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Although group A β-hemolytic streptococcus is an uncommon cause of infective endocarditis, an increase in the incidence of invasive group A streptococcus infections including bacteremia has been reported in the last two decades. Herein we report Streptococcus pyogenes endocarditis in a previously healthy adult patient who was hospitalized to investigate the etiology of fever. Because of a suspicion of a new vegetation appeared in the second (aortic) valve in the 14(th) day of high dose penicillin G treatment, the mitral and aortic valves were replaced by mechanical prosthesis on the 22(nd) day of treatment. He was discharged from hospital after the 6 week course of antibiotic treatment.

Blastoschizomyces capitatus is a rare fungal pathogen that may lead to fatal infections especially in immunosuppressive individuals. In this report, three cases of B.capitatus were presented. The patients were under treatment for acute myeloid leukemia and their blood cultures yielded B.capitatus. The patients clinical conditions deteriorated and they died despite amphotericin B treatment. The isolates were identified by conventional mycological methods and API 20C AUX (Bio-Mérieux, France) system. Antifungal susceptibility test of the strains was performed with Sensititre Yeast One Panel (Trek Diagnostic Systems, USA) and minimum inhibitory concentration (MIC) ranges for amphotericin B, caspofungin, fluconazole, itraconazole, voriconazole, posaconazole, and flucytosine were found as 0.5-1; > 16; 8-16; 0.5; 0.25; 0.5-1 and 0.06-0.25 µg/ml, respectively. Isolated strains were genotyped with RAPD-PCR (Random Amplified Polymorphic DNA-Polymerase Chain Reaction) using Cnd-3, Cnd-4, OPE-03, OPE-18 primers. The strains isolated from the first two cases were found to be genotypically identical, while the strain isolated from the third case was different. Genotypically identical isolates belonged to two patients who were admitted to the hospital with approximately 18 months interval. The other strain with a unique genotype, was isolated from a patient who was admitted to the hospital about two years later than the other two patients. In conclusion, B.capitatus should be considered as an important opportunistic pathogen especially in patients with hematologic malignancies. The data of this study demonstrated that the lowest MIC values for B.capitatus strains were with voriconazole.

Macrolide resistance mechanisms in 89 Streptococcus pneumoniae strains isolated from several clinical samples between February 2007 and May 2009 were investigated. Erythromycin resistance was noted in 35 (40%) S. pneumoniae strains. In these strains, the most frequent resistance phenotype was cMLS(B) (74%), and the most frequent resistance genotype was ermB (82%). Both ermB and mefA genes were positive in 20% of macrolide-resistant strains. While no resistance to vancomycin, linezolid and telithromycin was noted in 89 S. pneumoniae strains, 12 (13%) strains were penicillin resistant, 26 (30%) strains were clindamycin resistant, 35 (40%) were azithromycin resistant, 32 (36%) strains were tetracycline resistant, and 1 (1%) strain was levofloxacin resistant. The serotype distribution of 35 macrolide-resistant S. pneumoniae strains revealed that the most frequent serotype was serogroup 19 (45%). Multidrug resistance was present in 19 (86%) of 22 strains carrying only the ermB resistance gene. No clonal dissemination was noted in the macrolide-resistant pneumococcal strains. These findings suggest that macrolide resistance rates, resistance phenotype and genotype, as well as resistant serotypes of S. pneumoniae strains should be continuously monitored in our country.

Objective: The aim of this study was to determine whether serum levels of intestinal type fatty acid binding protein (I-FABP) are related to intestinal ischemia in patients undergoing coronary bypass surgery., Methods: The study was planned as prospective, observational. Elective coronary artery bypass candidate patients between ages of 50 and 70 were consecutively included in the study. Thirty-five patients scheduled for cardiopulmonary bypass (CPB) were identified as the CPB group and 16 patients not scheduled for CPB were identified as the off-pump coronary artery bypass surgery (OPCAB) group. The variables between and within the groups were analyzed with Student's t, Mann-Whitney U, Friedman and Wilcoxon tests respectively., Results: In both CPB and OPCAB groups, I-FABP level at the end of the operation was significantly higher than that noted at the beginning of the operation (p<0.005). In the CPB group, there was a significant drop in I-FABP from the end of the operation to each of the postoperative time points (12(th) hour and 24(th) hour) (respectively p<0.001, p<0.001). In the OPCAB group, the I-FABP levels at both postoperative time points were lower than that at the end of the operation (p<0.001), and the level at 24-hour post-surgery was significantly lower than at both the end-of-operation I-FABP value (p<0.001) and the 12-hour post-surgery I-FABP value., Conclusion: Since we have not observed any intestinal ischemia through our research, slight changes of I-FABP measurements make us believe that I-FABP would be a valuable way to monitor for intestinal ischemia in patients who undergo cardiac surgery.

