Psychiatric morbidity and different treatment modalities in children with chronic kidney disease.

INTRODUCTION: Chronic kidney disease (CKD) is a potentially life-threatening condition leading to various psychosocial problems associated with different treatment modalities in addition to their medical advantages and disadvantages. The aim of this study was to evaluate the psychiatric morbidity in children with CKD in terms of different treatment modalities in comparison to healthy peers. In addition, parental attitudes and psychiatric symptoms in this group of mothers were examined. POPULATION AND METHODS: A matched cohort study including 66 children with CKD (21 renal transplantation, 27 dialysis, 18 conservative treatment) and 37 healthy age- and sex-matched controls were evaluated. Children filled out the Children's Depression Inventory, the State-Trait Anxiety Inventory, and the Parental Attitude Scale, and the mothers filled out the Symptom Checklist-90-R. The Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime Version was used for psychiatric diagnosis. RESULTS: The overall depression scores in children and the mothers' overall symptom severity index were significantly higher in the CKD group: 40.9% of children in the CKD group were diagnosed with a psychiatric disorder, while the corresponding figure for the control group was 16.2%. The in-group comparison of the CKD group failed to detect any significant difference between the three treatment modalities. CONCLUSION: The results support the findings of research showing that CKD has high psychiatric morbidity. It is important to include psychosocial and psychiatric assessments in the evaluation processes of different treatment modalities in CKD.

R202Q/M694V as novel MEFV gene mutations in chronic periodontitis and familial Mediterranean fever.

BACKGROUND AND OBJECTIVE: Familial Mediterranean fever (FMF) and chronic periodontitis are inflammatory diseases leading to an increase in the number of inflammasomes. To date, no published studies have reported on mutations in the Mediterranean fever (MEFV) gene in patients with chronic periodontitis, although the roles of MEFV gene mutations in FMF and FMF-associated amyloidosis (FMF-A) are well known. Therefore, the aim of this study was to evaluate the frequencies of MEFV gene mutations and serum amyloid A (SAA) and high-sensitivity C-reactive protein (hs-CRP) levels in patients with chronic periodontitis, FMF and FMF-A. MATERIAL AND METHODS: The study population included 122 patients with FMF and 128 subjects who were systemically healthy. Clinical periodontal parameters, including the plaque index, gingival index, probing pocket depth, clinical attachment level and percentage of bleeding on probing were recorded. Blood samples were obtained from patients with FMF and systemically healthy controls, and all mutations located on exons 2 and 10 of the MEFV gene were analyzed by DNA Sanger Sequencing, which is the gold standard. SAA and high-sensitive CRP levels were also assessed. RESULTS: Mean gingival index, percentage of bleeding on probing, probing pocket depth and clinical attachment level, and the levels of SAA and hs-CRP were higher in the FMF-A group than those in the FMF and control groups. The two most relevant mutations in patients with FMF were heterozygous M694V (46.2%), and heterozygous R202Q (32.7%). The frequencies of the homozygous M694V and R202Q mutations in the FMF-A group were 53.8% and 46.1%, respectively. The complex R202Q/M694V homozygous state led to an increased risk of chronic periodontitis (odds ratio: 3.6), and FMF-A (odds ratio: 7.6). CONCLUSION: This is the first study to report the R202Q mutation in patients with periodontitis. Furthermore, the MEFV gene-mediated inflammatory pathway increased serum acute phase reactants, and the changes in the R202Q and M694V could play a role in inflammatory-genetic diseases, such as FMF, FMF-associated amyloidosis and chronic periodontitis.

Spread of carbapenem-resistant international clones of Acinetobacter baumannii in Turkey and Azerbaijan: a collaborative study.

