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All living organisms; from single-celled microorganisms to humans, they have to adapt to changing environmental conditions to maintain their survival processes. Circadian rhythm is one of the most important mechanism that associated with this adaptation processes. There are biological clocks in the body, which are related to the circadian rhythm and have a hierarchical organization. The master circadian clock is located in the suprachiasmatic nucleus (SCN) of hypothalamus. SCN maintain body rhythms in synchronous with the light-dark cycle in the external environment. There are also peripheral oscillators that work in coordination with SCN. Neurological, endocrinological, and immunological functions in the body are under the influence of circadian and seasonal rhythms. Melatonin and cortisol (corticosterone in animals) are among the most important hormones that show circadian rhythm in the body. The body adapts to daily and seasonal changes with biological rhythms regulated by biological clocks. It is well known that the immune system is affected by the external environment. Changes in endocrine system, hypothalaomo-pituitary adrenal (HPA) axis, and immune system are marked, especially depending on the seasonal changes. Therefore, the immune system has close relationship with the circadian rhythm. Understanding relationship between physiological regulation of the circadian rhythm, HPA axis and immune activity is important for to keep our body in healthy conditions and struggle with the diseases as well. In current review, the interaction and relationship of genes and proteins related to the circadian rhythm with HPA axis and immune system parameters are discussed with both physiological and pathological examples.

In this study, two novel photoactive xanthates, which bear a photoinitiator (PI) group in the middle and an S-alkyl dithiocarbonate group (–O–C(S)–S–R) at each of the two ends of the molecule, were synthesized as chain transfer agents (CTA) to be used in reversible addition-fragmentation chain transfer/macromolecular design via the interchange of xanthate (RAFT/MADIX) polymerization. Having the same central photoinitiator group, two chain transfer agents (CTA-PI-CTA 1 and CTA-PI-CTA 2) differ from each other in their R leaving groups; C6H5–CH2– and C6H5–CH(COOEt)–, respectively. The structures of CTA-PI-CTAs were elucidated via elemental analysis and spectroscopic techniques, such as 13C NMR, 1H-NMR, and FT-IR. Styrene (St) was used as the model monomer in MADIX polymerization. Its RAFT/MADIX polymerization with these chain transfer agents successfully produced mid-chain functional polystyrene macrophotoinitiators (PSt-PI-PSt 1 and PSt-PI-PSt 2) with well-defined structures. The GPC, FT-IR, 1H-NMR, UV, and fluorescence spectroscopic studies revealed that low-dispersity polystyrenes with desired photoinitiator functionality in the middle of the chain were obtained. Finally, these macrophotoinitiators were used as prepolymers in photoinitiated free radical polymerization of methyl methacrylate (MMA) to obtain polystyrene-poly(methyl methacrylate) (PSt-PMMA) block copolymers.

Acromegaly is associated with increased morbidity and mortality primarily attributed to cardiovascular and cerebrovascular diseases, thus demonstrating the negative arterial impact of chronic GH and IGF-1 excess. There are limited and conflicting data regarding coronary artery disease (CAD) in acromegaly that consists mainly of heterogeneous cohorts and pathological reviews of old case series. Increased arterial stiffness is associated with an increased risk of cardiovascular events such as myocardial infarction. Arterial stiffness may measured from pulse wave velocity(PWV). In this study we aimed to evaluate the association between pulse wave velocity and aortic augmentation index in acromegalic patients. Methods: Our study population consists of a consecutive subset of 32 acromegalic patients and 19 control. Acromegalic patients IGF 1 levels were noted. All patients BMI, age, blood pressure, gender also were noted. Also pulse pressure, central blood pressures were measured by non-invasive central blood pressure measurement device (SphygmoCor). Pulse wave velocity and aortic augmentation index were measured by the same device. Results: A total of 32 acromegalic patients and 19 control were enrolled in the study. Body mass index and gender were not significantly different between the groups. Aortic augmentation index (5 vs. 6, p =0,685) variables weren’t significantly different in the study. Systolic and diastolic blood pressures were significantly high in the acromegalic group. (130/82 vs. 120/70) PWV was significantly high in the acromegalic group. (13 vs 11,5 p=0,002)Conclusions: Our study results suggest that acromegaly patients have worse arterial stiffness due to increased pulse wave velocity. Acromegaly is associated with increased morbidity and mortality primarily attributed to cardiovascular problems. We thought that it may be a guiding method in disease management since it can be an early marker of cardiovascular risk.Keywords: acromegaly, pulse wave velocity, aortic augmentation index

Erzurum iline bagli Oltu Ilcesinin, tarihi bir yaklasimla ele alindigi bu calismanin amaci, 1920’li yillardan 1950 yilina kadar Turkiye’nin icinden gectigi degisim ve yenilenme surecinin Oltu’ya yansimalarini idari acidan incelemektir. Bu amacla calismada ilk olarak, Oltu’nun tarihi gelisimi ve Oltu Surâ Hukumeti hakkinda kisa bir bilgilendirme yapilmis, 1923-1950 yillari arasinda Oltu’nun idari anlamda gelisim surecinden bahsedilmis, bu yillarda Oltu’da gorev yapan kaymakamlar ve belediye baskanlari tespit edilerek yaptiklari calismalar ozellikle kaymakamlarin biyografileri ile birlikte anlatilmistir. Ilce belediyesinin teskilatlanmasi, gecirdigi degisim sureci Oltu’ya yapilan hizmetlerdeki rolu, ya da eksik kalan, yapilamayan faaliyetlerin bundan sonraki yillara yansimalarina yonelik tespitlerde bulunulmustur. Ilgili tarihlerde gorev yapan il genel meclisi uyeleri ve bu uyelerin calismalari anlatilmis, bu surecte yasanilan siyasi gelismeler ve sikintilar degerlendirilmistir.

