Comparison of Spinal Mobility in Professional Musicians With and Without Pelvic Girdle Pain.

BACKGROUND: Prolonged sitting and performance hours in musicians may lead to an increased risk of musculoskeletal pain around the spine and pelvis. This situation may lead to an asymmetry of spinal segments, which in turn may correlate with muscle contractions around the lumbopelvic area and can lead to musculoskeletal pelvic girdle pain. The aim of this study was to investigate the segmental mobility of the vertebral column in two groups of musicians, those with and without pelvic girdle pain. METHODS: This study included 45 musicians who played their instrument for at least 10 years. Musicians were divided into two groups depending on if they had pelvic girdle pain or not. Spinal mobility was evaluated by a hand-held computer-assisted device called the Spinal Mouse system, and pelvic girdle pain assessments were evaluated using orthopedic tests including the active straight leg raise (ASLR), flexion abduction external rotation (FABER), pelvic pain provocation (P4), and long dorsal ligament palpation (LDL). RESULTS: The current study found no significant differences in the thoracic, lumbar, and sacral curves in the trunk flexion tests between musicians with and without pelvic girdle pain (p=0.28, 0.54, and 0.63). However, analysis of spinal mobility revealed that musicians with pelvic pain had significant limitations of spinal flexion mobility, mainly in the thoracolumbar region in the sagittal plane (p=0.02 and 0.01). CONCLUSIONS: This study revealed a significant correlation between pelvic girdle pain and limitations of segmental spinal flexion mainly in the thoracolumbar region of the sagittal plane in musicians. A lack of spinal mobility appears to be prevalent among musicians with pelvic girdle pain.

Effects of progressive muscle relaxation training on sleep and quality of life in patients with pulmonary resection.

BACKGROUND: The inadequate quality and nature of sleep is a commonly reported problem among hospitalized patients. The purpose of this study is to examine the effects of progressive muscle relaxation training program on sleep quality, sleep state, pain, and quality of life in patients who underwent pulmonary resection. METHODS: Our study was planned as a single-blind prospective randomized controlled trial. The study was conducted on 26 patients who underwent surgery by using posterolateral thoracotomy method. Progressive muscle relaxation training were given to the training group with a therapist two times a day. Sleep quality, daytime sleeping, pain, and quality of life were respectively evaluated in the morning before the surgery and 1 week after the surgery by using Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, visual analogue scale, and Euro Quality of Life-5D (EQ-5D). RESULTS: There is no significant difference between preoperative groups in the total Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Euro Quality of Life-5D, and visual analogue scale scores (p > 0.05). The intra-group change in the study group showed a significant deterioration in the Euro Quality of Life-5D and visual analogue scale scores (p < 0.05). There was a significant deterioration in the total Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, EQ-5D, and visual analogue scale scores in the control group (p < 0.05). The Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Euro Quality of Life-5D scores showed significant improvements in the relaxation training group after treatment at 1 week (p < 0.05). CONCLUSIONS: Progressive muscle relaxation prevents a decline in patient-reported sleep quality following pulmonary resection.

Chronic lower extremity wound infection due to Kerstersia gyiorum in a patient with Buerger's disease: a case report.

BACKGROUND: Kerstersia gyiorum is an extremely rare pathogen of human infection. It can cause chronic infection in patients with underlying conditions. It can easily be misdiagnosed if proper diagnostic methods are not used. CASE PRESENTATION: A 47-year-old male patient with a history of Buerger's Disease for 28 years presented to our hospital with an infected chronic wound on foot. The wound was debrided, and the specimen was sent to Microbiology laboratory. Gram staining of the specimen showed abundant polymorphonuclear leukocytes and gram-negative bacilli. Four types of colonies were isolated on blood agar. These were identified as Kerstersia gyiorum, Proteus vulgaris, Enterobacter cloacae, Morganella morganii by Maldi Biotyper (Bruker Daltonics, Germany). The identification of K. gyiorum was confirmed by 16S ribosomal RNA gene sequencing. The patient was successfully recovered with antimicrobial therapy, surgical debridement, and skin grafting. CONCLUSIONS: This is the first case of wound infection due to K. gyiorum in a patient with Buerger's Disease. We made a brief review of K. gyiorum cases up to date. Also, this case is presented to draw attention to the use of new and advanced methods like MALDI-TOF MS and 16S rRNA gene sequencing for identification of rarely isolated species from clinical specimens of patients with chronic infections and with chronic underlying conditions.

Breast abscess due to Salmonella Typhimurium in a patient with rheumatoid arthritis: a case report.

