Publications by authors named "Zülal Özkurt"

28 Publications

  • Page 1 of 1

Hepatic actinomycosis: a very rare form of actinomycosis.

Rev Soc Bras Med Trop 2021;54. Epub 2021 Mar 8.

Ataturk University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Erzurum, Turkey.

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http://dx.doi.org/10.1590/0037-8682-0289-2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008916PMC
March 2021

The relationship with clinical course and prognosis of serum endothelin-1, angiopoietin-2, and tie-2 levels in Crimean-Congo hemorrhagic fever

Turk J Med Sci 2019 08 8;49(4):1192-1197. Epub 2019 Aug 8.

Department of Public Health, Atatürk University, School of Medicine, Erzurum, Turkey

Background/aim: Crimean-Congo hemorrhagic fever (CCHF) is a serious illness characterized by fever and hemorrhage. Endothelin-1 (ET-1), angiopoietin-2 (Ang-2), and endothelial cell-specific receptor tyrosine kinase (Tie-2) are believed to be important markers of the pathogenesis, clinical course, and prognosis of the disease. The aim of this study was to determine ET-1, Ang-2, and Tie-2 levels in adults with CCHF and investigate the associations between these markers and pathogenesis and disease course.

Materials And Methods: Sixty CCHF patients were included in the study. The patients were classified according to disease severity criteria and Ang-2, Tie-2, and ET-1 levels were compared.

Results: Mean serum ET-1 level was 36.62 ± 27.99 pg/mL in the patient group and 3.70 ± 4.71 pg/mL in the control group (P = 0.001). Mean serum Ang-2 levels were 2511.18 ± 1018.64 pg/mL in the patient group and 3570.76 ± 209.52 pg/mL in the control group (P = 0.001). Mean serum Tie-2 levels were 7.35 ± 7.75 ng/mL in the patient group and 0.67 ± 1.26 ng/mL in the control group (P = 0.001).

Conclusion: Elevated ET-1 and Tie-2 levels were associated with more severe disease course, while Ang-2 level was negatively correlated with severity in adult CCHF patients. ET-1, Tie-2, and Ang-2 levels are important prognostic parameters in CCHF and may contribute significantly to treatment and follow-up.
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http://dx.doi.org/10.3906/sag-1812-10DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7018223PMC
August 2019

Seroprevalence of hepatitis B, hepatitis C, and HIV in pregnant women from Eastern Turkey.

Turk J Gastroenterol 2019 03;30(3):260-265

Department of Gynecology and Obstetrics, Buhara Hospital, Erzurum, Turkey.

Background/aims: The vertical transmission of hepatitis B virus, hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections are essential public health problems. In this study, we aimed to investigate the seroprevalence of the aforementioned infections among pregnant women.

Materials And Methods: This study was done retrospectively on pregnant women who presented for antenatal follow-up and delivery between 2013 and 2016. Data were collected from the hospital's electronic health records and patient files. Blood samples were analyzed at the microbiology laboratory of the hospital. HBsAg, anti-HBs, anti-HCV, and anti-HIV titers were tested using the chemiluminescence enzyme immunoassay method (Architect, Abbott Laboratories, USA).

Results: HBsAg and anti-HBs levels were tested in 35,295 pregnant women aged 18-45 years. The HBsAg and anti-HBs levels were positive in 425 (1.2%) and 9583 (27.7%) patients, respectively. From 2013 to 2016, the HBV carrier rates have continuously decreased from 1.4% to 0.8%, whereas the anti-HBs positivity has increased from 25.4% to 30.2%. Anti-HCV was detected in 6 of the 9709 (0.06%) patients. All the 7113 pregnant women screened for HIV showed negative results.

Conclusion: Hepatitis B carrier rates among pregnant women gradually decreased with a simultaneous increase in the immunity rates. HCV seroprevalence was low and HIV positivity was not encountered in the study population.
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http://dx.doi.org/10.5152/tjg.2018.17634DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6428513PMC
March 2019

Retrospective Evaluation of Anti-Toxoplasma gondii Antibody Among First Trimester Pregnant Women Admitted to Nenehatun Maternity Hospital between 2013-2017 in Erzurum.

Turkiye Parazitol Derg 2018 Jun;42(2):101-105

Atatürk Üniversitesi Tıp Fakültesi, Enfeksiyon Hastalıkları Kliniği, Erzurum, Türkiye.

Objective: We aimed to investigate the Toxoplasma gondii seropositivity in pregnant women who referred to Erzurum Nenehatun Hospital for antenatal care, and to compare our data with other regions of Turkey.

Methods: In this retrospective study we evaluated Anti-Toxoplasma gondii IgM and anti-Toxoplasma gondii IgG screening results of pregnant women who admitted to our hospital between January 2013 and December 2016 for antenatal care. The data was obtained from hospital's digital data system and patient folders. Blood samples were investigated in microbiology laboratory with Macro-ELISA (Architect System, Abbott Diagnostics, Germany) method. Anti-Toxoplasma IgM positive cases were also evaluated with anti-Toxoplasma IgG avidity test. The results were evaluated as case numbers and percentages.

