Investigation of an algorithm for anti HCV EIA reactivity in blood donor screening in Turkey in the absence of nucleic acid amplification screening.

PURPOSE: In this study we aimed to propose an algorithm for initial anti HCV EIA reactive blood donations in Turkey where nucleic acid amplification tests are not yet obligatory for donor screening. METHODS: A total of 416 anti HCV screening test reactive donor samples collected from 13 blood centers from three cities in Turkey were tested in duplicate by Ortho HCV Ab Version 3.0 and Radim HCV Ab. All the repeat reactive samples were tested by INNO-LIA HCV Ab 3.0 or Chiron RIBA HCV 3.0 and Abbott Real Time HCV. Intra-assay correlations were calculated with Pearson r test. ROC analysis was used to study the relationship between EIA tests and the confirmatory tests. RESULTS: The number of repeat reactive results with Ortho EIA were 221 (53.1%) whereas that of microEIA, 62 (14.9%). Confirmed positivity rate was 14.6% (33/226) by RIBA and 10.6% (24/226) by NAT. Reactive PCR results were predicted with 100% sensitivity and 95% specificity with S/CO levels of 8.1 with Ortho EIA and 3.4 with microEIA. CONCLUSIONS: Repeat reactivity rates declined with a second HCV antibody assay. Samples repeat reactive with one HCV antibody test and negative with the other were all NAT negative. All the NAT reactive samples were RIBA positive. None of the RIBA indeterminate or negative samples were NAT reactive. Considering the threshold values for EIA kits determined by ROC analysis NAT was decided to be performed for the samples above the threshold value and a validated supplemental HCV antibody test for the samples below.

[The effectiveness of hand hygiene products on MRSA colonization of health care workers by using CHROMagar MRSA]. / El Hijyen Ürünlerinin Saglik Çalisanlarinda MRSA Kolonizasyonuna Etkilerinin CHROMagar MRSA ile Arastirilmasi

The aims of this study were; to investigate the hand hygiene compliance of the health care workers (HCWs) during their routine patient care, to determine the methicillin-resistant Staphylococcus aureus (MRSA) hand colonization of the HCWs, to investigate the effect of different hand hygiene products on MRSA colonization and to evaluate the effectiveness of chromogenic agar for detecting MRSA. HCWs were investigated during their routine patient care and hand cultures were taken before and after hand wash/hygiene. Two different techniques were used to obtain the hand cultures: fingertip method (CHROMagar MRSA containing HygiSlide); and direct swab method and then inoculation to CHROMagar MRSA media. MRSA strains grown on those cultures were confirmed with conventional methods. A total of 100 HCWs (of them 61 were female; mean age: 32.7 ± 5.2 years; age range: 25-51 years) involving physicians (n= 33), nurses (n= 38) and health care assistants (n= 29), were included in the study. MRSA was detected in 39% and 11% before hand hygiene and in 13% and 6% after hand hygiene, with HygiSlide CHROMagar media and with CHROMagar in plate media, respectively. No difference were found regarding clinics, occupations, or the type of patient handling in those HCWs who were positive (n= 13) for MRSA colonization following hand hygiene, and those who were negative (n= 26). However, the type of the hand hygiene product used exhibited a statistical difference. None of the seven HCWs who used alcohol based hand rub revealed growth in the second culture while 10 of 19 (53%) HCWs who used soap and three of 13 (23%) HCWs who used chlorhexidine were still colonized with MRSA. In terms of reduction in the MRSA counts, the most effective one was the alcohol based hand rub while the soap was the least, since seven of 19 (37%) HCWs who used soap showed no reduction at all in the MRSA counts. A high ratio of hand colonization with MRSA was detected in our hospital staff (39%). It was shown that the colonization could be reduced significantly (with a rate of 66%) with hand hygiene. Alcohol based hand rub was found to be the most effective method in hand hygiene. The fingertip technique was found to be superior to inoculation to plate media for obtaining hand cultures and CHROMagar MRSA media was found to be rapid, effective and practical for detecting the MRSA hand colonization.

