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Item The Role of Pneumococcal Pneumonia among CommunityAcquired Pneumonia in Adult Turkish Population: TurkCAP Study(2021) Senol, Esin; Cilli, Aykut; Gunen, Hakan; Sener, Alper; Dumlu, Ridvan; Odemis, Ayse; Topcu, Ayse Fusun; Yildiz, Yesim; Guner, Rahmet; Ozhasenekler, Ayhan; Mutlu, Birsen; Kokturk, Nurdan; Sevimli, Nurgul; Baykam, Nurcan; Yapar, Derya; Ekin, Selami; Polatli, Mehmet; Gok, Sebnem Eren; Kilinc, Oguz; Sayiner, Abdullah; Karasahin, Omer; Cuhadaroglu, Caglar; Kocagoz, Ayse Sesin; Togan, Turhan; Arpag, Huseyin; Kati, Hakan; Koksal, Iftihar; Aksoy, Firdevs; Hasanoglu, Canan; 35110252OBJECTIVE: To evaluate the rate of pneumococcal pneumonia (PP) among patients with community-acquired pneumonia (CAP) in Turkey and to investigate and compare features of PP and non-PP CAP patients. MATERIAL AND METHODS: This multicenter, non-interventional, prospective, observational study included adult CAP patients (age = 18 years). Diagnosis of PP was based on the presence of at least 1 positive laboratory test result for Streptococcus pneumoniae (blood culture or sputum culture or urinary antigen test [UAT]) in patients with radiographic findings of pneumonia. RESULTS: Four hundred sixty-five patients were diagnosed with CAP, of whom 59 (12.7%) had PP. The most common comorbidity was chronic obstructive pulmonary disease (30.1%). The mean age, smoking history, presence of chronic neurological disease, and CURB-65 score were significantly higher in PP patients, when compared to non-PP patients. In PP patients, 84.8% were diagnosed based ony on the UAT. The overall rate of PP patients among CAP was calculated as 22.8% considering the UAT sensitivity ratio of 63% (95% confidence interval: 45-81). The rate of intensive care treatment was higher in PP patients (P =.007). While no PP patients were vaccinated for pneumococcus, 3.8% of the non-PP patients were vaccinated (P =.235). Antibiotic use in the preceding 48 hours was higher in the non-PP group than in the PP group (31.8% vs. 11.1%, P =.002). The CURB-65 score and the rate of patients requiring inpatient treatment according to this score were higher in the PP group. CONCLUSION: The facts that PP patients were older and required intensive care treatment more frequently as compared to non-PP patients underline the burden of PP.Item The Prevalence, Etiologic Agents and Risk Factors for Urinary Tract Infection Among Spinal Cord Injury Patients(2014) Togan, Turhan; Azap, Ozlem Kurt; Durukan, Elif; Arslan, HandeBackground: Urinary tract infections (UTIs) are important causes of morbidity and mortality in patients with spinal cord injury and 22% of patients with acute spinal cord injury develop UTI during the first 50 days. Objectives: The aim of this study was to determine the prevalence, etiologic agents and risk factors for asymptomatic bacteriuria and symptomatic urinary tract infections in patients with spinal cord injury. Patients and Methods: This was a prospective investigation of spinal cord injury patients with asymptomatic bacteriuria and symptomatic urinary tract infections in Baskent University Medical Faculty Ayas Rehabilitation Center and Ankara Physical Therapy and Rehabilitation Center between January 2008 and December 2010. The demographic status, clinical and laboratory findings of 93 patients with spinal cord injury were analyzed in order to determine the risk factors for asymptomatic or symptomatic bacteriuria Results: Sixty three (67.7%) of 93 patients had asymptomatic bacteriuria and 21 (22.6%) had symptomatic urinary tract infection. Assessment of the frequency of urinary bladder emptying methods revealed that 57 (61.3%) of 93 patients employed permanent catheters and 24 (25.8%) employed clean intermittent catheterization. One hundred and thirty-five (48.0%) of 281 strains isolated form asymptomatic bacteriuria attacks and 16 (66.6%) of 24 strains isolated from symptomatic urinary tract infection attacks, totaling 151 strains, had multidrug resistance (P > 0.05). One hundred (70.4%) of 142 Escherichia coli strains and 19 (34.5%) of 55 Klebsiella spp strains proliferated