Objective: Nasal colonization of methicillin-resistant Staphylococcus aureus (MRSA) among the healthcare workers (HCWs), hospitalized patients, and healthy individuals was investigated by pulsed field gel electrophoresis (PFGE) for defining of clonally distribution of them. Methods: Totally 403 healthcare personnel, 744 patients, and 204 healthy individuals from the population were enrolled. Microbiological procedures were performed in the Bacteriological Laboratory at the Clinical Microbiology and Infectious Diseases Department of Firat University, and PFGE procedures were performed in the Microbiology Department of Inonu University. Results: Staphylococcus aureus was isolated in 296 (21.9%) of 1351 nasal swabs, and 69 out of 296 (23.3%) were defined as MRSA. Nasal S.aureus carrier state was identical between the patients and HCWs carrier state (p=0.14). It was significantly lower in healthy subjects than the other groups (p=0.02). Seventeen (25.8%) of 66 MRSA strains were defined to be in the cluster. These strains were in 7 different clusters. Among the typed strains, 21 had close relationship, 2 had possible relationship, and 26 had no relation. PFGE pattern was defined in 33 (50%) out of 66 strains and it was inconclusive in 3 strains. Conclusion: MRSA strains can be transferred commonly in the same hospital, among the hospitals located in the same region and the population. The results might be the indicators of increasing frequencies in population based MRSA infections. Multi-center studies are required to define clonally distribution of MRSA and the explanation of epidemiology may be helpful for preventing and controlling of MRSA related infections., Amaç: Sağlık çalışanları, hospitalize hastalar ve sağlıklı gönüllülerde nazal metisilin-dirençli Staphylococcus aureus (MRSA) kolonizasyonu ve klonal dağılımı pulsed field gel electrophoresis (PFGE) ile araştırıldı.Yöntemler: Çalışmaya 403 hastane çalışanı, 744 hasta ve 204 sağlıklı toplum bireyi alındı. Mikrobiyolojik işlemler Fırat Üniversitesi Klinik Mikrobiyoloji ve Enfeksiyon Hastalıkları Anabilim Dalı Bakteriyoloji Laboratuarı’nda, PFGE işlemi ise İnönü Üniversitesi Mikrobiyoloji Anabilim Dalı’nda çalışıldı.Bulgular: Toplam 1351 nazal sürüntü kültüründen 296 Staphylococcus aureus suşu izole edildi ve bunların 69 (% 23,3)’u MRSA idi. Nazal S. aureus taşıyıcılığı sağlık çalışanları ve hastalar arasında benzer idi (p=0,14). Sağlıklı gönüllü gurupta ise diğer guruplara göre anlamlı derecede az olarak bulundu (p=0,02). PFGE yöntemiyle 66 MRSA suşunun 17 (% 25,8)’sinin küme içinde olduğu saptandı. Bu suşlar 7 küme içinde yer almaktaydı. Tiplendirilen suşların 21 tanesi yakın ilişkili, ikisi ise muhtemel ilişkili olarak saptandı. Yirmi altı suş klonal olarak ilişkisiz bulundu. Toplam 66 suş içinde 33 (% 50) PFGE paterni belirlendi.Sonuç: Çalışmamız sonucunda MRSA suşlarının aynı hastane içinde daha fazla olmakla birlikte bölgedeki hastaneler arasında ve hastane-toplum arasında taşınabileceğini gördük. Çalışmadan elde edilen sonuçlar toplumda artan MRSA enfeksiyon sıklığı için bir indikatör olabilir. MRSA’nın klonal dağılımının saptanması ve epidemiyolojisinin belirlenmesi için çok merkezli çalışmalara ihtiyaç olduğunu ve MRSA epidemiyolojisinin aydınlatılmasının MRSA’ya bağlı enfeksiyonların önlenmesi ve kontrolünde yardımcı olacağını düşünüyoruz

Nowadays, the age group affected from measles has widened and the disease has become more common among adolescents and young adults. The number of measles case reports have increased in our country, particularly from 2010-2011, and measles outbreaks occurred in various regions in 2012 and 2013. The aim of this study was to analyze the demographical and epidemiological characteristics, clinical and laboratory findings, and complications of adult patients with measles who were affected during the outbreak. A total of 28 patients (25 male, 3 female; age range: 19-39 years, median age: 24) who were hospitalized and followed-up in our clinic between January 2013 and June 2013, were evaluated. In the serum sample of the index case, measles-specific IgM antibodies were detected by ELISA, and measles virus RNA by real-time polymerase chain reaction (RT-PCR), then genotyping was performed to detect the epidemiological relationship. In all of the other cases, measles IgM and IgG antibodies were screened by ELISA. The most common symptoms on admission included high fever (n= 28, 100%), malaise (n= 25, 89%), sore throat (n= 25, 89%), headache (n= 20, 71%) and cough (n= 18, 64%). At physical examination, rash (n= 28, 100%), lymphadenopathy (n= 11, 39%) and conjunctivitis (n= 10, 36%) were in the foreground, and Koplik spots were detected in five (18%) cases. The most common laboratory findings were; increased level of C-reactive protein (n= 15, 54%), leukopenia (n= 12, 43%) and increased serum levels of aminotransferases (n= 12, 43%), and thrombocytopenia was detected in five (18%) patients. One or more complications (secondary bacterial pneumonia in 5, diarrhea in 4, hepatitis in 3 and otitis in 2 cases) developed in the eight (29%) patients. Measles RT-PCR and IgM tests yielded positive results for the index case, and the isolate was identified as D8 strain by genotyping. Measles lgM antibodies were also positive in all of the other cases. The hospitalization period was estimated as 3-7 days (median: 5 days), while all the patients were discharged with recovery. It appeared that, our index case had come from a troop in Amasya province three days ago and he had a history of contact with suspected measles patients. In addition, the D8 strain determined in the index case was found to be related with the strain that caused the outbreak in Amasya province. Of the cases, 20 (71.4%) were military personnel, and eight (28.6%) were civilian who had histories of contact with military personnel. Regardless of immunity status in the outbreak period, all of the healthcare staff in our hospital, especially in risky departments, was recommended to be vaccinated. Personnel vaccination was provided at a high rate, however nosocomial transmission occurred in two unvaccinated cases. In conclusion, measles is an important health problem, especially in the adult age group, because of the complications and labour loss. For outbreak management; the awareness of health personnel should be increased following the identification of index case, proper isolation measures should be taken for the hospitalized patients, and routine reporting should be carried out timely and accurately.

