Serum soluble lectin-like oxidized low-density lipoprotein receptor-1 levels in patients with restless legs syndrome.

OBJECTIVE: The aim of this study was to assess the predisposition for atherosclerosis in patients with RLS through serum sLOX-1 (serum Lectin-Like Oxidized Low-Density Lipoprotein Receptor-1) measurements. BACKGROUND: Recent epidemiological studies have suggested an association of RLS with certain chronic conditions such as diabetes mellitus (DM), obesity, hypertension (HT), and hyperlipidemia. LOX-1 is expressed in endothelial cells, macrophages, and in smooth muscle cells under the effect of proatherogenic conditions. METHODS: This study was a prospective, cross-sectional, case-controlled. We measured the serum sLOX-1 levels in 37 restless legs syndrome patients and 38 controls. RESULTS: Serum sLOX-1 level was significantly lower in the patient group. The two groups were similar in glucose, HbA1c, creatinine, LDL cholesterol, TG, HDL, total protein, albumin, AST, ALT, GGT, ALP, HGB, HCT, MCV, transferrin saturation rate (TSR), ferritin, CRP, TSH, FT4, FT3, B12, and folic acid levels. Also the two groups were similar with respect to age at menarche, number of previous births, number of abortions and/or curettage, total duration of breastfeeding, percentage of patients in menopause, and age at menopause. CONCLUSION: Our results may suggest a lower atherosclerotic risk among RLS patients as compared to the general population (Tab. 3, Ref. 33).

Proximal muscle weakness as a result of osteomalacia associated with celiac disease: a case report.

UNLABELLED: A 24-year-old woman suffering from back and hip pain with difficulty in walking was reported. She had proximal muscle weakness. Laboratory findings led to the diagnosis of osteomalacia. Positivity of antibodies strengthened suspicion of celiac disease. In patients with proximal muscle weakness, osteomalacia should be considered in differential diagnosis even in a young woman. INTRODUCTION: A 24-year-old woman suffering from back pain, bilateral hip pain, and difficulty in walking was reported. Her symptoms had started in the first trimester of pregnancy. METHODS: In her physical examination, proximal muscle weakness and waddling gait pattern were determined. Her lumbar spine and hip MRI revealed no obvious pathological findings. Electromyography showed a myophatic pattern. RESULTS: Physical examination, normal values of creatine kinase, and muscle biopsy were supplied to exclude the diagnosis of primer muscle diseases. Laboratory findings led to the diagnosis of osteomalacia with normal renal function. Gastrointestinal symptoms and positivity of anti-gliadin and anti-endomysium antibodies strengthened the suspicion of celiac disease as a cause of the osteomalacia. The diagnosis of celiac disease was confirmed with duodenal mucosal biopsy. CONCLUSION: In patients with proximal muscle weakness and waddling gait pattern, osteomalacia should be considered in differential diagnosis even in a young woman and underlying disease should be investigated.

Impact of a multidimensional infection control strategy on catheter-associated urinary tract infection rates in the adult intensive care units of 15 developing countries: findings of the International Nosocomial Infection Control Consortium (INICC).

PURPOSE: We aimed to evaluate the impact of a multidimensional infection control strategy for the reduction of the incidence of catheter-associated urinary tract infection (CAUTI) in patients hospitalized in adult intensive care units (AICUs) of hospitals which are members of the International Nosocomial Infection Control Consortium (INICC), from 40 cities of 15 developing countries: Argentina, Brazil, China, Colombia, Costa Rica, Cuba, India, Lebanon, Macedonia, Mexico, Morocco, Panama, Peru, Philippines, and Turkey. METHODS: We conducted a prospective before-after surveillance study of CAUTI rates on 56,429 patients hospitalized in 57 AICUs, during 360,667 bed-days. The study was divided into the baseline period (Phase 1) and the intervention period (Phase 2). In Phase 1, active surveillance was performed. In Phase 2, we implemented a multidimensional infection control approach that included: (1) a bundle of preventive measures, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of CAUTI rates, and (6) feedback of performance. The rates of CAUTI obtained in Phase 1 were compared with the rates obtained in Phase 2, after interventions were implemented. RESULTS: We recorded 253,122 urinary catheter (UC)-days: 30,390 in Phase 1 and 222,732 in Phase 2. In Phase 1, before the intervention, the CAUTI rate was 7.86 per 1,000 UC-days, and in Phase 2, after intervention, the rate of CAUTI decreased to 4.95 per 1,000 UC-days [relative risk (RR) 0.63 (95% confidence interval [CI] 0.55-0.72)], showing a 37% rate reduction. CONCLUSIONS: Our study showed that the implementation of a multidimensional infection control strategy is associated with a significant reduction in the CAUTI rate in AICUs from developing countries.

