Does vaginal irrigation with saline solution in women with infectious vaginitis contribute to the clinical and microbiological results of antibiotic therapy?

AIM: To compare the clinical and microbiological results between patients with infectious vaginitis receiving vaginal irrigation with saline or no irrigation before standard antibiotic therapy. METHODS: Women with vaginitis (n = 109) were randomized to receive vaginal irrigation with saline or no irrigation before standard antibiotic therapy. The vaginal symptoms perceived by subjects and clinical findings were assessed with a standardized scale during four follow-up visits, and Gram stain Nugent scores and vaginal fluid cultures were analyzed at each visit. RESULTS: Vaginal discharge (z = 7.159; p < 0.001), pruritus (z = 5.169; p < 0.001), itching (z = 2.969; p < 0.003) and odor scores (z = 2.303; p < 0.021) were significantly reduced in the study group compared to the control group between the first visit and 3-5 days after irrigation, before the start of antibiotic therapy. The second and third visits (15 and 30-45 days after antibiotic therapy) showed that the patients' symptoms and amounts of visible vaginal discharge did not differ between the two groups. Moreover, the microbiological cures of patients in each group did not differ at these visits (z = 0.447; p = 0.655). CONCLUSION: Vaginal irrigation with saline significantly reduces self-reported symptoms in the short term but has no effect on long-term clinical and laboratory results in women with infectious vaginitis.

School-based deworming programme in Sanliurfa, Turkey: changing from externally funding phase to self-sufficient phase.

In Sanliurfa, Turkey, externally funded temporary deworming activities have led to an internally funded self-sufficient programme in 2004-05 academic year. A total of 200,000 doses of mebendazole were distributed to schoolchildren, absentee children and small children and women through both schools and health centres. We interviewed 64 representative teachers, 82 administrative teachers, 112 schoolchildren and 108 parents using questionnaires, department interviews and focus groups discussions. We also collected 162 stool samples from third- and fourth-grade schoolchildren and examined them using the Kato-Katz technique. The evaluation of second year's of deworming program indicated that the programme's methodology of training representative teachers to play a major role in organizing the activities within schools and liaising with health staff was found to be successful by most of the teachers. The results showed that 85.2% of the women had benefited from the extended anthelmintic coverage. A total of 67.4% of them received the drugs from schools and 10.9% obtained them from health centres. The prevalence of helmintic infection had declined from 77 to 35% in shantytown schoolchildren and from 53 to 6.4% in apartment schoolchildren. The prevalence of Ascaris lumbricoides and Trichuris trichiura decreased from 63.2 to 17% and from 16.8 to 1.1%, respectively, in schoolchildren. The results also indicated that 53.5% of the schoolchildren changed over to clean habits and began to use soap after using the toilet. The evaluation of the second year's deworming programme showed that the programme was sustainable and there was no risk of the programme being discontinued. Political commitment was obtained from the local business community, academic sector, the local governmental administrations and the city municipality. These organizations realized the programme's rapid and clear benefits and collaborated in a multipartners' programme. The cost of treatment per child was $0.05 and in total $11 000 was sufficient to implement a broad-range programme including education of children about cleanliness and treatment of infection to improve their health.

Two cases of rarely recognized infection with Entamoeba moshkovskii.

We report two cases (a 36-year-old woman and 2-year-old girl) infected with Entamoeba moshkovskii in Turkey. Entamoeba moshkovskii was identified and distinguished from the morphologically identical parasites E. histolytica and E. dispar by a nested polymerase chain reaction and restriction fragment length polymorphism analysis of the small subunit ribosomal DNA gene.

The diagnosis of malaria and identification of plasmodium species by polymerase chain reaction in Turkey.

More than half of the world's population is exposed to malaria in approximately 100 countries. Rapid diagnosis and correct treatment of cases are the main objectives of control programs in malaria endemic areas. We have developed a PCR method to determine the presence of plasmodium DNA in blood. The method can also identify the species of the plasmodium by restriction enzyme analysis of the amplified product. We evaluated the performance of this method in the diagnosis of malaria suspected cases in Turkey by comparing to microscopy of the blood smears: blood samples were obtained from 114 patients with malaria symptoms, including fever and/or chills lasting for several days, before starting treatment. Thin and thick blood smears were prepared immediately in the region of specimen collection. After isolation of DNA from blood samples, DNA was amplified by PCR and digested by restriction enzyme AluI. The obtained fragments were analyzed by agarose gel electrophoresis. The number of parasites in the thick and thin smears of the blood samples was evaluated microscopically after staining by Giemsa and results were compared by PCR results. Among 114 plasmodium positive cases detected by microscopy, 100 were also detected by PCR. There were 14 false negatives and no false positive by PCR. Compared to microscopy, the sensitivity, specificity and Positive Predictive Value (PPV) of PCR were determined as 76%, 100% and 100%, respectively.

