staphylococcus aureus (MRSA), 98.1% for methycilline resistant coagulase negative staphylocci (MRCoNS), 17.1% for Enterococus faecalis, 80% for Enterococcus faecium, 85.7% for Streptococcus pneumoniae and 100% for other streptococci. All Gram-positive cocci were susceptible to glycopeptides except the two vancomycin resistant E. faecieum isolates. Conclusion: We investigated the susceptibility of Gram-positive cocci to quinupristin/dalfopristin and other antibiotics. High susceptibility of Gram-positive cocci to quinupristin/dalfopristin may allow the use of this drug as an alternative in infections due to multidrug resistant pathogens. However, further studies are required to evaluate the clinical use.

Amaç:Çeşitli meslek gruplarına bağlı oluşan alerjik hastalıkları sorgulamak. Gereç ve Yöntem: İzmir Tepecik Eğitim ve Araştırma Hastanesi, Alerji ve İmunoloji polikliniğine alerjik yakınmalarla başvuran, çalışan 161 hastanın meslek kolu, işyerinde alerjene maruziyet durumu, süresi, kendisinde ve ailede atopi öyküsü, sigara kullanımı, hayvan besleme durumu sorgulandı. Alerjik hastalıklar, alerjik burun nezlesi, alerjik göz nezlesi, ürtiker, astma olarak gruplandırıldı. Bulgular: Alerji polikliniğine alerjik yakınmalarla başvuran herhangi bir meslek kolunda çalışan 161 hastanın 71’i kadın (%44)dı. Yaş ortalaması 34’dü.Meslek gruplarına göre; 40’ı (%25) tekstil işçisi, 39’u (%24) ofis çalışanı, 37’si (%23.1) boya-gıda-kimyevi madde sektörü çalışanı, 24’ü (%15) elektrik-makine-otomotiv sanayi çalışanı, 10’u (%6.2) temizlik işçisi, 7’si (%4.3) sağlık personeli, 3’ü (%1.8) tarım-ilaçlama sektörü çalışanı, 1’i (%0,6) kuaför olarak sınıflandırıldı. Hastaların yakınmalarına göre alerjik belirtileri, ürtiker 86 (%53.4), alerjik burun nezlesi 79 (%47.3), alerjik göz nezlesi 40 (%25), alerjik astma 10 (%6.2) kişi olarak saptandı. Sonuç: Çalışmamızda en çok tekstil, ofis, boya-gıda-kimyasal madde çalışanlarında alerjik hastalıklar saptanmıştır., Aim: To determine the allergic diseases related to occupational groups. Material and Method: In this study 161 patients who admitted to İzmir Tepecik Educational and Research Hospital included. We assessed occupation, duration of allergen exposure , history of atopy, history of smoking, having a pet ın each patient to clarify a possible underlying etiology. Allergic diseaases classified as allergic rhinit, allergic conjunctivitis,urticaire and asthma. Findings: Seventy one of the patients were female. The mean age was 34. According to the occupational groups; of the patients 40 were (25%) textile workers, 39 were (24%) officer, 37 were (23.1%) chemist, 24 were (15%) industial workers, 10 were (6.2%) cleaning workers, 7 were (4.3%) healthy workers, 3 were (1.8%) farmer, 1 were (0,6%)hairdresser. Based on the clinical symptoms, 86(53.4%) were urticaire, 79 (47.3%) were allergic rhinit , 40 (25%) were allergic conjunctivitis, 10 (6.2%) were allergic asthma. Conclusion: We found allergic diseases mostly in textile and industrial workers.

Objective: In this study, we aimed to determine the rate of spontaneous hepatitis B sur - face antigen (HBsAg) seroclearance in inactive chronic hepatitis B virus (HBV) carriers. We com - pared demographic and laboratory characteristics between the patients with and without seroclearance. Material and Methods: This study included retrospective evaluation of 2428 patients with chronic hepatitis B (CHB). The patients with HBsAg positivity for at least 6 months with HBV- DNA levels lower than 104 copies/ml, with normal serum alanine transaminase (ALT) levels, neg - ative for HBeAg, and with detectable anti-HBe antibodies were enrolled in the study. HBsAg seroclearence rates were determined, and the groups with and without seroclearance were com - pared in demographic and laboratory aspects. Results: The annual rate of spontaneous HBsAg se - roclearance in the study group was 0.17%. Among patients with seroclearance, the annual rate of seroconversion was 1%. There was no statistically significant difference between groups for demo - graphic characteristics. HBV DNA levels were significantly lower in patients with seroclearance (p

The age-specific prevalence of hepatitis A virus (HAV) infection and risk factors were evaluated in a low socioeconomic population in Izmir. Children and adolescents 1-18 years of age admitted to the outpatient clinics for follow-up visits, or healthy children between April-December 2009 were investigated for anti-HAV antibodies by a cross-sectional study. A questionnaire on sociodemographic and hygiene information was obtained from the parents. All unvaccinated children against HAV were grouped according to their age. Seven hundred and twenty-nine children were enrolled in the study. Total HAV IgG seropositivity was 29.5% while age related values were as follows: 1-2 years, 21.4%; 2.1-5 years, 15.1%; 5.1-8 years, 20.1%; 8.1-11 years, 32.6%; 11.1-14 years, 44.3% and 14.1-18 years, 52.4%. The presence of anti-HAV IgG was associated significantly with low family income and lack of education of parents and living in a crowded family. HAV infection was endemic in a population of children living in Izmir. Anti-HAV vaccination should be considered for preschool children because teenagers are at risk of infection in this region.

Hepatitis B infection is one of the infectious diseases quite common in Turkey and around the world. Hepatitis B virus infection is a significant health problem which may cause chronic hepatitis, cirrhosis and hepatocellular carcinoma. With the introduction of Hepatitis B vaccine, a significant progress has been made in the prevention of HBV infections. The purpose of the study was to evaluate the characteristics of the individuals included in the risk group who admitted to our vaccination clinic, as well as their immune responses following the vaccination. Among the patients admitted to the vaccination clinic of our hospital between January 2003-December 2005 and that were included in the risk group (patients who have family members with chronic Hepatitis B infection, healthcare workers, hemodialysis patients, etc.,) those who were included in the vaccination program by examining the results of HBs Ag, anti-HBc and anti-HBs were evaluated in terms of their characteristics (age, gender, smoking, etc.,) and results of Anti-HBs score. A total of 958 people were included in the vaccination program. Upon evaluation in terms of risk factors, presence of patients with chronic hepatitis B infection in the family was found to be 80.6% (772/958), being healthcare worker was 9.2% (88/958), HCV positivity and chronic liver disease was 3.0% (29/958), being a hemodialysis patient was 2.8% (27/958), and being an oncology patient was 2.1% (20/958). Post-vaccination immune response could be evaluated in 69.8% (669/958) of patients and no responsiveness to vaccine was detected only in 8.1% (54/669) of them. Of the non-responders, 64.8% (35/54) were hemodialysis and oncology patients. Anti-HBs positivity rate following hepatitis B vaccination program was found compatible with the results of previous studies. With this vaccine of considerably high effectiveness, immunization of the entire community including primarily the risk groups should be targeted.