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Introduction: This study aimed to identify a follow-up modality that can be used to evaluate therapeutic responses in patients receiving treatment for brucellar sacroillitis and to determine whether antibiotherapy can be stopped. Methodology: A total of 32 patients with sacroiliac joint involvement demonstrated via magnetic resonance imaging or bone scintigraphy were followed up and treated. Patients received 200 mg/day of doxycycline and 600–900 mg/day of rifampicin for 3–21 months, and 1 g/day of streptomycin for 21 days. Results: The mean age of the 32 patients involved was 21.81 ± 4.09. In total, 10/32 patients did not complete therapy, and the remaining 22 patients received combination antibiotic treatment for a mean of 8.95 ± 4.34 months. Of the 22 patients, 15 underwent MRI, and 7 of them did not consent to MRI. Similarly, 17 patients were followed up by bone scintigraphy, and 5 patients did not have scintigraphy results. In 9/17 patients followed up with bone scintigraphy, sacroiliitis findings were found to reduce after a mean of 7.44 ± 3.71 months, whereas in 12/15 patients on whom MRI was performed, there were no active sacroiliitis findings for a mean of 6.95 ± 2.83 months. Conclusions: While active involvement findings in bone scintigraphy were observed for a longer period in scintigraphy images, active sacroiliitis findings disappeared in a relatively shorter period of time with MRI. Therefore, we have demonstrated that high-resolution MRI is a very sensitive technique compared to scintigraphy.

WOS: 000374760800008, 27093110

Background and Objectives Screening of blood donations for antibodies against hepatitis B core antigen (anti-HBc) is used to prevent transfusion transmitted hepatitis B virus (HBV) infection. In this study, we studied the magnitude of blood donor gain by using a re-entry mechanism in our Blood Bank of Gulhane Military Academy of Medicine. Materials and Methods Between January and May 2013, 5148 voluntary blood donors were screened by ELISA method for HBsAg, anti-HBc total and other screening markers, prospectively. Samples with repeated reactivity for the presence of anti-HBc were further tested with four supplemental assays. Results We detected 515 (10%) anti-HBc positive and 4612 (90%) anti-HBc negative cases in 5127 HBsAg negative serum samples. A total of 461 (89.5%) blood units were reactive for at least one additional serologic parameter and 54 were (10.5%) negative. Isolated anti-HBc positivity rate was 1.3% (69/5127). In the isolated anti-HBc positive samples, 54 were also anti-HBe and HBeAg negative. HBV DNA was not detected in any of the samples. Conclusion Applying the EDQM criteria would decrease our blood donor loss from 10% to 5.4%. As alternative re-entry mechanisms have already been presented in the literature, institution of a new policy is needed to enhance the limited blood donor pool in our system.

Transfusion of platelet suspensions is an essential part of patient care for certain clinical indications. In this pioneering study in Turkey, we aimed to assess the in vitro hemostatic functions of platelets after cryopreservation.Seven units of platelet concentrates were obtained by apheresis. Each apheresis platelet concentrate (APC) was divided into 2 equal volumes and frozen with 6% dimethyl sulfoxide (DMSO). The 14 frozen units of APCs were kept at -80 °C for 1 day. APCs were thawed at 37 °C and diluted either with autologous plasma or 0.9% NaCl. The volume and residual numbers of leukocytes and platelets were tested in both before-freezing and post-thawing periods. Aggregation and thrombin generation tests were used to analyze the in vitro hemostatic functions of platelets. Flow-cytometric analysis was used to assess the presence of frozen treated platelets and their viability.The residual number of leukocytes in both dilution groups was1x106. The mean platelet recovery rate in the plasma-diluted group (88.1±9.5%) was higher than that in the 0.9% NaCl-diluted group (63±10%). These results were compatible with the European Directorate for the Quality of Medicines quality criteria. Expectedly, there was no aggregation response to platelet aggregation test. The mean thrombin generation potential of post-thaw APCs was higher in the plasma-diluted group (2411 nmol/L per minute) when compared to both the 0.9% NaCl-diluted group (1913 nmol/L per minute) and the before-freezing period (1681 nmol/L per minute). The flow-cytometric analysis results for the viability of APCs after cryopreservation were 94.9% and 96.6% in the plasma and 0.9% NaCl groups, respectively.Cryopreservation of platelets with 6% DMSO and storage at -80 °C increases their shelf life from 7 days to 2 years. Besides the increase in hemostatic functions of platelets, the cryopreservation process also does not affect their viability rates.Amaç: Trombosit süspansiyonlarının transfüzyonu, belirli klinik endikasyonlarda hastaların tedavisinin önemli bir parçasıdır. Bu çalışma ile Türkiye’de ilk kez olmak üzere trombositlerin in vitro hemostatik fonksiyonlarının kriyopreservasyon işleminden sonra değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmamızda 7 ünite trombosit süspansiyonu aferez yöntemiyle elde edildi. Her aferez trombosit konsantresi (ATK) iki eşit hacime ayrıldıktan sonra %6 dimetil sülfoksit (DMSO) kullanılarak donduruldu. Dondurulmuş 14 ünite ATK -80 °C’de bir gün süre ile bekletildi. ATK’lar 37 °C’de çözdürüldükten sonra otolog plazma veya %0,9 NaCl kullanılarak dilüe edildi. ATK’ların dondurma öncesi ve çözülme işlemi sonrası; hacim, rezidüel lökosit ve trombosit sayıları incelendi. Trombositlerin in vitro hemostatik fonksiyonların incelenmesinde agregasyon ve trombin jenerasyon testleri kullanıldı. Dondurma işlemine maruz kalan ATK’lardaki trombositlerin varlığı ve bu hücrelerin canlılığını değerlendirmek için akım sitometri yöntemi kullanıldı. Bulgular: Her iki dilüsyon grubunda yer alan ATK’ların residüel lökosit sayısı 1x106’nın altındaydı. Plazma ile dilüe edilen grubun ortalama trombosit geri kazanım oranı %0,9 NaCl ile dilüe edilen gruptan daha yüksekti (%88,1±9,5’e karşılık %63±10). Bu sonuçlar Avrupa İlaç Kalite ve Sağlık Hizmetleri Direktörlüğü’nün kalite kriterlerine uygundu. Trombosit agregasyon testine beklenildiği üzere yanıt alınamadı. Dondurulup çözülerek otolog plazma ile dilüe edilen ATK’ların ortalama trombin oluşturma potansiyeli (2411 nmol/L×dakika), %0,9 NaCl ile dilüe edilenlere (1913 nmol/L×dakika) ve dondurma işlemi öncesine göre (1681 nmol/L×dakika) daha yüksek saptandı. Kriyopreservasyon işlemi sonrası plazma ve %0,9 NaCl ile dilüe edilen ATK’ların akım sitometri yöntemi ile canlılığı sırasıyla %94,9 ve %96,6 olarak bulundu. Sonuç: Trombositlerin DMSO ile kriyopreserve edilerek -80 °C saklanmaları, raf ömürlerini 7 günden 2 yıla çıkarmaktadır. Kriyopreservasyon işlemi trombositlerin in vitro hemostatik fonksiyonlarını arttırmanın yanında canlılık oranlarını da etkilememektedir.

