Peer education model in Trakya university faculty of medicine.

BACKGROUND: Peer education is an education model applied to change knowledge, behavior, and attitude in groups equal to each other regarding age, education, and status. This model is preferred in universities to improve teaching skills and reduce the stress level of students. This study aims to apply the peer education model at Trakya University Faculty of Medicine to receive feedback from students and to examine its effect on exam results. METHODS: This cross-sectional, descriptive, and analytical study was conducted with second-year medical students in parasitology laboratory lessons. Eighteen out of a total of 264 students were selected as peer educators. Peer educators have reached the level of providing education to students by taking the training before the laboratory lessons. At the end of the study, questionnaires were applied to peer educators and students. The students' of 2021-2022 exam results were compared with the 2018-2019 academic year results. RESULTS: A total of 233 students were surveyed, and 78.5% (183/233) of them believe peer education is helpful, 69.9% (163/233) think it can help them reinforce what they have learned in theoretical lessons, 54.5% (127/233) think it should be used in other practical lessons, and 64.3% think it should be used in the coming years. While there was no significant difference between the exam results of the students in 2021-2022 and the 2018-2019 period (p: 0.462), a significant difference was found between the exam results of peer educators and students (p < 0.05). CONCLUSIONS: It is known that with the peer education model, student stress will decrease, and interest and participation in the lesson will increase. Continuing this education model in the coming years and expanding it to other laboratory courses will benefit medical education.

Retrospective Evaluation of Toxoplasma gondii Serological Test Results of Trakya University Health Center for Medical Research and Practice

Objective: Toxoplasma gondii (T. gondii) is an obligate intracellular parasite distributed worldwide. Serological tests investigating antibodies specific to T. gondii are widely used in diagnosis. The aim of this study was to evaluate the results of anti-T. gondii IgG, anti-T. gondii IgM, and anti-T. gondii IgG avidity tests, which were sent to the Serology Laboratory of Trakya University Health Center for Medical Research and Practice, retrospectively. Methods: Anti-T. gondii IgM, anti-T. gondii IgG, and anti-T. gondii IgG avidity tests were studied by enzyme-linked fluorescent assay or electrochemiluminescence immunoassay method between January 2012 and December 2021. The test results were evaluated retrospectively from laboratory records. Results: Of 18,659 serum samples were studied for anti-T. gondii IgG, 5,127 (27.5%) samples were positive, whereas 721 (3.4%) of 21,108 samples were positive for anti-T. gondii IgM. Of the 593 serum samples tested for IgG avidity, 206 (34.7%) samples had low avidity, 118 (19.9%) had borderline, and 269 (45.4%) had high avidity. Conclusion: Our study, compatible with other studies, showed that seropositivity is high in our region, which is not negligible. Especially in women of reproductive age population, T. gondii should be considered in suspected clinical cases.

Genotyping and Identification of Antigen B Gene Polymorphism of Echinococcus granulosus in Edirne, Thrace, and the First Report of Genotype G2 (Tasmanian Sheep Strain) in Turkey

Background: Echinococcus granulosus is the causative agent of cystic echinococcosis in humans and livestock. It is common worldwide. Cystic echinococcosis is still an important public health problem in Turkey, which is an endemic region. Aims: To genotype Echinococcus granulosus isolates and investigate antigen B gene polymorphism in Thrace, Turkey. Study Design: A cross-sectional study. Methods: Seventy-five hydatid cyst materials obtained between June 2020 and May 2021 were included in the study. Hydatid cyst materials were collected from 12 humans from various hospitals in Edirne and 63 from slaughterhouse animals during the same period. Cyst materials were localized in 8 livers and 4 lungs in humans, 23 livers and 17 lungs in cattle, and 13 livers and 10 lungs in sheep. In the first step, the 12S ribosomal RNA gene was amplified by polymerase chain reaction for all samples and run on an agarose gel. Band patterns were used for strain typing. Then, the selected samples that represented each of the band patterns obtained by single-strand conformation polymorphism analysis were sequenced for AgB1, AgB2, mt-CO1, and mt-ND1 genes. Results: Three different genotypes in Edirne, Thrace, Turkey, were observed for Echinococcus granulosus: G1 (domestic sheep strain), G2 (Tasmanian sheep strain), and G3 (buffalo strain). G1 was the dominant genotype in Edirne, and G3 was the second most common. Additionally, polymorphism in AgB1 and AgB2 gene regions was found. Conclusion: This study is the first to report on Echinococcus granulosus G2 (Tasmania sheep strain) in Turkey and G3 (buffalo strain) and antigen B polymorphism in Thrace. The study results will contribute to the prevention and control programs for cystic echinococcosis in Turkey and worldwide.

