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Objectives: Anti-osteoporotic drugs (AOD) are essential for secondary prevention of osteoporotic fracture (OF) in patients with established osteoporosis. However, data about AOD utilization rates are scarce among patients with OF. This study was therefore aimed at determining the AOD utilization rates among those particularly vulnerable patients. Materials and Methods: This cross-sectional study followed the medical records of patients with OF starting from their first OF diagnosis date. Each patient’s preventive osteoporosis treatments (vitamin D, calcium+vitamin D) and AOD utilization rate were recorded for a 12-month period following OF diagnosis. Results: A total of 210 patients (168 females, mean age: 67.8±11.9 years; 42 males, mean age 62.4±16.1 years) were enrolled in the study. Of these, 65.7% (n=138) did not use any medication for primary protection against osteoporosis before OF diagnosis. The ratio of patients not using any type of medication for secondary prevention after OF increased from 26.5% to 51% during a 12-month period. In addition, by one year following diagnosis, AOD usage rate had decreased from 62.3% to 41.3%. Conclusion: The AOD usage rates for secondary prevention of OF were insufficient, and cessation rates were high. Identification of factors associated with decreased AOD utility rates will provide important information for guiding patient follow-up in order to reduce the occurrence of OF.

Objective : Although cervical cancer is common, because of the presence of pre-invasive lesions and due to the fact that the cervix is an easily accessible organ, it is an appropriate disease for early diagnosis, prevention, treatment and even eradication. We aimed to evaluate the results of HPV-DNA screening program in women between the ages of 30-65 in a primary care setting and to make recommendations for preventable risk factors. Method: In this cross-sectional descriptive study we evaluated the records of 716 women 30-65 years old who scanned for HPV between 2014-2016 in a primary health care center. In the evaluation of data obtained, descriptive statistical methods and chi square test were used. Results: The average age of women included in the study was 44,11 ± 9,25, 97.1% were married; the age of first sexual intercourse was minimum 13 maximum 34 (mean 19,76 ± 3,67). Of women 20,81% smoked in various amounts, and 26,68% of them used hormonal contraceptives for varying periods of time. HPV-DNA (+) was found in 19 (2.65%) of the women. Of these, 7 (1%) were HPV-16. Conclusion: In our study, however the positive rate of HPV-DNA is lower than the studies done in Turkey and abroad, the high-risk HPV genotype-16 ratio was higher. We concluded that HPV vaccination, condom use and regular gynecological examination rates are inadequate in women which we included in our study and this may be due to economic reasons as well as socio-cultural factors.

Background: Multi-drug resistant organisms, especially Vancomycin-Resistant Enterococcus (VRE) and Carbapenam Resistant Klebsiella pneumoniae (KPC), are serious health threat. Early detection of resistant bacteria colonization amongpatients in intensive care units (ICUs) not only enables effective treatment but more importantly prevents disease and limits transmission. Therefore, we aimed to to assess the frequency of VRE and KPC colonization via rectal swab sampling. Methods: The study was carried out in ICUs of a tertiary hospital. Two rectal swab samples were collected within the first 24 hours of admission and another one was taken every subsequent 15 days to test for for VRE and KPC carriage. Results: A total 316 rectal swab samples taken from 230 patients. Forty-seven patients were screened at least 2 times. 183 patients were not further screened due to discharge, exitus or transfer to other wards. Thirty-six patients (16%) were determinedto be VRE (+). The most frequently isolated strain was E. faecium (80.5%) and its most common genotype was VanA (87.5%). Seven patients (3%) were identified as KPC (+). OXA-48 type crbapenamase was confirmed in all KPC isolates. Conclusion: This study shows that VRE and KPC colonization continues to be a serious threat in ICUs. Keywords: Carbapenam resistant klebsiella pneumoniae; vancomycin-resistant enterococci; intensive care units.