BACKGROUND: This is the first report of breast abscess due to Salmonella enterica serotype Typhimurium. Staphylococcus aureus is known as the most common cause of breast abscess. Salmonella spp. may occasionally form localized abscesses after dissemination to various organ systems following a bacteraemia. But breast abscess related to Salmonella spp is a very rare complication. CASE PRESENTATION: A 43-year-old female patient referred to our hospital with a lump, fever and mild pain in her breast. The patient was not pregnant or lactating at that time. She had a history of rheumatoid arthritis for 5 years and was under immunosuppressive therapy. Ultrasonography of the breast revealed an abscess. The abscess was drained and sent for culture to medical microbiology laboratory. The microorganism was identified as Salmonella enterica serotype Typhimurium and found to be sensitive to all antibiotics tested. The patient was cured after surgical debridement and antibiotic therapy. The abscess did not recur again. CONCLUSIONS: This case is presented to draw attention to non-typhoidal Salmonella as rare causes of breast abscess and submission of specimens to the microbiology laboratory for accurate diagnosis and treatment especially in patients with underlying immunosuppressive diseases.

Phenotypic and genotypic characteristics of carbapenem-resistant Enterobacteriaceae in a tertiary-level reference hospital in Turkey.

BACKGROUND: Enterobacteriaceae are among the most common pathogens that are responsible for serious community-acquired, hospital-acquired, and health-care associated infections. The emergence and spread of carbapenem-resistant Enterobacteriaceae (CRE) have become an increasing concern for healthcare services worldwide. Infections caused by these bacteria have been associated with significant morbidity and mortality and treatment options have been limited. The rapid and accurate detection of carbapenem resistance in these bacteria is important for infection control. The aim of this study was to investigate the phenotypic and genotypic features of CRE strains isolated in a tertiary-level reference hospital in Turkey. METHODS: A total of 181 CRE strains were included in the study. Antimicrobial susceptibility rates were tested using Vitek 2 system. Modified Hodge test (MHT) was performed using meropenem and ertapenem discs. Metallo-ß-lactamase antimicrobial gradient test (E-test MBL strips) were used for evaluation of metallo-ß-lactamase production. A multiplex PCR was used for detection of carbapenems resistance genes (IMP, VIM, KPC, NDM-1 and OXA-48). RESULTS: The OXA-48 gene was detected in 86 strains, NDM-1 gene in six strains, VIM gene in one strain. IMP and KPC genes were not identified. Three strains produced both OXA-48 and NDM-1 and one strain produced both OXA-48 and VIM. In two patients more than one genus of OXA-48 positive CREs was isolated. Ninety-two of the isolates were multidrug-resistant. One hundred and ten isolates were MHT with meropenem (MEM-MHT) positive and 109 isolates were MHT with ertapenem (ERT-MHT) positive. Nine of the isolates were positive with E-test MBL strips. The sensitivity of MEM-MHT and ERT-MHT for detection of OXA-48 was 70.9 and 70.6 %, respectively. MEM-MHT was found highly discriminative for OXA-48 Escherichia coli (p < 0.001). The sensitivity of E-test MBL for NDM-1 was 66.7 %. A statistically significant correlation was observed between OXA-48 gene and MHT positivity and between NDM-1, VIM gene and E-test MBL positivity (p < 0.001). CONCLUSIONS: OXA-48 gene is spreading rapidly to many different species of Enterobacteriaceae in the hospital environment. While OXA-48 is still the most common source of carbapenem resistance in Enterobacteriaceae in our country, NDM-1 is increasingly being isolated from patients without a history of foreign contact.

[Investigation of oxacillinase genes in nosocomial multidrug-resistant Acinetobacter baumannii isolates by multiplex PCR and evaluation of their clonal relationship with Rep-PCR]. / Nozokomiyal çok ilaca dirençli Acinetobacter baumannii izolatlarinda oksasilinaz genlerinin multipleks PCR ile arastirilmasi ve klonal iliskilerinin Rep-PCR ile degerlendirilmesi.

