An evaluation of the effect of ertapenem in rats with sepsis created by cecal ligation and puncture.

BACKGROUND: Intra-abdominal adhesions are still a major problem which is expected to be reduced by the provision of bacterial decontamination. Various antibiotics have been used to prevent the formation of adhesion in the septic abdomen. This study aims to investigate the efficacy of ertapenem in sepsis of rats induced by cecal ligation and puncture. METHODS: Twenty-eight Wistar rats were divided into four groups randomly. In all groups, bacterial peritonitis was created by cecal ligation and puncture method. Group 1 was considered as sham group. Groups 2, 3 and 4 were given, respectively, saline, a single dose of ertapenem and a dose of ertapenem intraperitoneally every day. Intra-abdominal adhesions were assessed seven days after surgery by histopathological examination. Microbiological examination was performed through the ascites obtained. TNF-α was measured from blood taken from rats. RESULTS: Adhesion score decreased significantly by the application of ertapenem (p<0.001) and fibrosis scores were found to be significantly lower (p=0.005). Among all groups, the relationship between the decrease in the number of colonies and antibiotics application was not statistically significant (p=0.109). No statistically significant difference was found between the group given a single dose of ertapenem and the group given multiple ertapenem (p=1). CONCLUSION: Peritoneal lavage with ertapenem appears to be effective in preventing the adhesion in the septic abdomen. As no difference was detected at the end of a single dose and multiple-dose administration of antibiotics in the adhesion scores, a single dose after surgery seems to be enough. The findings suggest that the results should be evaluated in a clinical trial.

Hepatitis B and Hepatitis C in prisons: a prevalence study.

PURPOSE: Prisons, which are hazardous places for various contagious diseases, carry additional risks for HBV and HCV because of the communal lifestyle (common use of tools like razor blades, tattoo applications, intravenous drug use and homosexual intercourse). The purpose of this paper is to determine the prevalence of HBV and HCV, and also provide information for prisoners in this respect. DESIGN/METHODOLOGY/APPROACH: This study included 180 prisoners from the Buca F-Type Closed Prison, and 180 prisoners from the Foça Open Prison in Turkey. After the training seminars, serum levels of HBsAg, anti HBs, anti HBc total and anti HCV in the prisoners were assessed using the MICROELISA method. FINDINGS: All the prisoners were male. The mean age was 40(21-73) years. According to the results of 360 prisoners from both prisons, 17 (4.7 percent) prisoners were HBsAg positive and were diagnosed as HBV. Isolated anti HBs was positive in 33 (9.1 percent) prisoners who had been previously vaccinated. In 25 (6.9 percent) prisoners isolated Anti HBc total was positive, and in 61 (16.9 percent) prisoners both Anti HBs and Anti HBc total was positive in those who were considered to be recovered from the HBV. Anti HCV was positive in 2 (0.5 percent) prisoners; the process was repeated twice, and found to be repeatedly positive. Coinfection of HBV and HCV was not detected. RESEARCH LIMITATIONS/IMPLICATIONS: In this study, the prevalence of HBV and HCV was determined to be similar to those in the normal population. However, it is not expedient to generalize this result and apply it to all prisons. For the sake of public health, prisons should be scanned for infectious diseases, and vaccinations must be applied as necessary, in order to provide protection. ORIGINALITY/VALUE: It is a study to determine the prevalence of HBV and HCV in the prisoner population, which constitute one of the risk groups because of the communal lifestyle (common use of some tools such as the razor blade, tattoo applications, intravenous drug use and homosexual intercourse), and to compare the results with other groups in Turkey and globally.

Clinical manifestations, complications, and treatment of brucellosis: evaluation of 72 cases.

AIM: Brucellosis is an important disease in developing countries. We aimed to determine the epidemiologic, clinical, and laboratory characteristics of brucellosis, which still has a high morbidity in Turkey. MATERIALS AND METHODS: Seventy-two patients with brucellosis, monitored at our clinic from January 2004 to July 2010, were reviewed retrospectively. RESULTS: The average age was determined to be 44.8 ± 18 years, and 40 of the patients were female (55.6%). The most frequent transmission route was the use of raw milk and dairy products, in 45 of the patients (62.5%). The most frequent complaints were joint pain, high fever, weakness, low back pain, and gastrointestinal symptoms, whereas the most frequent physical examination findings were fever, osteoarticular involvement, splenomegaly, hepatomegaly, and lymphadenopathy. All of the patients were positive for Rose Bengal testing. The standard tube agglutination titer was 1/160 or higher in 64 (88.9%) patients. Brucella melitensis was isolated from blood cultures of 13 (18.1%) patients and bone marrow cultures of 7 (9.7%) patients. Complications of sacroiliitis in 6 (8.3%), spondylodiscitis in 4 (5.6%), endocarditis in 2 (2.8%), neurobrucellosis in 1 (1.4%), and epididymo-orchitis in 1 (1.4%) of the patients were observed. CONCLUSION: Brucellosis has various clinical presentations. It should be included in the differential diagnosis of high fever and joint pains in endemic countries.

