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Öğe Acinetobacter pneumonia: Is the outcome different from the pneumonias caused by other agents(Wolters Kluwer Medknow Publications, 2010) Edis, Ebru Cakir; Hatipoglu, Osman N.; Tansel, Ozlem; Sut, NecdetBackground : The principal aim of the present study was to determine whether Acinetobacter spp. pneumonia differs from hospital-acquired pneumonias (HAPs) caused by other agents with respect to therapeutic success and survival rate. METHODS : This study includes 140 adult patients diagnosed with HAPs caused by identified etiologic agents between March 2005 and February 2006. These patients were divided into two groups according to the agent responsible for their infection (Acinetobacter spp. [n = 63] or non-Acinetobacter spp. [n = 77]). The groups were compared in terms of risk factors, therapeutic success and six-week survival rates. Results : Previous antibiotic use and the risk of aspiration were independent factors responsible for the development of Acinetobacter spp. pneumonia. Hypoalbuminemia, steroid use and the use of a mechanical ventilator were determined to be mortality-associated independent risk factors for Acinetobacter spp. pneumonia. The clinical success rate at the end of therapy was 41.6 and, at the sixth week, the survival rate was 35 among patients in whom Acinetobacter spp. was the causative agent. Conversely, in the control group, these values were 43 and 32, respectively ( P > 0.05). We found that the use of the appropriate antibiotics for the treatment of Acinetobacter spp. pneumonia was an important factor in survival ( P < 0.001). Conclusion : The outcomes of Acinetobacter spp. pneumonia do not differ from HAPs associated with non-Acinetobacter spp. in terms of therapeutic success and survival rates.Öğe Characterization of pncA mutations of pyrazinamide-resistant Mycobacterium tuberculosis in Turkey(Edizioni Int Srl, 2009) Yuksel, Pelin; Tansel, OzlemMutations in the pyrazinamidase (PZase) gene (pncA) are considered the major mechanism of pyrazinamide (PZA) resistance in Mycobacterium tuberculosis. The aim of this study was designed to determine pncA mutations among ten PZA resistant and two PZA susceptible M. tuberculosis strains from Turkey and also to compare the PZase activity of them with the genotype. All isolates were identified by BACTEC NAP (P-nitro-alpha-acetylamino-beta-hydroxy-propiophenone)test and PCR-RFLP (Polymerase Chain Reaction-Restriction Fragment Length Polymorphism) method. Drug sensitivity tests were performed by BACTEC system. PncA mutations were detected by DNA sequence analysis. No mutation was detected in two PZA susceptible and three out of tell PZA resistant strains. While, two of the PZA resistant strains had mutations in the same region (Gly24Asp), two of the PZA resistant strains had mutations in different regions (Thr160Lys), (His51Pro). Three of the PZA resistant strains had frameshift as a 167 bp deletion at nucleotide position 102. As a result, we detected two new mutations and a frameshift which may be responsible for PZA resistance in this study different from the other studies which previously 51st codon mutation was reported.Öğe Community-Based Seroepidemiology of Diphtheria and Tetanus in Edirne, Turkey(Natl Inst Infectious Diseases, 2009) Tansel, Ozlem; Ekuklu, Galip; Eker, Alper; Kunduracilar, Hakan; Yulugkural, Zerrin; Yuksel, PelinThe aim of this study was to evaluate the seroprevalence and correlates of diphtheria and tetanus in Edirne, Turkey. Tetanus and diphtheria antitoxin levels were determined by enzyme-linked immunosorbent assay. Among 99 participants, a diphtheria antitoxin level of >= 0.1 IU/mL was found in 97 (98%), while 2 (2%) had antitoxin levels of 0.011-0.099 IU/mL. The geometric mean titers (GMTs) in men were statistically higher. Among 295 participants, a tetanus antitoxin level of >= 0.1 IU/mL was found in 291 (98.6%), while 4 (1.4%) had antitoxin levels of 0.011-0.099 IU/mL. Participants who had completed secondary school or higher education showed higher GMT values. Additionally, participants vaccinated within the previous 5 years had higher GMT values and the percentage of participants who had completed secondary school or higher education was higher among them. GMTs decrease with increasing age and increase as the poverty index increases. The average socioeconomic status index of the participants was high for both diphtheria and tetanus seroepidemiology. In this community-based study, antitoxin levels of diphtheria and tetanus were high. However, revaccination of adults with tetanus-diphtheria toxoids at every opportunity (military service, pregnancy, post-injury prophylaxis, etc.) together with a single booster every 10 years should be considered as an immunization policy.