Left internal mammary artery (LIMA) to pulmonary vasculature fistula is a rare complication after coronary artery bypass surgery. In most cases, the duration between bypass grafting and fistula formation ranges from 2 to 5 years. We present a 62-year-old man who presented with anginal symptoms five years after bypass surgery. On coronary angiography, selective catheterization of the LIMA showed fistula formation to the pulmonary artery, which probably led to coronary steal syndrome and myocardial ischemia. He underwent surgery and the connection between the LIMA and pulmonary artery was terminated. After surgery, his anginal complaints improved and echocardiography showed improvement in the wall motion abnormality detected before surgery.

Candidemia is a serious clinical picture with a rather high mortality. Early diagnosis and appropriate treatment is crucial in this picture especially in immunocompromised cases. The aims of this retrospective study were to investigate the antifungal susceptibility patterns and to detect the presence of phospholipase, esterase and biofilm production which are excepted as virulence factors of Candida spp. strains and to evaluate the clonal relationships between isolates. A total of 46 Candida spp. Strains isolated from blood cultures of patients of whom eight were newborn and 38 were adults, between the period of February 2005 to July 2010, were included in the study. Of the isolates 17 were identified as C.albicans, 18 were C.parapsilosis, five were C.glabrata, four were C.tropicalis, one was C.guilliermondii and one was C.krusei. Antifungal susceptibility tests were performed by using "Sensititre Yeast One (Trek Diagnostic Systems, USA)" commercial kit. Esterase activity was detected in Tween-80 medium; phospholipase activity in yolk egg agar and biofilm formation was investigated by microplate assay. Strain genotyping was performed by RAPD-PCR (random amplified polymorphic DNA-polymerase chain reaction) by using OPE-03, OPE-18, AP50-1, Cnd-3 and Cnd-4 primers. All strains were found to be susceptible to amphotericin B, voriconazole, posaconazole, and caspofungin. C.krusei strain was defined as resistant (intrinsically) to fluconazole. All strains of C.albicans, C.parapsilosis, C.glabrata, and C.tropicalis were found to be susceptible to fluconazole. Three of five C.glabrata strains were resistant to itraconazole, while the other strains were found to be susceptible. All of the C.albicans strains had phospholipase and esterase activity, however none were biofilm-producing isolates. In contrast all of the C.parapsilosis strains were negative for phospholipase and esterase activity, however all were positive for biofilm formation. Phospholipase activity has not been detected in non-albicans strains; esterase activity were found positive in all of the C.tropicalis strains, while biofilm formation was detected in three C.tropicalis, one C.glabrata and one C.krusei isolates. The results of genotyping demonstrated that C.albicans strains displayed 5-8 different patterns and C. Parapsilosis strains 2-3 patterns with the use of five primers. Among C.parapsilosis strains, 14 were found identical (with the use of all the primers forming a single pattern (pattern A). In conclusion, the Candida spp. İsolated from blood samples were highly susceptible to the tested antifungals, and C.albicans strains had high phospholipase and esterase activity, while C.parapsilosis strains had high rate of positivity for biofilm formation. The predominant pattern amongst C.parapsilosis strains was thought to be related to exogenous dissemination.

Candida species which cause local infections, may also lead to fatal systemic infections. The increasing incidence of non-albicans Candida, especially fluconazole susceptible or resistant dose-dependent C. glabrata, increased the importance of rapid and accurate species level identification for Candida. Rapid and correct identification of C. glabrata is essential for the initiation of the appropriate antifungal therapy. This study was conducted to evaluate the performance of the rapid trehalase test in the diagnosis of C. glabrata isolates. A total of 173 Candida strains isolated from various clinical specimens and identified according to germ tube test, growth on cornmeal Tween 80 agar and the colony morphologies on Mast-CHROMagar Candida medium (Mast Diagnostics, UK), were included to the study. The identification of non-albicans Candida species were also confirmed by API 20CAUX (BioMerieux, France) system. Accordingly 86 (50%) of the isolates were identified as C. glabrata, 48 (28%) C. albicans, 17 (10%) C. krusei, 13 (8%) C. tropicalis, 5 (3%) C. parapsilosis, 3 (2%) C. kefyr and 1 (1%) Cutilis. In order to detect the presence of trehalase enzyme in Condida strains, all isolates were grown on Sabouraud dextrose agar containing 4% glucose and then one yeast colony was emulsified in 50 microl of citrate buffer containing 4% (wt/vol) trehalose for 3 h at 37 degrees C. Presence of glucose which emerged after the action of trehalase on trehalose, was detected by a commercial "urinary glucose detection dipstick" (Spinreacta, Spain). All C. glabrata strains yielded positive result by trehalase test. None C. glabrata isolates were found negative by trehalase test except for one strain of C. tropicalis. In this study, the trehalase test allowed identification of C. globrata with 100% sensitivity and 98.9% specificity. It was concluded that trehalase test is a rapid, cost-effective and simple test that can be used for the accurate identification of C. glabrata.