Community perception of school-based deworming program in Sanliurfa, Turkey.

This article presents an evaluation of the community perception of the recently implemented School Based Health Program, which delivered anthelmintics to 96,000 schoolchildren in Sanliurfa, Turkey. One hundred forty-four parents and 140 teachers were interviewed through questionnaires, focus group discussions, and in-depth interviews. The evaluation indicated that most of the parents and teachers reported that the program was beneficial as it led to improvement in children's health and well being. The evaluation also indicated that 99% of the parents and 98.4% of the teachers approved of the teacher's role in this program. Nearly all of the teachers and parents showed willingness to continue the program in the future and 75% of the parents indicated willingness to pay for the drugs. The evaluation also highlighted that there were critical issues for the successful implementation of the program such as the issue of educating illiterate mothers, higher involvement of families in the mass treatment process, ability to reach a larger number of school absentees, and overcoming the prejudice against externally funded measures, which are perceived by some of the members of the community as an experiment run by foreigners on the local population and the concern of some parents that anthelmintic drug (mebendazole) might cause sexual sterility.

[The results of a control program carried out on school children for intestinal parasites in Sanliurfa province, Turkey between the years of 2001 and 2005]. / Sanliurfa'da okul çocuklarinda uygulanan bagirsak solucanlari kontrol programinin 2001-2005 sonuçlari.

This paper presents a school-based deworming program carried out from 2001-2005. It began with baseline studies in 2001 which indicated that intestinal helminth infection was endemic among schoolchildren with a prevalence of 80%in shantytown schools and 53% in apartment district schools. Ascaris lumbricoides was the most frequently detected helminth (45%), followed by Trichuris trichiura (25-30%) and Hymenolepsis nana (10-15%) and Taenia species (5%). Also school children were very much affected by nutritional deficiencies such as prevalence of stunting (24%), underweight (25%) and anemia (45%). The parasite control project was begun in 2002 in which 40.000 school children were treated with a single dose of 500 mg mebendazole. This was followed by delivery of 100.000 doses of mebendazole to the school children during the 2003-2004 school-years. During the 2004-2005 school-years, 120.000 primary schoolchildren, 20.000 high school children, 10.00 rural schoolchildren and 50.000 women and children (1-7 years old) were treated with mebendazole for helminth infections. In October-2005, stool examinations were carried out again in the shantytown and apartment district schools and it was found that the prevalence of infection had declined to 35% in shantytown schools and 6.4% in apartment district schools. The rate of Ascaris lumbricoides infection had fallen to 17%, with the rate of Trichuris trichiura to 1% and that of Taenia species to 0%. In contrast, the rate of Hymenolepsis nana had increased to 21%. These results indicated that parasite control program was successful and should be continued.

Relationship between levels of DNA damage in lymphocytes and histopathological severity of chronic hepatitis C and various clinical forms of hepatitis B.

BACKGROUND AND AIM: A significant proportion of cancer is attributable to DNA damage caused by chronic infection and inflammation. Because both hepatitis B and C viruses (HBV and HCV, respectively) cause chronic infection and inflammatory disease, the aim of the present study was to investigate whether there is a difference in peripheral DNA damage in patients with chronic HCV compared with patients with chronic HBV; and whether there is an association in the level of peripheral DNA damage with a natural history of HBV infection. METHODS: Twenty patients with chronic hepatitis C, 20 patients with chronic hepatitis B, 11 patients with cirrhosis secondary to hepatitis B, 12 inactive hepatitis B s antigen (HBsAg) carriers and 21 healthy subjects were included in the study. The DNA damage in lymphocytes was determined using the alkaline comet assay. RESULTS: Although the chronic hepatitis C group had similar levels of DNA damage compared with patients with cirrhosis due to hepatitis B (P > 0.05) and non-cirrhotic patients with chronic hepatitis B (P > 0.05), they had higher levels of DNA damage compared with inactive HBsAg carriers (P = 0.021) and controls (P = 0.001). Hepatitis B cirrhotic patients and patients with chronic hepatitis B had significantly higher levels of DNA damage than inactive HBsAg carriers (P = 0.002 and P = 0.012, respectively) and controls (both P = 0.001). Linear logistic regression analysis showed that chronic hepatitis C and HBV-related cirrhosis were discriminators in determining DNA damage in lymphocytes (beta 0.424 and P = 0.013, beta 0.393 and P = 0.016, respectively). CONCLUSIONS: Chronic hepatitis C, based on the severity of liver disease, or cirrhosis as an advanced form of HBV infection increase DNA damage in lymphocytes independently of confounding factors such as age, gender, body mass index and smoking habits.