Öğe Evaluation of Patients with Acute Viral Hepatitis(Galenos Yayincilik, 2005) Eker, Alper; Tansel, Ozlem; Kuloglu, Figen; Akata, FilizThirty-eight patients with acute viral hepatitis were admitted to Trakya University Hospital from January 2001 to June 2004. These patients were evaluated according to their complaints, clinical findings and laboratory results, retrospectively. Twenty-one (55.3%) of the patients were acute viral hepatitis A; 17 (44.7%) were acute viral hepatitis B. In SPSS software, clinical findings were evaluated with Fisher's exact test and laboratory results were evaluated in independent groups with non parametric t-test. The symptoms of the patients were weakness (85.7%, 88.2%), jaundice (85.7%, 88.2%), anorexia (76.2%, 52.9%), nausea (76.2%, 64.7%), darkening of urine color (71.4%, 76.5%), vomitting (57.1%, 41.2%) in hepatitis A and B, respectively. the signs of the patients were icterus (95.2%, 100%), hepatomegaly (28.6%, 47.1%), splenomegaly (9.5%, 23.5%) in hepatitis A and B, respectively. The-re was no significant difference in clinical findings. The mean age was 21.5 in hepatitis A and 33 in hepatitis B. In hepatitis A, mean aspartate aminotransferase (AST) value was 1345 U/L and mean alanine aminotransferase (ALT) value was 1910 U/L; in hepatitis B mean AST value was 1475 U/L, mean ALT was 2445 U/L. The level of ALT in hepatitis B cases was significantly higher than hepatitis A. In hepatitis A, mean total bilirubin value was 5.9 mg/dL, direct bilirubin was 3.5 mg/dL. In hepatitis B, total bilirubin was found 11.4 mg/dL, direct bilirubin was 7.7 mg/dL. Bilirubin levels in hepatitis B cases were significiantly higher than hepatitis a cases. There was no significant difference between two groups in the other laboratory findings. Although ALT and bilirubin levels in hepatitis B is higher than hepatitis A, the etiology of acute viral hepatitis can not be determined with the initial clinical and laboratory results.Öğe Hospital-Acquired Pneumonia Developed in Non-Intensive Care Units(Karger, 2009) Edis, Ebru Cakir; Hatipoglu, Osman N.; Yilmam, Ilker; Eker, Alper; Tansel, Ozlem; Sut, NecdetBackground: There are few studies about hospital-acquired pneumonia (HAP) developing in non-intensive care units (non-ICUs). Objectives: The aim of this study was to determine the incidence rate of non-ICU HAP, the risk factors associated with mortality and the survival rates of HAP patients at 6 weeks and 1 year. Patients and Methods: Between March 2005 and February 2006, 154 adult patients (97 males) with HAP were prospectively evaluated. Immunocompromised patients who were developing pneumonia were excluded from the study. The HAP incidence was calculated and survival was noted at 6 weeks and 1 year later. Kaplan-Meier methods were used for survival analysis; Cox regression was used to identify the risk factors associated with HAP-induced mortality. Results: During the study, and not counting those in the ICU, 45,679 adult patients were hospitalized. Of these, 154 patients developed HAP (incidence 3.3 cases/1,000 patients). The mean age of those developing HAP was 64.53 +/- 14.92 years (range 15-98). Survival rates at the 3rd, 7th, 14th, 42nd and 365th day were 91, 89, 69, 49 and 29%, respectively. Independent risk factors associated with 6-week mortality were: age [relative risk (RR) 1.026; 95% confidence interval (CI) 1.008-1.045], chronic renal failure RR 1.8; 95% CI 1.087-3.086), aspiration risk (RR 2.86; 95% CI 1.249-6.564), steroid use (RR 2.35; 95% CI 1.306-4.257), and multilobar infiltration (RR 2.1; 95% CI 1.102-4.113). Conclusion: HAP - even if it develops in non-ICU environments-is hard to treat and has a higher mortality rate. Copyright (C) 2009 S. Karger AG, BaselÖğe Hospital-acquired pneumonia in patients receiving immunosuppressive therapy(Galenos Publ House, 2010) Edis, Ebru