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The present study evaluated the in vitro potency of ceftazidime and cefepime among carbapenem-resistant Pseudomonas aeruginosa isolates collected as part of a global surveillance program and assessed the pharmacodynamic implications using previously published population pharmacokinetics. When susceptible, MICs resulted at the high end of distribution for both ceftazidime and cefepime, thus 6 g/day was required to achieve optimal pharmacodynamic profiles. These findings should be considered in the clinic and for the application of CLSI susceptibility breakpoints. © 2021 American Society for Microbiology.

PubMed ID: 28929967, Colistin is a polymyxin antibiotic which is considered as one of the last line agents against infections due to multidrug resistant or carbapenem resistant gram-negative pathogens. Colistin resistance is associated with chromosomal alterations which can usually cause mutations in genes coding specific two component regulator systems. The first plasmid-mediated colistin resistance gene, mcr-1 was described in Escherichia coli and Klebsiella pneumoniae isolates in December 2015 and followed by another plasmidmediated colistin resistance gene mcr-2 in 2016. The rapid and interspecies dissemination of plasmidmediated resistance mechanisms through horizontal gene transfer, have made these genes considerably threatening. After the first reports, although mcr-1/mcr-2 producing Enterobacteriaceae isolates have been reported from many countries, there have been no reports from Turkey. Thus, the aim of this study was to investigate the presence of mcr-1/mcr-2 in clinical Enterobacteriaceae isolates from different parts of our country. A total of 329 Enterobacteriaceae isolates from 22 laboratories were collected which were isolated between March, 2015 and February, 2016. mcr-1/mcr-2 were investigated by polymerase chain reaction during February-March, 2016. Two hundred and seventeen of Klebsiella pneumoniae (66%), 75 of Salmonella spp. (22.8%), 31 of Esherichia coli (9.4%), 3 of Enterobacter cloacae (0.9%), 2 of Klebsiella oxytoca (0.6%) and 1 of Enterobacter aerogenes (0.3%) isolates were included to the study. Agarose gel electrophoresis results of PCR studies have shown expected band sizes for positive control isolates as 309 bp for mcr-1 and 567 bp for mcr-2. However, the presence of mcr-1/mcr-2 genes was not detected among the tested study isolates of Enterobacteriaceae. Although mcr-1/mcr-2 were not detected in our study isolates, it is highly important to understand the mechanism of resistance dissemination and determine the resistant isolates by considering that colistin is a last-line antibiotic against infections of multidrug or carbapenem resistant gram-negative bacteria. Thus, it is suggested that these mechanisms should be followed-up in both clinical and non-clinical (e.g. isolates from food animals, raw meats and environment) isolates of special populations.

Dengue fever is an acute viral disease that can affect all age groups in tropical and subtropical countries. The predominant vectors are the mosquitoes namely Aedes aegypti and A.albopictus. Although there have been no case reports in Turkey due to DF, there is seroepidemiological evidence indicating the presence of Dengue virus (DENV) in Turkey. In this case report we presented an imported dengue fever case. The patient was 40 years old, previously healthy male, Switzerland citizen. He had immigrated from Dubai to India two weeks ago and after one week from immigration he attended to a hospital in India because of high fever. The NS1 antigen test (Bio-Rad Laboratories, USA) was found positive and the patient was followed-up with diagnosis of dengue fever in India. During his visit to Turkey, he attended to the hospital for a routine control and his analysis revealed thrombocytopenia (PLT: 48.000/µl), leukopenia (white blood cell: 2800/µL) and elevated liver enzymes (AST: 76 U/L, ALT: 83 U/L). Fever was not detected in follow-up. The patient had petechial rash on his lower extremities. white blood cell and PLT count increased to 4100/µl and 93.000/µl, respectively. Liver function tests revealed a decrease in AST (63 U/L) and ALT (78 U/L) on the third day. The PLT count increased to 150.000/ml. Since the patient had no fever and had normal physical and laboratory findings, he was discharged from the hospital. For the confirmation of dengue fever diagnosis the serum sample was sent to National Public Health Center, Virology Reference and Research Laboratory where IgM and IgG antibodies against DENV types 1-4 were investigated by indirect immunofluorescence method (Euroimmun, Germany). The serum sample yielded positive result at the dilutions of 1/1000 for IgM and 1/10.000 for IgG. The last dilution of type 3 DENV IgM and IgG were determined high density of fluorescein, thus the serotype was identified as "DENV type 3". Travel-related diseases become important with increasing travel opportunities, globalization and transportation, recently. As a result, this imported case with foreign nationality was the first dengue fever case confirmed by clinical and laboratory tests in Turkey.