The evaluation of the distribution of yeast like fungi 'Candida Species' at a tertiary care center in western Turkey.

OBJECTIVE: Candida infections have increased due to transplant patients, prolonged ICU stay and invasive procedures. The most common isolated strain is C. albicans. The aim of this study was to evaluate the distribution of Candida isolates at Tepecik Education and Research Hospital. MATERIALS AND METHODS: Yeast like fungi were isolated between 13.01.2010 and 19.08.2011 at Mycology Laboratory. The identification was done by conventional methods and carbohydrate assimilation profile using the ID32C identification system (Biomerieux, France). RESULTS: Yeast like fungi were isolated from 337 clinical specimens. They consisted of urine, blood culture, respiratory specimen and wound. The most isolated yeast strains were C.albicans (38.6%), C.tropicalis (13.9%), C. parapsilosis (28.4%), C.glabrata (7.4%), C.krusei (3.8%). CONCLUSION: Recently there is an increment in Candida infections. In this study the most common strain was C.albicans and the rate C. glabrata and C. krusei isolates were lower than expected. C. parapsilosis was the most isolated strain in blood cultures and this may be due to invasive procedures and the use of indwelling catheters.

Disseminated candidiasis developing during prophylaxis with fluconazole in a small-intestine transplant recipient.

A 31-year-old man underwent immunosuppressive treatment and was treated with 150 mg per day of prophylactic oral fluconazole after receiving a small-intestine transplant. The patient had acute rejection by the end of the first week after the transplant. Endoscopic examination showed white plaques. In blood and urine cultures, growth of Candida albicans was detected. Biopsy specimens showed high levels of conidia and hyphae in all regions. Intravenous treatment with caspofungin was started for the patient. Candidal findings had regressed on follow-up endoscopy. However, the patient died 3 months after transplant because of the effects of immunosuppression on his bone marrow and the development of disseminated intravascular coagulation. Candida species are the most common cause of invasive fungal infections that develop after solid-organ transplant. Following transplant, candidemia may develop during systemic antifungal treatment with a high level of mortality.

Chronic hepatitis B with type I diabetes mellitus and autoimmune thyroiditis development during interferon alpha therapy.

Interferon alpha is a molecule frequently used in the treatment of chronic hepatitis B, C, and D, with immunomodulatory and antiviral activity. It is also used in some cancer types. It has been widely claimed that interferon alpha triggers autoimmunity, with its broad adverse effect profile. Here we present the case of a 29-year-old male patient with chronic hepatitis B diagnosis who developed type 1 diabetes mellitus and autoimmune thyroiditis during treatment with interferon alfa-2b. Within four months of initiation of treatment with interferon alfa-2b, the patient presented to our clinic with dry mouth, urinary frequency (8 to 10 times per day), drinking plenty of water, night time urination, and tiredness. He was admitted to the clinic when his fasting blood glucose level was detected to be high. After examinations, the patient was diagnosed with type 1 diabetes and autoimmune thyroiditis and began to receive treatment with insulin and propranolol. Fasting blood glucose levels were controlled and thyroid hormones decreased to normal levels within one month after the treatments began. For patients who will receive treatment with interferon alpha, especially those individuals with chronic hepatitis, pancreatic autoantibodies should be checked and close monitoring should be performed as there may be glucose tolerance impairment in patients with high titers. In addition, follow-up with thyroid function tests should be performed prior to and during the treatment.

Central nervous system aspergillosis in an immunocompetent patient.

Aspergillus sp. is a fungus that is very common in nature and may cause invasive disease with high mortality, especially in immunosuppressed patients. Here we present a case of central nervous system (CNS) aspergillosis in a previously healthy immunocompetent patient. A 23-year-old female was admitted to hospital with the complaints of headache, blurred vision, and double vision. In her cranial magnetic resonance imaging, abscess and paranchymal edema were observed in the left frontal lobe, and biopsy was performed with endoscopic nasal operation. The pathology result was consistent with aspergillus infection. It should be remembered that although CNS aspergillosis generally occurs in immunosuppressed patients, it may also rarely be diagnosed in immunocompetent individuals.

Entecavir therapy in Turkish adult patients with chronic hepatitis B: one-year results from Izmir province, Turkey.