Crimean-Congo hemorrhagic fever virus (CCHFV) is the causative agent of a tick-borne disease with high mortality Fates in humans. The distribution of CCHFV includes over 30 countries in Asia, the Middle East, southeastern Europe, and Africa. It was first recognized in Turkey in 2002, with an increasing number of cases reported between 2002 and 2009. Recent analysis of complete genome sequences of CCHFV isolates has revealed that the genomic plasticity of the virus is surprisingly high for an arthropod-borne virus. We have determined the complete nucleotide and deduced amino acid sequences of strain CCHFV Turkey-Kelkit06 isolated from the blood of a patient in an endemic region of Turkey in 2006. The complete sequence length of the CCHFV Turkey-Kelkit06 strain is 19,186 nt, consisting of a 1673 nt S segment, a 5364 nt M segment, and a 12,149 nt L segment. Based on the analysis of S, M, and L segments, CCHFV Turkey-Kelkit06 clustered in Group V, which represents the Europe/Turkey geographic lineage. Although glycoproteins encoded by the M gene are the most variable part of the CCHFV Turkey-Kelkit06 strain, some functional domains of the glycoproteins are well conserved. Here, we report the complete sequence and genome organization of the CCHFV Turkey-Kelkit06 strain and its phylogenetic relationship to other strains of CCHFV. Collecting data on viral sequences among isolates from CCHF epidemics may provide valuable information regarding the molecular basis of the epidemic potential of the virus. (C) 2009 Elsevier B.V. All rights reserved.

Crimean-Congo hemorrhagic fever (CCHF) virus is member of the genus Nairovirus of the family Bunyaviridae. All members of the family Bunyaviridae are enveloped viruses containing tripartite, negative polarity, single-stranded RNA. CCHF is characterized by high case mortality, occurring in Asia, Africa, the Middle East and Europe. During recent years, outbreaks have been reported in Turkey. However, little information is available on the genetic diversity of CCHF virus in Turkey. In this study, a total of 1227 adult ticks were collected from domestic ruminants (796 specimens from cattle, 399 specimens from goats and 32 specimens from sheep). The presence of the M segment of CCHF virus was determined in 4 of 40 (10%) Hyalomma marginatum marginatum pools, in 2 of 38 (7.89%) Rhipicephalus bursa pools, and in 1 of 7 (7%) Boophylus annulatus pools. Hyalomma anatolicum anatolicum pools gave negative RT-PCR result against CCHF virus. Serum samples from seven patients infected with CCHF were selected and subjected to RT-PCR to amplify partial M segment of CCHF virus. This report introduces the first data on partial nucleotide sequences of M RNA segments of CCHF virus strains circulating in Turkey, isolated from ticks.

Brucellosis is a systemic infectious disease caused by Brucella bacteria. A successful treatment requires antibiotics that can penetrate into the cell at high concentrations. The aim of this study was to assess the biotype and in vitro activity of 80 Brucella isolates obtained from blood against various antimicrobials for human brucellosis in Turkey.Identification of the types of the species designated Brucella species was made using the polymerase chain reaction (PCR), with type-specific primers. Serotyping was performed using mono-specific A and M antisera. The minimum inhibitory concentrations (MICs) of antibiotics known to have good intracellular penetration (doxycycline, rifampicin, ofloxacin, levofloxacin, moxifloxacin, clarithromycin, and azithromycin) were determined by the agar dilution method.All of the 80 Brucella isolates were determined to be Brucella melitensis: 75 B. melitensis biotype 3 (93.7%) and 5 B. melitensis biotype 1 (6.3%). Doxycycline was the most effective among the tested antibiotics against Brucella species (MIC(50)-MIC(90), 0.25-0.5 μg/ml), and it was followed by levofloxacin (MIC(50)-MIC(90), 0.5-1 μg/ml), moxifloxacin (MIC(50)-MIC(90), 1-1 μg/ml), ofloxacin (MIC(50)-MIC(90), 1-1 μg/ml), rifampicin (MIC(50)-MIC(90), 2-4 μg/ml), azithromycin (MIC(50)-MIC(90), 4-8 μg/ml), and clarithromycin (MIC(50)-MIC(90), 8-32 μg/ml), respectively.The in vitro activity of doxycycline and rifampicin, which are used in the classic treatment of brucellosis, was found to be very good. Quinolones were found to have in vitro activity against Brucella isolates. Among the macrolides, azithromycin had a higher level of activity compared with clarithromycin. A combination of quinolones and azithromycin could be an alternative to doxycycline and rifampicin in the treatment of brucellosis.

We report the first case ofextracranial tuberculous lymphadenitis which paradoxically developed during treatment of intracranial tuberculoma. Our patient, a 15-year-old girl who initially presented with meningitis and intracranial tuberculomas, developed extracranial tuberculomas during treatment for central nervous system tuberculosis. She was followed clinically with cerebrospinal fluid (CSF) studies and magnetic resonance imaging (MRI) at three monthly intervals. Within 18 months of specific antituberculous treatment, the patient had fully recovered. The course and response to therapy are discussed in light of the current literature.

The present study investigates serum hepatocyte growth factor (HGF) levels in patients with acute and chronic hepatitis B and the relation between these levels and intrahepatic inflammatory markers of the liver and fibrosis, as well as the cerebrospinal fluid (CSF) HGF levels in patients with meningitis and the relation between these levels and CSF findings. To our knowledge this is the first study regarding CSF HGF levels in tuberculous meningitis.The study consisted of 35 patients with chronic hepatitis B (HbeAg and HBV-DNA positive), 20 with acute hepatitis B, 20 with acute bacterial meningitis and 15 having tuberculous meningitis. HGF levels in the serum and CSF samples were measured by using the ELISA method.The mean serum HGF levels in acute hepatitis B group were found statistically significantly higher than those in the control group and chronic hepatitis B group (p0.0001). It was established that serum HGF levels in patients with chronic hepatitis B were significantly correlated with serum alanine aminotransferase (ALT) and HBV-DNA levels (r: 0.816, 0.951; p0.05, respectively). Similarly, serum HGF levels of patients with chronic hepatitis B were correlated with fibrosis score and hepatic activity index of the liver histopathology (r: 0.750, 0.459; p0.05, respectively). The mean CSF HGF levels of patients with acute bacterial meningitis and tuberculous meningitis were higher than those in the control group (p0.05). In addition, it was observed that mean CSF HGF levels in patients suffered from tuberculous meningitis were statistically significantly higher than those in acute bacterial meningitis (p0.05).We suggest that serum HGF level in patients with chronic hepatitis B might reflect viral load, necro-inflammatory activity in the liver and the degree of structural progression. Our findings have demonstrated that tuberculous meningitis cause increased HGF concentrations in CSF. It is, therefore, suggested that examination of HGF levels in CSF may provide additional information in the differential diagnosis.

