Blood transfusion knowledge levels of nurses in Izmir Atatürk training and research Hospital, turkey.

Despite their use in life-saving treatment, blood and blood products can cause life-threatening complications. To administer blood transfusion safely, national guidelines and protocols should be consulted in healthcare organizations. In Türkiye, there are guides and regulations published by the Ministry of Health. With the definition of hemovigilance in the regulations; training in clinical use of blood and transfusion practice fields is now mandatory. This study presents data from a survey designed to assess transfusion knowledge levels of clinical departments for the purpose of planning our training programs. A two-part survey was conducted on 110 nurses from various departments. Questions included sociodemographic attributes, department they worked in, employment duration, knowledge level on transfusion practices. Statistical analysis was performed. Of the nurses that participated; 52.7% were above 40 years old, 15.5% were 31-40 years old and 31.8% were below 30 years old. For education; 84.5% of the nurses were graduates or postgraduates. For work experience; 64.5% were working in internal medicine departments, 58.2% had been working as a nurse for 10 or more years while 85.5% worked in the same department for less than 5 years. It was determined that the nurses should know more about transfusion. Beginner nurses in the intense care unit were found to have lower levels of transfusion practice knowledge, from this it was deduced additional training should be scheduled for beginner nurses with low transfusion knowledge. In addition to theoretical instructions, one-on-one training on operation controls and "observation and guidance" style practical training should be implemented. Theoretical and practical topics with inadequate knowledge should be instructed in finer detail to increase the knowledge level in these subjects.

[An alternative biphasic nutrient medium for the diagnosis of cutaneous leishmaniasis]. / Kutanöz leysmanyazis tanisinda alternatif bifazik nutrient besiyeri.

Cutaneous leishmaniasis (CL) caused by the Leishmania spp. parasites, is a disease characterized by nodulo-ulcerative lesions in the skin. CL is transmitted to humans by infected sandflies during blood sucking, and is endemic in about 98 countries over the world. The demonstration of amastigotes via microscopic examination, and the growth of promastigotes in NNN (Novy-MacNeal-Nicolle) medium are gold standard methods for laboratory diagnosis. The aim of this study was to compare the biphasic NNN medium that is frequently used in routine laboratories with the biphasic nutrient medium that can be prepared easily in microbiology laboratories, for the growth of promastigotes. In the study, the aspiration fluid sample was used as clinical sample which was obtained from the skin lesion of a 47-year-old female patient admitted to Izmir Katip Celebi Ataturk Education and Research Hospital dermatology outpatient clinic and pre-diagnosed as CL. The aspirate sample taken from the lesion was evaluated with microscopy, cultivation in two different media and real-time polymerase chain reaction (Rt-PCR) methods. In microscopic examination Leishmania amastigotes were observed in Giemsa-stained smears prepared from the aspiration fluid. In Rt-PCR performed by using specific primers and probes targeting ITS1 region of Leishmania parasite, a melting-curve compatible with L.tropica was detected. For cultivation, triple inoculations of the aspirate sample into NNN (NNN + RPMI 1640 + 10% fetal calf serum) and nutrient media (nutrient agar + nutrient broth + 10% fetal calf serum) were used. The cultures were incubated at 27°C for 10 days, and the number of propagated promastigotes were counted on the third, seventh and tenth days. The growth of Leishmania promastigotes was detected in both media on the third day. The number of promastigotes grown in NNN medium on the third, seventh and tenth days were 105/ml, 106/ml and 108/ml, respectively. Those values in nutrient medium were 106/ml, 107/ml and 108/ml on the third, seventh and tenth days, respectively. Although the number of promastigotes on the third and seventh days were higher in nutrient medium than NNN medium, the number of cultivated promastigotes were equal on the tenth day. As a result, nutrient medium is considered to have an impact in the diagnosis of CL, by providing an alternative to the routine medium used and can readily be available in microbiology and parasitology laboratories with long shelf-life. It was concluded that biphasic nutrient medium could be used as a supplementary medium for diagnosis in laboratories in the absence of NNN medium or can not be provided.