BackgroundThere is a strong association between chronic kidney disease (CKD) and cardiovascular events. Increased arrhythmia risk in kidney disease is one of the main predominant factors in increased mortality and sudden cardiac death. To estimate this risk, noninvasive measurement of repolarization abnormalities including QT interval and its heart rate-corrected value (QTc) with surface ECG, are commonly used parameters in clinical practice. The aim of this study is to examine the effect of CKD-related problems – mainly acidosis – on QT intervals.Methods30 patients with stage 3–5 CKD whose serum bicarbonate concentrations below 20 mmol/L were included in the study. Alkali therapy with oral sodium bicarbonate was used to maintain the serum bicarbonate concentration in the normal range. At the beginning all patients had sinus rhythm on surface ECG records. Kidney function tests including serum urea, serum creatinine, uric acid, blood gas analysis, and electrolytes were analyzed at the beginning and at the end of alkali treatment. All patients underwent 12 lead-ECGs, recorded simultaneously. One cardiologist examined the ECGs manually in terms of QT intervals, corrected for heart rate (QTc), QT dispersion (QTd) and corrected QT dispersion (QTcd).ResultsThere were statistically significant differences in QT intervals, QTc, QTd and QTcd before and after sodium bicarbonate treatment. The correlation analyses revealed that there were significant negative correlations in pretreatment ECGs of patients between QTd and QTcd with blood pH level. Multivariate analyses between biochemical parameters and QTd-QTcd intervals have revealed that pH was related to QTd and QTc.ConclusionsThis study demonstrated that QT intervals on surface ECG are decreased after treatment of acidosis in CKD. Further studies are needed to show whether increased QT intervals cause ventricular arrhythmias in CKD.

Purpose: The aim of this study was to identify the knowledge and awareness about human papilloma virus (HPV) and human papilloma virus (HPV) vaccine of women in reproductive age. Material and Methods: The study covered 294 women aged between 15 and 49. A questionnaire was prepared by the researchers based on the literature review. Results: The mean age of the participants was 30.5±8.9 years. Only 24.5% had heard about HPV infection and 28.2% had heard HPV vaccine. Of the participants, 188 (63.9%) got zero point from the knowledge questions. Conclusion: This study indicates that the women who apply primary care units have low knowledge levels; it is apperent that personal and social education is needed. Paying importance to patient education on HPV and cervical cancer in primary care health politics will increase knowledge and awareness for HPV infection and HPV vaccination., Amaç: Bu çalışmanın amacı doğurganlık çağındaki kadınların HPV ve HPV aşısı hakkındaki farkındalık ve bilgi düzeylerini ortaya çıkarmaktır. Materyal ve Metod: Çalışmaya 15-49 yaş aralığındaki 294 kadın dahil edildi. Yazarlar tarafından literatür taranarak hazırlanan anket formunun doldurulması istendi. Bulgular: Katılımcıların ortalama yaşı 30.5±8.9 idi. Yalnızca %24.5'i HPV enfeksiyonundan, %28.2'si ise HPV aşısından haberdardı. Katılımcılardan 188'i bilgi sorularından sıfır puan aldı. Sonuç: Bu çalışma birinci basamağa başvuran kadınların düşük bilgi düzeyinde olduklarını , bireysel ve toplumsal eğitimin gerekliliğini göstermiştir. Birinci basamak sağlık politikalarında hasta eğitimine önem verilmesi toplumun bilgi ve farkındalık düzeylerini artıracak ve kanser insidansının düşmesini sağlayacaktır.