Acinetobacter baumannii is a major nosocomial pathogen which can cause infections with high morbidity and mortality in hospitalized patients. In recent years A.baumannii has become a serious clinical problem because of the development of resistance to many antibiotics, and especially to carbapenems. The aims of this study were to investigate the oxacillinase genes responsible for carbapenem resistance in multidrug resistant (MDR) A.baumannii strains and to evaluate the clonal relationship between these strains. A total of 62 MDR A.baumannii strains isolated from various clinical specimens (24 tracheal aspirate, 14 wound, 10 blood, 7 urine, 2 abscess, 2 sputum, 2 catheter tip, 1 pleural fluid) of hospitalized patients in intensive care units (n= 42) and other inpatient clinics (n= 20) between February-March 2012, were included in the study. Identification and antibiotic susceptibility of A.baumannii isolates were performed by Vitek-2 automated system (bioMérieux, France), and the identified bacteria were confirmed by Maldi Biotyper (Bruker Daltonics, Germany) system. Imipenem, meropenem, colistin and tigecycline were additionally tested by E-test strips (bioMérieux, France). The presence of carbapenemase-producing OXA genes (blaOXA-23-like, blaOXA-40-like, blaOXA-51-like and blaOXA-58-like) were detected by multiplex PCR (hyplex® CarbOxaID test system, Amplex Diagnostics, Germany) and the clonal relationship between isolates were investigated by rep-PCR method (DiversiLab, bioMérieux, France). In our study, all isolates were found resistant to ampicillin-sulbactam, piperacillin, piperacillin-tazobactam, ceftazidime, cefepime, imipenem, meropenem, ciprofloxacin, levofloxacin and tetracycline, while the resistance rates for amikacin, gentamicin, trimethoprim-sulfamethoxazole, netilmicin and tigecycline were 88.7%, 88.7%, 82.3%, 43.5% and 27.4%, respectively. All A.baumannii isolates were susceptible to colistin. All of the strains were positive for blaOXA-23-like and blaOXA-51-like genes, while blaOXA-40-like and blaOXA-58-like genes were not detected in any of them. Simultaneous cultures from environmental samples collected from inpatient clinics in which MDR A.baumannii strains isolated were negative in terms of A.baumannii growth. In evaluation of clonal relationship between isolates, 48 strains (77.4%) showed greater than 95% similarity and formed a big cluster, named Cluster A. The remaining 14 isolates formed 3 small clusters (each had 2 isolates), named Cluster B, C and D, showing greater than 95% similarity. Majority of isolates (58.3%) in Cluster A were from patients in the surgical intensive care unit, and the first isolate from this cluster was also from a patient in the same unit. In our opinion, isolates from Cluster A may have spread to other clinics from surgical intensive care unit through transferred patients or medical and non-medical devices and equipment. Nosocomial MDR A.baumannii isolates in our hospital are highly resistant to antibiotics and all harboured blaOXA-23-like genes. The rep-PCR analysis of these isolates indicated that a large portion of A.baumannii strains were clonally closely related, and they probably from the same source and common ancestor, and separated shortly from each other. This data emphasizes that the choices of treatment are quite limited for inpatients, and the need for improvement of the infection control measures in our hospital.

[Evaluation of common commercial systems for the identification of yeast isolates in microbiology laboratories: a multicenter study]. / Mikrobiyoloji laboratuvarlarinda maya türlerinin tanimlanmasinda sik kullanilan ticari sistemlerin degerlendirilmesi: Çok merkezli bir çalisma.

Accurate and rapid identification of yeast isolates have become important in recent years for not only antifungal susceptibility testing due to the species-specific clinical resistance breakpoints but also early initiation of appropriate antifungal therapy. In clinical microbiology laboratories species identification of yeasts is often performed with several commercial systems based on biochemical properties and rarely according to the physiological and morphological characteristics. The aim of this study was to compare the two common commercial systems, VITEK 2 YST ID Card (Vitek; bioMérieux, France) and API 20C AUX (API; bioMérieux, France) with conventional mycological methods. A total of 473 clinical yeast strains isolated from clinical specimens in different university and training/research hospitals and identified by Vitek system were included in the study. The isolates were re-identified with API and conventional methods including morphological identification in the Mycology Reference Laboratory of the Public Health Institute of Turkey. Candida dubliniensis MYA 583, Candida krusei ATCC 6258, Candida parapsilosis ATCC 22019, Candida albicans ATCC 10231 and Cryptococcus neoformans ATCC 32268 were used as quality control strains and those standard strains were studied consecutively 10 days with both of the methods. The results of identification by Vitek and API were compared with the results of conventional methods for those 473 yeast isolates [6 genus (Candida, Cryptococcus, Blastoshizomyces, Rhodotorula, Saccharomyces, Trichosporon), 17 species (5 common and 12 rarely isolated)]. The performances of the systems were better (Vitek: 95%; API: 96%) for the commonly detected species (C.albicans, C.parapsilosis, C.glabrata, C.tropicalis and C.krusei) than those for rarely detected species (Vitek: 78.4%; API: 71.6%) (p= 0.155). Misidentification or unidentification were mostly detected for C.parapsilosis (Vitek: 6/87; API: 7/87) and C.glabrata (Vitek: 9/104; API: 3/104) by both of the systems. For rarely detected yeast isolates, misidentification or unidentification were most frequently observed in species of C.pelliculosa (Vitek: 3/11; API: 6/11) and C.dubliniensis (API and Vitek: 2/5) isolates. Candida guilliermondii (API: 2/5) isolates had lower rate of identification with API compared to other species. Blastoschizomyces capitatus and Saccharomyces cerevisiae isolates could not be identified by both of the systems. As a result, the accurate diagnosis of Vitek and API systems were similar in terms of consistency (86.3%). Two systems performed well in correct identification of common clinical yeast species (at least 95%), while the identification of rare species was more challenging indicating that they require further morphological and physiological testing. The addition of morphological identification to commercial systems will be useful for accurate diagnosis and treatment of mixed infections.

