Comparison of Methods Used for the Diagnosis of Epstein-Barr Virus Infections in Children.

The accurate diagnosis of Epstein-Barr virus (EBV) infections is important, as many other infectious agents or diseases can cause similar symptoms. In this study, sera of pediatric patients who were suspected to have an EBV infection, were sent to Eskisehir Osmangazi University Faculty of Medicine, Department of Clinical Microbiology, and investigated by IFA, ELISA, immunoblotting and Real-time PCR. The performances of these tests were compared with IFA. The rates of agreement between ELISA and IFA were found as 100% for seronegative, 100% for acute primary infection, 22.2% for late primary infection, 92.1% for past infection. The rates of agreement between immunoblotting and IFA were found as 80.8% for seronegative, 68.8% for acute primary infection, 55.6% for late primary infection, 86.6% for past infection. The sensitivity of immunoblotting for anti-VCA IgM was identical with ELISA, and higher for anti-VCA IgG, anti-EBNA IgG, anti-EA antibodies, while the specificity of immunoblotting for these antibodies were found to be lower. The sensitivity and specificity of Real-time PCR for detection of viremia in acute primary infection were found as 56.25% (9/16) and 97.89% (139/142), respectively. The diagnostic methods should be chosen by evaluating the demographic characteristics of patients and laboratory conditions together.

Changes in the conjunctival bacterial flora of patients hospitalized in an intensive care unit.

PURPOSE:: To identify the changes in aerobic conjunctival bacterial flora and to correlate culture results with physical health and the duration of patients' hospitalization in an intensive care unit (ICU). METHODS:: Patients hospitalized in the ICU were included in this study. Conjunctival cultures from all patients were obtained using a standard technique on days 1, 3, 7, and 14. Swabs were plated on nonselective (blood agar) and enriched (chocolate agar) media within one hour. Visible colonies were isolated, and standard microbiological techniques were used to identify the bacteria. The frequency, identity, and correlation of culture results with patients' physical findings and the duration of hospitalization were determined. RESULTS:: We obtained 478 cultures (day 1, 270; day 3, 156; day 7, 36; and day 14, 16) from 135 patients; 288 (60.2%) cultures were positive, and 331 microorganisms were isolated. The most frequently isolated microorganism from the cultures was coagulase-negative Staphylococcus species (n=210/331, 63.5%), and the others were Corynebacterium diphtheriae (n=52/331, 15.7%), S. aureus (n=26/331, 7.9%), gram-negative bacilli other than Pseudomonas (n=14/331, 4.2%), Neisseria species (n=8/331, 2.4%), Pseudomonas aeruginosa (n=6/331, 1.8%), Haemophilus influenzae (n=7/331, 2.1%), Acinetobacter species (n=6/331, 1.8%), and Streptococcus species (n=2/331, 0.6%). The frequency of positive cultures significantly increased (p<0.03) with time. CONCLUSIONS:: Prolonged hospitalization significantly predisposes to bacterial colonization. The colonization rate of S. aureus and Neisseria spp. increased significantly after one week.

Changes in the conjunctival bacterial flora of patients hospitalized in an intensive care unit / Mudanças na flora bacteriana conjuntival de pacientes internados em unidade de terapia intensiva

ABSTRACT Purpose: To identify the changes in aerobic conjunctival bacterial flora and to correlate culture results with physical health and the duration of patients' hospitalization in an intensive care unit (ICU). Methods: Patients hospitalized in the ICU were included in this study. Conjunctival cultures from all patients were obtained using a standard technique on days 1, 3, 7, and 14. Swabs were plated on nonselective (blood agar) and enriched (chocolate agar) media within one hour. Visible colonies were isolated, and standard microbiological techniques were used to identify the bacteria. The frequency, identity, and correlation of culture results with patients' physical findings and the duration of hospitalization were determined. Results: We obtained 478 cultures (day 1, 270; day 3, 156; day 7, 36; and day 14, 16) from 135 patients; 288 (60.2%) cultures were positive, and 331 microorganisms were isolated. The most frequently isolated microorganism from the cultures was coagulase-negative Staphylococcus species (n=210/331, 63.5%), and the others were Corynebacterium diphtheriae (n=52/331, 15.7%), S. aureus (n=26/331, 7.9%), gram-negative bacilli other than Pseudomonas (n=14/331, 4.2%), Neisseria species (n=8/331, 2.4%), Pseudomonas aeruginosa (n=6/331, 1.8%), Haemophilus influenzae (n=7/331, 2.1%), Acinetobacter species (n=6/331, 1.8%), and Streptococcus species (n=2/331, 0.6%). The frequency of positive cultures significantly increased (p<0.03) with time. Conclusions: Prolonged hospitalization significantly predisposes to bacterial colonization. The colonization rate of S. aureus and Neisseria spp. increased significantly after one week.