Investigation of Antimicrobial Susceptibilities and Resistance Genes of Campylobacter Isolates from Patients in Edirne, Turkey.

Background: We aimed to determine the susceptibility of Campylobacter isolates obtained from patients to various antimicrobial agents and to investigate some related antimicrobial resistance genes. Methods: Fifty-six Campylobacter isolates obtained from fecal specimens by conventional methods at the Trakya University Health Center for Medical Research and Practice, Department of Medical Microbiology in Edirne, Turkey, from 2017-2017 were included. Antimicrobial susceptibilities were investigated by the gradient strip test method, and species determination was made by multiplex polymerase chain reaction (mPCR). The presence of the erm(B) gene and tet(O) gene was investigated in all isolates by PCR. DNA sequence analysis was performed to detect the presence of mutations in the 23S rRNA positions 2074 and 2075 in five isolates, including two erythromycin resistant isolates. The gyrA gene mutation was investigated by the mismatch amplification mutation assay (MAMA)-PCR. Results: In 54 C. jejuni isolates, resistance to erythromycin was 3.7%; to tetracycline, 59.3%; and to ciprofloxacin, 74.1%. Phenotypically, the tet(O) gene was detected in 33 tetracycline-resistant isolates, but no erm(B) gene was found in any of the Campylobacter isolates. As a result of the DNA sequencing, it was found no mutations in the 23S rRNA gene at the 2074 and 2075 positions. The gyrA mutation was observed in all 41 ciprofloxacin resistant Campylobacter isolates. Conclusion: Among the antimicrobial agents tested, ciprofloxacin had the highest resistance rate, and erythromycin had the lowest. Antimicrobial resistance in Campylobacter increased significantly compared with previously studies in our region as well as in the entire world. Monitoring the resistance to antimicrobial agents used to treat Campylobacter infections is important in determining empiric antimicrobial treatment.

Serological Follow-up of Human Cystic Echinococcosis in the Thrace Region, Turkey.

Background: Parasites of the genus Echinococcus are common worldwide and are important cestodes that cause serious infections in humans and animals. This retrospective study evaluated the indirect hemagglutination (IHA) test results of serum samples obtained from patients with a pre-diagnosis of cystic echinococcosis (CE) within ten years. In addition, the role of the IHA test results of the patients in the follow-up of the treatment and determining possible recurrences was investigated. Methods: The IHA test results of 2426 serum samples of patients with a pre-diagnosed CE admitted to Trakya University Health Center for Medical Research and Practice in Edirne, Turkey, between January 2011 and December 2020 were evaluated retrospectively. The data of 53 patients with CE who had medical treatment and/or postoperative follow-up serological records were evaluated. Results: Of 2426 IHA tests, 376 (15.5%) were seropositive, and 2050 (84.5%) were seronegative. It was determined that 376 serum samples detected as positive belonged to 207 patients with CE. Of 207 CE patients, 109 (52.7%) were female and 98 (47.3%) were male. The most common organ involvement was the liver in 186 (89.9%) cases. Of 53 patients, 16 were considered relapse cases. The median follow-up period for 16 recurrent cases was 31.8 (1-77) months. Our results showed a statistically significant correlation between long-term serological follow-up and recurrence detection (P=0.034). Conclusion: Long-term serological follow-up after treatment is considered useful in determining possible recurrent cases. CE is an important public health problem for endemic regions, including our country, and we think our study results will contribute to the status and follow-up of the disease.

Investigation of antimicrobial resistance and virulence genes of Campylobacter isolates from patients in a tertiary hospital in Edirne, Turkey.

Purpose: Campylobacter is one of the most common pathogens that cause food-borne infections worldwide. The aim of this study was to determine the antimicrobial resistance rates and the presence of multiple virulence genes in Campylobacter isolates obtained from humans. Materials and Methods: In this study, 71 Campylobacter isolates obtained from human faecal samples were used. Antimicrobial susceptibility tests were performed through the gradient strip method. The presence of virulence genes was investigated by monoplex and multiplex polymerase chain reaction. Results: The rate of resistance of the 66 Campylobacter jejuni isolates was 12.1% for erythromycin, 40.9% for tetracycline and 68.2% for ciprofloxacin. Only one of five Campylobacter coli isolates was resistant to these three antimicrobial agents. The flaB, pldA, cdtA, cadF, cdtC and ceuE genes were found in all 66 of the C. jejuni isolates. In the C. jejuni isolates, positivity rates of 92.4% for flaA, 96.7% for cdtB, 98.5% for ciaB, 90.9% for dnaJ and 96.7% for racR were observed. The flaA, flaB, ciaB, cdtA and cdtC genes were present in all C. coli isolates. Conclusions: It was detected that there is an increase in antimicrobial resistance of Campylobacter strains in our region, and most of the isolates harbour virulence genes.