[Characterization and determination of antibiotic resistance profiles of a single clone Acinetobacter baumannii strains isolated from blood cultures]. / Kan kültürlerinden izole edilen tek klonlu Acinetobacter baumannii suslarinin karakterizasyonu ve antibiyotik direnç profi llerinin incelenmesi.

Acinetobacter baumannii which is a significant cause of nosocomial infections, increases the rate of morbidity and mortality in health care settings especially in intensive care units (ICUs). The aim of this study was to determine the antibiotic resistance profiles of A.baumannii strains isolated from blood cultures of inpatients from different ICUs, wards and hospital environment and evaluate their clonal relationships and epidemiologic features. A total of 54 A.baumannii strains (47 from the blood cultures and 7 from the hospital environment), identified between 01 January 2012-28 December 2012 at the Clinical Microbiology Laboratory of Ankara Numune Training and Research Hospital, Turkey, were included in the study. Identification of A.baumannii isolates and their antimicrobial [sulbactam-ampicillin (SAM), piperacillin (PIP), piperacillin-tazobactam (TZP), ceftazidime (CFZ), cefoperazone-sulbactam (SCF), cefepime (CEF), imipenem (IMP), meropenem (MER), amikacin (AMK), gentamicin (GEN), netilmicin (NT), ciprofloxacin (CIP), levofloxacin (LVF), tetracycline (TET), tigecycline (TG), colistin (COL), trimethoprim-sulfamethoxazole (SXT)] susceptibility testing were performed by Vitek 2 (bioMérieux, France) system. The clonal relationship between the A.baumannii isolates was analysed by pulsed-field gel electrophoresis (PFGE). In our study colistin, tigecycline and netilmicin were found to be the most effective agents against A.baumannii isolates. All of the clinical isolates (n= 47) were found susceptible to COL, however all were resistant to SAM, PIP, TZP, CEF, IPM, CFZ, MER and CIP. While 1.85%, 14.8%, 14.8%, 16.6%, 59.2% and 22.2% of the isolates were susceptible to SCF, AMK, NT, GEN, TG and SXT, respectively; 1.85%, 1.85%, 9.2%, 16.6%, 38.8% and 27.7% of the isolates were intermediate to SCF, TET, AMK, NT, LVF and TG, respectively. Similarly, all of the environmental A.baumannii isolates (n= 7) were resistant to SAM, PIP, TZP, CFZ, CEF, IPM, MER and CIP, and all were susceptible to TG and COL. The resistance rates of the environmental isolates to SCF, AMK, GEN, NT, LVF, TET and SXT were determined as 57.1%, 85.7%, 85.7%, 28.8%, 28.6%, 85.7% and 57.1%, respectively. PFGE analysis done by the use of ApaI enzyme revealed the presence of one major clone. Dendogram analysis indicated that environmental and clinical isolates were in the same clone indicating that the outbreak was possibly originated from the same internal ICUs. Our data emphasized that multidrug resistant A.baumannii isolates were quite common in our hospital, and enviromental cross-contamination throughout the year was confirmed by molecular methods. Despite the precautions such as continous education on effective hand washing, use of gloves and hospital cleaning, established in our hospital, this single clonal spread was attributed to staff shortage and poor adherence to infection control rules. In conclusion, for the prevention of dissemination of multidrug resistant A.baumannii strains and control of nosocomial infections, infection control strategies should be established and strict compliance to these rules should be provided.