Results: In 151 (0.6%) of the 25525 pregnant women, who were aged between 18 and 45, Anti-Toxoplasma gondii IgM positivity was detected. In 5119 (31%) of the 16433 pregnant women, Anti-Toxoplasma gondii IgG positivity was detected.

Conclusion: Our data was similar to the rest of the country. We suppose that every pregnant women should be educated about the disease and the transmission routes to raise an awareness and while the ones in the risk group should be screened instead of the whole group.
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http://dx.doi.org/10.5152/tpd.2018.5544DOI Listing
June 2018

[Evaluation of epidemiologic and clinical features of oropharyngeal tularemia patients in the Eastern Anatolia Region of Turkey].

Mikrobiyol Bul 2018 Jan;52(1):108-110

Atatürk University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Erzurum, Turkey.

Tularemia is a zoonotic infectious disease caused by Francisella tularensis. Tularemia is endemic in the northern hemisphere and is usually seen in North America, Europe and Asia. Although the ulceroglandular tularemia is the most common form in these regions, the oropharyngeal form is more prevalent in Eastern Europe, including Turkey. The disease has importance in Turkey due to its wide geographic distribution and periodic outbreaks. The aim of this study was to determine the demographic, clinical and epidemiological characteristics of oropharyngeal tularemia patients. The demographic, clinical, epidemiological and laboratory findings of 26 tularemia patients admitted to our hospital from Erzurum and 5 neighbour provinces were analyzed retrospectively. Francisella tularensis microagglutination test (MAT) was performed for all patients whose clinical symptoms were consistent with tularemia and MAT titers ≥ 1/160 were considered positive. Twenty-six oropharyngeal tularemia patients (13 males and 13 females) were included in the study. All of the patients had cervical lymphadenopathy (LAP) at least one month period. Twenty (76.9%) of the patients included in the study were living in rural areas, and 17 (65.4%) were dealing with livestock. It was determined that 9 (34.6%) of the patients used water from municipal water supply, 9 (34.6%) of the patients used water from natural water supply and 8 (30.8%) of the patients used both of the water supplies. The most common symptoms among the patients in the study were fever in 23 (88.5%) patients, sore throat in 24 (92.3%) patients, and cervical LAP in all of the patients. Thirteen (50%) of the patients were treated with streptomycin, 7 (26.9%) with doxycycline and 6 (23.1%) with gentamicin. This is the first study showing that tularemia is present in Erzincan, Ağrı, Iğdır as well as Erzurum provinces, and it provides that the incidence has increased in this region. Tularemia diagnosis is generally underestimated due to the lack of specific symptoms. Therefore, tularemia should also be considered in patients who have complaints of sore throat and cervical LAP in non-endemic regions.
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http://dx.doi.org/10.5578/mb.57283DOI Listing
January 2018

Global Alert: Zika Virus-an Emerging Arbovirus.

Eurasian J Med 2017 Jun;49(2):142-147

Department of Medical Education, Atatürk University School of Medicine, Erzurum, Turkey.

Zika virus (ZIKV) is an arbovirus of the genus, and it has an envelope and a single RNA molecule. In early 2016, the World Health Organization declared ZIKV infection to be an emerging global health threat. The major transmission route of the virus to humans is mosquitoes. ZIKV can be transmitted between humans by transplacental, perinatal, and sexual routes and via blood and body fluids. ZIKV infection usually results in a mild and self-limiting disease with low-grade fever, conjunctivitis, and periorbital edema. Neurological complications such as Guillain-Barré syndrome, meningoencephalitis, acute disseminated encephalomyelitis, acute myelitis, and transverse myelitis have been reported during ZIKV infection. Intrauterine and congenital ZIKV infections have strong teratogenic effects on the fetus. Intrauterine or congenital ZIKV infection can lead to microcephaly, ocular anomalies (such as macular atrophy, pigment mottling, and optic nerve anomalies), and cardiac anomalies (such as atrial or ventricular septal defect). Calcification in the brain between the cortical and subcortical areas, ventriculomegaly, cerebellar hypoplasia, corpus callosum hypoplasia, cortical/subcortical atrophy, delayed myelination, enlarged cisterna magna, and craniofacial disproportion have been reported as brain development defects. ZIKV infection usually results in a mild disease, and it does not require specific therapy. However, complications of infection during the early period of life are serious. Thus, many drugs have been investigated, and vaccine development studies have been conducted to prevent ZIKV infection. Vector control and personal protection from mosquito-borne transmission are important for decreasing the prevalence of ZIKV infection. In particular, pregnant residents or travelers to endemic areas should be carefully protected against mosquito-borne transmission.
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http://dx.doi.org/10.5152/eurasianjmed.2017.17147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5469842PMC
June 2017

Cerebral and Spinal Tuberculous Leptomeningitis: Advanced Magnetic Resonance Imaging Findings.

