Profiling infectious diseases in Turkey after the influx of 3.5 million Syrian refugees.

BACKGROUND: Since 2011, the conflict in Syria has led to over five million refugees. Turkey hosts the highest number of Syrian refugees in the world. By February 2019 over 3.6 million people had fled to Turkey to seek safety. Only 6.1% of Syrian refugees live in temporary shelters. Owing to the disrupted healthcare services, many children coming from the conflict zones are less likely to have received vaccination. In temporary shelters immunization coverage is >95% and the refugee population is receptive to vaccination. AIMS: The objective of this study was to review the infectious diseases situation among Syrian refugees in Turkey. SOURCES: We have reviewed the reports and studies provided by the governmental and non-governmental organizations and obtained more detailed data from the Ministry of Health in Turkey. CONTENT: Between 2012 and 2016, 1 299 209 cases of respiratory tract infection and 158 058 episodes of diarrhoea with 59 bloody diarrhoeas were reported; 1354 hepatitis A cases and 108 active tuberculosis cases were detected and treated in the temporary shelters for Syrian refugees. Overall in Turkey, 7794 cutaneous leishmaniasis have been reported. IMPLICATIONS: Since the influx of Syrian refugees, there has been an increase in cases of leishmaniasis and measles. No significant increase was detected for tuberculosis, other vector-borne infections, and healthcare associated or sexually transmitted infections. The Syrian refugees can be considered as a vulnerable group in Turkey due to their living and working conditions. Based on available data and our detailed analysis, the numbers show a stable situation regarding infectious diseases.

Changes in oxidative stress parameters and antioxidant status in lung cancer: Western blot analysis of nitrotyrosine and protein carbonyls content.

INTRODUCTION: The source of many diseases, including tumors, lies in an increased generation of reactive oxygen species resulting in oxidative stress. We investigated the relationships between advanced oxidation protein products (AOPPs), nitrotyrosine (NT), protein carbonyls (PCO) content, and the prooxidant-antioxidant balance (PAB) in patients with lung cancer. METHODS: A total of 14 age-matched healthy controls, 14 subjects with non-lung cancer pulmonary disease, and 41 patients with lung cancer were included in this study. Spectrophotometry was used to examine plasma AOPP, serum FRAP, and PAB, while serum PCO and NT were assessed with western blot analysis. RESULTS: A significant difference in AOPP levels were found between patients and controls (p < 0.01). Also, there was a highly significant difference in NT levels between patients and controls (p < 0.001). PAB showed negative correlation with albumin (r = -0.340, p = 0.011) and positive correlation with CRP (r = 0.342, p = 0.011). AOPP, albumin, gender, and smoking were the significant independent variables found by backward stepwise multiple logistic regression (MLR) analysis method. MLR analysis revealed that AOPP was the variable that had a significant effect on lung cancer [(p = 0.006, OR = 1.074, (95% CI) (1.020-1.131)]. CONCLUSIONS: The use of non-invasive diagnostic biochemical parameters would represent a very important contribution to our diagnostic armamentarium in lung cancer, considering the high incidence of this deadly disease. In this regard, AOPP and NT levels have appeared to play a prominent role, although further studies are certainly warranted.

Public awareness of and support for smoke-free legislation in Turkey: a national survey using the lot quality sampling technique.

Six months after new legislation in Turkey banning smoking in all public places, a national survey was carried out to assess its implementation. This paper summarizes the main findings on the public's awareness of and support for the new law. In a household interview survey of 32 972 adults representative of the Turkish adult population, a high proportion of both non-smokers and current smokers (91.4% and 67.2% respectively) strongly supported the new law. Knowledge about the health hazards of passive smoking and support for the law, however, were relatively lower among smokers than non-smokers. After controlling for smoking status, people with better knowledge about passive smoking were over 5 times more likely to support the new law. Tobacco control activities should be tailored to local needs, with afocus on increasing awareness about the health hazards of passive smoking. The study also demonstrated application of the lot quality sampling technique (LQT) for monitoring tobacco control activities in a national survey.

Public awareness of and support for smoke-free legislation in Turkey: a national survey using the lot quality sampling technique

Six months after new legislation in Turkey banning smoking In all public places, a national survey was carried out to assess its implementation. This paper summarizes the main findings on the public's awareness of and support for the new law. In a household interview survey of 32 972 adults representative of the Turkish adult population, a high proportion of both non-smokers and current smokers [91.4% and 67.2% respectively] strongly supported the new law. Knowledge about the health hazards of passive smoking and support for the law, however, were relatively lower among smokers than non-smokers. After controlling for smoking status, people with better knowledge about passive smoking were over 5 times more likely to support the new law. Tobacco control activities should be tailored to local needs, with a focus on increasing awareness about the health hazards of passive smoking. The study also demonstrated application of the lot quality sampling technique [LQT] for monitoring tobacco control activities in a national survey

Recent findings on pertussis epidemiology in Turkey.