Comparison of two methods (microscopy and enzyme-linked immunosorbent assay) for the diagnosis of amebiasis.

Diagnosis of amebiasis is usually performed on a clinical basis alone in most endemic countries having limited economic resources. This epidemiological study was conducted using modern diagnostic tests for amebiasis in the southeastern region of Turkey, an endemic area for amebiasis. The population of this study included patients with symptomatic diarrhea/dysentery attending both Yuzuncu Yil University, Van and Harran University, Sanliurfa, Turkey. A total of 380 stool specimens were collected and examined for Entamoeba by light microscopy (fresh, lugol, and trichrome staining) and stool antigen detection based- enzyme-linked immunosorbent assay (EIA) test (TechLab Entamoeba histolytica II). 24% (91/380) of stool specimens were positive for E. histolytica/Entamoeba dispar trophozoites/cysts microscopically using trichrome staining. 13% (51/380) of the stool specimens were found to be positive for E. histolytica by the EIA test, including 15% (14/91) of microscopy (+) stool specimens and 13% (37/289) of microscopy (-) stool specimens. Enteric parasites were common in these populations with 66% (251/380) of the study population harboring more than one parasite. In addition to the 13% (51/380) of patients determined to have E. histolytica by EIA, eighty-six patients (22.6%) had Blastocystis hominis, 54 (14.2%) Entamoeba coli, 44 (11.5%) Giardia lamblia, 16 (4.2%) Chilomastix mesnili, 15 (3.9%) Iodamoeba bütschlii, 12 (3.1%) Hymenolepis nana, 9 (2.3%) Endolimax nana, 9 (2.3%) Dientamoeba fragilis, and 8 (2.1%) had Ascaris lumbricoides. We concluded that E. histolytica infection was found in 13% of the patients presenting with diarrhea in Van and Sanliurfa Turkey.

Demographic and parasitic infection status of schoolchildren and sanitary conditions of schools in Sanliurfa, Turkey.

BACKGROUND: The design and development of school health programmes will require information at demographic characteristics of schoolchildren and the major health burdens of the school-age group, the opportunities for intervention and the appropriateness of the available infrastructure. This study aims to analyse demographic and parasitic infections status of schoolchildren and sanitary conditions of schools in Sanliurfa province of south-eastern Turkey. METHOD: Three primary schools were randomly selected in the shantytown, apartment and rural districts. A total of 1820 schoolchildren between 7-14 years age were took part to the survey of whom 1120 (61.5%) were boys and 700 (38.4%) were girls. A child form (including child's name, sex, age, school grade and parasitic infections) and school survey form (including condition of water supply, condition of latrines, presence of soaps on the basins and presence of garbage piles around to the schools) were used for demographic, parasitic and sanitary surveys. Stool samples were examined by cellophane thick smear technique for the eggs of intestinal helminths. RESULTS: The demographic survey showed that number of schoolchildren was gradually decreased as their age's increase in shantytown school. The sex ratio was proportional until the second grade, after which the number of females gradually decreased in children in shantytown and rural schools while, in apartment area, schoolchildren was proportionally distributed between age groups and gender even the high-grade students. The prevalence of helminthic infections was %77.1 of the schoolchildren in shantytown, 53.2% in apartment district and 53.1% of rural area. Ascaris lumbricoides was the most prevalent species and followed by Trichuris trichiura, Hymenolepis nana and Taenia species in three schools. Sanitation survey indicated that the tap water was limited in shantytown school, toilet's sanitation was poor, available no soaps on lavatories and garbage piles were accumulated around the schools in shantytown and rural area, while, the school in apartment area was well sanitised. CONCLUSIONS: These results indicated that burden of parasitic infections and poor sanitation conditions constituted public health importance among to the shantytown schoolchildren. School health programmes including deworming and sanitation activities through the health education and improvement of sanitation conditions in the schools have a potential to better health and education for schoolchildren. These programmes also offer the potential to reach significant numbers of population in the shantytown schools with high level of absenteeism.