J Craniofac Surg 2017 Mar;28(2):477-478

*Department of Radiology †Department of Infectious Disease, Medical Faculty, Ataturk University, Erzurum, Turkey.

At diagnosis of the cerebral and spinal tuberculous meningitis magnetic resonance (MR) imaging is the primary imaging technique. Magnetic resonance images reveal cerebrospinal fluid collection and obliteration of the spinal subarachnoid space. The contrast-enhanced MR imaging shows nodular and thick intradural enhancement. Herein, the authors reported advanced MR imaging findings of the cerebral and spinal tuberculous leptomeningitis.
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http://dx.doi.org/10.1097/SCS.0000000000003297DOI Listing
March 2017

Cutaneous Anthrax on Eyelid in a Pregnant Woman.

Eurasian J Med 2016 Jun;48(2):142-4

Department of Infectious Diseases and Clinical Microbiology, Atatürk University School of Medicine, Erzurum, Turkey.

A 32-year-old patient who was 17 weeks of pregnant referred to our hospital due to a lesion on the eyelid and swelling on her face. Patient's history revealed that she helped her husband for slaughtering of a sick animal and contacted with the meat. A scabby lesion was detected on the inferior eyelid with hyperaemia around, central necrotic appearance and swelling. The diagnosis of anthrax was performed based on her epidemiological data, physical examination findings, and Bacillus anthracis were seen on direct preparation. This case was considered worthy to present since she was pregnant, the disease was located on the inferior eyelid, which is a rare place for location, and caused no complication or sequel either in mother or in baby.
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http://dx.doi.org/10.5152/eurasianjmed.2015.15131DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4970553PMC
June 2016

Multi-center prospective evaluation of discharge criteria for hospitalized patients with Crimean-Congo Hemorrhagic Fever.

Antiviral Res 2016 09 15;133:9-13. Epub 2016 Jul 15.

Department of Infectious Diseases and Clinical Microbiology, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey.

Introduction: The information of discharge criteria in patients with Crimean-Congo Hemorrhagic Fever (CCHF) is limited. In this study, we aimed to determine the clinical and laboratory parameters used in discharging the patients by the experienced centers.

Materials And Methods: The study was done in 9 reference centers of CCHF from May 1, 2015 to December 1, 2015 and included laboratory-confirmed patients with CCHF. The study was prospective, observational and non-interventional.

Results: The study included 260 patients. Mean age was 51.3 ± 16.3 years; 158 (60.8%) were male. Mean hospital stay was 7 ± 2.6 days. The decision of discharging was taken considering clinical and laboratory findings. On discharge, no patients had fever or hemorrhage. The patients were followed-up clinically and a repeat CCHF PCR was not studied. All centers considered the following criteria for discharge: no fever and hemorrhage, improvement in clinical findings and laboratory studies. For all patients except one, platelet count was >50,000/mm(3) and had a tendency to increase. Prothrombin time and international normalized ratio (INR) were normal in 258 (99.6%) and 254 (98.1%) patients respectively. Alanine aminotransferase (ALT) was either normal or not higher than 10-fold and had a tendency to decrease in 259 (99.6%) patients. ALT and aspartate aminotransferase (AST) levels were not taken as discharge criteria with priority. During 30 days following the discharge, complication, relapse, or secondary transmission were not reported.

Conclusions: The discharging practice of the centers based on clinical and laboratory parameters seems safe considering no complications, relapses, or secondary infection thereafter. Current discharge practice of the centers composed of no fever and hemorrhage, improvement in clinical findings, platelet count of either >100,000/mm(3) or >50,000/mm(3) with a tendency to increase, and normal bleeding tests can be used as the criteria of discharge.
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http://dx.doi.org/10.1016/j.antiviral.2016.07.010DOI Listing
September 2016

Crimean-Congo haemorrhagic fever and secondary bacteraemia in Turkey.

J Infect 2015 Nov 18;71(5):597-9. Epub 2015 Jul 18.

Liverpool School of Tropical Medicine, Liverpool, United Kingdom; NIHR HPRU in Emerging and Zoonotic Infections, University of Liverpool, Liverpool L69 7BE, United Kingdom.

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http://dx.doi.org/10.1016/j.jinf.2015.07.003DOI Listing
November 2015

Serum fibronectin levels in acute and chronic viral hepatitis patients.

Malays J Med Sci 2014 Jan;21(1):29-36

Department of Biochemistry, School of Medicine, Recep Tayyip Erdogan University, 53100 Rize, Turkey.

Background: The aim of this study was to investigate the serum fibronectin (FN) levels and liver enzyme activities in patients with acute hepatitis (A, B, C) and chronic viral hepatitis (B, C); determine whether the virus types correlated with disease severity; and assess whether FN could be used as a marker of virus type or disease severity in patients.

Methods: A total of 60 subjects were enrolled in the study, including 20 patients with acute hepatitis (A, B, C), 20 with chronic hepatitis (B, C), and 20 healthy controls. Serum fibronectin (FN), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), and albumin were measured in all patients from blood samples.

