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Öğe Analysis of the Patients with Sepsis Caused by Gram Positive and Gram Negative Bacteria(Ortadogu Ad Pres & Publ Co, 2008) Turan, Pinar; Tansel, Oezlem; Ekuklu, Galip; Celik, Ayguel DoganObjective: The objective of this study was to evaluate the epidemiological, clinical, laboratory features and risk factors associated with mortality of the 109 adult cases of sepsis in which gram positive, and gram negative bacteria isolated from blood cultures. Material and Methods: One hundred and nine patients with sepsis followed in our hospital between January 2002 and January 2003 were investigated prospectively. Results: Gram negative bacteria were isolated from blood cultures in the rate of 58.7%. The most frequent gram negative bacterium was Escherichia coli, and gram positive was Staphylococcus aureus. Statistically significant difference was not detected between gram positive, and gram negative bacteria sepsis related with development of hypothermia, appropriate antibiotic treatment, septic shock, multiple organ dysfunction syndrome (MODS), disseminated intravascular coagulation (DIC), and mortality rate. The mortality rate was 23%. The risk factors related with mortality were old age, hypothermia, staying in intensive care units, changes in consciousness, septic shock, MODS, DIC, renal failure, acute respiratory distress syndrome (ARDS), inappropriate antibiotherapy, and lack of infectious disease specialist consultation. Inappropriate antibiotic therapy, severe sepsis, and old age were found as independent factors in mortality by logistic regression analysis. Conclusion: There was no significant difference between the risk factors of gram positive, and gram negative bacteria sepsis. Prompt diagnosis and appropriate antibiotic treatment was important in decreasing the mortality in both of them.Öğe Evaluation of the flu vaccine administered to health care workers in Trakya University Hospital in 2006(Ankara Microbiology Soc, 2008) Kuloglu, Figen; Celik, Ayguel Dogan; Yulugkural, Zerrin; Erkan, Tuelay; Keskin, Serap; Akata, FilizAfter the detection of human cases of highly pathogenic avian influenza A (H5N1) virus in Eastern Turkey in January 2006, Turkish Ministry of Health has had declared National Plans of Activity for Pandemic Influenza. All health-care facilities were recommended to develop contingency plans. Then the essential activities were started in August 2006 in Trakya University, Faculty of Medicine (Edirne, Trace region of Turkey), and institutional education about pandemic influenza and preventive measures was implemented to health care workers (HCWs). In November 2006, health care workers were offered inactivated flu vaccine (Vaxigrip, Sanofi Pasteur, France) supplied by the Ministry of Health. The aim of this questionary survey was to evaluate the visions and conceptions of health care workers about influenza vaccination during the vaccination campaign. All the participants were informed by using an information form including the indications, contraindications and possible adverse reactions of flu vaccine, and were requested to complete the questionnaire about influenza vaccination according to their own perception before vaccination. Vaccine recipients were also invited to the vaccination unit if they had any adverse reaction. A total of 1041 HCWs (560 female, 481 male; mean age: 32.8 +/- 8.2 years) completed the questionnaire. Of them 884 subjects (85%) have accepted to be vaccinated, while 157 subjects (15%) have not. It was determined that 72 HCWs (6.9%) had been administered flu vaccine in 2005, and 38 (3.7%) have had an underlying chronic disease requiring medical therapy. Six subjects (16%) with an underlying chronic disease were vaccinated in 2005, while 66 HCWs (6.6%) without any chronic disease received vaccination voluntarily. Seven workers (0.7%) declined vaccination as they defined hypersensitivity to egg, and 84 workers (8%) had influenza vaccine voluntarily before the campaign in 2006. Sixty six workers (6.3%) have refused to be vaccinated as they considered influenza vaccination ineffective to protect against flu. Two workers (0.2%) had allergic skin reactions such as erythema and itching after vaccination. It can be concluded that influenza vaccination of the health care workers is a part of infection control policies and it is also a matter of patient safety. The implementation of necessary education programmes and attempts to emphasize the importance of vaccination of health care workers especially dealing with high risk patients, would be of crucial importance to decrease the morbidity and mortality due to influenza infections.