[Macrolide-lincosamide-streptogramin B (MLSB) resistance phenotypes in clinical Staphylococcus isolates and investigation of telithromycin activity]. / Klinik stafilokok izolatlarinda makrolid-linkozamid-streptogramin B (MLSB) direnç fenotipleri ve telitromisin etkinliginin arastirilmasi

Staphylococci are one of the most common pathogens isolated from nosocomial and community acquired infections. Antibiotics such as clindamycin and erythromycin have been useful options for treating skin and soft-tissue infections caused by staphylococci. However, expression of macrolide-lincosamide-streptogramin B resistance (MLSB) can limit the effectiveness of these drugs. The aims of this study were to investigate the prevalence and phenotypes of MLSB resistance in staphylococcus strains isolated from clinical samples and to determine the telithromycin activity against these isolates. A total of 218 strains [92 Staphylococcus aureus and 126 coagulase-negative staphylococci (CNS)] isolated from different clinical samples (wound, abscess, blood, sterile body fluids, catheter, upper respiratory tract samples) between February 2011 to December 2012 were included in the study. The isolates were identified by using conventional methods and automated bacterial identification system (BD Phoenix 100™ System, Becton Dickinson, USA). Methicillin resistance of the isolates was determined with the use of cefoxitin (30 µg) disk and telithromycin (15 µg) activity was detected by Kirby-Bauer disk diffusion method. MLSB resistance phenotypes were investigated by the D-test method using erythromycin (15 µg) and clindamycin (2 µg) disks. Of 92 S.aureus isolates, 23 were methicillin-resistant (MRSA) and 69 were methicillin-susceptible (MSSA), whereas 78 of 126 CNS isolates were methicillin-resistant (MRCNS) and 48 were methicillin-susceptible (MSCNS). Hundred and seventy-two (79%) isolates were found as erythromycin-resistant, and the rates of erythromycin resistance in MRSA, MSSA, MRCNS and MSCNS strains were 83%, 71%, 95% and 63%, respectively. Inducible type of MLSB resistance (iMLSB type) was observed in 26%, 6%, 51% and 33%; chromosomal resistance (cMLSB type) in 32%, 27%, 27% and 17% and efflux pump connected resistance (MSB type) in 42%, 67%, 22% and 50% of the MRSA, MSSA, MRCNS and MSCNS, respectively. Forty-four (20%) strains were found susceptible to both clindamycin and erythromycin (S type resistance). Resistance due to enzymatic inactivation (L type) was observed only in two of the CNS strains (0.9%), one was methicillin-resistant and the other was susceptible. Total telithromycin resistance was detected as 26.6% (n= 58), while the resistance rates in MRSA, MSSA, MRCNS and MSKNS isolates were 35%, 35%, 28% and 8%, respectively. Telithromycin resistance rate was 34% (58/172) in erythromycin-resistant isolates. However, all erythromycin-susceptible isolates (n= 46) were also susceptible to telithromycin. Telithromycin-resistant isolates frequently exhibited cMLSB phenotype (39/44; 67.2%), followed by MSB (16/72; 27.6%) and iMLSB (3/56; 5.2%). In conclusion, clindamycin is still an effective antibiotic for the treatment of staphylococcal infections in our hospital, however, 34% resistance rate against telithromycin may limit the use of this agent which is an alternative for the treatment of infections caused by clindamycin and erythromycin-resistant strains.

Parameters of infection in replacement and voluntary donors in the western part of Turkey.

