Assessment of influence of facemask treatment with skeletal anchorage on the temporomandibular joint using magnetic resonance imaging: a preliminary study.

OBJECTIVE: The aim of the study was to investigate the influence of facemask treatment with skeletal anchorage on the temporomandibular joint (TMJ) using magnetic resonance imaging (MRI), in patients with Class III malocclusion, accompanied by maxillary retrusion. METHODS: Fifteen patients with a mean age of 12.1±1.43 years were included in the study. All patients were treated using facemask with skeletal anchorage after eight weeks of Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) protocol. Magnetic resonance imaging was performed before and immediately after facemask treatment for TMJ evaluation. Disc position, condylar translation, degenerative changes of the condyles, and joint effusion were evaluated. To assess whether the alterations associated with the treatment were statistically significant, McNemar and marginal homogeneity tests were used. RESULTS: After facemask treatment, a statistically significant change was observed in the disc position (an anterior disc displacement with/without reduction in five TMJs) (p<0.05). The alteration in the condylar translation was not statistically significant (p>0.05). This treatment did not cause degenerative changes of the condyles or effusion in any of the TMJs. CONCLUSION: Facemask treatment with skeletal anchorage following the Alt-RAMEC protocol had a minimal influence on the TMJ, only by means of disc position, which was not negligible. Long-term results of such treatment are required for following up the changes observed in the TMJs.

Assessment of influence of facemask treatment with skeletal anchorage on the temporomandibular joint using magnetic resonance imaging: a preliminary study

ABSTRACT Objective: The aim of the study was to investigate the influence of facemask treatment with skeletal anchorage on the temporomandibular joint (TMJ) using magnetic resonance imaging (MRI), in patients with Class III malocclusion, accompanied by maxillary retrusion. Methods: Fifteen patients with a mean age of 12.1±1.43 years were included in the study. All patients were treated using facemask with skeletal anchorage after eight weeks of Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) protocol. Magnetic resonance imaging was performed before and immediately after facemask treatment for TMJ evaluation. Disc position, condylar translation, degenerative changes of the condyles, and joint effusion were evaluated. To assess whether the alterations associated with the treatment were statistically significant, McNemar and marginal homogeneity tests were used. Results: After facemask treatment, a statistically significant change was observed in the disc position (an anterior disc displacement with/without reduction in five TMJs) (p<0.05). The alteration in the condylar translation was not statistically significant (p>0.05). This treatment did not cause degenerative changes of the condyles or effusion in any of the TMJs. Conclusion: Facemask treatment with skeletal anchorage following the Alt-RAMEC protocol had a minimal influence on the TMJ, only by means of disc position, which was not negligible. Long-term results of such treatment are required for following up the changes observed in the TMJs.

RESUMO Objetivo: O objetivo desse estudo foi investigar a influência do tratamento com máscara facial com ancoragem esquelética na articulação temporomandibular (ATM), por meio de ressonância magnética (RM), em pacientes com má oclusão de Classe III acompanhada de retrusão maxilar. Métodos: Quinze pacientes com idade média de 12,1±1,43 anos foram incluídos no estudo. Todos os pacientes foram tratados com máscara facial com ancoragem esquelética após oito semanas de protocolo de Expansão Rápida da Maxila e Constrição Alternadas (Alt-RAMEC). Os exames de ressonância magnética foram realizados antes e imediatamente após o tratamento com máscara facial, para avaliação da ATM. Foram avaliados posição do disco, translação condilar, alterações degenerativas dos côndilos e derrame articular. Os testes de McNemar e de homogeneidade marginal foram utilizados para avaliar se as alterações associadas ao tratamento foram estatisticamente significativas. Resultados: Após o tratamento com máscara facial, uma mudança estatisticamente significativa foi observada na posição do disco (deslocamento anterior do disco com/sem redução em cinco ATMs) (p<0,05). A alteração na translação condilar não foi estatisticamente significativa (p>0,05). Esse tratamento não causou alterações degenerativas dos côndilos ou derrame em qualquer das ATMs. Conclusão: O tratamento com máscara facial com ancoragem esquelética ápós o protocolo Alt-RAMEC teve uma influência mínima na ATM, apenas quanto à posição do disco, que não foi desprezível. Resultados em longo prazo desse tratamento são necessários para acompanhar as mudanças observadas nas ATMs.

