Psychosocial Status of Healthcare Workers During the COVID-19 Pandemic.

Objective: This study aimed to determine the depression, anxiety, and stress levels of healthcare workers (HCWs) working actively in different health services during the pandemic. Materials and Methods: This cross-sectional study was conducted in Ankara at the Provincial Health Directorate Numune Campus between January and April 2022. The depression, anxiety, and stress levels of HCWs working actively in different health services during the pandemic were evaluated using the Depression, Anxiety and Stress Scale 21 (DASS-21). Univariate and multivariate linear regression analyses were performed to analyze the data. Results: The study included 381 healthcare workers, 272 (71.4%) of whom were female. The mean age was 40.0±9.9 (21-63) years, and 44.9% (n=171) of the HCWs had a COVID-19 infection at some point. While 28.6% of HCWs needed psychological support before the pandemic, the rate increased to 36.2% during the pandemic (p<0.001). DASS-21 results showed that the frequency of depression was 31.0%, anxiety 47.2%, and stress 22.8% among participants during the pandemic. Conclusion: One out of three HCWs reported experiencing mental health problems. It is essential to improve the working conditions of HCWs to help them cope with the effects of the pandemic on their mental health and to provide psychosocial support.

Should a third booster dose be scheduled after two doses of CoronaVac? A single-center experience.

In the 10th month of the pandemic, coronavirus disease 2019 (COVID-19) vaccination was given first to healthcare workers in Turkey after receiving emergency use approval from the Ministry of Health. This study, which was performed at the COVID-19 reference center in Ankara (the capital of Turkey) aimed to evaluate the seroconversion rate of the CoronaVac vaccine. The anti-spike immunoglobulin G response to the two-dose vaccination was retrospectively examined in healthcare workers who had no previous history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The postvaccine seroconversion rate was investigated by measuring the antibody levels of healthcare workers who had received CoronaVac. Vaccination was administered as 600 SU in 28-day intervals. The healthcare workers' anti-SARS-CoV-2 immunoglobulin G levels were used to determine the seroconversion rate 2 months after the second dose of the vaccine. Of the healthcare workers, 22.9% (n = 155) were seronegative. The younger the age of the participant, the higher the level of anti-SARS-CoV-2 immunoglobulin G. Furthermore, anti-SARS-CoV-2 immunoglobulin G levels were much higher in women than men.

Determination of Seroprevalence and Risk Factors of Crimean-Congo Haemorrhagic Fever (CCHF) in the Endemic Region in Turkey: A Population-Based Cross-Sectional Study.

OBJECTIVES: Turkey is one of the countries that has the most cases of CCHF in recent years among the endemic countries. The disease also poses an important health threat with high mortality rate. The aim of the study was to determine the seroprevalence and risk factors of CCHF in adults aged ≥20 years in Tokat in the endemic region, Turkey. METHODS: In this population-based cross-sectional study, a total of 85 Family Medicine Units (FMUs), from over 170 in Tokat, were randomly selected using 50% sampling. The sample size was determined among the subjects aged ≥20 who registered with the FMUs, due to gender, age group, and the urban/rural population size of Tokat using the stratified cluster sampling method. Subjects were invited to the FMUs. A questionnaire was performed face to face. The blood samples were taken, and anti-CCHFV IgG antibodies were measured with ELISA method. RESULTS: 1272 (54.9%) out of 2319 participants were female, and the mean age was 47.3 ± 15.3. Anti-CCHFV IgG seropositivity was 5.6% (n = 130). Seropositivity rates in terms of adjusted odds ratios (AOR) were higher 2.53 times (95% CI: 1.57-4.08; p=0.001) in males; 4.05 (95% CI: 2.14-7.65; p < 0.001) in age group ≥65; 0.33 (95% CI: 0.14-0.76; p < 0.001) in graduates of high school and above; 0.71 (95%CI: 0.33-1.52; p < 0.001) in ones with good income; 1.84 (95%CI: 1.18-2.86; p < 0.001) in farmers; 1.64 (95% CI: 1.04-2.27; p < 0.001) in people dealing with animal husbandry; and 1.02 (95% CI: 1.03-2.29; p < 0.001) in those with history of tick contact. CONCLUSIONS: CCHF seroprevalence is still a common public health problem in Tokat, Turkey. Male gender, advanced age group, low-educated, low-income, farmers, animal husbandry, and history of tick contact were found to be risk factors for CCHF. The importance of this kind of community-based studies to identify the seroprevalence in regional and national level increases even more.