Interest in childhood metabolic syndrome (MetS) has increased substantially due to the increasing prevalence of childhood obesity on a global scale. Early recognition of MetS is critical in order to delay the development of cardiovascular disease (CVD). In this study, we evaluated the relationship between complete blood count (CBC) parameters and MetS among pre-pubertal children which may provide evidence in support of using low cost, readily available clinical haematological parameters for the detection of MetS. A retrospective analysis was carried out on 330 (125 lean vs. 205 overweight) Turkish pre-pubertal children who attend to a paediatric outpatient clinic. Age, gender, puberty, body mass index, CBC parameters, cardiometabolic risk factors including lipid profiles, high sensitive serum reactive protein (hsCRP) and insulin resistance index calculated by homeostasis model assessment (HOMA-IR) were evaluated and compared among lean, overweight children and children with MetS. The mean age of the study population was 7.4 ± 1.9 years. In both gender, the mean values of mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH) and mean corpuscular haemoglobin concentration (MCHC) were significantly lower and red blood cell (RBC), platelet (PLT) counts were significantly higher in overweight children. Overall, 8.4% (n = 28) of patients met the criteria of MetS. Children with MetS had higher levels of PLT and lower levels of mean platelet volume (MPV). Of all the haematological parameters analysed, PLT was positively, whereas MPV was negatively correlated with MetS in girls. In addition, MPV was inversely correlated with fasting blood glucose, HOMA-IR, low density lipoprotein-cholesterol (LDL-C) and low density lipoprotein-cholesterol/high density lipoprotein-cholesterol (LDL-C/HDL-C) ratio in girls after adjusting for confounding factors. The risk analyses of MetS in terms of MPV quartiles showed that the adjusted OR (95% CI) for the lowest vs. the highest quartile was 7.71 (1.45-40.89) in girls. These data might suggest that MPV could be another feature of MetS in pre-pubertal girls and might be used as a surrogate marker for MetS in clinical settings.

Purpose: The aim of the study is to evaluate the knowledge of patients about hypertension (HT), compliance with lifestyle changes and to determine their blood pressure levels under antihypertensive therapy. Method: Hypertensive patients that applied to Family medicine outpatient clinics of Diskapi Yildirim Beyazit Education and Research Hospital for the first time, in 2012 (between February 1 to April 30), were included in our cross-sectional study. Patients are evaluated primarily for the control and the factors that can affect high blood pressure and the rate on achieving treatment goals. Results: Three hundred and forty patients were included in the study. The mean age of the patients was 60.5±10.7 years and 222 of them (65.3%) were female. The blood pressure was not under control in 108 (31.8%) patients. The mean body weight of male patients was statistically higher than females (p=0.015). The number of the patients that knew the normal blood pressure value was 249 (73.2%). Among those 155 (62.2%) were women and 179 (71.9%) were younger than 65 years of age (p=0.0001). Forty one patients (12.1%) were still smoking, 46 (13.5%) patients were exercising regularly and 32 (9.4%) were consuming regular diet. Blood pressure was better controlled in the group that was exercising regularly (p=0.001). The rate of male patients that were on regular exercise and diet, were higher than females (p=0.09). Only 86 patients (25.3%) knew the name of their antihypertensive medication and 65 of patients (19.1%) knew the dose of their medication. Female patients knew the name of their medication better than males (p=0.002). 156 patients (45.9%) were using two kinds of antihypertensive medication. 58 patients (17.1%) were skipping doses a few times a week. Conclusion: The knowledge of hypertensive patients on their illness and their compliance on non-drug treatments were inadequate. The compliance of patients should be improved by development of patient-doctor should be improved by development of patient-doctor relationship according to up-to-date guidelines, Amaç: Bu çalışmada hipertansif hastaların, hipertansiyon (HT) hakkındaki bilgi düzeylerinin değerlendirilmesi, yaşam tarzı değişikliklerine uyumlarının saptanması ve antihipertansif tedavi altındaki kan basıncı düzeylerinin tespit edilmesi amaçlanmıştır. Yöntem: Bu kesitsel çalışmaya, Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi Aile Hekimliği polikliniklerine 1 Şubat-30 Nisan 2012 tarihleri arasında ilk defa başvuran HT hastaları dahil edilmiştir. Hastalar, kan basıncı kontrolü başta olmak üzere tedavi hedeflerine ulaşma oranları ve bunları etkileyebilecek faktörler açısından değerlendirilmiştir. Bulgular: Çalışmaya 340 hasta dahil edildi. Hastaların yaş ortalaması 60,5±10,7 yıl olup 222"si (%65,3) kadındı. 108 (%31,8) hastanın kan basıncı kontrol altında değildi. Erkek hastaların ortalama vücut ağırlıkları kadın hastalara göre istatistiksel olarak fazlaydı (p=0,015). Normal tansiyon değerinin kaç olması gerektiğini bilen 249 (%73,2) hastanın, 155"i (%62,2) kadındı ve 179"u (%71,9) 65 yaşından gençti (p=0,0001). 41 (%12,1) hastanın halen sigara içmekte olduğu, 46 hastanın (%13,5) düzenli diyet yaptığı ve 32 hastanın (%9,4)"ünün düzenli egzersiz uyguladığı tespit edildi. Düzenli egzersiz yapan hasta grubunda kan basıncı kontrol oranı daha yüksekti (p=0,001). Erkek hastalarda düzenli diyet ve egzersiz yapma oranı kadınlara göre daha yüksekti (p=0,09). Hastaların ancak 86"sı (%25,3) kullandığı antihipertansif ilacın ismini bilmekte ve 65"i (%19,1) ilacının dozunu bilmekteydi. Kadın hastaların, erkek hastalara göre daha fazla oranda ilaçlarının adını bildiği tespit edildi (p=0,002). 156 hasta (%45,9) iki çeşit antihipertansif ilaç kullanmaktaydı. 58 hastanın (%17,1) haftada bir kaç defa doz atladığı öğrenildi. Sonuç: HT hastalarının, hastalıkları hakkındaki bilgi düzeyi ve ilaç dışı tedaviye uyumları yetersiz olup, güncel kılavuzlara göre geliştirilmiş bir hasta - hekim ilişkisi ile hasta uyumun arttırılmasına ihtiyaç vardır.