Is There Any Difference Between Gonial Angle Values Measured on Digital Lateral Cephalograms and Orthopantomograms?

OBJECTIVE: To determine whether there is a difference between the gonial angle (GoAng) values measured on digital lateral cephalograms (Lat Cephs) and orthopantomograms (OPGs) using a software. METHODS: This study was conducted by examining the digital Lat Cephs and OPGs of 51 patients (9 males, 42 females) who received orthodontic treatment. The mean age of the patients was 19.51±4.92 years. All digital radiographs were acquired with the same machine. The GoAng measurements were performed digitally using TotalCeph software. In order to evaluate the difference between the GoAngs measured on the digital Lat Cephs and OPGs, a paired t-test was used. To compare the two techniques (digital Lat Ceph and OPG) in terms of GoAng measurement, Bland-Altman analysis was used. The differences between the right and left GoAngs measured on the digital OPGs were evaluated using a paired t-test. The intraobserver reliability was assessed with the intraclass correlation coefficient (ICC) for repeated measurements. RESULTS: The intraobserver reliability was 0.99 for repeated measurements. There were no statistically significant differences between the GoAngs measured on digital Lat Cephs and OPGs (p=0.1). Bland-Altman analysis showed high levels of agreement between digital Lat Cephs and OPGs with a bias value of -0.4° for GoAng measurement. Moreover, the differences between the right and left GoAngs measured on the digital OPGs were not statistically significant (p=0.73). CONCLUSION: The results of this study demonstrated that the digital OPGs were as reliable as the digital Lat Cephs for measuring Go angles using a software.

Obesity and Loss of Kidney Function: Two Complications to Face for Older Living Kidney Donors.

OBJECTIVES: Although living kidney donors have a minimal lifetime risk of developing end-stage renal disease, long-term complications and physiologic and psychologic sequelae resulting from donation remain unclear because of lack of optimum follow-up after transplant. Here, we evaluated renal function, complications, and physical and mental performance of living kidney donors. MATERIALS AND METHODS: We evaluated 147 patients who donated living kidneys between 1981 and 2012 at Baskent University Hospital. We collected data on donor age, sex, body mass index, smoking status, hypertension before and after nephrectomy, proteinuria, estimated glomerular filtration rate according to the Modification of Diet in Renal Disease formula, and duration after donation. All donors answered the Medical Outcomes Study short-form general health survey; results were evaluated according to answers to 11 questions totaling 22 points. RESULTS: Body mass index of donors showed that 31 (21.1%) were in normal range, 66 (44.9%) had mild obesity (body mass index of 26-30 kg/m²), and 30 (34%) had moderate to high obesity (body mass index > 30 kg/m2). Results from the general health survey showed that 117 donors (80%) had no loss, 13 (9%) had mild loss, 12 (8%) had moderate loss, and 5 (3%) had high loss of ability. When we compared estimated glomerular filtration rates according to donor age, donors who were 18 to 34 years had a mean estimated glomerular filtration rate of 113.5 ± 40, donors 35 to 49 years had a mean rate of 95.01 ± 23.4, donors 50 to 64 years had a mean rate of 87.43 ± 25.4, and donors older than 65 years had a mean rate of 63.76 ± 11.35 mL/min/1.73 m², revealing a statistically significant loss of kidney function with aging (P = .001).. CONCLUSIONS: Careful evaluation of kidney donors before and after donation is essential for the most common risk factors, such as obesity, and for loss of kidney function, especially in older donors.

Effects of facemask treatment anchored with miniplates after alternate rapid maxillary expansions and constrictions; a pilot study.

OBJECTIVE: To describe the dentoskeletal and soft tissue effects of facemask treatment anchored with miniplates after alternate rapid maxillary expansions and constrictions (Alt-RAMEC) in maxillary retrusion patients. MATERIALS AND METHODS: The sample consisted of 15 patients with a mean skeletal age of 11.6 ± 1.59 years undergoing 8 weeks of Alt-RAMEC followed by maxillary protraction. Three hundred fifty to 400 g of force per side was applied to the facemask from the titanium miniplates inserted on the lateral nasal wall of the maxilla. Total treatment time was 9.9 ± 2.63 months. Treatment changes were evaluated cephalometrically and analyzed by means of the dependent t-test and the Wilcoxon signed rank test. RESULTS: The miniplates withstood the orthopedic forces exerted during the treatment. Cephalometric findings showed that the maxilla moved forward by 2 mm, with an 0.8° counterclockwise rotation and without maxillary incisor movement. The mandible moved slightly in a downward and backward direction (1.2°). The inclinations of the mandibular incisors decreased significantly (2°). Statistically significant increases were observed in the vertical dimension (1°-1.3°). Soft tissue changes were more marked in the upper lip and soft tissue pogonion than in the lower lip. CONCLUSIONS: This treatment approach can offer an advantage for correcting mild/moderate maxillary retrusion in Class III patients.

