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Background: Tularemia is a bacterial, zoonotic disease caused by Francisella tularensis . Although the ulceroglandular form is the most common form in the world, oropharyngeal tularemia is the most common form in Turkey . Lymph node suppuration is the most common complication. F. tularensis causes granulomatous and suppurative lesions in the lymph nodes and other organs. Methods: Seventeen suspected oropharyngeal form tularemia cases complicated with suppurated lymphadenitis have been examined in this study. All of the patients (17, 100%) had cervical lymphadenopathies and had a history of beta-lactam antibiotic use with the diagnosis of tonsillitis. Tularemia cases were diagnosed according to the case definition of World Health Organization (WHO). Results: All of the patients (17, 100%) had cervical lymphadenopathies ranging in size from 2-8 cm and unilateral lymphadenopathy, while 12 (71%) patients had right-sided lymphadenopathy. The rate of fever was 41% and the rate of pharyngitis or tonsillitis was 52% at presentation. All patients had a history of beta-lactam antibiotic use with the diagnosis of tonsillitis. Seven patients recovered with first-line monotherapy. In the remaining 10 patients, treatment was rearranged, and these patients were switched to combination treatment or another anti-infective. Surgical drainage was performed on all but two of the patients. Conclusions: The diagnosis of tularemia is often delayed. It may take a significant length of time to diagnose the condition and the disease may become complicated. As it is understood from our study and other studies, the types and duration of treatment can vary and differences can be observed in cases that are past the acute stage. Although the guideline has included a classical treatment approach for the tularemia, there is no standard approach to cases with delayed diagnosis, complicated cases and those refractory to conventional regimens. These observations and other examinations have raised the question whether the chronic form of tularemia should be defined, and whether the treatment options and durations should be re-standardized according to the ‘chronic tularemia’ definition as a ‘chronic granulomatous disease’

Diabetes mellitus küresel ölçekte sık izlenen kronik hastalıkların başında yer alır. Klinik süreçte infeksiyon hastalıklarına artmış yatkınlık nedeni ile aşı ile korunma önem arz eder. Bu çalışmada diyabetik hastaların influenza, pnömokok, hepatit B ve zona aşılarına karşı tutumlarının incelenmesi ve hastalardaki aşılanma oranlarının belirlenmesi amaçlandı. Materyal ve Metod: Balıkesir Üniversitesi Tıp Fakültesi Hastanesi’ne başvuran 310 diyabetik hasta yüz yüze görüşme yöntemi ile değerlendirilip hastalara önceden belirlenmiş olan aşı farkındalık anketi uygulandı. Hastaların influenza, pnömokok, hepatit B ve zona aşılarına karşı tutumları, aşı uygulamaları ve aşılanma eğitim durumları kayıt altına alındı. Elde edilen veriler SPSS 22.0 (Statistical Package for the Social Sciences, versiyon 22) ile analiz edildi. Bulgular: Çalışma kapsamındaki 310 hastanın 118 (%38.1)’i erkek; 192 (%61.9)’si kadındı. Yaş ortalaması tüm hastalarda 59.3 (± 11.3); erkeklerde 59.2 (± 12.8), kadınlarda 59.3 (± 10.6) olup cinsiyete göre yaş dağılımları arasında istatistiksel anlamlı farklılık saptanmadı (p= 0.972). Diyabet tanısı konulduktan sonra aşılama ile ilgili eğitim alıp almadığı sorgulandığında 44 (%14.2) hastanın eğitim aldığı, 266 (%85.8) hastanın bu konuda herhangi bir eğitim almadığı belirlendi. Ayrıca risk grubundaki diyabet hastalarında influenza, pnömokok, hepatit B ve zona aşılanma oranları (sırasıyla %28.4, % 4.8, %5.5, %1.2) olarak bulundu. Sonuç: Günümüzde diyabetik hastalarda aşılanma eğitimi düzeyi yeterli seviyede değildir ve buna paralel olarak aşılanma oranları da düşüktür. Hastalardaki aşı ile korunmanın arttırılması için hasta eğitimlerinin arttırılması, yaşa yönelik tedavi hedeflerinin belirlenmesi etkili olabilir., Diabetes mellitus is one of the most common chronic diseases on a global scale. Vaccination is important due to increased susceptibility to infectious diseases in the clinical process. The aim of this study was to investigate the attitudes of diabetic patients against influenza, pneumococcal, hepatitis B and zoster vaccines and to determine the vaccination rates in patients. Materials and Methods: Three hundred and ten diabetic patients who applied to Balikesir University Medical School Hospital were evaluated by face-to-face interview method, and a predefined vaccine awareness questionnaire was applied to the patients. The attitudes of the patients against influenza, pneumococcal, hepatitis B and zoster vaccines, vaccination applications and vaccination education status were recorded. The data were analyzed by SPSS 22.0 (Statistical Package for the Social Sciences, version 22.0). Results: Of the 310 patients included in the study, 118 (38.1%) were males; 192(61.9%) were females. Mean age was 59.3 (± 11.3) years in all patients; 59.2 (± 12.8) in males and 59.3 (± 10.6) in females, and no statistically significant difference was found between age distributions by sex (p= 0.972). When whether or not they got educated on vaccination following their diagnosis with diabetes mellitus, it was determined that 44 (14.2%) patients got educated and 266 (85.8%) patients did not get any education on this subject. In addition, influenza, pneumococcal, hepatitis B and zoster vaccination rates were observed as 28.4%, 4.8%, 5.5%, 1.2% respectively in diabetes patients. Conclusion: Today, vaccination education level of diabetic patients is not sufficient, and vaccination rates are low. Improving patient education in order to increase vaccine protection in patients and determining treatment targets for age may be effective.

