Genital region cleansing wipes: Effects on urine culture contamination.

INTRODUCTION: Urine culture is the gold standard test for revealing the microbial agent causing urinary tract infection (UTI). Culture results are affected by sampling techniques; improper sampling leads to contamination of urine and thus contamination of the culture with urogenital flora. We aimed to evaluate the effect of urogenital cleansing, performed with chlorhexidine-containing genital region cleansing wipes (GRCW) on contamination rates. METHODOLOGY: A total of 2,665 patients with UTI-related complaints and with urine culture requests from various outpatient clinics were enrolled in the study. Of the patients, 1,609 in the experimental group used GRCW before sampling, while 1,046 in the control group did not use any wipes. RESULTS: The contamination rate in the experimental group patients was 7.7%, while it was 15.8% in the control group. Contamination rates were significantly higher in the control group than in the experimental group for both women and men. Contamination rates for children and adults were also significantly lower in the experimental group than in the control group. CONCLUSIONS: Our study, conducted in a large population, showed that the use of chlorhexidine-containing cleansing wipes significantly reduced urine culture contamination rates in both genders, in both child and adult age groups. Using GRCW, collection of urine after urogenital area cleansing will decrease the contamination problem.

Anaphylactic reactions presenting with hypertension.

BACKGROUND: Although a few case reports about hypertensive anaphylaxis (HA) are available in the present literature, there is no study about the prevalence of HA. In this study, we review our cases with anaphylaxis presenting with hypertension and ascertain its prevalence. The documents of the patients who had anaphylactic reactions after the procedures performed for the diagnosis and treatment of allergic diseases in GATA Haydarpasa Clinic of Allergy and Immunology between January 2010 and December 2014 were retrospectively reviewed. Within the study period, 324 patients had undergone 4332 procedures in which 62 of them had developed anaphylaxis. RESULTS: During the procedures, the rate of anaphylaxis was found to be 1.43 %. The rate of HA among the anaphylaxis patients was 12.9 % (8 of 62 patients). During treatments, 2 patients received adrenaline injections without any adverse reaction. CONCLUSIONS: HA may be seen at a considerable rate during an anaphylactic reaction. Anaphylaxis and hypertension can be recovered by adrenaline injection when required. According to the best of our knowledge, this study is the first original study about the prevalence of HA in English-language medical literature.

Comparison of tuberculin skin test and quantiferon-TB gold in tube test for diagnosis of latent tuberculosis infection in health care workers: A cross sectional study.

OBJECTIVE: To compare the diagnostic efficacy and agreement of the traditional tuberculin skin test with QuantiFERON-Tuberculosis Gold In-Tube test for latent tuberculosis infection in healthcare workers. METHODS: The cross-sectional analytical study was conducted between March 1 and 31, 2008, at a specialist tuberculosis hospital in Istanbul, Turkey, and comprised healthcare workers who had been employed for at least one year at the hospital and volunteered to take part. Tuberculin skin test and QuantiFERON-Tuberculosis Gold In-Tube test were both performed simultaneously and their results were compared Using SPSS 12. RESULTS: Out of 34 subjects, 20(58.8%) had a positive tuberculin skin test, and 7(20.6%) had a positive QuantiFERON-Tuberculosis Gold In-Tube test. The two tests agreed in only 15(44.1%) cases and disagreed in 19(55.9%). In 16(47.1%) subjects, the QuantiFERON-Tuberculosis Gold In-Tube test was negative and tuberculin skin testwas positive, while in 3(8.8%) participants QuantiFERON-Tuberculosis Gold In-Tube test was positive and tuberculin skin test was negative. Kappa test revealed discordance between the two tests (k=-0.13; p=0.92). CONCLUSIONS: Latent tuberculosis infection prevalence was higher based on tuberculin skin test than QuantiFERON-Tuberculosis Gold In-Tube test. The results of the two tests were discordant.

[Investigation of the presence of human metapneumovirus in patients with chronic obstructive pulmonary disease and asthma and its relationship with the attacks]. / Kronik Obstrüktif Akciger Hastaligi ve Astimi Olan Hastalarda Insan Metapnömovirus Varliginin Arastirilmasi ve Hastalik Ataklari ile Iliskisi.

