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Öğe Antibacterial activity of propolis against MRSA and synergism with topical mupirocin(Mary Ann Liebert, Inc, 2007) Onlen, Yusuf; Duran, Nizami; Atik, Esin; Savas, Lutfu; Altug, Enes; Yakan, Selvinaz; Aslantas, OzkanObjectives: The aim of the present study was to investigate the activity of the propolis and its combinations with mupirocin against methicillin-resistant Staphylococcus aureus (MRSA) in nasal carriage. Methods: This study was carried out between June and August 2005. To infect nares of the rabbits, MRSA ( ATCC 33591) strain was used. Minimum inhibitory concentration was determined according to National Committee for Clinical Laboratory Standards. Each inoculum was prepared in the same medium at a density adjusted to a 0.5 McFarland turbidity standard (10(5) colony- forming units [cfu]/ mL) and diluted 1: 100 for the broth microdilution procedure. Ten microliters (10 mu L) (10(5) cfu/mL) of the bacterial suspension containing approximately 1000 cfu of MRSA was administered with sterile microsyringe through both nostrils of each rabbit. Ninety-six ( 96) hours after inoculation, the presence of infection was confirmed by using bacterial cultures. Twenty-six young New Zealand rabbits were randomly divided into 4 groups. Each treatment group ( 1, 2, and 3) included 7 rabbits and control group ( group 4) included 5 rabbits. Group 1 was treated with topical mupirocin + ethanolic extract of propolis drops, group 2 received topical mupirocin, group 3 was administered ethanolic extract of propolis drops, and the control group ( group 4) was only treated with phosphate-buffered solution drops for 7 days. At the end of study, nasal cultures and smears were obtained for bacterial count and cytologic examination. Results: The colony numbers of bacteria in group 1 were determined to be significantly lower than in group 2 (p= 0.0001), group 3 (p = 0.0001), and group 4 ( p = 0.0001). The mean bacterial cell counts of groups 1- 4 were 360.2 +/- 52.4 cfu/ mL, 4120.6 +/- 860.4 cfu/ mL, 5980.8 +/- 1240.6 cfu/ mL, and 11500.0 +/- 2568.4 cfu/ mL, respectively. Mupirocin + propolis administration ( group 1) resulted in a significant reduction in the polymorphonuclear leukocyte (PMNL) count in the mucous membranes of rabbits compared with the other treatment groups ( p < 0.05). Conclusions: Propolis addition to mupirocin regimen was found to result in more profound reduction in bacterial cell count and inflammatory response compared with the rest of the treatment modalities.Öğe Causes of nosocomial pneumonia and evaluation of risk factors in a university hospital in Turkey(Saudi Med J, 2007) Savas, Lutfu; Onlen, Yusuf; Duran, Nizami; Savas, NazanObjective: To determine the incidence, risk factors, mortality rate, and organisms causing nosocomial pneumonia (NP). Methods: We carried out this study in the Intensive Care Units (ICUs), General Medical and Surgical wards of Baskent University, Training and Research Hospital in Adana, Turkey, between November 2000 and August 2002. Patients were observed from the time of admission until 48 hours after discharge from the hospital. Results: In this study, 618 (2.1%) nosocomial infections (NIs) were detected in 29778 patients. One hundred and fifteen of these infections were NP and investigated with surveillance prospectively. The most frequently isolated microorganisms in NP were methicillin-resistant Staphylococcus aureus (MRSA) 32.8%, Pseudomonas species 21.5%, methicillin-sensitive Staphylococcus aureus (MSSA) 10.2%, Klebsiella species (9.1%) and Acinetobacter species 5.9%, E coli; 5.4% (10/186), Streptococcus species; 4.8% (9/186), Candida species; 4.8% (9/186), Enterobacter species; 2.7% (5/186) and the other bacteria; 2.7%. The predominant pathogens isolated in this study were MRSA (33.8%), Pseudomonas species (16.9%) and MSSA (16.9%) in early-onset pneumonias and MRSA (32.2%), Pseudomonas species (24.0%), and Klebsiella species (10.7%) in late-onset pneumonias. Conclusion: This study demonstrated that the possibility of developing NP, significantly increases with such risk factors as decreased level of consciousness, respiratory failure, mechanical ventilation and tracheostomy. Each center should know its patients' profile, the factors that increase the infection, the antibiotic resistance patterns of microorganisms, and the distribution of hospital infections in every department. Strategies to prevent both development of antibiotic resistance and spread of resistant organisms are necessary.