Epidemic clones of Acinetobacter baumannii, described as European clones I, II, and III, are associated with hospital epidemics throughout the world. We aimed to determine the molecular characteristics and genetic diversity between European clones I, II, and III from Turkey and Azerbaijan. In this study, a total of 112 bloodstream isolates of carbapenem-resistant Acinetobacter spp. were collected from 11 hospitals across Turkey and Azerbaijan. The identification of Acinetobacter spp. using conventional and sensitivity tests was performed by standard criteria. Multiplex polymerase chain reaction (PCR) was used to detect OXA carbapenemase-encoding genes (bla OXA-23-like, bla OXA-24-like, bla OXA-51-like, and bla OXA-58-like). Pulsed-field gel electrophoresis (PFGE) typing was used to investigate genetic diversity. The bla OXA-51-like gene was present in all 112 isolates, 75 (67 %) carried bla OXA-23-like, 7 (6.2 %) carried bla OXA-58-like genes, and 5 (4.5 %) carried bla OXA-24-like genes. With a 90 % similarity cut-off value, 15 clones and eight unique isolates were identified. The largest clone was cluster D, with six subtypes. Isolates from clusters D and I were widely spread in seven different geographical regions throughout Turkey. However, F cluster was found in the northern and eastern regions of Turkey. EU clone I was grouped within J cluster with three isolates found in Antalya, Istanbul, and Erzurum. EU clone II was grouped in the U cluster with 15 isolates and found in Kayseri and Diyarbakir. The bla OXA-24-like gene in carbapenemases was identified rarely in Turkey and has been reported for the first time from Azerbaijan. Furthermore, this is the first multicenter study in Turkey and Azerbaijan to identify several major clusters belonging to European clones I and II of A. baumannii.

Effects of ozone and photo-activated disinfection against Enterococcus faecalis biofilms in vitro.

OBJECTIVES: The purpose of this study was to compare the antibacterial effects of gaseous ozone (O3) and photo-activated disinfection (PAD) methods against Enterococcus faecalis (E. faecalis) biofilms. MATERIALS AND METHODS: Sixty-five human mandibular premolars with straight root canals were selected. After root canal preparation, the samples were sterilized and placed into eppendorf tubes with 1 mL brain heart infusion broth containing 1.5×10(8) colony-forming units (CFUs)/mL of E. faecalis. The contaminated samples were then divided into four groups (n=15) according to the disinfection method used: Group 1, Saline (positive control); Group 2, NaOCl (negative control); Group 3, Gaseous O3; and Group 4, PAD. Three non-contaminated teeth were used to control the infection and sterilization process. The CFUs were counted and the data were analyzed statistically. RESULTS: There was a statistically significant difference between the experimental and control groups (P<0.05). The saline group had the highest number of remaining microorganisms. Complete sterilization was achieved in the 2.5% NaOCl group. There were no statistically differences between PAD and gaseous O3 (P>0.05). CONCLUSION: Both PAD and gaseous O3 have a significant antibacterial effect on infected root canals. However, 2.5% NaOCl was superior in terms of its antimicrobial abilities compared with the other disinfection procedures.

Fetal nasal bone length at 11(+0) - 13(+6) weeks of gestation: an evaluation of 554 consecutive cases.

PURPOSE OF INVESTIGATION: To develop a nomogram for estimating nasal bone length (NBL) at 11(+0) - 13(+6) weeks of gestation in 554 consecutive cases and to determine the value of NBL measurement in screening for chromosomal abnormalities. MATERIALS AND METHODS: NBL and crown-rump length (CRL) were examined in 554 fetuses at 11(+0) - 13(+6) weeks' gestation. A nomogram for NBL was developed with data from 479 healthy fetuses in which fetal profile examination was possible. Reference values, including percentiles, weie calculated for each gestational age. RESULT: A linear correlation was noted between CRL and NBL in healthy fetuses at 11(+0) - 11(+6), 12(+0) - 12(+6) and 13(+0) - 13(+6) weeks of gestation. Mean NBL was 2.18 +/- 0.53 mm, 2.46 +/- 0.45 mm, and 2.91 +/- 0.55 mm in healthy fetuses, for these time frames, respectively. NBL increased significantly with CRL from respective means of 2.26 +/- 0.43, 2.60 +/- 0.48, 2.77 +/- 0.43, and 3.16 +/- 0.52 mm at 45 - 54.9, 55 - 64.9, 65 +/- 74.9, and 75 - 84 mm. CONCLUSION: The authors developed a NBL nomogram with data from normal, healthy Turkish fetuses at 11(+0) - 13(+6) weeks of gestation. These reference ranges may prove useful in prenatal screening and diagnosis of syndromes known to be associated with nasal hypoplasia.

Evaluating sleep characteristics in intensive care unit and non-intensive care unit physicians.

