Antibacterial effects of curcumin: An in vitro minimum inhibitory concentration study.

AIM: To evaluate the antibacterial effect of curcumin with the minimum inhibitory concentration (MIC) method in standard bacterial strains. METHODS: The in vitro antibacterial activity of curcumin was evaluated against methicillin-sensitive Staphylococcus aureus (MSSA) (ATCC 29213), methicillin-resistant Staphylococcus aureus (MRSA) (ATCC 43300), Enterococcus faecalis (ATCC 29212), Bacillus subtilis (ATCC 6633), Pseudomonas aeruginosa (ATCC 27853), Escherichia coli (ATCC 25922) and Klebsiella pneumoniae (ATCC 700603) using the macrodilution broth susceptibility test method. After incubation in tubes, the antibacterial activity of curcumin was detected by a lack of turbidity, which indicated the inhibition of bacterial growth. The concentration in the tube with the highest dilution showing no turbidity was defined as the MIC. RESULTS: The curcumin MIC values were 175 µg/ml, 129 µg/ml, 219 µg/ml, 217 µg/ml, 163 µg/ml, 293 µg/ml and 216 µg/ml against P. aeruginosa, B. subtilis, MSSA, MRSA, E. coli, E. faecalis and K. Pneumonia, respectively. CONCLUSION: This study revealed antibacterial effects of curcumin against standard bacterial strains in high concentrations. Animal experiments have demonstrated that curcumin applied at high doses has strong antibacterial activity. There is a need for further in vivo studies to shed light on antibacterial effects of curcumin with high concentrations.

Determination of Anti-nuclear Antibody Pattern Distribution and Clinical Relationship.

BACKGROUND AND OBJECTIVES: Autoantibodies are immunglobulins occurred directly against autoantigens that are known as endogen antigens. Autoimmune disease is an occasion that the body begins a fight against its own cells and tissues. The antibodies that are created by the body against its own cell nuclei are called as anti-nuclear antibodies (ANA), and one of the methods used for detection and pattern of ANA is indirect immunofluorescence test (IIF). In the present study, it was aimed to determine the rate of ANA positivity and patterns of the positive specimens, and to investigate the relationship between ANA positivity and diseases in patients. METHODS: ANA test results of a total of 3127 patients admitted during March 2010 to December 2012 were evaluated retrospectively. ANA test (HEp 20-10, EUROIMMUN, Germany) was used in dilution of 1:100 in IIF test. RESULTS: A total of 494 (15.8%) resulted as ANA positive. ANA positivity rate was significantly higher in female patients than the male ones (p<0.001). The most frequent ANA patterns were coarse speckled pattern (154 patients, 31.2%), nucleolar pattern (89 patients, 18.0%), fine speckled pattern (57 patients, 11.5%), and speckled pattern (48 patients, 9.7%). ANA positivity was most commonly determined in rheumatoid arthritis (RA) (42 patients, 8.5%), systemic lupus erythematosus (SLE) (29 patients, 5.9%), and rheumatoid vasculitis (RV) (28 patients, 5.7%). The most frequent symptoms or findings were joint pain (127 patients, 26.0%) and anemia (28 patients, 5.7%). ANA positivity rates were found to be significantly higher in patients with RA (p<0.001), with SLE (p<0.001), and with Raynaud phenomenon (p=0.001) in comparison to the controls. Amongst the most frequent diseases evaluated, no significant differences were found between the control groups and the groups of RV (p=0.089), multiple sclerosis (p=0.374), and Sjögren syndrome (p=0.311) in terms of ANA positivity rates. CONCLUSIONS: The present study is the first study reporting the positivity rate and distribution of ANA in Bolu located in northwestern Turkey. Information about the pattern types and the distribution of the patterns according to the diseases and symptoms contribute in diagnosis of autoimmune diseases. It is observed that clinical diagnosis has been supported significantly by ANA test according to data of our study.

[In vitro activity of ceftaroline to MRSA isolates: a multicenter study]. / Seftarolinin MRSA Izolatlarina In Vitro Etkinligi: Çok Merkezli Bir Çalisma.

Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging pathogen that cause severe community- and hospital-acquired infections. Studies continue on searching alternatives due to the limited number of therapeutic options in MRSA infections. Ceftaroline is a wide-spectrum new generation cephalosporin which has been begun to be used in treatment of skin and respiratory tract infections caused by MRSA. The aim of this study was to investigate the in vitro activity of ceftaroline against MRSA strains isolated from various clinical specimens in microbiology laboratories of seven hospitals located at different provinces (Bolu, Samsun, Rize, Tekirdag, Sakarya, Amasya, Osmaniye) of Turkey. A total of 192 MRSA isolates (89 skin/wound/abscess, 38 blood, 36 respiratory tract, 29 urine/sterile body fluids/catheter) were included in the study, and ceftaroline susceptibilities of the strains were detected by broth microdilution method. MIC values of 181 (94.3%) isolates were determined as ≤ 1 µg/ml meaning of susceptible according to the criteria of CLSI, and MIC values of 11 (5.7%) isolates were found as 2 µg/mL indicating intermediate susceptibility. The range of MIC values of the isolates was found between 0.25-2 µg/ml. The rates of intermediate isolates have varied between 0-12.5% from the participating centers. MIC50 and MIC90 values of all the isolates were determined as 0.5 µg/ml and 1 µg/ml, respectively. No significant differences were found between the centers in terms of mean MIC values (p> 0.05). MIC50 and MIC90 values in Samsun and Bolu isolates were found to be the same with the whole group, however, MIC50 and MIC90 were 0.5 µg/ml and 0.5 µg/ml in Amasya isolates and 1 µg/ml and 1 µg/ml in Rize, Tekirdag, Osmaniye and Sakarya isolates, respectively. When evaluating MIC50 and MIC90 values and isolation rates of intermediate strains according to the specimen types, there were no significant differences (p> 0.05). Susceptibility rates to ceftaroline and the distribution profiles of MIC values of the isolates obtained from seven centers of Turkey have been detected similar with the previous American and European reports. With this study, initial data on the activity of ceftaroline against MRSA were obtained from Turkey. These preliminary findings indicate that ceftaroline is effective even on Turkish isolates and can be a suitable treatment in cases requiring wide-spectrum antimicrobiotic use, however further large-scaled studies are needed.

Nosocomial Acinetobacter baumannii Infections and Changing Antibiotic Resistance.

OBJECTIVES: In the intensive care setting, Acinetobacter baumannii causes ventilator-associated pneumonia and other nosocomial infections that are difficult to treat. Objective of this study was to investigate nosocomial A. baumannii infections and its changing antibiotic resistance. METHODS: A total of 56 patients diagnosed with A.baumannii infections between January 2009 and December 2011 were included in the study. Diagnosis for nosocomial infections was established according to the CDC (Centers for Disease Control and Prevention) criteria. Identification of the agents isolated was carried out using conventional methods and VITEK 2 automated system, while antibiotic sensitivity testing was performed through VITEK 2 AST-N090 automated system. RESULTS: The most common infection was nosocomial pneumonia by 43%, among which 46% were ventilator-associated pneumonia. Considering all years, the most effective antibiotics on the isolated strains were found as colistin, tigecycline, imipenem and meropenem. However resistance to imipenem and meropenem was observed to increase over years. CONCLUSION: The issue of increased resistance to antibiotics poses difficulty in treatment of A. baumannii infections which in turn increases the rate of mortality and cost. In order to prevent development of resistance, antibiotics must be used in an appropriate way in accompanied with proper guidance.

[A rare cause of pneumonia: Shewanella putrefaciens]. / Nadir Bir Pnömoni Etkeni: Shewanella putrefaciens.

We read with interestingly the paper named "A Rare Cause of Pneumonia: Shewanella putrefaciens" presented by Durdu et al. published in Mikrobiyol Bul 2012; 46(1): 117-21. S.putrefaciens is a gram-negative, facultative anaerobic and non-fermentative rod that rarely causes infections in humans. First, the authors reported that antibotic sensitivity tests of S.putrefaciens in the presented case were performed by Kirby-Bauer disc diffusion method. However, there is no recommendation about the antibiotic susceptibility testing by disc diffusion test for this bacteria in Clinical and Laboratory Standards Institute (CLSI), European Committee on Antimicrobial Susceptibility Testing (EUCAST), and British Society for Antimicrobial Chemotherapy (BSAC) guidelines. According to CLSI criteria, antibiotic susceptibility tests for S.putrefaciens should be done by a method which detects minimal inhibitory concentration. Second, this paper reported that S.putrefaciens was sensitive to third generation cephalosporins and penicillins. Besides, the authors suggested that susceptibility of these bacteria to these antibiotics was helpful for the differential diagnosis of Pseudomonas aeruginosa and S.putrefaciens. However, in the literature, S.putrefaciens had been reported as resistant to penicillin. We thought that these additional information would be helpful in the future studies related to S.putrefaciens.

