Browsing by Author "Sunnetcioglu, Mahmut"

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Analyze of Ventilator Associated Pneumonia
(derman Medical Publ, 2015) Sunnetcioglu, Aysel; Karadas, Sevdegul; Cegin, M. Bilal; Sunnetcioglu, Mahmut; Kanter, Ahmet
Aim: Ventilator-associated pneumonia (VAP) is the infection that is an important cause of morbidity and mortality developed in patients whom the invasive mechanical ventilation (MV) were performed in intensive care units (ICU). In this study, the factors of VAP developing in patients whom the mechanical ventilation of ICU performed, antibiotic susceptibility to these factors and determining the risk factors were aimed. Material and Method: Between January 2009 and March 2013, 79 cases, followed with the mechanical ventilation for at least for 48 hours and developed VAP, were retrospectively reviewed at Anesthesiology and Intensive Care Unit of Reanimation at Faculty of Medicine at Yuzuncu Yil University, performing endotracheal intubation. The cases were evaluated in terms of microorganisms, antibiotic susceptibility and risk factors. Results: The rate of our VAP speed was calculated to be 19.68 on the day of 1000 ventilator. While a single microorganism could be isolated in 81.1% of the 74 VAP cases whose the active pathogen could be isolated, two or more than two microorganisms were isolated in 18.9% of them. While 83 of the strains (90.2%) were gram-negative bacteria, 7 of them (7.6%) were gram-positive bacteria. Acinetobacter spp. (40.2%) was most commonly isolated as a gram-negative factor, but methicillin-resistant S. aureus (4.3%) was isolated as a gram-positive factor. It was determined that the isolated factors in VAP cases were significantly resistant to the broad-spectrum antibiotics. Discussion: As a result, in patients with high-risk factors for the development of VAP, early and appropriate empirical antibiotic treatment should be started according to the results of the sensitivity of the unit and for the multi-drug-resistant microorganisms with common and high mortality.
Asymmetric Dimethylarginine Levels in Patients With Cutaneous Anthrax: a Laboratory Analysis
(Bmc, 2014) Sunnetcioglu, Mahmut; Mengeloglu, Zafer; Baran, Ali Irfan; Karahocagil, Mustafa; Tosun, Mehmet; Kucukbayrak, Abdulkadir; Aypak, Cenk
Background: Asymmetric dimethylarginine (ADMA), the main endogenous inhibitor of nitric oxide synthase, is considered to be associated with endothelial dysfunction. High ADMA levels have been shown to be related with disorders causing vascular inflammation such as hypertension, hypercholesterolemia, atherosclerosis, chronic heart failure, stroke and sepsis. Cutaneous anthrax (CA) is a serious infectious disease which may cause vasculitis. The aim of the study was to investigate the serum ADMA levels in patients with CA. Methods: A total of 35 serum samples of the patients with CA and 18 control sera were tested for ADMA levels using ADMA ELISA kit (Immunodiagnostik AG, Bensheim, Germany). Results: ADMA levels were found to be significantly higher in the patients group than the controls (p < 0.001). In addition, ADMA levels were found to be positively associated with sedimentation rates (R = 0.413; p = 0.026), and inversely associated with international normalized ratio (INR) levels (R = -0.46; p = 0.011). A cut-off value of 0.475 of ADMA had a sensitivity of 74.3%, specificity of 77.8%, and accuracy of 75.5% in the diagnosis of CA. Conclusion: Although the exact mechanism still remains unclear, ADMA levels could be related to immune activation in CA. In addition, these data might suggest the higher ADMA levels in patients could be due to the perivascular inflammation and vasculitis in CA.