Unilateral hypoplasia of the internal carotid artery, is an extremely rare conjenital anomaly. It is usually diagnosed incidentally during radiological examination for another reason. Although mostly asymptomatic, it may be accompanied with life-threatening developmental anomalies. In this report a case determined with left carotid artery hypoplasia in radiological imaging for evaluation of dizziness was presented., Tek taraflı internal karotis arter (ICA) hipoplazisi, son derece nadir rastlanan konjenital bir anomalidir. Tanı genellikle başka bir nedenle yapılan radyolojik araştırma esnasında rastlantısal olarak konulur. Sıklıkla asemptomatik seyretmekle birlikte, hayatı tehdit eden gelişimsel anomaliler eşlik edebilir. Bu çalışmada, vertigo nedeni ile araştırılırken yapılan radyolojik görüntülemelerde sol internal karotis arter hipoplazisi saptanan bir vaka sunulmuştur.

The risk of infection in burns is well-known. In recent decades, the antimicrobial resistance of bacteria isolated from burn patients has increased. For this reason, a retrospective study was conducted at Van Training and Research Hospital to analyze the bacterial isolates from the wounds of patients admitted to the Burn Unit and to determine the susceptibility patterns of the commonly cultured organisms over a 3-year period, January 2009 to December 2011. A total of 250 microorganisms were isolated from burn wounds of 179 patients. Our results revealed that the most frequent isolate was Acinetobacter baumannii (23.6%), Pseudomonas aeruginosa (12%), Staphylococcus aureus (11.2%), Escherichia coli (10%) respectively. Multidrug-resistance has emerged as an important concern in our burn unit. Tigecycline, and colistin were found to be the most active drugs against Acinetobacter baumannii. Carbapenems and amikacin, were found to be the most active drugs against other gram negative bacteria. Vancomycin and linezolid were active against gram positive bacteria. Aggressive infection control measures should be applied to limit the emergence and spread of multidrug-resistant pathogens.