Tuberculosis in stem cell transplant patients.

Tuberculosis (TB) is an increasing health problem, and patients undergoing stem cell transplantation (SCT) are at high risk of acquiring TB. Following a review of the medical literature, this article reports the current situation of TB in SCT patients. A PubMed search was undertaken using the keywords 'tuberculosis', 'stem cell transplantation' and 'bone marrow transplantation', and cases with meaningful data for analysis were included. The medical literature contains relatively few data on TB and SCT. Although there is a risk of TB in allogeneic SCT patients, this is less than in solid organ transplant patients, and the risk in autologous SCT patients is similar to the risk in the general population. The incidence of TB in SCT patients is proportional to the incidence of TB in the general population. Evidence favouring TB prophylaxis is not well established. While allogeneic transplantation carries a risk of TB, this is not true for autologous transplantation. Prophylaxis can only be an option for selected patients or countries with high rates of TB.

Nosocomial meningitis in a university hospital between 1993 and 2002.

The aim of this study was to establish the relationship between nosocomial meningitis (NM) and surgical interventions, type of pathogens and other hospital infections (HIs). Fifty-one patients diagnosed with NM, according to the criteria of the Centers for Disease Control and Prevention, in the Neurosurgery Department of Ibn-i Sina Hospital of Ankara University between 1993 and 2002 were evaluated retrospectively. All individuals with NM were hospitalized in the intensive care unit. Third-generation cephalosporins were used for surgical prophylaxis and broad-spectrum antibiotics were used for treatment. NM occurred in 0.34% of all admissions and accounted for 0.53% of all HIs. Fourteen cases (28%) had at least one concurrent HI, mainly originating from surgical wounds and related secondary bacteraemia. Four cases had NM following surgical site infection with the same causative agent and three cases had bacteraemia. All the individuals had surgical interventions and 26 (51%) had operations concerning ventriculoperitoneal shunt. A positive microbiological cause was found in the cerebrospinal fluid of 49 patients, with 16 cases having a polymicrobial cause. Of all 67 micro-organisms isolated, 41 (61%) were Gram-negative bacilli, 23 (34%) were Gram-positive cocci and the remaining three (5%) were Candida spp. Staphylococci were the most common pathogens (30%), followed by non-fermentative Gram-negative bacilli (22%).

Tumor necrosis factor-alpha and interleukin-1 beta levels in children with bacterial, tuberculous and aseptic meningitis.

Cerebrospinal fluid levels of tumor necrosis factor-alpha and interleukin-1 beta in 78 children with nonbacterial, bacterial and tuberculous meningitis, and in 34 control subjects were analyzed in order to evaluate the involvement of these cytokines in the pathogenesis of acute bacterial meningitis and their discriminative value between different etiologies of meningitis. Tumor necrosis factor-alpha and interleukin-1 beta levels were significantly higher in bacterial and tuberculous meningitis than in aseptic meningitis and in control subjects (p < 0.0001). There was no difference in the levels of tumor necrosis factor-alpha and interleukin-1 beta between nonbacterial meningitis and control groups. The finding that both tumor necrosis factor-alpha and interleukin-1 beta are increased in the cerebrospinal fluid of patients with bacterial and tuberculous meningitis whereas normal levels of these two cytokines have been found in patients with nonbacterial meningitis signifies that these cytokines may be used to differentiate between bacterial and nonbacterial meningitis.