Candida Globosa’nın Etken Olduğu Bir Piyojenikkaraciğer Apsesi Olgusu
(2019) Sunnetcioglu, Mahmut; Baran, Ali Irfan; Karahocagil, Mustafa Kasim; Çelik, Mehmet; Arslan, Yusuf
Piyojenik karaciğer apsesi bakteriyel veya fungal etkenlere bağlı gelişebilen, nadiren görülen bir hastalıktır. Uygun antibiyotik ve drenaj ile mortalitesi önemli ölçüde azaltılabilir. Bu yazıda ateş, sağ yan ağrısı, iştahsızlık, bulantı şikayetleriyle başvuran, radyolojik görüntülemelerde subhepatik karaciğer apsesi saptanıp perkütan apse drenajı uygulanan ve apse kültüründe Candida globosa üreyen, kaspofungin tedavisi sonrası kliniği düzelen bir olgu sunuldu. Karaciğer apselerinde bakteriyel ajanlar sıklıkla izole edilmekle beraber fungal ajanlar da enfeksiyon etkeni olarak karşımıza çıkabilmektedir. ( Sakarya Tıp Dergisi 2019, 9(3):550-553
A Case of Brucellosis Presenting as High Titer Negative Result by Standard Tube Agglutination Test
(Ankara Microbiology Soc, 2007) Buzgan, Turan; Karsen, Hasan; Karahocagil, M. Kasim; Akdeniz, Hayrettin; Sunnetcioglu, Mahmut
Since prozone is a well known phenomenon in the serologic diagnosis of Brucella infections, it is necessary to prepare higher serum dilutions in the standard tube agglutination (STA) test for the brucellosis suspected patients. However, due to limited economical support, the serum dilutions generally last at 1/320-1/640 titers in some laboratories in Turkey. In this report, a brucellosis case whose STA test was found negative until the titer of 1/1280, has been presented. A 36-year-old female was admitted to our hospital with the complaints of fever, sweating, fatigue, generalized arthralgia and weight loss, lasting for 45 days. Hepatosplenomegaly was detected in the physical examination, and laboratory tests yielded anemia, leucopenia, elevated erythrocyte sedimentation rate and high C-reactive protein levels. Although brucellosis was suspected, Brucella STA test was found negative at 1/640 titer. On the sixth day of admission, Brucella melitensis was isolated from her blood culture. Since a positive result at 1/40 titer was detected in Brucella STA test with the use of Coombs antiserum, the patient's serum was retested at higher dilutions than 1/640, and positive result was obtained starting from 1/1280 dilution and extended to 1/5120 titer. The patient was treated with rifampin and doxycyline and discharged with complete cure. In conclusion, in countries endemic for brucellosis, STA test should be performed at 1/1280 or higher titrations in suspected patients especially in the presence of negative culture results, for the prevention of false negative results due to prozone phenomenon.
A Case of Miliary Tuberculosis, Pneumothorax, and Pulmonary Thromboembolism: Original Image
(Ortadogu Ad Pres & Publ Co, 2009) Ozbay, Bulent; Sertogullarindan, Buenyamin; Asker, Selvi; Ekin, Selami; Yildiz, Hanifi; Sunnetcioglu, Mahmut
A 30 years old woman complained of high fever and dyspnea. She delivered her 7(th) child 4 weeks ago. Symptoms had started after delivery and increased during the last 3 days. PA chest roentgenogram showed diffuse and bilateral miliary nodules. Physical examination revealed temperature 39.2 degrees C, pulse 130/min, arterial tension 90/60 mmHg, respiratory rate 35/min, and lung sounds normal. Deep venous thrombosis was detected in the right leg. SaO(2) was 69% and PaO2/FiO(2) was 86 while on 6 L/min O-2 inhalation. Computed tomography of thorax showed filling defects as well as miliary nodules. The tuberculin skin reaction was positive. Bilateral tuberculosis foci were seen in the choroid of retina. Treatment consisted of antituberculous drugs, anticoagulants, fluid and nutritional support. PaO2/FiO(2) rapidly improved. Recurrent pneumothorax developed. A tube thoracostomy was inserted. This case was interesting regarding the coexistence of miliary tuberculosis, recurrent pnomothorax, and venous thromboembolism.