Results: Serum FN levels were significantly lower in acute (122.9 μg/mL (SD 43.1), P < 0.001) and chronic hepatitis patients (135.7 μg/mL (SD 46.0), P < 0 .001) compared to controls 221.4 μg/mL (SD 32.5). A negative correlation was found between serum FN and AST (r(2) = 0.528, P < 0.001), ALT (r(2) = 0.425, P < 0.001), and GGT (r(2) = 0.339, P < 0.001). Additionally, high serum GGT levels (β = -0.375, P = 0.010), and low serum albumin levels (β = -0.305, P = 0.008) were associated with low serum FN levels.

Conclusion: Serum FN levels were lower in both acute and chronic hepatitis patients, and an inverse relationship between serum FN and serum AST, ALT, and GGT levels was found. A decrease in serum FN levels may indicate hepatitis severity as AST and ALT represent hepatocyte damage.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3952345PMC
January 2014

Prognostic significance of antithrombin activity in patients with crimean-congo hemorrhagic Fever.

Eurasian J Med 2011 Aug;43(2):83-6

Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey.

Objective: Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral hemorrhagic fever. Disseminated intravascular coagulation (DIC) is an important complication of this disease, especially in severe and fatal cases. Antithrombin (AT) acts as an anticoagulant by inactivating thrombin, Factor IX, Factor X and Factor XI. We conducted this study to investigate the AT levels and their prognostic value in CCHF.

Materials And Methods: Twenty-eight confirmed CCHF patients were included in this study. Diagnosis of the disease was made by CCHF IgM and/or PCR positivity. Patients were grouped based on the severity criteria described previously. The patients with platelet counts <20 000×10(6) cell/L, white blood counts >10×10(9) cell/L, prothrombin times >60 seconds, aspartate aminotransferase levels >700 IU/L or alanine aminotransferase levels >900 IU/L were accepted as severe cases. Patients whose illnesses were self-limited and who did not require blood component replacement were accepted as mild cases, and patients who improved but required blood component replacement were accepted as moderate cases. Blood samples were obtained on the day that the patient had the lowest platelet count and before any thrombocyte replacement. The antithrombin activity was measured using a chromogenic substrate test (Diagnostica Stago STA Compact) at a research laboratory.

Results: Twenty-two (78.6%) of the cases were mild, 3 (10.7%) were moderate, and 3 were (10.7%) severe. The mean AT value was 101% for mild cases, 116.6 % for moderate cases, and 88% for severe cases (p>0.05). Although there were no statistically significant differences between the AT values, the mean AT activity was lower in severe CCHF cases.

Conclusion: The AT activity may have been decreased in severe CCHF cases. Further studies with greater numbers of patients are required to determine the level of AT activity and its correlation with disease severity and the prognosis of CCHF.
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http://dx.doi.org/10.5152/eajm.2011.19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4261357PMC
August 2011

Incidence and risk factors of vancomycin-resistant enterococcus colonization in burn unit patients.

Burns 2011 Feb;37(1):49-53

Department of Microbiology and Clinical Microbiology, Ataturk University, School of Medicine, Erzurum, Turkey.

This study was aimed to identify the incidence of vancomycin-resistant enterococcus (VRE) colonization in burn patients, to collate risk factors for colonization and to determine the VRE resistance profile to different antimicrobial agents. This prospective study was carried out on the burn unit, during the period from September 2008 to January 2010, in 128 patients who were hospitalized at least 3 weeks or more. Periodic swabs were taken from burn wound, rectal, axillary, umblicaly and throat regions of the patients on admission and 7th, 14th, 21st days of hospitalization. Demographics and known risk factors were retrieved and assessed by statistical methods. Only 20 patients (15.6%) were colonized with enterococci on admission and these strains isolated from rectal, umblical and throat samples were sensitive to vancomycin. Initial VRE isolation was made in the first samples from the rectum of two patients on the 7th day. The rates of rectal, umblical, throat and axillary colonization increased to 21.9%, 3.1%, 3.1% and 3.1% at 28th day, respectively. VRE strains were the first isolated from burn wounds of only one patient (0.8%) on the 14th day and the colonization rate increased to 7.0% at the 28th day. Our study indicated that rectal colonization was seen more than other sites of colonization and was strictly correlate to colonizing enterococci between burn wound and other body regions. Multivariate analyses showed that glycopeptide use, burn depth and total burn surface area were independent risk factors for acquisition of VRE. All VSE strains were susceptible to teicoplanin, tigecycline and linezolid. VSE strains were more resistant to gentamicin and streptomycin, and VRE strains were more resistant to penicillin and ampicillin. The present study showed tigecycline and linezolid to be most active agents against VRE strains. The determined VRE colonization and risk factors of VRE acquisition are expected to be useful in establishing guidelines for preventing VRE infection in burn unit.
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http://dx.doi.org/10.1016/j.burns.2010.08.007DOI Listing
February 2011

Efficacy of oral ribavirin treatment in Crimean-Congo haemorrhagic fever: a quasi-experimental study from Turkey.