RESUMO Objetivo: Identificar as mudanças na flora bacteriana aeróbia da conjuntiva e correlacionar os resultados da cultura com o estado de saúde física e a duração da hospitalização em pacientes em uma unidade de terapia intensiva (UTI). Método: Pacientes que estavam na UTI foram incluídos neste estudo. Culturas conjuntivais foram obtidas nos dias 1, 3, 7 e 14 de todos os pacientes com uma técnica normalizada. Zaragatoas foram semeadas em placas não seletivas (ágar sangue) e enriquecidas (ágar chocolate) dentro de uma hora. Colônias visíveis foram separadas, isoladas, e identificadas utilizando técnicas microbiológicas convencionais. A frequência, identificação e correlação da cultura resulta com achados físicos e a duração da hospitalização foram determinados. Resultados: Um total de 478 culturas (no primeiro dia 270, terceiro dia 156, sétimo dia 36 e dia catorze 16 culturas) foram obtidas de 135 pacientes hospitalizados durante o estudo. Duzentos e oitenta e oito (60,2% de todas as culturas obtidas) culturas foram positivas. Trezentos e trinta e um microrganismos foram isolados a partir dessas culturas. Em todos os grupos, o microrganismo mais frequentemente isolado foi o Staphylococcus species coagulase negativo (n=210/331, 63,5% de todos os microrganismos isolados). Outras bactérias isoladas foram Corynebacterium diphteriae (n=52/331, 15,7%), Staphylococcus aureus (n=26/331, 7,9%), bacilos Gram-negativos que não sejam Pseudomonas (n=14/331, 4,2%), Neisseria species (n=8/331, 2,4%), Pseudomonas aeruginosa (n=6/331, 1,8%), Haemophilus influenzae (n=7/331, 2,1%), Acinetobacter species (n=6/331, 1,8%), e Streptococcus species (n=2/331, 0,6%). Como o tempo de hospitalização prolongada, a positividade em culturas aumentou significativamente (p<0,03). Conclusões: hospitalização prolongada predispõe significativamente a frequência de colonização bacteriana. A taxa de colonização de S. aureus e Neisseria spp. aumentou significativamente depois de uma semana.

Serum Endocan Levels in Children with Febrile Neutropenia.

Endocan is an endotelial cell specific molecule; previous studies have shown that serum endocan levels increased in cancer and sepsis and are also related to the severity of sepsis. There are no clinical study about serum endocan levels in children with febrile neutropenia. The aim of this study was to evaluate serum endocan levels in pediatric leukemia patients with febrile neutropenia (n=33) and compare them with children with leukemia without fever (n=33) and also with healthy children (n=24). The median serum endocan level in the first group (children with febrile neutropenia) was statistically significantly higher compared to the leukemic children without febrile neutropenia and also control group (P<0.01 for both). No difference was determined between the serum endocan levels of the leukaemia patients without febrile neutropenia and the healthy control group (P>0.05). Serum endocan levels were also similar with febrile neutropenia due to bacterial causes comparing with the idiopathic febril neutropenia. The results of this study showed increased serum endocan in children with leukemia during the febrile neutropenia episode, and no changes of serum endocan levels in children without leukemia without infection/fever. The monitoring of a series of serum endocan levels would be helpful for the course of febrile neutropenia.

[Investigation of human papillomavirus prevalence in women in Eskisehir, Turkey by Pap smear, hybrid capture 2 test and consensus real-time polymerase chain reaction and typing with pyrosequencing method]. / Eskisehir'de kadinlarda insan papillomavirus prevalansinin, Pap yaymasi, hibrid yakalama 2 testi ve konsensus gerçek zamanli polimeraz zincir reaksiyonu ile arastirilmasi ve pirodizileme yöntemiyle tiplendirilmesigi.