A Case of Salmonella Typhi Mesenteric Lymphadenitis Accompanied by Acute Abdomen and Pancytopenia
(Aves, 2013) Bilici, Adnan; Cabalak, Mehmet; Sunnetcioglu, Mahmut; Ceylan, Mehmet Resat; Karahocagil, Mustafa Kasim
Presenting with abdominal pain in the right lower quadrant and mimicking acute appendicitis, mesenteric lymphadenitis can lead to unnecessary surgical interventions, especially in children. We present a case of a 16-year-old female with Salmonella typhi mesenteric lymphadenopathy, who was admitted to the hospital with symptoms of acute abdomen, including severe abdominal pain, fever, nausea and vomiting. In addition, because of the pancytopenia, the prolongation of the prothrombin time and the hypofibrinogenemia, the clinical picture was similar to disseminated intravascular coagulation. After the growth of S. typhi in blood cultures, she was successfully treated with ciprofloxacin.
Clinical and Laboratory Features of Adult Measles Cases Detected in Van, Turkey
(Pakistan Medical Assoc, 2015) Sunnetcioglu, Mahmut; Sunnetcioglu, Aysel; Mentes, Osman; Baran, Ali Irfan; Karadas, Sevdegul; Aypak, Adalet
Objective: To evaluate adult measles patients with respect to their clinical and laboratory findings as well as complications. Methods: The retrospective study was conducted at YuzuncuYil University, Van, Turkey, between December 2012 and June 2013, and comprised cases diagnosed with measles. The diagnosis was based on clinical findings and all were serologically confirmed with the presence of Anti-measles Immunoglobulin M antibodies. Results: Of the 50 records studied, 41(84%) related to women. Overall mean age was 25.52+/-4.07 years. The most common symptoms were fever and rash 50(100%), malaise 49(98%), cough 48(96%), headache 44(88%) and sore throat 36(72%). The presence of Koplik spots, lymphadenopathy and hepatomegaly were observed in 3(6%), 6(12%) and 2(4%) patients respectively. Thrombocytopenia and elevated liver enzymes were detected in 26(52%) and 22(44%)patients. Pneumonia was the most common complication in 9(18%) patients. Other respiratory complications were bronchitis 5(10%) and laryngotracheitis 6(12%). Of the cases, 9(18%) exhibited otitis media. Premature delivery and spontaneous abortus occurred in 2(4%) and 3(6%) patients of the 15(30%) pregnant women. Conclusion: Measles continues to be an important health problem in Turkey and needs an effective elimination programme.
Comparative Analysis of Pulmonary and Extrapulmonary Tuberculosis of 411 Cases
(Biomed Central Ltd, 2015) Sunnetcioglu, Aysel; Sunnetcioglu, Mahmut; Binici, Irfan; Baran, Ali Irfan; Karahocagil, Mustafa Kasim; Saydan, Muhammed Ridvan
Background: Tuberculosis is a disease that can involve every organ system. While pulmonary tuberculosis is the most common presentation, extrapulmonary tuberculosis (EPT) is also an important clinical problem. The current study aimed to outline and compare the demographic and clinical features of pulmonary and extrapulmonary tuberculosis cases in adults. Methods: Medical records of 411 patients (190 women, 221 men) treated between January 2010 and July 2014 in provincial tuberculosis control dispensary was retrospectively reviewed. Demographic and clinical characteristics were compared for pulmonary and extrapulmonary tuberculosis cases. Results: Of these 411 cases, 208 (50.6%) had pulmonary tuberculosis (PTB) and 203 were diagnosed with extrapulmonary tuberculosis (EPTB) (49.4%). The average ages for PTB and EPTB groups were 33.00-27.00 and 31.00-29.75, respectively (p = 0.513). Men were more frequently affected by PTB (59.6%), while EPTB was more commonly detected in women (52.2%) (p = 0.016). Main diagnostic modalities for PTB were sputum/smear analyses (72.7%), clinical-radiological data (21.7%) and biopsy (6.1%); while biopsy (71.5%), sputum/fluid analysis (18.8%) and clinical-radiological data (4.9%) were used for confirming EPTB (p < 0.0019). The most common sites of EPTB involvement were lymph nodes (39.4%), followed by pleura (23.6%), peritoneum (9.9%) and bone (7.4%). Conclusions: Extrapulmonary involvement of tuberculosis is common and females are more likely to be affected. Increased clinical awareness is important since atypical presentations of the disease may constitute diagnostic and therapeutic challenges.
