The frequency and clinical significance of antibodies to soluble liver antigen/liver pancreas in autoimmune hepatitis: a prospective single-center study.

BACKGROUND AND AIMS: Soluble liver antigen/liver pancreas antibodies (anti-SLA/LP) are specific markers for autoimmune hepatitis (AIH) that have been associated with a distinct clinical phenotype and a more aggressive form of AIH. We prospectively evaluated the frequency and clinical significance of anti-SLA/LP in Turkish patients with AIH. MATERIAL AND METHODS: We prospectively included patients diagnosed with AIH between January 2018 and May 2023. Autoantibodies were detected using by immunofluorescence and immunoblot. RESULTS: We included 61 (80%, female) AIH patients with a median age of 31 years (15-78) at the time of diagnosis. Anti-SLA/LP was detected in 20% ( n  = 12) of the patients. Baseline characteristics, treatment responses and outcomes were similar among anti-SLA/LP-positive and anti-SLA/LP-negative AIH patients. Anti-SLA/LP-positive patients had significantly higher biochemical response rates after 4 weeks (100 vs. 67%, P  = 0.027), 3 months (100 vs. 39%, P  < 0.001), 6 months (100 vs. 69%, P  = 0.041) of therapy but not after 12 months (100 vs. 76%, P  = 0.103) and at the end of follow-up (100 vs. 91%, P  = 0.328). Relapse rates following treatment response were similar in patients with and without anti-SLA/LP (22 vs. 23%, P  = 0.956). Second-line therapies (tacrolimus and mycophenolate mofetil) were given to seven (11%) patients, all were anti-SLA/LP-negative. Two of these progressed into end-stage liver disease and both underwent liver transplantation. CONCLUSION: Our study results suggest that anti-SLA/LP positivity does not entail clinically distinct or severe features in AIH. In our cohort, anti-SLA/LP-positive patients showed a quicker response to immunosuppressive therapy.

[Malaria and Gut Microbiota: Microbial Interactions in the Host]. / Sitma ve Bagirsak Mikrobiyotasi: Konakta Mikrobiyal Etkilesimler.

Malaria is still considered an important public health problem among parasitic diseases all over the world and poses a significant risk for half of the world's population. In recent years, both the human and animal experimental models pointed out that Plasmodium species that cause malaria changes the composition of the human gut microbiota and particularly certain gut bacterial communities are associated with the risk and severity of malaria infection. These data take the host-microbiota relationship to the next level and enable the scientific world to focus on the interaction in the host-microbiota-pathogen triangle. Plasmodium-gut microbiota interaction has attracted attention in the severe malaria infection, whose immunopathogenesis mechanism is still unknown and can show severe clinical symptoms from person to person. Studies on Plasmodium-gut microbiota are limited in the literature. Although it is difficult to compare the data due to the differences in method and purpose in the studies, in the case of Plasmodium infection, a decrease abundances of Bacteroidetes and Verrucomicrobia phyla and an increase abundances of Firmicutes and Proteobacteria phyla were observed in the gut microbiota. It has been noticed that Plasmodium can cause changes in the gut microbiota of the host and can differentiate the host immune response, especially by changing the short-chain fatty acids producing gut bacteria. The human immune response targets different stages in the complex life cycle of Plasmodium. The major immune response elements in the preerythrocytic and erythrocytic stages of Plasmodium are CD8+ T cells and antibodies, respectively. Germinal center B cells in the spleen have critical roles for the longevity of specific antibodies required in Plasmodium infections. Gut bacteria can influence germinal center B cell response in mice via CD40 ligand. Genes causing differentiation of Th17 cells are also upregulated in the late immune response to Plasmodium, and differentiation of Th17 cells has been found to be associated with changes in Sutterella and Parabacteroides distasonis in the gut microbiota. Data are currently limited to reveal causesconsequences relationships but the correlation of host cytokine responses due to malaria pathogenesis with the gut microbiota profile draws attention to the relationship. Although the changes in the human gut microbiota is examined in this review, it should be kept in mind that the microbiota in the midgut microbiota of Anopheles can have a negative effect on the physiology of Plasmodium. It was thought that the contribution of these differentiations in the host gut microbiota to the immune response and the host-microbiota-pathogen interaction, especially in severe malaria infections whose immunopathogenesis mechanism is not clear, should be investigated with standardized and comprehensive clinical studies. In this review article, human or animal studies on the interaction of Plasmodium-gut microbiota have been discussed.

[Typing of Leishmania Species Causing Cutaneous Leishmaniasis by Sybr Green Based ITS-1 Real Time Polymerase Chain Reaction Method]. / Kutanöz Laysmanyazise Neden Olan Olan Leishmania Türlerinin Sybr Green Bazli ITS-1 Gerçek Zamanli Polimeraz Zincir Reaksiyonu Yöntemiyle Tiplendirilmesi.

