The investigation of biochemical and microbiological properties of four different honey types produced in turkey and the comparison of their effects with silver sulfadiazine on wound healing in a rat model of burn injury.

BACKGROUND: To determine and compare the effects of different honey types on wound healing in an animal model, with silver sulfadiazine as the standard treatment. MATERIALS AND METHODS: Five different groups were created with eight rats in each group. Partial-depth burns were created, and different types of honey and silver sulfadiazine were applied to the respective groups. Rats were monitored for 21 days, and wound cultures were obtained. Histopathological evaluation and cytokine analysis of final tissue samples were performed. In addition, the biochemical and microbiological analyses of the four types of honey used in the study were performed. RESULTS: Wound shrinkage comparisons showed that all four honey-treated groups (Bingöl, Konya, cotton, and citrus) performed better than the silver sulfadiazine group (honey groups, respectively, 86.86%, 84.72%, 89.61%, and 95.33% vs. control 82.90%). However, only citrus honey caused a significant difference in wound shrinkage rate when compared with other groups as well with control group (95.34% vs. 82.9%, P < 0.05). In tissues, all honey groups had higher cytokine (interleukin [IL]-6, IL-1B, tumor necrosis factor [TNF]-α) values compared with controls (P < 0.001). Honey analysis showed a significant inverse relationship between Fe (iron) and the number of diastases. CONCLUSIONS: The results of this study support the role of honey in wound healing, due to its antibacterial and immunomodulatory effects. More studies are needed to identify the role of honey composition in wound healing.

Rapid detection of fosfomycin resistance in Escherichia coli and Klebsiella spp. strains isolated from urinary tract infections.

This study evaluates whether the rapid fosfomycin resistance (fosfomycin NP) method can be used for detecting fosfomycin resistance in routine laboratory work. Results from the disk diffusion and rapid fosfomycin NP methods were compared with the reference agar dilution method for Escherichia coli and Klebsiella spp. strains isolated from urinary tract infections. The study included 57 E. coli and 48 Klebsiella spp. isolates from urinary tract infections. The reference agar dilution and disk diffusion methods were performed in accordance with EUCAST recommendations, and the results were evaluated according to EUCAST V.10.0. The method developed by Nordmann et al. was used for rapid detection of fosfomycin resistance (Nordmann, P., Poirel, L., Mueller, L., 2019. Rapid Detection of Fosfomycin Resistance in Escherichia coli. J Clin Microbiol. 57(1), e01531-18. doi:https://doi.org/10.1128/JCM.01531-18). The acceptable categorical agreement (CA ≥ 90%) and the rates of major error (ME <3%) and very major error (VME < 3%) of the two methods were compared with the reference method according to the criteria of ISO 20776-1. Fosfomycin resistance was detected in 15.8% of E. coli and 75% of Klebsiella spp. isolates using the reference method. Disk diffusion method showed CA 89.5%, ME 12.5% in E. coli isolates, and CA 75%, ME 100% in Klebsiella spp. isolates. No VME was detected in both methods. The rapid fosfomycin NP method resulted in CA 96.4%, ME 0.0%, VME 22.2% in E. coli isolates, and CA 77.3%, ME 81.8%, and VME 3% in Klebsiella spp. isolates. We believe the results from both of disk diffusion assay and rapid fosfomycin NP for the E. coli and Klebsiella spp. isolates are incompatible with the reference method and should not be used as an alternative to the agar dilution method.

Molecular characterization and antimicrobial susceptibility of methicillin-resistant staphylococcus aureus isolates from clinical samples and asymptomatic nasal carriers in Istanbul (Turkey).

