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Öz.Amaç: Kırım-Kongo Kanamalı Ateşi, 2002 yılından itibaren ülkemizde epidemik olarak görül-meye başlayan zoonotik bir viral enfeksiyon hastalığıdır. Bu sunuda Kırım-Kongo Kanamalı Ateşi tanısı alan 10 olgunun klinik, epidemiyolojik ve laboratuvar bulgularının değerlendirilme-si amaçlanmıştır.Materyal ve Metod: 2011-2016 tarihleri arasında Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji servisimizde Kırım-Kongo Kanamalı Ateşi tanısı ile yatırılarak takip edilen 10 olgu retrospektif olarak değerlendirildi. Bulgular: Takip edilen tüm olgularımız nisan-ağustos tarihleri arasında başvurmuştu. Olguları-mızın dördü kadın altısı erkek idi. Ortalama yaş 42.7±10.75 yıldı. Yedi olguya PCR, üç olguya ise ELISA yöntemiyle tanı konuldu. Hemorajik semptom gözlenen iki olgudan birine kan ürünü desteği sağlandı. Ribavirin tedavisi sadece bir olguya verildi. Bununla birlikte tüm olgulara destek tedavisi verildi. Klinik tablosu düzelen tüm olguların ayaktan takipleri yapılacak şekilde taburculuğu yapıldı.Sonuç: Kırım-Kongo Kanamalı Ateşi nadir görülen bir hastalıktır. Özellikle bahar ve yaz ayların-da ateş şikayetiyle başvuran, trombositopeni, lökopeni, karaciğer fonksiyon testlerinde bo-zulma görülen hastalarda kene temas öyküsü sorgulanmalı ve Kırım-Kongo Kanamalı Ateşi tanısı atlanmamalıdır.Anahtar Kelimeler: Viral kanamalı ateş, Kırım Kongo hemorajik ateşi, Keneler

Amaç: Çalışmamızda, Hastanemiz Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Kliniği’nde Ekstra Pulmoner Tüberküloz (EPTB) tanısı alan olguların retrospektif olarak irdelenmesi amaçlandı. Gereç ve Yöntemler: Çalışmamız, Van Yüzüncü Yıl Üniversitesi Tıp Fakültesi Dursun Odabaş Tıp Merkezi Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Ana Bilim Dalı tarafından 1 Ocak 2015 tarihinden, 6 Haziran 2022 tarihine kadar olan süre içinde takip edilmiş akciğer dışı tüberküloz olgularının tanı, takip ve tedavi bilgilerinin retrospektif olarak incelenmesi ile yapıldı. Bulgular: Çalışmamıza, EPTB tanısı konulmuş olan 142 olgu dahil edildi. EPTB’un en sık görülen tutulum şekli, 61 olgu (%43.0) ile lenf nodu tutulumu (lenfadenit) olarak izlendi. 18 olgunun 15’inde (%83.3) ARB, 7 olgunun 5’inde (%71.4) PCR testi pozitifliği saptandı. 16 olgunun 13’ünde (%81.3) M. tuberculosis üremesi oldu. Histopatolojik inceleme için 106 olgudan (%74.7) biyopsi alındı ve sonuçlarda olguların tamamında kronik granülomatöz inflamasyon tespit edildi. Bunların 46'sında (%43.4) kazeifikasyon nekrozu, 20'sinde (%18.9) nekrotizan granülomatöz inflamasyon, 10 (%9.4) olguda non-kazeifiye granülomatoz inflamasyon ve diğer 30’unda (%28.3) ise granülomatoz inflamasyon mevcuttu. Olgulara standart 6-9 ay tedavi verilirken menenjit, dissemine TB ve osteoartiküler tutulumda tedavi süreleri 9-12 ay olarak uygulandı. Tedavide ilk iki ayda dörtlü anti-TB tedavisi verilirken daha sonra izoniazid (İNH) ve rifampisin (RIF) olarak ikili tedavi ile devam edildi. Sonuç: TB hastalığı ülkemiz için önemli bir sağlık sorunudur. En sık lenf bezi tutulumu şeklinde görülen EPTB olgularında erken tanı ve tedavi mortalite ve morbidite oranlarının azaltılması için önemlidir.