J Infect 2009 Mar 26;58(3):238-44. Epub 2009 Feb 26.

Department of Infectious Diseases and Clinical Bacteriology, Cumhuriyet University, Sivas, Turkey.

Objective: The aim of this study was to evaluate the efficacy of oral ribavirin treatment in patients with Crimean-Congo haemorrhagic fever (CCHF).

Methods: In 2004, all patients diagnosed with CCHF were treated with oral ribavirin, however in 2003 none of the CCHF patients had been given treatment due to lack of confirmatory diagnostic information at that time in Turkey. In this study, patients treated with ribavirin in 2004 (n=126) were compared with ribavirin-untreated CCHF patients (n=92) in 2003. Patients only with a definitive diagnosis of CCHF (clinical symptoms plus the presence of specific IgM antibodies against CCHF virus and presence of viral antigen) were included in this study.

Results: There was no difference in the case-fatality rate between treated and untreated patients (7.1% vs. 11.9%; P>0.05). A Cox Proportional Hazards regression analysis revealed that altered sensorium and prolonged international normalized ratio were independent predictors of mortality.

Conclusion: Our results showed that oral ribavirin treatment did not improve the survival rate in CCHF patients. Ribavirin and supportive care are the only available choices for treatment of CCHF patients, but to ascertain the efficacy of ribavirin, more laboratory and observational studies are necessary and ultimately, to elucidate these conflicting results and evaluate the efficacy undoubtedly, a multicenter randomised controlled trial will be needed.
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http://dx.doi.org/10.1016/j.jinf.2009.01.014DOI Listing
March 2009

Anthrax in eastern Turkey, 1992-2004.

Emerg Infect Dis 2005 Dec;11(12):1939-41

Department of Infectious Diseases, School of Medicine, Ataturk University, Erzurum, Turkey

We investigated animal and human anthrax cases during a 13-year period in eastern Turkey. From 1992 to 2004, a total of 464 animal and 503 human anthrax cases were detected. Most cases occurred in summer. Anthrax remains a health problem in eastern Turkey, and preventive measures should be taken.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3367647PMC
http://dx.doi.org/10.3201/eid1112.050779DOI Listing
December 2005

Changes in antibiotic use, cost and consumption after an antibiotic restriction policy applied by infectious disease specialists.

Jpn J Infect Dis 2005 Dec;58(6):338-43

Department of Infectious Diseases, Ataturk University Medical School, Erzurum, Turkey.

The study was designed to compare antibiotic use, cost and consumption before and after an initiation of an antibiotic-restriction policy in our hospital. The policy was applied in 2003, and the prescription of two groups of antibiotics (intravenously used and expensive antibiotics) was restricted. A prescription for the restricted antibiotics could be obtained with approval by an infectious disease specialist (IDS). All the hospitalized patients who received antibiotics were evaluated by a cross-sectional study with standard criteria. The annual cost and consumption of antibiotics were evaluated. After restriction, the rate of antibiotic use decreased from 52.7 to 36.7% (P < 0.001), and the appropriate use increased from 55.5 to 66.4% (P < 0.05). Appropriate use was higher for restricted antibiotics (88.4%) than for unrestricted ones (58.2%) (P < 0.001), and higher in the presence of ID consultation (97.5%) than in the absence of consultation (55.7%) (P < 0.001). Culture-based treatment was increased, and appropriate use in such cases (93.0%) was higher than empirical treatment (33.3%) (P < 0.001). After the restriction policy, consumption of antibiotics belonging to the restricted groups was decreased by 44.8%. Total expenditure of all antibiotics was decreased by 18.5%, and the savings were US$332,000 per year. This restriction policy was effective in promoting rational antibiotic prescription and lowering antibiotic cost and consumption in our hospital.
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December 2005

Nosocomial methicillin-resistant Staphylococcus aureus endocarditis with splenic abscess in a pregnant woman.

Jpn J Infect Dis 2005 Oct;58(5):323-5

Department of Clinical Bacteriology and Infectious Diseases, Ataturk University School of Medicine, Erzurum, Turkey.

A 36-year-old, 7-week-gravida patient with catheter-related nosocomial infective endocarditis due to methicillin-resistant Staphylococcus aureus (MRSA) is presented in this paper. The patient was admitted to our hospital because of carbon monoxide intoxication. After 14 days, MRSA catheter-related bacteremia developed. The central venous catheter was immediately removed, and teicoplanin therapy was started. Because of persistent fever, leukocytosis, and high C-reactive protein values, endocarditis was suspected. A transesophageal echocardiogram revealed 19-mm vegetation on her mitral valve, confirming the diagnosis of endocarditis. Gentamicin and rifampicin were added to the therapy regimen, and the dose of teicoplanin was increased to 12 mg/kg-day. After 8 days, a splenic abscess was detected by ultrasonography. Vegetation excision, mitral valve replacement by open-heart surgery and splenectomy were performed in the same operation. Antibiotherapy was continued for 6 weeks after surgery, and the patient's condition improved. The development of endocarditis could be prevented by proper clinical practices.
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October 2005

Genotoxic effect of ribavirin in patients with Crimean-Congo hemorrhagic fever.