Cakir; Hatipoglu, Osman Nuri; Yilmam, Ilker; Eker, Alper; Tansel, Ozlem; Sut, Necdet; Tekgunduz, EmreObjective: The aims of this study were to determine the clinical success rates, effect of neutropenia on treatment success rates, risk factors related to mortality, and survival in patients who developed hospital-acquired pneumonia (HAP) while receiving immunosuppressive therapy. Materials and Methods: Forty-three adult patients receiving immunosuppressive therapy who developed HAP were included in this prospective study. Transplantation patients and human immunodeficiency virus (HIV)-positive patients were not included. Antibiotic treatment was managed by a multidisciplinary team. The Kaplan Meier method was used for the survival analysis and Cox regression was used for the identification of mortality-related independent risk factors. The relationship between neutropenia and the clinical success rate was determined using the chi-square test. Results: Although anti-pseudomonal antibiotics were started empirically in 40 of the 43 patients (93%) at the beginning of the treatment, the most frequently isolated pathogens were Acinetobacter spp. and Escherichia coli. The success rate at the end of the treatment was 65.1%. The survival rates for the 3(rd), 14(th), 42(nd), and 365(th) days were 97%, 86%, 58%, and 19%, respectively. Elevated levels of urea [Hazard Ratio=1.01 (95% Cl: 1.00-1.02)] and blood glucose [HR=1.01 (95% Cl: 1.00-1.02)] were found to be independent risk factors affecting survival. The treatment success rate was higher in patients without neutropenia (n=23) than in those with neutropenia (n=20) (p=0.05). Conclusion: The treatment success rate was low in patients who developed HAP while receiving immunosuppressive therapy. (Turk J Hematol 2010; 27: 20-4)Öğe The Importance of Pathogen Identification in the Success of Treatment of Hospital Acquired Pneumonias(Aves, 2010) Edis, Ebru Cakir; Hatipoglu, Osman Nuri; Yilmam, Ilker; Eker, Alper; Tansel, Ozlem; Sut, NecdetObjective: The aim of this study was to determine the effects of identification of the pathogens and specific and appropriate treatments, and the success of these treatments for subjects who acquired HAP non-ICU. Material and Method: The analyzed data was obtained from the records of 154 consecutive HAP patients who acquired pneumonia non-ICU. We investigated whether the factor was identified, whether patients received a specific therapy according to the results of a culture antibiogram, and whether the patients received appropriate antibiotics therapy initially. Results: When the groups treated specifically (n=78) and empirically (n=76) were compared, there were no significant differences between the clinical success rates. The difference was not significant between the group given an appropriate antibiotherapy initially (n=42) and the group whose initial therapy was changed according to the culture antibiogram after the factor was found (n=36). When the group given appropriate initial antibiotherapy (n=42) was compared with all the other patients (n=112), the difference between the clinical success rates was not significant. The most remarkable result of the study was the success rate being significantly higher in the group in which the pathogen could not be identified (n=66) compared with the group in (n=88) which the pathogen was identified (p=0.022). Conclusion: The clinical success rate was low in microorganism-caused HAPs with a potential for drug resistance and having the characteristic of developing rapid resistance, such as Acinetobacter spp. and Pseudomonas spp, even though specific treatment was administered. These results indicate that the prevention of infections that occur with such microorganisms is more important than the treatment.