Introduction The human population is aging at an astonishing rate. The aim of this study is to capture a situation snapshot revealing the proportion of individuals aged 65 years and over among inpatients in healthcare institutions in Turkey and the prevalence and type of infections in this patient group in order to draw a road map. Materials and Methods Hospitalized patients over 65 years at any of the 62 hospitals in 29 cities across Turkey on February 9, 2017 were included in the study. Web-based SurveyMonkey was used for data recording and evaluation system. Results Of 17,351 patients 5871 (33.8%) were ≥65 years old. The mean age was 75.1 ± 7.2 years; 3075 (52.4%) patients were male. Infection was reason for admission for 1556 (26.5%) patients. Pneumonia was the most common infection. The median length of hospital stay was 5 days (IQR: 2–11 days). The Antibiotic therapy was initiated for 2917 (49.7%) patients at the time of admission, and 23% of the antibiotics prescribed were inappropriate. Healthcare-associated infections developed in 1059 (18%) patients. Urinary catheters were placed in 2388 (40.7%) patients with 7.5% invalid indication. Conclusion This study used real data to reveal the proportion of elderly patients in hospital admissions. The interventions done, infections developed during hospitalization, length of hospital stay, and excessive drug load emphasize the significant impact on health costs and illustrate the importance of preventive medicine in this group of patients.

Purpose: Ventilator-associated pneumonia is a significant disease with high mortality rates. Acinetobacter baumannii is one of the most critical pathogens leading to ventilator-associated pneumonia. This study aims to evaluate the underlying risk factors in patients diagnosed with ventilator-associated pneumonia caused by Acinetobacter baumannii, who were followed in intensive care units of our hospital.Patients and Methods: The data of 112 patients diagnosed with ventilator-associated pneumonia caused by Acinetobacter baumannii, who were followed in Intensive Care Units other than Pediatric Intensive Care Unit of our hospital from 2013 to 2017, were evaluated retrospectively.Results: Of the cases included in our study, 70.5% were male, and 29.5% were female patients. Of the cases, 87.5% were followed in Anaesthesiology and Reanimation Intensive Care Unit. The most common modifiable risk factors are mechanical ventilation, antacid use, and the most common non-modifiable risk factors were the presence of trauma and a history of cardiovascular disease.Conclusion: Ventilator-associated pneumonia is a clinical condition with high mortality and morbidity in intensive care units. Incidence and mortality of ventilator-associated pneumonia can be reduced through the implementation of some necessary policies for the prevention of ventilator-associated pneumonia and the practices for the reduction or elimination of modifiable risk factors.

WOS: 000474131600010, PubMed: 30601437, Objective The aim of this study was to evaluate the reproducibility of measurement of spleen stiffness at the time of the initial detection of splenomegaly, whether it is found incidentally or not, in determining the etiology of splenomegaly. Methods The pathologies that brought about the diffuse splenomegaly were evaluated in 3 main groups as follows: hepatoportal, myeloproliferative, and infectious causes. In addition, 17 healthy control patients were recruited. All patients were examined with acoustic radiation force impulse imaging with VTQ. Results The difference between the splenic parenchymal elasticity values in the hepatoportal group (3.27 +/- 0.36 m/s), in the myeloproliferative disease group (2.98 +/- 0.33 m/s), in the infectious disease group (2.44 +/- 0.21 m/s), and in the control group (2.08 +/- 0.19 m/s) was found to be statistically significant (P = 0.001). The intraclass correlation coefficient for shear wave velocity measurement between hepatoportal causes and myeloproliferative causes was 71.2% (95% confidence interval [CI], 54.9%-87.4%), between hepatoportal causes and infective causes was 99.7% (95% CI, 98.6%-100.0%), and between myeloproliferative causes and infective causes was 83.3% (95% CI, 68.8%-97.9%). In the same patient groups, spleen volumes were measured as 64.08 +/- 9.66, 78.18 +/- 18.52, and 51.57 +/- 7.44 cm(2), respectively; in the control group, it was 26.75 +/- 6.57 cm(2). The difference between spleen volumes was found to be statistically significant (P = 0.001). Conclusions Distinguishing the causes of splenomegaly is important because the disorders require different management strategies. In diseases that cause splenomegaly, tissue content may change according to pathogenesis. Such changes in the spleen are mechanical properties that can be quantified by elastography.