Human papillomavirus (HPV) infections have a broad range of clinical spectrum from subclinical or asymptomatic infection to anogenital carcinoma. The detection of HPV-DNA and determination of the risk groups in cervical cancer (CC) screening is very important because CC is considered to be a preventable illness which is the third most common cancer type of women in the world. The aims of this study were to investigate the presence of HPV-DNA in women by two different molecular methods and to compare their results together with the results of cytology, in Eskisehir, Central Anatolia, Turkey. A total of 1081 women aged between 30-65 years, who applied to Eskisehir Early Diagnosis, Screening and Training of Cancer Center (KETEM) for screening were included in the study. Three separate cervical samples were collected simultaneously from the participants for cytologic examination and molecular studies. In the first step of the study, all cervical samples were investigated for the presence of HPV-DNA by Hybrid Capture 2 (HC2; Qiagen, Germany) method. In the second part of the study, consensus real-time polymerase chain reaction (RT-PCR) (Takara Bio Inc., Japan) was performed in 152 samples which included HC2 positive and randomly selected negative samples, and then the HPV genotypes were detected by using a commercial kit based on pyrosequencing method (Diatech Pharmacogenetics S.R.L, Italy). In the first part of the study, HC2 test was found positive in 3% (32/1081) of the women, while in 4.4% (47/1081) Pap smear was positive alone or with HC2 test. Five (0.5%) samples yielded positive results with both of the methods, and four of them were positive for high risk HPV types. Cytology results were negative in 19 out of 23 (23/1081, 2.1%) samples that were reported as high risk HPV by HC2 test. On the other hand, 42 (42/1081, 3.9%) samples that were positive by cytology yielded negative results by HC2 test. In the second part of the study, 32 (21.1%) of 152 selected samples were positive by HC2 test, 40 (26.3%) were positive by Pap smear, and 53 (34.9%) were positive by consensus RT-PCR. All of the 32 samples that were positive by HC2 were also positive by RT-PCR, however 21 samples that were positive by RT-PCR were negative by HC2 test. Among 40 samples that were positive (abnormal) by Pap smear, HPV-DNA was positive in nine (22.5%) by RT-PCR and in five (12.5%) by HC2 test, but HPV-DNA was not detected in 31 (77.5%) samples by both of the tests. Genotyping of the strains could be performed in 44 samples, and the most common type detected was HPV type 16 (n=15, 34.1%), followed by type 90 (n=11, 25%) and type 18 (n= 4, 9.1%). In our study, the sensitivity, specificity, positive and negative predictive values of Pap smear method were estimated as 16.1%, 96%, 10.6% and 97.5%, respectively, based on the HC2 results which was approved by U.S. Food and Drug Administration (FDA). In addition, a significant degree of concordance was detected between HC2 and concensus RT-PCR methods (Cohen's kappa: 0.665). In conclusion, regarding the insufficient number of cytopathologists in our country and according to the recommendations of American Society for Colposcopy and Cervical Pathology (ASCCP) and FDA, it was once again demonstrated that, the implementation of molecular diagnostic methods in addition to the Pap smear for effective screening of CC are needed.

[Investigation of Epstein-Barr virus and herpes simplex virus markers by serological and molecular methods in patients with rheumatoid arthritis and systemic lupus erythematosus]. / Romatoid Artrit ve Sistemik Lupus Eritematozuslu Hastalarda Epstein-Barr Virus ve Herpes Simpleks Virus Göstergelerinin Serolojik ve Moleküler Yöntemlerle Arastirilmasi

Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) which are autoimmune diseases usually questioned for their association with many infectious agents have etiopathogenesis related to genetic, immunologic, hormonal and even environmental factors. The most commonly attributed etiologic agents are herpes group viruses. The aim of this study was to investigate the role of Epstein-Barr virus (EBV) and herpes simplex (HSV) viruses in the etiology of RA and SLE. A total of 137 patients (87 RA and 50 SLE; mean age: 33 ± 12 years) who were admitted to Eskisehir Osmangazi University Medical Faculty Rheumatology Department between January 2007-January 2008 and diagnosed according to 1987 ACR (American College of Rheumatology) criteria have been included in the study, together with 50 healthy blood donors (mean age: 35 ± 14 years) as control group. Serum samples obtained from all of the cases were tested for EBV VCA-IgG, VCA-IgM, EA/D-IgG and EBNA-IgG (Trinity Biotech, USA); IgM and IgG antibodies against HSV-1 and HSV-2 by ELISA method (Dia-Pro Diagnostic, Italy), and the presence of viral nucleic acids in blood samples were investigated by real-time quantitative polymerase chain reaction (RTPCR; Qiagen, USA). EBV VCA-IgM was negative in all of the RA, SLE and control group patients. VCA-IgG positivity were 98% and 96%, and for EBNA-IgG 98.5% and 100%, in patient and control groups, respectively. There was no statistically significant difference between the groups regarding VCA-IgG and EBNA- IgG positivity (p> 0.05). On the other hand, EBV EA/D-IgG positivity rate found in the SLE group (34%) was significantly higher than RA (7%) and control (12%) groups (p< 0.001 and p< 0.05, respectively). There was no significant difference between RA and control groups in terms of EA/D-IgG positivity (p> 0.05). Regarding herpes simplex virus serology, HSV1-IgG seropositivity were 99% and 94% and HSV2-IgG positivity were 8% and 12% in the patient and control groups, respectively. There was no statistically significant difference between the groups according to the positivity rates of IgM and IgG specific for HSV-1 and HSV-2 (p> 0.05). All of the cases were found negative in terms of EBV, HSV-1 and HSV- 2 DNAs according to double-checked RT-PCR results. In conclusion, no significant difference was determined for EBV and HSV serologic markers in RA and SLE patients compared to the control group. However, significantly higher rate of EBV EA/D-IgG positivity in SLE patients might have indicated a possible association between SLE and EBV infection. Larger scale, prospective studies including examination of the synovial fluid/tissue samples are required to enlighten the association between SLE and EBV.

Evaluation of the GenoType Mycobacteria Direct assay for direct detection of the Mycobacterium tuberculosis complex obtained from sputum samples.

An increase in the prevalence of tuberculosis (TB) in recent years has accelerated the search for novel tools for the rapid diagnosis of TB infection. This study evaluated the GenoType Mycobacteria Direct (GTMD) assay (Hain Lifescience) for direct detection of the Mycobacterium tuberculosis complex (MTBC) from sputum samples and compared it with conventional methods. The GTMD test is a commercial assay produced using strip techniques and works based on a nucleic acid sequence-based amplification technique. This test allows 23S rRNA amplification-based detection of MTBC, Mycobacterium avium, Mycobacterium intracellulare, Mycobacterium kansasii and Mycobacterium malmoense directly from decontaminated clinical samples within 6 h. In the present study, 115 sputum samples were processed to detect acid-fast bacilli (AFB) using two microscopy methods (carbol fuchsin and fluorescent staining), two culture methods [Löwenstein-Jensen (LJ) and BACTEC 12B media] and the GTMD test. The results showed that 86 of the samples were positive by direct microscopy, 84 were positive by BACTEC 12B culture, 73 were positive by LJ culture and 95 were positive by the GTMD test. All of the isolates turned out to be MTBC. Moreover, the sensitivity and specificity of the GTMD test for MTBC in patients were 97 and 58 %, respectively, taking the culture combination as the gold standard. When the test was compared with culture of samples from anti-TB-treated patients, the sensitivity and specificity for the test were 100 and 15 %, respectively. Low specificity in treated people might arise from depressed proliferation of AFB. As the two methods target the same living bacilli, the difference is obviously notable. When the culture results and clinical findings of the patients were evaluated together (true-positive specimens), the sensitivity and specificity values of the GTMD test for all patients were 97 and 90 %, respectively. However, both of these values increased to 100 % for the patients receiving anti-TB treatment. These results implied that, to determine whether the patient's sputum contains living AFB, more sensitive techniques should be employed during the follow-up of the patients. These observations suggest that the GTMD method can be useful for early diagnosis of clinically and radiologically suspicious TB cases where smears are negative for Mycobacterium. In addition, the use of a GTMD test in smear-positive cases is helpful and practical in order to identify MTBC quickly. This allows more rapid treatment decisions and infection control precautions.

Candida norvegensis fungaemia in a neutropenic patient with acute non-lymphoblastic leukaemia.

We report a case of fungaemia resulting from Candida norvegensis in a patient with acute non-lymphoblastic leukaemia-M4 from Turkey. Candida norvegensis was isolated from two different peripheral blood samples that were taken at 2-day intervals. Despite treatment with liposomal amphotericin B, the patient died of multi-organ system failure.

[Investigation of mupirocin resistance in nosocomial methicillin-resistant Staphylococcus aureus isolates by phenotypic and genotypic methods]. / Nozokomiyal kökenli metisiline dirençli Staphylococcus aureus izolatlarinda mupirosin direncinin fenotipik ve genotipik yöntemlerle arastirilmasi.