[Evaluation of the toxoplasmosis seroprevalence in pregnant women and creating a diagnostic algorithm]. / Gebelerde toksoplazmoz seroprevalansinin degerlendirilmesi ve bir tani algoritmasinin olusturulmasi

Toxoplasma gondii, an obligatory intracellular protozoon is widely distributed around the world and can infect all mammals and birds. While acquired toxoplasmosis is usually asymptomatic in healthy subjects, acute infection during pregnancy may lead to abortion, stillbirth, fetal neurological and ocular damages. For the prevention of congenital toxoplasmosis it is recommended that a screening programme and a diagnostic algorithm in pregnant women should be implemented while considering the cost effectiveness. Thus, it is necessary to determine the seroprevalence of toxoplasmosis in pregnant women and the actual risk of T.gondii transmission during pregnancy in a certain area. The aims of this study were to detect the T.gondii seropositivity in the pregnant women admitted to our hospital and to create a diagnostic algorithm in order to solve the problems arising from interpretation of the serological test results. A total of 6140 women aged 15-49 years who were admitted to our hospital between April 1st, 2010 to July 31st, 2013, were evaluated retrospectively. In the serum samples, T.gondii IgM, IgG and IgG avidity tests were performed by VIDAS automated analyzer using TOXO IgM, TOXO IgG II and TOXO IgG avidity kits (bioMerieux, France). It was noted that, both T.gondii IgM and IgG tests were requested from 4758 (77.5%) of the pregnant women, while only IgM test from 1382 (22.5%) cases. Sole IgM positivity was found as 0.2% (11/6140), IgG as 26.4% (1278/4758) and both IgM + IgG as 0.9% (44/4758). T.gondii IgG avidity tests were requested from 12 of 44 women who were found both IgM and IgG positive and eight of them revealed high avidity and four low avidity. Avidity test was ordered for the 91 (7.1%) of 1278 sole IgG positive cases and four of them were found to have low avidity. IgG avidity test was ordered for 554 (16.2%) of IgM and/or IgG negative subjects, however, the test was not performed according to rejection criteria of the laboratory. It was noticed that no re-testing was requested for none of the seronegative cases (3428/4758; 72%) during their follow-up. In our study, total Toxoplasma seropositivity rate among pregnant women was detected as 28% (1330/4758), showing statistically significant increase (p< 0.05) with age. There was no significant difference (p> 0.05) in the seropositivity rate between the years (2010-2013). Following the evaluation of the test orders, the problems related to test orders and interpretation of the test results were determined and a diagnostic algorithm to be used in our hospital, was established to minimize such problems in toxoplasma serology. It was concluded that a diagnostic algorithm related to toxoplasmosis serology should be implemented for the appropriate evaluation of the risk of acute toxoplasmosis during pregnancy. Such an approach is necessary to support the clinical diagnosis and to minimize the anxiety in pregnant women about congenital toxoplasmosis.

The effect of hemispheric lesion location on trunk control.

BACKGROUND: Trunk control is the basic component of postural control, and achieving trunk control is a complex process that can be achieved by dynamically building and maintaining neuromuscular function. Lateropulsion, which is also defined as the body falling to one side, is considered an important condition that is frequently encountered after stroke and affects trunk control. It is known that there are differences in the regulation of postural control and trunk control according to hemispheric localization. We had a very specific group of patients and tried to find out the outcomes prospectively in this study. METHODS: The patients were divided into 2 groups those with right hemisphere lesions (Group 1) and those with left hemisphere lesions (Group 2). Comorbidity and cognitive function were evaluated using the Charlson Comorbidity Index (CMI) and Standardized Mini-Mental State Test (SMMSE). Activities of daily living were evaluated using the Turkish version of the Modified Barthel Index (MBI). The Stroke Rehabilitation Assessment of Movement Instrument (STREAM) test was used to assess trunk control and the Brunnstrom (BS) test was used to assess motor functions. RESULTS: There was a significant difference between Groups 1 and 2 in terms of STREAM in lower extremity scores were higher in Group 2 (P < .05). The number of patients in BS lower extremity Stages IV-VI was higher in Group 1 and Group 2 (P < .05). It was determined that upper extremity, lower extremity and Total STREAM scores and BS Hand stage in Group 2 were significantly higher than Group 1 in patients with total middle cerebral artery (MCA) affected(P < .05). CONCLUSION: It was determined that trunk control was more affected in patients with right hemispheric lesions. Additionally, trunk control is significantly affected in patients with total MCA lesions.

The effect of an online-supervised exercise program in older people with diabetes on fasting blood sugar, psychological resilience and quality of life: A double blind randomised controlled trial.