A Salmonella ovarian abscess is a rare entity, and is similarly uncommon in cases with Systemic Lupus Erythematosus. To the best of our knowledge, thirty four cases of Salmonella ovarian abscess have been published in the literature, and only four of them were related to Systemic Lupus Eritematosus. Our aim is to review this clinical entity using information from our own experience as well as that from published cases. © 2020, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.

Infection control is a top priority for hospitals, especially in intensive care units (ICU). In intensive care units, prevalence of infection is estimated to be 30% worldwide, which is a major cause of morbidity and mortality. Many factors are known to increase the risk of infection in ICU patients. Since each of these may lead to different infections, it is important to recognize and identify predisposing factors for early diagnosis and treatment. The regional health care-associated infections (HCAI) prevalence and distribution of risk factors are important strategies in infection control. In this regard, the aim of this point prevalence study was to obtain data related to infections, the prevalence of HCAI among these infections, the epidemiology, agents and antibiotics used among adult ICU patients in the university hospitals, training and research hospitals and public hospitals located in eight of the cities of our region. In the light of these data, we aimed to review and emphasize the guidelines on HCAI prevention. The study included adult ICU patients followed up in nine hospitals in the Eastern and South-eastern Anatolia Regions of eight different cities (Sivas, Erzurum, Mardin, Batman, Diyarbakir Elazig, Van, Adiyaman) in Turkey. Of the hospitals six were university hospitals, one was training and research hospital, and two were public hospitals. The number of beds ranged from 358 to 1418. A specific day was determined on which the researchers concurrently carried out a prospective surveillance in all adult intensive care unit patients. The researchers collected data and recorded the demographic characteristics (age, gender), underlying diseases, length of hospital stay, presence of invasive intervention (urinary catheter, central venous catheter, external ventricular drainage, mechanical ventilator, presence of risk factors such as burn, trauma and surgery, number of infection cases, type of infection (hospital-acquired, community-acquired), type of microorganisms and whether polymicrobial or monomicrobial, which antibiotics were administered, and duration of antibiotic treatment. Our study assessed data of 429 inpatients in the adult ICU of nine hospitals in eight different cities. There were a total of 881 intensive care beds in these hospitals, and 740 (84%) beds were occupied. Of the study group 49.7% was male with a mean age (min-max) of 64.08 ± 18.78 (2-97) years. The point prevalence of HCAI was 21.7% (n= 93). Of the patients who were followed-up 182 (42.4%) presented infections. Of these infections, 21.4% were diagnosed as community-acquired pneumonia, 18.6% were ventilator-associated pneumonia (VAP), 16.3% were communityacquired urinary tract infection (UTI), and 16.3% were bloodstream infection. In addition, the most commonly administered antibiotics in the study group were piperacillin/tazobactam, carbapenem, quinolone and ceftriaxone, respectively. The most common types of HCAI were community-acquired pneumonia (10.7%), ventilator-associated pneumonia (8.9%) and bloodstream infections (8.2%). The mean length of hospital stay was 32.05 ± 66.85 (1-459) days and the mean duration of antibiotic therapy in patients with HCAIs was 7.76 ± 7.11 (1-41) days. The most widely accepted method to handle infection is to carry out active, prospective and patient-based surveillance studies on a regular basis, and to take control measures and arrange appropriate treatment in the light of the data obtained. We attribute the high prevalence of HCAI in our region to lack of personnel, lack of materials, inappropriate use of antibiotics, insufficiency of physical conditions, and little support for infection control committees. In conclusion, we emphasize that it is of importance to work closely with the hospital administration to take measures and that necessary assistance is provided.

