Search

Background: Few studies have addressed the indirect costs of chronic hepatitis B and C, and none has assessed the real costs of these conditions, including indirect costs caused by loss of work, in Turkey. Aims: This study therefore analysed the costs of treatment, follow-up, and complications of chronic hepatitis B and hepatitis C infections to the community. Study design: Cross-sectional study. Methods: This study analysed patients with chronic hepatitis B and hepatitis C treated at Pamukkale University Hospital Infectious Diseases and Clinical Microbiology Clinic, Denizli, Turkey between June 2009 and June 2010. Costs of antiviral treatment and follow-up were calculated from patients' medical records, and indirect costs were analysed from questionnaires completed by patients. Results: Data were analysed for 284 patients with chronic viral hepatitis. Indirect, hospital, treatment and total expenses were significantly higher for patients with chronic hepatitis B than for inactive hepatitis B virus carriers and patients with chronic hepatitis C. Hospital and total expenses of patients with complications were significantly higher than for patients with chronic hepatitis C. Hospital and total expenses were significantly higher for patients with than for individuals without cirrhosis. Indirect, hospital, treatment and total costs of patients were significantly higher for patients receiving combination therapy than monotherapy. Conclusion: Reducing the costs to society of chronic hepatitis requires the development of protection and screening programs.

BACKGROUND: Few studies have addressed the indirect costs of chronic hepatitis B and C, and none has assessed the real costs of these conditions, including indirect costs caused by loss of work, in Turkey. AIMS: This study therefore analysed the costs of treatment, follow-up, and complications of chronic hepatitis B and hepatitis C infections to the community. STUDY DESIGN: Cross-sectional study. METHODS: This study analysed patients with chronic hepatitis B and hepatitis C treated at Pamukkale University Hospital Infectious Diseases and Clinical Microbiology Clinic, Denizli, Turkey between June 2009 and June 2010. Costs of antiviral treatment and follow-up were calculated from patients' medical records, and indirect costs were analysed from questionnaires completed by patients. RESULTS: Data were analysed for 284 patients with chronic viral hepatitis. Indirect, hospital, treatment and total expenses were significantly higher for patients with chronic hepatitis B than for inactive hepatitis B virus carriers and patients with chronic hepatitis C. Hospital and total expenses of patients with complications were significantly higher than for patients with chronic hepatitis C. Hospital and total expenses were significantly higher for patients with than for individuals without cirrhosis. Indirect, hospital, treatment and total costs of patients were significantly higher for patients receiving combination therapy than monotherapy. CONCLUSION: Reducing the costs to society of chronic hepatitis requires the development of protection and screening programs.

Background: We evaluate the effectiveness of a multidimensional infection control approach for the reduction of catheter-associated urinary tract infections (CAUTIs) in 13 intensive care units (ICUs) in 10 hospital members of the International Nosocomial Infection Control Consortium (INICC) from 10 cities of Turkey. Methods: A before-after prospective active surveillance study was used to determine rates of CAUTI. The study was divided into baseline (phase 1) and intervention (phase 2). In phase 1, surveillance was performed applying the definitions of the Centers for Disease Control and Prevention/National Healthcare Safety Network. In phase 2, we implemented a multidimensional approach that included bundle of infection control interventions, education, surveillance and feedback on CAUTI rates, process surveillance, and performance feedback. We used random effects Poisson regression to account for clustering of CAUTI rates across time periods. Results: The study included 4,231 patients, hospitalized in 13 ICUs, in 10 hospitals, in 10 cities, during 49,644 patient-days. We recorded a total of 41,871 urinary catheter (UC)-days: 5,080 in phase 1 and 36,791 in phase 2. During phase 1, the rate of CAUTI was 10.63 per 1,000 UC-days and was significantly decreased by 47% in phase 2 to 5.65 per 1,000 UC-days (relative risk, 0.53; 95% confidence interval: 0.4-0.7; P value = .0001). Conclusion: Our multidimensional approach was associated with a significant reduction in the rates of CAUTI in Turkey. Copyright (C) 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Objective: Antibiotic resistance is an important problem for the treatment of P. aeruginosa infections. The aim of this study is to determine the alteration of the infection rates and antibiotic sensitivity of hospital-acquired P. auruginosa strains throughout the years and to evaluate the empirical treatment options. Material and Method: This study was performed in all patients hospitalized between 2004 and 2006. The antibiotic sensitivity of P. aeruginosa isolated by classical methods was determined according to the criteria of the Clinical and Laboratory Standards Institute. Results: In the study period, 228 P. aeruginosa strains were evaluated. The hospital infection rate of P. aeruginosa was found to be 0.3%, 0.9% and 0.9% among the years of 2004, 2005 and 2006, respectively. Amikacin was found the most sensitive aminoglycoside, and betalactam antibiotic sensitivity decreased between the years. Multidrug resistance for P. aeruginosa was increased from 9.3% to 15.3%. Conclusions: We suggest that amikacin, piperacillintazobactam and imipenem should be the first antibiotics choices for empirical treatment of pseudomonas infections due to the fact, multidrug resistance is a increasing by years and can be eliminated by the restriction of inappropriate antibiotic treatment.

We aimed to evaluate the impact of a multidimensional infection control strategy for the reduction of the incidence of catheter-associated urinary tract infection (CAUTI) in patients hospitalized in adult intensive care units (AICUs) of hospitals which are members of the International Nosocomial Infection Control Consortium (INICC), from 40 cities of 15 developing countries: Argentina, Brazil, China, Colombia, Costa Rica, Cuba, India, Lebanon, Macedonia, Mexico, Morocco, Panama, Peru, Philippines, and Turkey. We conducted a prospective before-after surveillance study of CAUTI rates on 56,429 patients hospitalized in 57 AICUs, during 360,667 bed-days. The study was divided into the baseline period (Phase 1) and the intervention period (Phase 2). In Phase 1, active surveillance was performed. In Phase 2, we implemented a multidimensional infection control approach that included: (1) a bundle of preventive measures, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of CAUTI rates, and (6) feedback of performance. The rates of CAUTI obtained in Phase 1 were compared with the rates obtained in Phase 2, after interventions were implemented. We recorded 253,122 urinary catheter (UC)-days: 30,390 in Phase 1 and 222,732 in Phase 2. In Phase 1, before the intervention, the CAUTI rate was 7.86 per 1,000 UC-days, and in Phase 2, after intervention, the rate of CAUTI decreased to 4.95 per 1,000 UC-days [relative risk (RR) 0.63 (95 % confidence interval [CI] 0.55-0.72)], showing a 37 % rate reduction. Our study showed that the implementation of a multidimensional infection control strategy is associated with a significant reduction in the CAUTI rate in AICUs from developing countries.

Objectives: To evaluate the beneficial effects of spirulina on the treatment of experimental colitis.

Ventilator-associated pneumonias (VAPs) are a worldwide problem that significantly increases patient morbidity, mortality, and length of stay (LoS), and their effects should be estimated to account for the timing of infection. The purpose of the study was to estimate extra LoS and mortality in an intensive-care unit (ICU) due to a VAP in a cohort of 69 248 admissions followed for 283 069 days in ICUs from 10 countries. Data were arranged according to the multi-state format. Extra LoS and increased risk of death were estimated independently in each country, and their results were combined using a random-effects meta-analysis. VAP prolonged LoS by an average of 2.03 days (95% CI 1.52-2.54 days), and increased the risk of death by 14% (95% CI 2-27). The increased risk of death due to VAP was explained by confounding with patient morbidity.

