Transition from sheltered workplace: Vocational skills are not the main concern.

The aim of this study was to investigate the transition of employees with intellectual disabilities to inclusive work environments from sheltered workplaces. The study was conducted in a sheltered workplace in Turkey for people with intellectual disabilities. Data was collected from 71 participants in interviews. Interviews were conducted with employees (n = 28), families of employees (n = 24), company human resource managers (n = 8), sheltered workshop foremen (n = 7), and special education teachers (n = 4). The study group asked about the future of the sheltered workplace and participants' views on transition to inclusive work environments. The answers of the participants were analysed using thematic analysis. Findings showed that many participants had positive views about transition along with concerns about accidents and security problems that may occur in inclusive environments. It was observed that negative attitudes and views were related with lack of knowledge about inclusive work environment conditions.

A rare cause of infection, Raoultella planticola: emerging threat and new reservoir for carbapenem resistance.

BACKGROUND: Severe cases of infections caused by Raoultella planticola are constantly being reported from all over the world with the increase in drug-resistance patterns. In this study, we retrospectively evaluated the clinical characteristics of R. planticola infections with patients' demographics and antimicrobial susceptibilities of the R. planticola isolates. METHODS: R. planticola isolates were retrospectively evaluated. VITEK 2® automated system was used for identification and antimicrobial susceptibility testing. Verification of the low-discriminated isolates was analyzed with MALDI-TOF method using VITEK MS® system. Gene-Xpert® system was used for detection of bla IMP-1-, bla KPC-, bla NDM-1-, bla OXA-48- and bla VIM-type carbapenemases. The data of the patients with R. planticola infection were collected from hospital records. RESULT: During the 4-year period, 42 episodes of R. planticola infections were detected. MALDI-TOF was used for 11 of the low-discriminated isolates, and 1 of which identified as R. terrigena was excluded. Carbapenems and aminoglycosides were the most effective antimicrobial agents. Extended spectrum beta-lactamases were detected in seven of the isolates. Three carbapenem-resistant isolates were detected as bla OXA-48-type carbapenemase carrier. Nosocomial R. planticola infections constituted 80.9 % (n = 34) of the infections. Most common infections related with R. planticola were blood stream infections (n = 24) (p < 0.005). The presence of indwelling catheter and intensive care unit stay were the most common detected risk factors (p < 0.005). Diabetes mellitus and chronic renal insufficiency commonly accompanied the infections (p > 0.005). CONCLUSIONS: Challenging infections caused by Raoultella spp., like those of multidrug resistant Klebsiella spp., will probably become a concern for clinicians as well as microbiologists . In literature, there were few cases, but we believe that the incidence of Raoultella spp. infections, which may result from misidentification, are more common than expected , and it is not unlikely that there will be a gradual increase and spread in multidrug-resistant isolates.

Detection of herpesviruses and human papillomavirus in acute apical abscesses by real-time PCR.

OBJECTIVE: The recent use of polymerase chain reaction (PCR)-based molecular methods to detect herpesviruses in periradicular lesions has suggested that some herpesviruses, especially human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV) can participate in the pathogenesis of the periradicular lesions. Based on the applicability of molecular techniques for virus identification, the aim of the study was to investigate the presence of HCMV, EBV, and human papillomavirus (HPV) in samples from acute apical abscesses. To the best of our knowledge, this is the first study in Turkish population to survey apical abscess samples for the presence of herpesviruses and HPV. MATERIAL AND METHODS: Microbial samples were collected from 27 apical abscess specimens and 6 control samples. DNA was extracted from clinical samples by using spin column-based nucleic acid purification method, and viral loads were evaluated using real-time PCR methods following the kit protocols recommended by the manufacturers. RESULTS: HCMV DNA was found alone in five (18.5 %) samples, EBV DNA alone in two (7.4 %), HPV DNA alone in two (7.4 %), and in one, both HCMV and EBV (4 %). As for the healthy pulps used as noninflamed controls, no control specimens contained HCMV, EBV, or HPV DNA. CONCLUSION: The present PCR-based findings have identified HCMV, EBV, and HPV as an inhabitant of acute apical abscesses. Additional studies using in vitro or animal model systems are required to elucidate the role of HCMV, EBV, and HPV in the pathogenesis of periapical pathosis. CLINICAL RELEVANCE: The present viral findings may have future therapeutic relevance for periapical abscesses and other periapical pathosis.

