Comparison of CHROMagar Orientation Medium with Traditional Methods in Urinary Tract Infection Cultures.

BACKGROUND: Urinary tract infections (UTIs) are the most common infections in adults, and urine culture is the parameter that uses the most time and cost in microbiology laboratories. For this reason, the selection of fast and cost-effective methods in the evaluation of urine samples is one of the priority issues of microbiology laboratories. The aim of this study was to investigate the compatibility and cost-effectiveness of routinely used Blood Agar (BA), Eosin Methylene Blue (EMB) medium, and CHROMagar Orientation Medium (CO Medium) in the identification of microorganisms in urine samples. METHODS: Consecutive urine samples (n: 700) sent to our laboratory were simultaneously inoculated onto BA/EMB media and CO medium. Urine samples were evaluated after 18 - 24 hours of incubation at 37℃ and the compatibility of the two methods was compared. The use of 104 Gram stains, 198 biochemical tests, and 9 identification kits was required with BA/EMB agar. RESULTS: When 104 colonies with single growth were evaluated, presumptive identification with CO medium was found to be 100% compatible with the VITEK 2 system. The most isolated 62 Escherichia coli (E. coli) colonies gave dark pink-red color and were found to be fully compatible with the VITEK 2 system. Compatibility of BA and EMB medium evaluations with VITEK 2 system; E. coli (n: 62), KES group (n: 26), Pseudomonas spp. (n: 6) and Proteus spp. For (n: 2), it was determined as 69.3%, 57.69%, 100%, and 100%, respectively. According to the results of our study, when BA/EMB and CO Medium methods were compared, 182 Euro (€) savings were achieved in 700 urine cultures with CO Medium. It was estimated that the amount of savings could be 15,600 € per year. CONCLUSIONS: CHROMagar Orientation Medium method can be used routinely with its advantages such as being cost-effective, reducing the workload, and not requiring additional operations. CHROMagar Orientation Medium can also be considered as an easily accessible method and opportunity that does not require infrastructure and trained personnel, especially for laboratories with low test capacity and having problems with the supply of com-mercial kits and automated systems.

Comparison of a novel antigen detection test with reverse transcription polymerase chain reaction assay for laboratory diagnosis of SARS-CoV-2 infection.

Molecular diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by real-time reverse transcription polymerase chain reaction (RT-PCR) in respiratory specimens is considered the gold standard method. This method is highly sensitive and specific but it has some limitations such as being expensive and requiring special laboratory equipment and skilled personnel. RapidFor™ Antigen Rapid Test Kit is a commercially available Ag-RDT which is produced in Turkey and designed to detect the nucleocapsid antigen of SARS-CoV-2 in nasopharyngeal swab samples. The aim of this study was to evaluate the performance of this novel SARS-CoV-2 antigen detection considering the RT-PCR method as the gold standard. Four hundred forty-four nasopharyngeal swab samples which were collected from the patients who met clinical criteria of COVID-19 from ten centers in Turkey between September 2020 and February 2021 were included in the study. All the nasopharyngeal swab samples were tested for SARS-CoV-2 RNA using commercial RT-PCR kits (Bioeksen and A1 Lifesciences, Istanbul, Turkey) according to the manufacturer's instructions. Viral loads were assessed according to the cycle threshold (Ct) values. RapidFor™ SARS-CoV-2 antigen test (Vitrosens Biotechnology, Istanbul, Turkey) was used to investigate the presence of SARS-CoV-2 antigen in all samples following the manufacturer's instructions. Out of 444 nasopharyngeal swab samples tested, 346 (77.9%) were positive and 98 (22.1%) were negative for SARS-CoV-2 RNA by RTPCR. Overall sensitivity of the RapidFor™. Antigen Rapid Test Kit was 80.3% whereas specificity was found to be 87.8%. Positivity rate of rapid antigen test in samples with Ct values over 25 and below 30 was 82.7%, while it increased to 95.7% in samples 20 ≤ Ct < 25 and reached 100% in samples with Ct values below 20. RapidFor™ SARS-CoV-2 Ag test might be a good choice in the screening of symptomatic and asymptomatic patients and their contacts for taking isolation measures early, with advantages over RT-PCR as being rapid, easy and being applicable in every laboratory and even at point of care.

Evaluation of the Effect of Sampling Strategy on Test Results in the COVID-19 Pandemic.