Comparison of Carbapenem Resistance Detected by the Bd Phoenix Automated System in Enterobacteriaceae Isolates E-Test Method
(Modestum Ltd, 2022) Celik, Mehmet; Sunnetcioglu, Mahmut; Guducuoglu, Huseyin; Arslan, Yusuf; Akyuz, Sumeyye; Baran, Ali Irfan
Objective: Automatic identification and antimicrobial susceptibility systems are frequently used to identify clinical isolates in hospitalized patients, but mistakes in these systems can lead to potentially devastating treatment failures for patients. Therefore, the "Centers for Disease Control and Prevention (CDC)" recommends confirming all Carbapenem-resistant and low-susceptibility isolates with a different method. The aim of this study is to compare the Carbapenem susceptibility results of isolates reported as Carbapenem-resistant Enterobacteriaceae according to the BD Phoenix 100 automated system with the E-test method. Materials and Methods: The study included 70 strains of Carbapenem-resistant Enterobacteriaceae members which were isolated and grown from several types of clinical samples in the Medical Microbiology Laboratory. Conventional methods (Gram stain, negative oxidase test) and the BD Phoenix 100 automated system were used to identify the isolates. The susceptibility of all strains to imipenem, ertapenem and meropenem was investigated by E-test method. Automated system results and E-test results were compared. Results: The frequency distribution of all isolated bacterial strains comprised K. pneumoniae in 56 (80%) of the samples included in the study. The automated system test results were correlated with the results of the E-test at a rate of 96.1 % for the imipenem-resistant strains, 84.3% for the meropenem-resistant strains, 84.1% for the ertapenem-resistant strains Conclusions: Automated systems are frequently used in microbiology laboratories to identify isolates. However, automated systems can show a high error rate against some antimicrobials. For this reason, comparing the results of automated system test results with tests such as E-test is very important to prevent both treatment failures and inappropriate antibiotic use that may occur on a patient basis.
Could Soluble Urokinase Plasminogen Receptor (Supar) Be Used as a Diagnostic Biomarker for Ventilator-Associated Pneumonia
(Wiley, 2017) Sunnetcioglu, Aysel; Sunnetcioglu, Mahmut; Adiyaman, Firat; Binici, Irfan; Soyoral, Lokman
BackgroundSoluble urokinase plasminogen activator receptor (suPAR) is a biomarker that is increasingly used for evaluation of systemic inflammation. This study was performed to investigate whether suPAR may possess a diagnostic value in patients with ventilator-associated pneumonia (VAP). MethodsThis clinical study was performed in the anesthesia intensive care units (ICUs) of our university. In addition to descriptive data, WBC, serum levels of C-reactive protein (CRP) and suPAR prior to and after development of VAP were noted and compared in 31 patients (22 men, 9 women) diagnosed with VAP (Study Group) and 19 patients without VAP (Control Group) in ICU (14 men, 5 women). ResultsThe suPAR (P=0.023), CRP (P=0.037), WBCs (P=0.024) in patients with VAP were significantly higher than patients without VAP. There was no remarkable difference in terms of WBCs (P=0.052) and suPAR levels (P=0.616) between groups on the first day of connection to mechanical ventilator. The suPAR and CRP levels in patients with VAP were significantly higher than prior to development of VAP (P=0.001 for both). Area under curve value after diagnosis of pneumonia was found 0.248 (P=0.002). ConclusionTo conclude, our results suggest that suPAR can be a useful diagnostic biomarker in patients with VAP. However, clinical trials on larger series are warranted to explore the clinical significance more accurately.