Predicting adult-age mental health with childhood reading and math disability: do resilience and coping styles matter?

We studied the associations between childhood-identified learning disabilities and adult-age mental health and whether adult-age reading and math skills, coping styles, or resilience influenced the associations. The participants were 159 Finnish adults (60.4% males). Of them, 48 (30%) had a reading disability (RD), 22 (14%) had a math disability (MD), 21 (13%) had RD + MD identified in childhood, and 68 (43%) were population-based controls, matched based on gender, age, and place of residence. At ages 20-40 (Mage = 29), they reported their mental health, coping styles, and resilience, and their reading and math skills were assessed. The hierarchical regression analyses, predicting mental health with RD, MD, and their interaction while controlling for gender and age, indicated that childhood MD predicted the occurrence of more mental health problems in adulthood, but this was not observed in the case of RD. The RDxMD positive interaction effect reflected better mental health in both the RD and the RD + MD groups than in the MD group. Controlling for adult-age reading and math skills had no effect on the association between MD and mental health outcomes while controlling for resilience and coping styles diminished the impact of MD. Strong resilience without the use of an emotion-oriented coping may thus alleviate the association between MD and mental health. As childhood MD can have long-term associations with mental health problems, these issues need to be addressed in school, at work, and in healthcare. Based on our findings, strengthening effective coping and resilience may be one avenue of support.

Epidemiologic and microbiologic evaluation of catheter-line bloodstream infection in a pediatric hematopoietic stem cell transplant center.

BACKGROUND: Children who underwent hematopoietic stem cell transplant (HSCT) transplants are at high risk of developing central-line-associated bloodstream infections (CLABSIs). The present study aimed to identify possible risk factors for mortality by analyzing the clinical and laboratory characteristics of patients diagnosed with CLABSI in our pediatric hematopoietic stem cell transplant unit. METHODS: The initial CLABSI episodes of 102 children were analyzed. Medical records of the patients were evaluated by preformed standardized surveys. Univariate analysis and multivariate logistic regression analysis were performed to identify risk factors for mortality. RESULTS: Thirty-five patients (34.3%) were female. The median age was 48 months (3-204). The median time to onset of CLABSI was 19 days (4-150). The gram-negative and gram-positive bacteria ratio among the causative agents was 57.8% to 34.3%. The mortality rate was 12.6%. The presence of severe neutropenia, initiation of inappropriate empirical antibiotic therapy, the presence of hypotension, persistent bacteremia, pediatric intensive care unit admission, growth of carbapenemase-positive gram-negative microorganism and multidrug-resistant bacteria were significantly high in the mortality group when compared to survivors. The presence of hypotension, inappropriate empirical antibiotic therapy, and persistent bacteremia were found to be independent risk factors for mortality. CONCLUSIONS: Rational use of antibiotics, active surveillance and screening of patients together with improved infection control practices may reduce the incidence and the consequences of CLABSIs.

Detection of human cytomegalovirus and Epstein-Barr Virus in symptomatic and asymptomatic apical periodontitis lesions by real-time PCR.

OBJECTIVES: Recent studies have investigated the occurrence of human cytomegalovirus and Epstein-Barr Virus in samples from apical periodontitis lesions and a role in the pathogenesis of this disease has been suggested. Because genotype distribution and seroprevalence of EBV and HCMV differ among populations, it is important to determine the presence of these viruses in endodontic periapical lesions of different populations. The aims of this study were to determine the presence of HCMV and EBV DNAs in samples from Turkish patients with symptomatic and asymptomatic apical periodontitis lesions using real-time polymerase chain reaction method and to evaluate their presence in both symptomatic and asymptomatic apical periodontitis lesions. STUDY DESIGN: Periapical samples were collected from 12 asymptomatic and 16 symptomatic periapical lesions in conjunction with apicectomy. HCMV and EBV DNAs were identified in the samples by real-time PCR. The chi-squared test with Yates's correction or the Fisher's exact test was used to analyse the significance of differences. RESULTS: HCMV DNA was detected in 10 of the 16 (62.5%) symptomatic and in five of the 12 (41.7 %) asymptomatic periapical study lesions. The EBV DNA was identified in seven of the 16 (43.7 %) symptomatic and three of the 12 (25 %) asymptomatic periapical lesions. The difference in occurrence of HCMV and EBV DNA between symptomatic and asymptomatic periapical lesions was not statistically significant. (All comparisons have p > 0.05). CONCLUSION: Our findings suggest that HCMV and EBV is a frequent inhabitant of both symptomatic and asymptomatic apical periodontitis lesions of endodontic origin in Turkish population.