Management of an Adult with Spaced Dentition, Class III Malocclusion and Open-bite Tendency.

The aim of this case report was to present the orthodontic treatment of an adult with spaced dentition, Class III malocclusion, and open-bite tendency. A 28.4-year-old adult woman was concerned about the unesthetic appearance of her spaced dentition localized at both upper and lower arches while smiling. She had a mild tongue thrust, hypertropic upper frenum, and mild speech difficulty while pronouncing "s". Her profile was straight with prominent lips. Molar relationship was Class III on both sides. Anterior teeth were in an end-to-end relationship. Lower dental midline was deviated to the left side. Cephalometric analysis revealed a skeletal Class III relationship with hyperdivergent facial pattern. The treatment plan included myotherapeutic exercises for the tongue thrust habit and a diagnostic set-up for closure of diastemas. A strict retention protocol was followed combined with gingivoplasty, fiberotomy, and frenectomy procedures. All spaces were closed successfully, adequate overbite and overjet relationships were obtained, and tongue thrust habit and speech difficulty while pronouncing "s" were eliminated. Clinical and cephalometric results indicated the maintenance of the treatment outcome at 6-months post-retention period.

Prevalence of toenail onychomycosis in patients with type 2 diabetes mellitus and evaluation of risk factors.

BACKGROUND: we sought to determine the frequency of toenail onychomycosis in diabetic patients, to identify the causative agents, and to evaluate the epidemiologic risk factors. METHODS: data regarding patients' diabetic characteristics were recorded by the attending internal medicine clinician. Clinical examinations of patients' toenails were performed by a dermatologist, and specimens were collected from the nails to establish the onycomycotic abnormality. All of the specimens were analyzed by direct microscopy and culture. RESULTS: of 321 patients with type 2 diabetes mellitus, clinical onychomycosis was diagnosed in 162; 41 of those diagnoses were confirmed mycologically. Of the isolated fungi, 23 were yeasts and 18 were dermatophytes. Significant correlations were found between the frequency of onychomycosis and retinopathy, neuropathy, obesity, family history, and duration of diabetes. However, no correlation was found with sex, age, educational level, occupation, area of residence, levels of hemoglobin A(1c) and fasting blood glucose, and nephropathy. The most frequently isolated agents from clinical specimens were yeasts. CONCLUSIONS: long-term control of glycemia to prevent chronic complications and obesity and to promote education about the importance of foot and nail care should be essential components in preventing onychomycosis and its potential complications, such as secondary foot lesions, in patients with diabetes mellitus.

Reliability of reference distances used in photogrammetry.

OBJECTIVE: To determine the reliability of the reference distances used for photogrammetric assessment. MATERIALS AND METHODS: The sample consisted of 100 subjects with mean ages of 22.97 +/- 2.98 years. Five lateral and four frontal parameters were measured directly on the subjects' faces. For photogrammetric assessment, two reference distances for the profile view and three reference distances for the frontal view were established. Standardized photographs were taken and all the parameters that had been measured directly on the face were measured on the photographs. The reliability of the reference distances was checked by comparing direct and indirect values of the parameters obtained from the subjects' faces and photographs. Repeated measure analysis of variance (ANOVA) and Bland-Altman analyses were used for statistical assessment. RESULTS: For profile measurements, the indirect values measured were statistically different from the direct values except for Sn-Sto in male subjects and Prn-Sn and Sn-Sto in female subjects. The indirect values of Prn-Sn and Sn-Sto were reliable in both sexes. The poorest results were obtained in the indirect values of the N-Sn parameter for female subjects and the Sn-Me parameter for male subjects according to the Sa-Sba reference distance. For frontal measurements, the indirect values were statistically different from the direct values in both sexes except for one in male subjects. The indirect values measured were not statistically different from the direct values for Go-Go. The indirect values of Ch-Ch were reliable in male subjects. The poorest results were obtained according to the P-P reference distance. CONCLUSIONS: For profile assessment, the T-Ex reference distance was reliable for Prn-Sn and Sn-Sto in both sexes. For frontal assessment, Ex-Ex and En-En reference distances were reliable for Ch-Ch in male subjects.