Human toxocariasis is commonly seen in places where stray and Toxocara canis-infected dog population is high. There is a strong correlation between frequency of Toxocara infection, life style, and infection risk. Institutionalization of mental retarded patients increases to risk of toxocariasis. In this study, we aimed at investigating the frequency of Toxocara infection among children with mental retardation not requiring institutionalization. The study included 96 cases, who had educatable mental retardation and 85 healthy subjects who comprised the control group. Anti-Toxocara IgG or IgM antibodies were investigated in all serum samples, using ELISA method. The frequency of Toxocara infection was found significantly higher in mental retarded cases than in those in the control group (18.8% and 7.1% respectively) (p < 0.05). There was no significant difference between mental retarded children and the control group in terms of mean age, age groups, gender, owning dogs and cats and duration of their ownership, socio-economic level and behavioural factors, and personal hygiene (p > 0.05). We did not find any significant difference between Toxocara seropositive and seronegative mental retarded children in terms of demographic factors and epidemiological factors that could increase the risk of Toxocara infection (p > 0.05). The present study is the first seroprevalence study carried out with a mental retarded group not requiring institutionalization. Determination of high frequency of Toxocara infection suggests that these subjects constitute a risk factor for Toxocara infection, which may be attributed to their behavioural patterns.

Lipid peroxidation is the most important mechanism in the pathogenesis of acute liver damage with carbon tetrachloride (CCl4). L-carnitine may prevent lipid peroxidation and thus may protect against liver damage. In the present study we investigated the protective effect of L-carnitine in experimental acute liver damage induced by CCl4.Fifty rats were allocated to five equal groups. The first group was the control (group 1), the second group received an intraperitoneal CCl4 injection for 3 days (group 2), and the third group received a 50 mg/kg subcutaneous L-carnitine injection for 4 days, beginning a day before CCl4 injection. The CCl4 injection was continued for 3 days in the concerned group (group 3). Group 4 was given a CCl4 injection for 7 days and group 5 received a 50 mg/kg subcutaneous L-carnitine injection for 8 days, beginning a day before CCl4 injection. This group continued to receive a CCl4 injection for 7 days. Rats in groups 2 and 3 were killed on the fifth day. Rats in groups 1, 4 and 5 were killed on the ninth day. Plasma and liver tissue malondialdehyde (MDA) levels, glutathione peroxidase (GSH-Px) activity and liver enzyme levels were studied. Histopathological investigations were conducted.Liver tissue MDA levels decreased significantly in group 3 compared to group 2 (P0.001). Liver tissue MDA levels in group 5 decreased significantly in comparison to those of group 4 (P0.001). Liver tissue GSH-Px activity in group 5 was significantly lower than that in group 4 (P0.05). There were no significant differences between groups 3 and 4 regarding GSH-Px activity (P0.05). Steatosis, inflammation and necrosis in group 3 were significantly reduced when compared to group 2 (P0.01). Fibrosis development was not identified in groups 2 and 3. Steatosis in group 5 was significantly lower than that in group 4 (P0.05) and there were no significant differences between groups 4 and 5 with regards to inflammation and necrosis (P0.05). Mild fibrosis development was identified in groups 4 and 5 but the difference between the groups was not significant.It appears that L-carnitine has a protective effect in the early stage of experimental acute liver damage induced by CCl4. As the toxic effect or damage continues, its effect lessens.

The number of clinical studies on gamma interferon (IFN-gamma), tumor necrosis factor-alpha (TNF-alpha) and interleukin-4 (IL-4) in human brucellosis is limited. The present study was focused on IFN-gamma, TNF-alpha and IL-4 levels in acute brucellosis cases, in the acute phase and at the end of the treatment. The relation of these cytokines to traditional inflammation markers was also investigated. The study included 27 cases of acute brucellosis and 20 healthy volunteers who had no complaints. It was found that mean IFN-gamma and TNF-alpha levels, CRP (C-reactive protein) levels and ESR (erythrocyte sedimentation rate) values were significantly higher in acute brucellosis cases as compared to post-treatment values and values measured in the control group. In addition, IFN-gamma and TNF-alpha levels measured in the acute phase correlated with the increase in CRP levels and ESR values. Our results confirmed that IFN-gamma and TNF-alpha are involved in the pathophysiology of brucellosis and are closely related to the inflammatory activation of the disease. In view of the present findings, it is suggested that IFN-gamma and TNFalpha may be used for monitoring brucellosis.

In this study, 30 cases of adult tuberculous meningitis treated in our department between August 1989-October 2002 were evaluated retrospectively according to history, physical examination, cerebrospinal fluid (CSF) analysis, laboratory and radio logically findings, clinical outcome, complication, efficacy of the treatment and sequel. Seventeen of them were male and 13 were female (mean age: 32.3 ± 17.2, range: 15-75). Four patients had either active or previous tuberculosis history. The most common complaints were vomiting (100%) and headache (93.3%), the most frequent finding was nuchal rigidity (100%). Only 9 (30%) patients had a positive CSF smear for acid-fast bacilli. Mycobacterium tuberculosis was isolated from 10 patient samples (33.3%). In 13 patients, CSF samples were evaluated with polimerase chain reaction (PCR) and 10 samples were found to be positive. The sequel rate was 16.7%. Mortality occured in 7 (23.3%) patients. It was established that the most important prognostic factor was clinical stage at the first admission.