Öğe Ceftriaxone-Associated Biliary Sludge and Pseudolithiasis in Children(Lippincott Williams & Wilkins, 2007) Onlen, Yusuf; Gali, Edip; Incecik, Faruk; Deviren, Mehmet; Savas, LutfuDetection of incidence and the risk factors of ceftriaxone (CTX)-associated pseudolithiasis (PL) in children. One hundred fourteen patients (75 boys and 39 girls) who used CTX for the treatment of various infections were admitted to the study. Pseudolithiasis was diagnosed by ultrasonography (USG). Ultrasonography was performed at the beginning, on the 5th and 10th days, and at the end of the treatment. Weekly USG was performed to patients who had PL until the findings improved. It was investigated whether the age, sex, weight, treatment duration, dosage, and the way of administration have effects on PL development. Ceftriaxone was administered intravenously. Fifty-seven patients received oncedaily and 57 patients received twice-daily dosage. Pseudolithiasis was observed in 37 (32.5%) of 114 patients. Age, sex, weight, treatment duration, and dosage had no role in PL development, whereas once-or twice-daily administration was found effective. Once-daily dosage of CTX treatment is recommended because of its lower incidence of PL development. Besides that USG should be performed regarding the risk of PL in children who are treated with CTX, further studies are necessary to determine the risk factors.Öğe Cutaneous manifestations in brucellosis: A prospective study(Springer, 2007) Akcali, Cenk; Savas, Lutfu; Baba, Mete; Turunc, Tuba; Seckin, DenizBrucellosis remains an important public health problem in Turkey, just as it is in other regions of the world. This study was conducted to determine the types and rates of cutaneous lesions that occur in patients with brucellosis. Brucellosis was diagnosed by standard tube agglutination testing for Brucella antibodies at a titer of 1/160 or higher in the presence of compatible clinical findings. A total of 140 patients who had been given a diagnosis of brucellosis were prospectively observed in the dermatology clinic. Of these patients, 102 (72.9%) were female, with a mean age of 44.11 +/- 18.22 y, and 38 (27.1 %) were male, with a mean age of 46.44 +/- 14.58 y. The duration of symptoms was less than 2 mo (acute) in 75 patients (53.5%), from 2 to 12 mo (subacute) in 30 patients (21.4%), and longer than 12 mo (chronic) in 35 patients (25.0%). Cutaneous findings related to brucellosis were observed in 8 (5.71%) of the 140 cases. Maculopapular eruptions were observed in 2 patients (25%), erythema nodosum-like lesions in 2 (25%), psoriasiform lesions in 1 (12.5%), palmar erythema in 1 (12.5%), malar eruption in 1 (12.5%), and palmar eczema in 1 (12.5%). The investigators concluded that although cutaneous findings encountered in brucellosis are generally not specific to this disease, the presence of these findings may be useful in diagnosing brucellosis in persons who live in, or used to live in, endemic regions.Öğe Efflux pump genes and antimicrobial resistance of Pseudomonas aeruginosa strains isolated from lower respiratory tract infections acquired in an intensive care unit(Springernature, 2012) Ozer, Burcin; Duran, Nizami; Onlen, Yusuf; Savas, LutfuThe aim of this study was to determine the antimicrobial resistance rates and the resistance genes associated with efflux pumps of Pseudomonas aeruginosa strains isolated from the patients who acquired lower respiratory tract infection (LRTI) in intensive care unit (ICU). Fifty P. aeruginosa strains isolated from the lower respiratory tract specimens of the patients who acquired LRTIs in ICU were included in this study. P. aeruginosa strains were isolated from tracheal aspirate (27), bronchoalveolar lavage (14) and sputum (9). The susceptibilities of the isolates were investigated by the disk diffusion method. Multiplex PCR assay was carried out for the detection of 13 antibiotic-resistance genes. Antimicrobial resistance rates of the isolates were found high and the highest resistance rate of the isolates studied was determined against to mezlocillin (50%) followed by norfloxacin (48%), ciprofloxacin (46%), meropenem (40%). Fourty-three isolates (86%) were determined to carry one and more resistance genes. NfxB gene was most often determined in the genes that were investigated. The significant relation between the resistance to cefepime, piperacilline/tazobactam and the mexC gene, that between the resistance to mezlocillin, piperacilline/tazobactam, ceftazidime, cefepime and ampC genes, and that between the resistance to ciprofloxacin, norfloxacin and oprJ, oprN and nfxB genes was identified. Resistance caused by genes for carbapenemases, aminoglycoside-modifying enzymes and other mechanisms were not identified in this study. Understanding the prevalence and mechanism of antimicrobial resistance in P. aeruginosa may help to select empirical therapy for nosocomial LRTIs due to P. aeruginosa in our ICU. The Journal of Antibiotics (2012) 65, 9-13; doi: 