The features of infectious diseases departments and anti-infective practices in France and Turkey: a cross-sectional study.

The aim of this study was to assess the infectious diseases (ID) wards of tertiary hospitals in France and Turkey for technical capacity, infection control, characteristics of patients, infections, infecting organisms, and therapeutic approaches. This cross-sectional study was carried out on a single day on one of the weekdays of June 17-21, 2013. Overall, 36 ID departments from Turkey (n = 21) and France (n = 15) were involved. On the study day, 273 patients were hospitalized in Turkish and 324 patients were followed in French ID departments. The numbers of patients and beds in the hospitals, and presence of an intensive care unit (ICU) room in the ID ward was not different in both France and Turkey. Bed occupancy in the ID ward, single rooms, and negative pressure rooms were significantly higher in France. The presence of a laboratory inside the ID ward was more common in Turkish ID wards. The configuration of infection control committees, and their qualifications and surveillance types were quite similar in both countries. Although differences existed based on epidemiology, the distribution of infections were uniform on both sides. In Turkey, anti-Gram-positive agents, carbapenems, and tigecycline, and in France, cephalosporins, penicillins, aminoglycosides, and metronidazole were more frequently preferred. Enteric Gram-negatives and hepatitis B and C were more frequent in Turkey, while human immunodeficiency virus (HIV) and streptococci were more common in France (p < 0.05 for all significances). Various differences and similarities existed in France and Turkey in the ID wards. However, the current scene is that ID are managed with high standards in both countries.

Fighting rabies in Eastern Europe, the Middle East and Central Asia--experts call for a regional initiative for rabies elimination.

MEEREB is an informal network of rabies experts from the Middle East, Eastern Europe and Central Asia, seeking to eliminate rabies from the region. They met for the second time to review the current rabies situation, both globally and in their respective countries, highlighting current rabies control problems and potential solutions. Success stories in Latin America, in Western Europe, in some Asian countries, as well as in Croatia and Serbia prove that elimination of human rabies is achievable in the MEEREB region. It requires political willingness and cooperation of all stakeholders, including Ministries of Health and of Agriculture; adequate management of animal bites through post-exposure prophylaxis; pre-exposure prophylaxis for populations at high risk of rabies exposure, animal vaccination and humane control of stray dog populations. MEEREB members called for a regional initiative for rabies elimination in Eastern Europe and the Middle East. They are confident that the elimination of human rabies of canine origin can be achieved in the region through adopting a One Health approach, and that campaigns for rabies elimination will have significant benefit for public health, including strengthening the structure for control of other zoonoses.

Healthcare-associated infections and the distribution of causative pathogens in patients with diabetes mellitus.

Diabetes mellitus (DM) is one of the most common diseases worldwide, and is a significant risk factor for healthcare-associated infections (HAIs). Our aim in this study was to compare the distributions of HAIs and the causative pathogens between diabetic and non-diabetic patients. In this study, 716 HAIs in 465 diabetic patients and 761 HAIs in 465 non-diabetic patients were evaluated. HAIs in patients with DM were most frequently urinary tract infections (UTIs) [266 infections (37.2 %)], followed by blood stream infections (BSIs) [161 infections (22.5 %)], surgical site infections (SSIs) [127 infections (17.7 %)], pneumonia [107 infections (14.9 %)] and any other infections [161 infections (22.5 %)]. The rates of UTIs, BSIs, SSIs, pneumonia and any other infections were similar between diabetic and non-diabetic patients. In terms of the causative pathogens, Staphylococcus aureus more frequently caused SSIs and Candida spp more frequently caused UTIs in diabetic patients compared with non-diabetic patients. We found no differences in the distribution of HAIs between patients without and with DM. However, S. aureus and Candida spp were more common causative pathogens of SSIs and URTIs, respectively, in diabetic patients than in non-diabetic patients.

Comparison of non-invasive fibrosis markers and classical liver biopsy in chronic hepatitis C.

The aim of this study was to compare the results of nine non-invasive serum biomarkers with liver biopsies to predict liver fibrosis stage. HCV-RNA-positive, HCV genotype 1, treatment-naive patients with chronic HCV infections were included from 14 centers (n=77). The platelet count, AST/ALT ratio (AAR), cirrhosis discriminate score (CDS), FIB4, AST/platelet ratio index (APRI), age-platelet (AP) index, Göteborg University cirrhosis index (GUCI), FibroTest, and ActiTest were calculated and compared to histologic findings. All serum biomarkers, except AAR, were weakly or moderately correlated with liver biopsy results (ISHAK fibrosis score). The mean scores of FibroTest, FIB4, APRI, and AP index were significantly different between F0-F2 and F3-F4 groups and the negative predictive values (NPVs) of the F3-F4 group were 95%, 85%, 85%, and 83%, respectively, for these serum biomarkers. Our study suggests that serum biomarkers may help to diagnose significant fibrosis but inadequate to detect fibrosis in early stages. Although liver biopsy is still the gold standard to diagnose liver fibrosis, FibroTest, FIB4, APRI, or AP index may be used to exclude significant fibrosis with >80% NPV.