Introduction: Diabetes mellitus is one of the most common chronic diseases on a global scale. Vaccination is important due to increased susceptibility to infectious diseases in the clinical process. The aim of this study was to investigate the attitudes of diabetic patients against influenza, pneumococcal, hepatitis B and zoster vaccines and to determine the vaccination rates in patients. Materials and Methods: Three hundred and ten diabetic patients who applied to Balikesir University Medical School Hospital were evaluated by face-to-face interview method, and a predefined vaccine awareness questionnaire was applied to the patients. The attitudes of the patients against influenza, pneumococcal, hepatitis B and zoster vaccines, vaccination applications and vaccination education status were recorded. The data were analyzed by SPSS 22.0 (Statistical Package for the Social Sciences, version 22.0). Results: Of the 310 patients included in the study, 118 (38.1%) were males; 192(61.9%) were females. Mean age was 59.3 (+/- 11.3) years in all patients; 59.2 (+/- 12.8) in males and 59.3 (+/- 10.6) in females, and no statistically significant difference was found between age distributions by sex (p= 0.972). When whether or not they got educated on vaccination following their diagnosis with diabetes mellitus, it was determined that 44 (14.2%) patients got educated and 266 (85.8%) patients did not get any education on this subject. In addition, influenza, pneumococcal, hepatitis B and zoster vaccination rates were observed as 28.4%, 4.8%, 5.5%, 1.2% respectively in diabetes patients. Conclusion: Today, vaccination education level of diabetic patients is not sufficient, and vaccination rates are low. Improving patient education in order to increase vaccine protection in patients and determining treatment targets for age may be effective., Giriş: Diabetes mellitus küresel ölçekte sık izlenen kronik hastalıkların başında yer alır. Klinik süreçte infeksiyon hastalıklarına artmış yatkınlık nedeni ile aşı ile korunma önem arz eder. Bu çalışmada diyabetik hastaların influenza, pnömokok, hepatit B ve zona aşılarına karşı tutumlarının incelenmesi ve hastalardaki aşılanma oranlarının belirlenmesi amaçlandı. Materyal ve Metod: Balıkesir Üniversitesi Tıp Fakültesi Hastanesi’ne başvuran 310 diyabetik hasta yüz yüze görüşme yöntemi ile değerlendirilip hastalara önceden belirlenmiş olan aşı farkındalık anketi uygulandı. Hastaların influenza, pnömokok, hepatit B ve zona aşılarına karşı tutumları, aşı uygulamaları ve aşılanma eğitim durumları kayıt altına alındı. Elde edilen veriler SPSS 22.0 (Statistical Package for the Social Sciences, versiyon 22) ile analiz edildi. Bulgular: Çalışma kapsamındaki 310 hastanın 118 (%38.1)’i erkek; 192 (%61.9)’si kadındı. Yaş ortalaması tüm hastalarda 59.3 (± 11.3); erkeklerde 59.2 (± 12.8), kadınlarda 59.3 (± 10.6) olup cinsiyete göre yaş dağılımları arasında istatistiksel anlamlı farklılık saptanmadı (p= 0.972). Diyabet tanısı konulduktan sonra aşılama ile ilgili eğitim alıp almadığı sorgulandığında 44 (%14.2) hastanın eğitim aldığı, 266 (%85.8) hastanın bu konuda herhangi bir eğitim almadığı belirlendi. Ayrıca risk grubundaki diyabet hastalarında influenza, pnömokok, hepatit B ve zona aşılanma oranları (sırasıyla %28.4, % 4.8, %5.5, %1.2) olarak bulundu. Sonuç: Günümüzde diyabetik hastalarda aşılanma eğitimi düzeyi yeterli seviyede değildir ve buna paralel olarak aşılanma oranları da düşüktür. Hastalardaki aşı ile korunmanın arttırılması için hasta eğitimlerinin arttırılması, yaşa yönelik tedavi hedeflerinin belirlenmesi etkili olabilir.