Viral hepatitis cases constitute the leading group of liver diseases both in our country and worldwide. The aim of the current study was to investigate seropositivity of HbsAg and anti-HCV in the patients who were admitted to the outpatient clinics of Tunceli State Hospital between January 2010 and December 2010. All HBsAg and anti-HCV levels were determined by chemiluminescence immunoassay method (Architect i2000, Abbott, USA) and the results were evaluated retrospectively. Statistical analysis of the results was performed using Fisher's Chi-square test. The seroprevalence of HBsAg was 4.22% and anti-HCV was 0.95%. The seroprevalences of HBsAg and anti-HCV among females were 3.50% and 0.92%, respectively, whereas 4.99% and 0.98% among males, respectively. The seroprevalences of HBsAg and anti-HCV were higher in males than females (p>0.05). When the seroprevalences were evaluated according to the age groups, HBsAg seropositivity was most frequently observed in 50-59 years of age group both in males and females; whereas, anti-HCV seropositivity was most frequent in the >= 70 years of age group. In the present study, HBsAg positivity was detected in two cases; a one year old and a six year old child born following the initiation of national immunization program. In conclusion; seropositivities of HBsAg and anti-HCV were determined to be similar to the mean levels in the eastern-southeastern regions, though they were higher than those in Turkey. Since no previous similar studies have been conducted in Tunceli province, it was not possible to perform a comparison or an overall evaluation for the city. The scope of the immunization program, which has been currently conducting by Ministry of Health, should be extended to include risk groups and necessary preventive measures should be taken as well

We used an experimental rat model to compare the therapeutic efficacy of teicoplanin, linezolid, and quinupristin/dalfopristin with that of vancomycin as standard therapy for infective endocarditis. Aortic endocarditis was induced in rats by insertion of a polyethylene catheter into the left ventricle, followed by intravenous inoculation of 10(6) colony-forming units of methicillin-resistant Staphylococcus aureus 24 hours later Forty-eight hours after bacterial challenge, intravenous antibiotic therapies were initiated. There were 6 groups of 8 rats each: un-infected control; infected, untreated control; vancomycin-treated (40 mg/kg twice daily); teicoplanin-treated (20 mg/kg twice daily after a loading dose of 40 mg/kg); linezolid-treated (75 mg/kg 3 times daily for 1 day, then 75 mg/kg twice daily); and quinupristin/dalfopristin-treated (30 mg/kg twice daily and an additional 10 mg/kg dalfopristin infusion over 6 to 12 hr daily). At the end of therapy, the aortic valve vegetations in the drug-treated rats were evaluated microbiologically. Compared with the infected, untreated group, all drug-treated groups had significantly reduced bacterial titers in the vegetations. Vancomycin, teicoplanin, and quinupristin/dalfopristin all effectively reduced the quantitative bacterial cultures of aortic valve vegetations. In addition, there was no significant difference in the comparative efficacy of teicoplanin, linezolid, and quinupristin/dalfopristin. Vancomycin significantly reduced bacterial counts in comparison with linezolid, which was nonetheless also effective. Our experimental model showed that each of the investigated antimicrobial agents was effective in the treatment of infective endocarditis. (Tex Heart Inst J 2010;37(4):400-4)

We analysed nosocomial M RSA cases between January 2004 and December 2006 in a retrospective case-control study in a 250-bed tertiary-care teaching hospital. During the study period, 265 nosocomial Staphylococcus aureus infections were identified in 231 patients. There was a significant increase in methicillin resistance in isolates (M RSA) from these infections with frequencies for 2004 of 39/88 (44.3%), 2005 (62/80, 77.5%), and 2006 (75/97, 77.3%) (P < 0.001). Multivariate analysis showed that associated factors for nosocomial M RSA infection were prolonged hospitalization (OR 3.982, 95% CI 2.235-7.094, P < 0.001), mechanical ventilation (OR 3.052, 95% CI 1.666-5.590, P < 0001), surgical operation (OR 2.032, 95% CI 1.102-3.748, P = 0.023), and male sex (OR 2.000, 95% CI 1.081-3.699, P = 0.027). The determination of associated factors for methicillin resistance in nosocomial S. aureus infections in hospitals will play an important role in efforts to reduce M RSA infection rates.

This cross-sectional study was intended to investigate the etiology of community-acquired pneumonia (CAP) in adult patients receiving no prior antibiotic therapy. Etiological agents were identified in 137 (62.8%) of 218 patients, the most frequent being Streptococcus pneumoniae (14.7%), Mycoplasma pneumoniae (13.8%) and respiratory syncytial virus (10.1%). A single pathogen was detected in 50.9% of cases and mixed pathogens in 11.9%. Typical pathogens were determined in 35.8% of cases, atypical pathogens in 20.2% and viral pathogens in 20.6%. Chronic obstructive pulmonary disease was a common (42.7%) comorbidity. S. pneumoniae was the most common pathogen in adult patients with CAP. Atypical pathogens were more common in patients < 65 years old, M. pneumoniae being the most common in this age group. Our results suggest that initial empiric antibiotic treatment in patients with CAP should cover S. pneumoniae and M. pneumoniae in Turkey.

We used an experimental rat model to compare the therapeutic efficacy of teicoplanin, linezolid, and quinupristin/dalfopristin with that of vancomycin as standard therapy for infective endocarditis.Aortic endocarditis was induced in rats by insertion of a polyethylene catheter into the left ventricle, followed by intravenous inoculation of 106 colony-forming units of methicillin-resistant Staphylococcus aureus 24 hours later. Forty-eight hours after bacterial challenge, intravenous antibiotic therapies were initiated. There were 6 groups of 8 rats each: uninfected control; infected, untreated control; vancomycin-treated (40 mg/kg twice daily); teicoplanin-treated (20 mg/kg twice daily after a loading dose of 40 mg/kg); linezolid-treated (75 mg/kg 3 times daily for 1 day, then 75 mg/kg twice daily); and quinupristin/dalfopristin-treated (30 mg/kg twice daily and an additional 10 mg/kg dalfopristin infusion over 6 to 12 hr daily). At the end of therapy, the aortic valve vegetations in the drug-treated rats were evaluated microbiologically.Compared with the infected, untreated group, all drug-treated groups had significantly reduced bacterial titers in the vegetations. Vancomycin, teicoplanin, and quinupristin/dalfopristin all effectively reduced the quantitative bacterial cultures of aortic valve vegetations. In addition, there was no significant difference in the comparative efficacy of teicoplanin, linezolid, and quinupristin/dalfopristin. Vancomycin significantly reduced bacterial counts in comparison with linezolid, which was nonetheless also effective.Our experimental model showed that each of the investigated antimicrobial agents was effective in the treatment of infective endocarditis.