BACKGROUND: Online exercise interventions can improve physical outcomes. Online supervised exercise program is more effective than unsupervised exercise program. OBJECTIVES: The aim of this study is to determine the effect of an online supervised exercise program on fasting blood glucose, body mass index (BMI), resilience and quality of life in older people with diabetes. METHODS: This parallel group randomised controlled study included 70 older patients with Type 2 diabetes. Participants were divided into online supervised and unsupervised exercise training groups. Participants in the online-supervised exercise group were given an online-supervised exercise program 3 days a week for 6 weeks. Personal Information Form, Short Resilience Scale and Quality of Life Scale in Older People were used to collect data. In addition, fasting blood sugar BMI and values were measured. RESULTS: According to the results of our study, while there was no significant difference between the pre-and post-training scores of the supervised and unsupervised groups on the Psychological Resilience Scale and Quality of Life Scale, it was observed that there was a significant difference in both groups according to time (p < .05). When the difference between the scores of the groups before and after the training was analysed according to time, a significant difference was observed between the online-supervised and unsupervised exercise groups (p < .05). In addition, it was seen that there was a significant difference in the fasting blood sugar and BMI results of the online-supervised exercise group according to time (p < .05). CONCLUSIONS: Online supervised exercise program decreases fasting blood sugar and BMI, increases psychological resilience and quality of life of older patients with Type 2 diabetes. IMPLICATION FOR PRACTICE: Online supervised exercise program may be an additional treatment that provides benefits for older people with diabetes who cannot participate in clinical-based rehabilitation programs.

The effect of kinesio taping on pain, respiratory function, and muscle strength after thoracotomy.

Background: This study aims to investigate the effectiveness of kinesio taping on pain, respiratory function, and respiratory muscle strength in patients after posterolateral thoracotomy. Methods: Between June 2019 and May 2020, a total of 88 patients (48 males, 40 females; mean age: 56.1±9.0 years; range, 28 to 69 years) following posterolateral thoracotomy were randomly allocated to the therapeutic kinesio taping group (n=44) or the control group (n=33). Kinesio taping was applied to the kinesio taping group for seven days. Pain, respiratory functions, respiratory muscle strength, amount of analgesic drug use, and quality of life were evaluated preoperatively, on postoperative Day 0, before tape application, postoperative Days 1, 2, and 7, and at postoperative first month. Results: There was no significant difference between the groups in terms of demographic and clinical characteristics. The results of respiratory functions and respiratory muscle strength were all improved in both groups, while there were more significant improvements in the kinesio taping group. There was a statistically significant difference in the mean Visual Analog Scale scores on postoperative Days 2 and 7 between the two groups. The amount of tramadol use of the patients in the kinesio taping group was significantly lower on postoperative Days 2 and 7 than in the control group. Conclusion: Kinesio taping is an effective method to reduce pain and improve respiratory function after posterolateral thoracotomy. Therefore, it is thought that kinesio taping should be applied as a part of the pulmonary rehabilitation program after thoracotomy.

Can trunk control scales differentiate for dependent and independent ambulation in ischemic stroke patients?

Objectives: This study aimed to compare the ability of trunk control scales (TCSs) to distinguish independent ambulation and investigate whether there was a relationship between TCSs and activities of daily living in patients with stroke. Patients and methods: The prospective, cross-sectional study was conducted with a total of 126 patients (52 females, 74 males; mean age: 64.9±10.7 years; range, 40 to 88 years) between August 2018 and January 2020. According to their ability to walk 10 m, the patients were divided into three groups: the nonambulatory group (Group 1, n=31), those who required an assistive device while walking (Group 2, n=35), and those who could walk independently (Group 3, n=60). The Stroke Rehabilitation Assessment of Movement Instrument (STREAM), Postural Assessment Scale for Stroke Patients Scale (PASS), Trunk Impairment Scale, Trunk Recovery Scale, Trunk Control Test, and Modified Barthel Index (MBI) were used to determine the relationship between TCSs and activities of daily living. Results: The median TCS scores differed between the groups; the lowest score was of Group 1, and the highest score was of Group 3 (p

Panton-Valentine leucocidin gene carriage among Staphylococcus aureus strains recovered from skin and soft tissue infections in Turkey.

OBJECTIVES: Regardless of methicillin resistance, Panton-Valentine leucocidin (PVL)-positive Staphylococcus aureus isolates are associated with various types of infections and outbreaks. Limited data exist about the PVL content of S. aureus strains in Turkey. In this multicentre study, we aimed to assess the PVL positivity and antimicrobial susceptibilities of S. aureus isolates recovered from skin and soft tissue samples of both community and nosocomial origin in the study period, 2007-08. METHODS: Two hundred and forty-two [92 community-acquired (CA) and 150 hospital-acquired (HA)] isolates were included in the study. Analysis of mecA and PVL was carried out using PCR. All isolates underwent susceptibility testing according to the CLSI. RESULTS: Out of 242 isolates, 77 were mecA positive. PVL was not found among methicillin-resistant S. aureus (MRSA) isolates, but 8 (5.3%) HA methicillin-susceptible S. aureus (MSSA) and 14 (15.2%) CA-MSSA, mostly isolated from furuncles (71.4%), were positive for PVL. Among PVL-positive strains, the penicillin resistance rate was 90.9%. Low resistance rates, <10%, were detected for erythromycin, fusidic acid and co-trimoxazole. PVL-positive strains showed higher rates of susceptibility to erythromycin, gentamicin and rifampicin than negative isolates. CONCLUSIONS: Based on the findings of this study, infection related to PVL-carrying CA-MRSA is not at an alarmingly high level, but population-based surveillance studies should be done to determine the real status.