Since methicillin-resistant Staphylococcus aureus (MRSA) has become one of the most prevalent nosocomial pathogens and a frequent cause of mortality and morbidity, there is an increasing tendency to use topical mupirocin for eradication of MRSA carriage. However, there have been recent reports of resistance against mupirocin among MRSA isolates. This study was conducted to investigate the presence of mupirocin resistance in a population of 595 nosocomial MRSA isolates by phenotypic and genotypic methods. In 35 (5.9%) of 595 isolates, mupirocin resistance was detected by disc diffusion and E-test methods. High-level mupirocin resistance was detected in 23 (65.8%) isolates and low-level mupirocin resistance in 12 (34.2%) isolates by E-test method. The molecular analysis of 35 mupirocin resistant MRSA isolates showed the presence of both mecA and mupA genes by polymerase chain reaction. While in 23 high-level mupirocin resistant MRSA isolates a 38 kb plasmid was detected, none of the low-level mupirocin-resistant MRSA isolates revealed the presence of this plasmid. Thirty-two of 35 mupirocin resistant MRSA isolates were genotyped with pulsed-field gel electrophoresis and 24 isolates were typed as identical (genotype A) and 8 as genetically-related (genotype A1), according to Tenover criteria. These data revealed that mupirocin resistant MRSA isolates in our hospital were of the same genotype or closely related.

Antifungal activity of caspofungin in combination with amphotericin B against Candida glabrata: comparison of disk diffusion, Etest, and time-kill methods.

The in vitro activities of caspofungin plus amphotericin B against 50 Candida glabrata isolates were evaluated by the time-kill, disk diffusion, and Etest methods. In vitro experiments showed a positive interaction. Even though each of these methods uses different conditions and endpoints, the results of the different methods frequently agreed.

The investigation of parvovirus B19 infection in patients with haematological disorders by using PCR and ELISA techniques.

Parvovirus B19 has a marked tropism for erythroid progenitor cells. This may lead to chronic anemia in predisposed individuals. The purpose of the study was to investigate the frequency of parvovirus B19 infections in patients with diagnosis of haematological disorders. In order to determine the diagnostic use of different markers of parvovirus B19 infection, serum specimens obtained from 79 patients with haematological disorders were tested for specific antibodies and viral DNA through the use of ELISA and PCR techniques. Evidence of parvovirus B19 infection was found in 23/79 (29.1%) patients by demonstrating viral DNA and/or specific IgM antibody. B19 infection was established in 3 of 11 patients with chronic myeloid leukemia, in 3 of 11 acute myeloid leukemia, in 2 of 11 patients with multiple myeloma, in 3 of 8 patients with Hodgkin's lymphoma, in 5 of 10 patients with non-Hodgkin's lymphoma, in 1 of 6 patients with myelodysplastic syndrome, in 4 of 11 patients with chronic lymphocytic leukemia, and in 2 of 11 patients with acute lymphocytic leukemia. In 4 of 23 positive patients, only parvovirus B19 DNA could be detected, while 7 patients were tested positive for both parvovirus B19 DNA and specific IgM. Nine patients were tested positive for both B19 DNA and specific IgG. In the remaining 3 positive patients only specific IgM could be detected. Due to the discrepancies between DNA and IgM results, the diagnostic procedures should include a search for specific DNA by PCR methods if specific IgM has been found to be negative.

The investigation of parvovirus B19 infection in patients with haematological disorders by using PCR and ELISA techniques

Parvovirus B19 has a marked tropism for erythroid progenitor cells. This may lead to chronic anemia in predisposed individuals. The purpose of the study was to investigate the frequency of parvovirus B19 infections in patients with diagnosis of haematological disorders. In order to determine the diagnostic use of different markers of parvovirus B19 infection, serum specimens obtained from 79 patients with haematological disorders were tested for specific antibodies and viral DNA through the use of ELISA and PCR techniques. Evidence of parvovirus B19 infection was found in 23/79 (29.1 percent) patients by demonstrating viral DNA and/or specific IgM antibody. B19 infection was established in 3 of 11 patients with chronic myeloid leukemia, in 3 of 11 acute myeloid leukemia, in 2 of 11 patients with multiple myeloma, in 3 of 8 patients with Hodgkin's lymphoma, in 5 of 10 patients with non-Hodgkin's lymphoma, in 1 of 6 patients with myelodysplastic syndrome, in 4 of 11 patients with chronic lymphocytic leukemia, and in 2 of 11 patients with acute lymphocytic leukemia. In 4 of 23 positive patients, only parvovirus B19 DNA could be detected, while 7 patients were tested positive for both parvovirus B19 DNA and specific IgM. Nine patients were tested positive for both B19 DNA and specific IgG. In the remaining 3 positive patients only specific IgM could be detected. Due to the discrepancies between DNA and IgM results, the diagnostic procedures should include a search for specific DNA by PCR methods if specific IgM has been found to be negative.