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) has been a widespread problem in Turkish hospitals. AIMS: The aim of this study was to investigate the staphylococcal toxin genes of the clinical and nasal MRSA isolates, and their antibiotic resistance profiles. MATERIALS AND METHODS: Isolation of nasal and clinical bacteria was done following standard microbiological methods. The presence of antimicrobial resistance genes (mec A, pvl, tsst-1, and SEs genes) was determined using the real-time polymerase chain reaction (PCR) assay. RESULTS: Among nasal MRSA isolates, 66.7% were toxigenic. The distribution of genes was as follows: pvl 26.7%, tsst-1 3.3%, and SEs 36.7%. Therefore, the nasal MRSA isolates had a rate of 23.3% multidrug resistance (MDR) pattern to the non-beta-lactams antibiotics. All (100%) clinical MRSA isolates were found to be toxigenic. The distribution of genes was as follows; pvl 10%, tsst-1 6.7%, and SEs 100%. The clinical MRSA isolates had a rate of 60% MDR. CONCLUSIONS: Following detection of pvl, tsst-1, and SEs among nasal and clinical MRSA isolates, and the presence of high antimicrobial resistance, the spread of these strains may be an additional factor contributing to the emergence of community-acquired (CA)-MRSA and hospital-acquired (HA)-MRSA. This study is the first to determine the resistance to linezolid and tigecycline in both nasal and clinical MRSA isolates, for the first time in Turkey. All nasal and clinical MRSA isolates were uniformly susceptible to vancomycin and quinupristin-dalfopristin. Our findings show that MRSA infections in Turkey can be empirically treated with vancomycin and quinupristin-dalfopristin based on the lack of demonstrable resistance to these drugs.

Evaluation of the performance of rapid antibiotic susceptibility test results using the disk diffusion directly from the positive blood culture bottles.

PURPOSE: In this study, we aimed to evaluate the compliance of rapid antibiotic susceptibility test (RAST) and conventional laboratory procedures. METHODS: The RAST was performed directly from the blood cultures of 71 Gram negative bacilli (GNB) and 38 Gram positive cocci (GPC) isolates. The results were evaluated at fourth, sixth and eighth hour. Categorical agreement (CA), very major error (VME), major error (ME) and minor error (mE) were calculated and compared with the results of conventional Vitek-2 system. RESULTS: Categorical agreement was detected ≥90 in cefotaxime and meropenem at fourth hour in Escherichia coli isolates. An encourage positive CA results were obtained from meropenem, ceftazidime and ciprofloxacin at the fourth hour in Klebsiella pneumoniae isolates. CA was compatible in imipenem, ciprofloxacin, gentamicin, and tobramycin for Pseudomonas aeruginosa at sixth hour. CA was low (<90%) in piperacillin-tazobactam for E. coli and K. pneumoniae, and meropenem in P. aeruginosa isolates. A good CA (≥90) with all tested antibiotics were found at all hours for Acinetobacter baumannii and also very high CA (100%) was detected at sixth and eighth hour in Staphylococcus aureus isolates. CA remained below the standard criteria at fourth hour in vancomycin and high level gentamicin, in addition to imipenem at sixth hours in enterococci isolates. VME and ME were not detected and mE was 12.7% in GNB and 50% in GPC at eighth hour. CONCLUSIONS: EUCAST RAST at eighth hour will be beneficial in urgent patients due to their high CA rate, easy preparation, inexpensive, and could be performed with the available equipment and personnel.

Should we leave the paper currency? A microbiological examination.