[Evaluation of antibiotic susceptibilities and VISA-VRSA rates among MRSA strains isolated from hospitalized patients in intensive care units of hospitals in seven provinces of Turkey]. / Türkiye'de Yedi Ildeki Hastanelerin Yogun Bakim Ünitelerinden Izole Edilen MRSA Suslarinda VISA-VRSA Arastirilmasi ve Antibiyotik Duyarlilik Durumlarinin Saptanmasi

The aim of this study was to determine whether vancomycin resistant Staphylococcus aureus (VRSA) and vancomycin intermediate susceptible S.aureus (VISA) strains were present among methicillin-resistant S.aureus (MRSA) strains isolated from patients hospitalised at intensive care units (ICU) of hospitals located at different regions of Turkey and to determine the minimum inhibitory concentration (MIC) values of teicoplanin, linezolid, tigecycline, quinupristin-dalfopristin and daptomycin, which are alternative drugs for the treatment of MRSA infections. A total of 260 MRSA clinical strains (isolated from 113 lower respiratory tract, 90 blood, 24 wound, 17 catheter, 13 nasal swabs, two urine and one CSF sample) were collected from nine health-care centers in eight provinces [Ankara (n= 52), Konya (n= 49), Antalya (n= 40), Istanbul (n= 7), Izmir (37), Diyarbakir (n= 15), Van (n= 12), Trabzon (n= 48)] selected as representatives of the seven different geographical regions of Turkey. Methicillin resistance was determined by cefoxitin disk diffusion in the hospitals where the strains were isolated and confirmed by oxacillin salt agar screening at the Refik Saydam National Public Health Agency. Screening for VISA and VRSA was conducted using the agar screening test and E-test. Susceptibility of the MRSA strains to other antibiotics was also determined by E-test method. None of the 260 MRSA strains were determined to be VRSA or VISA. All were susceptible to teicoplanin and linezolid, and susceptibility rates to daptomycin, tigecycline and quinupristin-dalfopristin were 99.6%, 96.9%, and 95%, respectively. Absence of VISA and VRSA among the MRSA strains surveyed currently seemed hopeful, however, continuous surveillance is necessary. In order to prevent the development of VISA and VRSA strains the use of linezolid, tigecycline, quinupristin-dalfopristin and daptomycin should be encouraged as alternative agents of treatment of MRSA infections.

[Evaluation of vancomycin, teicoplanin, linezolide and tigecycline susceptibilities of nosocomial methicillin-resistant Staphylococcus strains by E-test]. / Hastane Kaynakli Metisiline Dirençli Stafilokok Suslarinda Vankomisin, Teikoplanin, Linezolid ve Tigesiklin Duyarliliginin E-Test Yöntemiyle Degerlendirilmesi.

The aim of this study was to determine the minimal inhibitory concentration (MIC) values of vancomycin, teicoplanin, tigecycline and linezolid in 100 methicillin-resistant staphylococci [21 methicillin-resistant Staphylococcus aureus (MRSA) and 79 methicillin-resistant coagulase negative staphylococcus (MR-CNS)] isolated as agents of nosocomial infection from patients at Ankara Training and Research Hospital between June 2005-March 2007. The MIC values for vancomycin, teicoplanin, linezolid and tigecycline were tested by E-test method (AB Biodisk, Sweden). For 21 MRSA strains MIC50 and MIC90 values were as follows: vancomycin 0.125 µg/ml and 1 µg/ml; teicoplanin 0.5 µg/ml and 3 µg/ml, linezolid 0.047 µg/ml and 0.19 µg/ml; tigecycline 0.094 µg/ml and 0.5 µg/ml, respectively. For 79 MR-CNS strains MIC50 and MIC90 values were as follows: vancomycin 0.5 µg/ml and 2 µg/ml; teicoplanin 2 µg/ml and 4 µg/ml; linezolid 0.125 µg/ml and 0.25 µg/ml; tigecycline 0.38 µg/ml and 0.5 µg/ml, respectively. No resistance to vancomycin, teicoplanin, tigecycline and linezolid were determined in methicillin-resistant staphylococcus strains isolated from the inpatients in our hospital. Among glycopeptides, MIC50 and MIC90 values of vancomycin were found to be lower than that of teicoplanin.

Acupuncture for depression and myalgia in patients with hepatitis: an observational study.