The World Health Organization (WHO) reports that pertussis remains one of the least well-controlled vaccine-preventable diseases. It is supposed that the incidence of reported pertussis among adolescents, adults, and young infants has increased over the past decade. The aim of this study is to evaluate recent epidemiological data on pertussis in Turkey by regions. Data on vaccination coverage and pertussis incidence between 1986 and 2005 obtained from the Expanded Programme on Immunization national surveillance database of the Ministry of Health of Turkey were analyzed. Age and geographical distribution of the reported cases between 2000 and 2005 were evaluated. It was found that third-dose vaccination coverage increased from 1986 (45%) to 2005 (90%). In 2005, pertussis incidence tended to decrease (0.38 per 100,000) compared to 1986 (2.03 per 100,000). Even though only up to 6.5% of the cases were > or =15 years of age until 2005, 16.9% of them were included in this age group in 2005. It was observed that vaccination coverage rates steadily increased and pertussis incidence decreased by years despite some regional differences. In Turkey, pertussis incidence appears to be reaching the WHO targets, except East Anatolia. It is possible that waning immunity is responsible for the change of the age distribution of pertussis cases. However, priority should be given to strengthening available vaccination efforts throughout the country. A booster dose of pertussis vaccine in adolescence might be required in the future.

Food-borne botulism cases in Van region in eastern Turkey: importance of electromyography in the diagnosis.

OBJECTIVES: Food-borne botulism is an acute form of poisoning that results from ingestion of a toxin produced by Clostridium botulinum. Botulism toxin causes its major effect by blocking neuromuscular transmission in autonomic and motor nerve terminals. METHODS: In this study, we present the features of eleven cases of food-borne botulism admitted to our hospital in 2001. All of the cases were caused by home-prepared foods; green beans. In these cases, the main symptoms and signs were generalized muscular weakness, dry mouth, dysphagia, disponea and diplopia. Electrophysiological studies were performed on four patients. RESULTS: Motor conduction studies showed that compound muscle action potentials were decreased with normal latencies and conduction velocities. The needle electromyography showed signs of denervation potentials like fibrillation and positive waves in four patients. Repetitive nerve stimulation with high frequency (20 Hz) induced an increment close to 100% in the amplitudes in 2 of 4 patients. CONCLUSION: Although toxin could not be detected in the patients, the electromyographic findings supported our diagnosis. We concluded that electromyography has an important role in diagnosis of botulism, especially in the condition that serologic tests are negative or cannot be performed.

Tuberculous meningitis in adults in Turkey: epidemiology, diagnosis, clinic and laboratory [corrected].

A retrospective study was performed to assess the epidemiology, diagnosis, clinic, and laboratory of the patients with tuberculous meningitis (TBM) in a multicentral study. The medical records of adult cases with TBM treated at 12 university hospitals throughout Turkey, between 1985 and 1998 were reviewed using a standardized protocol. The diagnosis of TMB was established with the clinical and laboratory findings and/or microbiological confirmation in cerebrospinal fluid (CSF). The non-microbiologically confirmed cases were diagnosed with five diagnostic sub-criteria which CSF findings, radiological findings, extra-neural tuberculosis, epidemiological findings and response to antituberculous therapy. A total of 469 patients were included in this study. Majority of the patients were from Southeast Anatolia (164 patients, 35.0%) and (108 patients, 23.0%) from East Anatolia regions. There was a close contact with a tuberculous patient in 88 of 341 patients (25.8%) and with a tuberculous family member in 53 of 288 patients (18.4%). BCG scar was positive in 161 of 392 patients (41.1%). Tuberculin skin test was done in 233 patients and was found to be negative in 75. Totally 115 patients died (24.5%) of whom 23 died in 24 hour after admittance. The diagnosis was confirmed with clinical findings and CSF culture and/or Ziehl-Nelson staining in 88 patients (18.8%). Besides clinical criteria, there were three or more diagnostic sub-criteria in 252 cases (53.7%), two diagnostic sub-criteria in 99 cases (21.1%), and any diagnostic sub-criteria in 30 patients (6.4%). Since TBM is a very critical disease, early diagnosis and treatment may reduce fatal outcome and morbidity.

Predictors of outcome in patients with tuberculous meningitis.