Effects of Nasal and Paranasal Sinus Variations on Chronic Otitis Media Development in Pediatric Patients.

OBJECTIVE: Chronic otitis media is an inflammatory disease of the middle ear. The airflow in the nasal passage affects the development of mastoid air cells through the eustachian tube.Nasal and paranasal pathologies and their anatomical variations cause chronic sinonasal inflammation and affect the middle ear mucosa. This study aims to reveal whether the nasal and paranasal sinus variations in pediatric patients are a factor in developing chronic otitis media. MATERIALS AND METHODS: Eighty patients, with unilateral chronic otitis media, who were admitted to the otorhinolaryngology clinic between May 2015 and July 2019, were included in this retrospective study. The control group (Group 2) consisted of a total of 51 patients. None of the patients in Group 2 had otorrhea history and no signs of chronic otitis in their otoscopic examination, middle ear pathologies. The patient's anatomical variations of the nasal cavity and sinuses were evaluated with CT by a radiologist Results: Nasal septum deviation was found to be 53% in children with chronic otitis media. It was found 31.4% in the control group. Since the P value was found to be .04, this rate was considered as significant. Inferior concha hypertrophy was found to be 17.6% in the control group and 38.8% in the group with chronic otitis media, and this rate was considered significant since the P value was .035 Conclusion: We detected that septum deviation and inferior concha hypertrophy increased chronic otitis media formation in children. All these studies show that cases causing nasal obstruction, such as septum deviation, have a negative effect on middle ear pressure and increase the rate of ear diseases.

The Role of Manganese, Cadmium, Chromium and Selenium on Subjective Tinnitus.

Elevated levels of heavy metals like cadmium (Cd) and manganese (Mn) are known to lead to oxidative damage-related oto-toxicity and decreased levels of chromium (Cr) and selenium (Se) are known to lead to oto-toxicity due to reduced anti-oxidant activity. The aim of the present study was to evaluate serum levels of Cd, Mn, Cr, and Se and their relationship with tinnitus. A total of 48 patients with tinnitus (Group 1) and 40 healthy controls (Group 2) were included in the study. All participants were applied audiology tests. Severity of tinnitus was measured with Tinnitus Severity Index Questionnaire (TSIQ) in group 1. Serum Mn, Cd, Cr, and Se measurements were done by using The Agilent ICP-MS system consisted of a 7700 coupled plasma mass spectrometry (ICP-MS). Serum Cd, Mn, and Cr levels were higher in group 1 and Se level was lower in group 1 than that of group 2. We may conclude that Cd, Mn, Cr, and Se levels could play an important role in etio-pathogenesis of tinnitus, and thereby supplementation or reduction of these elements could be considered as novel therapeutic goals.

Molecular Epidemiology of Rotavirus Strains in Under Five Children.

OBJECTIVES: To determine the prevalence and genotype distribution of rotaviruses in children presenting to authors' hospital in Middle Black Sea region of Turkey. The results may supply important information about vaccine studies in Turkey. METHODS: Rotavirus antigen was detected by latex agglutination test and rotavirus RNA was detected by RT-PCR test. On the other hand, rotavirus positive samples were genotyped by semi-nested multiplex polymerase chain reaction. RESULTS: The highest rate of rotavirus positivity (46.9%) was observed among children in the 13 to 24 mo age group. All the positive-strains were in G1-4, G8-9, P [4], P [8], and P [9] genotypes. The most common G and P combination in present study was G9P[8] (n = 24, 28.9%). CONCLUSIONS: The present results indicated that the most prevalent genotypes were G1, G9, P8, G9P[8] and G1P[8] in authors' region. Rotavirus vaccines used in this region must include mainly these genotypes.