Summary Objective To review retrospectively the clinical symptoms, laboratory findings and treatment outcomes of patients with Brucellar epididymo-orchitis. Material and method Retrospective data of 28 patients with Brucellar epididymo-orchitis who admitted to four medical centers between 2005 and 2013 were retrospectively reviewed. Positive blood culture, positive Rose Bengal test results or high agglutination titres of ≥1/160 with the positive clinical and ultrasonographic findings of orchitis were accepted as the main criteria for Brucellar epididymo-orchitis. Results The mean patient age was 31 ± 16.9 years. Testicular involvement was on the left side in 16 patients and on the right side in 11 patients, one had bilateral disease. Testicular pain and swelling were the most common symptoms and elevation of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and leucocytosis were the most common laboratory findings. Initial treatment was orchidectomy in six patients due to malignancy suspicion. All but three patients were successfully treated with antibiotic combinations of rifampicin, doxycycline and streptomycin. Two of three treatment resistant patients underwent orchidectomy. Conclusion Brucellosis is a common cause of epididymo-orchitis in endemic regions. Early diagnosis and treatment is crucial in the management and thus it must be kept in mind in endemic and non-endemic regions.

Liver-derived paraoxonase-1 (PON1) enzyme that is found in the circulation is bound to high-density lipoproteins and reduces the amount of oxidized lipids with its antioxidant effect. Humans have at least three different PON gene regions which are adjacent to the other on the 7th chromosome. It has been shown that PON1 gene and its polymorphisms are related with various diseases. It is also known that, hepatitis C virus (HCV) is tightly associated with the cell lipoproteins in each step of its replication cycle leading to modulation of the host lipid metabolism. The aim of this study was to investigate the relationship between the response to chronic hepatitis C (CHC) therapy and aminoacid changes in 55' and 192' regions of PON1 enzyme believed to be involved in the pathophysiology of many chronic diseases. A total of 49 CHC patients (27 male, 22 female; mean age: 52.9 ± 12.6 yrs), all infected with HCV genotype 1b and positive for anti-HCV and HCV-RNA were included in the study. Patients who were HCV-RNA negative at the sixth month following at least once pegilated interferon + ribavirin treatment, were considered as therapy-responders, whereas those who were HCV-RNA positive were considered as non-responders. The genomic DNAs were isolated from patients' blood samples in their routine follow-ups and Q/R192 and L/M55 PON1 polymorphism analysis in 55. and 192. regions was performed by T-ARMS-PCR (Tetra-primer amplification refractory mutation system-polymerase chain reaction) method. In our study, the analysis of PON1 polymorphisms yielded 44.1% of LL, 44.1% of LM and 11.8% of MM genotypes at position 55 and 55.9% of QQ, 41.2% of QR, and 2.9% of RR genotypes at position 192 in therapy-responders. In the evaluation of combined genotype analysis of the patients, there was only one case who was responsive to treatment with LL/RR genotype. Of the patients, eight harbored LL/QQ genotypes and seven of them (87.5%) were responsive to treatment. However, statistical analysis indicated that there was no relationship between PON1 L/M55 and PON Q/R192 polymorphisms and response to CHC treatment (chi-square test, p> 0.05). Our data did not support a relationship between PON1 polymorphisms and response to CHC therapy, in contrast to a few studies pointing out of this correlation. This might be attributed to relatively low number of patients included. In conclusion, since antiviral agents used for CHC therapy are limited and costly, it was thought that further investigations with large numbers of patients should be conducted to establish the presence of any relationship between the response to CHC therapy and genotypes of the PON1 enzyme.

Introduction: This study aimed to review the possible sources of infection of 16 oropharyngeal tularemia hospital cases, and to document their epidemiological and demographical characteristics, laboratory findings, treatment methods, and treatment results. Methodology: Sixteen cases from a Turkish military hospital between January 2011 and December 2012 were retrospectively evaluated. The age, sex, occupation, place of residence, symptoms, duration of symptoms, laboratory results, treatment and duration, and treatment results were recorded. Tularemia was diagnosed through tularemia-specific tests once the other conditions that may have caused lymphadenopathy were excluded. Results: Twelve of the patients included in this study were males. The average age of the patients was 32.1±17.2 years. Sore throat, fatigue, and fever were the most frequent symptoms. The mean duration of symptoms was 21.6±6.9 days. All the patients had been treated for tonsillopharyngitis in primary healthcare institutions previously. However, despite the treatment, cervical lymphadenopathy had developed in these cases. Patients were given streptomycin, doxycycline, and ciprofloxacin monotherapy or in combination. Ten of the cases fully recovered, while five required surgical lymph node drainage. Spontaneous drainage occurred in the single remaining case. Conclusions: Turkey is considered to be an endemic country with regards to tularemia. Prompt diagnosis and proper treatment of the disease is imperative in providing cure. Since it can be potentially confused with tuberculous lymphadenitis, differential diagnosis is vital. Patients presenting with a condition of tonsillopharyngitis in endemic areas must be carefully monitored.

Objective It is commonly known that ultrasonography (US) transducers function as both a reservoir and means of transfer for hospital infections. The current study aimed to compare the antimicrobial effectiveness of using >80℃ water versus antiseptic wipes to disinfect US transducers. Methods Subsequent to abdominal inspections in three groups of 20 patients, a swab culture was taken from the transducer in each case. Neither a mechanical nor chemical disinfection was applied to the trans- ducer in the first group. As for the second group, the transducer was placed in >80℃ hot water for five min- utes. In the third group, the transducer was wiped clean using antiseptic wipes. Results Of the 60 swab samples collected, 40 did not produce any growth. The number of samples exhibit- ing growth in the first group involved 18 cases of coagulase-negative staphylococcus (CNS), as well as 15 cases of Listeria spp., one case of Corynebacterium spp. and one case of Bacillus spp., while only one case of CNS was observed in the second and third groups, respectively. The culture growth and colony forming units rate were significantly higher in the samples obtained from the first group than in those obtained from the other groups (p

Summary Background Chitotriosidase (CHT) enzyme has been known to be secreted from the activated macrophages. We infer with these data that CHT activity is an indicator for the defence. Methods In this study, we evaluated CHT levels in both neutropenic and non neutropenic patients. CHT enzyme activity was measured and compared to each other groups. Results Chitotriosidase levels were found to be significantly higher in neutropenic patients with candidemia. Conclusion In the comparison between neutropenic and non neutropenic patients, there was a significant difference for CHT levels. The use of this enzyme as a surrogate marker for candidemias were evaluated in neutropenic and non neutropenic patients.