OBJECTIVE: To assess predictors of mortality and neurological sequelae in patients with tuberculous meningitis (TBM). METHODS: Patients with TBM treated at 12 university hospitals in Turkey between 1985 and 1997 were evaluated using a standardised protocol applied retrospectively. Variables associated with hospital mortality as well as with the presence of neurological sequelae at 6 months were determined using logistic regression models. RESULTS: Four hundred and thirty-four patients between the ages of 13 and 83 years (mean 33 years) were evaluated. Sixty-eight per cent of these patients presented with Medical Research Council Stage II or III. One hundred and one patients (23.3%) died and 67 (27%) of evaluable survivors had neurological sequelae. In multi-variable analysis, convulsion (OR 3.3, 95%CI 1.2-9.0, P = 0.02), comatose mental status (OR 6.0, 95%CI 3.6-10.2, P = 0.01), and delayed or interrupted treatment (OR 5.1, 95%CI 2.4-11.2, P = 0.01) were shown to be predictors for mortality. The presence of extra-meningeal tuberculosis (OR 2.1, 95%CI 1.1-4.2, P = 0.035), cranial nerve palsy (OR 2.6, 95%CI 1.4-4.2, P = 0.01), hemiparesia/focal weakness (OR 9.3, 95%CI 3.8-22.6, P = 0.01), hemiplegia/multiple neurological deficit (OR 7.1, 95%CI 2.14-23.38, P = 0.01) and drowsiness (OR 4.2, 95%CI 2.04-8.82, P = 0.01) were independent predictors of neurological sequelae at 6 months following hospital discharge. CONCLUSION: The results of this study emphasise the importance of prompt and uninterrupted anti-tuberculosis therapy for tuberculous meningitis. The presence of seizures or coma on admission to hospital are important predictors for mortality, while the presence of focal neurological signs is a predictor for persistent neurological sequelae in survivors.

Central nervous system brucellosis: presentation, diagnosis and treatment.

Although neurological symptoms in brucellosis are frequent, central nervous system (CNS) involvement is uncommon. Five patients with neurobrucellosis are presented. Three patients presented with meningoencephalitis, one with polyradiculoneuritis and one with myelitis and an eighth nerve palsy. All patients had lymphocytic pleocytosis, low glucose and elevated levels of protein in the cerebrospinal fluid (CSF). Gamma-globulin and IgG values in the CSF were also increased. Results of agglutination tests for Brucella in serum and CSF were positive for all patients, although titres were less in the CSF. Brucella melitensis was cultured from two patients. Treatment included concurrent administration of three of the following drugs: doxycycline, rifampicin, streptomycin, co-trimoxazole, ceftriaxone or ciprofloxacin. The three patients with meningoencephalitis fully recovered; the other two patients were left with minor disability.

Hematological manifestations in brucellosis cases in Turkey.

The hematological findings of 233 patients with brucellosis are presented and the possible pathologies discussed. Anemia was present in 128 patients (55%), leukopenia in 49 (21%) and thrombocytopenia in 59 (26%). Bone marrow aspirates of 18 patients (8%) with pancytopenia were examined. The bone marrow was hypercellular in 15 and normocellular in 3 patients. Granulomatous lesions were detected in 12 cases (67%), and slight to moderate cytophagocytosis of erythrocytes, granulocytes and platelets existed in all patients. Blood cell counts reverted to normal within 2-3 weeks of initiating chemotherapy with recovery from the disease.

Nucleotide sequence of gene 6 of avian-like group A rotavirus 993/83.

Two cDNA clones, which hybridized in Northern blots to RNA segment 6 of the homologous avian-like group A rotavirus (RV) 993/83 and pigeon RV PO-13, but not to mammalian group A rotaviruses, were sequenced. The gene 6 sequence contained a single long open reading frame encoding a protein of 397 amino acids (total MW 44,460). Comparison of the deduced amino acid sequence with VP6 protein from mammalian group A RV revealed 72 to 74.3% of amino acid identity. These values are surprisingly low in view of the high homology levels described up to now for group A RV. Avian-like RV 993/83 is however not a missing link between group A and C RV as it is as distantly related to group C RV as group A mammalian RV to group C RV. The evolutionary implications of these observations are briefly discussed.

[HIV infections among Turkish citizens who have lived in foreign countries]. / Yurt disinda yasayan vatandaslarimizin HIV enfeksiyonu yönünden incelenmesi.

AIDS or HIV infection, since 1981 when the first description was made because of showing epidemic characteristics, present increasing in number of patients, go along with high mortality, the disease become an event not only medically but also for any parts of the society. There is a danger of AIDS in risky groups and also danger of spreading by those persons. Among the 10985 Turkish citizens who came Turkey from foreign countries to fulfill military duty, antibody research against HIV was made and one positive anti-HIV case was observed.

[Lyme disease]. / Lyme hastaligi.

Lyme disease, which is caused by the tick-borne spirochete Borrelia burgdorferi, usually begins with a characteristic skin lesion erythema chronicum migrans (ECM), that may be followed by neurological or cardiac abnormalities and is accompanied by malaise, fatigue, fever, myalgia, headache, lymphadenopathy and is often followed by arthritis. The disease takes its name from Lyme, Connecticut, where the full spectrum of illness was first described in 1975. It is known to be a multisystemic infectious disease. Because culture and direct visualisation of spirochetes are often negative in Lyme disease, serological testing has been the only practical laboratory aid in diagnosis and primarily clinical findings.

[Viral encephalitis]. / Viral ansefalitler.

Acute viral and other infectious causes of encephalitis usually produce fever, headache, stiff neck and alterations in consciousness, focal neurologic signs and seizures. A large number of viral and nonviral agents can cause encephalitis. Arthropod-borne viruses peak in summer, the tick-borne infections occur in early summer, enterovirus infections in later summer and mumps in the winter and spring.