BACKGROUND: According to our center's experiences familial/replacement donors (FRDs) frequently donate blood for the first time in their lives. Therefore, results of infection parameters are expected to be different voluntary donors (VDs), at similar rates to the population. The present study aimed to investigate if there were any difference in VDs and FRDs in terms of infection parameters. OBJECTIVE: The blood donation records over 6 years (2004-2010) were reviewed, retrospectively. HBsAg, anti-HCV, anti-HIV screening tests were performed by ELISA and syphilis screening was performed by the RPR method. MATERIAL AND METHODS: Out of 71.217, 16.727 donors donated whole blood as FRD. Among the whole blood donated by FRD, the positives for HBsAg, anti-HCV and RPR were 1.23%, 0.37%, and 0.07%, respectively. Confirmed anti-HIV screening test was not observed in this group. Positivities for HBsAg, anti-HCV, anti-HIV and RPR in VD were 1.36%, 0.42%, 0.004%, and 0.04%, respectively. RESULTS: When FRD and VD were analyzed statistically, HBsAg rates were significantly higher among FRD in the years 2004, 2007 and 2008, whereas they were significantly high among VD in year 2005. HBsAg rates stated in the years 2006-2009 were insignificant. Significantly high results were observed in HCV rates in the year 2005 among VD, whereas insignificant levels were observed in other years. HIV rates were insignificant among VD in the years 2004 and 2005, confirmed positivity was established in only one patient. Values in all years in RPR rates were statistically insignificant. Grouping donors as replacement and voluntary has no importance in infection parameters. CONCLUSION: Grouping donors as replacement and voluntary has no importance in infection parameters. Appropriate donor inquiries and screening of infection parameters by reliable proven tests preserve their significances.

Evaluation of hepatitis delta virus (HDV) infection in blood donors in western Turkey.

BACKGROUND: Hepatitis B virus (HBV) and hepatitis delta virus (HDV) infections are potentially dangerous complications of transfusion therapy. OBJECTIVE: The aim of this study was to determine the prevalence of HDV markers examined by serological and molecular methods in hepatitis B surface antigen (HBsAg)-reactive sera among blood donors. MATERIALS AND METHODS: Samples from 88 HBsAg-reactive blood donors were investigated for total anti-delta antibody (anti-HDV) and HDV-RNA between April 2010 and February 2011. HBsAg screening tests were performed by "microparticle enzyme immunoassay" (MEIA) method using the AxSYM system (Abbott Laboratories, USA), and total anti-delta antibody tests were performed by MEIA method using the Alisei system (Radim, Italy). HDV-RNA was quantified using the polymerase chain reaction (PCR) method. Viral nucleic acid isolation system (Anatolia Geneworks) was used with Bosphore HDV quantification kit. RESULTS: HBsAg reactivity was determined as 1% (124/12.423) among blood donors as a whole. Eighty-eight of these 124 samples were investigated further for HDV. Three (3.4%) of the 88 HBsAg-reactive serum samples were total anti-delta antibody-reactive. Of the 3 anti-HDV-reactive sera, 2 were reactive for HDV-RNA. Therefore, HDV-RNA reactivity was determined as 2.3% (2/88) in HBsAg-reactive donors as a whole. The 2 HDV-RNA-reactive donors were brothers. CONCLUSIONS: Investigation of HDV is important because HBV infection is endemic in Turkey. Intrafamilial transmission is important in HDV transmission.

Seroprevalence of transfusion transmissible infections among blood donors in western part of Turkey: a six-year study.

BACKGROUND: The most frequently encountered complication of blood transfusion is transfusion transmissible infections. Screening of transfusion transmissible infections are for safe blood transfusions, the results provide a crude idea about seropositivity rates of regions. OBJECTIVE: The present study aimed to investigate distributions of transfusion transmissible infection seroprevalences in years and according to gender through medical records, and to define the regional data, retrospectively. METHODS: 80.454 Blood donors, applied to our center between dates August 2004 and December 2010, were investigated by HBsAg, anti-HVC, anti-HIV ELISA (Abbott, AXSYM) and RPR methods. RESULTS: Out of 80.454 donors, 7.321 (9.1%) were females, 73.133 (90.0%) were males. Age range of donors was 18-64 years (mean 41 years). While 61.950 (77%) of donors were voluntary, 18.504 (23%) were familial/replacement donors. 1.405 units of blood out of 80.454 were disposed, because one of infection parameters was positive. 45 units (3.2%) of disposed blood were from females, the rest belonged to male donors (1.360 units; 96.8%). HBsAg was positive in 1.054 donors (1.31%), whereas positivities of anti-HCV, anti-HIV and RPR were 312 (0.38%), 2 (0.002%) and 39 (0.04%), respectively. CONCLUSIONS: Seropositivity was determined in accordance with national data, but was at lower limits. Seropositivity rates in years differed, but neither regularly increases nor decrease was observed. When all positivities were investigated according to genders, positivity in HBsAg and VDRL tests were significantly high in male donors.