Increased expression of CD11a and CD45 on leukocytes and decreased serum TNF-alpha levels in patients with isolated coronary artery ectasia.

BACKGROUND: Aneurysm and ectasia have similar pathological pathways. TH2-associated cytokines are stimulated by aneurismal tissue and correspondingly lack mediators associated with TH1 response. In this study, we measured serum TNF-alpha and IL-18 levels which are strong TH1 stimulating cytokines and also investigated the expression of CD11a, CD11b, CD18 adhesion molecules and CD45 on leukocytes in patients with coronary artery ectasia (CAE) and controls with normal coronary arteries (NCA). METHODS: A total of 51 isolated CAE patients free of atherosclerosis and 37 NCA controls were included in the study. Cell counts and cell surface adhesion molecules were detected by flow cytometry using fluorescence conjugated monoclonal antibodies. Serum TNF-alpha, IL-18 levels, and Chlamydophila pneumoniae IgG and IgM and Helicobacter pylori IgG levels were detected by ELISA methods. RESULTS: The mean fluorescence intensities of CD11a on granulocytes, monocytes and lymphocytes and CD45 on granulocytes and monocytes were significantly higher in CAE patients when compared with the NCA group (10.01 +/- 8.2 vs. 6.79 +/- 3.49, p = 0.04; 15.84 +/- 8.64 vs. 11.56 +/- 5.27, p = 0.016; 29.58 +/- 9.98 vs. 20.02 +/- 9.66, p < 0.001; 7.58 +/- 5.03 vs. 4.57 +/- 3.05, p = 0.003; 18.73 +/- 1238 vs. 10.74 +/- 738, p = 0.004; respectively) detected by flow cytometry. TNF-alpha levels were significantly lower in the patient group (18.76 +/- 7.07 vs. 24.29 +/- 8.46; p < 0.001) when compared with controls. The percentage of granulocytes was higher in the CAE group when compared with the NCA group (65.52 +/- 14.91 vs. 52.28 +/- 1537; p = 0.002). Contrarily, the percentage of monocytes was higher in the control group when compared with the CAE group (18.12 +/- 15.69 vs. 934 +/- 733 p = 0.008). Among the infection markers studied, only C. pneumoniae IgG levels were significantly higher in patients when compared with controls (81.62 +/- 48.53 RU/mL vs. 63.79 +/- 33.83 RU/mL; p = 0.045). In CAE patients, TNF-alpha levels significantly correlated with mean fluorescence intensity levels of CD45+ granulocyte (0.525, p < 0.001), monocyte (0.469, p = 0.001) and lymphocytes (0376, p = 0.013). CONCLUSIONS: The decreased levels of TNF-alpha may indicate predominance of TH2 and lack of TH1 type immunity in CAE patients, similar to patients with aortic aneurysms. Increased levels of cell surface adhesion molecules in CAE are an indicator of activation of leukocytes for adherence and transmigration through the vessels for the initiation of inflammation.

The role of helper and regulatory T cells in the pathogenesis of vitiligo.

BACKGROUND: Alterations in cellular immunity, including CD4(+) T and CD8(+) T lymphocytes, have been proposed in the pathogenesis of vitiligo. There is also a proposed role for cytokines in the depigmentation observed in vitiligo. However, previous reports on the role of cytokines in the pathogenesis of vitiligo have been few in number. OBJECTIVE: The purpose of this investigation was to assess the role of the major cytokines produced by T-helper 1 and 2 cells as well as T-helper 17 and regulatory T cells in the pathogenesis of vitiligo. METHODS: Forty patients with vitiligo and 40 age- and sex-matched healthy control subjects were enrolled in the study. Serum interleukin (IL)-4, IL-6, IL-10, IL-17, interferon-gamma, tumor necrosis factor-beta, and transforming growth factor-beta levels were detected by enzyme-linked immunosorbent assay in both groups. The correlations of serum cytokine levels with age of onset, sex, duration of disease, type and activity of vitiligo, percentage of involved body area, Koebner positivity, family history, and the presence of associated autoimmune diseases were assessed. RESULTS: Serum transforming growth factor-beta levels were significantly decreased in the vitiligo group compared with the control group (P = .004). No difference was detected between the patient and control groups in mean levels of serum IL-6, IL-10, and tumor necrosis factor-beta. In the patients with vitiligo, serum IL-17 levels were positively correlated with the extent of body area involvement (rho = 0.329, P = .038). LIMITATIONS: Tissue cytokines compared with those in the peripheral blood were not measured. CONCLUSION: Although multiple factors have been implicated in the pathogenesis of vitiligo, reduced serum transforming growth factor-beta levels, as observed in patients in the current investigation, may contribute to enhanced cellular immunity. This may facilitate the occurrence of vitiligo by leading to diminished maturation of regulatory T cells, followed by impaired inhibition of inflammation.