BACKGROUND. The International Nosocomial Infection Control Consortium (INICC) was established in 15 developing countries to reduce infection rates in resource-limited hospitals by focusing on education and feedback of outcome surveillance (infection rates) and process surveillance (adherence to infection control measures). We report a time-sequence analysis of the effectiveness of this approach in reducing rates of central line-associated bloodstream infection (CLABSI) and associated deaths in 86 intensive care units with a minimum of 6-month INICC membership. METHODS. Pooled CLABSI rates during the first 3 months (baseline) were compared with rates at 6-month intervals during the first 24 months in 53,719 patients (190,905 central line-days). Process surveillance results at baseline were compared with intervention period data. RESULTS. During the first 6 months, CLABSI incidence decreased by 33% (from 14.5 to 9.7 CLABSIs per 1,000 central line-days). Over the first 24 months there was a cumulative reduction from baseline of 54% (from 16.0 to 7.4 CLABSIs per 1,000 central line-days; relative risk, 0.46 [95% confidence interval, 0.33-0.63]; P < .001). The number of deaths in patients with CLABSI decreased by 58%. During the intervention period, hand hygiene adherence improved from 50% to 60% (P < .001); the percentage of intensive care units that used maximal sterile barriers at insertion increased from 45% to 85% (P < .001 ), that adopted chlorhexidine for antisepsis increased from 7% to 27% (P=.018 ), and that sought to remove unneeded catheters increased from 37% to 83% (P=.004); and the duration of central line placement decreased from 4.1 to 3.5 days (P < .001). CONCLUSIONS. Education, performance feedback, and outcome and process surveillance of CLABSI rates significantly improved infection control adherence, reducing the CLABSI incidence by 54% and the number of CLABSI-associated deaths by 58% in INICC hospitals during the first 2 years. © 2010 by The Society for Healthcare Epidemiology of America. All rights reserved.

Background. We aimed to investigate the therapeutic efficacy of linezolid in an experimental mediastinitis model and to compare it with vancomycin, which is commonly used. The objective of this study was also to evaluate the role of the immune system in mediastinitis. Materials and methods. Fifty adult Wistar rats were randomly divided into five groups: an uncontaminated and contaminated untreated control groups; a group that received sefazolin prophylaxis; and two groups treated with vancomycin or linezolid. Median sternotomy without access to pleural spaces was performed on all rats. All groups, except the uncontaminated one, were inoculated with 0.5 mL 10(8) colony-forming units/mL methicillin-resistant Staphylococcus aureus in the mediastinal and sternal layers. Postoperatively, vancomycin and linezolid groups were given antibiotic treatment for 7 d, starting 24 h after the end of the procedure. After 7-d treatment tissue samples from the upper ends of the sternotomy line and mediastinum. were obtained and evaluated microbiologically. Additionally, serum, heart, lung, liver, kidney, and mediastinal tissues samples were obtained to determine malondialdehyde (MDA) and myeloperoxidase (MPO). Results. The study showed that either vancomycin or linezolid successfully reduced bacterial counts in mediastinum and sternotomy line. MDA and MPO levels were found to be decreased in the treated groups, There was a positive correlation between serum and tissues MDA and MPO in all of the groups. Conclusions. Our study showed that linezolid appears to be a promising option for treating mediastinitis due to methicillin-resistant S. aureus. Additionally, it was demonstrated that a wide inflammatory process occurred after mediastinitis. (c) 2009 Elsevier Inc. All rights reserved.

BACKGROUND: We aimed to investigate the therapeutic efficacy of linezolid in an experimental mediastinitis model and to compare it with vancomycin, which is commonly used. The objective of this study was also to evaluate the role of the immune system in mediastinitis. MATERIALS AND METHODS: Fifty adult Wistar rats were randomly divided into five groups: an uncontaminated and contaminated untreated control groups; a group that received sefazolin prophylaxis; and two groups treated with vancomycin or linezolid. Median sternotomy without access to pleural spaces was performed on all rats. All groups, except the uncontaminated one, were inoculated with 0.5 mL 10(8) colony-forming units/mL methicillin-resistant Staphylococcus aureus in the mediastinal and sternal layers. Postoperatively, vancomycin and linezolid groups were given antibiotic treatment for 7 d, starting 24 h after the end of the procedure. After 7-d treatment tissue samples from the upper ends of the sternotomy line and mediastinum were obtained and evaluated microbiologically. Additionally, serum, heart, lung, liver, kidney, and mediastinal tissues samples were obtained to determine malondialdehyde (MDA) and myeloperoxidase (MPO). RESULTS: The study showed that either vancomycin or linezolid successfully reduced bacterial counts in mediastinum and sternotomy line. MDA and MPO levels were found to be decreased in the treated groups. There was a positive correlation between serum and tissues MDA and MPO in all of the groups. CONCLUSIONS: Our study showed that linezolid appears to be a promising option for treating mediastinitis due to methicillin-resistant S. aureus. Additionally, it was demonstrated that a wide inflammatory process occurred after mediastinitis.

Introduction: Urologic interventions increase the frequency of urinary system infections. The aim of this study was to evaluate the rates of sepsis after urologic interventions in Pamukkale University., Methods: Infectious Diseases and Clinical Microbiology Physician diagnosed sepsis in 84 of the 1170 patients who underwent surgical intervention., Results: The frequency of sepsis after urologic interventions was 7.2%. Percutaneus nephrolithotomy, extracorporeal shock wave lithotripsy, transurethral resection of the prostate and bladder were the most frequent interventions causing sepsis development. The most commonly isolated pathogen was Escherichia coli with a rate of 45.2%., Conclusion: Primary bloodstream infection was determined in 1.2% of the patients and secondary bloodstream infection due to urinary system infection was determined in 59.5% of the patients. Thirty-three (39.3%) patients were diagnosed as clinical sepsis.

INTRODUCTION: The treatment of postoperative mediastinitis is very important because of its high morbidity, mortality, and increased hospital stay and hospital costs. The aims of our research were to investigate whether linezolid alone can be an effective treatment agent for methicillin-resistant Staphylococcus aureus (MRSA) mediastinitis, and to determine whether linezolid can provide synergistic activity when given in combination with rifampin. METHODS: A partial upper median sternotomy was performed on 70 rats. The animals were divided into seven groups: an uncontaminated control group; an untreated contaminated group; three contaminated groups that received antibiotic therapy with either 25 or 50 mg/kg linezolid twice a day, or rifampin 5 mg/kg twice a day; and two contaminated groups that received a combination therapy consisting of 25 or 50 mg/kg linezolid and rifampin 5 mg/kg twice a day. The antibiotic treatment lasted 7 days. Tissue samples from the upper ends of the sternum and swab specimens of the upper mediastinum were obtained and evaluated microbiologically. RESULTS: The 25-mg/kg dose of linezolid, either alone or combined with rifampin, was not effective in reducing the bacterial counts in mediastinum and sternum. Quantitative bacterial cultures of mediastinum and sternum were significantly lower in the groups receiving 50 mg/kg linezolid alone or in combination with rifampin compared with the control. Adding of rifampin to linezolid therapy did not result in a significant change in bacterial counts versus linezolid alone. CONCLUSION: A high dose of linezolid should be considered as a possible therapeutic agent for the treatment of post-sternotomy infection caused by MRSA.