Cytomegalovirus Pneumonia and Pulmonary Haemorrhage in a Patient With Polyarteritis Nodosa
(Pakistan Medical Assoc, 2016) Sunnetcioglu, Aysel; Sunnetcioglu, Mahmut; Emre, Habib; Soyoral, Lokman; Goktas, Ugur
Cytomegaloviruses are opportunistic pathogens that cause lung infection in immunocompromised individuals. A 24-year-old male was admitted to the hospital with complaints of cough, fever and dyspnoea. He was receiving immunosuppressive therapy for polyarteritis nodosa. A chest X-ray showed heterogeneous right-sided opacity in the middle and lower lung zones. The diagnosis of cytomegalovirus pneumonia was confirmed by positive test for serum cytomegalovirus IgM antibodies. One day after admission, haemoptysis developed and patient with hemoptysis who had shortness of breath was intubated. Computed tomography (CT) showed bilateral alveolar opacity.
Ensefalomyelit İle Seyreden Bir Kızamık Olgusu
(2020) Baran, Ali Irfan; Sunnetcioglu, Mahmut; Karahocagil, Mustafa Kasim; Çelik, Mehmet; Mentes, Osman
Kızamık, bulaştırıcılığı yüksek olan enfeksiyonlardan biridir ve dünyadaki önemli morbidite ve mortalite nedenleri arasındadır. Erişkin dönemde komplikasyon hızı ve mortalitesi yüksek olan ciddi bir hastalıktır. Ensefalomiyelit, kızamık enfeksiyonun en fatal komplikasyonudur. Bu yazıda, bölgemizdeki kızamık salgını döneminde bilinç bozukluğu ve kismi motor defisit ile seyreden nadir görülen kızamık ensefalomyelit olgusunun sunulması amaçlandı.
Erişkin Kist Hidatik Vakalarının Retrospektif Değerlendirilmesi
(2024) Çelik, Mehmet; Baran, Ali Irfan; Altındağ, Deniz; Arslan, Yusuf; Tarcan, Tayyar; Sunnetcioglu, Mahmut; Alkan, Sevil
Amaç: Bu çalışmanın amacı kist hidatik nedeniyle takip edilen erişkin hastaların özelliklerini değerlendirmekti. Yöntem: Çalışmaya Ocak 2015-Eylül 2021 tarihleri arasında kist hidatik tanısı konan 18 yaş üstünde hastalar dahil edildi. Hastalara ait klinik, laboratuvar, radyolojik özellikler retrospektif olarak değerlendirildi. Bulgular: Çalışmaya 66 hasta dahil edildi. Hastaların %59,1’i kadın cinsiyette olup, yaş ortalaması 40.9±15.60 yıldı. Hastaların en sık tarifledikleri başvuru semptomu karın ağrısıydı (%42,4). En sık tutulum yeri sırasıyla karaciğer (%78,8) ve akciğerdi (%18,2). Hastaların büyük çoğunluğunda soliter kist (%84,8) vardı. Laboratuvar tetkiklerinde en sık saptanan bulgu total IgE yüksekliğiydi (%74,1). İndirekt hemaglütinasyon (IHA) testi, test edilen hastaların % 77,4’ünde pozitif olarak saptandı. Sonuç: Çalışmamızda kist hidatiğin en sık karaciğerde görüldüğü, sıklıkla tek organ tutulumu şeklinde olduğu, laboratuvar tanısında total IgE yüksekliğinin kist hidatik hastalığınını kesin tanısını koydurmasa da tanıya yardımcı olabileceği sonucuna varıldı.