[Evaluation of eosinophil cationic protein levels with clinical symptoms and laboratory findings of patients with cystic echinococcosis]. / Kistik ekinokokkozisli hastalarda eozinofilik katyonik protein düzeylerinin klinik semptomlar ve laboratuvar bulgulariyla birlikte degerlendirilmesi.

Among proteins secreted from activated eosinophil granulocytes, eosinophil cationic protein (ECP) is the most useful tool for the follow-up of inflammatory diseases. Since ECP level reflects the eosinophil activation, it gives valuable information about disease activity. In this study, we aimed to investigate the possible relation between ECP levels and symptoms and laboratory findings of cystic echinococcosis (CE) and to evaluate the role of this protein in the diagnosis of CE. The study which was conducted at Clinical Microbiology Laboratory of Suleyman Demirel University Medical Faculty, Isparta, Turkey, included 58 patients with a pre-diagnosis of CE and 32 healthy individuals as control group. The diagnosis of CE was established serologically by modified enzyme-linked immunosorbent assay (ELISA) and indirect hemagglutination (IHA) test. The quantitative determination of ECP levels was done by fluoro-enzyme immunoassay (FEIA; Uni-CAP ECP, Pharmacia-Upjohn). The mean ECP level was 31.6 +/- 37 microg/ml in the patient group and 9.1 +/- 2.1 microg/ml in the control group, the difference being statistically significant (p = 0.001). Significant differences were also detected for erythrocyte sedimentation rate (ESR) (p = 0.001), total IgE level (p = 0.001), eosinophile count (p = 0.05) and CRP (p = 0.001) between the patient and the control groups. ECP was detected to be high in 35 (60%), IgE in 37 (63%), CRP in 29 (50%) and eosinophile count in 9 (15.5%) patients. While age, gender, ESR, IgE and CRP levels of patients with high ECP levels were not significantly different from levels of patients with normal ECP levels, significantly different eosinophil counts were detected among patients with high ECP values when compared to patients with normal ECP values. Furthermore, a correlation was detected between ECP levels and eosinophil rate, IgE and CRP levels of patients with CE (p = 0.01), while there was no correlation between ECP and ESR levels. Although high ECP level patients exhibited higher ALT and AST levels, no correlation was determined between liver enzyme levels and ECP levels (p > 0.05). The most common symtoms among CE patients were abdominal pain (41%), other gastrointestinal complaints (38%), shortness of breath (12%) and fever (10%). No statistically significant difference in terms of symptoms was detected between patients with high ECP levels and normal ECP levels. However, statistically significant difference was detected between ECP levels of patients with symptoms (except shortness of breath) and patients without symptoms (p < 0.05). In conclusion, ECP seems to be associated with the symptoms and signs of CE and it can be used as a valuable marker besides the other laboratory tests for the evaluation of patients with CE.

[Investigation of the presence of autoantibodies in patients with toxocariasis]. / Toksokariazisli hastalarda otoantikor varliginin arastirilmasi.