The aim of this study was to compare in vitro reduction of Enterococcus faecalis by using three agitation methods. Fifty-five mandibular premolar teeth were used. The root canals were prepared by using ProTaper instruments to size F4. Fresh bacterial suspensions were inoculated into each canal and the teeth were incubated at 37°C under aerobic conditions for 3 weeks. The specimens in negative control group were not contaminated and the teeth in positive control receive no further instrumentation or irrigation after contamination. The contaminated teeth were divided into three experimental groups and two control groups. The experimental groups were as follows according to agitation of NaOCl irrigation solution; group 1, the brush-covered NaviTip FX needle; group 2, EndoVac apical negative pressure irrigation system; and group 3, self-adjusting file (SAF). Following the final irrigation, samples obtained with sterile #40 H-file from teeth and the file used were placed into sterile microcentrifuge tubes. After the incubation period, bacterial colony numbers were noted as CFU/ml. Three teeths were randomly selected from each group for scanning electron microscope evaluation. The three groups were compared with the Kruskal-Wallis test. Comparisons between three groups were made with the Mann-Whitney U-test with Bonferroni correction. SAF was significantly effective in elimination of E. faecalis when compared to EndoVac (p0.05). In conclusion, agitation of NaOCl with SAF for 2 min may be an effective alternative approach. © 2014 Wiley Periodicals, Inc.

Aim: In this study, patients who were admitted to the Ege University (EU) Emergency Service were evaluated retrospectively. It was aimed at obtaining the demographic data of patients who had traffic accidents, their usage frequency of protective measures (infant car seat, seat belt, helmet, etc.) types of injuries received, quality of medical intervention given and an overall legal examination of injuries. Materials and Methods: Patients who were admitted to the EU Emergency Service between 01.012011-31.12.2011 due to traffic accidents were analyzed with SPSS statistical programme. Results: Most of the subjects consisted of individuals over 18 years and were male. The percentage of accidents inside the vehicle was 48.6%. Data on protective measures could not be obtained in 80.6% of the motorbike and bike accidents. Legally, the patients who could be treated with non-dangerous simple medical intervention (SMI) were 63.5%. The patients who could not be treated with SMI were 18.7%. Conclusion: The number of cases that could not be evaluated in the emergency care unit was low, however, this did not occur due to insufficient recording by the attending physician. This happened mostly because of the difficulty seen in the interpretation of the data in the emergency unit. Emergency physicians have several responsibilities such as making medical interventions in accordance with the rules. For a physician to protect himself/herself and not cause any legal victimization, it is paramount that he/she must keep the medical recording neatly and properly, in particular, the final reports should be written properly with extreme caution., Amaç: Bu çalışmada, 2011 yılında trafik kazası sonucu Ege Üniversitesi Acil Servis'e başvuran hastaların dosyaları retrospektif olarak incelenmiştir. Trafik kazası geçirenlerle ilgili demografik veriler, koruyucu önlemlerin (çocuk koltuğu, emniyet kemeri, kask, vb.) kullanılma sıklığı, yaralanma tipleri, tıbbi müdahalelerin niteliği saptanarak yaralanmaların adli bakımdan değerlendirilmesi amaçlanmıştır. Yöntem ve Gereç: EÜTF Acil Tıp Anabilim Dalı'na 01.01.2011-31.12.2011 tarihleri arasında trafik kazası nedeniyle başvuran hastaların dosyaları Hastane Etik Kurulu'ndan izin alınarak incelenmiş, elde edilen veriler SPSS istatistik programıyla analiz edilmiştir. Bulgular: Çalışma kapsamına alınan hasta sayısı 1533'tür. Olguların çoğu on sekiz yaş üstü bireylerden (%80.2, n=1229) ve erkeklerden (%68.6, n=1051) oluşmaktadır. Araç içi trafik kazalarının oranı %48.6, araç dışı trafik kazalarının oranı %46.3, kaza tipi belli olmayanlar %5.1'dir. Motosiklet ve bisiklet kazalarının (n=320) %80.6'sında koruyucu önlem bilgilerine ulaşılamamıştır. Adli açıdan yaşamsal tehlike oluşturmayan, basit tıbbi müdahale (BTM) ile giderilebilir olanlar %63.5, BTM ile giderilemeyecek olanlar %18.7, yaşamsal tehlikesi bulunanlar %15.3'dür. 39 (%2.5) dosyada; tedavi reddi-izinsiz terk, ön raporlarda şüpheli radyolojik bulgular, hasta dosyalarındaki bilgilerin yetersizliği gibi nedenlerle adli bakımdan değerlendirme yapılamamıştır. Sonuç: Acil serviste saptanan ilk bulgularla adli değerlendirme yapılamayan dosyaların sayıca az olduğu, bu durumun yalnızca Acil Servis hekiminin kayıt yetersizliğinden kaynaklanmadığı, tetkiklerin Acil Servis koşullarında yorumlanmasının güç olmasının kayıt eksikliğine katkıda bulunduğu görülmektedir. Acil hekimlerinin, tıbbi kurallara uygun bir biçimde müdahale etmek, yaptığı tıbbi işlemleri kaydetmek, hasta ve hasta yakınlarının kaygılarını gidermeye çalışmak ve adli vakalarda yaşamsal tehlike kararının doğru verilmesi konusunda sorumlulukları vardır. Hekimin kendisini koruması ve adli vakalarda mağduriyete yol açmaması için, tıbbi kayıtları özenli ve düzenli şekilde tutması, özellikle kati raporlandırma aşamasında gereken bilgilerin düzgün kaydedilmesi önemlidir.