In the present study, 146 cases diagnosed as brucellosis and hospitalized between January 1995-July 2001 were evaluated retrospectively in terms of epidemiology, clinic, laboratory findings and treatment. Eigthy-seven (59.5%) of the cases were male whereas 59 of them (40.5%) were female. One hundred and twelwe (76.7%) cases had a history of fresh cheese consumption. One hundred and twenty-two of the cases (83.5%) were classified as acute whereas 13 (8.9%) and 11 (7.6%) were subacute and chronic, respectively. Most frequent complaints were fever (121 patients; 82.8%), sweating (114 patients; 78%) and arthralgia (95 patients; 65%). Physical examinations revealed presence of hepatomegaly (26.7%), splenomegaly (28%), lymphadenopathy (6.1%) and osteoarticular involvement (14.3%). In some cases, development of neurobrucellosis (n= 3), epididymo-orchitis (n= 2) and endocarditis (n= 1) were determined. Leukopenia and anemia were present in 26 (17.8%) and 71 (48.6%) cases, respectively, whereas increase in transaminase activity levels was determined in 53.4% of the cases. Antibody Titer levels of 95.2% of the cases were ≥ 1/160 as determined by standard tube agglutination and blood culture positivity was 22.6%. Most frequently used antibiotic combination (69.8%) was rifampicin and doxycycline. Relaps was observed in 4.1% of the cases. In conclusion; different clinical presentations, difficulties in clinical and laboratory diagnosis, compliance of patients to treatment, failure rate or relaps in response to presently applied antibiotic combinations are among the main problems encountered in brucellosis which is seen endemically in our country. We believe that this report where we share our experience about clinic, diagnosis, laboratory and treatment will contribute to solve problems about brucellosis.

In this study, serum trace elements, including selenium (Se), zinc (Zn), copper (Cu), were determined by using Atomic Absorption Spectrophotometer (SpectrAA 250 Plus Zeeman, Varian, Australia) in sera of patients with viral hepatitis (A, B, C, D, E) cases (n = 102), and statistically compared with the controls (n = 52). In viral hepatitis, Cu levels were found as 3.23 +/- 1.02 mg/L, and this value was significantly higher than the control group (1.13 +/- 0.21) (p < 0.01). Both, Se and Zn levels found to be significantly low in viral hepatitis cases (p < 0.01). While Se level was 81.4 +/- 26.01 microg/L in viral hepatitis (n = 101), it was found to be 166.15 +/- 4.58 microg/L in healthy individuals. Meanwhile, Zn levels were 0.230 +/- 0.081 mg/L and 0.748 +/- 0.392 mg/L in hepatitis cases (n = 101) and the control group, respectively. There was no difference amongst viral hepatitis groups classified in regard with agents and clinical manifestation, such as A, acute hepatitis B, chronic hepatitis B, C, D and E. Previously, it was indicated that absorption disorders in gastrointestinal system, especially in chronic cases, were not main causes of decrease of trace elements by iron and several other parameters in sera of the cases. Therefore, we suggest that decrease in Zn and Se levels and elevation in Cu levels are probably resulted from defence strategies of organism and induced by the hormone-like substances.

This study was undertaken to investigate the antibody levels against tetanus in the risk groups and the factors affecting the immunity in those individuals. In the present study, 100 construction workers, 100 mechanical workers and 100 farmers were included as risk groups and 100 blood donors as control group. All subjects filled the previously prepared questionnaire out and 6-8 mL of blood samples were obtained from each person. Tetanus antitoxin levels were determined by ELISA in the serum samples. The risk groups and the control group were compared in terms of tetanus immunity. In the control group, 49% immunity was detected. This ratio was 44% in the construction workers, 74% in the mechanical workers and 31% in the farmers. Of the risk groups, antitoxin (immunity) levels in the mechanical workers and farmers were significantly different from those seen in the controls (p < 0.001). However, immunity levels were not significant in the construction workers compared to the controls (p > 0.05). In all the subjects studied, there was statistically significant differences (p < 0.001) in the rates of antitoxin production between the group immunized within10 years and not immunized, between those over and under 30 years of age and between educated and uneducated individuals. Considering the difficulties in the treatment and high mortality rate, it can be considered that tetanus can be prevented in all individuals, particularly those in the risk groups, by booster application administered every 10 years after the primary immunization.

In this study, the influence of the employement period on the seropositivity of brucellosis and the relationship between this period and the agglutination titers were investigated in the risk groups of brucellosis. For this purpose, 300 subjects comprised of 100 butchers, 100 veterinary workers and 100 farmers were included in the study. The study subjects were divided into different groups according to the duration of their employement periods. The groups in veterinary workers and butchers were those who have been working for 1 to 5 years and those for 6 and more years. Among the farmers, the study groups were designed as those who worked for 10 to 30 years, 31 to 50 years and the last being 51 years and more. Furthermore, all the three risk groups were analysed together as 1 to 5 years, 6 to 10 years, 11 to 15 years, 16 to 20 years, 21 to 30 years and 31 years and over. Serum samples of all the subjects were tested using the standart tube agglutination assay for Brucella specific agglutinating antibodies. Overall analysis of the data from STA of serum samples of all the risk groups indicated that the duration of the employement period did not influence the seropositivity significantly. Morover, there is no statistically significant relationship between the employement period and the aglutination titers (p>0.05). Even though the period of employement has been cited as one of the factors increasing the seropositivity, the results of our study indicated that the duration of employement did not show a significant effect on seropositivity, and there was no significant relationship between the duration of employement and serum agglutination titers. It is our belief that since brucellosis has a high incidance rate among domestic animals in this region, risk groups have a chance to be exposed to the agent in the early years of their employement after which the titers drop gradually. Consequently, with these findings the duration of employement appears to have no influence on seropositivity.

Brucellosis is a zoonosis that affects several organs and has a protean presentation. The authors report the case of a 61-year-old male patient with brucellar spondylodiscitis involving several vertebrae and a paravertebral abscess localized in the erector spinae muscle. Diagnosis was made by positive blood culture and MRI. No relapse was seen with a combined treatment (doxycycline/rifampin) for 3 months, followed by doxycycline alone for 6 months. Almost all radiologic findings disappeared at the end of a 1-year follow-up without any further treatment.

Mumps is a disease caused by a virus that can infect many parts of the body, especially the parotid salivary glands. A case of epidemic parotitis in an adult female affected by bilateral conjunctivitis is presented. Mumps virus was detected in tear samples by reverse transcription nested polymerase chain reaction (RT-n-PCR). The conjunctivitis resolved completely within 11 d.