[Comparison of hepatitis C virus (HCV) RNA and anti-HCV results and evaluation of the relationship between transaminase levels]. / Hepatit C virus (HCV) RNA ve anti-HCV sonuçlarinin karsilastirilmasi ve transaminaz düzeyleriyle iliskilerinin degerlendirilmesi.

In this retrospective study, the data of hepatitis C virus (HCV) markers (anti-HCV and HCV-RNA) obtained from the patients who were prediagnosed and/or diagnosed as HCV infection have been comparatively evaluated and the relationship between these markers and transaminase (ALT and AST) levels have been analysed. A total of 690 sera from patients who were followed-up between January 2002 to December 2004 in Eskisehir Osmangazi University Medical Faculty Hospital were included to the study. Anti-HCV (Axsym System HCV version 3.0, Abbott Laboratories, USA) and HCV-RNA (Real-time Taqman Technology, Roboscreen kit and ABI Prism 7700 Perkin Elmer) tests were studied simultaneously and the results were examined together with the levels of ALT and AST of patients. In our study group, 455 (65.9%) of 690 samples were found positive for anti-HCV, while 235 (34.1%) were negative. Of anti-HCV positive patients, 51.6% (235/455) yielded positive and 48.4% (220/455) yielded negative results for HCV-RNA. The rate of anti-HCV negative but HCV-RNA positive sera was detected as 8.5% (20/235). When liver enzyme levels were taken into consideration, of 690 sera 338 (49%) showed normal transaminase levels, while 352 (51%) had elevated ALT and/or AST levels (23 with increased AST, 57 with increased ALT, and 272 with increased ALT and AST). Of the patients who exhibited increased ALT+AST levels (n=272), 50% were found positive for both markers (anti-HCV and HCV-RNA), 17% were only positive for anti-HCV, 3.6% were only positive for HCV-RNA, and 29% were negative for both markers. As a result, since anti-HCV negativity may be detected in viremic patients, molecular methods should be applied especially for the diagnosis of suspected cases and cases without seroconversion.

Anti-cyclic citrullinated peptide (CCP) antibodies in patients with long-standing rheumatoid arthritis and their relationship with extra-articular manifestations.

OBJECTIVES: To evaluate frequency of anti-cyclic citrullinated peptide antibodies (anti-CCP) in long-standing rheumatoid arthritis (LsRA) patients and their relationship with extra-articular manifestations of rheumatoid arthritis (RA), in addition to comparing frequency of anti-CCP antibodies in early RA (ERA) and LsRA group. DESIGN AND METHODS: One hundred and fifteen consecutive RA patients were included in the study as having LsRA because their disease duration was longer than 3 years. Thirty-nine consecutive patients with RA were included in the study as having ERA (<3 years). Also, 64 individuals were included in the study as healthy controls to verify the specificity and sensitivity of anti-CCP antibodies. Anti-CCP antibody and rheumatoid factor (RF) were evaluated with enzyme-linked immunosorbent assay kits and standard nephelometry methods, respectively. Extra-articular manifestations were diagnosed by relevant criteria. RESULTS: The total number of patients with extra-articular manifestations was found to be 45 (39%). No significant difference was found between LsRA group and ERA group in terms of extra-articular manifestations. There were no differences between both groups regarding the number of patients with positive anti-CCP antibodies and the levels of anti-CCP antibodies. In LsRA group, there was a positive correlation between erosion and disease duration (r=0.24, p<0.01), between erosion and RF (r=0.29, p<0.002), and between erosion and anti-CCP antibody (r=0.21, p<0.02). Positive correlations between RF and anti-CCP antibody (r=0.32, p<0.0001), as well as between subcutaneous nodule and lung involvement (r=0.24, p<0.008), were found in the LsRA group. However, no positive correlation could be found between anti-CCP antibody positivity and extra-articular organ involvement, either cumulatively or separately. CONCLUSIONS: Although anti-CCP antibodies are associated with the severity of the disease and erosion, they do not seem to have much linkage with extra-articular manifestations of RA.