10.1038/ja.2011.102; published online 16 November 2011Öğe THE ELEVATION OF LIVER ENZYMES DUE TO HEPATITIS B VACCINE(Modestum Ltd, 2006) Onlen, Yusuf; Savas, Lutfu; Ozer, Burcin; Iris, Nur Efe[Abstract Not Available]Öğe Epiderniologic, clinical, and imaging findings in brucellosis patients with osteoarticular involvement(Amer Roentgen Ray Soc, 2006) Pourbagher, Aysin; Pourbagher, Mir Ali; Savas, Lutfu; Turunc, Tuba; Demiroglu, Yusuf Ziya; Erol, Ilknur; Yalcintas, DefneOBJECTIVE. The aim of this study was to assess the epidemiologic and clinical features, complications, imaging findings, and outcomes for brucellosis patients with osteoarticular involvement. SUBJECTS AND METHODS. This prospective study was performed over 4 years (December 2000-December 2004). The subjects were 251 Turkish patients (age range, 2-77 years) who were diagnosed with brucellosis during that period. Joint sonography, radiography, radionuclide bone scintigraphy, and MRI were performed in all patients with osteoarticular and spinal manifestations. RESULTS. The disease was acute in 92 patients (36.7%), subacute in 48 patients (19.1%), and chronic in 111 patients (44.2%). Sonography of the joints showed bursitis in 13 patients (5.2%). Radiography, MRI, and scintigraphy revealed 71 patients (28.3%) with sacroiliitis, 26 (10.4%) with spondylodiskitis, three (1.2%) with acute osteomyelitis, and one (0.4%) with avascular necrosis of the femoral head. All patients received combinations of either two or three antibiotics. Surgery was performed in three patients with spinal instability or radiculopathy. CONCLUSION. Brucellosis is endemic to some regions. MRI is the method of choice for diagnosing osteoarticular and spinal complications of human brucellosis, especially during the early phase. It is important to differentiate tuberculous spondylodiskitis from brucellar spondylodiskitis because proper treatment for each of these diseases can prevent complications. The radiologic findings for these two forms of spondylodiskitis are similar, so serologic testing for brucellosis is necessary in such cases.Öğe The evaluation of blood cultures in afebrile and febrile neutropenic patients(Aves, 2006) Savas, Lutfu; Yildirmak, Taner; Onlen, Yusuf; Tan-Cetmeli, Gul; Savas, Nazan; Efe-Iris, Nur; Simsek, FundaThis study was designed to analyse the infectious etiology of afebrile and febrile neutropenic patients. and to investigate the in vivo effectiveness of the antibiotics used according to the susceptibility patterns of cultured microorganisms in neutropenic patients.107 attacks were enrolled in this study. 35 of whom were afebrile and 72 of whom were febrile neutropenic. In 27 (25.2%) of 107 attacks. bacterial growth were observed, 7 of which were from afebrile neutropenic and 20 of which were from febrile neutropenic attacks. In 20 of the 72 febrile neutropenic attacks. 22 microorganisms were cultured. In 18 attacks, single microorganism was detected, while in two attacks, two different microorganisms were found. Of the 29 microorganisms obtained from all attacks, 22 (75.8%) were staphy-lococci. five (17.2%) Gram-negative bacteria, and two (6.9%) Candida species. All of 22 Gram-positive bacteria were methicil-lin-resistant staphylococci. In the attacks of afebrile and febrile neutropenic patients. mortality rate was not significantly different between blood cultur-positive group and blood cultur-negative group.Öğe Evaluation of nosocomial infections and risk factors in critically ill patients(Int Scientific Information, Inc, 2011) Ozer, Burcin; Akkurt, Cagla Ozbakis; Duran, Nizami; Onlen, Yusuf; Savas, Lutfu; Turhanoglu, SelimBackground: Nosocomial infections are one of the most serious complications in intensive care unit patients because they lead to high morbidity, mortality, length of stay and cost. The aim of this study was to determine the nosocomial infections, risk factors, pathogens and the antimicrobial susceptibilities of them in intensive care unit of a university hospital. Material/Methods: The patients were observed prospectively by the unit-directed active surveillance method based on patient and the laboratory. Results: 20.1% of the patients developed a total of 40 intensive care unit-acquired infections for a total of 988 patient-days. The infection sites were the lower respiratory tract, urinary tract, bloodstream, wound, and the central nervous system. The respiratory deficiency, diabetes mellitus, usage of steroid and antibiotics were found as the risk factors. The most common pathogens were Enterobacteriaceae, Staphylococcus aureus, Candida species. No vancomycin resistance was determined in Gram positive bacteria. Imipenem and meropenem were found to be the most effective antibiotics to Enterobacteriaceae. Conclusions: Hospital infection rate in intensive care unit is not very high. The diabetes mellitus, length of stay, usage of steroids, urinary catheter and central venous catheter were determined as the risk factors by the final logistic regression analysis. These data, which were collected from a newly established intensive care unit of a university hospital, are important in order to predict the infections and the antimicrobial resistance profile that will develop in the future.