Stabilization of total ossicular replacement prosthesis using cartilage "shoe" graft.

PURPOSE: We aimed to determine the effect of a cartilage shoe graft placed between the foot of the TORP and the stapes footplate on hearing improvement and long-term displacement rates. MATERIALS AND METHODS: Patients who underwent TORP ossiculoplasty were divided into two groups. The TORP-alone group consisted of 32 patients who underwent TORP placement without cartilage shoe graft and served as the control group. The study group consisted of 56 patients who underwent placement of cartilage shoe graft together with TORP. Pure-tone audiometry was administered to all patients before and 3, 6 and 12 months after surgery. Indications for surgery, surgical technique used, postoperative complications, and air and bone conduction thresholds at 500, 1000, 2000 and 4000 Hz were recorded for all patients. RESULTS: No significant difference in postoperative air-bone gaps was observed between the groups. The number of patients with air-bone gaps less than 20 dB was 14 (25%) in the study group and 8 (25%) in the control group. There was no significant difference in changes in air-bone gaps between the groups. Dislocation of the prosthesis was observed in 3 patients in the study group (5.3%) and 4 in the control group (12.5%). There was less dislocation of the prosthesis in the study group, but the difference was not statistically significant. CONCLUSION: Placement of a cartilage graft between the footplate of the stapes and the foot of the prosthesis may have positive effects on long-term hearing improvement and rates of prosthesis displacement. Further research with larger patient numbers is needed to identify the advantages of shoe graft.

In Vitro Susceptibilities of Candida albicans Isolates to Antifungal Agents in Tokat, Turkey.

BACKGROUND: Candida albicans is the pathogenic species most commonly isolated from fungal infections. Management of these infections depends on the immune status of the host, severity of disease, and the choice of antifungal drug. In spite of the development of new antifungal drugs, epidemiological studies have shown that resistance to antifungal drugs in C. albicans strains is becoming a serious problem. OBJECTIVES: The aim of this study was to evaluate the in vitro susceptibility of C. albicans isolates to ketoconazole, fluconazole, itraconazole, voriconazole, posaconazole, amphotericin B, caspofungin, and anidulafungin. MATERIALS AND METHODS: A total of 201 C. albicans isolates were collected from clinical specimens. Antifungal susceptibility tests were performed using the Etest. RESULTS: All the tested C. albicans isolates were found to be susceptible to amphotericin B and anidulafungin. Although none of the isolates showed resistance to caspofungin, 15% of the isolates were classified as showing intermediate resistance. The resistance rates of C. albicans isolates to ketoconazole, fluconazole, itraconazole, voriconazole and posaconazole were 32%, 34%, 21%, 14% and 14%, respectively. CONCLUSIONS: Our findings indicate that resistance of C. albicans strains to azoles is more common in Tokat, Turkey. Therefore, a strategy to control the inappropriate and widespread use of antifungal drugs is urgently needed. Fungal culturing and antifungal susceptibility testing will be useful in patient management as well as resistance surveillance.

In vitro activities of antifungal drugs against dermatophytes isolated in Tokat, Turkey.

BACKGROUND: In this study, we aimed to establish the in vitro antifungal susceptibilities of terbinafine, miconazole, itraconazole, ketoconazole, griseofulvin, and amphotericin B against dermatophyte isolates. METHODS: One hundred and seventy-seven clinical isolates were tested: Trichophyton rubrum (n = 78), Trichophyton mentagrophytes (n = 49), Epidermophyton floccosum (n = 30), Trichophyton verrucosum (n = 16), and Trichophyton tonsurans (n = 4). The broth microdilution assay for antifungal susceptibility testing of dermatophytes was performed according to Clinical and Laboratory Standards Institute guidelines in the M38-A2 document. RESULTS: Our minimum inhibitory concentration (MIC) results showed that the values for terbinafine for all dermatophyte isolates were significantly lower than the values for amphotericin B, miconazole, itraconazole, ketoconazole, and griseofulvin. For T. rubrum isolates, amphotericin B was more active than miconazole, itraconazole, and ketoconazole. Among the antifungal drugs tested, griseofulvin had the highest minimum inhibitory concentration values for T. mentagrophytes isolates. CONCLUSION: Terbinafine was found to be the most effective antifungal drug against all tested dermatophyte isolates. Griseofulvin was the less active antifungal drug against T. mentagrophytes isolates. Performing antifungal susceptibility testing is especially important for screening the development of antifungal resistance.