Typhoid fever is a systemic infection caused by Salmonella typhi. It is a disease caused by food and water sources and is an important public health problem in developing countries. Fever, flu-like symptoms, headache, cough, malaise, nausea and myalgia are the most common symptoms. Venous thrombosis often occurs in the fourth week of the disease and was a common complication before the antibiotic era. In this article, we present a case who presented with high fever, headache, fatigue, diarrhea, had deep vein thrombosis as a result of the tests, Salmonella typhi produced in blood culture and healing with ceftriaxone treatment., Tifo, Salmonella typhi’nin neden olduğu sistemik bir hastalıktır. Yiyecek ve su kaynaklı oluşan bir hastalık olup gelişmekte olan ülkelerde önemli bir halk sağlığı sorunudur. Ateş, grip benzeri semptomlar, baş ağrısı, öksürük, kırgınlık, bulantı ve miyalji en sık görülen semptomlardır. Venöz tromboz sıklıkla hastalığın dördüncü haftasında ortaya çıkmaktadır ve antibiyotik döneminden önce yaygın bir komplikasyondu. Bu yazıda yüksek ateş, baş ağrısı, halsizlik, ishal şikayetleriyle başvuran, tetkikler sonucunda derin ven trombozu saptanan, kan kültüründe Salmonella typhi üreyen ve seftriakson tedavisiyle kür sağlanan bir olgu sunuldu.

WOS: 000388827200008, PubMed ID: 27138335, Objective Neuroimaging abnormalities in central nervous system (CNS) brucellosis are not well documented. The purpose of this study was to evaluate the prevalence of imaging abnormalities in neurobrucellosis and to identify factors associated with leptomeningeal and basal enhancement, which frequently results in unfavorable outcomes. Methods Istanbul-3 study evaluated 263 adult patients with CNS brucellosis from 26 referral centers and reviewed their 242 magnetic resonance imaging (MRI) and 226 computerized tomography (CT) scans of the brain. Results A normal CT or MRI scan was seen in 143 of 263 patients (54.3 %). Abnormal imaging findings were grouped into the following four categories: (a) inflammatory findings: leptomeningeal involvements (44), basal meningeal enhancements (30), cranial nerve involvements (14), spinal nerve roots enhancement (8), brain abscesses (7), granulomas (6), and arachnoiditis (4). (b) White-matter involvement: white-matter involvement (32) with or without demyelinating lesions (7). (c) Vascular involvement: vascular involvement (42) mostly with chronic cerebral ischemic changes (37). (d) Hydrocephalus/cerebral edema: hydrocephalus (20) and brain edema (40). On multivariate logistic regression analysis duration of symptoms since the onset (OR 1.007; 95 % CI 1-28, p = 0.01), polyneuropathy and radiculopathy (OR 5.4; 95 % CI 1.002-1.013, p = 0.044), cerebrospinal fluid (CSF)/serum glucose rate (OR 0.001; 95 % CI 000-0.067, p = 0.001), and CSF protein (OR 2.5; 95 % CI 2.32.7, p = 0.0001) were associated with diffuse inflammation. Conclusions In this study, 45 % of neurobrucellosis patients had abnormal neuroimaging findings. The duration of symptoms, polyneuropathy and radiculopathy, high CSF protein level, and low CSF/serum glucose rate were associated with inflammatory findings on imaging analyses.

To determine whether there were any changes in demographic and clinical features of extrapulmonary tuberculosis cases.This retrospective study was conducted at Yuzuncu Yil University, Van, Turkey, and comprised records of extrapulmonary tuberculosis patients treated between January 2009 and July 2014 at the tuberculosis control dispensary. Descriptive and clinical data, including age, gender, site of involvement, diagnostic method and coexisting systemic diseases, were noted. Any changes in terms of these parameters were investigated on a year-on-year basis. SPSS 20 was used for data analysis.There were 257 cases detected. Of them, 50(19.45%) related to 2009, 61(23.75%) to 2010, 24(9.33%) to 2011, 50(19.45%) to 2012, 47(18.28%) to 2013 and 25(9.72%) to 2014. Although lymph nodes were by far most frequently affected in 2009, 2010, 2011 and 2013; pleura was most commonly involved in 2012 and 2014. Age and gender distribution displayed no changes between 2009 and 2014 (p0.05). However, diagnostic method of choice and frequency of co-existent systemic disorders displayed remarkable alterations in this period (p0.05).Improved insight of clinicians for atypical demographic and clinical features at presentation may provide reduction of rates of morbidity and mortality due to extrapulmonary tuberculosis.