Aim: The aim of this study is to examine the views of family physicians working in the family practice field regarding good and problematic parts of the system and their views about educational needs. Materials and Methods: During 2010, before “The Conference of Legal Responsibilities of Family Physicians” a questionnaire of 12 questions were applied to the 104 family physicians from 6 provinces and the results were examined. Results: 77.7 % (81 respondents) of participants were seniors (11-25 proyears old) and 58,7 % (61 people) of participants have been working as family physician for two years. Most of the participants stated that they chose family practice, because of high salary and better work opportunities. Conclusion: When family physicians' positive and negative views are examined, the most mentioned positive views are the salary, the good relationship between patient and physician and better work conditions. On the other hand, negative views were expressed about poor working environments, and about Family Practice Application. A remarkable number of participants (25 respondents) stated that if they had another chance, they would not choose family medicine. To carry out this application more effectively, problems of family physicians should be examined in detail and should be resolved., Amaç: Bu çalışmanın amacı aile hekimliği uygulamasında sahada çalışan hekimlerin aile hekimliğini seçme nedenlerini, sistemin iyi ve sıkıntılı yönlerini ve eğitim ihtiyaçları hakkındaki görüşlerini değerlendirmektir. Gereç ve Yöntem: 2010 yılı içinde değişik illerde gerçekleştirilen “Aile Hekimlerinin Yasal Sorumlulukları” konulu konferanslar öncesinde, altı ilde çalışan 104 aile hekimine toplam 12 sorudan oluşan anket uygulanmış, verilen yanıtlar değerlendirilmiştir. Bulgular: Katılımcıların %77,7'si (81 kişi) 11–25 yıllık deneyimli hekimlerden oluşmakta ve %58,7' si (61 kişi) 2–4 yıldır aile hekimi olarak çalışmaktadır. Katılımcıların çoğu ücretin yüksek olması ve daha iyi hekimlik olanağı sağladığı için aile hekimliğini seçtiklerini belirtmişlerdir. Sonuç: Aile hekimlerinin uygulamayla ilgili olarak olumlu ve olumsuz görüşleri incelendiğinde; En çok ücretin iyi olması, hasta-hekim ilişkilerinin iyi olması ve daha iyi hekimlik olanağı sağlaması gibi olumlu görüşler ile çalışma şartları ve ortamıyla ilgili olumsuz görüşlere sahip oldukları görülmüştür. Azımsanmayacak sayıda katılımcı (25 kişi) ise yeniden seçme şansı olsa aile hekimliğini seçmeyeceğini belirtmiştir. Uygulamanın daha sağlıklı yürütülebilmesi için aile hekimlerinin sistemle ilgili sıkıntılarının daha ayrıntılı belirlenip giderilmesi gerekmektedir.