Alpay, Yeşim (Balikesir Author), Objective: Sleeves, rings, bracelets etc. are the surfaces that mostly get soiled and exposed to bacterial contamination while working at clinics, laboratories or contacting with patients. Since sleeves of white coats can be a suitable growth medium, we assessed and interpreted cultures which were taken from surfaces of sleeves. Methods: Samples were taken from contact surface sides of sleeves (considering right-left handedness) by sterile saline moisturized swabs. Samples were inoculated to eosin-methylene blue and blood agars. Samples with different colony morphologies were assessed with Gram staining after 24-hour incubation. Gram-positive cocci which were further tested for catalase and coagulase (tube and slide) reactions inoculated to Mueller-Hinton medium after being adjusted to 0.5 McFarland turbidity standard. Methicillin resistance tested by using cefoxitin disk. Antibiotic susceptibilities were investigated by disk diffusion method according to the recommendations of Clinical and Laboratory Standards Institute. Results: We assessed 80 samples and detected 4 types of colonies in 2 samples, 3 types of colonies in 9 samples, 2 types of colonies in 13 samples and 1 type of colony in 43 samples. There was no bacterial growth in 13 samples obtained after recent wash. Bacterial growths were 42 methicillin-sensitive coagulase-negative staphylococci (CNS), 8 methicillin-sensitive Staphylococcus aureus, 16 methicillin-resistant CNS, 7 micrococci, 10 diphtheroids, 7 Bacillus spp., 1 alpha-hemolytic streptococci, 2 Gram-negative bacilli and 5 yeasts., Amaç: Giysi kolları ve bilezik, yüzük gibi takılar, klinikte ve laboratuvarlarda çalışırken ve hastayla temas esnasında, çok kirlenen ve bakteri kontaminasyonu açısından uygun zemin oluşturan alanlardır. Beyaz önlüklerin uzun kollarında da benzer şekilde kontaminasyon olacağından yola çıkılarak, önlük kollarından alınan kültürlerin değerlendirilmesi amaçlanmıştır. Yöntemler: Steril serum fizyolojikle nemlendirilen eküvyonla önlük kollarının (sağ ve sol el kullanımına göre), yüzeylerle temas eden alt kısımlarına sürülerek örnek alınmıştır. Alınan örnekler eozin-metilen mavisi agarına ve kanlı agara ekilerek 37°C’de 24 saat inkübe edilmiştir. Kültür plaklarında üreyen koloniler Gram boyamasıyla değerlendirilmiştir. Gram-pozitif koklara katalaz, koagülaz (tüp ve lam koagülaz) testleri yapılmıştır. Stafilokok olarak değerlendirilen koloniler, bulanıklığı 0.5 McFarland standardına ayarlanarak süspansiyon haline getirildikten sonra Mueller-Hinton besiyerine ekilmiştir. Metisilin direnci sefoksitin diskiyle araştırılmıştır. Antibiyotik duyarlılık testi Clinical and Laboratory Standards Institute önerilerine göre disk difüzyon yöntemiyle yapılmıştır. Bulgular: Değerlendirilen toplam 80 örneğin 2’sinde farklı 4 tip, 9’unda farklı 3 tip, 13’ünde farklı 2 tip üreme, 43 örnekte ise tek tip üreme olmuştur. Yıkama sonrası 1-3. günlerde alınan 13 örnekte üreme olmamıştır. Üremelerin 42’si metisiline duyarlı koagülaz-negatif stafilokoklar, 8’i metisiline duyarlı Staphylococcus aureus, 16’sı metisiline dirençli koagülaz-negatif stafilokoklar, 7’si mikrokoklar, 10’u difteroidler, 7’si Bacillus spp., 1’i α-hemolitik streptokoklar, 2’si Gram-negatif basiller ve 5’i maya olarak tespit edilmiştir. Sonuçlar: Önlük kollarının çalışma alanlarıyla temas halinde olması mikroorganizma kolonizasyonu için uygun ortam hazırlamaktadır. Örneklerin %84’ünde üreme olması ve %30’unda birden fazla mikroorganizma saptanması bunu desteklemektedir. Kısa kollu önlük tercih edilmesi, el yıkamanın bilekleri de kapsayacak şekilde yapılmasını ve hastane infeksiyonlarının daha etkin bir biçimde önlenmesini sağlayabilir