Immunopathologic reactions may occur during toxocariasis due to tissue invasion and destruction by the secretions of larvae containing various enzymes with broad spectrum. The aim of this study was to search for autoantibodies such as anti-nuclear (ANA), anti-mitochondrial (AMA), anti-smooth muscle (ASMA), anti-neutrophil cytoplasmic (ANCA), anti-myeloperoxidase (MPO) and liver-kidney microsomal type 1 (LKM-1) antibodies in patients with toxocariasis, in order to investigate the role of toxocariasis as a trigger factor for autoimmune reactions. Forty patients (22 were male; mean age: 35.6 +/- 10.7 years) diagnosed as toxocariasis by clinical findings (abdominal pain, allergic symptoms and/or eosinophilia, without detection of any other causative agents, and without liver dysfunction, diabetes mellitus, cardiac or renal failure, and autoimmune disease) and in-house ELISA positivity and 32 healthy controls (16 were male; mean age: 40.7 +/- 11.2 years) were included to the study. ANA (screen), dsDNA, SS-A, SS-B, Scl-70, LKM-1, MPO and M2 autoantibodies have been investigated by ELISA (Euroimmun, Germany), while ANCA, AMA and ASMA antibodies by indirect immunofluorescence (IMMCO, NY) methods. Autoantibody positivity was detected in 18 (45%) patients of whom 11 yielded a single type, and 7 yielded > or = 2 types of autoantibodies. This rate was 12.5% for control group (two subjects were positive for ANA-Screen, one for anti-M2 and one for anti-LKM-1). The difference between the total positivity rates in patient and control groups was found statistically significant (chi2 = 5.72, p = 0.004). The most frequent autoantibody type among patients were ASMA (n = 6), followed by anti-dsDNA (n = 5), anti-M2 (n = 5), anti-SS-B (n = 4), anti-LKM-1 (n = 3), anti-SS-A (n = 2), ANCA (n = 2) and anti-MPO (n = 1). Positivity rate for ASMA was found statistically significant in patients' group compared to controls (chi2 = 12.24, p = 0.03), while there was no significant difference between the groups in terms of other autoantibody rates (p> 0.05). These data could be related to the possible release of autoantigens following muscle tissue injury during toxocariasis and/or antigenic mimicry of parasitic products during the infection in which muscle invasion is frequently seen. In conclusion, since autoantibodies are frequently detected in toxocariasis, this situation should be taken into consideration in the presence of autoantibodies.

Evaluation of Borrelia burgdorferi sensu lato seroprevalencein the province of Bolu, Turkey.

BACKGROUND/AIM: The aim of the present study was to determine the seroprevalence of Borrelia burgdorferi sensu lato in the city center and the province of Bolu, Turkey. MATERIALS AND METHODS: A stratified sampling method was used to determine the study population. A total of 196 blood samples were collected. A questionnaire was completed by each participant in the study. ELISA was performed and positive serologic results were confirmed using western blotting. Data were analyzed statistically using the chi-square test. RESULTS: Seropositivity rates of B. burgdorferi IgM and IgG were determined as 14.8% (29/196) and 13.7% (27/196) respectively by ELISA. A total of nine serum samples (4.6%) were found positive for IgG, and seven samples (3.8%) were positive for IgM according to western blotting. Seropositivity rates were found to be higher in people living in rural areas (11.1%), in women (8.3%), in people who were illiterate (10.0%), in people engaged in agriculture (10.8%), and in the age group of 40-60 years (10.0%). No statistically significant difference was found between seropositivity rates and survey data. CONCLUSION: The seroprevalence of Lyme disease was determined in our region. Detection of endemic regions of Lyme disease with determination of seropositivity rates will increase the awareness among clinicians about this disease.

An interesting case of childhood brucellosis with unusual features.

Brucellosis is a zoonotic infection, which is still a major public health concern worldwide. Common clinical findings are usually nonspecific involving fever, arthralgia, myalgia, weakness and malaise. Since none of the symptoms of brucellosis is pathognomonic, it may have a similar course with various multisystemic diseases. In terms of focal involvement, sacroiliitis is the most common musculoskeletal manifestation in adult patients, while it is quite rare in pediatric patients. Blood culture is the gold standard in the diagnosis of brucellosis. In the absence of culture facilities, the diagnosis traditionally relies on serologic testing with a variety of agglutination tests such as the Rose Bengal test and the serum agglutination test. However, these agglutination tests are accompanied by frequent false negative results such as seen in prozone phenomenon, which may lead to diagnostic delays. In this article we present a rarely encountered pediatric brucellosis patient who had sacroiliitis-spondylitis, which are rarely reported in children, and exhibited prozone phenomenon in agglutination tests.

Subclinical immune reactions to viral infections may correlate with child and adolescent diagnosis of attention-deficit/hyperactivity disorder: a preliminary study from Turkey.