Background: Infectious complications in febrile neutropenic patients are still major causes of morbidity and mortality despite significant advances in diagnostic techniques and antimicrobial therapy. In this study, we describe the characteristics of patients with hematological malignancies who were evaluated for suspected infection. This study was also conducted to assess the isolation rate of bacterial and fungal causative agents in febrile neutropenic attacks. Method: The study was conducted at Pamukkale University Hospital, Turkey. In order to identify the characteristics of patients with hematological malignancies in the presence/suspicion of any accompanying infectious disease, patients' charts with hematological malignancies were reviewed for signs/symptoms of any infection between October 1, 2001, and May 31, 2005, retrospectively. Results: Overall, 90 infectious episodes occurred in 59 patients. The most common underlying diseases were acute myelogenous leukemia (61.0%) and acute lymphocytic leukemia (15.3%). The absolute neutrophil count was lower than 100/mm(3) in 33 (36.7%) episodes. Microbiologically and clinically documented infections and fever of unknown origin were observed in 35.6%, 28.9%, and 35.6% of the participants, respectively. Bloodstream infections and pneumonia were detected in 21.1% and 18.9% of episodes, respectively. Gram negative organisms were most common (58.4%), followed by gram positive cocci. A combination of third generation cephalosporin and an aminoglycoside were used in 44.4% of episodes initially. Fever resolved in 24.4% of episodes using the initial therapy. The mortality rate was 15.6%. Conclusion: These results showed that infections with gram-negative bacteria continue to predominate in febrile neutopenic episodes in our center.

Intensive care units (ICUs) are unfortunately the epicenters of nosocomial infections. The aim of the study was to investigate device associated infection rates in a small Turkish hospital. Device utilization ratios and device associated infection rates were calculated according to definitions of the Centers for Disease Control (CDC). During a period of 24 months 1,387 patients were surveyed in our ICUs. A total of 287 device associated infections were detected. In our study ventilator associated pneumonia was the most frequent nosocomial infection with a rate of 59.7 per 1,000 ventilator days. The most frequent pathogen of device associated infection was Candida spp. High rates of device associated infections in a small Turkish hospital clearly indicate the urgent need of the implementation of infection control guidelines.

WOS:000261082300012 PubMed: 18801029 Cyclosporine A is a well-known immunosuppressor agent universally used in allotransplantation. However, it has been demonstrated that this drug produces side-effects in several organs, particularly in the kidney and in the heart. Nigella sativa oil has long been used in folk medicine for a wide range of illnesses. One of the potential properties of N. sativa oil is the ability of one or more of its constituents to reduce toxicity due to its antioxidant activities. The antioxidant effects of N. sativa oil have been examined using different hepatic and kidney toxicity in in vivo murine models. The aim of this study was to evaluate the effects of N. sativa oil in the antioxidant enzyme status and myocardium of cyclosporine-A-treated rats. This study included 24 male Wistar albino young healthy rats (8-12 weeks) weighing 150-200 g. The control group received sunflower oil (21 days, 2 ml/kg/day, orally) without any treatment. The second group received only N. sativa oil (21 days, 2 ml/kg, orally) (N. sativa oil group). The animals in the third group received only cyclosporine A (21 days, 25 mg/kg, orally) (cyclosporine A group). The animals in the fourth group were treated with cyclosporine A (21 days, 25 mg/kg, orally) and starting one day before cyclosporine A administration were treated with N. sativa oil (21 days, 2 ml/kg, orally) (cyclosporine A + N. sativa oil group). Superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH-Px) activities in the heart tissues were significantly reduced in the cyclosporine A group compared to control values. Nigella sativa oil treatment caused an increase in the activities of SOD, CAT and GSH-Px compared to the control group. Malondialdehyde (MDA), nitric oxide and protein carbonyl (PC) levels were increased in the cyclosporine A-treated group in comparison with the control and N. sativa groups. Co-administration of N. sativa oil and cyclosporine A abrogated the cyclosporine A-induced MDA, N. sativa oil and PC increase compared to the cyclosporine A group. The results of our study show that pre-treatment with N. sativa oil reduced the subsequent cyclosporine A injury in rat heart, demonstrated by normalized cardiac histopathology, decrease in lipid peroxidation, improvement in antioxidant enzyme status and cellular protein oxidation.

Acinetobacter baumannii is an important pathogen which causes severe nosocomial infections such as meningitis. Multidrug resistance is a growing problem throughout the world. In this report a case of multidrug resistant A.baumannii meningitis, treated with high dose of ampicillin-sulbactam (SAM) was presented. Rhinorrhea and confusion developed on the postoperative seventh day in a 67 years old male patient operated for macroadenoma of the hyphophysis gland. Since the cerebrospinal fluid (CSF) findings indicated a central nervous system infection, nosocomial meningitis was diagnosed and intravenous ceftazidime and vancomycin have started. Blood and CSF cultures of the patient revealed no growth and his general condition has improved. However, fever and confusion emerged again on the 21st day of therapy and the repeat CSF sample revealed increased pressure, purulent appearance, 510/mm3 leukocytes (90% PMNL), 58 mg/dl glucose (simultaneous blood glucose was 144 mg/dl) and 49 mg/dl protein. Direct microscopic examination of CSF revealed gram-negative coccobacilli and A.baumannii was identified in the culture. The isolate was resistant to piperacillin-tazobactam, third generation cephalosporins, aztreonam, ciprofloxacin, carbapenems and aminoglycosides, susceptible to sulbactam ampicillin and colistin. Ampicillin (12 gr) and sulbactam (6 gr) treatment was initiated and at the 72nd hour of the therapy the temperature and conciousness level of the patient returned to normal. Control CSF sample obtained on the 14th day of treatment revealed no leukocytes and no bacterial growth. The treatment was continued for 21 days and the patient recovered without any sequela. Since colistin which is one of the alternative antimicrobial treatment choices for resistant Acinetobacter infections, is not found in Turkey, sulbactam-ampicillin might be an effective and safe choice for the treatment of multi-resistant A. baumannii meningitis if the isolate was proven to be susceptible by antibiotic susceptibility tests.

BACKGROUND: Infectious complications in febrile neutropenic patients are still major causes of morbidity and mortality despite significant advances in diagnostic techniques and antimicrobial therapy. In this study, we describe the characteristics of patients with hematological malignancies who were evaluated for suspected infection. This study was also conducted to assess the isolation rate of bacterial and fungal causative agents in febrile neutropenic attacks. METHOD: The study was conducted at Pamukkale University Hospital, Turkey. In order to identify the characteristics of patients with hematological malignancies in the presence/suspicion of any accompanying infectious disease, patients' charts with hematological malignancies were reviewed for signs/symptoms of any infection between October 1, 2001, and May 31, 2005, retrospectively. RESULTS: Overall, 90 infectious episodes occurred in 59 patients. The most common underlying diseases were acute myelogenous leukemia (61.0%) and acute lymphocytic leukemia (15.3%). The absolute neutrophil count was lower than 100/mm(3) in 33 (36.7%) episodes. Microbiologically and clinically documented infections and fever of unknown origin were observed in 35.6%, 28.9%, and 35.6% of the participants, respectively. Bloodstream infections and pneumonia were detected in 21.1% and 18.9% of episodes, respectively. Gram negative organisms were most common (58.4%), followed by gram positive cocci. A combination of third generation cephalosporin and an aminoglycoside were used in 44.4% of episodes initially. Fever resolved in 24.4% of episodes using the initial therapy. The mortality rate was 15.6%. CONCLUSION: These results showed that infections with gram-negative bacteria continue to predominate in febrile neutopenic episodes in our center.