Cutaneous leishmaniasis (CL) is an important public health problem, most frequently seen in Sanliurfa in Turkey. It is important to determine the species in regions where infection occurs with different Leishmania species, as in our province. In this study, it was aimed to genotype 136 samples with suspected Leishmania from Sanliurfa using the Sybr Green-based ITS-1 real time polymerase chain reaction (Rt-PCR) method and then to compare them with ITS-1 PCR RFLP and direct microscopy methods. Wound fluid samples from patient lesions suspected of leishmaniasis were mounted on a slide, fixed, and stained with Giemsa dye. The preparations were examined under the microscope and evaluated for the presence of amastigote. After the extraction of DNA from Giemsa stained preparations by using the QIAmp DNA Mini Kit (Qiagen, Germany), the samples were studied with the Sybr Green based ITS-1 Rt-PCR method using LITSR and L5.8S primers. As a result of the PCR study, melting curve analysis was determined and the melting curves were compared with the reference strains. Then, PCR was performed in 136 samples for ITS1 region amplification using primers LITSR and L5.8S. PCR products were digested with Hae III restriction enzyme and RFLP process was performed. The products were run on metaphor agarose gel than the gels were stained with ethidium bromide for 15 min and visualized in a UV transilluminator In our study, the results of Sybr Green-based ITS-1 Rt-PCR, ITS-1 PCR-RFLP and direct microscopy methods were compared. The highest positivity rate was determined as 97% (136/132) in ITS-1 Rt-PCR method. With ITS-1 PCR-RFLP method 95.5% (136/130) positivity and with direct microscopy 94.1% (136/128) positivity were obtained, respectively. Of 132 samples, which were studied with the Sybr Green-based ITS-1 Rt-PCR method and found as positive, 121 were genotyped as L.tropica and 11 were genotyped as L.major by melting curve analysis. It was determined that, of 130 samples studied with ITS-1 PCR RFLP method 119 (91.5%) were detected as L.tropica and 11 (8.5%) were detected as L.major. The ITS-1 Rt-PCR method we used in our study was the method that detected the most positivity rate. With this method, Leishmania specimens were typed as L.tropica and L.major. It is thought that this method may be useful for the detection of the presence of Leishmania parasite and in the rapid identification of Leishmania species, as it does not require extra processes such as cutting and staining after PCR and results in a short time, but new studies are needed to observe its effectiveness in detecting other species other than L.tropica and L.major.

Relationship between erectile dysfunction and Helicobacter pylori: A prospective controlled pilot study.

This study sought to investigate the correlation between Helicobacter pylori (Hp) and arteriogenic erectile dysfunction (ED). This study included 30 patients diagnosed with ED due to penile arterial insufficiency, in accordance with the International Index of Erectile Function scores and penile Doppler ultrasonography results, and 30 healthy individuals without ED in the control group. The levels of fasting blood glucose, serum lipid and C-reactive protein (CRP) were recorded. Enzyme-linked immunosorbent assay revealed that the levels of Hp-specific Immunoglobulin G (IgG) antibodies in the patient and control groups were 39.7 ± 23.2 and 21.0 ± 19.8 arbU/ml, respectively (p = .001); the mean CRP levels were 0.3 ± 0.2 and 0.1 ± 0.1 mg/dl, respectively (p = .01). A positive correlation was detected between ED and the levels of Hp-specific IgG and CRP. Further comprehensive studies supporting these preliminary results may facilitate the use of Hp seropositivity as an auxiliary marker in the diagnosis of ED. These findings may also guide future research on the clinical benefits of Hp eradication strategies for the prevention and treatment of ED.

[In Vitro Efficacy of the Venome of Black Scorpion (Androctonus crassicauda) on Leishmania tropica Promastigotes]. / Kara Akrep (Androctonus crassicauda) Venomunun Leishmania tropica Promastigotlari Üzerindeki In Vitro Etkinligi.