Background Crimean-Congo hemorrhagic fever virus (CCHFV) is a tick-borne virus of the genus Nairovirus family Bunyaviridae, which are enveloped viruses containing tripartite, negative polarity, single-stranded RNA. CCHF is characterized by high case mortality, occurring in Asia, Africa, the Middle East and Europe. Currently, there are no specific treatments or licensed vaccines available for CCHFV. Recently, two research groups have found adult mice with defective interferon responses allowed to lethal CCHFV infection. These mouse models could provide invaluable information for further studies. Efforts to develop a vaccine against CCHFV are being made. To determine the efficacy of vaccine candidates it is important to conduct serological studies that can accurately measure levels of protective antibodies. In the present study, a pseudo-plaque reduction neutralization test (PPRNT) based on enzyme-catalyzed color development of infected cells probed with anti-CCHFV antibodies was used to measure neutralization antibody of CCHFV. Methods Sixty-nine human serum samples (20 acute and 49 convalescent) were tested. The presence of CCHFV antibodies was determined and confirmed by a commercial ELISA kit. CCHFV RNA was determined by RT-PCR. All the samples were analyzed by PPRNT and fluorescent focus reduction neutralization test (FFRNT) to measure of CCHFV-neutralizing antibodies. Results Pseudo-plaque reduction neutralization test showed a high sensitivity (98%), specificity (100%) and agreement (96,6%) in qualitative comparison with those of the FFRNT. There was a high correlation between the titers obtained in PPRNT and FFRNT (R2 = 0.92). The inter- and intra-assay variation of PPRNT revealed good reproducibility and positive cut-off of PPRNT was defined as 1:4 by the geometric mean titers for the individual samples distributed. Conclusion The pseudo-plaque reduction neutralization test described in this study is a fast, reproducible and sensitive method for the measurement of CCHF neutralizing antibodies. This novel assay could serve as useful tools for CCHF research in epidemiology, vaccine development and other studies of immunity. It also provides an alternative to PRNT when viruses with no or poor CPE in cell culture.

The aim of this study was to evaluate the effectiveness of daptomycin in left-sided infective endocarditis (IE) patients. Fourteen patients with left heart endocarditis, monitored with a diagnosis of IE based on modified Duke criteria between July 2010 and May 2011, and receiving daptomycin as monotherapy, were enrolled. The success of daptomycin in these patients was revealed with improvements in microbiological, biochemical, and radiologic findings, as well as physical examination findings. Patient average age was 63.5 ± 14.2 years (36–80 years); 8 (57 %) were men and 6 (43 %) women. The pathogens methicillin-resistant Staphylococcus aureus (71.5 %), Streptococcus mutans (21.5 %), and methicillin-sensitive Staphylococcus aureus (7 %) were isolated from our patients. Daptomycin was used in initial treatment in 5 (36 %) patients; treatment was subsequently modified to daptomycin in 9 (64 %) patients as a consequence of drug serum level insufficiency, agent sensitivity to the drug administered, or drug side effects. Thirteen patients were discharged in a healthy condition, with successful surgical treatment in 5 (36 %). Only 1, an 80-year-old IE patient, was lost from advanced cardiac failure. No significant side effects were seen in any patient receiving daptomycin. The most frequent side effects were minimal rises in serum CPK levels during treatment; these values returned to normal after treatment. Daptomycin can be used successfully in left heart endocarditis with no significant side effects. Studies involving a wider patient series are now needed to support the use of daptomycin in left heart endocarditis.

A pseudo-plaque assay was developed for detection and quantitation of Crimean-Congo hemorrhagic fever virus Turkey-Kelkit06. Enzyme-catalyzed color development of infected cells probed with anti-Crimean-Congo hemorrhagic fever virus antibodies was used for determining the titer of Crimean-Congo hemorrhagic fever Turkey-Kelkit06 and for its detection in samples from persons infected with the Crimean-Congo hemorrhagic fever virus. The pseudo-plaque assay accuracy was confirmed by comparing pseudo-plaque assay titers with fluorescent immunofocus assay and focus formation assay titers using three stocks of virus. No significant difference in virus titers of Crimean-Congo hemorrhagic fever Turkey-Kelkit06 among the three methods was observed. The pseudo-plaque assay is more sensitive than the fluorescent immunofocus assay for detecting the virus in primary isolates of Crimean-Congo hemorrhagic fever virus collected from humans, but no difference in sensitivity between the two methods was observed in the cell-adapted strain of Crimean-Congo hemorrhagic fever Turkey-Kelkit06. The pseudo-plaque assay is suitable for titration of Crimean-Congo hemorrhagic fever Turkey-Kelkit06, which does not develop plaques, suggesting it may also be suitable for the detection of other viruses. (C) 2012 Elsevier B.V. All rights reserved.

We investigated the effects of several antibiotics and anti-inflammatory agents on the purified protein derivative (PPD) response in the rat. Animals were immunized with Mycobacterium bovis vaccine BCG. Antibiotics and anti-inflammatory drugs were administered at therapeutic doses for 10 d. Chloramphenicol, erythromycin, aspirin and ibuprofen suppressed the PPD response, but penicillin and acetaminophen had no significant effects.

A polymerase chain reaction (PCR) assay followed by partial sequencing of the 16S ribosomal RNA gene was performed for the presence of Ehrlichia and/or Anaplasma. A total of 242 ixodid ticks were collected from domestic ruminants and their shelters, as well as humans, and their individual salivary glands were dissected out for DNA. From the 242 ticks analyzed, six (2.47%), comprising three Hyalomma anatolicum anatolicum, one Rhipicephalus bursa, and two Rhipicephalus sanguineus, were positive. Of these sequenced samples directly obtained from the PCR products, three sequences from H. a. anatolicum were identical to that of the gene of Ehrlichia spp. strains. One sequence identified in R. bursa was closely related to Anaplasma platys. The remaining two sequences detected in R. sanguineus were similar to that of the gene of Anaplasma ovis. The study presented here provides preliminary data regarding the presence of rickettsial pathogens in ticks in Turkey.

Rheumatoid arthritis (RA) is a chronic inflammatory disease for which immunogenetic susceptibility factors have been defined. The aim of this study was to investigate seroprevalence of Toxocara canis (T. canis) in patients with RA. Forty-five patients with RA who were all diagnosed according to the ACR criteria and 48 health controls were included in this study. The mean age of patients with RA and of controls was 50+/-14 and 49+/-13, respectively. In both groups T. canis IgG antibodies were investigated with ELISA. Toxocara canis seroprevalence in patients with RA (35.6%) was significantly higher than that in the control group (8.3%) (p=0.001). There was no significant difference between patients with RA and control group in terms of behavioral factors (except in frequency of hand washing), demographic and socio-economic factors, while there was a difference in terms of owning dogs and cats or in the duration of ownership. When the patients with RA were divided into seropositive and seronegative, there were no significant differences between both groups in terms of demographic factors, socio-economic factors, behavioral factors, owning dogs and cats or duration of ownership and active or remission state of the illness, duration of disease and disability level in patients with RA (p0.05). In view of the present results, it is suggested that Toxocara infection was acquired before RA had developed and that high seroprevalence may result from exposure to pets and soil. It seems that this subject requires further investigations with larger numbers of samples in order to fully evaluate the causes of high seropositivity.