Infectious diseases are important for all ages and adults should be vaccinated as in children. Immunization is an ongoing process of life. Therefore vaccination is also important for adults over 18 years. Especially in the elderly immunization is plays an important role in prevention of vaccine-preventable diseases disease and death. İnfluenza, tetanus, diphtheria and pertussis (Td/Tdap), varicella, human papillomavirus (HPV), zoster, measles, mumps, rubella (MMR), pneumococcal, meningococcal, hepatitis A, hepatitis B, Haemophilus influenzae type b(Hib) vaccines are recommended for all adults. Immunization can reduces the incidence of many diseases and costeffective. Today, despite to highlight the importance of adult vaccination is still not at ideal levels. Vaccination rates are very low in our country. Similar reports areobserved from other countries. There are some barriers for adult vaccination such as educational factors, lack of knowledge, concerns regarding to vaccine, costs and physician approaches. The most important steps for to improving adult immunization; Increasing the level of knowledge, awareness, education ofhealth workers and community, supply of vaccines and to provide repayment. Adult vaccination card may be useful as in child vaccination.

Alpay, Yeşim (Balikesir Author), Objective: Urinary tract infections (UTI) are the second most common infection in geriatric population. This study investigated clinical findings, diagnostic approaches, complicating factors, prognosis, causative microorganisms and antimicrobial susceptibility in geriatric patients diagnosed with UTI. Methods: A total of 140 hospitalised patients with UTIs were evaluated within three years between January 2011-January 2015 at the Eskisehir Yunus Emre State Hospital. UTI diagnosed when there were systemic and urinary signs and symptoms and a positive dipstick test and urine culture result, leukocyte and CRP like serum parameters. Results: Among the studied patients, 41.4% had urological diseases, 20.7% had diabetes mellitus and 19.2% had neurological diseases. The most common symptoms and signs were fever, dysuria nausea/vomiting, general condition impairment, pyuria, haematuria. The laboratory values for CRP, ESR and leukocyte count were 84 mg/dL, 56 mm/s and 11.9 (10 3 mu L), with mean values being determined. Among patients having a urinary catheter (17.1%), 27.9% had a history of UTI, while 29.3% had been hospitalised. Escherichia coli and Klebsiella pneumoniae were the most commonly identified microorganisms. The mean duration for hospitalisation was 7.6 days, while a 5% mortality rate was observed over the course of the disease. Conclusion: Because of the potential for serious complications and mortality, elderly patients with urinary tract infection, should receive immediate empirical treatment based on anamnesis, clinical evaluation and urinalysis and should be re-examined using results from cultures and antibiograms upon follow-up.

Brusellozis bir çok organ ve dokuları tutabilen bir zoonotik enfeksiyondur. İskelet sistemi bruselloziste en sık etkilenen bölge olup, sıklığı % 2 ile % 53 arasında değişmektedir. Multifokal spinal tutulum nadirdir. Bu yazıda torakal ve lomber bölgeyi aynı anda tutan brusella spondilodiskit olgusunun sunulması amaçlanmıştır. Brusellaya bağlı multifokal spinal infeksiyonun tanısı MRI ile konulabilir. Özellikle endemik bölgelerde brusellozis tanısında en az iki adet serolojik test yöntemi kullanılması gerekmektedir. Endemik bölgelerde uzun zaman devam eden sırt ve bel ağrısı şikayeti olan hastalarda ayırıcı tanıda mutlaka brusellozis düşünülmelidir, Brucellosis is a zoonosis that can affect many organs or systems. Musculoskeletal system is the most commonly affected site in brucellosis and the frequency of musculoskeletal system involvement varies between 2% and 53%. Multifocal spinal involvement is rare. Here, it was aimed to present our case with brucellar spondylodiscitis involving the thoracic and lumbar regions simultaneously. MRI is a useful imaging method in the diagnosis of multifocal spinal infection caused by brucellosis. Especially in endemic regions, at least two serological tests should be used in the diagnosis of brucellosis. Brucellosis should be absolutely kept in mind for the differential diagnosis of the elderly patients with complaint of longstanding thoracic and back pain in the regions where brucellosis is endemic. J Microbiol Infect Dis 2015;5(3): 129-132Key words: Brucellosis, spinal infection, spondylodiscitis.