Scorpion venom is a substance that shows strong neurotoxic effects with its complex protein content and thus plays an important role for the scorpion in catching and digesting the hunt. Human body stung by a scorpion can show life-threatening systemic effects in a short time, ranging from erythema, pain, edema and local fever to abdominal pain, nausea and vomiting, diplopia and even coma. Scorpion venome is known to possess antimicrobial activity, and some of its compounds have potent antibacterial and antifungal activities. Leishmaniasis is a common vector-borne parasitic infection caused by Leishmania sp. protozoa and can lead skin, mucosa and fatal internal organs involvement in patients . There is a need for new drugs in the treatment of leishmaniasis, because it has been documented lately that there is a growing resistance against antimonial compounds which have been used in its treatment for decades. Leishmania species are known to be susceptible to antimicrobial peptides that act as ion-channel inhibitors, which are known to be present in scorpion venome. In this study, it was aimed to investigate the anti-leishmanial activity of scorpion venome extract obtained from Androctonus crassicauda species in our country. In this context, Leishmania tropica promastigotes which were thawed from liquid nitrogen in our laboratory and first grown in NNN and then RPMI-1640 media, were exposed to different dilutions of the extract containing A.crassicauda venom and meglumine antimonate used in the standard treatment of leishmaniasis and the efficacies on the promastigotes were compared and measured in vitro. This was followed by XTT cell viability test, which assessed whether anti-leishmanial dose of the extract was lethal for human cells or not. Trials showed that the half maximal inhibitory concentration (IC50) values of the venome extract and meglumine antimoniate were 18.12 µg/ml (17.33-18.94) and 8.411 µg/ml (7.922- 8.927), respectively. This preliminary study showed that scorpion venome can be lethal on L.tropica promastigotes in vitro, on relatively higher doses compared to meglumine antimonate. Next step will be to determine the anti-leishmanial proteins in the extract and thus to identify new drug candidates with more specific studies.

Characterisation of the Leishmania donovani/L. infantum Hybrid Isolated from an Autochothonous Kala-Azar Patient: Preliminary Results of an In Vivo Model

Objective: In the present study, preliminary outcomes of the in vivo assessment of a Leishmania donovani/L. infantum hybrid isolated from a hospitalised patient with visceral leishmaniasis in Manisa and identified through analysis of the Leishmania-specific ITS-1, hsp70 and cpb gene regions are presented in comparison with reference strains of L. donovani and L. infantum. Methods: Three different study groups [(SG); n=16 mice each] and a control group (n=8 mice) were established with female Balb/C mice weighing 25-30 g. Reference L. donovani (MHOM/IN/1980/DD8), reference L. infantum (MHOM/TN/1980/IP1) and a L. donovani/L. infantum hybrid (MHOM/TR/2014/CBVL-LI/ LD), stored in liquid nitrogen, were thawed, cultured and incubated at 25 °C. A 15-µL dose of 1x108/mL promastigotes of three strains was applied to the tail veins of mice in the SG. After the mice were sacrificed, the liver and spleen tissues were removed and stored for immunological, immunohistochemical and pathological analyses. Results: The presence of infection in the liver and spleen tissues of mice was detected both by a specific enzyme-linked immunosorbent assay test and from the recovery of Leishmania promastigotes from liver and spleen tissues in NNN medium. However, Leishmania amastigotes were not observed in the touch biopsy smears of livers or spleens in either of the SGs. In addition, no evidence of tissue damage was identified in the SGs after immunohistochemical staining (with antibodies against IL-9, CD-117, MBP, CD163, CD4, CD8 and CD31). Conclusion: The obtained results show that hybrid Leishmania and reference L. donovani and L. infantum strains reached the liver and spleens of Balb/C mice in SGs but were of no pathological consequence. Yet, these three Leishmania isolates caused skin lesions when applied subcutaneously in Balb/C mice in another study. The findings presented in this study will be reassessed upon completion of the project, once the final results are obtained.

[Cutaneous Leishmaniasis Cases Caused by Leishmania infantum in Sanliurfa Province, Turkey]. / Sanliurfa'da Leishmania infantum'un Etken Oldugu Kutanöz Leysmanyazis (Sark Çibani) Olgulari.

Leishmaniases are a group of vector-borne diseases, and two clinical forms, visceral (VL) and cutaneous leishmaniasis (CL, Oriental sore), are seen in Turkey. While VL cases are recorded as 20-25 per year, CL cases are reported around 2000 per year, and nearly half of CL cases were recorded in Sanliurfa province. Therefore, by knowing the epidemiology of the disease in Sanliurfa province, it is possible to develop control measures and reduce the total number of cases across the country. Although Leishmania tropica is known as the main causative agent in Sanliurfa, other Leishmania species have also been identified as a result of mass human movements in the last 10 years. In this study, we aimed to present the first CL cases caused by Leishmania infantum in Sanliurfa. A total of 14 cases, which were admitted with the suspicion of CL and diagnosed as positive by direct microscopy and/or real-time ITS1-PCR using lesion aspiration samples are included in the study. Two or more smears were prepared from the samples taken from the lesions of the patients by fine needle aspiration. One of the smears was stained with Giemsa stain after fixation with methyl alcohol and examined under the light microscope at x1000 magnification for the presence of Leishmania amastigotes. DNA isolation was made from the other unstained preparations with a commercial kit (Qiagen DNeasy, Germany) according to the recommendations of the manufacturer. The real-time ITS1-PCR method was performed by using the Old World species-specific primers and probes. As a result, by the identification of the species with real-time ITS1-PCR, it was determined that the causative agent was L.infantum in five cases, L.major in one case and L.tropica in eight cases. It was learned that four of the cases in which L.infantum was detected as the causative agent were local, one was Syrian and they lived in the city center. Also two of the eight cases, which were identified as L.tropica, were Syrian and six of them were domestic cases and all of them lived in the city center. While all 14 patients included in the study were positive with real-time ITS1-PCR, amastigotes were detected in 10 cases only. The cases of CL presented in this study are the first cases caused by L.infantum reported from Sanliurfa, and are important in terms of concretely demonstrating the effect of mass human mobility and migration on the epidemiology of the infection.