Yukarı Söğütlü, Güneydoğu Anadolu Bölgesi’nde, antik dönemde Kommagene ismiyle bilinen Fırat Nehri ve Toros Dağları’nın sınırladığı bölgede yer almaktadır. Burada sunulan çalışmada Yukarı Söğütlü’nün mekânsal sınırlarının belirlediği bir alanda tespit edilen nekropollerdeki kaya mezarları değerlendirilmiştir. Köy ve yakın çevresindeki nekropollerde şimdiye kadar günümüzün arkeoloji anlayışı ve bilimsel çalışma esaslarına göre sistemli bir araştırma yapılmamıştır. İncelemeye konu mezarlar ve mezar yapıları bilinmeyen dönem/dönemlerde sürdürülen izinsiz kazılarda açığa çıkarılmıştır. Nekropoller, arazinin topografik yapısından kaynaklanan farklı tip ve karaktere sahiptir. Düzlükteki tarım alanlarını mezarlara ayırmak yerine, yerleşim yerinin yakın çevresinde bulunan ve gömü yapmak için elverişli her yer nekropol alanı olarak kullanılmıştır. Köyün yakınında bulunan kayalık yamaçlar, yerleşmeyi kuşatan sırt ve tepelerin yamaçları gömütler için değerlendirilmiştir. Nekropollere ayrılmış araziden mümkün olduğu kadar çok yararlanabilmek için uygun yöntemlere başvurulmuştur. Araştırmaya konu bölgede tespit edilen kaya mezarı tipleri mezarı yaptıranın ait olduğu sosyal statüye, ekonomik güce ve dönemin gelenek – göreneklerine göre çeşitlilik gösterdiğini ortaya koymuştur. Dromoslu hipojeler ve khamosorionlar nekropollerde tespit edilen hakim mezar tiplerini oluşturmaktadır. I. Antiokhos tarafından krallığın sınırları içerisinde pek çok alanda olduğu gibi mezar mimarisinde de reformlar başlattığı bilinmektedir. Bu uygulamaların Kommagene bölgesindeki kaya mezarlarının mimarisini etkilediği bilinmektedir. Kralın etnik kökenindeki doğululuk ve batılılık, gömüt kültüründe kendini göstermiştir. Kraliyet kültünün baş merkezi olan Nemrud Dağı’nda yer alan kral mezarı, Dikili Taş (Sesönk/Besni) ve Karakuş (Kâhta) tümülüsleri Kommagene halkının mezar mimarisine örnek olmuştur. Doliche (Gaziantep), Perre (Adıyaman) ve Turuş (Adıyaman) nekropol alanlarında sürdürülen çalışmalarda açığa çıkarılan mezarlar, Kommagene bölgesinin genelinde belirli bir gömüt tipinin yaygın olduğunu belgelemiştir. Burada sunulan çalışmada değerlendirilen kaya mezarları Kommagene’nin genelinde uygulanan Geç Hellenistik – Erken Roma kaya mezarı mimarisi geleneğini sürdürmektedir. Bunlarda Roma mezar tipleri ile Kommagene bölgesine komşu bir kültür merkezi olan Syria’da bilinen mezarın etkisi de belirgin biçimde izlenmektedir., Upper Söğütlü (Southeast Anatolian/Turkey), a region bounded by the river Euphrates and the Tauros Mountains, was known in classical antiquity as Commagene. In this study, rock tombs, which were found in the necropolises of the city, are evaluated. These tombs were brought out by coincidence at an indeterminate time and through excavations carried out without permission. Necropolises differ in their aspects and characteristics due to the topography of the land. Keysun (Southeast Anatolian/Turkey) and its fertile land create together excellent for small settlements build close to each other. Instead of separating a place for tombs on the plain fertile land, every suitable place near the settlements was used as necropolis. Rock faces found near the city of the plains, slopes around the settlements and hill sides were preferred as burial places. The region examined in this study establishes that the rock tombs with the forms sarcophagus and hypogaeum were the dominant grave types in the late Hellenistic and Roman period. It can be established that the reform policy within the borders of the kingdom of Antiochus I had an influence on the tomb architecture of the region, as on the types in Upper Söğütlü. The ethnic origin of the king, with eastern and western aspects, is reflected in the grave culture of this region. The tombs of the kings Dikili Taş (Sesönk) and Karakuş, in the main centre of the kingdom cult on the Nemrud Mountain, served as tomb-architecture-models for the people of Commagene. The tombs that have been found by surveys in the necropolis areas of Doliche, Perre and Turus confirm that there is a general type of tombs in the region of Commagene. Findings of researches in Upper Söğütlü back up this opinion. The main types of rock tombs determined in the necropolises of Upper Söğütlü are chamosorion and hypogaea. Among tombs seen in the same necropolis some must have had a high construction price like those with burial chambers build under ground or those build into rock slopes, they indicated luxury and were symbols of status in that society. Consequently must the first usage period be late Hellenistic - early Roman, since the region of Commagene at that time was at its peak. Although the impression arises, that the general Commagenian type of rock tombs expresses a local tradition of tomb architecture, are the influences from the tomb tradition of the neighbouring cultural centre of Syria and as well Roman Empire evident

Background: Acinetobacter baumannii is a major cause of nosocomial infections in many hospitals and appears to have a propensity for developing multiple antimicrobial resistance rapidly. Cases: We report two cases with post-surgical meningitis due to multidrug resistant A. baumannii which were successfully treated with high-dose intravenous meropenem therapy. Conclusions: Multidrug resistant Acinetobacter spp. in intensive care units are a growing concern. High-dose meropenem is used in the treatment of these infections. C1 [Sacar, Suzan; Turgut, H.; Cenger, D. Hircin; Asan, A.] Pamukkale Univ Hosp, Infect Dis & Clin Microbiol Dept, Denizli, Turkey. [Coskun, E.] Pamukkale Univ Hosp, Dept Neurosurg, Denizli, Turkey. [Kaleli, I.] Pamukkale Univ Hosp, Microbiol & Clin Microbiol Dept, Denizli, Turkey.

Background: Graft infections are severe complications of vascular surgery that may result in amputation or mortality. Staphylococci are the most frequent cause of vascular graft infections. Objective: In this study we assessed the prophylactic efficacy of linezolid in comparison with vancomycin in preventing prosthetic vascular graft infection due to methicillin-resistant Staphylococcus aureus (MRSA) or methicillin-resistant Staphylococcus epidermidis (MRSE). Methods: This randomized, controlled, experimental study using healthy adult (aged > 5 months) male Wistar rats was conducted in the research laboratory of the Pamukkale University, Denizli, Turkey. The study consisted of an uncontaminated control group and 3 groups for both staphylococcal strains: a contaminated group that did not receive any antibiotic prophylaxis; a contaminated group that received preoperative intraperitoneal (IP) prophylaxis with vancomycin; and a contaminated group that received preoperative IP prophylaxis with linezolid. All rats received a vascular Dacron graft placed inside a subcutaneous pocket created on the right side of the median line. Sterile saline solution (1 mL), to which MRSA or MRSE at a concentration of 2 x 10(7) colony-forming units per milliliter had been added, was inoculated onto the graft surface using a tuberculin syringe to fill the pocket. The grafts were explanted 7 days after implantation and assessed by quantitative culture. Results: Seventy rats (mean [SD] weight, 323.7 [17.9] g; mean [SD] age, 5.98 [0.64] months) were evenly divided between the 7 groups. Statistical analysis of the quantitative graft culture suggested that both vancomycin and linezolid were effective in significantly inhibiting bacterial growth when compared with the untreated contaminated groups (all, P < 0.001). However, a statistically significant difference was not observed between the bacteria count in the vancomycin and linezolid prophylaxis groups. When a comparison was made between the bacterial growth in the contaminated control groups, MRSA had significantly greater affinity to the Dacron prostheses than MRSE (all, P < 0.001). Conclusion: Our study found that linezolid was as effective as vancomycin in suppressing colony counts in MRSA- or MRSE-infected vascular Dacron grafts in rats.