BACKGROUND: In the present study, we aimed to present the initial results of chronic hepatitis B patients who received entecavir (ETV) therapy in our hospital in Izmir, Turkey. METHODS: A total of 52 patients were enrolled in the study. ETV was given in a dosage of 0.5 mg/day and 1 mg/day to 50 patients without Lamivudine/Adefovir (LAM/ADV) resistance and to 2 patients with LAM resistance, respectively. ETV was given in a dose of 0.5mg/day every three days to one patient with a renal transplant. The treatment duration was 48 weeks. RESULTS: Out of a total of 52 patients, 23 (44.23%) were hepatitis B e antigen (HBeAg)-positive, and 29 (55.77%) of them were HBeAg-negative. In 29 HBeAg-negative patients, early biochemical and virological responses were 82.6% and 100%, respectively. These responses were 97% and 79.3% in the 12th month. In HBeAg-positive patients, early biochemical and virological responses were found to be 78.3% and 82.6%, respectively. They were 100% and 52.2% in the 12th month. HBeAg s oconversion developed in 4.5% of HBeAg-positive patients. CONCLUSIONS: According to our one-year ETV treatment results, both HBeAg-negative and -positive patients had high biochemical and virological response rates. Their HBeAg seroconversion rate was 4.5%. In conclusion, more studies of longer duration are needed to understand the required duration of treatment, to assess its long-term effectiveness, and to check the resistance and side effects of ETV. There is also a need to have late-phase results after treatment.

The effectiveness of nucleoside analogues in chronic hepatitis B patients unresponsive to interferon therapy: our clinical trials for one year.

BACKGROUND AND AIMS: We aimed to evaluate the effectiveness of nucleoside analogues such as Lamivudine, Adefovir,Entacavir, and Tenofovir in patients with chronic hepatitis B who failed to respond to interferon therapy and relapsed. MATERIALS AND METHODS: We followed a total of 73 patients with hepatitis B in the hepatitis outpatient clinic in our hospital. The patients subsequently received nucleoside analogues therapy and their treatment data were evaluated retrospectively. The biochemical and virological response rates were evaluated at 3 and 12 months, and we compared these results with the results of treatment-naive patients. RESULTS: There were 29 (39.7%) HbeAg-positive and 44 (60.3%) HbeAg-negative patients, and their mean age was 35.8 (±13.4) years. Of these patients, 33, 18, 13 and 9 received Entacavir, Tenofovir, Lamivudine, and Adefovir treatment,respectively. In HbeAg-negative patients, at 3 months the biochemical and virological response (early response) rates were observed to be 91% and 98%), and at 12 months the two rates were 93% and 73%, respectively. In HbeAg-positive patients, the biochemical and virological response rates at 3 months were 83% and 97%, and the rates at 12 months were 90% and 48%, respectively. CONCLUSIONS: In CHB therapy with treatment-resistent patients, nucleoside analogues may be preferable. There are disadvantages to nucleoside analogues, such as a risk of developing resistance during therapy, reduced HBeAg seroconversion compared to interferons, and the therapy's ambiguous duration. In our study, in HbeAg-negative patients who received nucleoside analogues, a lower biochemical response rate was detected in patients with 1 year of Lamivudine therapy compared to other therapies. For HbeAg-positive patients, the virological response rate was higher in 1 year of Tenofovir therapy than with other therapies.

[Case report: two imported Plasmodium falciparum cases]. / Olgu sunumu: yurtdisi kaynakli iki Plasmodium falciparum olgusu.

A 23 year-old Pakistani man presented at the emergency clinic of Tepecik Research and Training Hospital with the symptoms such as fever (39.3 degrees C), blurred consciousness, subicteric sclera and splenomegalia. In the laboratory examination, a slightly increase of the liver enzymes and anemia were detected. The gametocytes and trophozoites of Plasmodium falciparum were seen in a bone marrow aspiration and treatment was started with quinine and doxycycline but since resistance was detected to these medicines, mefloquine was chosen as alternative therapy. He was cured and discharged. The second case was also a Pakistani 20-year old man and he was a friend of first case. He presented at our hospital with the symptoms such as fever (39.4 degrees C), closed consciousness, icteric sclera and systolic soufflé in all cardiac foci. During the laboratory examination, severe anemia and trombocytopenia, and an increase in the liver enzymes were found. P. falciparum gametocytes and young trophozoites were seen in a blood smear stained with Giemsa. For treatment, mefloquine was used but unfortunately the patient died due to an adult respiratory distress syndrome (ARDS) complication. In this study, two cases with different clinical manifestations were presented to emphasize the importance of timing in starting the correct treatment.