Dermatophytes isolated from the mosques in Tokat, Turkey.

Dermatophytes are a group of fungi that invade keratinized tissues such as the skin, hair and nails. The aim of this study was to investigate the existence of the potential causative agents of dermatophytosis in the mosque area in Tokat, Turkey. Thirty mosques were included in the study. A total of two hundred samples were collected from various parts of carpets and slippers in the mosques. Positive cultures were obtained in 144 samples (113 from carpets, 31 from slippers). Among the species isolated, Epidermophyton floccosum (n = 114) (79.2 %) was the most frequent, followed by Trichophyton mentographytes (n = 13) (9 %), Trichophyton tonsurans (n = 9) (6.3 %), Trichophyton rubrum (n = 5) (3.5 %), and Trichophyton verrucosum (n = 3) (2 %). Contamination of carpets and slippers with dermatophytes may act as a reservoir for transmission of these fungi. Educational health programs, appropriate treatment, and management of disease may provide to control of the spread of fungal organisms.

Association between elevated aminotransferase levels and the metabolic syndrome in Northern Turkey.

INTRODUCTION: Elevated aminotransferase levels(ATLs) are alert the physicians for liver-affecting disease and may reflect liver injury. We aimed to determine the prevalence of elevated ATLs and the association of elevated ATLs with the metabolic syndrome (MetS) in a northern province of Turkey. MATERIALS AND METHODS: Elevated ATLs were evaluated among 1,095 individuals of the Tokat Prevalence Study which have been described in detail elsewhere. 1,095 participants had been selected by a simple random sampling method among 530,000 inhabitants in 70 (12 urban and 58 rural) areas in the province of Tokat which is located in the Black Sea Region of Turkey. RESULTS: The prevalence of elevated serum ALT, AST, and ALT and/or AST were found as 11%, 7.2%, and 13.3%, respectively. Increased BMI, fatty liver, and MetS were higher in our general population with elevated ATLs. After exclusion of individuals with hepatitis B or hepatitis C infection, 132 individuals with elevated ATLs (91 male and 41 female) were evaluated. MetS was found in 59 participants and its prevalence was markedly higher in females with elevated ATLs (p < 0.0001). When the males with elevated ATLs were evaluated, the ALT levels of the persons who have no risk of MetS (p =0.007) and the persons who have one risk of MetS (p = 0.001) were lower than the persons with MetS. CONCLUSIONS: Elevated ATLs are common and it's an important cause is MetS in Northern Turkey.

[Phospholipase, proteinase and hemolytic activities of Candida albicans isolates obtained from clinical specimens]. / Klinik orneklerden izole edilen Candida albicans suslarinin fosfolipaz, proteinaz ve hemolitik aktiviteleri.

This study was aimed to determine the phospholipase, proteinase and hemolytic activities of Candida albicans strains isolated from clinical specimens. A total of 147 C. albicans strains isolated from blood (n = 29), respiratory specimens (n = 44), urine (n = 52), pus (n = 17) and stool (n = 5) were included in the study. Proteinase and phospholipase activities were determined in 81% and 76% of C. albicans isolates, respectively. All C. albicans isolates revealed beta-hemolytic activity on Sabouraud dextrose agar supplemented with 7% fresh sheep blood and 3% glucose. Phospholipase and proteinase positivity were highest among the respiratory isolates. Proteinase activity of respiratory (93%) and blood (83%) isolates were statistically significantly higher than that of urine (77%; p = 0.032), pus (65%; p = 0.007) and stool isolates (60%; p = 0.026). While phospholipase activity showed statistically significant difference between respiratory (84%) and pus (53%) isolates (p = 0.014), no statistically significant difference was determined for blood (79%), urine (75%) and stool (80%) isolates (p > 0.05). Two blood isolates with 4+ proteinase activity and 3 urine isolates with 3+ proteinase activity were phospholipase negative. One urine isolate with 4+ phospholipase activity and 4 with 3+ phospholipase activity were proteinase negative. Phospholipase and proteinase negative 1 isolate from stool and 1 isolate from pus were found to have 4+ hemolytic activity. In conclusion, besides proteinase and phospholipase enzyme activities, hemolytic activity may play an important role for the C.albicans infections. The pathogenetic role of these virulence factors should be evaluated by further clinical studies.