[Comparison of Cefoxitin Disk Diffusion Test, Automated System and Chromogenic Medium for Detection of Methicillin Resistance in Staphylococcus aureus Isolates]. / Staphylococcus aureus Suslarindaki Metisilin Direncinin Belirlenmesinde Sefoksitin Disk Difüzyon Testi, Otomatize Sistem ve Kromojenik Besiyerinin Karsilastirilmasi

The mecA gene is responsible for the development of methicillin resistance in staphylococci however accurate detection of methicillin resistance is not feasible evermore because of heterogenous expression of mecA gene. Although mecA gene determination by polymerase chain reaction (PCR) is considered as the gold standard method, molecular tests are not easily applied in all routine laboratories. Thus, for the rapid and accurate diagnosis of MRSA strains, easy and practical phenotypic tests are still required. This study was aimed to compare the performance of mecA gene analysis by gel bases multiplex PCR with dual primer (Seeplex, Seegene Inc, Korea), cefoxitin disc diffusion method (30 µg, Oxoid, UK), automated system (Phoenix 100, Becton Dickinson, USA) and chromogenic medium CHROMagar MRSA (CHROMagar Microbiology, Salubris, Turkey) for the detection of methicillin resistance in staphylococci. It was found that 60 of the 98 Staphylococcus aureus strains carried the mecA gene. Methicillin resistance was observed by cefoxitin disc diffusion test in 59 isolates, by automated system in 61 isolates, and by CHROMagar MRSA in 65 isolates. When mecA gene analysis was considered as the reference method, the sensitivity, specificity, positive and negative predictive values of the tests that were used for the detection of methicillin resistance were found as 98.3%, 100%, 100% and 97.4% for cefoxitin disc diffusion (CDD) method; 100%, 97.4%, 98.4% and 100% for automated system; 96.7%, 81.6%, 89.2% and 93.9% for chromogenic medium CHROMagar MRSA, respectively. The highest sensitivity and negative predictive values were obtained by the automated system, and the highest specificity and positive predictive values were obtained by the CDD test. Although the sensitivity of chromogenic medium was found to be similar with the CDD test at the end of 48 hours, the specificity of chromogenic medium was lower than the other tests at the end of each incubation period. Likewise, positive and negative predictive values of the chromogenic medium were determined low compared to other tests. In laboratories that cannot perform molecular analysis, the determination of methicillin resistance should be done by the CDD test which is known to be a better inducer of the mecA gene expression of staphylococci. Determination of minimum inhibitory concentration (MIC) with automated systems can be the second choice especially in laboratories with intensive work loads. As a result chromogenic media can be particularly used for screening in laboratories that have a heavy workload and insufficient personnel number. However, due to its low specificity and the possibility of false positive results, it was recommended that positive strains should be confirmed by other methods such as disc diffusion or microdilution.

[A case of leech infestation mimicking upper respiratory tract infection]. / Üst Solunum Yolu Enfeksiyonunu Taklit Eden Bir Sülük Enfestasyonu Olgusu.

Urban life and industrialization leads to a decrease in the incidence of many parasitic diseases. Especially, using the supervised water supplies in urban areas decreases the chance of such infestations and limits it in rural areas. However, the people who live in urban areas and have diseases such as kidney stones think that mountain waters may be beneficial for their illness. These types of water supplies are generally unsafe, uncontrolled and septic. That is why usage of them can cause some elusive parasitic infestations in people who live in urban areas. It is meaningful to submit the case described below to illustrate the possibility of parasitic infestations in patients who have upper respiratory tract infection symptoms who are admitted to the physician.