[Diversity of Leishmania Strains Isolated from Cutaneous Leishmaniasis Patients in Turkey and its Reflection to Clinics in Mice Model]. / Türkiye'de Kutanöz Leysmanyazis Hastalarindan Elde Edilen Leishmania Izolatlarindaki Farkliliklar ve Bunlarin Fare Modeline Klinik Yansimasi.

Although asexual reproduction has been attributed to Leishmania species, genetic exchange has recently been demonstrated, which helped emerging of hybrid isolates. Situated on the crossroads between three continents, Leishmania hybrids may be present in Turkey. In Turkey, visceral leishmaniasis caused by Leishmania infantum is less common, while cutaneous leishmaniasis (CL) caused by Leishmania tropica and L.infantum could reach 2500 reported cases a year. Our aim was to investigate genetic variability of local Leishmania species and presence of hybrid Leishmania strains in Turkey. Twenty CL patients from Sanliurfa and Hatay, where only L.tropica and both L.tropica and L.infantum cause CL, respectively, were registered equally. All isolates were assessed with real-time polymerase chain reaction (Rt-PCR), isoenzyme analysis, gene sequencing, two-dimensional gel electrophoresis (2D-PAGE) and MALDI-TOF/TOFMS followed by in vivo analyses on mouse model. Identification of differentially expressed proteins was performed. These proteins were confirmed by sequence analysis. All isolates from Sanliurfa were found to be L.tropica which caused cutaneous infection in mice. However, one of 10 isolates from Hatay was found as Leishmania major which caused cutaneous infection. Five isolates were found as L.tropica with Rt-PCR and gene sequencing, one of which had one different protein from the reference L.tropica strain and caused cutaneous infection. Four of the five isolates had five different proteins compared to reference strain and caused both cutaneous and visceral infections. Remaining four isolates showed double melting curves in Rt-PCR, which were concordant with L.tropica and L.infantum. Their sequencing and isoenzyme analyses indicated them as L.infantum. They had six different proteins compared to reference L.infantum strain and caused cutaneous and visceral infections. It is concluded that the isolates with different proteins were hybrid Leishmania species. In the present study, outcomes of the proteomics, genomics, clinical manifestations and tissue tropism on animal models were evaluated together for the first time. In addition to L.tropica and L.infantum, L.major was identified as a causative agent for CL and hybrids of L.infantum/tropica were also shown to be present.

[Determination of Antimony Resistance Mechanism of Leishmania tropica Causing Cutaneous Leishmaniasis in Turkey]. / Türkiye'de Kutanöz Leysmanyazis Etkeni Leishmania tropica'da Antimon Direnç Mekanizmasinin Belirlenmesi.

World Health Organization reported that approximately one billion people are at risk in endemic areas, one million cases of cutaneous leishmaniasis (CL) and approximately 300,000 cases of visceral leishmaniasis (VL) were reported per year in the last five years. The number of deaths due to VL is reported to be approximately 20,000 per year. Approximately 2500 cases/year have been reported as CL, caused by Leishmania tropica and Leishmania infantum, in Turkey. The significant increase observed in many cities mainly in the provinces of Mediterranean and Aegean regions in cases and foci in recent years, suggests that there may be an increase in this infections in the following years as well. In Turkey, the causative agent of CL is L.tropica and meglumine antimoniate is used in the treatment of CL. We aimed to determine antimony resistance genes specific for L.tropica by comparing the gene and protein expressions of antimony-resistant and non-resistant L.tropica strains. L.tropica isolates obtained from 3 CL patients without antimonate resistance from Aegean, Mediterranean and Southeastern regions of Turkey were provided to transform into 3 resistant isolates against meglumine antimony in the laboratory conditions. Gene expression alterations by microarray method; protein profiles by two-dimensional gel electrophoresis (2D-PAGE) and relevant proteins by MALDI-TOF/TOF MS of these isolates were accomplished and compared. L.tropica isolates from 10 CL patients who did not respond to antimony therapy were analyzed for resistance to antimonial compounds and quantitative real-time polymerase chain reaction was performed to detect the expression of genes responsible for resistance development. Moreover, differences in protein expression levels in isolates with and without antimony resistance were determined by comparing protein profiles and identification of proteins with different expression levels was carried out. Enolase, elongation factor-2, heat shock protein 70, tripanthione reductase, protein kinase C and metallo-peptidase proteins have been shown to play roles in L.tropica isolates developing resistance to antimonial compounds and similar expression changes have also been demonstrated in naturally resistant isolates from patients. In conclusion, it was revealed that L.tropica strains in our country may gain resistance to meglumine antimoniate in a short time. It is foreseen that if the patients living in our country or entering the country are treated inadequately and incompletely, there may be new, resistant leishmaniasis foci that may increase the number of resistant strains and cases rapidly.