Can Helicobacter pylori invade human gastric mucosa?: an in vivo study using electron microscopy, immunohistochemical methods, and real-time polymerase chain reaction.

UNLABELLED: BACKGROUND-GOALS: We used transmission electron microscopy and immunohistochemistry (IHC) to investigate how Helicobacter pylori affects the gastric mucosa of humans. STUDY: Gastric biopsy specimens were obtained from 15 patients with gastric discomfort. The samples were processed using both microscopic examinations and a real-time polymerase chain reaction to detect H. pylori DNA. IHC staining was performed with an avidin-biotin complex immunoperoxidase kit for paraffin-embedded tissue sections. Polyclonal rabbit anti-H. pylori was used as a primary antibody. RESULTS: IHC-applied slides with brown-stained spiral bacteria on the luminal surface and in the intercellular spaces of the gastric epithelium; electron-dense spiral H. pylori of approximately 200 to 300 nm in diameter both in the gastric lumen and between the gastric epithelial cells; coccoid or ellipsoid H. pylori attached to the epithelial cells through egg-cup-like pedestals; coccoid H. pylori within the endocytotic vesicles in the apical cytoplasmic part of the epithelial cells, thus suggesting their internalization by phagocytosis; electron-dense spiral H. pylori within the membrane-bounded vacuoles of both the gastric epithelial cells, and the lamina propria; a prominent vacuolization of gastric epithelial cells invaded by H. pylori; and swollen and lytic gastric epithelial cells that suggest a mucosal erosion and may lead to peptic ulcer. All of these microscopic findings were not present in the H. pylori DNA-negative specimens that were used as the control group. CONCLUSION: This is the first histomicrobiologic study to show gastric cells invaded by H. pylori in patients with H. pylori infection confirmed by real-time polymerase chain reaction.

Evaluation of the Relationship between Early Troponin Clearance and Short-Term Mortality in Patients with Chronic Renal Failure.

OBJECTIVE: In patients with CKD, cTn concentrations may be elevated in the absence of AMI, which is a predicted finding caused by chronic structural heart disease rather than acute injury. The increase in troponin level observed in noncardiac conditions provides conflicting results when predicting mortality. Low lactate clearance was associated with increased mortality. Lactate clearance is calculated as follows: (early lactate - late lactate/early lactate) ∗ 100. We aimed to investigate whether troponin clearance calculated according to this formula had an effect on short-term mortality. METHODS: The study included 300 patients with chronic renal failure who had a sepsis-related organ failure assessment (SOFA) score ≥3. By taking the baseline troponin at the time of emergency presentation as reference and comparing them with the fourth-hour troponin values, troponin clearance was investigated in the evaluation of mortality among hospitalized patients with CKD within the first month after discharge. The data obtained were analyzed using the SPSS data analysis software version 20.0. Student's t-test was used for the parametric data, and the Chi-squared test for the nonparametric data. RESULTS: Of the 300 patients evaluated, 189 patients survived (mean age 66.20 ± 14.597 years), and 111 died (mean age 74.81 ± 12.916 years). Troponin clearance was detected in 40 of the 111 patients in the mortality group and 119 of the 189 patients in the survival group. Troponin clearance was significantly more frequent in surviving patients (P=0.0000083). CONCLUSION: Troponin clearance can be considered as a valuable leading indicator of survival, but higher levels of troponin clearance did not lead to higher survival rates.

[Can Chlamydia trachomatis human biovars cause abortion in cattle? An immunohistochemical study on a new host-pathogen relationship]. / Chlamydia trachomatis'in insan biyotipleri sigirlarda düsük etkeni olabilir mi? Yeni bir konak-patojen iliskisini arastiran immünohistokimyasal çalisma.