A phase II, randomised clinical trial to demonstrate the non-inferiority of low-dose MF59-adjuvanted pre-pandemic A/H5N1 influenza vaccine in adult and elderly subjects.

BACKGROUND: Effective planning and preparedness against a possible future A/H5N1 influenza pandemic is a major global challenge. Because dose sparing strategies are required to meet the global demand for vaccine, efforts have focused on the development of adjuvanted vaccine formulations of relatively lower antigen content. AIM: This study aimed to demonstrate the non-inferiority of a low-antigen-dose (3.75 µ) [DOSAGE ERROR CORRECTED] A/H5N1 pre-pandemic vaccine compared with a licensed, higher-dose (7.5 mg) formulation in adult and elderly subjects. Immunogenicity was assessed according to European and U.S. licensure criteria. METHODS: A total of 722 subjects were randomized in equal numbers to receive either the licensed or low-dose formulation. All subjects received two vaccine doses administered three weeks apart. Immunogenicity was assessed three weeks after the administration of each vaccine dose by hemagglutination inhibition (HI), single radial haemolysis (SRH) and microneutralization assays (MN). Local and systemic reactions were assessed over a seven day period post-vaccination. Adverse events were recorded throughout. RESULTS: The low-dose vaccine was demonstrated to be non-inferior to the licensed formulation in terms of antibody titres against the vaccine strain. All three European licensure criteria were met by adult subjects in response to the low-dose vaccine; two criteria were met by the elderly age group. Cross-reactive antibodies were detected against the heterologous A/H5N1 antigen strains A/Indonesia/05/05 and A/turkeyTurkey/01/05. Both vaccines were generally well tolerated by both age groups. CONCLUSION: These data demonstrate that a low antigen dose in combination with MF59 adjuvant is adequate for the routine pre-pandemic immunization of adult and elderly subjects.

Effect of pegylated interferon treatments for chronic active hepatitis C on quality of life.

Health-related quality of life (HRQoL) during therapy was found to be improved in patients treated with peginterferon alpha-2a compared to patients receiving interferon alpha-2a. This study aimed to assess the effect of different pegylated interferon therapies used in the treatment of patients with chronic hepatitis C on HRQoL. Forty chronic hepatitis C patients were enrolled. 22 patients were given a combination of peginterferon alpha-2a plus ribavirin and 18 patients received a combination of peginterferon alpha-2b plus ribavirin for 48 weeks. Patients completed a Short Form-36 (SF-36) questionnaire at the start of treatment and at week 12, week 24 and week 48 of treatment and week 24 posttreatment to evaluate HRQoL. In conclusion, the effect of both combination treatments on quality of life was similar.

Device-associated hospital-acquired infection rates in Turkish intensive care units. Findings of the International Nosocomial Infection Control Consortium (INICC).

We conducted a prospective study of targeted surveillance of healthcare-associated infections (HAIs) in 13 intensive care units (ICUs) from 12 Turkish hospitals, all members of the International Nosocomial Infection Control Consortium (INICC). The definitions of the US Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System (NNISS) were applied. During the three-year study, 3288 patients for accumulated duration of 37 631 days acquired 1277 device-associated infections (DAI), an overall rate of 38.3% or 33.9 DAIs per 1000 ICU-days. Ventilator-associated pneumonia (VAP) (47.4% of all DAI, 26.5 cases per 1000 ventilator-days) gave the highest risk, followed by central venous catheter (CVC)-related bloodstream infections (30.4% of all DAI, 17.6 cases per 1000 catheter-days) and catheter-associated urinary tract infections (22.1% of all DAI, 8.3 cases per 1000 catheter-days). Overall 89.2% of all Staphylococcus aureus infections were caused by methicillin-resistant strains, 48.2% of the Enterobacteriaceae isolates were resistant to ceftriaxone, 52.0% to ceftazidime, and 33.2% to piperacilin-tazobactam; 51.1% of Pseudomonas aeruginosa isolates were resistant to fluoroquinolones, 50.7% to ceftazidime, 38.7% to imipenem, and 30.0% to piperacilin-tazobactam; 1.9% of Enterococcus sp. isolates were resistant to vancomycin. This is the first multi-centre study showing DAI in Turkish ICUs. DAI rates in the ICUs of Turkey are higher than reports from industrialized countries.