Cutaneous Leishmaniasis due to Three Leishmania Species Among Syrian Refugees in Sanliurfa, Southeastern Turkey.

Sanliurfa, a city in southeastern Turkey, is host to 477,166 Syrian refugees. The incidence of cutaneous leishmaniasis (CL) may be on the rise in areas affected by a refugee crisis, like Sanliurfa; thus, consequently, local uncommon species of Leishmania may be encountered in these regions. This might potentially make diagnosis and treatment more challenging over time. In this study, it was aimed to identify the causative agents of CL in clinical samples. A total of 154 patients (60 Syrian and 94 Turkish) who were diagnosed with CL via microscopical examination and PCR were enrolled this study. All of the samples were analyzed using internal transcribed spacer 1 genes, restriction fragment length polymorphism, DNA-sequencing, and phylogenetic analyses. In this study, Leishmania tropica was determined to be the predominant species in 140 of the patients (90.9%), followed by Leishmania major in 12 patients (7.8%), and Leishmania infantum in 2 patients (1.3%). Of the 94 Turkish patients, 94.7% were infected with L. tropica and 5.3% were infected with L. major, while none were infected with L. infantum. However, of the 60 Syrian patients, 85% were infected with L. tropica, 11.7% were infected with L. major, and 3.3% were infected with L. infantum. There was a significant association between the Leishmania species and the nations (Turkish-Syrian) (P < 0.001). The sequences were numbered from MH347941 to MH347953 and submitted to GenBank. This study confirmed that L. tropica, L. major, and L. infantum coexisted in Sanliurfa. This was the first time that the species L. infantum was reported among recent immigrants from Syria in Sanliurfa. Therefore, it is necessary to discriminate the Leishmania species for diagnosis, treatment, and controlled studies in hyper-endemic regions.

[Determination of imported malaria cases in Hatay by the use of molecular methods]. / Hatay'da yurt disi kaynakli sitma olgularinin moleküler yöntem kullanarak degerlendirilmesi.

Malaria, being among the most important diseases throughout history, is still an important public health problem among parasitic diseases due to increasing population movements with various reasons such as migration, war and travel. According to WHO data each year 300-350 million people get exposed to malaria, each year 1.5-2.7 million people die from malaria and also 40% of the world's population is still at risk for this disease. According to World Health Organisation (WHO) data, imported cases were not reported since 2013 in our country. However among imported cases Plasmodium falciparum malaria can be observed. The aim of this study wasto draw attention to the imported malaria cases increasing gradually and to the importance of the chemoprophylaxis in terms of malaria before travelling. In the study, male patients who have admitted to Hatay Province Malaria Center or Mustafa Kemal University Infectious Disease Department, ages between 25-60 years, were analyzed. All of the patients have worked abroad before. Patients were mostly from Sudan but there were also patients from endemic regions such as Africa, Nigeria, Pakistan, Mali island. The cases were evaluated according to age, gender and whether they had travel stories in Turkey or abroad. Blood samples taken from the patients were firstly prepared by thin and thick smear preparations and examined microscopically by staining with Giemsa stain method. Samples that were found positive by microscopic examination were impregnated on drying papers and genotyped using nested-PCR. Out of the 30 samples from patients who had traveled to endemic countries before, determined as positive by microscopical examination and genotyped by nested-PCR, 16 of them were identified as P.falciparum, six of them as P.vivax and eight of them as P.falciparum/P.vivax. The study suggested that malaria prophylaxis has to be applied before travelling to endemic countries, in return imported malaria has to be considered one of the first diseases in mind and people who will travel should be informed about this disease before travel.

Correction to: Molecular identification of Leishmania spp. isolates causes cutaneous leishmaniasis (CL) in Sanliurfa Province, Turkey, where CL is highly endemic.

In published article (Molecular Identification of Leishmania spp. Isolates Causes Cutaneous Leishmaniasis (CL) in Sanliurfa Province, Turkey, Where CL is Highly Endemic) Table 1 titled "The pH values of yogurts collected from villages in Turkey" doesn't belong to this article.

Molecular identification of Leishmania spp. isolates causes cutaneous leishmaniasis (CL) in Sanliurfa Province, Turkey, where CL is highly endemic.