AIM: To evaluate retrospectively adult cases of viral encephalitis. METHOD: Fifteen patients described viral encephalitis hospitalized between the years 2006-2011 follow-up and treatment at the infectious diseases clinic were analyzed retrospectively. RESULTS: Most of the patients (%60) had applied in the spring. Fever (87%), confusion (73%), neck stiffness (73%), headache (73%), nausea-vomiting (33%), loss of consciousness (33%), amnesia (33%), agitation (20%), convulsion (%20), focal neurological signs (13%), Brudzinski-sign (13%) were most frequently encountered findings. Electroencephalography test was applied to 13 of 14 patients, and pathological findings compatible with encephalitis have been found. Radiological imaging methods such as CT and MRI were performed in 9 of the 14 patients, and findings consistent with encephalitis were reported. All of initial cerebrospinal fluid (CSF) samples were abnormal. The domination of the first examples was lymphocytes in 14 patients; only one patient had an increase in neutrophilic cells have been found. CSF protein level was high in nine patients, and low glucose level was detected in two patients. Herpes simplex virus polymerized chain reaction (PCR) analyze was performed to fourteen patients CSF. Only two of them (14%) were found positive. One of the patients sample selectively examined was found to be Parvovirus B19 (+), the other patient urine sample Jacobs-creutzfeld virus PCR was found to be positively. Empiric acyclovir therapy was given to all patients. Neuropsychiatric squeal developed at the one patient. CONCLUSION: The cases in the forefront of change in mental status viral meningoencephalitis should be considered and empirical treatment with acyclovir should be started. [TAF Prev Med Bull 2012; 11(4.000): 447-452]

Giardia intestinalis is the cause of both epidemic and endemic diarrhea and upset of the gastrointestinal system. There are a number of drugs whose efficacies are well studied and that have been accepted for the treatment of patients with this infection. However, some individuals experience treatment failure, despite having received successive courses of treatment that have been documented to result in a cure for most patients. Nitazoxanide has been reported to be effective against a broad range of parasites, including G. intestinalis. In this case, we present a case of drug resistance G. intestinalis treated with nitazoxanide. [TAF Prev Med Bull 2012; 11(3.000): 369-372]

Brucellosis is a zoonotic disease caused by Brucella species that is a gram negative coccobacilli and can cause symptoms such as fever, diaphoresis, arthalgia and myalgia. Although humans become infected by contact with animals or consuming dairy products that are contaminated with Brucella, cases in which humans are infected by vaccination are rarely mentioned in the literature. Here, we present the a case of a 24-year old veterinarian who was diagnosed with brucellosis upon being exposed to Brucella abortus S19 while vaccinating a young cattle and accidentally inoculating the pathogen to the thumb of his left hand. He was admitted to the Kocaeli Ozel Konak hospital 36 hours after the inoculation with an edema and sensitivity to pressure in the innoculation site, while the other physical examination findings were normal. At this stage theserological tests (Rose Bengal and agglutination) were negative, while the routin biochemical tests were within normal range. In addition, samples collected from the inoculation site didn’t show any bacterial growth. Despite chemoprophylactic treatment with doxycycline, the patient developed fever, diaphoresis, and testicular pain 21 days after the contact. His body temperature was 38.3 OC and the patient complained about pain when the finger was bended during his second visit. Laboratory tests showed the aspartat aminotransferaz (AST) level was 32 U/L, alanin aminotransferaz (ALT) 25 U/L, and CRP 8.94 mg/dL. The OZET Bruselloz, gram negatif kokobasil olan Brucella cinsi bakterilerin neden oldugu, insanlarda ates, terleme, kas ve eklem agrisi gibi belirtilerle seyreden bir zoonotik hastaliktir. Bruselloz esas olarak enfekte hayvanlarla temas ve enfekte sut-sut urunlerinin tuketilmesi ile bulasmasina ragmen, literaturde asi kaynakli olgular da nadiren bildirilmektedir. Burada; genc sigirlarin asilanmasi sirasinda canli Brucella abortus S19 asisina maruz kalan bir veteriner hekimde gelisen mesleki bruselloz olgusu sunulmustur. Yirmi dort yasindaki erkek veteriner hekim, B. abortus S19 asisi ile sigirlari asilarken asiyi yanlislikla sol el basparmagina inokule etmistir. Hasta, asi inokulasyonundan 36 saat sonra Kocaeli Ozel Konak Hastanesine basvurmustur. Ilk muracaat ettiginde asi inokulasyon yerinde odem, sislik ve hassasiyet saptanmis, diger fizik muayene bulgulari normal olarak degerlendirilmistir. Baslangicta calisilan serolojik testler (Rose Bengal ve serum tup aglutinasyon testi) negatif, rutin biyokimyasal testler ise normal sinirlarda bulunmustur. Ayrica inokulasyon yerinden alinan yara kulturunde bakteri izole edilememistir. Hasta, doksisiklin ile kemoproflaksi uygulanmasina ragmen olaydan 21 gun sonra ates, terleme ve testis agrisi ile tekrar basvurdugu ikinci muracaatinda atesi 38,3 OC olarak saptanmis, inokulasyon bolgesinde fleksiyon sirasinda agri ve gerginlik yakinmasi oldugu belirlenmistir. Laboratuvar incelemesinde aspartat aminotransferaz (AST) 32 U/L, alanin aminotransferaz (ALT) 25 U/L, CRP 8,94 mg/dL, serolojik incelemede Turk Hijyen ve Deneysel Biyoloji Dergisi 1 Gulhane Askeri Tip Fakultesi, Enfeksiyon Hastaliklari ve Klinik Mikrobiyoloji Ana Bilim Dali, ANKARA 2 Ozel Konak Hastanesi, KOCAELI Gelis Tarihi / Received : Kabul Tarihi / Accepted : Iletisim / Corresponding Author : Ahmet KARAKAS Gulhane Askeri Tip Fakultesi, Enfeksiyon Hastaliklari ve Klinik Mikrobiyoloji Ana Bilim Dali, ANKARA Tel : +90 312 304 43 08 E-posta / E-mail : akarakas@gata.edu.tr 24,10,2011 05.02.2012 DOI ID : 10.5505/TurkHijyen.2012.64325 Karakas A, Mert G, Coskun O, Alga OH, Besirbellioglu BA, Eyigun CP. S19 hayvan asisinin kazayla inokulasyonu sonucu gelismis bir bruselloz olgusu. Turk Hij Den Biyol Derg, 2012; 69(1): 37-40. Cilt 69  Sayi 1  2012 Turk Hij Den Biyol Derg 38 Bruselloz gram negatif kokobasil olan Brucella cinsi bakterilerin neden oldugu, insanlarda ates, terleme, kas-eklem agrisi gibi belirtilerle seyreden bir zoonotik hastaliktir. Hastalik esas olarak hayvanlarla direkt temas, enfekte et ve sut urunlerinin tuketilmesi ile bulasir (1). Bununla birlikte; inhalasyon, solid organ ve hematopoetik kok hucre nakli, cinsel iliski ve veteriner hekimlikte kullanilan brusella asilarina maruziyet sonucu da hastalik gelistigi bildirilmistir (2-4). Bu makalede bir veteriner hekimde canli Brucella abortus S19 asisina maruziyet sonucu gelisen bir bruselloz olgusu sunulmus ve literatur isiginda temas sonrasi olgu yonetimi gozden gecirilmistir.