BACKGROUND: Depressive symptoms and myalgia are commonly seen in patients with chronic hepatitis B and chronic hepatitis C. OBJECTIVE: To investigate the efficacy of acupuncture treatment on depressive symptoms and myalgia in patients with hepatitis. METHODS: Of 44 patients with hepatitis screened for depression and myalgia, 28 were enrolled and included in the study. The main outcome measure for depressive symptoms was Beck's Depression Inventory (BDI). For pain/myalgia, patients rated their pain on a scale from 0 to 10. Patients with a score greater than the cut-off point in either score were allocated to acupuncture treatment. The Chinese method of acupuncture was used. Treatment continued for 6 weeks. RESULTS: At baseline, 17/44 patients (39%) had a BDI score ≥17 and 24 (55%) had a pain score ≥5. A total of 28 patients were allocated to acupuncture treatment, forming three groups: group 1, 13 patients with high BDI and high myalgia scores; group 2, 11 patients with low BDI score but high myalgia score; group 3, 4 patients with high BDI score but low myalgia score. Adherence to treatment was good; all patients completed the sessions and there were no drop-outs. Significant improvements in end-treatment BDI and in myalgia scores compared with baseline levels was found. CONCLUSION: Acupuncture seems to be a promising treatment for patients with hepatitis. Further studies are warranted in large populations to establish the therapeutic role of acupuncture.

[Methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus carriage rates in a neonatal intensive care unit]. / Yenidogan yogun bakim ünitesinde metisiline dirençli Staphylococcus aureus ve vankomisine dirençli enterokok tasiyicilik oranlarinin belirlenmesi.

This study was aimed to determine the rates of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) carriage in a neonatal intensive care unit in a Training and Research Hospital in Ankara, Turkey. A total of 135 newborns were included in the study. Following 5 days stay in intensive care unit, samples were taken from nose and umbilicus for the detection of MRSA and cultivated in mannitol-salt agar and oxacillin-resistance screening agar (ORSAB), respectively. The samples taken from rectum to screen VRE, were placed onto Enterococcosel agar which contained vancomycin and ceftazidime. The confirmation of methicillin resistance in MRSA suspected isolates was performed by oxacillin and cefoxitin disk diffusion tests according to Clinical Laboratory Standards Institute (CLSI) guidelines. Twenty eight (20.7%) of 135 newborns had nasal MRSA carriage, 30 (22.2%) of 135 had umbilical and 10 (7.4%) had both nasal and umbilical MRSA carriage. No rectal VRE carriage was found among the newborns. As a result, we suggest that periodical MRSA and VRE carriage investigation in the patients hospitalized in neonatal intensive care units is of outmost help to control and prevent nosocomial infections.

[Evaluation of oxacillin resistance screening agar and chromogenic MRSA agar media for the detection of methicillin resistance in Staphylococcus aureus clinical isolates]. / Staphylococcus aureus klinik izolatlarinda metisilin direncinin saptanmasinda oksasilin direnci tarama agar ve kromojenik MRSA agar besiyerlerinin degerlendirilmesi.

Methicillin-resistant Staphylococcus aureus (MRSA) strains which are the most frequent causes of hospital acquired infections, are also currently encountered with increasing frequency in community acquired infections. Therefore rapid and accurate identification of MRSA strains is essential in both implementation of infection control measures and prevention of the nosocomial spread of this microorganism. The aim of this study was to determine the specifisity, sensitivity, positive and negative predictive values of two commercial media, one was Oxacillin Resistance Screening Agar Base (ORSAB; Oxoid, England) and the other was chromogenic MRSA agar (BBL CHROMagar MRSA; BD, Paris, France), for the identification of MRSA strains. A total of 175 clinical S. aureus isolates, of which 45 were MRSA, and 130 were methicillin-susceptible S. aureus (MSSA), whose susceptibility to methicillin were determined by disk diffusion method using oxacillin and cefoxitin disks in Mueller-Hinton agar medium, were included in the study. When oxacillin disk diffusion test was accepted as the reference method, the specificity, sensitivity, positive and negative predictive values of ORSAB were found as 97.7%, 40%, 36.5% and 98.1%, respectively; while these values were detected as 95.5%, 37.6%, 35.7% and 96.1% for CHROMagar MRSA, respectively. These results indicated that both media may be used in laboratories where work load is high and the number of personnel is inadequate especially in screening studies together or in addition to another medium (mannitol-salt agar). However, since these methods exhibit low specifity (high false positive results), positive results should be confirmed using other methods such as disk diffusion, E-test or microdilution susceptibility testing.