The parasitic trematode Fasciola hepatica is the causative agent of fasciolosis that is common in ruminants especially sheep and cattle and is occasionally found in humans. Fasciolosis has a worldwide distribution including Turkey and causes major economic losses in agricultural industry. Cathepsin L1 is one of the major molecules in the excretory-secretory products of F. hepatica and is involved in tissue penetration, immune evasion and feeding and therefore may be used in vaccination and serological diagnosis. The aim of this study was to evaluate cloning and expression of the cathepsin L1 gene of F. hepatica eucaryotic cells. For this purpose, total RNA was extracted from adult F. hepatica. Cathepsin L1 DNA amplicons were obtained with the reverse transcription polymerase chain reaction (RT-PCR). The 981 base-coding gene region of cathepsin L1 was amplified using specific primers to the cathepsin L1 gene. Then, the cathepsin L1 gene was cloned into the pCI-neo mammalian expression vector. The presence of the cathepsin L1 gene was confirmed by PCR screening and enzyme digestion assays. So, the resulting recombinant plasmid was named pFhCL1. Afterwards, the pFhCL1 vector was transiently transfected into Vero cells. The presence of the cathepsin L1 proteins was shown by Western immunoblotting.

Crimean-Congo hemorrhagic fever virus (CCHFV) is a tick-borne virus in the family Bunyaviridae , genus Nairovirus . The virus is transmitted to humans through infected tick bites or from direct contact with viremic animals or humans. In the present study, a total of 1,015 adult ticks were collected from cattle (603 specimens), sheep (17 specimens), and goats (395 specimens) in the Kelkit Valley in Turkey. Four tick species were recognized on the animals in the surveyed region. The most abundant species were Rhipicephalus bursa and Hyalomma marginatum marginatum , at 47.68% (484/1,015) and 46.40% (471/1,015), respectively. Reverse transcriptase PCR was used to recover partial sequences of the CCHFV small (S) genome segment. The presence of CCHFV was determined in 3 of 33 (9.09%) R. bursa pools and in 1 of 31 (3.22%) H. m. marginatum pools. Virus sequences from R. bursa were extremely different from those of the Greek CCHFV strain (U04958) isolated from an R. bursa tick. Phylogenetic analysis indicated that the CCHFV isolates obtained in this study clustered in group 5, whose range encompasses southwestern Russian and Kosovo. This is the first evidence of CCHFV in ticks from Turkey. Even though Hyalomma is the main vector for CCHFV, R. bursa may play a role in CCHFV transmission.

Monitoring of HBV replication level is very useful for the management of patients with chronic HBV. However, the use of the correct tools to quantify HBV-DNA levels in serum and monitor the replication of HBV is of paramount importance in terms of diagnosis, and antiviral treatment of patients with chronic HBV infection. The aim of this study was to combine the bDNA assay and HBV PCR to improve detection of viremia the patients with HBeAg-positive chronic hepatitis B infection.In this study, 67 HBeAg-positive chronic hepatitis B patients were analyzed to determine viremia level using bDNA and HBV PCR assays.Sixty-four patients with HBeAg-positive chronic hepatitis B showed positivity by conventional HBV PCR, whereas 56 subjects with HBeAg-positive chronic hepatitis B showed HBV-DNA levels by bDNA.The results indicated that it is reasonable to use the bDNA assay to determine HBV replicative activity first, and use conventional HBV-PCR for HBeAg-positive chronic hepatitis B patient samples that are negative in bDNA assay.

We investigated the prevalence and genotypic distribution of GB virus-C/hepatitis G virus (GBV-C/HGV) and TT virus (TTV) in blood donors, mentally retarded children and four groups of patients living in Eastern Anatolia, Turkey. The prevalence and genetic analysis of TTV were determined by using the primers of the UTR and ORF1 regions of TTV, respectively. Reverse transcription nested (RT-n)-PCR was used to amplify 5' UTR of GBV-C/HGV. Genotyping of HGV was carried out by PCR-based genotyping assay while RFLP was conducted to determine the genotypes of TTV. TTV DNA was detected in 118 of 410 sera tested, giving an overall prevalence of 28.7%; GBV-C/HGV-RNA was detected in only 17 cases, giving an overall prevalence of 4.1%. No significant differences were observed in the number of positive or negative tests for GBV-C/HGV and TTV according to duration of illness or mean duration of institutionalization in any of the groups studied. Although all samples from the study population belonged to genotypes 1 and 4, the most common TTV genotype is G2. In conclusion, our results indicate a low endemicity of GBV-C/HGV and TTV infection in Eastern Anatolia, Turkey. The presence of G2 strains reveals the limited genetic diversity of the GBV-C/HGV circulating in Turkey. We suggest that TTV infection of genotypes 1 and 4 is prevalent in the same region.

The aim of this study was to determine the neopterin levels and peripheral blood lymphocyte subgroups in HBeAg-positive and -negative chronic hepatitis B patients. A total of 89 patients were included in the study. The mean serum neopterin level of patients with chronic hepatitis B was significantly higher than that of the control group. In HBeAg-positive chronic hepatitis B patients, the mean serum neopterin level was significantly higher than that of anti-HBeAb-positive patients. There was no significant correlation between the serum neopterin levels and alanine aminotransferase and HBV-DNA levels in HBeAg-positive chronic hepatitis B patients. There were no significant differences between the control subjects and patients with HBeAg-positive or anti-HBeAb-positive hepatitis in terms of the percentage of peripheral blood CD4+ or CD8+ or the ratio of CD4+/CD8+ lymphocytes. Our results suggest an association between elevated neopterin concentrations and HBeAg-positivity in patients with chronic hepatitis B. However, there appears to be no association between the neopterin levels and either hepatocyte damage or viral replication status.