Evaluation of 257 Extra Pulmonary Tuberculosis Cases at the Tuberculosis Control Dispensary, Van, Turkey
(Pakistan Medical Assoc, 2018) Sunnetcioglu, Mahmut; Baran, Ali Irfan; Binici, Irfan; Esmer, Fatih; Gultepe, Bilge
Objective: To determine whether there were any changes in demographic and clinical features of extrapulmonary tuberculosis cases. Methods: This retrospective study was conducted at Yuzuncu Yil University, Van, Turkey, and comprised records of extrapulmonary tuberculosis patients treated between January 2009 and July 2014 at the tuberculosis control dispensary. Descriptive and clinical data, including age, gender, site of involvement, diagnostic method and coexisting systemic diseases, were noted. Any changes in terms of these parameters were investigated on a yearon- year basis. SPSS 20 was used for data analysis. Results: There were 257 cases detected. Of them, 50(19.45%) related to 2009, 61(23.75%) to 2010, 24(9.33%) to 2011, 50(19.45%) to 2012, 47(18.28%) to 2013 and 25(9.72%) to 2014. Although lymph nodes were by far most frequently affected in 2009, 2010, 2011 and 2013; pleura was most commonly involved in 2012 and 2014. Age and gender distribution displayed no changes between 2009 and 2014 (p>0.05). However, diagnostic method of choice and frequency of co-existent systemic disorders displayed remarkable alterations in this period (p<0.05). Conclusion: Improved insight of clinicians for atypical demographic and clinical features at presentation may provide reduction of rates of morbidity and mortality due to extrapulmonary tuberculosis.
The Evaluation of Clinical and Laboratory Findings of 63 Inpatient With Cutaneous Anthrax: Characteristics of Cutaneous Anthrax in Turkey
(deri Zuhrevi Hastaliklar dernegi, 2014) Ozkol, Hatice Uce; Karadas, Sevdegul; Sunnetcioglu, Mahmut; Ceylan, Mehmet Resat; Calka, Omer; Guducuoglu, Huseyin
Background and Design: Despite a very uncommon disease in developed countries, cutaneous anthrax (CA) is currently endemic in our countries. In this study, we aimed to bring out characteristic of anthrax of Turkey by comparing our results and the other CA reports in Turkey. Materials and Methods: Sixty three inpatients with CA between October 2009 and December 2012 were investigated retrospectively. All patients were diagnosed CA by clinical finding and/or microbiological examination. The demographic characteristics patient, routine tests, wound culture and gram staining results were recorded. Results were recorded on statistical program of SPSS 13.0 and were written using percent (%). Results: There were 63 inpatients (41 female (65.1%), 22 male (34.9%), mean age 35.9 years range10-83). Forty nine patients (77.8%) had a history of contact with animals or animal product. Thirty-eight (60.3%) and twenty-one (33.3%) patients were found in the summer and fall season, respectively. Gram staining and culture were performed in 51 patients. Gram-positive bacilli were detected in 17 patients (33.3%) by gram smear. Bacillus anthracis bacilli were produced in 11 patients (21.5%) in cultures test. The lesions were mostly seen on the left hand (30.2%). Penicillin was most frequently preferred in treatment of CA (87.3%). Conclusion: CA is still endemic in Eastern Anatolia and continues to increase in recent years. Women living in the villages in which income is obtained from buying and selling of animals constitute the most important risk group. Preventive actions such as training of the risky society, vaccination of animals, and obstructing of illegal animal entries across the border, will reduce the incidence of CA.
Evaluation of Oculocutaneous Anthrax. a Series of 20 Cases
(Carbone Editore, 2015) Gonullu, Hayriye; Karads, Sevdegul; Batur, Muhammed; Baran, Ali Irfan; Sunnetcioglu, Mahmut
Introduction: Cutaneous anthrax is the most common clinical presentation of human anthrax. This study presents an evaluation of cases of ocular lesions from cutaneous anthrax. Methods: A total of 20 patients who attended the emergency department of Yuzuncu Yil University, School of Medicine between 2007 and 2013 were enrolled in the study. Results: 65% of the cases were female and 35% were male. The mean age was 29.16+/-14.80. In 60% there were periorbital lesions in the right eye. 90% of the patients had a history of contact with animals or had eaten animal meat. The mean starting time of lesion was 3.2+/-1.2 days before admittance. In 75% of the cases the diagnosis was based on the characteristic appearance of the lesion and the patient's history. All the patients spent 9.9+/-4.3 days in hospital. Upper eyelid scar tissue and ectropion were found respectively in 20 % and 10 % of the cases. Conclusions: Early diagnosis and appropriate antibiotic treatment can facilitate recovery and prevent the development of eyelid complications.