Onychomycosis infections in the Middle Black Sea Region, Turkey.

BACKGROUND: Onychomycosis, a fungal infection of the nail, is caused by dermatophytes, yeasts, and nondermatophyte molds. The causative pathogen and incidence of onychomycosis depend on age, gender, geographic and climatic conditions, living habits, and immune status of the host. AIM: To determine the incidence and etiologic agents of onychomycosis in the Middle Black Sea Region, Turkey. METHODS: Two hundred and seventy-six specimens were collected from patients with suspected onychomycosis during January 2004 to May 2008. RESULTS: Culture positivity was obtained in 240 of the 276 samples. Dermatophytes were isolated in 225 samples. The most common causative agent of onychomycosis was Trichophyton rubrum (91) (38%), followed by Trichophyton mentagrophytes (49) (20.4%), Epidermophyton floccosum (41) (17%), and Trichophyton verrucosum (34) (14.2%). Seven isolates were identified as yeasts (2.9%). Nondermatophyte molds were isolated from eight samples (3.3%). CONCLUSIONS: This survey reveals that the etiologic agents of onychomycosis in our area show large discrepancies from those in other regions of Turkey and Europe.

Comparison of dose-related ocular side effects during systemic isotretinoin administration.

PURPOSE: To compare the effects of high- (Group 1) and low-dose (Group 2) isotretinoin treatments for acne vulgaris on lacrimal functions and other ocular complications. METHODS: Twenty-six patients receiving high-dose (>0.5 mg/kg per day) systemic isotretinoin treatment and 25 patients treated with low-dose systemic isotretinoin (<0.5 mg/kg per day) underwent complete ophthalmologic assessment of both eyes before treatment, at days 45 and 90 of treatment, and 1 month after the completion of treatment, together with a microbiologic evaluation of conjunctival flora, tear film break-up time (BUT), and anesthetized Schirmer test of the right eye of each patient. RESULTS: When the results of the anesthetized Schirmer test for Groups 1 and 2 were compared (pretreatment, days 45 and 90 of treatment, and 1 month after treatment), there was no statistically significant difference between the groups (p > 0.05). Although BUT did not differ significantly between the two groups before treatment (p >0.05), there was a statistically significant decrease in BUT in Group 1 when compared with Group 2 at days 45 and 90 of treatment (p <0.05). One month after the completion of treatment, there was no difference in BUT between the two groups (p >0.05). No difference in Staphylococcus aureus colonization was detected between the two groups at days 45 and 90 of treatment (p >0.05). CONCLUSIONS: During systemic isotretinoin treatment, eye dryness was related to the dose used, at least during the period of treatment. Conversely, the rate of conjunctival S aureus colonization was unrelated to the dose of isotretinoin.

Seroprevalence of hepatitis B and C viruses in the province of Tokat in the Black Sea region of Turkey: A population-based study.