Hepatitis A virus (HAV) causes an acute hepatitis associated with significant elevatation in liver enzymes. The liver is main target of HAV and extrahepatic manifestations are scarce. The diagnosis of acute HAV infection is made by the detection of anti-HAV IgM antibody in patients with the typical clinical presentation.. Here in, we present a 22-year old male presented with malaise, fever, nause, and intensive stomach ache. In physical examination, the patient had fever, jaundice, and hepatomegaly. Laboratory tests resulted in elevated liver enzymes. Abdominal ultrasonography demonstrated thickening of the gallbladder wall, and intramural air. As the patient's symptoms failed to regress in follow up laparoscopic cholecystectomy was performed. To sum up, HAV infection can be seen in all age groups, in developing countries, such as our country. It must be kept in mind that, although very rarely, HAV infections may exhibit extrahepatic complications. [Dis Mol Med 2015; 3(1.000): 5-7]

Objectives: The purpose of this trial was to investigate in patients with sepsis, the correlation between prognosis ofdisease and factors, which influence prognosis like gender, focus of infection, bacterial growth in blood culture, growingpathogens in addition to serum levels of cytokines (TNF-α, IL-10, leptin) and C-reactive protein.Material and methods: Forty-six adult patients with sepsis and 55 healthy adults as control group were enrolled in thisstudy. Serum cytokine (TNF-α, IL-10 and leptin) levels were determined by ELISA method and C-reactive protein (CRP)levels were measured by nephelometric method. Serum cytokine and CRP levels on day 0 (initial), day 3 and day 5 werecompared in surviving sepsis patients and patients who died because of sepsis.Results: Serum IL-10 level on day 0 (initial) of adult patients who died as a result of sepsis was found to be higher thansurviving patients and the difference was statistically significant (p=0.025). On 3rd day of treatment, serum TNF-α andCRP levels of patients who dies because of sepsis were higher than values of surviving patients (for TNF-α p=0.033, forCRP p=0.026). In adult patient group with sepsis who died on the 5th day of treatment, serum TNF-α level was significantlyhigher than levels in surviving patients (p=0.030).Conclusion: It was determined that in patients who died due to sepsis, initial serum IL-10 level, TNF- α and CRP levelson 3rd day of treatment and finally on 5th day of treatment, only serum TNF- α level was higher than surviving patients.We believe that determining serum TNF-α and IL-10 levels in patients with sepsis before and during treatment will helpclinicians to clarify prognosis and enable them to implement appropriate treatment modifications. J Microbiol Infect Dis2011; 1(3):101-109

The aim of this study, which evaluated historical data, was to delineate the probable impacts of infectious diseases on human populations under extraordinary circumstances. The second goal was to disclose the mortality rates for infectious diseases in the absence of antibiotics.The Third Ottoman Army records at the Turkish General Staff Military History and Strategic Study Directorate were studied retrospectively for the period between March 1915 and February 1916.For the Third Ottoman Army, the number of infection-related deaths over the single-year period was 23,601. Malaria, relapsing fever and dysentery were the most common infections. In that pre-antibiotic era, the highest mortality rates were seen for cholera (80%), pulmonary tuberculosis (58%) and typhoid fever (51%). However, typhus had the maximum share in soldier deaths (6053 soldiers). The rate of vector-borne infections peaked in the summer of 1915, while the frequency of respiratory tract infections was highest in the colder months. In contrast, gastrointestinal tract infections appeared to maintain a steady state throughout the year.If the wartime data for 1915 are accepted to provide a model for extraordinary circumstances in the 21st century, vector-borne, respiratory tract and gastrointestinal infections can be accepted as the challenging issues with significant mortality.

Hospital environments are the most important source of nosocomial infections. The concept of the hospital environment that includes the hospital\'s air, water and environment, medical equipments, the patient\'s food, drinks and articles. Air and water are the most important in terms of infection within them. There are interactions with each other host, microbial and environmental factors in the development of these infections. The microorganisms live or inanimate resources can be transmitted from different ways to the individuals in the hospital environment. The hospital environment contains many components. Therefore, infections with the war are difficult and complex. [TAF Prev Med Bull 2011; 10(3.000): 379-386]

Objective The aim of this study was to investigate a large food-borne outbreak associated with eggs contaminated by Salmonella Enteritidis in a military unit using pulse field gel electrophoresis (PFGE) and the Repetitive-sequence-based PCR (rep-PCR) employing the DiversiLab system. Materials and Methods In mid-January 2008, a food-borne outbreak associated with S. Enteritidis occurred in a military unit located in the city centre of Isparta. A total of 2,469 patients were registered to six hospitals with gastrointestinal disease symptoms such as diarrhea and abdominal pain. Of those registered, 445 were hospitalized. S. Enteritidis was isolated from 276 stool samples and a blood sample of the hospitalized patients and from a food item. The PFGE patterns after XbaI digestion and rep-PCR profiles produced by the DiversiLab systemTM were determined for eight randomly selected stool isolates, one blood isolate and one food isolate. Results The PFGE patterns of all isolates were identical. The Rep-PCR profiles produced by using the DiversiLab system showed that all isolates were indistinguishable. The PFGE and rep-PCR interpretations were concordant for the S. Enteritidis isolates. All stool isolates, one blood isolate and one food isolate were susceptible to all antibiotics tested. Conclusion This data suggest that the DiversiLab system may be a reasonable alternative to PFGE for investigation and control of S. Enteritidis outbreaks, since it is easy to use, rapid and does not require highly skilled operators.

Objective Due to its high morbidity rates, brucellosis -a systemic inflammatory disease, is still an important health problem, particularly in Mediterranean regions. One-third of the patients are characterized with musculoskeletal involvement. Principally in chronic cases, there are difficulties in the follow-up of therapy success. Radiological imaging methods are used in musculoskeletal brucellosis in addition to standard serological tests. Two macrophage products, namely neopterin (NPT) and chitotriosidase (ChT), are used as novel markers in order to reflect the status of inflammatory diseases. In this study, we aimed to test the validity of these markers in follow-up of patients with brucellosis. Patients and Methods A total of 40 brucellosis cases were included in the study and 27 healthy individuals were used as controls. Twenty of the brucellosis patients were presented with sacroiliac joint involvement. A 6-week treatment of doxycycline combined with rifampicin or streptomycin was used to treat brucellosis. Clinical observations and serological outcome were used to determine whether treatment was successful or not. Results All of the 20 brucellosis patients without musculoskeletal involvement healed with the first cure of treatment, but all of the brucella-sacroiliitis patients had to be retreated. In addition to routine testing, serum NPT and ChT levels were evaluated after each treatment. The results presented a clear fall in both NPT and ChT levels in parallel with the serological data of the patients. Conclusion In conclusion, NPT as well as ChT seems to be a useful marker in the follow-up of brucellosis patients and for evaluating the success of therapy.