WOS: 000366655100045, PubMed ID: 26386176, BACKGROUND CONTEXT: No direct comparison between brucellar spondylodiscitis (BSD) and tuberculous spondylodiscitis (TSD) exists in the literature. PURPOSE: This study aimed to compare directly the clinical features, laboratory and radiological aspects, treatment, and outcome data of patients diagnosed as BSD and TSD. STUDY DESIGN: A retrospective, multinational, and multicenter study was used. PATIENT SAMPLE: A total of 641 (TSD, 314 and BSD, 327) spondylodiscitis patients from 35 different centers in four countries (Turkey, Egypt, Albania, and Greece) were included. OUTCOME MEASURES: The pre- and peri- or post-treatment spinal deformity and neurologic deficit parameters, and mortality were carried out. METHODS: Brucellar spondylodiscitis and TSD groups were compared for demographics, clinical, laboratory, radiological, surgical interventions, treatment, and outcome data. The Student t test and Mann-Whitney U test were used for group comparisons. Significance was analyzed as two sided and inferred at 0.05 levels. RESULTS: The median baseline laboratory parameters including white blood cell count, C-reactive protein, and erythrocyte sedimentation rate were higher in TSD than BSD (p

PubMedID: 25801665 SummaryBackground The Thwaites and Lancet scoring systems have been used in the rapid diagnosis of tuberculous meningitis (TBM). However, brucellar meningoencephalitis (BME) has similar characteristics with TBM. The ultimate aim of this study is to infer data to see if BME should be included in the differential diagnosis of TBM when these two systems suggest the presence of TBM. Method BME and TBM patients from 35 tertiary hospitals were included in this study. Overall 294 adult patients with BME and 190 patients with TBM were enrolled. All patients involved in the study had microbiological confirmation for either TBM or BME. Finally, the Thwaites and Lancet scoring systems were assessed in both groups. Results The Thwaites scoring system more frequently predicted BME cases (n = 292, 99.3%) compared to the TBM group (n = 182, 95.8%) (P = 0.017). According to the Lancet scoring system, the mean scores for BME and TBM were 9.43 ± 1.71 and 11.45 ± 3.01, respectively (P < 0.001). In addition, TBM cases were classified into "probable" category more significantly compared to BME cases, and BME cases were categorized into the "possible" category more frequently. Conclusions When the Thwaites or Lancet scoring systems indicate TBM, brucellar etiology should also be taken into consideration particularly in endemic countries. © 2015 Elsevier Ltd. All rights reserved.

Psychotic attacks due to toxic neurobrucellosis in two adolescent patients Brucellosis is a multisystem disease which can present with a broad spectrum of clinical manifestations and complications and affect the central nervous system directly or indirectly. Immunopathologic mechanisms like T-cell mediated cytotoxicity and microglia activation are suggested to play a role in neurobrucellosis. The diagnosis of toxic neurobrucellosis is confirmed by isolation of Brucella organism from blood cultures and/or positive Coombs Wright test and the Standard agglutination test (SAT) in serum when there are no cerebrospinal fluid (CSF) findings. The magnetic resonance imaging (MRI) of brain in patients with neurobrusellosis may show different findings mimicking such neurological diseases as inflammation, white matter changes and vascular involvements and other infectious and inflammatory conditions. Different clinical manifestations of neurobrucellosis have been described including meningitis, meningoencephalitis, myelitis, and psychiatric disorders. It has been indicated in case studies that neurobrucellosis may lead to psychotic disorders. In this study, we present two adolescents who presented with psychotic symptoms due to toxic neurobrucellosis.