Human echinococcosis is a zoonotic infection caused by larval forms (metacestodes) of tapeworms of the genus echinococcus found in the small intestine of carnivores. The eggs of these tapeworms excreted by carnivores may infect various species of natural intermediate host animals and humans. Hydatid cysts may be found in almost any part of the body, leading to many clinical presentations. The most common locations are the liver and lungs (2). In the heart, the left ventricle is the most common location (46%), followed by the right ventricle (21%), interventricular septum (19.3%), right atrium (9.7%), left atrium (1.6%), and sinus of valsalva (1.6%) .The treatment of intracardiac hidatid cyst is surgery (3).

Introduction : Hepatitis B virus (HBV) infection is an infectious disease that maintains its importance. Recovery, inactive HBsAg (hepatitis B surface antigen) carrier state, chronic hepatitis, cirrhosis, hepatocellular carcinoma and hepatic failure are the results which may occur during the clinical course of the disease. Immune system and host-related genetic factors play an important role in the prognosis. Mannose-Binding Lectin (MBL) is known to have a function in inflammatory response. In this study, it was aimed to investigate the role of serum MBL levels during the clinical course of HBV infection. Methodology-Result : A total of 147 patients were included in the study. Serum MBL levels of chronic HBV infection group, inactive HBsAg carrier group and healthy control group were determined to be 4504 ± 3185 ng/mL, 3301 ± 2631 ng/mL and 3329 ± 2484 ng/mL; respectively. Although serum MBL levels were determined to be higher in the patients with chronic HBV infection compared to the other groups, this was not statistically significant (p=0,148). Conclusions : The role of MBL in HBV infection is not clear as to reach a clear conclusion and it seems to be an insignificant factor compared to the more important factors contributing to the infection. Again in the studies performed in recent years, a strong correlation was determined between lower levels of serum MBL and codon variants and it has been suggested that codon variants could be used as genetic marker of lower levels of serum MBL. Based on the knowledge of there was a correlation between MBL gene mutations and lower levels of serum MBL, it has been thought that MBL gene study was not cost-efficient to determine the relationship of MBL gene mutations with infections.

DOI:10.5505/bsbd.2015.87587 OZET AMAC: Ellerin ve elle temas eden yuzeylerin mikroorganizma ile kolonizasyonu hastane enfeksiyonlari gelisiminde onemli yer tutmaktadir. Gunumuzde cep telefonlari saglik calisanlarinin gunluk en cok temas ettikleri gerecler arasinda yer almaktadir. Calismamizda dokunmatik ekranli cep telefonlarinin yuzeyinden alinan kulturler ile mikroorganizma kolonizasyonu ve ureyen patojenlerin turu belirlenerek, onemi ve hastane enfeksiyonu gelisiminde rol alip alamayacagi degerlendirildi. YONTEM ve GERECLER: Cep telefonlarinin yuzeyinden ekuvyonla ornek alinarak kanli ve EMB (eosin methylene blue) besiyerine ekim yapildi. 24 saat sonra koloni morfolojisi farkli olanlar gram boyama ile degerlendirildi. Gram pozitif koklara katalaz, koagulaz (tup ve lam koagulaz bakildi) yapildi. Mueller hinton besiyerine 0.5 macfarland ayarlanarak ekildi. FOX (sefoksitin) diski konuldu. Direncli ve duyarli bakteriler CLSI Kriterlerine gore degerlendiridi. BULGULAR: Alinan 45 ornekten 8 (%17.7)’inde ureme olmadi. Ureme gozlenen 37 (%82.3) ornegin 5’inde 3 farkli tip, 15’inde 2 farkli tip, 17’sinde ise tek tip ureme oldu. Identifikasyon sonrasi; 32 (%51.6) MSKNS (metisilin duyarli koagulaz negatif stafilokok), 13 (%20,9) MSSA (metisilin duyarli staphylococcus aureus, 5 (%8.06) MRKNS (metisilin direncli koagulaz negatif staphylococcus), 7 (%11.2) mikrokok,4 (% 6.4) bacillus spp ve 1 (% 1.6) AHS (alfa hemolitik streptokok) uredigi tespit edildi. TARTISMA ve SONUC: Elle temas sikligi nedeniyle cep telefonu yuzeyleri mikroorganizma kolonizasyonu icin uygun ortamlar olup hasta ile temas oncesi ve sonrasinda el hijyenine uyulmamasi, hasta, saglik calisani ve cep telefonu gibi cansiz yuzeyler arasinda mikrorganizma transferine neden olabilmektedir. Bu zincirin kirilmasi acisindan hastane enfeksiyonlarindan korunmada en temel yontem olan el yikama onerilmekte olup, dezenfektan mendil ile cep telefonu temizligi ikincil bir secenek olabilir. Nitekim karsilastirma icin yeterli sayida orneklem olmasa da ureme olmayan ve tek uremelerin oldugu cep telefonlarinin laboratuvar calisanlarina ait olmasi eldiven kullaniminin ve sik el yikamanin bu dongudeki katkisini dusundurmus olup daha kapsamli gruplarda calisilmasi fikrini dogurmustur. Anahtar Kelimeler: Saglik Calisanlari, Cep Telefonu, Mikroorganizma kolonizasyonu