Evaluation of Risk Factors in Patients With Ventilator-Associated Pneumonia Caused by Acinetobacter Baumannii
(Univ Udayana, 2020) Baran, Ali Irfan; Celik, Mehmet; Arslan, Yusuf; Demirkiran, Hilmi; Sunnetcioglu, Mahmut; Sunnetcioglu, Aysel
Purpose: Ventilator-associated pneumonia is a significant disease with high mortality rates. Acinetobacter baumannii is one of the most critical pathogens leading to ventilator-associated pneumonia. This study aims to evaluate the underlying risk factors in patients diagnosed with ventilator-associated pneumonia caused by Acinetobacter baumannii, who were followed in intensive care units of our hospital. Patients and Methods: The data of 112 patients diagnosed with ventilator-associated pneumonia caused by Acinetobacter baumannii, who were followed in Intensive Care Units other than Pediatric Intensive Care Unit of our hospital from 2013 to 2017, were evaluated retrospectively. Results: Of the cases included in our study, 70.5% were male, and 29.5% were female patients. Of the cases, 875% were followed in Anaesthesiology and Reanimation Intensive Care Unit. The most common modifiable risk factors are mechanical ventilation, antacid use, and the most common non-modifiable risk factors were the presence of trauma and a history of cardiovascular disease. Conclusion: Ventilator-associated pneumonia is a clinical condition with high mortality and morbidity in intensive care units. Incidence and mortality of ventilator-associated pneumonia can be reduced through the implementation of some necessary policies for the prevention of ventilator-associated pneumonia and the practices for the reduction or elimination of modifiable risk factors.
A Familial Outbreak of Fascioliasis in Eastern Anatolia: A Report With Review of Literature
(Elsevier, 2011) Karahocagil, Mustafa Kasim; Akdenin, Hayrettin; Sunnetcioglu, Mahmut; Cicek, Muttalip; Mete, Rafet; Akman, Nevzat; Yapici, Kubilay
Aim: To present the results of a cross-sectional epidemiological analysis of a familial outbreak of fascioliasis in Eastern Anatolia and to discuss the clinical, diagnostic and therapeutic properties of the patients. Materials and methods: A screening group consisting of 92 individuals from the same family with a history of watercress ingestion and a control group consisting of 30 individuals from neighboring families were included in the study. In both groups, full blood count, erythrocyte sedimentation rate, liver function tests and total IgE levels were assessed. Stool analysis was performed on three consecutive days with native, lugol and sedimentation methods. The diagnosis was based on the detection of parasite ova in the stool or alternatively based on consistent clinical, laboratory, and radiological findings or positive clinical findings in combination with a positive ELISA test. Abdominal ultrasonography and computerized tomography scans were performed on all patients. Results: 24 patients (21 women and 3 men) were diagnosed with fascioliasis. The mean age was 24.5 +/- 18.6 years (range, 5-64 years). All cases had a history of watercress ingestion, malaise, fatigue, lack of appetite, and abdominal pain. Clinical features included: weight loss was present in 18 cases (75%). dyspepsia in 12 (50%), headache in 11(45.8%), sweating in 10 (41.7%), fever and dyspnea each in 8 (33.3%), nausea and vomiting in 6 (25%), and itching in 4 (16.75). The most common laboratory abnormalities were total IgE elevation in 19 cases (79.2%) and eosinophilia in 17 (70.8%). The eosinophilia was >20% in 14 cases (58.3%) and the total IgE was >500 IU/ml in 15 cases (62.5%). Stool examination for ova was positive in 11 cases. 10 patients had positive clinical, laboratory and radiological findings. A further three patients were diagnosed based on their clinical findings and their ELISA results. All cases had positive ELISA results. All patients, except one pregnant woman, were treated with 10 mg/kg triclabendazole. Two patients required a second treatment course of triclabendazole 20 mg/kg in two divided doses due to persistence of ova in the stool. One patient who developed acute urticaria as a side effect of the drug was given three additional courses of 10 mg/kg triclabendazole in combination with prednisolone and antihistamines. The pregnant woman initially received four courses of 25 mg/kg praziquantel treatment for 1 week. As ova were still detected in her stool following delivery, she was subsequently treated with triclabendazole. Conclusions: One case of fascioliasis may indicate a familial outbreak. In the acute stage radiological investigations can assist in confirming the diagnosis. ELISA testing is a reliable and sensitive method for the diagnosis of fascioliasis during any stage of the disease and may also be useful during follow-up. (C) 2008 Elsevier B.V. All rights reserved.