BACKGROUND: The oronasopharyngeal (ONP) sampling phase is critical in the diagnosis of infection during the coronavirus disease-2019 (COVID-19) pandemic. In this study, the aim is to investigate the effect of the standardized operational team in the sampling unit on test results and repetitions. METHODS: Patients who applied to the Adult Pandemic Polyclinic between August 2020 and October 2021 and whose ONP samples were taken for Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) Polymerase Chain Reaction (PCR) test were included in the study. For August 2020, the Ear, Nose and Throat (ENT) specialists were appointed to work in the sample collection unit. For the following months, physicians from other clinics as well as ENT specialists were appointed under the same conditions. The ENT and other specialties were compared in terms of PCR positivity and test repetition. RESULTS: Out of a total of 129,808 patients, 21,602 (16.6%) of them were sampled by ENT physicians, and 108,206 (83.4%) by others. The first three months with the highest number of ONP samples were August 2021 (n: 20,317; 15.7%), July 2021 (n: 11,767; 9.1%), and November 2020 (n: 11,511; 8.9%). The highest positive PCR results were in August 2021 followed by August 2021 (37.3%), December 2020 (32.8%), and November 2020 (32.5%). In September 2020, more positive results were obtained from the samples taken by ENT specialists (p = 0.001). The repetition frequency of ONP samples taken by ENT and other specialists was calculated as 221 (1%) and 878 (0.8%), respectively (p > 0.05), and the month with the highest re-test rate was November 2020. CONCLUSIONS: It is seen that the training of ENT specialists given to non-ENT specialists on sampling technique is effective and the process is managed with optimal benefit. This study can be evaluated as the first step data in comparing all these organizations and emphasizing the importance of the cooperation created by the institutions during the pandemic process.

[Comparison of Two Different Quantitative Tests for Anti-Spike Measurement After Two Doses of Inactivated SARS-CoV-2 Vaccine in Healthcare Professionals]. / Saglik Çalisanlarinda Uygulanan Iki Doz Inaktif SARS-CoV-2 Asisinin Ardindan Anti-Spike Ölçümünde Iki Farkli Kantitatif Testin Karsilastirilmasi.

Serological tests developed to detect antibodies against severe acute respiratory syndrome Coronavirus disease-2 (SARS-CoV-2) antigens are used to demonstrate immunity level, vaccine efficacy and duration of protection. However, the evaluation of these tests and the interpretation of the results are still under investigation. In this study, it was aimed to compare the anti-spike measurement values in healthcare workers who have not experienced Coronavirus-2019 (COVID-19) after vaccination with two doses of inactivated SARS-CoV-2 vaccine with two commercial quantitative antibody detection tests which were used to give results in the same unit and work with different methods. The results obtained with Elecys Anti-SARS-CoV-2 S (Roche Diagnostics, Mannheim, Germany) and Aeskulisa Anti-SARS-CoV-2 S1 (Aesku diagnostics, Wendelsheim, Germany) kits of the serum samples of 90 healthcare workers were evaluated qualitatively and quantitatively in line with the recommendations of both manufacturers. Quantitative values given as units/mL (U/mL) were also evaluated by converting the binding antibody unit (BAU)/mL with the conversion factor obtained as a result of the studies carried out by the manufacturers with the World Health Organization anti-SARS-CoV-2 international standard. Positive results were obtained in 86 (95.6%) samples and negative results in 4 (4.4%) samples with the Elecsys kit; 55 (61.1%) positive, 20 (22.2%) negative and 15 (16.7%) intermediate results were obtained with the Aeskulisa kit. In common with both kits, negative results were obtained in four samples, and positive results were obtained in 55 samples. While the percent agreement observed with both kits was found to be 78.6 in 75 samples, excluding 15 samples in the intermediate with Aeskulisa kit, Cohen's kappa value was calculated as 0.26, indicating a close to moderate agreement, statistically. A high correlation was observed in the correlation analysis of the measurements of both kits (r= 0.611). When the scattering of the differences against the mean of the quantitative measurements made with both kits was examined by Bland-Altman analysis; higher measurements were determined with the Elecsys kit than with the Aeskulisa kit and the mean difference was found to be 58.68 ± 52.62. As a result of the studies carried out by the manufacturers, it was observed that the average difference decreased to 41.09 ± 50.22 when the U/mL values were converted to BAU/mL with the conversion factor. In the whole sampling, the measurements determined with the Elecsys kit were found to be 4.58 ± 3.44 times higher on average compared to the Aeskulisa kit while the measurements were found to be 2.35 ± 1.77 when the BAU/mL values were recalculated. The measurement values found with the Elecsys kit used in our study were found to be higher than that of Aeskulisa kit and qualitatively more positive results were obtained with Elecsys kit than with the Aeskulisa kit. In this study, Elecsys kit measurements were on average 4.06 times higher than Aeskulisa kit in samples (n= 55) with results compatible with both kits. The increase in these rates to 4.30 and 7.72 values, respectively, for 15 samples reported as intermediate and 16 as negative with the Aeskulisa kit, suggested that the success of quantitation decreased with the Aeskulisa kit at low antibody values. Since the harmonization of anti-SARS-CoV-2 tests has not yet been achieved, individual immune monitoring should be performed using the same method and even the results converted to BAU/mL should be specific to the antigen subunit.

[Evaluation of the Rapid Antigen Detection Kit with the Polymerase Chain Reaction for Detection of SARS-CoV-2 in Respiratory Samples]. / Solunum Yolu Örneklerinde SARS-CoV-2 Tespiti için Hizli Antijen Tespit Kitinin Polimeraz Zincir Reaksiyonu ile Birlikte Degerlendirilmesi.

The disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was named as coronavirus disease-2019 (COVID-19) by the World Health Organization (WHO) in February 11, 2020. The rapid diagnosis of COVID-19 patients is essential to reduce the disease spread. The reverse-transcription polymerase chain reaction (RT-PCR) is the gold standard test to diagnose SARS-CoV-2 acute infection. The rapid antigen test which can detect the presence of viral protein antigens in respiratory tract samples is being investigated as an alternative option, especially in cases where RT-PCR is not available or the test capacity is exceeded, due to its faster results, ease of application, low cost and lack of special equipment and personnel. In this study, it was aimed to evaluate the performance of a commercial rapid antigen test using nasopharyngeal samples of COVID-19 patients confirmed with RT-PCR. From the first day of the research, the first 80 consecutively SARS-CoV-2 RT-PCR positive and 40 RT-PCR negative respiratory samples sent to the Medical Microbiology Laboratory for routine SARS-CoV-2 RT-PCR testing were included in the study. RT-PCR tests of the samples were performed in routine studies with the BioSpeedy SARS-CoV-2 RT-PCR kit (Bioeksen, Turkey). Rapid antigen tests were performed with the Wesail COVID-19 antigen test kit (Guangdong, China) simultaneously with RT-PCR tests. Amongst the 80 positive RT-PCR samples, 56 were detected by the rapid antigen test. All the samples detected as positive with the rapid antigen tests were also positive with RT-PCR. There was a moderate agreement between the qualitative results of both tests (Kappa= 0.609, p<0.001). According to the PCR test, the sensitivity, specificity, positive predictive value (PPV), negative predictive value, and accuracy of the rapid antigen test were; 70%, 100%, 100%, 62.5%, and 80% (96/120), respectively. The sensitivities of the rapid antigen test were calculated as 92.6% in 54 samples with a cycle threshold (Ct) value of <17, 88.7% in 62 samples with a Ct value of <20, 77.8% in 72 samples with a Ct value of <22, and 74.7% in 75 samples with a Ct value of <25. According to our study data; the rapid antigen test was found less sensitive than the RT-PCR test. Negative results obtained with rapid antigen testing cannot exclude SARS-CoV-2 infection and must be confirmed by RT-PCR. In addition, according to the ROC analysis of rapid antigen test positivity obtained according to RT-PCR Ct values, the clinical performance of the rapid antigen test is good in samples with Ct values <20. The rapid antigen test should be evaluated as a reliable screening test in patients with high viral load. To the best of our knowledge, there is no other study in the literature performed with the Wesail COVID-19 rapid antigen test kit (Guangdong, China) used in our study. The fact that PPV was found to be 100% even at a low prevalence period of the pandemic will enable positive patients to be screened quickly and effectively with rapid antigen tests in the first step during the high prevalence period of the pandemic. In the light of these data and our results, it can be predicted that using the rapid antigen test as a screening test in the first step and confirming only negative patients with RT-PCR will contribute to the effective management of the pandemic process in terms of both time and cost. As a result of the study, the rapid antigen test with low sensitivity but high PPD can be included as a facilitating test in the first step of the diagnostic algorithm in terms of rapid identification of the patients with high viral load, initiation of treatment and providing filiation.

Is multiple sclerosis a risk factor for atherosclerosis?

BACKGROUND: Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system. We aimed to discuss possible predisposing factors to atherosclerosis such as carotid intima-media thickness (CIMT) and high-sensitivity C-reactive protein (Hs-CRP) levels in MS. METHODS: Thirty-five ambulatory patients with relapsing-remitting MS (RRMS) (22 females and 13 males) and 34 healthy controls (21 females and 13 males) with similar demographic variables were included. Blood cell counts, cholesterol levels, vitamin D and B12, Hs-CRP levels, body mass index (BMI), history of smoking, and CIMT of both groups, Expanded Disability Status Scale (EDSS) scores, and disease duration of patients were recorded. Patients with a history of other vascular diseases such as hypertension, diabetes mellitus, peripheral artery disease, and acute relapses were excluded. RESULTS: Sixty-nine participants were included. The mean age of the study population was 35.8±7.1 years. Right CIMT was significantly greater in the patient population (P<0.001). Spearman's correlation coefficient between age and right CIMT was r=0.41, P=0.01. When we compared the Hs-CRP with a cut-off value of ≤3, the right, left, and mean CIMT levels were not statistically significant (P=0.17; P=0.22; P=0.15). The mean serum vitamin D levels were higher in the patient group and this was statistically significant (P<0.001). The statistically significant factors identified with univariate analysis with P<0.2 were further entered into multivariate modelling. CONCLUSION: CIMT seems to be affected in patients with MS by means of the disease itself and age. Thus, CIMT might reflect the predisposition to subclinical atherosclerosis more than Hs-CRP. Further investigation in a large MS population is still needed.

The Prevalence of Mixed Genotype Infections in Turkish Patients with Hepatitis C: a Multicentered Assessment.