Serological screening for celiac disease in premenopausal women with idiopathic osteoporosis.

The aim of this study was to perform serological testing to screen for celiac disease (CD) among premenopausal women with idiopathic osteoporosis and to investigate the bone turnover in patients who are seropositive for CD. We studied 89 premenopausal women with idiopathic osteoporosis. The serological screening protocol was based on a two-level evaluation. The first level consisted of determining serum level of IgA antigliadin antibodies (AGA). Subjects who were negative for IgA AGA were classified as not having CD, while samples testing positive for IgA AGA underwent a second level of the screening process. For the second level of screening, the serum IgA endomysial antibody (EMA) test was performed. Bone metabolism was evaluated by serum calcium (Ca), phosphorus, alkaline phosphatase, parathyroid hormone (PTH), 25 (OH) vitamin D, osteocalcin (OC), urinary deoxypyridinoline (dPD), and 24-h urinary calcium levels. Of the 89 patients evaluated, 17 were found to have positive IgA AGA tests (19%) and 9 were found to be positive for EMA (10.11%). EMA-positive patients showed lower values of serum Ca (p<0.05) and 25 (OH) vitamin D (p<0.01) and significantly higher values of PTH (p<0.01) compared with the EMA-negative patients. The level of urinary dPD was found to be significantly higher in EMA-positive patients (p<0.05). The results of this study suggest that all patients with idiopathic osteoporosis should be screened for CD by measurement of EMA. Additionally, we believe that serological screening for CD and detection of such patients will allow determination of the most convenient treatment strategies for osteoporosis.

[Investigation of TT virus-DNA in multitransfused children and healthy children]. / Cok sayida transfüzyon alan Cocuklar ile saglikli cocuklarda tt virus-DNA varliginin arastirilmasi.

TT virus (TTV) is a naked, single stranded DNA virus, which has been discovered in the serum of a patient with posttransfusion hepatitis of unknown etiology. TTV is widespread in the population, however, the mode of its transmission is unclear. This study was conducted to search for TTV-DNA positivity rates and its relationship with the clinical outcomes of recipients who underwent multiple blood or blood product transfusion, together with healthy children. TTV-DNA was investigated in 52 multitransfused pediatric patients (age range: 3 mnths - 17.5 yrs, mean age: 9.2 +/- 5.7 years) and 18 healthy children (age range: 1 mnth - 16.5 yrs, mean age: 8.1 +/- 4.9 years), by qualitative in-house semi-nested polymerase chain reaction (PCR) with the primers NG059, NG061 and NG063, generated from ORF1 region of the viral genome. TTV-DNA was found positive in 30.8% of multitransfused, and 16.7% of healthy children. The differences of TTV-DNA positivity rates between the multitransfused and control groups, and ALT values between the patients with positive and negative TTV-DNA, were statistically insignificant (p>0.05). As a result, no relationship was detected between TTV positivity and hepatitis, although there was a statistically insignificant increase of TTV-DNA positivity in multitransfused children. However, since the primers of ORF1 N22 region used in our PCR method did not have enough sensitivity for the detection of TTV-DNA, it has been concluded that more sensitive primers such as UTR primers, should be used for more reliable evaluation of the results.

Antibiotic prescribing patterns for sore throat infections in a university-based primary care clinic.

BACKGROUND: Recent studies reveal that a high percentage (over 50%) of episodes for upper respiratory tract infections (URTIs) are treated with antibiotics, regardless of appropriateness or the necessity for prescription. We identified antibiotic prescriptions in a primary health care centre (PHC) and evaluated their suitability for sore throat infections. We also explored whether symptoms, signs, diagnosis and antibiotics prescribed differed by gender. PATIENTS AND METHODS: We collected data on all patients visiting the centre over a period of 12 weeks with a main complaint of sore throat who were prescribed antibiotics after taking a blood count and throat culture. Patients older than 16 years of age were included in the study irrespective of sex, nationality, marital status, occupation or location of residence. The chi square (chi2) statistical test was used in comparing categorical variables. A P value of < 0.05 was considered significant. RESULTS: During the period of study, 579 patients with URTIs presented to the health centre, from which 339 patients with a sore throat were enrolled. Of the study group, 48.7% (165) were male and 51.3% (174) female, with the majority of patients being under 30 years old (54.3%). Throat cultures were positive in 56 patients (16.5%). Most of patients were diagnosed as having pharyngitis (22.7%), and the most frequently prescribed medicine was an oral penicillin (39.1%). Two hundred eight-six patients (84.4%) had 2 or fewer Centor criteria. CONCLUSIONS: Throat cultures were positive in only 16.5% of the patients prescribed antibiotics. This indicates that physicians in the health centre of the university are prescribing antibiotics inappropriately and inconsistently. This also highlights the need for more prescriber education, especially as the range of medications available to the general practitioner for prescribing increases.