An outbreak of oropharyngeal tularemia with cervical adenopathy predominantly in the left side.

PURPOSE: We describe the epidemiological and clinical characteristics and the efficacy of a delayed initiation to therapy in an oropharyngeal tularemia outbreak in Duzce, Turkey. MATERIALS AND METHODS: Between March and June 2000, 22 patients with tularemia were diagnosed by microagglutination tests. RESULTS: Oropharyngeal and ulceroglandular forms of the disease were discovered. Most of the cases were oropharyngeal (19 cases). The most common symptoms were sore throat (95.4%) and fever (90.9%). Lymphadenopathy (95.4%) and pharyngeal hyperemia (81.8%) were usually observed signs. The lymphadenopathies were localized especially in the left cervical region (66.7%), a finding that has not been previously reported in the literature. The time between the onset of the symptoms and diagnosis was 40.7 +/- 22.8 (10 - 90) days. The patients were treated with streptomycin plus doxycycline and ciprofloxacin. The patients' recoveries took up to 120 days. CONCLUSION: This report describes the first outbreak of tularemia in northwest Turkey. Tularemia may occur in any region where appropriate epidemiological conditions are found and should be kept in mind for differential diagnosis in oropharyngeal symptoms. Late initiation of therapy may delay complete recovery. In this outbreak, cervical lymph nodes predominantly localized on the left side were found, which had not been previously reported.

Phospholipase and proteinase activities in different Candida species isolated from anatomically distinct sites of healthy adults.

The aim of the present study was to determine in vitro phospholipase and protease activities in 122 Candida spp. isolated from several anatomically distinct sites of healthy adults. C. albicans (66.4%) was the most frequently isolated Candida spp. C. glabrata (7.3%), C. tropicalis (6.3%) and C. kefyr (4.9%) were the most frequently isolated non-C. albicans Candida spp. Fifty (40.9%) of the isolates examined were phospholipase positive and 64 (52.4%) were protease positive. Forty-three (53.8%) of the C. albicans isolates tested were phospholipase producers--however, only a few strains of non-C. albicans Candida spp. behaved in the same way. Protease activity was detected in 46 (56.7%) of the C. albicans strains tested and in a few strains of non-C. albicans Candida spp. The levels of phospholipase and protease activities in commensal isolates were found to be lower than the levels of other enzyme activities previously reported in clinical Candida spp. isolates. The phospholipase activity of Candida spp. was found to be higher in oral (59.0%) and fecal (42.8%) isolates. The protease activity of Candida spp. was found to be higher in urogenital (55.1%) and skin (58.8%) isolates. We conclude that further investigations will be needed on the phospholipase and protease activity of Candida spp. in healthy subjects in order to clarify their contribution to fungal virulence.

Do baby wet wipes change periurethral aerobic flora?

There is massive enteric bacterial colonization in the periurethral region during infancy. Fecal soiling is considered to be responsible for this colonization. We hypothesized that baby wet wipes containing chemical cleansing compounds, which are used for the cleaning of babies after diaper soiling, could be a contributing factor in this colonization. Thus, the effect on periurethral flora of two different methods of baby cleaning was compared. Periurethral culture samples were obtained from 173 infants who were cleaned with baby wet wipes (Group A, n = 96) or water and napkins (Group B, n = 77) after diaper soiling. The colonization of uropathogens and the presence of flora were analyzed. The results of the periurethral cultures were similar in both groups. The rates of uropathogen colonization only, uropathogen and skin flora colonization, and skin flora only or no growth in Groups A and B were 18.7, 61.5, and 19.8%, and 14.3, 66.2, and 19.5, respectively. The differences between the groups were statistically insignificant (P > 0.05); however, there was no significant difference in the frequency of uropathogen isolation between males and females. We therefore concluded that baby wet wipes are as safe as water for the cleaning of babies after diaper soiling.