Healthcare workers' cognitive performances and alertness are highly vulnerable to sleep loss and circadian rhythms. The purpose of this study was to investigate the changes in sleep characteristics of intensive care unit (ICU) and non-ICU physicians. Actigraphic sleep parameters, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Hamilton Depression Rating Scale were evaluated for ICU and non-ICU physicians on the day before shift-work and on three consecutive days after shift-work. Total sleep time, sleep latency, wakefulness after sleep onset, total activity score, movement fragmentation index, sleep efficiency, daytime naps and total nap duration were also calculated by actigraph. In the ICU physicians, the mean Pittsburgh Sleep Quality Index score was significantly higher than the non-ICU physicians (P = 0.001), however mean Epworth Sleepiness Scale scores were not found significantly different between the two groups. None of the scores for objective sleep parameters were statistically different between the groups when evaluated before and after shift-work (P > 0.05). However in both ICU and non-ICU physicians, sleep latency was observed to be decreased within the three consecutive-day period after shift-work with respect to basal values (P < 0.001). Total sleep time, total activity score and sleep efficiency scores prior to shift-work were significantly different from shift-work and the three consecutive-days after shift-work, in both groups. Working in the ICU does not have an impact on objective sleep characteristics of physicians in this study. Large cohort studies are required to determine long-term health concerns of shift-working physicians.

Prevalence of Chlamydia trachomatis/Neisseria gonorrhoeae and human papilloma virus among women-at risk in the Aegian region of Turkey, and their knowledge about HIV/AIDS / Prevalencia de Chlamydia trachomatis/Neisseria gonorrhoeae y el virus del papiloma humano entre las mujeres en riesgo, y sus conocimientos sobre la VIH/SIDA, en la región egea de Turquía

BACKGROUND: The aim of this study was to determine the prevalence of selected sexually transmitted diseases (STDs) and the level of knowledge and attitudes regarding HIV/AIDS among Turkish brothel based sex-workers (SWs). SUBJECTS AND METHODS: A pre-designed questionnaire was administered to 199 SWs to obtain their sexual behaviours and their level of knowledge of HIV/AIDS. The specimens collected for C trachomatis/N gonorrhoeae and human papillomavirus (HPV) were tested using Gen-Probe PACE 2 and HPV-screening assays, respectively. RESULTS: Aproximatelly sixty-seven per cent of the SWs knew that condoms afforded protection against HIV/AIDS and 62% reported continued use of condoms. Although most of the SWs had heard about HIV/AIDS, thorough knowledge of transmission and prevention was lacking. The overall estimated rates for C trachomatis/N gonorrhoeae and HPV were 18.6% and 9.7%, respectively. CONCLUSION: There is a need for further studies to generate more data on the prevalence of STDs and the knowledge of STDs in this population.

ANTECEDENTES: El objetivo de este estudio es determinar la pevalencia de las enfermedades de trasmisión sexual (ETS) seleccionadas, y el nivel de conocimientos y actitudes en relación con el VIH/SIDA entre las trabajadoras sexuales (TS) en burdeles turcos. SUJETOS Y MÉTODOS: Se aplicó un cuestionario prediseñado a 199 trabajadoras sexuales a fin de revelar sus comportamientos sexuales y su nivel de conocimientos acerca del VIH/SIDA. Las muestras de C trachomatis/N gonorrhoeae y virus del papiloma humano (VPH) recogidas, fueron analizadas mediante la sonda genética conocida como Gen-Probe PACE 2 y ensayos de pesquisaje de VPH, respectivamente. RESULTADO: Aproximadamente sesenta y siete por ciento de las TS sabían que los condones daban protección contra el VIH/SIDA, y el 62% reportó uso continuado de condones. Aunque la mayor parte de las TS habían oído acerca del VIH/SIDA, les faltaban conocimientos cabales sobre la trasmisión y prevención de ETS. Las tasas generales estimadas de C trachomatis/N gonorrhoeae y VPH fueron 18.6% y 9.7%, respectivamente. CONCLUSIÓN: Es necesario realizar estudios ulteriores a fin de generar más datos acerca de la prevalencia de las ETS y los conocimientos acerca de ellas en esta población.

Prevalence and comorbidity of allergic eczema, rhinitis, and asthma in a city in western Turkey.