Seroprevalence of Leishmaniasis Among Dogs Living in a Municipal Dog and Cat Shelter in Edirne.

OBJECTIVE: In this study, we aimed to investigate the seroprevalence of canine leishmaniosis among dogs that live in the town center due to a lack of data on the prevalence of canine leishmaniasis (CanL) in Edirne. METHODS: In the present study, 37 dogs living in a municipal dog and cat shelter in Edirne were screened for leishmaniosis by the indirect fluorescent antibody test. RESULTS: All samples were found to be seronegative. CONCLUSION: Our study is a preliminary study for Edirne. We wish to perform a large-scale seroepidemiological study with a larger number of dogs from different regions and identify Phlebotomus species.

[Genotyping of Giardia intestinalis isolates in the Thrace Region, Turkey]. / Trakya Bölgesi'ndeki Giardia intestinalis izolatlarinin genotiplendirilmesi.

Giardia intestinalis is a common protozoon that infects humans and may cause water and food-borne outbreaks. It is regarded as a major public health problem worldwide and in Turkey as well. Molecular techniques are widely used to determine the epidemiology, genetic populations and taxonomy of G.intestinalis. It has two genotypes including genotype A and genotype B in humans. The purpose of the present study is to implement the molecular analysis and genotyping of the isolates of G.intestinalis obtained from human stool samples. A total of 39 isolates obtained from the stool samples of persons (30 male, 9 female; age range: 1-74 years, median age: 20) who have admitted to Trakya University Medical Research and Practice Health Center and Edirne State Hospital between September 2011- April 2013 were included in the study. The average number of cysts were identified both with native and lugol methods among all microscopically detected samples by screening at least 50 field with x400 magnification. The samples were then analyzed through loop-mediated isothermal amplification method (LAMP) for the presence of elongation factor-1 alpha (EF-1α) gene, and polymerase chain reaction (PCR) method for the presence of beta-giardin (bg) gene regions. In addition, sequence analysis of bg gene was performed. Of 39 samples, 32 (82%) and 19 (48.7%) were found to be positive for G.intestinalis EF-1α and bg genes by LAMP and PCR methods, respectively. Genotyping was implemented in 17 out of 19 samples yielding nine genotype A and eight genotype B strains. The sub-genotypes of these strains were identified as A2 (n= 6), A3 (n= 3), B2 (n= 6), B3 (n= 1) and B4 (n= 1). In eight isolates that could be typed among 21 symptomatic patients, genotype B (n= 5) and in nine isolates that could be typed among 18 asymptomatic patients, genotype A (n= 6) were more frequently observed. There was no significant association between symptomatic or asymptomatic status and genotypic patterns of the cases (p= 0.347). The PCR positivity rate showed a significant difference between patients with higher cyst density and lower cyst density (p= 0.0001). In conclusion, molecular methods such as LAMP and PCR might have the potential to provide a substantial guidance for the analysis of outbreaks. In addition, the determined subtypes of G.intestinalis in our region is expected to contribute to the global epidemiological data.

Molecular Characterization of Human and Animal Isolates of Echinococcus granulosus in the Thrace Region, Turkey.

OBJECTIVE: Echinococcus granulosus is the causative agent of cystic echinococcosis in humans and many domestic animals, and remains an important global health problem. The aim of this study was to genotype E. granulosus isolates obtained from humans and animals in the Thrace Region of Turkey. MATERIAL AND METHODS: A total of 58 isolates were obtained from patients who underwent surgery at several hospitals and from animals at a slaughterhouse in the province of Edirne. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis of ribosomal internal transcribed spacer 1 fragments, and polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) of the partial mitochondrial NADH dehydrogenase subunit 1 (ND1) gene, was used to characterize human and animal E. granulosus isolates. To investigate the genetic characteristics of isolates, deoxyribonucleic acid (DNA) sequencing of the mitochondrial cytochrome c oxidase subunit 1 (CO1) and ND1 genes was performed. RESULTS: Fifty-eight E. granulosus isolates, including 42 from human, 13 from cattle and 3 from sheep were, analyzed. The results indicated two distinct genotypes: the G1 (sheep strain) and G7 (pig strain) genotypes. The sheep strain was shown to be the most common genotype of E. granulosus affecting humans, sheep and cattle. Among the concatenated partial CO1 and ND1 sequence data, eight haplotypes of Echinococcus species were identified in the present study. CONCLUSION: This is the first report indicating that the E. granulosus pig strain is present in humans in this region. We suggest that new strategies be designed for E. granulosus control programs in Turkey.