Jpn J Infect Dis 2005 Oct;58(5):313-5

Department of Medical Genetics, Medical Faculty, Ataturk University, Erzurum, Turkey.

In this study, we investigated the in vivo genotoxicity of ribavirin in humans, studying 3 patients with Crimean-Congo hemorrhagic fever who were treated with high-dose ribavirin. In order to evaluate genotoxicity, both the micronucleus (MN) test and the sister chromatid exchange (SCE) test were used. In all patients, blood samples were taken during and after therapy. Whole blood cultures were performed for 72 h and the MN assay and SCE test were then carried out to demonstrate the genotoxicity. In all patients, both SCE and MN amounts were found to be higher in the samples which were taken during therapy than in those at 1 month after therapy. The results of our study reveal that ribavirin has a reversible in vivo genotoxic effect on humans.
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October 2005

Prevalence of metallo-beta-lactamase among Pseudomonas aeruginosa and Acinetobacter baumannii isolated from burn wounds and in vitro activities of antibiotic combinations against these isolates.

Burns 2005 Sep 1;31(6):707-10. Epub 2005 Apr 1.

Department of Microbiology and Clinical Microbiology, Ataturk University, Tip Fakultesi, Aziziye Hastanesi, Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dali, School of Medicine, Erzurum 25100, Turkey.

The prevalence of metallo-beta-lactamases (MBLs) produced by isolates of Pseudomonas aeruginosa and Acinetobacter baumannii and the activities of various antmicrobial combinations against MBL producer strains were investigated. During the period from June 2003 till July 2004, 120 P. aeruginosa and 9 A. baumannii nonduplicate isolates were obtained from burn wounds. Forty strains (37 P. aeruginosa, 3 A. baumannii) were selected because of resistance to carbapenems. Screening for MBL production was performed in the latter isolates by the combined disk method which depends on comparing the zones given by disks containing imipenem with and without ethylenediaminetetraacetic acid (EDTA). Of imipenem resistant P. aeruginosa strains, 21 and 1 of A. baumannii were found metallo-beta-lactamase producers. Disk approximation studies were then performed to test for in vitro activities of various antimicrobial combinations. For a total of 21 P. aeruginosa strains, synergy was demonstrated predominantly by ciprofloxacin in combination with ceftazidime and imipenem, by ofloxacin in combination with astreonam. Against MBL producer A. baumannii strain, synergy was detected only with imipenem-ofloxacin combination. None of the combinations were antagonistic. These results suggest that MBL producing P. aeruginosa and A. baumanni strains have been introduced into burn centers, and to prevent the further spread of MBL producers, it is essential for carbapenem resistant isolates to be screened for MBLs.
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http://dx.doi.org/10.1016/j.burns.2005.02.017DOI Listing
September 2005

The risk factors for acquisition of imipenem-resistant Pseudomonas aeruginosa in the burn unit.

Burns 2005 Nov 21;31(7):870-3. Epub 2005 Jun 21.

Department of Clinical Bacteriology and Infectious Diseases, School of Medicine, Ataturk University, Erzurum, Turkey.

Objective: This study was conducted to determine the risk factors for acquisition of imipenem-resistant Pseudomonas aeruginosa (IRPA) in the burn unit.

Methods: Patients hospitalized in the burn unit from July 2003 to November 2004 were included in this study. The features of patients with isolated IRPA were compared with those of patients with isolated imipenem-susceptible P. aeruginosa (ISPA). Demographic features, total burn surface area (TBSA), burn depth, antimicrobials used in 15-day period before isolation, and presence of IRPA in the unit at the same period were included in the risk factors analysis.

Results: P. aeruginosa was recovered from 133 patients in this period, 93 were IRPA and 40 were ISPA. There was no significant difference between patients with ISPA and patients with IRPA in terms of age, TBSA, and burn depth. In multivariate logistic regression analysis, hospital stay before isolation (odds ratio (OR): 3.6), carbapenem usage (OR: 7.4), broad-spectra antibiotic usage (OR: 6.5), previous presence of ISPA in the patient (OR: 1.7) and presence of IRPA in the unit at the same period (OR: 2.6) were independent risk factors for acquisition of IRPA.

Conclusion: Long hospitalization time, previous imipenem/meropenem use, previous broad-spectra antibiotic use, previous presence of ISPA in a patient and presence of IRPA in a unit at the same period were associated with acquisition of IRPA in the burn unit. In order to decrease the incidence of IRPA isolation, the usage of broad-spectra antibiotics, especially carbapenem, should be restricted, hospitalization time should be shortened if possible, and universal isolation precautions should be strictly applied to prevention cross-contamination.
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http://dx.doi.org/10.1016/j.burns.2005.04.015DOI Listing
November 2005

Crimean-Congo hemorrhagic fever in Eastern Turkey: clinical features, risk factors and efficacy of ribavirin therapy.