Chlamydiae, which are obligate intracellular bacterial pathogens, have been radiated from single-celled eukaryotes into multi-celled hosts during their evolution. Chlamydia trachomatis one of the important species in this group, is classified into three biovars as a result of their evolution. Two of those biovars, Trachoma and LGV, are pathogens only in humans. Initially, the presence of a high specificity between the host and chlamydiae has been recognized and this relation has been considered as an adaptation mechanism. However, some studies have indicated that chlamydiae can also grow in laboratory animals, yolk sacs of embryonated eggs and in vitro cell cultures. The aim of this study was to investigate if C. trachomatis human specific biovars are possible infectious agents in the aborted bovine fetuses. Ninety aborted bovine fetuses were included in the study, and the bacteria which could be the causative agents for abortion were searched by conventional microbiological methods. Twenty-three (25.6%) abortion materials which have yielded negative results with these methods for the presence of bacterial agents other than chlamydiae, were further evaluated in terms of the presence of C. trachomatis. For this purpose the samples were inoculated into the yolk sac of embryonated eggs and the slides prepared from the yolk sac membranes of embryons died after 24 hours of inoculation, were examined for the presence of inclusion bodies by staining with Giemsa method. The presence of C. trachomatis specific antigens and glycogen inclusions in those 23 samples were also investigated by immunohistochemical and Lugol's iodine staining methods, in the fetal tissue samples which were embedded in paraffin. Immunohistochemical method was performed with immunoperoxidase staining by the use of specific antibodies against C. trachomatis major outer membrane proteins. As a result, 5 (21.7%) of the 23 samples were found positive for C. trachomatis with three of the methods (Giemsa, immunoperoxidase and lugol stainings). Although the data of our study have supported that chlamydiae can adapt to new host species other than humans, further advanced studies are needed on this subject. Our results have also emphasized that novel routes of transmission should be considered for C. trachomatis infections.

Nail scissors and fingernails as reservoirs of hepatitis B virus DNA: Role of nail scissors in household transmission of hepatitis B virus.

BACKGROUND: No study in the current literature has scientifically clarified the transmission of hepatitis B virus (HBV) via personal hygiene tools. We determined risk of household transmission of HBV via nail scissors. Moreover, we assessed whether nails from HBV-infected people contained HBV, and evaluated correlations of HBV DNA levels of serum, nail specimens, and nail scissors. METHODS: Seventy patients testing positive for the surface antigen of the hepatitis B virus (63 positive for HBV DNA) treated for HBV infection and 27 healthy individuals were included. Real-time polymerase chain reaction method was used to detect HBV DNA levels in sera, nail, and nail scissors. RESULTS: HBV DNA was detected on 27% of nail scissors and in 50% of nail specimens from 63 serum HBV DNA-positive patients. Serum HBV DNA level >105 IU/mL was associated with 71.8% probability of nail scissors being HBV DNA-positive (P < .05). Serum HBV DNA level >107 IU/mL was associated with 71.5% probability of fingernails being HBV DNA-positive (P > .05). Shared-use of nail scissors was correlated with surface antigen of the hepatitis B virus positivity and total hepatitis B core antibody/immunoglobulin G positivity. A high HBV DNA level was detected in nail scissors and low level HBV DNA in the nails of persons with high serum HBV DNA levels. CONCLUSIONS: Nail scissors, shared-use of nail scissors, and duration of shared use play important roles in household transmission of HBV. Level of education within society in this regard should be increased via mass media.

[Seroprevalence of parvovirus B19 in patients with chronic idiopathic thrombocytopenic purpura]. / Kronik idiopatik trombositopenik purpura olgularinda parvovirus B19 seroprevalansi.