Serological monitoring of paediatric visceral leishmaniasis By IFA and ELISA methods.

OBJECTIVE: Visceral leishmaniasis (VL) is endemic in all Mediterranean countries including Turkey, and children are at greater risk than adults in endemic areas. In VL patients, serological assays are considered to be sensitive for the diagnosis and/or follow up. The aim of this study was to assess the usefulness of serology for following up of childhood VL in Turkey. METHODS: Sera obtained from twenty parasitologically confirmed children with VL were tested using IFAT and ELISA. The patients were monitored clinically and serologically (range: 20-500 days) during and after treatment. All VL patients were treated with meglumine antimonate. RESULTS: Anti-Leishmania antibodies in successfully treated VL patients showed a steep decline but, in three patients who had relapsed, an increase was detected. Significantly lower values were observed after treatment with both serological techniques. Mean ELISA optical density values before and after treatment were: 0.78 ± 0.36 (0.26-1.76) and 0.38 ± 0.24 (0.09-0.83) respectively, (p < 0.001) and mean IFAT values (log10 transformed titers) before and after treatment were: 3.02 ± 0.90 (1.81-4.51) and 2.16 ± 0.75 (1.20-3.90) respectively, (p < 0.001). CONCLUSION: ELISA and IFAT are valuable not only for diagnosis but also for monitoring of drug therapy in childhood visceral leishmaniasis as rapid and non-invasive techniques.

Fasciola hepatica infection in echinococcosis suspected cases.

OBJECTIVE: Fasciola hepatica, a liver fluke of sheep and cattle, may accidentally infect humans. The main signs and symptoms of the fasciolosis are eosinophilia, abdominal pain and hepatomegaly and may also be attributed to Cystic Echinococcosis (CE) caused by Echinococcus granulosus, which is a prevalent infection in Turkey. METHODS: Sera samples of 226 CE suspected cases were tested for anti-F. hepatica antibodies by an excretory secretory ELISA (ES-ELISA) and for anti-E. granulosus antibodies by ELISA and indirect hemagglutination (IHA) tests. Cases which were seropositive for fasciolosis were further evaluated radiologically and examined for F. hepatica eggs. RESULTS: Five (2.2%) and 96 (42.4%) of the 226 CE suspected cases were found seropositive for fasciolosis and CE, respectively. Although the radiological findings strongly suggested that there was fasciolosis in three cases, F. hepatica eggs were detected in two patients only. CONCLUSION: These data suggest that human fasciolosis is not as rare as previously reported in Turkey. F. hepatica infection should be suspected especially in the presence of eosinophilia, abdominal pain and liver lesions.

Case report: First evidence of human zoonotic infection by Onchocerca lupi (Spirurida, Onchocercidae).

In the past decades, cases of canine ocular onchocercosis have been reported worldwide, particularly in the United States and Europe. Onchocerca lupi, originally described from a wolf, has been implicated in some of these cases, and its zoonotic role has been hypothesized on the basis of the reexamination of two cases of human ocular onchocerciasis. In the present study, we describe, for the first time, the occurrence of O. lupi in the subconjunctival region of the human eye in a patient from Turkey. The nematode was identified as O. lupi based on its morphology and molecular phylogenetic analysis of partial cox1 and 12S ribosomal DNA genes. The results suggest that O. lupi should be considered in the differential diagnosis of other eye parasitic infections in humans. The role of dogs as natural hosts of O. lupi and the vectors of this zoonotic parasite need to be investigated.

Serological and entomological survey of zoonotic visceral leishmaniasis in Denizli Province, Aegean Region, Turkey.

A cross-sectional seroepidemiological survey of leishmaniasis was carried out among children and adults from four villages and one district of Denizli province located in the Southern Aegean Region of Turkey where 14 human visceral leishmaniasis (HVL) cases including 4 adults were reported between 1993 and 2000. Blood samples were taken from 329 children, 217 adults and 140 dogs and a physical examination was also done. Indirect fluorescent antibody test and enzyme linked immunosorbent assay were performed for all sera. All 329 sera collected from children were found to be negative while 2 (0.09%) out of 217 adult sera were found to be seropositive. One seropositive adult patient was confirmed parasitologically as HVL after bone marrow aspiration and treated with AmBisome while the other was followed only serologically because of the absence of symptoms. The overall canine leishmaniasis seroprevalence was found to be 20.7%. Sand flies were collected using CDC light traps in three out of five study sites and midguts of females were checked for promastigotes after dissection/identification. Eight Phlebotomus species were found in the region. Phlebotomus neglectus and P. papatasi were determined as dominant species with the ratio of 43.52% and 37.35%, respectively. No promastigotes were found in the midgut specimens. In addition, the results showed the presence of vector sand fly species, as well as a high seroprevalence of anti-Leishmania antibodies among dogs from rural and a suburban area of Denizli province with a large proportion of asymptomatic seropositive dogs.