J Infect 2006 Mar 13;52(3):207-15. Epub 2005 Jun 13.

Department of Clinical Microbiology and Infectious Diseases, School of Medicine, Ataturk University, 25240 Erzurum, Turkey.

Objectives: This study described the clinical features, factors affecting the outcome of this disease, risk factors, and efficacy of ribavirin therapy for CCHF patients in Eastern Turkey.

Methods: Between 2002 and 2004, 60 cases admitted to our hospital were included in this study. The diagnosis was confirmed through detection of IgM by ELISA and/or genomic segment of virus by RT-PCR.

Results: In multivariate analysis, farming (OR, 11.4), living in a rural area (OR, 10.05) and being bitten by tick (OR, 6.75) were determined as risk factors for CCHF. The rates of fever during hospitalization, confusion, neck stiffness, bleeding from multiple sites, and presence of petechia/ecchymosis were higher in the patients who died than in surviving ones. Additionally, the mean values of ALT, AST, LHD, CK, PTT, INR and urea were also higher, and the mean PLT count was lower in the patients who died. Mean recovery time was shorter in the cases treated with ribavirin than those of control. But, the need for blood and blood product, mean hospitalization duration, fatality rates, and hospital expenditure values were not significantly different between the group of patients treated with ribavirin and control groups.

Conclusions: In Eastern Turkey, clinical features, factors influencing outcome of the disease, and risk factors were similar to other outbreaks of CCHF. Further studies are needed for the evaluation of ribavirin therapy in CCHF.
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http://dx.doi.org/10.1016/j.jinf.2005.05.003DOI Listing
March 2006

[A transfusion-transmitted malaria case].

Mikrobiyol Bul 2005 Jan;39(1):101-5

Atatürk Universitesi Tip Fakültesi, Klinik Bakteriyoloji ve infeksiyon Hastaliklan Anabilim Dali, Erzurum.

Malaria is a rare but potentially serious complication of blood transfusion. In this report a transfusion-transmitted malaria case has been presented. A 47-years-old woman admitted to our clinic with the complaints of striking fever with chills, diarrhea and vomiting. She had history of an operation and transfusion before 10 days of admission. On physical examination jaundice, splenomegaly and abdominal tenderness were detected. Laboratory results revealed anemia, and elevated LDH and bilirubin levels. Examination of thin blood films yielded Plasmodium vivax trophozoites. Chloroquine was initiated for therapy and the patient was successfully treated. On the other hand, informations about her blood donor indicated that he had been in the military service in Southeast Anatolia of Turkey where malaria is endemic. All the efforts to reach the donor, for his diagnosis and treatment, were failed. Since our region (Northeast Anatolia) is not an endemic area for malaria and the patient had no travel history to an endemic area, it has been considered that the transmission route of malaria in this case was blood transfusion. In conclusion, as there are no available approved tests for malaria screening of donations, the transfusion-transmitted malaria can only be prevented by careful questioning of the donors.
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January 2005

Post-interval syndrome after carbon monoxide poisoning.

Vet Hum Toxicol 2004 Aug;46(4):183-5

Department of Emergency Medicine, Ataturk University, School of Medicine, Erzurum, Turkey.

Carbon monoxide (CO) exposure and toxicity is a potentially lethal disorder with immediate and delayed side effects. A 24-y-old driver was admitted to the University-based emergency department with altered mental status. He was found unconscious in the driver's seat of his vehicle in an indoor garage the morning before. An estimated 7 h later, he was comatose and taken to a nearby village clinic. Oxygen was administered immediately. Later, he was transferred to the university hospital. At the 12th h after exposure, the Glasgow Coma Scale score was 12/15 (E3, M5, V4). Co-oximetry disclosed a carboxyhemoglobin concentration of 10.5%. Normobaric oxygen was administered. He recovered completely the 3rd d after exposure; however, on the 7th d disorientation and agitation was noted, and the interval form of CO poisoning and leukoencephelopaty were suspected, for which he was readmitted the 10th d after exposure. Analysis of cerebrospinal fluid and blood revealed no abnormalities. Magnetic resonance imaging on the 11th d after exposure demonstrated an ischemic area in the posterior temporoparietal area. The patient continued improvement to discharge at 7th d of the second admission. Close follow-up should be scheduled for CO-poisoned patients to rule out the post-interval syndrome for at least 1 mo. This should also include those with apparent clinical and laboratory recovery.
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August 2004

[Streptococcal toxic shock syndrome: a case report].

Mikrobiyol Bul 2003 Oct;37(4):309-12

Atatürk Universitesi Tip Fakültesi, Klinik Mikrobiyoloji ve Enfeksiyon Hastaliklari Anabilim Dali, Erzurum.