Effects of melatonin on Candida sepsis in an experimental rat model.

As an immunomodulator, melatonin reportedly exhibits protective effects in severe sepsis/shock induced by bacterial lipopolysaccharides in animal models. The present study was conducted to evaluate the possible protective effects of melatonin against experimental Candida sepsis in rats. A total of 40 adult male Wistar rats were randomly assigned to 4 groups: control, melatonin-treated control, septic, and melatonin-treated septic. Melatonin (200 microg/kg/d, intraperitoneally) injections were begun a week prior to sepsis induction and were continued daily for 3 wk until the end of the study. Cyclophosphamide was administered to animals in all groups as an immunosuppressive agent as a single dose 4 d prior to yeast inoculation. To cause sepsis, the Candida albicans (ATCC 10259) strain was administered intravenously. Amphotericin B was given as an antimycotic therapeutic agent as a single dose to septic rats. Plasma levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), vascular cell adhesion molecule-1, and E-selectin were measured on the first and 15th days of sepsis. IL-6, TNF-alpha, vascular cell adhesion molecule-1, and E-selectin levels of septic rats were higher than those of controls. Melatonin reduced IL-6 levels and shortened time to improvement in animals with Candida sepsis. Levels of TNF-alpha and adhesion molecules in melatonin-treated septic rats were decreased compared with those in septic rats, but this difference was not statistically significant. In light of the current results, investigators conclude that melatonin may have therapeutic benefits in Candida sepsis and in classic antimycotic treatment because of its immune regulatory effects.

Fungal Agents as a Cause of Surgical Wound Infections: An Overview of Host Factors.

UNLABELLED: Microbial virulence and host resistance are the determinants of the surgical infections. Bacteria are responsible for the majority of cases, but fungi are rare. The aim of this study was to evaluate the fungi causing surgical infections and discuss host factors predisposing the infection. METHODS: A total of 824 surgical wound specimens had been evaluated. The specimens were cultured using 5% sheep blood, Sabouraud Dextrose, and Eosin methylene blue agars and the isolates were identified by classical methods and API identification system. RESULTS: Growth was obtained in 455 (55.2%) out of 824 specimens. Nine (2%) of the agents of surgical infections were yeasts: Candida albicans was isolated in 5 (55.6%), C tropicalis in 3 (33.3%), and C glabrata in 1 (11.1%) specimen(s). Examining the characteristics of the patients, fungal infection could be explained with the presence of at least 1 predisposing factor. Immunosuppression was closely related with fungal growth. CONCLUSION: Predisposing factors impairing the immune system were detected in most of the patients showing the possibility of onset of fungal, predominantly Candidal infections. It is important for clinicians to be aware of fungal infections that may develop in this group under risk, particularly after surgery and all Candida species isolated from high-risk patients should be identified to species level, as nonalbicans strains are often associated with resistance to antifungal agents.

Etiologic agents of cervicovaginitis in Turkish women.

OBJECTIVE: To investigate the distribution of microbiologic agents causing cervicovaginitis. METHODS: We conducted the study between October 2002 and December 2004 in Abant Izzet Baysal University, Duzce School of Medicine Hospital, Turkey. The samples were obtained from the posterior vaginal fornix and cervix by swabs in 828 patients. Direct microscopic examination, culture and enzyme immune assay (EIA) methods were performed in all patients for diagnosis of microbiologic agents. RESULTS: Gardnerella vaginalis (G. vaginalis) were diagnosed in 254 (30.7%) patients, Candida albicans (C. albicans) in 152 (18.4%), Candida glabrata (C. glabrata) in 36 (4.3%), Candida species in 52 (6.3%), Staphylococcus aureus (S. aureus) in 62 (7.5%), Streptococcus group B in 28 (3.4%), Escherichia coli (E. coli) in 42 (5.1%), Klebsiella species in 24 (2.9%), and Streptococcus group D in 8 (1%) patients in culture. Less frequent enterobacteria in 30 (3.6%) were: Pseudomonas species, Proteus species Enterobacter species, Hafnia alvei and Nonfermenter species. Neisseria gonorrheae (N. gonorrheae) was detected in one patient (0.1%) in culture. The Chlamydia trachomatis (C. trachomatis) antigen was detected by EIA methods in 130 (15.7%) patients and Trichomonas vaginalis (T. vaginalis) was observed in 8 (1%) patients by direct microscopic examination. CONCLUSION: Performing the etiologic diagnosis of cervicovaginitis is necessary in order to take appropriate therapeutic and preventive measures. Therefore, we recommend G. vaginalis, C. albicans and C. trachomatis should be investigated in patients having a diagnosis of cervicovaginitis in our population, since these were detected in a considerable number of cases. Additionally, C. glabrata and T. vaginalis should be kept in mind as possible pathogens.