[The rare genes related to resistance to macrolide-lincosamide and streptogramin B group antibiotics among coagulase-negative staphylococci]. / Koagülaz-Negatif Stafilokoklarda Makrolid-Linkozamid-Streptogramin B Grubu Antibiyotiklere Karsi Nadir Direnç Genlerinin Arastirilmasi

Macrolide-lincosamide-streptogramin B (MLSB) group antibiotics are recommended as first choice in the treatment of staphylococcal infections. All of those drugs bind to the 50S subunit of bacterial ribosomes, thus cross-resistance is a major concern in this group of drugs. The mechanisms associated to resistance are (a) ribosomal methylation due to the methylases encoded by erm genes, (b) active drug efflux due to msrA, msrB, vga, vgb gene activity, (c) enzymatic inactivation of the drug due to the activity of linA, vat, vatB genes. While the most common resistance genes are ermA, ermB, ermC, msrA and msrB genes; linA, vga, vgb, vat and vatB genes have also been found in some studies. In this study it was aimed to investigate the presence of the rare MLSB resistance genes and their coexistence with erm and msr genes in 454 clinical isolates of coagulase-negative staphylococci (CNS). Of them 46.5% (n= 211) were S.hominis, 30.8% (n= 140) were S.epidermidis, 12.1% (n= 55) were S.haemolyticus, 3.5% (n= 16) were S.warnerii and 7% (n= 32) were the other coagulase-negative staphylococcal species. Resistance phenotypes were determined by using D-test method according to the recommendation of Clinical and Laboratory Standards Institute (CLSI). With the D-test 107 (23.6%) strains were determined as M phenotype (resistant to erythromycin and inducible clindamycin resistance was not detected), 92 (20.3%) were iMLSB phenotype (inducible clindamycin resistance was detected by the D-test) and 110 (24.2%) were cMLSB phenotype (constitutive erythromycin and clindamycin resistance was detected). linA, vga, vgb, vat, vatB, ermA, ermB, ermC, msrA, msrB genes were investigated by polymerase chain reaction in all strains showing iMLSB (n= 92) and cMLSB (n= 110) phenotypes and 46 randomly selected strains among 107 strains exhibiting the M phenotype. linA gene was found in 91 (20%) strains as single gene or in combination with erm or msr genes, and vga gene was found in 19 (4.2%) strains. linA gene was found in 52% of iMLSB phenotype, in 26% of cMLSB phenotype and 13% of M phenotype while vga gene was found in 5.4% of iMLSB phenotype, in 12% of cMLSB phenotype and in 0.9% of M phenotype. The most common resistance gene among iMLSB and cMLSB phenotypes was ermC (32.6% and 42.7%, respectively), followed by ermC + linA gene combination (31.5% and 14.5%, respectively). The most frequent gene combination was msrA and msrB in M phenotype (34.8%) and it was followed by a combination of msrA + msrB + linA genes (19.1%). None of the strains revealed presence of vgb, vat and vatB genes. There were no previous reports about the rarely detected resistance genes against MLSB antibiotics in our country. This was the first study which reported the frequency of linA, vga, vgb, vat and vatB genes in MLSB resistant CNS. In conclusion, since linA and vga genes were detected in high frequency in MLSB resistant CNS in this study, it was thought that the investigation of these genes should be included in the further related epidemiologic gene research.

[Phenotypic and genotypic traits of vancomycin-resistant enterococci in a public hospital: the first vanB-positive Enterococcus faecium isolates]. / Bir Devlet Hastanesinde Vankomisine Dirençli Enterokok Suslarinin Fenotipik ve Genotipik Olarak Degerlendirilmesi: Ilk vanB-Pozitif Enterococcus faecium Izolatlari

Thirty eight vancomycin resistant enterococci (VRE) were isolated in one year surveillance study for hospital infection control programme in a state hospital in Ankara, Turkey. All isolates were identified as Enterococcus faecium by VITEK2 system (bioMerieux, France). Vancomycin and teicoplanin resistant 30 strains were defined as vanA phenotype while vancomycin-resistant teicoplanin-susceptible eight strains were defined as vanB phenotype. vanA genes were found in 30 strains while vanB genes were found in five strains by using PCR method. Those five strains were the first vanB positive E.faecium strains in our country. VRE strains revealed six different band patterns by PFGE, while six isolates could not be classified. All isolates with vanB type resistance were found in the same cluster. Source of vanB positive strains was considered as the hemodialysis unit. When the previous national reports related to vancomycin-resistant enterococci were considered, this was the first report of vanB positive E.faecium isolates in our country. This emphasized that both the diversity of VRE and the isolation rate was increasing. In order to eliminate the spread of VRE, effective surveillance studies should be performed and protective measures should be established promptly.