in patients with asymptomatic bacteriuria; 8 (80%) of 10 E. coli strains and 4 (80%) of 5 Klebsiella spp. strains were multidrug resistant. Conclusions: The most common infectious episode among spinal cord injury patients was found to be urinary tract infection. E. coli was the most common microorganism isolated from urine samples. Antibiotic use in the previous 2 weeks or 3 months, hospitalization during the last one-year and previous diagnosis of urinary tract infection were the risk factors identified for the development of infections with multi-drug resistant isolates. Urinary catheterization was found to be the only independent risk factor contributing to symptomatic urinary tract infection.Item Could there be an association between chronic brucellosis and endothelial damage?(2015) Togan, Turhan; Ciftci, Ozgur; Turan, Hale; Narci, Huseyin; Gullu, Hakan; Arslan, Hande; 25596571Introduction: In this study, we examined the effects of Brucella infection on endothelial dysfunction. Flow-mediated dilatation (FMD) measurement is indicator of the endothelial function, and abnormal values indicating endothelial dysfunction are accepted as the first stage of atherosclerosis. Methodology: Twenty-four patients who had been treated for acute brucellosis two years before, and who had had no relapses in the follow-up, were prospectively included in the study, along with 30 healthy individuals in the control group. Results: While the highly sensitive Creactive protein (hs-CRP) value was 2.42 +/- 1.45 in the patient group, it was 1.72 +/- 0.61 in the control group (p = 0.025). While the FMD value was 3.50 +/- 1.58 in the patient group, it was 5.88 +/- 1.88 in the control group (p < 0.001). While the percentage increase in FMD was 9.88 +/- 4.92 in the patient group, it was 17.49 +/- 6.3 in the control group (p < 0.001). It was observed that FMD value, the percentage increase in FMD, and basal radius were correlated with hs-CRP (r = -0.644, p < 0.001; r = -0.558, p = 0.002; r = 0.444, p = 0.018, respectively). The carotid artery intima media thickness (IMT) value was found to be 0.61 +/- 0.17 in the patient group and 0.49 +/- 0.12 in the control group (p = 0.004). Conclusions: The abnormal FMD and IMT values observed in brucellosis patients might be an indicator of more frequent arterial dysfunction, increased cardiovascular risk, and atherosclerosis.Item The Impact of Acute Brucellosis on Mean Platelet Volume and Red Blood Cell Distribution(2015) Togan, Turhan; Narci, Huseyin; Turan, Hale; Ciftci, Ozgur; Kursun, Ebru; Arslan, Hande; 25825650Background: Brucellosis is an inflammatory disease which may infect any organs or systems in the body. Mean Platelet Volume (MPV) is one of the most frequently used surrogate markers of platelet function. It reveals the presence of disease activity in many inflammatory diseases. Red blood cell distribution width (RDW) is a parameter that measures variation in red blood cell size or red blood cell volume. Its predictive value approves inflammatory and infectious diseases. Objectives: The current study aimed to determine the assessment levels of red blood cell distribution in cases with acute brucellosis. Patients and Methods: The current study investigated whether MPV and RDW played any roles in acute brucellosis diagnosis. The study was conducted from 2008 to 2014 through prospective examination of the inflammatory markers found in adult patients with acute brucellosis. Results: The follow-up within the year after treatment was examined. The values of age, gender, leukocyte count, C-reactive protein, RDW and MPV were recorded. The study included 351 subjects, 250 of them in the acute brucellosis group and 101 in the control group. The mean MPV levels were 7.64 +/- 1.30 fL, and 7.67 +/- 1.29 fL in the acute brucellosis and control groups, respectively (P > 0.05). The mean CRP levels were 32.57 +/- 53.20 mg/dL, and 4.81 +/- 4.89 mg/dL in the acute brucellosis and control groups, respectively (P < 0.05). There was no statistically significant difference between the two groups regarding the RDW level and the mean leukocyte count (P > 0.05). Conclusions: While the