Is aerobic preputial flora age dependent?

Urinary tract infection (UTI) is one of the most commonly encountered infections in childhood. It has been demonstrated that the preputial sac can act as a reservoir of organisms and is thus responsible for causing ascending UTIs. This study was performed to determine the presence of preputial flora in different age groups. Prepuce and urine samples were taken simultaneously from 92 uncircumcised and healthy male children aged between 0-12 years. The data were analyzed by age, with 47 subjects of 6 years of age or less, and 45 aged 7-12 years. Twenty-seven percent of the older patients had negative preputial cultures versus 8% of those under 6 years of age (chi2 = 5.27, P = 0.02). In addition, enteric bacteria were the most common pathogens isolated from the prepuce in younger children while skin flora bacteria were most common in the older group (chi2 = 9.18, P = 0.002). The urine was sterile in all cases. Preputial cultures change with age in uncircumcised boys. This change may be related to the development of immune status, to histological or anatomical changes in the prepuce, and/or to improved personal hygiene.

Molecular analysis of isoniazid, rifampin and streptomycin resistance in Mycobacterium tuberculosis isolates from patients with tuberculosis in Düzce, Turkey.

The aim of this study was to use DNA sequencing analysis to analyze the mutations in the most commonly targeted genes (katG, inhA, rpoB, rpsL) in isoniazid (INH)-, rifampin (RIF)- and streptomycin (SM)-resistant Mycobacterium tuberculosis strains obtained from subjects in Duzce, Turkey. Four isolates were found to be INH-resistant, 3 were RIF-resistant and 5 were SM-resistant, out of a total of 52 M. tuberculosis strains. In 3 of the 4 INH-resistant strains, a mutation in the katG gene in codon 315 appeared as AGC-->ACC (Ser-->Thr), and the other INH-resistant strain showed a mutation in the katG gene in codon 314 as ACC-->CCC (Thr-->Pro). There were no mutations in the inhA gene in INH-resistant isolates. Two of the 3 RIF-resistant strains were found to have mutations in the rpoB gene in codon 516 appearing as GAC-->GTC (Asp-->Val), and the other RIF-resistant strain has a mutation in the rpoB gene in codon 531 as TCG-->TTG (Ser-->Leu). These 3 RIF-resistant strains are also INH-resistant. All 5 SM-resistant strains have mutations in the rpsL gene in codon 43 appearing as AAG-->AGG (Lys-->Arg). Thus, we found common gene mutations that bring about the resistance of M. tuberculosis to antituberculosis drugs in all of our isolates from Duzce. To the best of our knowledge, the ACC-->CCC (Thr-->Pro) mutation in the katG gene in codon 314 has not been previously defined.

Dermatophytoses in forestry workers and farmers.

To assess the frequency of superficial mycoses in forestry workers and farmers in the rural region of Duzce, a total of 467 residents of the rural region were examined for dermatomycosis infection. Of these, 349 were forestry workers and 118 farmers. All specimens collected were analysed by direct microscopy and culture. Tinea pedis et manus was found in 23 (19.4%), and onycomycosis in 21 (17.7%) farmers. Tinea pedis et manus was found in 50 (14.3%), and onycomycosis in 28 (8%) forestry workers. One tinea corporis, two tinea inguinalis and two erosio interdigitalis cases were determined in the farmer group but no cases of tinea corporis, tinea inguinalis, or erosio interdigitalis were found in the forestry group. In total, five tinea versicolor cases were found in the two groups on clinical examination but no agent positivity was yielded in mycological cultures. The most frequently isolated agent in the two groups was Trichophyton rubrum. The frequencies of superficial mycosis and onychomycosis were found to be higher in the farmer group than in the forestry group, although similar aetiological agents were isolated in both groups. The farmers had greater rates of contact with pathogenic fungi present in soil as well as from infected farm animals than the foresters; furthermore, animal husbandry, and the wearing of rubber shoes and nylon socks were more frequent in the farmer group. These results suggest that habits such as the wearing of rubber shoes and nylon socks, and the practice of animal husbandry may be the most important factors in determining the frequency of superficial mycoses and aetiological agents in forestry workers and farmers. To our knowledge, there is no previous report about dermatophytoses in forestry workers.