Introduction: The aim of this study was to investigate the epidemiological characteristics of percutaneous injuries developed in the healthcare workers of our hospital and re-evaluate the precautions against these injuries. Materials and Methods: The follow-up forms belonging to one hundred and forty-two percutaneous injured personnel in our hospital were evaluated retrospectively between January 2008 and June 2013. Results: One hundred and thirteen (79.6%) healthcare workers were female and mean age was 29.4 ± 9.0 (15-52) years. When the personnel was analyzed according to occupational groups, 76 (53.5%) of the personnel were nurses, 6 (4.2%) were doctors, 30 (21.1%) were trainee nurses, 26 (18.3%) were cleaning staff, and 4 (2.9%) were anesthesia technicians. Forty-nine (31.7%) of the personnel were working in surgical services, 40 (28.2%) in internal services, 27 (19%) in the operating room, 17 (12%) in intensive care units, and 13 (9.1%) in the emergency room. The most common devices leading to injuries were needles, scalpels, suture needles and intravenous cannulae in 82.4%, 8.5%, 4.9% and 4.2% cases, respectively. Of the injured personnel, one hundred and eighteen were immunized against hepatitis B, and 89 were immunized against tetanus. During the follow-up, one of the personnel had seroconversion for hepatitis C. Conclusion: Healthcare workers should presume that all patients and their blood samples are infected and should work following standard infection control precautions. It seems to be the most effective method for reducing percutaneous injuries.

Our study aims to determine the efficacy of infectious dis- ease consultations and the interrelations between doctors in this social laboratory. This study was conducted at 34 centers located in 22 cities across Turkey and contributed by 210 infectious disease specialists (IDSs) and 970 nonYinfectious disease specialists (NIDSs), totaling 1180 medical doctors. Infectious disease specialists and NIDSs have sepa- rately contributed by responding to questionnaires designed specifically for the consultation process. It appears that a satisfactory collaboration has been established between IDSs and NIDSs during the consultation practices. There are some discrepancies in the perceptions of some of the NIDSs. These are the evaluation of patients holistically, the expec- tation of NIDSs in critical infection cases to start the therapy immedi- ately, losing the support of drug companies by NIDSs, and the restriction of NIDSs in routine medical practice. On the other hand, NIDSs seem to have real problems in the diagnosis or treatment of infectious diseases. The consultation service provided by the IDSs in Turkey is widely ac- cepted among other clinicians and appears to be of a crucial importance.

Pasteurella multocida has been isolated from 50% to 70% of healthy cats and most commonly associated with acute skin and soft tissue infections following an animal bite or scratch. As the zone and depth of injury can lead to more serious infections such as deep tissue infections, septic arthritis, osteomyelitis. However, no predictive factor showing which wound would be infected. In our case, patient whom applied with abscess after a cat scratch and P. multocida was found as a causative agent. This situation has caused to review us, once more, that which cases should be taken antibiotic pro­phylaxis in addition to immunoprophylaxis (for rabies post-exposure prophylaxis, and anti-tetanus prophylaxis) in the first admission. Antibiotic prophylaxis should be used for 3-5 days in selected cases if they include; moderate to severe crushing injuries especially edematous form, less than 8 hours old, bone or joint penetration, hand wounds, especially emphasizes the importance of hand injuries and deep penetrations. J Microbiol Infect Dis 2014; 4(4): 159-161