A 17-year-old male had been bitten by his dog. He was given one dose of rabies vac - cine after being bitten. Twenty days after vaccination, he developed complaints of itching and paresthesia at the bite area on his forearm. He was transferred to our department with the pre - liminary diagnosis of rabies due to his complaints of fever, abdominal pain, dysphagia and difficulty of breathing after 3-5 days. Rabies viral nucleic acid was positive by reverse transcriptase poly - meraze chain reaction in the cerebrospinal fluid and saliva samples, and corneal smear was found positive with fluorescence antibody method. Patient's complaints markedly subsided after hospi - talization and he was discharged on 66th day with complete recovery. In the literature, complete recovery in patients with clinical rabies is limited to a few cases. In this paper, we present the first case recovering from human clinical rabies, whose diagnosis was confirmed by direct diagnostic

Summary Introduction Brucellosis is the most prevalent bacterial zoonosis worldwide. In this study, we aimed to compare our 1028 brucellosis cases with other big series in the literature in view of epidemiological, clinical, and laboratory findings and therapeutic features. Methods A total of 1028 brucellosis cases admitted to the Department of Infectious Diseases and Clinical Microbiology over a 10-year period were included in the study. A retrospective analysis was undertaken and patient files were reviewed for history, clinical and laboratory findings, and therapeutic features, as well as complications. Results Of the 1028 patients, 539 (52.4%) were female and 489 (47.6%) were male. The mean age of patients was 33.7±16.34 years and 69.6% of cases were aged 13–44 years. Four hundred and thirty-five cases (42.3%) had a history of raising livestock and 55.2% of the cases were found to have no occupational risk for brucellosis. Six hundred and fifty-four of the cases (63.6%) had a history of raw milk and dairy products consumption. The most frequently seen symptoms were arthralgia (73.7%) and fever (72.2%), while the most common clinical findings were fever (28.8%) and hepatomegaly (20.6%). The most frequent laboratory finding was a high C-reactive protein level (58.4%). The standard tube agglutination (STA) test+Coombs STA test was positive in 1016 cases (98.8%). Focal involvement was present in 371 (36.1%) cases. The most frequent involvement was osteoarticular involvement with 260 cases (25.3%). The overall relapse rate for patients with brucellosis was 4.7%. The highest relapse rate, 8.5%, was observed in the group of patients with osteoarticular involvement. Regimens including doxycycline and streptomycin with or without rifampin appeared more effective than other regimens in osteoarticular involvement. Conclusions In humans, brucellosis may lead to serious morbidity, and it continues to be a major health problem in Turkey. There is no recommended treatment protocol for complicated brucellosis. Large multicenter studies are needed to determine the most appropriate treatment choices and durations in complicated brucellosis.

Urogenital myiasis cases occurring with the settlement of larvae of flies belonging to the order Diptera are facultative and are rarely encountered in humans. In this study, urogenital myiasis caused by Psychoda albipennis in a 20-year-old female patient was presented. The patient was admitted to our hospital with complaints of nausea, vomiting, and dysuria and claimed that she saw motile larvae in her urine. Five larvae collected from the patient's urine were microscopically examined, and they were identified as fourth-stage larvae of Psychoda albipennis. Complaints of the patient ceased after the application of an antibiotic and urinary antiseptic. It was concluded that myiasis should be considered in patients with urogenital complaints.