Periferik kan NKT hücre seviyeleri, sitokin profili ve sitotoksik aktiviteyi incelediğimiz çalışmamızda, tip 1 diyabetin farklı dönemlerindeki hasta grupları ve non-diyabetik gruplarda NKT hücrelerinin sayı ve fonksiyon açısından özellikleri incelenerek bu hücre grubunun tip 1 diyabet patogenezindeki olası rolü araştırılmıştır. Tip 1 diyabet teşhis süresi 1 ay-1 yıl olan grup (Grup 1, n:5, yaş ortalaması: 31±7), teşhis süresi 1 yılın üstünde olan grup (Grup 2, n:4, yaş ortalaması: 22±8), tip 1 diyabetiklerin 1. derece non-diyabetik akrabası olan grup (Grup 3, n:7, yaş ortalaması: 30±9) sağlıklı kontrol grubu (Grup 4, n:5, yaş ortalaması: 25±5) ile karşılaştınlmıştır. Flow sitometri yöntemiyle Va24 düzeyleri incelendiğinde, Grup 1, Grup 2, Grup 3'te Va24 düzeyleri kontrol grubuna göre anlamlı derecede düşük bulunmuştur (sırasıyla; p < 0.001, p < 0.01 ve p < 0.05,). CD161 düzeyleri bakımından Grup 1, Grup 2 ve Grup 3, kontrol grubuna göre anlamlı derecede düşük saptanmıştır (p < 0.001). Hücre içi IFN-y düzeyleri Grup 1, Grup 2 ve Grup 3'te kontrol grubuna göre anlamlı derecede düşük bulunmuş (p < 0.001), ayrıca CD161 ekspresyonu ile hücre içi IFN-y seviyeleri arasında güçlü bir korelasyon saptanmıştır (r=0.78). Grup 1, Grup 2 ve Grup 3'te sitotoksik aktivite kontrol grubuna göre anlamlı derecede düşük olarak bulunmuştur (p < 0.001, p < 0.01, p < 0.05, sırasıyla). Hücre içi IFN-y seviyeleri ve CD161 ekspresyonu, sitotoksite değerleri ile karşılaştınidığmda, anlamlı korelasyon saptanmıştır (r=0.76). CD161 ekspresyonu düşüşüne bağlı olarak gruplardaki IFN-y düzeyindeki azalış, NK ve NKT hücrelerindeki sitotoksik aktivite ile tip 1 diyabetin tanı süresi arasındaki ilişkiyi ortaya koymaktadır. Tip 1 diyabetlilerin birinci derece akrabalarında kontrol grubuna göre düşük olarak saptanan NKT hücre sayı ve fonksiyonları, bu hücrelerin hastalığın preklinik süreçte etkin bir rolü olduğunu düşündürmektedir.

Aim: Incised–penetrating wounds have an important focus for living subjects and medicolegal autopsies. In this study, we aimed to collect demographical data and their relationship to medicolegal autopsy cases due to incised penetrating injuries. Material and Methods: Death examination and autopsy reports autopsies performed by the Forensic Medicine Izmir Group Chairmanship during 2004-2007 were reviewed. Among a total of 6069 autopsied cases, the cause of death of 445 cases was found to be as incised –penetrating wounds. Results : The origin of death was homicide in 438 (98.4%), an accident in 4 (0.9%) and suicide in 3 (0.7%) of the cases. The mean age was 37.1 ± 15.8, the age range was between 3-81 years, and the most frequently seen age group was among 21–30 years of age (28.8%). All of the suicide cases and 82.9% of the homicide cases were men. Among alcohol detected cases, 93.5% were male, 6.5% were female and detected narcotic drugs showed increase The origin of death was homicide in 438 (98.4%), an accident in 4 (0.9%) and suicide in 3 (0.7%) of the cases. The mean age was 37.1 ± 15.8, the age range was between 3-81years, and the most frequently seen age group was 21– 30 years of age (28.8%). All of the suicide cases and 82.9% of the homicide cases were men. Among cases were alcohol was detected, 93.5% were male, 6.5% were female and the detection of narcotic drugs showed increase recently. Conclusion: Incised–penetrating weapons are easily obtainable and can be used for the purpose of murder. Injuries incurred with the intention of killing are mostly thoracal and abdominal. Rarely are these weapons used for suicidal purposes. Deaths due to incised–penetrating weapons increased during the summer time and 99.3% of the cases that alcohol was detected were homicidal in origin. It was also observed that young males form the risk group of the deaths due to incised–penetrating weapons. Young deaths at their most productive age and increase in narcotic drugs detected in autopsy cases are worrisome issues that need some measures applied., Amaç: Kesici-delici alet yaralanmaları hem canlı vakalar hem de adli otopsiler içinde önemli bir yere sahiptir. Çalışmamızda, kesici-delici alet (KDA) yaralanması nedeniyle adli otopsi yapılan olgularda demografik verilerin toplanması amaçlanmıştır. Yöntem ve Gereç: 2004-2007 yılları arasında İzmir Adli Tıp Grup Başkanlığı tarafından ölü muayenesi ve adli otopsileri yapılmış olan vakaların raporları incelenmiş, toplam 6069 adli otopsi vakası içinden 445 tanesinin ölüm sebebinin kesici-delici alet yaralanmasına bağlı olduğu görülmüştür. Bulgular: Olguların 438'i (%98.4) cinayet, 4'ü kaza (%0.9), 3'ü(%0.7) intihar orijinli olup, yaş ortalamasının 37.1±15.8, en gencinin 3, en yaşlısının 81 yaşında olduğu ve KDA ile yaralanmaların en sık 21-30 yaş grubunda (%28.8) görüldüğü, intihar olgularının tamamının, cinayet olgularının ise %82.9'unun erkek olduğu belirlenmiştir. Alkol tespit edilen olguların %93.5'inin erkek, %6.5'inin kadın olduğu, uyutucu-uyuşturucu madde (UUM) tespit edilen olguların son yıllarda artış gösterdiği belirlenmiştir. Sonuç: Kesici-delici aletler temin edilmesi kolay, cinayet amaçlı kullanılabilen aletlerdir. Öldürme kastıyla yapılan yaralanmalar daha çok göğüs ve batın bölgesine yoğunlaşmakta ve ender de olsa kesici-delici aletler intihar amaçlı olarak da kullanılabilmektedir. Kesici-delici alet ile meydana gelen ölümlerde genç erkeklerin risk grubunu oluşturduğu, UUM tespit edilen olguların özellikle son yıllarda artış gösterdiği belirlenmiştir. Genç yaşta ve en verimli olabilecekleri çağda kişilerin kaybedilmesi ve UUM tespit edilen olguların artması durumunu kaygı verici olarak görmekte ve önlem alınması gereken bir konu olduğunu düşünmekteyiz.