OBJECTIVE: Pathogens can be transmitted to banknotes due to the personal unhygienic habits. The aim of study was to find the possible pathogens on the banknotes circulating in the market and also to present their antibacterial resistance and their various virulence factors using genotypic and phenotypic methods. METHODS: A total of 150 samples of bank-notes were randomly collected between August 2017 and March 2018. VITEK systems were used for identification and antimicrobial susceptibility testing respectively. Antimicrobial resistance genes (mecA, van, extended-spectrum ß-lactamase [ESBL] and carbapenemases) and staphyloccoccal virulence genes (staphyloccoccal enterotoxins [SEs], pvl, and tsst-1) were determined using with real-time PCR. RESULTS: Staphylococcus aureus, coagulase-negative staphylococci (CoNS), Enterococcus spp., Gram-negative enteric bacteria, non-fermentative Gram-negative bacteria and Candida spp. were detected 48%, 54.7%, 56%, 21.3%, 18.7%, and 4%, respectively. Methicillin-resistant S. aureus, vancomycin-resistant enterococci and ESBL producing Gram-negative were found 46.8%, 1.3%, and 28.7%, respectively. Pvl, tsst-1, and SEs genes were found in a 2.8/4.9%, 1.4/1.2%, and 100/ 87.8% of the S. aureus/CoNS strains, respectively. The sea gene was found the most common enterotoxigenic gene. blaTEM, blaSHV, blaCTX-M-2, blaCTX-M-1, blaKPC, and blaOXA-48 were found 55.8%, 46.5%, 41.2%, 18.6%, 18.6%, and 18.6%, respectively in Gram-negative strains. CONCLUSIONS: These results is very important to highlight hygienic status of paper currencies. This can be considered as an indication that banknotes may contribute to the spread of pathogens and antimicrobial resistance. Therefore, we may need to start using alternative products instead of banknotes.

Association of the PTPN22 gene polymorphism with autoantibody positivity in Turkish rheumatoid arthritis patients.

The PTPN22 C1858T gene polymorphism has been recently reported to be associated with rheumatoid arthritis (RA) in European and North American ancestry. In contrast, the frequency of PTPN22 C1858T polymorphism is extremely rare in Asian and African populations. As the genetic heterogeneity between populations is clearly present in RA, we wanted to investigate whether the PTPN22 C1858T polymorphism is associated with RA in Turkey and with autoantibody positivity. A total of 323 RA patients and 426 healthy controls were genotyped by polymerase chain reaction restriction fragment length polymorphism for the PTPN22 C1858T polymorphism (rs2476601). The frequencies of heterozygote genotype (CT) were 8.4% in RA patients and 5.4% in the healthy controls, respectively [odds ratio (OR): 1.6, P = 0.14]. The homozygote genotype (T/T) was absent in both RA patients and the healthy controls. When compared with the healthy controls, we found the significant associations between the frequency of PTPN22 heterozygote (CT) polymorphism and RA patients with RF positivity and anti-CCP positivity, respectively (OR: 2.05, P = 0.04 and OR: 2.1, P = 0.03, respectively). Our study suggests that the PTPN22 C1858T polymorphism acts as a susceptibility gene for autoantibody-positive RA in Turkey.

Serum neopterin as a prognostic indicator in patients with gastric carcinoma.

PURPOSE: To evaluate the possible association between serum neopterin level and clinical and laboratory findings and their prognostic value of patients with gastric carcinoma. METHODS: Serum samples were collected from patients (n = 38) and normal volunteers (n = 39) and stored at -80 degrees C until analyzed. Neopterin, C-reactive protein (CRP), and IL-6 concentration were measured by ELISA. The clinicopathological parameters were determined by reviewing both medical charts and pathological records. RESULTS: Mean neopterin levels were 15.26 +/- 11.46 nmol/L in patients with gastric carcinoma and 9.87 +/- 2.90 nmol/L in the control group. Serum neopterin concentrations were significantly higher in patients with gastric carcinoma than in the control group. The number of patients with elevated neopterin level was significantly correlated with stage, gastric wall involvement, the number of metastatic lymph nodes, and the level of serum CRP. The mean neopterin concentrations were significantly elevated in patients older than 60 years, in the presence of venous invasion and increased metastatic lymph node number, and in patients with elevated CRP levels. Neopterin level was also correlated with overall survival as an independent prognostic indoicator. CONCLUSIONS: Serum neopterin levels were elevated in patients with advanced gastric cancer and correlated with prognostic parameters and overall survival. Moreover, neopterin measured at the time of diagnosis can be used to predict the survival of gastric carcinoma.