In this study, an appropriate sepsis model was created in rats. Additionally, the effects of steroid treatments on survival, in connection with antibiotic treatment, were investigated. The sepsis model performed via intraperitoneal injection of 3 ml/kg fecal suspension was determined as the most appropriate model for our study. Fifteen rats were used to investigate the effect of piperacillin-tazobactam on sepsis treatment. Forty-five randomly selected rats were used to investigate the efficacy of the antibiotic-plus-steroid combination. The rats were divided into three groups of 15 rats each. Twelve hours after the administration of fecal suspension, methylprednisolone (MP) at the dose of 0.25, 0.5, and 2 mg/kg/day was given to each group, respectively, in addition to an antibiotic administered intravenously. In order to investigate the effect of steroids alone in the treatment of sepsis, 0.5 mg/kg/day MP was given intravenously to 15 rats, 12 h after the fecal suspension was administered. It was concluded that administration of MP alone shortens survival time in rats with sepsis, whereas antibiotic therapy alone increases survival time significantly in rats with sepsis. It was seen that the antibiotic-plus-steroid treatment increases survival significantly compared to rats with no treatment (p0.05). In addition, steroids, when added to an antibiotic treatment in sepsis, affect survival positively when compared to the group with antibiotic therapy alone, depending on the dose given. Although, not statistically significant, high doses decrease survival (p0.05), and very low doses increase survival and mean survival time (p0.05) on the basis of clinical observation and average life time. However, low doses were found to increase survival significantly (p0.05). We concluded that low-dose MP, in addition to the appropriate antibiotic therapy, is the optimal in the treatment of rats with intraabdominal sepsis.

Objective The central nervous system involvement of Brucellosis causes a hard to treat infection with multiple sequelae. The aim of this paper is to discuss the course of neurobrucellosis in response to therapy. Patients and Methods Patients with neurobrucellosis were evaluated. The diagnosis was established by the isolation of bacteria, abnormal CSF findings and positive serology. Ceftriaxone, rifampicin, doxycycline and trimethoprim sulfamethoxazole were the antibiotic choices for these cases. Results We present 11 cases with neurobrucellosis. None of our patients died, albeit one case has a critical situation due to subarachnoid hemorrhage and its' concordant sequelae. Only one of four patients with walking difficulty and two with hearing loss were normalized with therapy. Imaging techniques did not provide any specific contribution regarding the Brucella infection. Conclusions Parenteral ceftriaxone should be used as an initial alternative in the management of neurobrucellosis. Although the therapy should be individualized, the duration of therapy should be a minimum of six months with suitable antibiotics.

To demonstrate the genotypic lamivudine resistance in liver tissue of patients with negative serum hepatitis B virus (HBV) DNA under long-term lamivudine therapy. Materials and methods: Fourteen patients (10 patients with elevated alanine aminotransferase and 4 patients under long-term lamivudine therapy for severe liver disease) with undetected serum HBV DNA were included in the study. A liver biopsy was performed for each patient, and HBV DNA extracted from liver tissue was analyzed with TaqMan real-time polymerase chain reaction. Results: Mutations conferring lamivudine resistance were shown for all 14 patients in their liver tissue-extracted HBV DNA. One patient had rtM204V, 4 patients had rtL180M, 2 had rtL180M + rtM204V, 4 had rtL180M + rtM204I, and 3 had rtL180M + rtM204I + rtM204V substitutions. Conclusion: Analyzing mutation in liver tissues of these patients might help demonstrate resistance earlier and prevent delaying of therapeutic modification. Therefore, all liver biopsy specimens of patients with severe liver fibrosis should be analyzed using the molecular technique.

Hepatitis A virus (HAV) causes an acute hepatitis associated with signifi cant elevation in liver enzymes. The liver is the main target of HAV, and extrahepatic manifestations are scarce. The diagnosis of acute HAV infection is made by the detection of anti-HAV IgM antibody in patients with the typical clinical presentation. Herein, we present a 22-yearold male presented with malaise, fever, nausea, and intensive stomach ache. In physical examination, the patient had fever, jaundice, and hepatomegaly. Laboratory tests resulted in elevated liver enzymes. Abdominal ultrasonography demonstrated thickening of the gallbladder wall, and intramural air. As the patient’s symptoms failed to regress in follow-up, laparoscopic cholecystectomy was performed. To sum up, HAV infection can be seen in all age groups, in developing countries, like our country. It must be kept in mind that although very rarely, HAV infections may exhibit extrahepatic complications.

Clinical features, cerebrospinal fluid (CSF) examination, and neuroimaging findings can yield a presumptive diagnosis of tuberculosis meningitis (TM). However, confirmed diagnosis depends on the culture of Mycobacterium tuberculosis from the CSF [1]. Generally, the decision to begin with tuberculostatic treatment cannot await the proof of the causative agent and the prognosis of the disease may be devastating even if treatment is started promptly [2]. Sometimes the clinicians are confused from the diagnostic burden whether to start therapy for TM or not. In some TM cases without microbiological confirmation, the clinical and laboratory parameters resolve very quickly after the initiation of antibiotics. There remains another controversy in this situation, i.e. whether the clinician will stop therapy or continue for 12 months. There is little knowledge on the changes of CSF biochemical parameters during antituberculosis therapy in TM patients. What happens to the biochemical profile in CSF in due course? To the authors’ knowledge there are no data in the literature on this issue. Our study, which was performed between 1 January 2000 and 31 December 2004, focuses on these CNF changes in biochemical profiles for TM patients receiving therapy. There is a chain of military hospitals over the country in Turkey. If a soldier is diagnosed as TM in 1 of the military hospitals, the patient is given antibiotics and sent home for 2 /3 months of rest following the hospitalization necessary for patient stabilization. The patient returns to hospital either in an emergency situation or following the end of the official rest period. Thus, all TM patients return to military hospitals every 2 to 3 months, but the patient does not necessarily apply to the hospital where the disease is diagnosed. Generally the patient applies to the military hospital nearest to where he lives, i.e. another institution may follow a TM case diagnosed in our hospital in the follow-up periods or we may follow a previously diagnosed case in another military hospital during the therapeutic course. In every periodical visit the patient was punctured once again either to delineate the status of infection or to present an official clue to provide the patient with an additional rest time. After the end of 12-month therapy, the surveillance of the patient is stopped. Therefore we have sparse data on TM patients which we may have encountered at any period during anti-tuberculosis therapy. All the cases were young males ranging from 20 to 28 y of age without immunosuppression. Dexamethasone was given to all patients in standard dosages