BACKGROUND: Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common neuro-developmental disorders of childhood and adolescence. Studies focusing on the relationship of infectious agents and ADHD are scarce. It is also known that cerebellar injury may lead to hyperactive behavior. This study aimed to evaluate the relationship between viral agents of cerebellitis and the diagnosis of ADHD. METHODS: The study group was formed of 60 consecutive ADHD patients and 30 healthy children. IgG levels for VZV; HSV-1, CMV, Measles, Mumps, Rubella and EBV were evaluated. RESULTS: Males were significantly higher among patients with ADHD (65% vs. 40%, p=0.025). Patients with ADHD displayed significantly higher positivity for measles IgG (80% vs. 60%, p=0.044). When patients with ADHD were classified according to their pubertal status, adolescents with ADHD displayed higher positivity for mumps (100% vs. 74.4%, p=0.043). Most of the patients were diagnosed with ADHD-Combined or Hyperactive/Impulsive Subtypes (56.6%) while 43.3% were diagnosed with ADHD-predominantly inattentive type. When patients with subtypes of ADHD were compared in terms of seropositivity, it was found that patients with ADHD-Combined/ Hyperactive-Impulsive subtypes had significantly elevated reactions for Rubella (100% vs. 88.5%, p=0.044). CONCLUSION: Although limited to a single center and may be prone to sampling biases, our results may support the notion that immune reactions may be related with ADHD among children and adolescents. Further, prospective studies from multiple centers are needed to support our findings and establish causality.

Evaluation of 4 methods for the serological diagnosis of Epstein-Barr virus infection using an immunofluorescence assay as the reference method.

BACKGROUND/AIM: Tests specific for VCA IgM, VCA IgG, and EBNA IgG are used to diagnose Epstein-Barr virus (EBV) infections and interpret disease status. The immunofluorescence assay (IFA) is accepted as the "gold standard" test. The purpose of this study was to evaluate the performance of 4 methods in comparison with IFA. MATERIALS AND METHODS: In total, 101 serum samples were obtained from clinically suspected cases of EBV infection between May 2010 and May 2012 and evaluated by IFA. All serum samples were analyzed by an immunoblot assay, enzyme-linked fluorescent assay (ELFA), enzyme immunoassay (EIA), and immunochromatographic assay (ICA). RESULTS: ELFA and ICA results were in good agreement with IFA for the detection ofVCA IgM, VCA IgG, and EBNA IgG. The results of the immunoblot assay agreed less well with IFA for EBNA IgG, while EIA results were not in agreement with IFA for EBNA IgG or VCA IgM. CONCLUSION: Among the tests studied, ELFA and ICA appear to be suitable methods for the diagnosis and staging of EBV when considering cost-effectiveness, turnaround times, need for a specialist, and IFA concordance.

Extracorporeal shockwave increases the effectiveness of systemic antibiotic treatment in implant-related chronic osteomyelitis: experimental study in a rat model.

Implant-related chronic osteomyelitis is a serious complication of orthopedic surgery requiring implant removal and radical debridement. Extracorporeal shockwave (ESW) have demonstrated significant bactericidal effectiveness in vitro and effectiveness and safety were evaluated in an animal model of osteomyelitis. In this experimental study, we aimed to test our hypothesis that the use of ESW together with systemic antibiotic treatment will provide synergy for the treatment of implant-related chronic osteomyelitis caused by methicillin-susceptible Staphylococcus aureus (MSSA). The proximal tibia of 32 rats was contaminated with (10) 8 CFU/ml methicillin-sensitive S. aureus (MSSA-ATCC 29213) and Kirschner-wires were placed into the medulla of the tibia. After 4 weeks, Kirschner-wires were removed and the rats were randomly divided into four groups: group I, untreated contaminated control group; group II, receiving only ESW therapy; group III, receiving only systemic teicoplanin; group IV, treated with a combination of ESW and systemic teicoplanin. ESW was applied twice to the infected limbs and all rats were sacrificed at the end of 8th week. The degree of tibial osteomyelitis was assessed by quantitative culture analysis. Bacterial counts in groups III and IV were significantly reduced relative to the control (p=0.002 and 0.001, respectively). The decrease in bacterial counts was more pronounced and significant in group IV compared to group III (p=0.024). In group II, bacterial counts also decreased, but the differences were in significant (p=0.068). Our experimental model suggests that ESW provides significant synergy for systemic antibiotic treatment. However, further clinical trials are required in order to use this treatment modality safely in patients, even though our study demonstrated successful results in the treatment of implant-related chronic osteomyelitis in rats.