Cutaneous leishmaniasis (CL) is an important public health problem in Turkey. CL has been most frequently seen in Sanliurfa. There is an expectation of increase in the population of leishmaniasis cases with the influence of Syrian refugees arriving in Turkey. In this study we aimed to diagnosis of CL and identifying of parasite from Leishmania isolates by using ITS 1 PCR RFLP. Samples were collected from 135 CL patients in Sanliurfa. After the specimens were inoculated in medium NNN, the ones which were cultures positive were cultivated in RPMI 1640 followed by PCR-RFLP. Genomic DNA was extracted phenol-chloroform procedure. Samples were examined by using ITS 1 PCR followed by RFLP analysis. Our results indicated that two species, L. tropica (132 samples) and L. major (3 samples), are responsible for cutaneous leishmaniasis in Sanliurfa. Our study is the first scientific study in which it is reported molecular analyses of cutaneous leishmaniasis cases caused by L. major in Sanliurfa in Southestern Anatolia Region. Because CL cases caused by L.major are detected in our study, it is considered that genotyping is important for diagnosis of Leishmania and following change of epidemiology.

The knowledge and high seroprevalence of hepatitis A in a high-risk group (agricultural reproductive-aged women) in the southeastern region of Turkey

Background/aim: The aim of this study was to determine the seroprevalence of antihepatitis A virus (HAV), risk factors, and the knowledge of female farm workers living in the Southeastern Anatolia Region (SAR) of Turkey. Materials and methods: This representative cross-sectional survey was conducted between January and April of 2013 in the SAR. A total of 705 reproductive-aged women were randomly selected by clustering method using Epi Info software. The sera were analyzed for anti-HAV antibodies using ELISA. Sociodemographic information and the knowledge of female farm workers regarding hepatitis A were collected using a questionnaire. Results: Of the female farm workers, 99.1% were seropositive for anti-HAV. The anti-HAV seroprevalence was significantly higher in the adults than in the adolescents (P < 0.05). Of the participants, 64.5% had 7 or more family members, 58.4% had 5 or more pregnancies, 68.1% were illiterate, 65.2% were family farmers, 90.6% were poor, 71.9% used unsafe water, 58.9% had toilets outside, and 68% had no knowledge about hepatitis A. Conclusion: Turkey is considered to have high endemicity and female farm workers are considered a high-risk group for hepatitis A. This high HAV exposure might be reduced with vaccination, as well as improvements in sanitation, living conditions, health care utilization, safer drinking water, and health education.

[Comparison of polymerase chain reaction using kinetoplast DNA specific primers and other parasitological methods in the diagnosis of clinical samples of suspected patients with cutaneous leishmaniasis in Sanliurfa]. / Sanliurfa'da kutanöz leysmanyazis süpheli hastalardan alinan klinik örneklerin tanisinda kinetoplast DNA'sina özgül primerlerin kullanildigi polimeraz zincir reaksiyonu ile diger parazitolojik yöntemlerin karsilastirilmasi.

Visceral leishmaniasis (VL) and cutaneous leishmaniasis (CL) are seen endemically in Turkey and CL caused by Leishmania tropica is an important public health problem in southeastern as well as other regions of Turkey. The diagnosis has been usually made by clinical view of lesion and/or parasitologically using lesion aspiration smears. Histological examination does not, always reveal the parasite in the skin biopsy, particularly in chronic lesions. Besides this, due to CL infections caused by different species in endemic areas, diagnostic methods enabling species identification are in great need. Species identification, in the time of diagnosis, is an important procedure for helping the clinicians in the planning of treatment as well as control measures. Polymerase chain reaction (PCR) is a specific and sensitive diagnostic tool that can also identify the parasite at species level. Kinetoplast DNA (kDNA) is one of the genetic regions that can be used for the detection of Leishmania parasites in clinical specimens, kDNA PCR is reported as one of the most sensitive methods related to species-specific variable regions in mini-circle long time ago. It has been considered as one of the most ideal targets for the diagnosis of leishmaniasis. The aim of the study was to perform PCR targeting kDNA by using the primers of Uni21/Lmj4 in clinical samples and compare the results with other parasitological methods like smear and culture, for the diagnosis of CL. The kDNA PCR, parasite culture and microscopical evaluation of stained smears of 62 specimens from suspected CL cases who have referred to Cutaneous Leishmaniasis Diagnosis and Treatment Center in Sanliurfa, Turkey were included in the study. The kDNA PCR showed the highest sensitivity 100% of the samples (35/35) among all diagnostic assays, followed by the microscopy (25/35 positive, 71.4% sensitivity) and culture (19/35 positive, 54.3% sensitivity). The sensitivity of combination of culture and microscopy was 88.6% (31/35 positive). These results suggested that performing kDNA PCR in addition to conventional techniques is important for improving the true diagnosis of CL to the species level and also important for establishing treatment regimens and designing appropriate precautions in highly endemic area like the southeastern region of Turkey.