A 79-year-old male suffering from nasal congestion was referred to our hospital. Endoscopic examination revealed a hyperemic mass obstructing the left nasal passage. The lesion's surface was smooth. The findings of imaging studies were consistent with a benign tumor despite the erosion and perforation of the septum. The lesion originated from the middle concha and was attached to it with a thin stalk. It was removed easily by endoscopic resection. Histopathology revealed significant infiltration of mononuclear inflammatory cells, mostly lymphocytes and histiocytes, into the edematous subepithelial connective tissue. High-power magnification showed numerous Leishmania amastigotes in the cytoplasm of the histiocytes. A polymerase chain reaction experiment for Leishmania also confirmed the morphological diagnosis. No relapse was observed in the 12 months after surgery and the patient was doing well.

The objective of this study was to compare the results of cultures obtained by mini-bronchoalveolar lavage (BAL) and endotracheal aspiration (ETA) techniques, used for rapid and accurate determination of pathogens causing ventilator-associated pneumonia (VAP) in intensive care units. Of the 92 patients on mechanical ventilation followed at the emergency intensive care unit of our hospital between June 2010 and June 2011, 30 (32.2%) patients were diagnosed as VAP and they were included in this study. VAP diagnosis were based on the clinical and radiological findings. Clinical pulmonary infection score (CPIS) of6 was accepted as the clinical criteria of VAP. Initially ETA samples were collected from the patients followed by mini-BAL sampling 15 minutes later, together with urine and two blood cultures. Microbiological evaluation and identification were performed by conventional methods and Phoenix 100 (BD Diagnostic Systems, ABD) automated system. In quantitative culture analysis,10.000 cfu/ml for BAL and100.000 cfu/ml for ETA were accepted as the positive result. The mean ages of VAP-developed (n= 30; 18 were male) and nondeveloped (n= 62; 39 were male) patients were 68.23 ± 16.19 and 52.16 ± 10.41 years, respectively, and the mean durations of mechanical ventilation were 29.57 ± 15.78 and 12.11 ± 6.01 days, respectively. Multivariate logistic regression analysis showed that older age (p0.001) and duration of mechanical ventilation (p0.001) were independent risk factors for VAP development. There was also a statistically significant difference in CPIS values between patients who developed VAP and not (6.8 ± 1.15 and 2.71 ± 1.06, respectively; p0.001). The use of CPIS for VAP diagnosis was found to be useful in patients on mechanical ventilation. In our study, a total of 16 strains (six A.baumannii, three P.aeruginosa, one K.pneumoniae, six S.aureus) were isolated from ETA cultures, while 34 strains (16 A.baumannii, six P.aeruginosa, four K.pneumoniae, two E.coli, six S.aureus) were isolated from mini-BAL cultures of 30 VAP patients. The contamination rate for ETA cultures was found as 27% (8/30), however there was no contamination in mini-BAL samples. The rates of negative cultures for ETA and mini-BAL were 20% (6/30) and 7% (2/30), respectively. Seven (87.5%) of the eight contaminated ETA samples, yielded pathogenic bacterial growth (six A.baumannii, one K.pneumoniae) in mini-BAL samples. Similarly, of the six negative ETA samples, 5 (83%) yielded bacterial growth (two E.coli, two K.pneumoniae, one P.aeruginosa) in mini-BAL samples. Statistical analysis with Spearman test indicated no positive correlation between the culture results of mini-BAL and ETA (p= 0.464), and the concordance between the culture results of those methods was found as 50%. It was concluded that the use of mini-BAL instead of ETA samples for the isolation of causative microorganisms of VAP seemed to be more useful due to the high contamination risk in ETA culturing techniques and higher bacterial isolation rates in mini-BAL sampling.

This research was carried out to determine most important risk factors in the development of MRSA by comparing infections due to methicillin resistant and susceptible strains to make suggestions to decrease MRSA ratios by pointing out the importance of pre-infection antibiotic usage in the development of MRSA infection and its place among the other risk factors.

Progressive multifocal leukoencephalopathy (PML) which is a severe demyelinating disease of the central nervous system (CNS), is caused by a human polyomavirus known as JC virus (JCV). PML is seen primarily in immunosuppressed (AIDS, organ transplant or malignancy) patients. In this report, a case of PML that developed in a 75-years-old female patient with no known immunosuppression was presented. The patient was admitted to the emergency department with complaints of headache and burning sensation in head. Cerebrospinal fluid (CSF) examination revealed increase in lymphocytic cells. Since lesions compatible with tuberculoma were detected in brain tissue by magnetic resonance imaging, antituberculous therapy initiated empirically. The disease exhibited a progressive course and all the serological, molecular, microbiological and biochemical tests performed in blood and CSF failed to identify the causative agent. Pathological and immunohistochemical examination of the brain biopsy specimens demonstrated demyelinating disease. Brain biopsy, CSF, serum and urine specimens were investigated by real-time polymerase chain reaction specific for JCV and JCV-DNA was detected in the urine samples. Follow-up visits of the patient indicated a progressive course. In conclusion, after ruling out the other primary causes, JCV should be investigated in patients with demyelinating CNS disease even in the absence of significant immunosuppressive condition. Elderly patients should be considered in the risk group for demyelinating disease of CNS due to JCV.

Vancomycin-resistant enterococci (VRE) have been increasingly reported from most countries around the world following initial isolation from patients in United States and European countries. A vancomycin-resistant Enterococcus faecium (VREF) outbreak was determined by hospital infection control committee in the pediatric unit of Gulhane Military Medical Academy, Ankara, Turkey in the first week of March 2008. While one of the 4 VREF strains was isolated from urine culture of a patient with neuroblastoma, the remaining strains were isolated from cultures of urine and rectal swab samples of a patient with nephrotic syndrome and from the hospital room doorknob of this patient. Aims of this study were to determine antibiotic susceptibilities by E-test, to investigate the presence of vanA, vanB and vanC-2 resistance genes by polymerase chain reaction (PCR), and to genotype the 4 strains by pulsed field gel electrophoresis (PFGE) and repetitive PCR (rep-PCR) (DiversiLab, bioMérieux, France). All isolates conferred high level [minimum inhibitor concentration (MIC)256 mg/L] vancomycin and teicoplanin resistance by E-test method. The isolates were also found resistant to gentamicin, streptomycin, ampicillin, erythromycin, penicillin and were susceptible to tetracycline and linezolid. The vanA gene was detected in all strains by PCR. It was demonstrated that the 4 VRE strains belonged to a single clone as shown by both PFGE and rep-PCR methods. Prompt and accurate detection of VRE and determination of the genotypes is of crucial importance to prevent horizontal transfer of the strains in the hospital. When compared with PFGE, the DiversiLab commercial rep-PCR seems to be a reliable and more rapid method to detect the genetic relationship between strains leading to an outbreak.