WOS: 000386954300001, PubMed: 27809934, Background: The aim of this study was to assess health-related quality of life (HRQOL) among chronic hepatitis B (CHB) patients in Turkey and to study related factors. Methods: This multicenter study was carried out between January 01 and April 15, 2015 in Turkey in 57 centers. Adults were enrolled and studied in three groups. Group 1: Inactive HBsAg carriers, Group 2: CHB patients receiving antiviral therapy, Group 3: CHB patients who were neither receiving antiviral therapy nor were inactive HBsAg carriers. Study data was collected by face-to-face interviews using a standardized questionnaire, Short Form-36 (SF-36) and Hepatitis B Quality of Life (HBQOL). Values equivalent to p < 0.05 in analyses were accepted as statistically significant. Results: Four thousand two hundred fifty-seven patients with CHB were included in the study. Two thousand five hundred fifty-nine (60.1 %) of the patients were males. Groups 1, 2 and 3, consisted of 1529 (35.9 %), 1721 (40.4 %) and 1007 (23.7 %) patients, respectively. The highest value of HRQOL was found in inactive HBsAg carriers. We found that total HBQOL score increased when antiviral treatment was used. However, HRQOL of CHB patients varied according to their socio-demographic properties. Regarding total HBQOL score, a higher significant level of HRQOL was determined in inactive HBV patients when matched controls with the associated factors were provided. Conclusions: The HRQOL score of CHB patients was higher than expected and it can be worsen when the disease becomes active. Use of an antiviral therapy can contribute to increasing HRQOL of patients.

EASL International Liver Congress -- APR 13-17, 2016 -- -- Barcelona, SPAIN, WOS: 000398711700582, …, EASL

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Alpay, Yeşim (Balikesir Author), "Background: Manynoninvasive methods, including aspartateaminotransaminase (AST)/alanineaminotransaminase (ALT) ratio (AAR), AST-to-platelet ratio index (APRI), Bonacini cirrhosis discriminant score (CDS), fibrosis-4 (FIB4) index, and age-platelet index (API), have been described to determine the stage of hepatic fibrosis. However, thesemethodsare developed for patients with chronic hepatitisC(CHC) andproduce conflicting results in the prediction of liver fibrosis in patients with chronic hepatitis B (CHB). Objectives: The aim of this study was to evaluate the relationship between 7 noninvasive models, including AAR, APRI, CDS, API, FIB-4, neutrophil-to-lymphocyte ratio (NLR), and red cell distribution width (RDW)-to-platelet ratio (RPR) in patients with CHB. Methods: The study population included all patients with CHB, undergoing liver biopsy to determine HBsAg and HBV DNA positivity in more than 6 months. Results: A total of 2520 treatment-naive CHB patients from 40 different centers were included in the study. In total, 62.6% of the patients were male, and the mean age was 40.60 +/- 12.34 years (minimum, 18 years; maximum, 77 years). The Ishak fibrosis score was >= 3 in 29.8% of the patients, indicating significant fibrosis. The mean API, APRI, CDS, NLR, FIB4, and RPR scores in the noninvasive models were significantly different between the groups with significant and low fibrosis (P < 0.05). All the noninvave models (API, APRI, AAR, CDS, NLR, RPR, and FIB4) were found to be significant in the discrimination of cirrhosis (P < 0.05). In the multiple logistic regression analysis, CDS, albumin, alkaline phosphatase (ALP), total bilirubin, neutrophil count, NLR, mean platelet volume (MPV), and FIB4 were independent indices for cirrhosis. Conclusions: In the present study, the role of noninvasive tests in the prediction of liver fibrosis stage and cirrhosis was evaluated in a large cohort of CHB patients. Overall, noninvasive models are gradually becoming more promising. Accordingly, the need for liver biopsy can be reduced with a combination of noninvasive methods in the future."

PubMedID: 23114743 OBJECTIVE: To evaluate the association of insulin resistance (IR), viral load, and adipokine levels with liver histology in patients with chronic hepatitis C (CHC). PATIENTS AND METHODS: In this noninterventional, multicenter study carried out at 11 infectious diseases clinics in Turkey, 103 CHC patients [mean (SD) age: 50.2 (11.0) years, 60 (58.3%) women] planned to be treated by ribavirin and peginterferon-?2a were included. Data on hepatic fibrosis and steatosis, IR, viral load, and hepatitis C virus-RNA genotyping, adipokine, and cytokine levels were collected. RESULTS: The mean (SD) Knodell score was 8.1 (3.6); grade I steatosis was evident in 46 (44.7%) patients and IR was identified in 56 (54.9%). There was a significant positive correlation of the homeostasis model assessment-IR index with Knodell fibrosis (r=0.235; P=0.027) and hepatic steatosis (r=0.435; P