BACKGROUND: HCV virus infections are one of the major health problems in the world that can cause cirrhosis and liver cancer at a higher rate than other hepatitis data. The aim of this study was to determine the prevalence of mixed infections with different HCV genotypes in Turkey and also to evaluate the current HCV genotype and sub-type distributions by a multicentered assessment. METHODS: The HCV genotype data of 17,578 hepatitis C patients collected from 23 centers from different geographic regions covering all Turkey were collected. The data included information about the HCV genotypes in the last 10 years (between 2007 and 2016), demographic properties of the patients and the methods/systems used to determine the genotypes. RESULTS: Two hundred twenty-eight of the patients (1.3%) had mixed genotype. The most common mixed genotype combination was 1b + 4 (0.83%) followed by 1a + 1b (0.26%). Genotype distribution varies according to geographical regions. However, genotype 1 (82.92%) was the most common genotype in all regions and all years. This was followed by genotype 3 (7.07%) and genotype 4 (5.43%). A variety of methods were used by the centers including sequencing, pyrosequencing, real-time PCR, in-house RFLP, reverse hybridization (LIPA), and hybridization. CONCLUSIONS: Infection with mixed HCV genotypes in Turkey is uncommon. Genotype distribution varies according to geographic regions; the most common genotype 1 is encountered all over the country, while genotypes 3 and 4 are only in some of the centers. Since there is limited information about mixed HCV infection, further investigations are needed to determine the clinical importance of mixed HCV infection.

Can apelin play a role in the etiology of tinnitus?

Background/aim: Tinnitus is seen in 15% of the general population; in 1%­6% of this number, the quality of life is seriously affected by this chronic condition. Chemical, oxidative, and emotional stressors are important in terms of the clinical course of tinnitus. Apelin is an endogenous peptide which is an oxidative stress mediator. It has been shown that the apelin/APJ (apelin junction receptor) system plays various roles in the physiology and pathophysiology of many organs. However, the role of the apelin/APJ system as an oxidative stress mediator in tinnitus is unknown. We investigated the level of apelin in patients with normal hearing and bilateral tinnitus. Materials and methods: We enrolled patients diagnosed with bilateral idiopathic tinnitus. Tinnitus severity was determined using the tinnitus handicap inventory (THI). We recorded the levels of plasma apelin-13 and biochemical parameters. Results: The mean apelin level of the control group was higher than that of the patient group (P = 0.002). A significant negative correlation was evident between the apelin level and the THI (r = ­0.460, P = 0.003). The triglyceride (TG) level was significantly higher in the patient group than in the control group (P < 0.001). Conclusion: In our study, we found a negative correlation between apelin and tinnitus severity. Thus, apelin may play a role in the pathophysiology of idiopathic tinnitus, and may be prescribed during follow-up to reduce oxidative stress in the future. Further clinical studies on the effects of the apelin/APJ (apelin junction receptor) system and the effects of antioxidants in patients with inflammatory diseases are required.

Matrix-Assisted Laser Desorption-Ionization Time-of-Flight Mass Spectrometry (MALDI- TOF MS) for Early Identification of Septic Patients.

BACKGROUND: Matrix-assisted laser desorption-ionization time-of-flight mass spectrometry (MALDI-TOF MS) is a powerful technique for the rapid identification of bacteria from growing colonies in routine cultures. In this study, we evaluated the feasibility of a 5-hour incubation on solid medium after sub-cultivation of positive blood culture broth without any preparation steps in order to speed up the identification of bacteria. METHODS: In addition to standard laboratory protocols, a Columbia agar plate with 5% sheep blood was inoculated with 1 drop from the blood culture broth. After a 5-hour incubation period, a colony from the culture plate was submitted to MALDI-TOF MS. RESULTS: A total of 1351 positive blood cultures (1299 monomicrobial and 51 polymicrobial) were analyzed. When compared to routine identification procedure results for positive blood cultures, 79.3% of isolates were correctly identified to the species level. When manufacturer-recommended score values were taken into account, MALDITOF MS correctly identified 98.4% of the isolates to the species level with a score of > 2.0, 89.1% with a score between 1.7 and 2.0, and 75.4% with a score of < 1.7. CONCLUSIONS: ln our evaluation, a large majority of the S. aureus (91.5%) and Enterobacteriaceae (87.6%) were correctly identified at the species level. A 5-hour incubation period was found to be associated with moderate identification results for CoNS, Enterococcus spp., and nonfermentative gram negative bacilli, with failure being mostly observed with Streptococcus spp., Candida spp., and other gram positive bacteria. We believe that the performance of MALDI-TOF MS identification after short-term culture is directly related to the sufficient growth of microorganisms at 5 hours.

The Frequency of Primary Sjogren's Syndrome and Fibromyalgia in Irritable Bowel Syndrome.