The aim of our study is to determine the role of oxidative stress on hepatic damage in patients with acute and chronic hepatitis B virus (HBV) infection and the efficacy of antioxidant-enzyme system against oxidative stress. Furthermore, the effect of interferon-alpha (IFN-alpha) plus lamivudine therapy on oxidative stress was also investigated. Nineteen patients with acute hepatitis B virus (AHBV) infection, 17 patients with chronic hepatitis B virus (CHBV) infection, 24 inactive HBsAg carriers and 21 healthy controls were included in the study. In control and patient groups, serum alanine-aminotransferase (ALT) and aspartate aminotransferase (AST) levels, erythrocyte malondialdehyde (MDA) levels, erythrocyte superoxide dismutase (CuZn-SOD) and glutathione peroxidase (GSH-Px) activities were measured. In CHBV group, after IFN-alpha plus lamivudine therapy for 6 months, these parameters were measured again. In all patient groups erythrocyte MDA levels were detected higher than control group (p0.05). Activity of CuZn-SOD was found to be the highest in AHBV (p0.05), and the lowest before the treatment in CHBV group (p0.05) compared with other groups. Activity of GSH-Px was found to be the highest in AHBV compared with inactive HBsAg carriers (p0.05) and CHBV group before treatment (p0.05). Activity of GSH-Px was found to be the lowest in CHBV group before treatment compared with other groups (p0.05). In CHBV group there was a significant decrease of MDA levels after treatment (p0.05) while there was a significant increase in activity of CuZn-SOD and GSH-Px compared with pretreatment levels (p0.05). A significant positive correlation was determined between MDA values and serum ALT levels, before and after the treatment (p0.05). Detection of the increase of MDA levels which is a product of lipid peroxidation in all patient groups, indicates that the oxidative stress is increased in HBV infection. Correlation between the levels of erythrocyte MDA levels and serum ALT levels supports the hypothesis concerning the role of oxidative stress in pathogenesis of HBV infection. Insufficiency of antioxidant capacity in CHBV and inactive HBsAg carrier groups may lead to progression of disease and results in fibrosis. Treatment with IFN-alpha plus lamivudine causes a decrease in products of lipid peroxidation and shows antioxidant activity via increasing the antioxidant enzymes. These data suggest that the addition of antioxidant agents to IFN-alpha and lamivudin combination therapy may be useful in CHBV treatment. Further in-vitro and in-vivo studies are required to enlighten the role of antioxidants on HBV disease progression and treatment.

Epstein-Barr virus (EBV) remains latent in 90% of the patients following primary infection. The infection might be reactivated due to various stress factors. We, therefore, examined the levels of stress hormones (epinephrine, norepinephrine and cortisol), viral capsid antigen (VCA) immunoglobulin Ig G, VCA IgM, EBV early antigen IgG, Epstein-Barr nuclear antigen (EBNA) IgG, EBNA IgM antibody screening tests and performed EBV polymerized chain reaction (PCR) test and EBV DNA PCR in 100 draftees on their first day of recruitment and at the end of 1 month. Examination of the initial samples revealed that 94 (94%) subjects previously had EBV infection and 6 (6%) were seronegative. Second samples obtained at the end of first month showed that 7 (7.4%) reactivations occurred in 94 subjects who previously had EBV infection (P < 0.001). Two out of six (33.3%) who were initially seronegative had acute infection (P = 0.289). There was no significant difference between the median values of the levels of stress hormones in the initial and second serum and plasma samples. There was a significant difference between the rates of acute infection and reactivation among subjects with elevated cortisol and epinephrine levels in the second samples compared to subjects with normal levels (P < 0.001). No significant difference was determined between the first and second sample hormone levels of all nine subjects whose EBV-DNA turned positive. Routine examinations might not reveal any specific findings since EBV infection often has an asymptomatic course. EBV reactivations should always be kept in mind in patients subject to such stressful conditions.

In our study, we tried to detect gastroenteritis causing intestinal protozoa in patients with immune deficiency and who suffered from diarrhea. We also tried to determine which laboratory methods should be used in detecting intestinal protozoon in these patients. Thirty-six immune deficient patients who had had diarrhea for more than 10 days and 44 immune deficient patients without diarrhea were included in the study. In stool samples taken from all cases, intestinal protozoa were detected using the conventional diagnostic methods including direct wet mount, trichrome and modified acid fast staining as well as serologic diagnostic methods such as ELISA, direct fluorescent antibody (DFA)] and the molecular method of polymerized chain reaction. In our study, we found that intestinal protozoan such as G. intestinalis; C. parvum, B. hominis and E. histolytica could be responsible for the long term diarrhea in patients with immune deficiency. If a pathogen is not detected in the feces by native Lugol (NL), DFA and MAF are suitable techniques for Cryptosporidium spp while ELISA or trichrome staining are suitable methods for E. histolytica. It was concluded in the study that the simple and inexpensive NL method is sufficient in the diagnosis of G. intestinalis and serological or molecular methods are unnecessary. Neutropenia in patients with immune deficiency did not enhance the frequent occurrence of intestinal protozoan infections; and also, in the cases with immune deficiency, it was found that the administration of steroid treatment was not a risk factor in intestinal protozoan disease.

Hematological complications have been frequently associated with acute brucellosis, but pancytopenia is less frequently seen. Also, capillary leak syndrome has been rarely reported in the literature. In this report, we present a case of brucellosis with pancytopenia leading to capillary leak syndrome. A 21-year-old man was admitted to hospital with complaints of a one-month history of weakness, sweats, and fever and he had hepatosplenomegaly and edema over the pretibial areas. Hemogram revealed pancytopenia and biochemical tests revealed moderate hypoalbuminemia, elevations of lactate dehydrogenase and aspartate aminotransferase. He was diagnosed as brucellosis and capillary leak syndrome. He was given doxycycline and rifampicin. The patient's symptoms were resolved after treatment.

Summary Aim The aim was to evaluate the changing trends in outpatient prescription of oral antibiotic forms at a Training Hospital in the last decade. Material and method All the outpatient prescriptions during April and May 2004 were evaluated. The diagnosis, the department of the prescriber, the count and generic name of each prescribed antibiotic were all noted. Results Of the 33 491 outpatient prescripitions, 14.9% included antibiotic ( n =5004). The pediatric clinics (26.4%), Ear, Nose and Throat department (13.7%), and the department of Gyneacology and Obstetrics (10.8%) were the leading departments in antibiotic prescriptions. Upper respiratory tract infections (45.4%), urinary tract infection (11.4%) and lower respiratory tract infections (4.2%) shared the first lines of diagnosis stated. Of the antibiotic prescriptions, 96.3% included oral forms. Co-amoxiclav (26.4%), quinolones (11.7%) and cephalosporins (16.5%) were the most frequently prescribed antibiotics. Percent of antibiotic prescriptions based on microbial sensitivity test results was 7.1%. Conclusion Compared with the results of the study carried out 11 years ago; though co-amoxiclav is still the most frequently prescribed antibiotic, many other changes have been observed in antibiotic prescription attitudes.