Intravenous catheterization can lead to colonization as well as a broad spectrum of infections ranging from catheter site infections to catheter-related blood stream infections (CRBSIs). The aim of this study was to evaluate the distribution of causative agents and their antibiotic susceptibility patterns in CRBSIs and catheter site infections along with the colonization rates and colonizing microorganisms in Zonguldak Karaelmas University Hospital, Turkey. The results of cultures from catheter tips and/or intracatheter blood cultures and simultaneously taken peripheral blood cultures were sent to medical microbiology laboratory and were retrospectively investigated for 201 patients hospitalized between September 2007 and September 2009. The catheter tips were cultured by semi-quantitative and quantitative culture methods. Blood cultures from the catheters and peripheral veins were performed in BACTEC 9120 (Becton Dickinson, USA) blood culture systems. The antibiotic susceptibility tests were done by Kirby-Bauer disk diffusion method according to the guidelines of the Clinical and Laboratory Standards Institute (CLSI). Out of 201 patients included, 28 (13.9%) had CRBSIs and 13 (6.4%) had catheter site infections while colonization was defined for 55 (27.3%) patients. Of 28 patients with CRBSIs, Acinetobacter spp. were isolated from 11 including five carbapenem-resistant strains, methicillin-resistant coagulase-negative staphylococci (MRCNS) from eight, methicillin-susceptible coagulase-negative staphylococci (MSCNS) from two, Klebsiella pneumoniae from two patients and one of each patient's cultures yielded methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Pseudomonas aeruginosa, Enterococcus spp., Escherichia coli and MRCNS + Enterococcus faecium. Of 13 patients with catheter site infections, five MSCNS, two methicillin-susceptible S.aureus (MSSA), two E.coli, and one of each K.pneumoniae, MRCNS, Enterococcus spp., K.pneumoniae + P.aeruginosa were isolated. No resistance to vancomycin and teicoplanin were detected among the staphylococci isolated from CRBSIs and catheter site infections. The distribution of the 55 colonizing microorganisms were as follows; 18 MSCNS, 18 MRCNS, four Acinetobacter spp., five K.pneumoniae, three E.coli, two MSSA, and one of each MRSA, P.mirabilis, P.aeruginosa, Corynebacterium spp., Candida albicans. In this study, the predominant microorganism isolated from CRBSIs was Acinetobacter spp., followed by coagulase-negative staphylococci. This unexpected distribution of the agents was related to the Acinetobacter spp. that have gained endemic potential following an Acinetobacter outbreak in our hospital in 2006. We emphasize that it is critical for any individual hospital to assess periodically the distribution and susceptibility profiles of isolates obtained from catheter-related infections to set out rational empirical treatment strategies.