Genotypes of hepatitis a virus in Turkey: first report and clinical profile of children infected with sub-genotypes IA and IIIA.

BACKGROUND: Hepatitis A virus (HAV) is a food and water-borne virus causing clinical (mainly hepatitis) and subclinical disease in humans. It is important to characterize circulating strains of HAV in order to prevent HAV infections using efficacious vaccines. The aim of this study was the detection and characterization of the circulating strains of HAV in Turkey by performing serology, RT-PCR, sequencing and phylogenetic analysis. METHODS: In this study, 355 HAV suspected cases were analysed by ELISA for the presence of antibodies to HAV. RNA was extracted from 54 HAV IgM positive human sera. None of the suspect cases were vaccinated against HAV and they never received blood transfusions. Samples found positive by RT-PCR using primers targeting the VP1/VP2A junction and VP1/VP3 capsid region of HAV, were subjected to sequencing and phylogenetic analyses. RESULTS: IgM type antibodies to HAV were detected in 54 patients. Twenty one of them were students. The age of IgM positive cases was between 3 and 60 years. IgM positivity differed in age groups and was higher in the age group 3 to 10 years. Phylogenetic analysis showed that the majority of HAV strains detected in this study belong to the "HAV 1B" cluster. In addition, the HAV sub-genotypes IA (KT874461.1) and IIIA (KT222963.1) were found in 2 children. These sub-genotypes were not previously reported in Turkey. The child who carried sub-genotype IIIA travelled to Afghanistan and presented with abdominal pain, icterus and vomitus. He was positive for anti-HAV IgM and IgG but negative for hepatitis B and C. Liver enzymes like aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transferase and lactate dehydrogenase were severely elevated. Bilirubin levels were also increased. White blood cells, neutrophils and hemoglobin were decreased while lymphocytes and monocytes were increased. Similar clinical signs and laboratory findings were reported for the child infected with sub-genotype IA but aspartate aminotransferase and alanine aminotransferase were not severely elevated. CONCLUSIONS: The results indicate that molecular studies determining the HAV genotype variation in Turkey are timely and warranted. The majority of IgM positive cases in 3-10 year old patients indicate that childhood vaccination is important. Sub-genotype IB is the most prevalant genotype in Turkey. Surprisingly, sub-genotype IA and IIIA are also present in Turkey; future diagnostic efforts need to include diagnostic methods which can identify this emerging HAV genotypes. Our results also show that one important risk factor for contracting hepatitis A virus is international travel since genotype IIIA was detected in a child who had travelled to Afghanistan.

Cardiovascular risk may be increased in women with unexplained infertility.

OBJECTIVE: Growing evidence suggests that increased cardiovascular disease (CVD) risk is associated with female infertility caused by conditions such as polycystic ovarian disease, obesity, thyroid dysfunction, and endometriosis. The aim of this study was to evaluate whether any relationship exists between CVD and unexplained infertility. METHODS: Sixty-five women with unexplained infertility and 65 fertile controls were enrolled in the study. CVD risk markers such as low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), triglycerides (TG), insulin resistance (defined by the homeostasis model assessment ratio), and high-sensitivity C-reactive protein (hs-CRP) were assessed. RESULTS: TG, TC, LDL, and hs-CRP levels were higher and HDL levels were lower in patients with unexplained infertility than in fertile controls (p<0.05 for all). Positive associations were found between unexplained infertility and TG, TC, LDL, and hs-CRP levels, and a negative correlation was found for HDL (p<0.05 for all). Multivariate logistic regression analysis showed that TG, HDL, and hs-CRP were independent variables associated with unexplained infertility. CONCLUSION: Our study showed that women with unexplained infertility had an atherogenic lipid profile and elevated hs-CRP levels, suggesting a higher risk of developing CVD in the future. Further studies with larger groups are needed to investigate the nature of this link.

Investigation of brucellosis in a female agricultural population in Turkey.

Much epidemiological information concerning brucellosis generally depends on the evaluation of hospital-based retrospective data. The aim of this study was to determine the prevalence and risk factors of brucellosis in female farmworkers in the south-eastern region of Turkey (GAP) in order to obtain a more representative analysis. Our representative community-based cross-sectional study was conducted during four months of 2013, in all nine GAP provinces. An optimum sample size was determined and blood samples were analysed from 707 reproductive-age female farmworkers using the Rose Bengal (RBT) and standard (SAT) agglutination tests. Sociodemographic information was collected during face-to-face interviews with consenting subjects. Crude odds ratios and 95% confidence intervals were calculated, and chi-square analyses and logistic regression were performed. Employment as a seasonal farmworker and having had five or more pregnancies were the only risk factors found to be significant. This study implies much greater priority needs be given to the control, early diagnosis and treatment in this population.