[Prognostic value of serum TNF-alpha, IL-10, leptin and CRP levels in newborns with septicemia]. / Sepsisli yenidoganlarda serum TNF-alpha, IL-10, leptin ve CRP düzeylerinin prognostik degeri.

This study was aimed to investigate the prognostic value of tumor necrosis factor-alpha (TNF-alpha), interleukin-10 (IL-10), leptin and C-reactive protein (CRP) levels in newborn sepsis. A total of 57 newborns with nosocomial sepsis and 30 healthy newborns were included to the study. Serum TNF-alpha, IL-10, leptin (Biosource, Belgium) and CRP (Dade Behring, Germany) levels were investigated by ELISA methodology before the initiation of the therapy (day 0) and on the third and fifth days of therapy. Initial leptin levels were found to be high in the control group (p = 0.00) and CRP levels were found to be high in the patient group (p = 0.00). No significant difference was detected for IL-10 and TNF-alpha levels (p > 0.05). CRP levels were significantly higher in the patient group than the controls on the third day of the therapy (p = 0.001), however, no significant difference was detected for the other parameters (p > 0.05). On the fifth day of the therapy CRP (p = 0.023) and leptin (p = 0.00) levels were significantly high in the patient group and TNF-alpha in the control group (p = 0.00) while no significant difference was observed for IL-10 levels (p > 0.05). Mortality rate was 24.5%. When the mean TNF-alpha, IL-10, leptin and CRP levels on the 0th, 3rd and 5th days were analysed for alive (n = 43) and dead (n = 14) newborns with sepsis, it was observed that TNF-alpha, IL-10 and CRP levels were related with poor prognosis (p < 0.05). The ROC analysis performed for the determination of the prognostic performance of TNF-alpha and IL-10 revealed that these parameters had predictive value about mortality when their levels were above certain cut-off values (on the 5th day of therapy for IL-10 > 1.8 ng/ml and for TNF-alpha > 21.1 ng/ml). It can be concluded that besides routine laboratory parameters, serum TNF-alpha and IL-10 levels at the initiation of therapy and afterwards may help to predict prognosis and guide treatment in newborns with sepsis.

[Peritonitis due to Kocuria rosea in a continuous ambulatory peritoneal dialysis case]. / Sürekli ayaktan periton diyalizi yapilan bir olguda Kocuria rosea'ya bagli peritonit.

Micrococcus strains which are the normal flora members of skin, mucosa and oropharynx, may lead to infections associated with intravenous catheter, chronic ambulatory peritoneal dialysis, venticular shunt and prosthetic valve. In this paper, a case of peritonitis due to Kocuria rosea of Micrococcea family, in a patient undergoing continuous ambulatory peritoneal dialysis (CAPD), was presented. Fiftysix years old female patient was admitted to the hospital by complaints of abdominal pain, nausea and fever. The patient was undergoing CAPD due to chronic renal failure for one and a half year and turbidity was detected in the peritoneal fluid during dialysis. Examination of the peritoneal fluid revealed 1800 cells/mm3, with no evidence of bacteria in Gram and Ziehl-Neelsen stained smears. No bacterial growth was detected in conventional culture media, however, bacteria was isolated from the peritoneal fluid culture on second day by Bactec (Becton Dickinson, USA) automated blood culture system. By means of API identification system (bioMerieux, USA), the causative agent was identified as Kocuria rosea. The patient was successfully treated with intraperitoneal teicoplanin (4 x 40 mg) for 14 days. In conclusion, in patients undergoing CAPD, rare pathogens should be considered in case of peritonitis and peritoneal fluid samples should be inoculated into automated culture systems.

[Two Crimean-Congo hemorrhagic fever cases without history of tick contact from Ankara region]. / Ankara bölgesinde kene temasi öyküsü olmayan iki Kirim-Kongo kanamali atesi olgusu.