CRP value was in patients with acute brucellosis in the current study, the MPV, RDW and leukocyte counts were within the normal range. CRP value remains the most valuable inflammatory marker in cases of acute brucellosis.Item The value of serum mean platelet volume in testicular torsion(2015) Cicek, Tufan; Togan, Turhan; Akbaba, Kaan; Narci, Huseyin; Aygun, Cem; 25762515Objective To compare the serum mean platelet volume (MPV) in patients with testicular torsion and healthy control subjects. Methods This retrospective study compared clinical and demographic data from patients who underwent surgery for testicular torsion and healthy controls. Testicular torsion was diagnosed with a physical examination and Doppler ultrasonography. Age, leukocyte count, platelet count and MPV were recorded for all participants. Results A total of 50 patients with testicular torsion and 51 healthy control subjects were enrolled. There was no significant difference in age and platelet count between the two groups. Patients with testicular torsion had a significantly higher leukocyte count and MPV, compared with controls. According to receiver operating characteristic curve analysis performed for the prediction of testicular torsion, the best cut-off point for MPV was 7.7fl (sensitivity 62%, specificity 96%), and the best cut-off point for leukocyte count was 9.5x10(9)/l (sensitivity 58%, specificity 80%). Conclusions The MPV may be useful as an ancillary test for the diagnosis of testicular torsion. Further studies are needed in order to confirm these preliminary results.Item A Cutaneous Infection Due to Mycobacterium Fortuitum(2015) Ozden, Hale Turan; Dursun, Recep; Togan, TurhanCutaneous infections caused by non-tuberculous mycobacteria are uncommon and are so difficult to diagnose. Rapidly growing mycobacteria can cause skin and soft tissue infections in immunocompromised patients. Mycobacterium fortuitum is one of the rapidly growing mycobacterium. In this article, in an immuncompetent patient, we present a case of cutaneous infection in which M. fortuitum is isolated. Our patient recovered completely by clarithromycin and ciprofloxacin treatment given perorally for 12 weeks.Item Osteoarticular Involvement among Brucellosis Cases in Konya City(2015) Ozden, Hale Turan; Togan, TurhanPurpose: Brucellosis is a systemic disease that can affect many organs and tissues. Musculoskeletal system is one of the most commonly affected systems. Disease may present itself with sacroiliitis, peripheral arthritis, spondylitis, paraspinal abscess, bursitis or osteomyelitis. The objective of the present study was to determine the frequency, types and clinical features of osteoarticular involvement among cases with brucellosis in Konya city and to establish the differences between patients with and without osteoarticular involvement. Material and Methods: Three hundred and sixteen patients with Brucellosis who presented between June 2003 and June 2014 were included in the study. Brucellosis was diagnosed by positive Bruce Ila Standard Agglutination Test (1/160 titer) and/or growth of Bruce Ila spp. in blood culture in addition to the presence of clinical signs and findings. Diagnosis of osteoarticular system complications was established by physical examination and radiological findings obtained by diagnostic imaging tools. Magnetic resonance images of the thoracic, lumbar or sacral vertebrae were acquired in patients with back pain, low back pain and sacro-iliac joint pain. Results: Osteoarticular involvement was noted in 129 patients (40.8%) (females: 52% and males: 48%). The most common route of transmission was employment in farming and/or consumption of un-pasteurized milk or dairy products, especially fresh cheese, in 97 (75%) cases. Mean age was 46 18 years. Sacroiliitis was the most frequent osteoarticular involvement (n: 68, 52.7%), 70.5% of which were bilateral. Sacroiliitis was followed by spondylodiscitis in 35 (38.7%), peripheral arthritis in 20 (15.5%), bursitis in 1 (0.8%) cases. Patients with osteoarticular involvement received medical treatment for at least three months. Discussion: Ratio and anatomical