Ofloxacin versus co-trimoxazole in the treatment of typhoid fever in children.

Ofloxacin has been successfully used in the treatment of typhoid fever and Salmonella infectious of adults for many years. However, it has rarely been tried for the typhoid fever of children. In the present study, the therapeutic efficacy of ofloxacin in the treatment of typhoid fever in children was compared to that of co-trimoxazole. Out of 41 patients with bacteriologically documented typhoid fever, those with co-trimoxazole-resistant strains received 20 mg/kg ofloxacin twice daily for 10 days, and those with co-trimoxazole-susceptible bacteria were given 60 mg/kg co-trimoxazole twice daily for 10 days. Both groups were compared according to the clinical variables (apyrexia, resolution of gastrointestinal, central nervous system reactions and articular symptoms) and the time when cultures became negative. All patients in both groups were cured without relapse. Apyrexia, resolution of gastrointestinal, central nervous system reactions and articular symptoms were obtained in a significantly shorter time with ofloxacin than with co-trimoxazole (P < 0.05). The interval between onset of therapy and the time when cultures became negative was significantly shorter in the ofloxacin group than in the co-trimoxazole group (P = 0.005). Ofloxacin seems to be a good alternative in the treatment of typhoid fever caused by co-trimoxazole resistant salmonellae in children aged less than 16 years. It is well tolerated by the patients and it causes no side effects with short-term usage.

Antibiotic susceptibilities of Salmonella serogroups isolated from Turkish children.

This study is performed to show the serogroup distribution and in-vitro antibiotic susceptibilities of Salmonella species that cause either gastroenteritis with/without bacteremia or enteric fever at Hacettepe University Ihsan Dogramaci Children's Hospital. Of the 309 Salmonella strains evaluated, serogroup B was the most common isolate (56%) followed by serogroup D (33%). Antibiotic susceptibility tests using the disk diffusion technique revealed resistance rates of 43 percent for ampicillin, 41 percent for chloramphenicol, 29 percent for trimethoprim-sulfamethoxazole (SXT) and 32 percent for ceftriaxone among Salmonella serogroup B. The same rates were 10, eight, seven and zero percent for Salmonella serogroup D, and seven, 14, and zero percent for serogroup C, respectively. S.thypi strains susceptible to all antibiotics studied except tetracycline (33% resistant). No resistance was detected against the quinolones. The antibiotic resistance of Salmonella species isolated from children seems to be important, especially in serogroup B. Susceptibility tests should be considered in the antimicrobial therapy of Salmonella infections where indicated.

Antibiotic susceptibilities of enterococci isolated from Turkish children.

To evaluate the antibiotic resistance rates of enterococci isolated at Hacettepe Children's Hospital, in vitro antibiotic susceptibility tests were performed in 77 enterococci (32 hospital, 45 nonhospital strains) isolated from various clinical specimens in 1994. Microbroth dilution tests against ampicillin, vancomycin, gentamicin and streptomycin were performed according to the NCCLS standards. High-level resistance to aminoglycosides was investigated. Ampicillin resistance rates were 21.9 percent and 2.2 percent for hospital and nonhospital strains, respectively (p < 0.01). The same rates were 46.9 and 13.3 percent for gentamicin (p < 0.01), and 15.6 and 13.3 percent for streptomycin (p = 0.25). No resistance was detected against vancomycin. Six strains (7.8%) showed high-level resistance to both aminoglycosides studied. Special attention should be paid to enterococci isolated from hospitalized patients. Appropriate antibiotic use in serious infections can only be achieved by choosing an appropriate regimen according to antibiotic susceptibility tests. Periodic evaluation of the antibiotic susceptibility patterns of enterococci is necessary for the empirical treatment of infections due to these microorganisms.

Microorganisms involved in acute bacterial meningitis in children and the role of Haemophilus influenzae.

