Genomic analyses of Francisella tularensis strains confirm disease transmission from drinking water sources, Turkey, 2008, 2009 and 2012.

Waterborne epidemics of tularaemia caused by Francisella tularensis are increasingly reported in Turkey. We have used whole genome sequencing to investigate if F. tularensis isolated from patients could be traced back to drinking water sources. Tonsil swabs from 33 patients diagnosed with oropharyngeal tularaemia in three outbreaks and 140 water specimens were analysed. F. tularensis subsp. holarctica was confirmed by microagglutination and PCR in 12 patients and five water specimens. Genomic analysis of three pairs of patient and water isolates from outbreaks in Sivas, Çorum, and Kocaeli showed the isolates to belong to two new clusters of the F. tularensis B.12 genetic clade. The clusters were defined by 19 and 15 single nucleotide polymorphisms (SNPs) in a multiple alignment based on 507 F. tularensis genomes. One synonymous SNP was chosen as a new canonical SNP (canSNP) for each cluster for future use in diagnostic assays. No SNP was identified between the genomes from the patient­water pair of isolates from Kocaeli, one SNP between the pair of isolates from Sivas, whereas the pair from Çorum differed at seven SNPs. These results illustrate the power of whole genome sequencing for tracing F. tularensis patient isolates back to their environmental source.

Turkish nurses' utilization of research evidence in clinical practice and influencing factors.

BACKGROUND: Implementing research evidence in clinical practice is a complicated process. Successful implementation requires an understanding of factors related to nurses' competency in different fields regarding research knowledge and skills, clinical practice, organizational and educational issues. AIM: To explore the factors that nurses believe are essential for research evidence to become the basis of their practice. DESIGN AND METHOD: A descriptive design was used in this study. With stratified sampling, a total of 219 nurses were recruited from 55 inpatient clinics of three hospitals in Turkey. The study data were collected by questionnaire consisting of non-numeric and open-ended questions in order to obtain the nurses' intact expressions regarding evidence-based nursing. FINDINGS: Respondents who perceived conducting research as a part of their professional role (82) were more likely to implement research into practice than others (68) (P < 0.05). Furthermore, older and highly experienced nurses were more likely to implement evidence into practice (P < 0.05). There was a difference between research utilization and perceived support from organizations (P < 0.05). Nurses who knew the definition of evidence-based nursing (36; 53.6% always, and 19; 28.5% sometimes) were more likely to utilize research findings in practice than others (P < 0.05). CONCLUSIONS: The study emphasized the importance of nursing education and organizational support in order to accomplish the implementation of evidence-based nursing. The findings indicated that integrating all sources of evidence into practice, and appreciating the use of evidence in clinical practice are crucial in surmounting the challenge of achieving evidence-based practice.

Are official reports sufficient? Official registration rates of patients with tuberculosis in Sivas, Middle Anatolia.

PURPOSE: The main goal of this retrospective study was to re-evaluate all available records of clinical and laboratory data of patients with tuberculosis (TB) in Sivas province, Middle Anatolia, Turkey. METHODS: TB registration data held at health institutions in Sivas province were compared and matched with data obtained from the local official TB registries from January 2000 to December 2001. RESULTS: Of the 536 TB cases found in 2000 and 2001, 255 (47.6%) were officially registered. Of the 127 cases with smear-positive pulmonary TB (PTB), only nine cases labelled as smear-positive were registered in local dispensaries. The incidence of unregistered cases with smear-positive PTB found by this study was approximately 40-fold and eightfold greater than the incidence of registered cases for 2000 and 2001, respectively. CONCLUSION: There were many more unofficially recorded TB patients compared with officially recorded cases in Sivas province between 2000 and 2001. The results of this study are disappointing and alarming for Turkey's national TB control programme, at least for its regional applications.

Pancytopenia with hypocellular bone marrow due to miliary tuberculosis: an unusual presentation.

In a patient who presented with fever, weight loss and abdominal swelling, blood counts revealed pancytopenia. Broad-spectrum empirical antibiotic treatment was started because of neutropenic fever, but without effect. The bone marrow was hypocellular with an increase in fat droplets. Peritoneoscopy was performed to evaluate ascites; in the liver biopsy specimen caseous granulomas were seen and the patient was found to suffer from miliary tuberculosis. Antituberculous therapy was begun and the patient recovered completely and the haematological parameters returned to normal.