Synthesis and antimicrobial activity of 4-phenyl/cyclohexyl-5-(1-phenoxyethyl)-3-[N-(2-thiazolyl)acetamido]thio-4H-1,2,4-triazole derivatives.

The increasing clinical importance of drug-resistant fungal and bacterial pathogens has lent additional urgency to microbiological research and new antimicrobial compound development. For this purpose, new thiazole derivatives of triazoles were synthesized and evaluated for antifungal and antibacterial activity. The reaction of propionic acid hydrazides with various aryl/alkyl isothiocyanates gave thiosemicarbazides which furnished the mercaptotriazoles by alkali cyclization. The 4-phenyl/cyclohexyl-5-(1-phenoxyethyl)-3-[N-(2-thiazolyl)acetamido]thio-4H-1,2,4-triazole derivatives were synthesized by reacting the mercaptotriazoles with 2-chloro-N-(2-thiazolyl)acetamide. The chemical structures of the compounds were elucidated by IR, 1H-NMR, FAB+-MS spectral data. Their antimicrobial activities against Candida albicans (two strains), Candida glabrata, Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa were investigated. The results showed that some of the compounds have very strong antifungal activity.

Biliary infection and bacteremia caused by beta-lactamase-positive, ampicillin-resistant Haemophilus influenzae in a diabetic patient.

We report the case of a 73-year-old female patient with diabetic nephropathy and cholelithiasis. She was admitted to our hospital with right upper abdominal pain, nausea, and vomiting. The patient had visited an outpatient clinic with the same complaints 2 days earlier, and had been prescribed antibiotics empirically (two doses ofloxacin orally). Blood cultures taken before the start of antibiotic treatment in our hospital were negative. The patient was treated with parenteral ampicillin/sulbactam + ciprofloxacin empirically. The empiric antibiotic treatment was discontinued after 7 days. Elective cholecystectomy was performed after her general condition improved. An aerobic chocolate agar culture of the cholecystectomy material yielded Haemophilus influenzae type b. On postoperative day 3 the patient developed fever again. The fluids collected after cholecystectomy were evaluated microbiologically. H. influenzae type b was isolated from the samples and blood cultures. The patient was diagnosed with H. influenzae cholecystitis, and recovered after 10-day treatment with ampicillin/sulbactam + ciprofloxacin. The findings are discussed together with references for differential diagnosis. H. influenzae cholecystitis due to cholelithiasis, although rare, should be considered in elderly patients with a history of chronic diseases such as diabetes mellitus or nephropathy.

The resistance to major antituberculous drugs of Mycobacterium tuberculosis strains isolated from the respiratory system specimens of tuberculosis patients in Duzce, Turkey.

Through generally curable, tuberculosis (TB) is becoming increasingly resistant to commonly used antibiotics. Drug-resistant and multidrug-resistant (MDR)-TB is a consequence of monotherapy, insufficient drug therapy and national TB control programs. The present study was designed to reveal the resistance to major antimicrobial drugs (isoniazid [INH], streptomycin [SM], ethambutol [EMB], and rifampicin [RIF]) of Mycobacterium tuberculosis isolated from the respiratory specimens of TB patients in Duzce, Turkey. A total of 62 TB patients (46 male, 16 female; age: 17 - 75 mean: 42 +/- 15.9) were included in the study; 52 (83.8%) were new cases and susceptible to all anti-TB drugs, while 10 (16.2%) were previously treated cases. Antimicrobial susceptibility tests were performed by the proportion method in Löwenstein-Jensen medium. Fifty-two of the 62 (83.8%) isolated M. tuberculosis strains were found to be susceptible to all drugs, and 7 (11.3%), 5 (8%), and 3 (4.8%) were resistant to SM, INH, and RIF, respectively; 3 (4.8%) were MDR. There were no EMB-resistant strains. The results of this study show the presence of drug-resistant and MDR strains of TB at Duzce in the northwest part of Turkey.