Acute bacterial meningitis (ABM) is an important cause of mortality and neurological damage in children. Documentation of the etiological agents is very important both for the treatment of patients and for prophylactic approaches. H.influenzae, N.meningitidis and S.pneumoniae are the three major pathogens involved in ABM. In Turkey for many years H.influenzae has not been isolated in cerebrospinal fluid (CSF) specimens. In order to show the bacteria involved in ABM in our hospital and to see the role of H.influenzae, we investigated the CSF of 59 patients with bacterial meningitis using Gram and Wayson stains, culture and latex agglutination techniques. The agents were determined in 38 (64.4%) specimens by using culture positivity in 30 (50.8%), and latex or stain positivity in eight (13.6%) specimens. The microorganisms causing ABM included S.pneumoniae (25.6%), gram-negative enteric bacillI (17.9%), N.meningitis (12.8%), alpha hemolytic streptococci (10.3%), H.influenzae (10.3%), nonfermentative gram-negative bacillI (5.1%), candida spp. (5.1%), group B streptococci (2.6%), coagulase negative staphylococci (2.6%), S.aureus (2.6%) and pseudomonas spp. (5.1%). In this study it has been shown that H.influenzae can cause ABM in Turkish children. Multicentric studies from different parts of Turkey will be helpful in showing the real incidence in our country.

Changing patterns of the prevalence of different Shigella species and their antibiotic susceptibilities in Ankara, Turkey.

Shigella flexneri was the most common Shigella serogroup isolated in Turkey. Recently, an increase in the number of Shigella sonnei isolates was noticed. A retrospective analysis of 2,710 isolates, obtained from stools of Turkish children between January 1980 and September 1994, revealed that, between 1980 and 1987, S. flexneri was the most common subgroup. The isolation rate of S. sonneri increased steadily from 1987 to 1994 reaching to a peak of 78% of all isolates in 1991. The antibiotic susceptibility of 206 strains isolated in 1994 was also studied. A marked difference between the two species was observed for chloramphenicol (98% susceptibility in S. sonnei versus 20% in S. flexneri, ampicillin (90% vs. 18%), ampicillin-sulbactam (98% vs. 53%), and tetracycline (46% vs. 18%) (p < 0.001). Susceptibility to trimethoprim-sulphamethoxazole was similar between the two groups (42% vs. 38%). All isolates were susceptible to ciprofloxacin and ceftriaxone. Comparing our results with resistance rates in 1989, a marked increase in amplicillin (from 44.1% to 82%), chloramphenicol (from 36.7% to 56%) and trimethoprim-sulphamethoxazole (from 35.8% to 62%) resistance was observed.

[Laboratory infections]. / Laboratuvar enfeksiyonlari.

Infection constitutes an important professional hazard for health care workers. Since the past decades infections acquired during laboratory work have caused morbidity and even mortality among laboratory employees. In this article the importance of laboratory acquired infections and some guidelines for protection are stated.

[Penicillin resistance in Streptococcus pneumoniae strains]. / Streptococcus pneumoniae suslarinda penisilin direnci.

In this study a total of 87 Streptococcus pneumoniae strains were tested for their susceptibility to penicillin with disk diffusion method by using 5 micrograms methicillin disks. In 68 strains susceptibility to penicillin was also determined by using agar dilution method performed in Mueller-Hinton agar supplemented with 5% sheep blood. Of 63 adult isolates tested with disk-diffusion method 35 strains (55.6%) were susceptible to penicillin, 24 strains (38.1%) had low level resistance and 4 strains (6.3%) had high-level resistance to penicillin. Of 24 S. pneumoniae isolates recovered from children 5 (20.8%) were penicillin susceptible, while 11 (45.8%) had low level resistance and 8 (33.4%) had high level resistance to penicillin. These values were 40 (45.9%), 35 (40.3%) and 12 (13.8%) in total isolates respectively. Of 44 isolates in which MIC values of penicillin were determined by agar dilution method, 34 strains (77.3%) were penicillin susceptible and 10 strains (22.7%) had low level resistance while none of these strains had high level resistance to penicillin. Of 24 children isolates tested with agar dilution method 11 strains (45.8%) were susceptible to penicillin, 8 strains (33.4%) showed low level resistance and 5 strains (20.8%) showed high level resistance to penicillin. For total of 68 isolates these values were 45 (66.1%), 18 (26.4%) and 5 (7.3%) respectively. These findings indicate the need to perform antibiotic susceptibility testing of all pneumococcal isolates to avoid therapeutic failure.