Background Molluscum contagiosum has a worldwide occurrence and its primary mode of transmission is via direct human contact including sexual means. The aim of the study was to implement a polymerase chain reaction-based assay for detection and subtyping of Molluscum contagiosum virus (MCV) in skin lesions diagnosed with molluscum contagiosum in a large regional teaching hospital in Turkey. Methods For this purpose, a total of 61 patients were included in the study. Randomly selected single lesion from each patient was used to extract DNA material and a specific PCR reaction amplifying 393-bp- and 575-bp-long regions from MCV genome was used in the detection. Subtyping was carried out by digestion of the amplified 575-bp product with restriction endonuclease enzyme Bam HI. Both amplified and restriction enzyme digested products visualized on agarose gel electrophoresis. Results All 61 molluscum cases (100%) included in the study contained MCV genetic material as demonstrated by the presence of 393- and 575-bp-long PCR amplified products. Restriction enzyme Bam HI digestion of the 575-bp-long amplicon indicated that the infecting subtype in all the cases (100%) was MCV subtype I. Conclusions Results of this study demonstrate that subtype I is the only infecting strain dominant in our region. Because the only consecutive molluscum patients admitted to our hospital were included in the study, our data do not rule out the possibility that other genotypes might be present in the Turkish population. However, it is not unreasonable to conclude that similar trends exist in the rest of the country. Results also show that a molecular-based diagnostic assay would be feasible in cases where diagnosis was deemed necessary.

Objective: To investigate etiological role of Epstein-Barr virus (EBV) DNA in breast cancer. Materials and Methods: The presence of EBV DNA in 57 breast cancer tissues was investigated with a sensitive PCR assay. The breast cancer tissues were from invasive ductular (n = 28), lobular (n = 20) and other miscellaneous carcinomas (n = 9). Tissues from normal breasts and patients with various benign breast diseases (n = 55): fibrocystic disease (n = 34), fibroadenoma (n = 16), hyperplasia, and granulomatous mastitis (n = 5), were used as control samples. Results: EBV DNA was detected in 13 (23%) cancerous tissues (7 ductular, 4 lobular, 2 other carcinoma) and 19 (35%) in the control tissues. The difference between EBV presence in malignant and benign tissues was not statistically significant (p > 0.05). Conclusion: The presence of EBV DNA was detected almost equally in both breast cancer and normal tissues, which indicates no etiological role for EBV in breast cancer. We suggest further etiological studies.

In this prospective study, we investigated the serum levels of hepatocyte growth factor (HGF) and C-reactive protein (CRP) before and after the treatment of patients with acute brucellosis. The study comprised 58 patients with acute brucellosis and 30 healthy volunteers. Pre-treatment serum HGF levels of 58 patients with acute brucellosis (1548.6 +/- 220.1) were significantly higher than levels of the control group (401.4 +/- 69.7) (p0.001). Serum levels of HGF and CRP significantly decreased at the end of the treatment period (p0.001). Post treatment, levels did not differ from those of the control group (p0.05). Serum HGF levels of patients with acute brucellosis correlated to CRP and ALT levels (r: 0.922, 0.752; p0.001, respectively). Our findings suggest that serum HGF levels may be used as a supplementary marker to evaluate the effectiveness of the treatment in patients with acute brucellosis.

Objectives: To study the prevalence and genotype distribution of hepatitis G virus (HGV) in hemodialysis patients in East Anatolia, Turkey. Subjects and Materials: Eighty-nine hemodialysis patients and 30 healthy individuals were analyzed by using reverse-transcriptase nested polymerase chain reaction with primers specific for 5′ untranslated region. HGV genotyping was performed by PCR and three randomly selected HGV-positive samples were sequenced. Results: Of the 89 hemodialysis patients, HGV RNA was detected in 9 (10.2%). All of our isolates were assigned to genotype 2. Conclusion: Our results showed that hemodialysis patients carry the risk for HGV infection in East Anatolia, Turkey.

In the present study, we have investigated the seropositivity of Epstein-Barr virus (EBV) and the epidemiological factors affecting this seropositivity. A total of 540 subjects living in central Elazig Province and its surroundings were enrolled in the study. IgG antibodies against capsid antigen of EBV (anti-VCA IgG) were determined by ELISA. Seropositivity was found to be 99.4%. There was a significant relationship between increased anti-VCA IgG levels and age, living in crowded families, exposure in public places and low income (p0.05). However, no significant alterations in serum anti-VCA IgG antibody were observed in terms of gender, blood transfusion and educational status (p0.05). In conclusion, we have demonstrated the commonly presence of EBV Infections in the public and contamination with the infection at early stages of life in the Elazig region. An overpopulated family environment, low income status and living in shared accommodation facilities play important roles in acquiring EBV infection.

In this study, for the detection of Fasciola hepatica infection seroprevalence in Elaziğ region (Eastern Anatolia), the presence of F. hepatica IgG antibodies were investigated by using a home-made enzyme immunoassay, in the sera of 540 healthy volunteers (254 males, 286 females) from different age groups (age range: 0-81 yrs, mean age: 33 +/- 20 yrs). The total seropositivity rate in this region of our country was found 2.78%, with no differences between males and females (respectively, 2.76% and 2.8%). F. hepatica IgG positive subjects were then evaluated for the parameters of age, educational and socioeconomical status, and it was found that there were no statistically significant differences.

The clinical features, therapy and outcome of anthrax cases from the Elazig province (the eastern Anatolian region) of Turkey seen in our clinic over an 8-year period were reviewed. The records of 25 anthrax cases observed in our clinic during the period January 1994 to April 2002 were examined. All cases were cutaneous; 18 (72%) patients exhibited malignant pustules and seven (28%) malignant edema. Three of the patients with a malignant pustule developed anthrax sepsis when admitted to our clinic. All cases were treated with penicillin. One patient who had penicillin allergy was treated with ciprofloxacin. In addition, patients with malignant edema were also treated with systemic corticosteroids (methylprednisolone or dexamethasone). Two patients died due to anthrax sepsis; one case with anthrax sepsis recovered. The mortality rate was 8%. Anthrax is still a reality in Turkey. Cutaneous anthrax should be considered in any patient with a painless ulcer with vesicles, edema and a history of exposure to animals or animal products. In our series, penicillin and ciprofloxacin were effective in treatment of anthrax. Our anthrax sepsis case demonstrates that anthrax sepsis is not always fatal if antibiotic treatment is given early after diagnosis.