Human metapneumovirus (hMPV), an enveloped RNA virus classified in Paramyxoviridae family, was first characterized in 2001 from children with acute respiratory tract infection. Recent studies have suggested hMPV to play a role in chronic obstructive pulmonary disease (COPD) and asthma attacks. The aims of this study were to investigate the frequency of hMPV in patients with COPD and asthma, its effects on the severity of the attacks and the relationship between demographical and clinical factors. A total of 123 patients, including 66 with COPD (45 were in attack and 21 were stable) and 57 with asthma (33 were in attack and 24 were under control) diagnosed according to the criteria of Global Initiative for Chronic Obstructive Lung Disease and the Global Strategy for Asthma Management and Prevention, respectively, were included in the study. Nasopharyngeal lavage samples collected from all of the patients have been evaluated for the presence of hMPV-RNA by using a reverse transcriptase-polymerase chain reaction (RT-PCR) targeting F gene region of the virus. hMPV-RNA positivity rates in patients with COPD and asthma were observed as 30.3% (20/66) and 31.6% (18/57), respectively, and the difference between the groups were not statistically significant (p= 1.00). When patients were compared according to their disease status, hMPV was detected in 31.1% (14/45) of patients with COPD attack and 28.6% of stable patients (p> 0.05). These rates were found as 36.4% (12/33) and 25% (6/24) in patients with asthma attack and controlled asthma, respectively (p> 0.05). Although the virus detection rates in patients with COPD and asthma attacks (26/78; 33.3%) were higher than the patients with stable/controlled disease (12/45; 26.7%), the difference was not found as statistically significant (p= 0.57). The detection rate of hMPV-RNA was 26.1% in patients who can be treated at home and hospital without any need of intensive care and mechanical ventilation, while this rate was 36.4% in patients with COPD attack who require intensive care and mechanical ventilation (p= 0.67). Similarly, hMPV-RNA was detected more frequently in asthma patients with moderate and severe attacks (45%) than in patients with mild attacks (23.1%); however this difference was also not statistically significant (p= 0.28). No association of hMPV-RNA detection and demographical and clinical characteristics (age, gender, medical history, smoking status, allergy, COPD severity, asthma severity, the severity of attacks, using inhaled steroid, fever) of the patients could be demonstrated (p> 0.05), except the severity of the disease in patients with asthma (p= 0.02). In conclusion, further studies with large number of cases are needed to elucidate the role of hMPV in the occurrence and severity of COPD and asthma attacks.

[Tuberculosis incidence and primary drug resistance rates in young soldiers: data from 14 military hospitals in Turkey]. / Genç Askerlerde Tüberküloz Insidansi ve Primer Ilaç Direnci Oranlari: Ülkemizdeki 14 Asker Hastanesinin Verileri.

Tuberculosis is an important health care problem worldwide as well as in Turkey and the control programmes are still in progress. Epidemiological data are necessary to conduct control studies related to the disease. Tuberculosis incidence and drug resistance rates are two necessary parameters which should be monitored for the effective establishment of tuberculosis control. In this objective, tuberculosis incidence and drug resistance rates were studied in young subjects performing their compulsory military service in Turkish Armed Forces. The study was performed in 14 military hospitals which served for the country-wide soldier patients. Based on the computerized medical database of these military hospitals, conscripts diagnosed with tuberculosis between January 01, 2009 and December 31, 2009 were retrospectively evaluated. Drug sensitivity tests of the Mycobacterium tuberculosis complex isolates were done prior to the treatment in the two military medical training hospitals of the two big cities of Turkey (Ankara and Istanbul). There were a total of 259 new tuberculosis cases in 2009 and they were all male with a mean age of 22.51 ± 4.63 years. The number of patients with pulmonary, extrapulmonary (pleuresia, lymphadenitis, others) and both pulmonary and extrapulmonary involvements were 175 (67.5%), 72 (27.8%) and 12 (4.6%), respectively. The total rate of pulmonary tuberculosis cases was 72.2% (187/259) and 64.7% (121/187) of them were smear positive. Since the number of soldiers in Turkish army in the midyear was 537.200; total tuberculosis, pulmonary tuberculosis and smear-positive pulmonary tuberculosis incidences were estimated as 48.2/100.000, 34.8/100.000 and 22.5/100.000, respectively. Drug sensitivity tests was performed for the M.tuberculosis complex strains isolated from 104 cases. Primary resistance rate to at least one drug was detected as 16.3% (n= 17), while the rates of resistance for isoniazid, rifampicin, ethambutol and streptomycin were 12.5% (n= 13), 7.7% (n= 8), 5.8% (n= 6) and 0.9% (n= 1), respectively. Multidrug resistant tuberculosis (isoniazid + rifampicin resistance) was detected in 6 (5.8%) patients. Our data indicated that although tuberculosis incidence among young soldiers was moderately high, a decreasing trend was observed when compared to the previous years. However, the rates of primary anti-tuberculosis drug resistance and multi-drug resistance were found to be high in our study. To decrease the incidence of tuberculosis and multidrug resistant tuberculosis, drug sensitivity tests should be performed for each patient and national tuberculosis programme should be established effectively.

