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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 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 HEPATITIS E VIRUS EPIDEMIOLOGY IN ADULT POPULATION IN EDIRNE PROVINCE, TURKEY(Ankara Microbiology Soc, 2009) Eker, Alper; Tansel, Oezlem; Kunduracilar, Hakan; Tokuc, Burcu; Yulugkural, Zerrin; Yusel, PelinHepatitis E virus (HEV) clinical presentations range from asymptomatic infection to fulminant hepatitis which is frequently seen in pregnant women. Epidemics due to HEV mostly originate from contaminated water and the virus is transmitted by fecal oral way. Its frequency is closely related to the socioeconomical status of the community. The aim of this first community-based study performed in Edirne province (located at Trace region of Turkey) was to determine the seroprevalence of HEV and the risk factors in the city center. Five hundred eighty two people (273 men, 309 women) over age 15 years, representing the population of Edirne city center were included in the study. Anti-HEV IgG antibodies were investigated in the serum samples by ELISA method. Anti-HEV antibodies were detected in a total of 14 cases (11 women, 3 men) and HEV infection prevalence was found to be 2.4%. The mean age of seropositive people was 50.86 +/- 16.76 years while it was 40.7 +/- 16.9 years in seronegative people (p= 0.027). This result was attributed to the better water supply and sanitation conditions in Edirne province in comparison to other parts of Turkey and shift of HEV seropositivity in older ages. No statistically significant difference was detected between seropositive and seronegative cases in terms of socioeconomical conditions, both groups being in high socioeconomical level. The analysis of the risk factors revealed that the rate of people living in houses built with materials other than reinforced concrete (p= 0.044), dealing with stockbreeding (p= 0.046) and consuming fruits and vegetables without proper washing (p= 0.015) were significantly higher in the seropositive group. No statistically significant difference was detected for the other risk factors such as the number of household, presence of city water supply and sewage system in the house, location of the water closet outside house, lack of hand-washing habits, sharing utensils, consumption of raw vegetables, history of blood transfusion, surgery, dental intervention, jaundice, contact with a case of hepatitis, abortion/stillbirth and suspicious sexual contact. While the HEV seropositivity rate (2.4%) detected in Edirne was lower than the average of Turkey (6%), it was similar to the results reported from western part of the country. High rates of seropositivity among people with individual incompatibility to the hygiene rules denotes that personal hygiene is an important factor for prevention from HEV infection. High rate of seropositivity among people dealing with stockbreeding also suggests that there may be different ways of HEV transmission other than contaminated water in sporadic cases.Öğe Retrospective evaluation of the cases prediagnosed as viral encephalitis in Trace University Hospital between the period of 2000-2005(Ankara Microbiology Soc, 2008) Yulugkural, Zerrin; Celik, Ayguel Dagan; Celik, Yahya; Kuloglu, Figen; Bueyuekkoyuncu, Nlluefer; Tansel, Oezlem; Akata, FilizIn this study, a total of 17 adult patients (( :18 years old; 12 male, 5 female) with encephalitis followed up in neurology and infectious diseases clinics of Trace University Hospital between the years 2000-2005 were retrospectively analyzed. The most common signs and symptoms were confusion (n: 13; 76.4%), nausea and vomiting (n: 13; 76.4%), disorientation (n: 12; 70%), fever and headache (n: 11; 64.7%), amnesia (n: 10; 58.8%), convulsions (n: 9; 52.9%), agitation (n: 7; 41%), dysphasia and aphasia (n: 6; 35.2%), nuchal stiffness (n: 5; 29.4) and focal neurological signs (n: 1; 5.8%). Six of the patients were admitted to the hospital during summer, six during winter, four during spring and one during autumn. Eleven (64.7%) of the patients had electroencephalographic signs compatible with encephalitis. Encephalitis related signs were detected in 83.3% (10/12) of the patients by cranial magnetic resonance imaging and in 58.3% (7/12) by computerized tomography. Cerebrospinal fluid (CSF) examination revealed low glucose levels in 17.6% (3/17), high protein levels in 47% (8/17) and increased white blood cells with a predominance of lymphocytes in 41.2% (7/17) of the cases. CSF findings were within normal limits in 23.5% (4/17) of the patients. Empirical acyclovir treatment was given to all patients. One patient died at the acute phase of the infection while all the other 16 recovered. Since none of the CSF samples yielded bacterial growth, all of the patients were diagnosed as viral encephalitis. However, no investigation was performed to identify the viral etiology and this was the major limitation owing to the inadequacy of laboratory facilities during the study period and/or unawareness of the physicians about viral identification methods.