Background: It is important to identify and immunize susceptible healthcare workers to prevent and control hospital infections. Our aim was to evaluate the specific antibodies against the measles, mumps, and rubella viruses and the varicella zoster virus among healthcare workers in a tertiary-care hospital. Patients and Methods: A total of 284 healthcare workers (89 men and 195 women; mean age, 33.5 ± 11 years), including 111 nurses, 87 physicians, 34 laboratory technicians, and 52 members of the housekeeping staff, of Van Training and Research Hospital were enrolled in this study. Antibodies were detected with an enzyme-linked immunosorbent assay. Results: The numbers of workers with serological susceptibility to mumps, measles, rubella, or chicken pox were 26 (9.2%), 18 (6.3%), 7 (2.5%), and 5 (1.8%), respectively. Although the difference was not statistical significant, the rate of seroprevalence of antibodies was lowest for measles (90.8%; p>0.05). Susceptibility to measles, mumps, and rubella, and chicken pox was more prevalent among young healthcare workers (p

Purpose: Brucellosis is a worldwide zoonotic disease and still constitutes a major public health problem. In the study we claimed to identify Brucella species from clinical samples of patients with active brucellosis from Van region of Eastern Anatolia and to determine in vitro antimicrobial susceptibilities of these strains to commonly used anti-Brucella agents and a possible new alternative tigecycline. Materials and Methods: A total of 56 Brucella isolates were enrolled the study and the identification of the isolates were based on conventional methods. In vitro activities of an-timicrobials were evaluated by the E test method. Results: All isolates were identified as B. melitensis. MIC90 values of doxycycline, strepto-mycin, rifampin, trimethoprim-sulfamethoxazole and tigecycline were 0.064 mg/L, 1 mg/L, 2 mg/L, 0.125 mg/L and 0.094 mg/L, respectively. Tigecycline had low MIC50 and MIC90 values against all B. melitensis strains; the highest MIC observed was 0.25 ?g/mL. Conclusion: Our data suggest that tigecycline can be a therapeutic alternative option for the treatment of brucellosis. © Ivyspring International Publisher.

Cholestasis contributes to the genesis of fatigue through several mechanisms. Among these mechanisms, affected serotonergic neurotransmission is important in the pathogenesis of central fatigue. Previously, elevated levels of 5-hydroxyindole acetic acid (5-HIAA), the metabolite of 5-hydroxytryptamine (5-HT) and increased 5-HT(2) receptor density were demonstrated in the anterior hypothalamus and in the hippocampus of bile duct resected rats (BDR), respectively. The aim of this paper is to demonstrate evoked 5-HT release in selected brain regions like anterior hypothalamus and hippocampal CA1 regions of cholestatic rats using BDR rats as an experimental model for cholestasis. In this study, we analyzed the K+ evoked 5-HT and its metabolite 5-HIAA levels by using HPLC with electrochemical detection in the microdialysis samples collected from anterior hypothalamic and hippocampal CA1 regions of sham-operated and BDR rats (n = 6). The ratios of [5-HIAA] to [5-HT] following perfusion with 100 mM K+ artificial cerebrospinal fluid was used for the comparison of the evoked release of 5-HT. Locomotor activity was used to assess the signs of cholestasis associated fatigue in the BDR rats. The vertical and horizontal activity counts within 15 min were found to be decreased in the BDR rats compared to sham-operated rats (p < 0.05). Besides, the number of fecal boli (an index of emotionality) was also significantly fewer in the cholestatic rats (p < 0.05). No significant difference between the sham-operated and the BDR rats was detected in the basal 5-HT and 5-HIAA levels of anterior hypothalamus. K+ stimulation yielded a more profound increase in the [5-HIAA]/[5-HT] in the BDR rats (p < 0.05). The basal levels of 5-HT in CA1 region of the BDR rats was found to be lower than that of sham-operated group (p < 0.05), but no significant difference was observed in terms of evoked 5-HT release in both sham-operated and BDR rats. These findings imply the presence of affected serotonergic system in cholestasis.