Amac: Bu calismada Van bolgesinde son 2 yil icindeki uriner sistem enfeksiyon ajanlarinin, altta yatan hastaliklarin ve gelisen antibiyotik direnclerinin incelenmesi amaclandi. Gerec ve Yontemler: Ocak 2012 ve Ocak 2014 tarihleri arasinda uroloji poliklinigi ve kliniginde uriner sistem enfeksiyonu suphesi ile idrar kulturu bakilan 3,887 hastanin sonuclari retrospektif olarak incelendi. Ureyen bakteriler, gelisen antibiyotik direncleri ve altta yatan patolojiler acisindan degerlendirildi. Bulgular: Ureme saptanan 864 (%22.2) kulturden 295’i (%7.6) anlamsiz ureme, 569’u (%14.6) anlamli ureme olarak kabul edildi. Ureme saptananlarin 394’unde (%69.2) E. coli , 56’sinda (%9.8) Klebsiella spp., 46 (%8.1) hastada Enterococcus spp., 18’inde (%3.1) Staphylococcus spp, 16’sinda (%2.8) Pseudomonas aeruginosa , 15’inde (%2.6) Enterobacter spp., 8’inde (%1.4) Candida spp . ve 16’sinda (%2.8) ise diger gram negatif mikroorganizmalar uredi. Siprofloksasine %36.5, TMP/SXT’ye %26.8, sefuroksim aksetile %31.6, ampisilin/sulbaktama %46, seftriaksona %38.4, gentamisine %21.9, amikasine %1.7, nitrofurantoine %9.3, imipenem-meropeneme %0.7 oranlarinda direnc saptandi. Ureme gorulen vakalarin %72.4’inde eslik eden uriner patoloji oldugu izlendi. Sonuc: Ucuncu basamak saglik merkezlerinde uriner sistem efeksiyonlarinda direnc orani altta yatan patoloji sikligindan dolayi yuksek bulunmaktadir. Ampirik tedavilerde bolgesel direnc paterlerinin bilinmesi onemlidir. Bu nedenle bolgesel calismalar yapilarak antibiyotik direnc oranlari belirlenmeli ve altta yatan patolojiler tedavi edilmelidir. Anahtar Kelimeler: Antibiyotik, direnc, uriner sistem enfeksiyonu

To evaluate adult measles patients with respect to their clinical and laboratory findings as well as complications.The retrospective study was conducted at YuzuncuYil University, Van, Turkey, between December 2012 and June 2013, and comprised cases diagnosed with measles. The diagnosis was based on clinical findings and all were serologically confirmed with the presence of Anti-measles Immunoglobulin M antibodies.Of the 50 records studied, 41(84%) related to women. Overall mean age was 25.52±4.07 years. The most common symptoms were fever and rash 50(100%), malaise 49(98%), cough 48(96%), headache 44(88%) and sore throat 36(72%). The presence of Koplik spots, lymphadenopathy and hepatomegaly were observed in 3(6%), 6(12%) and 2(4%) patients respectively. Thrombocytopenia and elevated liver enzymes were detected in 26(52%) and 22(44%)patients. Pneumonia was the most common complication in 9(18%) patients. Other respiratory complications were bronchitis 5(10%) and laryngotracheitis 6(12%). Of the cases, 9(18%) exhibited otitis media. Premature delivery and spontaneous abortus occurred in 2(4%) and 3(6%) patients of the 15(30%) pregnant women.Measles continues to be an important health problem in Turkey and needs an effective elimination programme.

Asymmetric dimethylarginine (ADMA) is the main endogenous inhibitor of nitric oxide synthase and is considered to be associated with endothelial dysfunction. Brucellosis, a zoonotic disease caused by Brucella spp., can manifest as vasculopathy. The present study was performed to investigate the relationship between ADMA and brucellosis. Serum samples from 39 patients with an accurate diagnosis of brucellosis and from 18 healthy control individuals were included in this study. ADMA levels were significantly higher in the patient group than the controls (P < 0.001). Receiver operating characteristic (ROC) curve analysis indicated that ADMA level a parts per thousand yen0.61 had a sensitivity of 79.5 %, specificity of 88.9 %, positive predictive value of 93.9 %, and negative predictive value of 66.7 %. This is the first report of an association between brucellosis and high levels of ADMA. In conclusion, ADMA levels should be tested in brucellosis cases and that further studies to clarify the mechanism underlying the association between ADMA and brucellosis are required.