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral disease presenting with flu-like symptoms, fever, hemorrhage and petechia. The virus (CCHFV) is a member of the Nairovirus genera of Bunyaviridae family and can be transmitted to humans by Hyalomma tick-bite, by exposure to infected blood and fomites of patient with CCHF or contact with animal tissue in viremic phase. In this study we present two cases with CCHF but without history of tick bite or exposure to infected fomites, even not coming from endemic areas. The first case was a 67 years old male patient presented with fever, fatique and shortness of breath. Physical examination revealed rales in right lower segments of lung. Laboratory findings showed elevation of liver enzymes with thrombocytopenia and prolonged prothrombin time. Serological markers for viral hepatitis, cytomegalovirus (CMV) and Epstein-Barr virus (EBV) were negative. The patient was found to be IgM and RNA positive for CCHFV by ELISA and polymerase chain reaction (PCR) methods, respectively. His history indicated a contact with livestock. The second patient was a 60 years old male dealing with husbandry. He had fever, fatique and myalgia. Physical examination revealed petechial rash on legs. Laboratory findings showed elevated liver enzymes, prolonged phrothrombin time and thrombocytopenia. Viral hepatitis markers, CMV-IgM and EBV-IgM were found negative. He was also found to be IgM and RNA positive for CCHFV in the reference laboratory. In conclusion, CCHF should be considered in the differential diagnosis of patients who contact with livestock and present with fever, fatigue, rash, elevated liver enzymes, thrombocytopenia and prolonged prothrombin time eventhough they do not reside in endemic areas for CCHF.

[A meningitis case of Brucella and tuberculosis co-infection]. / Menenjitli bir olguda Brucella ve tüberküloz koenfeksiyonu.

Turkey is located at an endemic area for brusellosis and tuberculosis which are both important public health problems. Meningitis caused by Brucella and Mycobacterium spp. may be confused since the clinical and laboratory findings are similar. In this report, a meningitis case with Brucella and tuberculosis co-infection has been presented. A 19-years-old woman was admitted to our clinic with severe headache, fever, vomiting, meningeal irritation symptoms, confusion and diplopia. The patient was initially diagnosed as Brucella meningitis based on her history (stockbreeding, consuming raw milk products, clinical symptoms concordant to brucellosis lasting for 4-5 months), physical examination and laboratory findings of cerebrospinal fluid (CSF). Standard tube agglutination test for brucellosis was positive at 1/80 titer in CSF and at 1/640 titer in serum, whereas no growth of Brucella spp. was detected in CSF and blood cultures. Antibiotic therapy with ceftriaxone, rifampicin and doxycyclin was started, however, there was no clinical improvement and agitation and confusion of the patient continued by the end of second day of treatment. Repeated CSF examination yielded acid-fast bacteria. The patient was then diagnosed as meningitis with double etiology and the therapy was changed to ceftriaxone, streptomycin, morphozinamide, rifampicin and isoniazid for thirty days. Tuberculosis meningitis was confirmed with the growth of Mycobacterium tuberculosis on the 14th day of cultivation (BACTEC, Becton Dickinson, USA) of the CSF sample. On the 30th day of treatment she was discharged on anti-tuberculous treatment with isoniazid and rifampicin for 12 months. The follow-up of the patient on the first and third months of treatment revealed clinical and laboratory improvement. Since this was a rare case of Brucella and tuberculosis co-infection, this report emphasizes that such co-infections should be kept in mind especially in the endemic areas for tuberculosis and brucellosis.

[Evaluation of the epidemiological, clinical and laboratory findings in continuous ambulatory peritoneal dialysis related peritonitis attacks]. / Sürekli ayaktan periton diyalizi ile iliskili peritonit ataklarinda epidemiyolojik, klinik ve laboratuvar bulgularinin degerlendirilmesi.