Obstructive sleep apnoea, cigarette smoking and plasma orexin-A in a sleep clinic cohort.

Orexin-A is a neuropeptide involved in the regulation of food intake and the sleep-wake cycle. This study investigated plasma orexin-A levels in a sleep clinic cohort, adjusting for smoking habits, in 76 participants comprising 41 with obstructive sleep apnoea (OSA) (apnoea-hypopnoea index [AHI] 44.1 +/- 19.1 events/h) and 35 without OSA (AHI 6.3 +/- 4.7 events/h). Plasma orexin-A levels were significantly lower in OSA patients (15.0 +/- 4.6 ng/ml) compared with those without OSA (31.4 +/- 6.5 ng/ml). In non-OSA subjects, there was no significant difference between never smokers and ex/current smokers in plasma orexin-A levels (32.9 +/- 9.5 versus 29.7 +/- 8.9 ng/ml, respectively) whereas, in the OSA sub-group, orexin-A levels were significantly lower in never smokers than in ex/current smokers (4.0 +/- 1.2 versus 21.4 +/- 7.0 ng/ml). A significant inverse relationship was found between plasma orexin-A levels and AHI amongst never smokers, but there was no significant relationship amongst ex/current smokers. These results confirm previous studies demonstrating lower levels of plasma orexin-A in OSA patients and indicate that smoking may affect orexin-A levels and AHI.

Effects of gender difference in early cytokine levels in trauma patients.

BACKGROUND: Experimental studies conducted on laboratory animals have demonstrated that gender differences affect the outcome following trauma-hemorrhage but, it is not clear yet whether the manipulation of sex steroids during clinical trauma affects the outcome. This study was designed to determine whether gender based changes occur in cytokine responses after trauma-hemorrhage. METHODS: Plasma cytokine, estradiol, and prolactin levels of 100 consecutive abdominal trauma patients admitted to an emergency unit were measured to determine if there is a gender based difference. RESULTS: There was no significant difference in trauma severity between male and female patients. Plasma interleukin-1beta levels were found to be significantly higher in male patients compared to females following trauma hemorrhage (p = 0.003). On the other hand, there was no significant difference in plasma interleukin-6, tumor necrosis factor-*, and prolactin levels between the male and female patients (p > 0.05). CONCLUSION: These results suggest that the role of sex steroids on immunomodulatory processes following trauma-hemorrhage should be further investigated before studies are undertaken to evaluate the effect of hormonal manipulation in patients with trauma (Tab. 1, Fig. 1, Ref. 26).

Potential role of interleukin 6 in reactive thrombocytosis and acute phase response in pulmonary tuberculosis.

OBJECTIVE: Reactive thrombocytosis is found in a number of clinical situations including infectious diseases such as pulmonary tuberculosis (PTB). To examine the possible role of interleukin (IL6) in reactive thrombocytosis and acute phase response in PTB this study measured serum IL6, C reactive protein (CRP), erythrocyte sedimentation rate (ESR), albumin concentrations in 62 PTB patients and 20 healthy volunteers. METHOD: PTB patients were divided into two groups based on thrombocyte counts. Twenty seven PTB patients with normal thrombocyte counts constituted group 1, 35 PTB patients with thrombocytosis constituted group 2, and 20 healthy volunteers constituted group 3. RESULTS: The median IL6 concentration of group 1 was 12.8 pg/ml (95% CI: 12.1 to 56.9 pg/ml) and group 2 was 40.6 pg/ml (95% CI: 67.1 to 168.7 pg/ml). The comparison of IL6 concentrations in the three groups was significant (p = 0.0001). Patients in group 1 had a higher concentration of CRP (p = 0.0001) and lower concentration of albumin (p = 0.002) than group 3 whereas group 2 had higher concentration of CRP (p = 0.003) and lower concentration of albumin (p = 0.002) than group 1. Serum IL6 concentrations were significantly correlated with thrombocyte counts (p = 0.004, r = 0.36), CRP (p = 0.007, r = 0.34), and albumin concentrations (p = 0.005, r = -0.34). IL6 concentrations were significantly correlated with the number of involved zones (p = 0.005, r = 0.35) and acid fast bacilli positivity (p = 0.03, r = 0.27). Patients in group 2 had weight loss (p = 0.004), fever (p = 0.038), and night sweats (p = 0.007) more frequently than group 1. Also, group 2 had more extensive radiological findings (involved zones p = 0.001, bilateral disease p = 0.0001, presence of cavity p = 0.02) than group 1. CONCLUSIONS: IL6 might play a contributory part in reactive thrombocytosis and acute phase response in PTB.