[Staphylococcal biotyping and the use of computers]. / Stafilokoklarin biyokimyasal tiplendirilmesi ve bilgisayar kullanimi.

Ninety coagulase negative staphylococci isolated from various clinical specimens in Clinical Microbiology laboratory of Hacettepe University Faculty of Medicine, were biotyped using a special computer program. Types of 30 strains isolated from pus were found to be S. epidermidis (36.7%), S. haemolyticus (20%), S. simulans (13.3%) and S. hominis (10%) respectively. Among the strains isolated from blood S. epidermidis was again the predominant microorganism (40%), followed by S. haemolyticus (20%) and S. simulans (10%).

Campylobacter and enterohaemorrhagic Escherichia coli (EHEC) associated gastroenteritis in Turkish children.

From May 1989 to April 1990, stool specimens of 677 children less than 15-years old who were admitted to the Hacettepe University outpatient department of Pediatrics with acute enteritis were collected to search for four common enteric pathogens: Salmonella, Shigella, Campylobacter, and enterohaemorrhagic Escherichia coli (EHEC). At least one of the three bacteria was detected in 107 (15.8%) of the patients. Campylobacter was found in 72 (10.6%) of the samples. Shigella and Salmonella spp. were isolated in 26 (3.8%) and 11 (1.6%) children respectively. EHEC was not isolated from any of the stool samples. None of the 100 healthy children examined as a control group yielded any of the four pathogens in their stools. Campylobacter should be considered as an important aetiological agent of diarrhoeal diseases in Turkey, where EHEC is not a common pathogen.

[Colony-stimulating factors]. / Koloni stimüle edici faktörler.

The colony-stimulating factors are glycoprotein hormones that regulate the proliferation and differentiation of hematopoietic progenitor cells and the function of mature blood cells. They are claimed to be used in the therapy of some hematologic disorders as well as infectious diseases in recent years.

[Comparison of two different media-atmosphere combinations on the isolation of group A beta-hemolytic streptococci from throat cultures]. / Farkli iki besiyeri-atmosfer kombinasyonunun bogaz kültürlerinden A grubu beta hemolitik streptokok izolasyonuna etkilerinin karsilastirilmasi.

In this study effects of incubation of sheep blood agar medium in aerobic conditions and incubation of sulfamethoxazole-trimethoprim containing sheep blood agar medium in 5 to 10% CO2, of the isolation of group A beta hemolytic streptococci from throat cultures were compared. 608 throat swab specimens were studied. Each agar medium was evaluated after 24 and 48 hours of incubation period. The aerobic incubation of sheep blood agar plates for 24 hours yielded 108 (17.7%) strains of beta hemolytic streptococci, of these 96 (15.8%) strains being group A. 113 (18.5%) strains of beta hemolytic streptococci were isolated after 48 hours of incubation and 100 (16.4%) of these were group A. The number of beta hemolytic streptococci isolated in 5 to 10% CO2 atmosphere for 24 hours was 62 (10.2%), and 57 (9.3%) of these were group A. When the incubation period was prolonged to 48 hours, the total number of beta hemolytic streptococci isolated increased to 82 (13.5%) and 76 (12.5%) of these were determined as group A. The difference between these two combinations was significant for 24 hours of incubation, but not significant for 48 hours of incubation. The highest isolation rate for group A streptococci was achieved in aerobic incubation of sheep blood agar plates for 48 hours.

[Group B streptococcal endocarditis]. / B grubu streptokokkal endokardit.

In this article, a case of group B streptococcal endocarditis in a diabetic patient, taking immunosuppressive therapy because of dermatomyositis is reported.