Aim: Our study was carried out to determine thoughts, perspectives and information levels among undergraduates of the Ege University Medical Faculty concerning organ donation. Material and Methods: This study was carried out between January and April 2009 with the participation of 171 undergraduates within Ege Universitesi Medical Faculty. Respondents completed a questionnaire which consisted of 36 question entitled “Organ Donation and Transplantation-Related Thoughts and Information Level Evaluation Survey“. The data was analyzed utilizing the SPSS program. Results: The mean of undergraduates participating in our study was 22.11 ± 2.35 years, 78 (45.6 %) were males and 93 (54.4%) were females. 3 (%1.8) had donated their organs. It was determined that 96 (56.1%) of them wanted to donate their organs. In response to the question “Do you find your knowledge concerning organ donation sufficient?” 100 (58.5%), undergraduates gave negative replies. Conclusion: In our study, it was observed that although those who wanted to donate organs knew what to do, their attitudes and behaviors were different, and very few of them had donated their organs. However, they would volunteer to donate their organs when one of the members of their family needed organ donation. Finally, in improving the organ donation rate; it is necessary to provide training at schools, to arrange organ donation campaigns and to prepare programs directed toward raising the consciousness of the community with the back up of media., Amaç: Çalışmamız Ege Üniversitesi Tıp Fakültesi öğrencilerinin organ bağışı hakkındaki bilgi düzeyleri ve düşüncelerini belirlemek için yapılmış bir ön çalışmadır. Daha sonra çalışma; eş zamanlı olarak hem tıp fakültesi, hem hukuk fakültesi, hem de diğer bölüm öğrencilerini de kapsayacak şekilde kapsamlı olarak uygulanacaktır. Yöntem ve Gereç: Ocak-Nisan 2009 tarihleri arasında Ege Üniversitesi Tıp Fakültesi'nden toplam 171 öğrenciye “Organ Nakli ve Bağışı Hakkında Bilgi Düzeyi ve Düşünceleri Değerlendirme Anketi” adlı 36 sorudan oluşan anket formları dağıtılmış ve yanıtlamaları istenmiştir. Elde edilen veriler SPSS programıyla analiz edilmiştir. Bulgular: Çalışmaya katılan öğrencilerin yaş ortalaması 22.11 ± 2.35 olup, 78'i (%45.6) erkek, 93'ü (%54.4) kadındır. Organlarını bağışlayanların sayısı 3'tür (%1.8). Organ bağışında bulunmak isteyenler 96 (%56.1) kişidir. “Organ bağışı konusundaki bilgilerinizi yeterli buluyor musunuz ?” sorusuna yanıt olarak; 100 (%58.5) kişi bilgilerinin yeterli olmadığı yanıtını vermişlerdir. Organ bağışlamak isteyenlerin ne yapmaları gerektiğini bilmelerine rağmen, tutum ve davranışlarının farklı olduğu; bağışlamak isteyenlerin ise çok azının organlarını bağışladığı, ayrıca ailelerinden birinin organ bağışına ihtiyacı olduğunda bağışta bulunmaya gönüllü oldukları görülmektedir. Sonuç: Organ bağış oranının artırılmasında; ilköğretimden yüksek öğretime kadar eğitimin her aşamasında okullarda bu konuda eğitime önem verilmesi, organ bağış kampanyalarının arttırılması ve medya aracılığı ile halkı bilinçlendirmeye yönelik programların hazırlanması gerekmektedir.

In this study, a total of 390 methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from clinical specimens between April 2004 and June 2008, in a university hospital in Zonguldak (located at Black Sea region), Turkey, were evaluated retrospectively for reduced susceptibility to vancomycin. Brain heart infusion (BHI) plates containing 4 and 6 µg/ml of vancomycin were used to screen for vancomycin intermediate S.aureus (VISA) strains. Additionally, vancomycin minimal inhibitory concentrations (MIC) of the isolates were determined by agar dilution method. No growth was observed on the screen plates after 24 and 48 hours of incubation. None of the isolates revealed MIC values equal to or higher than 2 µg/ml; MIC90 and MIC50 values were 1 µg/ml. Although VISA isolates were not detected in this study, no data was obtained for heterogeneous VISA isolates since macro-E test or population analysis were not performed. It was concluded that systematic surveillance of MRSA isolates is of particular importance to investigate the presence of VISA/hVISA isolates which may lead to treatment failures and hospital epidemics.

Hepatitis C virus (HCV) is one of the significant causes of hepatitis, cirrhosis and hepatocellular carcinoma all throughout the world. There are six genotypes and more than 50 subtypes of HCV. HCV genotyping is of crucial importance in the determination of the treatment protocols and the follow-up of the clinical course since treatment success is low and the duration of treatment is longer in HCV genotype 1 infected cases. The aim of the present study was to evaluate the HCV genotype profiles of the pa tients with chronic hepatitis C in Zonguldak, providing the first data about HCV genotypes from western Black-Sea region, Turkey. The HCV genotypes of 44 patients (26 female, 18 male; age range: 29-89 years, mean age: 60.05 ± 10.81 years) with positive anti-HCV antibody and HCV-RNA results, admitted to the hospital between May 2007 and July 2009, were retrospectively evaluated and included in the study. Alanine aminotransferase (ALT) levels of the patients were between 8-160 IU/L (mean 63.99 ± 37.15 IU/L) and the aspartate aminotransferase (AST) levels were between 17-160 IU/L (mean 62.77 ± 36.75 IU/L). HCV antibody was determined by ELISA method (Abbott Laboratories, USA), and HCV-RNA was determined by two commercial real-time polymerase chain reaction systems [Cobas Taqman (Roche Diagnostic, USA) and Rotor-Gene 6000 (Corbett Research, USA)]. The genotyping was performed by a reverse hybridization based method, Versant®HCV Genotype Assay (LiPA) 2.0 (Bayer Health Care, Belgium). HCV genotypes could not be determined for 5 (11.4%) patients since HCV-RNA levels were low. Genotyping could be performed for 39 (88.6%) patients and 38 (97.4%) had genotype 1b and one (2.6%) patient had genotype 1a. In conclusion, in concordance with the other studies conducted in our country, genotype 1b was found to be the most prevalent genotype in patients from our region.