region of osteoarticular involvement in brucellosis shows variability among areas. In the present study, we demonstrated that sacroiliitis was the most common form in Konya city. This disease should be included in differential diagnosis in patients with symptoms of sacroiliitis, spondylodiscitis or those with articular pain. Key words: Brucellosis, osteoarticular involvementItem An Unexpected Pseudomonas Luteola Bacteremia: Case Report(2015) Turan, Hale; Togan, TurhanPseudomonas luteola has rarely been reported as a human pathogen. It was showed in previous studies showed that P. luteola may cause septicemia, bacteremia, peritonitis, and endocarditis in patients with underlying disease or with indwelling devices. In this article we report a case of P. luteola bacteremia without any source. We successfully treated our patient with ceftriaxone and ciprofloxacin combination.Item Comparative Evaluation of Cases with Community-Acquired Infective Endocarditis and Health Care-Associated Infective Endocarditis(2015) Kursun, Ebru; Turunc, Tuba; Demiroglu, Yusuf Ziya; Togan, Turhan; Tekin, Goknur; Arslan, HandePurpose: The present study aimed to comparatively evaluate the cases with health care-associated infective endocarditis and the cases with community-acquired infective endocarditis. Material and Methods: Of the cases followed for infective endocarditis (IE), 21 (40 %) had health care-associated infective endocarditis and 31 (60 %) community-acquired infective endocarditis. Results: Comparing the cases with community acquired infective endocarditis and the cases with health care-associated infective endocarditis, it was determined that advanced age (58.0 +/- 15.1 years vs. 41.3 +/- 14.4 years, P=0.000), presence of chronic renal insufficiency (P=0.001) and diabetes mellitus (P=0.016) as concomitant diseases, being previously hospitalized (P=0.0001), hemodialysis in terms of diagnostic and therapeutic interventions (P=0.022), presence of central venous catheter (P=0.022), and undergone intervention for gastrointestinal system (P=0.060), as well as laboratory results including positive blood culture growth for S. aureus and Enterococcus (P=0.037), and complications such as development of embolic event (P=0.008), spondylodiscitis (P=0.034) and stroke (P=0.007) were statistically significantly more common in health care-associated infective endocarditis cases. Whilst mortality was higher in health care-associated infective endocarditis cases (28.6 %), it was determined that there was no statistically significant difference between the groups. Conclusion: Health care-associated infective endocarditis is a disease that is more common in the patients at advanced age, with concomitant disease and the history of exposing invasive procedures in the past for diagnostic and therapeutic purpose, and it is a disease with high morbidity and mortality that courses with serious complications.Item In Vitro Susceptibility of Tigecycline and Colistin Against Stenotrophomonas maltophilia(2018) Turan Özden, Hale; Togan, Turhan; Azap, ÖzlemIntroduction: Gram-negative bacillus Stenotrophomonas maltophilia is resistant to drugs (multi-drug resistance-MDR) and it can be isolated from nature. Treatment of the infections resulting from S. maltophilia could be problematic due to multi-resistance. Materials and Methods: 72 S. maltophilia strains isolated from clinical samples were included into the study. Sensitivity was determined using Tigecycline and Colistin E-test MIC method performed in the Clinical Microbiology laboratory of Baskent University, Medical Faculty between 2010 and 2014. Results: In our study, colistin MIC range was found as 0.016-8 mg/L. MIC50 and MIC90 values were determined respectively as 1.5 mg/L and 12 mg/L. Tigecycline MIC range was 0-96 mg/L, and MIC50 was 0.19 mg/L and MIC90 was 1.5 mg/L. Furthermore, one tigecycline resistant strain was detected. Conclusion: We believe that the determination of novel treatments and protocols and their standardization using multidisciplinary approaches can facilitate to cope with problematic and resistant nosocomial infections developed by S. maltophilia.