OBJECTIVE: To determine the frequency of sicca complex, Sjogren's Syndrome (SS) and Fibromyalgia (FM) in patients with Irritable Bowel Syndrome (IBS). METHODS: Seventy seven IBS patients who fulfilled the Rome-III criteria were included in the study. All patients were assessed for FM according to the American College of Rheumatology (ACR) 2010 criteria. After examination for objective evidence of sicca complex by Schirmer test, TBUT and Ocular Staining Score (OSS), serological tests were performed. And the diagnosis of SS was made according to the American College of Rheumatology (ACR) classification criteria for SS - 2012. RESULTS: Thirteen (16.9%) of IBS patients had FM. Dry eye was detected in 20(26.0%), 7(9.1%) and 29(37.7%) patients by OSS, Schirmer test and TBUT, respectively. Of 77 patients with IBS, the diagnosis of SS was established in two patients (2.6%). CONCLUSION: The frequency of Sjogren's Syndrome among patients with IBS is relatively higher than the general population. All IBS patients should be questioned for dryness of the mouth and eyes, and if necessary, should be evaluated for SS.

Evaluation of the BD Phoenix system for detection of methicilin resistance in Staphylococcus aureus isolates in comparison to BD GeneOhm MRSA assay.

BACKGROUND: In order to identify methicillin-resistant Staphylococcus aureus isolates quickly, automated and semiautomated systems, commercial media, and identification kits are widely used. The Phoenix system (BD, Sparks, MD, USA) has been available since 2004 in our laboratory. This study evaluated the reliability of the Phoenix system for the detection of methicillin resistance in Staphylococcus aureus isolates in comparison to BD GeneOhm MRSA assay (Becton Dickinson Diagnostics GeneOhm, CA, USA). METHODS: A total of 206 clinically significant Staphylococcus aureus isolates, submitted to the clinical microbiology laboratory between March 2011 and May 2013, were included in the study. Phoenix panels were studied for identification and susceptibility testing according to manufacturers' instructions. The detection of MRSA was performed using the BD GeneOhm MRSA assay (Becton Dickinson Diagnostics GeneOhm, CA, USA). The assay is a qualitative real-time PCR method. RESULTS: The Phoenix system results and mecA gene pozitivity were concordant for 134 methicillin-resistant and 71 methicillin-susceptible strains. One discordant isolate, identified as mecA negative by the PCR method, was methicillin-resistant Staphylococcus aureus positive by the Phoenix system (oxacilline MIC = 2 microg/mL; cefoxitin MIC = 8 microg/mL). In this study, Phoenix automated system's sensitivity, specificity, negative predictive value, and positive predictive value are found as 100%, 100%, 100%, and 100%, respectively. CONCLUSIONS: As a result of our study, use of the Phoenix automated identification method for the detection of methicillin-resistant Staphylococcus aureus isolates is a practical and reliable approach for daily clinical laboratory procedures.

[Investigation of hepatitis C virus genotype distribution in patients with chronic hepatitis C infections in Antalya Training and Research Hospital, Turkey]. / Antalya Egitim ve Arastirma Hastanesinde kronik hepatit C hastalarinin genotip dagiliminin arastirilmasi

Hepatitis C virus (HCV) infection is a major global health problem due to high chronicity rates, occurrence of severe hepatic diseases, and absence of an accurate therapy and effective vaccine. It is well known that viral genome is highly variable and HCV has at least six genotypes, each of them containing a series of subtypes. HCV genotypes exhibit geographical and epidemiological distribution. Genotype identification is clinically important to decide the dosage and duration of treatment since different genotypes exhibit variable response to treatment. The aim of this study was to determine the HCV genotypes in chronic HCV patients who were followed-up in Antalya Research and Training Hospital, Turkey. Anti-HCV and HCV-RNA positive blood samples obtained from 148 chronic hepatitis C patients (67 female, 81 male; mean age: 50.5 ± 10.8, age range: 17-73 years) who were admitted to Antalya Research and Training Hospital Microbiology Laboratory during January 2011-June 2013, were included in the study. Epidemiological data of the patients and HCV genotype results were evaluated retrospectively. Viral genotypes were determined by real-time (Rt) PCR assay (Abbott Molecular Diagnostic, USA). HCV genotype (Gt)-1 was detected in 119 (80.4%) of the patients, of them 15.9% (19/119) were identified as subtype 1a and 75.6% (90/119) were subtype 1b. The prevalence rates of Gt-2, -3, and -4 were found as 3.4% (n= 5), 11.5% (n= 17), and 2% (n= 3), respectively. Gt-6 was not detected in our patients. Mixed infection with HCV types was detected in four patients (2.7%) by Rt-PCR; of these three were detected as Gt-1 and one was Gt-2 by RFLP (Restriction Fragment Length Polymorphism) and sequencing. The high prevalence of Gt-3 (11.5%) obtained in this study was attributed to the determination of Gt-3 in seven of 13 foreign national subjects. Rt-PCR method used in this study is user independent, standardized, automated, rapid and reliable method, however in case of detection of mixed types, the samples should be confirmed by other methods. In conclusion, we reported that the majority of the chronic hepatitis C infected patients had Gt-1b, and Gt-3 exhibited the highest rate ever reported by other studies from Turkey.

Migraine and gasdermin D: a new perspective on the inflammatory basis of migraine.