The aims of this study were to assess epidemiological features, clinical outcomes, laboratory findings, causative organisms and treatment approach for continuous ambulatory peritoneal dialysis (CAPD) -related peritonitis cases. A total of 50 patients (35 male, 15 female; age range: 18-83 years, mean age: 49 +/-17 years) with CAPD related peritonitis treated in Infectious Diseases and Clinical Microbiology Department of Ankara Training and Research Hospital between February-July 2006 were enrolled into this study. Demographic characteristics, symptoms, physical examination findings and laboratory parameters of patients were recorded and evaluated at the baseline, 48 hours and at the end of treatment. Fifty six peritonitis episodes occurred during the study period, and overall incidence of peritonitis was calculated as 1.6 episodes/patient-year. The most common presenting symptoms were cloudiness of the peritoneal dialysis fluid (100%), abdominal pain (98%), nausea (74%) and vomiting (54%). Abdominal tenderness and rebaund (100%) were the most common physical examination findings. Increased levels of C-reactive protein, erythrocyte sedimentation rate and procalcitonin were detected in 88%, 94% and 42% of the patients, respectively. The mean white blood cell count of peritoneal dialysate fluids was 905/mm3 (170-17900/mm3) in 56 episodes. In direct microscopic examination of peritoneal fluid samples with Gram stain, positivity was detected in 10 (18%) of the attacks, in which eight yielded gram-positive cocci and two gram-negative bacilli. The rate of culture positivity was 74% in the peritonitis episodes, and no microorganism was isolated from the cultures of 26% of the episodes. The most frequently isolated microorganisms were coagulase-positive staphylococci, followed by Staphylococcus aureus (n:4) and E. coli (n:4) with the rates of 7% of each, Enterococcus spp. (n:3), Klebsiella spp. (n:3) and Pseudomonas spp. (n:3) with the rates of 5% of each, and Streptococcus spp. (n:1), diphtheroid bacillus (n:1) and Candida albicans (n:1) with the rates of 2% of each. Eightyfour percent of patients were successfully treated with intraperitoneal cefazolin and gentamicin empirically. Three of the patient's CAPD therapy was converted to hemodialysis, while two patients have died. As a result, since peritonitis is still the major complication of CAPD despite the technological developments, the informations about causative microorganisms and their antimicrobial susceptibilities would be helpful for the early and accurate treatment of peritonitis.

A MAP-Based Approach for Hyperspectral Imagery Super-resolution.

In this study, we propose a novel single image Bayesian super-resolution (SR) algorithm where the hyperspectral image (HSI) is the only source of information. The main contribution of the proposed approach is to convert the ill-posed SR reconstruction (SRR) problem in the spectral domain to a quadratic optimization problem in the abundance map domain. In order to do so, Markov Random Field (MRF) based energy minimization approach is proposed and proved that the solution is quadratic. The proposed approach consists of five main steps. First, the number of endmembers in the scene is determined using virtual dimensionality. Second, the endmembers and their low resolution abundance maps are computed using simplex identification via the splitted augmented Lagrangian (SISAL) and fully constrained least squares (FCLS) algorithms. Third, high resolution (HR) abundance maps are obtained using our proposed maximum a posteriori (MAP) based energy function. This energy function is minimized subject to smoothness, unity and boundary constraints. Fourth, the HR abundance maps are further enhanced with texture preserving methods. Finally, HR HSI is reconstructed using the extracted endmembers and the enhanced abundance maps. The proposed method is tested on three real HSI datasets; namely the Cave, Harvard and Hyperspectral Remote Sensing Scenes (HRSS) and compared to state-of-the-art alternative methods using peak signal to noise ratio, structural similarity, spectral angle mapper and relative dimensionless global error in synthesis metrics. It is shown that the proposed method outperforms the state of the art methods in terms of quality while preserving the spectral consistency.

Crimean-Congo hemorrhagic fever in Turkey: Current status and future challenges.

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral disease of humans that affects a wide geographic area of Africa and Eurasia, including Turkey, Iran, Pakistan, Afghanistan and Russia. Since the first detection of CCHF cases in Turkey in 2002, more than 9700 patients have been reported, with an overall mortality rate just under 5%. This article assesses the present epidemiological situation of CCHF in Turkey, with an updated literature review, describes national practices and summarizes lessons learned in preparation for future outbreaks.

Exposure to anti- and pro-tobacco advertising, promotions or sponsorships: Turkey, 2008.