WOS: 000276650000019 PubMed: 19541326 Background. To evaluate the effect of hypothermia on bacterial translocation, splanchnic vascular flow, lung tissue weight, and levels of malondialdehyde (MDA) and nitric oxide (NO) in a two-hit model of hemorrhagic shock. Methods. Thirty rats were randomly allocated into three groups of 10 rats each. In the control group (group C), rats were treated without hemorrhage, and normothermia (37 degrees C) was maintained. In the mild hypothermia group (group MH), rats were subjected to volume-controlled hemorrhage (2 mL/100g) and a rectal temperature of 34 degrees C was maintained. In the normothermic group (group NT), rats were treated as in group MH, except for hypothermia. Seventy-two hours after hemorrhagic shock (first insult), Pseudomonas aeuruginosa was administered intratracheally as a second insult. Finally, mesenteric vascular flow patterns were recorded. Bacterial translocation was studied from tissue samples of spleen, liver, and mesenteric lymph nodes. Blood samples were obtained to evaluate the possible presence of bacteria in the bloodstream. Lung tissue weight ratio, MDA, and NO levels in lung tissue were assessed. Results. Renal, mesenteric, and portal venous flow rates were found to be lower in groups Mill and NT in comparison with group C. Blood flow profiles were lower in group NT than in group MH (P < 0.05). Bacterial translocation was not observed in group C, and it was detected more often in group NT than in group MH. Lung weight ratio was found to be higher in group NT compared with groups MH and C. Although it did not reach the level of statistical significance, MDA level in the control group was lower than that in the NT group (P = 0.085). Conclusion. Hypothermia corrected mesenteric blood flow and decreased the occurrence of bacterial translocation in the two-hit model of hemorrhagic shock and tracheal inoculaton of P. aeruginosa (C) 2010 Elsevier Inc. All rights reserved.

WOS: 000243347400005 PubMed: 16902779 The objective of this study was to investigate the possible etiologic role of Chlamydia pneumoniae infection in nasal polyps. This prospective clinical study was undertaken enrolling 30 patients with nasal polyps, and 30 age and sex-matched control subjects from whom epithelial material was obtained during endoscopic surgery. IgG specific ELISA was used to determine seropositivity, and indirect immunoflorescence to determine C. pneumoniae in the biopsy material. C pneumoniae specific IgG antibodies were found to be positive in 16 (53.3%) of the patients with nasal polyps, and 9 (22%) of the control subjects (P = 0.065). Indirect immunofluorescence results indicate that there was a significant difference between groups; 16 (53.3%) patients in the study group and,8 (26.6%) patients in the control group were found to be positive (P = 0.034). We found no correlation with cigarette smoking. Our results indicated that Chlamydia pneumoniae is possibly associated with the presence of nasal polyps. However, these results remain to be confirmed with further studies using other techniques, and the underlying mechanism should be defined.

Recent reports have demonstrated that automated continous monitoring blood culture systems are fast and efficent in the detection of Brucella spp. In this retrospective study, the detection of these slow-growing bacteria by BACTEC 9050 blood culture system was evaluated. For this purpose, 60 patients, whose blood cultures were monitored by using BACTEC 9050 system were included into the study. Brucella spp. were isolated in 26 of 31 patients from whom two blood cultures were obtained and in 17 of 29 patients from whom single blood culture were obtained. The majority of isolates (84.1%) were detected within 7 days of incubation while the earliest detection was on the 3rd day in two samples. However, the bacteria were isolated by subcultures after 30 days of incubation in 8 of the samples. In conclusion, the routine 5 or 7 days-incubation protocols with BACTEC 9050 system were not efficient for the isolation of Brucella spp. Obtaining two blood cultures and prolonged incubation followed by subcultures increased the probability of bacterial isolation.

10th Annual Meeting of the Federation-of-Clinical-Immunology-Societies -- JUN 24-27, 2010 -- Boston, MA KISA, Ucler/0000-0002-8131-6810 WOS: 000277953700404 … Federat Clin Immunol Soc

PubMed ID: 22177310, Background: Training of infectious disease (ID) specialists is structured on classical clinical microbiology training in Turkey and ID specialists work as clinical microbiologists at the same time. Hence, this study aimed to determine the clinical skills and knowledge required by clinical microbiologists.Methods: A cross-sectional study was carried out between June 1, 2010 and September 15, 2010 in 32 ID departments in Turkey. Only patients hospitalized and followed up in the ID departments between January-June 2010 who required consultation with other disciplines were included.Results: A total of 605 patients undergoing 1343 consultations were included, with pulmonology, neurology, cardiology, gastroenterology, nephrology, dermatology, haematology, and endocrinology being the most frequent consultation specialties. The consultation patterns were quite similar and were not affected by either the nature of infections or the critical clinical status of ID patients.Conclusions: The results of our study show that certain internal medicine subdisciplines such as pulmonology, neurology and dermatology appear to be the principal clinical requisites in the training of ID specialists, rather than internal medicine as a whole. © 2011 Erdem et al; licensee BioMed Central Ltd.