Background. In this report we describe the in vivo antibacterial activity of linezolid in an experimental graft infection model in rats and compare it with teicoplanin. The objective of this study was also to determine the effects of the interaction of linezolid when it was combined with rifampicin and test this effect against strains of methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis. Materials and methods. Graft infections were established in the subcutaneous tissue of 130 Wistar rats by implantation of Dacron grafts followed by a topical inoculation with 2 X 10(7) CFU of clinical isolates of MRSA and MRSE. The study included a control group and six groups for each of the staphylococcal strains: an inoculated group that did not receive any antibiotic prophylaxis, two inoculated groups that received intraperitoneal prophylaxis with teicoplanin or linezolid alone, an inoculated group that received rifampicin-soaked grafts, and two inoculated groups that received a combination prophylaxis consisting of intraperitoneal teicoplanin or linezolid and rifampicin-soaked grafts. Results. There was a reduction in the quantitative bacterial graft cultures in all prophylaxis groups when compared with inoculated control groups. There was not a statistically significant difference between linezolid and teicoplanin prophylaxis groups. The best results were obtained by a combination of rifampicin-soaked grafts with linezolid or teicoplanin. Conclusions. We found no evidence to suggest that linezolid differs from teicoplanin regarding effectiveness in the prevention of prosthetic vascular graft infection. Linezolid plus rifampicin and teicoplanin plus rifampicin are demonstrated to be valuable prophylactic regimens. (C) 2007 Elsevier Inc. All rights reserved.

BACKGROUND: Graft infections are severe complications of vascular surgery that may result in amputation or mortality. Staphylococci are the most frequent cause of vascular graft infections. OBJECTIVE: In this study we assessed the prophylactic efficacy of linezolid in comparison with vancomycin in preventing prosthetic vascular graft infection due to methicillin-resistant Staphylococcus aureus (MRSA) or methicillin-resistant Staphylococcus epidermidis (MRSE). METHODS: This randomized, controlled, experimental study using healthy adult (aged >5 months) male Wistar rats was conducted in the research laboratory of the Pamukkale University, Denizli, Turkey. The study consisted of an uncontaminated control group and 3 groups for both staphylococcal strains: a contaminated group that did not receive any antibiotic prophylaxis; a contaminated group that received preoperative intraperitoneal (IP) prophylaxis with vancomycin; and a contaminated group that received preoperative IP prophylaxis with linezolid. All rats received a vascular Dacron graft placed inside a subcutaneous pocket created on the right side of the median line. Sterile saline solution (1 mL), to which MRSA or MRSE at a concentration of 2 × 10(7) colony-forming units per milliliter had been added, was inoculated onto the graft surface using a tuberculin syringe to fill the pocket. The grafts were explanted 7 days after implantation and assessed by quantitative culture. RESULTS: Seventy rats (mean [SD]weight, 323.7 [17.9]g; mean [SD]age, 5.98 [0.64] months) were evenly divided between the 7 groups. Statistical analysis of the quantitative graft culture suggested that both vancomycin and linezolid were effective in significantly inhibiting bacterial growth when compared with the untreated contaminated groups (all, P < 0.001). However, a statistically significant difference was not observed between the bacteria count in the vancomycin and linezolid prophylaxis groups. When a comparison was made between the bacterial growth in the contaminated control groups, MRSA had significantly greater affinity to the Dacron prostheses than MRSE (all, P < 0.001). CONCLUSION: Our study found that linezolid was as effective as vancomycin in suppressing colony counts in MRSA- or MRSE-infected vascular Dacron grafts in rats.

Vascular prosthetic graft infection is a major complication of vascular surgery that starts with adhesion of the microorganism to the graft. Because slime-forming microorganisms are the major causative agents in graft infection, the goals of investigators in this study were (1) to investigate the bacterial adherence of slime-forming and non-slime-forming coagulase-negative staphylococci (CNS), and (2) to determine the role of neuraminidase (NANase) in bacterial adherence to the biosynthetic ovine Collagen graft. Human plasma was instilled and incubated at 37 degrees C in preparation for fibrin deposition of grafts. After 48 hours, incubation grafts were drained and inoculated with slime-forming and non-slime-forming CNS in tryptic soy broth in the presence and in the absence of neuraminidase. After 24 hours of incubation at 36 degrees C, grafts were vortexed and cultured for colony count. Bacterial counts were expressed as total colony-forming units per longitudinal centimeter of the graft. Slime-forming CNS had greater affinity to the collagen graft compared with non-slime-forming CNS (P < .05). Adherence of slime-forming CNS was impaired by NANase treatment (P < .001). NANase treatment of patients with non-slime-forming CNS did not change adherence to the graft (P > .05). Results show that slime plays an important role in the pathogenesis of vascular graft infection. Adherence of slime-forming CNS can be decreased through the administration of NANase. This may have implications for the development of neuraminidase-embedded vascular grafts designed to reduce the occurrence of biomaterial-related infection. C1 Pamukkale Univ, Fac Med, Dept Cardiovasc Surg, TR-20070 Denizli, Turkey. Pamukkale Univ, Fac Med, Dept Infect Dis, TR-20070 Denizli, Turkey. Adnan Menderes Univ, Fac Med, Res & Dev Lab, Dept Infect Dis & Clin Microbiol, Aydin, Turkey. Pamukkale Univ, Dept Infect Dis, Fac Med, Denizli, Turkey. Pamukkale Univ, Dept Cardiovasc Surg, Fac Med, Denizli, Turkey.

Background: Hospital-acquired infection often occurs because of lapses in accepted standards of practice on the part of health care personnel. The aim of this study is to attract attention on poor hospital infection control practice in venepuncture and use of tourniquets and emphasize the importance of hand hygiene. Methods: Overall compliance with hygiene during usage of tourniquets and routine patient care before and after implementation of a hospital infection control measures was evaluated. Results: According to the questionnaire, only 26.9% of respondents always washed their hands both before and after venepuncture. In the second step of the study, based on direct observation, hands were washed both before and after venepuncture on only 41 (45.1%) occasions. Failure to remove gloves after patient contact was observed on 23.1% occasions. Conclusion: Our survey reveals poor infection control practice in hand hygiene, glove utilization, and usage of tourniquets and the implementation of infection control measures produced a moderate improvement in compliance with them. C1 Pamukkale Univ, Fac Med, Dept Infect Dis & Clin Microbiol, TR-20070 Denizli, Turkey. Pamukkale Univ, Fac Med, Dept Microbiol & Clin Microbiol, Denizli, Turkey. Pamukkale Univ, Fac Med, Dept Cardiovasc Surg, Denizli, Turkey. Pamukkale Univ, Fac Med, Dept Gen Surg, Denizli, Turkey.