Dear Editor, We previously reported a mutation from methionine to serine (M204S) in YMDD motif of HBV polymerase gene in an HBeAg-negative patient having breakthrough under lamivudine treatment (Bozdayi et al., 2003). This mutation was associated with leucine to methionine (L180M) change in B subdomain of reverse transcriptase region of HBV polymerase gene. M204S change was a result of ATG to AGT change, which also resulted in an amino acid change in corresponding 195th codon of the surface gene from tryptophan to valine (sW195V). The same pattern in HBV pol and surface gene was also reported by Niesters et al. (2002). One important feature of this novel mutation may be its persistence and dominance over the wild-type strain even 9 months after stopping lamivudine, which is in contrast to the conventional mutations, where a reversal to wild-type strain is observed after stopping lamivudine (1). In our study, we also showed that this mutation pattern (L180M + M204S) conferred resistance to lamivudine in vitro (1). We recently identified a new L180M + M204S pattern in a patient. The patient was a 43-year-old Caucasian male with known HBV infection since 1997. A liver biopsy in 1998 revealed chronic active hepatitis with a histological activity index of 11/18 according to Knodell et al. (1981). He was HBeAg negative, anti-HBe positive, as well as positive for HBV DNA by PCR (sensitivity: 1000 copy/mL)

AIM: This study aims to compare point prevalence results which were done with one year interval in a university hospital with a 1,200-bed capacity. METHODS: The study assessed antibiotic usage among all hospitalised patients in the hospital on April 20, 2012 and April 19, 2013, using the point prevalence method. The assessment was carried out by an infectious disease specialist relying on the basic principles of antibiotic usage and current antimicrobial treatment guides. The causes of antibiotic usage were classified under three groups, namely, empirical, infection diagnosis and prophylactic. Data were transferred to computer and analysed using SPSS 15.0. We used the chi square method for comparisons of categorical variables. P values

Background: CccDNA serves as a template for the production of HBV pregenomic-RNA and shows viral replication activity. It is responsible from the persistence of HBV during antiviral therapy. We report total-DNA and cccDNA levels in the liver biopsy samples of 6 chronic hepatitis B(CHB) patients during different phases of undergoing antiviral therapy by a sensitive and specific quantitative real-time polymerase chain reaction(PCR) assay. Methods & Materials: All the patients had undetectable serum HBV-DNA at the time of biopsy. Each patient underwent a liver biopsy, and a small piece of the biopsy specimens at least 2mm in length was sent to labaratory in 0.9% NaCl solution. DNA was extracted from tissue using Alkaline phenol-chloroformizoamyl alcohol process. PCR amplification was performed by TaqMan realtime PCR method. Primers and probes for intrahepatic total-DNA, cccDNA and lamivudine-resistancewere designed using Oligoware 1.0 software program. ABI PRISM 7700 Sequence Detection System was used for all the analysis. Results: First patient was recieving lamivudine(LAM) for 5 years. Second and third patient recieving LAM for 38 and 42 months had elevated transaminase for the last 14 and 18 months despite undetectable serum HBV-DNA. Fourth patient was recieving LAM add-on adefovir dipivoxil for 63 months following 5 years of LAM. Fifth patient was recieving LAM add-on tenofovire disoproxil fumarat(TDV) for 3 months following 9 years of LAM. Sixth patient was recieving TDV for 3 months following one year of pegylated-IFN. Intrahepatic total\cccDNA levels in patients were 5,6x106\6,4x104, 8,8x107\4x104, 4,9x106\9,5x104, 5,5x106\2,7x104, 5,1x103\-, 9,2x107\1,1x104 coppies\mg.tissue, respectively. Although all the patients except first and second had normal levels of serum transaminase aswell as undetectable serum HBV-DNA at the time of biopsy, YMDD mutations were identified in all except fourth and sixth one, then treatment regimens were reconstructed. Conclusion: Our results show that cccDNA persists in hepatocyte nucleus, even in with serological evidence of viral clearance under the long-term antiviral theraphy and its detection provides valuable information for the emergence of drug-resistance to manage treatment early. Investigating the intrahepatic forms of HBV-DNA is a good implementation for evidence-based medicine as an alternative in clinical practice. Therefore it is important to develop standardized assays to be used on clinical samples.

Hepatitis B virus (HBV) infection is the leading cause of chronic hepatitis and cirrhosis in Turkey. The prevalence of hepatitis B surface antigen (HBsAg) positivity in Turkey is 5 to 10%. HBV is almost completely preventable with the use of hepatitis B vaccines. The most commonly used vaccine is that which contains the predominant viral surface (S) polypeptide. It elicits protective antibodies in greater than 90% of healthy subjects. A vaccine containing the PreS1 and PreS2 antigenic domains has recently been reported as being more efficient in achieving successful immunization in individuals who have not previously responded to the isolated S-antigen vaccine. In this study, the efficacy of a S and PreS-containing vaccine was compared with that of two different standard isolated S-antigen-containing vaccines in terms of the immunization protection produced against HBV in normal healthy adults who had not previously been immunized. Seventy-six young adults (aged 17-22) were randomly assigned to receive 1 ml (20 micrograms) of either one of two standard S-subunit recombinant hepatitis B vaccines (Engerix B. or Hepavax) or the combined S and PreS subunit vaccine (Gen Hevac B) intramuscularly in the deltoid muscle at 0, 1 and 2 months. Hepatitis B surface antigen antibody titres were measured at 1, 2 and 12 months. A titre > or = 10 IU ml-1 was considered to be protective. All subjects receiving the two standard isolated S-antigen-containing vaccines responded to the vaccination with reasonable antibody titres. One-half to two-thirds of those vaccinated developed high antibody titres (> 100 IU ml-1). In contrast, 9% of those receiving the combined PreS1 and PreS2 plus S antigens failed to respond, as demonstrated by antibody titres below the level considered to be protective. The mean titres at 12 months were 107 +/- 12 IU ml-1 (Engerix B), 102 +/- 12 IU ml-1 (Gen Hevac B) and 117 +/- 12 IU ml-1 (Hepavax Gene). Hence, no important difference in term of response to vaccination was found between the two different types of vaccines. As recombinant S-subunit vaccines are less expensive than those that combine S and PreS antigens, it is suggested that, when immunizing normal healthy adults, a standard isolated S-antigen-containing vaccine should be used.