Although there are several studies indicating the relationship between parvovirus B19 (PV-B19) and acute idiopathic thrombocytopenic purpura (ITP) which is a form seen frequently in children, the data are not enough in terms of chronic ITP, which is a more insidious form frequently seen in adults. The aim of this study was to investigate PV-B19 seroprevalence in adult chronic ITP cases diagnosed at the haematology clinics of Atatürk University Research Hospital in Erzurum (located in eastern Anatolia, Turkey). A total of 61 patients (38 female, 23 male; mean age: 34.4 +/- 11.2 years) and 60 healthy control subjects (30 female, 30 male; mean age: 35.6 +/- 9.6 years) were included to the study. All possible etiological agents and factors other than PV-B19 were eliminated on the basis of clinical and laboratory findings. PV-B19 antibodies were screened by ELISA method, and 73.7% (45/61) of the patients were found IgG, whereas 3.2% (2/61) were found IgM seropositive. In the control group, these rates were detected as 38.3% (23/60) and 1.6% (1/60), respectively. IgG antibodies were negative in the two patients and one control who were positive for IgM. The presence of PV-B19 DNA was investigated in all of the three IgM positive subjects, and was found positive in only one patient by real-time polymerase chain reaction (PCR). The difference between patient and control groups with regard to IgG seropositivity was found statistically significant (p < 0.01), however statistical evaluation could not be performed for IgM seropositivity because of the low number of cases. As a result although the rate of IgG positivity was found statistically higher in the ITP patients in our study, this data is inefficient for the evaluation of relationship between PV-B19 and chronic ITP, indicating the need for further studies.

Socioeconomic indicators are strong predictors of hepatitis A seroprevalence rates in the Middle East and North Africa.

The goal of this analysis was to examine the association between age-specific hepatitis A virus (HAV) seroprevalence rates and various socioeconomic indicators within the Middle East and North Africa (MENA) region. We conducted a systematic review of all recently published studies on HAV conducted in the MENA region and identified the highest quality studies for inclusion in our analysis. We calculated the age at midpoint of population immunity (AMPI) for each study and estimated seroprevalence rates at the ages of 5, 10, and 15 years. Next, we identified the correlations between these metrics and several socioeconomic variables. HAV data collected in or after 2000 were available for 14 of the 19 countries in the MENA region. Four of the 14 included countries had intermediate HAV endemicity (Algeria, Saudi Arabia, Turkey, and UAE), five had high endemicity (Iran, Jordan, Lebanon, Morocco, and Tunisia), and five had very high endemicity (Egypt, Iraq, Palestine, Syria, and Yemen). Water and sanitation were not significant predictors of AMPI or seroprevalence, most likely because most countries in this region have high rates of access to these utilities. However, gross domestic product (GDP), gross national income (GNI), and the human development index (HDI) were all highly associated with AMPI and prevalence. The observed correlations suggest that of the MENA countries without recent HAV data, Bahrain, Kuwait, and Qatar most likely have low endemicity, Oman likely has intermediate endemicity, and Libya likely has high endemicity. While it is unlikely that a single correlation model would be suitable for use in all world regions, the approach utilized in this analysis might provide a simple but accurate method for using economic data to impute the endemicity profiles of countries without recent data in regions where at least several neighboring countries have conducted recent serostudies.

[Histologic demonstration of adrenal macrophages as a member of mononuclear phagocytic system in guinea pig models]. / Mononükleer fagositik sistem üyesi olarak adrenal makrofajlarin histolojik olarak kobay modelinde gösterilmesi.

Macrophages as mononuclear phagocytes, function in removing foreign substances and in the initiation of the immune response. Although some tissue-specific macrophages such as Kupffer's cells and alveolar macrophages are well-known, any knowledge about the adrenal macrophages are not yet documented in the textbooks. The aim of this study was to demonstrate the resident macrophages in the adrenals of a total 16 (8 pregnant, 8 non-pregnant) guinea pigs. Four of the animals were injected with India ink (no intervention for the other animals), and after sacrificing all animals, removed adrenals were fixed in Bouin's solution, and embedded in paraffin. Sections were stained with haematoxylin-eosin (HE) and periodic acid-Schiff (PAS) methods. Many macrophages with yellowish-brown cytoplasm in HE slides, especially adjacent to sinusoids, were observed primarily in the zona reticularis, suggesting that they are rich in lipofuscin pigment. These cells were also PAS positive. Adrenals of India ink-injected animals demonstrated perisinusoidal macrophages phagocytosing the ink. Much more adrenal macrophages were seen in the pregnant animals in comparison with the non-pregnants. It has been previously reported that the number of human macrophages increases with rising concentrations of estrogen during pregnancy. Thus, higher number of adrenal macrophages in pregnant animals was an expected result. Since they secrete cytokines, macrophages are favorable cells in terms of interactions of the neuro-endocrine organs with the immune system. Some cytokines released by macrophages have been stated to induce adrenocortical steroidogenesis independent from adrenocorticotropic hormone through medullary catecholamines. Thus, macrophages may have a significant role in the immune-adrenocortical communications within the adrenal. Finally, resident macrophages of the adrenals wait to be documented in the textbooks.