Öğe Nocardial brain abscess: Review of clinical management(Elsevier Sci Ltd, 2006) Kilincer, Cumhur; Hamamcioglu, M. Kemal; Simsek, Osman; Hicdonmez, Tufan; Aydoslu, Bayram; Tansel, Ozlem; Tiryaki, MehmetNocardiosis has become a significant opportunistic infection over the last two decades as the number of immunocompromised individuals has grown worldwide. We present two patients with nocardial brain abscess. The first patient was a 39-year-old woman with systemic lupus erythematosus. A left temporoparietal abscess was detected and aspirated through a burr-hole. Nocardia farcinica infection was diagnosed. The patient had an accompanying pulmonary infection and was thus treated with imipenem and amikacine for 3 weeks. She received oral minocycline for 1 year. The second patient was a 43-year-old man who was being treated with corticosteroids for glomerulonephritis. He was diagnosed with a ring-enhancing multiloculated abscess in the left cerebellar hemisphere, with an additional two small supratentorial lesions and triventricular hydrocephalus. Gross total excision of the cerebellar abscess was performed via a left suboccipital craniectomy. Culture revealed Nocardia asteroides, and the patient was successfully treated with intravenous ceftriaxone, then oral trimethoprime-sulfamethoxazole for 1 year. The clinical course, radiological findings, and management of nocardial brain abscess are discussed in light of the relevant literature, and current clinical management is reviewed through examination of the cases presented here. (C) 2006 Elsevier Ltd. All rights reserved.Öğe A patient with brucellar cervical spondylodiscitis complicated by epidural abscess(Elsevier Sci Ltd, 2011) Eker, Alper; Uzunca, Ilkay; Tansel, Ozlem; Birtane, MuratBrucellar cervical spondylodiscitis and epidural abscess are serious medical conditions that can cause permanent neurological deficits. Fortunately, they are rare. We report a 34-year-old male patient, complaining of fever and neck pain and stiffness, with increased deep tendon reflexes. A lumbar puncture was normal. Brucella species organisms were isolated from blood cultures, and the Rose-Bengal test and the standard tube agglutination (STA) test were positive. The diagnosis was made on MRI. The patient was treated with doxycycline and rifampin daily for 16 weeks. On day 51 of treatment, the patient had no symptoms and his physical and neurological examinations were normal. His repeat cervical MRI was almost normal. The STA test was negative at week 20. It is important to consider brucellar cervical spondylodiscitis with epidural abscess in endemic regions. (C) 2010 Elsevier Ltd. All rights reserved.Öğe Seroepidemiology of Toxoplasmosis and the Theoretical Incidence of Congenital Toxoplasmosis in Women of Reproductive Age in Edirne, Turkey. A Community Based Study(Ortadogu Ad Pres & Publ Co, 2009) Tansel, Ozlem; Ekuklu, Galip; Kunduracilar, Hakan; Eker, Alper; Yulugkural, Zerrin; Yuksel, PelinObjective: The aims of this community-based study were to determine the seroprevalence of toxoplasmosis in women of reproductive age, to identify the risk factors, and to estimate theoretical incidence of congenital toxoplasmosis in Edirne city center. Material and Methods: Sera from 96 women representing the female population in the city center were tested for toxoplasma IgG antibody using the ELISA technique, For each participant, a questionnaire was completed to provide information on socio-demographic data, obstetrical history, and life style parameters. The relation between toxoplasma positivity and probable risk factors was investigated with chi-square and independent samples t test during statistical analysis. Results: The ages of the study population ranged from 15 to 49 years with a mean age of 31.2 years. 33 (34.4%) of 96 women were positive for toxoplasma IgG antibody. The mean age of women with seropositive samples was 34.2 +/- 10.4 years. The mean age of seronegative women was 29.7 +/- 9.2 years. Although the mean age was higher in seropositive women when compared with seronegative, the rates of seropositivity were not significantly different between age groups (p = 0.246). Toxoplasma seropositivity was 85.7% for women with high income and 100% for women with low income. This difference was statistically significant (p = 0.025). The other risk factors were not significantly different between seropositive and seronegative cases. The mean theoretical incidence of congenital toxoplasmosis was 0.7% in our study and it decreased from 1.3% to 0.2% as the person aged. Conclusion: Approximately two out of every three reproductive age women in Edirne city center is at risk of toxoplasmosis. The risk of congenital toxoplasmosis is higher for babies of women aged 15-24 years. These results underline the necessity of promoting preventive measures for toxoplasmosis in reproductive age women.