Staphylococcus lugdunensis is an infrequent cause of infective endocarditis (IE) and usually involves native valves of the heart. It causes life-threatening events such as rupture of cardiac valve or cerebral or pulmonary embolism due to necrosis on the endocardial tissue involved by the bacteria. Antibiotic therapy without cardiac surgery or delayed cardiac surgery usually follows a fatal course in S.lugdunensis endocarditis. In this report the first case of S.lugdunensis endocarditis from Turkey was presented. A 37 years-old man was admitted to the emergency department with a 2-weeks history of fever chills and accompanying intermittent pain on the left side of the thorax. Other than recurrent folliculitis continuing for 20 years, his history was unremarkable. Echocardiography revealed vegetation on the mitral valve of the patient and vancomycin plus gentamicin were initiated with the diagnosis of IE. All blood cultures (5 sets) taken on admission and within the initial 48 hours of the antibiotic therapy yielded S.lugdunensis. According to the susceptibility test results, the antibiotic therapy was switched to ampicillin-sulbac-tam plus rifampin. Blood cultures became negative after the third day of therapy, however, cardiac failure was emerged due to rupture of mitral valve and chorda tendiniea on the 12 th day of the therapy. Cardiac surgery revealed that mitral valve and surrounding tissue of the valve were evidently necrotic and fragile, anterior leaflet of the mitral valve was covered with vegetation, posterior leaflet and chorda tendiniea were ruptured. Vegetation was removed and the destructed mitral valve was replaced with a mechanical valve. Vegetation culture remained sterile, however, antibiotics were switched to vancomycin plus rifampin due to persistent fever on the 21 st day of the therapy (9 th day of operation). Fever resolved four days after the antibiotic switch. Antibiotics were stopped on the 9 th weeks of admission and the patient was discharged. He had no problem in follow-up controls for one year. In conclusion, proper antibiotic therapy combined with early cardiac surgery seems to be the optimal therapeutic approach in IE caused by S.lugdunensis.

Upon isolation of the first vancomycin resistant enterococcus (VRE) from the urine sample of a nine months old patient in pediatric unit of Van Yuzuncu Yil University Hospital (located in eastern part of Turkey), we aimed to search for the presence of VRE isolates in the unit, to determine the resistance genotypes and to evaluate the clonal relationships among isolates. A total of 28 rectal swabs and 28 skin swabs from the patients, 12 skin swabs from the staff giving care to the patients, 15 skin swabs from the mothers of the patients and 96 environmental samples from the pediatric unit were screened. Antibiotic susceptibilities were tested and the resistance genotypes were determined. Molecular typing of the isolates was performed using pulsed-field gel electrophoresis (PFGE). Apart from the first case, 13 more VRE isolates, one being a clinical isolate from the urine of a patient and 12 isolates from the screening samples (8 rectal swabs, one skin swab and three swabs from patients' beds) were obtained. All of the isolates were identified as Enterococcus faecium with similar antibiotic susceptibility patterns. VanA gene was present in all of the isolates. PFGE demonstrated two major clones and five clones closely related with the major ones. This was the first VRE isolation and colonization reported in our region. The isolates belonged to more than one clone. Currently, VRE did not seem to be a significant pathogen in Turkey, however, there may be an underestimation of the problem and continuous surveillance studies should be undertaken in every region.

In this study, carried out between November 2006 and September 2007, amebic cysts were observed in 44 (0.37%) out of a total of 1720 stool specimens which were examined by direct microscopy. Entamoeba histolytica specific antigen was investigated with ELISA in the specimens in which cysts were observed. Specific antigen was detected in 26 (59.1%) of these specimens. The diagnosis of amoebiasis for the patients whose ELISA tests were positive was confirmed and the appropriate therapy was immediately begun. This prediagnosis was abandoned for patients whose test results were "negative". Because of the low sensitivity of direct microscopy in confirming the prediagnosis of amoebiasis, it is necessary to perform ELISA on the specimens in order to determine whether the patient should be treated or to prevent patients from being given an unnecessary treatment.