Streptococcal toxic shock syndrome (STSS) is the most severe form of invasive infections caused by group A streptococci. In this report, a 36-years-old man who was admitted to our clinic with the complaints of fever, rash, skin lesions, abdominal pain, weakness and anuria for 2 days, has been presented. His body temperature was 39.5 degrees C and blood pressure was 50/20 mmHg. In physical examination, diffuse erythematous rash on the body, cellulitis on left leg and foot, fungal lesions on the toes, and abdominal tenderness were noted. Laboratory results revealed a dramatic increase in leukocyte count, increased sedimentation rate, elevated blood urea nitrogen, cretinine, liver enzymes and bilirubin levels. Group A streptococci were isolated from the blood culture of the patient. Despite supportive (intravenous saline, dopamine) and antibiotic (clindamycin-ceftriaxone combination) therapies, adult respiratory distress syndrome has developed in two days, and he died on the third day. This case was presented to draw attention to STSS, which was a rare clinical entity with rapid progression to mortality despite aggressive medical therapy.
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October 2003

[Activity of frequently used disinfectants and antiseptics against nosocomial bacterial types].

Mikrobiyol Bul 2003 Apr-Jun;37(2-3):157-62

Atatürk Universitesi Tip Fakültesi, Klinik Bakteriyoloji ve Infeksiyon Hastaliklari Anabilim Dali, Erzurum.

In this study, bactericidal activity of widely used disinfectants and antiseptics (glutaraldehyde, laurylbispropylidentriamin 5 g and benzalkoniumchlorid 20 g, polyvinylpyrolidon iodine, benzalkonium chloride and sodium hypochloride) against some nosocomial bacterial isolates were investigated by qualitative and quantitative suspension test methods. One methicillin-resistant Staphylococcus aureus (MRSA), 6 multi drug-resistant Gram-negative hospital isolates (Escherichia coli, Pseudomonas aeruginosa, Enterobacter cloaca, Klebsiella pneumoniae, Citrobacter diversus, Serratia marcescens) and 3 standard strains of American Type Culture Collection (ATCC) bacteria (S. aureus, P. aeruginosa, E. coli) were tested against three different concentrations of disinfectants of which, manufacturer's recommended use-dilution, 1/2 and 1/4 of those recommended dilutions. All tested disinfectants were found effective in all three concentrations against nosocomial isolates in five minutes, by using both qualitative and quantitative suspension methods. When the test was repeated with albumine, bactericidal activities of disinfectants were found the same. Our findings showed that these disinfectants can be still used in safe for the sterilization in hospital, and routine disinfection protocols do not need to be alerted.
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June 2004

Intrafamilial transmission of hepatitis B virus in the eastern Anatolian region of Turkey.

Eur J Gastroenterol Hepatol 2003 Apr;15(4):345-9

Ataturk Universitesi, Tip Fakultesi Aziziye Hastanesi, Infeksiyon Hastaliklari Klinigi, Erzurum, Turkey.

Objective: To determine the possible route of hepatitis B virus (HBV) transmission throughout a family setting.

Method: Two hundred and forty family members (42 spouses, 32 offspring, 34 mothers, 35 fathers and 97 siblings) of 84 HBsAg carriers attending the Ataturk University Medical Faculty Hospital between July 2000 and May 2001, and 384 first time blood donors (control group) were screened prospectively for markers of HBV by using an ELISA. The chi-squared and Fisher's exact tests were used for statistical analysis.

Results: The prevalence of HBsAg and HBV infection among the family members (29.6% and 43.8%, respectively) was significantly higher than in the control group (9.6%, and 29.7%), P < 0.001. Among family members, the highest prevalences of HBsAg and HBV infection were in the husbands (70.0% and 90.0%, respectively), offspring (66.7% and 100.0%) of female index cases, and siblings (40.2% and 49.5%, respectively) of all index cases. Transmission of HBV to offspring was high in cases where both the parents were positive, but there was no difference in cases where only the mother or father was positive. Despite a high prevalence of HBsAg in the offspring of female index cases, HBsAg and anti-HBs seroprevalences in the mothers of index cases were not higher than the control group (P < 0.05). Thus, it appears that mothers do not have an important role in the acquisition of HBV infection.

Conclusion: In the area studied, in addition to the sexual route, both parents-to-child and sibling-to-sibling horizontal transmission might be the main route of intrafamilial spread of HBV infection.
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http://dx.doi.org/10.1097/00042737-200304000-00002DOI Listing
April 2003

Radiographic Findings in Hyperimmunoglobulin E Syndrome.

Turk J Haematol 2002 Dec;19(4):465-72

The aim of this study is to demonstrate the spectrum of radiologic findings of hyperimmunoglobulin E (hyper- IgE) syndrome that is relatively rare in adults. We describe the imaging findings of this rare disease in five patients. The study group consisted of 4 men and 1 woman. The final diagnosis was made according to laboratory findings in all cases. We detected lung involvement in 3 cases, paranasal sinus involvement in 4 cases and vascular involvement in 1 case. Soft tissues were involved in 5 cases. Bone involvement was demonstrated in 3 patients. The most frequent radiologic finding was widespread infectious involvement of soft tissues, bones and neighboring structures such as bursae and tendons and respiratory system.
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December 2002