BACKGROUND: Allergic diseases co-occur in many patients. There is no published population-based epidemiologic study about allergic diseases in Turkey. OBJECTIVE: The aim of this population-based study was to investigate the prevalence of allergic eczema, allergic rhinitis, and asthma and their co-occurence in Manisa. METHODS: The sample size was calculated using an estimated prevalence of ever wheezing for the analyzed age group. Interviews were conducted with 725 children. The survey instrument consisted of a set of sociodemographic questions plus the questionnaire of the International Study of Asthma and Allergies in Childhood. RESULTS: The mean (SD) age of the children studied was 8.94 (5.16) years. The prevalence of ever having allergic eczema was 4.7% whereas that of current allergic eczema was 3.2%. Current allergic rhinitis and allergic conjunctivitis were present in 14.5% and 13%, respectively. Asthma was reported in 14.7% of the children older than 3 years of age while the prevalence of physician-diagnosed asthma was 7.9%. The burden of allergy was 27.1%. The prevalence of concomitant eczema and rhinitis was 1.9%. Among children aged between 3 and 17 years, 1.5% and 4.7% had asthma along with eczema and rhinitis respectively. Asthma was significantly more common in children with rhinitis (31.5% vs 11.8%; P < .01; odds ratio [OR], 3.45). Asthma was diagnosed in 28.1% of children with eczema and 14% of children without eczema (P = .03; OR, 2.41). CONCLUSIONS: Atopic diseases seem to significantly increase the risk of developing another atopic disease with ORs that range from 2.4 to 3.4.

Prevalence of Chlamydia trachomatis/Neisseria gonorrhoeae and human papilloma virus among women-at risk in the Aegian region of Turkey, and their knowledge about HIV/AIDS.

BACKGROUND: The aim of this study was to determine the prevalence of selected sexually transmitted diseases (STDs) and the level of knowledge and attitudes regarding HIV/AIDS among Turkish brothel based sex-workers (SWs). SUBJECTS AND METHODS: A pre-designed questionnaire was administered to 199 SWs to obtain their sexual behaviours and their level of knowledge of HIV/AIDS. The specimens collected for C trachomatis/N gonorrhoeae and human papillomavirus (HPV) were tested using Gen-Probe PACE 2 and HPV-screening assays, respectively. RESULT: Aproximately sixty-seven per cent of the SWs knew that condoms afforded protection against HIV/AIDS and 62% reported continued use of condoms. Although most of the SWs had heard about HIV/AIDS, thorough knowledge of transmission and prevention was lacking. The overall estimated rates for C trachomatis/N gonorrhoeae and HPV were 18.6% and 9.7%, respectively. CONCLUSION: There is a need for further studies to generate more data on the prevalence of STDs and the knowledge of STDs in this population.

Serum her-2/neu and survivin levels and their relationship to histological parameters in early-stage breast cancer.

This study was conducted to investigate the serum levels of her-2/neu and survivin in patients with early-stage breast cancer and their relationship with known histological parameters. Forty-one patients with early-stage breast cancer were investigated. Serum samples were collected from patients on their first admission before adjuvant chemotherapy, and from healthy controls. Serum her-2/neu and survivin levels were determined using an enzyme-linked immunosorbent assay. There was no difference in the levels of serum her-2/neu and survivin between the breast cancer patients and the control group. Serum her-2/neu concentration showed moderate correlations with disease stage and the Ki-67 level, and the serum survivin level showed a moderate correlation with progesterone receptor concentration. Serum levels of her-2/neu and survivin were not significantly related to age and histological parameters in patients with early-stage breast cancer. However, much research continues on the prognostic value of serum her-2/neu and survivin levels, and important new knowledge may ultimately emerge.

Pulmonary hypertension in patients with chronic renal failure.