Montelukast is a leukotriene receptor antagonist that is effective in the treatment of allergic rhinitis and asthma. We report a rare case of a 31-year-old woman with a history of allergic rhinitis and moderate persistent asthma, who experienced severe bruising on her lower extremities after starting montelukast treatment. Clinicians should be aware of the possibility of unusual bruising during montelukast therapy, and in those patients montelukast should be discontinued.

Unilateral absence of the pulmonary artery (UAPA) or pulmonary artery agenesis is a rare congenital disorder presenting with a wide spectrum of symptoms. UAPA is usually associated with cardiac anomalies and surgically treated in childhood. We report a rare case of a 50-year-old woman who was diagnosed with left pulmonary artery agenesis without any other cardiac anomalies. Clinicians should be aware of the possibility of undiagnosed cases of UAPA in patients through a chest radiograph that suggests the diagnosis. Confirmation of the diagnosis and anatomic details can be discerned by CT scanning.

Aim: Low serum vitamin D and calcium levels as well as high parathyroid hormone (PTH) levels are the most important risk factors in osteoporosis. The aim of our study was to estimate the optimal vitamin D status needed to prevent a rise in PTH concentrations in postmenopausal women. Materials and methods: A total of 197 postmenopausal women who were at the menopausal period for at least 1 year and who had body mass indexes (BMIs) 70 years). Results: The mean age of patients was 60.8 ± 10.9 years. Serum 25-hydroxyvitamin D3 [25(OH)D3] levels were lower than 10 ng/mL in 94 patients (47.7%) and lower than 20 ng/mL in 167 (84.8%) patients. The mean vitamin D level was lowest in group 2 (51–60 years), but the difference was not statistically significant (P = 0.57). PTH levels were higher than 75 pg/dL in 52 patients, and 65.4% of those patients (n = 34) had vitamin D insufficiency (

Purpose: Brucellosis is a worldwide zoonotic disease and still constitutes a major public health problem. In this study, we aimed to identify biovars of Brucella strains isolated from clinical specimens taken from brucellosis patients from the Eastern Anatolia region as well determine the susceptibility of these isolates to tigecycline and azithromycin, drugs that may serve as alternatives to the conventional drugs used in the therapy. Materials and methods: Seventy-five Brucella spp. isolates were included in the study. All strains were identified by both conventional and molecular methods. Brucella Multiplex PCR kit (FC-Biotech, Code: 0301, Turkey) and B. melitensis biovar typing PCR kit (FC-Biotech, Code: 0302, Turkey) were used for molecular typing. Antimicrobial susceptibilities of all strains were determined by E-tests. Results: By conventional biotyping, 73 strains were identified as B. melitensis biovar 3 and two strains as B. abortus biovar 3. Molecular typing results were compatible with conventional methods. The MIC50 and MIC90 values of doxycycline were 0.047 and 0.094; tigecycline 0.094 and 0.125; trimethoprim/sulfamethoxazole 0.064 and 0.19; ciprofloxacin 0.19 for both; streptomycin 0.75 and 1; rifampin 1 and 2 and azithromycin 4 and 8. According to the MIC values, doxycycline was found to be the most effective antibiotic, followed by tigecycline, trimethoprim-sulfamethoxazole and ciprofloxacin. Conclusion: Currently recommended antibiotics for the treatment of brucellosis such as doxycycline, rifampin, streptomycin, trimethoprim-sulfamethoxazole and ciprofloxacin were found to be still effective. While our results showed that tigecycline can be used an alternative agent in the treatment of brucellosis, azithromycin has not been confirmed as an appropriate agent for the treatment.