A severe Morganella morganii endophthalmitis; followed by bacteremia.

Morganella morganii is rarely isolated from nosocomial infections. However, postoperative infections due to Morganella spp. were documented in literature and eye involvements of the infections usually result in severe sequels. We present a severe case infection, which was caused by M. morganii subsp. morganii, firstly appearing as conjunctivitis and complicated by bacteremia. The infectious agent isolated from both conjunctival and consecutive blood cultures. Identification and antimicrobial susceptibility tests were performed with the Vitek 2(®) automated system. The isolate was resistant to cephalosporins and carbapenems and it had ability to produce extended spectrum beta-lactamases. Patient was successfully treated with intravenous ciprofloxacin according to susceptibility test results. This is the first report of M. morganii infection detected as a local infection then complicated by bacteremia.

Intra-Abdominal Abscess and Primary Peritonitis Caused by Streptococcus anginosus.

INTRODUCTION: The Streptococcus anginosus group of bacteria are low-virulence bacteria existing as commensals in the oral flora and gastrointestinal tracts of humans. S. anginosus may spread to the blood in individuals with poor oral hygiene in cases of oral infections, such as gingivitis and tooth abscesses, that develop following the loss of mucosal unity. This may lead to infections in the whole body, primarily as brain and liver abscesses. CASE PRESENTATION: A 32-year-old male patient presented with complaints of nausea, vomiting, and diffuse abdominal pain. Diffuse abdominal tenderness and rebound tenderness were detected particularly in the epigastrium and right upper quadrant. Laboratory assessment revealed a leukocyte count of 20,500/mm(3). Free fluid around the liver and heterogeneous areas of abscess formation in the right lateral gallbladder were revealed on abdominal computed tomography. Diffuse adhesions between the bowel and seropurulent free liquid in the abdomen were detected on surgical exploration, and a sample was taken for cultures. The patient was discharged without complications on the sixth postoperative day and his antibiotic course was completed with 4 weeks of oral treatment. We reviewed the literature for similar cases of disseminated pyogenic infections caused by the S. anginosus group. CONCLUSIONS: It should be kept in mind that the oral flora bacterium S. anginosus may cause transient bacteremia and deep-seated organ abscesses in immunodeficient patients with poor oral hygiene. Such patients with intra-abdominal abscesses should be treated with antibiotics and surgery.

Hepatitis A virus epidemiology in Turkey as universal childhood vaccination begins: seroprevalence and endemicity by region.

This paper presents the results of a comprehensive examination of current distribution of Hepatitis A virus (HAV) seroprevalence and endemicity in Turkey and the possible links between HAV endemicity and socioeconomic development. We performed a systematic search in online resources published between January 2000 and August 2015. The 22 provinces were able to be assigned a hepatitis A endemicity level based on this systematic review. The incidence rates for symptomatic hepatitis A infection are higher in the eastern part of Turkey than in the western and central region. These differences in socioeconomic indicators by region suggest the likelihood of lower seroprevalence rates in the western parts of the country and higher rates in the eastern region. Turkey's current policy of recommending hepatitis A immunization for all children without contraindications is an appropriate one and is likely to remain the best option for at least the next decade or two.

The first case of Raoultella terrigena infection in an infant.

Raoultella terrigena, formerly known as Klebsiella terrigena is Gram-negative, non-motile, facultative anaerobic, encapsulated bacilli and is a very rare cause of infections in humans. Until now, only two cases of actual clinical infection caused by R. terrigena were reported in adults. This report is the first case of neonatal infection with this microorganism, which was isolated from the urinary tract of a premature newborn followed in Neonatal Intensive Care Unit. Vitek 2® automated system had identified the bacteria as R. planticola. The result was duplicated with a new urine sample. Although Vitek 2® automated system identified the isolates as R. planticola, 16S rRNA sequencing and blast analysis of the bacterium had figured out that the bacterium was R. terrigena with 92% identicality. The bacterium was resistant to empirically given antibiotics, ampicillin and gentamicin. The patient was successfully treated with cephaperazone/ sulbactam according to antimicrobial susceptibility test result.