INTRODUCTION: In 2008, Turkey became one of 26 countries with a complete ban on all forms of direct and indirect tobacco marketing. We assessed the level of exposure to anti- and pro-cigarette advertising and to cigarette promotions and sponsorships among various demographic groups in Turkey. METHODS: We used the data from the Global Adult Tobacco Survey (GATS), conducted in November 2008 in Turkey. The data consist of answers to GATS questions by 9030 respondents from a nationally representative, multistage probability sample of adults 15 years of age or older. To find differences in exposure to the advertising by sex, age, education level and smoking status, we analyzed responses to GATS questions about cigarette advertisements and anti-cigarette smoking information in various forms and through various advertising channels, during the 30 days before the survey, using bivariate analysis. RESULTS: Overall, 13.3% of respondents aged 15 years or older noticed some type of cigarette marketing during the 30 days before the survey: 7.1% saw advertisements, 5.3% saw promotions and 3.3% saw sports sponsorships. Men were more likely than women to have seen cigarette promotions (7.8% versus 3.0%) and sports sponsorships (5.3% versus 1.4%). Respondents aged 15-24 years were more likely than those aged 25 years or older to have seen cigarette advertisements (10.2% versus 6.2%), promotions (8.7% versus 4.4%) and sponsorships (6.6% versus 2.3%), respectively. Respondents were most likely to have seen cigarette advertisements on television (3.4%) or in shops (2.7%). In addition, 2.8% of respondents reported seeing a clothing item with a brand name or logo, 2.5% reported that they received free samples of cigarettes and 0.3% received gifts along with the purchase of cigarettes. Almost 9 of 10 survey respondents (88.8%) reported having noticed some anti-cigarette information during the 30 days before the survey. Most anti-cigarette information was seen on television (85.5%). The anti-cigarette information was seen by slightly more cigarette smokers (91.6%) than nonsmokers (87.6%). Persons with less than a primary education were less likely to notice anti-cigarette information than those with a higher level of education, in all examined media channels. CONCLUSIONS: Our findings showed a low prevalence of noticing cigarette marketing, which indicates high compliance with the Turkish law banning such marketing. GATS data provide an in-depth understanding of the level of exposure to pro- and anti-cigarette information in 2008 and they are of practical assistance to those who implement policies to reduce the demand for tobacco. The challenge now is to maintain rigorous enforcement. To do so requires ongoing surveillance to produce data on the effectiveness of the enforcement efforts.

Chronic hepatitis delta virus infection in Van region of eastern Turkey.

BACKGROUND/AIMS: Hepatitis delta virus infection is an important cause of liver morbidity and mortality worldwide. In Eastern Turkey, hepatitis B virus infection is the major cause of chronic liver diseases. We aimed to research the role of hepatitis delta virus infection in chronic liver diseases related to hepatitis B virus infection in the Van region of Eastern Turkey. METHODS: Serological markers of hepatitis B virus and hepatitis delta virus infection [HBsAg, HbeAg, Anti-HBe and Anti- hepatitis delta virus total (IgM+IgG)] were determined by ELISA test in patients with chronic hepatitis and cirrhosis. Serum hepatitis B virus DNA was determined by polymerase chain reaction (PCR) method in chronic hepatitis B patients. RESULTS: Hepatitis delta virus infection was detected in 5% (7/138) of asymptomatic hepatitis B virus carriers, in 16% (24/148) of chronic hepatitis B patients and in 45% (34/75) of cirrhotic hepatitis B virus patients. hepatitis delta virus infection showed a three-fold increase in chronic hepatitis (p<0.01) and nine-fold increase in cirrhosis (p<0.001) compared to hepatitis delta virus carriers. Also, it was three times more frequent in cirrhosis (p<0.001) compared to chronic hepatitis. Chronic hepatitis delta virus infection was equally distributed between sexes in patients with chronic hepatitis B virus infection, whereas chronic hepatitis B virus infection alone was three times more frequent in males (p<0.001). Mean ages of hepatitis delta virus carriers, chronic hepatitis D and hepatitis delta virus cirrhosis patients were 30.7+/-8 (14-65), 36+/-13 (19-70) and 44 +/-16 (25-55), respectively. CONCLUSIONS: The higher prevalence of hepatitis delta virus infection in more severe form of hepatitis B virus infection suggests that hepatitis delta virus infection increases the severity of chronic hepatitis B virus infection in the Van region. hepatitis delta virus infection remains a second major cause of chronic liver diseases in Eastern Turkey in spite of its decreasing prevalence in Western countries and in Western Turkey.

Nationwide Smoking Cessation Treatment Support Program--Turkey project.