High Asymmetric Dimethylarginine (Adma) Levels in Patients With Brucellosis
(Springer/plenum Publishers, 2014) Mengeloglu, Zafer; Sunnetcioglu, Mahmut; Tosun, Mehmet; Kucukbayrak, Abdulkadir; Ceylan, Mehmet Resat; Baran, Ali Irfan; Akdeniz, Hayrettin
Asymmetric dimethylarginine (ADMA) is the main endogenous inhibitor of nitric oxide synthase and is considered to be associated with endothelial dysfunction. Brucellosis, a zoonotic disease caused by Brucella spp., can manifest as vasculopathy. The present study was performed to investigate the relationship between ADMA and brucellosis. Serum samples from 39 patients with an accurate diagnosis of brucellosis and from 18 healthy control individuals were included in this study. ADMA levels were significantly higher in the patient group than the controls (P < 0.001). Receiver operating characteristic (ROC) curve analysis indicated that ADMA level a parts per thousand yen0.61 had a sensitivity of 79.5 %, specificity of 88.9 %, positive predictive value of 93.9 %, and negative predictive value of 66.7 %. This is the first report of an association between brucellosis and high levels of ADMA. In conclusion, ADMA levels should be tested in brucellosis cases and that further studies to clarify the mechanism underlying the association between ADMA and brucellosis are required.
Hospital Outbreak of a Colistin-Resistant, Ndm-1 Oxa-48 Klebsiella Pneumoniae: High Mortality From Pandrug Resistance
(Mary Ann Liebert, inc, 2018) Guducuoglu, Huseyin; Gursoy, Nafia Canan; Yakupogullari, Yusuf; Parlak, Mehmet; Karasin, Gokhan; Sunnetcioglu, Mahmut; Otlu, Baris
Colistin resistance causes substantial problems in the treatment of serious infections with carbapenem-resistant (CR) gram-negative bacteria. In this study, we report a fatal hospital outbreak from the spread of a pandrug-resistant Klebsiella pneumoniae clone. An outbreak investigation was conducted after consecutive isolation of nine CR-K. pneumoniae (CR-Kp) strains from eight patients in two intensive care units of a university hospital within 2 weeks. Carbapenem and colistin resistance genes were investigated with PCR, clonal relationships of isolates were studied with pulse-field gel electrophoresis, and multilocus sequence types were determined. The outcomes of the affected patients were analyzed. Genotyping showed a predominant CR-Kp clone consisting of seven strains from six patients. These strains were in ST11 type, an international high-risk clone. They were resistant to all antimicrobials, including colistin, and positive for NDM-1 and OXA-48 carbapenemases, but negative for plasmid-borne colistin resistance genes. One patient had colonization and the remaining five died due to the infection within mean 12 days. No environmental or staff links could be established, and the outbreak was stopped by augmenting infection-control measures. Colistin-resistant K. pneumoniae could clonally expand in the hospital setting, and this spread might be associated with high mortality due to the lack of an appropriate treatment option. Immediate implementation of infection-control measures may be the best way to limit fatal consequences of the spread of such incurable pathogens.