Öğe Fever of Unknown Origin Due to Left Atrial Myxoma(Lippincott Williams & Wilkins, 2006) Savas, Lutfu; Onlen, Yusuf; Kiziltan, Tarik; Pourbagher, Ali; Seyfeli, Ergun; Turunc, Tuba; Yalcin, FatihFever of unknown origin may present diagnostic and/or curative difficulties. Myxomas are one of the rare causes of fever of unknown origin. A 67-year-old man with a 4-month history of fever of unknown origin was admitted to our department. Physical examination revealed 38.4 degrees C axillary temperature and accentuated second heart sound in cardiac auscultation. Blood, urinary, and throat cultures were negative. Transesophageal echocardiography showed a left atrial mass partially prolapsing into the left ventricle during diastole. Left atrial mass was excised, and histological examination showed atrial myxoma. Fever resolved within 48 hours after the operation, and the patient was discharged from hospital with complete improvement.Öğe HBV, HCV, HIV and VDRL Seropositivity in Blood Donors in Hatay(Galenos Yayincilik, 2005) Ocak, Sabahattin; Duran, Nizami; Savas, Lutfu; Onlen, Yusuf; Dibek, M. AliIn this study, seroprevalence of HBsAg, anti-HCV, anti-HIV and VDRL were screened in the blood donors by donor screening tests in blood centers of Antakya State Hospital, Antakya Maternity Hospital and Iskenderun Kizilay Blood Bank between 2003 and 2004 retrospectively. A total of 12.026 (97.6%) male and 287 (2.3%) female donors were screened for HBV, HCV, and HIV using commercially available ELISA kits, VDRL test for syphilis. A total of 12.313 donors were screened. The seropositivity rates of HBsAg and anti-HCV were found as 249 (2.02%) and 65 (0.52%) respectively. Only 3 (0.02%) donors for HIV and 4 (0.03%) donors for VDRL were positive. Three patients with HIV seropositivity by ELISA technique were found negative by Western blot and accepted as false seropositivity. In conclusion, in our region, while the seroprevalence of HBsAg and VDRL were less than that reported in previous some studies carried out in Turkey, anti-HCV seropositivity was similar to among as compared to the other sides of Turkey.Öğe Inducible nitric oxide synthase and histopathological correlation in chronic viral hepatitis(Elsevier Sci Ltd, 2008) Atik, Esin; Onlen, Yusuf; Savas, Lutfu; Doran, FigenBackground: Chronic liver disorders represent a serious health problem. Nitric oxide (NO) synthesized by inducible nitric oxide synthase (iNOS) can function as an antimicrobial agent able to kill or reduce replication of microorganisms, and plays an important role in immune regulation. This study was undertaken to evaluate the expression of iNOS in chronic viral hepatitis and its relation to histopathology. Methods: This study included 56 patients with chronic viral hepatitis (38 hepatitis B, 18 hepatitis C). There were 35 men and 21 women with a mean age of 38.6 +/- 21.731 years. A modified form of the histology activity index (HAI) designed by Ishak and colleagues was used to assess grading and staging of chronic viral hepatitis. The needle biopsy specimens were fixed in 10% formalin and routinely processed. Routine hematoxylin-eosin, periodic acid-Schiff, and reticulin staining, and iNOS immunoperoxidase technique were performed on paraffin-embedded tissues. Results: We demonstrated that all Liver samples had a marked iNOS expression, with a diffuse distribution pattern. iNOS consistently labeled mononuclear cells infiltrating portal tracts in all samples. Statistical evaluation of data showed that the iNOS expression correlated with the HAI and fibrosis. Furthermore a correlation between iNOS and severity of disease was detected (r = 0.772, p = 0.000). Conclusions: Further investigations are required to determine whether iNOS-related treatment protocols could be useful in reducing disease severity. (C) 2007 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.