Antimonial therapy induces circulating proinflammatory cytokines in patients with cutaneous leishmaniasis.

The objective of this study was to evaluate the association between antimonial therapy and circulating levels of proinflammatory cytokines in patients with cutaneous leishmaniasis (CL). Patients were treated with conventional chemotherapy by using pentavalent antimonium salts (Glucantime) for 3 weeks. Circulating plasma levels of the proinflammatory cytokines interleukin-1beta (IL-1beta), IL-6, IL-8, and tumor necrosis factor alpha (TNF-alpha) were determined for CL patients and healthy subjects before and 3 weeks after the treatment was started. Plasma IL-1beta, IL-6, IL-8, and TNF-alpha levels were significantly higher for pretreatment CL patients than for healthy subjects. Proinflammatory cytokines significantly increased after 21 days postinfection compared to levels for the pretreatment patients. These increments were approximately 3-fold for IL-1beta and TNF-alpha levels, 10-fold for IL-6 levels, and 20-fold for IL-8 levels in patients with CL. Taken together these results indicate that circulating proinflammatory cytokine levels were increased in patients with CL as a consequence of host defense strategies, and antimonial therapy may induce these cytokines by affecting the macrophage or other components of the host defense system.

Cutaneous leishmaniasis in Sanliurfa: epidemiologic and clinical features of the last four years (1997-2000).

BACKGROUND: Sanliurfa is located in south-east Anatolia, the region with the largest focus of anthroponotic cutaneous leishmaniasis (CL) in Turkey. The present study was designed to determine the epidemiological and clinical patterns of cases of CL in the Sanliurfa area over a period of 4 years (1997-2000). METHODS: 2120 CL cases attending the Harrankapi in this study. RESULTS: There were 790 cases of CL in 1997, and 778 in 1998. The numbers declined to 277 in 1999 and to 275 in 2000. The majority of patients (70%) were less than 20 years of age, with the highest percentage (27%) occurring in the 5- to 9-year age group. Acute CL and chronic CL were observed in 1926 (90.8%) and 63 (3%) patients, respectively. Leishmaniasis recidivans (LR) was found only in 131 (6.2%) patients. Lesions of CL were seen mainly on the exposed parts of the body such as the face and neck (57.5%), upper limbs (32.2%) and lower limbs (10.2%). Ninety-three percent of the patients were residents of central Sanliurfa from the southern and eastern parts of the city, areas with poor housing and low socio-economic conditions. CONCLUSION: Although the incidence of CL showed a sharp decline from 1997 to 2000 in Sanliurfa, this does not mean that the disease is on its way to eradication.

Environmental pollution with soil-transmitted helminths in Sanliurfa, Turkey

Soil transmitted helminth (STH) infection are endemic in developing countries. A study was carried out of sewage farms, streams and vegetables to determine the sources and routes of STH infection in Sanliurfa, Turkey. Stool samples from farmhouse inhabitants as well as soil and vegetable samples from the gardens were collected and examined. In addition, water samples from streams and vegetable samples from the city market were collected and examined. One hundred and eighty-seven (59.5 percent) of a total of 314 samples, including 88.4 percent of the stool samples, 60.8 percent of the water samples, 84.4 percent of the soil samples and 14 percent of the vegetable samples, were found to be positive for STH eggs. These results indicate that the water, soil and vegetables are heavily contaminated, and suggest a vicious circle between humans and the environment. Improving environmental sanitation is imperative for the control of soil-transmitted helminthiasis in Sanliurfa

Diagnostic performance characteristics of rapid dipstick test for Plasmodium vivax malaria

We compared the diagnostic performance characteristics of newly developed method, the rapid dipstick test, which provides colorimetric determination by developing antibody to the lactate dehydrogenase enzyme of parasites, with conventional standard thick-blood film examination. For the rapid test, OptiMAL commercial kits were used. The results were also evaluated with clinical findings from patients. The parasites were determined by microscopic examination of thick-blood films from 81 patients with vivax malaria from southeastern Anatolia, Turkey. The OptiMAL test results were found to be negative in five patients who were diagnosed clinically and through thick-film testing as having vivax malaria. There was no false positivity observed with the OptiMAL test. We concluded that this rapid malaria test has a lower level of sensitivity than the classical thick-blood-film test for malaria, but that these methods have equal specificity