BACKGROUND/AIMS: Viral hepatitides are considered a major health problem worldwide. There are only a few studies relevant to the epidemiology of these types of infection in the normal healthy population. In this study, we aimed to determine the seroprevalence of hepatitis B and hepatitis C as well as the frequency of isolated anti-HBc IgG positivity among a normal healthy population in a northern province of Turkey. METHODS: This study was conducted in 70 areas (12 urban and 58 rural) in the province of Tokat, which is in the Black Sea region of Turkey, with about 530,000 inhabitants 18 years and older. All urban regions and some rural regions selected by a cluster sampling method were included in the study. The study population of 1,095 subjects (541 male and 554 female; urban 555 and rural 540) was selected by a random sampling method among 530,000 individuals. All individuals were tested for HBsAg, anti- HBs, anti-HBc IgG, anti-HCV, and alanine aminotransferase. RESULTS: The mean age of all participants was 41.4+/-17 years (range, 18-95). HBsAg, anti-HBs, anti-HBc IgG only, isole and anti-HCV were detected in 60 (5.5%), 250 (22.8%), 132 (12.1%), and 23 (2.1%) individuals of the 1,095 total participants, respectively. We did not find statistically significant differences between hepatitis B and C markers for men versus women or those living in rural versus urban areas. The rate of HBsAg positivity in individuals with a history of marriage to close relatives was higher. CONCLUSIONS: We found that the seroprevalences of hepatitis B and C in a northern province of Turkey are similar to the averages reported in other studies that were conducted in a different region of our country. The history of marriage to close relatives was associated with hepatitis B.

Aqueous humor erythropoietin levels in patients with primary open-angle glaucoma.

PURPOSE: To evaluate the levels of erythropoietin (EPO) in the aqueous humor in eyes with primary open-angle glaucoma (POAG) and without glaucoma. METHODS: Levels of EPO were measured using a sandwich enzyme-linked immunosorbent assay kit in aqueous humor aspirates taken during anterior segment surgery from 45 patients, of whom 20 had POAG and 25 had senile cataract only. RESULTS: The mean aqueous humor EPO concentration in eyes with POAG (10.91+/-4.32 mU/mL) was significantly higher than that from eyes with cataract (8.24+/-1.77 mU/mL, P=0.008). There was no significant difference between the serum EPO concentrations of POAG (26.46+/-10.36 mU/mL) and the control group (24.50+/-7.59 mU/mL, P=0.468). There was no correlation (P=0.165) between the EPO aqueous humor concentration and the EPO serum concentration while there was no correlation between the EPO aqueous humor concentration and the EPO serum concentration in the control group (P=0.819). CONCLUSIONS: The aqueous humor EPO level is increased in eyes with POAG.

Acute otitis media and respiratory viruses.

The present study was performed to elucidate the clinical outcome, and etiology of acute otitis media (AOM) in children based on virologic and bacteriologic tests. The study group consisted of 120 children aged 6 to 144 months with AOM. Middle ear fluid (MEF) was tested for viral pathogens by reverse transcriptase polymerase chain reaction (RT-PCR) and for bacteria by gram-staining and culture. Clinical response was assessed on day 2 to 4, 11 to 13, 26 to 28. Respiratory viruses were isolated in 39 patients (32.5%). Respiratory syncytial virus (RSV) (46.5%) was the most common virus identified in MEF samples, followed by human rhinovirus (HRV) (25.6%), human coronavirus (HCV) (11.6%), influenza (IV) type A (9.3%), adenovirus type sub type A (AV) (4%), and parainfluenza (PIV) type -3 (2%) by RT-PCR. In total 69 bacterial species were isolated from 65 (54.8%) of 120 patients. Streptococcus pneumoniae (S. pneumoniae) was the most frequently isolated bacteria. Viral RNA was detected in 31 (56.3%) of 55 bacteria-negative specimens and in 8 (12.3%) of 65 bacteria-positive MEF samples. No significant differences were found between children representing viral infection alone, combined viral and bacterial infection, bacterial infection alone, and neither viral nor bacterial infection, regarding clinical cure, relapse and reinfection rates. A significantly higher rate of secretory otitis media (SOM) was observed in alone or combined RSV infection with S. pneumonia or Haemophilus influenzae (H. influenzae) than in other viruses infection. Conclusion. This study provides information about etiologic agents and diagnosis of AOM in Turkish children. The findings highlight the importance of common respiratory viruses and bacterial pathogens, particularly RSV, HRV, S. pneumoniae and H. influenzae, in predisposing to and causing AOM in children.

[Antimicrobial susceptibilities and serotype distribution of Streptococcus agalactiae strains isolated from pregnant women]. / Gebe kadinlardan izole edilen Streptococcus agalactiae suslarinin antimikrobiyal duyarliliklari ve serotip dagilimi.