[Investigation of E6/E7 mRNAs of high risk human papilloma virus types by a commercial automatized NASBA assay in cervical swabs]. / Servikal sürüntü örneklerinde yüksek riskli insan papilloma virus tiplerine ait E6/E7 mRNA'larinin ticari otomatize bir NASBA sistemiyle arastirilmasi.

High-risk human papillomaviruses (HPV) are associated with the development of cervical cancer and its precursor lesions. In addition to cytological screening, nucleic acid testing is the mainstay of diagnosis and follow-up. The molecular tests used for the detection of HPV-DNA in cervical specimens, usually rely on consensus polymerase chain reaction assays that target L1 region of the viral genome. Diagnostic assays that monitor mRNAs from HPV oncogenic proteins, E6 and E7, have also been recently developed. This study was aimed to detect E6/E7 mRNAs from high-risk HPV types 16, 18, 31, 33 and 45 qualitatively by a commercial Nucleic Acid Sequence Based Amplification (NASBA) assay (NucliSENS EasyQ HPV; bioMérieux, France) from cervical specimens. Cervical smear samples were collected from 57 women who had suspected lesions in gynecologic examination and transported by a commercial liquid-based cytology system (ThinPrep Pap Smear Method, Cytyc, USA). Nucleic acid purification was performed by an automated commercial station (NucliSENS easyMAG, bioMérieux, France) as directed by the manufacturer. Presence of viral E6/E7 mRNAs were detected in 38.6% (22/57) of the samples. HPV type 33 mRNA was observed as the most common (11/22, 50%), followed by type 16 (9/22, 41%), 31 (5/22, 22.7%), 45 (4/22, 18.2%) and 18 (1/22, 4.5%). Single and multiple infections with 2 HPV types were identified in 63.6% (14/22) and of 36.4% (8/22) of the positive samples, respectively. The most common co-infection pattern was observed as HPV type 16 and 33 that comprised 13.6% (3/22) of the positive samples. This study was conducted as a preliminary evaluation of commercial NASBA E6/E7 mRNA testing in routine molecular microbiology applications. More studies are required to fully assess the performance of the system for diagnostic laboratories in Turkey.

[Tuberculin skin test screening in a military school in Istanbul city center]. / Istanbul il merkezindeki bir askeri okulda tüberkülin cilt testi taramasi

To investigate the reason of high incidence of annual patients with tuberculosis (TB) in a military school previously known by screening tuberculin skin test (TST) and finding out the proportion of annual infection risk (PAIR), the prevalance of TB infection and the distribution for each grades. Our study is a cross-sectional epidemiologic study made about TB infection. TST were screened for all students in the school. 5 TU PPD was injected to every student and after 72 hours, the results were evaluated by measuring the diameter of enduration. Test was repeated after 10 days for negative reactions. Age, sex, the number of BCG wound, smoking and dwelling for last 5 years were asked from the students and their answers were recorded. More than 10 mm enduration for cases who had no BCG and 15 mm enduration for cases who had BCG were accepted positive. Chest roentgenogram was taken for each student enrolled into the study. Infection prevalance and PAIR were calculated after tests and measurements. The total number of students was 948. Of 917 (96.7%) were male and 31 (3.3%) were female. The mean age was 19.72 +/- 1.25. The mean of TST was 12.79 +/- 5.96 mm for all students. According to the number of BCG scar, the numbers of students, percentage and the mean of TST were like that 70 (7.3%) cases no BCG scar 8.41 +/- 7.87 mm, 393 (41.4%) students one BCG scar, 11.94 +/- 6.26 mm, 343 (36.1%) cases two BCG scars, 13.74 +/- 5.12 mm, 142 (14.9%) students three or more then three scars, 14.97 +/- 4.11 mm. In the students who had no BCG, TST positivity was 50%. TB infection prevalance of entire school and PAIR were 46% and 3.44% (respectively). In this study, we found that increased number of BCG wound associated with the increased diameter of TST enduration. The proportion of unvaccinated students was similar to the same age population in our country but it showed differences in the distribution of regions. The students who started first grade had serious TB infection risk in their first school year. We think that PAIR values derived from TST conversions done in high risky community by screening annual TST could show all aspects of TB infection risk in those community.