The aim of this study was to investigate clinical findings and the effects of trimethoprim-sulfamethoxazole (TMP-SMX) in cases of blastocystosis. A total of 37 cases whose stool specimens were sent to the parasitology laboratory from the outpatient clinics of our hospital for various reasons were included in the study. Only five or more Blastocystis hominis were found during examination with direct wet mount using the 40x objective. The stool specimens were tested for other agents (Salmonella spp., Shigella spp., Escherichia coli H157:07, rotavirus) and cases with one of these were excluded from the study. The cases with blastocystosis were given TMP-SMX for 7 days. After the treatment, the cases were questioned as to symptoms once again, the stool specimen examinations were repeated with the same methods, and the results were evaluated. In 34 (91.89%) out of the 37 cases where B. hominis was found, various clinical symptoms such as stomach ache, flatulence, diarrhea, itching and fever were observed singly and/or together. After the treatment it was found that 36 (97.3%) out of 37 cases improved. This study supports the premise that TMP-SXT is effective in the treatment of B. hominis.

Occlusive lesions in the arterial endothelium are often caused by formation of intimal hyperplasia and fibrinoid necrosis. The objective of this study was to investigate the association between antiendothelial cell antibodies (AECAs) and the development of coronary artery disease (CAD) and peripheral artery disease (PAD). In this study, 94 patients with CAD or PAD and 94 healthy volunteers serving as control subjects were examined. Frozen sections of human umbilical vein endothelial cells and primate smooth muscle cells were used to detect the presence of AECAs, which were found in 52 of 94 patients (55%) and in 15 of 94 controls (16%) (P < .001). Endothelial structure tissue damage is a major factor in arterial diseases. In the present study, a statistically significant relationship was found between AECAs and the development of CAD and PAD. The presence of AECAs has been identified as a risk factor for these diseases. According to this study, AECAs are reliable prognosticators for the development of CAD and PAD. Further studies with large numbers of serum samples are under way.

Background: Involvement of the brain by Aspergillus fumigatus, named as invasive aspergillosis, is extremely rare. Definitive diagnosis needs isolation of the fungus from the tissue specimens and its culture. The disease is very resistant to treatment and quickly becomes fatal despite antifungal chemotherapy with AmB preparations, the drugs of choice for the infection., Case Description: We hereby present a unique case of fungal granuloma of the brain due to A fumigatus, which was cured successfully by intensive antifungal treatment, along with a brief literature review., Conclusions: Although it is rare, we draw the attention to the fact that early diagnostic procedures with rapid confirmation of Aspergillus infection and an early initiation of therapy are pivotal for a benign clinical course in such cases. A complete regression of the disease could be achieved with medical therapy alone with conventional AmB or liposomal AmB combined with oral itraconazole even if a total surgical excision of the lesions could not be performed in complicated cases, as in our patient.

Background: Allergic rhinitis is the most common allergic disease in Turkey. Our objective was to determine the prevalence of allergic rhinitis among adults living in Aydin, Turkey., Methods: A population-based survey was undertaken among adults aged 16-64 years. Allergic rhinitis was confirmed in the subjects screened positive by the clinical examination and specific immunoglobulin E testing., Results: A total of 465 interviews were conducted in spring 2005. The prevalence of allergic rhinitis in the past 12 months was 14.0%. The prevalence rate of clinically confirmable AR was computed as 11.4%. The prevalence was significantly higher among females and in urban areas. Specific IgE were detected for at least one of tested aeroallergens in 34.8% of the subjects with self-reported AR., Conclusion: Our study revealed that the prevalence of allergic rhinitis among adults living in the city of Aydin was as high as the prevalence in other regions of Turkey but less than in Europe.