Stenotrophomonas maltophilia is an important nosocomial pathogen in hospitalized patients, particularly those with prior broad-spectrum antibacterial therapy. The microorganism mainly infects severely ill, debilitated patients and is most frequent in immunocompromised hosts. A prominent feature of this organism is its resistance to multiple antibiotics including ß-lactam agents, carbapenems and aminoglycosides. Community-acquired infection with Stenotrophomonas maltophilia is reported rarely. This is the first report of a child patient diagnosed with septic arthritis due to Stenotrophomonas maltophilia.

Infective endocarditis has variable clinical presentations and may present with rheumatologic manifestations. Infective endocarditis due to high level aminoglycoside resistant enterococci represents a severe therapeutic challenge as none of the currently recommended treatment regimens are bactericidal against these isolates. In this report, a case of infective endocarditis with double aetiology, high level aminoglycoside resistant Enterococcus faecalis together with methicillin-resistant coagulase-negative staphylococci (MR-CNS), presenting with leukocytoclastic vasculitis and rapidly progressive glomerulonephritis, has been presented. A 48-years-old woman was admitted to our hospital with malaise and non-pruritic purpural rush on her lower extremities. On admission she had no fever or leukocytosis. Skin biopsy showed leukocytoclastic vasculitis and steroid therapy was started. On 12th day of admission rapidly progressive glomerulonephritis was diagnosed and she received plasmapheresis and haemodialysis support. Transthoracic echocardiography (TTE) demonstrated 1 × 1.5 cm vegetation on the mitral valve. An initial diagnosis of infective endocarditis was made and empirical treatment with vancomycin and gentamicin was started. All blood cultures yielded high level aminoglycoside resistant E. faecalis and additionally two of them yielded MR-CNS. Vancomycin was administered in combination with high dose ampicillin and repeated blood cultures taken after administration of ampicillin, revealed no growth. The patient remained afebrile, renal functions improved and a repeat TTE done on 20th day of ampicillin therapy showed waning of the vegetation. On 42nd day of treatment repeat TTE showed new vegetation on the mitral valve and severe valve insufficiency, so the patient was scheduled for mitral valve replacement. She was treated for 12 weeks with vancomycin and ampicillin and recovered successfully. In conclusion; infective endocarditis should be considered in the differential diagnosis of leukocytoclastic vasculitis and rapidly progressive glomerulonephritis. Physicians should document their treatment outcomes and experience with high level aminoglycoside resistant enterococcal infective endocarditis, which is a therapeutic challenge, so that the best therapeutic options can be identified.

Between 1990-1994, legal investigations, autopsy, toxicology, histopathology and alcohol reports of 2740 cases whose autopsies were performed at Council of Forensic Medicine İzmir Group Chairmanship were evaluated. Two hundred fifthy three cases who died due to poisoning were evaluated according to age, sex, origin and toxicologic substance. İt was detected as they were died due to toxic substances, were examined. Most of the cases were in 20-29 age group (24.1%) and male (62.9%). İt was detected that primary origin was silicide (60.9%). The second cause was accidental intoxications (29.6%). The most frequent toxic substance vvhich detected in bloods of cases were insecticides (48.2%), second was carbon monoxide (26.5%)., Çalışmamızda Adli Tıp Kurumu İzmir Grup Başkanlığı Morg İhtisas Dairesi'nde 1990-1994 yılları arasında otopsisi yapılan 2740 olguya ait adli tahkikat, otopsi, toksikoloji, histopatoloji ve alkol raporları incelenmiştir. Yapılan incelemelerde çeşitli toksik maddelere bağlı olarak öldükleri saptanan 253 olgu çalışma kapsamına alınarak olguların yaş, cinsiyet, orijin ve zehirlendikleri maddeler gibi toksikolojik açıdan önemli özellikleri değerlendirilmiştir. Olguların çoğunluğu 20-29 yaş grubu (%24.1) ve erkekti (%62.9). Orijin olarak ilk sırayı intiharlar alırken (%60.9) bunu kaza sonucu zehirlenmelerin takip ettiği, toksik madde olarak da en sık insektisidlerin (%48.2), ikinci sırada ise karbonmonoksitin (%26.5) yer aldığı saptandı.

The purpose of this study was to evaluate the comsumption of concentrated fruit juice by household, and determine the socio-economic factors that affect the level of comsumption. For this purpose, data was collected from a survey of 225 households in Adana in February 1997. A Tobit model was used in the analysis to determine the effects of various socio-economic variables on consumption. It was concluded that four variables are significant on househod fruit juice purchase. These are: the mothers' status, household income, the number of teenagers in the household, and the mother's education level. Two of these factors were found to strongly influence comsumption: the number of teenagers in the household (a positive effect) and the mother's level of education (negative effect).