BACKGROUND We investigated the seroprevalence of human brucellosis and risk factors in a village in Eastern Anatolia, Turkey, where a brucellosis outbreak among cattle had recently occurred. PATIENTS AND METHODS All 501 inhabitants enrolled were screened with the Rose Bengal Test and were asked to fill out a questionnaire to determine the signs and symptoms of brucellosis and the risk factors. Patients' laboratory findings and clinical responses were also evaluated. RESULTS The Rose Bengal Test was positive in 44 persons. In comparison of age groups, fever (20.2%), arthralgia (19.2%) and weight loss (8.4%) were frequently seen in children (p

Özet Amaç. Ayak komplikasyonları, gelişmekte olan ülkelerde Diabetes Mellitus (DM) hastalarında önde gelen mortalite nedenlerindendir. Diyabetik ayağın önlenmesinde, düzenli ayak bakımı en etkili yöntemdir. Bu çalışmada, aile hekimliği polikliniklerine başvuran diyabetik hastaların, ayak bakımı uygulama konusundaki yeterliliklerini tespit etmek amaçlanmıştır. Yöntem. Bu kesitsel çalışma, Şubat-Nisan 2012 döneminde Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi Aile Hekimliği polikliniklerinde gerçekleştirildi. Araştırmaya katılan diyabetik hastalara, ayak bakımı davranışlarıyla ilgili yapılandırılmış anket formu uygulandı. Ayak bakımı açısından; 0-4 puan alanlar ‘yetersiz’, 5-8 puan alanlar ‘Orta’, 9-12 puan alanlar ise ‘İyi’ olarak değerlendirildi. Bulgular. Çalışmaya katılan 200 diyabetik hastanın yaş ortalaması 61,5 (±11,3) yıldı. Hastaların ortalama ayak bakımı değerlendirme puanı 5,99 (±2,4) olarak bulundu. Evli olan hastaların ve daha önce herhangi bir sağlık kuruluşunda diyabetik ayak bakımı konusunda bilgilendirildiğini belirten hastaların ortalama puanları, daha yüksekti (p

Purpose: Antimicrobial resistance among microorganisms is a global concern. In 2003, a nationwide antibiotic restriction program (NARP) was released in Turkey. In this study we evaluated the effect of NARP on antibiotic consumption, antimicrobial resistance, and cost. Materials and Methods: The data obtained from all of the four university hospitals, and one referral tertiary-care educational state hospital in Ankara. Antimicrobial resistance profiles of 14,233 selected microorganisms all grown in blood cultures and antibiotic consumption from 2001 to 2005 were analyzed retrospectively. Results: A negative correlation was observed between the ceftriaxone consumption and the prevalence of ceftriaxone resistant E.coli and Klebsiella spp. (rho:-0.395, p:0.332 and rho:-0.627, p:0.037, respectively). The decreased usage of carbapenems was correlated with decreased carbapenems-resistant Pseudomonas spp. and Acinetobacter spp (rho:0.155, p:0.712 and rho:0.180, p:0.668, respectively for imipenem). Methicillin resistance rates of S.aureus were decreased from 44% to 41%. After two years of NARP 5,389,155.82 USD saving occurred. Conclusion: NARP is effective in lowering the costs and antibiotic resistance.

Background The aims of this study were to determine the antimicrobial susceptibility patterns of urinary isolates from community acquired acute uncomplicated urinary tract infections (uUTI) and to evaluate which antibiotics were empirically prescribed in the outpatient management of uUTI. Methods Among the patients which were admitted to outpatient clinics of Ankara University Medical Faculty, Ibni-Sina Hospital during 2005-2006, a total of 429 women between the age of 18 and 65 years old who were clinically diagnosed with uUTI and to whom prescribed empirical antibiotics were enrolled in this prospective observational study. Patients' demographical data, urine culture results, resistance rates to antimicrobial agents and prescribed empiric antimicrobial therapy were analyzed. Results Totally 390 (90.9%) patients among all study population were requested for urine culture by their physicians. 150 (38.5%) of these urine cultures were positive. The most common isolated uropathogen was Escherichia coli (E. coli) (71.3%). The variations of uropathogens according to age and menopause status were not significantly different. The resistance rates of E. coli isolates for ampicillin, ampicillin-sulbactam, amoxicillin-clavulonate, cefuroxime, ceftriaxone, fluoroquinolones (FQ), co-trimoxazole (TMP-SMX) and gentamicin were 55.1%, 32.7%, 32.7%, 23.4%, 15.9%, 25.2%, 41.1%, 6.1% respectively. FQ were the most common prescribed antibiotics (77.9%) (P < 0.001), followed by TMP-SMX (10.7%), fosfomycin (9.2%), nitrofurantoin (2.1%). Treatment durations were statistically longer than the recommended 3-day course (P < 0.001). Conclusion Empirical use of FQ in uUTI should be discouraged because of increased antimicrobial resistance rates.