[Cystic echinococcosis in Turkey from 2001-2005]. / Türkiye'de 2001-2005 Yillari Arasinda Kistik Ekinokokkozis.

Cystic echinococcosis (CE) caused by the metacestode form of Echinococcus granulosus is a major public health problem especially in animal-raising regions of the world. In the present study, CE cases were determined during 2001-2005 by investigating different hospital and health directorship documents and Health Ministry documents, retrospectively. Our results show that there were 2534 (13.13%) cases in the Marmara region; 2114 (16.94%), in the Aegean region; 2578 (16.09%), Mediterranean region; 5404 (38.57%), in the Middle Anatolian region; 428 (5.70%), in the Black Sea region; 844 (6.80%), in the eastern Anatolian region; and 887 (2.75%), in the southeastern Anatolian region making a total of 14,789 CE cases. Finally, it has been determined that the patients were hospitalized for a total of 149,464 days.

Investigation of asymptomatic visceral leishmaniasis cases using western blot in an endemic area in Turkey.

In Turkey, Leishmania infantum is responsible for human visceral leishmaniasis (VL), which is seen mainly in the Aegean, Mediterranean, and Central Anatolia Regions. This study aimed to determine asymptomatic infections in an endemic area of VL in Turkey using the western blot technique. A total of 82 persons including children and adults were chosen randomly in Denizli province which is one of the endemic sites for VL. Serum samples were collected and screened using indirect immunofluorescent test (IFAT), enzyme-linked immunosorbent assay (ELISA) and western blot (WB). One year later, 35 of the 82 persons were sampled and screened serologically for the second time. Seven out of 82 samples were found to be positive by western blot analysis with the presence of 14 and/or 18 kDa bands. Two of these seven sera were also positive by IFAT, but only one of these two was positive by ELISA. Only one person showing seropositivity with all three tests had clinical symptoms and was diagnosed as VL with the presence of amastigotes in bone marrow aspirate. Because six people, including the one found to be seropositive in all two tests, had no clinical symptoms, they were accepted as asymptomatic carriers. The ratio of asymptomatic infection was calculated as 7.41% (6/81) in the region. In the second sampling, the western blot revealed antibodies against the same antigens in all seven subjects. Our findings showed that the presence of antibodies against 14 and 18 kDa antigens are important for the diagnosis of symptomatic and asymptomatic infections. Western blot was found to be effective in the detection of asymptomatic persons in the epidemiological studies in endemic areas.

Tularemia re-emerging in European part of Turkey after 60 years.

The aim of this study was to investigate a tularemia outbreak in the Thrace region of Turkey. The outbreak occurred in Demirkoy village of Edirne, in 2005. Of 400 villagers, 266 were examined and their sera were taken. Throat swabs and lymph node aspirates were cultured. Specific antibodies in patients and domestic animals were screened by a microagglutination test. PCR assays and cultures of the samples of patients, animal tissues, and water sources were performed, along with active surveillance to identify risk factors. Seven out of 10 cases were diagnosed as oropharyngeal form; the remaining three patients were asymptomatic. The cultures for tularemia were negative; however, PCR assays were positive in one lymph node aspirate and in water from one spring. Some animals had the specific antibody at low levels. Increased rodent population in the vicinity, exposure to wild rabbits, and drinking from one of the springs were identified as risk factors with the risk ratios (and 95% confidence interval) of 10.5 (10.3-10.7), 6.5 (5.43-7.57), and 2.1 (1.1-2.5), respectively. Therapeutic and preventive measures were taken. When tularemia cases have been detected in a region even a few decades earlier, tularemia should be considered in the differential diagnosis of patients.

Visceral larva migrans presenting as acute abdomen in a child.

An unusual presentation of visceral larva migrans observed in a patient is reported. A 5-year-old boy suffering fever, abdominal pain, tenderness, and rigidity in the right lower and upper quadrant of the abdomen was operated on, with the false diagnosis of acute abdomen, and exploratory surgery was carried out. The pathological examination of the liver biopsy revealed eosinophil-rich necrotizing granulomatous inflammation with Toxocara spp larva. The diagnosis was also confirmed by serologic results. Clinicians should remember that toxocaral visceral larva migrans may rarely mimic an acute abdomen and cause unnecessary operations.