Spinal subdural Staphylococcus aureus abscess: case report and review of the literature.

Spinal subdural abscesses (SSA) are rare and to date only 57 cases have been reported. The exact incidence of the SSA is unknown. The most affected region is the thoraco-lumbar spine and the most common bacterial source is Staphylococcus aureus. The timing for magnetic resonance imaging is very important in these patients. Because early diagnosis and emergent treatment is vital to prevent the formation or progression of neurologic deficits.

Comparison of different treatment combinations for chronic hepatitis B infection.

Chronic hepatitis B virus (HBV) infection is a leading cause of cirrhosis and hepatocellular carcinoma worldwide. Its prevalence approaches 10% in hyper endemic areas. The aim of treating chronic HBV infection is to halt progression of liver injury by suppressing viral replication or eliminating infection. This study was planned to evaluate the advantages of combination therapy with interferon-alpha plus second-generation nucleoside analogues (lamivudine or famciclovir), or vaccination with a pre-S2 and S proteins containing vaccine in chronic HBV infection. 29 patients were divided into three groups and were treated with the following combinations: (1) IFN-alpha2a 9 million units 3x week for 6 months with HBV vaccine 20 microg given on 0, 1 and 2 months; (2) IFN-alpha2a 6 million units 3x week plus famciclovir 250 mg 3x day for 6 months; (3) IFN-alpha2a 6 million units 3x week plus lamivudine 100 mg/day for 6 months. Complete response was suspected in 3 patients in group 1, in 4 patients in group 2, and in 7 patients in group 3. Partial response was suspected in 4, 1 and 2 patients in groups 1, 2 and 3, respectively. The results of the present study suggest that the combination of IFN-alpha with lamivudine is more effective than the combination of IFN-alpha with HBV vaccination or famciclovir.

The effects of fusidic acid on the inflammatory response in rats.

In the present study the antiinflammatory activity of fusidic acid was investigated in a model of formalin-induced edema formation in rats. Fusidic acid at doses of 50 and 100 mg kg (-1) was administered p.o. to rats for ten days. It was observed that fusidic acid inhibited edema formation significantly (P< 0.05). After this period, gastric mucus secretions were evaluated by the Alcian blue dye binding method. Mucus secretion decreased significantly in the control group. Fusidic acid increased the amount of gastric mucus. Moreover, in all of the animals with paw edema, platelet count was also increased. Red blood cell count, haemoglobin concentration and haematocrit were all higher in the control group than those of the fusidic acid groups. The present observations suggest that fusidic acid suppressed the inflammatory response and stimulated the gastric mucus secretion and it prompts further experiments for delineation of the mechanism of these actions as well as clinical trials.

[Antimicrobial sensitivity of some gram-negative bacterial strains causing hospital or community-acquired infections]. / Hastane veya hastane disi enfeksiyonlara neden olan bazi gram negatif bakterilerin çesitli antimikrobiklere duyarliliklari.

The susceptibility to various antimicrobics of E. coli, Klebsiella, S. typhimurium, Pseudomonas, Proteus and Edwardsiella strains causing hospital or community acquired infections were investigated by Kirby-Bauer's disk diffusion method. It was found that ampicillin was the least and quinolones were the most effective antimicrobics for the both hospital and community acquired infections. In general, the antimicrobic resistance was significantly increased for the hospital isolates.

Efficacy of prophylactic and early fluconazole treatment on systemic candidiasis in experimentally neutropenic rabbits.

The efficacy of prophylactic and early fluconazole treatment on experimental systemic candidiasis was investigated in neuropenic rabbits. Fifteen rabbits were used and divided into three groups: fluconazole was started 24 h before the inoculation of Candida albicans in the first group, and 24 h after the inoculation in the second group. The third group was the control group without antifungal therapy. Prophylactic and early fluconazole treatment for 7 days after C. albicans inoculation did not reduce the mortality and tissue culture positivity in the rabbits significantly. Four of the five rabbits survived 7 days both in the prophylactic and early treatment groups. However, only one rabbit survived for 7 days in the control group. In diagnostic procedures, histopathological examination and evaluation with periodic acid-Schiff stain was found to be the most sensitive. In this study, prophylactic and early fluconazole treatment were found to be insufficient for treatment of systemic candidiasis in neutropenic rabbits.

[Comparison of the Wright, indirect Coombs and enzyme immunoassay IgG methods for the diagnosis of chronic brucellosis]. / Kronik Brusellozis tanisinda wright, indirekt coombs ve enzim immuno assay IgG yöntemlerinin karsilastirilmasi.