Streptococcus agalactiae (Group B streptococcus, GBS) is an important cause of neonatal morbidity and mortality. The aim of this study was to determine the serotype distribution and antibiotic susceptibility patterns of GBS isolated from pregnant women. A total of 671 pregnant women were screened for vaginal carriage of GBS, and vaginal colonization rate was found to be 14.6%. All GBS isolates were susceptible to penicillin, vancomycin, chloramphenicol and ofloxacin. The rates of GBS resistance to tetracycline, erythromycin and clindamycin were 81.6%, 24.5% and 19.4%, respectively. The serotype distribution of GBS isolates was as follows in order of frequency; serotype III (33.7%), serotype Ib (24.5%), serotype V (18.4%), serotype Ia (7.1%), serotype IV (3.1%) and serotype II (2%). Eleven GBS isolates could not be serotyped by the antisera set used in the study.

Bacterial etiology of acute otitis media and clinical efficacy of amoxicillin-clavulanate versus azithromycin.

BACKGROUND: Acute otitis media (AOM) is one of the most common acute bacterial infection in childhood and also the most frequent reason for outpatient antibiotic therapy. Little recent information about susceptibility patterns of AOM bacterial pathogens in Turkish children has been reported. OBJECTIVE: To determine the bacterial etiology of acute otitis media in children and to compare the efficiency of 3 days course of azithromycin with a 10 days course of amoxicillin-clavulanate. METHODS: This prospective, single blind, randomised comparative study was carried out in 180 children with AOM. Paracentesis was performed for middle ear fluid culture before the first dose antibiotic therapy. Children with acute otitis media were randomised to receive either low dose amoxicillin-clavulanate (45/6.4 mg/kg/day in two divided doses for 10 days) or low dose azithromycin (10mg/kg/day for 3 days). Clinical response was assessed on days 2-4, 11-13, 26-28. RESULTS: Bacterial pathogens were isolated from 108 (60%) of 180 children. Streptococcus pneumoniae was the most common isolated pathogen (39.7%), followed by Haemophilus influenzae (20.7%), Moraxella catarrhalis (15.5%), Staphylococcus aureus (13.8%), Group A beta-hemolytic streptococcus (5.1%), Escherichia coli (3.4%) and Enterococcus faecalis (1.7%). This study demonstrated low resistance rates compared to studies of different countries. Although clinical response rates were better in patients treated with amoxicillin-clavulanate, this was not statistically significant [86.6% (78 of 90)] versus [95.2% (80 of 84)]. Success rates of amoxicillin-clavulanate were high for both S. pneumoniae and H. influenzae. Difference between success rates was not statistically significant (P=0.144 and 0.352). CONCLUSIONS: Bacteria were isolated in 60% of AOM cases. The clinical efficiency of amoxicillin-clavulanate was found to be equal compared to azithromycin in children with acute otitis media.

Internal mammary artery atherosclerosis in segments removed during coronary artery bypass grafting surgery and C.pneumoniae infection.

OBJECTIVE: Recent studies suggest the association of atherosclerotic cardiovascular disease with Chlamydia pneumoniae infection. We investigated C. pneumoniae DNA in internal mammarian artery (IMA) (used as a coronary bypass conduit) and its relationship with atherosclerosis. METHODS: Sixty-six consecutive patients who underwent coronary artery bypass grafting (CABG) during an eight-month period were included in this study. From all patients, we attempted to obtain surplus segments of harvested IMA grafts. The vessels were examined histopathologically, and presence of C. pneumoniae DNA in IMA grafts was assessed by polymerase chain reaction (PCR). RESULTS: C. pneumoniae DNA was found in 7 (10.6%) of 66 IMA specimens. The light microscopic examinations of IMA segments from the C. pneumonia positive group showed atherosclerotic intimal changes in four of the seven patients. These atherosclerotic changes were type II in three patients and type III in one patient according to the AHA classification. The rest of the IMA segments from 62 patients did not show any discernible atherosclerotic lesion. CONCLUSION: The IMA graft examination by PCR and histopathology may be helpful in the determination of future graft patency for IMA bypass surgery.