Evaluation of patients with Tularemia in Bolu province in northwestern Anatolia, Turkey.

INTRODUCTION: Tularemia is a zoonotic disease caused by Francisella tularensis. Here we present an epidemic occurring in Bolu province, located in northwestern Anatolia in Turkey, and some features of the cases. METHODOLOGY: The data was provided by the Bolu Provincial Health Directorate. All of the antibody response tests were studied in the National Health Institute (formerly named Refik Saydam Hygiene Department), the reference laboratory of the Ministry of Health of the Turkish Republic. A total of 393 individuals were tested by microagglutination test (MAT) for tularemia between 2006 and 2011. A total of 218 patients whose demographical data were available were included in the study; 83 were accepted as the patient group and 135 were the controls. Of the patients, 31 (37.3%) were male and 52 (62.7%) were female. RESULTS: Fever (p < 0.001), URTI symptoms (p = 0.047), conjunctivitis (p = 0.004), and rash (p = 0.026) were significantly higher in the patient group. A positive association was found between MAT and fever (r = 0.324; p < 0.001), and a negative association was found between MAT and both lymphoadenopathy (r = -0.25; p = 0.013) and chills (r = -0.218; p = 0.035). Higher MAT titers were detected in oropharyngeal tularemia (r = 0.306; p = 0.003). CONCLUSIONS: In conclusion, tularemia must be considered in differential diagnosis in patients presenting with fever and LAP in non-endemic regions. Furthermore, water sources and contact with rodents must be investigated.

Comparison of contamination in simultaneous blood cultures with clinical findings.

Blood culture, the basic method used in the diagnosis of bacteremia or sepsis, is decisive for patient's treatment. It is emerging whether the isolated microorganism is a causative agent of the infection or a contaminant. The aim of this study was to determine whether Gram-positive microorganisms, which were isolated from blood cultures simultaneously collected from two distinct veins both revealed the same species and same susceptibility profiles as they were causative agents of the bloodstream infection. Among the strains isolated from a total of 67 cultures, which revealed the same species, 52.2% (35/67) were considered to be clinical causative agents and 47.8% (32/67) were considered as skin contaminants. Inoculation of the simultaneous blood cultures collected from two distinct veins should be performed.

Investigation of in-vitro susceptibility of multidrug-resistant Acinetobacter baumannii strains isolated from clinical specimens to tigecycline.

The management of infections due to A. baumannii is difficult because of rapidly developing resistance, however, tigecycline, a glycylcycline antimicrobial, is in use for several years. In the present study, it was aimed to determine the susceptibility rates of A. baumannii to tigecycline. A total of 90 A. baumanni isolates were tested using three methods such as disk diffusion, broth microdilution, and E-test. The MIC50 and MIC90 values and the MIC range were found as 2 µg/ml, 4 µg/ml, and 0.1-8 µg/ml by microdilution; and 2 µg/ml, 6 µg/ml, and 0.1-12 µg/ml by E-test, respectively. There were a few major errors as well as the minor rates were all high as between 35.7%-46.7%. The accuracy rates between the methods were low as 53.3% (48/90) between disk diffusion and E-test, 51.1% (46/90) between disk diffusion and microdilution, and 60.0% (54/90) between E-test and microdilution. In the ROC curve analysis, an inhibition zone diameter of susceptibility breakpoint of 21.5 mm had sensitivity between 68.8%-88.9%; specificity between 81.9%-87.9%; and accuracy between 80.0%-83.33%. An analysis based on EUCAST's non-species breakpoints, the MIC tests showed higher accuracy with a rate of 96.7%, however, performance of disk diffusion got worse as lower than 25%. In conclusion, we showed that the reliability of the methods even did not remain as high as the past. Our study presented that none of three methods revealed reliable results in determination of susceptibility of A. baumanni to tigecycline, so the clinical response should be followed up carefully in such cases.

Determining immunoassay cutoff value using Western blot results to predict hepatitis C infection in blood donors with low-titer anti-HCV reactivity.