Öğe Knowledge, attitude and sources of information regarding aids of high school students in Antakya (Antioch) City(De Gruyter Poland Sp Z O O, 2011) Onlen, Yusuf; Savas, Nazan; Ozer, Cahit; Savas, Lutfu; Incecik, Faruk; Kanatli, AliThe aim of the current study was to investigate the knowledge of senior High school students, sources of their knowledge, and the socio-economical facts acting on their knowledge about AIDS. A cross sectional, descriptive study, included a total of 2838 students (1368 females and 1470 males) from 16 high schools of 4 different types (State, Anatolian, Trade, and Private high schools). A questionnaire composed of 5 different sections was used to analyze the knowledge level separately what kind of disease is AIDS, how AIDS can be transmitted, risk factors for AIDS, ways of protection from AIDS, and the sources of their knowledge about AIDS in sections from 1 to 5 respectively. In the first 4 sections the right answers were graded with a score of 2, wrong answers were graded with a score of 0, and a score of 1was given when the student did not have an idea. The maximum score for the first 4 sections of the questionnaire were 12, 38, 14, and 14 respectively. In the 5(th) section the probable sources of knowledge of AIDS, such as school, friends, family, newspapers, books, and TV, were questioned. The mean score received from the questionnaire were 49.50 +/- 6.50 (minimum: 27, maximum: 69). The mean score for the females was 49.69 +/- 6.46, it was 49.32 +/- 6.66 for the males (p > 0.05). The mean score for the first 4 sections were 8.2 +/- 2.15, 24.7 +/- 4, 16, 9.70 +/- 2.30, and 6.90 +/- 1.79, respectively. Statistically, there was no significant difference observed between the 15-16, 17-18, and 19-20 age groups on knowledge about risk factors for AIDS (p > 0.05). However, there were meaningful differences in what kind of disease is AIDS, how AIDS can be transmitted, and ways of protection from AIDS (p < 0.05). In aspect of type of high school the knowledge levels of students about AIDS obtained from the questionnaire were statistically different. Concerning the total score of the questionnaire, the students from trade schools received the lowest score, while the highest score of risk factors for AIDS. were received by Anatolian high school students. The highest score for what kind of illness is AIDS, how AIDS be can transmitted, and ways of protection from AIDS were received by private high school students. High school students in this region do not have enough knowledge on AIDS. They need education especially on ways of protection and spread of AIDS.Öğe Malignant syndrome of two Parkinson patients due to withdrawal of drugs(Acad Medicine Singapore, 2008) Akcali, Aylin; Savas, Lutfu[Abstract Not Available]Öğe An outbreak of aseptic meningitis in Hatay province, Turkey(Riyadh Armed Forces Hospital, 2008) Onlen, Yusuf; Ozkaya, Etem; Savas, Lutfu; Incecik, Faruk; Akcali, Aylin[Abstract Not Available]Öğe Prospective Evaluation of 140 Patients With Brucellosis in the Southern Region of Turkey(Lippincott Williams & Wilkins, 2007) Savas, Lutfu; Onlen, Yusuf; Savas, Nazan; Yapar, Ali; Aydin, Mehmet; Tugal, OnderThe aim of this study was to asses the epidemiological, clinical, and laboratory characteristics of brucellosis in Adana region, Turkey. In this prospective study, a total of 140 patients with brucellosis were investigated in terms of spread of infection; seasonal, age, and sex distribution; clinical and laboratory characteristics; depression and anxiety rates; relapse rates; and response to different treatment combinations. One hundred two patients (72.9%) were female, and 38 patients (27.1%) were male; mean age was 45.81 +/- 15.62 years, ranging from 2 to 77 years. Twenty-five patients (17.8%) had history of contact with animals, and 31 patients (22.1%) had history of consumption of raw milk and/or its products. The highest seasonal distribution was observed during summer. Malaise (95.0%), sweating (85.7%), and arthralgia (85.0%) were the major presenting symptoms. The most common physical examination findings were fever (52.9%), hepatomegaly (20.7%), and splenomegaly (12.1%). Osteoarticular involvement, orchitis, and iridocyclitis were observed in 64.9%, 38.0% (of male patients), and 0.7% of the patients, respectively. Scintigraphy was performed for 114 patients who have focal joint and bone complaints and findings. Beck Depression Inventory and State-Trait Anxiety Inventory testing were applied to 98 patients with brucellosis, and depression was observed in 37.8% of these patients. The total point of State Anxiety Inventory testing was 46.21 +/- 12.87, and the total point of Trait Anxiety Inventory testing was 46.98 +/- 10.11. Either the depression rates or points of State Anxiety Inventory testing and Trait Anxiety Inventory testing in patients with brucellosis were statistically higher than in the control group. In 134 patients, initial standard tube agglutination testing titer was 1/160 or more. Brucella melitensis was found positive in 22 patients. Relapse rate was 3.5%. Brucellosis continues to be a health problem in countries where consumption of unpasteurized dairy products and stockbreeding are common.