Background: Ventriculoperitoneal (VP) shunts are used for intracranial pressure management and temporary cerebrospinal fluid (CSF) drainage. Infection of the central nervous system (CNS) is a major cause of morbidity and mortality in patients with CSF shunts. The aim of the present study was to evaluate the clinical features, pathogens, and outcomes of 22 patients with CSF shunt infections collected over 4 years. Methods: The patients with shunt insertions were evaluated using; age, sex, etiology of hydrocephalus, shunt infection numbers, biochemical and microbiological parameters, prognosis, clinical infection features and clinical outcome. Results: The most common causes of the etiology of hydrocephalus in shunt infected patients were congenital hydrocephalus-myelomeningocele (32%) and meningitis (23%). The commonest causative microorganism identified was Staphylococcus (S.) aureus, followed by Acinetobacter spp., and S. epidermidis. Conclusion: In a case of a shunt infection the timely usage of appropriate antibiotics, according to the antimicrobial susceptibility testing, and the removal of the shunt apparatus is essential for successful treatment. C1 Pamukkale Univ, Fac Med, Dept Infect Dis & Clin Microbiol, Denizli, Turkey. Pamukkale Univ, Fac Med, Dept Neurosurg, Denizli, Turkey. Pamukkale Univ, Fac Med, Dept Gen Surg, Denizli, Turkey.

Vascular prosthetic graft infection is a major complication of vascular surgery that starts with adhesion of the microorganism to the graft. Because slime-forming microorganisms are the major causative agents in graft infection, the goals of investigators in this study were (1) to investigate the bacterial adherence of slime-forming and non-slime-forming coagulase-negative staphylococci (CNS), and (2) to determine the role of neuraminidase (NANase) in bacterial adherence to the biosynthetic ovine collagen graft. Human plasma was instilled and incubated at 37 degrees C in preparation for fibrin deposition of grafts. After 48 hours, incubation grafts were drained and inoculated with slime-forming and non-slime-forming CNS in tryptic soy broth in the presence and in the absence of neuraminidase. After 24 hours of incubation at 36 degrees C, grafts were vortexed and cultured for colony count. Bacterial counts were expressed as total colony-forming units per longitudinal centimeter of the graft. Slime-forming CNS had greater affinity to the collagen graft compared with non-slime-forming CNS (P.05). Results show that slime plays an important role in the pathogenesis of vascular graft infection. Adherence of slime-forming CNS can be decreased through the administration of NANase. This may have implications for the development of neuraminidase-embedded vascular grafts designed to reduce the occurrence of biomaterial-related infection.

BACKGROUND: Hospital-acquired infection often occurs because of lapses in accepted standards of practice on the part of health care personnel. The aim of this study is to attract attention on poor hospital infection control practice in venepuncture and use of tourniquets and emphasize the importance of hand hygiene. METHODS: Overall compliance with hygiene during usage of tourniquets and routine patient care before and after implementation of a hospital infection control measures was evaluated. RESULTS: According to the questionnaire, only 26.9% of respondents always washed their hands both before and after venepuncture. In the second step of the study, based on direct observation, hands were washed both before and after venepuncture on only 41 (45.1%) occasions. Failure to remove gloves after patient contact was observed on 23.1% occasions. CONCLUSION: Our survey reveals poor infection control practice in hand hygiene, glove utilization, and usage of tourniquets and the implementation of infection control measures produced a moderate improvement in compliance with them.

Aims: Methicillin-Resistant Staphylococcus Aureus (MRSA) is an important problem in many hospitals and Healthcare institutions, as a cause of hospital-acquired infections. Recently, increasing number of infectious outbreaks are declared. The aim of this study is to evaluate the patients who had MRSA infection during their hospitalisation and to emphasize the importance of this infection. Material and methods: The "Centers for Disease Control and Prevention (CDC)" criteria were used to evaluate the hospital injections at Pamukkale University Hospital. The patients were classified according to sexuality, department, previous antibiotic therapy, diagnosis, catheter existence and type. Findings: The most common nosocomial infection was pneumonia and this infection was followed by surgical site infection, blood stream infection, umbilical infection and urinary tract infection. When all the patients with MRSA related infections were overviewed, peripheral catheter and central catheter placements were present on 127 (%47.4) patients and 92 (%34.3) patients, respectively. Central or peripheral catheter placement was present on 46 (%97.9) of patients who had blood stream infections and 92 (%91.1) of patients who had nosocomial pneumonia. The most frequent MRSA infection was found at Anesthesia Intensive Care Unit (11.4%) followed by Neurosurgery Intensive Care Unit (4.8%). Results: The study shows that MRSA is an important infection problem in intensive care units. Review of the infection control practices and appropriate and duly usage of the antibiotics are needed to prevent the spread of MRSA.

OBJECTIVE: To investigate the prophylactic efficacy of systemic, topical, or combined antibiotic usage in the prevention of late prosthetic vascular graft infection caused by methicillin-resistant Staphylococcus epidermidis (MRSE) and the differential adherence of S. epidermidis to Dacron and ePTFE grafts in a rat model. MATERIALS AND METHODS: Graft infections were established in the back subcutaneous tissue of 120 adult male Wistar rats by implantation of 1-cm(2) Dacron/ePTFE prosthesis followed by topical inoculation with 2 x 10(7) CFU of clinical isolate of MRSE. Each of the series included one group with no graft contamination and no antibiotic prophylaxis (uncontaminated control), one contaminated group that did not receive any antibiotic prophylaxis (untreated control), one contaminated group in which perioperative intraperitoneal prophylaxis with vancomycin (10 mg/kg) was administered, two contaminated groups that received rifampicin-soaked (5 mg/1 ml) or vancomycin-soaked (1 mg/1 ml) grafts, and one contaminated group that received a combination of rifampicin-soaked (5 mg/1 ml) graft with perioperative intraperitoneal vancomycin prophylaxis (10 mg/kg). The grafts were removed sterilely 7 days after implantation and evaluated by using sonication and quantitative blood agar culture. RESULTS: MRSE had significantly greater adherence to Dacron than ePTFE grafts in the untreated contaminated groups (P < 0.001). Rifampicin had better efficacy than vancomycin in topical application, but the difference was not statistically significant (P > 0.05). Intraperitoneal vancomycin showed a significantly higher efficacy than topical vancomycin or rifampicin (P < 0.001). The best results were provided by a combination of intraperitoneal vancomycin in rifampicin-soaked graft groups (P < 0.001). CONCLUSIONS: The combination of rifampicin and intraperitoneal vancomycin seems to be the best choice for the prophylaxis of late prosthetic vascular graft infections caused by MRSE.