Migraine is a common and disabling primary headache disorder and inflammation is a proposed factor in the complex ethiology of the disease. Gasdermin D (GSDMD) is a membrane pore-forming protein acting through the caspase system. End result is cell death caused by leakage of intracellular components to extracellular space which also results in inflammation. Stemming from this knowledge, the potential role of GSDMD in migraine was investigated in this prospective study. This prospective study was conducted between September 2022 to April 2023. 47 patients with migraine were designated as the patient group, whereas 47 healthy volunteers were designated as the control group. Serum GSDMD levels of both groups were compared, with an additional comparison between migraine patients during symptom-free and attack periods. Migraine related characteristics of the patients were also included in the study. Median GSDMD levels of the patient and control group did not reveal a significant difference. Nausea, vomiting and severity of headache were found to be correlated with GSDMD levels in migraine patients. Patients with nausea revealed a higher GSDMD level compared to patients without nausea during both symptom-free and attack periods (p = 0.021 and p = 0.01, respectively). Nausea was correlated to higher GSDMD levels in the patient population during symptom-free period (p = 0.030). The severity of pain was positively correlated with GSDMD levels during the attack period (p < 0.001). Gasdermin family and GSDMD in particular are promising prospects for therapy in a wide spectrum of disorders. Gasdermin proteins are candidates to be the focus for future studies both related to pathogenesis and drug therapy in migraine and varying inflammatory-driven clinical pictures.

The role of serum procalcitonin levels in predicting ascitic fluid infection in hospitalized cirrhotic and non-cirrhotic patients.

OBJECTIVE: To determine the role of serum procalcitonin levels in predicting ascites infection in hospitalized cirrhotic and non-cirrhotic patients. METHODS: A total of 101 patients (mean age: 63.4 ± 1.3, 66.3% were males) hospitalized due to cirrhosis (n=88) or malignancy related (n=13) ascites were included in this study. Spontaneous bacterial peritonitis (SBP, 19.8%), culture-negative SBP (38.6%), bacterascites (4.9%), sterile ascites (23.8%) and malign ascites (12.9%) groups were compared in terms of procalcitonin levels in predicting ascites infection. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of procalcitonin levels and predicting outcome of procalcitonin levels was compared with C-reactive protein (CRP). RESULTS: Culture positivity was determined in 26.7% of overall population. Serum procalcitonin levels were determined to be significantly higher in patients with positive bacterial culture in ascitic fluid compared to patients without culture positivity (median (min-max): 4.1 (0.2-36.4) vs. 0.4 (0.04-15.8), p<0.001). Using ROC analysis, a serum procalcitonin level of <0.61 ng/mL in SBP (area under curve (AUC): 0.981, CI 95%: 0.000-1.000, p<0.001), <0.225 ng/mL in culture-negative SBP (AUC: 0.743, CI 95%: 0.619-0.867, p<0.001), <0.42 ng/mL in SBP and culture-negative SBP patients (AUC: 0.824, CI 95%: 0.732-0.916, p<0.001), and <1.12 ng/mL in bacterascites (AUC: 0.837, CI 95%: 0.000-1.000, p=0.019) were determined to accurately rule out the diagnosis of bacterial peritonitis. Predictive power of serum procalcitonin levels in SBP + culture-negative SBP group (AUCs: 0.824 vs 0.622, p=0.004, Fig 4), culture-positive SBP (AUCs: 0.981 vs 0.777, p=0.006, Fig 5) and (although less powerfull) in culture-negative SBP (AUCs: 0.743 vs 0.543, p=0.02, Fig 6) were found significantly higher than CRP. CONCLUSION: According to our findings determination of serum procalcitonin levels seems to provide satisfactory diagnostic accuracy in differentiating bacterial infections in hospitalized patients with liver cirrhosis related ascites.

[Evaluation of a hospital outbreak related to carbapenem-resistant Pseudomonas aeruginosa]. / Karbapeneme Dirençli Pseudomonas aeruginosa'ya Bagli Bir Hastane Enfeksiyonu Salgininin Incelenmesi.

Pseudomonas aeruginosa is an important nosocomial pathogen that causes opportunistic infections and hospital outbreaks. During October 2012, carbapenem-resistant P.aeruginosa strains with similar antibiotic resistance patterns, were isolated from specimens sent from the intensive care and plastic surgery units in our hospital. Thus a hospital outbreak was suspected. The microbiology laboratory database was retrospectively searched and all strains of P.aeruginosa isolated during the four month period, starting with the initial carbapenem-resistant strain in August 2012, was evaluated as a hospital outbreak. The aim of this study was to define the outbreak by investigating the clonal relationship between the strains, to detect the potential environmental sources and to evaluate the period of the outbreak, risk factors and the efficiency of infection control measures. The study was conducted between August-November 2012. Twenty patients with carbapenem-resistant P.aeruginosa (CRPA) positive cultures were included in the study. The control group consisted of 22 patients with carbapenem-susceptible P.aeruginosa (CSPA) positive cultures. The clonal relationship between 26 CRPA strains was studied by pulsed-field gel electrophoresis (PFGE). The PFGE results indicated that CRPA strains in our hospital were not related to a single clone, however, there were four major clones composed of four to eight strains. Logistic regression analysis indicated that the risk increased 15.7 fold (95% CI: 1.19-207.76) by the use of carbapenem, 76.8 fold (95% CI: 2.03-2901.30) by surgical procedures and 0.787 fold (95% CI: 0.63-0.97) by the duration of hospital stay. Surveillance cultures from health-care personel and the environment performed in course of the outbreak, yielded no growth of a strain with the similar antibiotic resistance pattern. The spread of CRPA has been controlled by the use of effective precautionary measures, regressing the isolate number to 0-1 strain/month. Since CRPA infections have high mortality and lack therapeutic alternatives, they should be regarded among the priorities of the infection control programmes. This study has enabled to test the effectiveness of the infection control program, to make plans for the possible future outbreaks and to train the staff.