Prevalence of microsporidia in healthy individuals and immunocompetent patients with acute and chronic diarrhea.

BACKGROUND: Previously published studies of microsporidial infections have primarily focused on immunodeficient or immunocompromised patients. Data regarding infections caused by this microorganism in immunocompetent subjects are lacking. In the present study, we investigated the prevalence of microsporidia in healthy individuals and immunocompetent patients with acute and chronic diarrhea. METHODS: The study included stool samples from 74 patients with acute diarrhea, 41 patients with chronic diarrhea, and 88 healthy volunteers. Slides were prepared after concentration with a formalin-ethyl acetate technique and were stained with modified trichrome, calcofluor white, and Uvitex 2B stains. The number of spores observed in each magnification field (×1000) was scored as follows: 1+, 1-10; 2+, 11-20; 3+, > 20. RESULTS: The prevalence of microsporidia was 27.0% in patients with acute diarrhea, 34.1% in patients with chronic diarrhea, and 45.5% in healthy volunteers. The parasite score was 1 + in all positive samples. The rate of microsporidia positivity was higher in solid stools (51.4%), and the rate of positivity increased with advancing age. CONCLUSION: Unexpectedly, a high prevalence of microsporidia was found in immunocompetent individuals in our region. There was no relationship between positivity for microsporidia and the presence of symptoms, due to higher rates both in solid stools and in healthy subjects. The parasite score was the same in all groups. Our results indicate that there is high exposure to microsporidia in immunocompetent subjects in our region. Natural reservoirs and environmental sources of microsporidia should be determined to design strategies for effective prevention of transmission.

High-risk Oncogenic Human Papilloma Virus Infection of the Foreskin and Microbiology of Smegma in Prepubertal Boys.

OBJECTIVE: To evaluate the prevalence and genotypes of human papillomavirus (HPV) infection and microbiological status of the foreskin in asymptomatic prepubertal boys. METHODS: A total of 100 prepubertal healthy boys who underwent a standard circumcision procedure were included in the study. High-risk HPV status was determined by real-time polymerase chain reaction for the genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68. The swabs were immediately sent to microbiology laboratory for culture and sensitivity tests. RESULTS: The median age at the time of surgery was 5.7 years (range, 2 months-9 years). High-risk HPV was detected in 9 foreskins (9%). Positive samples showed are HPV16 (n = 3), 31 (n = 2), 39 (n = 3), and 51 (n = 1). There were a total of 72 organism isolates: 54 gram-positive (75%) and 17 gram-negative (23.6%) bacteria and 1 (1.4%) Candida. The most commonly isolated gram-negative bacterium was Escherichia coli (41.2%), whereas the commonly isolated gram-positive bacterium was Enterecoccus sp. (57.4%). CONCLUSION: Our results showed that subclinical high-risk HPV infections are found in the foreskin, which could be a reservoir for HPV-associated diseases, and smegma seems not to be a risk factor for drug-resistant infection in children.

[Role of Dientamoeba fragilis and Blastocystis spp. in Irritable Bowel Syndrome]. / Irrite Bagirsak Sendromunda Dientamoeba fragilis ve Blastocystis spp.'nin Rolü

OBJECTIVE: We investigated the prevalence of Dientamoeba fragilis and Blastocystis spp. in IBS patients and evaluated whether there was a possible link between IBS and these parasitic infections. METHODS: Stool specimens collected from 55 IBS patients, 80 patients with gastroenteritis as control group 1 (CG-1) and 50 healthy volunteers as control group 2 (CG-2) were included the study. Samples were examined by direct microscopy, trichrome staining and culture methods. RESULTS: While there was no significant difference in the prevalence of Blastocystis spp. between IBS patients and CG-1 (p > 0.05), a significant difference was found between IBS and CG-2 (p < 0.05). Patients with IBS were found to have five or more Blastocystis spp. per field than control groups. After eradication, all symptoms were cured in four patients, there were only constipation problems left in eleven patients and there were no changes in clinical findings in three patients. D. fragilis was not found in any of the samples. CONCLUSION: The reason we did not find any D. fragilis may be due to the low infection rate in the region. However, significantly having five or more Blastocystis spp. per field (X40) in IBS patients and regression of IBS symptoms after treatment in most of the patients suggested a possible link between IBS and Blastocystis spp.