Investigation of the course of proinflammatory and anti-inflammatory cytokines after burn sepsis.

Cytokines have been considered as important participants in the post-burn pathophysiological process. The aim of this study was to investigate the course of a proinflammatory cytokine interleukin-8 (IL-8) and an anti-inflammatory cytokine IL-10 in burned patients and whether there was a correlation between mortality and serum levels of these cytokines. Thirty-six acutely burned patients, admitted to Ankara Numune hospital burn unit, entered into the study. A series of serum samples were collected, and serum levels of IL-8 and IL-10 were determined using enzyme-linked immunosorbent assay kit. According to definition utilised, 21 patients developed septic shock and nine of them died. There was no mortality among the 17 non-septic patients. In all 36 patients, there was an increase in serum IL-8 levels, and a peak level was detected shortly after burn injury. The peak IL-8 value of the non-survivors was greater when compared with that of the others. On admission, a significant difference in serum IL-8 values was found between survivors and those who died. In all patients, a peak level of IL-10 was detected between 5 and 9 days of injury. In non-septic survivors, this peak level was less when compared with that of the others. After this peak level, in all patients, serum IL-10 levels showed a decrease, but in non-survivors, a second peak level was detected. A greater understanding of the pathology of the burn sepsis allows rationale use and assessment of current therapies. The results obtained in this study provide useful information on the formulation approaches to this task. Also, IL-8 and IL-10 are prognostic factors in burn sepsis.

Effect of pinealectomy on immune parameters in rats with Staphylococcus aureus infection.

It is generally accepted that the pineal gland is a neuroendocrine organ. Several recent experiments have shown that the pineal gland has functional and anatomical connections, particularly with the immune system, and therefore the gland is now recognized as an important immunoneuroendocrine organ in both man and animals. The present study investigates the effect of pinealectomy on some immune parameters, including hematological alterations, and the response of the brain tissue against infection caused by Staphylococcus aureus. Experiments were performed on two different age groups of rats (neonatal and young). The results showed a significant reduction of the plasma zinc level in the third week following pinealectomy, impairment of the hematological parameters including lymphocyte, erythrocyte, and leucocyte, and the deficiency of the brain response to the infective agent, particularly in pinealectomized neonatal rats. In view of these data and as described previously, the pineal gland has a main regulatory function in immune physiology, but our study indicates that only neonatal immune functions are significantly affected by pinealectomy.

Surveillance of antimicrobial resistance among gram-negative isolates from intensive care units in eight hospitals in Turkey.

With the participation of eight major reference hospitals in Turkey, 749 aerobic Gram-negative isolates obtained from 473 intensive care patients in 1997 were tested for their susceptibility to 13 commonly employed antibacterial agents. The frequency with which species were isolated and resistance rates were compared with data from the previous 2 years. Imipenem was the most active agent against the majority of isolates (75%), followed by ciprofloxacin, cefepime and amikacin. The per cent susceptibility to all antibiotics declined from 1995 to 1996. With the exception of imipenem, for which there was no change in resistance, the per cent susceptibility somewhat increased in 1997. However, it was still lower than in 1995.