Since the 1990s, blood donors have been scanned for anti-hepatitis C virus (anti-HCV) antibodies, which can be defined by enzyme immunoassay as a screening test. In this population, false-reactive ratios have been high. Recently, some authors have aimed to find a cutoff value for anti-HCV different from those established by test manufacturers to predict HCV infection. In this study, 321 patients, after two repeating tests, had reactive results in s/co <10 titers on anti-HCV test. The patients were 29.6 % (n = 95) in women and 70.4 % (n = 226) in men. The patients were classified into three groups by Western blot (WB) results (PS, positive; NG, negative; and ID, indeterminate). The average anti-HCV titer of the whole group was 2.61 ± 1.96. Anti-HCV titers of subgroups were 2.43 ± 1.95 in NG, 4.93 ± 2.53 in PS, and 2.50 ± 1.65 in ID (p < 0.001). There was a significant difference between NG and PS and between PS and ID subgroups (p < 0.001). There was a positive correlation between WB and anti-HCV titers in all patients (r = 0.298, p < 0.001), in women (r = 0.282, p < 0.001), and in men (r = 0.337, p = 0.002). According to receiver operator characteristic curve analysis, the cutoff value of anti-HCV titer to predict hepatitis C infection was >2.61 s/co, with 74.1 % sensitivity and 71.6 % specificity (area under the curve, 0.820; 95 % confidence interval, 0.753 to 0.887). We suggest that an effective cutoff value for anti-HCV other than that established by the manufacturer cannot be assigned to predict hepatitis C infection for blood donors in low-prevalence areas.

Could thrombocyte parameters be an inflammatory marker in the brucellosis?

AIM: To investigate links between platelet parameters mean platelet volume (MPV), platelet count (PC), platelet distribution width (PDW), platelet mass (PM) and brucella tube agglutination titers (BSTAT) in patients with brucellosis. Initially, PC, MPV, PM and PDW calculations were compared between periods before and after treatment. The correlation between inflammation markers (erythrocyte sedimentation rate, ESR, white blood cell count, WBC, and C reactive protein, CRP) and platelet parameters was subsequently investigated. METHODS: This self-controlled study included 40 patients who had positive BSTAT at least at a titer of 1/160. Platelet parameters and inflammation values (CRP, ESR) at the time of positive BSTAT at least at a titer of 1/160 (pre-treatment) were compared with control of the same parameters at the time when BSTAT became negative or when the titers reduced 4 folds (post-treatment). RESULTS: Mean platelet volume values (7.90+1.96) were significantly elevated in post treatment period when compared to pre treatment (7.58+1.96), (p= 0.023). Post treatment CRP, ESR and PC were significantly reduced when compared to pretreatment values (p=0.000, p=0.000 and p=0.025, respectively). In the pretreatment period, a direct correlation between ESR and PC values (r=0.036, p=0.025), and inverse correlations between ESR with MPV (r=-0.337, p=0.038) was found. A dependent predictive factor in multivariate logistic regression analysis for BSTAT was not found. CONCLUSION: We suggest that PC and MPV may be inflammatory markers in brucellosis.

Linezolid versus vancomycin for the treatment of methicillin-resistant Staphylococcus aureus keratitis in rabbits.

PURPOSE: To compare the efficacy of topical linezolid (LZD) 1 mg/mL or 2 mg/mL to vancomycin (VA) 50 mg/mL for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) keratitis in rabbits. METHODS: One hundred colony-forming unit (CFU) MRSA bacteria were injected intrastromally into rabbit corneas. Sixteen hours after the injection, 24 rabbits were randomly divided into 4 groups. Rabbit eyes were treated with 1 drop of topical LZD 1 mg/mL, LZD 2 mg/mL, VA 50 mg/mL, or isotonic saline every 15 minutes for 5 doses and then every 30 minutes for 14 doses. Eyes were examined before and after the treatment using slit-lamp biomicroscopy by 2 observers blinded to the study for the determination of clinical severity. Then, corneas were harvested for the quantification of bacteria and histopathology. RESULTS: There were no differences in clinical severity among the groups before and after the treatment in each eye. The mean CFU × 10(6) of MRSA recovered from the LZD 1 mg/mL, LZD 2 mg/mL, and VA 50 mg/mL groups were significantly lower than that recovered from corneas treated with isotonic saline. There was no statistically significant difference among the treatment groups in terms of CFU × 10(6). Epithelial erosion in the VA 50 mg/mL group was significantly worse than that in the other groups. LZD 2 mg/mL group had the lowest mean epithelial erosion values. CONCLUSIONS: Topical LZD showed activity against MRSA that was comparable to fortified VA in this experimental keratitis model.