BACKGROUND: Many etiologies causing pulmonary hypertension (PH) have been reported, and one of the background disease seen with patients with PH is chronic renal failure (CRF); however, the pathogenesis of PH in this group of patients is not explained satisfactorily. OBJECTIVES: The aims of this study were to evaluate the incidence of unexplained PH among patients with CRF and to suggest possible etiologic factors. METHODS: Two hundred and eleven patients with CRF were evaluated and the ones who have comorbid conditions that cause PH were excluded. Pulmonary arterial pressure (PAP) and cardiac functions were evaluated by Doppler echocardiography. Arteriovenous fistula (AVF) flow was measured by Doppler sonography. The patients were followed for at least 6 months. RESULTS: Forty-eight CRF patients (20 males, 28 females) were included: 23 were predialysis patients, and 25 patients received hemodialysis via AVF. Patients were followed for 7.5 +/- 1.01 months. Systolic PAP >35 mm Hg was found in 56% (14/25) of patients receiving hemodialysis (36.8 +/- 10.7 mm Hg) and in 39.1% (9/23) of predialysis patients (29.5 +/- 9.5 mm Hg). The parathyroid hormone level, cardiac output values and CRF duration were found to be increased in patients with elevated systolic PAP (p < 0.05). AVF flow and AVF duration were positively correlated with systolic PAP in patients receiving hemodialysis (p < 0.05). There was a negative correlation between systolic PAP and residual urine volume (p < 0.05). AVF compression in hemodialysis patients decreased systolic PAP from 36.8 +/- 10.7 to 32.8 +/- 10.5 mm Hg. Systolic PAP values were increased at the end of the study in the predialysis group, whereas they were decreased at the end of the follow-up in the hemodialysis group (36.9 +/- 10.5 and 32.04 +/- 10.5 mm Hg, respectively). CONCLUSIONS: This study demonstrates a high incidence of PH among patients with CRF. CRF duration, AVF flow, parathyroid hormone level and cardiac output may be involved in the pathogenesis of PH. The effective hemodialysis and dry weight reduction decreased systolic PAP values.

Comparison of antimicrobial effects of dexmedetomidine and etomidate-lipuro with those of propofol and midazolam.

BACKGROUND AND OBJECTIVES: The aim of our study was to investigate the antimicrobial effects of dexmedetomidine and etomidate-lipuro, and to compare these effects with those of midazolam and propofol on Staphylococcus aureus, Escherichia coli, Pseudomonas aeroginosa, Acinetobacter baumannii and extended-spectrum beta-lactamase Escherichia coli ( E. coli ESBL). METHODS: All hypnotic dilutions were exposed to micro-organisms for 0, 30, 60, 120 and 240 min at room temperature in vitro. The inoculums taken from diluted suspensions were re-inoculated on blood agar and incubated for 18-24 h at 35 degrees C after which a count of the colonies was compared. RESULTS: Midazolam reduced the viable cells of S. aureus at 30, 60, 120 and 240 min, and also completely inhibited the growth of E. coli, P. aeroginosa, A. baumannii and E. coli ESBL. Dexmedetomidine, etomidate-lipuro and propofol, however, did not inhibit any of the micro-organisms tested. CONCLUSION: In vitro, midazolam had an antimicrobial effect on E. coli, P. aeroginosa, A. baumannii and E. coli ESBL. Like propofol and dexmedetomidine, etomidate-lipuro had no antimicrobial effect on any of the micro-organisms tested.

Is there an association between clinical symptoms and intestinal parasitic infections?

Intestinal parasitic infections are major causes of childhood diseases in rural regions. The significant causes of this problem are the insufficient resources to improve the infrastructure in these regions and inadequate health services in both the diagnosis and treatment of diseases. The aim of this study was to assess the association between intestinal parasitic infections and clinical symptoms of infected children. Cellophane tape and stool samples of 100 children, aged between 7-10 years, from two villages of Manisa city, were examined for intestinal parasites and their symptoms were recorded. Although some symptoms, such as abdominal pain, anorexia and fatigue were found to be common in infected children, no significant relationship was found between symptoms and intestinal parasitic infections.

The venous drainage of the heart in porcupines (Hystrix cristata).

The venous drainage of the heart in porcupines (Hystrix cristata) was investigated. Each of the five adult porcupines (three males, two females) was injected with a coloured latex mixture via the V. cava caudalis for the demonstration of the cardiac veins. The dissection of the specimens revealed that the venous drainage of the heart in porcupines was made by the V. cordis magna, V. distalis ventriculi sinistri, V. proximalis ventriculi sinistri, V. cordis caudalis (the left marginal vein), V. cordis media and Vv. cordis dextrae. The cardiac veins were observed in a subepicardial course on the heart except for the R. interventricularis paraconalis. The R. interventricularis paraconalis showed an intramyocardial course until the middle of the sulcus interventricularis paraconalis, and a subepicardial course after this point. The V. cordis magna and V. distalis ventriculi sinistri opened to the sinus coronarius. The V. cordis caudalis and the V. cordis media drained into the V. cava caudalis. The venous drainage of the conus arteriosus was made by the left V. coni arteriosi opening to the R. interventricularis paraconalis, and by the right V. coni arteriosi which continued to the Vv. cordis dextrae.