The authors compared asymptomatic hepatitis B virus carriers and healthy subjects in terms of their psychological state. Participants (43 asymptomatic hepatitis B virus carriers and 43 healthy comparison subjects) completed self-report questionnaires. Psychiatric disorders and psychosocial functioning were evaluated with structured clinical interviews and the Global Assessment of Functioning scale. Hepatitis B virus carriers were more likely to have psychiatric disorders than comparison subjects (30.2% vs. 11.6%). Also, carriers had significantly higher depression and anxiety scores and lower Global Assessment of Functioning scores than did comparison subjects. Worries about contamination and illnesses related to hepatitis B infection were associated with the presence of psychiatric disorder. The results suggest that asymptomatic hepatitis B virus carriers need emotional support.

Henoch-Schölein purpura is usually a disease of children presenting with arthralgia, abdominal pain, renal involvement, and palpable purpura. Viral and bacterial infections may have a role in its etiology. We present a 32-year-old male patient with recurrent Henoch-Schölein purpura in association with a chronic hepatitis B infection of ten years duration. The patient had received lamuvidine and interferon-alpha for the treatment of hepatitis B infection for a year. The skin lesions disappeared with the treatment of the hepatitis B infection. Four months after discontinuation of the therapy, the purpuric papules reappeared with reactivation of the hepatitis B infection. Although rarely reported, hepatitis B virus infection should be considered in patients with Henoch-Schölein purpura.

Background: The aim of the study was to investigate the in vivo efficacy of local and systemic antibiotic prophylaxis in the prevention of Staphylococcus ( S.) epidermidis graft infection in a rat model and to evaluate the bacterial adherence to frequently used prosthetic graft materials. Methods: Graft infections were established in the subcutaneous tissue of 120 male Wistar rats by implantation of Dacron/ePTFE grafts followed by topical inoculation with 2 x 10(7) CFUs of clinical isolate of methicillin-resistant S. epidermidis. Each of the graft series included a control group, one contaminated group that did not receive any antibiotic prophylaxis, two contaminated groups that received systemic prophylaxis with teicoplanin or levofloxacin and two contaminated groups that received teicoplanin-soaked or levofloxacin-soaked grafts. The grafts were removed 7 days after implantation and evaluated by quantitative culture. Results: There was significant bacterial growth inhibition in the groups given systemic or local prophylaxis ( P < 0.05). Methicillin-resistant S. epidermidis had greater affinity to Dacron graft when compared with ePTFE graft in the untreated contaminated groups ( P < 0.05). Conclusion: The study demonstrated that the usage of systemic or local prophylaxis and preference of ePTFE graft can be useful in reducing the risk of vascular graft infections caused by staphylococcal strains with high levels of resistance. C1 Pamukkale Univ, Fac Med, Dept Infect Dis & Clin Microbiol, Denizli, Turkey. Pamukkale Univ, Fac Med, Dept Microbiol & Clin Microbiol, Denizli, Turkey. Pamukkale Univ, Fac Med, Dept Cardiovasc Surg, Denizli, Turkey. Pamukkale Univ, Fac Med, Dept Gen Surg, Denizli, Turkey.

Cerebral biopsy is an invasive technique with limited, specific indications in view of the potential risk of complications. Brain biopsy, aside from the direct sampling of a suspected neoplasm, is often diagnostic in cases of granulomatous angiitis, some forms of encephalitis, subacute spongioform encephalopathy, and a number of other rare diseases. Two cases who had a central nervous system infection and had undergone diagnostic brain biopsy in our clinic will be discussed by reviewing the literature. Copyright © 2005 by Türkiye Klinikleri.

Objective. To investigate the prophylactic efficacy of systemic, topical, or combined antibiotic usage in the prevention of late prosthetic vascular graft infection caused by methicillin-resistant Staphylococcus epidermidis (MRSE) and the differential adherence of S. epidermidis to Dacron and ePTFE grafts in a rat model. Materials and methods. Graft infections were established in the back subcutaneous tissue of 120 adult male Wistar rats by implantation Of 1-cm(2) Dacron/ePTFE prosthesis followed by topical inoculation with 2 X 10(7) CFU of clinical isolate of MRSE. Each of the series included one group with no graft contamination and no antibiotic prophylaxis (uncontaminated control), one contaminated group that did not receive any antibiotic prophylaxis (untreated control), one contaminated group in which perioperative intraperitoneal prophylaxis with vancomycin (10 mg/kg) was administered, two contaminated groups that received rifampicin-soaked (5 mg/1 ml) or vancomycin-soaked (1 mg/1. ml) grafts, and one contaminated group that received a combination of rifampicin-soaked (5 mg/1 ml) graft with perioperative intraperitoneal vancomycin prophylaxis (10 mg/kg). The grafts were removed sterilely 7 days after implantation and evaluated by using sonication and quantitative blood agar culture. Results. MRSE had significantly greater adherence to Dacron than ePTFE grafts in the untreated contaminated groups (P < 0.001). Rifampicin had better efficacy than vancomycin in topical application, but the difference was not statistically significant (P > 0.05). Intraperitoneal vancomycin showed a significantly higher efficacy than topical vancomycin or rifampicin (P < 0.001). The best results were provided by a combination of intraperitoneal. vancomycin in rifampicin-soaked graft groups (P < 0.001). Conclusions. The combination of rifampicin and intraperitoneal vancomycin seems to be the best choice for the prophylaxis of late prosthetic vascular graft infections caused by MRSE. (c) 2005 Elsevier Inc. All rights reserved. C1 Pamukkale Univ, Fac Med, Dept Cardiovasc Surg, Denizli, Turkey. Pamukkale Univ, Fac Med, Dept Infect Dis & Clin Microbiol, Denizli, Turkey.

The purpose of this study was to investigate knowledge and practices of assistant doctors who are at risk about hepatitis B virus. It was seen that assistant doctors did not pay a sufficient attention on prevention of HBV transmission and vaccination.

Henoch-Scholein purpura is usually a disease of children presenting with arthralgia, abdominal pain, renal involvement, and palpable purpura. Viral and bacterial infections may have a role in its etiology. We present a 32-year-old male patient with recurrent Henoch-Scholein purpura in association with a chronic hepatitis B infection of ten years duration. The patient had received lamuvudine and interferon-alpha for the treatment of hepatitis B infection for a year. The skin lesions disappeared with the treatment of the hepatitis B infection. Four months after discontinuation of the therapy, the purpuric papules reappeared with reactivation of the hepatitis B infection. Although rarely reported, hepatitis B virus infection should be considered in patients with Henoch-Scholein purpura. C1 Pamukkale Univ, Fac Med, Dept Dermatol, Denizli, Turkey. Pamukkale Univ, Fac Med, Dept Infect Dis, Denizli, Turkey. Akdeniz Univ, Fac Med, Dept Microbiol, Antalya, Turkey.

BACKGROUND: Common variable immunodeficiency syndrome predominantly affects adults. It is characterized by low production of all the major classes of immunoglobulins. We report a case of common variable immunodeficiency syndrome with right aortic arch. An association of right-sided arch and common variable immunodeficiency syndrome has not been previously reported. CASE PRESENTATION: A 41-year-old female patient presented with a history of recurrent pneumonia, sinusitis, otitis media, diarrhoea, cystitis since childhood. Biochemical and immunocytochemical analysis revealed common variable immunodeficiency syndrome and radiological evaluation confirmed right aortic arch and aberrant left subclavian artery. CONCLUSION: Common variable immunodeficiency syndrome syndrome is a clinical entity that should be kept in mind in patients with recurrent infections of different sites.