Investigation of clonal relationships of K. pneumoniae isolates from neonatal intensive care units by PFGE and rep-PCR.

INTRODUCTION: Clonal relationships of Klebsiella pneumoniae strains obtained during an epidemic and after a one-year post-epidemic (non-epidemic) period in the same neonatal intensive care unit (NICU) using pulsed-field gel electrophoresis (PFGE) and repetitive polymerase chain reaction (rep-PCR) by the DiversiLab (DL) system were investigated, and the results of both molecular techniques were evaluated. METHODOLOGY: Fifteen K. pneumoniae strains were included in this study. All identified bacterial strains were confirmed by 16S rDNA sequencing and analyzed by PFGE and the DL system. RESULTS: According to the PFGE results, 15 isolates showed 10 different band profiles. Nine of these 15 isolates were included in one of the formed clusters, and the remaining six isolates were not included in any of them. According to the DL system results, 15 isolates showed two different clusters, with three strains in one cluster and four strains in the other. The remaining strains could not be placed any one of the clusters. PFGE was used as the gold standard based on its strong genetic discriminatory power. The DL system results showed that  PFGE missed the relationship of the two epidemic-related strains and demonstrated one epidemic-unrelated strain to be epidemic related. CONCLUSIONS: Both systems may easily be used for clonal relationships of K. pneumoniae strains. The DL system was clearly more rapid and convenient than PFGE, but its discriminatory power seemed to be inferior to that of PFGE based on 15 K. pneumoniae strains.

Are there standardized cutoff values for neutrophil-lymphocyte ratios in bacteremia or sepsis?

Bacteremia and sepsis are common causes of morbidity and mortality worldwide, with incorrect or delayed diagnoses being associated with increased mortality. New tests or markers that allow a more rapid and less costly detection of bacteremia and sepsis have been investigated. The aim of this study was to clarify the cutoff value of the neutrophillymphocyte ratio (NLR) according to procalcitonin (PCT) level in the decision-making processes for bacteremia and sepsis. In addition, other white blood cell subgroup parameters, which are assessed in all hospitals, for bacteremia and sepsis were explored. This retrospective study included 1,468 patients with suspected bacteremia and sepsis. Patients were grouped according to the following PCT criteria: levels <0.05 ng/ml (healthy group), 0.05-0.5 ng/ml (local infection group), 0.5-2 ng/ml (systemic infection group), 2-10 ng/ml (sepsis group), and >10 ng/ml (sepsis shock group). One important finding of this study, which will serve as a baseline to measure future progress, is the presence of many gaps in the information on pathogens that constitute a major health risk. In addition, clinical decisions are generally not coordinated, compromising the ability to assess and monitor a situation. This report represents the first study to determine the limits of the use of NLR in the diagnosis of infection or sepsis using a cutoff value of <5 when sufficient exclusion criteria are used.

Evaluation of two recovery methods for detection of Mycobacterium avium subsp. paratuberculosis by PCR: direct-dilution--centrifugation and C(18)-carboxypropylbetaine processing.

A duplex polymerase chain reaction (PCR)-hybridization assay based on Mycobacterium avium subsp. paratuberculosis (MAP)-specific IS900 integration sites was used to evaluate two mycobacterial recovery methods from bovine feces: a direct-dilution-centrifugation method and a C(18)-carboxypropylbetaine (CB-18)-based method. All MAP PCR results were confirmed for absence of inhibitors using a novel PCR system based on the rpoB gene of plant chloroplasts as an internal control. The detection limits of both MAP recovery methods when coupled with PCR were determined to be between 100 and 1000 organisms. Using culture as a 'gold standard' PCR following the direct-dilution-centrifugation protocol was 92.6% sensitive and 83.7% specific, whereas PCR following the CB-18 method was 100% sensitive and 53.5% specific. Both methods were 100% specific when 60 'true' negatives from two uninfected herds were tested. Both the CB-18 and direct processing methods coupled with a target-specific amplification technique may provide greater sensitivity to diagnose subclinical animals as they were able to detect more positives, on samples derived from infected herds, than conventional culture methods; however, more extensive investigation and follow-up of suspect animals will be required to fully validate the MAP recovery and molecular detection protocols described.