[Comparison of Phoenix Automated System, API ID 32 Strep System and LightCycler Enterococcus MGRADE System in the Identification of Clinical Enterococcus Isolates]. / Klinik Enterokok Izolatlarinin Tanimlanmasinda Phoenix Otomatize Sistemi, API ID 32 Strep Sistemi ve Light Cycler Enterococcus MGRADE Sisteminin Karsilastirilmasi

Enterococci which are part of the commensal flora of the human gastrointestinal and genitourinary tracts, are increasing in importance as the cause of hospital-acquired infections. Identification of Enterococcus spp. at the species level is of great importance, for appropriate treatment of patients, infection control and to supply epidemiological data. Conventional methods for the identification of enterococcus isolates at species level is difficult and time consuming. Correct identification of enterococcus isolates in clinical microbiology laboratory by conventional methods is replaced by semi-automated or automated identification and molecular methods. The aim of this study was to evaluate the performance of Phoenix automated system (BD Diagnostic Systems, USA), API Rapid ID 32 Strep System (bioMerieux, France) and Enterococcus MGRADE LightCycler kit (Roche Molecular Biochemicals, Germany) used in real-time polymerase chain reaction (Rt-PCR), for the species level identification of enterococcus strains isolated from clinical specimens. A total of 90 vancomycin susceptible enterococci isolated from different patients were identified by all of the three commercial systems, together with conventional methods. Of the strains, 59 were identified as E.faecalis, 28 were E.faecium, and one of each as E.raffinosus, E.hirae and E.casseliflavus with conventional methods. One E.faecalis strain identified by the conventional system was identified as E.faecium by Phoenix system and one E.faecium strain as E.durans. One E.raffinosus strain identifed by the conventional method was identified as E.avium by API. Conventionally identified four E.faecalis strains were determined to be E.faecium by Rt-PCR and one E.faecium, one E.raffinosus and one E.casseliflavus as E.faecalis. Accordingly, the consistency of Phoenix, API Rapid ID 32 Strep and LightCycler Enterococcus MGRADE systems with the conventional methods were detected as 97.8% (88/90), 98.9% (89/90), and 92.2% (83/90), respectively. In conclusion, all of those three commercial assays are appropriate methods to be used for the identification of enterococci at the species level in the routine clinical microbiology laboratories, due to their high compliance with the conventional method, and their ability to yield the results at the same day.

Serotype distribution of Streptococcus pneumoniae and pneumococcal vaccine coverage in adults in Turkey between 2015 and 2018.

OBJECTIVE: To evaluate the serotype distribution and antibiotic resistance in pneumococcal infections in adults and to provide a perspective regarding serotype coverage of both current and future pneumococcal vaccines. PATIENTS AND METHODS: This passive surveillance study was conducted with the Streptococcus pneumoniae strains isolated from the specimens of patients with pneumonia (materials isolated from bronchoalveolar lavage), bacteraemia, meningitis, pleuritis and peritonitis between 2015 and 2018. Serogrouping and serotyping were performed by latex particle agglutination and by conventional Quellung reaction using commercial type-specific antisera, respectively. The strains were analysed for penicillin, cefotaxime, erythromycin and moxifloxacin susceptibilities by E-test. RESULTS: In the whole study group (410 samples from adults aged ≥18 years), the most frequent serotypes were 3 (14.1%), 19 F (12%) and 1 (9.3%). The vaccine coverage for PCV13, PCV15, PCV20 and PPV23 was 63.9%, 66.6%, 74.1% and 75.9%, respectively, in all isolates. Penicillin non-susceptibility in invasive pneumococcal disease (IPD) was 70.8% and 57.1% in the patients aged <65 and ≥65 years, respectively. About 21.1% and 4.3% of the patients with and without IPD had cefotaxime resistance. Non-susceptibility to erythromycin and moxifloxacin was 38.2% and 1.2%, respectively. CONCLUSIONS: The results revealed that novel PCV vaccines may provide improved coverage as compared with the currently available vaccine, PCV13. The significant antibiotic resistance rates imply the need to extend the serotype coverage of the vaccines. Continuing the surveillance in pneumococcal diseases is critical to explore the serotype distribution and incidence changes of IPD cases in the population and to inform policy makers to make necessary improvements in the national immunization programmes.Key messagesThis multicentre study demonstrated the most recent serotype distribution and antibiotic resistance in adult population in Turkey.Shifting from PCV13 to novel conjugated vaccines will significantly increase the coverage.Continuing the surveillance in pneumococcal diseases is critical to explore the serotype distribution changes and the incidence of cases with invasive pneumococcal disease in the population.