Öğe Evaluation of Twelve Patients with Tuberculous Meningitis(Ortadogu Ad Pres & Publ Co, 2008) Eker, Alper; Tansel, Oezlem; Yuksel, Pelin; Celik, Ayguel DoganObjective: To assess the presentation, diagnosis and treatment of patients with tuberculous meningitis (TM). Material and Methods: Clinical and laboratory findings of 12 patients with TM, followed-up between 2000 and 2004, were evaluated retrospectively. Results: Seven male and five female patients were enrolled in this study. The mean age of the patients was 34.5 years. Culture of cerebrospinal fluid (CSF) in 10 cases revealed Mycobacterium tuberculosis. None of the CSF samples was positive for acid-fast bacteria (AFB) by Ehrlich-Ziehl-Neelsen (EZN) staining. M. tuberculosis was also isolated from the sputum sample of one patient. Isoniasid (INH) resistance was detected in two isolates. The most frequent finding on cranial computerized tomography (CT) and magnetic resonance imaging (MRI) was tuberculoma. Hydrocephalus was observed in 4 cases. Five patients had pulmonary lesions on chest radiographs. One patient had cavitation on the right upper zone, one patient had bilateral apical hyperdensity, and three patients had miliary involvement. Liver toxicity due to anti-tuberculosis drugs developed in 2 patients. Paradoxical enlargement of tuberculomas was detected during therapy in one case. Cranial MRI appeared to be more sensitive than CT in detecting intracranial lesions of four patients. Three patients died and neurological sequels developed in three patients. Conclusion: Early diagnosis and treatment is of major importance in TM, which is the most serious form of extrapulmonary tuberculosis. However, some problems such as drug toxicity and resistance, and occurrence of paradoxical response during follow up cause problems in treatment course.Öğe STAPHYLOCOCCUS AUREUS HEPATIC ABSCESS ASSOCIATED WITH CERVICAL LYMPHADENITIS(Ankara Microbiology Soc, 2009) Celik, Ayguel Dogan; Yulugkural, Zerrin; Kuloglu, Figen; Akata, FilizPyogenic liver abscesses usually develop secondary to biliary tract and intraabdominal infections and members of the Enterobacteriaceae family are usually implicated as the etiologic agents. In this report a case of hepatic abscess devoloped secondary to cervical lymphadenitis caused by Staphylococcus aureus, was presented. Twenty-one years old male patient was admitted to the hospital with complaints of fever, swelling and pain at the right side of the neck and difficulty in swallowing. Physical examination revealed painful submandibular lymphadenopathy with hyperemia. Upon demonstration of cystic lymphadenopathy by magnetic resonance imaging of the neck, the mass was aspirated. Gram-positive cocci with abundant leucocytes were detected in Gram stained smears of the aspiration material and methicillin-susceptible S.aureus (MSSA) was identified in the culture. Treatment with ampicillin/sulbactam (4 x 1.5 g/day) was initiated. However, since patient still had fever and abdominal pain, nausea and vomitting were also added to his complaints, abdominal ultrasonography and computerized tomography (CT) were done and abscesses were demonstrated in liver. The abscesses were drained under CT guidance and the fever of the patient resolved. Treatment with ampicillin/sulbactam was continued for 6 weeks. Although it was considered that the hematogenous spread of MSSA that led to cervical lymphadenitis caused the hepatic abscesses, the agent was neither isolated from the blood culture nor from the hepatic abscess material. It should always be taken into consideration that liver abscesses might accompany distant infections and antibiotic therapy alone might not be sufficient for the complete resolution of such infections.Öğe Subcutaneous Granuloma Annulare(Ortadogu Ad Pres & Publ Co, 2009) Arican, Ozer; Temizoz, Osman; Yalcin, Omer; Celik, Ayguel Dogan; Guzel, Ahmet[Abstract Not Available]