Phenotyping and genetic characterization of Salmonella enterica isolates from Turkey revealing arise of different features specific to geography.

192 Food samples (commonly consumed 8 food types), 355 animal samples (animal feces of bovine, ovine, goat and chicken) and 50 samples from clinical human cases in Sanliurfa city, Turkey in a year were collected to determine the Salmonella enterica subsp. enterica mosaic in Turkey. 161 Salmonella isolates represented 17 serotypes, 20 sequence types (STs) and 44 PFGE patterns (PTs). 3 serotypes, S. Enteritidis, S. Typhimurium and S. Kentucky, were recovered from three different hosts. The highest discriminatory power was obtained by PFGE (SID=0.945), followed by MLST (SID=0.902) and serotyping (SID=0.885) for all isolates. The prevalence of antimicrobial resistance genes (aadA1, aadA2, strA, strB, aphA1-Iab, blaTEM-1, blaPSE-1, tetA) was highly correlated with phenotypic profiles of aminoglycoside, ß-lactam and tetracycline groups (kappa >0.85). From our knowledge, this is the first study reporting spatial and temporal distribution of Salmonella species through phenotypic and genetic approaches over farm to fork chain in Turkey. Thus, our data provided further information for evolution, ecology and transmission of Salmonella in Turkey.

[Evaluation of epidemiological data of malaria between 2001-2011 in Sanliurfa, Turkey]. / Sanliurfa'da 2001-2011 yillarina ait sitma epidemiyolojik verilerinin degerlendirilmesi.

Although Plasmodium vivax is the only cause of malaria cases detected in Turkey, an increase number of imported P.falciparum cases have begun to be observed recently. Sanliurfa is a province located at Southeastern region of Turkey where malaria is endemic and also one of the two largest malaria epidemics of Turkey was experienced with 84.345 cases in 1994. As this region has borders with countries like Iraq, Iran and Syria, cross border migration caused an increase in imported cases. In addition, climate change, alteration in temperature and humidity due to the Southeastern Anatolian Irrigation Project have led an increase in suitable breeding grounds for mosquitoes. Since new indigenous malaria cases, except imported ones are not detected in Sanliurfa nowadays, there is not enough data on the malaria epidemiology in this region including recent years. The aim of this study was to evaluate the epidemiological data in connection with malaria cases observed in Sanliurfa which is a critical region for this infection for a 11-year-period, between the years of 2001 to 2011, retrospectively. Data obtained from the Malaria Control Unit of the Communicable Diseases Division of Sanliurfa Provincial Health Directorate were analized in terms of frequency of the cases, distribution of the cases in years and months, demographical characteristics, the source and species distribution of the parasite and the locations of the disease. A total of 1.149.196 blood smear samples have been examined during 11-year-period as part of surveillance programme and 4394 (0.4%) of them were positive for Plasmodium spp. The agent was P.vivax in 99.9% (4391/4394) of the cases, while in three cases (0.07%) who were diagnosed after 2010, it was P.falciparum. Of the patients 2351 (53.5%) were male and 2043 (46.5%) were female (p> 0.05), whose age ranging from 3 months to 80 years (mean age: 19.21 ± 16.12 years). The frequencies of the cases according to the age groups 0-11 months, 1-4 years, 5-9 years, 10-14 years and 15 years were as follows; 2.5%, 15.1%, 18%, 13.9% and 50.5%, respectively. The detection of Plasmodium spp. in the samples examined in 2002 (1244/110.533; 1.1%) was the highest, and in 2011 (1/50.981; 0.002%) was the lowest. The distribution rates of 4394 cases according to the years between 2001 to 2011, were found as 25.4%, 28.3%, 17.8%, 10.9%, 8.9%, 5.6%, 1.4%, 1.4%, 0.2%, 0.009% and 0.02%, respectively. Of all cases, 80.6% were autochthonous and 19.4% were imported. Most of the cases were detected in Siverek county with a rate of 71.4%, followed by Ceylanpinar (13.5%) and Viransehir (6.6%) counties. Although malaria cases were detected throughout the year in Sanliurfa in respect to the climate, the highest numbers were recorded in September (832/4394; 18.9%) and November (1054/4394; 24%). This study emphasized that malaria cases due to local transmission declined to zero in Sanliurfa like the recent situation in Turkey. However, P.falciparum malaria cases are being reported due to the travels to endemic countries or migrations from those countries. Effective malaria control attempts, within the scope of Malaria Elimination Programme implemented in Turkey, should be continued with the same stability without any abruption in Sanliurfa province where the disease had been endemic in the past.