Blastocystosis in patients with gastrointestinal symptoms: a case-control study.

BACKGROUND: Blastocystosis is a frequent bowel disease. We planned to to evaluate the prevalence of Blastocystis spp. in patients who applied to the same internal medicine-gastroenterology clinic with or without gastrointestinal complaints to reveal the association of this parasite with diagnosed IBS and IBD. METHODS: A total of 2334 patients with gastrointestinal symptoms composed the study group, which included 335 patients with diagnosed inflammatory bowel disease and 877 with irritable bowel syndrome. Patients without any gastrointestinal symptoms or disease (n = 192) composed the control group. Parasite presence was investigated by applying native-Lugol and formol ethyl acetate concentration to stool specimens, and trichrome staining method in suspicious cases. RESULTS: Blastocystis spp. was detected in 134 patients (5.74%) in the study group and 6 (3.12%) in the control group (p = 0.128). In the study group, Blastocystis spp. was detected at frequencies of 8.7% in ulcerative colitis (24/276), 6.78% in Crohn's disease (4/59), 5.82% in irritable bowel syndrome (51/877), and 4.9% in the remaining patients with gastrointestinal symptoms (55/1122). Blastocystis spp. was detected at a statistically significant ratio in the inflammatory bowel disease (odds ratio [OR] = 2.824; 95% confidence interval [CI]: 1.149-6.944; p = 0.019) and ulcerative colitis (OR = 2.952; 95% CI: 1.183-7.367; p = 0.016) patients within this group compared to controls. There were no statistically significant differences between the control group and Crohn's disease or irritable bowel syndrome patients in terms Blastocystis spp. frequency (p = 0.251, p = 0.133). CONCLUSIONS: Blastocystosis was more frequent in patients with inflammatory bowel disease, especially those with ulcerative colitis. Although symptomatic irritable bowel syndrome and Crohn's disease patients had higher rates of Blastocystis spp. infection, the differences were not significant when compared to controls.

Demodex Species Frequency and Risk Factors in Patients With Rheumatoid Arthritis.

OBJECTIVES: This study aims to investigate the presence of Demodex species in rheumatoid arthritis (RA) patients, to identify the risk factors for developing Demodex infestation, and to determine the effect of immunosuppressant drugs on Demodex mite infestations. PATIENTS AND METHODS: The study included 93 RA patients (16 males, 77 females; mean age 53.3±11.3 years; range, 27 to 83 years) and 76 healthy controls (19 males, 57 females; mean age 50.3±13.9 years; range, 19 to 86 years). Specimens were collected from face skin by using standardized sur- face skin biopsy. Demodex infestation was considered for ≥5 living parasites/cm2 of skin while Demodex mite presence was defined as any Demodex larvae, adults, or eggs found in the specimen. RESULTS: The frequencies of Demodex mite presence were 44% for the RA patients and 15.7% for the healthy controls (p<0.001). The rates of Demodex infestation were similar between the two groups (18.3% versus 7.9%, p=0.054). There were no statistically significant differences between the groups regarding skin type, skin care, epilation, body washing, use of a moisturizer, personal towel use, the number of residents at home, or whether there were pets at home or in proximity. Itching in eyes was higher in RA patients, but the frequency of other skin symptoms was not differ- ent from healthy controls. Logistic regression analysis indicated that the diagnosis of RA was an independent risk factor for Demodex mite presence in this study population. Disease activity and duration, use of corticosteroids, conventional disease-modifying anti-rheumatic drugs (DMARDs) and biological DMARDs were not effective factors on Demodex mite presence in RA patients. CONCLUSION: Although Demodex mite presence was 3.5-fold higher in RA patients, the rate of Demodex infestation was similar to that of healthy controls.

The Presence of Demodex Mites in Patients with Dermatologic Symptoms of the Face

Objective: The aim of the study was to investigate the Demodex prevalence in patients with dermatological complaints who were admitted to our hospital, and to evaluate the socio-demographic characteristics and risk factors of the patients. Methods: A total of 133 patients who were sent for Demodex screening were included and questionnaire for risk factors was administered. Samples were taken by standard superficial skin biopsy method and the different developmental stages were investigated under microscope. Results: Demodex species were found in 93 (69.9%) of the patients. Demodex folliculorum was found in 58 (62.4%) of the patients, Demodex brevis in 13 (14%), Demodex folliculorum and Demodex brevis in 4 (4.3%) and Demodex species in 18 (19.4%) of the patients. At least one of the Demodex species was found in 77.1% of patients with acne rosacea. No statistically significant relation was found between Demodex positivity and age, gender, number of weekly baths, use of makeup, and common towel use. Though statistically not significant, an increase of Demodex infestation with increasing age was observed. Conclusion: Demodex mite infestations are widespread worldwide without showing important racial and gender differences. In the present study, prevalence of Demodex infestation in patients with acne rosacea was high and this should be taken into consideration, when such patients are treated for their symptoms.