[The relationship between airborne colonization and nosocomial infections in intensive care units]. / Yogun bakim unitelerinde gelisen nozokomiyaL enfeksiyonlar ile hava kaynakli kolonizasyon iliskisi.

The relationship between the airborne contaminants obtained from operating theatres and intensive care units and the colonizing and infecting microorganisms isolated from patients were investigated. Air samples were obtained with the biocollector air IDEAL (BioMerieux, France). During the study period (19 weeks), a total of 77 air samples and 870 clinical specimens (swabs from throat, nose, conjunctiva and skin) from 174 patients were collected weekly. Microorganisms were identified by using Vitek system (BioMerieux, France) and conventional methods. According to the criteria of Federal Standard 209E (FD 209E) on cleanrooms, the conventionally ventilated operating- and general surgery rooms, and the anesthesia intensive care unit have been ranked as less than class 3.5 and 3, respectively. The frequency of nosocomial infection related to air-colonization was higher in patients of anestesia intensive care unit (16.4%), than in those of general surgery intensive care unit (4.9%). In general surgery rooms and anesthesia intensive care unit, the most frequent air-colonization related nosocomial infections were surgical wound infections and bacteremia, respectively. The most frequently isolated microorganisms were methicillin resistant Staphylococcus aureus (MRSA) and Acinetobacter baumannii. It can be concluded that, total number of airborne viable particles in the critical areas such as operating theatres and intensive care units, seems to be a significant risk factor for the development of nosocomial infections in immunocompromised patients.

Prevalence and characteristics of nosocomial infections in a Turkish university hospital.

BACKGROUND: The purpose of this study is to estimate the prevalence of nosocomial infections in a university hospital, as well as determining the groups at high risk of such infections. MATERIALS AND METHODS: Two surveys based on a modification of the British National Survey protocol for nosocomial infection were conducted in July and December 1998. RESULTS: In the first survey, hospital infections were found in 41 (13.4%) of the patients, and in the second survey in 34 (10.9%). The study showed that the risk of nosocomial infection was associated with being in the intensive care unit, undergoing surgery, and invasive procedures. CONCLUSION: Prevalence data are consistent with results reported in many other regions of the world. These findings provide the principal information for future surveillance in association with prevention programs in Turkish hospitals.

Tuberculous peritonitis in a case receiving continuous ambulatory peritoneal dialysis(CAPD) treatment.

BACKGROUND: Tuberculosis continues to be an important health problem in the world. Besides pulmonary involvement extrapulmonary involvement becomes an affair in developing countries, even in developed countries. CASE PRESENTATION: A thirty-six year old male patient was admitted with abdominal pain, diarrhea, nausea, vomiting and fever which had started one week before. The patient had been followed up with predialisis Chronic Renal Failure(CRF) diagnosis for 4 years and receiving continuous ambulatory peritoneal dialysis (CAPD) treatment for 4 months. In peritoneal fluid, 1600/mm3 cells were detected and 70% of them were polymorphonuclear leukocytosis. The patient begun nonspesific antibiotherapy but no benefit was obtained after 12 days and peritoneal fluid bacterial cultures remained negative. Peritoneal smear was positive for Asid-fast basilli (AFB), and antituberculosis therapy was started with isoniazid, rifampicine, ethambutol and pyrazinamide. After 15 days his peritoneal fluid cell count was decreased and his symptoms were relieved. Peritoneal fluid tuberculosis culture was found positive. CONCLUSION: Considering this case, we think that in patients with CAPD catheter and peritonitis; when peritoneal fluid leukocytes are high and PMNL are dominant, AFB and tuberculosis culture must be investigated besides bacterial culture routinely.