To assess the impact of a rational pharmacotherapy (RP) teaching program during clinical pharmacology clerkship by analyzing the results of prescription audits (PAs) of the medical students. Collectively, we intended to observe the possible improvement of the students in their prescribing, problem solving and self-directed learning skills.At the beginning and end of the clerkship, the students were presented with cases of uncomplicated osteoarthritis to assess their prescribing skills; format and rationality were scored.A medical school in Turkey that teaches RP to the fourth-year students in clinical pharmacology clerkship.There were 94 students of the 2002-2003 academic year in three groups and a single group of students belonging to the previous academic year tested. Of those students from the previous academic year, 26 were also analyzed a year later to demonstrate the long-term impact of the training.Prescribing skills of medical students and their opinions about PA.Direct assessment via PA demonstrated that the scores for post-clerkship prescriptions were far better than those for pre-clerkship prescriptions in terms of format and rationality. Long-term assessment showed that the scores declined within a year following clerkship, but they were still higher than those of their pre-clerkship scripts. Analysis of the questionnaires revealed that the students were satisfied with PA. The majority of the students stated they had learned the general principles of RP and gained better prescribing skills, and they intended to apply most of the principles learned to their future professional lives. The script format scores of a retrospectively created PA-exempted group were significantly lower than those of the students to whom an established PA education was given.PA sessions were shown to be an easy and a useful method of both evaluating and reinforcing prescribing skills gained though problem-based RP education.

WOS:000334615100001 PubMed: 24669818 Background: Asymmetric dimethylarginine (ADMA), the main endogenous inhibitor of nitric oxide synthase, is considered to be associated with endothelial dysfunction. High ADMA levels have been shown to be related with disorders causing vascular inflammation such as hypertension, hypercholesterolemia, atherosclerosis, chronic heart failure, stroke and sepsis. Cutaneous anthrax (CA) is a serious infectious disease which may cause vasculitis. The aim of the study was to investigate the serum ADMA levels in patients with CA. Methods: A total of 35 serum samples of the patients with CA and 18 control sera were tested for ADMA levels using ADMA ELISA kit (Immunodiagnostik AG, Bensheim, Germany). Results: ADMA levels were found to be significantly higher in the patients group than the controls (p < 0.001). In addition, ADMA levels were found to be positively associated with sedimentation rates (R = 0.413; p = 0.026), and inversely associated with international normalized ratio (INR) levels (R = -0.46; p = 0.011). A cut-off value of 0.475 of ADMA had a sensitivity of 74.3%, specificity of 77.8%, and accuracy of 75.5% in the diagnosis of CA. Conclusion: Although the exact mechanism still remains unclear, ADMA levels could be related to immune activation in CA. In addition, these data might suggest the higher ADMA levels in patients could be due to the perivascular inflammation and vasculitis in CA.

Cameron ulcer is a linear gatric ulser on the mucosal folds in patients with a large hiatal hernia. Cameron ulcer could be seen in 5% of patients with hiatal hernia who undergo upper gastrointestinal system (GIS) endoscopy examination. The clinical relevance of Cameron ulcer is due to its potential complications such as GIS bleeding and anemia. In this report a case who was applied to Family Medicine outpatient clinics with the diagnosis of iron deficiency anemia and determined Cameron ulser at upper gastroentestinal endoscopy was presented. [Cukurova Med J 2013; 38(2.000): 315-318]