Objective: Life-threatening arrhythmias and sudden death remain to be serious late complications after correction of tetralogy of Fallot. The aim of this study was to detect ventricular arrhythmia incidence and to find out the relationship between ventricular arrhythmia and the transannular and infundibular patch repair techniques to correct tetralogy of Fallot. That is still unpredictable exactly., Methods: Thirty-nine patients with mean age of 12.1+/-3.1 years were studied prospectively for 7.1+/-2.1 years after operation. They were all investigated with electrocardiography, echocardiography, treadmill and Holter monitorization. Right ventricular functions, exercise capacity and arrhythmia patterns were assessed. Lown criteria were used for grading the arrhythmia patterns. QRS duration, QT dispersion and QT dispersion indexes were calculated., Results: Follow up time was 5 to 13 years in both groups. All QT dispersion times and indexes were within normal ranges and there were no differences between two groups. Holter and treadmill studies did not reveal during any ventricular arrhythmia risk in the study and control groups., Conclusion: Seven years of follow-up after correction of tetralogy of Fallot revealed that transannular patch reconstruction is not a cause of tendency for ventricular arrhythmia according to Lown criteria, QT dispersion, QT dispersion indexes and QRS duration do support the results of previous studies.

Background: Recently, several temporary multisite pacing methods have been developed for prevention of postoperative atrial fibrillation (AF)., Hypothesis: In this study, we evaluated the effect of triple-site temporary triggered pacing in the AAT mode on the development of AF in patients undergoing coronary artery bypass graft (CABG) at high risk for developing postoperative AF., Methods: A total of 70 patients undergoing CABG were randomly assigned either to pacing group (study group, n = 35 patients) or to no pacing group (control group, n = 35 patients). The external pacemaker was programmed to pace at the atrial triggered mode at a lower rate of 40 beats/min for 4 days., Results: Atrial fibrillation, defined as lasting > 30 s, occurred in 4 patients (11.4%) in the study group and in 16 patients (45.7%) in the control group (p = 0.003). Sustained AF, defined as AF lasting > 10 min, also was observed less frequently in the study group than in the control group (11.6 vs. 37.1%, p = 0.024). Triple-site triggered atrial pacing was observed to reduce the incidence of AF by 75% and the incidence of sustained AF by 69%., Conclusions: We believe that multiple-site temporary pacing in the triggered mode is an effective way of preventing postoperative AF. This technique may be used especially in patients at high risk of developing AF.

Identification of Candida species is important to guide treatment in vulvovaginal candidiasis which is seen frequently and needs long-term therapy due to recurrence. The aim of this study was to determine the species distribution of Candida isolated from vaginal specimens and evaluation of CHROMagar Candida medium in the laboratory diagnosis. Samples from 80 patients who were clinically diagnosed as vaginitis have been analysed in our laboratory. Colonies appeared on CHROMagar Candida media after 48 hours of incubation at 35 degrees C were evaluated for their colors and characteristics. Candida strains were identified by germ tube test, growth on corn meal Tween 80 agar and when necessary also by API 20 C AUX commercial kit. A total of 84 Candida strains were isolated from 80 patients. Two different Candida species have been isolated from four (5%) of the samples. Among Candida strains isolated, 45 (53.6%) were C. albicans, 29 (34.5%) C. glabrata, 7 (8.3%) C. krusei, and 3 (3.6%) C. kefyr. All of the C. albicans and six of the seven C. krusei isolates have been identified correctly by CHROMagar Candida medium. These results showed that C. albicans is still the most frequently isolated species from vaginal samples. It was concluded that CHROMagar Candida medium is useful for identification of colonies due to frequently seen Candida species and also in differentiation of multiple Candida species grown on the same culture.

Today, the use of medical textiles is very important for health and hygienic purposes. Although some of medical textile materials are disposable, surgery gowns are usually laundered and re-used. After the laundering it is desirable to have these gowns keeping some of their properties such as anti-microbial and tenacity properties. For this in mind, different surgery gowns were washed and compared. In this work, a special blend of polyester carbon anti-microbial and other surgery gowns were stained with blood and later washed with both conventional method and with ultrasonic energy. The results were also analysed spectrophotometrically and the tenacity of the fabrics were determined.

Purpose: To evaluate the efficacy of US-guided glue injection in the treatment of femoral pseudoaneurysms., Materials and Methods: In 13 patients, 14 femoral pseudoaneurysms were embolized with direct percutaneous glue injection with ultrasonographic guidance. We compressed the aneurysm neck during glue injection to prevent distal embolization., Results: All of the patients were treated successfully. In each patient, complete occlusion of the pseudoaneurysm was achieved without complication. The procedure time varied between 5 and 20 minutes., Conclusion: Direct percutaneous glue injection with ultrasonographic guidance is an effective and easy method in the treatment of pseudoaneurysms.