Case Report. Tinea pedis and onychomycosis in primary school children in Turkey.

A cross-sectional study was performed in two primary schools with different socioeconomic status in the suburban and central areas of Manisa, Turkey, in order to determine the prevalence of tinea pedis and onychomycosis. A full dermatological examination and a questionnaire on socioeconomic conditions were performed in a group of 785 randomly selected children aged 6-14. Of 9 clinically suspected tinea pedis and 4 onychomycoses cases, KOH examination (direct microscopy) and/or mycological cultures were positive in six boys, in whom Candida glabrata and C. tropicalis grew. Older age and higher number of siblings were found to be significant factors for fungal infection.

The anatomy of the arterial supply of the thoracic limb of the porcupine (Hystrix cristata).

The aim of this study was to investigate the anatomy of the arterial supply and branches of the thoracic limb of the porcupine. With this aim, five (three male and two female) adult porcupines were used. The vascular tree of the thoracic limb was injected through the common carotid arteries with coloured latex. The a. thoracica externa arose from the a. axillaris at the level of the fourth rib. It divided into two branches and went to the m. cutaneus trunci and the m. pectoralis ascendens. The a. subscapularis came off the a. thoracodorsalis. Later, the a. circumflexa humeri caudalis et cranialis, the three muscular branches and the a. circumflexa scapulae arose from the a. subscapularis. The a. profunda brachii arose together with the a. bicipitalis from the same truncus. The a. collateralis ulnaris left from the a. brachialis independently. Rete carpi dorsale was formed by the a. radialis. the r. carpeus dorsalis of the a. collateralis ulnaris and the a. interossea caudalis. Arcus palmaris profundus was formed by the r. profundus of the a. interossea caudalis and the r. palmaris profundus of the a. radialis. In conclusion, despite a partial resemblance to that in the rat, the distribution of the thoracic limb arteries in the porcupine was found to be completely different from that of other mammals. These findings represent, to our knowledge, the first study on the distribution of thoracic limb arteries in the porcupine.

[Tuhfetü'l-Tib, as a pioneer periodical of the medical history]. / Basili Tip Yayinlari Alaninin Oncülerinden Biri "Tuhfetü'l-Tib".

Tuhfetü'l-Tib is a Turkish medical history periodical published regularly every two weeks in Istanbul since December 27th, 1867. Its collection comprises totally 15 issues, every one of which is consisted of 16 pages with a hard cover, printed at the Maltepe Military Hospital printing press for more than seven months. As far as we know, Tuhfetü'l-Tib's last issue was dated on July 21st, 1868. The aim of its publication was to introduce contemporary medical knowledge by translating articles from the respected academic periodicals in the West. Among the issues wer have studied, twenty chapters were about gynecology, while twenty five ones about the newborn diseases. Tuhfetü'l-Tib is the second Turkish medical review ever printed in Turkey, succeeding Vakayi-i Tibbiye (1849). It is also the first periodical in Turkey, publishing articles on gynecology and pediatrics. Having played an important role in struggle for the Turkish education at the Imperial Medical School, it was issued on the basis of the principles defended by the Ottoman Association of Medicine.

Evaluation of rational antibiotic use.

The emergence of antibiotic resistant bacteria is a major problem throughout the world and a rational use of antibiotics is therefore very important. This study was performed to estimate the appropriateness of antimicrobial drug use in Celal Bayar University Hospital in Manisa. The data of all inpatients (n=937) between October and December 1998 were collected according to the Kunin and Jones criteria. Of the patients, 16.6% (n=156) were receiving antibiotics, and in 63.5, 23.0 and 13.5% of these, a single, two and three agents were used, respectively. The purpose of antibiotic use was for prophylaxis in 23.9%, as an empiric decision in 71.4% and for therapeutic culture-based reasons in 4.7%. The rate of rational antibiotic use was 45.7% and it was statistically higher in those patients from whom specimens had been taken for culture than in patients receiving prophylactic or empiric antibiotics. On medical wards, rational antibiotic usage was 55.1%, while it was 26.3% in surgical wards (P<0.0001). The low rate of appropriate antibiotic use in our university hospital reflects the urgent need of rationalization.