BACKGROUND: In 2011, Turkish Ministry of Health (MoH) initiated a nation-wide "Smoking Cessation Treatment Support Program" (SCTSP), to provide smoking cessation drugs free of charge. METHODS: SCTSP was conducted in all 81 cities of Turkey, at 228 smoking cessation clinics, and by over 400 physicians. In total, 164,733 participants took advantage of the program between January and November 2011. Varenicline (Champix(®), Pfizer) and Bupropion (Zyban(®), GlaxoSmithKline) were used in the program at a ratio of 0.7 and 0.3 respectively. Post-program data were obtained by phone interviews from randomly selected participants, who had completed a 1-year follow-up after enrollment in the program. FINDINGS: Quit rates were 29.6% for those given Varenicline and 25.1% for those given Bupropion. The quit rates for participants with hypertension (35.0%), diabetes mellitus (36.9%), coronary artery disease (32.1%) and cerebrovascular events (34.0%) were higher than those without. Increased age, female gender, longer duration of cessation drug use, low Fagerstrom score, the presence of hypertension, the absence of chronic obstructive pulmonary disease, and the absence of cancer were found to be associated with higher success rates. INTERPRETATION: SCTSP is the first successful report of a nation-wide community-based smoking cessation intervention. The real-life quit rates obtained herein are comparable to those of clinical evidence to date. The centralization of smoking cessation clinics, standardization of treatment guidelines, application of a specific drug assignment algorithm, and provision of primary care support and follow-ups by trained physicians, appeared to be key elements for success.

Use of the Brucella IgM and IgG flow assays in the serodiagnosis of human brucellosis in an area endemic for brucellosis.

The clinical utility of two complementary tests for brucellosis, the Brucella IgM and IgG flow assays, was evaluated in a hospital in eastern Turkey. The results show that the flow assays are convenient diagnostic tests for use in endemic areas. A positive result in the flow assays was obtained in 91% and 97% of the admission sera from adult and pediatric patients with brucellosis, respectively, and the sensitivity at admission was 100% for culture-confirmed brucellosis. The assay system performed equally well in diagnosing patients at different stages of illness including patients with acute, subacute, or chronic disease and with relapse. The results of the flow assays correlated well with those of a serum agglutination test at a cut-off > or =1:160. The agreement was 92%. Application of the flow assays on serum samples collected during a village survey for brucellosis after an outbreak demonstrated their diagnostic potential as field tests.

Cutaneous manifestations of anthrax in Eastern Anatolia: a review of 39 cases.

Anthrax is essentially a disease of grazing herbivorous animals. The most common form of the disease is cutaneous anthrax, which accounts for 95% of all cases. We report here 39 cutaneous anthrax cases in humans that were seen in Eastern Anatolia over a six-year period. The clinical presentation was malignant edema in 16 of the cases (41%) and malignant pustule in 23 (59%). A secondary bacterial infection was present in 13 patients (33.3%) in the vicinity of the lesions. The agent was observed using Gram-stained smears in 25 patients (64%), and Bacillus anthracis was isolated from 15 patients (38.5%). All of the patients were treated with penicillin G or penicillin procaine, except one patient who had a penicillin allergy. One patient with cervical edema (2.5%) died as a result of laryngeal edema and sepsis syndrome. In conclusion, we found that the appearance of the skin lesion of cutaneous anthrax may vary, and this fact, combined with the rarity of this disease, which contributes to a general lack of experience among medical personnel, may make diagnosis difficult in nonagricultural settings

[Tibial osteomyelitis following intraosseous infusion: a case report]. / Kemik içi infüzyonuna bagli tibia osteomiyeliti: Olgu sunumu.

Fluids, medications, and blood products can be rapidly administered via intraosseous infusion under emergency conditions, particularly to pediatric patients aged from 0 to 2 years. A five-month-old infant who had been hospitalized with a diagnosis of sepsis developed swelling and hyperemia at the infusion site 10 days after an intraosseous infusion in the right proximal tibia. Physical examination showed a serous discharge from a fistula on the anteromedial side of the right proximal cruris. Plain radiographs demonstrated periosteal reaction in the right tibia and osteolytic areas in the proximal metaphysis. With a diagnosis of acute osteomyelitis, drainage and medullary irrigation were performed and parenteral antibiotic treatment was initiated. Cultures from the surgical site yielded Candida albicans, upon which fluconazole (8 mg/kg) treatment was administered for four weeks. A complete clinical and radiographic improvement was observed at the end of a 12-month follow-up.