Incomplete IgG and IgA class immunoglobulins are formed in chronic brucellosis and these antibodies do not detect with classical Wright agglutination test (WAT). However these antibodies are measured with indirect Coombs and enzyme immune assay (EIA) techniques. In this study 90 patients serum samples were tested with WAT, indirect Coombs and EIA. All of the patients had chronic brucellosis. EIA was used to determine the levels of brucella specific IgG antibodies in 44 patients whose WATs were negative and indirect Coombs assays were positive and 46 patients whose WATs and indirect Coombs tests were negative. Thirty-seven (84.08%) of the 44 patients whose WAT negative and indirect Coombs positive were found positive for EIA IgG. Sixteen (34.7%) of the 46 patients whose WAT and indirect Coombs negative were found positive EIA IgG. The importance of EIA and indirect Coombs tests was discussed at the diagnosis of chronic brucellosis.

[The effects of ciprofloxacin and ofloxacin on the cellular and humoral immune response in mice]. / Siprofloksasin ve ofloksasinin farelerde hücresel ve hümoral immün cevap üzerine etkileri.

The effects of a 7 days chemotherapy with ciprofloxacin or ofloxacin on the cellular and humoral immune responses in albino mice were studied. The non-toxic doses of the drugs (10 or 30 mg/kg/day) were used. The delayed-type hypersensitivity reaction to sheep blood cells and skin biopsy were evaluated for cellular immune response. The complement fixation method was applied for the determination of the humoral immune response. Both drugs increased the cellular and humoral immune responses.

[Stability of cefazolin sodium as eyedrops in various solutions]. / Cesitli sivilar ile göz damlasi olarak hazirlanan sefazolin sodyumun stabilitesi.

Cephazolin sodium prepared with four different solutions (NaCl 0.9%, Protagent, Liquifilm and phosphate buffer) to be used as eye drops, was evaluated as to its physicochemical features at +4 degrees C, +37 degrees C and at room temperature and its activity in terms of minimal inhibition concentration. In conclusion, cephazolin sodium prepared with artificial tears at acidic pH can be kept for 3 days at room temperature and at +4 degrees C without any loss of its activity.

[The effects of ciprofloxacin on intestinal flora and Paneth cells]. / Siprofloksasinin barsak florasi ve paneth hücrelerine etkileri.

The effects of ciprofloxacin were investigated on colonic microbial flora and Paneth cells in eight healthy albino rabbits following a 10 mg intravenous dose. Two rabbits were used as control group. Aerobic fecal cultures were negative on rabbits of experiment. Vacuolisation and reduction of eosinophilic fields were seen in Paneth cells by light microscopic examination.

[Mycoplasma pneumoniae cultured from a healthy population aged 8 to 16]. / 8-16 yas grubu saglikli popülasyonda kültür yöntemleriyle mycoplasma pneumoniae aranmasi.

Throat Cultures have been taken from 100 persons on May 1986 and 100 persons on December 1986. Finally 200 throat cultures have been taken and cultures were determined for M. pneumoniae. M. pneumoniae has been isolated in 3 female and 2 male cases which sum up to 5 cases (2.5%). All these cases were asymptomatic and 8-16 old-year. All samples has taken in spring. These show parallelism with other research in the same subject. The isolation of M. pneumoniae in 2.5 percent has shown that M. pneumoniae doesn't cause infection very often around Eskisehir area and also has supported that the idea of asymptomatic cases are frequent especially in childhood.

[Comparison of ampicillin, chloramphenicol and trimethoprim-sulfamethoxazole (TMP-SMZ) for the treatment of Salmonella typhi infections in clinical practice]. / Salmonella typhi infeksiyonlarinin tedavisinde ampicillin, chloramphenicole ve trimethoprim-sulfamethoxazole (TMP-SMZ)'ün klinik uygulamada karsilastirilmasi.

Ninety-four patients with Salmonella typhi infection hospitalized and treatment. Widal test results, blood cultures, stool cultures and physical examination findings were admitted infection criteria. Ampicillin used 100 mg/kg/day four divided dose in 52 patients, chloramphenicol used 2g/day four divided dose in 28 patients and TMP-SMZ 160-800 mg used bid in 14 patients. All of the treatments applied for 2 weeks. Ampicillin 92.30%, chloramphenicol 82.15% and TMP-SMZ 85.71% were found success. Fever dropped in normal degrees 3.43 +/- 1.71 days in ampicillin group, 3.47 +/- 1.13 days in chloramphenicol group and 3 +/- 1.41 days in TMP-SMZ group.