We aimed to examine cases of brucellosis that presented with severe thrombocytopenia and hemorrhagic diathesis.A total of 10 brucellosis cases with severe thrombocytopenia were included in this case-series study. Patients' files were reviewed for their clinical and laboratory findings, as well as clinical outcomes and complications. Platelet counts of20,000/mm³ were diagnosed as severe thrombocytopenia.The lowest thrombocyte count was 3000/mm³ while the highest was 19,000/mm³ (mean: 12,000/mm³). Patients had the following symptoms: epistaxis (7 cases), petechia with epistaxis (4 cases), bleeding gums (3 cases), ecchymosis with epistaxis (2 cases), melena and renal failure (2 cases), and hematuria (1 case). Patients were given rifampicin and doxycycline along with supportive hematological therapy. All were treated successfully with no evidence of recurrence at follow-up visits.Since brucellosis is endemic in developing countries, it must be considered in the differential diagnosis of cases that present with severe thrombocytopenia and hemorrhagic diathesis.

Background: The hepatitis B virus is a significant pathogen that causes cirrhosis, and hepatocellular cancer as a result of the damage it causes to liver cells. Its infection affects more than 400 million people globally. Although there is an effective vaccine and treatment methods, almost 1, 000, 000 people die every year. Objective: To investigate paraoxonase and arylesterase activities along with oxidative status parameters and serum lipid levels, and to find out if there is any increased susceptibility to atherogenesis. Methods: Thirty-four subjects with chronic hepatitis B and 39 healthy subjects as control were enrolled in the study. Age, body mass index and gender, Serum Triglycerides (TG), High-density Lipoprotein (HDL) and Low-Density lipoprotein (LDL) levels, serum paraoxonase-1 and arylesterase activities were determined. Oxidative and antioxidative statuses were evaluated by measuring serum-free sulfhydryl groups, lipid hydroperoxide levels, total antioxidant capacity, total oxidant status, and oxidative stress index. Results: Serum TG and LDL levels were higher while serum HDL levels were lower in patients with chronic hepatitis B than in controls but the differences did not reach statistical significance. Serum paraoxonase-1 and arylesterase activities, plasma free sulfhydryl groups, and total antioxidant capacity were significantly lower in patients than in controls (p=0.018, p=0.005, p

Food-borne botulism is an acute form of food poisoning that results from ingestion of the toxin produced by Clostridium botulinum. Intoxication classically presents as an acute, symmetrical paralysis. In this study, we report a case of botulism with unilateral paralysis that was confirmed by the mouse inoculation and neutralization method.

Malaria is an important parasitic infection which is endemic in the Eastern Mediterranean and Southeastern Anatolia regions and sporadic in other regions of Turkey, while Plasmodium vivax is the most common cause. Two patients who were admitted to our hospital in October with complaints of high fever, chills, nausea-vomiting, generalized body pain and fatigue and diagnosed as P. Vivax malaria are presented, because they were two brothers with no history of travel outside of Van city.

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.

Background Tuberculosis is a disease that can involve every organ system. While pulmonary tuberculosis is the most common presentation, extrapulmonary tuberculosis (EPT) is also an important clinical problem. The current study aimed to outline and compare the demographic and clinical features of pulmonary and extrapulmonary tuberculosis cases in adults. Methods Medical records of 411 patients (190 women, 221 men) treated between January 2010 and July 2014 in provincial tuberculosis control dispensary was retrospectively reviewed. Demographic and clinical characteristics were compared for pulmonary and extrapulmonary tuberculosis cases. Results Of these 411 cases, 208 (50.6 %) had pulmonary tuberculosis (PTB) and 203 were diagnosed with extrapulmonary tuberculosis (EPTB) (49.4 %). The average ages for PTB and EPTB groups were 33.00-27.00 and 31.00-29.75, respectively (p = 0.513). Men were more frequently affected by PTB (59.6 %), while EPTB was more commonly detected in women (52.2 %) (p = 0.016). Main diagnostic modalities for PTB were sputum/smear analyses (72.7 %), clinical-radiological data (21.7 %) and biopsy (6.1 %); while biopsy (71.5 %), sputum/fluid analysis (18.8 %) and clinical-radiological data (4.9 %) were used for confirming EPTB (p

A case of hypersensitivity reaction, myelodysplastic syndrome and pancytopenia, which developed after an administration of thimerosal-containing tetanus vaccine, is presented and discussed.